“My tutor is refusing to predict me the grades I need to apply for medical school!”

It’s almost always too late by the time this question comes up.

I usually hear from desperate would-be applicants who now find their plans ruined. They are terrified of the prospect of taking a year out or changing their career plans because some teacher apparently knows that they won’t be getting an A grade next year and is prepared to put that down in writing.

Now, whilst it seems pretty audacious for a teacher to be able to predict a grade so far in advance, these teachers often have a pretty good track record and are therefore unlikely to change their mind once they’ve decided.

In this article we’re going to show you how best to influence your predicted grade to your advantage, what to avoid at all costs and what to do if you fail to get your desired predictions.

There are two main reasons you aren’t getting the A-level predictions you need.

One is that you have failed to convince your teacher that you are worthy of the grade. The other is that some event has caused your performance to suffer and cause your teacher to suddenly have real doubts about your ability to perform under pressure.

The following 6 steps will ensure that you are as effective as possible in trying to get the right predictions for your application to read medicine.

1. Plan to get the right predictions early

You need to convince your tutors that you are A grade material from the very first day that you sit in one of their lessons.

This means that you should answer questions during lessons and ask enough intelligent questions of your own to make it clear that you’re here to gain a good understanding of the subject.

The best way to do this is to spend ten minutes having a quick read of the next lesson beforehand. Ten minutes is really all you need to gain that extra edge during the lesson.

2. Let your teachers know your plans

You need to let your teachers know as soon as possible that you’re planning on a medical school application and will be aiming for an A grade in every module.

That may seem like your exposing yourself too early but it lets the teacher know you’re serious and should also convince you take things seriously from day 1.

Your teacher can then let you know if you’re not on track in a certain area, and furthermore you have a free license to ask about how to deal with difficult topics without dropping any marks.

By the time it comes to predictions you should already have done enough to easily get an A grade predicted.

If there are one or two modules exams that go badly and you’re suddenly off your target, you still have some negotiating room with the teacher who will be more likely to believe that your poor exam performance was an unlucky blip than a lack of ability.

3. Speak to your teachers as soon as possible after any poor performance

If it’s a key module result that will influence your A2 prediction, have an explanation ready for your poor performance. If you had a family problem for example, le your teachers know as soon as you can. Don’t wait for the B or C prediction before trying to explain things.

4. Negotiate

If after all of the above you end up with a prediction that is too low, you need to think carefully. If it really means that you’re not good enough for that A grade perhaps you ought to stop fighting the system and plan on alternative routes into medical school.

However, if you’re convinced you can get an A, now is the time to negotiate.

Did you have any reasons for your poor performance in any particular exam? A family bereavement?

Have you recently improved your revision method and are getting better results?

Are you planning on getting some extra tuition in  areas of weakness?

Are you planning on retaking any modules and have a revision plan set out already?

These are all excellent negotiating points and can get your prediction pushed up a grade. Just make sure you have your plan set out clearly BEFORE you meet the teacher.

5. Do not rely on your parents to do the talking

There is nothing more annoying for a teacher than to have the quietest student who has just earned a C grade prediction to suddenly bring is his pushy parents who think they can pressure the teacher into upping a prediction so little Johnny can apply for medicine.

If you haven’t followed rules 1 to 4 above, suddenly bringing in your parents will not help and might make things worse.

On the other hand if there are genuinely extenuating family circumstances and you have already discussed these with your tutors, perhaps your parents can come in and clarify things and show that you have some good family support behind you. That can be very helpful indeed. As I hope you can see, it’s all in the tactics.

6. Don’t push your teachers too hard

If you still can’t get that A or B prediction, my advice is simple. Don’t apply yet.

Work hard, make sure you get the grades and apply next year. Keep your teachers on your side as you need them to help you get the best grades possible. If you turn things nasty now over a poor predicted grade, you may not get all the help you need from your teachers.

Remember that teachers are human too and the last thing you want is an angry chemistry teacher out to prove that he was right all along when he said you would get a C at best.

Leo

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With the recent grade slips landing into people’s hands, it’s been a busy time at www.doceatdoc.com.

We’ve been giving specific advice to students over email, twitter and facebook.

One common theme question is from people who have got their eyes set on a medical application for next year and are looking at their lower than expected AS grades and wondering whether things are salvageable or whether they should give up.

Please advise. My AS results were not quite as good as expected. Should I apply for medicine anyway in the hope that my A2 results will be better? Or take a year out?

The answer depends on two main questions.

1. Are you confident that you can convert B, C or D grades into A’s in less than a year?
2. Will your school or college predict the grades you need for A2 to allow the medical schools to look at your application seriously?

The first thing that you ought to realise is that in the good old days the only thing that a university had to assess your potential for medical school was your predicted grades. Schools were, and still are pretty good at getting accurate predictions and the universities will still look at these closely when deciding whether or not to give you an interview or offer you a place.

It was well recognized that students would not have achieved their full potential by the time it came to predicting these grades. Therefore a student who might get a grade B or C in August of year 1 would quite likely improve over the next few months and perhaps therefore be heading for a high B or A grade by the time they end up sitting the final A-level exam.

Although this is more difficult to do with a poor AS grade that has eaten up a chunk of the potential marks available to you, your school and college will be aware that your motivation and exam technique will improve over the next few months. You may also have to resit some modules in to make up some marks. With all this in mind, your school / college may well give you the predicted grades that allow you to send off the medical school application this year.

In the eyes of the universities, the predicted grades will count, even if your actual AS level grades are lower.

If your teachers think you’ve been a less than convincing pre-medical student so far, you may need some help in convincing them. (We have some tips for you in an upcoming article on how to do this.)

So with less than ideal AS grades in your hand your first task is to make sure you can get some appropriate predictions.

But I’m seriously worried that I’m now way off target for the A-level grades I need…

Well in that case you need to think carefully about your next step.

You have the following four options:

1. DO NOT APPLY FOR MEDICINE THIS YEAR. Work hard and see what grades you get. You will have to take a year out and apply next year. You may have to retake some modules but you can also do some other relevant stuff in your year out that can help you to strengthen your application.  We have a strategy that can help you.

2. Apply to medical school if you can somehow get the required predictions and think the application proves might motivate you to get the grades.

3. Choose a different degree that is more suited to your grades. You can consider medicine after a year out in the event that you get some surprisingly good grades, or apply for medicine as a graduate in a few years.

4. Consider an overseas medical school application if all of the above seem unpalatable.

That should cover every option and make the path ahead pretty clear!

Leo

If you’ve read this far, please I’d be grateful if you could give this article a Facebook Like or a Tweet by clicking on the icons at the bottom.  This is just the sort of advice from a hard won lesson that someone will thank you for. 

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GAMSAT is basically designed to narrow down graduate applicants for medical school. It does this rather ruthlessly but serves medical schools well, in reducing the applicants they must consider for a place.

The most discerning part of the test is probably the essay question. There are a few reasons why this is deemed difficult by most graduates.

1. Many graduates today, particularly those from a science background, have little experience in essay writing.
2. Many graduates are not as well read as they would like to be and so lack confidence in writing about current issues with confidence.
3. For the not so well read, trying to get the required level of knowledge over such a wide range of topics could take over a year of careful reading of selected books and articles. (see last section of this article)

Key points for your GAMSAT essay strategy

1.Your essay is an argument

This is obvious to seasoned essay writers, but actually a key point that never quite gets explained properly to the rest of us.

Any essay has to have a central point of view that its writer is seeking to convince the reader about. Each point made in the essay will contribute to the formation of an often multi-faceted argument.

As an essay writer you can and should include arguments made by ‘the other side’ that you disagree with and then explain why you think they are invalid or at least why they fail to disprove your central argument.

The conclusion should tie the argument together and give a final parting shot for your side.

Click here for a good example.

Don’t worry about the over-reliance on figures and data but do get an idea of the  way the argument builds up sentence by sentence, paragraph by paragraph.

Key point: His point of view is so clear to the reader that you can literally scan the article and miss some points and pick up on others and regardless of this, the central thrust of the argument is always clear.

2. Writing the essay plan should take longer than writing the essay.

This is controversial, but it is something I was told at an early age and it has always served me well.

The steps to writing a plan are as follows:

1. Decide on the overall thrust of your argument. (Hackers tip: If your knowledge in this area is really sketchy and you’re in a tight corner come back to this step once you have listed your points and can defend at least ONE viewpoint adequately)
2. Use a whole sheet and place rough headings for
   Introduction,
   Main argument,
   Counter arguments
   Conclusion
   
3. As quickly as you can, add points to each section in whichever order they come to your into head. If the conclusion is clear, get that down first. Personally, I often put my main argument and counter arguments down first. Scribble them down. Hurry up.
4. Number the points in the order you want them to appear in the essay. This is unlikely to be the order in which you’ve written them down. They should flow easily from one point to the next, making the essay easy to read and the argument easy to grasp. Remember, your examiner will probably not read every word but skim. The better it flows, the quicker that lazy, cheating, skim reading examiner, can score you well and move on to the next paper!
5. Write the essay. Twenty minutes of planning followed by 10 minutes of writing takes guts but is the an ideal formula. (Ammend this if you feel it doesn’t work for you. It does take nerves of steel in an exam setting) This ensures your plan is perfectly tuned and all your points are clear. Writing the essay should simply be a case of transferring your plan into a neater form with all the points in the correct order.

3. Keep it simple

Keep your argument simple and easy to understand. Use lots of simple individual points for your argument rather than a convoluted or complex point that requires careful reading to digest. This is easy for most science graduates, but if you’ve spent your undergrad years writing sophisticated essays for politics or English literature, now is the time to dumb things down. Ask yourself, will this essay score lots of points in quick succession, or will it be better appreciated by an academic with a keen interest in this area?

You definitely want the quick, successive point scoring style for your  GAMSAT essay.

4. Sound like an authority

• Make your points concisely and confidently to sound like you know what you’re talking about.
• Use correct grammar, spelling and style.
• Use correct terminology including technical terms.
• Quote statistics, surveys, and other forms of ‘evidence’ to back up your points wherever possible. (Although fabricated surveys showing X or Y to be true are not easily verifiable by your examiner, they can cause you to lose badly if you get found out. You simply don’t need to do this for GAMSAT – yes, you know who you are!)
• Sound like you actually care a lot about the topic. Again this will lend credibility to your argument.
• Use up to date examples from the mainstream media (ie broadsheet newspapers). In this day and age you are considered well read if you read a newspaper regularly. (If you think this is ridiculous, I agree.)

These are all techniques used by most modern day journalists, almost all of whom are not specialists (or even knowledgeable) in any area at all.

5. So how can I think of good points to make when my brain is actually empty!

If you have more than six months before you sit the GAMSAT, it is definitely worth having some sort of reading regime that will help you feel confident constructing arguments that are pitched at the correct level for the GAMSAT essay.  Ideally you also want to read things that will make you sound well rounded and intelligent at your future interview and kill two birds with one reading regime. You might have been told that there are no shortcuts to this but in fact there are:

1. Read a newspaper every day. If you want to follow my advice, this means a quick look through the guardian headlines each day (currently free online), skimming through any useful news and reading through the editorials and the opinion pieces a little more carefully. This chap writes about anything well and will save you much thinking. Have a quick look through the reader comments below each article too for any useful points. I’ve found that over 90% of GAMSAT essay questions can be dealt with perfectly with just the material available on the Guardian comment is free section of the website. What could be easier?
2. For those with more time, read the latest key texts on various current topics.For a complete critique on the media, this cannot be bettered.
1. For a lowdown on ethics in current political life try this.
2. Book reviews in the LRB are an amazing way to digest the key arguments contained in a book without going to the trouble of reading the whole book. The essays are always written by experts in the field. They are often good material for interview practice too. Not all are free, but subscription isn’t too expensive and you get a paper copy posted to you each fortnight. I would particularly recommend David Runcimans pieces.
3. For other sources of free, online, high quality writing on current affairs, try the following:
   a) Arts and letters
   b) The New yorker
   c) The Huffington Post
   d) Spiked online -plenty of simple arguments to emulate

6. Finally,

Do not overestimate the competition. If you do the simple things mentioned above, you will kill off the competition with ease. Most people read advice but never act on it. Do a little reading each day, do a few practice questions (not too many) just to get the timing and technique right, and then concentrate on other areas of the GAMSAT and your med school application.

Best of luck!

Leo

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Now before we divulge our very valuable insider tips about cracking the Oxbridge interview (currently being prepared) there is an important question to consider. Should you even be applying for Medicine at Oxford or Cambridge? Read the following carefully because I really do think the emperor has no clothes. I need your thoughts and comments.

Here’s a question I received recently on our private mailing list:

• “I need some help. I’m thinking of applying to Oxford or Cambridge for medicine next year. My teachers tell me I have a strong application but is it going to be worth the extra effort? What do Oxford and Cambridge offer that other medical schools do not?”

A very perceptive question by a clearly above average student. A potential Oxbridge student.

Obviously, just because you have the grades to do something doesn’t automatically make that the right decision.

Oxford and Cambridge routinely get excellent teaching scores across all courses, not just medicine. Their degrees are highly regarded both in the UK and internationally.

So does that mean that if you’re a top student and want to be a doctor you should automatically be applying to Oxford and Cambridge?
No.

You need to think carefully before following the crowds of knee jerk, trigger happy A-grade students who shoot off an Oxbridge medicine application as soon as they possibly can.

Firstly, what do I know about this?
I have taught medical students at these universities and at other medical schools. I have also taught junior doctors both from Oxbridge and elsewhere.

So here are some pretty uncontroversial facts from my experience about Oxford and Cambridge medics:

Oxbridge medical students do not make better doctors.
Medical schools in general select the brightest students. Oxford and Cambridge students are not easy to differentiate from other students once they become junior doctors. Some are good doctors whilst others are bad. Some are disillusioned with medicine, others are keen and enthused. Junior doctors are a pretty homogenous bunch overall.

Oxbridge medical students have less free time per week than students from any other UK medical school.
At Oxford or Cambridge you will be writing more essays in one year than your non-Oxbridge colleagues will write during the whole 5 or 6 years of their medical undergraduate training. Does assignment writing make you a better doctor? The evidence is unclear but plenty of people have strong thoughts about it. Does doing more assignments help you better retain information? Quite possibly, yes.

Oxbridge medical students learn things in a lot more detail.
This is true particularly at pre-clinical level.
Once you hit the wards in year 3, clinical training doesn’t differ hugely across medical schools. It is much more dependent on the individual clinicians and their enthusiasm for teaching (which is highly variable). Plenty of Oxbridge students leave for London or other big cities for their clinical training anyway. The big differences are therefore at the pre-clinical level. There is no doubt that teaching in anatomy, physiology and other basic sciences is more in-depth and better taught at Oxbridge than almost anywhere else.

The overdependence on PBL (problem based learning) seen at certain other institutions (resulting in many saved pounds and many frustrated students) does not exist at Oxbridge.

Does this better medical science teaching help after graduating? In my experience most junior doctors applying for postgraduate exams still need to revise their anatomy and physiology all over again regardless of how good their teaching was. Most of us are pretty forgetful.
It is therefore difficult to say how much benefit is conferred by the undoubtedly high quality Oxbridge teaching standard, in what remains a vocational degree course with a practical career at the end of it.

Oxbridge Medical students have harder end of year exams
It’s difficult to compare such things directly but I have in my hand some year 1 anatomy papers from Cambridge and from some other medical schools and to get a decent mark in the Cambridge paper you simply have to work harder and longer. Enough said.

But I thought Oxford and Cambridge were the best Universities in the world?
Yes, but pay some regard to the course you intend to study. If you’re studying a truly academic course like biology, physics, English or PPE there is no university that will offer better teaching and better employment and earning prospects when you graduate.

However, medicine is a vocational course and is simply training you to be an FY1 doctor at the end of 6 years. You are pretty much guaranteed a job upon graduation.
Contrary to what some might tell you, most of your clinical training will actually take place in the first few years after graduation when you will be allowed to prescribe drugs, make clinical decisions, organise investigations, treat sick patients, and learn how to perform basic surgical procedures. This is on the job training and has always been an integral part of a medical career.

This is why I believe that the benefits of the Oxbridge system are a little wasted on medical students. Very few of these overworked, essay writing, sleep deprived medics will follow a truly academic career.

Medicine as a vocation on the other hand, is all about learning quickly, devising shortcuts around problems, rules of thumb, pattern recognition and presenting oneself to patients and colleagues by way of a highly standardised and widely accepted protocol. This is the very antithesis of the traditional Oxbridge academic who is taught to inquire perceptively, reflect deeply and (it must be hoped) write frequently.

What about career prospects in competitive specialities?
Current selection for the most competitive (ie surgical) specialities such as cardiothoracics, orthopaedics and plastics are on a points based system. There is currently a point for getting an honours degree and for getting prizes at undergraduate level. Most of the points are for interview performance, publications, courses and references. It is essentially a free for all once you graduate. Whilst an Oxbridge degree won’t hold you back, it is not clear that all that extra work as a student counts for very much in the postgraduate medical world.

So why apply to medicine at Oxbridge?

The following would be good reasons to apply:

• You are intent on an academic career after graduation
• You are intent on applying internationally
• You want to do a medical science degree and then consider non-medical career options as well as clinical medicine.
• You live in Oxford or Cambridge and will save money on living expenses.
• You want the prestige of an Oxford or Cambridge degree and want to be a doctor.
• You have visited Oxford or Cambridge and have fallen for the beauty and charm of either place and now MUST go there. (A common problem!)

In summary
If you want to go to Oxford and Cambridge and have got an excellent CV and the required grades, my advice would be to avoid medicine and do a proper academic course in a subject that interests you. It will be fulfilling, inspiring and cultivating. You can always come back to medicine as graduate and shouldn’t have a problem getting in.

If you’re pretty set on becoming a doctor however, remember that medicine at its very root is about memorising a whole load of facts as quickly as possible. There is not much of the nuance and subtlety of English literature and little of the hard scientific rigour of physics. Getting through a degree in medicine is difficult enough. Go somewhere that allows you to do that with the least amount of fuss and the minimum amount of back breaking hard work.

Leo

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Passing AS and A2 is not enough. For a guaranteed place to read medicine you must:

• KILL your A-levels 
• without dropping a single grade 
• at the first sitting

These exams are the single most important hurdle between you and a place at medical school. Any other shortcomings can be can be fixed relatively quickly and easily, but a single dropped grade at A-level can simply end your application in an instant.

I see the odd last minute work experience student these days trying to spin a good story after a couple of hours following a junior doctor around. Invariably that person has grade A  A-levels in his or her pocket, and is trying to ‘fit in’ the other aspects of his application where possible. Very wise.

A-level retakes are even more critical, as dropping a grade at a second sitting means you’ll be even more likely to be pushed aside in favour of somebody else.
You may rightly worry about work experience, personal statements and all those “extra-curricular” activities needed for a respectable application to medical school, but without the right grades it is pretty much impossible to get in.

My strategy does not actually involve cheating, but it may as well, so seldom is it used by students, despite it’s excellent success rate.

Anyway, let’s get to the theory behind my strategy.

Firstly you need to understand how an exam paper gets written. The most important point to stress is that it is incredibly difficult to write a good exam question for any subject. Most questions will fail the vetting process which is very stringent. I’ve written exam questions for trainee surgeons sitting the MRCS and out of every ten questions I wrote, only one passed the stringent requirements for a standardised examination.

So examiners are forced to depend on recycled old questions that have passed the test of time with some minor alterations. Completely new questions are rare and in some subjects are actually NEVER seen.

You’re probably thinking that if the above is true, why are exams seen as difficult, and why do people still fail?

The answer is that the vast majority of people sitting the exam have no insight at all into how an exam is put together.
When grades are so criticial, this amounts to immense carelessness. Don’t you agree?

The strategy

When I studied for A-level chemistry, biology and physics, my revision strategy was as follows. It can be applied with minor modifications to any subject.

1. Understand the syllabus. Most people get this far without any trouble.

2. Order every past paper possible. I was lucky enugh to find every UK A-level chemistry paper going back to 1976. You can ask senior students, search E-bay and various online collections for papers. Start early.

3. Order mark schemes for as many papers as possible. These are available directly from the exam boards, for the more recent papers.

4. Stop reading any revision material once you are confident with the concepts involved. Stop re-reading definitions, stop re-doing calculations, stop looking through your textbook.

5. Start going through one old paper at a time. Start with the oldest. Try and answer the definitions and calculations without referring to any reference material. On the really old papers, skip over any questions that are no longer on the syllabus. Be grateful that your exam will be much easier than the 1985 paper.

6. Mark your paper yourself using mark schemes where available. Make a list of your errors. If you’re anything like me, you’ll have some of the definitions slightly wrong causing you to drop a mark here or there. Perhaps some calculation errors may creep in too. Are you dropping marks for simple things like forgetting to include units?

7. Kick yourself for any silly errors and look over any missing knowledge areas.

8. Repeat the process for each paper you have in your posession until you get to last years paper.  You will notice that you can score pretty near 100% on all of the more recent papers. If you’re still making silly mistakes, kick yourself and go back to step 5.

9. Sit back and wait for exam day.

10. Shamelessly crush the pathetic, infantile excuse for a paper that passes for the modern A-level.

11. Check through your answers twice amd then leave the exam hall. A grade A should be pretty easy to achieve by now, what you want to know is how many marks short of 100% are you and why?
I used this strategy myself. I initially tried it during the mock exams that we used to have and it worked so well I got some suspicious looks from my teachers. I was not quite scoring 100% though so had to repeat the process before the actual exam, with more attention to detail.

A slight problem you may encounter

Some people have a weak spot when it comes to calculations for Physics and Chemistry A-levels!
It is probably not your fault. GCSEs leave you totally unprepared for real study and the teaching in this area is terrible!  I struggled too, until I took things into my own hands and went through the Calculations for A-level Chemistry and Calculations for A-level physics books. They make the whole thing quick and easy and once through you can easily handle anything the real exam throws at you. For A-level chemistry this calculation book has some incredible recommendations and sounds awesome, but I  haven’t personally used it. My advice is to buy them early and use them throughout each module.

(These books should be part of step 1 of the strategy, unless you are a calculation legend.)
Remember that the competition is not as good as you think it is. Across the nation (the UK) there will be people who have only just learned to read and will bring the grade boundaries down quite a bit.

Final word

Most medical school applicants just follow the crowd and rely on luck. They think their above average intelligence will see them through. Some of these are people you will be leaving behind on your way to medical school. The real competition begins when you’re competing for that elusive cardiothoraic surgery fellowship. But that’s a few years down the line yet.

Good luck!

Leo

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I was desperate to study medicine but hadn’t considered whether I too might be unsuitable because of similar fears.

During my work experience, aged 16, I had seen a huge facial tumour excision with a pedicled flap reconstruction. I remember having to sit down after feeling a little dizzy. Needles and other equipment associated with pain also made me a little uncomfortable. The desire to become a doctor was stronger then these concerns and I put them to one side hoping I’d get over them in time.

My friend ended up applying for a different course altogether and I’ve since lost touch with her but it seems obvious that there must be individuals in a similar position to my friend and I, and who worry about being too squeamish for a medical career.

In my experience this is, in most cases at least, an irrelevant concern.

Speaking for myself I found that I was indeed a little disturbed by certain horrible things in the early years at medical school. When I looked around me, many others were too.

On our very first day at medical school, the trauma team decided to lecture us on the most spectacular injuries they’d treated that year. It was supposed to be entertaining and informative. Once the close up photographs of facially injured patients with teeth sticking out of strange places began to appear, two students fainted and a few others had to leave the room.
All continued with the course and graduated five years later and one of them is today a successful general surgeon.

As time went on I became immune to all manner of seemingly squeamish sights and built up my resistance to almost anything over the years. I say almost anything, as there are still certain horrifying situations for me, listed later.

For anyone actually worried about this issue, the following is important:
Every single student that ever embarked on a medical career has felt horrified or faint on occasion. This is entirely normal even if many won’t admit it. If you are someone who can stand through a lengthy, painful or bloody procedure on day one at medical school (not that you’d ever be expected to), you’re probably not normal and you are probably unsuited to being a good doctor.
So now, to the main point of this argument. I think that the main difference between students is that whilst most manage to avoid making a fool of themselves, a few cannot help but faint publicly whenever the opportunity to do so presents itself.

I therefore gathered the following anti-fainting tips from various doctors across different specialities. They should help the novice avoid the major embarassment of fainting in front of a hundred fellow students in a lecture room, or collapsing mid-seizure into an open abdomen in theatre.

1. Maintain adequate fluid balance
As a medical student and as a junior doctor, you will be busy and you will neglect your own needs sometimes. If you are dry, you are more likely to drop your blood pressure and feel faint. Keep well hydrated. Your urine should be light in colour and high in volume. In summary, keep peeing and stay vertical.

2. Look after your blood glucose levels.
Thinking of missing breakfast before the weekly consultant ward round? You’ll have only yourself to blame if you later feel dizzy and sweaty when the ward round gets particularly smelly.

3. Increase venous return
This is a common technique, taught to me by one of my senior students during junior surgery attachment. The idea is to push blood out of reserve areas whilst standing, which means tensing your calves, thighs and buttocks (in that order). An alternative way of achieving the same thing is to rock a few degrees forwards and backwards on the balls of your feet. This is effective and very discrete.

4. Escape, avoid, run away.
There are times when the best way to remain standing is to look away from the offending scene, avoid a certain situation or failing that, to politely leave and sit down somewhere out of sight of your colleagues.

In summary, don’t worry if you are affected by this initially or are concerned that you might be. You will eventually grow out of it with increased exposure.

My own initial discomfort at the sight of blood or pain had disappeared by the time I was a fourth year medical student. There are however a few ugly things that can still upset me on a bad day:

1. Bad feet
You will at some point see very badly looked after feet. If concerned, try to avoid becoming too involved with diabetes or vascular surgery as I have.

2.Infected ulcers
As above.

3.Toenail removal
Long bloody operations where the patient exits theatre in a body bag are not the most fulfilling events but cannot, in my book at least, be compared to the removal of an infected, ingrowing toenail. Somehow watching one is worse than doing one.

4. Patients screaming in pain
Severe pain should not really be witnessed in hospital, as modern analgesic methods are sophisticated enough for most eventualities. Of course obstetrics is the obvious exception here, but I’m sure they too will exit the dark ages if and when a medical degree becomes a prerequisite for midwifery.

Sorry.

What makes him so appealing to us doctors is his posession of talents that most medics secretly wish we had. Namely, his intellectual ability and knowledge combined with a flagrant disregard for hospital protocols and policies.

If you’re about to start medical school and harbour hopes of becoming an all knowing, all seeing, rule flouting medical genius think again.

Firstly, as a doctor entering a modern healthcare system you’ll find that the autonomy enjoyed by fictional medics simply doesn’t exist in reality. Todays real doctors have rules and protocols that govern just about every aspect of medical practice. Usually this makes good medical sense. For example the requirement to wash hands between patients, or to perform a rectal examination in suspected cauda equina syndrome.

More and more however, we have dubious regulations imposed upon us by people that have no idea about the way doctors work or the scientific basis for anything.

At one hospital I worked at, the x-ray department imposed a rule that the patients name must be written  twice on each form to prevent any repeat of an earlier error where the wrong patient was x-rayed uneccesarily. Although errors still ocurr on occasion, the rule is an immovable landmark that will scar every doctor that has worked there, and had requests for urgent x-rays repeatedly refused.

Another example is the decision over whether to wash hands, which is no longer left to an individual doctors discretion. I have personally been reprimanded by plain clothed undercover hygeine inspectors for not washing my hands after speaking to a patients relatives touching nothing but my own nose.

An old consultant general surgeon with decades of experience was told that he could not even see his patient from the end of the bed without first rolling up his sleeves and removing his wristwatch. His refusal to comply with such a baseless demand meant that a clinical incident was recorded against him by one of the nurses and he later found himself explaining himself to the chief executive of the hospital. He has now learned his lesson and has invested in some sleeveless shirts.

Any doctor who thinks too hard or questions the evidence behind these ever changing protocols will find that even their senior colleagues won’t back them for too long.

And this is what distinguishes the world of work from medical school. In the workplace the curious mind is seen as potentially dangerous. You must join the cult and accept the doctrine. Everybody that works in a hospital “knows” that MRSA is spread primarily by shirt sleeves and wristwatches. There is of course no evidence for this but no matter: the doctors who supposedly worry about evidence based practice are no longer in charge.

Ok, so not only is flouting rules out. Following many alternating and often meaningless rules is in.

So what about the other long held hope of the medical student?

You mean that of exercising ones intellectual muscle each working day? Well, if you’re hoping that after five years of med school you might possess the mental abilities and in depth pan-specialty knowledge of the likes of Gregory House, you can forget about that now.

On your first day in hospital medicine you will find yourself swamped with the sheer amount that there is to learn. The only relief is the realisation that as you ascend the ranks of seniority, your field of interest will get narrower and anything outside your immediate field will be referred to someone else with more experience. This happens at the most senior levels and the few doctors of yester-year that are lingering around with their years of wide and varied experience, find that involving colleagues from other specialties with specific expertise early on in patient care is mandatory, if only for the medico-legal protection this offers.

In summary the best you can hope for is depth of knowledge and experience, but in a narrow and ever narrowing field.  There is simply too much to know and too much at risk to begin offering opinions outside ones own focused area.

What about general practice then?

Well, this is seen perhaps by many as the last true retreat of the generalist with expertise across many areas. The modern GP however, is as much a specialist as anyone else. It’s more difficult to define the specialty, but perhaps it lies in managing vast numbers of chronic and non-serious conditions whilst keeping an eye open for the serious but rare and easily missed. A difficult job at the best of times, but with clearly defined boundaries and protocols.

So, if your attraction to a career in medicine lies in your admiration of medics in drama, that’s fine. Just make sure you appreciate the unglamorous reality too.

Some of the best medical students when I was at university were overseas students. They were mainly from China and Malaysia but also from the Middle East, Europe and Africa. These were individuals who had worked harder than me to win their place at med school. No doubt they have all have become good doctors.

Some of them have stayed in the UK, but plenty have returned to their home countries. One or two have found attractive opportunities in the Gulf, Australia and the US. Every one of them that I personally know are doing very well in their careers. A UK MBChB degree goes a long way almost anywhere in the world.

If you’re an overseas student, the chances are that you’ll be a great asset to any UK medical school. Overseas students offer a reliable bank of good exam results and almost never drop out.

So it isn’t surprising that medical schools like overseas students, and would prefer to fill their classes with as many as possible.

As an overseas student you are also likely to pay much more in tuition fees than a home student and this is a further reason why medical schools might be fighting for you to accept a place. You may be aware that universities have a quota to fill with overseas students.

However, as an individual student it may not feel that you are in such demand. In fact it will probably feel like an uphill struggle. More recently there has been increasing interest by overseas candidates and competition for places has increased.

Compared to UK students, overseas students are given very limited guidance about the application process and have poorer interview and presentation skills.

In addition they are competing with ever increasing numbers of students from a vast number of countries, many of whom are good candidates.

Here are the top reasons why you might get rejected as an overseas applicant and what you can do about them.

1. Poor English
Even with the best background education in English, the demands of writing a perfect personal statement or the pressure of performing under interview can make you suddenly look like a complete tourist.
The only solution is to practice speaking under pressure. That means mock interviews wth someone who is prepared to criticise every grammatical and pronounciation error.

2. Poor knowledge about medical training in the UK
I remember interviewing a young girl from Zimbabwe who was an excellent candididate in almost all regards but the panel (including me) reluctantly rejected her. The reason? She lacked awareness about postgraduate exams for GP training and didn’t know about the length of training. The relevant information is widely available. Make sure you’re familiar with it.

3. Sartorial incongruity (!)
Candidates from mainland China are often guilty of this but so are plenty of others. It’s not your fault. You wear the standard formal wear of your city or country which is probably a suit of some description. However one small error in colour, cut or style can make you look like an incongruous loser, or worse still, like you’re using the interview to make some sort of fashion statement.
My advice? Dress like the people you are going to impress, not like they do in the country you’re leaving. Look like you fit in and they are more likely to believe you.
Read the upcoming article on how to dress and be very, very careful.

4. Style failure in your personal statement
I’ve read some personal statements from brilliant students who have lost everything because they couldn’t get the style right. Medical schools expect too much and are not forgiving because they have so many good candidates to choose from. Make sure you read through examples of winning statements and compare yours to see if you have the tone and style right.
One more point here. Are you doing medicine for ‘job security’? Do not put this on your statement! It is commonly seen and seldom liked. See the articles on how to articulate this.
Get someone else to read your statement for you too. Do not rely on your own judgement. Email me for guidance if you really are struggling to find help.

5. Too few places!
The truth is that we receive huge numbers of applicants from overseas. Way more than we can possibly accomodate. Some excellent candidates are therefore rejected where they would possibly have been offered a place had they been a home student.
This is good news for home students of course, but the quotas for overseas students will undoubtedly increase in future years due to funding problems in the higher education sector as a whole. There are big changes just around the corner.

Finally, as an overseas student you probably have many medical schools, possibly in different countries as options.

Remember, if you’re called for an interview, make sure you tell the panel how much you want to study at their medical school. Better yet, if you can tell them you know someone that studied here and liked the course, or you have some connection with the city or some other specific reference point you can add some authenticity to your story and perhaps get some sympathy from the panel.

In one way, the process is designed to assess the risk of you dropping out. And drop outs are a waste of money.

Apart from work experience, you need to devote some time to speak to junior doctors and medical students at various levels about what they do and how they find it. It’ll be useful for you and your insights will be obvious at interview.

To help you get an idea of what your first few years at medical school will be like, here’s a diary of a single day for a preclinical student at a more traditional UK medical school.

Remember, this is typical but variable.

8.45am
I step into the medical school building and hed straight to the library drop off box where i unload six hard back books from my rucksack. I can finally stand upright! Much of the weekend was spent finalising the main first semester pharmocology essay. The topic i chose was on the uses of muscarinic antagonists. The deadline is tomorrow and i regret leaving things to the last minute.

8.55am
A quick coffee before heading into the lecture room.

9.00
The first lecture is by someone from the hospital. She’s a junior surgeon, sent in by her seniors to cover the topic of colorectal pathology. She apologises profusely for having to stand in at short notice. None of the students seem too bothered though. Some very interesting pictures and descriptions of surgical procedures.

10am
Straight into the second lecture which is part of the medical ethics module. There is a long discussion about consent and competence. A few late comers sneak in midway through the doors at the rear of the lecture room.

11am
Another lecture. I feel like i should have had more coffee as I attempt to concentrate on some detailed slides on the sympathetic nervous system. There are lots of questions at the end but the lecturer has overrun a little and seems to be in a hurry for her next session.

12.30pm
I head over to the medical school canteen – it’s too cold to head out for lunch today.
It’s a good chance to catch up with a few friends. It seems like I wasn’t the last to complete the pharmacology essay. Several people are typing away over lunch trying to meet tomorrows looming deadline. I feel better about lugging those books back and forth over the weekend.

1.30 pm
We are in smaller groups for the first of three communications skills sessions. Actors are brought in to simulate patients.
The first patient is an angry young man. The purpose of the excercise is to get him to calm down before adressing his problems. The actors are always a little too convincing. The student chosen to role play is making a mess of things. Everything he says makes the ‘patient more angry’ The supervising tutor eventually intervenes amid fits of laughter from the rest of us.

3.00
In between sessions I check my emails and realise I have a meeting with my personal tutor at the end of the week. I also start a preliminary literature search for a study on attitudes to risk amongst students of different disciplines. It’s a study done by some of the senior clinical students but I’ve voluteered to help out and get some research experience.

4.30
It’s the turn of the last actor and I’ve been selected to role play. Although it’s nerve racking at first I find the teaching has been very useful. To my own surprise, I get through the simulated consultation without a hitch. It was certainly easier that the aggressive scenario from earlier on.

5.30pm
Although the day is over I have a medical society meeting to attend. This is where issues affecting medical students are represented and is also where the social events are organised. We are currently in the last stages of organising the January ski trip.

If this sounds like hard work though remember that it only gets harder as things get more clinical and you end up on hospital attachments.

The key things to take away are that it is harder work than a typical undergrdauate course with longer hours and more assignments. However, you may well have some early clinical attachments added in at most medical schools during the first two years, even if it’s just an occasional day at a GP surgery. Some people find that helpful and interesting whilst others feel it’s a premature token gesture before you’re truly ready to start seeing patients.

If you are applying to medical schools, see what the course you are going for has to offer and speak to current students. Don’t simpy believe the medical school prospectus with it’s typical photographs of trees and sunshine.

When it comes to interview however, you’re a beggar not a chooser. Look like you’ve found out how the first few years are going to be. Focus on the good things you’ve heard about the school. Speak glowingly about the curriculum. It’s likely that one of the people in front of you is partly responsible for it.