Following the success of the 2018 conference, the 2020 Medical Trainees’ annual conference was once again held in Manchester. With the increasing complexity of patients seen during medical training, the conference focused on how to recognise and manage commonly seen problems and presentations from a wide variety of medical specialties. The clinical lessons presented as posters and as oral presentations at the end of the day provided an opportunity for trainees of all grades to present interesting cases.
Session 1: Problem solving
The morning started with Dr Rachel Williamson (Borders General Hospital, Melrose) informing us that there are over 60 types of diabetes and although type 2 diabetes mellitus is the most common form in adults, type 1 diabetes mellitus is an important diagnosis to consider as 25% of patients present in adulthood. The high prevalence of liver cirrhosis (1–2%) means that it is an important presentation in the UK, but Dr Stuart McPherson (NHS Newcastle upon Tyne) highlighted in the next talk that 80% of these patients present with complications of their liver cirrhosis. Patients with decompensated cirrhosis need prompt management and
Dr McPherson signposted the national decompensated cirrhosis bundle as a great resource.1 At the end of the session Dr Siobhan McManus (Queen Elizabeth University Hospital, Glasgow) highlighted the burden of cardiovascular disease in dialysis patients, cautioning that cardiac troponins and D-dimers are often difficult to interpret in this population.
Session 2: Keynote lecture – Just because I can, doesn’t mean I will: the psychology of practice change
Professor Jo Hart (University of Manchester) delivered her keynote lecture outlining that people find it hard not only to change, but also to sustain that change. For this reason, practice change depends on capability, opportunity and the motivation of those involved. In order to design interventions she suggested that it is useful to use a Behaviour Change Wheel which provides a framework for implementing change.2
46th Croom Lecture – Of mice and men: how neurology has shaped our understanding of memory
The prestigious Sir John Halliday Croom Medal was awarded to Dr Tom Miller (Royal Free Hospital/National Hospital for Neurology and Neurosurgery, London) who took us on a trip down his memory lane to explain how memories are formed and, specifically, the importance of the hippocampus in forming autobiographical memories. He showed us that patients with LGI1-limbic encephalitis (LGI1-LE) had isolated atrophy of the CA3 region of the hippocampus making it a human model of pure hippocampal damage.3 The CA3 region of the hippocampus is critical for creating and retrieving autobiographical memories and his research demonstrated for the first time that humans with LGI1-LE and therefore pure hippocampal damage have a deficit in creating new autobiographical memories and retrieving old ones.
Session 3: Emergency and ethics lessons
The afternoon started with a talk on toxicology troubles from
Dr Euan Sandilands (Royal Infirmary of Edinburgh) who discussed some of the more complex cases that get referred to the national on-call consultant for TOXBASE. A main emphasis of his talk was that in the era of polypharmacy overdoses and new psychoactive substances, it is important to treat the presenting toxidrome because the exact pharmacological compounds ingested are not always clear. Dr Gwilym Morris (Manchester Royal Infirmary) provided an interactive talk on recognition and treatment of ECG emergencies dividing them into: bad fast things, bad slow things and things that might be bad but haven’t happened yet. The session was capped off by a talk on palliative care from Dr Gursaran Purewal (Manchester University) who directed us to One Chance to Get it Right which outlines the five priorities of care for dying people and is an invaluable resource for end-of-life care.4
Session 4: Clinical lessons and the RCPE College Journal Prize
The top three clinical lessons submitted were presented at the end of the day. Dr Kaitlyn Mayne (Queen Elizabeth University Hospital, Glasgow) presented an interesting case of Mycoplasma pneumonia presenting with chest pain and a troponin rise due to Mycoplasma-associated myocarditis. The danger of hypertension was highlighted by
Dr Madeleine Sharp (Royal Oldham Hospital, Manchester) who presented a case of posterior reversible encephalopathy syndrome. Finally, Dr Natalie Lee (North Manchester General Hospital) used a case of adult-onset Still’s disease to present an investigation of pyrexia of unknown origin. The RCPE College Journal Prize was presented to Dr Alison Donaldson (University of Aberdeen and Aberdeen Royal Infirmary) for her work on the variation in acute and community service provision of care of the elderly services across Scotland.
Take-home messages
The symposium certainly lived up to its title of The On-call Handbook as it addressed a wide variety of acute presentations of medical problems that are pertinent to trainees. Personally I think that the keynote lecture by Professor Hart will change my practice as now I have a better understanding of the importance of thinking about the target audience for any intervention. In future when attempting to implement practice change, I will certainly use the Behaviour Change Wheel2 to ensure that my intervention has maximum impact.
References
1 McPherson S, Dyson J, Austin A et al. Response to the NCEPOD report: Development of a care bundle for patients admitted with decompensated cirrhosis - The first 24 h. Frontline Gastroenterol. 2016; 7: 16–23.
2 Michie S, van Stralen MM, West R. The behaviour change wheel: A new method for characterising and designing behaviour change interventions. Implement Sci. 2011; 42: 1–11.
3 Miller TD, Chong TTJ, Aimola Davies AM et al. Focal CA3 hippocampal subfield atrophy following LGI1 VGKC-complex antibody limbic encephalitis. Brain. 2017; 140: 1212–9.
4 Leadership Alliance for the Care of Dying People. One chance to get it right. London; 2014.https://www.gov.uk/government/uploads/system/uploads/attachment_data/fil... (accessed 23/02/20).
