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Half UK’s junior doctors work
more than 48 hour weeks
Almost half of the United Kingdom’s
junior doctors are working more
than the maximum 48 hours a week
allowed by the European Working

Time Directive, to take effect from
August 2009, the BMA has said,
citing figures from the NHS.
    Ram Moorthy, chairman of the
BMA Junior Doctors Committee, said
that trusts had had many years to
prepare for the directive.
    “It is important that the change
is carefully managed so that the
reduction in working hours does
not negatively impact on the quality
of junior doctor training or patient
care,” he said. “We need to ensure
that junior doctors can acquire the
skills and experience required to
practise safely within the new limit
on working hours.”
    But consultants writing in the BMJ
argued that cutting junior doctors’
hours to fit the directive could “spell
disaster for medicine in Britain”
    Hugh Cairns and colleagues at
King’s College Hospital in London
said that shorter hours would mean           UK medical students have published unreleased government
inadequate experience: “Training
has deteriorated and, for most
                                             plans to restrict failed asylum seekers’ access to medical care,
patients, medical care is not safer.”        reports Christopher Hands
They added that plans to cut the
maximum week to 48 hours should

                                                    recent report published by the Global     proposals threaten to allow health problems to
be abandoned.                                       Health Advocacy Project shows medical     develop until they became emergent, placing
                                                    students making an impact on behalf       a new time consuming and expensive burden
                                                    of vulnerable people in the United        on acute medical services.
Doctor suspended in                        Kingdom (see          A public health imperative was also identified
blogging row                               The project, part of the national student group    because if vulnerable migrants were not being
A junior doctor has been suspended         Medsin, led an investigation into government       offered primary health care, it would be much
for posting derogatory comments            plans to deny primary health care to vulnerable    more difficult to identify and treat communi-
about a leading medical figure             migrants, including failed asylum seekers, and     cable diseases. The proposals might, therefore,
on an online forum. The trainee            uncovered information that had been gathered       lead to the increased spread of dangerous infec-
surgeon, who has not been named,           but not released four years ago.                   tious diseases, such as tuberculosis.
made remarks—described as                     In 2004 the Department of Health began
“scatological”—about Carol Black,          consulting key stakeholders about the idea         Students should comment
professor of rheumatology at the           of withdrawing free health care from failed        Susan Wright, from the medical non-govern-
Royal Free and University College          asylum seekers and undocumented migrants.          mental organisation Médecins Du Monde,
Medical School, on            The results of the consultation were never         explains that medical students may often think
uk. Remedy UK is furious about             published. When Tom Yates, a medical student       that they can’t make a difference to impor-
the continuing suspension of the           from Cambridge, and his colleagues at Medsin       tant debates: “If you’re training as a medical
junior surgeon from a hospital in          realised this, they set out to discover what the   professional, there’s an idea that you should
Scotland. He has been off work for         government didn’t want to publish.                 stay on the sidelines, but students shouldn’t
six weeks since the decision by the           The results of their inquiries, Where’s         feel like that, they shouldn’t feel that they
deanery, although the comments,            the Consultation, were published in August,        can’t comment.”
which Remedy UK say were posted            including many of the responses to the orig-          She was impressed by how the report
for only a few hours, have been            inal consultation.                                 managed to deal with the substantive issue and
removed, and the doctor has                                                                   the procedural one: “The central questions are
apologised.                                Concerns                                           very important but also, when you consult the
    “Suspension is devastating for         Ninety seven per cent of stakeholders              public, you can’t say you’re going to release
doctors and carries a significant          consulted raised at least one concern about        the information on some occasions and not
morbidity,” said Matt Jameson              the proposals, with 82% raising three or more.     on others. The authors have grounded their
Evans, a founding member of                The objections to the proposals fell into four     report and questions in their own expertise
Remedy UK. “A dressing down                broad categories.                                  and future specialties, as well as dealing with
or warning would have been a                  A large majority of the agencies surveyed       political questions that affect everyone. We’re
proportionate response to the              thought that it contravened a doctor’s ethical     interested in this because we’re doctors but
alleged crime. Suspension is usually       duty to his patients to offer treatment based      also because we’re people.”
reserved for doctors who pose a            on immigration status. Many were concerned            In response to the project’s initial Freedom
potential risk to patients, or following   that there would be logistical problems asso-      of Information request, the Department
a serious adverse incident.”               ciated with billing patients who were clearly      of Health released only the names of the
According to Remedy UK, a local            unable to pay.                                     organisations involved. Discovering what
disciplinary committee advised that           Another cost effectiveness matter raised        they had said in the original consultation was
the doctor should be reinstated, but       was that good primary care helps to prevent        painstaking work. It involved tracking down
this was blocked by the deanery.           expensive emergency admissions. These              each organisation and asking them to find

340                                                                                                      STUDENTBMJ | VOLUME 16 | OCTOBER 2008
                                                                                                                                Coaching doesn’t help                      clinical clerkships at New York’s 11
                                                                                                                                medical school hopefuls                    public hospitals.
                                                                                                                                Expensive coaching courses for                Critics worry that the deal may
                                                                                                                                students hoping to win a place in          squeeze out students from New York’s
                                                                                                                                medical school may be a waste of           medical colleges, who may have to
                                                                                                                                money, research in Australia has           compete, and thus pay more, for
                                                                                                                                found. Of more than 2300 applicants        remaining clerkships in the city.
                                                                                                                                to the University of Western Sydney’s         “This changes the whole dynamic
                                                                                                                                medical school, the 340 with the           from an academic relationship to a
                                                                                                                                highest marks in the admission test        dollar based relationship,” Michael
                                                                                                                                were invited to attend a multiple          Reichgott, associate dean for
                                                                                                                                mini interview, a test used by several     clinical affairs and graduate medical
                                                                                                                                Australian medical schools.                education at Albert Einstein College of
                                                                                                                                   More than four out of five students     Medicine in the Bronx, told the New
                                                                                                                                agreed to take part. Half said that they   York Times.
                                                                                                                                had attended admissions coaching              Some 70% of students at St
                                                                                                                                sessions, which can cost as much           George’s are US citizens. The
                                                                                                                                as $A1700 (£786; 974; $1370) for a         university’s chancellor, Charles
                                                                     ‘ACCESS DENIED CONFERENCE’ GUYS HOSPITAL 2008/MEDSIN GKT

                                                                                                                                weekend.                                   Modica, said that New York’s
                                                                                                                                   Coached students had slightly           own medical colleges were only
                                                                                                                                better results in non-verbal reasoning,    complaining because the new contract
                                                                                                                                but the difference was too small to        threatened their monopoly.
                                                                                                                                be significant. Coached applicants
                                                                                                                                performed slightly worse in the
                                                                                                                                admission interviews.                      Irish students head to the UK for
                                                                                                                                   The researchers said that the           medicine
                                                                                                                                findings, published in the Medical         Students from the Republic of Ireland
                                                                                                                                Journal of Australia, show that            are enrolling in increasing numbers
                                                                                                                                coaching “does not assist and              on medical courses in the United
                                                                                                                                may even hinder” students                  Kingdom, statistics show. Figures
                                                                                                                                (2008;189:270-3).                          from the 2006-7 intake showed that
                                                                                                                                   “I think it’s reassuring that           523 Irish students started medicine
                                                                                                                                coaching . . . didn’t help in the          in the UK, a rise of 150% from 214
                                                                                                                                interview,” said the author Neville        students in the 2002-3 academic year.
                                                                                                                                Yeomans. “If it did help, that sets up        A large rise has also been recorded
                                                                                                                                a real unfairness . . . that those who     for Irish students of pharmacy and
                                                                                                                                can’t afford to pay are disadvantaged”.    pharmacology. Critics of the situation
                                                                                                                                                                           are concerned that students who
                                                                                                                                                                           study abroad may not wish to return
                                                                                                                                Tanzania recruits more                     soon, if at all, leaving the country’s
                                                                                                                                medical students                           health system short of workers.
their original response, or in some cases to                                                                                    Tanzania’s medical colleges have              Changes have been made to
remember what they had said.                                                                                                    boosted their student intake to try to     medical courses throughout Ireland,
                                                                                                                                increase the number of doctors in the      including the introduction of
Threat to health                                                                                                                country’s healthcare system. Tanzania      graduate entry programme places,
Yates explained why he and his colleagues                                                                                       has about two doctors per 100 000          but competition for undergraduate
chose to take on such a large piece of work:                                                                                    people, according to recent statistics     medical places remains tight, and
“We picked this issue because it’s the biggest                                                                                  from the World Health Organization,        students must achieve near perfect
threat to health and human rights in the UK                                                                                     one of the lowest doctor to patient        leaving certificate scores.
in the past 10 years. Other people weren’t                                                                                      ratios in Africa. It also suffers
campaigning on it.” He is keen to see further                                                                                   heavily from migration of healthcare
work in medical student advocacy because he                                                                                     personnel.
thinks that “there’s a lot of opportunity for                                                                                      The deputy minister for health and
students to make a difference.”                                                                                                 social welfare, Aisha Kigoda, told
   Abi Smith, deputy chairwoman of the                                                                                          the National Assembly that as part of
BMA’s International Students Committee, was                                                                                     plans to improve rural health care,
impressed by what the students achieved: “I’d                                                                                   intake of medical students had been
encourage fellow students and young doctors                                                                                     increased by 44% to reach more
to take every opportunity to input into activi-                                                                                 than 1000 annually, Tanzania’s Daily
ties such as this to strengthen the voice of the                                                                                News reported. The government had
young medical community and enable an                                                                                           also reopened five medical training
increasing number of reports to be produced                                                                                     colleges that had been closed.
to lobby for improved health both within the
UK and globally.”
Christopher Hands final year medical student, St George’s,                                                                      New York hospitals to take
University of London                                                                                                            Caribbean medical students                 Labour party health spokesperson                                                                                                      New York city’s public hospitals have      Jan O’Sullivan
Competing interests: CH is chairman of Student Action for Refugees                                                              agreed to give clinical training places
at St George’s, University of London.                                                                                           for hundreds of students from a profit        The Labour party health
Provenance and peer review: Commissioned; not externally peer
                                                                                                                                making Caribbean medical school,           spokesperson Jan O’Sullivan told the
see the BMJ feature “Free for all” (2008;337:a1111).
                                                                                                                                prompting fears from New York’s own        Herald newspaper that the country
                                                                                                                                medical colleges that there will not be    risked a “brain drain” to the UK and
                                                                                                                                enough places to go around.                that the government should increase
 What do you think?                                                                                                                The contract will see students          the number of places at Irish medical
 Send a response to                                                                                            from St George’s University School         colleges and improve job prospects
                                                                                                                                of Medicine, Grenada, undertaking          for new graduates.                                                                                                                                                                                               341

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