Edition 33 – Winter 2020

gogledd north C21 Cymru Inside: C21 Vaccination against HPV: a story of cancer prevention in 2 parts… is Launched MedSoc Diagnose the past, research the present, repair the future Welcome

This edition has learning as its theme and in generating data to support a policy Welcome to the explains in more detail the introduction of change which has led to the introduction of the C21 north Wales initiative that provides the human papillomavirus (HPV) vaccination thirty third edition students with a unique opportunity to to both girls and more recently boys in the undertake a medical degree in North Wales. prevention of certain types of cancer. of ReMEDy. Launched in September, this four-year For information, I will shortly be stepping programme, delivered with our colleagues down as Acting Dean of the School of at the School of Medical Sciences at Bangor Medicine and Professor Stephen Riley will University, is an exciting innovation in take over, following his recent appointment medical . to the substantive role. Steve is currently Our ‘In the Spotlight’ feature focuses on the Dean of Medical Education and always the Medium team that provides a curriculum update following is committed to supporting our medical the Dean’s welcome in ReMEDy so I am students to develop their Welsh language sure the name will be familiar to most of skills academically and in professional/ you. Steve is a Cardiff alumnus and his clinical settings. Dr Awen Iorweth, who academic interests are in curriculum design, delivered the first medical lecture in Welsh education leadership and application in January 2017, is committed to promoting of systems theory to education delivery. the natural use of Welsh in the health His clinical interests are in the field of workforce and in scientific work, giving nephrology where he continues to practise patients a language of choice. The work in Cardiff and Vale University Health Board. of this team also hopes to mitigate the ReMEDy is available electronically to the problems in recruiting doctors in Wales. School’s alumni and to ensure that you This edition’s alumnus conversation is receive your copy, please inform us if you with Dr Alice Toole, a 2014 graduate of have changed your contact email address. the School of Medicine who has started Professor Ian Weeks her second year of training as an Acute Update your details now: Acting Dean Internal Medicine speciality trainee in the www.cardiff.ac.uk/alumni-update School of Medicine Intensive Care Unit at the University Hospital of Wales. We also highlight the impact of a I hope you enjoy reading this edition and I team of colleagues, including Dr Ned Powell, wish you all a very happy 2020.

Curriculum Update

Recruitment to the Welsh The C21 north Wales programme is This work is supporting the innovative this edition’s main feature and provides development of Welsh Medium education NHS is challenging and the students with the unique opportunity to at Cardiff and more information about this uncertainty over is likely undertake their medical degree in North team is featured on page 4. Wales, directly addressing the need to to compound existing challenges Taken together these initiatives, alongside educate students in the underserved areas. that we face in Wales. our main programme, suggest a bright The Community and Rural Education future for our graduates and the Welsh NHS. With an increasing shortfall of doctors (CARER) initiative which was featured in The hard work of our PGT teams also means available to serve rural communities in Mid edition 30 of ReMEDy gives Cardiff based that ongoing development of the workforce and North Wales we need to think creatively medical students the opportunity to have is accessible and relevant to improving and draw on international evidence to help a year of their education delivered in GP patient care across all disciplines. address apparent health inequalities. practices and hospitals in North and Mid Professor Stephen Riley Wales, providing invaluable experience of At Cardiff School of Medicine we have Dean of Medical Education responded promptly to the call from Welsh working closely with clinicians and patients Government to increase the numbers of in community settings. This should inspire Welsh domiciled students, achieving 40% in these students to consider working in these Year 1 this academic year. This has mainly communities following graduation. been achieved through the introduction of a The Welsh Language Medium team has portfolio of activity that is tailored to support developed significantly over the last four the specific needs of our domestic student years and is continually developing Welsh population. language provision opportunities within the undergraduate curriculum.

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rags on, ready to celebrate our five years of memories/should-remember-ies. Everyone In Conversation with our Alumni from our academic year was together reunited after our time away, and I got to meet the nearest and dearest of my nearest and dearest friends, which was special. This circle of friends Dr Alice Hoole that formed in university have kept me going, made me laugh when I’ve been crying and cry (MBBCh (2014), MRCP, PG Cert 2019) when I’ve been laughing, and the opportunity to have these pals as my colleagues one day is genome! Cardiff has felt like home from home Alice is an Acute Internal a real treat. Thanks Cardiff!” since those early years and so the decision to Medicine (AIM) specialty trainee attend a open day was a no- and has started her second year brainer. I sat next to a fellow student on a bus of training in the Intensive Care tour of the city and immediately got on with them. I saw that people like me liked Cardiff Unit at the University Hospital of too, so I was sold.” Wales, Cardiff. “Cardiff life as a student was perfect for Alice says: “It is a busy and stimulating place me” describes Alice. “There were university to work and invaluable for medical trainees societies, clubs and events every day and like myself as it better places us to talk to our night, and the city itself had so much to offer patients about what it means to be “admitted right on my doorstep. Some of my favourite to ITU.” times were probably spent with lifelong friends in living rooms and pubs across the city, but Immediately after graduation, Alice worked the most memorable memory of my time in as a Foundation doctor in Newport. Alice Cardiff was the first day. 300 of us bleary- reflects on this year and recalls: “I met some eyed medical students in a huge lecture irreplaceable mentors and friends, and found theatre in Park Place. I remember being myself settling into my role as a doctor. My thrilled and terrified in equal measure, whilst first experience of life on the wards was very also excited at the prospect of beginning stressful but also rewarding, and I realised Alice’s shared my training. With doctors in the family, I had that actually, long shift work and decision an idea of what was to come, but I never alumni wisdom: making under pressure was really good fun!” felt more prepared than when I heard the Alice completed her Foundation training and professor say: “You are different from other “Always take an Core Medical Training in South , students. You are young professionals, and travelling to Abergavenny and Merthyr Tydfil doctors in training.” At the time, I’m not sure umbrella. And don’t for 6 month rotations. Alice says: “I didn’t take I was capable of appreciating the gravity of a break unlike most of my peers so spent my this statement, but as I have progressed in forget your coat first registrar training year in Ysbyty my training and help other students with their in Bangor which, despite my anxieties about studies, I understand it was an extremely (even in August!)” leaving my home, family and friends, was valuable piece of advice.” probably the best year of my training so far. Alice’s five words describing Reflecting on how Cardiff School of Medicine North Wales is a beautiful part of the world, contributed to her success, Alice mentions: Cardiff School of Medicine: with countless stunning views, and the medical “I was an open book when I started at admissions team, within which I worked, university, an uncomplicated, happy, piano- was fab. Diolch yn fawr! It was in Bangor playing rugby-tackling teenager with some Best that I decided to complete the Postgraduate science A levels, and I am forever grateful Certificate in Medical Education, which I have for the university seeing the all-rounder continued this year to the Diploma. Clinical in me as a worthy prize for the School of medicine is a tortuous place for medical years Medicine. Cardiff helped me see my “jack students and trainees alike and I think this of all trades, master of none” perception of tortuosity scares many talented and capable myself as a strength and not a weakness, doctors away from medicine altogether. I want and this approach has brought confidence of to use my skills to make learning the art of to my work as a doctor. I have been taught medicine more fun, engaging and valuable for by some inspirational people during my students and trainees in an attempt to bring student years and have them to thank my glamour and excitement back to the job that for my love of teaching and my interest in we train so hard to do.” medical education. Mentorship has been On being asked why she chose Cardiff, Alice so important to me in my career so far and I life explains that “I am half Welsh – Cardiff has hope I can give that support to others in the been part of my life from a young age, visiting future having learned from the best!” the Welsh contingent of my mum’s side of Alice’s concludes: “I think graduation day the family every school holiday, and wearing summarises my lasting impressions of the the Welsh flag with pride as a cape watching School of Medicine. I had just returned from the Dragons triumph (!!) in what was then the my elective with five of my best (and most . My grandmother went tolerant) pals and Cardiff had never felt better. to the Welsh National School of Medicine in It was swelteringly hot and sunny, a rare and the 1940s and, although we joke about how welcome treat, and we were dressed up, glad daft we both are, something must be in my

Edition 33 – Winter 2020 REMEDY 3 Diagnose the past, research the present, repair the future

In the Spotlight: Iechyd da! Welsh medium medical education in Cardiff

Generations of Welsh doctors have been trained in Cardiff to serve the Welsh population’s needs. Before Students and Academic staff at the first Coleg Cymraeg Medical School Celebration day, June 2019 2015, however, there was

never any emphasis on the With the appointment of Dr Awen Iorweth, and the Innovation in Science Award at the language of healthcare. the first Welsh-medium clinical lecturer under National Eisteddfod in Cardiff. This Any Welsh provision in the the Coleg Cymraeg Cenedlaethol’s Academic same enthusiastic group of students also Staffing scheme, Cardiff School of Medicine studied Welsh-medium medical education training or delivery was were finally able to offer Welsh-medium and have presented in the Academy of haphazard and reliant on provision, concentrating on small group Medical Educators Conference. This vital enthusiastic individuals. learning, personal tutors, communication research is to continue with the intention skills and Welsh examination papers. In the of establishing a higher degree in minority Autumn of 2015, the School welcomed the language medical education. first 4 Coleg Cymraeg Scholars. The Coleg Following devolution, Wales became The exciting thing is that this is just the was established in 2011 to work with Welsh responsible for its own policies on education beginning! Four years on and Dr Alun Owens Universities to develop Welsh-medium and health and the focus changed to is the second clinical lecturer to join the courses and resources for students. The developing a high quality workforce to fulfil team alongside a cohort of invaluable part Coleg awards Incentive Scholarships of the needs of a bilingual nation. According time educators. Strong links have been £500 per year for students studying at least to the Office of National Statistics in March forged with medical students from other a third of the degree course in Welsh. In 2019, nearly 900,000 are able to speak universities (through our residential course in this academic year 2019/20, there are 24 Welsh and the Welsh Language Measure of the Urdd outdoor centre, Glan Llyn, learning scholars – 3 small learning groups – in the 2011 meant Welsh was to be treated no less about rural emergencies) and international first year. The first generation will graduate favourably than English. links with the Basque Country, Canada in the summer of 2020 and their experience and Ireland. The team are aiming to host a Previously, students from Welsh-medium has been very positive. education (26% of all Welsh schools) conference for medical education in minority were arriving in medical school fluent and In 2015-2016, “Doctoriaid Yfory” an award- populations in the summer of 2021 which confident in Welsh but by the time they winning television series following a group will affirm Cardiff University Medical School graduated, their professional Welsh fluency of our undergraduate medical students as a leader in this field. was filmed. It highlighted the training and and confidence was lost. It was their anxiety Dr Awen Iorweth affirms: “The evidence recruitment of doctors for Wales and this and their feedback in 2013 which triggered is incontrovertible now that patient care became a priority for the . this new direction. Following research and is safer in their mother tongue, especially Following on from this, a group of students consultation, it was concluded that Cardiff in paediatrics, mental health and care of passionate about continuing their learning University needed to make “opportunities the elderly. It is wonderful therefore that in Welsh throughout their course developed available for Welsh speaking students to this recent development is innovative mentoring and school liaison projects for complete a part of their training in Welsh, educationally, gives status to Welsh-medium their Self Selected Components (SSC) and systematically throughout their education, education, eases the anxieties of students presented their work in Welsh. These projects placements and personal support.” but most importantly contributes to improving won the main prize in the annual Cymdeithas the healthcare of our bilingual nation.” Feddygol (Welsh Medical Society) conference

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Vaccination against HPV: a story of cancer prevention in 2 parts…

The size of problem oropharyngeal cancers and it soon became recently received funding of £2.3 million Over four decades have passed since apparent that incidence of HPV-associated from Cancer Research UK for international Human papillomavirus (HPV) was first linked cancers was increasing at an alarming rate roll-out of a clinical trial to optimise to cervical cancers. HPV is now established – indeed faster than for any other cancer treatment of HPV-driven tonsil cancers.” as the fundamental cause of nearly all in the UK. Furthermore, most of these cancers occur in men, who were not directly cervical cancers and as a major contributor For further information, to many other anogenital cancers, especially protected by vaccination of young girls. please see invited 2018 BMJ anal cancers. Worldwide, HPV is the cause A case for vaccinating boys was growing, editorial “Gender neutral of 5% of all cancers. Vaccination to prevent but there was a lack of evidence to support HPV infection promises to dramatically it. In 2016 Dr Powell, Professor Evans and vaccination against HPV: A cause reduce this disease burden. collaborators from University, for celebration” Ned Powell, Sam published an investigation of incidence of Hibbitts & Mererid Evans (5). The path to vaccination HPV-driven oropharyngeal cancers across Two areas of research have made the UK, which showed that incidence had vaccination possible. Firstly, epidemiological doubled in the preceding decade and 1. Hibbitts S, Rieck GC, Hart K, Powell NG, Beukenholdt R, Dallimore N, McRea J, Hauke A, Tristram A, Fiander studies to understand which types of HPV that the majority of these cancers were AN. Human papillomavirus infection: an anonymous cause cancer, and how common they caused by HPV (4). This data challenged prevalence study in , UK. British Journal of are in various populations, and secondly the assumptions that had previously led to Cancer 2006 95(2):226-32. development of virus-like-particle (VLP) vaccination of boys being considered not 2. Powell NG, Boyde A, Tristram A, Hibbitts S, Fiander vaccines against the relevant HPV types. AN. The potential impact of Human Papillomavirus cost effective. vaccination in contemporary cytologically screened In 2008, UK HPV vaccination was populations is underestimated: an observational Vaccination for all retrospective analysis of invasive cervical cancers. introduced for 12-13 year-old girls. International Journal of Cancer. 2009 125: 2425-7. This decision was underpinned by data Having considered these data, in July 2018, the committee that advises UK 3. Evans M, Newcombe R, Fiander A, Powell J, Rolles M, generated by the Cardiff University HPV Thavaraj S, Robinson M, Powell N. Human Papillomavirus- Research Group, led by Professor Alison Governments on vaccination, changed their associated oropharyngeal cancer: an observational advice to support vaccination of both boys study of diagnosis, prevalence and prognosis in a UK Fiander, Dr Ned Powell and Dr Sam Hibbitts, population. BMC Cancer. 2013 13: 220. (1,2) which defined the prevalence of HPV and girls. UK wide vaccination of 12-13 year-old boys is now expected to start in 4. Schache AG, Powell NG, Cuschieri KS, Robinson M, in the Welsh population, and the HPV types Leary S, Mehanna H, Rapozo D, Long A, Cubie H, Junor present in cervical cancers diagnosed the 2019/20 academic year. This policy E, Monaghan H, Harrington KJ, Nutting CM, Schick in Welsh women. This showed that change represents the culmination of a U, Lau AS, Upile N, Sheard J, Brougham K, West CM, long journey, beginning with recognition Oguejiofor K, Thomas S, Ness AR, Pring M, Thomas approximately 30% of women in their early GJ, King EV, McCance DJ, James JA, Moran M, Sloan P, twenties carried a genital HPV infection, and that cervical cancer had an infectious Shaw RJ, Evans M, Jones TM. HPV-Related Oropharynx that 80% of cancers could be prevented cause, through identification of HPV as Cancer in the : An Evolution in the the agent responsible, to development of Understanding of Disease Etiology. Cancer Res. 2016 using current vaccines. This evidence was Nov 15;76(22):6598-6606. highly persuasive in making the case for UK- effective vaccines, followed by accumulating evidence for multiple malignancies caused 5. Powell N, Hibbitts S, Evans M. Gender neutral wide vaccination of young girls. vaccination against HPV. BMJ 2018; 362: 3837. https:// by HPV, and finally to implementation of doi.org/10.1136/bmj.k3837 A sub-plot takes centre stage gender-neutral national vaccination. Many people were aware of the link Dr Ned Powell, Reader, Cardiff School of between HPV and cervical cancer, but in Medicine said: “This story is an important 2010, international studies suggested a victory in the struggle against infectious strong link to oropharyngeal cancers too, disease and cancer, and it should be especially tonsil cancers. Initial studies celebrated. It will however, be 20-40 years by Professor Mererid Evans (a consultant before the impact of vaccination is reflected oncologist at Velindre Cancer Centre) and in reduced rates of cancer.” Dr Powell Dr Powell, showed HPV to be implicated in added: “In the meantime there will be a lot 55% of oropharyngeal cancers diagnosed of HPV associated cancer to treat. Professor in Wales (3). Unlike cervical cancers, there Evans and I are now focused on improving is no screening programme to prevent treatment for these patients, and have

Edition 33 – Winter 2020 REMEDY 5 Diagnose the past, research the present, repair the future

Introducing… the C21 north Wales programme

Building on the success of previous collaborations with universities in Wales to deliver the CARER (Community and Rural Education Route) programme, the C21 north Wales initiative expands our commitment to devolve medical education in north Wales in line with Welsh Government objectives.

The C21 north Wales programme gives students in August 2019. Funded by Welsh Year 1. The students then started their Cardiff medical students the option to study Government, bespoke facilities have been substantive curriculum in September 2019, 4 years of their MBBCh degree based at identified and renovated for the C21 north mirroring the curriculum delivered to Year the School of Medical Sciences at Bangor Wales students at the School of Medical 2 MBBCh students based in Cardiff. The University. Working in partnership with Sciences. These facilities will provide faculty in Bangor aim to make the most Betsi Cadwaladr University Health Board students with the most up to date clinical of the unique educational opportunities (BCUHB), the objective of the programme skills facilities and teaching environments. that being based in north Wales affords is to meet the commitment of Welsh them, including the academic expertise of Government to increase the recruitment Story so far educators at , in addition and retention of the medical workforce to the clinicians and lecturers appointed in underserved communities in Wales. The team based at the School of Medical specifically to the programme. The students This new initiative in Wales will provide Sciences at Bangor University, led by will be able to experience Student Selected students with the opportunity to study Professor Dean Williams, have expanded Component (SSC) projects with a unique whilst embedded in communities, reflecting to include newly appointed clinicians to north Wales focus, and take advantage of Welsh Government policy that ‘care lead the primary care education. The faculty the wider access to a variety of educational should be delivered as close to patients’ have worked quickly to identify support from experiences. Placements are varied, with homes as possible’ which has heralded a colleagues in BCUHB to teach and provide mountain, island and coastal communities change of direction for clinical services in placement opportunities for the students. involved during this inaugural year, with Wales, putting greater emphasis on primary many opportunities to experience bilingual care and community-based services. A collaborative approach with colleagues environments. The students are also in Ysbyty Gwynedd, Bangor ensured enjoying access to facilities and award- An additional 20 medical student places that the cohort of students enjoyed a winning teachers at Ysbyty Gwynedd which were announced in September 2018 with comprehensive Graduate Entry Module has a long tradition of educating Cardiff the allocations mandated to be undertaken in August 2019, compulsory for the 17 University medical students. entirely within the north Wales . students joining the accelerated 4 year C21 north Wales Programme Lead Dr Ffion A formal collaboration between Bangor MBBCh through the recognised graduate Williams says “I have been honoured to be and Cardiff Universities was signed by both feeder stream degree route. In addition, appointed as programme lead for C21 north Vice-Chancellors in March 2019, and teams one student has transferred from Cardiff, Wales during this exciting time for medical across both institutions have worked hard to having chosen to complete her degree in education in North Wales. Student feedback set up the programme to welcome the first north Wales after successfully completing to date has been very positive with students

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valuing how responsive and supportive staff Cardiff students who have undertaken the The School has a long tradition of facilitating have been during the initial weeks of the CARER programme to date, which include medical education in north Wales and this new programme. Our current students are better understanding of patient needs collaboration with Bangor University and really enjoying the friendly and welcoming and stronger working relationships with BCUHB is a natural evolution to strengthen course and benefitting from the smaller patients, families and healthcare teams. this offer to our students and ensure that cohort numbers.” With greater flexibility to shape their own we equip them with the skills they will need learning, students will have an opportunity to practice medicine in a modern Wales. Student Elen Sanpher transferred from to follow patients as they navigate through Year 1 in Cardiff and states “When the the different healthcare environments and opportunity to complete my degree in north strengthen their communication skills. Wales came about I jumped at the chance. They will also have the unique opportunity The quality of the teaching has been to work in a variety of community based outstanding so far. There’s only 18 of us settings unique to north Wales including which makes us a tight knit community. This coastal, mountainous and farming suits me perfectly’. communities. Future plans Following the CARER year, C21 north Wales students complete their final two Following the success of the CARER years based across the A55 corridor in the programme pilot as reported in ReMEDy secondary care placements in Ysbyty Glan Interested? Edition 30, the north Wales based , Maelor Hospital and Ysbyty students will spend the next academic Gwynedd. The first cohort of students will The School of Medicine is always year based entirely in communities. graduate from Cardiff University in 2023. looking for opportunities to develop their educator base. Based on an internationally tested model The recruitment for the 2020 cohort is of ‘longitudinal integrated clerkships’, already underway and interviews for the If this article has sparked your interest placements have been secured with GP graduate entrants will be held in February in getting involved with the C21 north practices across BCUHB and students will 2020. The School is also currently accepting Wales programme please contact remain in one placement for the duration expressions of interest from students [email protected] of the year. Students will benefit from who wish to transfer following successful the positive elements reported by the completion of year 1.

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The Challenge aims to inspire pupils to Funding Boost consider careers involving science and is run by staff and students from the School 4 For Cancer-killing of Medicine. ‘Smart’ Viruses Both English and Welsh finalists included a Nearly £1.4m in funding by Cancer North/South Wales split of teams - Brynteg Research UK has been awarded to School, Bridgend v Ysgol Brynhyfryd, Ruthin, scientists to support the development of (English) and Ysgol Bro Morgannwg, Barry cancer-killing viruses. v Ysgol Tryfan, Bangor (Welsh). The worthy 2019 winners were Tryfan and Brynteg.

Cracking “Virus Code” 2 Could Help Fight Cancer Virus experts have uncovered, for the first time, how a virus known as Adenovirus type 26 (Ad26), which has been used effectively in a tamed form as a vaccine, can infect human cells. The research, published in the journal Science Advances (https:// advances.sciencemag.org/content/5/9/ “Oncolytic” viruses are widely seen as the eaax3567), provides the first detailed next breakthrough in cancer treatments. analysis of the structure of the virus in They destroy cancer cells but leave health complex with its newly discovered receptor. cells unaffected. Dr Alan Parker said “Our research finds that Ad26 uses a type of “Viruses haven’t evolved to infect and kill sugar found on the surface of most cells to cancer cells - unfortunately they infect enter and infect human cells,” according to healthy cells, making us ill in the process. Alexander Baker, who led the research. Our research has focused on generating The School of Medicine has ‘smart viruses’ that can discriminate By understanding how the virus infects between cancerous and healthy cells. a successful track record of human cells the team believe this will allow contributing to society through them to develop antivirals to prevent the “Our next challenge is to engineer the virus to make it even more potent and deliver this its Research, Learning and spread of infectious forms of Ad26 and will result in the development of more effective to clinical trials. This funding from Cancer Teaching, and Innovation and vaccines, based on tamed Ad26, to fight Research UK will accelerate this process infectious diseases as well as cancer. and help us to deliver these exciting new Engagement activity. Efforts therapies to cancer patients sooner.” by many staff and students Two Medic Societies highlight a rich variety of ways Restart A Host First Aid Day in which the School is engaging 3 5 Heart Day 2019 and benefitting society. Here Our medical students, led by fifth year are just ten recent examples: students Hayley Taylor and Elliot Phillips, taught CPR to members of the public at locations in Cardiff as part of the World Restart a Heart Day on Wednesday 16 2019 Life Sciences October. 1 Challenge Winners Restart a Heart Day is an annual initiative led by the European Resuscitation Council and the Resuscitation Council (UK) alongside other partners, with the aim to raise awareness and improve the low On Halloween, two Cardiff University numbers of people surviving out-of-hospital societies- MediCan and WEMS- worked cardiac arrests. together to put on a free day of first aid activities for Welsh sixth formers with an interest in studying medicine. The morning was spent in mini lectures giving the basics, before putting the pupils through their paces! Our volunteer medical students acted as casualties in (very dramatic) The Life Sciences Challenge for Year 10 scenarios including basic life support and pupils features parallel competitions catastrophic bleeds. After a whistle stop for Welsh-medium and English-medium lunchtime tour of UHW pupils settled down schools. It has grown since its inception for talks and group work about applying to in 2013, and this year attracted entries medical school. The pupils enjoyed the day, from over 100 teams, involving almost 500 giving it an average rating of 9/10! pupils across the whole of Wales.

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Hayley said: “Anyone has the ability to save antibiotic resistance) was the favourite. £2M Trial Seeks To a life. Chest compressions are simple once Very enthusiastic scientists.” you know how, and automated external 9 Inform Better Use Of www.cardiff.ac.uk/superbugs defibrillators (AEDs) are becoming more and Antibiotics In Sepsis more common in public places. Chronicling The The Centre for Trials Research is to “If people are taught these skills, and shown coordinate a trial looking at the use of that AEDs are designed for anyone to use, 8 Visual Hallucinations antibiotics in sepsis. Sepsis is a potentially they could have the skills and confidence to Described By Patients life-threatening complication of an save a life.” infection and it is estimated that 52,000 The Delirium Study led by Dr Martyn Stones, people in the UK die every year as a result Psychiatry trainee and PhD student at the of it. Optimal treatment includes early New Postgraduate School of Medicine in collaboration with recognition, prompt antibiotics and fluids. Diploma In Healthcare Jan Sharp, Senior Medical Artist at the 6 The trial will look at emergency assessment University Hospital of Wales, provides a Planning Launched unique insight into patients’ subjective of sepsis and whether antibiotics are being Healthcare professionals tasked with experience on the intensive care unit (ICU). oversubscribed, which experts cite as a planning the future direction of the NHS significant factor leading to increasing Delirium is a common condition affecting in Wales will receive academic training at antimicrobial resistance. about 20% of all hospital patients. Cardiff University. Symptoms fluctuate and include poor Emma Thomas-Jones, senior research fellow The Postgraduate Diploma in Healthcare attention, disorientation and in severe at the Centre, said: “The aim of the trial is to Planning will be delivered by academics cases visual hallucinations and paranoia. assess whether the addition of a point-of- from , the School care blood test can aid clinicians in their The aim of this study is to investigate the of Mathematics and the School of Medicine. decision-making around the requirement relationship between the biological and The 18-month programme of learning will for urgent antibiotic treatment in patients psychological changes that occur in patients involve professionals from across Wales – presenting to the emergency department on intensive care after heart surgery. from seven health boards and three with suspected sepsis, which will hopefully NHS trusts. Patients described their visual lead to a reduction in antibiotic usage hallucinations to Jan Sharp who used without increasing risk of mortality.” Funded by Welsh Government and NHS photo-montage in an attempt to accurately Wales, the course is part of a wider initiative represent the hallucinations and enable to develop employees already working in Hot Drinks Are viewers to experience what they saw. healthcare planning in Wales. A total of 10 The Most Common 125 people will be trained over five years. Cause Of Burns To Superbugs Science Young Children Shop Success Research shows that more than 50,000 7 children in the UK attend hospital with burns each year, with the majority happening to children under five. Hot drinks account for 60% of hospital attendances with burns in children under three years.

Dr Jonathan Tyrrell and his team set up shop in Cardiff St David’s 2 last summer, providing visitors with the opportunity to find out more about the microbial world and the increasing threat of antibiotic resistance to public health globally. During the two week period, 6566 visitors enjoyed a mixture of The SafeTea campaign is based on evidence activities including games, arts and crafts collected by researchers from Cardiff and laboratory experiments and 1626 University, the and the youngsters became ‘Antibiotic-Resistance University of the West of and tested Champions’ representing 200 schools in collaboration with early years teaching throughout Wales. staff and parents of young children. Superbug visitor quotes include: Professor Alison Kemp, who led on the research, said: “To avoid risk, parents should “The children enjoyed the event. The keep hot drinks out of reach of children, never activities were brilliant and informative. pass a hot drink over a child, or hold a drink They liked the coconut shy game.” and a baby at the same time. We also advise “Engaging for my boys, I was surprised by them to learn the correct burns first aid to their understating of antibiotic use and help them in the event of an accident: Cool happy they learned the rules throughout the the area under running water for 20 minutes; science shop.” An exhibition of these strange and Call for medical advice, NHS Direct or 999; bizarre, dream-like scenes can be seen Cover the area with clingfilm. The moments “Interactive activities to help children in the building, Maindy following a burn are the most critical time for understand complexity of antibiotics. Road, Cardiff. preventing long-term damage.” Station 11 (Fighting back, how we combat

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Qi Zhuang Siah (Medicine 2017-) I am a third-year medical student at Cardiff University, and I am particularly passionate about the role of research in driving the medical field forward. I plan to take up research alongside my clinical practice in the future. At the moment, my 2. Who is your personal or interests involve looking at the ReMEDy talks to Dr Catherine professional hero? pathophysiology of Diabetes and the services delivered by healthcare professionals to provide Britton-Jones, alumnus; Qi CB My parents, they have always put me the best treatment and care for patients with Zhuang Siah, undergraduate and my sister’s needs before their own Type 1 and 2 Diabetes. student; Dr Martyn Stones, needs, without their support I wouldn’t be where I am now. postgraduate student and 4. What is/was your favourite thing QS My brother has always been my source about living and working in Wales? Ruth Coomber, member of of motivation. He has encouraged me to staff, to ask the questions we become the best version of myself and CB Cardiff is an amazing city with the coast and mountains close by and all the love to know the answers to! continues to help me grow. He truly has helped shape me into who I am now – and amenities of a big city but on a smaller for that I am super grateful. Most (not all) of scale. With family and friends close by what 1. As a child what did you want my success could easily be attributed to his more could I want from a place. to be when you grew up? help and also nagging. QS At the beginning, it was a very big CB When I was a child, I remember wanting MS My first job was in the biochem labs at transition to move to the UK for university, to be a mummy. We had a great fancy the old Cardiff Royal Infirmary. The world but the people whom I have met in the past dress party in medical school to celebrate leader in Forensic Pathology, Professor 2.5 years have made it more tolerable. being half way through the course and the Bernard Knight worked out of the mortuary Another thing I really like about Cardiff theme was ‘when I grow up I want to be a… next door. I used to measure the blood Medical School is the large international I dressed up as a pregnant lady with a small alcohol levels on the cadavers for him. His student community which I can always turn baby doll in a baby carrier’. forensic pathology book is the best medical to when I am feeling homesick. text book I have ever read. MS I went to , it was the third biggest school in Europe when I Catherine Britton-Jones RC My personal hero must be my mum. Bringing up two children on your own, attended, so lots of friends and probably the (MBBCh 2007) working part time and giving us a happy best rugby teachers and best sports teams After graduating in 2007 childhood deserves a “hero” status. ever! On my first day our PE teacher Mr I have spent the last 12 Williams put me in the school rugby team as years rotating through 3. What first brought you to our a winger, I never looked back. He went on to most of the South School of Medicine? teach sporting heroes; Gareth Bale, Geraint Wales hospitals. I Thomas and Sam Warburton all in one year, am currently enjoying CB Growing up in Cardiff and wanting to unbelievable! my 2nd maternity go to medical school in Wales, Cardiff med leave having recently school was the obvious choice and being RC It has to be the friendly people… a completed my training in close to home meant I had the benefit beautiful capital city (with great shopping) anaesthesia and am excited of being able to take my washing home with beautiful beaches and landscapes on to commence my first consultant job when and grab a home cooked Sunday lunch your doorstep. I return to work in 2020 at the University whenever I wanted. Hospital of Wales. 5. What does a day in your life look like? QS Well, it was the only offer I received. However, it hasn’t turned out to be a bad choice CB Busy and long. Trainee life had me up QS I have always wanted to be a after all. The only downside is the weather. at 05:30 to commute to various hospitals. commercial pilot. I love travelling and I am looking forward to living the dream of exploring the world, and I feel that being MS I am from Cardiff and have always worked not having to commute so far to work and a pilot would fulfill my dream. in Wales (mainly as a process improvement having a lie in till 6 am when I return to work engineer) except for a short stint as a MS I didn’t know then and I don’t know now! as a consultant (I have 2 small kids – 6 am medicines inspector for the MHRA in . I never wanted to be tied down as there is too is definitely a lie in!) In my spare time I was a parachuting trauma much interesting stuff to do. I think I wanted to medic in a Llandaf Territorial Army unit. My QS As we speak, I am on my first block of do everything. In the 6th form I was considering boss, a surgeon, suggested doing medicine placement in . Like pharmacology and toxicology. so I went to Hull-York Med School. I wanted to several of my peers, I have a typical 9 am RC I can’t remember being very career come home to do my medical jobs in Wales. to 5 pm day of placement. However, if I am focused … at the age of seven, I can I find it a real advantage as a psychiatrist to lucky, I have a late start with an early finish. remember always wanting to work in a know where my patients live and work and MS Research days: arrive at intensive care post-office or work in Tesco! There was one speak ‘Cardiff’ with them. at 06:00 to collect patient samples, then other career-direction I was interested in but RC A part-time role working in administration into theatres at 08:00 to collect samples you will have to ask me about that one. which fitted in around bringing up my family. from patients as they are prepared for their Twenty years on and I am still here! operation. Then into the lab to prepare the samples for storage (a lengthy process), then back to ICU to assess the patients. Then back

10 REMEDY Edition 33 – Winter 2020 Contact us: 029 2074 6735 Visit us: www.cardiff.ac.uk/medicine over to the surgical ward at 18:00 to recruit ever for a psychiatric disorder. Specifically, to new patients and perform more research be able to stratify patients with delirium into Ruth Coomber questionnaires. Then cycle home to bed. appropriate drug therapies. When I get time, I I have worked in the Liaison psychiatry days: see patients in would like to do fine art, exploring physical and School of Medicine medical hospitals and hospices all across mental trauma. for 20 years in Cardiff, always fascinating and challenging. a number of RC To be able sing as well as I think I can sing. administrative RC It always starts with a coffee followed by and management a day in the office with meetings, attempting 8. What is the funniest thing that has roles. I am currently to keep on top of emails and responding happened to you recently? the Manager for the to different deadlines – every day brings a CB Umm does the word poonami mean Centre for Medical Education and the Division different challenge. Home via the gym and anything to any of you? of Population Medicine. then time to relax and at this time of year, QS I was at this new Pho place the other day, lighting the wood burner getting ready to start and I specifically told them about my food again the next day! like something, don’t do it, do something allergies. However, they messed up my order. I else. If you are thinking about academia, 6. How do you relax? was not too bothered by the mistake. However, write one paper during med school, network the frantic reaction of the waitress to stop CB I love to spend time with my family and make friends. Don’t take yourself too me from eating made my day. She literally and friends. I have made some incredible seriously, always be completely honest, ask came running. In the end, I GOT FREE LUNCH. friendships along my journey through medical for help when you are getting stuck, never Moral of the story: having a food allergy isn’t school and onwards. Once my kids are a little criticise a colleague, eat breakfast, wear necessarily bad. older, I am looking forward to rekindling my love sunscreen and don’t forget to network. MS Funny strange, I treated a delusional of sailing and other hobbies that have fallen by 11. What does the School of Medicine the wayside. psychotic patient with niacin, the stuff they spray on cornflakes (vitamin B3). He had a need more of? QS I watch a lot of television programmes special kind of neuroendocrine tumour. CB When I was in university we had med and variety shows. Spending time with I saw a patient in A+E the other day. I asked club, a great place to unwind and relax after friends and going for a run also help me “how can I help?”. He said “Doctor I just a busy and sometimes stressful day. Since wind down. However, ultimately, I feel the want to be normal”. I thought to myself it no longer exists, I would say that you can most relaxed when I am talking to my “you’re not the only one!”. never have too many social activities. parents on the phone. Their voices have a calming effect on me. RC Not so recently but getting stranded in QS Supportive members of staff and Prague airport with my sister because the supervisors who will go the extra mile to Martyn Stones (BSc, PGDip passport details were incorrect. Rebooking help students to achieve great things or to, flights back to Birmingham to pick up a hire at least, support students who are troubled 2015, PhD 2017-) car to drive back to Cardiff. Arriving back by personal circumstances and family For my PhD I am at 11pm and realising that the only vehicle issues on top of the stress from investigating the available was a highway maintenance van. their studies. biochemistry of delirium on Let’s say it was an adventure. MS Needs to persuade the Deanery to help accommodate junior doctors with a more Cardiac Intensive 9. If you could have any job in the Care. The patients flexible approach to medical training. Every develop distressing whole wide world that you could trainee lost is one less doctor to serve the psychotic symptoms imagine or make up, what job would , leaving more strain on the including confusion, that be? doctors who are left behind. visual hallucination and paranoia. CB Having finally reached the end point in RC More opportunities to celebrate the staff I also work part-time as a speciality Locum training I am not sure I would like any other job, and students who make up our School. SHO in Liaison Psychiatry at the University but being paid to sail around the world would Hospital of Wales (UHW). I am currently be a pretty cool job for a couple of years. 12. If you could turn the clock back, collaborating with Jan Sharp, senior medical what would you do differently? artist, at UHW who produces images of the QS Probably getting paid as a domestic CB If I could turn back the clock, I would patients’ hallucinations. helper in my house by my parents. make sure that I maintained a better work- MS Monday: Medicines inspector; life balance, too often my balance was MS Gardening, restoring classic motorbikes Tuesday: Process improvements at UHW; skewed towards work with exams taking and swimming lessons. I grow apples for cider, Wednesday: Liaison psychiatrist; Thursday: over. If I had to do it all again, I would try to hops for beer and Riesling grapes for wine. Research and teaching psychopharmacology maintain more time for my hobbies. There is to medical students; Friday: Research; more to life than passing exams. RC I can’t believe I am saying this, but Saturday/Sunday: TA, hobbies and family. going to the gym after work, which I do a QS Nothing - I am happy at where I am few times a week… it really helps to clear RC Any job that involved travelling the world right now. and getting paid for it!. your mind after a long day. Spending time MS Do applied maths ‘A’ level, and after with friends and family with a glass of Pinot 10. What advice would you offer sixth form join the army to be an airborne Grigio blush also does the trick. School of Medicine students today? paramedic. All the rest I would do the same. On reflection, I would have eaten breakfast, 7. What is your secret ambition? CB Medicine is a marathon not a sprint, you worn sunscreen and networked more. (just between us) need plenty of stamina. Make sure that you RC Nothing. I am a firm believer that if CB To sail around the world. remember the importance of work-life balance. you look back and there is something that QS Try to push your limits while you are in QS To live life to the fullest every day, you really want to do, there are always medical school. Don’t be afraid of trying. Seek I presume. opportunities to still do it. help when necessary. Doubt anyone will bite. MS To be a neuropsychpharmacologist, a bit like David Nutt. My dream would be to develop MS Plan flexibly, have an open mind, don’t the first routine panel of biochemistry tests put your heart on one speciality. If you don’t

Edition 33 – Winter 2020 REMEDY 11 Diagnose the past, research the present, repair the future

Cardiff MedSoc 2019/20

Within Cardiff University MedSoc, one goal is to provide academic support for students, both in terms of revision of course content and looking towards the future of students’ careers. Within the last month Cardiff MedSoc have organised a mock Year 4 ISCE, attended by 180 students, a Clinical Careers Evening featuring 29 specialities and attended by approximately 100 students, as well as multiple peer-led From left to right: Emily Lloyd, Marcus Powis, Thomas Grother, Ellen Davies, Jessica Randall, Taylor Youngsmith, revision sessions aimed at Thomas Beresford, Lawrence Pugh. students in phase 1 (previously A more contemporary introduction to year, and will be putting it all into termed ‘pre-clinical’). Cardiff MedSoc is the welfare team, practice before next year’s conference Cardiff MedSoc are proud to maintain who act as an initial point of contact for in Nottingham - hopefully we can bring close links with medical school struggling students. As well as providing the conference to Cardiff the year after staff, and hold positions on the a formal line of support for members to show students from other medical Undergraduate Board of Medical Studies who may be struggling with stress, schools what they’re missing out on!” (UBOMS), the Education Committee, or worried about exams, they also the Professionalism Committee, the run a variety of events. These events Cardiff MedSoc are always happy Equality and Diversity Committee, and include the Welfare Café, a recurring to hear from alumni - whether you’d event where the committee hand out have recently been invited to advise like to share stories of your time at refreshments and provide support and the Admissions Team. Jessica Randall, medical school, or if you have any advice for any student who needs it, Medsoc President, 2019/20 said: “The interest in helping to teach or talk medical school actively considers student and the Inner Child Day, which aims to to students. Feel free to contact opinions, and we’re privileged to have provide fun stress-relieving activities the Alumni Rep, Lawrence Pugh; a direct impact on policy decisions. Our for students during the exam season. academic team, including an academic Jessica comments: “We’re very proud or President, Jessica Randall, at chair and representatives from each year to have welfare representatives in each [email protected]. group, have regular meetings with the year group, so everyone can feel that medical school to discuss course content they have somebody who will listen and and assessments, ensuring student understand if they need it.” To keep up-to-date with MedSoc feedback is acted upon by staff.” activities (and reminisce about The Cardiff MedSoc committee your time at Cardiff), you can also recently attended the National MedSoc Marcus Powis, MedSoc Phase 1 Vice follow on President, 2019/20 said: “Excitingly, Conference in Birmingham, an annual facebook.com/CardiffMedSoc we continue to provide a range of social student-led event where medical students events throughout the year, including a from universities across the country meet @CardiffMedSoc. Freshers’ Ball, which acts as a welcoming to share ideas and advice around a range introduction to university for the new first of topics, such as student engagement, welfare, and communication with the Editor: Sarah Hatch, Cardiff University year students. Our annual Christmas School of Medicine, Heath Park, Cardiff, Ball, attended by members from all year medical school and Students’ Union. CF14 4XN. Marcus said: “It was a great weekend, The Editor wishes to thank all contributors groups, is always a nice way to end the to this edition of ReMEDy. term and truly get into the festive spirit! with seminars and lectures in the daytime The Editor reserves the right to edit and a ball at the Botanical Gardens in the contributions received. Whilst care Other fun activities include karaoke is taken to ensure the accuracy of nights, pub quizzes and we hope to evening. It was amazing to meet students information, this cannot be guaranteed. from other universities (our potential Views expressed in ‘ReMEDY’ do not expand our social calendar to include necessarily reflect those of the School. booking out a cinema screen and future colleagues!) and brainstorm ways Feedback and items of interest relating to help students make the most of their to the School are welcome and should trampolining events!” be sent to: time at university. We now have some [email protected] bright ideas for the rest of the academic Cardiff University is a registered charity, no. 1136855.

12 REMEDY Edition 33 – Winter 2020