Sustainable healthcare in medical education: survey of the student perspectives at a UK medical school.

BACKGROUND: It is now a General Medical Council requirement to incorporate education for sustainable healthcare (ESH) into medical curricula. To date, research has focussed on the perspectives of educators and which sustainable healthcare topics to include in teaching. Therefore, due to this gap in the literature, we have investigated the perspectives of medical students in the UK regarding current and future incorporation of ESH in medical education. METHODS: A survey was circulated to 851 clinical year medical students and students intercalating after completing at least one clinical year in a London University. The anonymous survey consisted of sections on the environmental impact, current teaching and future teaching of ESH. RESULTS: One hundred sixty-three students completed the survey. 93% of participants believed that climate change is a concern in current society, and only 1.8% thought they have been formally taught what sustainable healthcare is. No participants strongly agreed, and only 5 participants (3.1%) agreed, that they would feel confident in answering exam questions on this topic, with 89% agreeing that more ESH is needed. 60% believe that future teaching should be incorporated in both preclinical and clinical years, with 31% of participants preferring online modules as the method of teaching. CONCLUSION: Our study has stressed the lack of current sustainable healthcare teaching in the medical curriculum. There is student demand for ESH, however, uncertainty remains regarding who is best placed to facilitate ESH, how it should be delivered, and whether there is a gender discrepancy regarding sustainable healthcare importance, emphasising the need to close the gap between educational rhetoric and action.

Prevalence of acute neurology: a 2-week snapshot in a district general hospital.

Neurological illnesses are a common cause of hospital admissions, yet most patients are not primarily managed by neurologists. Acute neurology service provision varies across the UK. This study aimed to establish the number of neurological admissions during a 2-week period in a district general hospital, as well as the proportion of those patients who were seen by the hyperacute neurology team. This was done by analysing the diagnostic codes. It was established that there was a total of 2,242 admissions during the study period and, of those, 491 (22%) had neurological codes. Analysis of the 491 hospital electronic records revealed that 229 (10%) were truly neurologically relevant and, of those, 14% of patients received an opinion from the neurology team. Therefore, it can be concluded that only a small proportion of acute neurology is currently being seen by neurologists.

A hyperacute neurology team - transforming emergency neurological care.

We present the results of an 18-month study of a new model of how to care for emergency neurological admissions. We have established a hyperacute neurology team at a single district general hospital. Key features are a senior acute neurology nurse coordinator, an exclusively consultant-delivered service, acute epilepsy nurses, an acute neurophysiology service supported by neuroradiology and acute physicians and based within the acute medical admissions unit. Key improvements are a major increase in the number of patients seen, the speed with which they are seen and the percentage seen on acute medical unit before going to the general wards. We have shown a reduced length of stay and readmission rates for patients with epilepsy. Epilepsy accounted for 30% of all referrals. The cost implications of running this service are modest. We feel that this model is worthy of widespread consideration.

Breakfast time blackouts.

We present the case of a 16-year-old girl who suffered from repeated episodes of collapse and loss of consciousness which could be provoked by undertaking a stretching manoeuvre comprising a combined breath hold and neck torsion. A review of the literature is provided on other cases of so-called "stretch syncope" which appears to be a rare form of reflex syncope affecting patients in adolescence.

Lesson of the month (1): cabergoline - 'i eat funny on that'.

We present the case of a patient treated for hyperprolactinaemia with weekly doses of cabergoline for 12 years. Over this time she had suffered from binge eating and compulsive shopping which impacted on her weight and made her finances precarious. We discuss the features of impulse control disorders and suggest that seeking out these side effects in patients taking such agents is important. The behaviours may be embarrassing and patients may not volunteer them, likewise if the doctor dismisses them they may continue unabated, causing significant social harm.

Socioeconomic variation in incidence of epilepsy: prospective community based study in south east England.

OBJECTIVE: To determine the incidence of epilepsy in a general practice population and its variation with socioeconomic deprivation. DESIGN: Prospective surveillance for new cases over an 18 or 24 month period. PARTICIPANTS: All patients on practice registers categorised for deprivation with the Carstairs score of their postcode. SETTING: 20 general practices in London and south east England. MAIN OUTCOME MEASURE: Confirmed diagnosis of epilepsy. RESULTS: 190 new cases of epilepsy were identified during 369 283 person years of observation (crude incidence 51.5 (95% confidence interval 44.4 to 59.3) per 100 000 per year). The incidence was 190 (138 to 262) per 100 000 in children aged 0-4 years, 30.8 (21.3 to 44.6) in those aged 45-64 years, and 58.7 (42.5 to 81.0) in those aged > or =65 years. There was no apparent difference in incidence between males and females. The incidence showed a strong association with socioeconomic deprivation, the age and sex adjusted incidence in the most deprived fifth of the study population being 2.33 (1.46 to 3.72) times that in the least deprived fifth (P=0.001 for trend across fifths). Adjustment for area (London v outside London) weakened the association with deprivation (rate ratio 1.62 (0.91 to 2.88), P=0.12 for trend). CONCLUSIONS: The incidence of epilepsy seems to increase with socioeconomic deprivation, though the association may be confounded by other factors.