Remedy edition 35

Welcome to the 35th edition of ReMEDy

Since our last publication in October 2020, the world is still living with restrictions to reduce the spread of COVID-19. With the roll out of several different vaccines to combat this pandemic there is now real hope that we will be able to return to greater social interaction over time.

In this edition, we explore and highlight how staff and students are rising to the challenges of working and studying during such difficult times. There are so many things I could mention here but I am very proud that so many of our students, including our C21 north Wales students, have been volunteering in vaccination centres across Wales to support the mammoth effort to bring this pandemic under control.

With having to adapt many of our activities during the pandemic, using a variety of online tools. It has been a steep learning curve for everyone (teaching, admissions, assessments, placements, public engagement etc) made a little easier by the endeavours of colleagues Professor Marcus Coffey and Drs Duncan Cole and Athanasios Hassoulas from the Digital Education Group, who
organised and hosted a successful series of workshops for staff and students providing additional teaching/learning and technical support on the remote delivery of teaching and assessment. Everyone across the School has really worked so hard to provide as good a student experience as we can under these circumstances – I thank you all.

The main feature highlights some of the ongoing initiatives that are being driven by our Student Staff Race Equality Task Group, alongside students in the African Caribbean Medical Association (ACMA), Cardiff Healthcare International Perspectives Society (CHIPs) and MedSoc. This work is of paramount importance to the School as we continue to embed our equality, diversity and
inclusivity values, ensuring that students from all backgrounds are meaningfully supported. There are conversations about how curricula need to change to recognise our inherent diversity taking place at many of the medical education meetings I attend – I welcome these discussions and support them at every opportunity. I hope we continue to walk this path and develop solutions together.

Our popular alumnus conversation feature is with Dr Eli Wyatt, who graduated in 2020 at the height of the COVID-19 pandemic and is now an F1 doctor in Glan Clywd Hospital. We have a feature on the work of some of our students to combat COVID-19 misinformation supported by colleagues Drs Athanasios Hassoulas and Eliana Panayiotou, as well as the excellent work of Muslim Doctors Cymru involving Drs Bnar Talabani and Mohammad Alhadj Ali to engage black, Asian and minority ethnic communities in the rollout of the COVID-19 vaccination programme.

Finally, this edition’s fantastic front cover image was created by fourth year undergraduate medical student Abhay Ghaiwal, responding to a call to create some resources for small children who were fearful of seeing medical staff wearing full PPE. This is one of several images created by students reflecting PPE as part of a superhero costume which has helped children to feel more confident and happier about meeting with medical staff during the pandemic.

ReMEDy is available electronically to the School’s alumni and to ensure that you receive your copy, please inform us if you have changed your contact email address.

In Conversation with…Dr Eli Wyatt (MBBCh 2020)

Eli currently works as a foundation year 1 doctor at Glan Clwyd Hospital, working on the renal ward, following a few redeployments to help on COVID wards.

A regular day includes a board round, followed by a ward round with/without a consultant and a collection of jobs to complete. However, even before graduating Eli had become a volunteer in the fight against COVID-19 and began to assist in any way that she could at Glan Clwyd Hospital. Eli says: “The year since graduation has been a complete whirlwind having graduated during a global pandemic! I have learned and experienced an awful lot in a relatively short space of time, having made strong bonds with other healthcare professionals in work.”

On being asked why Eli chose Cardiff, she explains: “There are many reasons. I wanted to stay in Wales, it meant I could remain close to my grandparents, whom we were supporting as a family. I am also a Welsh speaker so for me, I wanted to be able to use some of my Welsh when completing placements etc. The curriculum style suited me with lots of hands-on experience and case-based learning. I also played netball to a high standard and wanted to keep it up during my university years. I had heard that the university team was really good and there were plenty of clubs to join in and outside of Cardiff University.”

As an undergraduate student, Eli describes her most favourite memory from her fifth-year medical elective where she volunteered for a charity in Namibia to help with rural healthcare. She said: “The charity I helped also run a few wildlife sanctuaries around Namibia, so I had the privilege of getting involved with the wildlife there too. I have many memories from this time, assisting malnourished and neglected children and adults, whilst also remembering my time caring for many and varied wildlife such as baboons, cheetahs, meerkats and so much more. I felt privileged being able to see the huge difference in rural healthcare over there compared to here and it reminded me of how lucky we really are with our NHS.”

Reflecting on how Cardiff School of Medicine contributed to her success, Eli mentions: “Cardiff University helped to equip me with the key skills needed to become an ever-developing junior doctor. Although nothing could have prepared me to begin working during a global pandemic, I feel that many vital skills that supported me through, had been developed during my time in Cardiff University, and for that, I am hugely grateful.”

Eli concludes: “Looking back I am so impressed how well Cardiff University School of Medicine coped when the pandemic became apparent. Fifth year students were scattered all over the World on their electives and we were kept fully informed in a very professional manner. They made what was a scary and unpredictable time feel well constructed and thought out.”

Eli’s shared alumni wisdom:

“Don’t put so much pressure on yourself to know/learn everything. Medicine is one of the few careers where you never stop learning, so there is plenty of time. Medical school is for giving you the foundations to build upon in future.”

“Learning, training and working in a global pandemic has brought to light additional uncertainties, changes and challenges. Be proud of yourselves and know that it is always ok to ask for help.”

In the Spotlight: The Masters in Wound Healing and Tissue Repair Programme

The Masters in Wound Healing and Tissue Repair is a well-established three-year, inter-disciplinary, part-time, distance-learning programme.

The programme began as a postgraduate diploma in 1996, later becoming a Masters in 1999. The programme attracts healthcare professionals from fields such as nursing, medicine, pharmacy and podiatry, and offers the opportunity to study online alongside an international group of students from around the globe.

The programme has over two decades of success with teaching supported by a range of international, inter-professional experts in wound healing and tissue repair. Since the programme began there have been almost 350 graduates including 184 MSc, 130 Postgraduate Diploma and 34 Postgraduate Certificate awards.

The majority of students are from the UK, however over the last two years there has been an increase in the range of countries represented including; Belgium, Switzerland, Netherlands, Singapore, Malaysia, Australia, USA and Isle of Man.

In September the programme rose to the challenge of the pandemic by providing all teaching online, rather than having a 5-day, face-to-face, study block on campus. Whilst this tested the resilience of all individuals involved the switch to being completely remote has been a success, with an increase in student numbers for Year 1. This achievement would not have been possible without the dedication of all the individuals involved with the delivery of the programme - thank you!

Wound Healing and Tissue Repair (MSc)

Myth busting during COVID-19

One of the many challenges that healthcare professionals have encountered during the pandemic is the amount of false information being circulated at an alarming rate. The spread of such misinformation can have a damaging impact on public perception of, and confidence in, key public health campaigns.

Various misrepresentations and inaccuracies have been doing the rounds, specifically on social media, regarding the origins of the virus, how it is spread, and the science underpinning the vaccines that have recently been developed. In response to the misinformation, fake news and conspiracy theories being propagated, a few of our medical students have stepped up to the mark by creating a range of engaging resources aimed at debunking some common myths, as well as striving to provide support to those who may be feeling anxious or low at this time.

Dr Athanasios Hassoulas worked with a team of year one C21 students in disseminating a suite of informative resources that include a patient information leaflet, a public health pamphlet, and a student-led video dissecting unverifiable claims. The patient information leaflet, created by year one C21 students Meghan Edwards and Sanya Trikha, was designed to be distributed on social media and in primary care settings.

The leaflet challenges certain myths being perpetuated, provides information about the nature of the COVID-19 vaccines currently available in the UK, and aims to manage the public’s expectations in relation to how the vaccination programme is being rolled out.

In addition to the leaflet, a public health pamphlet was designed by year one C21 students Praveena Pemmasani, Molly Sherriff, Je Yin Chooi and Rebecca James, with guidance from Consultant Paediatrician Dr Eliana Panayiotou.

The aim of the pamphlet is to dispel false claims being circulated on social media about the nature of the vaccine, by providing a lay summary of how the vaccine works and signposting the public to reliable sources of information.

Adding further to the suite of myth-debunking resources, year one C21 student Anna Thomas created an engaging and informative video whereby she systematically dissects false claims being promoted on numerous social media platforms.

Watch the video

Anna’s professional and evidence-based approach to appraising and challenging false claims, made on the nature of the virus and the vaccination development process, has received praise from staff on the C21 programme. Her video has been viewed hundreds of times and has been shared by numerous healthcare professionals as part of ongoing efforts to empower the general public in distinguishing false information from fact.

Working together to embed values of equality, diversity and inclusivity

2020, was a challenging and difficult year, from the onslaught of COVID-19 to the reignition of Black Lives Matter (BLM) movement, after the tragic death of George Floyd with his final words ‘I can’t breathe’. His death was a catalyst for the numerous protests that sprouted globally in Spring 2020, bringing the topic of racism to the forefront of the general public’s attention.

Individuals across different sectors highlighted the barriers they face with systemic racial inequalities and within medicine this was no different for both healthcare professionals and patients alike. Traditionally in the UK, medical education has a Eurocentric perspective, particularly obvious in more visual specialties such as dermatology, however this persists throughout all specialties in medicine. This lack of diversity fails to prepare trainees to care for a growing multicultural society in a patient centred manner.

At the School of Medicine, concerns surrounding racism have been raised in the past and in 2017 an independent review provided 13 recommendations in areas of policy, training, and professional development. Following this, there was a renewed commitment towards equality, diversity and inclusion.

In response to and empowered by the BLM movement and protests, passionate Cardiff medical students were engaged with this discourse and collaborated to organise open letters about curriculum changes with regards to race, and a document formulated by the African Caribbean Medical Association (ACMA) provided recommendations in areas such as equality, diversity, and inclusivity (EDI) training, tackling micro-aggressions, updating the Raising Concerns policy, and changing the culture.

To address these proposals in a cohesive manner, the medical school responded favourably, and the Cardiff MEDIC Student Staff Race Equality Task Group was created in the new academic year. This includes staff from various disciplines as well as student representatives from six societies, representing different religions, ethnicities, and the overall student body as well as a student British Medical  Association (BMA) representative. A member of the wider university EDI team is invited to provide an outside perspective and accountability. They meet six times in an academic year with the flexibility to hold ad hoc meetings if a time-critical issue arises. Other staff members are also invited depending on the focus of each task group meeting, with student surveys distributed where relevant before meetings to get a wider perspective.

The remit of the task group is to discuss and create action plans around certain key points proposed by the student body on how to improve racial equality within the medical school, the medical student environment and the curriculum. They advocate for and ensure racial equity and representation in the faculty and the student body.

Their initial focus for this academic year has been prioritising the concerns raised in the open letters and advisory documents, starting to decolonise the undergraduate curriculum and promoting racial equality across the medical school. For example, the Raising Concerns policy was amended to include examples of religious and racial discrimination, and Cardiff University School of Medicine also signed the BMA Charter to commit formally to preventing and addressing racial harassment.

Decolonising the curriculum, an ongoing project has concentrated on three specialties this year: dermatology, obstetrics & gynaecology and psychiatry. These specialties were chosen to introduce small improvements within each phase whilst ensuring that the core curriculum was maintained. In Phase 1 the aim was to encourage discussions in Case Based Learning by supporting facilitators and students in discussions looking at racial disparities and how patients might experience different outcomes. In Phases 2 and 3 resources were added offering a more diverse image bank, as well as an e-module looking at maternal health outcomes.

In April, members of the Task Group hosted a Race Awareness Day virtual event spread over two days to have these often difficult discussions. Each day comprised of three to four parallel workshops that staff and students attended, sandwiched between two plenaries. The aim of the event was to enhance our staff and students’ understanding of allyship and the global perspective of cultural diversity in healthcare that exist in today’s world. A broad range of speakers were invited on each day to present different topics about race and cultural awareness, through theuse of workshops and plenaries.

This coming December, some members will also deliver a workshop for the Developing Excellence in Medical Education Conference (DEMEC). This is a great opportunity for the medical school to showcase the work they are doing on a national level. It will be attended by clinicians and educators in the medical education community with the aim of encouraging positive and sustainable transformation. The workshop will involve looking at strategies for improving race equality in healthcare institutions with the hope of identifying barriers to facilitating conversations about race.

A major achievement of the Task Group has been the establishment of collaborative student-staff working relationships with increased trust and transparency. This has allowed open discussions with key contacts and the use of protected speaking time helps to both create a ‘safe space’ for discussions, and ensure all voices are valued equally. Although opinions can differ, a diverse membership means a wide variety of perspectives are considered and any agreed action points are likely to be acceptable to all key stakeholders.

However, as a newly formed working group, there have also been challenges. Differing expectations of what is achievable within certain timeframes has caused frustration, with the need to balance constraints on staff workloads and time versus wanting immediate change. There was a recognition that shorter-term goals are more realistic and an appreciation that for cultural change to be embedded into the fabric of the school, a longer-term strategy would be required. The task group is committed to implementing changes that are sustainable and dynamic, with a desire to change mindsets with regards to race rather than introduce ‘tick-box’ exercises.

Overall, the Task Group is and will continue to be significant in improving medical education with respect to race and ethnicity at Cardiff University medical school. The ultimate goal is to produce generations of doctors who are both confident and competent in providing care to a constantly evolving, multicultural population, and the Task Group will be key to achieving this. They would encourage any current medical student and alumni to get involved and support the work they are doing.

10 ways Medic is making an impact

The School of Medicine has a successful track record of contributing to society through its Research, Learning and Teaching, and Innovation and Engagement activity. Efforts by many staff and students highlight a rich variety of ways in which the School is engaging and benefitting society.

Here are just ten recent examples:

1 - E-Guide promotes good mental health during covid-19 pandemic

The COVID-19 pandemic has caused significant disruption to all our lives, which in turn has had a profound impact on our collective mental wellbeing. Dr Athanasios Hassoulas, MSc Psychiatry Programme Director, has worked with year 3 medical students Srinjay Mukhopadhyay and Ravanth Baskaran in developing an openaccess mental health e-guide designed to provide remote support during this time.

The e-guide contains interactive exercises, videos, and tasks aimed at promoting good mental health and providing support to people of all age groups. The e-guide has been accessed by thousands of people across the UK and can be easily shared with anyone who you feel might be struggling at this time.

Access the e-guide

2 - Science in Health Live Online 2021

This year’s event for year 12 pupils took place virtually on 10th & 11th March, offering a combination of pre-recorded resources and four live online sessions. A total number of 464 registered and received the interactive programme with links to all resources.

Feedback was collected, both live and online, and of those who participated -

• 95% felt the event had helped them to further their future career goals
• 76% stated that they were more likely to study at Cardiff University after attending the event
• 70% strongly agreed that the event had inspired them towards a career in science in health.

3 - The Wolfson Centre for Young People’s Mental Health

Established in 2020, brings together world-leading researchers to focus on reducing anxiety and depression in young people.

Although several of the Wolfson Centre’s research workstreams have been impacted by delays associated with the pandemic, the Centre has already been busy in producing research papers and grants on the topic of young people’s mental health as well as establishing its social media platforms and website.

Co-director, Professor Stephan Collishaw, said “Finding interventions and influencing policy that will help improve young people’s mental health is a priority, particularly given the impact of the COVID-19 pandemic.

We are looking forward to increasing the pace of our research endeavours and working with young people through our planned new focus group and key stakeholders on what research they’d like to see being developed.”

4 - Langerin versus HIV

Research led by Dr Magdalena Czubala (Cardiff University), Miss Ghizlane Maarifi and Dr Fabien Blanchet (both from University of Montpellier) has shined a new light on the potential mechanism by which interferons can protect from sexual transmission of HIV. The research published in Cellular & Molecular Immunology described Langerin, a well-known surface receptor on Langerhans Cells, as a novel interferon inducible gene. Dr Czubala said:

“ These are very exciting findings. Langerhans cells play an important role in HIV capture and killing, but also sexual transmission. Inducing Langerin on these cells could potentially increase efficiency of HIV capture and degradation, thus decrease chances of virus transmission between partners”.

5 - MEDIC postgraduate wins prestigious award

Postgraduate student Dr Charlotte Brown has won the prestigious Medawar Medal at the NHSBT British Transplantation Society 2021 congress. Charlotte won the award with her presentation entitled “Ischaemic preconditioning drives expansion of a protective cell population in the renal stroma”.

Charlotte, a surgical trainee with an interest in transplantation, is on the verge of submitting her PhD thesis at Cardiff University and is supervised by a team of clinical and non-clinical investigators from the Wales Kidney Research Unit – Dr Soma Meran, Mr Usman Khalid, Dr Robert Steadman and Mr Rafael Chavez.

Her project investigates the role of the extracellular matrix polysaccharide Hyaluronan in the acute kidney injury to chronic kidney disease continuum and she has used in vivo models, developed by the research team to investigate mediators of renal injury.

6 - Professor Adrian Edwards appointed director of new Wales COVID-19
Research Evidence Centre

Health and Care Research Wales has appointed Professor Adrian Edwards as the director of the new Wales COVID-19 Evidence Centre. This £3m centre is being created on behalf of Welsh Government to make use of UK-wide and international research findings to answer key questions and support decision making in Wales. This could include addressing the long-term effects of the pandemic and investigating challenges such as infection control and social distancing, the consequences of isolation and the health effects of the economic disruption.

The Centre will enable rapid access to key international research findings and evidence, so decisions can be made by Welsh Government and NHS Wales. It will also allow fast and focused research studies to be undertaken on a Welsh level, including into long COVID.

7 - Two awards for pressure ulcer-sensing mattress topper

Cardiff medical student Luthfun Nessa and Harvard University data scientist Anna McGovern created CalidiScope - a pressure ulcer-sensing mattress topper which has won two top innovation awards totalling £40,500 in just two days.

First, Luthfun and Anna beat four other finalists to take the £10,000 prize fund in the Institute of Global Health Innovation (IGHI)’s annual Health Innovation Awards. Then, two days later, CalidiScope clinched Imperial Enterprise Lab’s Venture Catalyst Challenge, winning £30,000 plus the audience prize of £500.

CalidiScope hopes to significantly improve the prevention strategy for patients at risk of developing a pressure ulcer by helping nurses to personalise patient care.

8 - Scientists develop rapid test for diagnosis of rare set of genetic conditions

This research led by Professor Duncan Baird at Cardiff University School of Medicine and Professor Tom Vulliamy at Queen Mary University of London is published in the journal Human Genetics.

Telomeropathies are caused by premature shortening of the tips of chromosomes, the DNA molecules which contain our genetic information. They can result in a range of symptoms, including bone marrow failure, pulmonary fibrosis, cancer and liver disease in adults and children. There are currently about 1,000 people living with telomeropathies in the UK, many of which are undetected. Professor Baird said:

“ If a patient presents with a severe symptom such as bone marrow failure we can now test, more accurately and rapidly than ever before, if this is the result of a telomeropathy, thereby speeding up the process of providing a diagnosis for these patients.”

9 - Healthy Ramadan Cymru

Cardiff University’s School of Medicine has partnered with Diabetes UK Cymru and Diabetes and Ramadan International Alliance (DAR) to run a series of ‘Healthy Ramadan Cymru’ webinars led by Dr Mohammad Alhadj Ali, Clinical Lecturer in Diabetes and Endocrinology. Dr Mohammad Alhadj Ali said:

“Estimates suggest that there are 148 million Muslims with diabetes worldwide and up to 79% of Muslims with diabetes fast for at least 15 days in Ramadan. Healthy Ramadan Cymru aims to provide health care professionals in Wales with the most up-to-date information and guidelines on managing diabetes during Ramadan, as well as supporting Muslims who fast during Ramadan to have a safe and healthy fasting.”

The sessions were be hosted by Muslim Doctors Cymru and supported by British Islamic Medical Association (BIMA) and Muslim Council of Wales.

Find out more

10 - Let the immune cell see the virus: scientists discover unique way to target common virus

Human cytomegalovirus (HCMV) is a common virus that affects one in 200 newborn babies in the UK, for which there is only limited treatment available. Researchers have discovered a new type of antibody in the lab which – instead of killing the virus directly – marks infected cells so the immune system can “see” them.

Lead author Dr Richard Stanton, a virologist, said: “HCMV is a major challenge because it has evolved a range of different techniques to avoid the body’s own immune response. “ We have developed a really unique way of letting the immune system see the virus so it can get on with its task of killing it.”

The study is published in the Journal of Clinical Investigation.

Engaging black, Asian and minority ethnic communities in the COVID-19 vaccination programme

At the outset of the vaccination rollout programme, a group called Muslim Doctors Cymru involving Drs Bnar Talabani and Mohammad Alhadj Ali, from the School of Medicine began work to dispel some of the myths circling on the internet in the first languages of black, Asian and minority ethnic communities.

“I think the problem is that whereas resources that combat this misinformation are available in English, they’re not necessarily available in languages that some of these communities speak as a first language,” explains Dr Bnar Talabani.

Muslim Doctors Cymru are carrying out a survey asking people for their views on the vaccine - over 300 people have replied so far, and the results paint a picture reflected in other polling on the issue. About 10% of people said they would not be taking the vaccine, with 16% unsure.

“These aren’t anti-vaxxers, they are actually very, very open to dialogue,” Dr Talabani said.

“One elderly gentleman I recently had a conversation with said to me ‘well, does the vaccine change my DNA?’ and I said ‘Well, no, it cannot because it doesn’t come into contact with your DNA’.

“And he said ‘okay, well that was my only concern. I’m happy to have it now’, and it was really that simple.”

Dr Talabani said a problem within communities is that people receive misinformation in their own language via social media.

“If English is not your first language, you receive lots of misinformation via WhatsApp and other social media platforms in languages that are your first language, but the accurate information that is needed to combat this you don’t necessarily have access to in that language,” she said.

Having that information accessible and readily available and actually using social media as a platform to spread it just as the misinformation is also being spread, so arming communities with accurate information in multiple languages will go a long way in helping address this.”

She added it was important this information comes from a “grassroots” level as well as from the government, and to engage faith leaders.

Muslim Doctors Cymru are working with Welsh Government and local health boards to improve access to the vaccine. For example, two mosques have been set up as vaccination centres. This has led to a positive take up of the vaccines across these local communities (not just Muslims) including amongst homeless people who didn’t know where else to go for their vaccines.

Muslim Doctors Cymru are holding weekly webinars in different languages and engaging people within different communities.

Dr Talabani concluded: “We’re having feedback that dialogue, the possibility to ask questions about the vaccine in a language they’re comfortable with, with people who are from their own community, is really helping them address those concerns.”

Muslim Doctors Cymru can be found on Facebook and Twitter where you will be able to access a range of resources in multiple languages.