Maybe I have reading Pulse too much, but it is always hard to attach meaning to the first tremors, before the ground visibly shakes. Lots of interesting memes: whether a medical degree is now a signal not of medical competence but of general skills (hard work, group work, perseverance, ambition); and whether we are seeing a widening of expectation gap between different groups of our own students. What seems clear, and has been for some while, is that an undergraduate medical degree needs to be dissociated from a career in the NHS: this can no longer be its prime educational purpose. Rash talk, perhaps. But please don’t think making medical apps will pay the bills.