This Page Intentionally Left Blank GETTING AHEAD IN MEDICINE TO A GUIDE PERSONAL SKILLS FOR DOCTORS C.J.H. Johnson, C.R. Hall Anaesthetic Department, Southmead Hospital, Bristol, UK and F.C. Forrest Sir Humphry Day Department of Anaesthesia, Bristol Royal Infirmary, Bristol, UK BIOS 0 BIOS Scientific Publishers Limited, 1998 First published 1998 All rights reserved. Nop art of this book may be reproduced or transmitted, in any form or by any means, without permission. A CIP catalogue record for this book is available from the British Library. ISBN 1 859960 21 9 BIOS Scientific Publishers Ltd 9 Newtec Place, Magdalen Road, Oxford OX4 lRE, UK Tel. +44 (0) 1865 726286. Fax +44 (0) 1865 246823 World Wide Webh ome page: http://www.BIOS.co.uk/ DISTRIBUTORS Australia andZ NeIna eldaw ina d Blackwell Science Asia Viva Books Private Limited 54 University Street 4325/3 Ansari Road, Daryaganj Carlton, South Victoria3 053 New Delhi 110002 Singapore and South EAas Ust i aS A and Canada Toppan Company( S) ME Ltd BIOS Scientific Publishers 38 Liu Fang Road, Jurong PO Box 605, Hemdon Singapore 2262 VA 20172-0605 Important Note from the Publisher The informationc ontainedw ithint hisb ook was obtained byB IOSS cientific Publishers Ltd from sources believed by ust o be reliable. However, while every effort has been made to ensure its accuracy, no responsibility for loss or injury whatsoever occasioned to any person acting or refraining from action as a result of information contained herein can be accepted by the authors or publishers. The reader should remember that medicine is a constantly evolving science and while the authors and publishers have ensured that all dosages, applications and practices are based on current indications, therem ay be specific practices which differ between communities. You should always follow the guidelines laid down byth e manufactur- ers of specific products and the relevant authorities in the countryi n which you are practising. Typeset by Creative Associates, OxfordU, K. Printed by Biddles Ltd, Guildford,U K. Cover Design by Designersa nd Partners, Oxford, UK. CONTENTS (The logos denote topics of practical interest at the skill levels shown.) Abbreviations viii Using this book ix Preface xiii About the authors XiV 1. Getting a job 1 Career planning 1 Preparation 2 Producing a curriculum vitae 3 The job application G The appointments procedure 9 Induction procedures 13 2. Organizing yourself 15 Time management 15 Assertion 18 Stress 19 Advice 20 3. Structured training 25 Structure of medicale ducation in the UK 25 Organization of training 26 The process oft raining 27 Appraisal and assessment 29 Counselling 33 Mentoring 34 4. Teaching and learning 37 Learning techniques 37 Small group teaching 41 Problem-based learning 43 Preparing for examinations 45 Passing examinations 47 5. Computers and information technology 51 Computer hardware 51 Computer software 55 Computers in hospitals 58 m Basic use of a computer GO m Finding out information G3 CONTENTS v G. Talks and lectures G7 General principles G7 m Presenting a clinical case 71 m Presenting at a journal dub 72 m Research presentations 74 m Lecturing 77 - 7. Visual aids 81 The media 81 Graphic design 84 Displaying data 85 Producing a basic OHT -l 86 Using a presentation program 87 8. Quality in medicine 91 Quality 91 Clinical audit 94 m Collecting data 98 m Completing a criterion-based clinical audit 99 Evidence-based medicine 102 Other ways of using evidence to make judgements 103 The valueo f quality initiatives 105 9. Research 107 Research skills 107 Selecting at opic for research 108 Getting ethical consentf or human research 109 Performing research 11 2 Writing a paper 11 4 10. Getting things done 11 9 Management 11 9 Planning 120 Marketing 123 Committees 124 Budgets 127 11. Beginning a consultant job 131 The consultant contract 131 Getting started 133 The clinician as leader 135 Writing a reference 137 Private practice 139 vi GEllING AHEAD IN MEDICINE 12. The structure of health care 145 Historical perspective 145 Organization of health care in Britain 146 Funding health care in Britain 147 Management structurea nd finance in trusts 150 The underlying dilemma of health care 151 The health of the population 152 13. Society, medicine and doctors 153 The historical context 154 Oaths, codes and declarations 156 An ethical approach to decision making in medicine 1G O Doctors, duties, discipline and complaints 1G 2 14. Skill exercises 163 Appendix Further reading 173 Index 175 CONTENTS vii ABBREVIATIONS A-V audio visual (aid) ACME Advisory Committee on Medical Establishments AGMETS Advisory Group on Medical and Dental Education, Traininga nd Staffing (England and Wales) AOB any other business (in a committee meeting) APACHE acute physiology agec hronic health evaluation ARR absolute risk reduction BIT binary digit BMJ British Medical Journal CAL computer-aided learning CCST Certificate of Completion of Specialist Training CD-ROM compact disk-read only memory CEPOD confidential enquiry into pen-operative deaths CME continuing medical education CPC clinico-pathological conference CPU central processingu nit (of a computer) CV curriculum vitae dpi dots per inch (computer screen or printer definition) DVD digital versatile disk EEC European Economic Community EPR electronic patient record GMC General Medical Council (of the United Kingdom) GP general practitioner (family doctor) HMO health maintenance organization IT information technology LREC Local Research Ethics Committee M&M morbidity and mortality (meeting) MAAG medical audit advisory group MB megabyte (one million bytes - a unit of computer memory) MCQ multiple choice questionnaire MRC Medical Research Council MREC Multicentre Research Ethics Committee NCEPOD National Confidential Enquiry into Pen-operative Deaths NHD notional half day (unit of workload inc onsultant contract) NHS National Health Senrice (of the United Kingdom) NNT number needed to treat OHT overhead transparency OMR optical mark reader OSCE objective structured clinical examination PAS patient administration system PC personal computer PRHO pre-registration house officer POWAR place of work accredited representative quango quasi-autonomous non-governmental organization RAM random access memory (of a computer) RRR relative risk reduction SHO Senior House Officer SWOT Strengths/Weaknesses/Opportunities/Threats- a management tool SPR Specialist Registrar TRISS trauma injury scoring system WORM write-once read-many( a form of computer memory) viii GElTlNG AHEAD IN MEDICINE THIS USING BOOK This book consists of 14 chapters, each sub-divided into sections. Each chapter begins witha set of objectives. Some sections are practical gutiod es completing a task; others provide background information designed to make you think more deeply about a topic, or enable you to answer an interview question. At the end of the book we have included a set of skill exercises to emphasize the points mentioned in the text and to enable you to assess your progress. You could read this book from beginning to end, but we think that you would rapidly become saturated with information. Instead we recommend that you select the sections that are relevant to you at each stage in your career. To help you select which topics to read about, we have divided the book into four skill levels: Level 1 Appropriate for student and pre-registration house officer years Level 2 Required as a senior house officer Level 3 Learneda s a registrar Level 4 Acquired as an experienced registrar or consultant You will find these categories in the boxes overleaf. Practical information relating to these skill levels isa lso indicated in the Contents list. We have been anxious to keep this book compact, so there are some large topics that we have deliberately covered superficially. Whapenp ropriate, we have included references to other texts whichw e think will enable the inter- ested reader to explore a subject in greater detail. We know from the comments we received from those who read drafts of this book thatd octors hold disparate views about, for instance,t he best way to give a case presentation or produce a CV. We think that the advice we offer is sensible, but would always recommend that you also seek advice from seniors in your own region. USING THIS BOOK ix