Medical Emergency

For the first time, students of medicine may not be able to finish their training as doctors. What can be done?

Donna Tooth will have spent six years studying for her degree in medicine at King’s College London when she graduates next year. But with a four-year-old son to support, and around £50,000 of student loans to repay, she is just one of hundreds of medical students who this year – for the first time – may not be able to complete their qualifications to become a doctor in the UK.

For the first time ever, the number of places for medical students on the UK foundation programme – the two-year, paid NHS training placement that all graduate medical students must take to become registered doctors – will not match the number of students graduating. Students, unions, medical schools and doctors are all now worried about those who could be left out in the cold.

In pictures: Dave Eggers, south Sudan and learning

Dave Eggers and Valentino Achak Deng are the driving force behind a new much-needed secondary school in south Sudan.

View my photos on The Guardian’s Online Photo Gallery here. 

Dave Eggers helps Sudan’s ‘Lost Boys’ get a fresh start at school

When Eggers met Achak Deng seven years ago neither of them could have predicted that they would end up building a school together

The sound of the generator clicking on at 9pm in Marial Bai secondary school, south Sudan, is a noise that students know well. In a region with no electricity or running water and battered by more than two decades of civil war, the three hours of generated power allow a little more time to prepare for the next morning’s physics exam. The young men and women pick up their notebooks to study through the night. They are here tonight thanks to the generator, but mostly thanks to two particular friends, who value action over debate.

Sudanese refugee Valentino Achak Deng had been in the US for a year when, in 2002, he told Mary Williams, daughter of Jane Fonda and founder of the Lost Boys Foundation, that he wanted to tell the real story of south Sudan’s “Lost Boys” in a book. When she recommended the American writer Dave Eggers to assist, her logic seemed clear: Eggers had gained literary recognition through publishing a memoir, A Heartbreaking Work of Staggering Genius, that chronicled life after the death of both of his parents within a five-week period, and Valentino had not seen his parents since he was nine years old. “She said he will understand you better than any other writer,” says Achak Deng.

Awarded Runner-Up Diversity Writer of the Year at The Guardian Student Media Awards 2009

Read the full shortlist for the 2009 Guardian Student Media Awards

Arts activities aid people with mental health needs

Research suggests arts activities boost confidence and reduce mental distress

• Sarah Morrison
• , Wednesday 24 September 2008 10.25 BST

Stuart Davies, who painted this picture, says art has given him a sense of purpose, knowing that he can achieve something

People with mental health needs receive significant benefits from taking part in arts activities, research has shown.

The study, carried out by Anglia Ruskin University, the University of Central Lancashire and South Essex Partnership NHS foundation trust, found that participants who took part in the programme experienced improvements to their mental health, social inclusion and their sense of empowerment.

The participants, aged 16 to 65, had a range of mental health needs and the art projects reflected this diversity.

Jenny Secker, professor of mental health at Anglia Ruskin University and leader of the study, said: “The projects were equally broad in scope, ranging from short courses in basic art skills to projects offering opportunities for ongoing development through provision of studio space and support, or a rolling programme of differing opportunities.

“The art forms varied from visual arts to creative writing, decorative design, handicrafts and performance arts,” she said.

The benefits to mental health varied depending on the individual involved but were said to include improved confidence and self-acceptance, an improved sense of pride and achievement and an alleviation of worries and responsibilities.

The study found participants experienced decreased mental distress after participating in the art projects, leading to wider aspirations and opportunities for those with mental health needs.

Secker added: “Our main conclusion from the research was that our results justify funding for arts in mental health work.”

A sober view of freshers’ week

Posted bySarah Morrison Tuesday 9 September 200800.07 BS

Don’t blame student unions for binge-drinking, says Sarah Morrison

Students at Manchester University’s freshers’ fair. Photograph: Christopher Thomond

OK, so let’s get this straight. Students, on the whole, like to drink. They will have a pint in the day or at night, during the week as well as weekends, and yes they will also drink during that famous rite of passage known as freshers’ week. I mean, can you honestly remember the last time that you went to a party all alone, in a strange place and perhaps an alien city, facing thousands of new people, without the aid of a little Dutch courage to help you on your way? No? Thought not.

Yet, according to a group of experts, this seven-day traditional introduction into university life has been transformed from an opportunity for students to get to know each other, familiarise themselves with their surroundings and join societies, to an “alcoholic haze” in which memories are lost, ditches fallen into and drink-related accidents reign.

Professor Oliver James, a liver disease specialist and head of the medical faculty at Newcastle University, told the prime minister at a Downing Street seminar that he was “appalled” by the quantity of drinking that goes on during freshers’ week. For him, it is “a sort of excuse to get exceptionally and paralytically drunk”, and can lead to a harmful drinking career.

In fact, Gordon Brown was so impressed by this report that, reportedly, he was to investigate whether the Higher Education Funding Council, which distributes public money to universities and colleges for teaching and research, could use its powers to ban universities from encouraging “excessive” drinking on their campuses. If this came into effect, one could only imagine that student unions would face severe restrictions on what alcohol they could sell, at what price and in what time periods.

The seminar was held in February, and so far, no policies have been written.

But, while there is an alarming lack of statistics concerning alcohol consumption in freshers’ week or the number of alcohol related accidents that are caused, the message is clear: the days of hedonistic freshers’ play might very well be numbered.

Yet, do these images of beer-guzzling freshman endorsing in 2-for-1 discount deals at their local unions hold any truth in today’s society? I think not. It seems that student communities have never been more vigilant when alcohol consumption is concerned. Yes, 15% of a UK sample of 3,075 students drank at hazardous drinking levels of 51 or more units per week for men and 36 or more units for women, but research shows that most will not be doing so from their local university-run bars.

In reality, the income that student unions make from drink has declined so much that they are now changing bars into coffee and juice venues, with union bars actually being praised by alcohol support groups for their sensible and responsible policies. Gone are the days of free shots at the door, and in are the alcohol advice leaflets that scatter the bar tops and litter the floor.

What’s more, if students are going to drink “exceptional” amounts of alcohol, surely there is no safer place to do it than within one’s unions? After all, how many bars out there will stop serving drunken students when they have had one too many, offer them transport home and stay with them until such transport arrives? I, for one, don’t know any such premises in my local area, but these were the exact sorts of services that my union offered throughout not only my freshers’ week, but also my whole university career.

Yes, binge drinking is a problem that affects students, but it is also part of a much wider, national problem that does not originate in student communities.

If the government is going to impose regulations on drink, then it should start to monitor it from the very top. It is supermarkets and pubs that target students with their discount cards and deals, not the student unions that look out for the students’ social welfare, when no one else will.

After all, students are more known for their thrifty nature than their loyalty, and if the price of alcohol in their student bars increases, they will have no qualms about moving to a place where the price is more appealing. Yes, more drunk students on the streets and outside pubs – that is exactly what the government wants now, isn’t it? Perfect for the “youth culture” that it so publicly adores.

So, I say leave students and their unions alone. The government should be focusing on national education programmes that teach young people about the safe consumption of alcohol and stop picking on universities, which are already informed. It is not often that I agree with the Tories, but I think their universities spokesman David Willetts was spot on when he said: “If the government is going to pick a fight with students enjoying a few drinks, the government will lose.”

A novel campus

Sarah Morrison found a lot could be learned from her year abroad at university in California

• Sarah Morrison
• , Monday 8 September 2008 16.38 BST

Arriving at UC Berkeley’s campus on my first day of my year abroad, I could not have felt further away from home. The sprawling grounds, freshly painted white buildings and sun-speckled green gardens were a far cry from Edinburgh’s grey, 1960s tower blocks that characterise its George Square campus.

Upon entering the regal gate that marked the start of university grounds, I was engulfed in a sea of tables, placards and banners, as well as deafening cries of “Join our club”, “Attend our conference” and “You can save the world”.

As I fought through the throng of student societies, clubs and activists that used this area as a daily meeting ground, I noticed an unusual thing: not only were students up and awake before the usual midday start that I had been used to in Edinburgh, but their enthusiasm and energy was contagious.

As an English literature student at the University of Edinburgh, I had been lucky enough to take up two additional subjects in my first two years. That, for me, was the real draw of the Scottish education system, which offers more breadth than its English counterpart. While I had to choose my degree at the age of 17, I had been able to speak Spanish and discuss philosophy, while reading Chaucer and Shakespeare at university.

However, this freedom was limited to certain courses, and classes in the science department were strictly off limits for a literature major. Conversely, American students call university, “school”, and have to take a wide variety of subjects in a range of departments before they are allowed to graduate.

As a student who loves literature, but sees little connection between my degree and a practical job, this freedom was unbelievably exciting. As Americans literally shopped for courses, from peace and conflict studies to astronomy and Asian studies, I found a passion amongst students that I felt had been somewhat lacking in my third year contemporaries in Edinburgh.

The ability to choose the layout of your course means that degrees become personalised and very few students graduate with the same class history. This create-your-own-major model will certainly not suit every student, and I did have international friends, for whom this was a point of contention.

Certain classes at UC Berkeley were not as detailed or challenging as many of the ones I took in Edinburgh, and professors were prone to spoon-feeding students in a manner that could occasionally seem condescending. Emphasis is certainly on opinion and self-expression and historical or critical theory is often actively discouraged. Due to the size of the student body, smaller tutorial classes were something of a luxury, but there was something about being taught modern poetry by a Pulitzer Prize winning Beat poet that made sure even the most cynical of students turned up to class.

When discussing the American university system, there is, of course, the question of finance to consider. For an international student to study full-time at UC Berkeley, the costs can be staggering and make top-up fees pale in comparison. While Californian students have to pay less than an out-of-state applicant, the fees are still considerable for the majority of UC Berkeley’s community.

However, during my year abroad, I met very few students who took their education for granted, something which cannot always be said of my experience at Edinburgh. The majority of students at UC Berkeley take a full course load, run extra-curricular clubs and work to fund their education. This does leave less time for daytime TV, pub visits and the general “relaxation” time that characterises much of British university culture, but surprisingly, I did not miss it. Attending lectures, doing homework and being continuously assessed might seem daunting to the British student, but I found that once more was expected of me, I actually wanted to do more.

Now I am back on British soil, I am often asked if in hindsight, I would choose to spend my entire university experience at an American university. My answer: it depends on what university and where. Just as British universities differ considerably from place to place, I realise that UC Berkeley was unique. But, despite this realisation, I do believe that the American and British attitudes to university are strikingly different.

While British universities offer a challenging environment for students who are inherently driven, they can make it very easy for others to sit back, relax and leave hard work until later. This mentality is just not acceptable in most American universities and certain British students might just benefit from giving this alternative approach to education a try.

Call to listen to mentally ill youth

Charity claims young people with mental problems need input into treatment

• Sarah Morrison
• , Thursday 4 September 2008 10.57 BST

If young people are not involved in their own treatment, they might become cause anxious and suspicious of medical professionals. 

Mental health professionals who do not involve young people in their treatment are to be “shamed” in a new charity campaign.

According to children’s mental health charity YoungMinds, 97% of mental health professionals, parents and young people believe children should have a say in their treatment. But despite this, the charity says very few are given a chance to contribute.

When professionals overlook young people’s opinions and concerns when treating them for a mental illness, they seriously underestimate the individual involved, it says. The charity wants to put pressure on workers to make sure young people are consulted.

“Young people in general are not always listened to and their views are not always taken into consideration in society in general,” says Sarah Brennan, chief executive of YoungMinds. “There is something about having a mental health problem that exacerbates that even more and somehow they are not seen as able to make a reasonable judgement, but of course they can.”

Not including a young person in his or her treatment could have a detrimental effect on their health, caused by increased anxiety, refusal to take medications, and distrust of future professionals.

She adds that young people are especially affected by the stigma surrounding mental health and should be made to feel comfortable when talking with professionals.

The charity, which works with child and adolescent mental health services around the country, wants to launch a national program that will provide training and information, set standards and raise awareness among mental health professionals of the need to include young people in their treatment.

Amy Shaw (not her real name), 13, is part of the children’s panel Very Important Kids and advises the charity on mental health issues. Shaw has been receiving treatment for the past year and said she still does not really understand why she needs to take the drugs she does or what they do to help.

“It would be great if there was somewhere that told young people more about medications and different treatments,” Shaw says. “Even if a child has a disability or a mental health problem it doesn’t mean they are dumb and that they don’t understand, it just means they may not take it all in at once and may need it explaining to them again.”

David Cottrell, consultant psychiatrist and dean of medicine at the University of Leeds, says the inability to include them marks a failure that should be looked at and changed.

“Sometimes professionals just get it wrong and you have to accept that sometimes happens,” Cottrell says. “The treatment of young people with mental health needs has been changing, and for the better, but there is definitely still room for improvement.”

According to Cottrell, a professional not only has to satisfy the needs of the young person receiving the treatment, but must also take into account the desires of their parents, which are often different and hard to reconcile.

“Many of the young people are in conflict with the adults in their lives and can’t agree on the same form of treatment,” Cottrell says. “Professionals can try and facilitate discussion between them to understand different points of view, but ultimately, it’s the parents who have the final decision.”

YoungMinds says that while there is a lot of good practice being carried out, the new campaign would raise awareness about the importance of talking all young people through their treatment, from start to finish.

“If young people understand what’s happening they are much more likely to feel a sense of control over their treatment and it can help their success considerably,” Brennan says. “If they understand what is going to happen and the consequences of not doing it, they are far more likely to follow the care pathway.”

Shaw says a child of any age or ability should be able to decide on their treatment if they are able to understand the seriousness of a condition they may have.

“I think it is very unfair to put a young person in a position where you are choosing their life steps because you think they are incapable,” Shaw says. “If most doctors had the patience to sit and listen for a little longer, they would realise that they are underestimating these children.”

Government sets pre-school learning targets

Nurseries and childminders to monitor children’s progress and record their performance against 69 ‘early learning goals’

• Sarah Morrison
• , Monday 1 September 2008 15.34 BST

Campaigners fear the ‘toddler targets’ could affect children’s enthusiasm for learning

Under-fives who play in the sandpit and recite nursery rhymes are to be assessed under a new government-enforced national curriculum that comes into force today.

The early years foundation stage means that all childcare providers who are registered with and inspected by Ofsted – including nurseries and childminders – must monitor children’s progress and record their performance against 69 government-set “early learning goals”.

When children enter compulsory schooling, they should be able to interact with others, negotiate plans and take turns in conversation, recite the alphabet, count to 10 and write simple letters, according to the targets.

At five, each child will be assessed against 13 scales based on the learning goals put forward. Their score will result in an early years profile that must be passed to the Department for Children, Schools and Families.

The new “toddler curriculum” will replace non-statutory guidance already in place and is aimed at providing the same standards of early learning across all areas of England.

While care providers can choose to opt out of these new requirements, for example if they favour an alternative educational philosophy that introduces reading and writing at a later stage, they will have to apply for an exemption and run the risk of losing state funding.

The Department for Children, Schools and Families’ legal framework has come under attack by a group of education experts who feel that the curriculum is flawed, arbitrary and could have unforeseen negative effects on a child’s development.

“The goals in this curriculum are just inappropriate for young children,” said Kim Simpson, a Montessori practitioner and member of the Open Eye campaign against the new curriculum. “If they are required by law to achieve certain goals when they are not ready, it could totally destroy their enthusiasm for learning.”

The experts emphasise the need to build a child’s sense of self in their early years and object to the new curriculum being compulsory, as well as its emphasis on reading and writing at a young age.

Government officials say the framework is a way of ensuring high standards of early education, and said the curriculum that has been based on research from top experts in the field.

“The EYFS will help make sure that all young children have the chance to engage in stimulating play and hear and respond to rich and varied language,” said the children’s secretary, Ed Balls, and children’s minister Beverley Hughes in a joint letter to the managers of the country’s 3000 children’s centres. “Children’s centre staff will be able to use it to engage mothers and fathers, to make sure these experiences are built on at home.”

They added that children will not be tested and are expected to reach these goals at different ages so will not be deemed to have failed if they do not reach them.

Balls said extra funding will be available to provide 15 hours of free childcare and early learning for the 25% most disadvantaged three and four year olds, a year before their peers receive the same entitlement.

“I am driven by a determination to make sure that the most disadvantaged children get the very best start in life,” said Balls. “We want to give all children a level playing field and help all parents get the best care and support for their children.” 

While the National Day Nurseries Association says that while it embraces the ideas behind the curriculum, it is concerned about the practicalities.

“We wouldn’t want it to be a move to more paperwork and it is important for us that the approach remains flexible to each individual child,” said a spokeswoman for the association. “It continues the idea of a single national framework that is consistent, which is a development of what we had before.”