exeter

why do you want to be a doctor?

same as why med

tell me about a challenge in your life and how you overcame it?

S: challenge ( when i realised i had an e.d.)

T: i had to want to get better, yt vids, strong support network, self acceptance, falling in love with exercise for the right reasons

A: used to think it was an experience that made me very weak, never thought id be here today telling a panel of interviewers but it increases my empathy

R: BRING IT BACK summarise

S: challenge( man cracked his face open - we did not have the right resources nor sufficient medical knowledge

TAR: learnt para on this experience and bring it back

what do you do in your spare time?

S:art,music, bsl

T: produce music - conflict resolution, team morale

art - out of comfort zone

bsl - self explanatory i i

A: bring it back to med

R: summarise

what book have you recently read? what did you learn?

S: Tony Hope’s: v short introduction to medical ethics such an enjoyable read

T: the important principle of ‘reasoned argument; and how to 1) propose what u think is the morally best decision or course of action and specify main arguments why 2) articulate as many counters to that proper decision as poss 3) consider each counter argument in turn and think whether there is a counter to that counter-argument, being able to spot and name fallacious arguments e,g, argumentum ad hominem and that its a useful exercise in medical ethics to spot and avoid them as it helps us to see through a rhetorically powerful but ultimately false argument e.g. many invalid arguments cannot add up to a valid one e.g. euthanasia - argument from nature: it is not natural therefore it is morally wrong. 1) it is not clear what it means to say something is unnatural if 10% of hums are predom homosexual and homosexual behaviour is seen in other species, what is meant by saying that homosexuality is unnatural? 2)why does unnatural mean morally wrong? 3) a child with meningitis may be saved by antibiotics and intensive care neither of which is natural and informed me on resource allocation/which intervention? - buy max amount of extra life that we can (maximisation view)? or the no of ppl u help?? those who need it most urgently\`? - right procedure for making decisions:

what is the right procedure for making decisions?
two american ethicists, Norman Daniels and James Sabin developed an approach for fair dming for allocating health resources. This is now adopted by the UK’s national institute for Healtha and care excellence (NICE) which makes rationing decisions in the setting of the National Health Service (NHS). central idea is that the procedure should be reasonable and accountable to the public

procedure involves a core group of ppl who take the key decisions:
those w specific relevant expertise (medical,scientific,ethics)
those w relevant experience (patients or those who represent patient groups)
those who represent the general public (laypeople)
this grp composition ensures that dming is made on the basis of proper understanding of the scientific and clinical evidence and appreciation of the effects of illness on those who are ill

group must layout the reasons for their decisions and make this public
appeals process also in place - decisions made in one case at one time cannot be unreleased to relevant decisions made in prev cases

summarise

what exposure do you have to medicine? tell me about a clinical experience

work experience paragraph

what are the qualities that make a good doc do you have them?

active listener, continual growth, ability to work in a team

what role does research play in medicine? have you engaged in any research projects? tell me about them?

* Research is, of course, important for the advancement of Medicine as it énables doctors and private institutions to derive new techniques, new Technology and new drugs that all contribute to better care for patients.
* Research leads to publication and the build-up of knowledge that can then be used to improve standards of care in Medicine. This process of analys- in information and evidence derived from research and applying one's clinical judgement to make it relevant to individual patients' situations is called Evidence-Based Medicine.
* Research can take many forms. It can be lab-based, or patient-based, or even sometimes simply literature-based (i.e. analysing the different pieces of literature existing on a particular topic and drawing conclusions from it - metanalysis).
* Research also informs us on the biological processes of human behaviour (watson and rayner, conditioning, systematic desensitisation - loftus and palmer, language and memory, CBT ) this has lead to the development of psychoactive drugs which treat serious mental illness e.g. depression and lead to therapy formation

summary: its something i really take an interest in and i look forward to getting involved in research projects at some stage as a doctor.

T: although not directly research: undertook a study of whether owning a pet impacts stress levels - decided to take on non directional hypothesis - sample of 15 teachers within the school who undertook questionnaire about stress levels and last question was if they own a pet - to try and prevent social desirability bias

tell me about the terri schiavo case and what do you think about it?

S: this case sparked significant controversy in the US. 25, 1990, Terri Schiavo suffered a cardiac arrest caused by hypokalemia induced by an eating disorder. ultimately leaving her in a PVS (for 15 yrs), w/ her husband insisting to remove her feeding tube and her parents the opposite. there was no living will vegetative state is best understood as an “eyes-opened unconsciousness”; there is a disassociation between wakefulness and awareness. While patients may appear awake, there is a lack of evidence that the upper brain receives or projects information. In November 1990, Michael Schiavo took his wife to California for experimental therapy, including placement of a thalamic stimulator implant. From November 1990 to April 1994, Terri also received physical, occupational, and speech therapy at two rehabilitation facilities.

In March 1994, 4 years after entering the vegetative state and 2 years after completion of both experimental and rehabilitative therapy, Terri Schiavo was transferred to a nursing home.

Finally, in May 1998, 8 years after Terri entered the vegetative state—which was now clearly permanent—Michael Schiavo filed his first petition asking a court to allow removal of Terri's gastrostomy tube. His position was that Terri would not want to be kept alive in a vegetative state. Terri's parents took the opposite position.

Beneficance: Removing Terri Schiavo's feeding tube would potentially lead to her death, which some may argue is not in her best interests and does not serve the goal of promoting health and well-being. On the other hand, others may argue that keeping her alive through artificial means does not serve her best interests either, as she is in a persistent vegetative state and will never regain consciousness or be able to lead a meaningful life.

Non-maleficence: Removing Terri Schiavo's feeding tube could be seen as causing harm, as it would likely lead to her death. However, some may argue that continuing to provide artificial nutrition and hydration is also harmful, as it prolongs her suffering and may cause additional medical complications.

Autonomy: Terri Schiavo's wishes with regard to her medical care were not explicitly stated, so the decision to remove her feeding tube involved considering what she might have wanted. Her husband and legal guardian argued that she would not have wanted to be kept alive artificially, while her parents argued that she would have wanted every effort made to keep her alive.

Justice: The allocation of resources to keep Terri Schiavo alive through artificial means could be seen as unfair to other patients in need of medical care. On the other hand, ending her life could be seen as discriminatory against individuals with disabilities, as it may be based on the assumption that their lives are not worth living.

Ultimately, the decision to remove Terri Schiavo's feeding tube involved considering these complex ethical considerations and weighing the potential benefits and harms to her and to society

how do you feel about ‘doctor compensation?’

In the United Kingdom, doctors working for the National Health Service (NHS) are paid a salary based on their level of training, experience, and responsibilities. The pay scale for doctors in the NHS is divided into pay bands, with higher bands corresponding to more senior roles and higher levels of responsibility.

The amount of compensation a doctor receives can vary depending on their specialty, location, and other factors. For example, a specialist doctor working in a major city may receive a higher salary than a general practitioner working in a rural area.

Doctors in the NHS also receive additional pay for working unsociable hours or for taking on additional responsibilities, such as being on call or leading a team.

In addition to their salary, doctors in the NHS may also receive benefits such as pension contributions, sick pay, and leave entitlements.

It's worth noting that the compensation of doctors in the NHS may differ from that of doctors working in the private sector. In the private sector, doctors may be paid on a fee-for-service basis, meaning they receive a fee for each patient they see or procedure they perform. This can result in higher overall compensation for private sector doctors, but it can also involve more unpredictable and irregular income compared to the more stable salary structure of the NHS

Describe a time you have shown great problem solving skills

S: at my job at the local public house, the restaurant was completely full no spare table, only 2 waitresses, booking of 20 people on one table and over 60 tables in the restaurant

T: the table of 20 people all order dessert and that’s responsibility of the floor staff. i stepped up and began delegating tasks ill do all desserts you do the rest of it based on our strengths and weaknesses to ensure we are provided cuastomer-centered service

A: issue no 2 - only one microwave which doesnt cut it for 20 deserts most of which go in the microwave. - all desserts that take same amount of time for microwave

went to kitchen so went to ask chef if they could put it in for 1 minute.

meant i could focus on the other desserts and have some to take out

R: this ofc important in med bc blah blah

Tell me about a recent NHS policy which interests you

One recent policy implemented by the National Health Service (NHS) in the UK that may be of interest is the "Long Term Plan" which was published in January 2019. The Long Term Plan sets out a vision for the NHS over the next decade, with the goal of improving the health and well-being of the population while also addressing the challenges facing the NHS.

The Long Term Plan focuses on several key areas, including:

* Improving primary and community care services/supporting ppl to age well: The plan aims to make it easier for patients to access care closer to home, such as through the expansion of GP services and the development of new community-based health services.

• increasing funding for primary and community care by at least £4.5bn
• bringing together different professionals to coordinate care better
• helping more people to live independently at home for long
* Mental health: The plan aims to improve access to mental health services for children and young people and also for adults.

spending at least £2.3bn more a year on mental health care • helping 380,000 more people get therapy for depression and anxiety by 2023/24

* Delivering world-class care for major health problems

\- preventing 150,000 heart attacks, strokes and dementia cases • providing education and exercise programmes to tens of thousands more patients with heart problems, preventing up to 14,000 premature deaths • saving 55,000 more lives a year by diagnosing more cancers early • investing in spotting and treating lung conditions early to prevent 80,000 stays in hospital

* Prevention: The plan emphasizes the need to prevent illness and improve health outcomes through public health measures such as vaccination programs and anti-smoking campaigns.
* Technology: The plan also aims to make use of technology to improve the delivery of care and make it easier for patients to access services, such as through the use of digital tools and telemedicine.

The Long Term Plan also includes commitments to recruiting more staff, such as more doctors, nurses and other healthcare professionals, and investing in new facilities and equipment. This policy aims to provide a comprehensive and sustainable healthcare for all citizens

~~What do you think the NHS could do better?~~

1. educing waiting times for appointments and procedures: The NHS has struggled with long wait times for certain treatments and procedures, which can cause patients significant distress and inconvenience.
2. Improving mental health services: The NHS has been criticized for not providing enough resources for mental health services, which has led to long waiting times for mental health treatments and a shortage of beds for patients with mental health conditions.
3. Increasing funding: The NHS has been struggling with a funding crisis, which has led to a shortage of staff and equipment and a reduction in the quality of care.
4. Improving technology: The NHS could benefit from investing in more advanced technology, such as electronic health records and telemedicine, to improve efficiency and patient care.
5. Addressing staff shortages: The NHS is facing a shortage of staff, including doctors, nurses, and other healthcare professionals, which has led to increased workloads and longer working hours for existing staff.
6. Diversity and inclusion : The NHS should strive to become more diverse and inclusive in all its aspect, providing fair and equal access to care for all patient regardless of their background.

Your friend has cheated on an exam at Medical School and you know about this. What would you do?

GMC’s value of professionalism - goes against this

defies the whole point of exam and is very unfair on students

speak in priv area - if no satisfactory answer - consult senior colleague e.g. educational supervisor

Why should patients trust you?

* empathetic, communication, them first
* without trust lack of trust in the profession, d-p relationship
* Patients should trust doctors because they are highly trained and qualified healthcare professionals who have dedicated many years of their lives to studying and practicing medicine. They have completed extensive education and training in medical schools, and have passed rigorous exams to become licensed to practice medicine. They are also required to maintain their knowledge and skills through continuing education and professional development. Doctors are also bound by strict codes of ethics, which prioritize the well-being and best interest of the patients over any other considerations. They are also regulated by professional bodies such as the General Medical Council (GMC) in the UK, which sets standards for medical education, training, and practice, and hold doctors accountable for their actions. (revalidation,audits and CPD)

What are your strengths and weaknesses?

strengths: communication, teamwork and independent study.

weaknesses: ambiguity, take too much on

Tell us about a time when you have prioritised effectively

mocks, w/ extracurriculars, work

What is it like to be a doctor?

Being a doctor is a challenging and rewarding profession that involves providing medical care to patients. This includes performing physical exams, diagnosing illnesses, and developing treatment plans.

Doctors must have a strong knowledge of human anatomy, physiology, and medical treatments. They must also be able to communicate effectively with patients and other healthcare professionals, as well as stay up to date with the latest medical research and advancements.

The work schedule for a doctor can vary depending on the specialty and place of work. Some doctors work regular office hours, while others may work evenings and weekends. Many doctors work long hours, including overnight shifts.

Doctors also have to deal with emotionally and mentally demanding situations, having to deliver bad news to patients and their families, dealing with critical and life-threatening situations, and making critical decisions that can affect patients' lives.

Being a doctor also involves a lot of responsibility, as they are responsible for the health and well-being of their patients. This can be stressful, but also rewarding when they are able to help patients recover from illnesses or injuries.

Overall, being a doctor is a challenging and demanding profession that requires a great deal of dedication and skill, but it can also be very rewarding and fulfilling.

How do you deal with overpopulation?

1. Family planning and education: Encouraging people to have smaller families through access to contraception and education on family planning can help slow population growth.
2. Economic development: Raising living standards and providing economic opportunities can lead to a decrease in fertility rates.
3. Migration: Encouraging people to move to areas with lower population densities can help redistribute the population.
4. Sustainable development: Implementing sustainable development policies that balance economic growth with environmental protection can help ensure that the needs of a growing population can be met without exceeding the carrying capacity of the planet.
5. Government policies: Government policies such as incentives for smaller families, increased retirement ages, and immigration policies can also play a role in controlling population growth.

It's important to note that these solutions are not mutually exclusive and often work best in combination. Additionally, it's important to consider the cultural, economic, and political context when implementing any solutions to overpopulation.

Tell us about recent advancements in the NHS.

telemed and AI

Mental health: The NHS has been investing more in mental health services to tackle the increasing demand for mental health services and the need to improve access to mental health care services.

How has COVID changed the way the NHS operates?

1. ncreased capacity for COVID-19 patients: The NHS has had to significantly increase capacity to treat patients with COVID-19, including setting up temporary hospitals and repurposing existing facilities.
2. Remote care: Telemedicine
3. Prioritizing care: The NHS has had to prioritize care for patients with COVID-19 and other urgent conditions, while postponing or canceling non-urgent procedures. (this led to huge backlog) A&E
4. Redeployment of staff: NHS staff have been redeployed to different areas of the service to meet the increased demand caused by the pandemic.
5. Vaccination: The NHS has been responsible for the distribution and administration of the COVID-19 vaccine, and has set up vaccination centers throughout the country to vaccinate the population.
6. Mental health: The NHS has had to address the increased demand for mental health services due to the pandemic and its effects on people's mental health.

What do you think are going to be the long-term consequences of COVID on the NHS?

backlog: Prioritizing care: The NHS has had to prioritize care for patients with COVID-19 and other urgent conditions, while postponing or canceling non-urgent procedures. (this led to huge backlog) A&E

unnecessary appointments

BAME - burden on individuals - deter ppl of colour

How does the healthcare system differ here compared to other areas in the UK?

england NHS vs others

the healthcare system in Exeter and other areas of the UK can vary in terms of the specific healthcare facilities and services available, as well as the level of funding and resources allocated to the area.

For example, Exeter has a major hospital, the Royal Devon and Exeter Hospital, which provides a wide range of services including A&E, maternity, and cancer care. Additionally, Exeter is home to the University of Exeter Medical School, which is involved in research, education and training of healthcare professionals.

In terms of access to healthcare, Exeter has a relatively low deprivation index compared to other areas of the UK, which may indicate a higher overall level of health and access to healthcare services.

Overall, while the healthcare system in Exeter is similar to other areas of the UK in terms of the services provided, there may be some variations in terms of the specific facilities and resources available.

1. Explain the concept of Gillick competence and the Fraser guidelines.

2. The Fraser guidelines still apply to advice and treatment relating to contraception and sexual health. But Gillick competency is often used in a wider context to help assess whether a child has the maturity to make their own decisions and to understand the implications of those decisions.

if a child or young person:
* would like to have therapeutic support but doesn't want their parents or carers to know about it
* is seeking confidential support for substance misuse

* has strong wishes about their future living arrangements which may conflict with their parents' or carers' views.

The Fraser guidelines apply specifically to advice and treatment about contraception and sexual health. They may be used by a range of healthcare professionals working with under 16-year-olds, including doctors and nurse practitioners.

Following a legal ruling in 2006, Fraser guidelines can also be applied to advice and treatment for sexually transmitted infections and the termination of pregnancy

When using Fraser guidelines for issues relating to sexual health, you should always consider any potential child protection concerns:

* Underage sexual activity is a possible indicator of child sexual exploitation and children who have been groomedmay not realise they are being abused.
* Sexual activity with a child under 13 should always result in a child protection referral.
* If a young person presents repeatedly about sexually transmitted infections or the termination of pregnancy this may be an indicator of child sexual abuse or exploitation.