🧑‍⚖️Training Bills, ♋Ovarian Cancer and 💃SENIOR-RITAs?

Every day, we drink from the firehose of the internet.
Gallons of content: watched, skimmed, read, and immediately forgotten.
After a long week of celebrity breakups and TikTok Shop ads, our thirst for useless information is finally quenched. 🧑‍⚖

But between you and me, you remained parched. Thirsting for something, social media just can’t satisfy… It’s medical news.

👋 Happy Friday. Here’s what we got:

If you want to read any previous editions of The Handover, you can on our website.

It began the usual way.
Crushing chest pain. Shortness of breath. Nausea and vomiting. 
Julie Roberts, 88, is having a heart attack. 

ED is ready. The basics are complete. NSTEMI identified.
GRACE score? High. Very high. 
I guess it's time for PCI.
Very reasonable. Totally appropriate. 

Except for two small problems.

Our dear Julie is 88 years old.
And medical research… is deeply ageist.

You see, elderly patients(over 75) make up more than half of the hospital admissions for myocardial infarctions. But you wouldn’t know from the literature…

Most trials exclude people over 75 completely.
God forbid, they’re frail, demented or riddled with comorbidities.
They have a better chance of appearing at a Fred Again set at Drumshed.

The above factors are often grounds for disqualification. Which is convenient… if you’re trying to publish. Not so convenient if you’re trying to treat patients. 

But one trial dared to ask: what if we actually studied them?

Enter the SENIOR-RITA trial: The largest trial to date on the management of NSTEMI in over-75’s. With a super sexy name to boot!

This multi-centre, open-label RCT published in NEJM compared routine invasive therapy + best medical therapy to a conservative, medical strategy alone. 

The aim of the game (primary outcome) was to see if invasive management led to more deaths or non-fatal myocardial infarctions than conservative management. 

The researchers recruited 1518 patients(mean age 82) across 48 sites across the UK. Randomising them 1:1 into either:

Then followed them over the next 5 years.
And the sweet bonus was that inclusion didn’t just stop at age. 32% were classified as frail, and 62.5% had cognitive impairment. How incredibly progressive!

So what did they find? 

Ultimately, that routine invasive strategy did not significantly reduce the overall risk of the primary outcome compared to a conservative strategy.
There was no meaningful difference.

So What? Does this mean you shouldn’t PCI an old person? 

Well… no, only NICE can suggest that. Plus, this study had its fair share of blemishes:

TL;DR: more studies needed.

But if the sexy SENIOR-RITA trial suggests anything, it’s this:

In ≥75’s, don’t default to the cath lab just because the GRACE looks scary.
This study says, sometimes the brave thing to do…
is nothing at all*.

*Well, nothing besides a blister back of Ramipril, Bisoprolol, Aspirin, Clopidogrel, Atorvastatin and Spiranolactone.

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Exciting eh?
To be honest, we wanted to use ChatGPT, but it just wasn’t cutting it.
Smart? Sure. Accurate? 🤔…

So instead, we use something superior. 
Something specially trained for the people of the NHS ✊

It’s called Medwise.ai 

It’s like ChatGPT but force-fed every NICE guideline, society consensus statement, and Royal College publication until it begged for mercy.
Accurate. Sharp. Clinically on point. 

It’s used by over 2,000 NHS organisations.
It’s completely free.
If you’re still not convinced you get free CPD points just for asking questions too!

So keep up and check out Medwise.ai for free below.

👉 https://medwise.ai 

It’s finally here.
The Medical Training Prioritisation Bill.

On the 13th January 2026, the Medical Training Prioritisation Bill was introduced to the House of Commons by the Government. 

“British taxpayers spend £4bn training medics every year, so it makes little sense for many of them to then be left struggling to get speciality training places and fearing for their futures.” - Wes Streeting

I mean, I’d have to agree. Wasting £4bn sounds like a bad plan.

So the Government’s slapping an “EMERGENCY” sticker on this bill, letting it dodge red tape and fast-track into law before the 2026 training cycle ends.

What’s actually in it? Who does it affect? Why Now?

We’ll skip the parliamentary essay. Here’s the short version. 👍

There are two main bottlenecks to becoming a consultant in your dream speciality in the UK.

In the olden days (2019), the bottle was less Coke-shaped, more Red Bull.
Slim, but manageable. There were enough jobs to go around.

Then came the change. 

Visa laws were loosened in 2020, allowing for more international medical graduates(IMGs) to come to the Land of the Tea 🇬🇧

Presumingly seduced by grey skies and Greggs sausage rolls, international clinicians from far and wide saw the opportunity and applied along with the FY doctors for speciality training posts. 

This has resulted in a jump from 12,000 in 2019 to over 47,000 applications in 2025. Looking upstream, foundation year applications have also taken a hike. From 8,137 to 11,205 in the same period. 

As a result, many doctors were left without a training post.
Hence the hubbub.
Hence the strikes.

Ultimately, with things looking very bleak, the government stepped in. Bringing us to the emergency legislation of today.

Let's focus on the current cycle first, using an analogy. 

In 2025, applications began.
There were 500 applicants to become ST1 Handologists at the esteemed Deanery of Handovia.

Unfortunately, Handology is a speciality as competitive as Derm or Opthalm. There were only 200 interview spots available for 150 total job postings.

Under the old system, everyone would throw their hat in the ring at the same time.
The applicants would be scored, rank and offered jobs purely on merit, regardless of whether they studied in London or Djibouti. 

After interviews, perhaps 180 of those 200 were deemed “appointable” - i.e they passed the interview threshold. Then the 150 jobs were allocated based on who did the best. 

For the 2025/26 cycle, shortlisting and interview invites have already gone out; that part hasn't changed.

But once interviews are over, and the appointable list is drawn up, this is where new prioritisation kicks in.

Applicants are split into priority and non-priority groups:

Priority includes:

And for 2025/26 only on Immigration-status protected groups: Irish citizens, Indefinite leave to remain, British Citizens and Commonwealth Citizens. 

So let’s say, of the 180 appointable candidates, 100 are in the “priority” group.
Under the new system, those 100 will be considered first.
Since there are 150 spots available, they’ll all get jobs.

The remaining 80 non-priority candidates will then be ranked by score as usual, and the top 50 will get the remaining places. The bottom 30, despite being appointable, will be left without training posts.

For the future cycles 2026/27 onwards, the criteria change slightly. 

The priority group remains the same, besides the Immigration-Status Protected Groups. That’ll be scrapped and replaced by a category defined as “Significant NHS experience”. The significance of that experience is still TBD. 

Well, for those in the priority group its happy days. You’re much more likely to get that job posting.

For the non-priority group, it's a massive shake-up. 

Extra bits:

This all is well and dandy, but the overarching limitation remains: the availability of postings. If we return to our ST1 Handologist applicants, the majority were because there were enough postings. In reality, this isn’t the case.

The definitive step to fixing the bottleneck will ultimately be creating more postings.

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Prioritisation Bill: Foundation Year Effects

For final-year students about to start training (UKMLA results pending – you’ve got this), here’s what the bill actually means for you:

For FAQ questions and answers, please read here

NICE Guideline Change: Age-Based Ovarian Cancer Screening

Another day, another guideline change. Today, it's the ominous ovarian cancer. Ominous is fitting as it presents so vaguely, leading to a poor prognosis when finally detected. 

The biomarker for this cancer is CA125. Currently rule is ≥35 IU/ml => 2-week wait. But it’s not all that specific. This seems to miss cancers in the elderly and lead to unnecessary referrals in the young. 

The new draft guidelines scrap the one-size-fits-all approach and suggest age-specific thresholds, as well as ultrasounds in younger patients.

There is a nice table here

AI Now Prescribes: It’s So Over

For the first time in history, AI has been given legitimate clinical autonomy and can now prescribe medication to patients. The pilot programme being run by medtech company Doctronics has been approved in the state of Utah. Chat… are we cooked?

The AI assesses drug efficacy, side effects, personal history, and drug interactions to decide whether a medication should be renewed. It then sends the prescription straight to the pharmacy, cutting out that pesky, medically qualified middleman.

The company’s CEO claims the AI is “actually better than doctors” at performing renewal checks. That might even be true…but I’d love to see one of their clankers try motivational interviewing on an 80-year-old refusing their statin(it’s no mean feat i’ll tell you that much!)

Emojis in Medical Documentation?

If there were ever a sign that Gen Z medics are coming through, this might just be it. Which one of you is putting emojis in patients' EMIS notes🤨? 

This cross-sectional study, conducted by JAMA Network Open, observed over 200 million notes from 2020-2025. The absolute incidence is tiny; 4,162 notes had emojis in them. The regular old smiley face “😊” is the most common. 

This has inspired a new series in The Handover: Guess That Medical…Thing(working title, as it’s both diseases medication or a disease feature)

@ 🪢🌲= ? 

💀🐝👕= ?

🧹🖼️🐆= ? (very impressed if you get this one right)

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