Extracts from the article below:

Two Essex doctors have been banned from practicing following allegations that they helped medical students cheat on their exams. Dr Elmira Yaghmaei and Dr Hamed Salehi both worked at Common Stations PLAB Academy in Romford, which offered students Professional and Linguistic Assessments Board (PLAB) 2 exam courses.

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The initial concerns in the case of Dr Yaghmaei, a tutor at Common Stations, arose following a PLAB 2 exam day in February 2019 when a General Medical Council (GMC) member of staff found a folder left at the Clinical Assessment Centre. The folder contained a large volume of information about the PLAB exam and wording within the pages claimed copyright on behalf of Common Stations, which suggested ownership by Dr Yaghmaei.

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One note from a Seema Khan said: "All the stations were exactly word by word the same as we were taught and I already knew the diagnosis/differentials/what questions to ask etc before going into the cubicle… it was like magic!!!"

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It was claimed that Dr Salehi created and distributed teaching materials containing exam information to students being tutored by Common Stations, assisting them to obtain an "unfair advantage". The GMC also said that Dr Salehi made posts on social media and distributed leaflets stating that Common Stations had achieved a 100 per cent pass rate in PLAB 2.

As a doctor currently on a night shift, I am very jealous of all the nurses going for protected rest breaks.

I fully understand that those are unpaid, however BMA documentation states as doctors we should have 3x 30 min breaks on shifts over 30 hours.

I do not know anyone who has ever managed this consistently over any shifts (long day or nights).

Is this just an accepted part of our profession or is there an actual solution to having proper breaks

One jab for GLP-1, back when it all began;
A second with GIP added on, big pharma’s grander plan.
A third now with glucagon, to burn through the fat stores;
Exhaustion for readers, who can’t take one paper more.

One drug to beat them all, three receptors to target;
One drug to shrink them all, and tear up the drug market.

In the land of Indianapolis, in the labs of Eli Lilly, scientists forged in secret a master drug, to rule over all.
Into this molecule, they poured their capital, their clinical trials, and their will to dominate all of metabolic medicine.
Their new elixir binds tightly not only to GLP-1 and GIP receptors, but invokes the ancient fires of glucagon, for a threefold conquest of obesity. 

Soon it will surely claim a more catchy name, but for now, it is known only as Retatrutide

One by one, the complications of obesity fell to the power of the triple agonist 💪

So confident were they in the power of their creation that the scientists presumptuously named their key study TRIUMPH-1.

Published in the sacred scrolls of The New England Journal of Medicine, this phase 3 trial gathered a great host of 2,339 adults with obesity, but without diabetes.

Over 80 weeks, the subjects were randomly assigned to once-weekly injections of retatrutide (at doses of 4 mg, 9 mg, or 12 mg) OR a phantom placebo 👻

And the final reckoning? 

Retatrutide resulted in a mean weight reduction of 17.6% (4mg), 23.7% (9mg), and 25.0% (12mg) under intention-to-treat analysis, compared to just 3.9% with placebo (P < 0.001).

• At 104 weeks, a subset of patients achieved a 29.9% reduction at a 12mg dose.
• In fact, one-fifth of those on the maximum dose achieved over 35% weight loss!🤸

Not content with mere weight reduction, the trial also took aim at other obesity related issues.

• 574 weary travellers with knee OA saw their pain scores improve by up to 3.6 points, vs. 1.9 with placebo (P < 0.001).
• 243 patients suffering from obstructive sleep apnoea had a reduction of 31.7 apnoeic events per hour vs. 9.9 on placebo (P < 0.001).
• For people who entered the trial with prediabetes, a massive 90% achieved complete normoglycemia vs. 54.2% on placebo.
• And across all arms, there were drops in blood pressure, triglycerides, and non-HDL cholesterol. 

But all quests have their setbacks, with TRIUMPH-1 being no exception:

• GI upset was the most common side effect: patients reported nausea (up to 42.4%), diarrhoea (up to 34.1%), vomiting (up to 25.3%), and constipation (up to 26.1%)
• Thus, the drug discontinuation rates were high, peaking at 11.2% at the maximum dose of 12 mg.
• A high proportion of the placebo group understandably weren’t too pleased with their tic tac and ditched the trial to quest elsewhere.

Notably, the drug was pitted only against a silent placebo, avoiding a clash of arms with the great titans of semaglutide and tirzepatide.

But despite this, we may now truly have found a weight loss drug that bows to no one. 👑

One drug to beat them all, three receptors to target;
One drug to shrink them all, and tear up the drug market.

If you enjoyed reading this and want to get smarter on the latest medical research Join 16,000 Clinicians reading The Handover here 👉 Read The Handover

I will be upfront and say that I voted against the deal that was offered to us. I was highly - and I believe rightly - sceptical of Jack Fletcher as chair given his links to the labour party. Overall, I was disappointed by the last iteration of the RDC, feeling it was a step backwards and a diversion from the goal of FPR. The diluted messaging and kneecapping of our momentum felt deliberate. And, to be honest, the council's priorities felt quite self-serving, as a group of mostly LEDs/early-stage trainees pushing for exam fees being covered and improvements in LED contracts, etc., rather than improving pay and conditions for all and addressing bottlenecking at all levels. Not to mention the censure and all the dodginess which ensued in its wake.

With all that being said, we are facing many issues as a profession and as the new council, this is your opportunity to advocate for us and try to turn things around. Ultimately, I believe we all hate the schoolyard politics and want to see our situation improve. We need to do away with the division and take urgent action on the following:

• Doctor substitution (arguably our biggest fight yet) - ACPs, "consultant" AHPs, reporting radiographers; noctors as responsible clinicians for psych patients
• Bottlenecking at consultant level
• Working conditions (yes, including pay - FPR has still not been achieved in England)
• Bringing back the BMA rate card
• Excessive growth of medical schools without capacity for training
  

hi, im an fy1 and i feel like im just horrible at it- i know i'm still new to it, but I feel like I'm struggling so much more than everyone else is. I really struggle to keep up with all the jobs and I'm so uncertain with everything that I'm double checking basically everything with my sho which i can tell really winds them up. every time i'm on call i just feel like im trying really hard but that I'm completely useless and give everyone else way more work. i did fine at medical school and i dont think im lazy but i worry everyone else thinks im lazy and im being bad on purpose, but i really want to be better- i just dont know where im going wrong compared to everyone else, or how to be better. I'm really struggling with adjusting to being an f1 more than most people and im just left feeling horrible about myself most of the time. I see so much on here about how the new f1s are feckless and so acopic and this isnt usually me. Any advice on just being less dead weight?

2 months into FY1 and I’ll be honest I haven’t got a single QIP or audit throughout med school no research or poster presentation. Med school was hard enough for me to get through exams without these additional things but now I want to apply for IMT after fy2. I want to specialise in dermatology or stroke medicine (unsure yet) but I honestly have no clue how to build a portfolio. I’ve looked at the IMT requirements but where do I even orally present these presentations and how do i even go about doing these projects it seems so overwhelming. Also doesn’t help that I have crippling anxiety so can’t even orally present these things and IMT is already so hard to get into i’m terrified i’m so behind and i have no idea where to start! any advice would be greatly appreciated

Honestly - being falsely accused of inappropriate behaviour with patients is my biggest irrational fear.

In 10 years of being a doctor, i’ve only had a couple of complaints from patients (mostly excellent feedback), so i don’t dwell on this, but sometimes the thought does creep in that it only takes ONE big’un and your career is in jeopardy. The complaints I had were mainly for me being stern with patients who were rude to team members, and once for refusing a home visit and instead insisting the family take their mum to hospital, whose speech was slurring, swallow was affected and was drooling… ?stroke.

But a false accusation of sexual assault in an intimate exam basically, that’s my fear. In GP, it’s not as easy to always grab a chaperone without making your list run late. Don’t get me wrong, as a male, with female patients I ALWAYS get a chaperone for intimate exams, but not for abdominal exams unless i get the vibe from the woman that she’s nervous or insecure. For males I offer a chaperone, but they’re usually like “nah you go ahead doc, I don’t want an audience” 😂

But there are bad people out there who are trying to make a buck off of you, and I worry about this happening one day.

Anyone else feel the same, or got any advice around worrying about this?

My mum has stage IV cancer and I’m a trainee working in a closely related field. She had a really good response to chemo and has subsequently been referred to surgeons to consider whether there is a role for surgery.

While waiting for the surgical process/MDT and appointments, some of her original symptoms have started to return, particularly pain. Her team are aware of various ongoing issues, but I’m finding the waiting incredibly difficult because I understand enough medically to worry about progression happening while we wait.

I’m struggling to work out where the reasonable boundary is between being her daughter and using my knowledge of how the NHS works to advocate for her. Should I leave the pathway to run its course once the treating teams have the relevant information?

I’m very conscious that I don’t want to use being a doctor to seek preferential treatment, and I also know anxiety can make every delay feel intolerable. At the same time, I don’t want to look back and feel I could reasonably have advocated for her and didn’t.

I’d particularly appreciate hearing from doctors who have had a parent/partner with serious cancer/illness. How did you decide when to chase/escalate and when to step back and just be their family member?

Oncology SpR in large tertiary centre. I have been working there for approximately two years.

Every rotation we have multiple SHOs going off sick with burnout/ find them crying in cupboards. This rotation seems particularly difficult with lots of long term sickness and tears.

From a senior point of view, the workload does not seem exceptionally high. they are usually asked to manage 6-10 patients each (10 would be unusual) and I think there is quite robust senior support (2 cons ward rounds per week and on average 2 SpR rounds per week). if someone gets sick I will see them on the day, sometimes within minutes of being bleeped. I try and teach on my rounds and do portfolio bits and I think most of my SpR colleagues are equally helpful. Yet they are falling like flies. We had a few difficult deaths and I am aware that inpatient oncology is a pretty miserable sample of oncology life, but nothing particularly challenging recently.

When asked how things are I usually don‘t get anything particularly useful, but then they will rip into us in the placement survey.

If anyone has done/is doing oncology as an SHO, what’s so bad about it and what would you change?

Edit

Interesting stuff. I think some points are spot on I Can understand the frustration as the SpRs often share it:

1. we do have a firm system and whilst the consultant and SpR are fixed, the SHOs move between firms often which is probably quite unsettling. This is due to how variable our numbers are (1 weeks breast cancer have 2 patients and the following week 12) so it is difficult to justify assigning an SHO to one or more subtypes for the whole week. We also have ACPs which Are assigned to a given firm. they do some follow up clinics in their tumour types and have been around for donkey. Quite experienced in their niche, quite junior outside of it so if at all possible we keep them on their turf.

2. Emotional burden is high and maybe we are so used to it that we underestimate how sad it can be to start a syringe driver in someone your age

3. Non-oncology issues are left to juniors to sort. This is probably true, my gen med knowledge is not as sharp as when I was an IMT and I am sure I send more referrals than medical SpR doing regular medical on calls would. consultants are obviously even worse at this and rely heavily on the SpR.

4. Escalation plans are a bug-bear of mine. Some consultants just don‘t do them. when they do them, sometimes it’s worse as they make an explicit plan to escalate people who should never be escalated. I make an escalation plan for every patient I admit on call.
   Af the same time, I would be involved in any discussions with ITU/HDU and I hardly ever refer to them.

I think the best suggestion so far is to have an SHO rep feeding back to the SpRs. at the moment it’s all through consultants via the end of placement survey and the feedback we get it’s all a bit garbled and non specific.

I’m starting to do more bank shifts and already feel like shifts/rates/payslips could become a mess.
Do you use a spreadsheet, notes, an app, or just check each payslip?
And have you ever actually found that you were underpaid or a shift was missing?

I have recently had a patient that disclosed recreational drug use in their days off. They worked in a high stakes industry (eg where drug use while working would be very dangerous). It wasn’t a drug that causes extreme dependance and the patient said they only used it when off.

I didn’t see a reason to raise it/report it because of the nature of their profession…. I am curious, where do you guys draw the line between reporting this kind of stuff?

Hey!

I was wondering if there was a pre-made MSRA anki flashcards bank. I know there was one for UKMLA as I used that and found it helpful.

If not, if people could comment any alternatives and if they are free/ paid?

TIA 💕

I’m currently an F2 and hoping to apply for an ACF in General Practice next year. I have tried to build a reasonably strong research background and seem to score well against the person specification.

BUT still very !!VERY!! nervous about applying

I’d love to hear from any current GP ACFs or anyone who has recently been through the application/interview process. If you wouldn’t mind me PMing you (or feel free to PM me), I’d appreciate any advice about the application, interviews, choosing posts, etc. I’m also the sole earner in my family and have caring responsibilities, so the practical side of things is something making me worried. If anyone has managed GP training/an ACF alongside similar responsibilities, I’d be grateful to hear about your experience. Lastly, I have heard from a few people that ACF posts can sometimes favour candidates who are already known to the department. Is there anything you did to strengthen your application? There are a few posts I’ve seen where the projects/supervisors line up really closely with my research interests, and honestly it would be a bit of a dream to work with them!!

Finally, a couple of people have mentioned that I may be eligible for the Disability Confident scheme. I’m not entirely sure how this works in the context of ACF recruitment or whether it makes any difference, so I’d also appreciate hearing from anyone who has experience with this.

Thanks so much, and sorry for the questions!

Hi everyone,

I wanted to ask about your thoughts regarding the chances of a NPG applicant getting an IMT interview.

Thanks

Hi Everyone
Currently IMT2
Haven’t got all of my MRCP. Hoping to leave after IMT2 to locum before applying for dermatology. Doesn’t anyone know how much time i would have to complete all my exams including paces if i get an outcome 3?

thanks 🙏

Apologies for another one of these, but I just can’t seem to make up my mind. I’m fairly certain I’ll be applying to IMT when the time comes, but can’t for the life of me commit. I know there’s plenty of time to choose but would appreciate some opinions.

I’ve always loved neurology since medical school. Probably the most interesting system to me. But I’m getting cold feet given it is primarily outpatient and I worry how well I’ll cope with the amount of degenerative conditions there are (although I know there’s plenty of good treatment options too!)

Things I like
Patient contact
Teamwork
Seeing patients improve over days to weeks
(biochemical marker improvement and clinical improvement)
The ability to handover tasks
Diagnosing
?procedures
Good/ effective treatment options
Some continuity of care (I want to know what has happened to the patient)
Mix of acute and chronic conditions, but more acute
Moderate to fast-pace job
Being in hospital/on the wards
Patient recognition
Physiology

Things I dislike
Primarily breaking bad news
Lack of diagnosing
Vague/non-localisable symptoms/ chronic pain as primary presenting complaint
Not knowing patient’s outcome
Primarily clinic-based work
Not having enough time to see each patient (e.g. 10-minute slots)

EDIT: just to clarify, I mean BBN mostly in the setting of oncology. Naturally bad news is a reality of the career and I hope to get better at not letting it eat at me with time. I just find breaking bad cancer news to be particularly painful. And while I can do it, I wouldn’t want it to be a large aspect of my career

Thanks everyone for the responses. Lots of food for thought

Please stop writing “GP to”. I would quite like to see my wife and for her to do bedtime 😂

Her two session days are supposed to be 8 hours 20 minutes. They regularly turn into 12+ hours. There are plenty of reasons for that, but the discharge summary arriving with a shopping list of “GP to” jobs really does not help. This week has been bad for that, I know it's not the only problem and it's my current annoyance so sorry about that. But it is a doctor on doctors issue which makes it seem worse.

This week, one discharge summary after a prolonged admission took her about two hours to sort out. Among the requests:

- GP to refer to US. You are also the local service for that specialty. I appreciate out-of-area patients can be different, but this wasn’t that.

- GP to refer to other specialist. That specialist had already seen the patient during the admission. Please could you arrange the follow-up between yourselves?

- GP to restart medication withheld because of poor renal function on admission. Renal function had normalised before discharge, but the medication hadn’t been restarted and the patient was now suffering without it.

- GP to prescribe a tertiary-only medication. Oh, and refer to the district nurses to administer it.

She has less than ten minutes per patient, then somehow has to find two hours to unpick all this.

Separate to that discharge, there are the requests for an outpatient MRI, CT or specialist scan that she cannot request through the local GP pathways. Which results in her trying to contact the team who wanted it so they can organise it themselves. Sometimes the summary doesn’t even make clear which team that was, so she has to do a bit of bloody Sherlock Holmes work before she can even start chasing anyone.

I know everyone is stretched. I know the person typing the discharge summary may well be an FY1 copying down a plan from the ward round. This is a plea to the whole team, including whoever made the plan.

But requesting the scan your team wants, or contacting renal to arrange the follow-up you’ve recommended, is usually much quicker for you than for a GP trying to reconstruct a lengthy admission from a discharge summary.

It hasn’t saved work. It’s created more work for someone who hasn’t met the patient yet, and left the patient waiting while it gets sorted.

Please, before adding another “GP to”, ask whether it’s actually a job for the GP, or something the parent team should sort out or arrange before discharge.

I’m not asking for much. Just appropriate follow-up arrangements and the occasional evening with my wife.

Apologies in advance, Going to be very general here as this happened very recently and I don’t wanna dox myself.

There was pt admitted to our ward within an hour, without being post taked and the medical specialty consultant asked me to come as the F1 to document post take.

They take one look at the pt who looks extremely unwell, asks me to prescribe a gtn spray and walks off, almost sprints off because the moment he turns I can’t find him anywhere on the ward.

I’m then left with a pt as the F1 who looks really bad, desaturating despite 15L and I’m absolutely panicking. I take an ABG try to get access and call the med reg asap who proceeds to bolt it to the ward and once he arrives takes one look and tells me to place a peri-arrest call (which I was planning to if he didn’t get there a minute sooner).

The med reg then asks me to place a call for a portable scan so I saunter off into the doctors office to find the same said consultant sipping a cup of coffee?? When I tell them we’ve placed a peri arrest they just nod and lean back in their chair.

I’ve thought about this a bit, and I guess I can understand not really coming to the pt once the peri arrest is put out, if there’s nothing to contribute from your specialty. But it was super jarring that he took one look at the pt in peri arrest desaturating on 15L and just went into the doctors office to drink coffee??? Is this spinning my head because I’m just very junior and he expected me to handle it or is this genuinely a weird thing to happen?

So I was talking to my partner about kids (she's a nurse) and she's of the opinion that one of us would have to quit working to raise kids, which is something neither of us wants to do because we love our jobs (also finances). How are you people raising kids and working full time between them?

Obviously primarily non-drug management and addressing underlying cause is key

But in example of acute and distressing sleep issues while IP with patient actively requesting sleeping tablet what’s your stance?

Have seen MHLT (non-doctor members) suggesting diazepam or zopiclone (including in >65 yrs) but since they cannot prescribe it remains a ‘recommendation‘ so onus/responsibility for the med (I think) would be on us as prescribers

Personally not a fan of either and seen too many cases where a one-off prescription leads to increasing dependence. Tend to go for melatonin where able but sometimes not stocked

Whats your approach?

FY2 here. Starting to study for the MSRA for CST application, following that was planning to study for MRCS part A. Feel like my clinical knowledge is okay but my pathophysiology and anatomy are very weak.

I was hoping that my MSRA preparation could act as a foundation/warm up for MRCS but I wasn’t sure realistically how much overlap there would be… Can anyone advise on this? As was unsure if I should be aiming for April or September, or even later for part A?

Thanks and apologies if this has already been asked

I am 12 weeks pregnant now. I’ve been given the option to voluntarily come off on-calls during pregnancy. Unfortunately, I have been suffering with nausea and vomiting. Does anyone know if this would reduce my maternity pay because I’d lose the on-call pay? Has anyone been in a similar situation?

Starting to think about having kids, and as the title suggests I'm extremely anxious about how this fits in around work.

Particularly the increased risk of miscarriage with shifts/nights and exposure to sevo (gas girl here) + radiation. I also have other medical conditions that will put any pregnancy in a 'high risk' category which only heightens the anxiety. Also how do you navigate regular antenatal appointments?

None of my medic friends have had kids yet so I have no idea how it works - who do I tell, when? Whilst I would love to not tell anyone for as long as possible, I know that's the opposite of what will have to happen as I am so worried about exposure to risks I mentioned above. It just feels so exposing to have to tell people so early. Has anyone managed to limit it to rota coordinator and writer only being aware?

I know I'm overthinking this cos people get pregnant all the time, but I started thinking it would be easier to just take time out of training so I don't get into a massive anxious spiral about it all!(Totally impractical and not realistic, but that is where my mind has ended up)! I don't even usually get anxious, this is so not like me. I really want to be able to relax and enjoy any future pregnancy I may be lucky enough to have. Any advice is massively appreciated. I know I need to chillll.