The United Kingdom kicked off its leading mass coronavirus disease-2019 (COVID-19) vaccination programme by vaccinating the first person, Margaret Keenan on 8th December 20201 which was followed by many other countries.2 COVID-19 vaccines were developed in less than 12 months after the pandemic began3, 4 and have offered hope of bringing normalcy back to many around the globe, but it is not without its challenges.5, 6 The infrastructure of coordinating frontline response and the development of confidence among various communities to accept vaccination posed significant challenges. This required input from governments, healthcare professionals, the media, and importantly the public who play a vital role in not only accepting the vaccines and busting the myths but also actively volunteering for this great cause.
After watching my father, a frontline COVID-19 healthcare worker, receive the vaccine and at the same time sensing the reluctance of some family and friends to take the vaccine, despite the pandemic hitting Black, Asian and minority ethnic (BAME) communities disproportionately, I felt energised to play my role. When I saw an exciting opportunity for volunteering for this noble cause coordinated by my school, Bolton School, I promptly put an application forward in February 2021. The whole process was streamlined, and soon afterwards I embarked on volunteering at the Bolton Wanderers Football Club vaccination centre.7 There was some initial anxiety about contracting COVID-19, but I discussed it with my mentor and was reassured about the safety standards of the vaccination centres.
I was pleasantly surprised to see a range of roles for a non-clinician volunteer including being the face of the vaccination programme by greeting patients, explaining the vaccination process and allying anxieties, handing out written information, managing patient flow, ensuring maintenance of social distancing, checking temperatures, and liaising with clinical staff. There was also an element of an administrative role and keeping the registers. However, what I found most fulfilling was to talk to some of the patients who said that they had been socially isolating for several months and were excited to talk to someone face to face. One could see a sense of liberation the vaccination was bringing to them. It was a truly humbling experience to go out of my way to support some of the BAME patients, and speaking to them in their native language to make the whole process a memorable experience. I remembered one elderly lady who seemed distressed as she could only communicate in Hindi and I was fortunate that she allowed me to take her through the whole process and later assist with arranging transport.
I am going to continue with my volunteering on weekly basis and I found that it revitalised me for the rest of the week to engage in my full-time academic studies at school. This being my first work experience, I must admit the shifts were well-paced, lasting 4-5 hours and not too demanding. I was made to feel safe, and the senior members of the team would regularly communicate and offer me guidance and support.
Working closely with clinicians helped me gain new insights into the importance of true multidisciplinary teamwork in healthcare. I appraised it as the epitome of how colleagues with a unique set of skills, and driven by a shared desire to bring about a real difference to people’s lives, strived together selflessly as a team. Furthermore, it was inspiring to observe the leadership of the senior volunteers acting as role models with their professionalism, unflinching dedication to their job and willingness to proactively offer support to others. However, the watershed moment that shaped my thinking to take on medicine as a career was the reward I got from the empathic interaction with patients and gratitude in their eyes. It was pleasing to see in practice the Good Medical Practice8 attributes of working collaboratively with colleagues, professionalism, communicating effectively, and treating patients with dignity.
I have been feeling proud to be at the frontline working shoulder to shoulder with my clinical colleagues in this battle to end the pandemic. I would highly recommend vaccination volunteering to others as it is truly a once in a lifetime opportunity to make a real difference in the lives of so many.
For generations the mind has been mystifying physicians all around the world. It is the powerhouse behind everything we do, and everything that we are therefore there is no wonder that reams of time, research, money and effort has been poured into this1.
The Association of British Neurologist, through various publications in the last 10years, has stated that there are too few neurologist consultants, and that provisions need to be made to ensure that there is comprehensive care to patients in hospitals2. In light of this there has been a recent drive into increasing the number of clinical consultant posts in local hospitals. This drive has lead to more innovative measures being implemented in this field, including new research on pharmaceuticals as well as introduction of new technologies.
A general misconception of the field of Neurology by medical students is that it is too complicated3. However, I found my experience to be one of the most organised, patient orientated, enjoyable experiences I have encountered on a ward setting. The teaching sessions that accompanied the firm brought all of the previous years of knowledge together like a solved jigsaw puzzle linking the neuroanatomy with the pathophysiology of an illness and the role and impact pharmaceuticals have4. With everything falling into place and having a better understanding, it gave me more confidence to explore further into this field.
Having previously only had brief exposure to Neurology, to be in a committed arena focused on this speciality was a daunting experience. Opposed to other specialities, where history taking is the millstone to your diagnosis, management and follow-up care, there is a much bigger onus on clinical skills and interpreting findings. The obvious signs of loss of sensory or motor functions are evident, but more subtle focal lesions are sometimes harder to pick up, this is when drawing on your clinical knowledge and application is required. This remains one of the evident advantages to Neurology, compared to other disciplines - that it remains clinically orientated. There is only so much that could be galvanised from a case history. As medical students we had ample exposure to the ward, and were able to approach patients and hone in on our clinical skills. As our basic knowledge had been laid down, through teaching sessions and also clinical case studies, we had the theory behind many of the clinical assessments, but lacked confidence and appropriate patients to assess. This changed as we integrated ourselves with the close-knit multidisciplinary team and the patients. There seemed to be buoyancy in mood, as we became more proficient undertaking assessments, for instance a cranial nerve examination that once took 10minutes to carry out was halved, without feeling like we had missed anything vital out.
More so, it was an eye-opener to experience, (even for a brief period), the sub-specialities that Neurology caters for, an aspect that I particular enjoyed was neuropsychiatry. Essentially the brain is an intricate piece of machinery, as with all things in life, sometimes this goes awry. For me to observe from a clinicians point of view and come to the same conclusion as my peers, gave me a sense of pride, knowing that I was moving in the right direction in my medical career, and that all that pent up knowledge was at last being implemented on a practical level. Unlike other fields, for the most part we were left to our own devices we were not spoon fed. This was refreshing, although a little overwhelming at first. We were responsible to find, clerk, assess and present patients to our team-members. The feedback we received was invaluable; it illustrated the extent of our competency and also left you with a sense of achievement knowing that you are capable and apt.
For those that are looking for a speciality once they have started their medical career, Neurology is an exciting and innovative place to be at right now. With an aging population worldwide, more effort, resources and money is being spent on degenerative illnesses such as Alzheimers disease and Parkinsons disease.5
Although to some extent current treatments offer benefits to sufferers, there is hope that new pioneering forms of treatment will be developed to manage patients. Additionally this gives students and qualified peers alike a great opportunity to conduct research and audits and get the opportunity to be published. Neurology still remains a minefield of the unknown, and it seems to be constantly on a quest to better itself and find new measures and treatments to bring to the patients.
With its new advancements in the pipeline, Neurology seems to have a bright future. However, there is the obvious downside to being in a speciality of this nature. You will come into contact with a large number of patients with untreatable disorders. It needs someone with a strong constitution to see someone that has a poor prognosis and an almost certain decrease in quality of life. For some, there will be an obvious deterioration before your eyes, others may have already suffered severe neurological deficits that ethical questions on the continuation of the life may arise. These are tough decisions to make, and needs someone with conviction and strong-will to stand by their decision.
Overall Neurology is what you make it, as is every profession. What stands out with Neurology is the exposure you get to patients. For students this is a valuable and undoubtedly crucial time in their medical training to perfect skills that will be called on in the future. Where else would we find another welcoming and encouraging place to learn the tools of our future trade, that allows freedom to learn, exposure to patients, a myriad of different diagnosis, and most importantly a practical use of your knowledge and clinical skills?
COMPETING INTERESTS
None Declared
AUTHOR DETAILS
MATHAVI UTHAYANAN and MASHUD SOUROYER, 4th Year Medical Students reading at the Barts and London School of Medicine and Dentistry
Psychiatry is an unattractive profession. A bold statement to be made by medical students who have committed four years to this vocation, with an additional lifetime to follow. However, if facts and figures are to be believed medical students are turning their backs on this once valued and highly sought after profession and are chasing the glamour of emergency room medicine, serialised by popular television programmes. Within the UK approximately 4% of newly-qualified doctors specify Psychiatry as their first preference1, a remarkable low number, considering vast numbers qualify every August.
Maybe approaches like The Student Psychotherapy Scheme (SPS), implemented some 43years ago at University College London is needed. Whereby, medical students were given the opportunity to experience the doctor-patient relationship in a psychiatric setting. This led to a higher proportion of students choosing Psychiatry as a speciality, compared to a control group that were not given the opportunity.
The influence of a student psychotherapy scheme – a10-year retrospective study (2004)2
163 medical students undertook the SPS scheme, of which 77 replied to the questionnaire. Of these, 11, (14.3%), had become Psychiatrists, who had not thought about doing Psychiatry before entering the scheme. In the control group of 152, of which 128 responded, only two, (1.6%), had become Psychiatrists, who had not thought about this speciality at the same stage.
So why did the SPS have such an impact improving recruitment rates amongst medical students? From my point of view, it seems to be simply due to exposure. Exposure to the unknown and familiarisation of a speciality that is not regularly given the time and efforts during our medical training at University.
Our time in Psychiatry was punctuated by apprehension and a sense of intrigue. The hesitancy was rooted in preconceived notions that we were being sent to a sanatorium, whereby we would be battling to shake off patients that had latched on to my trouser legs in a bittersweet attempt to escape everyday - thankfully that never came into fruition. However, what did occur was far more surprising. We could see ourself pursuing a career in this speciality in the not so distant future. With acute medical emergencies, there seems to be an emphasis placed on ‘patching’ patients up and sending them home in an attempt to meet targets and tick all the boxes. With Psychiatry you play the ‘waiting game’, it requires patience, the efficacy of treatments rely on regular and lasting compliance, and the majority of benefits are seen in the long-term rather in an acute setting. Maybe the high rate of morbidity in psychiatric illnesses we see in our ageing population is dissuading potential Psychiatrists. Whatever the reason, there is a risk that this speciality will be understaffed in the future, creating a vacuum of care for those that really need it, especially when they do not have the mental faculties to be aware of their own needs.
The problem with Medicine as opposed to other careers is the wide range of specialities and sub-specialities that are available to students once they have finished the formal University training. There are the baseline individual specialities, such as Surgery, Medicine or General Practice – all of which have sub-specialities, intensifying their focus on particular area of clinical care available to patients. Perhaps that is why, in most cases, students allow their path to be dictated by their interests rather then the greater good of Medicine as a whole. As stated, there is a current crisis in Psychiatry, with only a 4% recruitment of newly qualified doctors. The 5-year undergraduate medical degree only allows a small window of exposure to Psychiatry and this is not enough to be able to explore the speciality and come to a conclusion, which would affect the students for the rest of their lives. Perhaps the short period of exposure continues to exacerbate the problem that most medical students view Psychiatry as a separate entity to Medicine, completely devoid of concrete management, unable to implement true and tested methods that would guarantee a cure.
There are 12 different sub-specialities in psychiatry3, of which we were exposed to General Adult and Old Age Psychiatry, from our time there we were able to experience the full spectrum of presentation, from the difficulties of dealing with mentally unstable patients, to the satisfaction of seeing slowed and gradual progress in someone’s mental wellbeing. What Psychiatry offers, that some fields tend to lack is rapport, created by extended patient contact and treating them as a whole rather then a specified issue. It dawned on me that even general practitioners do not have the luxury of getting to know their patients as well as Psychiatrists and that appealed to me a great deal, as I believe in the holistic approach to management. However, Psychiatry is still viewed as being disconnected from the rest of Medicine, perhaps due to the different history taking techniques, the lack of focus on the practical skills of medicine, the ‘trial and error’ method of therapy, whereby if one drug does not work another is given. Instead the focus lies on communication skills and other psychosocial aspects and this I find dissuades many of my colleagues, as there is nothing tangible for them to get to grips with and apply their knowledge to. In hindsight, Psychiatrists are not wholly responsible for just the mental health of a patient, but it does fall within their remit to identify, and manage co-morbidities they may have as well. A sound knowledge of all aspects of Medicine is required, and maybe the fact that ‘mind and body’ needs treating discourages future Psychiatrists.
Overall, there have been many times when we have been surprised at our own interest in Psychiatry. It is comforting to know that it is a welcoming speciality, unlike many other competitive specialities where there is intense pressure and any sense of enjoyment or achievement may be diminished. There are also immense opportunities open for research, even at this level as a medical student. Undoubtedly compared to other fields, Psychiatry offers a balance between work and personal life. Our only regret is that we did not have the opportunity to experience everything that Psychiatry has to offer, and make a more informative and well balanced decision on where my future lies within Medicine. Perhaps we will take the initiative to explore this field in my own time. One thing is for certain, Psychiatry is a dynamic field with many opportunities, and should not be disregarded for the flashing blue lights of emergency medicine.
COMPETEING INTERESTS
None Declared
AUTHOR DETAILS
MASHUD SOUROYER, 4th Year Medical Student, Bart’s and London School of Medicine and Dentistry, United Kingdom
MATHAVI UTHAYANAN, 4th Year Medical Student, Bart’s and London School of Medicine and Dentistry, United Kingdom
[1] The Royal College of Psychiatrists: Tackling the recruitment crisis in psychiatry Student Psychotherapy Scheme encourages medical students to choose psychiatry as a career [online]. 2004. Available URL: http://www.rcpsych.ac.uk/pressparliament/pressreleasearchive/pr550.aspx [Accessed 02/12/2008]
[4] Michael Gelder, Richard Mayou and John Geddes. Psychiatry: Third edition. Oxford University Press, 2005.
[5] Psychiatric Bulletin: What impact do undergraduate experiences have upon recruitment into psychiatry? [online]. 2007. Available URL:http://pb.rcpsych.org/cgi/content/full/31/2/70 [Accessed 02/12/2008]
