MBChB Curriculum Map

The evening before her civil service examinations, Ms Jane Gower began to feel unwell. She put the pain in her abdomen down to the ‘pub food’ that she had eaten for lunch. Stephanie Jones, Jane’s flatmate and a health correspondent for the local newspaper, said it was either pre-exam nerves or colic, and suggested that she take something. However, Jane did not feel like eating, so she just drank some milk and went to bed early. At 1 am, she awoke from a fitful sleep, feeling sick and hot, with severe pain in her abdomen.

Stephanie waited with her flatmate in the local Casualty where she was seen by Dr Chowdhury. Stephanie waited outside but could not help overhearing Dr Chowdhury’s questions about any possible problems at home or work, about her lifestyle and diet, her ‘waterworks’, and the date of her last period. Dr Chowdhury noted that she had a high pulse rate, low blood pressure and that her abdomen was quite tender to palpation. Eventually, Stephanie is told that they would be admitting her friend and that she may require surgery.

Stephanie then asks Dr Chowdhury about whether the post-surgical complication rates are relatively high in this hospital compared to others. He tells Stephanie that there are published league tables for some surgical procedures but comparing between hospitals is complex for a number of reasons. He translates into lay terms that confounders such as case-mix are relevant, and that standardization must be applied to compare ‘like with like’. He also explains that issues can arise with misinterpretation of clinical data which could lead to a wrong diagnosis.

Later in the day, Stephanie returns to visit Jane. Jane asks her whether she should agree to take part in a research study on outcomes after surgical admission. “You don’t want to be experimented on” says Stephanie. ‘’Is it an RCT”? Jane replies “It’s just about getting information out of my case-notes”. Stephanie says, “Researchers have to now ensure that any form of human or clinical research accords with strict research ethics principles and guidelines. Have they given you a patient information sheet?”

That evening, Stephanie decides to familiarise herself with the ethical issues surrounding therapeutic and non-therapeutic research.