AFPHM eBulletin – 16 November 2018

Public health crisis: Accelerated Silicosis

In response to a recent outbreak of the life-threatening lung disease accelerated silicosis, the Australasian Faculty of Occupational and Environmental Medicine (AFOEM) and the Thoracic Society of Australia and New Zealand (TSANZ), have made an immediate call for action, requesting regulators to address this public health crisis.

The request for immediate action includes:

  • respiratory health assessments of all workers (past and present) in the industry
  • an urgent review of the dust control measures used in the industry, including independent monitoring of dust levels
  • comprehensive enforcement of hazardous substances regulations related to silica dust exposure
  • enforcement of an immediate prohibition on dry cutting techniques
  • a national occupationally acquired respiratory disease surveillance and registry program.

“Silicosis is a lung condition that has historically occurred in the mining industry when airborne silica-containing dust isn’t adequately controlled. It can take up to 40 years for workers to develop chronic silicosis,” said Dr Graeme Edwards, FAFOEM.

“We are now seeing an increasing number of people who work with artificial stone materials used for kitchen, bathroom and laundry benchtops, diagnosed with accelerated silicosis after only three to 10 years."

Silicosis is caused by inhalation of silica dust. Unlike natural stone such as granite, which comprise approximately 30 per cent silica, artificial stone materials typically contain over 90 per cent silica, leading to an accelerated form of silicosis.

Recent health surveillance of workers in the artificial stone benchtop industry in Queensland has revealed alarmingly high rates of accelerated silicosis with approximately one in three workers in the industry being diagnosed. Both the RACP and TSANZ expect these rates to be the same across Australia.  

TSANZ spokesperson Dr Ryan Hoy said, “Accelerated silicosis is normally rare, so there is much to learn about how to best treat it. Early identification, even before symptoms have developed, and avoidance of further exposure to silica dust are crucial.

“Many of these workers have already developed a silicosis complication known as Progressive Massive Fibrosis (PMF). Both silicosis and PMF are life-shortening illnesses, for which the only treatment at present is lung transplantation.

“Urgent clinical trials are required to assess the potential effectiveness of some new drugs being used for a different lung scarring condition.

“Our members have been reporting cases of silicosis in this industry for the last few years. We are eagerly awaiting a positive response to our call for a national respiratory health surveillance and registry program to drive an evidence-based approach to this burgeoning public health crisis.

“Australian workers deserve a safe workplace, and early intervention and treatment when problems arise. The current situation is simply unacceptable. Prevention is the best strategy, but we need to know the scale and to act now,” said Dr Hoy.  

Further information on the prevention, diagnosis and management of accelerated silicosis can be found on the RACP website.

A message from your President

I’ve been thinking about leadership recently. Last week I participated in a meeting with public health physicians working for Queensland Health in which we discussed the importance of their leadership in driving climate change adaptation and mitigation within their Hospital and Health Services and communities. During our AFPHM planning day in July we identified leadership as an important skill that public health physicians bring to their workplaces, and we asked ourselves the question whether our training program adequately equipped our trainees with the requisite skills.

Sometimes public health physicians are put into leadership roles due to the nature of our roles compared to our non-medical colleagues. Does either our medical training or our public health medicine training make us better equipped to lead than our non-medical colleagues?  

I’m currently involved in a project in which we are interviewing RACP Fellows in rural and regional Australia. A couple of interviewees spoke about the lack of good medical leadership in their workplaces and its impact on the quality health services. Others described their own leadership (although not necessarily calling it that) in developing initiatives to support trainees and to improve the quality of care in their health services. The former described the importance of quality leadership in formal leadership positions; the latter, informal leadership that we all can engage in regardless of our position.

In public health, leadership is even more important as leadership is necessary to achieve the changes that are required to improve health. I gave a lecture on advocacy to first year medical students earlier this year in which I drew from the literature about the evidence behind successful advocacy. Following the lecture, one student commented that they were intelligent people and therefore didn’t need to be taught how to do advocacy.

So, given that we are all smart people (although we definitely don’t have a monopoly on that), do we need to ensure that our Fellows are trained in leadership and advocacy or can we learn this on the job? I think that it is possible to short-cut our leadership journey and learn to be more effective more quickly. I spoke about this recently at the Australian Public Health Conference.

I would love to find out what you think. This will be very useful in reviewing how our training program prepares consultants for leadership. These are the things I would like to know from you: 

  • How important is leadership in your work?
  • Did your public health medicine training adequately prepare you for leadership (formal or informal)?
  • What additional training (if any) would have helped to prepare you for leadership?

You can answer these three questions via an online survey. Your responses will be received directly by me and are non-identifiable. 

Associate Professor Linda Selvey
President, AFPHM 

New approach for 2019 Divisional Clinical Examination scoring

A new approach to scoring candidates’ performance in the Divisional Clinical Examinations was approved by the College Education Committee on 2 November 2018. The way that candidates need to prepare for the examination has not changed: candidates still need to demonstrate the same skills and competencies as they have in past years.  The Divisional Clinical Examinations will continue to consist of two long cases and four short cases involving real-patient situations.  

The changes in 2019 will include:

  • a clarified examination purpose, and definitions of the long case and the short case
  • improved scoring guides for examiners that link the purpose of the exam to the candidate scores and guide the application of a new six-point scoring scale
  • a score combination grid to combine each candidate’s scores for the long cases and short cases, determining their overall pass/fail outcome.

Details of the changes for the 2019 Divisional Clinical Examination, scoring guides, videos explaining the new approach, and examples of how the score combination approach works, along with other information, is available on the RACP website’s exam information page.

Regional Gerry Murphy Competitions

Calling all AFPHM trainees: Applications are now open for the 2019 Gerry Murphy Prize in Victoria and Tasmania. Check the RACP website to confirm your regional competition date. 

This is an opportunity of all AFPHM trainees to present and be recognised for their research.

Regional finalists are then selected to represent their region at the national competition during the 2019 RACP Congress. They will receive:

  • full registration for the 2019 RACP Congress, held in Auckland from 6 to 8 May 2019
  • return economy airfares for travel to and from your hometown to the 2019 RACP Congress
  • an invitation to the AFPHM Dinner at the 2019 RACP Congress.

The national recipient of the Gerry Murphy Prize receives a certificate signed by the AFPHM President, A$500 and a copy of The People's Health written by Faculty Fellow, Dr Milton Lewis.

For information on eligibility, competition dates and the application process, please visit the Gerry Murphy Prize webpage.

Seeking AFPHM representatives for committees

Are you willing to represent your colleagues and be a voice for the Faculty? Would you like to be part of creating positive change within the Faculty? 

The Faculty is currently seeking Expressions of Interest for the following positions on: 

Accredited AFPHM training positions

As a part of the AFPHM training program, trainees are expected to complete their core training in an AFPHM accredited training position.

A list of accredited AFPHM training positions is available on the RACP website.

Urogynaecological Mesh Senate Inquiry

The Australian Government has tabled its response to the Senate Community Affairs Reference Committee Urogynaecological Mesh Inquiry. A copy of the Government’s response is available on the Department of Health’s website. In addition, the TGA has launched a web hub to help consumers and health professionals find information about urogynaecological surgical mesh.

Time to recharge with up to 60 per cent off at selected hotels 

RACP members have access to the buying power of the world’s largest online travel agency, offering over 100,000 promotional deals and competitive rates on hotel accommodation in more than 71,000 locations worldwide.

No matter your destination or whether it’s for business or leisure, browse through an extensive range of properties, from resorts and villas to executive apartments and five-star luxury suites.

To access this benefit, visit your RACP Member Advantage website or call 1300 853 352. 

Terms and Conditions apply. Savings dependent on availability and location. Information correct as at 7 November 2018.

Career opportunities

View all medical positions vacant.

The following opportunities may be of particular interest for public health members. The Sydney School of Public Health is currently recruiting for four positions:

  • The Sydney School of Public Health is currently recruiting for a Professor of Public Health (Prevention & Health Promotion). Closing date: 11.30pm on Sunday, 25 November 2018
  • Western Australia Country Health Service is currently recruiting for a Public Health Registrar in Pilbara. Placement is flexible 6 to 12 months from March 2019, for second or third year trainees seeking rural public health experience.

Expressions of Interest

RACP Fellowship Committee Specialty Society representative opportunity

Check the Expressions of Interest page at any time to find out if there are any opportunities that are of benefit to you.

Conferences and events

The Royal Australasian College of Physicians publishes notices of events and courses as a service to members. Such publication does not constitute endorsement or mandating of any such events or courses.

Go to the RACP events list at any time to see what events are coming up.

AFPHM contact details

AFPHM Faculty enquiries (including Council and committees):
Rachel Smith, Executive Officer
Phone: +61 2 9256 9622

AFPHM Education and Training enquiries:
Anusha Kumar, Education Officer
Phone: +61 2 8247 6286

AFPHM Oral Examination enquiries:
Caroline Greenaway, Examination Coordinator, Assessment and Selection Unit
Phone: +61 2 9256 9681

AFPHM training site accreditation inquiries:
Site Accreditation Unit

Phone: +61 2 9256 9674

AFPHM CPD enquiries:
Office of the Dean (CPD)
Phone: +61 2 8247 6285

AFPHM New Zealand enquiries:
RACP New Zealand Office
Phone: +64 4 472 6713
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