Pot-pourri eBulletin 16 October 2020

President's Message

I would like to congratulate Professor Anne Chang, the 2021 recipient of the Howard Williams Medal. Anne is the Professor of Child Health and Head of the Child Health Division, Menzies School of Health Research (Darwin) and Adjunct Professor, Queensland University of Technology, Brisbane, Australia. Anne is also a Senior Staff Specialist at the Queensland Children’s Hospital and is recognised for her research contributions to evidence-based management and clinical care in the areas of paediatric cough, asthma, bronchiectasis and Indigenous child lung health. Her original works include the world’s first description of protracted bacterial bronchitis and international multicentre trials involving children with bronchiectasis. She has been a NHMRC practitioner fellow since 2004 and has published over 500 articles. Her major interests are in undertaking clinical research that improves the management of Indigenous health, cough and suppurative lung disease in children. I look forward to hearing Anne speak at Congress next year. Watch out for the RACP Congress 2021 program launch coming soon.

I am pleased to announce that two of our paediatric colleagues are recipients of the prestigious Churchill Fellowship. Associate Professor Margie Danchin and Dr Daniel Engelman have been awarded the opportunity to work with leaders internationally, gain knowledge and explore their fields of interest. A full list can be viewed on the Winston Churchill Trust website.

A recent article published in the BMJ Paediatrics Open “Hitting Children is Wrong" is a timely reminder that Australia lags behind many countries in that it is yet to outlaw all forms of corporal punishment. The evidence is well established that using physical punishment (such as hitting or smacking) to discipline children can have adverse consequences in the long-term for the child’s health, particularly their behaviour and emotional wellbeing. As paediatricians and as a College, we have a duty to be the voice for children and support the families we see to use more effective forms of discipline.

The RACP recommends in our position paper “Early Childhood: The importance of the Early Years“ the following:

  • That the Australian Government amends the legal defences in Australia for the use of corporal punishment to state that all forms of corporal punishment are unlawful so that the law protects children from assault to the same extent that it does adults.
  • The Australian Government develops health promotion activities encouraging parents to use more effective, non-violent methods of parenting by explaining early childhood social, emotional and cognitive development.

The RACP Aotearoa New Zealand team have recently re-launched their campaign to address health equity in Aotearoa New Zealand – Make It The Norm. The campaign looks beyond the three-year election cycle for the resources to make and sustain the changes urgently needed to realise the promises of Te Tiriti o Waitangi – equity, active protection and tino rangatiratanga for all people of Aotearoa New Zealand. We recognise that good health is supported by much more than infrastructure or staff – we need to look at the factors that promote healthiness and work outside our traditional borders to advocate, collaborate and create. At its core, the campaign points to four things that, when we get them right, will lead to good health for all New Zealanders. They’re backed up by our knowledge, experience, and evidence of the things that matter for health:

  • Somewhere to live: It needs to be the norm that everyone has healthy housing.
  • Someone to love: It needs to be the norm that all whānau enjoy wellbeing.
  • Something to do: It needs to be the norm that everyone has good work.
  • Something to hope for: There needs to be justice. Everyone has to have a fair go.

You can read more about the campaign and explore case studies on the RACP’s website, and read an opinion piece from Dr George Laking, RACP Aotearoa New Zealand President. 

Clinical Professor Catherine Choong
PCHD President

Opinion piece: Referral letters from paediatricians need an urgent life lengthening operation

The three-months-referral letter expires by the time it reaches its intended cause. Its limited validity is affecting professionalism, communication, healthcare costs and worsening coordinated care. The paediatric referral policy needs an immediate rescue plan as it currently offers low value in care. There is no better time to give it a life lengthening operation than in the current COVID-19 crisis.

Paediatricians are increasingly managing complex cases and rare diseases. They are no longer acting in their intended role as mere consultants. General Practitioners (GPs) find it challenging to manage such difficult cases and prefer not to lead their complex and multidisciplinary management. However, GPs continue to hold the main task of providing referral letters.

Our health system continues to ignore the important role of the general paediatrician as it is dominated by adult-centred policies. The limitation of the paediatricians’ referral letters angers the parents who are already overwhelmed by their children’s complex, exhausting and time-consuming needs. They become very stressed when the referral has lapsed as they are told to seek a lengthier referral from the GP. If met with more barriers, they become emotionally explosive, but they are the innocent party and the victims of a less compassionate system. The COVID-19 restrictions have added immense challenges to all aspects of medical care.  

Adult general medicine is different. GPs have a better capacity to manage it with quality. GPs have taken over the role of the nearly extinct general adult physician, as they are managing increasingly complex adult mental health problems and ageing chronic diseases. With the RACP rebranding as ‘Specialists Together’, the loss of general medicine is devastating holistic care.

GP referral letters are often poor in details as they may be written ineligibly or typed hurriedly. That can be the reason of rejection to offer specialised outpatient paediatric appointments. Whereas paediatricians' letters provide more clinical details, but ironically, they are given less value.

Poorly written referrals reflect badly on the profession as it is an essential form of communication. GPs are already busy with an unfairly large share of paperwork, so they cannot be blamed for their hurried referrals. Sleep deprived parents of children with complex diseases lack the time and energy to attend a medical practice for a piece of paper, let alone at times of COVID-19.

There is no perfect system, but improvements are due. The important role of the general paediatrician needs to be recognised as the leading team member in complex cases to improve the quality of care. The next step is to give their referral letters an increased lifespan, as chronic conditions usually last a lifetime. The current policy lacks convincing logic.

Dr Joseph Khouri, FRACP

Disclaimer: Please note that the opinions and comments expressed in this article reflect the opinions and positions of the author and do not reflect the opinions and positions of the RACP.

Reminder to register: Minister Hunt is in the room – join our virtual member Town Hall with the Hon Greg Hunt MP, Minister for Health

5pm to 6pm (AEDT), Monday, 19 October 2020, via Zoom

Don’t forget to register for next Monday’s virtual Town Hall meeting to discuss a range of topical health policy issues hosted by the RACP President, Professor John Wilson AM and President-Elect Dr Jacqueline Small. We’re also excited to welcome the Hon Greg Hunt MP, Minister for Health to join us to speak directly with you, our members.

Please register via Eventbrite and you will be sent the Zoom link ahead of the event. If you have a question for the Minister, please provide it during the registration process via Eventbrite. We can’t guarantee that we’ll have time to ask every question, but we hope to cover all the main themes.

Register now

2020 Physician Training Survey

The 2020 Physician Training Survey will open on Thursday, 22 October.

This is your chance to help strengthen RACP training programs and the workplace experiences in the settings in which you work and train. With the impacts of COVID-19 on training throughout this year, it’s more important than ever that we understand your experience.

The survey will open to trainees and educators across Australia and Aotearoa New Zealand and includes for the first time our Public Health and Occupational and Environmental Medicine trainees and educators. 

The survey is completely anonymous. Your participation helps us build robust data so we can make evidence-informed improvements to training. This includes support for your health and wellbeing. 

For information about the survey, including confidentiality and how you could win an iPad in the prize draw, please visit the Physician Training Survey page.

The Physician Training Survey has been approved by the Human Research Ethics Committee (HREC) – Concord Repatriation General Hospital of the Sydney Local Health District 2019/ETH12472.

If you have any concerns or complaints about the conduct of the research study, you may contact the Executive Officer of the Ethics Committee, at SLHD-concordethics@health.nsw.gov.au or on +61 2 9767 5622.

Trainee Research Awards

Support your trainees by watching them compete at the regional events over Zoom. The best presenters selected at each event are invited to present as part of the 2021 RACP Congress Program. See the Trainee Research Awards webpage for event details and to register.

RACP Indigenous Health Scholarships

The Paediatric & Child Health Division is proud to offer the 2021 Indigenous Australian and Māori Health Scholarship for paediatrics and child health as part of the RACP Indigenous Health Scholarship Program.

The Program aims to support those medical graduates and current trainees of the RACP who identify as Aboriginal, Torres Strait Islander or Māori on their chosen career path to becoming a physician. The scholarships provide a funded pathway through Basic, Advanced, Faculty or Chapter training in Australia and/or Aotearoa New Zealand.

Several other scholarships are available for 2021, including:

  • College Indigenous Australian and Māori Health Scholarship
  • Aboriginal and Torres Strait Islander Health Scholarship
  • NZ Aotearoa Māori Health Scholarship
  • Aotearoa New Zealand Pacific Islander Health Scholarship.

Applications close Monday, 30 November 2020.

Further details are available on the RACP Foundation webpage.

RACP Online Congress Series: Future COVID-19 Symposia

A special three-part COVID-19 Symposia series has been included in this year's Online Congress Series. 
  
2020 has been a challenging year for healthcare and our community. Over three sessions we will explore the complexities of the COVID-19 pandemic. Our focus will be on clinical aspects of COVID-19 and will involve clinicians who have been treating COVID-19 patients, experts in epidemiology, drug therapy, vaccines and research.

Register now for the second and third symposiums. Recording of symposium one will soon be made available via the Congress Online Learning Series

Symposium one: COVID-19 – Emerging patterns: in illness and in therapies

Our understanding of COVID-19 and its clinical course, especially post-acute, continues to develop. We know that many chemicals can kill viruses like COVID-19 in the lab. However, ensuring they are safe and effective for patient use is a completely different process. Before we can design any drug therapy trials, we need knowledge of drugs, pharmacology and a clinical understanding of the physiology of COVID-19.

Held on 15 October 2020, Chair, Dr Jacqueline Small was joined by our panel, Mr Karl Schurr, Professor Greg Dore, Professor Jennifer Martin and Dr Philip Britton.

Recording will shortly be available via the Congress Online Learning Series.

Symposium two: Vaccinations: What we know and where we're going

Thursday, 22 October 2020

5.30pm to 7pm (AEDT), 7.30pm to 9pm (NZDT)
  
Chaired by RACP President, Professor John Wilson AM, the panel will address emerging vaccine contenders, safety, strategies for the elderly population and implementation of population vaccination programs. 
 
Professor Terry Nolan will discuss the science of vaccines and describe the front runners in COVID-19 vaccine development. 

Professor Kristine Macartney will provide an overview of safety concerns, delivery methods and implementation strategy.

Professor Tony Cunningham will present a vaccine strategy for the elderly population and discuss therapeutic treatments for the very sick and elderly in the absence of a vaccine. He will look at efficacy results in people over 60 years of age and why their response is different to younger people. 

Associate Professor Margie Danchin will ask the difficult questions about vaccine program effectiveness. Which groups should be prioritised? Why mandatory vaccination should wait. How do we achieve high uptakes rates on an Australian, Aotearoa New Zealand and global scale?
 
There will be time for Q&A at the end of the presentations.

Register now

Symposium three: COVID-19: Redesigning healthcare systems

Thursday, 29 October 2020
5.30pm to 7pm (AEDT), 7.30pm to 9pm (NZDT)
  
Join the panel:

  • Professor Don Campbell, Medical Director of the Hospital Without Walls and Staying Well Program, Northern Health
  • Professor Graeme Maguire, Head of the General Internal Medicine unit at Western Health Melbourne
  • Dr Jade Tamatea, member of Te Rōpū Whakakaupapa Urutā, the National Māori Pandemic Group
  • Mr Ben Gauntlett, Disability Discrimination Commissioner for the Australian Human Rights Commission

Chair: Dr George Laking, RACP President Aotearoa New Zealand

To discuss:

  • community support from a Victorian perspective
  • innovative models of care for different patient groups such as inpatients, and those in ICU
  • Indigenous community led decisions, the Aotearoa New Zealand experience
  • equity and human rights especially for people with disabilities.

Register now

Online Supervisor Professional Development Program

Don’t miss your chance to register for Supervisor Professional Development Program (SPDP) 3, our last online course of the year. Running from Monday, 19 October to Monday, 23 November 2020, this work-based learning and assessment is a five-week, online facilitated course. The program covers important topic areas including the learning and assessment cycle and determining trainee performance and progression based on evidence of learning and achievement. This is a great opportunity for those who enjoy learning with peers through discussion and shared experiences and prefer time flexibility.

Note that supervisors are required to complete:

  • one SPDP workshop by the end of 2021 (an extension of 12 months)
  • all remaining workshops by the end of 2022.

Please visit the SPDP webpage for more information, or contact us to register with your full name and MIN. RACP Online Learning resources are free for members and count towards Continuing Professional Development requirements.

Research Projects and Research Supervision: online courses for trainees and supervisors

Each trainee is responsible for completing their own research project. Trainees can learn about conducting a research project via our Research Projects online course. It’s designed to support trainees with a detailed walk-through of the research process.

A trainee’s experience can be greatly enhanced by a supportive and informed supervisor. The Research Supervision online course helps supervisors who want an update on research project requirements and the research process in general.

We understand you are busy and on-the-go, and that’s why our online courses are designed to enable you to dip in and out, or just do the parts that are relevant to you.

RACP Online Learning Resources are free for members and count towards Continuing Professional Development (CPD) requirements.

New clinical ethics resources webpage

The RACP Ethics Committee is pleased to advise members of a new RACP clinical ethics resources webpage. Curated by the RACP Clinical Ethics Working Party, the new webpage provides a set of clinical ethics resources for Fellows and trainees.

The clinical ethics resources webpage will assist with reflection on the role clinical ethics plays in practice and healthcare settings. The new webpage includes clinical ethics information for:

  • professional development
  • trainee education
  • clinical ethics services
  • academic studies
  • research and fellowships, and
  • other clinical ethics related resources.

RACP Fellows and trainees are encouraged to review the new webpage and consider clinical ethics as part of their education and continued professional development. The site provides information about clinical ethics support services, and access to clinical ethics information.

The Genes That Make Us

The Genes That Make Us

Genes – we all have them and we’re all affected by them, often in unknown ways.

Directly inherited or modified by environment, genes control or influence almost every aspect of our lives. Genetic screening is already available for major diseases and will become an increasingly prevalent medical tool. Genetic research is having a major impact in areas as diverse as cancer, neurodegenerative disorders and a host of syndromes. New therapies promise the prospect of modifying our genome in ways that could change what it means to be human.

Navigating this world of heartbreaking uncertainties, tantalising possibilities, and thorny questions of morality is Professor Edwin Kirk. In The Genes That Make Us, he tells the story of the genetic revolution, of the people behind it and the people whose lives are most affected by it, with humour, insight and great humanity.

Professor Kirk is a clinical geneticist at Sydney Children’s Hospital. He also practices in genetic pathology at the NSW Health Pathology Randwick Genomics laboratory. His areas of research include cardiac genetics, metabolic diseases, and intellectual disability, as well as reproductive carrier screening (he is co-lead of the $20m Mackenzie’s Mission carrier screening project).

New Medical Specialist Access Framework case studies

Two new Medical Specialist Access Framework case studies have been released – ‘ANTAC and the Ngangkaṟi Healers of Central Australia’ and ‘Regional specialist services in the Kimberley’. The Medical Specialist Access Framework is a guide for health sector stakeholders to promote and support equitable access to specialist care for Aboriginal and Torres Strait Islander people. The case studies demonstrate successful approaches to increasing Aboriginal and Torres Strait Islander access to specialist care across Australia in various health settings.

RACP members are encouraged to read the Medical Specialist Access Frameworkthe case studies and use the Guide for Physicians to implement these tools in your workplace and professional practice. Please share the Medical Specialist Access Framework and case studies with your networks.

Pomegranate Health podcast Ep63: the WHO’s biggest test

During the COVID-19 crisis there has been some criticism of the World Health Organization (WHO) as to whether it declared a pandemic soon enough or covered up for China’s failings.

But few commentators have explained the role and responsibilities the WHO shares with its member states in dealing with a pandemic. A prototype of the International Health Regulations (IHR) was conceived during the cholera epidemics of the mid 1800s, and the most current version of the IHR was formalised in 2005 in response to SARS. Associate Professor Adam Kamradt-Scott has documented the political and social factors that have accompanied the implementation of the IHR.

In this podcast we consider how the unprecedented scale of the current pandemic and the mixed response from member states has challenged the viability of the WHO.

Guest

  • Associate Professor Adam Kamradt-Scott (University of Sydney, United States Studies Centre)

Fellows of the RACP can claim CPD credits via MyCPD for listening to this episode and reading the resources at the website. Subscribe to Pomegranate Health in Apple PodcastsSpotify, any Android podcasting app or our email alerts list.

Launch of Cancer Australia’s Children’s Cancer website and new support resource for children affected by cancer

Cancer Australia has released the Children’s Cancer website, an online hub to support and inform children and families and meet the challenge of a diagnosis and lived experience of children’s cancer.

The Children’s Cancer website provides current, evidence-based information, resources and data about children’s cancer for children, parents and families, health professionals, educators and the community in a user-friendly and accessible format. The website includes information on types of cancer that affect children, living with cancer, life after cancer, finding support, clinical trials, information for health professionals, statistics and information about children with cancer and COVID-19.

Cancer Australia has also released a new video, Cancer Sucks, for children with cancer. The video, developed with RedKite, underscores the reaffirming message that no matter what type of day a child with cancer is experiencing, their family, friends, healthcare team and teacher are there to support them.

For more information, visit childrenscancer.canceraustralia.gov.au.

Journal of Paediatrics and Child Health September 2020 is available online

The Journal of Paediatrics and Child Health, Volume 56, Issue 9, September 2020 is now available on the JPC Wiley page.

An early view is also available of future articles.

Upcoming RACP Victorian Regional Committee webinars

Climate change: What can we do?

Saturday, 24 October, 10am to 12.30pm AEDT (12pm to 2.30pm NZDT), online.

This webinar will discuss topics such as zoonoses and pandemics, as well as bushfires and emergency medicine. 

Register now

Investigations in medicine

Saturday, 7 November, 9am to 5pm AEDT (11am to 7pm NZDT), online. 

This webinar will cover: 

  • ECG and electrophysiology
  • cardiac catheters
  • echocardiography
  • endocrinology
  • haematology
  • gastroenterology
  • respiratory
  • rheumatology
  • allergy
  • neurology
  • blood films. 

Register now

An invitation to engage with the Obesity Collective  

In 2019, the College joined the Obesity Collective, a platform for individuals and organisations across the community to take on the obesity challenge together, with empathy and from a whole-of-society perspective. We invite members to explore the key activities of the Collective: its system activity mapping that sets out current obesity-related actions and opportunities for action, the frequently updated Obesity Evidence Hub, the advocacy of the peer-led Weight Issues Network and the ongoing campaign to shift away from shame and blame towards a better understanding of the obesity challenge.  

The Obesity Collective has recently issued a statement on the Healthy at Every Size® (HAES) movement. The Collective supports most of the principles of HAES and believes it is possible and positive for people to take steps to improve their health at any size, that equitable access to health care should be available to people of all sizes and that there is an urgent need to reduce societal weight bias and stigma to prevent harm to physical health, mental health and wellbeing. The Collective also acknowledges that obesity is a serious public health issue and advocates for respecting the diversity of people’s wishes for support in managing their health and weight. Read the Collective’s full statement.

Notable to early career professionals, the Emerging Leaders of the Collective are gearing up for their next event, ‘Systems thinking for healthier environments’, on Tuesday, 24 November 2020. The Emerging Leaders recently hosted their first virtual event, 'Obesity as a systems challenge'; presentations from Ms Jane Martin, Professor Stephen Simpson, Associate Professor Michael Talbot and Ms Clare Mullen are available for viewing.   

Find out more about the Collective

End of Life Law for Clinicians: Supporting end-of-life and palliative care practice 

The End of Life Law for Clinicians (ELLC) national training program has been extended to June 2023. ELLC is a free training program funded by the Department of Health that delivers education to clinicians about the law at end-of-life. The program for clinicians and medical students focuses on the law relating to end-of-life decision-making, including the law about decisions that happen in the last days and months of life, as well as earlier Advance Care Planning (ACP). The next phase of ELLC will deliver updated modules tailored to medical practitioners, medical students, nurses and allied health professionals. New content will be produced for clinicians working with specific populations at the end of life. These will focus on care for older people, people living with disability, Aboriginal and Torres Strait Islander people, people who identify as LGBTIQA+, and people from culturally and linguistically diverse backgrounds. Workshops and webinars will commence in 2021. 

Further information about ELLC can be found on CareSearch Blog. You can register for the ELLC training modules or contact endoflifelaw@qut.edu.au to join the ELLC mailing list. 

In a related development, the recently updated Factsheet for clinicians – Informed consent in health care from the Australian Commission on Safety and Quality in Health Care provides information for clinicians on the key principles for informed consent, how to obtain informed consent, principles for assessing legal capacity and legal obligations. Members might also be interested in a recent article in the Internal Medicine Journal that sets out key recommendations for policy and practice in the system-wide implementation of ACP, to enable a more ethical, coordinated and person-centred response in the COVID-19 context. 

End of year funding available for women’s leadership development

Women & Leadership Australia (WLA) has residual funding available to support the development of female leaders across Australia’s healthcare sector.

The initiative is providing women with grants of between $1,000 and $5,000 to enable participation in one of three programs that cover such things as elements of a successful team, communication, presence and influence, driving performance, problem solving and decision making, and progressing diversity and inclusion.

The scholarship funding is provided with the specific intent of providing powerful and effective development opportunities for healthcare sector women.

The funding needs to be allocated by the end of 2020.

Find out more and register your interest by completing the Expression of Interest form on WLA’s website by Friday, 4 December 2020.

Newly released guidance for the management of early breast cancer

Cancer Australia has released a new evidence-based resource for health professionals to guide the management of patients with early breast cancer in Australia. Guidance for the management of early breast cancer comprises approximately 200 recommendations and practice points underpinned by the current evidence-base to assist health professionals and patients engage in shared decision-making and support the delivery of best practice patient-centred care for people with early breast cancer.

Medicinal cannabis: new materials from the Therapeutic Goods Administration (TGA) on access pathways

The TGA has developed new communication materials to help consumers and health professionals understand access pathways for medicinal cannabis in Australia including videos and printable infographics. This new material is available from the TGA Medicinal Cannabis webpage.

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.

Go to the events list at any time to see what events are coming up.

Career opportunities

Please see the College website to view all medical positions vacant.

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'.

Summer specials at commercial prices

Get ready for summer with this month’s specials from The Good Guys Commercial. Find household essentials like reverse-cycle air conditioners, washing machines and vacuums. Upgrade your TV and make life easier with commercial prices on kitchen appliances.

Available online 24/7, The Good Guys Commercial will deliver your products to your door and even arrange installation. Register for your free account through your benefits portal and talk with the dedicated Member Advantage commercial team today. 

Register for your account online

Terms and conditions apply.

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