AFPHM eBulletin – 18 October 2019

AFPHM Webinar #8 2019: Cultural awareness

Dr Ngaree Blow will be presenting on cultural awareness for the AFPHM Webinar #8. Ngaree is a Noonuccal, Yorta-Yorta woman and doctor. She is currently working as the Director of First Nations health at the University of Melbourne and as a Research Officer at the Murdoch Children’s Research Institute (MCRI). Ngaree has a keen interest in paediatric medicine and public health, having completed both her Master of Public Health and the Doctor of Medicine degrees concurrently. Ngaree has been a strong advocate for her people and has been a member of the Australian Indigenous Doctors Association (AIDA) since 2011 and was recently elected on the board. She has been involved in many First Nations health and education roles and was recently recognised in the Australian Financial Review as one of the 100 Women of Influence 2019. 

Ngaree will draw upon her experiences during her presentation on cultural awareness. We invite you to join this informative session.

Presenter:  Dr Ngaree Blow 
Date:  Tuesday, 29 October 2019
Time:  3pm AEDT
Location: Online

For information on how to join this webinar, please see the event listing on the RACP website

To watch previous webinars, go to our Youtube playlist.

If you are interested in presenting a future webinar, please contact AFPHM@racp.edu.au.

A message from your President

Last week was Mental Health Week in Australia and Mental Illness Awareness Week in New Zealand. The week might have passed most of us by without fanfare, particularly as it may have been overshadowed by the first week of the two-week International Rebellion. Rather than writing about the climate crisis yet again, however, this month I wanted to write about the role of public health in promoting mental health at a population level.

People with a mental illness, particularly if it is severe, have poorer physical health than the rest of the population. They have higher smoking rates, higher rates of misuse of alcohol and other drugs, and higher rates of poverty and homelessness. According to the World Health Organization (WHO), people with a severe mental illness have a reduced life expectancy of between 10 and 20 years. While suicide is one cause of death, the commonest causes of death among people with severe mental are largely preventable chronic diseases. It is clear that as a society we are failing people with serious mental illnesses. While population-based approaches have resulted in reductions in smoking rates it is clear that additional measures are necessary for people with mental illnesses. In addition to physical impacts of mental illness, mental illness, itself, particularly if severe, can be highly disabling.

It has been estimated that one in five adult Australians experience a mental illness in any one year. The most common mental disorders in Australia are anxiety, depression and substance misuse, or a combination of these three conditions. Evidence suggests there are a number of effective interventions to support people at risk of or who are showing early signs of mental illness, and some population-level interventions as well. There is also some evidence that general chronic disease prevention strategies such as improved nutrition and physical activity is also good for our mental health. 

At this stage, though, the role of the public health physician in preventing mental illness is not clear, at least to me. While we don’t have to be involved in every aspect of public health, I think it would be worthwhile to consider what role public health physicians and other public health practitioners can play in improving the mental health of the population. If there is insufficient evidence, perhaps now is a good time to develop some?

If anyone has any thoughts on this matter, particularly in terms of what these startling statistics mean for the training of public health physicians, and our ongoing professional development, I would love to hear from you. Thanks.

Associate Professor Linda Selvey
AFPHM President

Good luck exam candidates

Good luck to all our trainees who will be attempting the AFPHM Oral Examination on Tuesday, 29 and Wednesday, 30 October 2019. We wish you all the best for your exams.

Don’t forget to take care of yourself while you prepare. There are a number of resources available on our website including the Instructions to Candidates. If you need support in the lead up to, or following your exam, the RACP Support Program is available 24 hours, seven days a week. This free, fully confidential and independent helpline is available to all Fellows and trainees and is managed by Converge International.

If you have any questions about the upcoming exam, contact faculty.examinations@racp.edu.au
 

RACP Congress 2020 – Early bird registration now open

Join your colleagues at RACP Congress 2020, from Monday, 4 to Wednesday, 6 May 2020 at the Melbourne Convention and Exhibition Centre in Melbourne, Australia. 

Listen to what Lead Fellow, Professor Don Campbell has to say about RACP Congress 2020: Balancing medical science with humanity.

In this rapidly changing world, RACP Congress 2020 will equip you to deliver healthcare, provide leadership and respond to need.

Congress 2020 Lead Fellow, Professor Don Campbell, encourages Fellows, trainees and stakeholders to attend Congress 2020. 

“Be a part of something bigger, contribute to the conversation. Congress 2020 will broaden your horizons, challenge your thinking and inform your practise.” 

With the theme of ‘Balancing medical science with humanity’, RACP Congress 2020 will look at a range of topics, exploring how the profession is transforming.

For more information on the program and to register visit racpcongress.com.au

 AFPHM Faculty awards 

AFPHM President’s Awards for Outstanding Contribution

Nominate a Fellow or Advanced Trainee of the AFPHM for the AFPHM President’s Awards for Outstanding Contribution to recognise their extraordinary contribution to the Faculty in any of the following areas:

  • education, training and assessment
  • policy and advocacy
  • trainee commitment
  • other.

Nominations open Friday, 1 November 2020 and close Friday, 31 January 2020.

Faculty prizes for trainees and medical students

The Gerry Murphy Prize is open to trainees for the chance to present at local events organised by AFPHM regional committees during the month of November. Applications close 14 days prior to each regional competition. Selected representatives from each local event will be invited to attend and present at RACP Congress 2020 in Melbourne. Regional presentation dates are published on the Gerry Murphy Prize webpage.

The John Snow Scholarships are available to medical students to promote appreciation of public health medicine as a medical specialty and potential career path. Nine scholarships are available each year, with recipients selected from each state/territory of Australia and New Zealand. The selected representatives are invited to present at RACP Congress 2020 in Melbourne. Applications are due Thursday, 31 October 2019.

Details about these prizes are available on the RACP Foundation website.

RACP Indigenous health scholarships

The Australasian Faculty of Public Health Medicine is proud to offer the 2020 John McLeod Indigenous Health Scholarship as part of the RACP Indigenous Health Scholarship Program.

The Program is an opportunity for those who identify as being Aboriginal, Torres Strait Islander, Māori or Pacific Islander to receive support throughout their Basic, Advanced, Faculty or Chapter Training in Australia and New Zealand. Each scholarship is valued up to $40,000 over three to four years, depending on the training pathway taken.

Several scholarships are available for 2020:

  • College Indigenous Health Scholarship
  • Aboriginal & Torres Strait Islander Health Scholarship
  • New Zealand Indigenous Health Scholarship
  • Indigenous Health Scholarship for Paediatrics and Child Health.

Applications are open now and close on Saturday, 30 November 2019.

Further details on these scholarships are available on the RACP Foundation website.

New Faculty exam email 

Faculty examinations have a new email address to better support Faculty candidates. 

Please make sure you update your email contacts to faculty.examinations@racp.edu.au and send any emails about Faculty exams to the new address. 

The old address (examinations@racp.edu.au) still exists but for Divisional Exam queries only.

Doctors say “Save Medevac”: Your opportunity to be part of the campaign

The Medevac Legislation, introduced in February 2019, has improved access to appropriate healthcare for refugees and asylum seekers being held offshore. It allows medical experts to make decisions about healthcare for seriously ill individuals and ensures they receive the medical treatment that they need in a clinically appropriate timeframe. Previous delays and failures to transfer ill asylum seekers resulted in preventable suffering. The RACP is proud to have been a key part of the campaign to establish Medevac, and we are now continuing this by leading medical college opposition to its repeal. 

Last weekend the RACP released an unprecedented statement with 10 other medical colleges calling on the Australian Parliament to maintain the Medevac legislation and the Independent Health Advice Panel (IHAP) process.

To continue keeping up pressure on the Parliament in the lead up to the Senate voting on this legislation in mid-November, we encourage all doctors to take part in our social media campaign to save Medevac. Show the Parliament that doctors say #SAVEMEDEVAC by retweeting with comment our kick-off campaign tweet featuring Professor Paul Colditz, RACP President, Paediatrics & Child Health Divisionwith your own selfie with the sign and #SAVEMEDEVAC.

You can also engage with our existing tweets (tweet #1tweet #2) and Facebook and LinkedIn posts to support momentum for this cause.

Download sign #SAVEMEDEVAC

RACP History of Medicine Library Opening

Represent the College on the Australian Gun Safety Alliance

The RACP joined the Australian Gun Safety Alliance earlier this year and we are now seeking a member to represent the RACP on the Alliance.

The Alliance's objectives are to:

  • ensure a safer community for Australian children 
  • have all jurisdictions comply with the National Firearms Agreement 
  • increase public awareness of the poor compliance by all Governments 
  • hold governments to account for their non-compliance
  • contribute to a balanced public conversation about the importance of a strong gun safety framework. 

The Alliance counts the Australasian College of Emergency Medicine (ACEM), the Australian and New Zealand Intensive Care Society (ANZICS) and the Public Health Association of Australia (PHAA) amongst its current supporters.

The Alliance holds quarterly teleconferences for about one hour and has ad hoc special interest groups which meet at the convenience of interested members.

If you are interested to represent the College on the Alliance, please email your CV and some information about your interest and expertise in the area of gun safety to AFPHM@racp.edu.au by Friday, 1 November 2019.

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: 

  • AFPHM Council
    The AFPHM Council invites Fellows who identify as Aboriginal, Torres Strait Islander and/or Māori to submit an Expression of Interest to join the AFPHM Council. This is a chance to advocate for and support AFPHM members across Australia and New Zealand. Please contact afphm@racp.edu.au for further details.
  • Members, AFPHM Regional Committees
    If you are interested in supporting and advocating for your local colleagues within the Faculty, please consider submitting an Expression of Interest form and your CV to afphm@racp.edu.au, for one of the vacant member or Chair positions on your local AFPHM Regional Committee.
  • AFPHM Northern Territory Regional Education Coordinator
    This is an opportunity for AFPHM Fellows residing in the Northern Territory to further their leadership experience by supporting local trainees, supervisors and mentors through the AFPHM Training Program. Please submit an Expression of Interest form and your CV to afphm@racp.edu.au if you are interested in applying for this position.
  • Chair, AFPHM New South Wales Regional Committee
    This is an opportunity for AFPHM Fellows residing in New South Wales to lead the AFPHM Regional Committee’s activities. Please submit an Expression of Interest form and your CV to afphm@racp.edu.au if you are interested in applying for this position.

Registrations now open for IMS 2020

Registrations are now open for the Tri-nation Alliance International Medical Symposium (IMS), 20 March 2020, Amora Hotel Sydney, Australia.

Now in its ninth year, IMS is an annual event that reinforces the strong historical relationship between medical professions from Canada, New Zealand and Australia. Cementing these ties, a formal agreement between the Royal College of Physicians and Surgeons of Canada, The Royal Australasian College of Physicians, The Royal Australasian College of Surgeons, The Australian and New Zealand College of Anaesthetists and the Royal Australasian College of Psychiatrists created the Tri-Nations Alliance.  

The IMS 2020 theme, 'Providing care to underserved populations', is relevant to health professionals from all member countries. With a focus on higher medical education, delegates will explore how specialist training can support and enhance access to healthcare for critical populations experiencing difficulties in accessing healthcare, potentially due to location or isolation, social determinants or other specific issues.

Register now on the IMS website.  
 

AIDA Conference 2019 – Disruptive innovations in healthcare

The RACP were proud conference partners at this year’s Australian Indigenous Doctors’ Association (AIDA) Conference held in Darwin on 2 to 4 October. A number of RACP Fellows and trainees were present at the conference, including RACP President Associate Professor Mark Lane, Associate Professor Tamara Mackean, Dr Dennis Bonneyand and Dr Angie dos Santos. Staff included Director of Education Robyn Burley and Director of Policy and Advocacy Patrick Tobin.

The conference began with a Welcome to Country delivered by Dr Aleeta Fejo, the first locally-trained Northern Territory GP. Keynote speakers included AIDA President Dr Kristopher Rallah-Baker, Northern Land Council CEO Ms Marion Scrymgour, Danila Dilba Health Service CEO Ms Olga Havnen and Australian Medical Association Federal President Dr Anthony Bartone. In her address, Ms Scrymgour emphasised “let's not forget the importance of Aboriginal health practitioners who are the cultural brokers within our communities". Ms Scrymgour also drew attention to leadership and to the role of Treaty as vital to improving the health of Indigenous peoples.

The RACP held a workshop on ‘Community collaboration as a basis for specialist outreach services and innovative change’. Dr Josh Francis facilitated a powerful conversation with Indigenous patients, community leaders and doctors on the synergistic power of Indigenous community leadership and specialist physician care to tackle Rheumatic Heart Disease in Maningrida, a community of 2,400 people 500km from Darwin.

RACP President Mark Lane spoke at the ‘Growing our Fellows’ workshop, which was an opportunity for medical students and interns to interact with Indigenous members and leaders of Australia’s specialist medical colleges, ask questions and discuss career pathways through medicine.

A special congratulations to Dr Jaquelyne Hughes FRACP who was awarded Indigenous Doctor of the Year 2019. Dr Hughes is an inspirational leader in the field of kidney health, and advocate for Aboriginal and Torres Strait Islander doctors and patients.

RACP Curated Collections 

Your one-stop-shop to professional online resources

Curated Collections are learning guides based on the contributions and peer review of RACP Fellows and other industry experts. Each guide presents key readings, online courses, webcasts and other tools for physicians’ continuing professional development. 

Discover more today
 

$10,000 grants for doctors in training

Are you undertaking Advanced Training to further your career? Consider applying for a $10,000 grant through MIGA’s Doctors in Training Grants Program. There are many eligible training types including post graduate study, specialised fellowships, volunteer placements and more. Applications for the 2019 Program are open until Friday, 1 November 2019.

Find out more and apply

Physicians shaping Evolve

Evolve is a flagship initiative that aims to support physicians to safely and responsibly phase out low-value tests, treatments and procedures where appropriate, provide high-value care to patients based on evidence and expertise, and influence the best use of health resources, reducing wasted expenditure. RACP Fellows and trainees have recently shaped the next Evolve Strategy for 2019-21.

From 1 to 31 July 2019 the draft strategy was circulated through Divisions, Faculties and Chapters, Specialty Societies and through the Presidents eBulletins. We received 27 responses to the survey, one email response and also undertook a face-to-face consultation with the Paediatrics & Child Health Division. 

We received a lot of positive feedback and constructive criticisms. We value all feedback and have made changes to the strategy accordingly and are looking at how we can incorporate it in the implementation of the strategy to ensure Evolve is better meeting the needs of our members. We are pleased to share the updated Evolve Strategy 2019-21 and a summary of the consultation feedback.

Get involved in shaping and implementing Evolve by emailing evolve@racp.edu.au.

AFPHM training resources

A reminder to all AFPHM trainees, the following resources are available for your training:

Other resources you may be interested in, include:

Read the September/October 2019 edition of RACP Quarterly

RACP Quarterly is the RACP's member magazine.

Articles in the September/October 2019 edition include:

  • New discovery in the fight against Vitamin D deficiency
  • In-flight medical emergencies: Is there a doctor on board?
  • Obesity: Rising to the challenge
  • Medical needs of adolescent refugees resettling in Western Australia

Access previous editions of RACP Quarterly on the RACP website.

New Pomegranate podcast: Ep52 Opioids Part 2 – Regulation and marketing

In the previous episode we talked about the science of pain, opioid analgesia and dependence. Now we look at the influence of culture, regulation and marketing on opioid prescribing for chronic non-cancer pain. First, we ask which are the prescription opioids most commonly leading to dependence and why are they prescribed? Then we discuss the mixed messages that prescribers are getting from guidelines and pharmaceutical regulation. Ever-relaxing indications for pharmaceutical subsidies can nudge prescribing behaviour in the wrong direction.

Tasmania was for many years the worst performer on measures of opioid use and harm, but this all began to turn around from 2006. Addiction medicine specialist Associate Professor Adrian Reynolds explains how education, regulation and real-time prescription monitoring were brought together in that state.

Finally, an undeniable influencer of prescribing behaviour are the promotional campaigns organised by pharmaceutical companies. Pain medicine specialist Dr Chris Hayes explains that those within the medical profession should not be surprised by this, but should be wary so their professional judgement isn’t compromised. A couple of case studies provide context for the RACP’s Guidelines for ethical relationships between health professionals and industry.

Guests:

  • Dr Christopher Hayes FFPMANZCA (Director Hunter Integrated Pain Service)
  • Clinical Associate Professor Adrian Reynolds FAChAM (Clinical Director Alcohol and Drug Service, Tasmania)

Fellows of the RACP can claim CPD credits via MyCPD for listening to this episode.

Subscribe to Pomegranate Health in Apple iTunesSpotify or any Android podcasting app

SOMANZ evolving clinical practice

As evidence and clinical practice advances, Evolve and Choosing Wisely recommendations will reflect these changes. The previous iteration of the Society of Obstetric Medicine of Australia and New Zealand ‘Top-Five’ recommendations included: Do not perform a D-Dimer test for the exclusion of venous thromboembolism during any trimester of pregnancy. 

Recent studies have shown that using a D-Dimer along with a clinical algorithm can increase the reliability of D-Dimer testing in ruling out DVT and PE in pregnancy.

Furthermore, the alternative to D-Dimer tests for these purposes is the use of imaging tests, which have their own set of risks from radiation exposure. Where previous evidence which suggested D-Dimer testing was highly unreliable would have tipped the scales towards discouraging D-Dimer testing, the new evidence suggests the results of D-Dimer testing can be made more reliable. Thus, it is no longer apparent there would be strong benefits from discouraging the use of D-Dimer testing in these settings. Due to this change in evidence and physician support, this recommendation was officially removed in August 2019. A fifth recommendation has not been identified yet.

Australian Guidelines for the Prevention and Control of Infection in Healthcare

The National Health and Medical Research Council (NHMRC) is pleased to announce the release of the revised Australian Guidelines for the Prevention and Control of Infection in Healthcare (2019) (the guidelines). 

These have been produced by NHMRC in collaboration with the Australian Commission on Safety and Quality in Health Care, to ensure they reflect the latest national and international evidence on infection prevention and control. 

Effective infection prevention and control is central to providing high quality healthcare for patients and a safe working environment for those who work in healthcare settings. The guidelines provide evidence-based recommendations that outline the critical aspects of infection prevention and control, focusing on core principles and priority areas for action. 

The guidelines are for use by all working in healthcare – including healthcare workers, management and support staff. They provide a risk-management framework to ensure the basic principles of infection prevention and control can be applied to a wide range of healthcare settings. The level of risk may differ in different types of healthcare facilities; risk assessments are encouraged as part of the decision making and use of guideline recommendations. When implementing these recommendations all healthcare facilities need to consider the risk of transmission of infection and implement according to their specific setting and circumstances.

For further information on the review please visit the NHMRC Preventing Infection website.

Department of Health: Media release on the use of e-cigarettes

A media statement was recently released from Professor Brendan Murphy, Chief Medical Officer and jurisdictional Chief Health Officers’ relating to the use of e-cigarettes and reports of severe lung disease (including deaths) reported from the United States.

The media release can be found on the Department of Health's website. Please consider this information when assessing patients with unexplained respiratory symptoms.

PBAC outcome – changes to antibiotic listings on the PBS 

The Department of Health is undertaking a review of antibiotic listings on the Pharmaceutical Benefits Scheme (PBS).

In 2018-19, the Department commenced a review of antibiotic listings on the PBS that currently include a repeat when prescribed. The review is part of the Australian Government’s broader ongoing strategy to support best practice prescribing in Australia, as outlined in Australia’s First National Antimicrobial Resistance Strategy 2015-2019.

The review is being undertaken in stages with the first stage focusing on the top five antibiotics with repeats prescribed (by volume) on the PBS, being:

  • Amoxicillin
  • Amoxicillin + Clavulanic Acid
  • Cephalexin
  • Doxycycline
  • Roxithromycin.

The department’s review proposed changes to some of the PBS listings for antibiotics listed above.

The Pharmaceutical Benefits Advisory Committee (PBAC) considered the proposed changes to the listing of certain antibiotics to encourage antimicrobial stewardship at its August 2019 Intracycle Meeting.

The PBAC recommended the removal of repeat options for a range of listings where no repeats were deemed necessary as per the Therapeutic Guidelines. The PBAC also recommended aligning the listings for specific indications to the Therapeutic Guidelines where increased quantities are clinically indicated. The PBAC considered that the recommended changes, aligned as best possible with the current version of the Therapeutic Guidelines (version 16), would support antimicrobial stewardship and quality use of medicines as well as assist in the reduction of antimicrobial resistance.

An implementation date for the changes has not yet been established. More information on the specific PBS listings considered, changes recommended and implementation timeframes will be provided in the near future.

If you have any questions, please contact the Department at amr@health.gov.au.

An update from the Obesity Collective

Earlier in the year the College joined the Obesity Collective, a group of individuals and organisations from across Australia working to take on the obesity challenge together, with empathy and from a whole-of-society perspective.

Since then, the Collective has been active across a range of initiatives, including the launch of the Weight Issues Network (WIN). WIN is a growing organisation that represents the perspectives and needs of people living with overweight and obesity and those who care. The WIN hosted its first workshop at Westmead where over 40 new members discussed the need for a strong lived experience voice, advocacy priorities and the power of personal stories.

The challenge of obesity is widely discussed in the media, reports and strategic plans. The framing of the challenge influences the public’s perception and weight stigma. It is a goal of the Collective to have a more unified, consistent and balanced narrative around obesity. These key messages and concepts have been developed for Collective members to consider, use and adapt when referring to obesity, including in clinical settings and in discussions with patients. We invite you to review and comment on these messages by sending us an email at racpconsult@racp.edu.au. You might also be interested in the Collective’s Tiffany Petrie talking to the ABC about the dangers of fat shaming.

Finally, we invite you to fill in a survey from the National Association of Clinical Obesity Services (NACOS). NACOS represents organisations providing clinical obesity services in Australia. NACOS is committed to driving improvements to access to clinical obesity services and raising standards in clinical obesity care. The team are working with stakeholders to develop a framework for clinical obesity services and are asking for input from clinicians and people with lived experience of obesity.

To learn more about the Collective and participate in its work, visit the website or contact the organisation.

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.

Expressions of Interest for Public Health Medicine Advanced Training positions in Hobart

Positions are available for Advanced Trainees in public health medicine interested in working in Hobart, Tasmania in 2020. Training positions are for up to three years depending on satisfactory progress and continuation of Commonwealth funding. The positions offer diverse and high-quality training opportunities in communicable disease control, environmental health, population health improvement programs, Aboriginal health and public health research. Training positions are provided by a consortium led by Public Health Services (Department of Health), the Menzies Institute for Medical Research (University of Tasmania) and the Tasmanian Aboriginal Centre. Your training will be supported by an enthusiastic and diverse local network of public health physicians.

To express interest or enquire further, please send a current CV to either Fay Johnston at fay.johnston@health.tas.gov.au or Shannon Melody at shannon.melody@health.tas.gov.au. Formal applications for these vacancies will be advertised shortly.
 

Expression of Interest  

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

Career opportunities

View all positions vacant

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 events list at any time to see what other events are coming up.

AFPHM contact details

Member enquiries
Phone: 
(AUS) 1300 69 7227
Phone: 
(NZ) 0508 69 7227
Email: memberservices@racp.edu.au 

AFPHM Faculty enquiries (including Council and committees):

Rachel Smith, Executive Officer
Phone: +61 2 9256 9622
Email: afphm@racp.edu.au

AFPHM Education and Training enquiries:
Education Officer
Phone: +61 2 8247 6286
Email: publichealth@racp.edu.au

AFPHM Oral Examination enquiries:
Examination Coordinator, Assessment and Selection Unit
Phone: +61 2 9256 9681
Email: examinations@racp.edu.au

AFPHM training site accreditation inquiries:
Site Accreditation Unit

Phone: +61 2 9256 9674
Email: accreditation@racp.edu.au

AFPHM CPD enquiries:
Office of the Dean (CPD)
Phone: +61 2 8247 6285
Email: mycpd@racp.edu.au

AFPHM New Zealand enquiries:
RACP New Zealand Office
Phone: +64 4 472 6713
Email: nz_afphm@racp.org.nz
 

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