AMD Newsletter 27 August 2018
I would like to thank members for your continuing thoughtful comments about trainee welfare. The AMD Council considered this issue at its strategy meeting on 16 August and the results are being collated. There are many ideas and I am confident that we will be able to compose an effective plan. I will let you know as soon as we have a proposal to share.
Today I would like to address the question of international engagements by College members and the RACP itself. Despite its undoubted importance and high levels of interest this is another area where much work remains to be done. As with my previous posts, my intention in this one is to raise issues in a preliminary manner to seek ideas and suggestions about how we should proceed. I will then return at a later time with a draft plan for further comments by members.
There are two key sets of developments that have changed the way we need to look at global health. First, in a globalised world, health and health care can no longer be understood or addressed in purely local terms. Their conditions are not limited within national boundaries. The effects of climate change, environmental degradation, industrial development, depletion of resources, war and social conflict, are experienced by all people in all the countries across the world. Whereas only a few years ago it may still have been possible to question the impact of such large-scale developments, this is no longer the case. Whether we like it or not, we are enmeshed in a global system that extends to almost everything we do, professionally, socially and personally.
Secondly, there has been increasing recognition that the old models of foreign and humanitarian aid are defective, and often do more harm than good. Aid paradigms that are premised on “donors” providing “aid” to “recipients”, often generate major unintended consequences, such as inhibiting local sustainable development, intensifying dependency, and breeding corruption. There has been increasing recognition of the need for equitable partnerships that break with the old colonial models, allow poorer countries to define their own pathways to development and achieve reciprocal benefits for all involved parties. Accordingly, much “development” work these days involves joint projects that respond to the complexity and specificity of local condition to develop capacity and resources, breaking entrenched cycles of dependency, inequality, poverty and disease.
Many members of the RACP have contributed to this paradigm shift and to its ongoing development. College members occupy leading positions both nationally and internationally in relation to policy, planning and delivery of services and research. Many Fellows and trainees are involved in active service to address the health needs of other countries. Our members have had a major impact – and indeed, have even played key roles in two Nobel Peace Prizes focused on nuclear disarmament. In all this work and achievement the College itself has played a negligible role. Many members have expressed the view that this is the time to change this unfortunate state of affairs.
So what contributions could the College itself make? This is the question I would like to put to readers of this post. Here, three points are immediately relevant:
- In spite of our recognition of the high levels of interest and involvement by College members in global health work we have little knowledge of who is actually doing what, what skills are available within the organisation, or what opportunities exist for fellows and trainees to become involved in overseas projects. The lack of data undoubtedly makes planning difficult.
- Many trainees are keen to undertake some of their training overseas, where they can have experiences and encounter clinical material not accessible in Australia or New Zealand. There can be no doubt that overseas deployments during training are likely to be of benefit for trainees and for our national health care systems. However, the processes for accreditation, supervision, assessment and safety are poorly defined and in many cases simply unavailable, posing significant obstacles to trainees wishing to follow such a path.
- Related to this, many Fellows and trainees are keen to incorporate intermittent overseas deployments into their career paths. However, there are only limited mechanisms for education, support, and coordination of such a professional strategy – including training in specific areas of medicine, ethics, culture and law, and advice regarding insurance, visas, employment relationships, and accreditation requirements.
Taking these facts into account, here are some preliminary thoughts about how we could support members in overseas work or other engagements. The College could:
- Collect data about the resources available within the membership, including who is doing what and where. This could contribute to the establishment of a mechanism for advising members of opportunities and establishing networks and relationships to facilitate training, deployments, research partnerships, and other kinds of service delivery. Such a database could also provide a register to assist outside agencies in locating individuals who have skills they may be seeking to assist with particular projects.
- Establish a coordinated process for supporting overseas deployments as part of advanced training, in consultation with the Speciality Societies and trusted overseas organisations.
- Provide assistance, through partnerships or our own initiatives, for the development of sustainable career paths that include overseas deployments. This might include educational programs, psychological support, ethical, cultural and legal awareness, along with assistance with the administrative requirements mentioned above.
- Help establish short and long-term exchanges, and educational and research projects. The exchanges would be in both directions. Education could include both focused, task-directed activities and larger, more comprehensive programs, delivered face to face and via the internet. Research programs would encompass investigations in the laboratory, the clinic and the social sciences, and techniques and approaches for evaluating the partnership programs themselves.
- Facilitate the development of projects in areas of particular need, as identified by members and local partners. Examples, of such areas of need may include the development and application of new technologies, administrative and infrastructural support, access to and regulation of pharmaceuticals, responses to epidemics, and development of community-based programs to combat non-communicative diseases.
Many of the initiatives mentioned above would involve modest or little cost and could readily draw on knowledge and expertise already in abundance within our organisation. Further, there are undoubtedly multiple other possibilities. As mentioned, a great deal of work is already being undertaken by our Fellows and trainees. It should be the College’s job to support those already active in the field, as well as to create opportunities for members who wish to become active in the future.
In order to define the needs to be addressed, to set priorities and to develop an effective implementation plan for the benefit of Fellows, trainees and our overseas colleagues, the Adult Medicine Division has established an informal working group consisting of senior figures in this field. To progress their work, Fellows and trainees are invited to submit comments and suggestions about how we should proceed. We will be particularly interested to receive accounts of personal experiences and what you consider to be priorities and areas of greatest need.
Please feel free to share this article with colleagues and to contact me directly with any thoughts, ideas and suggestions you might have.
Professor Paul Komesaroff FRACP AM
President Adult Medicine Division
Telephone: +61 (0)417 55 26 59
AChAM President’s Report
President-elect of the AChAM, Professor Nick Lintzeris, hosted a well-attended webinar on behalf of APSAD on 8 August on medicinal cannabis as it relates to the drug and alcohol field. For those who missed the live webinar I encourage you to head to the RACP website where you can access this and other webinars in the Specialty Society Webinar Series. APSAD will be holding two further webinars in the series, one by Dr Matthew Dunn on Performance and Image Enhancing Drugs on 30 October, and one from the AChAM Committee’s own Professor Adrian Dunlop on Injectable Buprenorphine on 20 November. Be sure to put these dates in your calendar.
Registrations will open for the International Medicine in Addiction Conference 2019 in two weeks’ time. We have three fantastic keynote speakers lined-up to present including: Professor Jon Grant from the Department of Psychiatry and Behavioural Neuroscience at the University of Chicago who will be presenting on gambling and behavioural addictions; Professor Rajita Sinha from the Yale School of Medicine presenting on the connection between stress and addiction; and Dr Ivan Montoya from the National Institute on Drug Abuse (NIDA) with a NIDA update and presentation on treatment developments.
Finally, on behalf of the AChAM Committee I would like to welcome Dr Chris Tremonti as the new Trainee Representative. The Committee is excited to have Dr Tremonti on board in this important role representing our trainees – welcome Chris.
The next AChAM Committee meeting will be held at the Sydney College office sometime in mid-November when we all get back from APSAD, which this year is being held in Auckland.
Dr Martyn Lloyd-Jones
Australasian Chapter of Addiction Medicine
AChPM President’s Report
Every year the College grants a number of medals and awards to acknowledge the outstanding achievements of our Fellows and trainees. These awards provide an opportunity for the College and its membership to recognise and celebrate the accomplishments of members as well as promote their successes to inspire others. If one of your trainees or Supervisors are deserving of recognition for their outstanding contributions I encourage you to nominate them. Award categories include RACP Mentor of the Year, Trainee of the Year, and the Medal for Clinical Service in Rural and Remote Areas. You can find out more information on the RACP Foundation website.
The Chapter Committee will be meeting this week on Friday, 31 August via teleconference. If there are any issues you would like to raise with the Committee, or if you have any feedback for us, please don’t hesitate to contact us through our secretariat at PallMed@racp.edu.au.
With kind regards,
Professor Greg Crawford
Australasian Chapter of Palliative Medicine
AChSHM President Report
Following on from my meeting in July with representatives from the Australian Government’s Enhanced Response Unit in the Office of Health Protection on the implementation of the Action Plan: Enhanced response to addressing sexually transmissible infections (and blood borne viruses) in Indigenous populations, several key activities have occurred:
- We were invited to provide RACP representatives to the Action Plan Implementation sub groups, including the Clinical Education, Workforce, and Antenatal groups. I will be chairing the Clinical Education sub group.
- The RACP provided a submission to the MBS Doctors Bag Review recommending the addition of syphilis treatment medication benzathine penicillin to enable General Practitioners and other primary care services, including Aboriginal Health services, to supply and stock benzathine for syphilis treatment.
- The RACP Sexual Health in Aboriginal and Torres Strait Islander Communities Expert Reference Group have agreed to develop a brief consensus statement on interpreting syphilis point of care test (POCT) results to assist with the POCT roll out.
The AChSHM formally recognises the outstanding contributions made by Fellows of the Chapter through biennial awards announced at the AChSHM Annual Scientific Meeting. For 2018 the Chapter will grant an award for Outstanding Contribution to Education and Training in Sexual Health Medicine, and one for Outstanding Contribution to Research in Sexual Health Medicine. Nominations for the awards open next week and close on 31 October 2018. If you know a Fellow deserving of recognition for their contribution to Sexual Health Medicine I encourage you to nominate them.
The Chapter Committee will next meet via teleconference on 14 September 2018.
Associate Professor Catherine O’Connor
Australasian Chapter of Sexual Health Medicine
Discussing disability internationally
RACP Fellows Doctors Tracey Symmons, Anne Drake, Kimberly Oman and Professor Robert Moulds took part in the Internal Medicine Organisation of the Pacific (iMOP) Annual Scientific Conference held in Suva, Fiji on Thursday 23 and Friday 24 August.
Effectively tackling disability issues in resource deprived settings was the focus of conference – which was opened by the Fiji Minister of Health, the Honourable Rosy Akbar and drew speakers and delegates from across the Pacific, Australia, New Zealand and India.
“Where is disability preventable in low resource settings and can we enable people to have a life worth living, that is meaningful and can enable enhanced participation in society?” Dr Symmons asked in her keynote address. She also noted that disability should not be regarded as just part of the human condition that needs to be accepted and endured and that we should not be looking at disability as being dichotomous – disabled or not disabled.
Dr Symmons said while the Pacific region is known for cyclones, floods, tsunamis, earthquakes and other natural disasters – the real challenge was resource limitations. Limitations in the health sector related to human resources, procurement, health facilities and supplies as well as the challenges of helping communities isolated by environment and geography access health care.
While noting the key challenge she called on the region to take proactive measures to minimise the effects of disabling conditions, and to limit the impact of these conditions on the lives of people living in the Pacific. She noted that a tidal wave of non-communicable diseases has been sweeping the region and which results in individuals losing limbs, sustaining strokes and becoming weaker from cancer and respiratory diseases. The region also experiences conditions rarely seen in resource rich settings, such as Potts disease, tuberculosis, meningitis, leprosy, tetanus, effects from neonatal sepsis and limited antenatal care, and effects of rising road related trauma in a setting that has few mechanisms for injury reduction. She noted examples of good work happening in the region and asked “Can more be done?”
RACP Fellow Dr Anne Drake also attended the conference and spoke about infectious complications arising from disability. Dr Kimberly Oman attended and spoke about the prevention of disability in patients with advanced HIV. Professor Robert Moulds led a team during a debate about the topic Older and Wiser vs Younger and Bolder.
Specialists from Apollo Hospital in India made several case study presentations on cardiac, oncology and dialysis related matters. Final year Masters of Medicine internal medicine candidates from Fiji National University presented their research findings. Trends in childhood cancer outcomes, stemming from a paediatric oncology twinning program between Fiji and New Zealand hospitals, was the focus of one of the presentations.
Seeking feedback on the Draft International Standards for the Treatment of Drug Use Disorders
The World Health Organisation’s Department of Mental Health and Substance Abuse (MSD) and the United Nations Office on Drugs and Crime (UNODC) are seeking feedback from member nations on the Draft International Standards for the Treatment Of Drug Use Disorders
The MSD and UNOCD are interested in feedback from Australia, given our well-developed drug and alcohol treatment system. For feedback to be considered Australia needs to have 150 responses to the email survey. RACP members are encouraged to provide feedback on any or all sections of the document. Feedback is via a web survey that is open until Friday, 31 August 2018.
Child health experts and key stakeholders come together in Canberra for the RACP Inequities in Child Health Forum
On Wednesday, 15 August the Royal Australasian College of Physicians hosted our Inequities in Child Health Forum at Parliament House in Canberra, where leading child health experts presented to an audience including senators and members of Parliament, state and territory chief paediatricians and heads of key medical, public health and community bodies.
Australian Federal Minister for Health and Shadow Minister for Health and Medicare spoke at the event, with the Minister for Health announcing funding for the development of a National Action Plan for Children’s Health 2020 – 2030. The Minister stated that the plan “will ensure that we give our Indigenous Australians, our rural Australians, and our younger Australians in more difficult socio-economic circumstances, the best shot at the best life to be the best person that they can otherwise ever hope to be."
Child health experts Associate Professor Susan Woolfenden, Professor Sharon Goldfeld and Professor Ngiare Brown presented on the actions and strategies needed to reduce inequities in health care access and outcomes, and the part that health practitioners and politicians can play in acting as a buffer against cycles of disadvantage. The Forum and its messages received significant media coverage across print, radio, social media and television, helping to promote discussion of an important area for child health and wellbeing.
The RACP President Associate Professor Mark Lane, President of the Paediatrics and Child Health Division Professor Paul Colditz, and senior paediatricians also met with the Commonwealth Chief Medical Officer, and other government representatives.
The RACP will continue its dialogue with key decision makers to ensure high quality, truly universal health care services are available to all children regardless of their postcode.
To find out more about this issue, you can read our Inequities in Child Health Position Statement or its accompanying fact sheet, and access the tools in our online advocacy kit.
You can also listen to Professor Sharon Goldfeld discuss the issue of child health inequities on ABC RN Breakfast as recorded on 15 August 2018.
Webinar- Shift Work, Sleep & Health
Australasian Sleep Association - Professor Sally Fergusson
Topic: Shift Work, Sleep & Health
When: Monday, 27 August 2018 at 5pm (Canberra, Melbourne and Sydney)
Topic: ASA Webinar Two - Professor Sally Fergusson
Up to 500 registrations available, please register in advance to avoid disappointment:
After registering, you will receive a confirmation email containing information about joining the webinar.
This webinar is part of the Specialty Society Webinar Service pilot that is being undertaken by the Royal Australasian College of Physicians in partnership with its affiliated specialty societies.
Australia and New Zealand Society of Blood Transfusion
The Australian and New Zealand Society of Blood Transfusion is presenting a three part webinar series co-hosted by RACP on Contemporary Issues in Transfusion Medicine.
The first topic, Haemovigilance and Adverse effects of transfusion was presented by Dr Alison Street. The content included discussion of hospital, state and national quality systems set up to monitor safe transfusion practice with illustrative case studies, audits and recommendations. The webinar recording will be available on the RACP website from Monday, 27 August 2018.
The remaining two webinars will be presented on:
- Blood product modifications – who needs what? presented by Dr Zoe McQuilten on Tuesday, 25 September 2018
- Evolve – the ANZSBT’s top 5 recommendations presented by Dr James Daly on Wednesday, 7 November 2018
Managing Medicine Access Programs
The Council of Australian Therapeutic Advisory Groups (CATAG) is writing to advise of the revised and updated publication, the 'Managing Medicine Access Programs: Guiding principles for the governance of Medicines Access Programs in Australian hospitals. Version 2, 2018'.
The Guiding Principles will be available on the CATAG website www.catag.org.au and can be downloaded in a pdf format.
Advances on Developmental Disorders: From Research to Policy to Practice
Location: Acton, Australian Capital Territory
Venue: Centre for Mental Health Research, The Australian National University
Date: 3 September 2018, 9am to 1pm
What are the policy and practice implications of the advances of research in developmental disorders?
Over three per cent of Australians have a developmental disorder. These conditions are associated with significant problems in physical and mental health and have a major impact on carers and society.
Major changes and improvements have happened during recent years including the release of new classification of developmental disorders in the WHO international classification of diseases (ICD-11); the advances in the genomics of autistic spectrum disorders and intellectual disabilities; or the progress in new interventions and policies.
This international workshop will provide an update on several of these developments and revise their implications for Australia.
For full details please visit the website.
Apply or Nominate for College Awards and Prizes
Recognise an outstanding colleague or apply for a career-enriching opportunity through the different Awards and Prizes offered by RACP. Nominations are now open for several prestigious College awards and prizes, including:
Trainees are also encouraged to apply for the RACP Trainee Research Awards for Excellence. Regional awardees will be invited to attend and present at the 2019 RACP Congress in Auckland. They will also have the opportunity to have their abstract published.
Visit the RACP Foundation webpage for full details of all awards and prizes offered by your Division and Chapters. For more information about the eligibility criteria or the application process, please contact RACP Foundation at Foundation@racp.edu.au or call +61 2 9256 9639.
Trainee Research Awards Reminder
Deadlines for abstract submissions for Trainee Research Award events are fast approaching.
Trainees across Australian states and territories, and in New Zealand can take part.
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.