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Should there be other (non- uni) routes into Medicine/ becoming a doctor? Watch

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    (Original post by NHSFan)
    He gor AABB, which were fantastic grades when he took them in 1987.
    David Miliband fared worse than his brother when it came to his results, receiving three Bs and a D. The D was in Physics, a subject that – as he told The Telegraph shortly after he lost the Labour leadership election to his brother back in 2010 – was “indeterminably difficult.”

    yh was his brother apparently
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    Too many people would enter nursing for the ''exit opportunities''
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    Yes they should still go to uni, being a doctor is a very serious job and people's lives depend on it. If as a doctor you do something wrong to your patients, oh boy the consequences won't be good at all, so it's important doctors know how to do their job inside out.
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    (Original post by Hippysnake)
    Patient comes in with congestive cardiac failure, on Furosemide 80mg BD and all sorts of other wonderful medications. He also has CKD with a Creatinine of 146 at baseline. Now his Creatinine has jumped to 402 and his urine output has dropped. There are a few non-specific bibasal crackles, his JVP is 6cm and he has oedema up to his abdomen.

    A doctor without a rigorous academic base (or just slept through medical school)-
    Identifies the patient as fluid overloaded, prescribes Furosemide 80mg BD IV and applies a fluid restriction of 1l.
    Result: renal function goes way off. patient dies.

    A doctor with some understanding of how the body works-
    Identifies the patient as fluid overloaded, but can see the patient is not in acute heart failure. Reduces the Furosemide dose to 40mg BD IV and places a fluid restriction of 1.5l, but encourages the patient to drink up to this
    Result: patient alternates between renal and cardiac failure until either ATN or pulmonary oedema set in. Patient dies on ward 4 weeks later from a HAP.

    A doctor with a rigorous understanding of medicine-
    Identifies the patient as fluid overloaded, but is fluid depleted intravascularly. Recognises this as cardiorenal syndrome, which is pre-renal. Can see the patient does not have pulmonary oedema. Reduces the Furosemide dose to 40mg OD IV and starts slow IV fluids.
    Result: patient's renal function improves, urine output picks up, the reduced dose of Furosemide is now more effective because the kidney's are actually filtering it into the tubules, the patient fluid offloads naturally. The patient goes home.

    A doctor with too much medical knowledge (or a bowtie)-
    Identifies cardiorenal syndrome. Asks his medical students to explain this syndrome then gives them a condescending look when they're unable to answer. The SHOs are secretly praying they don't get asked next, because they don't have a clue either. He gives Furosemide 160mg BD IV because he knows that Furosemide will reduce in efficacy in renal failure as less of it is filtered into the tubule. At the same time, he starts a dopamine infusion to ensure that renal perfusion is maintained in the face of the rapidly worsening hypovolemia that the resulting diuresis will certainly cause. He knows that dopamine infusions have no evidence that they improve morbidity in these kinds of patients, but that's not the point.
    Result: The patient's cardiac and renal function improve. Until the dopamine infusion stops. Then the patient dies. The case is presented at grand round but nobody pays attention because the lasagna is ****ing banging.
    A good GP will have educated the patient about fluid balance, alternate daily/daily weights and self-management of diuretics, with regular U&Es if increased, so would never have needed his furosemide increased that far in the first place; nor admitted him to hospital, where he will get a HAP; will have optimised meds as appropriate and referred to heart failure team long before it got to this stage and had the patients PPoC and DNAR status recorded and a full Care Plan drawn up with the patient and relatives!
    And whoever finishes morning surgery first takes the orders and goes down the butty shop for lunch. And ALL the butties and cakes from there are banging and at a discount as it is for "the hard-working doctors and nurses at the medical centre"
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    (Original post by paulbarlow)
    a degree in nursing and a few years of experience should be treated as matching the entry requirements. a levels really mean nothing. most new nurses have aaa or aab. so in balance a qualified nurse will make a hell of a better student doctor than a kid from school thats been taught how to do a levels. an important point out of 30 years experience we have only known 1 nurse that trained. she still works on the same wards as she used to. she is an excellent doctor with a better skill set than your standard new doctor. sorry for the rant.
    I think a lot of nurses are amazing, talented, and intelligent individuals. But still I cannot agree with this.

    The thing about nursing, is that there are a wide variety of avenues and jobs that you can go into with it. I think it's fantastic that the many capable and nurses out there can train to become ANPs or go into managerial roles and use their skills and experience. A lot of them do extremely difficult jobs that I could never do. But the fact is that there are also jobs in nursing that are important and need to be done, and done well, but don't require a great deal of academic rigor. Lots of nurses don't have AAB, and that's a GOOD thing.

    I'm sure there are plenty of nurses with a few years experience who could handle a medical degree (though I'm sure most of them don't actually want to, but that's another matter), but there are probably plenty who would not. And that's ok

    (Also, you've said A levels mean nothing, and then said most nurses have AAB or AAA. So which is it? Do they mean nothing or what?)
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    (Original post by Ghotay)
    I think a lot of nurses are amazing, talented, and intelligent individuals. But still I cannot agree with this.

    The thing about nursing, is that there are a wide variety of avenues and jobs that you can go into with it. I think it's fantastic that the many capable and nurses out there can train to become ANPs or go into managerial roles and use their skills and experience. A lot of them do extremely difficult jobs that I could never do. But the fact is that there are also jobs in nursing that are important and need to be done, and done well, but don't require a great deal of academic rigor. Lots of nurses don't have AAB, and that's a GOOD thing.

    I'm sure there are plenty of nurses with a few years experience who could handle a medical degree (though I'm sure most of them don't actually want to, but that's another matter), but there are probably plenty who would not. And that's ok

    (Also, you've said A levels mean nothing, and then said most nurses have AAB or AAA. So which is it? Do they mean nothing or what?)
    I agree with you. I think my previous problem stemmed from the insuinuation that nurses could never be "intelligent" enough to make the transition.
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    (Original post by The Asian Tory)
    Posting from friends account.
    As a theatre practitioner, i have gained the knowledge and skills to work in a fast paced environment. I deal with CODE REDS (as in life and death situations) and staff members have to learn anatomy and physiology to a suitable standard to do their job. I've developed close relations with Anaesthetists and Surgeons which has provided me with the opportunity to ask questions and learn from them. Heck i get medical students asking me to clarify things for them.
    So please try not to belittle us health care professionals, our jobs will make yours a heck of a lot easier.
    Oh btw I have seen applicants get into medicine with ABB, so she is not lying.
    .


    My daughter entered medicine with. A*BB 3 years ago and has never had any issues. Regarding exams etc
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    (Original post by GANFYD)
    A good GP will have educated the patient about fluid balance, alternate daily/daily weights and self-management of diuretics, with regular U&Es if increased, so would never have needed his furosemide increased that far in the first place; nor admitted him to hospital, where he will get a HAP; will have optimised meds as appropriate and referred to heart failure team long before it got to this stage and had the patients PPoC and DNAR status recorded and a full Care Plan drawn up with the patient and relatives!
    And whoever finishes morning surgery first takes the orders and goes down the butty shop for lunch. And ALL the butties and cakes from there are banging and at a discount as it is for "the hard-working doctors and nurses at the medical centre"
    Unless the GP has a specialist interest in Cardiology the best they'll be able to do is start Furosemide at 20mg and send them in ?AKI when there Creatinine goes up by 7. Don't get me wrong, GPs are awesome (generally), and I plan on becoming one with a specialist interest. Generally speaking if they're on 40mg PO BD then it's likely they were discharged from hospital with that on a previous admission.

    We didn't get butties at our GP surgery. We got banging drug rep lunches though.
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    Pff witchdoctor gives me all the treatment I need and bwonko never went to any fancy 'uni' he says those places infect you with the demon spirits that make you ill anyway.
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    (Original post by Hippysnake)
    Unless the GP has a specialist interest in Cardiology the best they'll be able to do is start Furosemide at 20mg and send them in ?AKI when there Creatinine goes up by 7. Don't get me wrong, GPs are awesome (generally), and I plan on becoming one with a specialist interest. Generally speaking if they're on 40mg PO BD then it's likely they were discharged from hospital with that on a previous admission.

    We didn't get butties at our GP surgery. We got banging drug rep lunches though.
    That is rather patronising and dismissive of GPs, and shows little understanding of what most of us do these days! I have absolutely no specialist knowledge, training or interest in cardiology, but do have a knowledge of first principles, pharmacology and systems, good communication skills and allow my chronic disease patients good access. I also have a good relationship with our local cardiologists (and renal drs) if I need support and amazing practice nurses. I initiate and escalate diuretics (though usually encourage patients to self-manage, with support, once they are stable), including furosemide, bumetanide and spironolactone.
    I use ACE inhibitors, beta blockers, digoxin, nitrates, hydralazine, ivabradine, anti-platelets and statins where appropriate.
    I treat causative, exacerbating and co-morbid factors. I immunise, screen and treat related depression, discuss prognosis, care plan and document accordingly. We encourage lifestyle modification and self-management where suitable. I manage acute and chronic renal impairment and only admit when absolutely necessary and when a situation is likely to be reversible and it is in the patient's best interests, with full discussion with the patient and their relatives, if appropriate,
    I DO refer early for confirmation of diagnosis, an ejection fraction, angio, stress echo or whatever other management may need a big shiny hospital, and I use our community heart failure nurses extensively for rehab. I find patients are invariably discharged to GP care after initial investigations and interventions are complete unless they need monitoring for valvular abnormalities.
    All in 10 minutes.
    And I don't see drug reps, as I don't have the time or inclination, so we stick with the local butty shop, who also do salads, pies, something-and-chips, etc as it supports our local community.
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    (Original post by GANFYD)
    That is rather patronising and dismissive of GPs, and shows little understanding of what most of us do these days! I have absolutely no specialist knowledge, training or interest in cardiology, but do have a knowledge of first principles, pharmacology and systems, good communication skills and allow my chronic disease patients good access. I also have a good relationship with our local cardiologists (and renal drs) if I need support and amazing practice nurses. I initiate and escalate diuretics (though usually encourage patients to self-manage, with support, once they are stable), including furosemide, bumetanide and spironolactone.
    I use ACE inhibitors, beta blockers, digoxin, nitrates, hydralazine, ivabradine, anti-platelets and statins where appropriate.
    I treat causative, exacerbating and co-morbid factors. I immunise, screen and treat related depression, discuss prognosis, care plan and document accordingly. We encourage lifestyle modification and self-management where suitable. I manage acute and chronic renal impairment and only admit when absolutely necessary and when a situation is likely to be reversible and it is in the patient's best interests, with full discussion with the patient and their relatives, if appropriate,
    I DO refer early for confirmation of diagnosis, an ejection fraction, angio, stress echo or whatever other management may need a big shiny hospital, and I use our community heart failure nurses extensively for rehab. I find patients are invariably discharged to GP care after initial investigations and interventions are complete unless they need monitoring for valvular abnormalities.
    All in 10 minutes.
    And I don't see drug reps, as I don't have the time or inclination, so we stick with the local butty shop, who also do salads, pies, something-and-chips, etc as it supports our local community.
    I jest dude...chill. I thought very little of gps until I did my gp placement and realised that it is what i wanted to do as well. Partly because I saw what difference a good gp could make. Having said that, there are plenty of rubbish GPs who provide contrast and would do exactly as I've stated above.
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    (Original post by Hippysnake)
    I jest dude...chill. I thought very little of gps until I did my gp placement and realised that it is what i wanted to do as well. Partly because I saw what difference a good gp could make. Having said that, there are plenty of rubbish GPs who provide contrast and would do exactly as I've stated above.
    I don't know about plenty......There are good and bad doctors in every specialty. I am fortunate to work in an area with some amazing primary care colleagues
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    (Original post by Ambitious1999)
    Should there be other routes into becoming a doctor in addition to Medical School?

    With very high tuition fees and cost of living as a student, 5-6 years at medical school can seem daunting. There are a shortage of doctors in Britain and getting into Medical School is so hard that few even consider applying.

    My idea is that people who want to become doctors could take a more vocational route by becoming nurses, health care assistants or physicians assistants. Here they would gain invaluable clinical experience working in hospitals with modules they can take that would work towards an eventual medical degree. They would learn all the things a medical student learns such as anatomy and physiology, pathology etc but some of it would be learnt on the job and they would get a regular income. They would get the same assessments university medical students get and the same standards to pass would be required.

    You could say it's a bit like an apprenticeship in medicine.
    Also unlike Uni entry may not be so strict, as progress could be via a rank system.


    It may take a different length of time but at graduation you'd have new doctors who are highly experienced and hit the ground running. They'd then have all the options any other dcctor has after F1 and 2 such as becoming a: GP, surgeon, consultant, specialist etc.

    Opinions please?
    I disagree.

    - The shortage in doctors is not due to a lack of applicants, it is due to a lack of funding. Places are incredibly competitive and oversubscribed.

    - 'Becoming a nurse', although it gives you exposure to the environment, is not an effective way of preparing you to be a doctor. Doctors have extensive scientific and medical knowledge; nursing is a care role with medical elements. Note also that to become a nurse, you do need to go to uni, so this kind of kills your idea of it being vocational.

    - The reason you spend 5-6 years at medical school, compared to the usual 3 years for any other degree, is that the amount of knowledge, skills and experience you require are vast, and incredibly difficult. It is not a number of years that has been plucked out of thin air to make people's lives difficult.

    - Being a doctor is an incredibly stressful job. As we know from recent strikes, doctors can have to work up to 70 hours a week. If you find 5-6 years of training too daunting, it may not be the job for you.

    - You say 'more vocational' as if the years in medical school are spent sitting in a classroom taking notes. It is already vocational. It includes placements and training. You don't just learn out of a book and then become a doctor.



    It is a nice idea in the sense that it could make medicine more accessible to people, but ultimately it would result in a massive decline in quality. There may be vocational routes for those who are less academic - e.g. someone may be a HCA or a nurse for a while which would give them the confidence to go to med school, but I strongly feel that you cannot replace med school with training.
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    its not a very sensible route to becoming a doctor. there are nurses that want to train as doctors and thats excellent they should have lots of skills that others dont. but to train as a nurse only then to start medicine is both a waste of 3/4 years of your life but your also stopping another person from gaining a place on the nursing course.
 
 
 
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