Catrin Jones
@catiwat
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drwy ddulliau crwydro yn unig mae llwyddo 🏴🏴🇿🇦 SpR General Surgery WoS, sworn enemy of the mighty scottish midge
Glasgow, Scotland
Joined March 2012
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@geordie_medic
the biggest irony with ‘as a father and a husband’ is that most violence and abuse that women face is domestic
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I’m genuinely a bit taken aback.
Constitutionally, there’s no need for the decision to be taken today.
Historically it’s a role rooted in the humiliation and subjugation of the newly conquered Welsh.
Wales today is very different to 1969.
Are we not going to talk about this?
I must admit I expected the Prince of Wales announcement to be handled a lot more sensitively. Charles more than anyone would know how divisive it would be. I think a lot of goodwill among Welsh republicans due to the death of the Queen may have been squandered there. 😬
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Cheap(ish) innovation idea:
We need to be more American about our training programmes.
Hear me out
Deaneries should cultivate a institutional identity and pride around their speciality training programmes
Proudly be the West of Scotland General Surgery Program (for example)
Today in the
@RCSnews
Bulletin:
@AquaAsif
and
@ollieburtonmed
begin explore the existential challenges to surgical training in 🇬🇧
Defo worth a read and a share
#MedEd
#medtwitter
#surgery
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After months of tedious and frankly unwelcome life developments, finally a slice of really really good news. I got my first choice Reg job! In my favourite city of them all!! Glasgow, I hope I’ll do you proud.
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@elle_hunt
It’s a brilliant article but when you say British, you really mean English. The extreme privilege and public school connections simply isn’t true for Welsh and Scottish stars that have broken through to anywhere near the same degree.
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Medicine isn’t just another uni course though is it? From cadavers donated for anatomy to seeing patients in hospital, people let us in at their most vulnerable. Births. Deaths. Their life history. Intimate examinations. People agree to this because it’s to train doctors.
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I’m a female surgical trainee in a TV drama.I do successful solo thoracotomies in stairwells midway between shagging my boss in the linen cupboard, shouting orders that are obeyed and going on the roof looking over the city with a wistful gaze alluding to a complex troubling past
I’m a female hospital consultant in a TV drama. I save lots of lives whilst wearing high heels and lipstick, and occasionally have sex with my colleagues in the sluice.
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@StephenHearns1
As a student I was adamant that I would always make lots of time for medical student teaching when I was a Dr, then brutally realising once qualified how difficult this can be to do especially when you’ve not been forewarned (this esp true for ward, theatre and clinic easier)
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@DrJSherrington
Yes, but I also look at decisions to roll out HPV vaccination (esp initially) in a limited and specific way and with inexcusable squeamishness rather than go thermonuclear and give it to all sexes and push the catch up vac harder with 10x more side eye
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@D_Rodders
Few yrs ago I was scrubbed on the hottest day of the yr with air conditioning broken. Theatre roasting, dissection miserable, nobody was having fun. Looked over- the anaesthetist was in the anaesthetic room, fan on, eating a lollipop. I have never regretted my life choices more
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@timricketts_
That there is much to be gleaned by the presence, absence or character of bowel sounds in isolation.
That an AXR is a useful imaging modality except in very specific situations.
That you need a surgical review prior to CT in patients with high suspicion of significant pathology
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@mstotty88
Tbh I just read it as a clumsy attempt at inter subspeciality banter rather anything misogynistic and I’m quite sensitive to tone around women in surgery and especially women in general surgery subspecs not classically seen as female friendly.
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@NadiaKamil
Idris is a name that is in both Welsh and Arabic with completely different entomologies, familiar and pronounceable to English and Australian ears and mouths.
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@svig2
@ShafiAhmed5
@ASiTofficial
@OrthopodReg
@RoshanaMN
FY1-CT2 needs a lot more streamlining than ST3-8. you spend the first few years doing a grand tour of largely unrelated specialities for ‘breadth’, then start ST3 and get asked what sub speciality you are before you’ve had a chance to explore the breadth your chosen speciality
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@MissBethanEJohn
@two_medics
see I’ve changed- I used to not have my profession on my profile cos I felt embarrassed I suppose. I’ve now put it on, it’s a good filter. If it’s a turn off for a guy then it’s never gonna work is it 🤷🏻♀️
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@GaslingSarah
I don’t mind FY3- I think it describes a particular phenomenon and is defo useful in gauging (lack of) seniority. FY4 much more honest than ‘CT2 equivalent’ if you haven’t done the training programme.
FY5+ tho is nonsense. Behave yo self.
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@beckybeckyfish
Swear to god 90+% of the personal growth work you need to do in medicine is learning how to be an over-achiever in an universe of overachievers, find your niche/vibe and not implode.
Everything else is easy
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@ellennelsonrowe
Honest answer- I got a Mirena coil mainly because I found long theatre days esp days 1-3 of period difficult to manage. It was unexpectedly way more painful to insert than I expected and bad cramping+irregular bleeding for 3m but since then has been a blessing+glad I have it.
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@rhiannonlucyc
💯 this. It’s the same left leaning allegedly progressive english intelligentsia who just don’t get Ireland at all. No concept of legitimate Irish grievance, of history, weird jarring patronising almost colonial attitudes. And we wonder why we are where we are as an archipelago.
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When your trainees succeed openly celebrate them
Have high quality regional training days and research days. Have medals and a nice meal. Make a fuss.
Have a branded patagonia fleece if you must
There’s lots we can’t fix, but we could make it feel less indifferent
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Have a prospectus to attract applicants advertising how great your training is
When you get a new intake of ST3s openly welcome them with corporate looking releases, nice pictures, celebrate the calibre of your recruits
Cultivate a rotational identity and pride
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I learnt this lesson when I did my paper round when I was 13.
The council houses that looked liked they had the least to give always had the best christmas tips, easter eggs, everything .
The nice houses… not so much
I delivered to Park Lane apartments, Bloomsbury flats with swanky concierges and to the 7th floor of council flats.
The bankers/Mayfair residents didn’t tip once. People in council flats were the ones who did.
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@Dr_BellaR
@UKFPO
You shouldn’t allow informal swaps (too much scope for dodgy deals) but why not have an official swap shop after rotations come out.
There may be peeps that would rather eg surgery heavy rotation in NI over gen med/geris heavy in Manc that wouldn’t be reflected in original prefs
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@gasbagheera
What madness. The correct answer is obviously to look at the lactate in isolation and be completely reassured if it’s less than 2.
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@sefkhet
@ACEMcCormack
Only way it’s going to get safer is if the streets are full of women. Terrifying women to stay at home only makes the streets more dangerous for those (often already more vulnerable) who have to be out for whatever reason and can’t afford taxis etc. We need to reclaim the night!
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@CharSquires
@ValleyWye
i think access to the extra stuff is a huge hidden source of inequality
anonymous criteria based scoring is superficially very fair
but people don’t have equal access to research/committee positions/extra degrees/academic opps/mentorship.
it appears fair, but it often isn’t
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It’s completely unethical to deliberately train people who will never work as doctors. It breaks the moral contract with society.
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My sister (who’s an island warden) was briefly on countryfile tonight and the comments on our accent are a thing of beauty!!! welcome to my life....
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@StephenHearns1
Not justifying your son’s experience, but reflecting on how some places just tell students to pitch up to Ward X for the WR and get involved isn’t fair on anyone, esp early clinical yrs and I remember the feeling well
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@lewis_goodall
The leader of the Welsh Conservatives had to resign as well drinking wine in the Senedd estate when Welsh regulations banned this last December
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@DrLindaDykes
There’s a very casual attitude towards early years training: doesn’t matter that you do rotations you don’t want, doesn’t matter that you’re not acting to the max of your scope, doesn’t matter that you’re bored/frustrated: you’re a doctor, it’ll come. JFDI and keep your head down
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@WelshGasDoc
what about the united celtic nations. like the nordic council, independent nations with a common cultural background united when it helps, different when it’s appropriate. why would it be worse than this? how could it possibly be worse than this?
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@MarkGaze
Decent rest areas with lockers, showers, on call rooms.
Training informed schedule: if you’re in a training post there’s consistent prioritisation for the opportunities that train you to be a future consultant rather than meeting current service needs
Hot decent food OOH
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@JoanneBell5
Anaethetists don’t understand how little theatre time juniors get.
If I’ve done all the work to get a pt to theatre, there’s a senior on that will get me operating, there’s a night SHO to take the bleep and it’s only 8pm- no brainer. I’d stay. Had some 💯 training that way
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@ollieburtonmed
I think the sequence of events is:
1) Visa rules change, big increase in IMGs, while UK grad numbers stay the same applicant pool doubles
2)Trad process overwhelmed-need shortcut- big move to MSRA
3)MSRA+competition ratios encourages multiple applications
Plan. Your. Workforce
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@angharadPJ
@rhysllwyd
dyma oedd fy mhrofiad i. mi wnes raddio yn gyntaf yn fy mlwyddyn yn lerpwl. bellach yn lawfeddyg dan hyfforddiant yn yr alban. peidiwch a beriniadu pobol am adael, cwestiynwch pan fod rhai’n cael ei gorfodi dros y ffin heb fod eisiau mynd
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@sh_abbers
@delirious_dr
Exactly this.
Incel is a very specific form of misogynistic sexual entitlement and rape culture not some vague descriptor of opinions that you disagree with regarding task shifting in the NHS.
Don’t throw it about lightly.
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@Dr_BellaR
The more I’ve done, the more convinced I am that all these complicated regimes are BS and the key is to be as well rested as possible going into nights, ride it out and then try to be somewhat disciplined with your sleep hygiene afterwards whilst still being kind to yourself.
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@Dr_BellaR
You look at the consultant job.
The training program will last maximum 7 full time years. That will pass, the same way as med school passed.
Then you have decades of practice.
So you work out which consultant job works for you. Speak to people. Shadow. Take your time.
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@rosieICM
Career plans aside, it’s such a personal topic.
How many desperately want but can’t conceive?
How many always thought they would but are piecing life back together from a shattered relationship in their mid30s + time’s running out?
How many just don’t want kids (bit taboo)?
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@DrJonathanD
@techpriest
@rosieICM
I think there’s a trap in assuming that the problem is the exam itself and not the wider social structure, opportunities and training inequities leading up to taking postgrad exams (probably aged 25-35). The difference measured might be real because of structural inequality.
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@ollieburtonmed
This sounds v harsh, but we really need some expectation management about a medical career from 6th form onwards
It’s competitive, sometimes very. Not everyone gets what they want
It’s rotational- almost everyone will have at least 1 job miles from their life, sometimes more
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@NadiaKamil
7.5 yrs into this myself
Embrace slob life
Accept that the house gets messy, clutter doesn’t kill
Buy more underwear so you don’t run out if you go 2-3 weeks without a laundry
Wear scrubs at work
Cook big batches of stuff and freeze portions so it takes 5 mins when you’re home
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@Xeon4f145d96s1
@sh_abbers
@delirious_dr
Women have been raped+murdered by men who perceive themselves to be involuntarily celibate and it to be their right to have sex.
You may think the PA debate is not in the right place, but if you’re not describing that the word for it is not incel.
Why does it need to be said.
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@timricketts_
This, but tourists on Scottish roads (specifically-A82) that will not pull to the side to let you pass. Yes I know Loch Lomond is very beautiful Stanley, you’ve never driven a campervan before and there’s the occasional turn BUT 20mph IS NOT APPROPRIATE. Sweet jaysus.
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@Shr_Nottingham
If a supervisor thinks this but doesn’t tell you then they are doing you a far greater disservice than being forthcoming with the uncomfortable truth.
It’s clear that they are trying get you better, and will help you (bluntly)
It’s the drive-by shootings that are unforgivable.
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Lots of these things are happening but nobody is bringing it all together on a package, and it’s not universal
Belonging and identity are important human instincts, and if we have to rotate through different hospitals at least we can feel that we belong to the training programme
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@k_d85
@WelshGasDoc
The longer the permacrisis last, the more convinced I am that the only way that elective surgery can ever function reliably again is by having fully functional proper hospital cold sites that are geographically distinct from any ED or acute medical take.
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@peteturton85
Its also bizarre how they conflate absolute minimum standards ‘don’t shag your patients, don’t attempt to shag your patients’ very bad you’ ll get struck off stuff with moralistic etiquette stuff. They’re nowhere near equal, not in the same league, do not belong in the same list.
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@zackferguson
@NadiaKamil
Hahaha this is such a classic registrar thing.
How senior you think/know you are: not at all. So much you don’t know. So much to learn. Still pretty far down the pecking order. Stress stress stress.
How senior your brand new FY1s think you are: minor deity.
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@oli_m_sims
I’d take the recent news that trust are being told to tighten belts by cutting down on staffing costs seriously: fixed term locally employed drs posts are second easiest to cut (after locums).
Unless you have a rock solid JCF post or emigration plans, I’d take the CT1
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@jprgooch
ST3 is a very cruel point for big bottlenecks. PGY5 (at least), you’ve made choices, you’ve done exams, you’ve differentiated…then you get stuck.
If you’re going to plan your workforce, surely it’s at CT1 (+wiggle room for attrition). Then you’re commited to see them through.
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THIS 🙌🏻
Not to take away from the joy of a first appendix, but it is NORMAL to do some operating as a CST. CST should be full of firsts. It’s not extraordinary best practice but the absolute basics of training+if we forget that then we’ve really gone through the looking glass
We are surgeons first. What we do that others can’t is operate. Yes you need to develop all the other clinical skills + leadership & ed and academic skills, but first be a surgeon! A CSTs role on call is ALSO learning how to do cases suitable for them. Not just living in ED.
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@PadKnight
@DrLindaDykes
@BDChadwick
@ollieburtonmed
@dean_susi
I honestly think it’s time to ditch ‘practitioner’ .
It’s one of those words that seems to mean something but doesn’t. What on earth does it mean in healthcare?
Medical practitioner is legalese for Dr medical degree+licence to practice
General Practitioner is a senior doctor
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@TheEMboardround
The presence or absence of a perforation would quite significantly change your management, and wanting a proper portovenous phase CTAP in acute pancreatitis rather than just the last few slices of a CTPA is very normal safe practice
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@ZS_Chaudhry
UK system is worst of all worlds at the moment- neither has the early certainty+efficiency of straight to speciality or the flexibility of old school standalone SHO jobs that would let you try before you buy. Slow start+still limited experience in chosen spec before committing.
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@VirtueOfNothing
I think we have to be very very careful to distinguish between advanced practice more generally (broadly a Good Thing, implementation sometimes sketchy) and PAs specifically (fundamentally flawed role, shouldn’t be a thing imo)
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@sh_abbers
If she’d said that she knew young women that had been rendered dialysis dependent or TPN dependent or even died as a result of complications from those surgeries it would be sadly entirely believable. Kidney snatching though….just logistically nonsensical save everything else
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@hlnewey
Don’t make drastic decisions about being a Dr based on your experiences as a med student or how bad the NHS is now.
It’s ok to walk away but
FY is so much better than clinical bit of med school
You don’t have to work in the UK
*This* level of NHS awfulness is unsustainable
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@JonnyGucks
@Xe4f145d16s2
My 2 pence would be that sub specialist AHPs probs have an awful lot to teach Drs + med students about their area, but generalist AHPs (eg ED, acute med, community) often don’t as those are already extensively covered in medical degrees in good detail
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@timricketts_
Honestly- you’re giving me strong anaesthetics with a sprinkling of ICU vibes of the perpetually irritated workhorse variety.
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@nightflightdan
As a former anti-shit-magnet (to the point my lack of emergency operating experience was becoming a training issue) I have to warn that poles can switch devastatingly quickly 💩
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@BLMCardiff
you’d 100% have my support if there was any connection with the actual Lord Penrhyn.
But Penrhyn is just a really common Welsh word that far predates the transatlantic slave trade. It just means peninsula. Nothing more.
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@mark_tehan
@ivabrodine
I always find it a bit gaslighty.
New development objectively detracts from the quality of a JD role.
Gets called out.
Cons pile in to explain in some ideal world how this may have some training potential, ignoring obvious calculation that training was acceptable collateral.
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@clare_eliza
Nothing good ever comes from deviating from the fundamental truth that all human life is equal.
If you start thinking some civilians are completely expendable and some are absolutely not you are wrong
No civilian life is expendable
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@DrBenLovell
Let’s be realistic about determinants of health. I bet those attendees enjoy better than average health-not because they always have the brown bread and never put sugar in their tea but because they’ll have a decent income. If you prevent poverty, you’ll prevent disease.
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@henbapur
surely you can do both. call Everest Chomolungma, call New Zealand Aotearoa, call Snowdon yr Wyddfa. Recognise when we’ve colonised and when we’ve been colonised. Use Welsh names at home, use the original names abroad. History is complex, subjective, nuanced. Names are powerful.
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@Dr_BellaR
Single no kids I think you can live pretty well - by that I mean live in decent accommodation, run a car, do nice things on the weekends, eat out, afford the occasional holiday, not worry about money every day- on about £3000 a month post tax.
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@meganheaguexx
In pre-covid old school selection portfolios certainly for Core and to a degree HST never had to be speciality specific: the commitment to speciality thing was a small domain (?3 marks/50).
Research/audits/teaching/intercal could be in anything and rightly so
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@TurtonsOther
@MStott88
@DrNickTwit
‘There’s something to learn from every patient’
‘Who do you think you are, do you think this is beneath you’
No, sometimes there isn’t. And no, I don’t think it’s beneath me but I don’t think it’s wrong to drop the earnestness and recognise that it’s a bit tedious
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@WhistlingDixie4
I don’t think medicine has made me cautious: if anything has exacerbated a somewhat nihilistic/hedonistic streak in me that’s always existed.
Random awful things happen to lovely people. The absolute risk of most things is surprisingly small. Life is for the living.
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@NadiaKamil
1) Decide whether you wanted to permanently emigrate, explore + return or take the unconventional road in the UK
2) Decide whether you care about being a Consultant or not
3) Do you know what speciality you want to do now or do you want some time/extra experience to decide
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Wales is literally invisible to London media isn’t it
Meanwhile, Labour has actually had some big electoral successes today - taking West of England mayoralty, big gains in Manchester, London mayoralty holding strong, far exceeding expectations in Scotland...
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@LeylsTurk
When the workforce shifts towards being more female and more ethnically diverse the pay drops. Our labour is just as valuable. I think the consultants should strike even though they may be financially ok, cos as the manics said if you tolerate this then your children will be next
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@DrRJWebb
@Dr_BellaR
I hate relatives on ward rounds 😱
Big confidentiality challenges if not single rooms.
Disrupts flow of WR, people think of another question/want more time + chase the round.
Conflict between keeping WR moving vs giving relatives their due time+full attention
Terrible idea.
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@clifford0584
@DrRJWebb
Using time in ED as *the metric* rather than time to definitive diagnosis/management has been the biggest process analysis error of 21st century. Has produced processes and roles (esp NMP) that provide and priorities flow over definitive decisions- more than just cons on floor
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@Abi_Rimmer
It’s totally fine
In some older med schools the medical school predates the university/used to exist as a separate institution so for some when they attended, it wasn’t part of the current parent uni or even if the merger had happened no joint institutional identity
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@BigBaldDr
@hayleymagill
If only there was another three letter acronym starting with an S that perfectly captures the juniors medical skillset that they’re looking for….
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@WelshGasDoc
@RhonddaBryant
Must be a v.similar experience to watching Grey’s Anatomy if you’re in politics.
So far from reality it’s almost not annoying.
Ah yes ofc you’re doing open heart surgery in a lift on your half sister 2 weeks outta med school. Why not. That’s *exactly* what it’s like. Uncanny.
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@ujwaliofficial
@DrBenLovell
Absolutely this.
In my working life (qual 2014) there’s been a big shift to routine things being deemed ST3+ responsibilities often at the same time as NMPs being used to do things that traditionally would’ve been FY/SHO fodder. Little though to opportunity cost to reg training.
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@KatyStevenson_
because if you train in the UK you spend a prolonged period of time employed in a largely secretarial capacity suspended in a state of learned helplessness performing tasks (scribing, phleb) that would be undertaken by non-doctors in other systems
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@Hels_chapman
@DrLindaDykes
@Aidan_Baron
i think Dr entitlement is a)overstated especially in FY1s and b) best tackled by modelling good practice on placements
Did do some excellent joint sim sessions in deteriorating patients as a final yr med student along with final yr nursing students tho- valuable for all of us
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@MarkBagnallSurg
I think we already know the answer.
It’s not simulation
It’s not e-learning
It’s not a powerpoint on the acute abdo
It’s being part of a team
Progressive entrustment
Clerking, acute diagnostics
Theatre time
Coffee
Mentorship
Fun
We all know all of those have got a bit lost
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@clare_eliza
@elinlowri
@techpriest
@mark_tehan
@CSGNottingham
@MedCrisis
Personally, I would have the moral fibre to just not get sick
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@timricketts_
I took 2 yrs out post FY2.
Pros:
Get to enjoy being a Dr without ARCP
Travel, work abroad
Flexibility
Locum cash is v nice
Holidays without worry bout AL quota + arranging leave
Was brilliant, no regret
But I think there are cons that people don’t discuss (1/2)
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A thought on losing Erasmus (amongst other things). When I was 23 I was in Salamanca reading Medicine and living my best life with friends from all over the EU. At the same age my grandfathers were at War. Thought that difference was one of the great successes. Alas no more.
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@OrthopodReg
Good. Having both run through trainees (the golden children) and uncoupled trainees (the unwanted spawn) on the same training programme was intrinsically flawed from the outset. Pro+cons to both run through and uncoupled but whatever the system it has to be the same for everyone
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@BLMCardiff
the debate you think you’re having is equivalent to renaming Penny Lane due to a possible connection with James Penny, slaveowner
The debate you’re actually having is= whether we should stop calling a 1p coin a penny because there was a slaveowner that incidentally had that name
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@VirtueOfNothing
@BellaRoscetti
I have to say that I agree. If they’ve not behaved honourably when you’ve made a completely reasonable request then name and shame the organisations involved. They way they’ve treated you is wrong on so many levels- personal, environmental, pastoral, due process.
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@Abi_Rimmer
Strange. Obviously it’s not a great idea to have a big bender the night before an elective operation and moderation in the days before is wise but telling you to have a formal 3 day wash out period on fear of anaesthetic complications doesn’t sound like official guidelines to me.
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@WelshGasDoc
@EwenPearson2
Good god.
It’s also a godawful question because on a population level hepatitis c is considerably more prevalent, hepatitis b is by far the most transmissable via needlestick, but high risk population profile a bit different. So what are they looking for?
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