Over the summer holidays several people have got in touch with us wanting to find out more about the Diploma in Mountain Medicine (DiMM). In this posting STDZ spoke to Mike Greene, the Programme Lead for the DiMM and asked him to fill us in...
Thanks Mike for speaking to STDZ. Can I start by asking how you became involved in the DiMM?
I started climbing and mountaineering as a younger teenager, went to the Alps for the first time with friends at 17 years old and spent maybe too much time climbing at Medical School. My elective was spent doing high altitude “research” climbing on Mt Kenya and Kilimanjaro. My medical career ended up in Emergency Medicine and pre hospital care and I moved to the Lake District and became involved in mountain rescue and International Commission for Alpine Rescue (ICAR). I took a sabbatical from work and completed the DiMM as a “mature” student. This opened lots of new doors and for the last three years I have privileged to be the Programme Clinical Lead at the Royal College of Surgeons (Edinburgh) Faculty of Pre Hospital Care.
Dr Mike Greene is the Programme Clinical Lead for the Diploma in Mountain Medicine organised by the Royal College of Surgeons (Edinburgh). He is Medical Officer for England and Wales Mountain Rescue and in 2014 was awarded an MBE for his services to medicine.
What skills or experience did you pick up whilst studying for the DMM?
I joined the DiMM with a background in mountaineering and pre hospital emergency medicine. The mountain guides were fantastic and shared their extensive knowledge. I picked up lots of tips about moving fluently in the hills and went onto expand my skills particular in ski mountaineering, which is terrific way to explore the winter Alpine environment. Much of the high altitude medicine was new to me and this is fascinating physiology with relevance to acute injury and illness.
Can you remember a patient where these skills and experiences helped?
I was fortunate to work at a high altitude rescue post in Nepal for IPPG as a direct result of the DiMM. This was one of the best experiences of my life living in the local community and looking after some very sick porters and trekkers in remote conditions.
A porter was carried by his friends down from a high village suffering from HACE, he was confused and very sick. We placed him in a portable hyperbaric bag and pumped the bag with a foot pump all night. In the morning we transferred him by horse to the local Nepali hospital. Without knowledge gained from the DiMM he would most likely have died.
Who else is involved in the DMM?
The DMM is supported by an experienced administrative team at the FPHC who are focused on giving students a good experience. The teaching faculty come from different aspects of mountain medicine; high altitude climbers, mountain rescue experts, expedition doctors. All the tutors are both experts in their fields and most importantly are out there “doing it” in the mountains. They understand what it is like to be cold, wet, gasping for breath and sometimes scared. I’m not sure this is always the case with some courses. The mountaineering instruction is provided by a guiding team who are at the top of their game and teach and assess other UK guides and instructors. You can’t be in better company.
Who is the DMM aimed at?
The DMM is aimed at health care professionals with an interest in exploring how mountain skills, medicine and practice interact in challenging environments. It is a “learning journey” and it is best to come with an open mind and lots of enthusiasm. A sound basis in fundamental mountaineering skills and medical skills are important. The more you bring at the start the further the journey can take you!
What does the DMM provide students with?
The formal outcomes are to found on the course information! It’s like a mountain journey. Adventures are journeys with uncertainty! The DMM will definitely provide the student with knowledge and skills but also some personal challenges to explore both the content and themselves. This should help us become, thoughtful, flexible and practical mountain medical practitioners.
What have students gone on to do with the DMM?
Some students just want to explore mountain medicine for personal interest. For others it has provided opportunities in expedition work, mountain events medicine, mountain rescue and research. A recent survey (2018) of DMM holders confirmed that everyone had enhanced their personal mountain and medical skills but also felt more motivated, had better career opportunities and valued the chance to meet likeminded people.
What do students find most challenging on the DiMM?
The mountain weather in Scotland – it’s an acquired taste!
The academic skills required for the written pieces of work.
Thinking outside the normal constraints of their day jobs.
Unusual winter conditions in Scotland.
What's the best bit of feedback you've received?
When students are genuinely enthused by the experience and have enjoyed learning.
If someone is thinking about enrolling on the DMM in a few years time what experience and skills should they gather first?
They should go into the mountains and gain lots of experience in summer and winter conditions. Do some “trad” rock climbing and practice navigation in all types of weather. This is one of the few times you can claim climbing as CPD! Gain experience in emergency medicine so they are really familiar with basic emergency care and can then transfer this to the mountain environment. Start to browse some of the specific mountain medical literature. Try looking at the journals of Wilderness and Environmental Medicine or High Altitude Medicine and Biology.
How long do most students take to complete the course (timeframe, order of assessments etc)?
The RCSEd FPHC Certificate (equivalent to the International Diploma in Mountain Medicine) is taken as four residential Modules over a period of a year. However many students will take two years to complete these and this is sensible if more learning time and experience is required. A maximum of 3 years is allowed and students must start with Module 1 in North Wales and finish with the Alpine assessment Module 4. The RCSEd FPHC Diploma requires another four modules that are taken as supported distant learning and they explore mountain medicine through academic inquiry. A maximum period of five years is allowed to complete all 8 modules.
Plas y Brenin is the National Outdoor Centre located in the heart of the Snowdonia National Park and hosts two of the DiMM's residential Modules.
How are the students assessed?
There are practical summative assessments in both mountaineering and medical skills. There is an emphasis on good navigation skills and basic casualty assessment. These are spread through the Modules and there is always an opportunity for further support and reassessment. The Alpine Module assesses the student’s ability to move safely in the mountains at a moderate level of technical ability but a high level of competence. Students must demonstrate a crevasse rescue. They will also manage mountain incidents both as a medical responder and incident commander.
What do students fail on?
Practical deferrals are most common on navigation, the ability to do an effective primary survey outdoors and incident command.
Some students underestimate the amount of work and study required for written work and most often fail to place the medicine into a mountain context. You can’t do an MRI on a mountain or use oxygen if you're not carrying it!
Who is the course open to?
The FPHC is a multidisciplinary faculty and ours students have included doctors, paramedics, dentists and nurses. Applicants should normally be registered with one of the nine UK Health and Care Regulatory Bodies, (GMC, HCPC, NMC, GDC etc…). Applications will also be considered from final year medical students who will complete the course after they are fully registered. These applicants should normally hold a first degree or provide evidence of the ability to study at master's level. Those applicants who's first language is not English must be able to demonstrate a satisfactory level of both spoken and written English. You may be asked to provide evidence of an English Language test.
How many undertake the course each year?
The current intake is 24 students a year.
Thanks Mike for speaking to STDZ!
Before signing off, it's worth mentioning that Abbi Forsyth, one of our Mountain Medicine Fellows at Chesterfield Royal Hospital (CRH), has written a very good post about the DiMM from the student's perspective. You can read it here. In addition, if you're interested to hear more from the DiMM teaching faculty here are posts from Karen Greene and Stuart Allan. They're both well worth looking at!
Finally, it's worth mentioning that if you like the content of this blog then you'll probably find the DiMM a really engaging experience. Why not come to Chesterfield, develop your clinical skills and have the DiMM paid for you?
The British Mountain Medicine Society (BMMS) are organising a Science Day in the Peak District on the 13th November 2019. Why not come along? Details can be found here.