Career planning

Chapter 56 provides advice on early career planning, with specific reference to Foundation Programme applications, Academic Foundation Programme applications, and career taster opportunities. The Foundation Programme application process is summarized, with details about the types of application, timeline of application, online submission, educational performance measures used, situational judgement tests, and top tips to maximize the chance of a successful outcome. The situational judgement test forms a significant part of the overall score: the chapter covers example questions and the rationale for the preferred response. Academic Foundation Programmes allow additional scope and funding for research and form the early stages of the academic career pathway. Career taster weeks allow an opportunity to look closely at a career of interest by spending a week in that specialty. Advice on how to organize a taster week, what to ask about, and top tips in organizing your own career taster are provided. A comprehensive list of resources is provided for the reader.

Clinical assessments

This chapter focuses on a number of different assessments that occur during clinical medical years and at the end of medical school, which may be formative or summative. The chapter reviews case presentations, and how best to structure them to reach a proposed management plan and summary. It provides students with an opportunity to explore differential diagnoses. It also discusses objective structured clinical examinations including examples of stations and practical advice with a focus on patient safety. This chapter includes examples of work-based assessments such as mini clinical evaluation exercises, case-based discussions, direct observation of procedural skills, and multisource feedback. It is written for both those looking to apply for medicine, and those in medical school.

Ethics and law

Knowledge of medical ethics and law plays an essential role in the training of future doctors and this chapter provides a clear overview of what medical students need to know in terms of ethical decision-making and practice. The 1998 Consensus Statement on ethics for UK medical schools is summarized. The chapter discusses patients—their values, narratives, rights, and responsibilities. Consent and refusal in medical decision-making, including the main elements of valid consent, are analysed, along with the right to confidentiality and its limits. The chapter gives practical guidance on ethical behaviour while at medical school, ensuring patient dignity during physical examinations (e.g. pulling the curtains round a bed) and protecting patient confidentiality (e.g. not discussing a case in a crowded hospital lift). The chapter also advises medical students on how to learn from what they observe during their training, whether in the lecture theatre or on the ward, to help build their own ethical practise.

Trauma and orthopaedic surgery

This chapter on trauma and orthopaedics covers musculoskeletal trauma, sports injuries, infections, tumours, and congenital and degenerative diseases. The chapter is well structured, describing conditions seen commonly in clinic, in the emergency department, and in theatre. It highlights important cases to see during medical school, both in emergency and elective theatres, as well as key investigations to observe. It reiterates consideration of past medical history and a holistic approach to the patient rather than dealing with only a focus on pain or joint problems. It reviews improvement of quality of life. It also discusses common conditions such as osteoarthritis and rheumatoid arthritis, providing a table to clearly differentiate between the two. This chapter includes clear pictorial principles of orthopaedic management, and a clear system for describing X-rays systematically.

Palliative medicine

The chapter underlines the importance of early involvement of the palliative care team to help patients to live better and longer. Palliative care is a multidisciplinary specialty and the role of community and inpatient nursing staff, physiotherapists, occupational therapists, psychologists, and the bereavement, chaplaincy, and medical teams are discussed. The chapter also covers where palliative care is delivered, which can be at home as well as in a hospice or a hospital. Advice is given on where and when medical students can learn the most from the palliative care team, from listening to one of the palliative care consultants take a history to observing the palliative care team prescribing anticipatory medications for the dying patient. Symptom control, including pain, nausea and vomiting, anorexia, constipation, diarrhoea, and breathlessness are also discussed. The chapter focuses not only on the patient and her/his psychological and spiritual needs but also on family members and carers who might also have their own needs. The chapter underlines the importance of communication skills in palliative care and how medical students should observe carefully in either the hospice or in hospital to learn from interactions that are difficult as well as the ones that go well.

Neurology

This chapter details the main neurological presentations in adults, both chronic and acute, that a medical student should be familiar with. The common presentations of headache such as migraine, tension, and cluster headaches are covered, as are important less common diagnoses such as tumours, central nervous system infections, and subarachnoid haemorrhage. The chapter considers in detail the management of Parkinson’s disease and attendant movement disorders and includes a summary of drug therapies and multidisciplinary management of this disorder. The chapter discusses the difference between delirium and dementia and continues on to cover the epidemiology and presentations of the main types of dementia, including Alzheimer’s disease, vascular dementia, Lewy body dementia, and frontotemporal dementia. Screening tools for dementia such as the Mini-Mental State Examination are also covered. Acute neurological presentations are also included: status epilepticus, central nervous system infections and their management, acute stroke, and Guillain–Barré syndrome. The management of acute stroke, including thrombolysis, is discussed in detail, including several recent clinical trials. The chapter also devotes space to careful history taking, especially in the diagnosis and management of seizure disorders.

Genetics

Clinical genetics is the medical specialty that deals with diagnosis and counselling of patients affected (or potentially affected) with disease that may have a genetic basis. These conditions include chromosomal abnormalities (e.g. Down’s syndrome/trisomy 21), single gene disorders (e.g. cystic fibrosis), familial cancer syndromes (e.g. hereditary non-polyposis colorectal cancer), and birth defects with a genetic component (e.g. cleft palate). The service is largely consultant led, supported by genetic counsellors in tertiary referral centres. Different inheritance patterns are described, autosomal dominant, autosomal recessive, X-linked, and mitochondrial, as well as the range of different genetic tests currently in clinical use (karyotype, microarray, gene panel, exome sequencing, and genome studies). The importance of empathetic communication, a detailed family history, and a multidisciplinary approach are emphasized.

Endocrinology and diabetes

The specialty of endocrinology and diabetes specializes in the management of disorders of hormone production or action. Type 2 diabetes mellitus is by far the commonest condition and is characterized by insulin resistance (in comparison to insulin deficiency in type 1 diabetes). Diagnostic criteria and glycaemic management (both oral and injectable) are discussed, as well as complications (including foot ulcers, retinopathy, and increased cardiovascular risk) and diabetes in pregnancy. The next commonest endocrine diseases affect the thyroid gland, causing both hyperthyroidism and hypothyroidism; the pathophysiology, clinical features, and management of both are outlined. Rarer endocrinopathies affect the adrenal glands (e.g. Addison’s disease, Conn’s disease, and phaeochromocytoma) or pituitary gland (e.g. Cushing’s disease, prolactinoma, and acromegaly). Endocrine disorders can also lead to metabolic disturbances including hypo/hypernatraemia and hypo/hypercalcaemia.

Dermatology

Dermatology is the study of the skin, hair, nails, and oral and genital mucus membranes and the diseases affecting them. It is predominantly an outpatient specialty. This chapter explains the common terminology used to describe skin lesions and dermatoses. The commonest conditions encountered in the dermatology clinic are described: eczema, psoriasis, pyoderma gangrenosum, skin cancers (basal cell skin cancer, squamous cell skin cancer, malignant melanoma), acne vulgaris and bullous disorders, in addition to dermatological manifestations of systemic disease such as vasculitis. Emergency presentations such as Stevens–Johnson syndrome/toxic epidermal necrolysis, anaphylaxis, and necrotizing fasciitis are outlined. A practical guide to common dermatological procedures such as punch biopsy, and a clinical approach to the dermatological patient are included.

Cardiology

Cardiology specializes in disorders of the heart, primarily ischaemic heart disease, rhythm disturbances (arrhythmias), and structural defects. Emergency presentations with chest pain, breathlessness, or palpitations are extremely common. This chapter describes the pathophysiology, presentation, diagnosis, and management of the leading cardiac complaints including unstable angina, ST elevation myocardial infarction (STEMI), non-STEMI, atrial fibrillation, heart failure, hypertension, infective endocarditis, and syncope. Basic electrocardiogram interpretation is explained, in addition to the jugular venous pressure waveform and risk stratification tools for atrial fibrillation and heart failure. A practical guide to the cardiovascular examination (as well as tips for success in exam situations) is included.