Round Up

Today's post will cover a few bits and pieces - including Daisy's promised introduction to the NHS couch to 5k programme (she's going to keep us updated on her progress over the coming few weeks). There are also some news stories about disability or the NHS that I would like to highlight.

Hi, I'm Daisy and I'm Flo's fiancee. 4 weeks ago I started couch to 5k using the NHS choices podcast. I would thoroughly recommend couch to 5k to people who are interested in taking up running and don't know where to start. I can't believe I've been running for 4 weeks and I'm excited to tell you a little bit about why I decided to start running and to maybe review some running podcasts/apps for beginners. In my next post I'll explain how the c25k program works and why I started. I look forward to sharing this with you!

We've been asked to spread around this open letter to Iain Duncan Smith from the Broken of Britain, about how it feels to hear a life changing diagnosis, what it feels like to be ill, what it feels like to be a carer or to worry about a family member or friend and their health. It felt especially relevant yesterday, as we were getting our head around the fact that yet another thing has happened to make us feel vulnerable. Please consider sharing that link on your networks, to encourage people to remember that any of us could become ill at any time.

Today (I think) the Commons will release a negative report on ATOS "healthcare"(Guardian story here), the (IT) company who have been contracted to conduct "assessments" for DLA and ESA. There are some awful stories of bad practice out there, assessors are expected to deny people, and the huge number of individuals who are then granted at appeal shows how ridiculous the system is. Reports are almost always completely inaccurate, but it is hard to refute, as any form of recording is not allowed (without huge effort and expense as they require a trained engineer to examine the equipment beforehand). ATOS and the ridiculous system of computer assessment are the reason I have still not claimed for DLA (once I was aware of it), although I have been eligible at various rates for over 10 years now. And now everything's changing, to make these benefits harder to claim. I'm really scared about what will happen to some of my friends and patients, and to me - especially if the appropriate adaptations cannot be made to enable me to work.

Next, Bendy Girl has posted a great video showing what happened at the first 100 Voices conference (you should watch her keynote speech also, it was very well pitched)- a real first - the Brandon Trust (a Bristol based charity supporting those in SW England with learning disabilities) asked their clients with learning disabilities what they wanted their priority to be for the upcoming year. The video is a really inspiring example of facilitating people to make their own choices, rather than patronising them. It's made me think really hard about how I would try and facilitate an individual who was learning disabled to make decisions about their own care. Employment was the issue voted as most important (the variety of voting methods offered was really cool) and the Trust has committed to taking that forward.

This week, the government slipped out the first wave of privatisation of the NHS in the middle of the Murdoch enquiry. Luckily twitter is wise to that trick. Here Max Pemberton argues that this truly is the end of the NHS - because while any aspect is privatised, it is no longer a national, nationalised service. I'm worried, and mainly because any examples of private contracting of other services by the NHS, such as cleaning, seems to have been linked with a reduced quality, because people are treated like crap (but it's ok because it's not directly the NHS doing it...) and so it's not worth it and they're not motivated to do a good job.

I hope you find something to interest you in there. Following yesterday's A and E trip in my placement hospital, tomorrow I'm going to talk about different experiences of A and E. I also took part in my first twitter-based journal club on Sunday. I really enjoyed it, and will post about it later in the week. (Google for more info, their exact twitter name escapes me, but the tag is #twitjc)

Have you come across any stories this week you want to share?

Just Checking In

Hi,

Just a quick message to say that I'm sorry not to bring you the promised post tonight. I haven't forgotten you, but I've managed to have a fracture-dislocation of my rib today so spent the afternoon in A and E and the evening feeling a bit vulnerable and emotional. Tomorrow's post will be about starting to run, as promised, and also be a bit of a news round up of various disability and NHS stories that have caught my eye.

Foundation Programme : Applying for flexible training

[This post is now several years old. In fact, I am now working as a less than fulltime FY1 on a 50% pro rata basis. The first part of the application process is ranking your preferred foundation schools. When you find out which foundation school you have been matched to, you should contact them about working less than fulltime. They require at least 3 months notice before you would start work. In my foundation school the only official options now for the foundation programme are fulltime or 50%, although I know one doctor working on a supernumerary basis. You can be less than fulltime for reasons of childcare, health or for some professional reasons. I will write more about my experiences now I have the answers to a lot of my questions.]

Again, this is just my understanding, which is not a substitute for actual information being obtained from a proper grown-up, k?

This post has actually been several months in the brewing - that's how hard it is to get any straight answers on this topic. I still have plenty of questions left unanswered, as you'll see.

If you wish / need to complete the foundation programme on a less than fulltime basis, you go through the application process as normal, until you're allocated to a foundation school. Then it gets confusing, because you are then told to contact the Associate Dean for Flexible Training of the relevant deanery, even though you won't know which deanery you'll be in until you've got a job. The first area which needs further clarification.

As far as I understand from conversations with the med school, you wait until you have a job, and then you ask for flexible training. This is good in terms of anti-discrimination-ness, and would be fine if the NHS wasn't as it is. I'm just worried that they won't get anyone extra to cover the rest of 'my' hours, so other juniors will take up the slack, and everyone will hate me. Anyway...

My med school has already had a 'quiet word' with the relevant person in my deanery (with my consent, because it is for his ears only, and so that we can have conversations about the various options early - he is not part of the selection process). This is fine, as long as I get a job in the deanery I want to, otherwise I'll have a frantic few months trying to sort this all out, during my finals.

At this point you have to provide evidence to back up your reason - which are basically health or caring issues (although there are a variety of more unusual circumstances that can qualify). This then goes through the Associate Dean, and then to someone else (hospital, trust...?) who can approve or deny the application. (Apparently my letter of diagnosis from my consultant which the med school has a copy of is enough evidence. I hope this is true.)

That is the sum total of the information that I can find.

Flexible training during other stages is calculated on a pro rata basis (as in, if you're doing 0.6 of a fulltime job, you do 60% of the nights, 60% of the on calls and 60% of the hours. You also, as far as I can tell, get 60% of the pay, and 60% of the annual leave entitlement.), so I imagine this is true for foundation years.

However, there is no information about what would happen for those who cannot work night shifts, or who would need to work half days, for example. I personally need to know if I would be expected to work the same blocks of shifts as other folk (for example 12 days on) with just longer to recover, or if I could work shorter blocks, with more regular breaks.

There is also no information about how the programme works on a LTFT basis. Do I do 4 foundation years? And if so, do I get a 'normal' F1/F2 allocation, and then have to find locum jobs to bring up my hours, or do I get allocated to 4 years worth of job? When in those 4 years do I get my full GMC registration? After year 1, or after I've done a 'normal' 1 year's worth of hours?

There is so little information about this, which is really frustrating. Why should I, as a disabled applicant, have less of an idea of the application process I will go through than a non-disabled applicant? The long and short answer is that so few people do flexible training during foundation years that it's really dealt with on a case-by-case basis. Not helpful.

Yes, we are individuals, and a lot of applicants for flexible training will have different needs, but even a recognition of that would be useful. There is just no indication about how 'flexible' flexible training can be, if needed. This is a real flaw in the one-size-fits-all national application process. Obviously, I haven't been through the system that came before, so I don't know if it was any better...

There seems to be every chance of me pushing my way through the application process, only to get a job and not be able to take it, because the hours will be unworkable. There is also no way to factor in things like travel time or relative accessibility of different wards / hospitals into the process, but that is another conversation entirely.

It just feels very much like disabled applicants haven't been taken into account, or properly catered for at any stage of the planning process.

Does anyone have any more information about flexible training? I've never even met any F1/F2 who aren't training fulltime.

Foundation Programme : FPAS and disability

[This post is now several years old. For up to date information on FPAS, please see www.foundationprogramme.nhs.uk]

Here are some specific things to consider related to FPAS applications as a follow-up to yesterday's post, again with reference to the 2012 applicant's handbook :

- Some with evidence of a good reason they need to be placed in a specific foundation school (for example, school-aged children, staying with a certain healthcare team) can apply to do so. The application and evidence must be submitted by 29 Sept. However, this isn't a guarantee that you will get a job in this foundation school - you still have to have as high a score to be allocated a place as you would otherwise.

- The form does ask if you are disabled or have health problems. This will not affect your allocation to a foundation school (which is based purely on your score), but the foundation school will see it. Bear in mind that it takes time to put adaptations in place so it is probably wise to disclose at the time of application. You can tell them later in the process, but you don't want to give folk any excuse to not adequately deal with your needs.

*Edit : I am investigating this point further, in relation to a comment left below.*

- If you want to link your application to somehow - which may be extra important if, like me, your partner is also your carer to whatever degree - bear in mind two things :

1) You will both be assigned based according to the lower of the two scores

2) Linking applications will limit the number of posts you can apply for, because not all posts have a suitable 'sister' post that will work.

You need to talk this stuff out in advance, to avoid nasty surprises.

- Your referee will be asked if you have any health problems which will have an impact on your work. I think that this is really odd. To be frank, I don't think it is your referee's place to disclose personal information about you. For one, these referees are colleagues/supervisors - and my health, or lack of it, is none of their business to start with. I don't think it's appropriate, but maybe it's a standard questions for employers to ask referees, I don't know.

- The handbook points out that spelling and grammar mistakes can cause you to be marked down in the questions section. I would suggest that if this is likely to be an issue, you ask someone to proofread, which is allowed (and is probably a good idea anyway).

Foundation Programme : FPAS, the basics

[This information is now out of date - please see www.foundationprogramme.nhs.uk]

Hey gang. I'm doing some research about the foundation programme today* because the applications are slowly sneaking up on me, and I need to get some things straight in my head. I'm hoping that Seph's going to help me a little bit, because she's just jumped through all of these particular hoops.

I'm planing to start off with the basics of how applications work (because every time I think I have it straight I end up thinking "but what the hell is a foundation school?"** and that's me back to square one). I'm using the 2012 Foundation Applicant's handbook (available here) for reference. Note, this post should not be considered the final word on anything, this is only a summary of my understanding. Refer to the handbook or other official documentation. Thanks =)

Application Form

You will register on FPAS between 3 and 10 Oct, ready to complete the application form between 10 and 21 Oct. The form consists of :

Personal Information - unscored : includes address etc, but also whether you want to link applications, and if you want to disclose an illness or disability (which I'll discuss tomorrow)

Qualifications - unscored : degrees awarded and such - also what you've been up to if you've not gone straight from med school into F1/F2

Clinical Skills - unscored : a tick list of skills supposedly so that your employer knows what you need to cover during F1/F2. I wonder if anyone actually looks at it?

Equal Opportunities - unscored : for the foundation school to see whether they're getting a good enough mix. Doesn't seem to include sexuality, which is odd as most forms like this seem to.

References - unscored : one doctor who can talk about your clinical skills, and one from someone within the med school (they have from 16 Dec-24 Feb to do it, but basically if you don't have 2 for your employer by August you can't start work). The list of questions they'll be asked is available in the handbook, one is of particular relevance here, which I will discuss tomorrow.

Preferences - unscored : you have to sort every foundation school into order of preference.

Questions - this is the only scored bit : 1) Education Achievements - other degrees, publications etc are scored up to a maximum of 10 points. 2) 5 questions, requiring a 200 word answer, which are related to the "Person Specification", which are worth up to 10 points each. The scoring of these seems to have no rhyme or reason, which will explain why all the people that you think are the best in your year won't get a job in the first round.

Quartiles - as far as I know, these don't go on the form and supplied by your medical school. Basically, you get points out of 40 depending on where you stand within your class, which takes you up to a score out of 100 - you cannot appeal this score. Irritatingly enough for me this will mean that the last assessment which will count towards this is 3rd year exams, which will be more than 2 years ago when I apply. Finals happen after application, and in terms of F1/F2 all that matters is pass/fail.

What next?

If you score high enough to get a place in your favourite foundation school then that's you. Otherwise you move down the list until you end up in your favourite of the foundation schools that you score highly enough to get into. (I believe this is a slightly different system to last year)

By 8 Dec if all goes to plan you will be told you have a place at your favourite foundation school. Otherwise you'll be told that you're on the reserve list, and what will happen next. I don't really understand the explanation of it. Once you have a foundation school, you apply for actual jobs - the system for doing this differs from place to place. Some have interviews, some have to rank every.single.job. in order of preference, some have it easy... You will find out your job on 15 Feb, unless you are on the reserve list, in which case you will find out between May and July.

Apparently, at some point this year we're also supposed to fit in a Situational Judgement Test, as a pilot for next year's applicants. I believe this will be an hour-long written paper. (Will extra time be allowed I wonder?) They're also piloting a new score - the Education Performance Measure - which I think will just involve them doing calculations based on information about us they already have.

*Foundation programme = first two years of postgraduate training out of medical school, aka F1 and F2

**Foundation School = not an actual school - made up of all the med schools, deaneries, hospitals, NHS trusts etc in a given area (Scotland, Wales and N Ireland are all foundation schools, England is split into regions). To be honest, I'm not entirely sure what their role actually is.

Guest post by Seph : how to survive moving house

As you will have noticed, this is a guest post. Assuming Ms Disabled Medic approves it, this will be my first guest post, but I hope to write a few more in time.

So who am I? I'm a medic, although I have now completed my studies and I'm about to start work as a junior doctor or FY1 as it's known. I have just (as in two days ago) moved about a hundred miles, which was, er, interesting.

I do not consider myself disabled, but for a long time I have had an undefined depressive illness. Medical school presented some interesting challenges which I hope to discuss at some point - tips for surviving final exams, special circumstances in MTAS, starting work and so on.
This post talks about moving house, because it's something that medics tend to do a *lot*, and it can use an awful lot of spoons. It's commonly known as one of the most stressful life events to go through. My partner is dyslexic so he and I both tend to get very tired when trying to do certain things. I also have a quite limited capacity for stress and things going wrong before I lose the plot. This post comes from our collective experiences over the past couple of weeks.

1. Know your limits. Figure out what you can do and what you can't. Ask people for help, pace yourself, and if you can, pay removal companies to do some things. If you know you can't shift your worldly possessions up three flights of stairs, don't try. You'll only end up knackered and that doesn't help. Don't feel bad about not doing everything. Everyone has limits.

2. Rest appropriately. If you tend to get fatigued you probably know your limits pretty well anyway, but this can go out of the window when you're trying to get so much done, particularly if you're working alongside someone who has different limits to you. Don't feel guilty if you need to take more breaks. You might feel like you just want to get it over and done with but you know the reality is it will get done faster and better if you're not exhausted.

3. Make a "home" space early. Pick one room – bedroom, living room, whatever you want (although it needs to be comfortable, so maybe not the bathroom!) - and make it as homely as you possibly can as fast as you can. This means unpacking that room first, arranging some of your bits of artwork, photographs, books, cushions, birthday cards or other familiar, homey items, and moving most of the boxes out. This way, even if the rest of the flat is total chaos, you have one area where you can go to rest and relax a little. When you're freaking out because the place is a madhouse and there's loads to do, you can go to your “home” space, take a few deep breaths and feel a bit better. A plant or some flowers might also help, plus your stereo or tv or even just a clock for some friendly noise.

4. Talk. If you have a roommate or a partner, sit down with them well before the move and talk about it. Even if you know each other well, moving will raise unique issues and it is worth going through them. Try to make a rough list of tasks (changing addresses, organising particular rooms, etc) and decide who could do each one. It won't work out exactly that way, and there will always be things you miss, but having a rough plan and a good idea of each others' abilities and limits will help.

The picture shows a variety of cardboard moving boxes taped shut

and stacked up in piles. By skrewtape on flickr.

5. Take your time. Start packing in plenty of time before the move (more than three days. Oops!) and don't expect to have everything sorted out the day after. Be realistic.

6. Figure out what you need. Is your support network largely on the internet? Do you need to have a working phone line for emergencies? Do you need to set up clinic appointments, blood level monitoring or counselling? Whatever it is, make sure you have it in place well before you move. (I suggest looking into these things at least a month in advance because it always takes longer than you expect.)

7. Figure out what you need (part 2). If there are any items you absolutely need - splints, meds, hot water bottle, whale song CD, blanket, cat, whatever - make sure you know where they are and that they're not at the bottom of a huge box (particularly the cat).

8. Arrange food. The last thing you want to do after a day's unpacking is cook, so make sure you have something sorted out. You'll be hungry and tired and you need something good to eat that will give you energy, not just junk food. Make some sandwiches or just put some tupperwares of food where you can find them. This is particularly important if you have a specific diet.

9. Get your prescription. If you take any medication, regular or PRN, make sure you have *at least* three weeks' supply before you move, from your old GP. It might take you a wee while to find a new GP and you don't want to run out. Also make sure that you have a copy of your repeat prescription, any relevant clinic letters, and if necessary (e.g. if you take opiate painkillers or odd doses of things) a letter from your old GP explaining your medication regime. Anything which makes it easier for your new GP to give you your medication is good. Your notes will take a while to come through, so don't rely on the new GP being able to access them.

10. Go outside. Being surrounded by boxes is overwhelming and unpacking creates a lot of dust. Go outside at least twice a day. Explore your new area or just sit outside the house and breathe the fresh air. At the very least, open a window. It will help, I promise.

Moving is hard work and it's stressful, but you'll get there.

Have you moved house recently? Did you find that it presented you with any particular challenges? What tips do you have?

This month in the student BMJ

This month's sBMJ had two articles that particularly sparked my interest.

Firstly "People with disabilities face barriers to healthcare"* - a brief article on the first World Report on Disability produced by the WHO and the World Bank. Fine, it's stating the obvious, but even what's included in the wee article seems to suggest that the report will be worth a read. I'll give you my thoughts in a few weeks.

The picture alongside the article however (I'm not sure if it's from the report or not) is the standard wheelchair-user-disabled-logo, pictured at the bottom of a flight of stairs. It's strange because as you'll see if you follow the link, the cover picture is a blurred background with a hand holding the top of a white cane in the middle - quite striking, and not 'predictable'. (There's also an article in the grown-up BMJ, but I don't have an Athens account these and I've forgotten my BMA log-in, so I'll have a look at it later) It's interesting that they've used the phrase "people with disabilities", rather than "disabled people", as the second seems to be more then norm in the UK (I'll explain the difference at some point) but I suppose it is an international document.

(Incidentally, if you're tired of wheelies being portrayed as lifeless, genderless, boring symbols, check out Hannah Ensor's website Stick Man Communications - Hannah is a wheelie herself, and has a huge talent for showing the joyful and ridiculous side of disability. And she's a bendy like me!)

There is another article called "Under Pressure"**, about stress / mental health problems in medical students. It's really quite good - thoroughly outlining the situation, but also offering some examples of good practice under the heading "Preparation and Prevention". I'm really pleased with it. It outlines the spectrum of stress-by-high-pressure, to 'clinical' mental health problems, and deals with the issues surrounding both. This issue is really important, and I don't believe it is dealt with sufficiently at most medical schools. It would be great to have other articles of this quality on other aspects of health and disability specifically for medical students.

All in all, big thumbs up. Both articles managed to penetrate the current brainfog, which is an achievement in itself.

*BMJ 2011; 342:d3618 (this is the citation it gives, confusingly enough)

**Student BMJ 2011;19:d3678