Rhaïa December 2015

Editorial: Damien Daniel

From the President: Steve de Graaff

Clinical Articles, Course Reviews and Reflections
Pain in spinal cord injuries – does it need a rethink?  Vernon Hill
The early history of rehabilitation medicine in Queensland – Tim Geraghty
My  journey into rehabilitation research (and dancing) – Peter New
St Vincent’s Intensive Exam Preparation Course in Rehabilitation Medicine – Steven Faux
Building an Enabling Society – Will Taylor, 2015 AFRM/NZRA Combined Rehabilitation Meeting Organising Committee Chair
Rehabilitation specialists lead the call for a New Zealand strategy – Cynthia Bennett, AFRM NZ Branch Committee Chair
Rehabilitation in Oceania – Andrew Cole
Arthur Mills Oration - Dr Ranjana Srivastava

RMSANZ -  Alex Ganora

Reports
Faculty Policy & Advocacy Committee (FPAC) – Andrew Cole
Faculty Education Committee (FEC) - Tim Geraghty
Trainees’ Committee - Emma-Leigh Synnott
CPD - Ruth Marshall
SA Branch - Peter Anastassiadis
NSW/ACT Branch - Steven Faux
NeuroSIG - Fary Khan
Paediatric Rehabilitation SIG - Katherine Langdon
MIND SIG - Barbara Hannon

Conferences 2016

Editorial: Damien Daniel

All too quickly another year begins to end. 2015 has brought with it a number of changes and 2016 promises (or threatens, depending on your viewpoint) more. But change, as discussed in this year’s earlier edition of Rhaïa is a natural, in fact essential, part of evolution. Indeed, Rhaïa itself has undergone significant changes recently, including the evolution to a solely electronic medium and a reduction in the number of editions per annum. Despite the reduction in editions, each separate one seems busier than the last, propelled by the momentum of activity that is taking place amongst Fellows, trainees and the Australian health system. 

For me this has been a momentous year, it being just over a year since I was awarded my Fellowship. I remember thinking how far I’d come and how much I’d learned, only to learn in the next 12 months how little I really knew, as I negotiated how to not only be a competent doctor but also a good Fellow . My graduation ceremony was held on 24 May in Cairns, at the commencement of this year’s RACP Congress. At that ceremony the key note speech – the Arthur Mills Oration – was given by Dr Ranjana Srivastava – columnist, author, educator, oncologist, mother of three, Fulbright scholar, and much more. Yet what impressed that day were not her achievements or qualifications, but her heartfelt message on what it means to be a doctor. Her message not only struck me deeply on the day of my graduation, but has remained with me, and guided me, as I have attempted to chart the difficult course from rehabilitation trainee to Fellow. I asked her if we could reproduce a slightly edited version of her words in Rhaïa and she kindly agreed. I think her words will be just as potent for both trainees and Fellows, and I hope you get as much from them as I did.  

Queensland, it seems, is not only “beautiful one day, perfect the next”, nor just a great place to live during State of Origin rugby league each year. In terms of rehabilitation medicine the state continues a rapid advancement and growth. Very soon the Queensland Statewide Rehabilitation Network is being launched to bring together interested individuals from all relevant medical specialties and therapies into a forum of sharing and understanding to enhance the state’s capacity to provide world class rehabilitation. Timely then, is Professor Tim Geraghty’s exploration of the history of rehabilitation medicine in Queensland.  You will find an abridged version with links to the full version later in this edition. Though rehabilitation had a smaller and slower start in Queensland compared to other states, they are proving to be quick learners, just like in rugby league. With the commencement of the National Disability Insurance Scheme there in July 2016 the growth looks set to continue. 

Another new and important development for rehabilitation medicine in Australia and New Zealand has been the establishment of the Rehabilitation Medicine Society of Australia and New Zealand (RMSANZ). The inaugural President, Alex Ganora, provides an informative update of RMSANZ activities, and outlines plans for 2016 in this edition. All members and potential members are encouraged to keep abreast of the society’s activities. With AFRM trainees currently receiving free membership there really is no excuse for anything but full membership. The RMSANZ joins the list of AFRM groups and committees comprised of enthusiastic and hardworking members that report their activities and plans to Rhaïa as a vital part of each edition. 

In the final edition of Rhaïa for 2015 we are also discussing research – our way of looking at both the past and the future. We have an article outlining Dr Peter New’s fascinating journey into the research field, one that possibly follows its own unique Bayesian statistical interpretation! Either way, it certainly is an inspiring and informative journey for any AFRM members out there interested in turning their clinical curiosities into published works. Dr Vernon Hill, the “never-quite-retired spinal injuries consultant” from Queensland then presents us with just such a clinical conundrum: “Do spinal cord injury patients experience more neuropathic pain now than in the past?” His initial research seems to suggest so. Dr Hill goes on to ask, “If so, why?” and then presents his argument for an interesting and controversial answer – is it our modern management techniques? It is a fascinating and essential question that we must never cease to ask ourselves. Despite all the changes and advancements in modern medicine, at our very heart we all seek to adhere to the most basic essence of the Hippocratic Oath – “First do no harm.”   

From the President: Steve de Graaff

2015 has been a very busy year for the Faculty and its Council and Committees. A full list of the Council Membership can be found on the College website.

2015 AFRM/NZRA Combined Scientific Meeting

More than 200 of our Faculty colleagues gathered in Wellington for the AFRM/NZRA Combined Rehabilitation Meeting – Building an Enabling Society, taking the opportunity to share amongst our own community the latest developments in our field and the significant gains in engaging broader society on the improvements to quality-of-life rehabilitation can provide. It was a highly productive, rewarding and enjoyable experience.

The meeting opened with Dr Cynthia Bennett launching the Call for a New Zealand Rehabilitation Strategy. As the culmination of years of engagement across a range of health areas, the Call recognises the unique New Zealand rehabilitation landscape and current provisions while identifying opportunities for strengthening and increasing collaboration when providing rehabilitation services. The Call presents the rationale for a New Zealand rehabilitation strategy as a tool to ensure equitable access to rehabilitation services and improve outcomes for patients and their whānau/families, and encourages continued development work in this area to secure a national rehabilitation strategy.

Professor Derick Wade from Oxford gave this year’s Burniston Oration.  In this inspiring presentation, Professor Wade challenged us to position ourselves strategically in all areas of health and disability care to change the culture of healthcare and decrease societal disability.

In what was perhaps one of the most captivating sessions of the meeting, Professor Richie Poulton discussed the Life Study undertaken in Dunedin and demonstrated the impact this extraordinary 45 year study has had on health policy decisions across the globe. The Life Study has greatly influenced the holistic care of patients and has the potential to shape the care programs we develop for our patients for years to come.

Another outstanding session was ‘Rehabilitation in the Context of Natural Disasters’ presented by Professor Fary Khan. This is an area we are becoming more involved in as we recognise the need to ensure critical rehabilitation needs are met in communities recovering from natural disasters. We need to seize the opportunity presented by rebuilding after a natural disaster to advocate for urban design and planning controls to provide improved amenity for people with a disability.

I would like to thank the Organising Committee and College staff who contributed to the development of this event and worked tirelessly to create an enjoyable and rewarding learning opportunity for delegates. I would also like to thank all Fellows and trainees who attended the AFRM/NZRA Combined Rehabilitation Meeting and played a vital role in its success.

Achievements of Council and President 2014 – 2015 

The Rehabilitation Trainee of the Future Report (full report)

Compiled by Dr Shari Parker, the report will be released shortly for Fellow and trainee feedback by late February 2016. The AFRM Council are mapping out next steps which may involve a series of consultations, meetings and workshops which will be held with the aim of developing recommendations to be voted on at the 2016 Annual Members’ Meeting (AMM).  

Horizon Document 2030

Looking at the trainee and Fellow educational and professional requirements in the future continues to be a significant factor in strategic planning.

Call for a New Zealand Rehabilitation Strategy

See further details on this in the Call for a New Zealand Rehablilitation Strategy Report.

NDIS

Continued liaison with Mary Hawkins and NDIA staff has led to increased rehabilitation physician involvement with expert decisions on resource/care provisions and also participation in pilot projects with NDIS participation in ABI and Spinal Rehabilitation discharge planning. Feedback has also been given to the RACP NDIS Working Group.

RMSANZ

Support from the Society allows Fellows and trainees to develop relationships beyond the College and meet the unique needs of rehabilitation physicians. The Faculty and Society are working together to develop a Model of Collaboration. 

College Board

Remaining on the College Board ensures a strong Faculty voice within the College and allows strengthening of our relationships with the Faculties of Public Health Medicine and Environmental and Occupational Medicine.

Annual Trainee Meeting (ATM)

An extremely successful meeting was held on the Gold Coast this year with the next ATM confirmed for Melbourne on 5 and 6 March 2016.  Future ATMs are a Faculty priority.

AROC

Dr Nathan Johns is now the Faculty Lead and Prof John Olver, the Clinical Director of AROC.
Regional Visits - I have attended most Branch AMMs. This provided the opportunity to give updates to Fellows and trainees and to receive feedback and considered advice. I also had the opportunity to be the keynote speaker at the Ceylon College of Physicians 48th Annual Academic Sessions in Colombo, Sri Lanka - ‘Towards Team Care’.

College Committees/Working Groups

In my role as President of the AFRM, I have had the opportunity to be part of the following College Committees/Groups beyond my Faculty role:

  1. College Board
  2. Fellowship Committee
  3. NDIS Working Group (also Kate Langdon, Chair of Paediatric Rehab Committee and Elizabeth Thompson)
  4.  International Strategy Working Group (Chair)
  5. Educational Governance Implementation Working Group
  6. Consumer Engagement Project
  7. Review of IMJ
  8. Election Working Group
  9. Model of Collaboration Working Group

I also represented RACP at the RACS and Lancet Commission on Global Surgery Global Health Symposium on October 26 and 27, 2016 in Melbourne.

College Council

Dr Jenny Mann is the AFRM representative on the newly formed College Council.

Finally Thanks

I would like to express my appreciation to all Fellows and trainees who give up their precious time voluntarily to participate in committees, workshops, supervision and assessments, working groups and projects. Without this dedication, we would not function as a Faculty let alone have the ability to share time together professionally, socially and personally. 

To the members of Faculty Council, I am fortunate to have such a great team to work with. I always look forward to our meetings as they make things happen.

In particular I wish to thank Andrew Cole, Tim Geraghty and Chris Poulos for their support and advice as part of the Faculty Council Executive. 

Thank you to all the College Faculty Team: Dominique Holt (Faculties Manager), Phillipa Warnes (Executive Officer of AFRM) and Annette Barker (Faculties Administration Officer). You work tirelessly for the Faculty and your support is greatly appreciated.

Clinical Articles, Course Reviews and Reflections

Pain in spinal cord injuries – does it need a rethink?  Vernon Hill

The pathways by which pain is transmitted and registers in the brain are gradually being unravelled and better understood. For many years we have had maps of the brain showing which areas are responsible for interpreting pain, the more sensitive being those that take up the largest area. We also now know that there is a significant amount of plasticity in the brain. Being able to demonstrate, non-invasively, which areas of the brain are being activated using new MRI techniques should enable us to better understand the pathways traversed by nociceptive and neuropathic pain. I believe that we have, in our university research centres, an opportunity to do just such a study and complete tetraplegics are an ideal group to examine and perhaps help resolve the reasons for the increased incidence of neuropathic pain. 

Pain in spinally injured people has been teased out into several different categories. In a revision of earlier definitions, by Siddall et al in the April 2014 edition of the journal Spinal Cord, the following categories were listed:

  1. Musculoskeletal pain, in areas above the lesion
  2. Visceral (related to visceral pathology)
  3. Pain related to pressure problems or headaches etc
  4. At level spinal cord injury (neuropathic pain related to nerve root damage and extending to three dermatomes below the level of the lesion)
  5. Below the level of the spinal cord injury
  6. Other neuropathic pain (refers to pain not related to SCI such as post-herpetic neuralgia)
  7. Other – this is pain without any identifiable noxious stimulus, such as Complex Regional Pain Syndrome, type 1
  8. ‘Unknown’ – refers to pain of unknown aetiology.

This classification system needs simplification. In addition it seems to skate over the possibility that psychological stresses can be interpreted as pain. ISCOC/WHO picked up on this in their December 2014 publication, saying “Experiences of pain are different for each individual and therefore considerations needs to be given to biochemical, cultural and psychological factors”. The many different variables make concise dissection of the different components causing pain in incomplete lesions complex. Complete lesions however, have only two possible pathways, which might account for pain below the lesion, and this might be a good place to start:

  1. Visceral via the Autonomic Nervous System
  2. Pain recorded in the brain caused by PTS or something similar.

There has been a significant increase in the overall incidence of pain following spinal cord injury. The increase seems to have gone from 8%-10% to 70%-80%. In my experience in Queensland, this dramatic increase seems to have happened over the past twenty years. To test this hypothesis I went through the hospital records of well over one hundred traumatic tetraplegic injuries, defined as being complete at the time of discharge. The Queensland experience is interesting as conservative management continued under Dr Bill Davies for longer than in most other spinal injury units in Australia and New Zealand, and the swing to surgery was more gradual. Three groups were selected from different five-year periods: Group 1. 1985-1989; Group 2. 1990-1994; Group 3. 2006-2010. These groups were selected because they represent three specific periods of changes in management.

Of the 28 people in Group 1, 25 were managed in cervical traction, on Egerton tilting and turning beds and three underwent surgical fusion after they were noted to be unstable at six weeks post injury. Of the 32 people in Group 2, 17 were operated on and 15 treated conservatively in traction. There were 42 people classified as ASIA A in Group 3. Three were treated conservatively in a cervical collar and the remainder were surgically reduced and stabilised. 

To get an indication of the incidence of neuropathic pain, the incidence of usage of Gabapentin was used.  This drug only became available to spinal patients in Queensland after 1996. This meant that none of the people included in Groups 1 and 2 would have been trialled on Gabapentin when they were first discharged. Because of the severe nature of their injury, most complete tetraplegic patients continue to be reviewed by the Spinal Injury Unit annually. It is reasonable to presume that pain would have been discussed on these visits to their clinicians and that Gabapentin would have been prescribed if appropriate. Between 1996 and 2011 Gabapentin was only available through State Hospital Pharmacies and it was therefore possible to establish those who were getting Gabapentin by checking the pharmacy records. The results were interesting: 50% were on Gabapentin in Group 3, and only 1 person each in Groups 1 and 2.

Some possible reasons, which might help account for these differences:

  1. People in Groups 1 and 2 may not have been offered the option of Gabapentin, or perhaps were coping with any pain they may have had with the medication they were initially prescribed.
  2. Some people from Groups 1 and 2 may have been given a trial on Gabapentin, but had rejected using it, either because of the side effects or because it did not help relieve their symptoms (a recent article on Gabapentin suggested that it was effective in 50% of cases only).
  3. Some people may have been taking Pregabalin as this was thought to be more beneficial. At the time of the survey this was not yet available on the PBS.
  4. Most people who have been in a wheelchair for twenty years will have in place a well-established pattern of life and tend to be reluctant to consider alternative therapies.
  5. Perhaps Groups 1 and 2 had less neuropathic pain? 

Putting option 5 aside, how to explain the apparent increase in neuropathic pain:

  1. Younger patients do not accept that some pain has to be tolerated, expecting to be given a drug to block out the pain.
  2. Perhaps pain has always been a problem, but because we had so few drugs which helped, people learned to live with their pain. If this were really the case, one might expect the subject of pain to have featured more in the old Spinal Cord journals and as ‘hot topics’ at annual conferences. It did not.
  3. Research and the potential for cure has become almost an obsession. The recent spinal cord meeting in Auckland highlighted a number of projects covered by keynote speakers, which seemed to suggest that a cure was in sight. Too many patients are taking off for Project Walk and stem cell therapy instead of getting on with their lives. The misinformation being published is mischievous and there is usually a vested interest involved. The frustration of patients who mistakenly feel they are being denied the benefits of these treatments can be psychologically very damaging. 
  4. Postsurgical neuropathic pain is now noted in 50%-80% of post-amputation, so why shouldn’t it be a factor in tetraplegia? 

If surgical fixation, per se, is not the key factor in this pain saga, perhaps it is time to look at the overall changes that have occurred in early management? Groups 1 and 2 were admitted by the Rehabilitation Consultant who looked after them from then on, rather than being operated on and admitted to ICU before coming to the SIU. There are a number of advantages to this: the information given to the patient and their family all came from the same source; the ward was full of people with similar problems; the well-recognised complications associated with the multisystem disruptions of a spinal cord injury were minimised; regular assessments of function and sensation were discussed with the patient and recorded; patients who were further ahead with their treatment, would often come and talk to the acute admissions, often the people who acute patients found it easiest to talk to; the return of muscle tone and spasm was discussed and explained before it occurred, which helped prevent it being misinterpreted; and the families were supported by the same social worker and future goals were discussed.

Conclusions:

  1. Neuropathic Pain in SCI patients is now more common.
  2. The cause is most likely due to the changes in the patterns of management.
  3. Surgery may be a factor, due to surgical complications, or postsurgical neuropathic pain.
  4. We should not make people worse.

Suggestions:

  1.  Study, using the new PET/MRI technology, the tetraplegics in my study.
  2. All new acute SCI patients should be offered the viable alternative of conservative management.
  3. All patients need to be initially admitted under the Spinal Rehabilitation Consultant once more.
  4. Paralysis, not the fracture, is the major problem.
  5. Remember, “Young surgeons fuse, older surgeons re-fuse. Old surgeons refuse to fuse!”

The early history of rehabilitation medicine in Queensland – Tim Geraghty

Introduction

For a number of years, I have been trying to get around to putting on paper the early history of the specialty of rehabilitation medicine and the work of Queensland Fellows of the AFRM (and ACRM before it) in developing rehabilitation services in Queensland. This was initially prompted because while there was some information on the history of rehabilitation medicine for most other states, there was a distinct lack of information regarding Queensland. The document that I ended up with was more detailed than I originally envisaged and what follows is a shorter summary – the more detailed version can be found on the AFRM website.

Please note that the following information has been gleaned and collated from a wide variety of disparate sources including personal communications with Fellows. I have done my best to ensure that it is accurate but I apologise in advance for any errors or omissions. I am happy to receive and incorporate additional information or make corrections from any sources. This document covers the period up to ~ 2005.

Rehabilitation medicine as a specialty was slower to develop in Queensland than in some other states although rehabilitation and related services were being developed as early as the late 1950s.

Dr Paul Hopkins returned to Australia in 1964 having obtained his FRCS in the UK in 1963, however illness changed his career direction significantly. His first rehabilitation appointment was as Rehabilitation Medical Officer at Rosemount Repatriation Rehabilitation Hospital in Brisbane. The following year he commenced at the Repatriation Artificial Limb and Appliance Centre where he continued until 1969 when he was appointed Medical Director, Kingsholme, the Commonwealth Rehabilitation Service Centre at Taringa.

Male and female head injury wards were first being developed in the late '60s and early '70s as part of chronic and geriatric services at Princess Alexandra Hospital (PAH). Geriatricians Dr Keith Hirschfield and Dr Glenda Powell were prominent in the early days of geriatric and brain injury rehabilitation services at PAH.  

Dr Frank Johnson returned from training in rheumatology and rehabilitation in the UK and the USA in 1969 and established a Rheumatology and Rehabilitation Unit at Royal Brisbane Hospital (RBH).  In 1977, he established the Queensland group of the Australian Association of Physical and Rehabilitation Medicine (AAPM&RM). He later set up the Rehabilitation Units at both the public hospital at the Gold Coast and at Allamanda Private Hospital,also Gold Coast. 

Organised care for people with spinal cord injuries (SCI) first commenced at PAH around 1962 but the Spinal Injuries Unit as it exists today started with the appointment of Dr Bill Davies as Director in 1972. Dr Vernon Hill first worked on the Spinal Ward at PAH in 1965 as a physiotherapist and after completing his medical degree returned in 1975 as a Senior Medical Officer.  

Neurosurgeon, Dr Leigh Atkinson returned to Brisbane in 1970 from Edinburgh where he had been involved in the rehabilitation of spinal injury. He worked at the Cerebral Palsy Unit in New Farm in Brisbane and weekly multidisciplinary meetings were commenced. In 1970 he co-founded the multi-disciplinary pain service at the PAH. Other prominent surgeons involved in chronic pain management and rehabilitation in Brisbane were Dr Bill Ryan (orthopaedic surgery) and Dr Ivan Yaschich (neurosurgery). 

At the time of the incorporation of the Australian College of Rehabilitation Medicine in August 1979 there were eight Founder Fellows from Queensland including Drs Leigh Atkinson, Bill Davies, Keith Hirschfield, Paul Hopkins and Frank Johnson. Dr Ivan Yaksich was also a Founding Fellow based in Darwin at the time.

In ~ 1980, Glenda Powell became Director of the new Geriatric and Rehabilitation Unit at Ipswich Hospital and also subsequently of the Rehabilitation Unit at the Repatriation General Hospital Greenslopes. She became a Fellow of the AFRM in 1988. In 1989, the Head Injury Unit was transferred to the new purpose-built Geriatric and Rehabilitation Unit (GARU) at PAH. Dr Chris Davis was appointed Director at GARU at The Prince Charles Hospital in 1992.

In 1992, Paul Hopkins was appointed full time Director of Rehabilitation at Princess Alexandra Hospital with responsibilities as Director of the Brain Injury Rehabilitation Unit (BIRU) and for amputee services in Queensland. Dr Ron Hazelton was appointed Director of BIRU in 1998 on Dr Hopkins’ retirement. Others notable in rehabilitation services throughout the ‘80s and ‘90s, which were or later became Fellows of the Faculty include: John Wicks (cardiology and cardiac rehabilitation), Dr Sue Urquhart (spinal cord injury), Kathryn Pugh (spinal cord and brain injury rehabilitation) and Kong Goh (general rehabilitation).

With regard to AFRM Queensland Branch matters, Dr Paul Hopkins was either Chair or Secretary of the Queensland State Branch from 1981-1995. Dr Vernon Hill took over as Chair in the mid 1990s and Dr Ron Hazelton was Secretary for many years in the late ‘90s and early 2000s. Dr Tim Geraghty returned to Brisbane to take over from Vernon Hill as Director of the SIU in 1999 after completing the AFRM training program in Sydney. He became keen to reinvigorate the Queensland Branch and took over as Branch Chair in early 2000. 

From a Paediatric Rehabilitation Medicine perspective, Dr Lynne McKinlay took over the Statewide Paediatric Rehabilitation Service (SPRS) and received her Fellowship in Paediatric Rehabilitation Medicine in 2001. Dr Priya Edwards also received her Fellowship in 2001 and commenced at the SPRS.

Dr Wilbur Chan was the first advanced trainee to complete the full adult rehabilitation medicine training program in Queensland in 1999. Dr Saul Geffen also returned to Queensland from training in Sydney in 2001 and established the first new private practice in rehabilitation medicine in Queensland for many years.

In 2000, Queensland had three registrars undertaking training, one paediatric rehabilitation medicine trainee and two adult rehabilitation medicine trainees. Only the paediatric rehabilitation service, the SIU and the BIRU were accredited for training in rehabilitation medicine. 

With the help of Dr Jill Collins, the first new rehabilitation medicine training position in Queensland was established at St Vincent’s Hospital, Robina, on the Gold Coast and commenced in early 2002. This was a very important development as it was the first training position with a general rehabilitation medicine case mix and was vital to the development of the training program in Queensland. 

By 2002, the rehabilitation medicine services at Townsville Hospital had begun to expand under the leadership of Dr Paul Goldstraw. 

Two new registrar training positions (general rehabilitation) commenced in 2003 – at The Prince Charles Hospital (under Dr Wilbur Chan) and at Mt Olivet Private Hospital (Dr Saul Geffen), bringing the total to five accredited training positions in Queensland. The first group of trainees in Queensland included Drs David Douglas, Kathryn Pugh, Mark Tadros, Cassandra McLennan and Michael Johnson. In 2003, Dr David Douglas became the first trainee in Queensland to successfully complete training in Queensland since the establishment of the new Queensland Branch training program.  

There was slow but steady growth in the public and private rehabilitation medicine sectors during this period including: Kong Goh taking over at Robina, John Wicks at Allamanda Private Hospital and Martin Dunlop in Cairns Base Hospital – all in 2003; David Douglas at Ipswich Hospital, 2004 and Gerrit Fialla at Caloundra Hospital and Peninsula Private Hospital in 2005. 

While rehabilitation medicine services were slower to develop in Queensland, they have taken a very encouraging trajectory over the past 10 to 15 years. 

At the time of preparation of this document, there were 68 active Fellows of the AFRM in Queensland (compared to ~20 in 1999) and 38 trainees (compared to 2).

Active Fellows QLD

Active Trainees in QLD


My  journey into rehabilitation research (and dancing) – Peter New

I like to tell work colleagues who comment on my frequent attendance at conferences that the only reason why I do research is so I have an excuse to travel to conferences. And the only reason why I attend conferences is so that I can dance at the conference dinner! But I wasn’t always ‘into research’.

My journey into rehabilitation research wasn’t planned or intentional, at least not initially. At university we had a series of lectures in 2nd year on biostatistics, but they were presented in a way that made them seem irrelevant at the time, so I went to the pub instead.

Fast forward over a decade, and after a 12-month break from my registrar training backpacking in ‘The Americas’, I was flying back to Australia and contemplating the start of my registrar rotation in the Spinal Rehabilitation Unit at the Austin Hospital. From somewhere in the stratosphere came the idea (must have been the extra radiation or the end of a long-term relationship) that maybe because spinal patients are complex and interesting it could be an opportunity to do some research. With trepidation and excitement I started work in the spinal unit and once settled in I discussed my idea with the consultants. Spurred on by a fascination with myofascial pain and the use of ‘dry needling’ an opportunity emerged to undertake a small and simple research project documenting the types of pain and treatments used in SCI rehab patients.

Unfortunately, back then I suffered from ‘mouth work before brain work’ syndrome in oral exams, and failed the Fellowship Exam several times. As a result I kept applying for different rotations. Fortuitously, the last registrar rotation I was to do was in the Spinal Rehab Unit at Caulfield Hospital.

This unit, for historical reasons, focussed on non-traumatic SCI, to which I had no previous exposure. I asked the consultant for suggestions of relevant journal articles, because I couldn’t find any information in textbooks and in my own literature search, but was told ‘there are none’. At this same time I’d just had the first paper on pain in SCI published, so I decided that this was an opportunity to address the shortcomings in non-traumatic SCI research. Back then, about a third of patients were admitted with severe sacral pressure ulcers. I decided to focus the research on pressure ulcers, but at the same time explore ‘other things’. This resulted in my ‘trilogy in four parts’ – papers on demographics characteristics, functional outcomes, impact of pressure ulcers, and influence of age and gender. 

Serendipity would have it that two months after I started in the Spinal Rehab Unit at Caulfield I passed my final Fellowship Exam and a fortnight prior to that the consultant resigned. I was subsequently appointed to the position as Head of Unit and was determined to continue exploring the niche opportunity to address the dearth of research in non-traumatic SCI.

During the course of doing the analysis for the ‘trilogy in four parts’ I had help with statistics from a biostatistician at Monash University (who I was put in touch with by the lecturer who gave the 2nd year biostatistics talks that I stopped attending!). The biostatistician encouraged me to get some formal statistics training so that I could do the simple stats myself. I enrolled in a part-time Grad Dip in Clinical Epidemiology, which I subsequently rolled over to a Masters.

Peter NewNowadays, it is fair to say, that I am very much ‘hooked on research’. It is a passion and a hobby. Research grants are few and far between – especially in the current funding climate. I do almost all research ‘in my own time’ – after the kids are in bed – I don’t really like TV. A couple of grants and generous assistance of the Epworth Monash Rehabilitation Medicine Unit have allowed me to now employ a part-time research assistant – which is a fantastic help.

Over the years I have developed much collaboration, both national and international. Inspiration and networking at conferences results in a perpetual cycle of new projects and collaborations, international friendships and dancing opportunities!

Inspiration for research projects comes from a number of sources, particularly clinical challenges and frustrations. Process changes are also a useful stimulus. As a result of clinical frustration with barriers to admission and discharge facing the spinal patients, and a process change that was being implemented in my other clinical appointment in a general rehabilitation unit, I developed an interest in patient flow. I ended up with a dozen related projects. Fary Kahn encouraged me to tie these projects together and do a PhD – which I have just finished. Now the world of post-doc funding opportunities awaits…

Over the years I have enjoyed mentoring many rehabilitation trainees with their research modules and am now involved with an RACP initiative to design a web-based platform to help all physician trainees with their research modules.

Research is not for everyone. You must be passionate and sincerely curious about what you research. My advice to those contemplating research in rehabilitation is to try and recognise a niche opportunity, find mentors and collaborators, start with a simple project, and finally, be patient – research takes time.

St Vincent’s Intensive Exam Preparation Course in Rehabilitation Medicine – Steven Faux

To coincide with the inaugural RMSANZ Conference, the 2015 St Vincent's Intensive Exam Preparation Course in Rehabilitation Medicine was held at St Vincent's Hospital, Sydney. There were 27 registrars permitted into the course after successfully completing an online examination demonstrating sufficient knowledge of the content of the AFRM's curriculum in rehabilitation medicine. The course required trainees to attend for five long days, each of which was filled with ten hours of lectures, OSCE examinations, practical sessions teaching exam technique and performance under pressure.  Perhaps, however, the most interesting aspect of the course is the way that different trainees react to the demands of professionalism, namely the rapid and meaningful integration of book knowledge, hands-on examination techniques and communication skills. For many this integration of skills, which is demanding of critical thinking (is this diagnosis a blind alley I am going down?), self-editing (am I sweating over the small stuff?) and a focus on how to deliver the patient outcomes (how can I get this patient to ever do that therapy?) was like going for a hike into territory rarely seen. And the next day did their muscles ache!!

For others, the course was a time to test their mettle, developing skills in managing real life clinical problems away from the comfort of their supportive supervisor or the familiarity of staff. I can say it was eye opening for many. As a clinical academic constantly inspired by seeing growth and learning in talented junior medical staff, I was absolutely delighted by both this year's group and last year’s. Many started the week with real problems in developing clinical approaches to simple problems, or even stage fright,  but their early experiences galvanised people into putting on a higher level performance. While some suggested that the high standards set at the beginning of the course softened by the end, I beg to differ. What changed was the level of confidence and the meticulous attention to detail required to approach clinical problems in rehabilitation medicine. I saw those trainees step up and find strengths and talents that they hadn't acknowledged they even had.

Many of the patients commented that they wanted the registrars to know important aspects of patient care – and unlike an OSCE many patients gave feedback and advice on presentation skills, levels of perceived compassion and aspects of patient focus. One patient, who worked as a motivational speaker, delivered an address on presentation skills completely impromptu and demonstrated fantastic mastery of his dysarthria!

It would be unfair not to comment on the feedback given which was overwhelmingly positive. Like any course convenor we looked for comments on the food, lighting, air conditioning, costs and course content. Suffice to say that the course cost was reviewed and only decreasing the time of the course or sacrificing some of the more important but expensive aspects such as the video feedback and organising large numbers of patients would offer substantial savings. 

However, efforts are being made to enhance the course content and organisation for 2016. For the first time, the course will be opened to trainees in South East Asia who may be interested to enhance their skills but, as always only the first 28 - 30 who are able to pass the online course will be admitted because the course does not focus on teaching content. The course focuses on the practical skills of being a rehabilitation physician and also on life after becoming a consultant. 

Many trainees attended a seminar at the RMSANZ conference on how to successfully obtain jobs as a junior consultant, what the pay awards are in the public sector and what are considered important features of a job application in the private sector.

The exam results of those in the course will be carefully followed this year and as many successful junior consultants from the first course are able to testify, the course does not guarantee a pass, it simply sets up a template for each trainee to practice the hands-on skills to be excellent in the discipline of rehabilitation medicine. From there it is up to each individual trainee to demonstrate this skill during that three hour period in August every year.

Building an Enabling Society – Will Taylor, 2015 AFRM/NZRA Combined Rehabilitation Meeting Organising Committee Chair

The Australasian Faculty of Rehabilitation Medicine (AFRM) and the New Zealand Rehabilitation Association (NZRA) co-hosted the AFRM/NZRA Combined Rehabilitation Meeting 2015 from Tuesday, 13 to Saturday, 17 October in Wellington, New Zealand. 

Delegates
With 320 delegates from across Australia and New Zealand representing rehabilitation physicians, researchers and allied health professionals, the event, themed ‘Building an Enabling Society’, was a fantastic opportunity to share ideas, rethink assumptions, and discover new ways of helping individuals attain the health and social outcomes that matter the most to them. 

The 2015 George Burniston Oration was delivered by Professor Derick Wade from the United Kingdom and the Norrington Lecture by Associate Professor Barbara Gibson from Canada. 

Professor Wade’s presentation was titled ‘Healthcare disables people, rehabilitation can change the culture of healthcare and thus reduce societal disability’. In this inspiring presentation, Professor Wade challenged all conference participants to change the culture of healthcare and decrease societal disability. As editor of Clinical Rehabilitation he was well-placed to also deliver a breakfast session on ‘Writing for Publication’.

Professor Barbara Gibson discussed novel and challenging concepts on the values attributed to modes of physical functioning, particularly mobility. In this presentation she questioned the need for therapists to constrain their interventions by notions of ‘normality’ and encouraged the audience to consider the goals of disabled people more creatively. 

AFRM and NZRA have also collaborated on the development of The Call for a New Zealand Rehabilitation Strategy and it was fitting that it was launched at the event co-hosted by the two organisations. Read more about the launch below.

Boasting plenary sessions, scientific updates, workshops and breakfast sessions, the event successfully provided a program that met the needs and interests of the diverse crowd. A number of experts delivered presentations on a wide range of topics ranging from enabling recovery after non-catastrophic injuries to a well-received session on rehabilitation following natural disasters.

The highlight of the social program was the Gala Dinner held in the historic Old St Paul’s, a former cathedral. Attendees were awed by the incredible architecture of the venue, and the opportunity to enjoy a meal in a very unique setting. Dr Maria Paula and Dr Hima Venugopal performed a wonderful traditional Indian dance for the crowd. 

I would like to thank all members of the organising committee: Dr Cynthia Bennett, Dr Richard Seemann, Dr Shaun Xiong and our NZRA Colleagues Professor Kathryn McPherson and Associate Professor Nicola Kayes. Your hard work and dedication to the organisation of this event is greatly appreciated.  From 2016, the Rehabilitation Medicine Society of Australia and New Zealand (RMSANZ), will take over the organisation of the Annual Scientific Meeting (ASM). The first RMSANZ ASM will be held from Sunday, 16 to Wednesday, 19 October 2016 at the Crown Promenade Melbourne. 

Rehabilitation specialists lead the call for a New Zealand strategy – Cynthia Bennett, AFRM NZ Branch Committee Chair

The Australasian Faculty of Rehabilitation Medicine (AFRM) in collaboration with the New Zealand Rehabilitation Association (NZRA) and key stakeholders have developed the Call for a New Zealand Rehabilitation Strategy (the Call), which was launched at the AFRM/NZRA Combined Rehabilitation Meeting in October 2015 in Wellington.  

The Call identifies the current disparities in the availability and provision of disability and rehabilitation services and calls for the immediate development of a New Zealand-wide rehabilitation strategy to improve patient outcomes and reduce preventable disability through fiscally responsible and sustainable healthcare for those living with disability. 

A comprehensive New Zealand rehabilitation strategy will identify current services, providers and programs; identify unmet needs and inefficiencies; and will help determine opportunities for streamlining, strengthening and increasing collaboration in provision of rehabilitation. The strategy will ensure alignment of current services and provide the framework for development of future services and healthcare planning.

New Zealand was among the first signatories to the United Nations Convention on the Rights of Persons with Disabilities (the Convention) in 2007, which identifies rehabilitation as a human right. 

The Convention provides clear standards for signatory states to follow in order to establish rehabilitation services and support for people living with disability in the areas of housing, education, social engagement and in the workplace. New Zealand has made some progress, but a more strategic approach is required to ensure those requiring rehabilitation services have access to the right service at the right time.
  
There is now a consensus amongst health and political leaders that New Zealand is moving towards an unsustainable health and social support system.  

Rehabilitation physician and AFRM NZ Branch Committee Chair, Dr Cynthia Bennett, said rehabilitation is an integral component of healthcare, yet many New Zealanders do not have access to skilled, specialist rehabilitation. 

“Our population is growing, as is the percentage of New Zealanders living with disability,” she said. Between 2006 and 2013, the number of New Zealanders living with disability increased by seven per cent. Māori and Pacific peoples make up a higher proportion of this population. In addition, Māori and Pacific peoples generally have lower rates of access to rehabilitation services. 

“There are great disparities in the availability of rehabilitation services, the skill of the services providers, equipment provision, funding of environmental modifications and available social supports across the country due to geographical location, age and whether the disability is due to illness or injury. A national strategy is crucial to improving the health, wellbeing and functional abilities of New Zealanders who live with a disability,” said Dr Bennett. 

“Extensive international evidence confirms that timely and skilled rehabilitation leads to improved patient outcomes and healthcare savings. A coordinated approach to rehabilitation services in New Zealand will have a positive impact not only on individuals and their Whānau/families but on the overall healthcare budget.” 

The aims of the joint Call for a New Zealand Rehabilitation Strategy are to: 

  • guide policy and practice of health care for people with disability 
  • improve the health, wellbeing and functional abilities of New Zealanders who experience disability from illness or injury 
  • reduce the individual and Whānau/family burden of impairment and disability 
  • enhance functional ability and independence, thus reducing the need for community support for personal care and societal cost of disability 
  • improve participation outcomes and the person’s ability to contribute to family, the community and the economy by encouraging return to life roles and work force participation 
  • create equity in rehabilitation service accessibility and provision across New Zealand 
  • promote leadership in health care and rehabilitation reform.

The AFRM NZ Branch will continue to collaborate with individuals and organisations to raise awareness of the Call, its key messages and the need for a New Zealand Rehabilitation Strategy.

Download the Call for a New Zealand Rehabilitation Strategy.

Rehabilitation in Oceania – Andrew Cole

Any rehabilitation doctor who has travelled overseas in South East Asia or the South West Pacific, with an interested eye to what is happening in rehabilitation in our part of the globe, will realise just how fortunate we are to have expert rehabilitation services, with well trained staff in much of Australia and New Zealand.

Sadly, many developing countries in our immediate neighbourhood have few or no rehabilitation services, and nearly all lack doctors trained in rehabilitation. Specialist training in our largest neighbours, PNG and the Fiji Islands, is by Masters Degree in the Universities of PNG and the South Pacific respectively, and there are no rehabilitation specialists in PNG, and just one in Fiji, with only a couple of identified hospital rehabilitation services between the two countries. 

Most of the smaller South West Pacific nations simply do not have a population base to justify full specialist rehabilitation services. People nevertheless suffer traffic accidents and strokes, fall out of trees, and are affected by natural disasters. Most will need ‘pop-up’ community-based rehabilitation services to cope with caring for residual disability, especially if high level, when they leave hospital care.

In early 2015, the International Society for Physical and Rehabilitation Medicine (ISPRM) reconstituted its Education/Policy Working Groups to include a group that is specifically looking at this specialist medical education and training needs in parts of the world without significant rehabilitation presence. This group has had three teleconferences in the four months since its establishment.

The College’s International Strategy Working Group is also interested in these matters, and is considering what alternative non-Fellowship forms of special-interest qualification might be developed for individual physicians with special interests in our part of the world. 

In parallel with these processes, I have convened an informal working group of interested Fellows to start looking at what specialist rehabilitation resources are available for our South West Pacific neighbours, and what may possibly be done to help educate and train interested doctors in future. Each of us has worked in the South West Pacific or South East Asia, in different settings and various times in the past, and we have met twice, to start scoping the task, defining what is presently available, and what the needs for education and training might be.

It is not a task for the faint hearted, and if anyone else is interested, please get in touch through the Faculty at afrm@racp.edu.au.
 

Arthur Mills Oration - Dr Ranjana Srivastava

Dr. Ranjana Srivastava is a medical oncologist, educator, volunteer, award-winning writer, and a columnist for The Guardian newspaper. In 2004, she was awarded a Fulbright Award, using it to complete an ethics fellowship at the University of Chicago. She became a Fellow of the RACP in 2005 and now practices in the public hospital system in Melbourne. She is on the advisory committee to the Health Commissioner and plays an active role in shaping doctor-patient communication skills training.

Ranjana has been published in multiple eminent medical journals, writing widely on the subject of medicine and humanity and ethics. She has won the Cancer Council Victoria Award for Outstanding Writing as well as the Gus Nossal Prize for Global Health Writing. Her interest in explaining and demystifying medicine to the general public has led to a regular media presence in Australia, including on radio and a monthly health segment on ABC television. She was listed as a Westpac Top 100 Women of Influence in 2015. 

Becoming a physician is a hard-won prize but one that will keep giving in extraordinary ways. You are also entering a profession where you will walk in the shadow of giants. They are everywhere. Not just on the honours and awards lists and in large academic centres but in regional hospitals and tiny rural areas that are kept alive by dedicated physicians. I thought I would tell you about some of the giants that I have encountered in my journey.

Despite sound training, I became a newly minted oncologist with trepidation, convinced that everyone knew more than I did. Oncology, of course, also has its own special issue of highly vulnerable patients and being a new consultant is no excuse for getting things wrong. One of my earliest patients had undergone a complex lung resection resulting in extensive scarring. A CT report concluded that her disease was on the move again and I shared this news with the patient during my first week as a consultant. As it turned out, the report was incorrect. In today’s era you would follow this with a PET scan but in those days studying the film required the kind of instinct that I simply hadn’t developed. The patient was quickly reassured, and indeed, forgiving of my error. Alas, a senior oncologist wasn’t. He upbraided me for being irresponsible which did nothing to make me feel better or become better. Instead, I fretted so much about making another mistake that I took to knocking on people’s door to ensure that I was making the right decision. 

Enter the first giant in my life. He told me about all the oncologists who were now senior staff who had once stood at his door for advice, instantly normalising my uncertainty and giving me hope that I too would feel competent one day. He welcomed my questions, never made me feel inadequate and very quickly helped me realise that I didn’t need nearly as much support as I had feared. 

Of course, looking back, it seems ridiculous to expect that wearing the brand new badge of a consultant should have resulted in instant transformation. We know that takes years. Last year when one of my registrars became a consultant he said the most difficult thing was knowing that the buck stopped with him.

So here is my first message to you. It’s okay to feel uncertain, it’s okay to wonder where all your training went because you can’t even dictate a cogent letter, and it’s certainly okay to ask questions without hesitation. Ours is a human profession. Our decisions have the power to change lives. If I had to choose between standing at someone’s door, feeling transiently foolish, and making a decision with permanent consequences, I’d take the former every time. And I hope that you will too.

In the next few years, since I had convinced myself that I lacked intellect because I couldn’t remember the chemotherapy protocols that changed with the seasons, I couldn’t believe that my patients seemed to like me. They seemed to like the fact that I spoke with them unhurriedly, was interested in their children, and remembered what they did for a living. At Christmas I received cards that said ‘thank you for always making me feel special’ although I privately longed for one that said, ‘you’re so clever for having sequenced my genome.’

There is now a fashionable name for this, patient-centred care. The next giant in my life had been practising this all his life because treating people as human beings was the only way he knew to fulfil his obligation to medicine. He had sterling academic credentials, was published and globally regarded. Yet, the average patient adored him because he remembered their name and helped them cross the busy street across the hospital. He sat with intubated patients when there was no need and consoled their relatives when there was nothing else to be done.

Tragically, he died prematurely. At his memorial service, the grief of his fellow physicians spilled over but honestly, what struck me was the reaction of his patients who had shown up. They didn’t care that he had known how to adjust the PEEP or get the dose of Frusemide just right. They cared that he had said a kind word at the right time and sat with their worried family when their world was falling apart. In awarding the late Dr. Ramesh Nagappan the John Sands medal posthumously, our College has signalled the value it places on humanity in medicine.

Which brings to my second message. Medicine has never been more exciting, more competitive and more fast-paced. But you can’t navigate any of this without a moral compass. A moral compass that has personal integrity as its true north.

In this day, we are all touched by the stories of simmering rivalry, academic one-upmanship and workplace politics. Healthcare funding has gone from a vague concept to a live tension for each one of us as we are asked to modify our clinical behaviour in line with the needs of our times. If you are a new consultant, you can expect to have a set of guidelines for everything, from how to manage an insulin infusion to the most efficient direction in which to direct your ward round, clockwise or anticlockwise.

But what you almost certainly will not find is any compelling guideline on how to be a good doctor, the kind that all of us wanted to be when we first entered medicine with dreams in our eyes of making a difference. We start off thinking big but somehow end up acting narrowly. What more, we know it when we falter but all too often, it’s hard to self-correct.

I don’t need to think too hard to recall the times I could have been kinder to a patient, spent more time at the bedside or acted a little more thoughtfully towards a tense family. And the thing is that in all these instances where I failed my patient, there was no one watching and certainly, no one complaining. 

You see, not checking someone’s troponin after chest pain can be considered an act of commission. Not checking the Paracetamol level in an overdose patient can be considered an act of commission. In both instances, you could be pulled up for your actions. But you can lose patience and walk away from the disabled patient, never bother to get an interpreter to figure out what’s troubling the distraught refugee and avoid discussing a poor prognosis and chances are you will get away with it. Nobody logs these sins of omission. Except your conscience. 

So here is a definition of integrity that I hope you will remember throughout your professional life. Integrity is doing the right thing when no one else is looking. 

The irony is that you will check the troponin and order the MRI quite frequently because that’s where you might think value for money lies, especially when you are a new consultant. But the most value for society’s money actually lies in you having a genuine conversation and figuring out what’s really important to the patient. Our hospitals abound with instances of futile care, expensive care and inappropriate care. In fact, sometimes when you see what passes for care, it seems ironic to use the word care at all.  And now that you are a consultant you will find yourself sitting at tables where your colleagues will bemoan the system that compels us to behave like this. It’s the system’s fault you will soon learn to say. But I would argue that you and I are the system. And the system will only ever be as good as each one of us makes it. 

The road to becoming a physician involves a fundamental transition. You go from being a confident registrar to a somewhat irresolute consultant before regaining your bearings to become a seasoned physician, the kind who is not just intelligent but also wise and ultimately loved. Here I am reminded of a small town that erected a statue in the town square in memory of a doctor. Don’t you find this poignant in an era of healthcare increasingly viewed as a transaction?

This man was another giant amongst us. And although I didn’t know him I have met people like him.

What makes such people unforgettable is not the fact that they could recite the Antibiotic Guidelines backwards or never needed to look up the diagnostic criteria for lupus. On the contrary they leave an impression of their humanity wherever they go. They are usually humble and possessed of the perspective that says medicine is teeming with brilliant people that have gone and will come. They are not afraid to admit uncertainty and they are certainly not shy of giving praise. 

In one of my first jobs as a registrar, I saw a man with heart failure and made a clinical diagnosis of a saddle embolus that turned out to be correct. Thrombolysis saved the man’s life. Later, the consultant said, ‘congratulations.’ Then he added something unprecedented. He said, ‘I don’t think I could have come up with that diagnosis.’ I didn’t for a moment think this to be true but in life, you only need a few pieces of encouragement like this to make you soar, to truly believe that you could yet be a capable physician.

I’d like to remind you that while you are busy finding your own feet, don’t forget that all the people under you are watching you closely, in admiration that you have arrived. They can look up protocols for themselves, what you can give them is a lesson in integrity. How to practice a brand of medicine with compassion, empathy and personal integrity and how to take people along with you might be the greatest hurdle you will face in medicine.

It would be remiss of me to not turn to the subject of being a woman in medicine, something that really should not be remarkable given that we admit equal numbers of men and women to medicine. But the ranks of women do thin out the higher you get and I think we are familiar with many of the reasons. Our surgical colleagues have dominated the news lately with tales of blatant sexism that is disadvantaging women surgeons. 

As physicians we are better known for using our intellect but I will put to you that gender bias against women exists within our ranks too and we would do well to confront it. It may not take the same form as that in surgery but the life of a female physician is not immune from derogatory remarks and antiquated attitudes. As brand new physicians you can do something about this. You can pledge that you will respect your female colleagues, support their choices and acknowledge the richness that women bring to a team. You can remember the words of retired army general David Morrison: ‘The standard you walk past is the standard you accept.’

In the decade since I became a consultant, I have also had three children and juggled childcare with my husband, also a doctor. Like every woman, I have struggled with the things that we constantly tell our patients are the things that matter. How to time my marriage with the FRACP Exam, whether to finish training or interrupt it to have children, whether or not to pursue a further degree, the list is endless and familiar to so many of you, men and women.

I am often asked how I balance my home life and a multipronged career. At these times I am reminded of the legend perpetuated by a surgeon that his doctor wife had used her brief maternity leave to complete her PhD thesis. The image of this unseen superwoman dominated the thoughts of many of my friends as we stumbled through the fog of childbirth, barely awake to flick through New Idea, let alone the New England Journal

All too often in medicine, we want to present an edited version of ourselves. But I think the least we owe women and for that matter, men who are trying to figure out how to live the life they preach to their patients, is to allow them an honest glimpse into our lives. 

To the question, how do you do it, I have resisted giving a superficial answer. 

It takes a village. Without the support of my husband and extended family, I would not be here today. In between, there are friends, neighbours and babysitters. Sometimes my patients or a Guardian column take precedence, other times the school assembly trumps everything else. Both give me equal pleasure and I frankly don’t know anybody who hasn’t juggled competing interests. But the thing is, I don’t necessarily regard them as compromises as much as the stuff of life. 

Whether we like it or not, you and I are role models for more than the practice of medicine. Our residents look at us and try to find a reflection of their entire future selves. They want to know how we treat lung cancer or diagnose pituitary insufficiency but they are eager to know how we live our lives beyond medicine. They watch how we nurture various relationships, how we regard parenthood and how we let our profession shape the rest of our lives.

We do them a disservice by pretending that their dilemmas are unique and that we have arrived at our destination smoothly. The giants of medicine are not afraid of revealing their human imperfections and I sincerely hope that you won’t be either. Welcome to the most wonderful profession. Welcome to the vocation of a lifetime. In the words of Hippocrates may you cure sometimes, treat often, comfort always.

RMSANZ -  Alex Ganora

We are very proud to announce that our new society, RMSANZ, now has over 300 members. These comprise about 250 Fellows and 60 trainees. A strong Society needs full membership to represent and serve the objectives and needs of our profession. We urge remaining Fellows and trainees to become active in the affairs of our new Society. Trainees can currently join for free so there really is no excuse not to become involved right now. 

The Society would like to congratulate RACP/AFRM and NZRA for holding a very successful ASM in Wellington. A wonderful program, with wonderful people in a wonderful location, it will be a hard act to follow. RMSANZ is grateful and proud to accept responsibility for hosting the next ASM which will occur in Melbourne from 16 to 19 October 2016. The Scientific Organising Committee is well under way with planning of this meeting, with the assistance of DC Conferences. A number of Keynote Speakers have been confirmed, including Prof Jianan Li of Nanjing Medical University, China, the current President of ISPRM; Dr David Kennedy, Clinical Assistant Professor, Orthopaedic Surgery of Stanford University, USA;  Dr Gaetan Tardiff, Physiatrist-in-Chief and Medical Program Director, Toronto Rehabilitation Institute, Canada; Professor Barbara McPake, Director of the Nossal Institute for Global Health, University of Melbourne, Victoria; and Dr Nick Coatsworth, Executive Director, National Critical Care and Trauma Response Centre, Darwin. Please make sure you visit the conference website and register your interest to stay informed of any changes or the addition of new speakers: www.dcconferences.com.au/rmsanz2016

Conference
 
It is possible that RMSANZ will also be co-hosting the next AOSPRM International Meeting in Auckland 2018 in conjunction with the Asia-Oceanian Society of Physical and Rehabilitation Medicine and the Canterbury District Board of Health  . These and other developments and events will soon be described and updated further at the new RMSANZ website: www.rmsanz.net

By the time you read this edition of Rhaia, the RMSANZ will have held its 2nd AGM on 16 November 2015, a legal necessity under the Corporations Act 2001 to hold the AGM within five months after the end of our financial year. Also on 16 November 2015, we enjoyed the first CPD Dinner hosted by the newly established NSW/ACT Branch of the Society, chaired by Prof Stephen Faux.

The RMSANZ Board has adopted a funding model for Branches and SIGs that establishes a reserve of money within the Society central account for each separate group, maintains a cost centre for them and provides them financial and administrative support. Branches will be encouraged to adopt a self-sustaining, self-funding philosophy of group activity and will be assisted with the organisation of successful events by utilising previously developed resources. Branches that hold successful events will be allocated a proportion of the profits for their future use. 

A number of Board Committees have been formed to address such matters as legal, communication, membership, meetings, trainee members, financial management, scientific programs and submissions to government. There is work enough for every member to be an active part of this new Society and we encourage you to do so! An example is the communication committee, which is currently working to establish a regular RMSANZ bulletin in 2016. You can register your interest in becoming an active member of RMSANZ by contacting us via www.rmsanz.net

Reports

Faculty Policy & Advocacy Committee (FPAC) – Andrew Cole

Since my last report, two FPAC members have stepped down (Drs Tracey Simmonds and Damien Daniel) and have been replaced by Drs Julie McLeod and Colin Crawford. My thanks go to both Tracey and Damien for their enthusiastic hard work and contributions to FPAC during my time as Chair.

College P&A Committee (CPAC) Activity

The College has established a broad-based NDIS working group, with members drawn from all relevant disciplines, including several of our Fellows. The NDIS roll-out will be a measured and step-wise process over several years, with early visibility in selected areas of NSW and Victoria, other jurisdictions following, though the participation of WA has not yet been agreed. Dr Stephen de Graaff and I continue to meet with Mary Hawkins, the head of the NDIA office based in Geelong, on a regular basis.

A College Working Paper on Pain Management is crystallising, with debate about opioids divided between those who prescribe opioids regularly in their practices, and those who see the problems with addiction. Watch this space. 

Amongst other topics, CPAC Working Groups continue in the areas of Social Determinants of Health, End of Life Decision Making, Health Benefits of Work, and Effects of Climate Change upon Health. The College has re-established its Ethics Committee.

The College has recently established an Integrated Care for the Elderly Working Group. Following a call for Expressions of Interest, our Faculty representative is Dr Tai-Tak Wan. The College has recently become involved in the Commonwealth’s review process of the Medicare Benefits Schedule, and Fellows will have seen requests for EOIs in the e-bulletin for involvement in this.

Faculty P&A Committee (FPAC) Activity

Dr Jeremy Christley is chairing the group developing the Guiding Principles for Rehabilitation Medicine in Telehealth Settings. Vigorous discussion has occurred in the context of questions of role responsibilities in the telehealth setting. An advanced draft is due for consideration by FPAC later in 2015.

A scoping document has been prepared by Dr Tai-Tak Wan and Ms Claire Celia, entitled The Role of the Rehabilitation Physician in Integrative and Preventative Community Care, the scope having been narrowed in focus following discussions. Email commentary from FPAC members is in process, with another comment round occurring this month. 

After a very lengthy gestation, of which a mother elephant would be proud, the Call for a New Zealand Rehabilitation Strategy was sounded by Dr Cynthia Bennett (NZ Chair) at the start of the recent joint AFRM/NZRA Wellington meeting. It is well worth reading in detail, as a comprehensive strategic paper for any general rehabilitation planning process.

The final version of Rehabilitation Physician Scope of Practice (Paediatric Rehabilitation Medicine) has been prepared, and once approved, it will be sent to CPAC for their approval and posting on the AFRM website. 

The draft Queensland Health State-wide Brain Injury Rehabilitation Plan was discussed in detail by FPAC, and multiple comments sent back to Queensland Health planners, within a very short time-frame. FPAC notes a similar state-wide planning process is underway for spinal cord injuries in Queensland, and that establishment of a State-wide Rehabilitation Clinical Network is considerably facilitating the developments like these.

Faculty Education Committee (FEC) - Tim Geraghty

FEC Membership 

Since the last Annual Members’ Meeting, we have welcomed Caitlin Anderson, Michael Johnson and Emma-Leigh Synnott to their respective roles and Rachel Smith to the role as Education Officer for the FEC.  A full list of the current membership can be found on the College website

Achievements 
Standard Setting for Exams

In 2015, the Assessment Sub-Committee put into place two new processes for improving the rigour of our examinations. The clinical examination questions are now reviewed via a calibration process involving the examination working party members and Faculty examiners. The written examinations are standardised by panels of Fellows implementing a statistical analysis (Modified Angoff Process) with the assistance of the College psychometrician. This year these panels were primarily made up of members of the Assessment Sub-Committee. 2016 will see a move toward having more non-committee member participants on these panels.      
Trainees and Supervisors
As at 30 September, there are currently 212 general adult trainees and 13 paediatric trainees of the AFRM. The breakdown of trainees per state is: ACT 3, NSW 95, NT 2, QLD 42, SA 18, TAS 4, VIC 47, WA 8 and NZ 6. 

As at 5 October, there are 247 accredited supervisors of the AFRM and 125 accredited training sites.  
Sub-Committee Updates
Assessment Sub-Committee
2015 FWE (Adult)
The 2015 Fellowship Written Examination was convened in Sydney, Auckland, Christchurch, Melbourne, Adelaide, Brisbane and Canberra on 26 May 2015. There were 29 candidates for the Short Answer Paper and 27 candidates for the MCQ Paper. 19/29 candidates passed the Short Answer Paper (a pass rate of 65%) and 20/26 candidates passed the MCQ Paper with (pass rate of 77%).
2015 FCE (Adult)
The 2015 Fellowship Clinical Examination was convened on Sunday, 16 August 2015 at the Alfred Hospital in Melbourne. There were 41 candidates. 32/41 candidates passed the FCE – a pass rate of 78%.
Membership
After many years of service, the following Fellows have resigned from the Assessment Sub-Committee during 2015: Dr Anuka Parapuram, Dr Jane Wu, Dr Kathryn Brooke and Dr Lynette Lee. The importance and the impact of the work from these Fellows cannot be overemphasised. Through their various roles on the Assessment Sub-Committee they have helped to develop and direct the process of the assessment of our Faculty’s candidates, with their personal commitment and energy being the driving force behind an ever-evolving assessment process.

On behalf of the Chair of the Assessment Sub-Committee and their fellow committee members I would like to thank these Fellows for their many years of hard work and involvement on this committee.

The AFRM examination dates for 2016 are:

Module 1: Tuesday, 19 April and Tuesday, 11 October 2016
Module 2: Sunday, 26 June 2016 [location TBA]
Fellowship Written Exam: Tuesday, 31 May 2016 (Adult & Paediatric)
Fellowship Clinical Exam: Saturday, 13 August (Adult) and Friday, 16 November (Paediatric) [locations TBA].

Continuing Professional Development Sub-Committee
AFRM fellows continue to lead the way in CPD completion at >98%. We are now using the RACP MyCPD online programme which has been extremely well received. The Rural and Remote SIG is leading the way for the College in the Peer-to-Peer Review process. 
New Zealand
There are currently 7 accredited training positions: 1 in Dunedin, 1 in Christchurch and 5 in Auckland, and 6 trainees. Recently there has been increased difficulty recruiting new trainees. This is only a recent trend and will be discussed at the next Branch meeting.
Overseas Trained Physicians
The important work of this OTP unit has continued throughout the year.
Paediatric Rehabilitation Sub-Committee
The standard setting process (Modified Angoff Process) has also been embraced by for the Paediatric Examination process and is considered to have been of great benefit in improving the standard of examinations. There has also been a strong emphasis on increasing the number of quality questions in the MCQ bank.
Physician Education
Dr Kochiyil has continued to take the lead in organising Supervisors and Long Case Workshops including those at the ASM.
Training Sub-Committee

BNTP
During 2015 there have been 10 monthly sessions covering various topics Chronic Pain, Cardiac Rehab, Acquired Brain Injury, Cancer Rehabilitation, Occupational and Vocational Rehab, Upper and Lower Limb Amputation.  
Accreditation Committee
The Accreditation Sub-Committee has been incorporated as a sub-committee into the FTC (rather than reporting directly to the FEC), and continues to be chaired by Dr Gavin Chi.
Committee Membership
Committee membership is now at full capacity and I would like to thank new members who have joined the committee this year, in addition to the long-standing members who continue to serve: Sue Inglis, Hiliary Taylor-Evans (Trainee Rep), Michael Ponsford, Sharon Wong (Deputy Chair), Kellie Perrie, Louisa Ng and Jon Ho Chan who has previously served as the Trainee Representative. 
Training Business 
There have been several policy changes affecting the training programme. Any changes that have an impact on trainees have been communicated through e-bulletin and direct contact as appropriate.  The new Trainee in Difficulty Policy comes into effect in 2016.  
Trainee

Annual Trainee Meeting for 2015
 
This was held at the Gold Coast University Hospital and saw a crowd of close to 70 trainees attend from around Australia and New Zealand.  Feedback was largely positive from all involved including trainees, sponsors, and presenters. Important take away points via feedback from trainees who attended this year included: 

  • recognition of the importance of Faculty-approved teaching events that were based on the AFRM curriculum
  • request for more similar events, and suggestions that perhaps we could have two meetings per year

We have established a 2016 ATM Sub-committee and hope to continue the success next year.

Other News
Curricula review

The FEC is continuing to be involved in the larger College process of Curricula review. 

Special Interest Groups (SIGs)

The FEC has been asked by Council to assist with a process to review the Faculty SIGs. Many of you (if you were identified as a member of a SIG) would have received a survey monkey link recently, asking for your opinion regarding the current state of the SIGs and your ideas for improving the situation. A meeting of SIGs chairs to further discuss was held during the ASM in Wellington.

I would like to sincerely thank all sub-committee leads and members as well as all those others who have assisted in, for example exam working groups for their help and support. Without your interest and dedication, the important work of the Faculty in educational activities would not be possible. 

I would also like to thank all the Education Office staff who provide ongoing assistance the FEC and sub-committees especially Isabel Roos who moved on several months ago and more recently Rachael Smith, as well as Neelam Huda, Paul Washington and Marie-Ann Van Roie, as well as Dominique Holt, Phillipa Warnes, and Annette Barker from the AFRM Office who have also helped me greatly throughout the year.

Trainees’ Committee - Emma-Leigh Synnott

I don’t know how the rest of you feel, but as I sit down to write another Rhaïa Trainee Report I can’t help but feel as though time has flown far too quickly. 

Over the last few months we have seen many trainees work tirelessly toward their exams. So it is good to say that many trainees have now successfully completed Modules I, and II, and many more passed their Fellowship Clinical and Written Exams in both Adult and Paediatric Medicine. Congratulations to all those trainees who were successful!  And now that the exams are over we again draw our attention to planning future education and training experiences.

As I reported in my last communication, the Annual Trainee Meeting for 2015 was held at the Gold Coast University Hospital and saw a crowd of close to 70 trainees attend from around Australia and New Zealand.  It was a huge success and feedback very positive from all involved including trainees, sponsors, and presenters. Important take away points from trainee feedback were that these structured face-to-face teaching opportunities were highly valued, with trainees very keen for events to continue in the future. They will therefore be pleased to know we have already set up the Annual Trainee Meeting Committee for 2016, and the event is set to take place in the first half of the year in the lovely city of Melbourne. 

Other progress has been made in terms of online communication and resources. Many would have noticed the changes to the AFRM website, with new and improved accessibility to the Trainee Portal, the return of the Rehab Search Functions, and much work being done to give trainees access to BNTP sessions and other Teaching Resources. For those who have not seen the changes I would encourage trainees to check the website

Another little gem for those who are interested in podcasts, a fantastic resource called Pomegranate is available. It gives 20 minute podcasts on areas of medicine and again I urge you to search it out and give them a go, at www.racp.edu.au/pomcast.  

And with that, I wish everyone a safe and happy holiday season and look forward to seeing more developments in the future.

CPD - Ruth Marshall

Did you make it to the combined AFRM and NZRA conference in Wellington? If you didn't get there, you missed some wonderful presentations and there were some great posters too. Much to provide thought and contemplation. If you did get there, you will know what I mean. 

Conferences are a great way to catch up with colleagues and friends from ‘all over’ and hopefully glean some new ideas. All too often however, even if we take notes, we put them away and never touch them again.  A case in point is that, a few months ago, my daughter was helping me tidy up my study at home.  “Mum, do you need these papers?” she asked. They related to conferences I had attended over five years earlier. I said that if I hadn't looked at my notes by now, I wasn't going to and promptly threw them all out.

So to those of you who attended the conference, I challenge you to review your notes and utilise at least one of the ideas you gleaned to change something you do or a treatment you provide. The same should be true for any conference or workshop you attend. We need to turn passive learning into an active exercise.

In reality, although conferences are great fun, they are not necessarily the best way to learn. We are better off developing our own learning needs analysis and then plan what we need to do to meet those needs. You can link your learning plan to your MyCPD page and log your learning as you go. Actively engaging ourselves in our own learning requirements and then reviewing our results is one option. Another is to audit an issue in your unit, introduce an intervention and then review the outcome, perhaps six months later. Did you achieve the outcome expected? Can you do better?

Another option is to seek the opinion of your colleagues and team members on how you are functioning as a team member, a clinician, a leader.  Sometimes called ‘multi-source feedback’ or a 360, it can be an excellent (although sometimes a bit threatening) exercise. My employer uses an outside agency to provide a confidential process so that I won't know who actually was asked of the list I provided. My list includes medical colleagues, trainees, nursing and allied health staff and wheelchair users who are members of my team.  I hope that the feedback I receive will enable me to improve those areas which need a bit of ‘fixing’…we can all do better with a little help from our friends. 

As we move towards the end of the year, don't forget to log on to your MyCPD page and upload your credits – you can attach your evidence too. You don't need to wait until the end of the year or 30 March 2016 – the RACP MyCPD program allows you to upload as you go (and attaching your evidence makes auditing much easier took for you are one of the 5% of the RACP Fellowship who is audited each year). If you need advice, email MyCPD@racp.edu.au.

I've already uploaded my credits for 2015 even though the year is not yet over, and you can do yours too – think of it as an early New Year’s present.

Best wishes for the rest of 2015.

SA Branch - Peter Anastassiadis

The South Australian health system is undergoing transformation under the Transforming Health initiative. There will be opportunities and challenges for rehabilitation medicine under Transforming Health especially with focus on centralising the rehabilitation service and on acute rehabilitation provision. 

The state-wide Rehabilitation Clinical Network was decommissioned in mid-2015. The network was effective in providing the overarching strategies in response to the priority areas of need and drafting rehabilitation models of care in metro and country areas. It took initiative in providing guidelines and protocols such as the Amputee Specific Falls Prevention Protocol and Guideline and Data Collection Process for use of Botulinum Toxin in Spasticity. More recently it had successfully initiated the clinics to facilitate transition from paediatric to adult rehabilitation services. Last year the Network, with significant input and persistence from our Steering Committee, was successful in securing a two year Transition Coordinator position, to ensure transition pathways, processes, education and resources are embedded as part of the rehabilitation service system. 

Under Transforming Health, there is an ongoing commitment to clinician consultation and engagement. As part of the new governance structure the Minister for Health has appointed a Ministerial Clinical Advisory Group, who will be responsible for providing expert advice and defining projects for Transforming Health. Rehabilitation has been given due attention in the advisory process and several workshops were conducted to identify new strategies to improve service and patient flows. The model of care is being discussed among the Working Committee members for inpatient rehabilitation, early supported discharge, nurse-led rehabilitation, ambulatory services and acute rehabilitation. The Acute Rehabilitation Working Party is in the process of meeting and working on governance structure in the new services. Individual departments will be preparing the documents and there will be a further meeting soon to discuss.

The rehabilitation departments at Hampstead Rehabilitation Centre and Repatriation General Hospital are in the process of relocation. The designs of rehabilitation facilities at the Flinders Medical Centre and the Queen Elizabeth Hospital are under evaluation. There will be 10 acute spinal rehabilitation beds and 6 brain injury beds in the new Royal Adelaide Hospital. Architectural plans for Flinders Medical Centre’s new rehabilitation facility have been drawn and the plans will be presented to the rehabilitation department in next few days.  

The Rehabilitation Medicine Society of Australia and New Zealand

The RMSANZ will not be a federation of individual branches. The local state branches are not a requirement but are allowed. Some states have formed their local state branches such as the New South Wales local RMSANZ branch which has incorporating the AFRM local state branch executive members. The funding will be maintained centrally. Further work needs to be done regarding the formation of special interest groups. There is an interest in forming the local SA branch using the NSW model and having meetings in parallel with the AFRM SA branch meetings. There will be further communication to seek input from all Fellows with regards to the SA RMSANZ branch formation. NT and WA fellows will be included at some stage in formation.

SA Branch Annual Scientific Meeting

The SA Branch Annual Scientific meeting was held on Saturday, 7 November. The guest speaker was Professor Paul Rolan with his presentation ‘Mind the gap – how to treat the complex patient when the evidence base is too patchy’.

Registrar training report

Since 2014, regular monthly weekend teaching was organised which was taken well by the rehabilitation Fellows as well as the trainees. More recently there were concerns about the lack of attendance. To improve the registrar attendance, a system to send RSVPs was introduced which worked well. The consultants are requested to provide their feedback on the Saturday teachings as well. 

Exams

Mock exams were organised for Module II (11 June 2015) and FCE (on 11 July 2015) which attracted interstate candidates (1 in Module II and 6 in FCE). Feedback was generally positive.

3/4 candidates passed the Module II exam. The only registrar enrolled in the FCE exam has also passed. 

Registrar recruitment

Interviews for 16 rehabilitation training positions were conducted on 18 August 2015 and the selection was done using SA Health matching system.

NSW/ACT Branch - Steven Faux 

The NSW Branch of the Faculty met a number of times over the preceding four months, and most recently held an open meeting at the Annual Scientific Meeting in Wellington NZ, which was well attend by over 30 NSW physicians and trainees and 20 went on to have dinner at local restaurant after the meeting.

The main issues that were dealt with were the holding of a Christmas CME event at the RACP Offices in December. We also discussed the NSW committee for the recommendation of trainee appointments which was undertaken under the guidance of John Estel in September this year. 

Dr Estel has completed five years of this activity which occupies a huge amount of his time and the support of his secretary. The NSW Branch of the Faculty extends a great vote of thanks to him for the professional and efficient manner he has undertaken this service. More than 93 trainees were interviewed for over 45 positions in NSW. The issue of the time commitments for this activity was discussed at the open meeting in Wellington and it is clear that some changes may need to be made before next year to minimise the time taken to interview and appoint.

A Yammer account has been set up with the support of the ACI in Rehabilitation Medicine, NSW Health, which is a closed forum of social media available on iPhone and android phones. The Yammer program allows trainees and rehabilitation physicians to exchange brief communication and send each other articles. There is regular use of the website, however despite more than 30 trainees indicating an interest the trainee group only comprises of only 17 members and regular users are few. 

Further, the committee of the Faculty has decided to also act as the interim committee of the NSW/ACT Branch of the RMSANZ and each committee meeting is split between Faculty business and Society business. It is thought that this structure will continue for 12 months until the Society has developed by-laws so that a separate committee can be elected. The Society is in support of this structure.

Thanks go to Phillipa Warnes and Dominique Holt for their support of our Branch’s Faculty business. We look forward to a further year of ongoing activities involving CME weekends and CME evenings.

NeuroSIG – Fary Khan

The first NeuroSIG meeting was held on 4 May 2015 (I commenced the role of Chair in February). The previous Chair, Kong Goh, did an excellent job in furthering the agenda of the NeuroSIG. 

The Committee has been active in organising educational activities. Steven Faux organised two workshops in NSW (Nerve Conduction Studies and Neuroimaging), and we continued with the Annual Rehabilitation Update Day 2015 at the Royal Melbourne Hospital (RMH) – with over 120 attendees. Geoffrey Abbott, Senen Gonzalez and Edwin Luk conducted a spasticity workshop for upskilling trainee injection techniques as part of the program. The feedback received was very encouraging. The next Rehab Update days are 19-20 February 2016 at the RMH (endorsed by the neuroSIG), with workshops on spasticity, research methodology and the role of rehabilitation in global health.

At the AFRM ASM in Wellington New Zealand, both Steven Faux and I organised concurrent workshops on Saturday on rehabilitation updates in various neurological conditions. I also took on the role of invited speaker for the ‘Enabling patients in Disaster Settings’ session at this meeting, owing to my experience leading the Australian Rehabilitation team under the WHO for the Nepal Earthquake Disaster as Lead Task Force. 

In Berlin I was elected as the Secretary of the Committee of Disaster Relief for the ISPRM and was invited by the WHO to be the reviewer for its WHO guidance document on Rehabilitation Competencies in Emergency Settings. These initiatives have improved the awareness and need for an integrated rehabilitation effort in disaster settings. I have also been Lead Task Force for Independently Elected Members for Asia- Oceania for the last three years and will step down at the next ISPRM In May 2016. I have joined the Executive Committee for Womens’ Health ISPRM and have been invited to present at the Kuala Lumpur ISPRM meeting.

Steven Faux is to be commended on his excellent bid for the ISPRM. Unfortunately, it was not successful- but he put in a tremendous effort and made us all proud. 

The Committee is actively involved in organizing the next Annual Scientific Meeting of the Society of Rehabilitation Medicine of Australia and New Zealand to be held from 16-20 October 2016, in Melbourne. 

I thank the committee members for their support and contribution.

Paediatric Rehabilitation SIG - Katherine Langdon

The Paediatric Rehabilitation SIG has had a somewhat frustrating year and, owing to the clash of the AFRM ASM with the AACPDM meeting in San Diego, we were not able to have a face-to-face meeting.  We have had three teleconferences however, and actively quizzed members about the way forward for our group.

The Paediatric Rehabilitation SIG is unusual among SIGs in having a separate stand-alone committee made up of PRSIG members and chaired by Prof Ray Russo, to oversee Paediatric Rehabilitation training and the exams.  Unlike other SIGs therefore, which are charged with training as their primary role, the PRSIG functions to offer a forum: for the dissemination of new ideas; about clinical challenges and also for research and other opportunities. Increasingly across Australia, safety and quality and also efficiency in the provision of health care is under scrutiny and I think the PRSIG has a role in providing an opportunity for discussion around these topics as they affect our practice.  

Many of us are facing physical changes in the way we work owing to upgrades and new hospital builds. Management structures are tightening up along with reduced health budgets and Activity-Based Funding is a reality to be reckoned with. The NDIS is being fully rolled out next year- except in WA. There are some hopeful preliminary signs that the health needs of NDIS consumers are being recognised and that advocacy for their inclusion in plans is not being confused with the hateful propagation of the ‘medical model of disability’.  Advocacy is an important role for the PRSIG and will increase. Advocacy for the sensible utilisation of NDIS funds for evidence-based interventions will be an increasing role of PRSIG members but one we will need to alert the NDIA that we can fulfil.  We need to ensure that disability is not seen as the exclusive domain of Fellows of AFRM but also all Fellows of RACP.  Perhaps the shared working spaces and open plan designs we are moving towards will foster a more collaborative approach.

The PRSIG is keen to maintain its links with AFRM and that may mean the entire body joining the RMSANZ. This new group had its inaugural workshop in Sydney this year and will be instrumental in the planning and organisation of the ASM from here on. Ultimately my understanding is that membership of the RMSANZ will extend to many disciplines working in the field of disability.   

It is advantageous (and may be important for trainees) that the PRSIG has established links to the Division of Paediatrics within the RACP. By far the majority of PRSIG members and Fellows of AFRM are also Fellows of the RACP. We are keen that paediatric trainees can work in rehabilitation medicine as part of their advanced training in paediatrics but it is important that we can ensure that this training is counted. Similarly adult trainees in rehabilitation should be able to consider a term in paediatric rehabilitation medicine training. This kind of exposure will pave the way for better transition into adult care and to increase our skills those of our colleagues.

Close links with the Centre for Research Excellence in Cerebral Palsy have been established with multicentre, multidisciplinary projects underway.  Similarly many PRSIG members are actively involved in the AusACPDM. There is a national database of ITB and also now SDR being established with PRSIG members leading these important projects. 

The PRSIG’s next face-to-face meeting will be held at the AusACPDM meeting being held in Adelaide in March 2016.  Expressions of interest for the position of Chair of the PRSIG are welcome ahead of this meeting and can be forwarded to AFRM@racp.edu.au

I would like to extend my thanks to Dr Simon Paget, Secretary of the PRSIG and also Annette Barker, RACP, for her assistance with administrative support.    

MIND SIG - Barbara Hannon

Two executive teleconferences were held in March and August, with one further executive teleconference to be held before the end of the year.

A webinar  by Dr Craig Hassed was held in May, titled 'Mindfulness in Medicine - What is the new scientific evidence for the Mind-Body Connection?' This stimulated a lot of interest, and was aligned with a breakfast session held at the ASM in Wellington which was presented by Professor Richard Siegart and Dr Alice Threadom, both from New Zealand. A slide copy of the presentation is available on the MIND SIG website.

Conferences 2016

10-13 March 2016
IACFS/ME Biennial Conference
Florida, USA
www.iacfsme.org

23-28 April 2016
20th European Congress of P&RM
ESPRM
Estoril, Portugal
www.esprm2016.com/en  

10-13 May 2016
9th World Congress for NeuroRehabilitation
WFNR
Philadelphia, USA
www.wcnr2016.org 

29 May - 2 June 2016
10th World Congress
ISPRM
Kuala Lumpur, Malaysia
www.isprm.org/

29 May - 2 June 2016

13-15 July 2016
15th International Conference of Computers Helping People with Special Needs (ICCHP)
Linz, Austria
www.icchp.org

25-29 September 2016
One Vision, One Mission - 5th Congress
WUWHS
Florence, Italy
www.wuwhs2016.com

Contributors

Damien Daniel
Steve de Graaff
Vernon Hill
Tim Geraghty
Peter New
Will Taylor
Cynthia Bennett
Andrew Cole
Ranjana Strivastava
Steven Faux
Alex Ganora
Andrew Cole
Emma-Leigh Synnott
Ruth Marshall
Peter Anastassiadis
Fary Khan
Phillip Funnell
Kate Langdon

Disclaimers

Opinions, Accuracy and Advertising

The statements and opinions contained in the articles of this Newsletter are solely those of the individual author and contributors and not of the Australasian Faculty of Rehabilitation Medicine of the Royal Australasian College of Physicians.  The Australasian Faculty of Rehabilitation Medicine of the Royal Australasian College of Physicians disclaims responsibility for the accuracy of the information contained in the scientific articles or advertisements.  The appearance of an advertisement in the Newsletter is not a warranty, endorsement or approval of the products or services advertised or of their effectiveness, quality or safety.

Editorial Policy for written material and letters

Written material and letters will be published at the discretion of the Editor as space permits and are subject to editing and abridgement. Letters will be considered if they are type written double-spaced and do not exceed 300 words. Letters will not be returned unless specifically required.  Members must acknowledge duplication of other material published or submitted for publication and the AFRM reserves the right for appropriate editorial input, which will be discussed with the contributor prior to publication.

Published by:
The Australasian Faculty of Rehabilitation Medicine
145 Macquarie Street
SYDNEY   NSW   2000
Email:  afrm@racp.edu.au
Website:  www.afrm.racp.edu.au 




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