Pipe cleaners.

So this week I was thinking what to blog about this year. Ideally, I'd write about Lady Gaga - but I struggled enough making Derren Brown relevant... I suppose I could discuss hermaphrodites.

But instead of wasting revision time YouTubing Gaga's mythical penis I could write a revision blog, therefore killing two birds with one stone. I know that sounds dull but I promise you it won't be- maybe only relevant if you have exams this/next month but it should provide you with a 5 minute distraction and then a kick up the ass to open your books.

One of my pet hates is people who discuss their exam performance and say 'Yeah, but it's easy for you, you're clever!' And I guess if you define 'clever' by exam results I probably am. But it's not like I turn up the exam and go 'Oh well, let's see how I do...' In my opinion there aren't really 'clever' people- sure, some people are naturally gifted, seem to learn quickly or simply enjoy their school subjects. I get that, and I'm sure people will disagree with me, but I think getting good grades is just as much about effort as any kind of 'innate' ability.

I've always been a 'booky' child; more interested in nature documentaries than cBBC. I love learning new information, not everyone does. I'm also lucky enough to have the ability to focus and plan and commit to my studies.

And you're thinking good-for-friggin'-you. But as well as that I put a lot of work into my exams; and if you're struggling with revision it might help to know that somebody else is hating it just as much as you are, begrudging their non-exam friends just as much and snapping just as many pen nibs in revision breakdown-anger as you may be.

Basically, I'm shallow enough to judge myself as compared to other people; and I hope you are to- and this will make you persvere (or step up) your revision and we can wallow in exam success together... she hopes.

Remember those quizzes we had to complete at school, asking whether you can learn the words quickly to a new song and other tripe? And you come out with an assesment of being an 'audio, visual or kinesthetic' learner? As superficial as they sound, I think they hold some truth and can be a good guide for revision - but if you're as meticulous as me you'll want to do a bit of all three...

Reading textbooks can be dull. And useless. I always find I can recite information perfectly but struggle when it comes to applying it to exam questions etc. Over the last two years of college I've become used to what works (and what doesn't) in my exam technique. Reading definately doesn't. Writing notes in your own words is a slight step better but equally tedious. Me? I prefer to write quizzes - questions designed to test basic knowledge but maybe ask in a slightly more inverted, applied way. And then I get my boyfriend, Jordan, to test me over the phone. This probably sounds like super-geek territory but it means revision doesn't have to be confined to the desk and slightly uncomfortable office chair.

For fact-based knowledge (mathematical equations, tables/lists, graphs etc) I prefer to draw up posters. The drawing process can be useful but the really great part is the 'suggestive learning' they provide, where the brain draws in and retains information without actually processing it. What this means is you'll find you can picture specific information written on posters you've had up, despite not spending particularly long staring at it. (See my previous Derren Brown blog for some suggestion clips and you'll get a vague idea). Obviously, simple, bold information is best but it really is a useful tool. I've uploaded some pictures of my bedroom as an example... I think revision-wallpaper really is a step too far...

The 'Biology' wall

Maths revision lives on the  wardrobe door



The scary thing is that this is only half finished...

 I'm aware that this makes me seem a little bit mental, but if it gets you a good grade it doesn't matter right?

Along with all the coloured paper and felt tip pens purchased at Hobbycraft I also had a mad urge to buy sequins, pipe cleaners, felt, glue and god only knows what else. I'm going to be one of those mothers who saves every single yoghurt pot, loo roll or milk carton for 'arts and crafts'. Unsurprisingly Biology concepts are far more easy to model out of pipe cleaners than Maths and so much of my time is spent on pipecleaner models of DNA and sequin nucleotides. Genuinely a fabulous (if time-consuming and expensive) method of understanding tricky concepts, I find it really helps to talk through (preferably to another person, or to yourself... you already seem deluded enough by making cells out of playdough) whatever it is you're making, as well as adding notes and annotations. Here's one of my prettiest efforts

The process of transcription/assembling polypeptides

And that is essentially my magic 'A grade' formula. Along with putting in Christ-only-knows how many hours.

And after all that revision? I take regular breaks watching stuff like this:

Or this:

Or this:

I've had a literal nightmare about that dog. Ask Jordan.

Appetiser.

One of the things I originally said I wanted to use this blog for was the sharing and discussion of interesting articles... something which I haven't actually done yet.

Seeing as it's exam period I've dug something out which is both interesting and informative for medics and non-medics alike, as well as providing some useful inspiration for any Psychology students reading. Yup, we're talking ethics.

The following extracts are taken from an article published in the BMJ last year by Daniel Sokol. Entitled 'What to tell junior doctors about ethics' it's essentially a brief discussion of how ethics often aren't as transparent as we initially think.

It's probably one of my favourite articles from my scrapbook. I think at this point I should mention my medical scrapbook; I was advised by a lovely anaethetist to keep a record of any medical articles I find interesting, as they can provide useful memory joggers. Once you start looking it's amazing what you can find - and how you can relate it to broader discussions on current issues such as euthanaesia, obesity surgery and the state of the NHS. It's something I'd recommend to any budding medical student as interviews are very focused on hot topics and contentious issues which test your ability to reason and empathise.

Aside from using it as interview ammunition, I've regularly quoted this when talking with people about my interest in medicine, and I think it can be enjoyed by most people, as it really does make you question what we mean by ethics and fair treatment of patients. I think it also gives us, as patients, a sense of the difficulties our doctors face when asked an awkward question - and how negotiating the minefield of ethics can be just as difficult as providing a diagnosis. These rules aren't just for medicine - all social research and interactions are based on ethical codes, hence why psychology students may be particularly interested.

You can pay for and read the full article here and to avoid being sued I'll just take quotes and add my own commentry.

What to tell junior doctors about ethics by Daniel Sokol
Commentary by me, Shannon Hilton.

Consent is probably the most obvious ethical issue that arises in medical care. Informed consent is always preferable and in medicine,patients should always be fully aware of the risks and expected outcomes of any procedure before agreeing to it, free of pressure from medical staff. Realistically it appears that

"some junior doctors are asked to obtain consent for unfamiliar procedures; and. although some politely decline to do so, others do not want to make a fuss and acquiesce"

This represents a warped sense of what consent is: whilst the patient feels like they're fully informed, surely this is voided if a doctor has unknowingly missed out a few key aspects of the procedure or it's after-effects. And if you're thinking "well surely it doesn't matter if they get it a little bit wrong" the example quoted by Sokol goes as follows

"on the trolley heading for the operating theatre, one patient at a colleague's hospital told the porter that she was relieved at finally having the operation as she was looking forward to starting a family. She was about to undergo a hysterectomy"

Not meaning to patronise you (that means talking down to people*) a hysterectomy involves removing the patients womb (as well as possibly other bits and pieces). Clearly, this could prove problematic for baby-making.

Another common (but I guess under-appreciated) ethic is that of confidentiality. Easy, surely? Don't tell your colleagues, don't leave notes lying around. Slightly trickier issues arise when calling patients to discuss,for example, blood tests, where the spouse can't technically be told who or why, they're calling. Potential domestics may arise concerning the 'mystery woman' calling after a curious wife's husband. The example offered is pure brilliance.

"the story this time will be of the patient who dies from a ruptured cerebral aneurysm during overzealous intercourse with his mistress. The distraught wife asks the medical team what happened. Discuss."

And I think that discussion could extend way past the ethics of the situation. However, practicalities and specific definitions of "overzealous sex" aren't really relevant. Either way, an interesting thought-provoker. Break the doctor's oath of honesty, or break the patient's confidentiality. And consider the third-party here, the spouse, which option benefits her most? Is the patient's confidentiality renounced due to his death? Interesting.

Another topic that has often made me ponder is that of operating in the 'patient's best interests'. The definitions of a doctor's role often rely on semantics; most people are happy to believe a doctor's role is to preserve life and ease suffering. When do these come into conflict? For instance, a patient riddled through with cancer and in immense pain - preserving life involves keeping the patient alive by whatever means. Easing suffering could mean pumping a weak and vulnerable patient full of morphine to the point of removing all consciousness, or in many people's opinion the most humane option may be euthanasia.

Other related issues occur on a daily basis for sports doctors - rugby players often insist on continuing a match with minimum pain relief or dressing for deep gashes, boxers finish the round with a broken rib. What is the best interest of the patient? Personal ones, or health ones? And as Sokol offers

"a prison doctor may also face a dilemma when she knows that a patient requesting diazapam is being coerced by some rough types to ask for the drug. The patient will not be treated kindly by the requestors if he fails to get some"

The article goes on to discuss work-place related ethical dilemmas, such as the safety of locums whose English may by substandard or the classic case of the 'incompetent colleague'. To be honest, as a student with the tiniest experience of clinical settings I think my opinion is irrelevant here, but the comments offered by Sokol certainly provides some interesting stimulus.

I think the summary paragraph encapsulates the purpose of the article well

"the purpose... is not to provide junior doctors with a solution to their problems... but to whet their ethical curiosity and provide them with a deeper appreciation of the pervasiveness of medical ethics. Most importantly... what other profession can boast such a fascinating range of challenges and opportunities? That, perhaps, should be the essential message"

And I think 'pervasiveness' is an excellent term for any pre-interview candidate to have prepared for an ethics discussion.

*Jimmy Carr, possibly my favourite one-liner ever.

Dole.

So after the tears of rejection, the bitterness of a gap year, and the denial by writing (irrelevantly) about Derren Brown I'm finally manning up.

I'm not really one to dwell much; usually I forget that I'm supposed to be angry about ABC or that I'm ignoring DEF. I think it's kind of, well... childish?

Generally, I'd much rather get on with my life and things that are important, than cry over spilt milk. So, for now, that involves revising for my exams (dull) and lookin for jobs (frustrating) and then applying for afore mentioned job (cumbersome) by writing an interesting and potentially career-securing statement (hand-aching).

Essentially, life isn't allowed to be interesting or exciting for the next few weeks as I spend all my time perusing the NHS careers website or the local council's job vacancy page. The most exciting thing to recently happen has been a sudden acquisition of books, which unfortunately I don't currently have time to read. Among them, a book on Mental Diseases written in 1898 and a fabulous book of quotations, collaborated by the producers of QI (possibly my favourite thing ever shown on television).

So, as an excuse to read I'll be peppering this with quotations. Hopefully philosophers regularly mention the dwindling job opportunities in the NHS.

Options

My biggest worry is what universities want from a gap year. It's mostly about proving your commitment and medical interest, which is easier said than done. Whilst at school, universities can't expect students to have committed more than a few hours a week volunteering, or maybe a week or two work experience placement. But a whole year to play with? That's a lot of potential.

Half our time is spent trying to do something with the time we have rushed through life trying to save - Will Rogers

The common preconception is that gap year students go travelling. Backpack. One way ticket. Hostels. Bar work. Diphtheria. You get the picture.

Which would be perfect, except travel requires money. And money is gained through work. So, work, save, leave, right? Well, apparently nothing is hated more by application reviewers than 'I'm planning on doing this...' or 'I'm hoping to do that...' They want concrete evidence. Preferably you've already done it. Or you're submitting your statement whilst trekking through the Borneo jungle. Or at the very least booked a plane ticket.

Which is difficult, when the application is written over the summer, directly after leaving college when nobody's had a chance to make any money yet... Ah.

And on a practical note, medical interviews can range from November through to April time, with very little warning. Meaning being abroad risks a last-minute trip home for an interview. Nightmare.

Sooner or later we must realise there is no station, no one place to arrive at once and for all. The true joy of life is the trip - Robert J. Hastings

Another option is work placements abroad; there's plenty of fabulous opportunities to work in schools and hospitals all across the world and reflect/contrast with the magnificant yet underappreciated institution we call the NHS. But these all cost money. Big money.

One company emailed me to ask if I was interested in their 'Gap Year Medics' scheme which sends prospective medical students to hospitals in India, Tanzania or the Caribbean islands for work experience. Places start at £990 for two weeks in India up to £2490 for four weeks in the Caribbean. Sounds like very expensive volunteering to me.

As somebody interested in Medical Anthropology (watch any of these and you'll see why) I can see the benefits of excursions like this. But unfortunately, not all of us can afford it.

You don't seem to realise that a poor person who is unhappy is in a better position than a rich man who is unhappy , because the poor person has hope. He thinks money would help. - Jean Kerr

So the only other really feasible option seems to be working. Obviously a health-related job is ideal; medical schools want students who have at least tried to understand what life as a doctor consists of.

Health jobs seem to be difficult to find - obviously many, many careers require degree-level education so they are scored out. Others accept non-qualified candidates on the condition that the relevant qualification is studied for after joining (Dental Nurses work this way for example.) Clearly most gap year students don't have the time available to commit to this.

Not everything is ruled out; common jobs for 'non-qualified' people tend to include Nursing Auxiliaries, Health Care Assistants, Phlebotomists and various technician/assistant/ward bitch roles. The other big employer tends to be care homes for care assistants and NA's.

Personally, I've developed an affinity for working with SEN children so I've also been looking into Teaching Assistant work in Special Needs schools. It appears now that jobs many people think of as 'unqualified' actually can now be studied for e.g. Teaching Assistants. And for everything else experience is nearly always essential, at the very least listed as 'desirable'. 

Coupled with the factors of high numbers of unemployed graduates, NHS job cuts, increased numbers of under-18s studying NVQs and increased numbers of prospective medics taking gap years means application is looking bleak. Nearly everything I've applied for I've barely been qualified to do, and if so, experience (which is impossible for me to have) is highly desirable.

Full time healthcare employment would be ideal for me, not only for the extra income and kudos on my statement but simply I feel so motivated and energised all the time, I couldn't cope with working part-time in a retail-type role and sitting on my ass for the rest of my week.

The cure for boredom is curiosity. There is no cure for curiosity - Dorothy Parker.

And if I can't find a job..?

I'll work unpaid. And take extra hours in my retail job. And fill the rest of my time with nourishing, interesting, stimulating things. Like reading and writing and exercising.

One could even argue that unpaid work would be more appealing to an admissions tutor that being paid for it. But they would probably be the ones who are going to the Caribbean for work experience.

About the only thing that comes to us without effort is old age - Gloria Pitzer

When I was a young man I observed that nine out of ten things I did were failures. I didn't want to be a failure, so I did ten times more work - George Bernard Shaw

* And if you do have any exciting and unique ideas for spending a gap year I'd be interested to know; not to steal them off of you but I do enjoy hearing good ideas
** The title of this blog is a pun. Before you ask.