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I was so pleased with myself recently during our departmental case presentation. A woman who complained of her legs shaking when she was standing……bingo, orthostatic tremor, something I have never even seen, but I did not need to as I had recently edited the article by Leah Jones (a medical student) and Peter Bain (a medical student long ago) now published on page 240. Nor have I ever seen melanoma associated retinopathy but now I know what to look out for from reading Ruth Dobson and Mark Lawden's article on page 234. And I certainly had no idea there were so many interesting new substances for people to try until I read Killian Welch's article on page 206. In my day it was just alcohol, the aroma of cannabis smoke had hardly permeated the courtyards of Cambridge. And nor have I ever seen bilaterally dilated pupils caused by what Marcel Bulder and Jan van Gijn describe on page 231. I have seen some of the gastrointestinal causes of neurological problems that Nicholas Evans and Martin Turner write about on page 220, but certainly not all of them (of course I had swotted up on lathyrism for my early postgraduate exams but I have never seen a case, and back then mitochondrial disease was not even invented). Which all makes me wonder whether I would pass these new fangled European and UK neurology knowledge exams to allow me to become a card-carrying neurologist. Well I probably would pass because I would again commit a whole lot of stuff to my short term memory, and then forget it. But would I be caught out by not having provided evidence that I had reflected 25 times, like the neurology trainees in Scotland this year? Almost certainly yes I would have been. I absolutely cannot be bothered to record all my reflections any more than record all my bowel motions, I probably have more than 25 before breakfast anyway (reflections that is). I cannot see why our trainees now have to write down all this ridiculous time wasting junk in their e-portfolios (time wasting for their consultants too, who have to tick all the silly boxes). I confess my generation failed to stop this nonsense, probably because we didn't see it coming in time. Maybe I could make amends by writing the sort of articles my old boss Gerald Stern is now writing, one is on page 247 recalling the (good) old days. Of course all this navel gazing in the UK pales into insignificance against the problems of teaching medical students and training neurologists in so many other countries, as has been described in several of the “neurological letters from..” over the years in Practical Neurology; Palestine is a good example on page 256.
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