Tasmania - April 2021
Dear colleagues,
Greetings – I am happy to be back with the foreword to the first eBulletin for 2021. From a medical perspective, the most significant event on our horizon is the rollout of the COVID-19 vaccination. As the vaccines have been received across Australia and the rest of the world, one can cautiously begin to hope that things will slowly return to how they were.
On the College front, we are now completing the last of the Long Case examinations of the Divisional Clinical Examinations 2020 cycle. Overall, the administration of the examination, via telephone for the first time, was a success. Organisers of the examinations and local examiners everywhere deserve our appreciation and gratitude. We moved to the Short Case examinations – where Tasmania hosted the exams on a weekend after Easter in Launceston and Hobart.
Finally, I would like to remind Fellows about the changes to the 2021 MyCPD Framework regarding reporting continuing professional development activity, which was rolled out over 2019. Our CPD requirements continue to be important from 2021, particularly after all the disruptions due to the epidemic in 2020. Please visit the MyCPD webpage for helpful links to frequently asked questions and examples of activities are available.
Once again, I would like to remind all Fellows and trainees that the College attaches great importance to the needs of its members. As always, I welcome discussions about issues that are important for those of us members in Tasmania.
Associate Professor Rajesh Raj
Tasmanian Regional Committee Chair
Thank you to everyone who participated in the 2020 consultation on the proposed common learning, teaching and assessment (LTA) programs for Advanced Training (AT). Your feedback was used to refine the programs and ensure they are robust and appropriate. The common LTA programs for Advanced Training have now been finalised.
The common LTA programs will establish a baseline for learning, teaching and assessment across all AT programs. As each specialty undertakes their program-specific curricula reviews, they will build on the common LTA programs to meet the needs of their specialty.
This year, in collaboration with Curriculum Advisory Group, we will continue to support the first six specialty groups to undertake the development process:
- Cardiology (Adult Medicine)
- Cardiology (Paediatrics & Child Health)
- Gastroenterology
- Geriatric Medicine
- Nephrology
- General Rehabilitation Medicine.
Find out more
I’m originally from Tasmania but moved to Melbourne to do undergraduate medicine at Monash University. I completed my Basic Training at Austin Health and then went on to complete my first year of renal Advanced Training in Far North Queensland, working in Cape York and the Torres Strait. I did my renal transplant training at Royal Melbourne Hospital and moved back to Hobart in 2019 to finish my nephrology Fellowship. I decided to finish dual-training in general medicine and as part of this I have completed the Diploma of Palliative Care. My current role at Royal Hobart Hospital is part time Hospital in the Home (HITH) and part time General Medicine post-Fellowship training. I also have a teaching role with the University of Tasmania.
What is the most rewarding aspect of your role?
I’m enjoying having the flexibility to work in quite different roles between HITH and general medicine. HITH is community based which is a nice change from working in a purely hospital-based role. I enjoy the teaching and administrative aspects of the senior medical registrar role in general medicine.
What is it about your work that makes you want to get out of bed each morning?
The one thing about medicine is that it always keeps you on your toes. No two patients are ever the same and each day brings new challenges. Monotony is the thing that wears many people down and there is very little of this in my current role. I also have a very supportive workplace with great colleagues, which is a real positive.
What does a typical day at work look like for you?
I don’t really have a typical day. Mornings will generally be ward rounds or HITH clinic. Afternoons is patient reviews, administration duties, clinic or medical student teaching. Usually, some sort of combination of the above.
How do you manage work-life-balance?
Work-life-balance is something I’m still trying to perfect. It is certainly much better since I moved back to Hobart from Melbourne. I’m learning to set boundaries with work and to say no to some opportunities if I don’t have the time. Many of my older patients have said to me that no one gets to the end of the road and wishes they had worked more. I try to bear this in mind.
Are there any patient success stories that you can share?
I’ve had several success stories working in the palliative care setting, particularly around patients on renal supportive care pathways who have done well and had really high-quality care. I have an interest in renal supportive care and have recently got involved in the national working group and I’m hoping to contribute more to this space in Hobart.
It is now only one day until the start of RACP Congress 2021 in Brisbane and for those of you wanting to join us for a face-to-face event, time is running out to secure your ticket. Remember that when you purchase your face-to-face ticket for one of the six cities, you can also live stream the entire RACP Congress 2021 program. Online access to the RACP Congress 2021 sessions will be available exclusively to those who register, so do not miss the opportunity to hear from expert voices across a range of topics.
For those of you making the journey to Melbourne, join us for the Tasmanian 2020 Trainee Research Award recipient presentations.
When you register, you will also have access to sessions such as:
- Remote retinal scanning: Transforming early detection outcomes
- Genetic discovery and translation in neuromuscular diseases
- Our digital health future, today
- Climate change in the Pacific
- Advancing Women in Healthcare
- Artificial intelligence: Ready or not here it comes
- Building a solution space for Indigenous health at the RACP: Transformations, challenges and opportunities.
Find out more
Dr Sunday Pam, a paediatrician based at Rockhampton Hospital, received a call from Rockhampton Zoo for the treatment of an unlikely patient. Below is Dr Pam’s account of treating the chimpanzee patient, Gandali.
I received a call on 1 December 2020 – it was the head of an allied health department, with an explanation that their request was ‘weird’. I was silent. “Are you still there? Pop your seat belt on” he said. “I have been asked by the Zoo Manager to get you to see a 10-month-old infant chimpanzee following possible severe injuries from a fall.” I could not laugh, cry, or even speak. My silence betrayed me. He continued, “Human doctors generally see them instead of veterinarians because they are closer to humans.” Reference was made to a local human subspecialist who sees the adult chimps. In this case, the local vets had been consulted and declined.
My mind went to ‘what about registration regulations?’ I was reassured that this was not an issue for the above reasons. I was asked for my number to give to the lovely zoo manager, a few minutes later she called. I was again reassured and now I was getting interested, but cautiously. I was invited to name my fee and to decide how I would be paid. I quickly declined and told her that it would be my contribution to the local zoo.
Having heard the story and the behaviour of the animal, I suspected an intracranial bleed and recommended a quick CT. This would need to be under general anaesthetic. The vets, doctor and nurse were willing to give the general anaesthetic but not make any decisions on the health of Gandali.
At 7pm, my recipe-style cooking was interrupted to head to the radiology outfit in town for the celebrity CT. On arrival, I had difficulty touching the animal due to fear of zoonoses. The pictures will show me standing far away from Gandali. My physical examination with gloved hands, was similar to what I would do for a child with the same history. It was based on symmetry to rule out lateralising signs. There were none, however, there were bruises on the head, ear, and arm on the same side. This reinforced my suspicion and confirmed my request for the CT.
The CT was preceded by celebrity pictures with the sick animal. Finally, Gandali was under general anaesthetic and the CT completed without further ado. The CT showed as normal, later confirmed by the radiologist. Again, my reading of the image was purely on principles of symmetry and appearance in the human child. I cleared my chimpanzee patient of severe intracranial bleed. Gandali returned to the zoo that night.
By the next morning, I had become a celebrity Chimp Paediatrician, that I had never trained for, with only the very basic principles of medicine delivered by me.
Dr Sunday Pam FRACP
Image one (at start of article): Dr Sunday Pam and Primate Keeper Blair Chamma and Gandli, Image two: Chimp Gandali in MRI, Image three: Chimp MRI, Image four: Chimp Gandali sedated.
On 11 March 2021, we celebrated World Kidney Day. It may surprise you to know that Tasmania has the highest incidence per million of chronic kidney disease in non-Aboriginal populations among all Australian states, at about 11 per cent.
In recent years, a group of Tasmanian researchers, with support from the Tasmanian Community Fund, have been reporting on Chronic Kidney Disease (CKD) in Tasmania using a unique approach: combining information from several databases and registries with advanced data linkage techniques. Patients with CKD were identified from hospital and community pathology reports. These patients were then linked to information in the Australia and Aotearoa New Zealand dialysis and transplant registry (ANZDATA), the Tasmanian death and cancer registries, as well as datasets from hospitalisations across Tasmania. Together, this provided a picture of the distribution of CKD, its treatment and outcomes.
This research project identified about 56,000 Tasmanians with CKD between 2004-2017, of whom 44 per cent died during this period. In 2017 alone, 4,000 Tasmanians developed CKD for the first time. There were significant regional differences across the entire study period, with the north-west of the state having a 45 per cent higher incidence and an 18 per cent higher prevalence of CKD compared with the rest of the state. There were gender differences too: women had a 31 per cent greater likelihood than men to have CKD in the state.
So what happens to patients with advanced CKD in Tasmania? Forty-five per cent of all deaths during the study period in Tasmania were in people with CKD. Mortality rates were similar across the regions of the state. Cardiovascular disease and cancer were the two commonly reported causes for death. Annual mortality rates increased as kidney disease became more severe. Of the 2,600 who died with advanced CKD, only 374 (15 per cent) had recorded dialysis or transplant.
The factors that contribute to this discrepancy between the high rates of kidney disease and low rates of treatment in Tasmania remain unknown. Digging deeper, the authors reported that the transplantation rate among patients who start dialysis was actually better in Tasmania than the rest of the country, suggesting that the real difference in Tasmania is a lower number of people coming on to dialysis. We don’t know why this is the case – it could be our well-dispersed population, the older age of residents in Tasmania or the inability of our services to reach areas of greatest need.
Curiously, there is a gender difference in these numbers. While the community has 80 Tasmanian males with chronic kidney disease for every 100 females, among those on treatment (dialysis or transplant) there are 150 Tasmanian males for every 100 females. Again, the reasons for this discrepancy are unknown, and deserve further exploration.
This research project is being led by Professor Matthew Jose, Professor of Medicine at the University of Tasmania and Consultant Nephrologist at the Royal Hobart. Other members of the research team include Associate Professor Jan Radford; a GP, Associate Professor Rajesh Raj; a Nephrologist in Launceston, University of Tasmania research fellows, Dr Charlotte McKercher and Dr Kim Jose, with assistance from an experienced team of data analysts. Data from this work has already been submitted to the Tasmanian Community Fund and presented at national conferences. More work is underway in this area, and shortly, a PhD candidate is expected to join this project. Further quantitative and qualitative research work is expected in coming years.
Chronic Kidney Disease is a silent killer, yet another chronic illness that is disproportionately more common in Tasmania. Continued interest and research into CKD remains an important aspect of our efforts to improve the overall health of Tasmanians.
Dr Rajesh Raj PhD
Clinical Associate Professor - UTAS and Consultant Nephrologist
The Tasmanian RACP Trainee Research Awards were held on 6 November 2020. This years' event was extremely successful, with high-quality abstracts received.
The finalists who presented their abstracts were:
- Dr Michael Thompson – Adult Medicine: Population vitamin D stores are increasing in Tasmania and this is associated with less BMD loss over 10 years
- Dr Velislava Kiriakova – Adult Medicine: Glucose Tolerance Test Induced Hypoglycaemia
- Dr Charles Sparrow – Paediatric Medicine: “Another septic baby?" Using a Neonatal Sepsis Calculator to evaluate overtreatment in our newborn population: A respective audit
- Dr Laura Cuthbertson – Adult Medicine: Acute kidney injury, stroke and death after cardiopulmonary bypass surgery: The role of perfusion flow and pressure
- Dr Theresa Naidoo – Paediatric Medicine: Trends in emergency department presentations in the paediatric population with suicidal ideation and self-harm during the COVID-19 pandemic
- Dr Hikaru Hashimura – Adult Medicine: Adrenocortical Carcinomas in Multiple Endocrine Neoplasia Type 1: The Tasmanian Experience
Congratulations to the Tasmanian winners:
- Dr Michael Thompson – Adult Medicine: Population vitamin D stores are increasing in Tasmania and this is associated with less BMD loss over 10 years
- Dr Charles Sparrow – Paediatric Medicine: “Another septic baby?” Using a Neonatal Sepsis Calculator to evaluate overtreatment in our newborn population: A respective audit.
Dr Thompson and Dr Sparrow receive the opportunity to present their research at RACP Congress 2021 in Melbourne, including travel, accommodation and complimentary registration. We encourage all trainees to submit an abstract this year to be recognised for their research work.
The Foundation would like to express its appreciation to the Grants Advisory Committee as well as other Fellows whose generous contribution of time and expertise have made the review process for these awards possible.
Applications for the 2022 funding round will open on Monday, 3 May 2021. Upwards of 50 awards up to a total value of $2.5M are available across the different categories:
Applications for the following other award categories will open Tuesday, 1 June 2021:
AChPM Award for Outstanding Contribution to the Discipline of Palliative Medicine
Nominate a Fellow for their outstanding contribution to Palliative Medicine. The award includes a cash prize of $500 and a certificate formally presented at the ANZSPM Conference in September 2021. Please see the website for further details. Nominations close 30 June 2021.
AChSHM Jan Edwards Prize
The Jan Edwards Prize is awarded for the best research-based abstract oral presentation by a registered AChSHM trainee. The prize includes $500 and a certificate. For further details and to apply please visit the website. Applications close 31 May 2021.
We're busy planning various webinars for Autumn and Winter and encourage you to register. You can also access past events and webinars recordings.
Australian Digital Health Agency and Avant Mutual webinar
You're invited to our webinar held on Saturday, 29 May from 10am to 12pm. Data, technology, and medical indemnity insurance in healthcare is more important than ever before. Learn all about these incredibly relevant topics at this interactive webinar.
Register now
Overseas trained specialists and the Australian healthcare system
Held on Saturday, 17 July from 10am to 12pm. if you are an overseas specialist, this webinar is for you. You'll gain access to vital information about the Australian healthcare system.
Register now
Practical Skills for Supervisors incorporates the overarching themes of developing trainee expertise and using coaching techniques to improve feedback practice. This workshop focuses on delivering feedback using two frameworks, the GROW model and the four areas of feedback. By using these models, supervisors can facilitate change and growth in trainees towards expert performance.
Learning objectives are to develop a culture for learning, provide feedback and improve performance and deliver feedback in challenging situations.
SPDP 1:
- Wednesday, 7 April 2021, 2.30pm to 5.30pm: face-to-face
- Thursday, 8 April 2021,1pm to 4pm: via Zoom
- Thursday, 6 May 2021, 9am to 12pm: via Zoom
- Wednesday, 5 May, 6pm to 9pm: Face-to-face
SPDP 2:
- Thursday, 8 April 2021, 9am to 12pm: via Zoom
- Tuesday, 11 May 2021, 9am to 12pm: via Zoom
- Tuesday, 15 June 2021, 9am to 12pm: via Zoom
SPDP 3:
- Wednesday, 14 April 2021, 1pm to 4pm: via Zoom
- Wednesday, 21 April 2021, 1pm to 4pm: via Zoom
- Thursday, 29 April 2021, 9am to 12pm: via Zoom
- Tuesday, 18 May 2021, 3pm to 6pm: via Zoom
- Tuesday, 25 May 2021. 2pm to 5pm: via Zoom
Register now
We’re hosting more online events than ever before, so have introduced a condensed monthly events digest. The first one was sent to you on 7 April, but you can also read it online.
This monthly communication will be sent to you on the first Wednesday of each month, to provide you with an opportunity to virtually attend events from all over Australia and Aotearoa New Zealand. We hope this makes your life that little bit easier and we look forward to seeing you at our next event.
Read the April events digest
The College Learning Series – success story
Since its inception in 2018, the College Learning Series (CLS) has quickly grown, with over 85 per cent of Adult Medicine Basic Trainees now enrolled. With the series providing College members with free access to more than 450 clinically reviewed lectures, the CLS has become a key resource for physician training.
Its success is not by chance, but through the support of more than 200 Fellows - lecturers and clinical reviewers – each with a deep commitment and passion for trainee education and online medical education. At the front, networking with lecturers, finding new speakers, and providing strategic direction on the CLS Committee, are the program’s Regional Coordinators.
Calling Tasmanian Adult Medicine Fellows
We are looking for Adult Medicine Fellows who meet the criteria above, with a flair for identifying talented lecturers within Tasmania. Bring your exceptional organising skills to work on the CLS Committee (Adult Medicine), and in partnership with our RACP teams in Professional Practice.
Find out more (PDF)
Online course: Physician wellbeing in challenging times
Physicians often fail to put on their own oxygen masks when dealing with the challenges and stresses that come with practising during a pandemic. This online course explores in-depth how to better support your own wellbeing, as well as the wellbeing of your staff and colleagues through compassionate leadership. The course covers concepts, strategies, and tools to help you mitigate the impact, set healthy boundaries, prevent burnout, and build support networks during a crisis.
Enrol now
Fellows and trainees of all specialties are invited to enrol in this new Qstream course, which has a mid-May start. The course is designed to provide practical strategies to help you enhance your teaching skills and effectively balance teaching with a busy workload.
You'll access in-depth case studies with questions that are sent directly to your inbox at spaced intervals over a three-week period. Each question takes just ten minutes to complete, and participants are encouraged to discuss the case studies and share opinions with others through secure, online discussion forums.
The course is designed to enhance your knowledge in adult learning, provide practical strategies to incorporate effective teaching skills into day-to-day settings, and encourage self-reflection and peer discussion.
Enrol now
This is the third and final part of the series on gendered medicine. We step back and look at the way that health care and research are funded. It’s been said that the health needs of women are undervalued by our existing fee-for-service model, down to individual item numbers in the Medicare Benefits Schedule. There’s also evidence that diseases predominantly experienced by female patients receive less research investment. Is this blatant sexism or a symptom of structural imbalance, and what do we do about it?
Guest
Dr Zoe Wainer BMBS, PhD, MPH (Director of Clinical Governance, BUPA)
Listen now
Expressions of Interest are still open for Fellows in the Adult Medicine and Paediatric & Child Health Divisions to join our team of accreditors. As an accreditor, you play a vital role in ensuring the delivery of high-quality workplace training. Your contribution to accreditation can also count towards your annual CPD credits.
Please submit an Expression of Interest (EOI) form by Wednesday, 30 June to accreditation@racp.edu.au.
What are the opening hours of the RACP VIC/TAS Regional Office?
Victorian staff currently work from home due to COVID-19 measures. Normal business hours, Monday to Friday from 9am to 5pm, remain unchanged.
Where is the RACP VIC/TAS Regional Office located?
The RACP VIC/TAS Regional Office is currently closed to members and staff are currently working from home. However, the address is: Level 2, 417 St Kilda Road, Melbourne VIC
What is the contact number for the VIC/TAS Regional Office?
You can reach our office on (03) 9927 7700 or Member Services on 1300 697 227.