AMD eBulletin 24 July 2020
In May, when I wrote my first post for this eBulletin, I reflected on the impact that events can have on even the best laid plans. Unfortunately, last week, we had cause to reflect upon this yet again, as both AMD President-elect Professor Graeme Maguire and I were both called upon to respond to the ongoing COVID-19 situation in Victoria's hospitals.
This meant the postponement of both the AMD Council’s Planning Day and Meeting, planned for 15 and 16 July 2020. I would like to apologise to Council members for the short notice of the postponement and I am hopeful that both events can be rescheduled for mid to late August.
In the meantime, as we look to the important task of planning the work of the AMD Council for the next two years, I hope that the increased pressure on our time and resources provides us with fresh focus and clarity of intent. What can we, as members and leaders of the AMD, do to leave the AMD a better place than we found it?
The College is seeking an AMD Lead for Congress, to coordinate content within the adult medicine stream for Congress in 2021 and 2022, and also seeking an AMD representative on the College Journals Committee, which would suit a member looking to develop experience in medical journalism. The AMD Council is also seeking an Aotearoa New Zealand Fellow. All EOIs are available on the RACP website. I would also like to draw your attention to a number of College awards, many of which are available to AMD members. The closing date for this year’s awards is Monday, 14 September 2020 and successful award nominees will be notified in January 2021.
Finally, in the midst of all this as the work continues, we recognise that this is going to be a much longer, tougher and drawn out battle than we first thought. There will be many clinical and also personal challenges that confront us along the way. Above all, take moments from time to time to pause, draw breath and reflect. Take care of yourselves, each other, and your families. The College is here to help. The RACP Support Program is a fully confidential and independent help line available 24 hours a day, seven days a week and free for Fellows and trainees.
Professor Don Campbell
Adult Medicine Division
The newly constituted Committee first met over Zoom on 24 June 2020. At that meeting, and through subsequent conversations, we agreed to ensure that the Committee operate in as inclusive and non-hierarchical manner as possible. One way in which this will be reflected is in the crafting of these posts, which will be written by the President in consultation with Committee members.
Further to this goal, we thought it would be useful to ensure that member representation on other bodies is shared across Committee members. Representation of the Committee on other bodies will be as follows:
- Associate Professor Catherine O’Connor will represent the Committee on the AMD Council, College Council, RANZCOG Sexual and Reproductive Health Special Interest Group, and on the Australasian Sexual Health Alliance Committee.
- Dr Nathan Ryder will represent the Committee on the College Policy and Advocacy Council and the ASHM Sexual Health Subcommittee.
- Dr Julian Langton-Lockton will represent the Committee on the ASHM HIV Subcommittee.
- Dr Massimo Giola will represent the Committee on the New Zealand Sexual Health Society Executive Committee.
At our first meeting, we also discussed ways our Committee could contribute to the AChSHM and decided on a number of areas including increasing the research profile of the AChSHM and how we could better ‘share’ and ‘communicate’ ideas between different clinics. We’ll be working on this for the next meeting.
Finally, we would like to draw attention to two items:
- The Jan Edwards Prize is now open for applications. This prize is awarded for the best abstract oral presentation by a registered Australasian Chapter of Sexual Health Medicine (AChSHM) trainee.
- The RANZCOG Sexual and Reproductive Health Special Interest Group has opened expressions of interest to members. Please contact the Chapter Secretariat or RACPConsult@racp.edu.au for further information.
The Chapter Committee will next meet on Wednesday, 2 September 2020. If you have any feedback for the Committee please don’t hesitate to contact us through our secretariat at firstname.lastname@example.org.
Professor Kit Fairley
Australasian Chapter of Sexual Health Medicine
The newly constituted Committee first met on 5 June 2020. At this meeting, preliminary discussions were held to revise the work plan for 2020-2022.
The Chapter Committee agreed that it would be represented on College Council by Professor Greg Crawford, and on the College Policy and Advocacy Council by Associate Professor Peter Poon. I will represent the Committee on the AMD Council and on the Training Committee in Palliative Medicine.
At our meeting, members of the Committee echoed the concerns of colleagues about recent changes to Pharmaceutical Benefits Advisory Committee (PBAC) opioid listings. On 1 June 2020, the Pharmaceutical Benefits Scheme listings for opioid medicines changed, with the aim to address the high number of deaths and hospitalisations due to prescription opioids. While supporting the rationale for the changes, AChPM Committee members raised serious concerns as the changes have imposed unnecessary prescribing impediments for the pain management of people receiving palliative care, in particular those with a diagnosis other than cancer. The RACP is actively working with other key organisations on this issue. The RACP, Palliative Care Australia (PCA) and the Australian & New Zealand Society of Palliative Medicine (ANZSPM) have written to the PBAC outlining that provisions need to be made to ensure palliative care patients have access to the medications their needs. PBAC will be considering this letter at its internal meeting this month and the RACP will monitor outcomes of this meeting and any progress made in this area.
The Committee also recommended that the College Policy and Advocacy Council endorse the ANZSPM COVID-19 guidance documents.
As at June 2019, palliative medicine had 174 trainees, including 54 in the Chapter training pathway.
In response to the COVID-19 pandemic, the RACP has postponed the 2020 Divisional Clinical Examination (DCE). Information regarding the rescheduled DCE can be found on the College website. Additionally, the College Education Committee agreed on a range of interim measures for training and accreditation for all training programs.
The Training Committee in Palliative Medicine (TCPM) is working through the practical processes and rules to support the changes, including reviewing the impact of COVID-19 on current training requirements and preparing program-specific guidance. Updated information will be published on the training program page of the website.
The TCPM want to provide timely, accurate and equitable information to all members. However, given the volume of enquiries, the number of different individual circumstances and the challenges of remote working, it may take longer than anticipated to respond to individual enquiries. Members are encouraged to continue viewing the latest information on the COVID-19 page on the College website.
Completion of 2019 CPD submissions has been extended until Friday, 31 July 2020. Continuing participation in CPD during 2020 is encouraged, however the Medical Board of Australia won’t take action if you can’t meet the CPD registration standard when you renew your medical registration this year and neither will the College. For Aotearoa New Zealand members, the Medical Council of New Zealand will exempt all general and vocationally registered doctors from recertification program requirements until Sunday, 28 February 2021. For further details, please see the College website.
It is also important to note that the College recognises that many Fellows will complete a multitude of different CPD activities this year, whether upskilling in the use of telehealth for virtual consultations, reviewing online resources, or other activities. The types of innovation we’re currently seeing from our medical profession are perhaps the ultimate CPD. Whilst neither AHPRA nor the College will monitor or audit CPD records in 2020, many Fellows will still want to record their CPD. Your MyCPD record will remain open if you wish to do so.
I have been attending the regular Australian COVID-19 Palliative Care Working Group meetings, under the auspices of PCA, and including representation from PCA, the ANZSPM, Palliative Care Nurses Australia, Caresearch, Paediatric Palliative Care Australia and New Zealand, and Caring@home, as well as AChPM. This has been a powerful forum for sharing and disseminating information, advocating for vulnerable patients and ensuring that the role of Palliative Care in pandemic situations is recognised at all levels of government and health care provision.
The Chapter Committee will next meet on Friday, 14 August 2020. If you have any feedback or comments, please do not hesitate to contact us through the Chapter secretariat at PallMed@racp.edu.au.
Dr Michelle Gold
Australasian Chapter of Palliative Medicine
Responding to COVID-19: 2020 has become a year unlike any other – and the impact of COVID-19 upon health care services is considerable. There has been considerable disruption to services in the alcohol and other drug sectors, with remarkable adaptations by many health care providers to ensure that essential treatment services have continued. In particular, residential services and opioid treatment services have had to make considerable changes to the way services are delivered, and we have all become accustomed to telehealth modalities.
The Chapter led a group of professional societies, colleges and consumer groups in developing national guidance regarding opioid treatment in response to COVID-19, and these were well received by clinicians across the country. Whilst many people thought that we would ‘snap back’ to ‘business as usual’ within weeks or months, the second wave of COVID-19 affecting Victoria has highlighted that COVID-19 provisions will most likely need to remain in place for many months (or years) to come. The Chapter will work with other professional and consumer groups to examine whether further national guidance is required in coming weeks, and input from Fellows would be appreciated.
Another challenge arising from COVID-19 has been the surge in online gambling, and evidence of increased alcohol consumption by people in ‘lock-down’. These concerns need to be addressed, although to date there has been minimal investment by governments to address the impact of COVID-19 upon alcohol and other drugs and gambling treatment services.
The role of drug policy and deaths in custody: Another issue of ongoing concern is deaths in custody for Aboriginal and Torres Strait Islander people, which has been highlighted by the Black Lives Matter movement. Substance use is one of the major contributors to arrests and imprisonment of people of Indigenous background. Data from 2010 to 2015 shows that alcohol or other drugs were a factor in more than 35 per cent of Indigenous deaths in custody compared to 25 per cent of non-Indigenous deaths in custody. Aboriginal leaders have highlighted the lack of resources available to deal with drug and alcohol abuse (see, for instance, comments from Pat Turner AM and Professor Tom Calma AO in this communique from the National Aboriginal Community Controlled Health Organisation).
Many commentators in the USA – including the presidents of the National Institute of Drug Abuse (NIDA) and the American Society of Addiction Medicine (ASAM) have highlighted that legal responses to drug use (e.g. laws against public intoxication, illicit drug laws and policing approaches that drive ‘stop and searches’) are one of the key drivers of imprisonment of black Americans, and that a reconsideration of how society responds to substance use (‘police first’ or ‘health first’) is an essential step in preventing deaths in custody. To quote Professor Nora Volkow, Director of NIDA: “Whites and Black/African Americans use drugs at similar rates, but it is overwhelmingly the latter group who are singled out for arrest and incarceration. This use of drug use and addiction as a lever to suppress people of a particular race has had devastating effects on communities of colour”.
Similar issues apply here in Australia – with both substance use and incarceration overly affecting Indigenous communities. It is incumbent upon us as a Chapter to advocate for better societal responses to these issues. The Chapter will be leading work to develop a new Drug Policy for the RACP, where some of these issues will be examined further. We will be asking for volunteers for a Working Group in coming weeks.
Representation of medical practitioners in a professional society for the addictions: Finally – individual members of the Chapter have embarked in discussions examining the future professional society representation of medical practitioners working in the addictions (substance use and behavioural conditions), spanning medicos from different colleges.
The AChAM Committee will next meet on Friday 18 September. If you have any feedback, questions or comments for the Committee, please get in touch via our secretariat at AddictionMed@racp.edu.au.
Professor Nicholas Lintzeris
Australasian Chapter of Addiction Medicine
Telehealth was brand new for many of us, and now some of us might be getting rusty on the fundamental considerations to make before, during and after telehealth consultations.
The animation below will be included in a new online learning resource that will be available on eLearning.racp.edu.au and will also include Aotearoa New Zealand specific information.
The dates for the rescheduled exams for Adult Medicine and Paediatrics & Child Health are now available on the RACP website. These exams will only be for those trainees who were eligible to sit the exam originally scheduled for 2020. Applications will open in August and we will remind all eligible trainees closer to the date.
Trainees who are eligible for the 2020 DCE will receive a survey in the next few weeks to seek expressions of interest to sit the long cases later this year.
We are also currently reviewing the exam dates for Victorian candidates in light of the increase in COVID-19 cases. We will use the trainee survey to help inform this decision.
The 2021 DCE is still on track to be run during its normal timeframes.
To minimise the risks of COVID-19 impacting the rescheduled exam, we’ve changed the way it will be delivered.
The new ‘modular format’ will now be used for all Adult Medicine and Paediatrics & Child Health exam candidates, with the exception of Paediatrics & Child Health in Aotearoa New Zealand who will continue to use the traditional exam format.
Further details on what is involved with the modular approach are available on our website.
Many trainees have asked if the 2020 DCE in its new format will count as an attempt. A decision on this is being considered by various Committees and is imminent and should be announced in the next week.
This year’s Cottrell Memorial Oration, Towards universal healthcare is delivered by Professor Des Gorman (Ngati Kuri and Ngapuhi). His oration explores how universal healthcare coverage remains elusive, even in well-funded health systems and how inequality in health systems contributes to system recidivism. He also explores how RACP members can play a pivotal role in addressing inequality and developing universal healthcare systems.
Professor Gorman is a Professor of Medicine in the Faculty of Medical and Health Sciences at the University of Auckland and from 2005 to 2010, he was the Head of the University’s School of Medicine. Beyond his clinical interest in brain injury research, he also focuses his attention to health system design and funding, and health workforce planning and development.
Although we are unable to meet face-to-face this year, we have made the Cottrell Memorial Oration available on-demand as part of the RACP Online Congress Series. Following the oration, Professor Paul Komesaroff presents Professor Gorman with the Adult Medicine Division Cottrell Memorial Medal for 2020.
At RACP Congress 2019, we launched the inaugural Fringe Experience. The Fringe Experience provided an opportunity for you to share the things you do outside of your life as health care professionals. We were treated to singing performances, poetry readings, art displays and yoga sessions, highlighting the extraordinary talents of our members and focusing on some of the things you do to look after your health and wellbeing.
Although we are unable to meet face-to-face this year, we are still excited to bring you the Online Congress Series Fringe Experience.
Are you a budding musician, singer, dancer or mime artist? Send us a short video that we can share on the Online Congress Series platform.
Do you dabble with paints, pencils or crayons? Send us a picture of your artwork to include in our Fringe Experience Gallery on social media
Perhaps you have an eye for photography. We would love to share your work.
The Online Congress Fringe Experience will include meditations, yoga sessions, creative writing workshops and more.
If you would like to lead a session, showcase your art or share a performance email email@example.com with a short synopsis of your presentation. We will work with you to bring your ideas to life.
Do you want to be a force for change and be recognised and listened to by health policy decision-makers and be an advocate for patients’ interests? Apply to be a member of the Executive Committee for our College Policy and Advocacy Council.
There are seven vacant positions open on the College Policy and Advocacy Council Executive Committee (CPAC EC). Members of the CPAC EC make a real difference by tackling emerging policy and advocacy issues to improve the quality and safety of healthcare in Australia and Aotearoa New Zealand.
Find out more
Nominations are now open for the following College Prizes which acknowledge outstanding contributions and achievements made by Fellows and trainees in their respective fields:
- The John Sands Medal recognises a Fellow who makes a significant contribution to the welfare of the RACP and its members.
- The College Medal is aligned to the College motto 'Hominum servire saluti'. It is awarded to a Fellow who makes a significant contribution to medical specialist practice, healthcare and/or health of community through physician activities.
- International Medal recognises a member who has provided outstanding service in developing countries.
- Medal for Clinical Service in Rural and Remote Areas recognises a Fellow who has provided outstanding clinical service in rural and remote areas of Australia or Aotearoa New Zealand.
- Mentor of the Year Award recognises a Fellow who has made an outstanding contribution to mentoring or provided a high level of support and guidance throughout training.
- Trainee of the Year recognises a trainee who has made an outstanding contribution to College, community and trainee activities.
- The Eric Susman Prize is awarded by the College to a Fellow for best contribution to the knowledge of internal medicine.
Successful nominees are presented a medal at the RACP Congress.
Full details are available on the RACP Foundation webpage.
The Chapter offers the following awards and prizes to recognise trainees and Fellows:
Nominations for the AChSHM Awards for Outstanding Contribution to Sexual Health Medicine and AChSHM Award for Best Postgraduate Thesis in Sexual Health Medicine are open from Monday, 3 August to Wednesday, 30 September 2020.
Advanced Trainees are encouraged to apply for the AChAM Research Project Prize which is awarded to the best advanced training research project for addiction medicine submitted for assessment between 1 July 2019 and 1 July 2020. Applications are open from Monday, 3 August to Wednesday, 30 September 2020.
The AChAM Indigenous Prize provides an opportunity for medical students, junior medical officers and registrars, who identify as Aboriginal, Torres Strait Islander or Māori to attend the International Medicine in Addiction Conference in 2021. The prize includes registration, return economy airfares, and two-nights' accommodation to attend the conference. Applications open from Monday, 3 August to Wednesday, 30 September 2020.
Applications for Trainee Research Awards are now open for trainees and new Fellows undertaking post-Fellowship training.
The Trainee Research Awards provide a valuable opportunity for trainees to present their research at an Australian regional or Aotearoa New Zealand event. The best presenters from each local event are invited to be part of the Research and Innovation stream at the RACP Congress. Selected representatives will also receive complimentary registration, return airfares, and accommodation for up to three nights to attend the RACP Congress.
Please send your abstract submissions or inquiries by email to your respective regional RACP offices. Applications are due Monday, 31 August 2020.
On 17 July 2020, the Ministerial Forum on Food Regulation made the important and pioneering decision to endorse evidence-based pregnancy warning labels on alcohol products, safeguarding the health and wellbeing of children in Australia and Aotearoa New Zealand. The College has welcomed the Ministerial decision to adopt effective pregnancy warning labels on alcohol products.
The evidence-based labelling scheme recommended earlier in the year by Food Standards Australia and New Zealand was finally endorsed by a majority of ministers after a more than decade-long campaign for mandatory, clear and effective labelling of alcoholic products with warnings that indicate drinking while pregnant harms the unborn baby.
Special thanks in this long, coordinated campaign go to Professor John Wilson, Associate Professor Mark Lane, Professor Elizabeth Elliott, Dr Adrian Reynolds, Dr George Laking, Professor Judy Savige, Dr Rajesh Raj and Associate Professor Nick Buckmaster, as well as to our dedicated partners at the Foundation for Alcohol Research and Education. It’s truly impossible to overestimate the positive effects of this critical public health win.
In the words of Professor Elliott, “The colour of this label is particularly important. Red attracts attention and conveys warning, the black text on white background is easily legible, the pictogram is understandable even by non-English speaking populations, and the words ‘alcohol can cause lifelong harm to your baby’ give a clear warning message.”
As Professor Wilson stressed, “The RACP has been supportive of pregnancy warning labels on alcohol products for over a decade – it’s great to see Australian and New Zealand governments now take this necessary step for the health of our communities.”
The Northern Territory Regional Committee has developed an election statement to identify and advocate for its priority areas.
The statement makes NT-specific recommendations on the following priority areas, drawn from existing approved College positions:
- climate change and health
- Indigenous health
- acute rheumatic fever (ARF) and rheumatic heart disease (RHD)
- raising the age of criminal responsibility.
This statement is designed to position the Committee and the RACP for post-election advocacy on these priorities over the next four-year term.
The Australian Government Department of Health has set up a telephone advisory service providing specialised clinical advice for health professionals involved in the care of people with disability during the COVID-19 pandemic.
Some people with disability may become very anxious in these situations and require reasonable adjustments to their healthcare to ensure they receive either COVID-19 testing or treatment with minimum distress.
Health professionals can call the service on 1800 131 330 between 7am to 11pm (AEST), seven days a week.
Thank you to RACP Fellows who are involved in this service.
From 1 July 2020, additional at-risk groups will be eligible for funded vaccines under the National Immunisation Program.
Changes relate to the following vaccines:
- Pneumococcal vaccine (Pneumovax 23 and Prevenar 13) – there are changes to the timing and type of pneumococcal vaccine for some at risk groups, adults and Aboriginal people.
- Meningococcal B vaccine (Bexsero) – this vaccine is now funded for Aboriginal children and some at risk people.
- Meningococcal ACWY (Nimerix) – this vaccine is now funded for some additional at-risk people.
- Haemophilus influenzae type b (ACT-Hib) – this vaccine is now funded for some additional at-risk people.
For further details on the changes, please visit the NSW Health website.
Detection and Causes: In the first part of these podcasts we talk about the presentations and detection of delirium. We also go through some of the medical risk factors, including dementia, infection and metabolic disorders like hypercalcaemia. Even more common than these precipitants, are a host of drugs that can alter cognition or increase agitation by their anti-cholinergic properties. Importantly, we hear Adam Kwok describe his experience as the carer of a patient going through the trauma of three bouts of delirium, and the challenges of care.
Prevention and Management: In the second part we discuss a host of environmental triggers that are highly modifiable. Anything that contributes to a person’s disorientation and discomfort can increase the likelihood of a delirium episode. While a lot of these factors are compounded in elderly and frail patients, it’s important not to be fatalistic. Delirium can be reversed in a majority of patients by non-pharmacological means, though there are no medications indicated for treatment anywhere in the world. Antipsychotics should only be considered in patients experiencing severe distress intractable by other means as they are associated with many adverse side effects.
- Adam Kwok
- Professor Meera Agar FRACP FAChPM (Liverpool Hospital, UTS)
- Professor Gideon Caplan FRACP (Director of Geriatric Medicine, Prince of Wales Hospital, UNSW)
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, Spotify or any Android podcasting app.
Listen to Ep60: Delirium Part 1- Detection and Causes
Listen to Ep61: Delirium Part 2- Prevention and Management
The July 2020 issue of the IMJ (Volume 50, Issue 7) is now live on the RACP website and IMJ Wiley page.
Key highlights from the issue are:
- the Australian and New Zealand Vasculitis Society
- observation and response charts
- COVID-19 and inflammatory bowel disease management
- a rapid-access respiratory clinic for lung cancer
- treatment duration of immunotherapy
- dosing medicinal cannabis.
The Editor's Choice is a OA titled 'Lupus Nephritis in Indigenous Australians - A single centre' study by Amit Nigam, Richard Baer, Stella Green, Brendon Neuen, Alexander Vile and Murthy Mantha.
Check the Expressions of Interest page
at any time, to find out if there are any opportunities that are of benefit to you.
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.
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