AFRM eBulletin – 3 April 2020
A message from your President
COVID-19 pandemic and rehabilitation including establishment of COVID-19 Special Interest Group
In the February edition of the eBulletin I commented on the terrible Australian bushfire season that we had endured and made a passing reference to the emergence of a novel Coronavirus. How quickly things change.
As rehabilitation medicine physicians most of us won’t be at the forefront of dealing with acutely unwell patients with serious complications of COVID-19 and I’m sure that our thoughts are with our colleagues in emergency medicine, intensive care and acute medical sub-specialty colleagues. However, none of us is immune to the effects of the pandemic.
As rehabilitation medicine physicians, we are worried about the impacts of the pandemic on our patients, our services and our teams, our trainees, not to mention ourselves and our family and friends. We are concerned about our current and previous patients, many of whom are at significantly increased vulnerability to COVID-19. How will they be triaged, and will they have equitable access to care if they become unwell with COVID-19? What will happen to them if they lose their usual formal and informal supports in the community? How can we help?
I am sure that many of us are also concerned about the current and future impact of the pandemic on our rehabilitation teams and services and on our trainees. Many rehabilitation services whether inpatient or ambulatory will be impacted in some way. Many outpatient clinics have already been cancelled or converted to telehealth clinics, staff in rehabilitation outpatient or community teams may be at risk of being re-deployed to acute services, all services may have to deal with reduced staff numbers and different models of care due to staff illness, absence or the need to be isolated. In my own hospital, one of our outpatient areas is now the COVID-19 Screening Clinic and the Day Hospital is being assessed for how many acute beds it can hold if required. We are also very concerned about how we can best continue to support and train our trainees who are being significantly affected.
We are also thinking about the future. Will our services return to usual at the end of all of this? What should we think about doing differently in the future? How can we best serve our future patients and support our acute hospital services? For example, I think there is little doubt that there will be an increased importance placed on pulmonary rehabilitation and many people recovering from COVID-19 who will require reconditioning rehabilitation.
No doubt we are all going to be exceedingly busy in the next six months, but it has been suggested that we should establish a COVID-19 Rehabilitation Special Interest Group (SIG) (further details can be found later in this eBulletin). The aim of the SIG would be to provide an avenue for interested members to network and support each other as well and to start to think about the current and future impacts and challenges for rehabilitation medicine physicians and trainees as well as our services and teams.
Further information about the RACP response to COVID-19
can be found on the website.
To all Fellows and trainees, as we enter uncharted waters in the coming months, please look after yourselves, your family, your patients and teams and each other… and stay safe. If we can do anything to help, please contact email@example.com
More than ever... all the best.
Professor Tim Geraghty
Update on postponed exams
As the COVID-19 pandemic continues to unfold we have had to consider all 2020 examinations.
Finding solutions to the impact of postponed exams has been a priority for the College to support trainees to continue progressing through their training and into their careers as physicians.
The COVID-19 Examinations Advisory Group which is made up of the chairs of all exam committees, and the College Education Committee have made the difficult decision to postpone most 2020 exams in light of COVID-19 and the increased demands on our health system and membership.
We are continuing to look at contingency plans for each exam and put measures in place to assist trainees through progression of training.
We will provide trainees a minimum three months’ notice of any rescheduled exam to give time for preparation.
COVID-19 and rehabilitation
What happens after ICU?
COVID-19 represents an unprecedented challenge for our health system. To date, the emphasis has been on acute inpatient hospital facilities.
Early data suggests that the mortality rate for people over 70 is in the range of 8 to 15 per cent (1)
. This means 85 to 92 per cent of patients over 70 survive and will require discharge planning.
As you know, after significant illness, many people over 70 are referred to rehabilitation services. How are we going to accommodate the expected post COVID-19 patient surge?
Of particular concern, severe pneumonia is more likely in people with underlying conditions such as hypertension, diabetes, cardiovascular disease, chronic respiratory disease and cancer (2, 3, 4, 5, 6)
Many of these patients would also usually be referred to a rehabilitation service.
For many of our patients, a short period of rehabilitation is the difference between nursing home placement and staying in their own home. A timely conversation about the exponential increase in demand for rehabilitation services in aged care is warranted. Alongside planning for the expected increase in demand for rehabilitation equipment and services: Zimmer frames, home shower chairs, home care packages, meals on wheels.
There is also an emerging picture for the need for increased pulmonary rehabilitation services.
Recently Dr Owen Tsang Tak-yin, Medical Director of the Infectious Disease Centre at Princess Margaret Hospital in Hong Kong, told the South China Morning Post
that his team had already seen about a "dozen discharged patients in follow-up appointments, and two to three were unable to do things as they had in the past.
"They gasp if they walk a bit more quickly." Tsang said. "Some patients might have around a drop of 20 to 30 per cent in lung function (after recovery)" (7)
Whilst the clinical picture of post COVID-19 pneumonia is still emerging, recent radiology research out of Wuhan reported persistent chest CT opacities in 94 per cent of discharged patients (8)
We know pulmonary fibrosis was a complication of both SARS-CoV (9) and MERS-CoV (10)
Critically, we need to plan for an increase in rehabilitation patients with Post ICU Syndrome.
Cognitive impairment has been reported to occur on average in 25 er cent of ICU survivors (11)
, whilst ICU-acquired neuromuscular weakness occurs in more than 25 per cent (11)
Discussion about a rapid deployment of home-based rehabilitation services seems practical given the pandemic proportions of COVID-19.
These services can be delivered via telehealth or online platforms, in a way that minimises risk to health professionals and doesn’t further deplete PPE.
The COVID-19 emergency is posing some urgent questions. Rehabilitation physicians are well placed to workshop some answers.
Establishment of a COVID-19 SIG
Are you interested in joining a specialist interest group (SIG) as we brace for the challenges arising from COVID-19?
Please email your details to firstname.lastname@example.org
. If there is enough interest, there is potential for a new SIG to be established.
Save the date for an initial discussion on Wednesday, 15 April 2020 at 5pm.
Dr Jane Malone
30 March 2020
1. Jason Oke, Carl Heneghan:Global Covid-19 Case Fatality Rate Updated 23rd March 2020 https://www.cebm.net/global-covid-19-case-fatality-rates/
2. World Health Organization (WHO). Report of the WHO-China Joint Mission on Coronavirus Disease 2019 (COVID-19) 2020 [cited 2020 1 March]. Available from: https://www.who.int/docs/default-source/coronaviruse/who-china-joint- mission-on-covid-19-final-report.pdf
3. Huang C, Wang Y, Li X, Ren L, Zhao J, Hu Y, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. The Lancet. 2020 2020/02/15/;395(10223):497-506.
4. Fei Zhou* TY, Ronghui Du*, Guohui Fan*, Ying Liu*, Zhibo Liu*, Jie Xiang*, Yeming Wang, Bin Song, Xiaoying Gu, Lulu Guan, Yuan Wei, Hui Li, Xudong Wu, Jiuyang Xu, Shengjin Tu, Yi Zhang, Hua Chen, Bin Cao, Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. The Lancet. 2020 March 9, 2020.
5. Liang W, Guan W, Chen R, Wang W, Li J, Xu K, et al. Cancer patients in SARS-CoV-2 infection: a nationwide analysis in China. The Lancet Oncology. 2020 2020/03/01/;21(3):335-7.
6. Chen N, Zhou M, Dong X, Qu J, Gong F, Han Y, et al. Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study. The Lancet. 2020 2020/02/15/;395(10223):507-13.
7. Chung, E. Coronavirus: some recovered patients may have reduced lung function and are left gasping for air while walking briskly, Hong Kong doctors find. South China Morning Post. 13 March 2020
8. Yuhui Wang, Chengjun Don, Yue Hu, Chungao Li, Qianqian Ren, Xin Zhang, Heshui Shi, Min Zhou. Temporal Changes of CT Findings in 90 Patients with COVID-19 Pneumonia: A Longitudinal Study. Thoracic Imaging 19 March 2020
9. Zhang, P., Li, J., Liu, H. et al. Long-term bone and lung consequences associated with hospital-acquired severe acute respiratory syndrome: a 15-year follow-up from a prospective cohort study.Bone Res 8, 8 (2020). https://doi.org/10.1038/s41413-020-0084-5
10. Das KM, Lee EY, Singh R, etc. Follow-up chest radiographic findings in patients with MERS-CoV after recovery. Indian J Radiol Imaging. 2017; 27: 342-349
11. Rawal G, Yadav S, Kumar R. Post-intensive Care Syndrome: An Overview. J Transl Int Med. 2017;5(2):90–92. Published 30 June 2017. doi:10.1515/jtim-2016-0016
New education and training principles
A new set of education and training principles
have been developed to guide the College’s decision-making during the COVID-19 pandemic and provide our position on potential impacts to training.
This includes decisions about the impacts of training time and progression through training as a result of exam changes and cancellation of training events.
Our new COVID-19 Training and Accreditation Advisory Group is discussing these issues and will advise on key decisions. The committee recommendations will be provided to the CEC and we will endeavour to let you know the outcomes as soon as possible.
The new COVID-19 Exams Advisory Group is also discussing contingency planning for all postponed exams.
Save the date – AFRM Annual Trainee Meeting 2020
The essential training course for AFRM trainees is back. Planning is well under way and there will be a jam-packed program of interesting sessions including the all-important 'Exam prep' session. This will also be an opportunity to hear about the work being done on computer-based testing ahead of the roll out of the AFRM Module 1 exam in 2021.
Other topics also covered will include 'Disabled athletes', 'Refugee health/disaster rehabilitation', 'Regional and remote working experiences', 'Stroke rehabilitation', 'Transition intrathecal and spasticity'.
Further information will be published shortly. In the meantime, here are the details for your diary:
Saturday, 24 and Sunday, 25 October 2020
opening May 2020.
Expressions of Interest are open for the AFRM Trainee Research Project
Interested trainees can apply to be part of a project where they will be linked with research experienced mentors as well as their usual supervisor and mentor. They will then receive semi-structured inputs to help them develop a refined research question, a relevant research protocol, access to quality data (via the Australasian Rehabilitation Outcomes Centre) and processes to help understand biases, interpret data and reach meaningful conclusions, hopefully enabling an outcome that can be published or presented at national or international level conferences.
Trainees should be aware that this research is not in addition to the Module 3 / RACP research tasks but can be a part of this assessment. There are limited positions available to join the research project.
Submissions close on Friday, 24 April 2020 at 5pm (AEST).
Further details can be found on the EOI webpage
The RACP’s 2020-2021 Pre-Budget Submission
More needs to be done to address the joint needs of investment in prevention and deep-seated health reform to better connect the Australian health system and address identifiable gaps in care. The College calls for the 2020-2021 Federal Budget to look longer term.
Access the College’s 2020-2021 Pre-Budget Submission, which addresses the need for:
- prevention strategies on obesity and alcohol-related harm
- early intervention in mental and physical health of infants and children
- calls for more integrated approaches to care and for fundamental reform of the aged care system.
RACP Congress update
The RACP has made the decision to cancel RACP Congress 2020 and postpone the Convocation Ceremony, which were scheduled for May 2020.
These difficult decisions were not taken lightly. Considering the global repercussions of COVID-19, as physicians it is our responsibility to put the safety of our members and the community we serve above all else.
Presenters will be offered the option to present at RACP Congress 2021 being held in Brisbane on Wednesday, 28 April to Saturday, 1 May 2021.
We are currently looking at alternative options for delivering the Congress 2020 program and will provide an update on this as soon as we are able.
Further information is available at the Congress website
. Any enquiries can be directed to email@example.com
RMSANZ 2020 events postponed
Unfortunately, all RMSANZ events scheduled for 2020 have been postponed, including the RMSANZ Conference which was due to be held in September 2020.
Dates for rescheduled events and arrangements for the RMSANZ Annual General Meeting and AFRM Annual General Meeting will be announced soon – stay tuned.
Updated – AFRM and RMSANZ Top 5 Evolve List
Evolve aims to reduce low-value care by supporting physicians to:
- be leaders in changing clinical behaviour for better patient care
- make better decisions
- make better use of resources.
Evolve identifies a specialty's Top 5 clinical practices that, in particular circumstances, may be overused, provide little or no benefit or cause unnecessary harm. Evolve recommendations aim to ensure every patient receives the test, treatment or procedure they need.
Top 5 low-value practices and interventions:
- Do not discharge patients with osteoporotic fractures without an assessment and/or treatment for osteoporosis
- Discourage the use of lumbar supports or prolonged periods of bed rest in patients with non-specific low back pain
- Do not use Mini Mental State Examination as the only tool to assess cognitive deficit in acquired brain injury
- Do not routinely use splinting for prevention and/or management of contractures after stroke
- Do not use imaging for diagnosing nonspecific acute low back pain in the absence of red flags.
Further details can be found on the Evolve website.
Stage 5 Australian telehealth items
The College has been working closely with the Department of Health advocating to expand the current list of COVID-19 phone and/or telehealth services available for patients for specialist services on the Medical Benefits Schedule (MBS). This is Stage 5 of the critical work of transforming the MBS to support Australians impacted by COVID-19. The College has been consulting with all specialty societies and the Divisions and Faculties to ensure that all remaining relevant and appropriate specialist and consultant physician and paediatrician items are given telehealth and telephone equivalent attendance items.
Apply to be the Congress 2021-2022 AFRM Representative
Looking for a diverse and challenging way to contribute to physician learning?
Would you like the opportunity to shape the future of an educational meeting that attracts over 1,000 healthcare professionals worldwide?
Join the Congress team and present AFRM’s best program yet.
As an AFRM Representative you will help shape the wider Congress program for 2021 and 2022 with the Congress Program Committee (CPC).
The Representative will lead the development of the AFRM stream and work with the CPC and College staff to implement the agreed Congress themes and develop shared interest sessions.
The closing date for EOIs is 31 May 2020. Further information is on the EOI webpage
Bi National Training Program – 2020 timetable
The BNTP lectures will proceed – attendance in person is no longer available but trainees can continue to join via teleconference/videoconference.
If trainees cannot join the live teleconference/videoconference, the recording of the sessions are uploaded to the event listings webpage
to watch at a convenient time.
Further details of each presentation are also available on the event listings webpage
|Wednesday, 22 April 2020
||3pm to 5pm AEDT
|Wednesday, 27 May 2020
||3pm to 5pm AEDT
|Wednesday, 24 June 2020
|3pm to 5pm AEDT
Guillain Barre Syndrome
|Wednesday, 22 July 2020
|3pm to 5pm AEDT
||SCI and disease
|Wednesday, 26 August 2020
||3pm to 5pm AEDT
SCI and disease
|Wednesday, 23 September 2020
|3pm to 5pm AEDT
||Multidisciplinary management of spinal cord injury
|Wednesday, 28 October 2020
|3pm to 5pm AEDT
Multiple Sclerosis (MS)
- pathogenesis and management
|Wednesday, 25 November 2020
|3pm to 5pm AEDT
Request for input from members: College submission to the Royal Commission into Violence, Abuse, Neglect and Exploitation of People with Disability
Disability and the National Disability Insurance Scheme (NDIS) has been a key ongoing policy priority for the College and the broader health sector. The Royal Commission into Violence, Abuse, Neglect and Exploitation of People with Disability (the DRC) was established in April 2019 in response to community concern about widespread reports of violence against, and the neglect, abuse and exploitation of, people with disability.
The DRC’s terms of reference cover what should be done in all settings such as the home, schools, out-of-home care, the justice system, as well as in the disability support system to:
- prevent, and better protect, people with disability from experiencing violence, abuse, neglect and exploitation
- achieve best-practice in reporting and investigating of, and responding to violence, abuse, neglect and exploitation
- promote a more inclusive society that supports the independence of people with disability and their right to live free from violence, abuse, neglect and exploitation.
The DRC has released four issues papers to date: education and learning, group homes, criminal justice system and healthcare for people with cognitive disability.
Our Policy & Advocacy team has developed a draft submission which covers a range of areas that the DRC is interested in and that the College has a position on.
You are encouraged to provide feedback, with particular regard to the sections where it is noted that there are no College positions yet. Please provide feedback to Rebecca Randall, Senior Policy & Advocacy Officer, via RACPConsult@racp.edu.au by close of business Friday, 24 April 2020. We look forward to receiving your valuable feedback.
Access draft submission
The World Health Organization has warned that alcohol is an ‘unhelpful coping strategy’ for the stress and isolation of COVID-19 lockdown. Professor Michael Farrell of the National Drug and Alcohol Research Centre says there is little doubt alcohol consumption will increase in this “time of great social anxiety and stress", especially among vulnerable people.
Commonwealth Bank of Australia data shows alcohol sales have risen by 20.4 per cent compared to this time last year. Amid reported panic buying and stockpiling of alcohol, the Alcohol and Drug Foundation has expressed fears of increased domestic violence, accidents and injuries.
Trauma surgeons have warned that the availability of alcohol during the crisis, including via online sales and delivery, is likely to see an increase in the number of victims of domestic violence attending emergency departments. Chair of the Royal Australasian College of Surgeons Trauma Committee John Crozier said emergency departments in Sydney and Newcastle were already dealing with the effects of the pandemic.
In addition to an increase in accidental and domestic violence-related injuries, increased consumption of alcohol will likely result in a raise in acute hospital presentations for cardiovascular disease, stroke and depression, putting even more pressure on Australia’s overextended health system.
Western Australian Premier Mark McGowan stepped in to mitigate these potential harms by placing limits on takeaway alcohol. The restrictions are designed to assist with the state’s COVID-19 response.
The Foundation for Alcohol Research and Education CEO Caterina Giorgi says leaders must be able deal with an unfolding crisis while acting to prevent future harm. “It would be an even greater tragedy if the fallout from COVID-19 was made far worse through a significant escalation of alcohol-fuelled harm in our community.”
RACP-supported restrictions on the trading hours for alcohol are especially needed in such times of an expanding physical and mental health crisis like COVID-19.
Rehabilitation medicine in the news
RACP’s Model of Chronic Care Management featured at IHCRC 2020
On 27 March, Co-Chair of the Integrated Care Working Group Dr Nick Buckmaster featured at the International Health Care Reform Virtual Conference presenting on complex subacute care and the RACP’s Model of Chronic Care Management
Dr Buckmaster described how the healthcare system could be re-oriented away from episodic care bringing services together for the patient, and incorporating care plans linking care across sectors towards a more integrated approach. In practice, what this means is that a patient is supported and rehabilitated by a team, including a coordinator, a generalist specialist, GP and other key clinicians, such as other specialists and allied healthcare.
COVID-19 information for people affected by cancer
Cancer Australia has launched a dedicated hub
providing coronavirus (COVID-19) information for people with cancer, health professionals and researchers.
People with compromised immune systems or pre-existing medical conditions, including cancer, may be at increased risk of contracting coronavirus (COVID-19) and increased risk of more severe infection.
The website features information for people affected by cancer and a repository of up-to-date, evidence-based resources and guidance from some of the most trusted sources in Australia and around the world for people affected by cancer, health professionals and researchers in the wake of the coronavirus (COVID-19) pandemic.
For more information on coronavirus (COVID-19) and cancer treatment, visit the hub
New Pomegranate podcast: Ep56: Billing in Byzantium
Australia has one of the best-value health systems in the world, but also some of the most complicated health regulation. Amongst the Medicare scheme, the state hospitals, the private health insurers and the patient, it’s not always clear how a provider should invoice their services.
To explain some of the fundamentals, this podcast features a former nurse and lawyer, Margaret Faux, CEO of Synapse Global Medical Administration. Faux describes areas of ambiguity in the legislation and the Medical Benefits Schedule which create confusion as to when and where certain services can be billed, or which items should not be claimed together. While there are many traps for well-intentioned providers and loopholes for the less well-intentioned, there are some simple solutions that would make medical billing much more streamlined.
Guest: Margaret Faux (CEO, Synapse Global Medical Administration).
Fellows of the RACP can claim CPD credits via MyCPD for listening to this episode and reading the resources
Subscribe to Pomegranate Health in Apple iTunes
or any Android podcasting app
Listen to podcast
My Health Record webinar – Getting started
My Health Record is a secure online summary of an individual's health information available to all Australians. Healthcare providers authorised by their organisation can access My Health Record to view and add to their patients' health information. Understanding how to register and upload to My Health Record can be challenging.
Watch Professor Steven Boyages' interview of Carey Doolan from the Australian Digital Health Agency, where they explore and provide practical advice to help you register and upload to My Health Record.
New online course: Working with migrants, refugees and asylum seekers
Learn how to work more sensitively and effectively with migrant, refugee and asylum seeker patients in this new online course
The course provides relevant facts and practical strategies for developing good cross-cultural communication and facilitating easier navigation of the healthcare system. The course includes the perspectives and stories of a diverse range of individuals to provide the full picture.
Accessible anywhere and optimised for mobile on-the-go learning, RACP Online Learning Resources
are free for members and count towards Continuing Professional Development (CPD) requirements
Access the course
The Good Guys Commercial through Member Advantage
As we are all trying to adjust to this new way of the world, The Good Guys Commercial are committed to take care of your needs in the best possible way during this time.
Whether it is a laptop or monitor to assist with new working from home arrangements, a microwave or small appliance for preparing healthy meals, a fridge, a washer or any other white goods – they can help with what you need and deliver to your door in the current and ever changing environment.
The team are operating as normal, and members will continue to be supported by TGG Commercial Sales Support Centre who are available to assist with any enquiries – Phone 1300 22 55 64 or Email firstname.lastname@example.org
Visit your RACP Member Advantage website
today to register for this benefit.
*Terms and conditions apply.
Expressions 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.
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Events and conferences
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 events are coming up.
AFRM contact details
Phone: (AUS) 1300 69 7227
Phone: (NZ) 0508 69 7227
AFRM Faculty enquiries (including Council and committees):
Jane Henderson, Executive Officer, AFRM
Phone: +61 2 8076 6315
AFRM NZ Committee
Executive Officer DFAC’s NZ
AFRM Education and Training enquiries:
Phone: +61 2 8076 6350
AFRM oral examination enquiries:
Phone: +61 2 9256 5422
AFRM training site accreditation enquiries:
Phone: +61 8247 6233