Tasmania – November 2020
Dear colleagues,
As I write these words, Spring has arrived in Tasmania. The nip in the early morning air and the flowers sprouting in impossible colours everywhere remind us that the best time of the year is here. And it's not just the weather changing – over the next few months, the College is going to be entering uncharted waters with the new formats in some of the Divisional Clinical Examinations too. Interesting times lie ahead for trainees, Fellows and examiners.
We continue to be fortunate with low case numbers as the epidemic swells in other parts of the world. Hopefully, we are now better prepared to tackle our next health emergency. I believe that as a profession, we have learnt valuable lessons about the importance of coming together in the face of adversity. It goes without saying that we need to continue to be careful and not lower our guard.
The new examination patterns will be especially stressful for our trainees. Selection into training posts for next year have also largely been completed across the state. There is an understandable sense of anxiety among some trainees who have not been able to complete all the requirements for advancement. The College continues to have resources to help with this, and they can be accessed on the College website.
This is the season of renewals and new beginnings, and I hope we can put the past few distressing months behind us as we look forward to better times in this last quarter of 2020.
Associate Professor Rajesh Raj
Chair, Tasmanian Regional Committee
The location for RACP Congress 2021 has been unveiled and it is… everywhere. Spread over six cities, two countries and streaming live, it has never been easier attend.
Under the theme of Transformation: Adapting for the future, RACP Congress 2021 will explore diverse topics that address ideas of transforming the way we deliver healthcare, how we look after ourselves in a connected age and what we need to know to prepare ourselves and our practice to remain relevant.
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After ceasing full-time work reluctantly as a consultant occupational physician due to my age six years ago, I now marvel at how quickly those years have passed. There is no doubt that there was a clear transition as one adapts to change and learns new skills. The most obvious change lies with the fact that my time was no longer controlled by appointments and the necessity of 'eyeballing' patients was no longer there. It is well known that change is never easy even when you are actively embracing the possibility. As the man said, “you’ve got to have a plan.”
I had no formalised plan. I was to stop work at the end of June and go to Europe for a holiday, catching up with family and friends. Following this break, I would then return to Hobart. However, there was no plan as to what would then occur. You could say that 'playing it by ear' was the plan. I had some commitments mainly centred on mentoring my occupational physician trainee, which gave the opportunity to tidy up some loose ends from my practice. After seeing three patients, I had a real surge of adrenaline that had me firing again on all cylinders. I was like a drug addict who had been given a shot just as I was withdrawing from an addictive substance.
I continued to mentor, but would also see one or two patients on a fortnightly basis. I also spent two days per month in Melbourne performing independent medical examinations. This coincided with and allowed me to attend to a Melbourne business interest. I was obtaining academic satisfaction without chasing my tail. It was low-key and very enjoyable. The difficulty with retirement for me lay with the fact that I was at my peak in terms of experience within my field and easing out has been the best method for me, rather than going cold turkey.
However, retirement success is directly proportional to having good physical and mental health. My wife, Mary and I have always believed (rightly or wrongly) that good health can be influenced, but not controlled. There are probably genetic and environmental factors at play which have a strong influence but looking after yourself is of paramount importance and is something that you can control. Having the desire to do so is of prime importance.
We have always had a keen focus on daily exercise, generally first off in the morning. Our repertoire has included walking, swimming, jogging, climbing the Mount Nelson Steps, attending the gymnasium and more recently cycling. Generally, we go independent of each other that suits as we had worked together in the medical business and two thran individuals needed some space. We have continued in this mode except for cycling which we generally do together.
We eat a balanced diet and have a moderate consumption of alcohol with alcohol free days being more of the norm. Our routine generally has us looking forward to our exercise with a keen relish and is a solid foundation for the day. In addition to the morning exercise I played golf and had been as proficient at golf as you can be on half a dozen rounds every five years. I decided to enrol into a golf club and learn how to become proficient. So, I joined the Royal Hobart Golf Club and regularly play there. It has led to a new circle of acquaintances from all walks of life, but the game brings the best and worst out of me. Every so often, I have a good round or maybe put two good rounds together and the associated hubris is such that one believes that yes, I’ve finally got it, the game’s easy just watch me.
This newfound exhilaration only lasts for a moment before the earth comes crashing down and you can hardly make a shot. You have days where the ball is going nicely toward the green and all it takes is for an appropriate bounce to occur and your ball is on the green. Instead Shane appears and the ball leg breaks superbly and nestles in the bunker. Once they start it can be challenging. Analysis of the very best professionals illustrate that they are subject to wild fluctuations in scores. The variation is right across the game at all levels.
Mary comforts me by asking me "what, on earth, were you doing near the bunker in the first place?” She means well but that’s life and there is no satisfactory retort as there is an assumption with the question that I have some sort of control on the shot outcome. "I hear from my colleagues about course management. The game’s all about course management. It means take your punishment." "Make sure to get back on to the fairway. Don’t hit the cover off the ball, stroke it." Still it’s not all bad, the 18th hole will often lead to a superb drive and one thinks “I’ll be back again” and sure enough one is. But why does it take to the 18th to hit a shot reflective of our perceived ability. The answer of course has got to be reasoned as we are all getting older.
Two things have changed over the past dozen years at the club. Whereas I was frequently referred to as an Irish bastard; in keeping with changes within society that form of racial vilification no longer occurs even though I had always recognised that it was actually a term of endearment. Secondly cigarette smoking has ceased totally as compared with a dozen years ago. It is amazing just how long a public health message actually takes to permeate society.
The Corona pandemic caused a panic. The golf club closed for about a month and when it reopened we were only permitted to play in pairs and you could not drive off from the tee until the pair in front were off the green and were on to the next tee. It was actually quite interesting as with only two people playing there were only two political parties’ maximum per hole. Thus, it was less controversial and the golf was better. Also dealing with only one person allowed you to get to know that person better which in a four is more difficult.
The issue with the game of golf, I have concluded, is that there are those at one end of the spectrum who wish entirely to have a social round with good crack and bonhomie and the means to that is not a concern. Then there are those who have a type A personality’s and who are always striving to achieve and do as best as they can. Anything less can be frustrating to them. Not surprisingly I belong to the type A personality. Can a personality change? Well the evidence so far is not promising would be my submission. However here is a conversation about the ramifications of the COVID-19 virus.
Another facet of retirement has been to document my career experiences in occupational medicine which has been quite challenging but a lot of fun. Exactly what I will do with the various chapters remains to be seen. The COVID-19 pandemic has been fascinating as modern medicine has been strangely ignorant about the history of previous pandemics and so we relearn from the same mistakes again.
Finally, I must confess that I am no longer a reluctant retiree, so the master plan has worked.
Dr Tim Stewart
Part-time Consultant
Learning Russian for free on the internet, or at least on the cheap. That is one of the post-retirement brain-saving projects I set myself over a year ago. Has technology really revolutionised traditional language learning techniques?
Why Russian? I have had a long standing interest in Russian political anecdotes and I wanted to read these in the original Russian. Visit Russia before Russia visits you! I’d also like to better get to know the Russian speakers in Latvia, where our family visits every year.
Regarding brain saving, I wanted to learn Russian for the same reason President Kennedy wanted to go to the moon. Not because it’s easy but because it’s hard. There is evidence that bilingual persons have onset of Alzheimer’s delayed by four years. But because I can already speak moderately okay Latvian, I was only hoping to consolidate such benefits, if any. My goal was to spend an hour a day using free internet resources to get to an A2 basic user level within a year. I did not want to use traditional paid language courses or engage personal tutors. Over the next months I searched the internet and YouTube and tried using free trial resources.
After some trial and error time, I concluded that the most efficient way of learning vocabulary is with spaced repetition of electronic flash cards. The cards are displayed by an app or program at increasing time intervals as the words sink into more persistent memory. A web or phone app called ANKI has historically been the most popular means of generating flash cards on any topic. There is a substantial literature about using ANKI in medical school. I wish I had known about that one a few years ago.
The most thorough explanation I found of how to use ANKI flash cards for language learning was by Gabriel Wyner, an opera singer who had to learn several languages in quick time. Having a word on one side of a piece of paper and the translation on the other side is inefficient. ANKI cards have the advantage that they can contain multiple images and sounds and embedded logic. Hence more memory hooks to assist recall. The actual process of personally selecting the images and sounds also makes them memorable. It was fun searching for visual and verbal metaphors and onomatopoeia, the weirder the better. The word for cow is Корова, pronounced something like 'kaROHva'. A Google image search will find a car on its roof after hitting a cow.
The first step was to learn what my wife jokingly calls the acrylic Russian alphabet. Flashcards were very useful here, but my reading is still hesitant, especially for unfamiliar words. It’s possible to set up Google Chrome so that mousing over Russian text will automatically display a word translation in English. The pronunciation of some Russian words changes with where words are stressed, and this is a bit unpredictable in text.
It’s easy to get bogged down and discouraged learning the numerous grammar tables. Russian grammar is very complex, but I recognised echoes of Latvian grammar. I found support from several sources for putting the emphasis on learning lots of vocabulary and working out the grammar as I went along. This was much more enjoyable for me, which meant it was more likely I'd persist with the learning.
While exploring the net for resources I found that learning a language is like solving an enormous multi-dimensional puzzle that benefits being illuminated from multiple directions. There was some rewarding 'aha' moments when I recognised a weird word learned the previous week or after working out an apparent grammar inconsistency. I also found use for a Russian dictionary arranged in frequency of use order, not alphabetical order. Why not focus on learning the most used words first, rather than lists of colours or vegetables?
After learning about one thousand words, I could then start looking at YouTube videos or text in Russian, such as anecdotes which were of particular interest to me and puzzle out the meaning. A long-time YouTube favorite of mine is Alexei Navalny, recently recovering from Novichok poisoning in Germany. He has a very clear speaking voice which improves comprehension. Don't call him Dimon (with English captions) has been viewed by thirty-six million Russians.
How did it all go? Well it’s been over a year. I gave up on the intention of not spending any money on courses, but I didn't spend very much. The obvious thing missing from my program so far is conversation practice. I will be contacting some very gregarious Russians my wife and I met during a cycling club tour from Moscow to St Petersburg last year for some skype or WhatsApp sessions.
Learning Russian had an unexpected benefit. My Australian wife has been tinkering with Latvian for years. But seeing my persistent efforts with Russian has motivated her to bite the bullet and seriously learn Latvian. She likes the grammar method combined with immersion, starting at the shallow end of the pool. We have found another dimension in our relationship through previously familiar phrases such as “Do you want anything at the shops?”
A final few word of Russian wisdom:
Жизнь похожа на рампу в дом курицы. Короткий и дерьмовый
Dr Martin Bicevskis was previously Senior Medical Officer, Occupational and Environmental Medicine in the Tasmanian Department of Health and Human Services. He held positions on AFOEM Council and was a Regional Committee Victoria member.
The College delights in receiving positive feedback from our members. Feedback serves as confirmation that we are supporting their career and profession in the best possible way and in addition feel inspired to innovate and improve on our processes. We received the below feedback from a trainee who attended one of webinars recently, Preparation for Adult Medicine Long Case Examinations.
“I just wanted to thank the RACP staff for hosting the transplant webinar last weekend. I am a trainee at Monash Health, and I am really grateful for the efforts everyone went to in order to facilitate that learning opportunity. I realise it would have taken a lot of effort (and on a Saturday morning), but please know that effort does not go unnoticed. I look forward to any further webinars and of course remain excited about the chance to sit the reconfigured clinical exam shortly. Thanks again for your compassion and effort."
Dr Amy Davies,
Basic Trainee
The RACP appreciates the value and experience Aboriginal and Torres Strait Islander and Māori doctors can provide to the health sector and communities in treating Aboriginal and Torres Strait Islander and Māori health issues. The RACP Indigenous Health Scholarship Program provides funded pathways through physician training. Applications are now invited for 2021 Indigenous Health Scholarships. Hurry, applications close Monday, 30 November 2020.
RACP President's Indigenous Congress Prize
The RACP President's Indigenous Congress Prize is open to medical students, junior medical officers and RACP trainees who identify as Aboriginal, Torres Strait Islander or Māori. The selected applicant will receive support to attend the 2021 RACP Congress to gain educational and networking opportunities and exposure to career pathways within the College.
Applications for 2021 are open. Please encourage anyone you know who is eligible to apply before the deadline on Friday, 31 January 2021.
You are invited to free one-hour sessions aimed at specialists, practice managers and practice nurses who are interested in learning more about My Health Record and how to use it most effectively in routine practice. Run via GoTo webinar platform, these sessions will afford an opportunity for participants to raise questions directly with the instructor and, if time permits, discuss other issues encountered in using My Health Record. These demonstrations will be run on a weekly basis at varying times throughout the day.
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Practical Skills for Supervisors incorporates the overarching themes of developing trainee expertise and using coaching techniques to improve feedback practise. 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. The course aims to help you develop a culture for learning, provide feedback and improve performance and deliver feedback in challenging situations.
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The 2020 Physician Training Survey is your chance to help strengthen RACP training programs and the workplace experiences in the settings in which you work and train. Open until Wednesday, 2 December, with the impacts of COVID-19 on training throughout this year, it’s even more important for us to understand your experience. By completing the survey, you can also enter the prize draw with a chance of winning one of two iPad Pros (256GB, cellular).
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New online course on thalidomide
The new thalidomide online course aims to introduce Australasian medical specialists to thalidomide and thalidomide embryopathy (TE), and their implications for thalidomide survivors today.
By completing this course, you will:
- develop a background knowledge of thalidomide and TE, the history attached to these and a basic knowledge of the range of birth defects, mechanism of action and current uses
- understand the range of secondary health problems from age-related deterioration and special considerations for medical investigation and management
- understand the implications of TE for other health conditions and for healthy living
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