UCL Interview Notes

NHS 10 Year Health Plan

• hospital → community based care

  • neighbourhood health services, digitally by default - starting where life expectancy is lowest

  • increasing role of pharmacies

  • over long time shift pattern of health spending from hospital to out of hospital care

  • ending 8am scramble to get same day appts. by training more GPs

  • allow patients to book appts. through app

• analogue → digital

  • single patient record system

  • continuous monitoring on app, if deterioration bring into hospital

  • AI scribes to limit admin work

• sickness → prevention

  • Tobacco and Vapes bill preventing kids born 2010

  • expanding Universal Credit - free school meals

  • tackling harmful alcohol consumption - new standards

  • expanding mental health support

  • restricting junk food advertising & banning <16 sale of energy drinks

What new research are doctors using in day to day practice?
narrative based medicine (NBM) - about addressing the divide between the doctor and the patient: patient experience of illness vs doctor’s education of disease

• recognising the divide between doctor and patient and taking steps to bridge this: listening closely, exploring fears & emotions → develop understanding of patient as well as of illness

• acknowledging the uniqueness of each patient, validating their story through genuine interest and concern

• need to understand rather than JUST solve the problem

→ intrinsically therapeutic for patient

→ prevents disconnect and strengthens rapport

→ empowers patients by recognising their concerns & individuality

How are you preparing for your med school application?

• WEX

• volunteering

• debate

What are some of the ethical concerns surrounding AOMs?

• good because it helps people suffering from obesity that can’t easily adopt lifestyle changes

• lowers risk of CVD

• help to address health inequalities - obesity is prevalent in deprived areas, some lifestyle changes are only available to richer people

• abuse of mounjaro - people with lower BMIs

• doesn’t tackle root cause of disease

• may set unrealistic expectations for overweight patients - not trying other weight loss interventions

• very expensive - distribution of resources (weigh expense of treating complex patient cases with cost of AOMs)

How will digitalisation change patient care, what are the impacts of this on patient care?

digitalisation - shift from analogue to technology & AI

• NHS app, booking appts online, patient health records - could speed up patient care, particularly with referrals

→ patients empowered, speeds up referral times, more streamlined process, less stress for patients booking appts.

• AI scribes - frees up time for doctors, more focused on patients - could hallucinate/make things up

→ patients feel doctors are listening to them more, more satisfaction, could cause made up things in patient notes

• motorising/robotic-assisted surgeries - could cause deskilling, bad when tech goes down, can increase patient success outcomes

→ increasing patient satisfaction & recovery, deskilling

• remote monitoring/advice for patients monitoring chronic conditions online → empowers patients to play an active part in their care, does require constant doctor monitoring¬

How can the NHS increase its sustainability?

• NHS Net Zero by 2040 for directly controlled emissions

• NHS fleet/transport of goods (second largest fleet in country) → zero emission vehicles

• sourcing energy from solar panel farms

• proper disposal of PPE

• reducing single use gloves/gowns or making them from biodegradable sources

Social Determinants of Health (SDOH)

• education access:

  • more educated → less likely to suffer long term disease/mh disorders

• economic status:

  • long term unemployment → lower life expectancy

• healthcare access:

  • systemic biases

  • transport limitations

• neighbourhood/living standards:

  • pollution, safety, fuel poverty,

  • green space access, transport

• social community

  • discrimination

  • support system (family & friends)

Tell me about a time you demonstrated integrity

• upcoming debate competition only a few space available

• chose who came based on helper points, earned by volunteering

• i was chosen for the comp

• later looking at the helper points spreadsheet, realised i had more points than sessions i had helped

• knew it would be unfair on other members but i would also not be able to go

• owned up and told him that i had too many, wasn’t able to go to the competition but the other person who deserved it did

• reflecting on this, I learned that even though it may not be the outcome you wanted, it’s important to always be honest, most importantly when it is difficult

• speaking up for your colleagues or team members if you know something isn’t right

• important as a doctor because you have a duty of candour

→ in summary, i was truthful about a mistake that would have benefited me, but punished the other member

How can you link this example to the role of a doctor?

• important to always uphold your duty of candour as a doctor

• even if you made a small mistake you must report it and inform your seniors

• important to be transparent with patients, even if you made a mistake and it’s embarrassing for you

How can we solve the obesity crisis? What are some of the barriers to dealing with the obesity crisis?

• educating patients individually at GP, as well as public health campaigns

• using social media to promote fitness/food trackers

• training clinicians to have conversations about weight/diet

barriers

• funding

• health inequalities

• education/literacy levels

What negative impacts does it cause different groups in the UK?

• increased comorbidities → more strain on NHS, more strain on patients

• more bariatric surgery

• more pressure on GPs

What did you learn from watching the GP build rapport with patients and why is rapport important?

• GP listened to the patient’s mother suffering council troubles & her daughter not attending school

• saw the mother open up the GP, and later in the appt. she was grateful for the solutions the GP offered her (e-consult, home visit)

• GP made her feel listened to, empowering, gives her a more positive perspective of her daughter’s care

• rapport makes patients more trusting of their doctors & their advice/treatment

• rapport means patients will disclose personal symptoms/issues

• rapport means patients trust doctors to ask questions about their health, be more involved

Why did you choose to contact University of Warwick and what did you gain from your lab experience there?

• to develop my understand of gene expression T4 A level bio

• learned how to apply new scientific knowledge and thinking

• learned about the applications of research - e.g. CRISPR from E.coli

• gained an understanding of the importance of research in medicine, and that medicine is not just the doctors, but the researchers as well

• sustained my interest in gene expression

What interested you most about CRISPR and why do you think it is important for the future of medicine?

• discovered in E.coli as a response to certain bacteriophages - interesting how groundbreaking scientific research can come from the smallest microorganisms

• important in gene therapies, disease modelling/drug testing, increasing nutritional value of food, CAR T cells for certain blood cancer

What did observing the surgeon explain the procedure to a patient teach you about communication?

Why is CPD/engaging with research as a doctor important?

• affirms your foundation knowledge, like what you did in med school - increased confidence

• allows you to identify areas of weakness 

• reflects changes in patient needs/society’s expectations of doctors

• improves the quality of your practice

• knowledge you learn enables you to teach other HCPs with less experience

How has your work with Anthony Nolan helped you develop skills that will be useful as a doctor?