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Suzanne Gordon: Pimping has no place in medical education

15 Apr, 15 | by BMJ

suzanne_gordonUntil recently I thought I knew the meaning of the term “pimp” or “pimping.” But a couple of weeks ago a friend who is a student in a physician’s assistant program at a major medical school gave me new insight into the word when she told me how stressed she was because she was being “pimped out” by so many attending physicians during her training rotations. “Pimping out,” I asked her, what is that? Surprised that someone who’s written about medicine didn’t know the term, she explained that “pimping” occurs when attending physicians deliberately ask trainees questions that the senior physician knows the trainees cannot possibly answer. When, as expected, trainees couldn’t answer the unanswerable, they would be deliberately humiliated. “It’s horrible,” she said. “They roll their eyes, look at you like you’re an idiot, and, make you feel like a piece of dirt. When this goes on during a procedure, it makes it really hard to concentrate.” more…

Neel Sharma: Does the cost of using technology in medical education unfairly disadvantage developing countries?

14 Apr, 15 | by BMJ

Medical education reform has seen significant changes since the days of the Flexner report. What remains true are the rigorous entrance requirements, the scientific method of thinking, learning by doing, and the need to undertake original research (1). The advent of technology over the past decade and more has meant that learning by doing has taken on a whole new meaning. more…

Michelle Rydon-Grange: Sex and intimate relationships in secure inpatient forensic settings

9 Apr, 15 | by BMJ

Michelle Rydon-Grange_picIt seems that Britain is becoming more liberal in its approach to sex in UK prisons. Last week, the country witnessed its first same sex marriage in prison. And a report published last month by the Howard League for Penal Reform revealed the true scale of consensual sexual activity in UK prisons. While this might indicate a change in attitude to sex in British prisons, are attitudes towards sexuality in inpatients detained in Britain’s secure forensic hospitals changing?

The Royal College of Psychiatrists (Sexual boundary issues in psychiatric settings, 2007) is clear in its recommendations on managing the sexuality of patients in secure settings: each inpatient has the right to expect an individualised, person centred approach to managing their sexual and emotional relationships while in hospital. However, most forensic psychiatric hospitals in the UK either prohibit or actively discourage the sexual expression of inpatients (Bartlett et al, 2010), and sex is typically far down the priority list (if on the list at all) of debates held about forensic mental health services. more…

Caroline Fryar: Risky business

2 Apr, 15 | by BMJ

caroline_fryarA UK Supreme Court ruling has implications for the way doctors obtain consent from patients, particularly the way they tell patients about the risks of any treatment.

The details of the judgment in Montgomery -v- Lanarkshire Health Board have been previously reported in The BMJ but doctors may be left wondering what practical implications this has for them when requesting patients’ consent. more…

Conor Farrington: Lords reform—bad news for expert scrutiny in Westminster?

31 Mar, 15 | by BMJ

conor_farringtonAs the general election draws near, a wide range of medical issues will be examined through political lenses in The BMJ and elsewhere. However, few (if any) pre-election medical debates will focus on the constitutional status of the House of Lords.

In many ways, this is an unsurprising omission. Parliamentary politics in general is distant from most people’s day to day concerns, and the Lords—seen as an antediluvian chamber populated by aristocratic relics, political cronies, and bishops—often seems particularly remote. Moreover, with all the main parties likely to commit themselves to replacing the current chamber with a mostly or wholly elected senate, the political stakes also look rather low. And, of course, it is difficult to argue against the introduction of elections in the upper chamber without looking undemocratic. more…

Neel Sharma and Chaoyan Dong: Learning analytics—a potential tool in medical education

30 Mar, 15 | by BMJ

Technology utilization in medical training is ubiquitous. As instructors we recognise the fact that no lecture or tutorial is devoid of some form of technology. E-learning and mobile learning has introduced the potential for teaching to take place round the clock, at the convenience of the user. One such example is the highly talked about Massive Open Online Course (MOOC) initiative. However, it is still too early to ascertain the potential of such intervention from a medical perspective. Portfolio use is also technology based, as is the use of high fidelity simulation, although this is cost dependent, of course. Assessment is yet to follow suit globally but examples do exist of computer based testing, case in point the United States Medical Licensing Examination and the MRCP UK Specialty Certificate Examinations.  more…

Katherine Brown: The UK government’s relationship with the alcohol industry

27 Mar, 15 | by BMJ

Digital Printing SystemConcerns have been raised about this government’s relationship with the alcohol industry and the conflict of interest this presents in delivering better public health outcomes. At a time when alcohol related hospital admissions top one million, and the cost of alcohol misuse to the economy exceeds £21bn each year, there is a sense of urgency about getting to grips with the nation’s drinking problem by looking to policies with strong evidence of effectiveness. Minimum unit pricing appeared to be a powerful solution in the pipeline, promising to save thousands of lives and prevent thousands of crimes each year when it was announced with great fanfare in March 2012.

However, following what has been termed an aggressive lobbying campaign from the global alcohol producers, plans for minimum unit pricing were put on hold. Instead, attention has been focused on the Public Health Responsibility Deal as the cornerstone policy for reducing alcohol harm in England and Wales. This partnership agreement between drinks industry bodies and the government has very little public health representation, after the majority of NGO and health partners walked out when the announcement to delay plans for minimum pricing was made. more…

Kallur Suresh: The aviation industry needs to address human factors in aviation safety

27 Mar, 15 | by BMJ

Generation Q 12 June 2012The unspeakable tragedy of the death of 150 people in what is thought to be a deliberate act of pilot suicide over the French Alps has brought into sharp focus the question of mental health of airline pilots. French investigators say that the Germanwings plane was brought down by the co-pilot who locked the pilot out of the cockpit and refused to let him back in despite his desperate attempts to force entry.

Airline safety has been an exemplar for other safety-critical industries. Healthcare has learnt a lot about patient safety by looking at and emulating many of the safety features adopted by airlines, including a highly professional attitude, a step-by-step approach to tasks, standardised operating procedures, and checking and cross-checking by independent members of staff. Such an approach has made flying a very safe undertaking. more…

Suzanne Cahill: What are the next steps on global action against dementia?

26 Mar, 15 | by BMJ

suzanne_cahillThe first World Health Organization ministerial conference on global action against dementia which took place in Geneva was organized to encourage governments worldwide to take action to prevent dementia and improve health and social care services, based on current scientific knowledge, evidence, and global experience. It was attended by some 400 invited delegates, representing 80 countries including those from low to middle income countries where dementia prevalence is greatest. A very sizeable UK representation was in evidence over the two days, with over 25 invited delegates participating and several excellent UK presentations delivered.


Clare Wenham and John Edmunds: How effective is this year’s flu vaccine?

26 Mar, 15 | by BMJ

This flu season, Influenza A (H3N2) has been the dominant circulating strain, with transmission occurring unusually early (November and December). By December 2014, influenza rates were higher than they had been in the previous three years. However, recent research by Public Health England (PHE) suggested that there was a mismatch between the H3N2 strain selected for this year’s vaccine and the H3N2 that is circulating in the UK this winter. [1] This was based on an assessment of the vaccine effectiveness (VE) which was estimated to be only 3.4% (95%CI -44.8 to 35.5) against laboratory confirmed influenza (all types) and -2.3% (95%CI of -56.1 to 33.0) for Influenza A (H3N2). This is in comparison to the estimated average VE of influenza vaccines of 59%. [2] Furthermore, the VE for the same vaccine in Canada this season is also effectively zero, being estimated as -8% (95% CI:-50 to 23) but in the United States it appears to have a moderate effect, being estimated at 22% (95% CI 5 to 35). [3] more…

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