AFRM eBulletin – 8 February 2019

Interview with Mrs Catherine Ephraums

You will be one of the speakers at the upcoming AFRM Annual Training Meeting in early March discussing cognitive behaviour therapy (CBT), acceptance and commitment therapy (ACT) and goal settings with patients, what drew you to speak at this event? 

I was invited to speak by Dr Stephanie Lam, the rehab trainee in the Spinal Injury Unit (SIU) at Royal Rehab where I work as a member of the multidisciplinary team. I agreed to speak at the training meeting because I believe it is important for members of different disciplines to have some understanding of the role that others play in the treatment. In our rehab unit we refer to our patients as clients to emphasise that they are no longer in an acute hospital setting and their role as partners in their recovery is important.

Clinical psychologists can help their clients to think about what they value in life and then use this information to look at what is working and what they need to change to improve their functioning as well as their satisfaction with life. CBT and ACT provide tools and approaches to help the clients through this process. 

Goal setting is important in the rehab setting as it assists the treating team to work with the client towards goals that are important and meaningful.

How do you engage your clients in the process of goal setting? Are there any measures you take to help the client to continue to see you while they are in the rehab unit?

I see clients within their first week on the SIU, I discuss the role of the clinical psychologist and explain the goal setting process. The discussion focuses on the clients’ values, key aspects of their life that guide who they are and what they do such as the importance of being able to play an active role in their family. Once the client understands that we are interested in who they are and what is important to them, they are usually happy to work with me on the goal setting. 

Once the initial goal setting is completed, I discuss with the client what role I can play in their rehabilitation. This can include helping them to adjust to the major life changes that have occurred, reducing the impact of anxiety and treating depression. If the client is feeling and functioning well, there is no need for active psychological therapy, but I stay engaged as a member of the treating team to assist the other therapists and re-engage actively with the client if needed.

From your experience, what words of wisdom would you pass onto AFRM trainees during their training? 

Listen to your patients – it is their life and they are entitled to be involved in and make decisions that we may not agree with. Talk with them, explain, advise and then listen.

Catherine Ephraums
Clinical Psychologist 
Royal Rehabilitation Centre Sydney - Royal Rehab

A message from your President

AFRM 25th Anniversary Commemorative Gift and Editor of Rhaia EOI

AntarticaDear AFRM Fellows and trainees, 

Welcome to the first AFRM eBulletin for 2019. I hope that you all had great break over Christmas and New Year and no doubt most are well and truly back into work by now. I am writing this President’s Post while on important Faculty business.......setting up the Antarctic Branch of the AFRM and currently moored in Port Lockroy, Antarctica – the southernmost Post Office in the world and ex-British research station. It appears that the Antarctic Branch membership will consist mostly of Gentoo penguins, Weddell seals, the odd Humpback whale and the odd Shag or two (and yes, they do actually sit on rocks).

AFRM_25thAnniversary_KeyringI hope that you enjoyed reading the 25th Anniversary edition of Rhaia, that went out in December and thank you to everyone who submitted articles. It is always very interesting to reflect on where we have come from as part of planning the way forward.

As part of our ongoing celebration of our 25th Anniversary we will be issuing all Fellows and trainees with a commemorative gift – an AFRM keyring emblazoned with the 25th Anniversary AFRM logo. These are being produced at the moment and we hope to distribute them over the next month or so. 

In this edition of the eBulletin you will also find an EOI for the Editor of Rhaia. For the past few years we have not had a continuing editor for Rhaia but have been extremely grateful to have had a number of great guest editors who have worked very hard, along with Stacey Barabash, Council members and many other individual contributors, to enable us to keep publishing a very high quality Rhaia. Having a consistent person in the editor position will ensure that Rhaïa continues to thrive and develop even further. I encourage you to consider applying for this important Faculty role. 

Now back to the penguins........

Professor Tim Geraghty 
President, AFRM
 

RACP Fellows honoured

Congratulations to the 35 RACP Fellows recognised in the 2019 Australia Day and New Zealand New Year Honours lists. We would also like to congratulate Dr Sue Packer AM who is the 2019 Senior Australian of the Year recipient.

These awards highlight the outstanding work RACP members do and the importance of that work in local, national and international communities.

Read more

Have you registered for 2019 Australasian Faculty of Rehabilitation Medicine Annual Training Meeting?

With just five weeks to go until the AFRM ATM registrations close we want to remind those of you who have not yet registered of what you will gain by attending. And of course, refresh the memory of those who are coming by outlining what they can expect from their participation.

Day One:

  • The International Classification of Functioning, Disability and Health (ICF) 
    Professor Friedbert Kohler
  • Models of Care / Telehealth
    Dr Zoe Adey-Wakeling
  • High Risk Foot Care
    Dr Howard Flavell
  • Rural & Remote 
    Dr Ashlyn Alex
  • Pain Management Network – MDT Management
    Dr Amanda Johns
  • Workshops in MSK (shoulder) and Parkinsons and cerebellum
    Dr Howard Flavell and Dr Alex Ganora 

Day Two:

  • Cognitive Behaviour Therapy (CBT), Acceptance and Commitment Therapy (ACT) and goal settings with patients
    Mrs Catherine Ephraums
  • Robotic Technologies in Rehabilitation
    Professor Ray Russo
  • Occupational Therapy in traumatic brain injury
    Mr Iain Irving
  • Transitional Care
    Dr Asma Taskin

Registrations close on Friday, 8 March 2019.

We look forward to seeing you there, register at www.afrmatm.com.au. If you have any questions regarding the ATM, please contact afrm@racp.edu.au.

Dr Ashlyn Alex
Chair, AFRM Trainee Committee 
AFRM ATM Organising Committee 

The ISPRM registration code for 2019

The Australasian Faculty of Rehabilitation Medicine (AFRM) is currently in the process of renewing our membership with ISPRM. Once the 2019 registration codes are generated by the International Society of Physical and Rehabilitation Medicine (ISPRM), and provided to the Faculty Office, this information will be communicated to AFRM members.
 
 

Faculty Paediatric Training and Assessment Committee (FPTAC) Membership

The FPTAC is currently seeking Expressions of Interest (EOI) for two member positions on the FPTAC. 

The AFRM FPTAC key responsibilities include:

  • overseeing the coordination of the AFRM Paediatric Fellowship Written and Clinical Examinations
  • engaging in continuous quality improvement of all assessments
  • responsibility for the annual working parties that write examination questions for all the AFRM Written and Clinical Examinations as well as oversee the External Training Modules.

The FPTAC meets four times a year, twice face to face and two times via teleconference. The term of office is for two years, with the option to serve up to a maximum of six years. 

If you are interested in the above opportunity, do not hesitate to contact the Education Officer, for Paediatric Rehabilitation Medicine, Lia Iliou, on 02 8076 6350 or via email Rehab@racp.edu.au to obtain an EOI form.

Applications are due by close of business on Friday, 22 February 2019.

Mind Special Interest Group invites you to join their teleconference.

The Mind Special Interest Group will be hosting its first teleconference of 2019 on Wednesday, 20 February. 

  • 5.30pm to 6pm – Mind SIG General Meeting
  • 6pm to 6.30pm – Presentation from Professor Catherine Crock AM who is a physician at The Royal Children’s Hospital Melbourne and founder of the Gathering of Kindness.

Professor Catherine Crock:
Over the last decade, Catherine has successfully implemented a raft of positive changes to healthcare in the areas of organisational culture, services and patient/family support. Catherine is the Chair and Founder of The Hush Foundation, a registered charity organisation working to transform healthcare by improving partnerships, culture and the environment to support health and wellbeing. Catherine established a Gathering of Kindness initiative in 2016 to help redress the imbalance in the healthcare sector by using creative ways to bring people together from inside and outside the healthcare sector. Catherine will speak on her motivations and progress in these areas.

To join the teleconference please use the below dial in details:

Video-conference: Join from PC, Mac, Linux, iOS or Android https://racp.zoom.us/j/741209675
Telephone from Australia: (02) 8015 2088 or (08) 7150 1149 or 1800 893 423 (Toll Free)
Telephone from New Zealand: (04) 831 8959 or (09) 801 1188
Meeting ID: 741 209 675

Dr Jane Malone
Chair, Mind Special Interest Group

RACP Congress 2019 – early bird closing soon

Join colleagues from Monday, 6 to Wednesday, 8 May 2019 at the Aotea Centre in Auckland, New Zealand, for RACP Congress 2019. As the premier annual event on the RACP calendar, Congress includes the College’s convocation ceremony as well as a diverse program with topics that span the breadth of the medical industry.

RACP Congress 2019 key topics include:

  • Life course theory ‘How do we impact health along the life course?’
  • Obesity: rising to the challenge
  • First 1000 days and non-communicable diseases
  • Medically unexplained symptoms master class
  • Mental health and addiction of patients
  • Chronic disease and integrated care.

Early bird registration closes 22 February 2019.

Visit the Congress website to register and view the program. 

AFRM Examinations: 2019 Important Dates

All examination dates are now available on the College website

Applications for the rehabilitation medicine examinations will open on Monday, 4 March 2019.

If you are unsure of your eligibility for any of the rehabilitation medicine examinations, please email rehab@racp.edu.au for further details.

Applications close on Friday, 15 March 2019 at 5pm (AEDST) and no late applications will be accepted. 

For further information please email examinations@racp.edu.au.

PREP program requirement website content updated

The new Physician Readiness for Expert Practice (PREP) program requirements are now available on the relevant Basic Training and Advanced Training specialty pages.

Basic Training
The 2019 Basic Training program requirements apply to all trainees registered in a PREP Basic Training program in 2019.

Advanced Training
The 2019 to 2020 Advanced Training program requirements apply to all trainees registered in a PREP Advanced Training program in 2019 and/or 2020.

PREP trainees and their supervisors should familiarise themselves with the updated program requirements for their specialty.

It is the responsibility of the trainee to ensure that they are following the correct guidelines for each training year.

Have you read our new position statement? 

A position statement setting out the RACP’s role in improving Aboriginal and Torres Strait Islander health, including work within the College and our partnerships and advocacy outside the College, was released in December 2018.

The Aboriginal and Torres Strait Islander Health Position Statement was developed by the Aboriginal and Torres Strait Islander Health Committee (ATSIHC), chaired by Professor Noel Hayman.

A 2018 deliverable contained in the Indigenous Strategic Framework, the statement combines the RACP's existing support for Constitutional recognition of Australia’s First Peoples, development of a Treaty, a human rights approach to health equity, and advocacy for the health benefits of genuine reconciliation.

Read the Position Statement

Register now for the Tri-Nation Alliance annual International Medical Symposium

The Tri-Nations Alliance annual International Medical Symposium (IMS 2019) will be held in Auckland, New Zealand on Friday, 22 March 2019. 

IMS 2019 is a one-day event bringing together representatives from international and local specialist medical colleges, medical schools, health services and regulators for an inspiring day where challenges are discussed, and new ideas explored. 

The theme for the 2019 symposium is 'Visioning the impact of advanced technology on medical education' with a program featuring diverse sessions including:

  • Professor Enrico Coiera – Trust and AI 
  • Professor Jenny Weller – Using simulation training to learn about non-technical skills management 
  • Associate Professor Rebecca Grainger – Current research on apps to monitor patient self
  • Mr Andrew Connolly – Informed by AI: the systemic challenges before us 
  • Professor Jim Warren – Consumer health information revolution 
  • Mr Greg Cross – Using avatars for teaching 
  • Dr Jaron Chong – Training radiology residents when machines read imaging
  • Professor Tim Shaw – AI in trainee assessment. 

To view more IMS 2019 sessions and to register visit the IMS 2019 website.

Fellows funding opportunity

Grants worth up to $10,000 are on offer to RACP Fellows living and working in rural and remote Australia.

Learn more

Importance of mulitsource feedback highlighted

As the RACP's new MyCPD Framework comes into effect, Dr Peter Roberts and other Fellows who are incorporating the changes into their practice and lifestyles, share their thoughts on Continuing Professional Development (CPD).

Read more

In-Training Long Case Assessment

The current accredited list of Long Case Assessors is uploaded online and can be found on the RACP website.

Expressions of Interest – AFRM QLD Regional Committee

Expressions of Interest are being sought for an opportunity within the AFRM QLD Regional Committee.

The AFRM QLD Regional Committee has been established to:

  • advise the Faculty Council on matters relevant to the Faculty in their region
  • promote rehabilitation medicine in their region
  • respond to new and emerging rehabilitation medicine issues relevant to the Faculty as they arise provided the issue is approved by the Faculty President or Faculty Council prior to work commencing
  • work with other relevant appropriate College bodies and staff in relation to training and continual professional development and contributing to policy and advocacy matters
  • the activities of the Committee must be consistent with the College’s Strategic Directions document or any successor document.

For further information please visit the EOI wepage.

NDIS and the provision of disability services in NSW  

The RACP recently made a submission to the Inquiry into the Implementation of the National Disability Insurance Scheme (NDIS) and the provision of disability services in New South Wales (NSW). The Inquiry was established to investigate systemic and policy issues concerning the wider provision of disability services and the roll out of the NDIS in NSW. As a result of the submission, the RACP was invited to attend the hearing of the Inquiry in October 2018, and RACP Fellows Dr Graham Vimpani and Dr Jacki Small attended to give evidence regarding the current issues facing disability service provision in NSW.

At the hearing, Dr Jacki Small gave evidence regarding the issues surrounding swallowing assessments, particularly the recent transfer to the health sector. The Australian Government has announced that until long-term arrangements are agreed between governments, the NDIS will fund the ongoing assessment and monitoring of meal plans for NDIS participants with dysphagia who aren’t in a hospital or an acute care setting. Although not a permanent solution, this is an important recognition by the government of the seriousness of swallowing problems for people with developmental disability.

The Inquiry’s final report was released in December 2018. Several of the Committee’s recommendations are aligned with those made by the RACP in its submission, particularly regarding current eligibility criteria, appropriate training for Local Area Coordinators, and early childhood intervention supports. The NSW Government has also released its response  to the Inquiry’s final report, in which it commits to establishing an Ageing and Disability Commissioner from 1 July 2019. The Commissioner will have powers to investigate matters affecting adults with disability and older Australians, and will be independent and not subject to Ministerial direction and control in exercising its investigation functions and ability to report and make recommendations to government.

The RACP will continue to engage in the NDIS and disability space and will keep members abreast of future developments or updates.

Care pathways for people with intellectual disability living with dementia: A modified Delphi study conducted by the Department of Developmental Disability Neuropsychiatry at UNSW

This study is being conducted by Julian Trollor, Liz Evans, and Rebecca Daly at the Department of Developmental Disability Neuropsychiatry UNSW. The project is being done to learn more about care pathways for people with intellectual disability living with dementia, and potential ways they could be improved. The study seeks the opinions of clinicians, policy-makers and academics with experience in both dementia and intellectual disability, using a series of brief online surveys. 

The researchers are looking for people who want to take part and who:

  • live in Australia 
  • have at least two years’ experience working with people with intellectual disability living with dementia, or conducting research, or developing policy in this area. 

To learn more about the study, please read the full version of the advertisement. The advertisement includes a link to the registration form.

Please register by 18 February 2019 if you wish to take part. 

A new training program to support your clinical practice

End of Life Law for Clinicians (ELLC) is a new training program for clinicians and medical students about the law relating to end of life decision-making.

ELLC has been developed by the Australian Centre for Health Law Research, Queensland University of Technology (QUT) and the Institute of Health and Biomedical Innovation, QUT, with funding from the Australian Government Department of Health.

ELLC is a free program, the online training modules are available on the ELLC online training portal.

For more information, please visit the ELLC website.

Did you know that Australians are living 25 years longer than we did 100 years ago? 

The Australian Government has developed a new tool ‘Life Checks’, for Australians aged 45 and older to help them plan and prepare for a longer life. The website provides people with a free, quick and easy 'Life Check' to see how ready they are for the next stage of their life.

The 'Life Check' covers finances, health, work and social life, and provides tips on healthy eating, exercise, achieving financial goals and maintaining good health and wellbeing. Once a person completes their check, they will be directed to tailored information to help them better prepare for a healthy and secure future.

For more information please visit the Life Checks website.

Guidance on implementing the The Misuse of Drugs (Medicinal Cannabis) Amendment Act 2017 NZ; exemption and statutory defence for patients requiring palliation (New Zealand)

What you need to know about the Act
The Misuse of Drugs (Medicinal Cannabis) Amendment Bill came into effect on 18 December 2018. 

The Act provides an exemption and a statutory defence for people who require palliation to possess and use illicit cannabis, or a cannabis utensil. In the Act – ..."a person requires palliation if, in the opinion of a medical practitioner or a nurse practitioner, the person has an advanced progressive life-limiting condition and is nearing the end of their life."

What does the exemption and statutory defence mean?
A person with evidence from a medical practitioner or nurse practitioner that they require palliation would not be committing an offence if they possess or use illicit cannabis or a cannabis utensil.

People who do not have evidence at the time of questioning about possession and use of illicit cannabis, but can produce evidence from a medical practitioner or nurse practitioner that they require palliation in court, will have a defence against conviction.

How to certify a person requires palliation

A medical practitioner or nurse practitioner can certify that a person requires palliation (as defined in the Act). The certification is a written statement that in the medicinal or nurse practitioners’ clinical opinion, the patient meets the definition of palliation in the Act. The certification is not an endorsement of the use of illicit cannabis.

There is no prescribed template for certification in the Act. The documentation could be in the form of a letter and needs to contain:

  • the patient’s name and address
  • the practitioner’s name, address and Medical Council/Nursing Council number
  • the date that the patient was seen
  • a statement that s/he requires palliation as defined by the Act.

While the Act does not specify a requirement to renew certification, the Ministry recommends patients’ certification are renewed after 12 months.

Relevant links and resources
NZ Ministry of Health Website and example certification letter
The Misuse of Drugs Act 1975

Guidance on products containing cannabidiol (CBD) are now prescription medicines only (New Zealand)

CBD products
The passing of the Misuse of Drugs (Medicinal Cannabis) Amendment Bill means some products containing cannabidiol (CBD) are now prescription medicines only.

Key points

  • Products that meet the definition of a CBD product  are prescription medicines.
  • Ministry of Health approval is not required to prescribe, supply or administer products for medical purposes if they meet the definition of a CBD product.
  • Medical practitioners and pharmacies are allowed to import CBD products, as are persons or companies holding a licence to sell medicines by wholesale.
  • Individual patients may import CBD products provided they meet the requirements for importing prescription medicines (see below) but not any other cannabis based products.
  • A maximum of three months’ supply is allowed on a prescription for CBD products.

For further information please refer to their website.  

New Guidelines for healthcare workers living with a blood borne virus (BBV)

There has been an update to the Guidelines for healthcare workers who perform exposure prone procedures and healthcare workers living with a blood borne virus (BBV). Exposure prone procedures (EPPs) are procedures where there is a risk of injury to the healthcare worker resulting in exposure of the patient’s open tissues to the blood of the health care worker.

The Guidelines have been updated to reflect new evidence and are consistent with changes made by other countries. They provide information and recommendations for:

  • all healthcare workers who perform EPPs
  • healthcare workers who live with a BBV and perform EPPs
  • treating doctors of healthcare workers with a BBV who perform EPPs
  • public health authorities.

The new Guidelines allow healthcare workers living with a BBV, to perform EPPs, provided they abide by these Guidelines.

They also provide guidance for all healthcare workers who perform EPPs. 

Healthcare workers who perform EPPs must take reasonable steps to know their BBV status and should be tested for BBVs at least once every three years. They are also expected to:

  • be tested for BBVs after an occupational exposure incident
  • be tested according to Australasian Society for HIV, Viral Hepatitis and Sexual Health Medicine (ASHM) guidelines following non–occupational exposure
  • confirm that they comply with these Guidelines when applying for renewal of registration.

The new Guidelines, exposure prone procedure guidance and information sheets can be found on the Department of Health website.

Billing multiple MBS items

The guide helps you understand Medicare Benefits Schedule (MBS) item descriptions and how to bill items together.

The updated guide, Billing multiple MBS items, has new information about complete medical services and the multiple operation rule.

It includes scenarios about:

  • comprehensive and combined items
  • interpreting common MBS phrases
  • multiple attendances on the same day
  • attendances with other health services.
  • independent procedures.

It also includes more detail about MBS item descriptions like:

  • ‘attendance not payable with another service’
  • ‘not being a service associated with’ 
  • ‘not being a service to which another item in this group or subgroup applies’.

Trainee 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 events are coming up.

Bi-National Training Program (BNTP)

NSW Lecture Series – Wednesday and Saturday sessions

Events and conferences

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

Rehabilitation Medicine Society of Australia and New Zealand (RMSANZ)

RMSANZ is the professional body for Rehabilitation Physicians and Trainees in Australia & New Zealand.

AFRM contact details 

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

AFRM Faculty enquiries (including Council and committees):
Anastasia Barabash, Executive Officer, AFRM
Phone: +61 2 8076 6315
Email: afrm@racp.edu.au

AFRM NZ Committee
Lauren Darrah, Executive Officer DFAC’s NZ
Email: nz_afrm@racp.org.nz 
 
AFRM Education and Training enquiries:
Name: Lia Iliou, Education Officer
Phone: +61 2 8076 6350
Email: rehab@racp.edu.au  

AFRM Examination enquiries:
Name: Irene Atsiaris, Examination Coordinator 
Phone: +61 2 9256 5422
Email: examinations@racp.edu.au  

AFRM training site accreditation enquiries:
Name: Sonia Tao, Education Officer
Phone: +61 8247 6233
Email: accreditation@racp.edu.au 
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