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Year of Publication
1.  Outcome and Biomarker Analysis from a Multicenter Phase 2 Study of Ipilimumab in Combination with Carboplatin and Etoposide as First-Line Therapy for Extensive-Stage SCLC 
Journal of Thoracic Oncology  2016;11(9):1511-1521.
Objectives
Our aim was to evaluate the safety and efficacy of ipilimumab combined with standard first-line chemotherapy for patients with extensive-stage SCLC.
Methods
Patients with chemotherapy-naive extensive-stage SCLC were treated with carboplatin and etoposide for up to six cycles. Ipilimumab, 10 mg/kg, was given on day 1 of cycles 3 to 6 and every 12 weeks. Response was assessed by the Response Evaluation Criteria in Solid Tumors (RECIST), version 1.0, and immune-related response criteria. The primary end point was 1-year progression-free survival (PFS) according to RECIST. Secondary end points included PFS according to immune-related PFS and overall survival. Autoantibody serum levels were evaluated and correlated with clinical outcomes.
Results
A total of 42 patients were enrolled between September 2011 and April 2014; 39 were evaluable for safety and 38 for efficacy. Six of 38 patients (15.8% [95% confidence interval (CI): 7.4–30.4]) were alive and progression-free at 1-year by RECIST. Median PFS was 6.9 months (95% CI: 5.5–7.9). Median immune-related PFS was 7.3 months (95% CI: 5.5–8.8). Median overall survival was 17.0 months (95% CI: 7.9–24.3). Of the patients evaluable for response, 21 of 29 (72.4%) achieved an objective response by RECIST and 28 of 33 (84.8%) achieved an objective response by the immune-related response criteria. All patients experienced at least one adverse event; at least one grade 3 or higher toxicity developed in 35 of 39 patients (89.7%); in 27 patients (69.2%) this was related to ipilimumab. Five deaths were reported to be related to ipilimumab. Positivity of an autoimmune profile at baseline was associated with improved outcomes and severe neurological toxicity.
Conclusions
Ipilimumab in combination with carboplatin and etoposide might benefit a subgroup of patients with advanced SCLC. Autoantibody analysis correlates with treatment benefit and toxicity and warrants further investigation.
doi:10.1016/j.jtho.2016.05.028
PMCID: PMC5063510  PMID: 27296105
Small cell lung cancer; Ipilimumab; Autoantibodies; Biomarker; CTLA-4 immunotherapy
2.  Oncology and medical education—past, present and future 
ecancermedicalscience  2016;10:ed54.
Oncologists should contribute to the undergraduate curriculum whenever they can, and should teach communication skills, acute oncology, prescribing, and other transferable skills. Newly qualified doctors will care for many patients with cancer in their first years of work, and all doctors need to know when an urgent oncology referral is required and to be aware of the pace of change in oncology. Oncologists should involve their patients in teaching whenever it is appropriate. We should aim to inspire junior doctors to consider a career in oncology. The oncology education community should adopt new teaching methods, for example simulation, mock MDTs and student led clinics. CPD provided by honorable organisations, including online learning, is becoming more important for oncologists to keep up to date.
doi:10.3332/ecancer.2016.ed54
PMCID: PMC4898942  PMID: 27350792
oncology; medical education
3.  Dealing with complaints 
BMJ : British Medical Journal  2008;336(7639):326-328.
This article explores why patients complain and outlines some strategies for reducing the rising number of complaints and for dealing appropriately with any that do occur
doi:10.1136/bmj.39455.639340.AD
PMCID: PMC2234562  PMID: 18258968
4.  DR WHO: a workshop for house officer preparation 
Postgraduate Medical Journal  2007;83(975):4-7.
Background
Newly qualified doctors should be competent in advanced life support (ALS) and critical care. The Resuscitation Council has published a course about ALS for undergraduate medical students (the intermediate life support (ILS) course). However, there is no undergraduate‐level course on assessing and treating critically ill patients, despite the fact that postgraduate courses on this topic are extremely popular. We have developed a new course called Direct Response Workshop for House Officer Preparation (DR WHO), which teaches both ALS and critical care at an undergraduate level.
Methods
We taught the Resuscitation Council ILS course to our 2003–4 cohort of final year medical students (n = 350), and the new course (DR WHO) to our 2004–5 cohort (n = 338). Students filled in feedback forms immediately after the courses, and a subset repeated the feedback forms 4 months after they had started work as house officers.
Course evaluation
Student and house officer feedback was positive. The DR WHO cohort was more confident in caring for critically ill patients (18/26 (69%) were confident after ILS, and 40/45 (89%) were confident after DR WHO (χ2 = 4.3; df = 1; p = 0.06)). Both cohorts were competent in ALS, each with a mean score of 18.6/20 in a finals level practical examination on this topic.
Conclusions
The DR WHO course is popular with the students and practical to run. The course needs to be re‐evaluated to determine the long‐term competency of graduates.
doi:10.1136/pgmj.2006.049643
PMCID: PMC2599956  PMID: 17267671
5.  Ethnic stereotypes and the underachievement of UK medical students from ethnic minorities: qualitative study 
Objective To explore ethnic stereotypes of UK medical students in the context of academic underachievement of medical students from ethnic minorities.
Design Qualitative study using semistructured one to one interviews and focus groups.
Setting A London medical school.
Participants 27 year 3 medical students and 25 clinical teachers, purposively sampled for ethnicity and sex.
Methods Data were analysed using the theory of stereotype threat (a psychological phenomenon thought to negatively affect the performance of people from ethnic minorities in educational contexts) and the constant comparative method.
Results Participants believed the student-teacher relationship was vital for clinical learning. Teachers had strong perceptions about “good” clinical students (interactive, keen, respectful), and some described being aggressive towards students whom they perceived as quiet, unmotivated, and unwilling. Students had equally strong perceptions about “good” clinical teachers (encouraging, interested, interactive, non-aggressive). Students and teachers had concordant and well developed perceptions of the “typical” Asian clinical medical student who was considered over-reliant on books, poor at communicating with patients, too quiet during clinical teaching sessions, and unmotivated owing to being pushed into studying medicine by ambitious parents. Stereotypes of the “typical” white student were less well developed: autonomous, confident, and outgoing team player. Direct discrimination was not reported.
Conclusions Asian clinical medical students may be more likely than white students to be perceived stereotypically and negatively, which may reduce their learning by jeopardising their relationships with teachers. The existence of a negative stereotype about their group also raises the possibility that underperformance of medical students from ethnic minorities may be partly due to stereotype threat. It is recommended that clinical teachers be given opportunities and training to encourage them to get to know their students as individuals and thus foster positive educational relationships with them.
doi:10.1136/bmj.a1220
PMCID: PMC2517162  PMID: 18710846
6.  Ethnic stereotypes and the underachievement of UK medical students from ethnic minorities: qualitative study 
The BMJ  2008;337:a1220.
Objective To explore ethnic stereotypes of UK medical students in the context of academic underachievement of medical students from ethnic minorities.
Design Qualitative study using semistructured one to one interviews and focus groups.
Setting A London medical school.
Participants 27 year 3 medical students and 25 clinical teachers, purposively sampled for ethnicity and sex.
Methods Data were analysed using the theory of stereotype threat (a psychological phenomenon thought to negatively affect the performance of people from ethnic minorities in educational contexts) and the constant comparative method.
Results Participants believed the student-teacher relationship was vital for clinical learning. Teachers had strong perceptions about “good” clinical students (interactive, keen, respectful), and some described being aggressive towards students whom they perceived as quiet, unmotivated, and unwilling. Students had equally strong perceptions about “good” clinical teachers (encouraging, interested, interactive, non-aggressive). Students and teachers had concordant and well developed perceptions of the “typical” Asian clinical medical student who was considered over-reliant on books, poor at communicating with patients, too quiet during clinical teaching sessions, and unmotivated owing to being pushed into studying medicine by ambitious parents. Stereotypes of the “typical” white student were less well developed: autonomous, confident, and outgoing team player. Direct discrimination was not reported.
Conclusions Asian clinical medical students may be more likely than white students to be perceived stereotypically and negatively, which may reduce their learning by jeopardising their relationships with teachers. The existence of a negative stereotype about their group also raises the possibility that underperformance of medical students from ethnic minorities may be partly due to stereotype threat. It is recommended that clinical teachers be given opportunities and training to encourage them to get to know their students as individuals and thus foster positive educational relationships with them.
doi:10.1136/bmj.a1220
PMCID: PMC2517162  PMID: 18710846
7.  'It gives you an understanding you can't get from any book.' The relationship between medical students' and doctors' personal illness experiences and their performance: a qualitative and quantitative study 
Background
Anecdotes abound about doctors' personal illness experiences and the effect they have on their empathy and care of patients. We formally investigated the relationship between doctors' and medical students' personal illness experiences, their examination results, preparedness for clinical practice, learning and professional attitudes and behaviour towards patients.
Methods
Newly-qualified UK doctors in 2005 (n = 2062/4784), and two cohorts of students at one London medical school (n = 640/749) participated in the quantitative arm of the study. 37 Consultants, 1 Specialist Registrar, 2 Clinical Skills Tutors and 25 newly-qualified doctors participated in the qualitative arm. Newly-qualified doctors and medical students reported their personal illness experiences in a questionnaire. Doctors' experiences were correlated with self-reported preparedness for their new clinical jobs. Students' experiences were correlated with their examination results, and self-reported anxiety and depression. Interviews with clinical teachers, newly-qualified doctors and senior doctors qualitatively investigated how personal illness experiences affect learning, professional attitudes, and behaviour.
Results
85.5% of newly-qualified doctors and 54.4% of medical students reported personal illness experiences. Newly-qualified doctors who had been ill felt less prepared for starting work (p < 0.001), but those who had only experienced illness in a relative or friend felt more prepared (p = 0.02). Clinical medical students who had been ill were more anxious (p = 0.01) and had lower examination scores (p = 0.006). Doctors felt their personal illness experiences helped them empathise and communicate with patients. Medical students with more life experience were perceived as more mature, empathetic, and better learners; but illness at medical school was recognised to impede learning.
Conclusion
The majority of the medical students and newly qualified doctors we studied reported personal illness experiences, and these experiences were associated with lower undergraduate examination results, higher anxiety, and lower preparedness. However reflection on such experiences may have improved professional attitudes such as empathy and compassion for patients. Future research is warranted in this area.
doi:10.1186/1472-6920-7-50
PMCID: PMC2211477  PMID: 18053231
8.  Newly qualified doctors' views about whether their medical school had trained them well: questionnaire surveys 
Background
A survey of newly qualified doctors in the UK in 2000/2001 found that 42% of them felt unprepared for their first year of employment in clinical posts. We report on how UK qualifiers' preparedness has changed since then, and on the impact of course changes upon preparedness.
Methods
Postal questionnaires were sent to all doctors who qualified from UK medical schools, in their first year of clinical work, in 2003 (n = 4257) and 2005 (n = 4784); and findings were compared with those in 2000/2001 (n = 5330). The response rates were 67% in 2000/2001, 65% in 2003, and 43% in 2005. The outcome measure was the percentage of doctors agreeing with the statement "My experience at medical school has prepared me well for the jobs I have undertaken so far".
Results
In the 2000/2001 survey 36.3% strongly agreed or agreed with the statement, as did 50.3% in the 2003 survey and 58.5% in 2005 (chi-squared test for linear trend: χ2 = 259.5; df = 1; p < 0.001). Substantial variation in preparedness between doctors from different medical schools, reported in the first survey, was still present in 2003 and 2005. Between 1998 and 2006 all UK medical schools updated their courses. Within each cohort a significantly higher percentage of the respondents from schools with updated courses felt well prepared.
Conclusion
UK medical schools are now training doctors who feel better prepared for work than in the past. Some of the improvement may be attributable to curricular change.
doi:10.1186/1472-6920-7-38
PMCID: PMC2203980  PMID: 17945007

Results 1-8 (8)