Pot-pourri eBulletin 13 December 2019

President's Message

Last week the Australian Parliament repealed the Medevac legislation. We have stood united with the entire medical community in their position to save the Medevac legislation which has proven effective in improving timely access to necessary healthcare for asylum seekers and refugees. The repeal of these laws may result in serious and preventable harm to asylum seekers and refugees. As paediatricians we must call on the government to do all it can to ensure that this vulnerable group of people is able to access appropriate, necessary and timely care.

Until further details emerge providing insight into whatever understanding may have been reached in order to enable the passage of the repeal legislation and how this may impact the ability of refugees and asylum seekers to access necessary and timely care, the RACP considers repealing this legislation as an enormous step backwards.

I thank all our members who were involved in the #SaveMedevac campaign, our voices were heard and noted by the broader Australian public and many parliamentarians. While in this instance it wasn’t quite enough, we must continue to advocate on this issue as further opportunities arise.

I am pleased to see the RACP Congress 2020 program come together with some outstanding speakers for the PCHD stream. Professor Lynn Gillam will lead a discussion on a complex clinical case and the ethics surrounding it. Professor Gillam has a wealth of experience as the Academic Director of the Children’s Bioethics Centre at the Royal Children’s Hospital Melbourne, and Professor in Health Ethics at the University of Melbourne, in the Melbourne School of Population and Global Health. To register for Congress, please visit the website.

Congratulations to Professor Gervase Chaney who was recently appointed as Chair of the Board of the Australian Research Alliance for Children and Youth. Professor Chaney will be a great leader and advocate for children and young people, and I wish him every success in his role.

As the year ends, we can look back on our successes as a division and use this to further drive our agenda next year. Some key achievements include:

We have also been involved in numerous RACP submissions including:

  • MBS Taskforce
  • Choosing Wisely New Zealand recommendations about Choosing Wisely and Equity
  • The Australian Digital Health Agency’s Medicines Safety Program Draft Blueprint
  • Response to Ministerial Advisory Committee report on out-of-pocket costs
  • Endorsement of the Children's Digital Health Record Clinical Information Model
  • Australasian Diabetes in Pregnancy Society Guidelines for Pre-existing diabetes and pregnancy
  • Tasmanian Law Reform Institute Consultation on Legal Recognition of Sex and Gender
  • Food Standards Australia New Zealand – addition of oligosaccharides to infant formula products.

I thank all the PCHD Committees for their ongoing work and dedication and wish you all a safe and happy holiday.

Professor Paul Colditz
President, Paediatrics & Child Health Division

Changes to key education policies

The RACP has reviewed and updated the Progression Through Training, Flexible Training and Recognition of Prior Learning policies. The changes apply to all RACP trainees and will take effect from August 2020.

The changes:

  • respond to feedback from trainees, committees and members
  • improve the clarity of the documents
  • respond to how the policies are working in practice
  • align the language to apply to all training programs (including the new Basic Training Curricula)
  • ensure that the provisions for flexibility and time limits to complete programs are benchmarked to other medical colleges and universities.

The biggest change is in the Flexible Training policy (item 4.3). The current rule requires part-time trainees to complete the same number of work-based assessment tools as full-time trainees.  

In response to overwhelming support, part-time trainees will be able to pro-rata the number of work-based assessment tools to the amount of training they have been approved for. The change will still collect multiple observation and assessments to inform progression decisions while reducing the demand on part-time trainees to a more reasonable level.   

Changes to the policies are considered low impact and will take effect from August 2020.

Find out more

Community Child Health accreditation of training settings

From 2020, all Advanced Trainees in Community Child Health (CCH) will be required to undertake their training in an accredited position. This will be checked upon submission of the Annual Prospective Training Applications, and training periods that are not completed in an accredited position may not be eligible for approval and certification.

When applying for Advanced Training in CCH, trainees are advised to check if the position is accredited via the CCH Accredited Sites for Advanced Training List. If the position is not on the CCH Accredited Sites for Advanced Training list, trainees should have their supervisor or appropriate person at the setting contact the Education Officer for CCH via CommunityChildHealth@racp.edu.au to get information on how the site can apply for accreditation in CCH Advanced Training. Settings with Advanced Trainees in CCH were notified of this change in January 2019.

Please note that a position accredited for General Paediatrics Advanced Training is not automatically accredited for CCH Advanced Training.

For all queries related to training and accreditation, please contact CommunityChildHealth@racp.edu.au.

Dr Sarah Loveday
Chair
Advanced Training Committee in Community Child Health

Congress 2020 “Balancing Medical Science with Humanity” – What’s in it for the kids?

The next RACP Congress will be held in Melbourne in May next year and an exciting program is being developed for the PCHD stream. Register now to secure your place at RACP Congress 2020.

Confirmed speakers in the PCHD stream include:

  • Professor Lynn Gillam (Children’s Bioethics Centre, RCH) speaking on ethics
  • Dr David Burgner (Murdoch Children’s Research Institute) on Kawasaki disease – this presentation will form part of the PCHD Clinical Updates session  
  • Associate Professor Sue Woolfenden (UNSW School of Women’s and Children’s Health) speaking on inequities in child health advocacy. Associate Professor Woolfenden will be joined in this session by the College’s Director of Policy and Advocacy, Dr Patrick Tobin.

More speakers are being confirmed, so please regularly check the website and this publication for updates.

The Congress will also feature the 2020 Rue Wright Memorial Award. This session will be held on Monday, 4 May and showcases oral presentations from Fellows and trainees; the award is given to the applicant who best demonstrates excellence of hypothesis, scientific merit and relevance to Community Child Health. Applications remain open for this award until Friday, 31 January 2020 and abstracts must be submitted via the RACP Congress website.

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My Work Profile

Many Government decisions on workforce are based on anecdotal data. As a response to this we are updating our records to assist our future decision making for physician education programs.

Did you know the hours you work, the professional activities you are engaged in and where you work impact the adult medicine workforce?

When you pay your annual College subscription fees you’ll find My Work Profile on the payment confirmation page that will take you to your own work profile, or you can access it in MyRACP.

MyRACP supported internet browsers are Microsoft Edge, Chrome, Firefox and Safari.

How does My Work Profile benefit you?

Workforce data will be made available to you and will help:

  • new Fellows decide which geographic area to work in Australia and New Zealand
  • new Fellows choose between private or public practice
  • you understand how your work hours compare with your peers
  • the RACP and stakeholders including government policy-makers make better workforce decisions, based on current data
  • Fellows understand activities they are undertaking; research, administration or clinical.

Hear what others have to say about My Work Profile

For more information, please read the My Work Profile FAQs. For details on what data will be collected and how it will be stored, please read the Privacy Statement.

Complete today

Chapter of Community Child Health (CCCH) Satellite Day 2020

The next annual Chapter Satellite Day will be held on Sunday, 3 May 2020, the day prior to the opening of RACP Congress 2020. The venue is the Melbourne Convention and Exhibition Centre, and the event is open not just to Chapter members, but also to all RACP members as well as members of the Neurodevelopmental and Behavioural Paediatric Society of Australasia (NBPSA). The NBPSA is planning a workshop the day prior, Saturday, 2 May 2020, and there will be a joint dinner of the CCCH and the NBPSA that Saturday evening. Information regarding the dinner venue and registration will be available soon from the Ancillary Events webpage.

The Chapter Satellite Day 2020 will have a theme of 'Child mental health and wellbeing', with a number of speakers presenting on this topic via lenses of child development and behaviour, child protection, and child population health. We are happy to announce that Professor Harriet Hiscock has confirmed to speak on 'Inequalities in mental health for children and adolescents'; information regarding other sessions will be added to the Chapter Satellite Day 2020 Program as arrangements are finalised.

To register for the Chapter Satellite Day 2020 and the joint CCCH/NBPSA Dinner, please visit the Ancillary Events page of the RACP Congress website.

PCHD presentation awards at RACP Congress 2020

Submit an abstract for your opportunity to present and be recognised at RACP Congress 2020.

Best Poster Prize in Paediatrics and Child Health

The Best Poster Prize in Paediatrics and Child Health is presented for excellence of hypothesis, scientific merit, and oral presentation. It is open to paediatrics and child health Fellows and Advanced Trainees.

The Fellow and trainee with the best poster presentation will each receive $750AUD and a certificate at the RACP Foundation Dinner.

Abstract submissions are accepted via the RACP Congress website. Applications close Friday, 31 January 2020.

Rue Wright Memorial Award

The Rue Wright Memorial Award is awarded to a Fellow or trainee who demonstrates excellence in hypothesis, scientific merit and relevance to Community Child Health in an oral presentation at RACP Congress.

The recipient will receive $1,500AUD and a certificate presented at the RACP Foundation Dinner.

Abstract submissions are accepted via the RACP Congress website. Applications close Friday, 31 January 2020.

MCRI awarded grant to help vulnerable preterm babies

Investigators at the Murdoch Children’s Research Institute (MCRI) have recently been awarded $1.4 million by the MRFF International Clinical Trial Collaboration Scheme to lead a group of investigators from Australia, Europe and North America who aim to determine how best to support the lungs of preterm babies <29 weeks gestation when they start breathing at birth. The Positive End-expiratory Pressure Levels during Resuscitation of Preterm Infants at Birth (POLAR) Trial will study 906 preterm babies and be the largest delivery room respiratory trial to date. The investigators will compare the current practice of a static PEEP level of 5-6 cmH2O against higher PEEP levels (8-12 cmH2O) titrated to clinical need (dynamic PEEP). Whilst all neonatal resuscitation guidelines recommend the use of PEEP at birth, there is no evidence to guide what PEEP level to use in preterm infants.

At birth the human lung must quickly adapt to air-breathing. The process of aeration is complicated, first requiring foetal liquid to be cleared from the lung, then creating a functional residual capacity and finally defending this FRC during tidal ventilation. Most preterm infants are unable to do this without some form of mechanical support. Whilst lifesaving this support can cause injury if applied inappropriately. The POLAR Trial is based on work done by the Neonatal Research group at the MCRI. This work showed that preventing lung collapse during expiration is more important than how the lung inflates during the respiratory transition at birth, and PEEP is the easiest and best way to prevent lung collapse. At birth the preterm lung needs a higher PEEP to prevent collapse than during later tidal ventilation. The new strategy developed by the trial investigators uses an initial high PEEP that is adjusted during resuscitation based on the baby’s clinical response. The investigators hope that this approach might reduce the long-term risks of preterm birth, specifically death and/or bronchopulmonary dysplasia.

Associate Professor David Tingay
Murdoch Children’s Research Institute

Paediatric Society NZ annual conference (Auckland, November 2019): In our backyard

A couple of weeks ago, 250 delegates, including child health professionals from across Aotearoa New Zealand and further afield, participated in the Paediatric Society NZ annual conference in Auckland. The overarching tagline – ‘In our backyard’ – captured the essence of relaxed but invigorating interchange of new research, innovations, ideas on implementation and the all important opportunity to network with colleagues across the discipline of healthcare.

Kate O’Brien from the World Health Organization opened with a keynote (very effectively beamed in from Geneva) providing an overview on global child health including some salient points on vaccine coverage.  Other keynote speakers included Gabrielle McDonald reviewing child mortality in New Zealand, and Susan Morton updating us from the current 'Growing up in NZ' cohort study. An inaugural ‘Leo Buchanan Memorial Lecture’ was brought by GP/poet who read his 'Letters to young people' and challenged the other sides of our brains. Poetry threaded through the conference with a poetry board gathering some great home-grown compositions emerging. Our visitors from the Mayo Clinic, Sheryln and Colin Driscoll, brought their expertise in rehabilitation medicine and ENT conditions respectively.  Respiratory medicine and a focus on bronchiectasis were also a highlight for me. The fantastic line-up of speakers continued in this vein right throughout. The Montgomery Spencer Memorial Lecture was given by Dr Rosie Marks and included her fascinating anecdotes and reflections on her long career in paediatric disability work.

This year I thought the free paper presentations were all of high-quality showcasing new research from nursing, allied health, and medical streams. Prize winner for the RACP Trainee Research Award for Excellence was Sarah Primhak for her presentation on ‘Script for paediatrics – creating a smartphone application to improve antimicrobial prescribing for children’.

Once again the social events including the conference dinner overlooking Auckland Harbour proved a real highlight, with members brushing off their dancing shoes. The evening was suitably enlivened with a great band led by our own Richard Matsas and Richard Smiley. 

We look forward now to the next PSNZ conference in Rotorua, 10 to 13 November 2020. It is not too soon to get this in your diary, line up your research and lock it in to your CPD plan.  It's a great chance for our Australian colleagues to also plan a New Zealand escape for a few days as well.

Dr Tim Jelleyman
President, Paediatric Society of New Zealand

Paediatric emergency research 

Network research has emerged as an important tool to improve the power of studies and the generalisability of research findings in several paediatric specialties. The Australian and New Zealand Paediatric Research in Emergency Department International Collaborative (PREDICT) is conducting multicentre studies to improve the evidence base for the emergency care of children. Every year four million sick and injured children are seen in emergency departments across in Australia. A particular focus of PREDICT has been the inclusion of non-tertiary emergency departments, where 70 per cent of children are seen in Australia, as both research and implementation sites. We now have 34 active research sites and members from more than 50 hospitals in Australia and New Zealand.

While we initially focused on surveys and retrospective studies, we are now conducting large observational and interventional studies. An example of a large observational study is a project of 20,000 children with head injuries to determine the best clinical decision rule for the use of a head CT scan (published in The Lancet). Recently completed randomised trials are studies assessing the optimal management for status epilepticus (published in The Lancet) or on how high flow should be used in infants with bronchiolitis (published in the New England Journal of Medicine). More recently the PREDICT network has been focusing on improving the translation of new knowledge into clinical care. An example is a cluster randomised trial to reduce the use of proven non effective treatments in bronchiolitis at 26 hospitals in Australia and New Zealand.

While many studies have been conducted without funding we are currently receiving grants from the National Health and Medical Research Council and the Medical Research Futures Fund. PREDICT received NHMRC Centres of Research Excellence grants in 2014 and in 2019. NHMRC CRE grants provide funding for five years and are ideal for work beyond individual projects, the translation of research outcomes and the development of national research capacity. A focus of our workforce strategy has been the fostering of multicentre capable higher degree students- five of which will be part funded through CRE scholarships. Membership is open to all staff working in emergency departments and related research fields such as the ambulance service. For RACP fellows wishing to get involved and for more information visit www.predict.org.au.

Professor Franz Babl
PREDICT network
University of Melbourne, Royal Children’s Hospital and Murdoch Children’s Research Institute

Medical Specialist Access Framework – Guide for physicians

Aboriginal and Torres Strait Islander peoples access specialist medical services 40 per cent less often than non-Indigenous Australians. Inconsistent availability and access to specialist medical services across Australia is just one of the barriers contributing to the poorer health status of Aboriginal and Torres Strait Islander people. We encourage you to get involved in implementing the RACP's Medical Specialist Access Framework in your professional practice and work environment. Read our practical guide, which supports equitable access to specialist care for Indigenous peoples.

Rural communities deserve consultation on alcohol takeaway hours

As the final salvo of the year in our ongoing campaign to reduce the harms of alcohol in Australia, the College joined the Royal Australasian College of Surgeons, Australian Medical Association NSW, Alcohol and Drug Foundation, Public Health Association Australia, NSW ACT Alcohol Policy Alliance and other groups in delivering a strongly-worded letter to Premier Gladys Berejiklian.

The letter objects to proposed legislative changes that would allow a whole-of-state extension of takeaway liquor outlets and online courier sales until midnight. That this proposal arose from the inquiry into Sydney’s night-time economy is especially troubling. Not only did the inquiry ignore appeals of first responders, clinicians and academic experts to not remove the highly effective last-drinks measures, it went beyond its terms of references to impose an extension of alcohol trading hours across NSW.

The more immediate outcomes of this action will be an increase in domestic and non-domestic violence. Longer-term, NSW will see a rise in non-communicable diseases and mental health harms related to alcohol. In the words of the letter 'Alcohol-related harm is a cost to government, as well as to the community'. Read more about the letter and the issues it canvasses in the press release.

The College vows to remain at the forefront of the fight to minimise the harms of alcohol in our community in 2020.

The RACP's Model of Chronic Care Management 

The RACP Integrated Care Subgroup led by Associate Professor Nick Buckmaster and Dr Tony Mylius has led the development of the health system reform needed for patients with chronic conditions. This addresses a significant gap in current care organisation and supports patients to access physician care in a coordinated way. This model is the basis for strong advocacy to the Australian Government to fund the model or similar, from proof of concept sites through phased introduction.

Read the RACP’s Model of Chronic Care Management 

Physicians talking about Evolve at the Tasmania Physicians Conference

On 8 November, Professor Peter Procopis and Professor Graeme Jones presented at the Tasmania Physicians Conference on Evolve.

As the RACP myCPD Champion, Professor Peter Procopis is passionate about the need for physicians to keep up-to-date through lifelong learning. There are many ways physicians can engage with CPD, with Evolve providing physicians with a trusted resource to support them to keep abreast of best practice and help them reduce low-value care in their specialty. Peter believes these projects, as well as other CPD activities, require advanced planning to not only put the project in place, but also determine if a given activity has been successful.

View Professor Procopis’ presentation slides

Professor Graeme Jones is passionate about reducing low-value care in rheumatology. He has played an important role in helping shine a light on the low value practices through the Evolve initiative and will be sharing his experiences of identifying and implementing Evolve recommendations.

View Professor Jones’ presentation slides

Webinar: My Health Record – Opportunities to better serve the population

Did you miss the recent ‘My Health Record – Opportunities to better serve the population’ webinar? You can now watch Associate Professor Nick Buckmaster, Dr Rosalie Schultz and Carey Doolan’s presentations.

Watch webinar

Policy and Advocacy report

The College Policy and Advocacy Council (CPAC) met on 20 November for their last meeting of 2019. A formal Chair communique of the meeting will be released soon to outline the main discussions and outcomes of the day. During the meeting CPAC members reviewed the successes and achievements of the past six months of College policy and advocacy, which are also highlighted in the Policy and Advocacy report. This is a true showcase of all the great effort and hard work every CPAC member, their College bodies, and the wider membership have accomplished. It is a real testament to the College working together, and an impressive end to the year.

New Pomegranate podcast: Ep54: My Health Record in practice

How many times have you thought "Things would be so much more efficient if we had shared electronic health records”? Australia now has the My Health Record covering 90 percent of the population with individual profiles.

It is proposed that this will improve safety, especially for people with chronic and complex healthcare needs. It could reduce medication mismanagement and duplication of pathology and diagnostic imaging tests, and help improve health literacy among the public. At the point of care, it might prove safer for the previously unseen patient who arrives at emergency unable to say anything about what allergies they have or what medications they’re already on.

However, that’s only if everyone is putting information to My Health Record. It’s been a long process getting health providers to upload data to My Health Record routinely, and the uptake differs wildly between primary, secondary and tertiary care.

In this podcast we visit each of these settings and hear what the different expectations are of this new tool, what are the benefits gained, and how well it fits into the workflow of a consultation. The RACP received support from the Australian Digital Health Agency for the production of this podcast.

Guests: A/Professor Nicholas Buckmaster FRACP (Gold Coast University Hospital),Dr Ron Granot FRACP (East Neurology and Clinical Advisor for Healthshare Digital), Professor Meredith Makeham (Chief Medical Adviser Australian Digital Health Agency, Macquarie University).

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 iTunesSpotify or any Android podcasting app.

Listen to podcast

Online course: Working with migrants, refugees and asylum seekers

The College’s Continuous Learning Unit has recently released a new online course: Working with Migrants, Refugees and Asylum Seekers.

This course is designed to educate physicians on working more sensitively and effectively with migrant, refugee and asylum seeker patients. It provides relevant facts and practical strategies for objectives such as good cross-cultural communication and facilitating easier navigation of the healthcare system. The course includes the perspectives and stories of a diverse range of individuals to help show the full picture.

As with all College online learning resources, it is free for members and accessible on any device. 

A new repository for resourceful physicians

Would you like to share educational resources with other RACP members? A new repository has been added to our Online Learning platform, which enables you to share external resources, tools, courses or readings with your peers. Submit your recommended resources, browse member submissions, or suggest a topic for a resource you’d like developed.

Accessible anywhere and optimised for mobile on-the-go learning, RACP Online Learning Resources are free for members and count towards Continuing Professional Development requirements.

Journal of Paediatrics and Child Health early view of next issue available online

The early view of the next issue of the Journal of Paediatrics and Child Health is now available on the JPC Wiley page

Medical Board of Australia consultation on CPD Registration standard

The Medical Board of Australia (MBA) has proposed changes to CPD. They are currently consulting on their proposed revised CPD Registration standard designed to build on existing arrangements and strengthen CPD requirements for medical practitioners. The changes put reviewing performance and measuring outcomes at the centre of CPD requirements.

The College has been advocating strongly on behalf of members and will submit a response to this consultation. Members are encouraged to provide an independent submission to the MBA’s public consultation, which is currently open until Friday, 14 February 2020. Members can find further information on the AHPRA website.

In response to the proposed future regulatory requirements, we have been making changes to assist Australian Fellows towards meeting these changed requirements. We are encouraging all Fellows to work within the new CPD Framework.

If you are not able to meet the new requirements in 2019, you can access the CPD transition course – CPD: Applying the New Framework. By completing this course you can successfully meet your 2019 CPD requirements.

Find out more at CPD: Applying the New Framework and access the new MyCPD Interactive handbook for further information and guidance.

This transition course is for 2019 only. From 2020 onwards, you will be expected to complete and record CPD against the most current version of the MyCPD Framework.

Colonoscopy Clinical Care Standard implementation resources

The Australian Commission on Safety and Quality in Health Care have developed a number of resources to help implement and address a number of the quality statements outlined in the Colonoscopy Clinical Care Standard. These resources are intended to support consumers, clinicians, organisations and assessors.

Access resources

Pot-pourri submissions welcome

To submit an article for publishing in Pot-pourri, please email paed@racp.edu.au. The article should be no more than 350 words. If you would like to submit an image with your article, it would be assumed that you have received appropriate permission to use the photo and it needs to be of high resolution, above 300 dpi. Please note that articles may need to be edited by the RACP Communications Team.

Update your details with the College

Did you know that you can now update your address details online? Simply Login to MyRACP and go to 'Edit my details'.
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