Harm occurs in 10% of hospitalised patients. After 20 years of patient safety implantation plans using a Safety 1 paradigm, developed from high-risk industries, there has been no significant change, except in certain niche areas. Hospital medicine has changed over the last two decades; we now work in an intractable system. The Safety 2 paradigm looks at how things go right (90% of times) so often. Clinicians are able to adjust their work to conditions (work as done) and adapt to changing conditions. Therefore, the way forward, is a combination of these two paradigms. It is still the case that some of these adverse events are relatively simple or can be treated as relatively simple without serious consequences. Using a Safety 1 paradigm will therefore be appropriate. But there is a growing number of cases where this approach will not work. In these instances, it is necessary to adopt a Safety 2 view.

The Hippocratic Oath, written by the father of medicine, Hippocrates in 430 BCE has been sworn for millennia across the world by new doctors. Its nine articles outline how a doctor must treat their patients effectively, abiding by the core ethical principles that underscore Good Medical Practice today, including a focus on beneficence and non-maleficence. Today, the Gods of Olympus are no longer routinely worshipped, and we benefit from vast medical and technological advances, so the question arises whether the principles of Hippocratic medicine are still relevant? On the island of Kos, Hippocrates' birthplace, there continues the tradition of an annual 'oath swearing' ceremony for students that have completed medical school both from Greece and across the world. Whilst this event can be used to celebrate the achievements of the new doctors in training, is there still a need for them to retrace the routes of the profession? This article aims to explore the core principles of the Oath and Hippocratic medicine and determine their relevance in today's modern society.

This article describes the discovery and deployment of the world's first clinically useful insulin in Toronto more than 100 years ago. It addresses the propagation of a false account of how this breakthrough was achieved and the controversy that ensued leading to a diminution of the contribution of the Scottish academic leader of the discovery team. It describes how, despite the advent - some 60 years later - of a meticulously compiled and definitive history of what really happened in Toronto, the traditional account has proved resistant to correction. It concludes with a description of a spectacular memorial project in Aberdeen restoring the reputation of Professor JJR Macleod, and going on to respectfully reunite 'the Toronto Four'.

Medical education podcasts are increasingly popular, providing high-quality, asynchronous education to listeners. Here, we describe our experience developing the Royal College of Physicians of Edinburgh (RCPE)'s trainee-led podcasts, Clinical Conversations and Career Conversations. Both podcasts have been designed by resident doctors for resident doctors and are in high demand, approaching one-quarter of a million plays and international listenership. In this article, we explore the myriad benefits for resident doctor hosts, guest speakers and staff involved in podcast production, as well as reflecting on the challenges faced. Providing free, high-quality medical education is a core purpose of RCPE to benefit patients, physicians and healthcare systems around the world, and podcasts play a key role in this. By openly sharing our achievements, challenges and lessons learnt during our journey, we hope we may inspire others to engage in creating high-quality, accessible medical education.

The Royal College of Physicians flagship chief registrar programme, an initiative launched nearly a decade ago was an innovative leadership and management programme for medical registrars which has now been rolled out to other specialties as well. The role has evolved over time and explores the broader aspects of the ways of workings in the UK National Health Service, the progression and impact for individuals, teams and organisations across the wider health economy both from the perspective of acute care as well as treating long-term conditions. A personal reflection on connecting the experiential learning attained from being a chief registrar and transitioning through this unique and distinctive programme towards embedding into the Consultant Physician job that encompasses broadening horizons into non-clinical managerial domains such as Clinical Lead from a service line perspective as well as academic Co-lead to widen the landscape of undergraduate medical school placements is illustrated in this article.

Academic publishing is increasingly prevalent in clinical training and practice, as part of the burgeoning field of academic medicine, where physicians are expected not only to perform their conventional clinical duties and responsibilities, but also increasingly have to engage in various forms of scholarly activities to contribute to evidence-based practice, as part of their key performance indicators. However, for physicians who are not trained as academics or scientists, the learning curve for scholarly endeavours can be steep and fraught with setbacks and rejections. Therefore, in this editorial article, we offer our perspectives as residents-in-training on the roles of both clinician-authors and journal editorial/peer review teams in facilitating healthy cognitive-emotional processing of unfavourable manuscript decisions in academic medicine.

Cutaneous tuberculosis (TB) is an uncommon condition, the diagnosis of which can be challenging. Biologic disease-modifying anti-rheumatic drugs (bDMARDs) are associated with a higher risk of opportunistic infections, including TB. We present a case of cutaneous TB in a 56-year-old male with psoriatic arthritis on adalimumab. He developed skin lesions on his thumb and axilla, and Mycobacterium tuberculosis was isolated in cultures sent from a skin biopsy. Four months after commencement of TB treatment, he presented with a new onset of seizures. An MRI head showed two tuberculomas, with no further lesions identified in cross-sectional imaging. A tapering course of steroids was started alongside a 12-month course of anti-TB treatment for post-tuberculous treatment paradoxical reaction. In conclusion, although uncommon, cutaneous TB should be considered in patients on bDMARD treatment with atypical skin lesions.

We provide historical context for the recently discovered University of Glasgow Library records of Archibald Hewan (1832- 1883), the first Black medical doctor known to have served as a missionary in Africa. An audit of several different manuscript records of the University of Glasgow's Archives and Special Collections and an analysis of their meaning within the broader historical context of medical libraries during the mid nineteenth century. The records offer insight into what kinds of books were borrowed, how they connected to the curricula of Glasgow's universities, where they were consulted and what kinds of topics caught the attention of students. The records of medical libraries offer unique insight into the information sources and learning strategies employed by Hewan and other contemporary university students who later worked in colonial locations.