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Issue 3 - Getting involved in research, diagnosis of Myeloma & more...

Issue 3 - Getting involved in research, diagnosis of Myeloma & more...
By Pulsenotes • Issue #3 • View online
Hey guys,
Welcome to the third edition of our Pulsenotes ‘weekly dose’.
This week, Sam will be tackling how to get involved with research, I’ll be covering what’s new this week (sneak peek below!) and Norton’s got another Medical top tip… enjoy!

Pulsenotes 'Rounds' starts next Thursday with Chest pain...
Pulsenotes 'Rounds' starts next Thursday with Chest pain...
Getting involved with research…
We get loads of questions about how to improve your CV whilst a student - and one that always comes up - How do I get involved in research?
It’s all too easy to heap huge amounts of pressure on yourself to get publications at increasingly early stages in your training. Everyone’s had the conversation about some unnamed person with ‘10 (ten) publications and they’re only in fourth year’. However, university comes with a significant work load and getting involved in research can be tough. Remember there’s also plenty of time to get involved in research in your foundation years!
If you are looking to get involved in research now, be clear with yourself as to what your aims are. Your approach should be guided by what interests you and what you need to do to achieve your career goals. What specialty are you interested in? Do you want to be an academic? What skills do you need to demonstrate to a potential employer? ‘Person specifications’ are available online for each specialty to give you an idea what they might expect.
Realistically COVID-19 will mean much of what is discussed below may not be possible in practice. However as things (hopefully) get back to normal with time, it will become relevant again.
Why it’s important
Publications are a great way to demonstrate an active interest in the academic side of medicine and commitment to specialty. Unfortunately, opportunities are often sparse as a student - and as you probably know there is a fair amount of luck involved. The actual process of publishing is a great experience to have - and you’ll learn a lot. But be prepared for rejection and revisions.
Points are available in FPAS for publications with a Pubmed ID. The maximum you can score on the Educational Performance Measure (EPM) is 50 - the most you can score from publications? 2. Though the points may help you get the job and location you want - other factors are clearly more important. Only 5% of the graduating class of 2019 submitted two publications for FPAS
Looking forward to applications for higher training (e.g. surgery, medicine, GP), publications become more important and can help set you apart from the field. Getting involved in research in your student years will help you make the most of the more abundant opportunities afforded in clinical practice. 
How to get involved
Ask! If I could give one piece of advice it is to ask. On a placement or special study component (SCC) in an area that interests you? Get to know the team. ASK the house officers, registrars, consultants and professors. Do they have any projects? Are they planning any audits? Do they need help gathering data or completing a literature review? Be prepared to be brushed off - but eventually if you’re keen and demonstrate an active interest, opportunities WILL come your way.
Say yes! At an early stage in training don’t become too focused on only getting involved in the perfect project. Be open to smaller projects that may just result in a poster presentation - or even go nowhere! You will gain invaluable experience - as you get more senior, you should become more discerning as to which projects you get involved with.
Be reliable. It can be difficult to balance work-life commitments. So when you do get involved in a project be honest about how much time you can spend on it and try to meet any deadlines that may be set. Once you’ve established yourself with a team and shown you can be reliable further opportunities often follow. 
Intercalation. It offers a great opportunity to get involved in clinical and lab-based research. It’s not for everyone (except at unis where it’s mandatory!). You need to be sure you want to spend an extra year at university and there are financial implications. However, most will include a dissertation project, which could lead to a presentation, poster or publication. Personally, it was the source of my first publication and medical prize.
My top tips:
  • Good Clinical Practice. It’s free, looks good on the CV and will give you an understanding of the international standards for ethical scientific research. An online course provided by the National Institute of Health Research can be found here.
  • Poster presentations. Completed an interesting audit or readying a paper for publication? Submit an abstract to a conference. A poster looks great on the CV and you may get an oral presentation or a prize. Some conferences publish abstracts in their associated journal further bolstering the CV. ASiT is great for this.
  • Avoid ‘pay to play’. There are journals that publish liberally but will charge huge amounts for the privilege. Expect a fee when publishing case reports, though in my experience, if you ask the supervising department they often have some discretionary funds for this kind of research.
University should be enjoyable. My advice, try to do one additional thing during each of your clinical years - be it a small local audit, poster, oral presentation or if you get the opportunity, publication. This will put you in good stead once you graduate, and you’ll be able to take advantage of all the opportunities afforded to you when you qualify.
Samuel Belete (@pulse_notes)
What's new this week?
Pulsenotes LIVE
We had two LIVE lectures this week. Norton presented a fantastic lecture on Microbiology, and I gave a surgical perspective on Melanoma. Both lectures were watched LIVE by over 800 attendees. Missed them? don’t worry, the recordings are available to watch NOW on our website!
This week also saw the launch of our Pulsenotes COMMUNITY, a Facebook group established in conjunction with our LIVE Q&A series. The community is a forum to discuss medicine, medical / surgical training, work-life balance, running a business and any other questions you may have. Since launch (less than a week ago) we’ve amassed over 550 members! You can join them here!
Our brand new Community group
Our brand new Community group
Events - what we’ve got lined up…
  1. Saturday 16th 19:00 - LIVE Q&A with Pulsenotes. We’re here to tackle any queries you may have medically-related or not - definitely not one to be missed!.. Details to be posted on our Community FB group.
  2. Thursday 21st 19:00 - Pulsenotes ‘Rounds’. A brand-new webinar series exclusively for our members. This time we’re covering chest pain. Get ready as we guide you through histories, examinations, investigations, forming differentials and initiating management - from the perspective of a newly-qualified doctor, in classic Pulsenotes simplicity… Details to be posted on our Community FB group.
Remember that all events will be LIVE-streamed to the Pulsenotes website, plus recordings will be available for those that aren’t able to make it!
New topics, over 1K questions…
We’ve been working tirelessly in the last week and we’ve just released two new beautiful sets of lecture notes on Pulmonary Embolism and Deep Vein Thrombosis. We’ve also just passed 1,000 SBA questions… Enjoy!
Norton's Corner
Basics in myeloma and the myeloma ‘screen’.
The team suspect myeloma and send a ‘screen’, but why doesn’t it contain a Bence-Jones protein? What even is a Bence-Jones protein? And what’s Myeloma?!?
Myeloma refers to a malignant disorder of mature B lymphocytes, known as plasma cells. These cells are responsible for the secretion of antibodies, which are central to our antibody-mediated immunity.
Antibodies are composed of heavy and light chains. There are five types of heavy chain (A, D, E, G, M) and two types of light chain (kappa, lambda). Two heavy chains form with two light chains to create the complete antibody.
A 'typical' antibody
A 'typical' antibody
In myeloma, the malignant B cells, which are all clones of each other, secrete the same antibody. We call these monoclonal antibodies. In 20% of myeloma cases, the malignant cells only secrete the monoclonal light chain of the antibody.
So when do we suspect myeloma?
Myeloma can cause high calcium, renal impairment, anaemia and boney lytic lesions. These can be remembered using the mnemonic ‘CRAB’. The presence of these features may lead the clinician to consider myeloma and request a ‘screen’. 
What’s in a myeloma screen?
When we ‘screen’ for myeloma we are looking for the secretion product of the malignant plasma cells - the monoclonal antibodies. We do this using protein electrophoresis, which can detect a monoclonal antibody, and either serum free light chains (SFLCs) or urine electrophoresis. Both SFLCs and urine electrophoresis are important for the 20% of patients that only secrete light chains. Monoclonal light chains detected in the urine are known as Bence-Jones proteins. SFLCs has largely superseded the use of urine electrophoresis.
Want something covered next week? - send me a tweet @pulse_notes
Final words
Remember to get in contact with any questions, suggestions, or topics that you wish to be covered!
Thanks for reading, see you next week!
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