On Becoming A Respectable Quack

Blogging on a hammock...

2008-07-03T15:44:00.004+02:00

Two weeks after the end of the exams, and yours truly has exploited this time to the fullest by mostly being asleep. "Ah, the joys of summer holiday !", I hear you say.

Sadly, this debauchery is soon going to be over for me, so I decided to change my frame of mind by dedicating some time to my -disappointingly neglected- blog.

There are many interesting topics that I could write about, like the political situation in Zimbabwe or the recent increase in utility bill surcharge. But this blog is not about politics, be they national or international, so I think I'm going to stick with something that my readers are more familiar with : the RCSI saga (part MCMLXXXVIII).

In the beginning of the academic year, I would hear something new about that proposal every week. But this was no longer the case. After the RCSI conference in March, there was complete radio silence, which really made me wonder how (and if) things were progressing.

But then, on the 20th of June, I came across this, a letter to the Times in which Dr.F.Portelli more or less advises the government to go ahead with the RCSI proposal, and exclude the current faculty of the Malta Medical School from any involvement in postgraduate medical training.

I must confess that this letter puzzled me. I knew Dr.Portelli as the man behind St.Philip's hospital, a surgeon-businessman who wouldn't normally want to be involved in the whole government-RCSI-UoM-SGUL game. So what could have turned him into such a zealous supporter of the RCSI proposal ? Call me a cynic, but I don't think it is down to a genuine concern for the future of junior doctors...

Perhaps a partnership of some sort between St.Philip's and the RCSI is on the cards ? And why not ? St.Philip's would have a (much needed, according to some) financial benefit and the RCSI will be able to start their graduate programme without any need for access to Mater Dei. Even I would be happy, since we (the UoM medical students) will be able to keep Mater Dei to ourselves !

Either way, I expect more news from RCSI to emerge in the following months... They might have slightly altered their short-term target from offering a state-of-the-art, world-class medical course to opening a shonky office in Valletta, but at least it's a beginning.

In the meanwhile, I read here that the UoM-SGUL agreement is to be signed on July 17th, with the relevant course starting January 2009. As I've said in the past, I am concerned about the potential over-crowding of MDH that the additional four-year students will cause, so I'm looking forward to the university releasing information on how they plan to avoid this problem.

Another one of my concerns was to what extent the university is willing to take advantage of its partnership with SGUL on a postgraduate level. Last Tuesday, I came across this, a letter to the Times in which Prof.G.LaFerla attempts -amongst others- to clarify how the Malta Medical School is planning to improve the current situation in postgraduate medical training. The letter is an interesting read, and without doubt very promising.

Now all that remains is to see things put to practice ! Who knows, perhaps many of us will then be tempted to stop browsing through this website...

And now...

2008-06-18T13:12:00.002+02:00

...holiday !!!

Unless, of course, you are anxiously waiting for your exam results to make sure you don't have a resit. In that case your summer might be slightly ruined by a decision that the (...student-centred and caring...) people of UMASA took a couple of weeks ago.

If you've been buried under a ton of books until recently, and have no idea what this is about, you can check this for the lowdown. As per usual, students aren't really doing much about it. You may check this and this for more, but be warned that the material linked to may be unsuitable for minors as it includes some shockingly inefficient student reactions.

UPDATE : The industrial action is now suspended !!! Enjoy your holiday (...or resits...), everyone !

Light at the end of the tunnel ?

2008-05-13T19:37:00.000+02:00

If you haven't read this already, take a look here !

Is there light at the end of the tunnel, or is it just some bastard with a torch, bringing us more work ? Answers on a postcard ;-)

The June exams are coming...

2008-04-21T16:47:00.005+02:00

...and therefore what better thing to do than to enjoy some brilliant med-related cartoons :

Check Scutmonkey for more wonderfully silly cartoons like the above.

Procrastination...

2008-03-08T21:30:00.003+01:00

Specially devoted to the people who couldn't really study today... Or yesterday... Or the day before... Or......

UoM and SGUL sign memorandum of understanding !

2008-02-25T14:09:00.011+01:00

Last Friday, I was forwarded a document by an anonymous reader (whom I have to thank deeply for his contribution), according to which a memorandum of understanding had been signed between the University of Malta and St.George's.

This morning, I was able to verify the authenticity of that document (by being shown an original hard copy), so I can now post it here for the benefit of all the medical students who -like myself- are interested in the course and outcome of this collaboration :

19th February 2008

Dear Colleagues,

Further to my last letter, I write to inform you about the recent visit by delegates from St. George’s, University of London (SGUL).

As a result of this visit the Rector of the University of Malta has signed a Memorandum of Understanding between the University of Malta and St. George’s, University of London. The MOU regulates discussions between the two parties with an eye to signing an Agreement by late Spring in order to launch an international four-year, graduate entry programme in 2009/2010 leading to a registerable medical qualification. It is hoped that this will be the first step in a long term partnership.

During their visit the visitors from St. George's met with various officials in Malta including the Prime Minister , the Minister for Education, Youth and Employment, the Minister of Health , Care of the Elderly and Community Care as well as the Deputy Leader of the Malta Labour Party and the shadow Minister for Education.

In addition they met with HE Mr Nicholas Archer, British High Commissioner, and senior members of the University and National Commission for Higher Education.

A visit to Mater Dei Hospital was arranged for the visitors to see the hospital and medical school as well as meet some senior members of the medical profession who were on duty there.

The visitors discussed a number of areas of possible cooperation including the establishment of a graduate entry medical education programme for international students alongside the existing University of Malta course. St. George’s has been successfully running graduate and undergraduate entry medical education programmes together for over seven years. SGUL was the first medical school in the British Isles to offer a Graduate Entry Programme. Its next intake will be 98 students. SGUL is the only independently-governed medical school in England. It is a premier educational establishment. St. George's gained an excellent score of 23 out of 24 in the Quality Assurance Agency (QAA) inspection of medicine - the highest score of any London Medical School.

Further discussions are taking place and it is hoped that the proposed graduate entry programme would only be the start of a long-term relationship between the University of Malta and SGUL that would include postgraduate education.

SGUL offers a wide range of postgraduate programmes at certificate, diploma, masters and doctoral level that could complement the University of Malta's own postgraduate programmes. SGUL has approximately 5500 students, made up broadly of 1300 undergraduate medicine and bioscience students; 3700 health professions undergraduates in the joint faculty; 300 taught post-graduates, and 200 research students. A number of postgraduate qualifications are offered in conjunction with Kingston University in the Joint Faculty of Health & Social Care Science.

Future collaboration could also include combined research projects with joint applications for international research grants between the University of Malta and St. George's, University of London. SGUL is a major international research centre. SGUL came second in a Guardian (2007) newspaper league table of research papers and their impact, published in November 2007. Figures show that SGUL research papers had twice as much impact as the world average in terms of how often they were cited in peer-reviewed journals. SGUL beat Oxford and Cambridge, Imperial College London and University College London. In the last Research Assessment Exercise (2001) St George's was rated as conducting research of at least national excellence in the majority of its activities (with cardiovascular and respiratory epidemiology receiving flagged status). Work in the area of pre-clinical studies was considered to be of international excellence.

Research is also strong in basic medical sciences, particularly cell biology and molecular genetics. St George's research continues to be influential in the fields of medical epidemiology.

The research base at SGUL is further strengthened through its close proximity and interaction with St George's Healthcare NHS Trust and other hospitals.

These relationships provide unique opportunities for translational research that links basic science to clinical care.

Total research income was about €30 million last year and SGUL has recently been awarded $21 million as part of the Grand Challenges in Global Health Initiative. There are about 150 active researchers in permanent positions, with about 200 research assistants. There are 170 MPhil/PhD students and 120 MD/MS/MD(Res) students studying both in full-time and part-time mode in all divisions. There are a number of companies (including pharmaceutical companies) on site, that work collaboratively with researchers in SGUL. These include Antisoma, Onyvax, Richmond Pharmacology, Helperby Therapeutics and Phytofusion.

Finally, cooperation could extend to George's Healthcare NHS Trust including interchanges between students, postgraduates and hospital staff. SGUL shares its site with St George's Hospital in Tooting, one of the biggest NHS hospitals in the United Kingdom.

St George's Healthcare NHS Trust employs over 5,000 staff with 2,500 nurses and 800 physicians with over 1000 beds and trains over 4,000 healthcare professionals. The annual budget of the Trust is close to €500 million. The Trust provides the services of a district general hospital (secondary care) and specialist (tertiary care) hospital services from three sites.

The Rector has stated that this is a further step in the university's strategy of partnering with prestigious international educational institutions and would help realise the vision of Malta as an international preferred provider of quality higher education, the "Teacher of the Mediterranean". He has said that these partnerships enhance the University of Malta as well as the country as a whole.

I hope that you share my enthusiasm for such a joint venture which would be a true partnership between two. equals where the responsibilities and benefits would be shared. This is unlike the franchises previously proposed by other institutions. I augur that such a partnership would open opportunities to all members of the faculty as well as all the other doctors working at Mater Dei Hospital and beyond. I envisage that this would be a superb way of improving the currently high standards achieved as all programmes both offered locally as well as the one offered as a result of the partnership would run in parallel and not in direct competition.

I am calling an Extraordinary Meeting of the Faculty Board to be held on Tuesday 4th March 2008 at 11 am at the University of Malta Medical School Board Room at Mater Dei Hospital. The subject of the Future of the Medical School will be discussed as the only item on the Agenda. I look forward to seeing Faculty members at that meeting.

I shall keep you informed of progress with regards to the discussions with St. George's.

Yours sincerely,
Professor G LaFerla

I was very happy to read that the co-operation will not just be a money-making venture but will also cater for the improvement of the normal five-year UoM medical course and for the establishment of urgently needed postgraduate medical training programmes.

The only thing I am still wondering about is what measures the faculty is planning to take to avoid an over-crowding of MDH by medical students. I understand that it might be too early for that sort of detail to be publicised, but it would surely make me feel better if MMSA was to raise that issue in the upcoming faculty board meeting...

The medical student of today !

2008-02-14T15:49:00.007+01:00

The modernstudent, we gather, is bored by the lectures he has to attend,and a genuine interest in his work, or a real scientific curiosity,is rare. Nevertheless, having the fear of the examiner beforehis eyes, he reads hard, but the whole system of examinationsis "soul-killing, destroying originality, destroying continuity,and bestowing the prize on the man who patiently `swots' uphis subjects and mechanically gives forth the answers he hasbeen told to give." That lectures often cause boredom is trueenough, but that is not altogether the fault of the student.That the passing of examinations is to a considerable extenta mechanical art cannot be denied, but that is mainly the faultnot of the system, but of the way in which it is too often applied.As long as mere book knowledge is accepted as a passport bythose who guard the portals of medicine, so long will crammingcontinue.

What the above excerpt describes is surprisingly familiar, don't you find ? And what is even more surprising is its origin : BMJ 1905;ii:971 !!!

Could it be that today's medical education in Malta is not all that different from what medical education was in the UK more than a century ago ?

Answers on a postcard or, rather, a blog comment !

Good news, at last ?

2008-01-27T12:43:00.000+01:00

Hello and welcome to another very late update of my blog... But I'm sure you will excuse the delay, because I have some very fresh and very important news. So important that I've broken my self-imposed computer use ban to post them... Read on !

A few days ago, I heard something on the grapevine about an imminent visit to our university by people from St.George's... Great, I thought to myself, after RCSI there's now yet another bloody medical school franchise that wants to strip UoM Medical School of its good lecturers and take over Mater Dei...

So I started asking around, to see what's going on (..again !).

One of the people I talked to was kind enough to show me a document circulated to all medical staff and signed by our dean. What this document said is that the UoM Medical School and the SGUL Medical School are looking into the possibility of setting up a four-year graduate-entry medical course together.

I don't remember the exact text, but it was pointed out that the partnership would be equal and that the new four-year programme will run in harmony with the existing UoM five-year programme. So the whole thing is not a franchise, and the UoM would actually be gaining financially from it ! Sounds better than the RCSI proposal to me...

All I want to know now is what they are planning to do to avoid congestion at Mater Dei, and how much time our consultants will have to devote to the four-year course. If they solve those two issues, then the news of this partnership are very good news indeed.

If anybody knows more, please share your information ! I'll keep asking around and will let you know what I find out...

Assisted inspiration needed :-P

2007-12-16T20:14:00.001+01:00

Almost a month since the clinical students migrated to Mater Dei and almost a month since my last proper post on this blog... time really flies !

Despite being very lazy on the blog front, I did find the time to compile a short article for InSite, regarding the RCSI medical school issue. I must confess I am not an avid reader of InSite (or any other student publication, for that matter) but it does have quite a large audience and the more people that know about the issue, the better it is !!!

On the same topic (the proposition, not my silly article !), I heard that the ministry of education has yet to sign the RCSI agreement. Does anybody know if this is true and what are the reasons behind it ? Is it a true victory of the UoM or just a political trick, due to the forthcoming election ?

Last but not least : as most of you should have noticed by now, posts are becoming more and more scarce as time goes by. This is not due to a loss of interest, but due to a lack of both time and inspiration. And while there's nothing you can do about the former, you can help me with the latter by suggesting topics or sending questions... So go on and click that "publish your comment" button ! You know you want to !!!

Ho, ho, ho !!!

2007-12-08T14:21:00.001+01:00

Mother of God (...in Latin !)

2007-11-19T20:53:00.000+01:00

Ladies and gentlemen, our dream has finally become true : the venerable University of Malta Medical School has finally moved (well, started moving, but that's good enough) to the brand-spanking-new Mater Dei Hospital !!!

The first lectures were held at MDH today, tutorials will soon follow, and with a little bit of luck we will soon get lockers there, so we won't have to carry our massive copies of Kumar or Burkitt with us to the patients' bedside (occasionally placing them on their beds, as a minimal contribution towards the spread of MRSA to the new hospital :-P ).

A pleasant surprise was the parking situation : in St.Luke's you had to sell your soul for a parking space, while in MDH you have 666 places to choose from, most of which seem to be empty before 07.30.

But there was also an unpleasant surprise : most areas are access-protected and it is said that we won't be given access cards for them. If this is true, we will constantly be at the mercy of the nursing staff to access wards and theatres. This will be a huge obstacle to our training, and may also cause serious inequality issues, since some students have friends or relatives working at MDH and others don't...

I really hope that the Medical School administration and MMSA have understood this problem and are already looking into solutions... And I also hope that some day both the former and -especially- the latter will start regularly and reliably informing students about what's going on... I'm sick and tired of learning things through the grapevine !!!

[UPDATE : I should take the last comment about MMSA back, since they did send us a very informative email on the issue earlier today. Apparently, there will be clerks at each ward that are supposed to do the gatekeeper's work. And they will be obliged to open for us, as long as we flash our ID tags at them. Fair enough, and I am starting to like MDH even more now :-D ]

MDII Physiology Past Papers

2007-11-12T18:20:00.000+01:00

It's been quite a while since my last post... But free time has been scarce, and I do have other priorities to take care of.

Still, I did find some time to dig through my infamous "pile-o-shite" and find some nice MDII past papers for our lovely "Physiology, Biochemistry and Molecular Biology" module. Those papers were taken to Papier Plus this morning, and can be found inside the MDII folder.

You will notice that some questions keep coming up, especially in the case of two specific lecturers that take pity on us and always ask variations of the same questions. So make sure you know those questions well !!!

Money money money (in a doctors' world) !

2007-10-28T23:26:00.000+01:00

A quick update, to inform you of some breaking news ! Apparently, the government has finally decided to increase the salaries of public doctors to decent levels !!!

But will this be enough to limit the infamous 'brain drain' ? Answers on a postcard...

One month later...

2007-10-26T22:58:00.000+02:00

One month online, over 750 unique visits from all over the world and quite a few hours of wasted time for the author...

As a means of celebrating the first month online of this blog, I have finally done what many visitors have been requesting for a long time : moved all the juicy files from RapidShare to Google Pages. So check the respective blog entries for the new links !

And because I feel generous, I have also uploaded a full MDII Pathology past paper (supposedly of June 2005) here... Enjoy !!!

Sex, pharmacology and rock'n'roll.

2007-10-21T00:00:00.000+02:00

Well... It wasn't exactly 'pharmacology' that Mick Jagger was preaching, but then again I don't have many things in common with him... And therefore this post will contain absolutely nothing about the very interesting topics of sex and rock and roll, but loads of stuff about the much less interesting topic of the MDII pharmacology module.

Surprisingly, the department of clinical pharmacology is very well organised, has a website that is regularly updated, most of the lectures are very good and the tutorials actually teach you stuff !!! Eat your heart out, Physio&Biochem department :-P

So my first piece of advise would be for you to attend the lectures and tutorials. Not only because they are good, but also because you won't find much in the books about the topics covered in them.

For this reason, I would advise you against buying Rang&Dale and the BNF yet. If you need something to study pharmacodynamics and pharmacokinetics from, I recommend Katzung. It's a very well written book, and since you only need a couple of chapters off it, you don't really need to buy it (check here for more). For everything else, you'll be getting lecture notes.

My next piece of advise is about the pharmacology project. Don't overlook it, and don't leave it for the last minute. Find as many resources as possible, and don't forget that most of the information required for the project will be on the manufacturer's website. Read about kinetics and dynamics before you start writing, otherwise things will simply not make sense.

And do ask questions if things don't make sense. Make an appointment with Dr.J.Mifsud, take a hard copy of your resources with you, and she will be happy to answer all your questions. But make sure you have done your reading and know your stuff, otherwise you will be asking silly questions and wasting her time, which she doesn't seem to like...

And onto the juicy part of this post... A compilation of the topics covered in past exam papers :

Receptors : G-protein-coupled, glycocorticoid, desensitisation, spare, intrinsic activity.
Tachyphylaxis.
Potency and efficacy + use.
Agonists and antagonists + respective diagrams.
Pharmacogenetics : prescribing, ethics, genetic variations.
Definitions : drug/medicine, ideal drug.
Pharmacodynamics and pharmacokinetics : importance in therapeutics.
Drug-induced allergic reaction.
Pharmacokinetics in children and elderly.
Pharmacoeconomic methodologies and comparators.
Asthma : metered dose inhalers, dry powder inhalers and large volume spacers.
Controlled release formulations : repeat action tablets and spansules.
Same dose to different patient : four reasons for different plasma concentrations.
Drug plasma concentration measurement and narrow therapeutic range.
Clinical trials : phases and process details, blinding and randomisation.
Pharmacokinetic processes and relation to therapeutic outcome.
Drug interactions + drug classes susceptible.
Bioavailability, bioequivalence.
Steady state + graphs, therapeutic range.
Value of drug history against adverse reactions.
Increasing healthcare cost, prescribing influences.
Hepatic function impairment.
Drug assay principles.
Drug study reliability, NNT, ARR.
Drug targeting.
LD50, ED50, therapeutic index.

You'll notice that the above questions cover pretty much the whole syllabus, but this is how the paper is : they examine a little bit of everything they've taught us ! But don't worry... Pharmacology is not a hard subject and, traditionally, most of the questions of the June paper are repeated in the September resit paper. So even if you manage to fail in June, there's no way you'll fail in September !

Something for the weekend, sir ?

2007-10-19T13:48:00.000+02:00

I have been told that quite a few people in MDII are starting to get worried about the Pathology paper. But they shouldn't.

The MDII Pathology paper consists of 60 MCQs, all of which come from a question bank. That question bank is a bit on the small side, so all that you have to do is get your hands on as many past papers as you can, and you will practically have the entire question bank at your disposal. To make things even easier, the faculty always organises a 30 MCQ pre-test in May, and most of the questions in that one come up in the exam. Clearly, they want as many people as possible to get into the clinical years (so they can fail half of them in MDIII :-P ).

I have scanned a pre-test, which I am sharing with you. In the future, I will also share a couple more pre-tests, plus a normal past paper. Studying all of those will be enough not only to pass the paper but also to get a very decent grade.

So spend your weekend studying Anatomy and Physiology... There will be loads of time for you to study Pathology in your clinical years !

Who the hell is Louis and what's with his angle ?

2007-10-17T13:59:00.000+02:00

Earlier today, I was in the library, killing a bit of time I had between the ward round and a lecture. And since I wasn't really in the mood of studying (as per usual :-P ) I picked an old issue of BMJ and started browsing through it...

What I found was a very interesting feature about the use of eponyms in medicine. I suggest you check the two articles that it consists of (one for and one against) in your free time, they are really worth it !

The RCSI medical school in Malta. A curse or a blessing ?

2007-10-10T21:12:00.000+02:00

Exactly two weeks have passed since the newspapers informed us of a 'plan of the RCSI to open a private medical school in Malta'. In those two weeks, a lot of things have happened, but very little has been made known through official channels.

However, a fair bit of information seems to have leaked. Some of it we've heard on the grapevine, and some of it has been posted on this very blog by a handful of anonymous contributors. Now, I have no idea who those people are, and how reliable what they have posted is. So it's in the hands of the visitors of this blog to judge how reliable this information is.

But it's in my hands to protect two things that I consider as basic human rights : freedom of speech and access to information. So feel free to post any comments or information that you might have anonymously. It's the only way to safeguard the above two rights in a small place like Malta.

Having said that, I've noticed that the comments posted are becoming increasingly harsher towards the MMSA. One of the visitors has -eponymously- criticised those anonymous contributions, and I can really see his point.

So if you'll allow the resident twit to use the words of a most prominent wit, and make a request to all of you : "Don't shoot the pianist ! He's doing his best !". So, instead of criticising MMSA, be a bit more constructive and post some ideas and suggestions on how the medical student body can deal with the issue.

Anyway... Onto the main part of this post : I have taken some time to prepare a compilation of all the information I have at this point, for the benefit of anyone interested :

The Facts (sources : The Times, MMSA statement)

The RCSI is really interested in establishing a medical school in Malta. They have already submitted a proposal to the Maltese government and negotiations are at an advanced stage.
The medical school will admit students that already have a bachelor's degree in their possession and will be a private institution, charging considerable tuition fees.
The duration of studies will be 4 years, and upon graduation the students will be given a degree equivalent to the MD degree offered today by the University of Malta.
The students will be trained using state-of-the art equipment.
The medical school will employ both Irish and Maltese lecturers.

The Speculations (sources : visitor comments, Pawlu's blog, the grapevine)

'Advanced stage' means that the RCSI proposal has actually been accepted by the government, and the only thing that remains is to settle the details of the deal.
The proposal was kept secret until two weeks ago. No-one consulted the UoM Faculty of Medicine and Surgery, MAM or MMSA about it.
A committee will be formed, to decide on the final details of the RCSI deal. The UoM Faculty of Medicine and Surgery will be part of that committee, but MMSA will not.
The RCSI is willing to share it's high-tech teaching toys with the University of Malta and also provide post-graduate facilities and research opportunities for the UoM students.
In exchange, the RCSI wants full access to the patients in Mater Dei.
Only 20% of the faculty members of the RCSI medical school will be foreign.
The RCSI plans to recruit the best lecturers from the University of Malta, by offering them significantly higher salaries than the ones they currently have.

The Reactions (sources : visitor comments, MMSA statement, Pawlu's blog, the grapevine)

The board of the Faculty of Medicine and Surgery had an emergency meeting last Tuesday.

There is no doubt that this event has taken place, but the outcome has not been made public yet. There is an enigmatic post on a board member's blog, that reads : "Following the path of least resistance is what makes rivers and men crooked."

And we all wonder : what does this mean ? Does the faculty agree with the deal ? Someone posted a comment on the same blog, asking for clarification. But the reply he received was even more enigmatic.

One of the readers of this blog posted that the faculty considers the proposition of the RCSI as a "good opportunity" ! Could it be that the faculty members are mainly interested in the research funds which the RCSI will allegedly provide ?

What about the effect of the deal on the quality of teaching ? Will the high-tech resources of RCSI be enough to compensate for the significantly reduced exposure to patients that the UoM students will get ?

Yesterday, MMSA publicised a short text, describing their concerns.

The text was essentially a slightly enriched version of the Times article. The only part I found interesting was the following :

"...the Faculty is in concordance vis-à-vis our concerns, and is looking to secure discussions with the bodies responsible for decisions regarding this issue, i.e. the Ministries of Health and Education, the NCHE Steering Committee, and the University Administration. We have been assured that any talks will be held with the students' best interests in mind, and that they are open to further comments and concerns of the students."

So have we agreed to sit back while the faculty does all the work ? Has the faculty specifically requested that, due to some reason that hasn't been made public ? Wouldn't it be better if our colleagues at the MMSA EB asked for a student representative to attend the discussions ?

And I am not suggesting this because we don't trust the faculty (on the contrary, those people have taught us all we know about medicine, and much more ! so they certainly have our highest respect !). It's just that I believe that two -synchronised- voices are always better than one !

[UPDATE : According to a comment posted by Pawlu, MMSA was simply not allowed to participate in the discussions. Which means that no-one really cares about the opinion and the needs of the students. Certainly not good news, then... Is there something that we can do for this ? ]

The Dean of the Faculty of Medicine and Surgery has sent a letter to the Ministers of Health and Education.

I don't know if this is true, but it has been mentioned twice so far. Plus, someone actually posted a short extract, that is supposedly part of the letter :

"The numbers of students being admitted to our medical school every year is frequently disproportionate with the resources and facilities available to sustain high quality teaching and training. Indeed, an in-depth study by the Board of the Faculty of Medicine and Surgery in 2004 states that the optimum number of students per clinical year is 54. The average number of students per year currently exceeds 60, and the intake for the MD Degree course in 2007 was 81. Whoever enters into any agreement with another medical school on behalf of the Government of Malta has a clear responsibility to safeguard the interests of the University of Malta Medical School. Nothing must be done to compromise the teaching facilities of this school and indeed these assets should be protected by all means possible."

I have no idea whether this extract is authentic or not. Does anyone know ?

[UPDATE : The authenticity of the letter has now been verified. Could the person who contributed the extract also share the rest of the letter with us ?]

MAM has planned an urgent meeting, to discuss the issue.

Is this true ? I have absolutely no further information on this. Can anyone help ?

Build Muscle !

2007-10-09T15:01:00.000+02:00

Anatomists of the -not so distant- past seemed to have a muscle-fetish. They would spend hours describing them to their half-asleep students, and you were certain to find questions regarding origins and insertions in every self-respecting anatomy paper.

Thankfully, as pure anatomy is rapidly being replaced by clinical anatomy in most medical courses, students are required to focus less on the exact attachments and more on the rough position, function and innervation of those annoying little masses of contractile cells.

But there is still a fair bit of information to remember, and I couldn't find a resource that kept things nice and simple. The textbooks had too much useless information, the atlases looked chaotic, and most of the revision books only provide you with a don't-ask-just-memorise table that doesn't really cut it for me.

So Google came to the rescue, and I came across a marvellous creation called the LUMEN Master Muscle List, which has a dedicated drawing for each muscle, in addition to a small table with all the necessary information. This format was exactly what I was looking for, but there were two problems : first, each muscle had its own page, so you didn't really know what group it belonged to, and second, the whole thing was on-line, and I prefer to study from a hard copy.

So I decided to compile the most important muscles (head, neck and limbs) into three print-friendly .pdf files, which were a great help for my revision, and which I am sharing with you here.

What's going on ?

2007-10-03T20:29:00.000+02:00

Despite what the above picture might suggest, this post is not about the author's Gaye (Marvin Gaye, to be more precise) taste in music. It is the result of a short conversation I had yesterday with one of my colleagues :

- Aye, barrani, kif inti ? Orrajt ?
- Mhux hazin ! U inti ? [This was uttered using a most pathetic accent, I must admit.]
- Tajjeb, tajjeb ! Aye, listen, do you know what's going on with the new med school ?
- New med school ? You mean the new facilities, in Mater Dei ?
- No, no... The new one, the irish one !
- Duh ? Irish ? You're sure you're not talking about a pub ?

But he wasn't, and I didn't have the slightest idea what he was talking about... A few hours later, I was back home and decided to Google it...

I found this article, recently published in The Times, which worried me a bit. What worried me even more was that the MAM and the MMSA don't have any information on their websites on this issue, despite the fact that the whole thing is already "in an advanced stage" (according to The Times).

So what's going on ? Should we be worried ? Will this affect the quality of our course ?

Will we have to share Mater Dei with the new medical school ? If so, will we have priority over them ? If they'll be charging their students over 30K US$ per year (very rough estimate, based on what they charge at their Bahrain branch), I bet they will want them to have priority over us...

To facilitate the above, will the new medical school attempt to 'steal' our best lecturers, by offering them the decent salaries that they deserve, and which the state hasn't been able to offer them until now ?

What's going on ?

Please post your comments, and start prodding people to get more information, because this thing looks big and ugly...

Neuroanatomy Notes (...and a fair bit of ranting !)

2007-10-02T19:58:00.001+02:00

Neuroanatomy seems to be by far the most hated subject in the whole MD Intermediate curriculum... The reasons ?

1. The subject is quite extensive and very complicated by its nature.
2. Most good books on the subject are equally extensive and complicated, and very few MDII students can afford to devote a couple of months to the exclusive study of such a book.
3. The suggested book is too short and not particularly clear on far too many topics.
4. The lectures and tutorials are very controversial, and don't seem to contribute much (if at all) to the understanding of the subject.
5. The exam questions are even more controversial, completely ignoring basic information (that is clinically significant to most doctors) for the sake of minor details (that are only useful to the extremely small percentage of the class that will become neurosurgeons).

So what can students do ? Completely ignore the subject ? That's what many students did until last year, when the people at the anatomy department decided to change the exam regulations. The new regulations force students to get a minimum of 35% in each subject tested in the anatomy paper, or else they fail the paper, regardless of their performance in the rest of the subjects.

Of course, what the department should have done instead would have been to look for the reasons behind the students' bad performance in neuroanatomy, and possibly introduce changes to the way it's taught, making it more accessible and more clinically relevant. But they didn't.

So what can students do (I ask again) ? Well... What I did, was to ignore lectures and tutorials and dedicate a reasonable amount of time to study the subject from the best book available (FitzGerald et al.), hoping that I would get the minimum required grade. What I should have also done would be to take a look at some lecture notes, to get a basic grasp of the seemingly pointless details that the lecturer considers important. And I should have also gone through the past papers, because there seems to be a certain degree of repetitiveness in the exam questions.

Good night, and good luck.

Riding The System !

2007-10-01T19:53:00.000+02:00

A few minutes ago, one of the visitors of this blog sent me a question, asking what book I would recommend for the acid/base part of the physiology curriculum.

As you all know, the lectures on acid/base are notoriously incomprehensible, partly due to the inherent difficulty of the subject and partly due to the way the lecturer approaches it. Things are not made better by the equally incomprehensible set of 'notes' which he kindly provides for the... 'benefit of the students'.

So what can a responsible student do to overcome this obstacle ? Read one of the popular physiology textbooks, like Guyton or Ganong ? Nope, the profs says they're no good. Keep lecture notes and try to memorise them ? Nope, the profs says that's no good either. Ask for a four-year leave and move to Great Britain to get an MSc in acid/base physiology ? That might help, but it's hardly a reasonable option, don't you find ?

The real solution is much simpler, my friends : ride the system !!!

Riding the educational system is an ancient art, almost as ancient as educational systems themselves. And, unlike riding a motorbike, it doesn't need any special training and involves no risks for the people that practice it. All you need is some common sense and the realisation of a basic principle : every educational system has weaknesses, and many of them can be exploited by students to make their life easier.

One such weakness is the way the physiology paper is set in our university : eight essay questions, out of which you have to answer five. Of those eight question 'slots', only one can be used for acid/base. So why bother ? Don't study acid/base at all, and you can still afford not to study an additional two physiology topics :-)

"But are we supposed to do that ?", I hear you ask. "Are we going to be good doctors like that ?", I hear you ask.

And I say, RUBBISH ! Being able to write a four-page essay on the Siggaard-Andersen equation will NOT make you a good doctor. It might make you a good physiologist, but it's trivial knowledge for a clinical doctor, which is what most of us want to become. And that is not the opinion of just a humble medical student, but of many people I have discussed this issue with, who happen to be REAL doctors, not lab scientists who have never touched a patient in their lifes.

So feel free to ride the system, and please start being critical about the knowledge you're being spoon-fed with. Because that is what you will need in the clinical years and this is what is going to ultimately make you a good doctor ;-)

"Histology For Retards"

2007-09-28T18:30:00.001+02:00

As promised a few days ago, my histology notes are now available for download !

The first version of those notes was a small 15-page booklet, which I prepared during the last few days before my MDI progress test. It had no drawings and the text was limited to the bare essentials. The name, 'Histology for Retards', originated from a private joke and was meant to emphasize the over-simplified nature of the text.

One year later, while preparing for my MDII final exam, I decided to use that little booklet for revision, but it quickly became evident that it simply wasn't enough. Loads of information was missing, and the plain text didn't really make sense without images. So I borrowed some extra sets of notes and started making additions and corrections to the little booklet. The result was a -comparatively- massive 55-page 'second edition' , which I used to prepare for my exams and which I'm now sharing with you.

I hope you find it useful, and I'm looking forward to receiving your feedback !

ECG Tools

2007-09-28T12:43:00.000+02:00

If you're like me, you probably think that the 'ECG Made Easy' book doesn't make things all too easy...

Thankfully, after a bit of googling I discovered that there are some nice people at a company called SkillStat, who have created an interesting series of flash-based applications that make things a bit easier :-D

Book-o-nomics

2007-09-28T11:11:00.000+02:00

So... After asking around (and hopefully also reading my opinion), you've finally decided which books you want to buy. The question is, where should you buy them ?

Mireva is one of the staples of medical education in Malta and a kind of Alladin's cave for every even-slightly-nerdy medical student. The variety of medical titles offered is excellent and if you're looking for something über-obscure you can order it and they will have it within a month or so.

Agenda (on campus) offers a much smaller variety of books, and also seems to target the students in the intermediate years much more than those in the clinical ones. However, you will probably find most of the faculty-suggested books there, and the book prices are usually a bit lower than in Mireva.

Amazon might have excellent prices compared to UK bookstores, but is extremely expensive compared to the local ones (and that is way before postage costs are added !). Only recommended if you're really desperate for a specific book, and you can't wait a whole month for Mireva to get it for you .

Last, but certainly not least, we have the Internet !!! Sometimes you will find yourselves looking for a very specific piece of information in a book, and it's rather silly to invest Lm20 (or almost €50, as of 1/1/2008 :-P) in a book that you will only use once ! But worry not ! Google is your friend, and it can trawl through zillions of med student forums to discover links to .pdf versions of the book you desire :-)

What is a 'respectable quack' ?

2007-09-26T21:17:00.000+02:00

To answer this question, we shall examine the example of Dr. Walter Freeman. This fine gentleman was a very prominent psychiatrist of the early-to-mid 20th century and a pioneer in the introduction of prefrontal lobotomy as a radical cure for mental disease.

When this procedure was introduced in the '40s it was considered as a panacea, and Dr. Freeman gained incredible popularity, performing the operation almost 3000 times, in an attempt to cure a wide spectrum of conditions ranging from schitzophrenia to sexual disorders. He was a very respectable gentleman. So respectable that even the Kennedy family entrusted him with the health of their daughter, Rosemary, whose alleged mood swings were treated with a lobotomy performed by Dr.Freeman.

Twenty years later, research data had started showing that prefrontal lobotomy wasn't the miracle cure that psychiatrists had believed it to be and the discovery of antipsychotic medicine accelerated the marginalisation of psychosurgery even more. Dr.Freeman, though, continued advocating and performing the procedure, and managed to lose his medical licence in the process. He no longer was respectable.

Fourty years later, lobotomy was outlawed in many US states and was widely considered by the public as one of the most barbaric treatments ever devised. A true shame for medical science. It was now clear that the ex-respectable Dr.Freeman (who had died in 1972) would finally remain in history as a most prominent quack.

The above example is very characteristic of a danger that no doctor (or, in our cases, future doctor) should ignore. We should never have too much faith in ourselves or our knowledge. Medicine is changing every day, new cures are discovered and old cures are rendered obsolete. We must be aware of this fact and constantly be on the lookout for signs that some of our miracle cures might not be so miraculous after all.

This is what 'respectable quack' means. A person who is a highly regarded professional, but still remains fully aware that his knowledge is both limited and mostly empirical, acting accordingly.

Books bloody books !!!

2007-09-26T20:54:00.000+02:00

OK, a new academic year is starting and everyone is panicking about what textbook to choose... So allow me to give the intermediate MD students some advice :

First of all, every person is different and therefore has a different way of learning.

There are people who can learn endless pages by heart, and reproduce them perfectly without really understanding what the hell they're talking about. Those people can do really well in medicine (at least, the pre-clinical years), and there are some excellent books out there that they can use for memorisation.

I, on the other hand, belong to a less fortunate group of people who can't memorise for love or money, and always have to find a way to work things out, starting from the minimal amount of information that their little brain is able to hold. And this group of people always seeks a specific type of book : those that do away with endless text and use loads of pictures, diagrams and tables to help you understand what's going on.

The books I would suggest to the second group would be the following :

Anatomy Textbooks :

Moore's Clinically Oriented Anatomy : a marvellous book, with well-written text, loads of clinical correlations and a large number of high-quality images, diagrams and tables. Its negative points are the large amount of small, insignificant details it contains (which can be overwhelming) and the fact that it only makes sense if you read a whole chapter at a time, from beginning to end. Therefore it's a book that requires time, and can't really be used for revision. But I still consider it the ultimate anatomy textbook that is currently available, and did use it for my study.

Gray's Anatomy For Students : A very well thought-out book, that has excellent images and tables, but does away with the insignificant details of Moore's. Sometimes it seems too simplistic, but it has been proven to be more than enough for our exams, and really makes your life easier compared to Moore's. If I had to start the course over again, it would certainly be my choice.

Anatomy Atlases :

Both Rohen's and McMinn's photographic atlases are great. The latter looks a bit more contemporary, but I would be happy to use any of the two (or both !). Photographic atlases are be much better than drawn ones for spotting test preparation, because it is done on real specimens, where the arteries aren't red, the veins aren't blue and the nerves are anything but yellow.

Sobotta's and Netter's are the two great drawn atlases, which aren't very useful in the dissection lab but offer great help when the textbook's illustrations aren't clear enough. Small differences exist between them, and they're both on the expensive side (especially Sobotta), but they're worth it.

Imaging Atlas of Human Anatomy : A book that is essential for the imaging part of the spot test, and which can also give you an excellent 3D perspective of the anatomical relations in the trunk, which are otherwise quite hard to understand.

Revision Books :

Instant Anatomy : I don't know of anyone who doesn't have this book, and this says something. It doesn't make too much sense at the beginning of the year, but when you reach May it proves to be an indispensable revision tool.

Anatomy At A Glance : The whole of anatomy, crammed into 170 pages, half of which are pictures ? Including clinical correlations ? This book is useless as a main textbook but a great last-minute read that can make the difference between passing and failing.

MCQs In Anatomy (Lumley et al.) : I won't lie to you, saying that this book is good. In fact, I would normally not even touch it with a bargepole. You see, most of the questions in this book require you to know a ridiculous amount of completely pointless anatomical detail, which is completely useless for a medical student. BUT (and every sentence starting with a 'but' means trouble is on the way), one of the anatomy lecturers seems to be in love with it, and all the head and neck MCQs in the MDII final exam are usually taken straight from this book. So do get it, and make sure that you learn all the stupid details about the various insignificant foramina of the palate...

[MDII] Neuroanatomy :

Fitzgerald's Clinical Neuroanatomy And Neuroscience : Huge book, with abundant useless detail, but it seems to make loads more sense than the textbook recommended by the lecturer. Use at your own risk, though, because neuroanatomy exam questions seem to be completely unrelated to both the book and the lectures... [UPDATE : More information and a set of notes are here !]

Histology :

Ignore the textbooks and try to get your hands on a set of lecture notes. I will try and publish my notes on this blog in the near future. [UPDATE : The notes are here !]

Embryology and Cell Biology :

Ignore the textbooks and use Prof.Cuschieri's lecture notes, which can be found on his website.

Physiology Textbooks :

Pocock and Richards' Human Physiology : Short, simple and comprehensive. Far easier than Ganong's and far shorter than Guyton's, without lacking in content.

Master Medicine Physiology : This book was recommended to me by a colleague and I found it ideal for the study of cardiorespiratory physiology, which seems to be quite long even in Pocock's.

Use the lecturer's notes for endocrine physiology, they're short, simple and comprehensive.

Ignore the Israels' Hematology book that is recommended by the hematology lecturer, because it's far too detailed and sometimes incomprehensible. Pocock covers the topic very well.

Biochemistry Textbooks :

Lippincott's : Probably the simplest biochemistry book available that we can use.

Avoid Stryer's at all costs, I know far too many people that bought it and never opened it.

Also use the lecture notes provided by Prof. G. Hunter and Dr. T. Hunter. They're quite short and the exam questions are always out of them.

[MDII] Genetics :

Most of the material covered in the lectures isn't available in medical genetics textbooks. Thankfully, lecture notes are provided and they're reasonably short and quite easily comprehensible.

[MDII] Neuroscience :

Neuroscience (Purves et al.) : Excellent book but extremely long and detailed for the purposes of our course.

The notes provided by one of the two lecturers are even longer and even more detailed (and not particularly well-written). Ignore them, for the sake of your sanity.

Get your hands on past papers, and study very selectively from Purves.

[MDII] Pathology and Microbiology :

Ignore the books and use the lecture notes.

Make sure you get your hands on some past papers, because they are essential.

[MDII] Pharmacology :

Again, ignore the books and use lecture notes.

Past papers are easily available and should help you organise your study.