Rhaïa December 2018

AFRM 25th Anniversary Commemorative Edition

Rhaia commemorative edition
Welcome from your President

Welcome to this commemorative edition of Rhaïa to celebrate the 25th anniversary of the Australasian Faculty of Rehabilitation Medicine (AFRM) of the RACP.

In this edition we are featuring articles from a number of Past-Presidents of the Faculty as well as from more recently graduated Fellows to both celebrate the past and look to the future.

The AFRM was formally inducted into the RACP at the College Ceremony on 28 April 1993 in the Great Hall of the University of Sydney. During the ceremony the RACP President presented the Faculty with a caduceus, which was a replica of the silver wand or caduceus given to the RACP by the Royal College of Physicians (London) at the first College Ceremony held in the same location in Sydney on 12 December 1938. At this time, there were about 213 full Fellows and 18 retired Fellows. Most of the Australian College of Rehabilitation Medicine (ACRM) Fellows accepted the invitation to become Founding Fellows of the AFRM and about 50 took the opportunity of receiving their new testamurs during the same ceremony. Dr David Burke was the first Faculty President with Dr William (Bill) Stone as Honorary Treasurer.

The first Annual General Meeting of the Fellows of the AFRM was held in Dunedin, New Zealand on 17 August 1993. At this time the Faculty listed 231 full Fellows and 57 trainees. At the same time that the Faculty was being formed, the ACRM was winding down. If you would like to read more about the history of rehabilitation medicine, please visit the History of Rehabilitation Medicine.

The first edition of Rhaïa Magazine was published in December 1998, having previously been published under the name Newsletter since late 1993. It has been an important and constant method of communication for the AFRM ever since. Not sure what it means or even how to correctly pronounce it? I encourage you to read the short article later in this edition.

As I hope you have already noticed, to celebrate our silver anniversary, we have designed an amended AFRM logo which will be used on Faculty documents and the website. We will continue to look for opportunities to mark the anniversary.

It is very interesting to look back over the last 25 years and see how far we have grown and progressed in that time. Just in numbers alone, from 231 and 57 we now have 611 Fellows and 212 trainees. We have had some remarkable successes over the 25 years of the AFRM – and before that with the ACRM – that are definitely worth celebrating.

We now also have our sister society, the Rehabilitation Medicine Society of Australia and New Zealand (RMSANZ). Together we will work to continue to promote the great value and significance of our specialty – Rehabilitation Medicine.

Co-incidentally, 1993 was also the year that I arrived in cosmopolitan Sydney from sleepy-old Brisbane to commence my training in Rehabilitation Medicine. I will be forever grateful that I discovered Rehabilitation Medicine while working as a junior doctor in the Spinal Injuries Unit in Brisbane a few years earlier. I have loved my work, learnt so much and made great friends in the AFRM over the past 25 years.

All the best.

Professor Tim Geraghty
AFRM President

Do you know what Rhaïa means?

The first edition of the AFRM newsletter with the name Rhaïa was published in December 1998. Previously the regular magazine was just called the Newsletter. Dr Iain Rodger was the editor at the time and came up with the name and provided an explanation of the word Rhaïa.

Rhaïa (pronounced ray-ah) is an abstract noun meaning ‘restoration from illness’ derived from the Ancient Greek verb Rhaidzein meaning ‘to find relief’ or ‘recover from illness’. In my opinion, a pretty appropriate name for our newsletter.

A brief history of the Australasian Faculty of Rehabilitation Medicine

AFRM Presidents

  • Dr David Burke –  April 1992 to March 1994
  • Professor Dennis Smith – March 1994 to March 1995
  • Dr Peshotan (Pesi) Katrak – March 1995 to March 1997
  • Dr William (Bill) Stone – March 1997 to May 1998
  • Professor Hugh Dickson – May 1998 to August 2000
  • Dr Pamela Toni Hogg – August 2000 to May 2002
  • Professor Hugh Dickson – May 2002 to April 2004
  • Associate Professor John Olver – April 2006 to May 2006
  • Dr Garry Pearce – May 2006 to May 2008
  • Dr Stephen Buckley – May 2008 to May 2010
  • Dr Kathleen McCarthy – May 2010 to May 2012
  • Professor Chris Poulos – May 2012 to May 2014
  • Dr Steve de Graaff – May 2014 to May 2016
  • Associate Professor Andrew Cole – May 2016 to May 2018
  • Professor Tim Geraghty – May 2018 to May 2020
  • Dr Greg Bowring – May 2020 to May 2022

AFRM Honorary Secretaries

  • Dr Joseph Sandanam – April 1992 to March 1995
  • Dr Greg Bowring – March 1995 to May 1998
  • Dr Garry Pearce – May 1998 to May 2001
  • Dr Kathleen McCarthy – May 2001 to May 2008

ACRM Presidents

  • Dr Bradley Norington – August 1979 to February 1980
  • Dr George Burniston – February 1980 to 1982
  • Dr Gary Andrews – 1982 to 1983
  • Dr Conrad Winer – 1983 to May 1985
  • Dr Attila Györy – May 1985 to March 1987
  • Dr Robert Oakeshott – March 1987 to March 1989
  • Professor Dennis Smith – March 1989 to April 991
  • Dr David Burke – April 1991 to April 1993
  • Dr Alex Ganora – April 1993 to August 1993

ACRM Honorary Secretaries

  • Dr J E (Ben) Marosszeky – August 1979 to May 1991
  • Dr Joseph Sandanam – May 1991 to April 1992
Rhaia_old issues

Past AFRM President's reflect on 25 years of AFRM

Rhaïa in the noughties and now

My first error was to agree to Garry Pearce’s request “to write something”.

The first week of September 2001 was really quite routine. Unleaded petrol cost 77.9 cents a litre, we parents were driving four teenagers and friends around Sydney in a big red van, the Faculty was housed in a front room at 145 Macquarie St, and the (broadsheet) Saturday Sydney Morning Herald cost $2. Happy days! My diary from then has a great weekly quote from Mark Twain ("I can live for two months on a good compliment") and notes include that our registrar John Estell was due back on Monday the 3rd, from leave at the snow, but was impeded by an unfortunate fracture of one leg.

It was a busy time, as I was due to head off the following week, to attend the American Academy of Physical Medicine and Rehabilitation (AAPMR) meeting in New Orleans. The diary also has reminder notes to pick up travellers’ cheques (remember those?), make final arrangements for my parents’ golden wedding anniversary on the 22nd, organise UNSW student vivas for 2002 and call my father’s cardiologist about a follow-up appointment later in the year.

Anyway, I left home on Sunday morning the 9th, heading for Tokyo (via Perth and Singapore, thanks to a weird round-the-world ticket from the NSW Government travel agent), to see a cancer rehabilitation service there first. I then flew on to Chicago overnight, arriving there on 9/11 around 8.30 am.

On the TVs in the terminal concourse were pictures of a terrible incident: a plane had flown into one of the Twin Towers and by the time I reached the domestic terminal the second tower was on fire. They collapsed one after the other. All US airspace was closed, and we were told by large men carrying very large guns to leave the airport immediately, on the now-free metro to downtown. Airline cabin attendants on the train were in tears, wondering how on earth they would get home to Denver and their children. It was a brutal personal awakening to the world of urban terrorism.

I wandered around deserted city streets, looking for a place to stay, to work out what to do next. All I had to do was get to New Orleans, where four days of prepaid hotel accommodation awaited me. Whilst airspace was closed, it soon became clear that trains were still running as normal, and I found a coach seat on the overnight City of New Orleans Amtrak train, running down the route of the old Illinois Central Railroad, made famous by Casey Jones’ negligent driving. At breakfast on the 12th, we stopped at Memphis, and numbers of Elvis impersonators left the train, and more of them got on. By late that afternoon, we reached New Orleans, and I had arrived at the conference that never was. I did however manage to eat quite a bit of Cajun food and hear good jazz over the remaining days of that week.

Getting out of the USA was just as adventurous, involving taking the Amtrak Crescent Limited train from New Orleans up to Washington DC. I took whatever flight to Europe I could find, picking up the rest of my itinerary in Germany and finally escorting my father’s elderly sister back from London to Sydney, arriving home just two days before the big golden wedding celebrations.

At a Faculty meeting a couple of weeks later, I recounted some of the story of these extraordinary days to Garry, and he asked me “to write something for Rhaïa”. Over a few months, that led me to take on the editing role in early 2002, following after Iain Rodger.

In those years, the editor of Rhaïa had three main tasks. The easiest was to review and edit materials received, and send them on via Sybil, Annette and other Faculty staff to June, who lived somewhere in the Riverina and set up everything into a template, ready for off-set printing. Another task was to ring various people up and ask them “to write something” that fitted with the context of other articles of interest. I have to say that few of our colleagues refused my requests. The final task was the most difficult: write an editorial that might be interesting and relevant to our Fellows and trainees, and to do it in a timely way that did not hold up the production of Rhaïa.

Writing editorials is not easy. They are traditionally placed in the first few pages of a newsletter or journal, they need to say something of interest and relevance in a few hundred words and usually with a real connection to one or more of the main articles following. Topics ranged widely – quality assurance, data collection, models of care etc – with the final one being about succession planning. In those years it was a great joy for me to be speaking with a colleague about something, and have them then to switch to talk about something they had read in a recent Rhaïa.

Rhaïa was produced in a very distinctive format, using colours from the AFRM logo, and by the late noughties was also available in a digital format. Times moved on however, and by the end of the decade, the College developed a new series of common taglines and colour schemes, many still in use today. Unfortunately, the-then senior College administration (like many organisations) equated unity with uniformity and Rhaïa had the same corporate look as other College publications by the time I wrote my last regular editorial at the end of 2012, which was also Sybil’s last month in the Faculty office.

Finally, distribution of the print version of Rhaïa ceased with the end-of-year edition for 2013. I wrote a final guest editorial comparing the disappearance of print in favour of digital, with the disappearance of cash in favour of bank cards. If you have visited any Asian megacity in recent months, you might think that my words written five years ago were quite prescient.

For most people, it is however clear that materials for long-term memory are better read and absorbed from a physical format that you can return to, if interrupted, or review something that wasn’t clear the first time round. In a digital-only format, especially if you follow ‘OHIO’ (Only Handle It Once) Outlook rules and delete after a quick read, or if you think "I’ll read it later", the email drops eventually below the bottom of the screen, into electronic Hades and the full content is never absorbed. Be honest – if we read something really good on-screen and want to retain it long-term, what do many of us do? Print it out, scribble in the margins and dog-ear the pages we really like!

Thank goodness for the genius of Cai Lun, who invented a completely-consistent and reliable recipe for making good quality paper, presented as a gift to the Emperor He of Han, in the year 105 CE. Whilst improved in quality and function over time, the basic invention has never been bettered and there is nothing quite like the smell of a new book, opened to be read for the first time.

I hope you will really enjoy reading this special 25th Faculty Anniversary edition of Rhaïa.

Associate Professor Andrew Cole
AFRM President May 2016 - May 2018

Strong track record of achievement

After serving as Honorary Secretary to the ACRM and AFRM Board of Censors for nearly 15 years, it was an honour to be elected President. My task over those early years of our organisation was to maintain an overall handle on the Board’s diverse activities, which included reviewing trainee applications, answering trainee correspondence, setting and organising Part 1 and Part 2 examinations, accreditation of advanced training positions, reviewing Fellowship applications and ensuring that the Board’s decisions were fair and consistent with current regulations.

AFRM Standards on Rehabilitation Medicine in Public and Private Hospital
The Standards booklet was released in May 1995 during the last  International Society of Physical and Rehabilitation Medicine (ISPRM) Conference in Sydney. The Standards document has proven to be very useful particularly with reference to staffing levels.

Recognition by NSQAC as Consultants in Rehabilitation Medicine
On 16 August 1995, the National Specialist Qualification Advisory Committee (NSQAC)  recommended that AFRM Fellows be recognised as ‘Consultant in Rehabilitation Medicine’ and their services attract rebates under Medicare arrangements at the consultant physician level. This significant event was the culmination of many years of work by several Fellows and has been instrumental in allowing our Fellows to have a viable private practice.

AFRM logo
On 1 December 1995, Faculty Council considered designs for a Faculty logo submitted by three Fellows (Dr Pearce, Dr Fialla and myself) in response to a competition. An innovative design depicting the Southern Cross within three circles representing impairment, disability and handicap submitted by Dr Garry Pearce was voted unanimously (including my vote from the Chair) as the best design. This logo is proudly displayed on all Faculty documents to this day.

Director of Fellowship Training
Dr Phil Funnell was appointed to this part-time salaried position in 1996, leading the RACP President to comment at a College Council meeting that "paying a salary to a Fellow was breaking new ground and setting a precedent".

Special Interest Groups (SIGs)
Faculty Council agreed to my recommendation to establish SIGs to “.. advise the Faculty Council, Executive or Board of Censors on matters related to its core area and to facilitate continuing education in that area”.

Forerunner to AROC
In November 1996, Dr Garry Pearce and the AFRM Clinical Assessment Committee successfully obtained a grant of $86,000 from the Commonwealth “to enable the AFRM to establish, in conjunction with other relevant specialties and administrative bodies, an agreed set of definitions and standards for Rehabilitation Medicine which will be useful for casemix improvement, clinical study and epidemiological analysis.”. This led eventually to the establishment of Australasian Rehabilitation Outcomes Centre (AROC) a few years later.

Faculty Medal
As President I had the privilege to award the inaugural Faculty Medal in 1997 to Dr Ben Marroszeky. His citation deservedly concluded with “there can be few, if any of our Fellows at any stage of our history who have given more of their time and energy to the interest of their Fellows”.

Sybil Apted (nee Cumming)
In May 1996, AFRM was fortunate to attract Sybil to the position of Executive Officer of AFRM from another section of RACP. Sybil continued as the ever reliable and super-efficient ‘rock’ behind every Faculty President for over 20 years and still continues to serve our Specialty as the Administrative Officer for RMSANZ. We are indeed very fortunate to have her.

Dr Pesi Katrak AM
AFRM President March 1995 – March 1997

Advocacy and achievements make a lasting difference

I became President of the Faculty in 1997. This was an exhilarating experience though also a huge load, especially for someone not salaried. However, I had a great Faculty Council and a wonderful Executive Officer in Sybil Cumming. I made sure I shared the load as much as possible, though it was necessarily very much a  'Presidential' modus operandi at that time. 

Probably the most outstanding thing we achieved was the establishment of the AROC. This initially involved difficult calls to Carl Granger and his colleagues at the Uniform Data System for Medical Rehabilitation at the State University of New York at Buffalo - the owners of Functional Independence Measure (FIM). Once the international arrangements were in place, Dr Ben Marosszeky, then Dr Garry Pearce, both did splendid jobs in working with the University of Wollongong to set up AROC and develop it into a truly wonderful benchmarking system. We were able to get seven parties to fund the establishment of AROC, and we were most grateful for their significant contributions. We were also much assisted by the Federal Department of Health giving us $86,000 to develop the Australian data set. This grant was then repeated after I had ceased the Presidency. 

Probably the second most important thing during my Presidency was our training becoming the best organised in the College. We were able to appoint a Project Coordinator who surveyed every Fellow of the Faculty. The funding for the Project was provided by Allergan, courtesy of the efforts of Associate Professor Barry Rawicki. This Training and Assessment Review Project, overseen by Dr Phil Funnell, was a tremendous success. It has since been further reviewed in light of changes the RACP was wishing us to consider. When the Australian Medical Council (AMC) assessed our Training and Assessment program, they recommended to the RACP they could benefit by adopting many of the things we had implemented. 

Thirdly, at that time we started to implement the objective structured clinical examination (OSCE) format of examination. The only other medical body in Australia implementing the OSCE format at that time was the College of Ophthalmologists. 

We were also discussing the possibility of secure exchange of examination questions with the American College of Physical Medicine and Rehabilitation. 

Fourthly, as President, I had to mount a major fight with the private health insurers as they wanted to cease funding rehabilitation and psychiatry. This was a very difficult and very time consuming period, and eventually I was much assisted by a lobbyist used by Australian Hospital Care (AHC). I was able to gain a lot of support from the bureaucrats, but I had trouble gaining the support of the politicians. This was where the lobbyist was invaluable. 

Where would our private rehabilitation facilities be today if this fight, and it was a fight, had not been successful? 

Dr William (Bill) Stone
AFRM President March 1997- May 1998

Leadership in the new millennium 

I was honored to have been elected as AFRM President in 2000, the year of the Sydney Olympics, a time of great optimism. I was surprised to have been elected to represent my peers as I was a woman, mother of school-aged children, from a regional center (Geelong), working part-time and not a professor.

It was a complex time for the medical colleges, facing scrutiny and criticism from the National Competition Commission for allegedly limiting the number of specialist trainees for reasons of self interest. At the time the Faculty was very small and facing a shortage of trainees, taking every opportunity to promote the specialty to government, health services, other medical specialties, universities and the community.

AFRM achieved a representation to influence policy at the highest level vastly out of proportion to our size. I regularly attended national meetings of the Council of Medical Presidents with Federal Health Ministers (one of whom had been my resident when I had been a registrar and therefore was fully aware of the benefits of Rehabilitation), Shadow Ministers, Federal and State Health Departments, Presidents of other Medical Colleges, University Deans, the Chair of the National Health and Medical Research Council (NHMRC) and other august bodies. I was awed to be at the table with people who had been leaders of the profession when I was a student. Yet, whenever there was a question regarding disability or recovery from injury or illness, it was my voice that was sought. One of the meetings achieved a promise from the Federal Health Minister to set sub acute service targets with the states as part of the health services agreement.

The Olympics and Paralymics gave us the opportunity to reflect on the meaning of sport to our community and to focus on ability and participation rather than disability, and reminded us that the goals of rehabilitation are about return to meaningful activity rather than discharge from hospital.

I had the privilege of managing the final negotiations to establish the AROC. There had been an enormous amount of lobbying and preliminary work done by AFRM Fellows in preparation but I had the task of negotiating the final business model with the Commonwealth, State Health Departments, consumers, Private Health Insurers, Private Hospital Association and the University of Wollongong. It was immensely satisfying to get the negotiations over the line and to see the benefits of AROC. It is still one of the faculty’s most significant achievements.

My term as President was enormously rewarding, exposing me to the complexity of the entire healthcare system, enabling relationships to be established with other medical and allied health specialties and concluded with one of the most memorable Annual Scientific Meetings (ASMs) and conference dinners in Brisbane.

As I read my old President’s Reports and reflected on the fantastic experiences and skills I gained, I did wonder, why, in a specialty with high female participation, there has only been one other female President in the 16 years since I served.

Dr Pamela (Toni) Hogg
AFRM President August 2000 - May 2002

Promoting AFRM on the world stage

I assumed the mantle of President of the Faculty in 2004 after taking over from Hugh Dickson when he completed his second term as President. At the time Sybil Cumming was our Senior Executive Officer, but in July of 2004 she moved to Cairns precipitating a shuffle of responsibilities which saw Rebecca Bermingham take over as Senior Executive Officer, a position she held throughout most of my term. Sybil continued to work from Cairns with responsibilities including the Board of Censors and the Australian Medical Council (AMC) accreditation.

One of the themes which ran through my years as President was to promote the Faculty and Australian Rehabilitation Medicine on the international stage. I was the Faculty Representative on the International Brain Injury Association organising committee for a combined meeting with our Faculty ASM in Melbourne in May 2005. The success of this collaboration with 1,100 delegates led to a successful bid for the 2012 World Federation of Neurological Rehabilitation Conference. This combined meeting in Melbourne which I was privileged to chair with our ASM had 1,830 delegates and was a success from a scientific and financial viewpoint.

During my Presidency we met with a delegation from Saudi Arabia to sign a Memorandum of Understanding (MOU) as we were training some of their future rehabilitation physicians in our program (mainly Sydney based). Our Fellows were assisting them to set up their own training program. We also had registrars coming from Malaysia to train in rehabilitation units in Melbourne and Sydney and some of our Fellows were examiners in the University of Malaya Rehabilitation Training Program.

In 2006 we set up the International Affairs Committee as a Faculty Council Committee, to continue to promote liaison with international bodies in our sub-specialty areas.

In 2004 the Faculty combined for the first time with the Australian Society for Geriatric Medicine for a meeting in Perth which attracted over 500 delegates

A significant event which also occurred in 2004 was the audit of the RACP by the AMC. Rebecca and I were present at the presentation of their findings in a RACP Council Meeting. It was particularly pleasing that the Faculty was singled out as having a robust training and examination process by the AMC. Following this review the RACP launched a series of strategic planning meetings which were to review the role of Council and the relationships within the RACP, including the Faculties. During my term as President I went to the first of these meetings. At this time the Faculty enjoyed autonomy in its examination processes and financial management. As part of a re-alignment, however, the Faculty started the process in 2005 of amalgamating our Board of Censors with our Board of Continuing Professional Development (CPD) to form a single Board of Education and Standards.

Also in 2005 a new strategic plan was developed to guide priorities for 2006-2008 and we re-drafted the 1995 Standards for Adult Rehabilitation Medicine Services in Public and Private Hospitals. We also endorsed a policy on land mines and successfully bid for a grant to support our rural education.

During 2006 we started the idea of arranging an annual meeting between the Faculty Council and Past Presidents to discuss developing issues of the day. In 2006, I completed my term as President and handed over to Dr Garry Pearce.

Associate Professor John Olver
AFRM President April 2004 - May 2006

A resilient Faculty and strong Society

I was elected to commence my Vice Presidency under the leadership of Dr Garry Pearce, in 2006.

During the next two years Garry instituted an extensive research project (Tavener), with the goal of raising awareness of Rehabilitation Medicine in both the health sector, and with the general public. He determined that there was no point of contact for rehabilitation medicine in the Federal Department of Health (DOH) and commenced the long project to establish formal links.

During this period, the RACP CEO resigned from his position and the RACP Treasurer retired. Following this, a very energetic new CEO joined the College but then died very suddenly just before Garry’s term ended. Garry was the Faculties representative on the College executive over those years and did much to assist the College through those difficult times. I feel with the loss of continuity in College leadership, much of Garry’s work was neither minuted nor remembered.

However, his work for the Faculty proceeded apace and a formal strategy for the Faculty was developed, early links with the DOH were established, and recognition of our training program was proposed by the Australian Medical Council as a model for the College.

In December 2007, a Labor Government under Kevin Rudd was elected. A new emphasis on engagement with the DOH began after a long period under John Howard, when the federal government was devolving responsibility to the states. This coincided with our own efforts to highlight the importance of rehabilitation medicine to the overall system. Several inquiries were established, and the Faculty had the opportunity to use the information and insights that had been gleaned to influence those inquiries.

As President, I was able to address some of these with then Health Minister, Ms Nicola Roxon. A formal subcommittee in the DOH (Sub-Acute Care) was instituted and regular meetings commenced.

A critical issue at the time was our insistence that rehabilitation medicine controlled the 'back door' of hospitals, and complex long stay patients were best and most quickly discharged if rehabilitation medicine services were properly funded.

Dr Garry Pearce had worked for years to commence and develop the AROC. The availability of such extensive data about rehabilitation medicine put us in a unique place when developing our positions on key issues and converting stakeholders to our point of view. No other speciality in medicine, as far as we could see, had anything like it.

At one point it seemed that the federal government might even take over healthcare altogether because it seemed that Mr Rudd was heading that way. It became apparent that the states would never relinquish their control, held since federation.

In the Labor budget of 2009 it seemed that all our Christmases had arrived because $2 billion was set aside for sub-acute care. At that time sub-acute care was 80 per cent rehabilitation, 10 per cent palliative care and 10 per cent psycho-geriatric care. In the same budget, there was almost no new funding for mental health, which had been screaming for assistance.

In hindsight, the inevitable occurred. The funding was given in untied form to the states, and the vast majority was spent in mental health, who suddenly found that they actually provided sub-acute care. There were benefits for rehabilitation. Much of our Specialist Management with Acute Rehabilitation Treatment (SMART type rehabilitation services) were developed with that funding, as well as some service improvements in other contexts, depending on state-based preferences. The lesson we learnt was to maintain very active state-based political contacts, as well as federal.

With new College leadership from 2007 to 2009, there was a very commendable effort to reign in College expenditure. Millions of dollars in savings were made each year but by the end of my Presidency it was apparent that the College intended to remove the relative financial independence of the Faculties. Dr Kathleen McCarthy was left with the very difficult result of our finances being absorbed by the College altogether. The inevitable result has been the need to develop the Society.

This difficulty with the College remains my greatest regret, although financial independence through the Society may be a much more secure position into the future.

Efforts to reignite our engagement with other health professionals in rehabilitation medicine also commenced during this period. The Australian Rehabilitation Alliance was formed, with several meetings between the Faculty, and leaders of the other rehabilitation health professions. The Faculty provided all the funding for this enterprise but despite our best efforts to maintain contacts, financial issues could not be resolved with the College.

It remains my belief that 'leadership' within the medical/health world will only be achieved by engagement with all the health professions. Under present circumstances, medicine and doctors do not engage sufficiently to maintain such a “leadership” role, other than in our own minds.

Dr Kathleen McCarthy as VP, worked very hard to support me through my time and was left with one of the most difficult situations that the Faculty has encountered in its relationship with the College. Fortunately, much of that is behind us, and subsequent changes in College management have diluted the effects of our difficulties back then. The establishment of the Society has been a vital part of our independence and I commend the leadership of the Society in developing this really important initiative for our future.

It was always my observation that the Faculty had an extraordinarily high proportion of Fellows actively engaged in its business, sitting on numerous committees, with few who only observed from the sidelines. The support from our staff – Sybil Cumming, Rebecca Udemans and Rebecca Forbes – was also overwhelmingly effective and without them, little could have been achieved. The friendships I have made in the Faculty are a life-long pleasure.


Dr Stephen Buckley
AFRM President May 2008 - May 2010

Rising to the challenge and creating lasting change

It is marvellous to be celebrating 25 years of the AFRM. I have been extremely grateful to have played a part and applaud all who have contributed to ensuring that a small enthusiastic group of those dedicated to rehabilitation medicine as a profession, accomplished the feat of setting up the Faculty and enabled it to thrive in a complex and at times fraught medical environment.

I was a late comer to rehabilitation medicine, having first dallied with Geriatric Medicine. After seeing rehabilitation in practice under Drs Ben Marosszeky, Stephen Buckley and Tom O’Neill, l moved to the right path. This followed the excellent advice from someone who rose to President of the Faculty, that if he can pass the exam so could I. I received my Fellowship of the Australasian College of Rehabilitation Medicine in 1992. There were four candidates at my part 2 clinical exams which were held in South Sydney Hospital. This seems a world away from the recent excellently run OSCE which had well over 50 candidates.

The same year, I became a State and Federal Councillor ably trained by Jenny Ault. It was a pleasure to be part of the change from ACRM to AFRM. I well recall in 1993 the inaugural Faculty Council in the very grand RACP Council Room. After holding meetings in less plush settings as a College, such a transition meant that our small organisation needed to become more professional and at the forefront of medical education to survive.

From 1995 to 1997, I was Assistant Honorary Secretary, Board of Censors. Then from 1997 to 2007 I was Honorary Secretary of the Faculty Education Committee. This came about after meeting with Dr Stephen Buckley who asked if I wanted the role. I had recently read that a good way of approaching life was to say "yes" to any invitation to work. I learnt many years down the track that to say "no" was just as important.

During my time in Education, I helped to change the Faculty to a professional, responsive and well-grounded medical educator and credentialing organisation. Dr Phil Funnell’s work on the curriculum, syllabus and examinations was vital in this process. I applaud the foresight of the Council and Board of Censors for undertaking this seminal work. It meant that well before the AMC review of the RACP occurred, the Faculty was well positioned to cope with anything. Then the Faulty achieved glowing reports with very few suggestions of change. It was recognised as being the leader in education in RACP.

During this time, the examinations structure evolved from an event that one person convened, devised and wrote the questions and organised patients and marked the answers (of the essay papers, and initially MCQs which were thankfully computerised later). It changed to an OSCE with its committees, statistical data over many years to ensure consistency, and a vigorous process with separate committees for multiple choice questions (MCQ) with training by American Board credentialing colleagues, short answer papers and so on. I look back at the time when the staff (not yet management) and I did all this ourselves and truly wonder.

I then became Honorary Secretary from 2001 to 2010 and again helped in the transition to more proficient in our dealings both internally and externally. It was a time of enormous change within the RACP as it underwent the same painful process of developing into a 21st century medical educator and policy maker.

Advocacy was identified as a great need and successive Presidents developed relationships with the Federal Government as the State branches were working on similar interactions. From 2007 until 2010, I was the inaugural Chair of the Faculty Policy & Advocacy Committee. This was an interesting time as the RACP was becoming more aware of the various components of the RACP and now wished to have a more integrated College. Until this time, the Faculty had functioned autonomously and the need to alter our ways to suit the greater good was complex and stressful. However, there was good will and determination on both sides.

From 2010 to 2012 I was President and a Director on the Board and on its executive. This was a very steep learning curve and an enormous workload while I still had a full-time job. I am grateful to Dr Ben Marosszeky and Dr Joe Gurka that they tolerated my need to spend time on Faculty affairs.

My achievements, again during an extremely stressful period in RACP, involved ensuring that our money, which was at risk of being consigned to general RACP funds, became the nucleus of a large research and education fund. I also developed lasting relationships with the Presidents of the other faculties and became more aware and understanding of the issues within the RACP and in medical advocacy externally.

The Faculty developed the National Statement on Rehabilitation Medicine through the unstinting efforts of Dr Stephen Buckley. This statement enabled the Faculty to develop awareness of rehabilitation and its benefits in the federal and state jurisdictions at a time when Rehabilitation Medicine was seen as less important. The establishment of the sub acute service concept and pricing for such services was much informed by the Statement. I was able to export so to speak the National Statement to New Zealand and it was gratifying to see it become adapted and revised to meet the needs of Rehabilitation Medicine there.

Another achievement was the establishment of the Australian Rehabilitation Alliance driven again by Dr Stephen Buckley. It brought together all the peak associations dealing with rehabilitation including nursing and allied health professionals. It was warmly accepted by our team colleagues but could not be funded through RACP structure at that time. Perhaps in the future it may have a new home?

I also count as an achievement that I was the first to raise the option of a Society of Rehabilitation Medicine physicians which would allow advocacy and involvement in areas that were not feasible within a learned College. This became a reality and I am now on the Board of the RMSANZ.

I have been so fortunate to have worked with selfless and dedicated colleagues who were unstinting in the advice and help. I also have the deepest respect for Sybil Cumming, Rebecca Udemans and Rebecca Forbes who were as dedicated as any Fellow. They empowered the Faculty to achieve the gains that we made and managed a huge workload, inadequate resources and me very well.

Dr Kathleen McCarthy
AFRM President May 2010 - May 2012

What went down on my beat

As I look back on my term as President, I think the overarching theme that I tried to adopt was for us to ‘look forward’ as a Faculty.

In my final President’s Report for Rhaïa in March 2014 I wrote: "The AFRM needs to be a dynamic body. I am firmly of the view that we must constantly adapt to keep pace with our ever changing environment – both the external environment and that within the College itself. This should not be 'change for change’s sake', but deliberate and considered change that will help us to continue to deliver the best possible care to our patients."

This is as true today as it was four years ago. But what did it mean for the issues and initiatives that were addressed during my tenure? Reflecting, the main ones were:

RMSANZ
It became clear that we needed another body, separate to the AFRM, to fully represent the interests of the rehabilitation sector and rehabilitation medicine physicians. I am pleased to say that we established the foundations for the RMSANZ, with the launch of the Society later in 2014. The Society has been a resounding success, especially in terms of the provision of continuing medical education (CME(). As it matures, the Society’s advocacy role can and should develop further.

Training
In December 2012 I wrote a piece for Rhaïa titled Is it time for change?. This coincided with the 40th anniversary of the election of the Whitlam Government, which had a highly successful advertising campaign featuring the “It's Time” jingle. The change I was referring to was the need to update our training program so as to best address the needs of the profession in coming years. What followed was significant debate within the Faculty, and a report (The Rehabilitation Trainee of the Future), written by Dr Shari Parker and delivered to Fellows following the conclusion of my tenure. Discussion about our training program, including consideration that our trainees should undertake basic physician training, flowed freely. My personal perspective then, and now, is that our trainees need more exposure to dealing with disability in the context of increasing medical complexity, as that is becoming the norm with population ageing. Our training program needs to deliver this.

Horizon Paper 
During my term we also had the College fund a strategy paper – the AFRM Horizon Paper – which was broad in scope, including visibility of rehabilitation medicine, changes in models of care and demographics, and where rehabilitation medicine could position itself for the future. This paper, too, was delivered post my tenure. It is an excellent piece of work and, after a re-read for this article, I am of the view that the Horizon Paper remains highly relevant today.

Ambulatory Rehabilitation Standards
Following a rather prolonged process, the Ambulatory Rehabilitation Standards were developed and endorsed. The importance of this is that growth in rehabilitation services will be biased towards the community in the future. This is already occurring now with some private health insurers.

Where to now?
Now that we are ‘post-Society’, the challenge is for both the Faculty and the Society to work effectively together in a coordinated way. While there is a clear demarcation in responsibilities between registrar training (Faculty), and events (Society), we need a more coordinated approach to dealing with the big strategic issues facing rehabilitation medicine.

Professor Chris Poulos
AFRM President May 2012 - May 2014

Productivity a pivotal part of Presidency

It is an honour to be asked to reflect on my term as President of AFRM in this 25th Anniversary edition of Rhaïa. I believe it was a productive period for the Faculty in a time of significant change both for the Faculty and within the College.

The 2014 ASM in Adelaide was an outstanding meeting with the organising committee producing a high quality educational program which highlighted the great work undertaken by our Fellows and trainees. This set the bar higher for the 2015 ASM in Wellington. Our New Zealand Branch, in association with the New Zealand Rehabilitation Association (NZRA), produced an exceptional meeting with strong research and educational components as well as being fiscally robust. This laid the foundations for future ASMs being the responsibility of the RMSANZ but with the Faculty continuing to assist with the educational components of these meetings. There has also been an increased role for the Faculty in RACP Congress.

The Call for a New Zealand Rehabilitation Strategy was launched at the Wellington ASM. This Strategy has been incorporated prominently into the overall New Zealand Health Strategy.

The annual Trainees' Meetings became a priority on the educational calendar. These meetings have been extremely well attended with enthusiasm abounding and a clear desire for more educational events for trainees where possible. I remain grateful to all the Fellows and administration staff who put in the precious time at these meetings to assist in the education of our trainees.

It was reassuring to be part of the RMSANZ evolution with the development of the Memorandum of Collaboration on behalf of the College occurring soon after my Presidency. Dr Alex Ganora and the RMSANZ Committee were great to work with over my two years as President. Discussions and interactions continue to make this relationship strong and productive.

The Horizon Report and Trainee of the Future document continued to develop. There was significant feedback into these important projects and an all day workshop prior to the RMSANZ ASM in Melbourne in October 2016 was undertaken to ensure the Faculty remained influential and relevant in the health environment.

As part of the  AFRM Council Strategic Plan there was an emphasis on setting up a Rehabilitation Research Network which is now developing rapidly.

National Disability Insurance Scheme (NDIS) discussions occurred regularly. It is pleasing to note that the National Disability Insurance Agency (NDIA) came to us for advice and I believe we did have an influence on the rollout of this critical community program.

I had the privilege of participating in the College Ceremony at RACP Congress. This is an extremely important role for the Faculty President. Being able to welcome new Fellows in 2015 and 2016 was certainly a highlight of my Presidency.

Another great thrill was the awarding of the RACP Medal for Clinical Service in Rural and Remote Areas in 2016 to Associate Professor Adam Scheinberg, one of our outstanding Paediatric Rehabilitation Physicians. 

I handed the Presidency to Associate Professor Andrew Cole on May 16 2016. Andrew was a tremendous support to me and I will be eternally grateful to him for his advice and discussion. The Faculty was extremely fortunate to have Andrew at the helm and now Professor Tim Geraghty is doing an outstanding job as President. Photo - Steve De Graaff Article

I would like to thank all Fellows and trainees who have and continue to work tirelessly on Council, Committees and special Projects on behalf of the Faculty. Your efforts do not go unnoticed and are greatly appreciated

Also thank you to the Faculty Office for all the work you do. You are the engine room of the Faculty and your input makes our roles much easier.

Dr Steve de Graaff
AFPHM President May 2014 - May 2016

Fellows reflect on AFRM as part of 25th anniversary celebrations

Proud to be a Rehabilitation Medicine Physician

In the UK, during my medical training, Rehabilitation Medicine was a burgeoning speciality. None of my contemporaries, nor myself had had any exposure to it and there were few advanced training opportunities available. I completed a Diploma in Geriatric Medicine and found myself in Australia sitting opposite Professor Tim Geraghty enquiring about rehabilitation medicine. This seemed like a practical speciality with a multi-dimensional care approach that had a tangible effect on how patients live their lives. I was thrilled to be appointed as a registrar in a small hospital in Caloundra on the Sunshine Coast in Queensland. I met a wonderful and experienced multidisciplinary team and have never looked back. 

The recognition and emphasis on functional recovery for patients, the variety of conditions, the strong focus on teamwork and the opportunity and privilege to work with patients whose lives were in turmoil, drew me in. No two patients are the same. Managing complex disability and how this impacts each person and their families and carers constantly provides new challenges. I have met some fabulous consultants and mentors during my years of training and even now working as a Rehabilitation specialist at the Gold Coast University Hospital.

When talking to those more experienced and established in the field, it seems that the face of adult rehabilitation medicine is changing. Our scope of practice continues to be defined and re-defined and perhaps as a group, we take some control over this. There are opportunities of expansion with in-reach models into acute medicine and trauma, peri-operative care, prolonged disorders of consciousness and minimally conscious patients. Potential also exists in paediatric transition services, research and technological innovation, community programs and Australia's NDIS, occupational and pain medicine as well as cancer and palliative rehabilitation. As one of the newer Fellows in the speciality, part of our role may be to keep abreast of these sub-speciality areas, pursue novel professional development opportunities, expand our speciality and permeate the philosophy of Rehabilitation medicine throughout the healthcare setting.

No doubt, a patient remembers their rehabilitation medicine physician. We guide them through living with their disability, take the time to connect with patients and their families, provide invaluable education and co-ordination of care as well as help these people find a meaningful place in their world.

Dr Teresa Boyle

Why I love being a Rehabilitation Medicine Physician

She sat motionless. The tray remained untouched in front of her. Her eyes looked at me helplessly for a brief moment, and then looked quickly away.

She was only young. Left school at 15. She’d come speeding around a wet corner, unlicensed. Straight into a tree. Cardiac arrest at the scene. Significant head injuries. Airlifted to the closest trauma centre. And here she was, several months later.

Fast forward eighteen months, and I was attending her “Brain Injury Rehabilitation Graduation”. She had learnt how to walk again, feed and dress herself. She’d even begun jogging – no mean feat when spasticity and impaired balance dogged her every step.

With her determination, and months of rehabilitation by her dedicated multi-disciplinary team and a very supportive community case manager, Sarah (not her real name) had turned her life around. She was back home, slowly returning to an increasing amount of daily chores, and caring for her children. She’d even begun studying at TAFE.

Not everybody does as well as Sarah did. But big gains or small, each person’s story inspires and humbles me. This is why I love being a rehabilitation medicine physician.

Dr Karen Chia

Facing the future with confidence and optimism

I was so pleased to become a rehabilitation medicine physician in January 2014. It felt like the right place for me, I could easily get lost in the flow of rehabilitation ideas and I enjoyed the multifaceted and practical work with clinicians who were humble, gracious and intensely interested in the human condition (my type of girl/guy). I was ready to take off in my career.

Then my focus was diverted because, guess what, life happened – as it tends to do of course. My recent years have been both ordinary (young kids- one who can’t sleep- even at three-and-a-half) and a bit more extraordinary (like a hellish month I had in 2017 accompanying both parents through neuro intensive care units in quick succession with serious illness and injury, quickly followed by the very un-fantastic personal experience of breast cancer age 37). ‘There but by the grace of randomness go I’: there can be no surprises if sometimes you are the “I”.

So I have been a bit slow to get going really, but my thoughts are now turning to the hope of a more positive and stable future with older children who are less exhausting (don’t tell me its not true - please), where I can give my practice of medicine a little more energy. The only thing to do is to find a way to grow from whatever life might throw at you and the more experiences you collect the better a doctor you become, because you learn more about what it means to be human.

I have just been to World Stroke Congress 2018 which was amazing because of the incredible trials being presented. I did find myself a little envious of how neatly neurologists can package up their patients (outcomes were death, new radiological events, or if they were feeling complicated, the modified Rankin Scale- reducing a person to a number 0-6 - how straightforward).

Being a rehabilitation medicine physician is a lot more complicated in some ways. For every patient we meet we wade afresh through the muddy waters of the biopsychosocial model and the International Classification of Functioning (ICF), coming to an understanding of their place in the world, their values, their resilience, and the scope and effect of this sudden awful thing that has happened to them. To be a good rehabilitation medicine physician we have to be able to authentically communicate that we understand where they are at, and that we are able to do something meaningful to help when, to them, all has spiralled out of control. We can only do this well using a combination of three things: ongoing conscientious study to keep abreast of evidence based medicine, collecting experience with our own patients (and having an ability to learn from them), and having the strength to draw on ones own life experiences – good and bad.

I am still so pleased I am a rehabilitation medicine physician and it continues to suit me well because I value the richness of humanity and I don’t want to reduce things to numbers, or black and white (CT scans).

Dr Jasmine Gilchrist and family

Dr Jasmine Gilchrist

AROC – only a vision 25 years ago; today rehabilitation is leading the way in the measurement and benchmarking of outcomes

As many of you would be aware, the AROC was the brainchild of two well known and highly respected Rehabilitation Medicine Physicians, Drs Ben Marosszeky and Garry Pearce. In this 25th anniversary edition of Rhaïa, I thought it appropriate to reflect on the history of AROC, given that it was probably about 25 years ago that the idea began as a twinkle in Ben and Garry’s eyes.

Sixteen years ago the AROC opened its doors, but the idea behind establishing an outcomes benchmarking initiative for rehabilitation was conceived quite a few years earlier.

It was actually in May 1998, through the endeavours of Dr Garry Pearce, the Faculty’s Honorary Secretary at the time, that AFRM was awarded a Federal Government grant to develop a standard data set for rehabilitation. This was considered to be essential for the development of the comparable measurement of outcomes of patient care. It was recognised that the collection and analysis of outcome information would assist in the development of clinical protocols for rehabilitation, help the interpretation of outcome and service utilisation data, and assist in the development of quality improvement initiatives and in the interpretation of variations between service providers (1).

A project officer, Lyn Arnold, was employed and with the support of more than 85 per cent of the Fellowship who completed the survey form, an Australian Minimum Data Set for Rehabilitation Medicine was developed (1).

Dr Garry Pearce submitted another successful proposal for additional funding to assist in the establishment of a national outcomes benchmarking centre in collaboration with the Centre for Health Service Development (CHSD) at the University of Wollongong. As a result of this successful collaboration, and with further funding support from key stakeholders in the rehabilitation sector, the AROC was established.

From small beginnings, AROC worked to recruit all inpatient rehabilitation services to become members and participate in the national benchmarking initiative.  Members collect data describing each episode of inpatient rehabilitation they provide and submit it to AROC.  AROC provides members with six monthly benchmarking reports comparing their outcomes with those of peer services, and with the national data.  It also holds benchmarking workshops which aim to identify best practice processes, infrastructure and models of care and promote the uptake of these across the sector.

By 2008 almost all inpatient rehabilitation services were members of AROC and benchmarking in rehabilitation in Australia had become a reality. In the years since, not only has rehabilitation as a sector expanded but AROC has evolved. The dataset has been updated, the benchmarking initiative has expanded to include New Zeland, paediatric rehabilitation, ambulatory rehabilitation, and to cover newer models of care such as  in-reach rehabilitation. Today AROC members number 292 services, and between them they submit data describing more than 140,000 episodes of rehabilitation each year. The AROC database holds more than a million records describing rehabilitation outcomes, and is a rich source of information.

What will the next 20 or 25 years hold?  My crystal ball is not telling, but I do know that rehabilitation plays an increasingly important role within the health system, and AROC, as the clinical quality registry and outcomes benchmarking arm of AFRM and the rehabilitation sector, will continue to play an important role in driving continued improvement in rehabilitation outcomes, and in providing evidence of the value of rehabilitation not only to individuals but also to the broader health sector.

  1. A Brief History of the AFRM, Chapter 5

Growth in AROC inpatient data

Growth in AROC inpatient data

Frances Simmonds
AROC Director

Faculty Council – November 2018 report

Faculty Council Member

Position

Professor Tim Geraghty

AFRM President

Associate Professor Andrew Cole

Immediate Past President

Dr Greg Bowring

AFRM President-elect

Dr Michael Johnson

Faculty Education Committee Chair

Dr Venugopal Kochiyil

SA/NT representative

Dr David Murphy

VIC/TAS representative

Dr Cynthia Bennett

NZ representative

Dr David Eckerman

QLD representative

Dr Jon Ho Chan

WA representative

Dr Ashlyn Alex

Trainee representative

Vacant

NSW/ACT representative

Dr Lisa Copeland

Paediatric representative

It has been another busy year for Faculty Council and I would like to thank all members for their significant contributions and commitment to the effective running of the Committee.

Council Work Updates

Ongoing Matters

AFRM Value Proposition and Narrative document
This document was endorsed by AFRM Council, at the November teleconference meeting.

Review of AFRM Inpatient Standards document
A response was received from the Allied Health Professionals Association which suggested minor amendments and the document will be reviewed and hopefully finalised very soon. It will then come to Council and FPAC for endorsement out of session.

Regular communication with the RMSANZ
Council Executive has continued regular teleconferences (every second month) with RMSANZ and has discussed a number of specific issues including RMSANZ endorsement of the Rehabilitation Medicine Evolve list, the WorkCover Queensland issue and the Medical Journal of Australia (MJA) article regarding rehabilitation following total knee replacement and response.

Opportunity for additional registrar training positions through Health Workforce NZ (HWNZ)
There has been no further communication from Health Workforce NZ regarding the registration of interest (ROI) submitted by the AFRM NZ Committee for the funding of two additional registrar training positions in NZ.

WorkCover Qld Issue
On behalf of the AFRM, I have written to WorkCover Queensland to express our concern regarding their decision to no longer have Rehabilitation Medicine represented on their Independent Medical Examination panel. We have not had a response to the issue at this stage although I am aware that a meeting has occurred between Saul Geffen and Workcover. The RMSANZ has also responded on this issue.

New Matters

Draft AFRM Work Plan
Following on from our work at the strategic planning day, the Executive office staff and I have worked on the first draft of the AFRM Work Plan which was presented to AFRM Council at the November teleconference meeting.

MJA article on rehabilitation following total knee replacement 
This article will not be published until early 2019. AROC and RMSANZ also wrote letters to the editor.

25th Anniversary Commemorative edition of Rhaia
Planning is continuing for the special edition of Rhaia to commemorate this years’ AFRM 25th Anniversary.

Contact from Medibank Private to discuss Rehabilitation in the Home models
We have been contacted by a representative of Medibank Private to open discussions regarding the Rehabilitation at Home program. The first meeting is being organised at present.

College Council and Ceremony
I attended the College Council meeting and RACP Convocation Ceremony on 4 and 5 October in Melbourne.

The College Board established the College Council in 2015 to act as its peak advisory body on strategic and cross-College issues. As a senior advisory body, the Council makes recommendations to the Board by consensus. More information can be found on the RACP website. College Council is likely to be increasingly important to the AFRM now that the Board re-structure has been completed and the Faculty is not directly represented on the Board. The new College Board Strategic plan was discussed on the day allowing attendees input to the plan which was very useful.

While in Melbourne I also had the pleasure of attending my first Convocation Ceremony as Faculty President. It was an honour and privilege to be able to hand their testamurs to our newest AFRM Fellows and it also gave me the opportunity to reflect on when I was in that same position myself. To me, this seems both a very long time ago (1997) but then again, only yesterday: I congratulate all of our new Fellows and hope that they have rich and fulfilling careers in rehabilitation medicine.

AFRM WA Branch Annual Members Meeting
I attended the Annual Members Meeting of the WA branch on Tuesday, 23 October. This was a great opportunity to get to know some of the members of branch the better and discuss issues of concern to them.

CPAC Planning Day
I recently attended the second day of the College Policy and Advocacy Planning session on behalf of Greg Bowring. Dr Rabin Bandari, AFRM PAC member represented the Faculty on the first day and thanks to Rabin for his assistance.

Almost the entire second day was devoted to a discussion about possible devolution of some CPAC policy and advocacy activities to other College bodies including Division, Faculty and Chapter Councils and FPACs. This is an important discussion and several possible models of devolution / delegation were presented and discussed in some detail.

A final decision was not made on the day, but it was clear that some changes will be made to current processes to increase the delegation and devolution of responsibility for policy and advocacy matters.

Professor Tim Geraghty
AFRM President

Report from the Faculty Policy and Advocacy Committee (FPAC) Chair – November 2018

FPAC Member  

Position

Dr Greg Bowring

Chair

Professor Tim Geraghty

AFRM President

Dr Robin Sekerak

NZ Representative

Dr Lisa Sherry

VIC/TAS Representative

Dr Tai-Tak Wan

NSW Representative

Dr Louis Baggio

Rural and Remote Representative

Dr Rabin Bhandari

SA/NT Representative

Dr Emma-Leigh Synnott

WA Representative

Dr Harry Eeman

Appointed Member

Dr Monika Hasnat

Paediatric Representative

Dr Angela Wills

Trainee Representative

Dr Cassandra McLennan

QLD Representative

It has been another busy year for FPAC and I would like to thank all members for their significant contributions and commitment to the effective running of the Committee.

FPAC Work Updates

Review of the Rehabilitation Medicine Inpatient Standards document
The review of this document is almost at completion, with the Working Group consisting of Tim Geraghty, Pesi Katrak, John Estell, Angela Wills, Maria Paul, and Cynthia Bennett, who met to finalise the document on Thursday, 8 November. The document will be circulated to FPAC, AFRM Council and CPAC for final approval before being made available on the RACP Policy and Advocacy web page.

Review of existing Rehabilitation-related policies and position statements on RACP website
FPAC continue to review the existing AFRM policy and advocacy documents, including the development of a Working Group to review AFRM Position Statement on Stem Cell Therapy for Children with Cerebral Palsy and the Position Statement on Patients with Multi-Resistant Organisms (MROs) in Rehabilitation Units.

The AFRM Special Interest Groups (SIGs) Reinvigoration Project
This project has also continued throughout the year with available SIG chairs meeting via teleconference on a three-monthly basis to consider ways of reinvigorating the SIGs.  

Activities have included: developing meeting documentation templates, assisting SIGs to develop a Statement of Purpose and Induction Packs for new members, commencing a review on SIG information on the website and looking at ways to raise the profile of the SIGs including asking them to contribute brief stories to the AFRM e-bulletin.

Other matters
The AFRM PAC has also contributed its expertise to the following policy matters.

Finally, I would particularly like to thank Claire Celia, Senior Policy and Advocacy Officer and Renata Houen, Policy and Advocacy Officer, supporting FPAC. Also Stacey Barabash, Phillipa Warnes and Lisa Penlington from the Faculties Office.  Without their assistance, much of the work of FPAC over the past 12 months would never have happened.

Dr Greg Bowring
Chair, FPAC

Faculty Education Committee (FEC) – November 2018 report

FEC Member

Position(s)

Dr Michael Johnson

Chair

Dr Caitlin Anderson

Deputy Chair
Committee Lead – Curriculum Renewal

Dr Ashlyn Alex

Trainee Representative

Dr Toni Auchinvole

New Zealand Representative

Dr Clayton King

Lead in Continuing Professional Development (CPD)

Dr Shari Parker

Lead in Assessment

Dr Michael Ponsford

Lead in Physician Education

Dr Kirily Adams

Lead in Overseas Trained Physicians

Associate Professor Louisa Ng*

Lead in Teaching and Learning

Dr Adam Scheinberg*

Lead in Paediatric Rehabilitation

* These positions are yet to be ratified by the FEC.

It has been another busy year for the Faculty Education Council and I would like to thank all members for their significant contributions and commitment to the effective running of the Committee. I would also like to thank Dr Greg Bowring for his excellence in overseeing the Committee during his time as Chair.

FEC Work Updates

New Matters
The College has commenced work on Curriculum Renewal for all 38 Advanced Training programs – including Rehabilitation. Dr Caitlin Anderson has accepted the position of Committee Lead for this important task.

    The AMC’s mid-term review is due to be held in late November. From the previous review, the College received accreditation for six years (until March 2021) subject to 31 conditions and 25 recommendations. To date, 15 conditions and 18 recommendations have been finalised.

    There will be changes to the CPD program commencing 2019. From next year, the following will apply:

    • Educational Activities –1 credit per hour
    • Reviewing Peformance – 3 credits per hour
    • Measuring Outcomes – 3 credits per hour

    Fellowship examination results for 2018: FCE 58.9 per cent (33/56). MEQ 73.2 per cent (60/82).

    Dr Michael Johnson,
    Chair, Faculty Education Committee

    Celebrating 25 years of AFRM in New Zealand – Regional Committee report

    Before the AFRM our specialty was represented by the ACRM. New Zealand foundation fellows included Drs Dick Wigley, Bill Utley, Hugh Burry (former rugby player and self-professed TBI survivor), Graeme Parry, Tudor Caradoc-Davies, Glenys Arthur, Bill Morris, Phillip Wrightson, and Peter Gow.  Drs Peter Disler (South Africa), Chris Roy (Scotland) and Jeremy Jones (Wales), as well as Paul Goldstraw, provided rehabilitation services until moving overseas. In 1993 ACRM Fellows gained fellowship in the newly-formed AFRM. Dr Jurriaan de Groot joined the ACRM training programme becoming the first New Zealand-based candidate to gain fellowship through examination (1994).  RACP fellows Drs Richard Seemann, Harry McNaughton and Will Taylor soon after sat the exam and gained AFRM fellowship.

    The inaugural ASM of the newly formed AFRM, convened by Drs Tudor Caradoc-Davies and Peter Disler and well attended by Australian AFRM fellows, was held at Otago University, Dunedin. Since then, the NZ branch has been well represented on Faculty committees including the Board of Censors, Council, Accreditation, Policy and Advocacy, Education, Trainee, CPD, Training, and the ASM Scientific Program committee.

    NZ AFRM Fellows have enjoyed a strong affiliation with our parent body in Australia while remaining rooted in New Zealand’s rehabilitation scene. AFRM Fellows played an important role in the 1987 emergence of the NZRA. AFRM Fellows continue to be active in this organisation whose members include a wide range of rehabilitation professionals and consumers of rehabilitation services. Recognition of the importance of rehabilitation research, and the unique opportunities of research in the New Zealand setting, led to the inception of the New Zealand Rehabilitation Research Institute (NZRRI).  After an interlude of 16 years, AFRM ASMs held in conjunction with the NZRA and NZRRI, were held in Queenstown (2009) and Wellington (2015). 

    During the early days the NZ branch activities were mostly managed by the Chair, Secretary and Treasurer without formal clerical support. Annual members’ meetings were organised with help from the Chair’s hospital-based PA, who sat with the AFRM logo affixed to the wall behind her workstation. Reams of Faculty letterhead paper were transported in personal luggage from Sydney after AFRM meetings. NZ Fellows assisted during the AMC and MCNZ accreditation processes, the latter due to different CPD/peer review requirements of the NZMC.   

    Initially, there was no home-grown registrar training programme in New Zealand. The first formal branch trainee sessions in 2001 included mock OSCEs in Auckland, Palmerston North, Christchurch and Dunedin. Through the outstanding efforts of a succession of NZ training coordinators, including Drs X Xiong, Sridhar Atresh, the late Boris Mak, Suresh Subramanian, Kellie Nichol (nee Perrie) and Bensy Mathew, weekly training sessions for NZ AFRM trainees parallel the training programme across the Tasman.

    Despite decades of specialist rehabilitation medicine presence and AFRM Fellows’ efforts, New Zealand continued to have a limited knowledge, understanding and appreciation of the scope and benefits of rehabilitation medicine’s role in the healthcare system. In order to bring to light this deficiency, the AFRM NZ branch in collaboration with the NZRA developed the document A Call for a New Zealand Rehabilitation Strategy.  The 'Call' was launched at the AFRM(RACP)/NZRA Combined Conference in Wellington in October 2015. It was further publicised through the media to increase national discussion to maintain and grow a strong rehabilitation medicine presence in public hospital environments; integrate rehabilitation medicine and rehabilitation principles into government policy and the healthcare system; and to ensure all New Zealanders receive the rehabilitation services they require.

    Today finds us continuing to face the challenge of integrating Rehabilitation Medicine into the business as usual of healthcare planning and provision in New Zealand. Through ongoing efforts by NZ Fellows, the number of AFRM trainees has increased with hopes of further increase through the opportunities provided by Health Workforce NZ to vulnerable specialties such as Rehabilitation Medicine. Despite being the site of the successful, international, combined conference of the Asia Oceanian Conference of Physical and Rehabilitation and the Rehabilitation Medicine Society of Australia and New Zealand in November 2018 – awareness of the scope and benefits of specialist rehabilitation medicine remains extremely limited. This is evidenced by the fact that only four of the 20 DHBs in NZ have specialised AFRM accredited rehabilitation services. This leaves a large portion of New Zealanders without access to, and fulfilment of, their right to rehabilitation. But there remains hope. Increasing socialisation of the updated Call for a NZ Rehabilitation Strategy, used as a support document for various rehabilitation initiatives, is occurring. If our call for a NZ Rehabilitation Strategy is heeded, with our Fellows and trainees continuing to grow our specialty, we will see another 25 years of valuable contributions to the New Zealand health environment.

    Dr Cynthia Bennett
    Chair, NZ Regional Committee

    Victoria/Tasmania Regional Committee report

    The Victorian/Tasmanian Branch reformed in 2016 after a hiatus and has been meeting on a two-monthly basis since that time. Meetings coincide with meetings of the Vic/Tas branch of the RMSANZ, which has facilitated cooperation and coordination between the Faculty and the Society.

    The branch is well represented by Melbourne based physicians and we are grateful for the involvement of Dr Warren Jennings-Bell from Tasmania and the trainee representative, a position currently held by Dr Imogen Windle.

    The branch will aim to recruit regional physicians and some more recent graduates in the next year as elections for branch positions are due in early 2020.

    The business of the Vic/Tas branch has included the oversight of trainee education. Victoria is privileged to have the resources of the Victorian Rehabilitation Training Program, headed by Dr Rob Weller and supported by Dr Michael Ponsford and Lee McDonald. This team has spent much time fine tuning the extensive training program in Victoria and setting up practice exams for the trainees.

    The Branch is represented on a number of Victorian Department of Health and Human Service bodies that deal with rehabilitation service issues. Recent issues of import discussed at the bodies include:

    • the impact of Australia's National Disability Insurance Scheme (NDIS) on rehabilitation services in Victoria
    • barriers to discharge (such as homelessness which is a major issue in Melbourne)
    • the sub-acute funding model which currently appears to put rehabilitation services that provide more complex rehabilitation at a disadvantage.

    The Branch plans to tackle the thorny issue of rehabilitation trainee selection and placement in Victoria. Trainees and a number rehabilitation services have expressed their dissatisfaction with the current system which is service based and lacks central coordination. This places a considerable burden on trainees and the services negotiating the recruitment process.

    I am very grateful to the Branch members for their support in establishing and maintaining the branch and in particular Dr Jill Collins, Branch Secretary whose organisation (and supply of nice drinks and snacks at the meetings) keeps the Branch in action.

    Dr David Murphy
    Chair, VIC/TAS Regional Committee

    Western Australia Regional Committee report

    The AFRM WA Regional Committee recently held its Annual Members’ Meeting (AMM) on 23 October 2018 at Perth Children’s Hospital (PCH). AFRM President Professor Tim Geraghty made the journey across the continent to address the WA AFRM membership and we were updated on the recent initiatives of AFRM Council.

    The commissioning of PCH four months prior and transition of Paediatric Rehabilitation Services has been uneventful. We noted that the State Rehabilitation Service (adult) has been open now for four years and the membership shared their experiences and insights with such service reconfigurations, including paediatric to adult transition.

    The membership resolved to strengthen the adult and paediatric training programs by mutually inviting all trainees (adult and paediatric) to their respective teaching activities and to continue to share resources where possible. The AMM was followed by a short tour of the some of the impressive facilities of PCH. Many thanks to our PCH hosts, Dr Jane Valentine and Claire Stevenson and the support from the RACP Perth and AFRM Sydney offices.

    This is an exciting time for us in WA because rehabilitation services and AFRM membership continues to organically grow. We look forward to welcoming our newly graduated Fellows in 2019.

    WA Regional Branch meeting AFRM
    PHOTO: Professor Geraghty with some of the WA membership at the Perth Children’s Hospital whale shark during the AFRM WA Regional AMM.

    Dr Jon Ho Chan
    Chair, WA Regional Committee

    Queensland Regional Committee Report

    I have been in Rehabilitation Medicine for the last 15 years and I can see many differences to the specialty I took on in the beginning and what it looks like now. The bones are the same, but the flesh looks different, the patients we see are much more complex medically, we start providing rehabilitation earlier, we tend to see older patients, we are trying to keep people home for as long as possible, there are new treatments for cancer and cancer rehabilitation is becoming more prevalent. We must be prepared for the changes that will come as medicine evolves to keep ourselves in the game.

    We are living in interesting times where there is economic uncertainty and political games are being played with frequent changes in policy sometimes without foresight into the future. The health system is currently undergoing changes, some more obvious than others, and we run the risk of disappearing into oblivion if we don’t take up leadership roles to get our specialty further in the vanguard and not to be looked as just the back door of the hospital or health services.

    More and more I am seeing health practitioners call themselves rehabilitation services without really being that. This confuses the public and other health providers. We must make our specialty group stronger and a real contender as we overlap between many other specialties. This gives us a distinctive advantage as we have a holistic approach and manage patients in a more complete manner, and we forge alliances with other specialists and health providers to service our clients. We need to take on a preventative role and not just be reactive however due to funding systems it becomes more difficult to achieve. We need to influence policy making by our actions and strong position on current health issues affecting our clients.

    For the first time in a very long time QLD has a larger number of both Fellows and trainees and we must take advantage of that to promote our specialty and our views. I hope some of the newer Fellows will look at our rural positions to service their needs for rehabilitation medicine which will be a very rewarding opportunity.

    Finally, I feel privileged to practice in our specialty, which looks at the human side of our clients and not just at an organ putting the person first and aiming to improve their quality of life by improving their function.

    Best wishes.

    Dr David Eckerman
    QLD Branch

    Cancer Rehabilitation Special Interest Group (SIG) update

    The Cancer Rehabilitation SIG held their first teleconference on Wednesday, 21 February. At this first meeting, the newly formed SIG began planning future directions. These included requesting the opportunity to present a Cancer Rehabilitation Workshop at the 6th Asia-Oceanian Conference of Physical & Rehabilitation Medicine (AOCPRM) and RMSANZ 3rd Annual Scientific Meeting – North to South, East to West –  from 21 to 24 November 2018 in SkyCity Auckland, New Zealand.

    Members of the Cancer Rehabilitation SIG worked to present a rapid-fire seven segment educational workshop program. A couple of segments focused on specific cancers, and included an overview of patient journey mapping to think about service development. Several segments described different models of care provision and the cancer survivor experience in our programs. The workshop was very well attended and audience involvement was very good.

    We warmly welcome others to come and join our combined efforts in the Cancer Rehabilitation SIG.

    Associate Professor Andrew Cole
    AFRM Past President
    Chair, Cancer Rehabilitation SIG 

    Members of the Cancer SIG with colleagues in New Zealand

    Members of the Cancer Rehabilitation SIG with colleagues in New Zealand.

    Mind SIG update 

    The Mind SIG has been listing things for which to be thankful in its gratitude diary after a wonderful 2018. Such a list includes our fantastic group, the dedicated team and attendees at our new quarterly phone-up 'Mind' presentations and Stacey. We're even grateful for gratitude! It's no surprise that practising gratitude and feeling thankful has been shown to have such a positive impact on the mind that the Gratitude Diary has been one of kikki.K best sellers for most of this year. Hopefully soon we'll see gratitude diaries alongside every meal tray, in patient rooms and on doctor's tables alike.

    It's as obvious as ptosis that the mind plays a role in the rate of rehabilitation and recovery. It's been great to see so many Mind SIG members opening the eyes of their medical communities to the now mainstream science of psycho-neuro-immunology. Thanks to our secretary Jo Braid for her work as the Mind SIG secretary, and her leadership in this space in Orange. And to Barbara Hannon and Susannah Ward for their work in Melbourne and Newcastle respectively. And to all for their work this year with junior doctors and in physician wellbeing. We're very grateful!

    Many of you would have seen the Harvard study on longevity and happiness. It showed that after all those years, the thing that made the most difference to happiness and longevity wasn't being a non- smoker, living with a disability or working in a hospital with designated doctor's parking. It was the quality of a person's relationships. It's in this spirit that the Mind SIG thanks all who have shared with our group this year and particularly those who have dared to be vulnerable, authentic or late. Our discussions have been rich and enlightening. Quality in-fact. 

    Looking forward to next year!

    Dr Jane Mlone
    Chair, Mind SIG

    Rehabilitation Medicine Society of Australia and New Zealand (RMSANZ) report

    I greatly appreciate the work, commitment and results from all members of the Board during the last year. The Society is in a sound structural and financial condition after four years and continues to work hard to meet the expectations of its members.

    I believe the average Fellow of AFRM, and increasingly the trainees, are able to differentiate the two entities (Society and Faculty) better. There is still work to be done, especially in relation to the SIGs and Branches, in the way they interact with the Society and with our profession of Rehabilitation Medicine at large.

    I would like to welcome our newest Board member Dr David Murphy and look forward to his experience and knowledge furthering our work.

    Earlier in 2018, we needed to accept the resignation of former RMSANZ Director, Dr Greg Bowring. He took on the role of AFRM President-elect in May. We thank him for his contributions. I am confident the Board will be reinvigorated by new faces which may change the current appearance from what some cheeky younger consultant referred to as the Jedi council.

    I would like to thank all those who attended and contributed to the success of our recent ASM in Auckland from 21 to 25 November. The formal presentations were well received and the importance of the venue for networking was recognised and appreciated. It was interesting and somewhat of a challenge to co-host a meeting and to work with another conference organiser who was not our usual one. The dust is still settling on the accounts but there is the prospect of a reasonable dividend to the Society as a consequence of our profit-sharing arrangement entered into early in our formation. I would like to especially thank Alex Ganora and Sybil Cumming for the persistence of their work through this long process. At times it was tempting to question the wisdom of getting involved in such a large undertaking, but to me the results and benefits of the hard work were clearly to be seen in Auckland. The total registrant count was approximately 520.

    Dr Rob Smeets capably presented the inaugural Garry Pearce Lecture and this Lecture will be an annual event at each of our RMSANZ ASMs. There was a strong feeling that Dr Smeets’ Lecture reflected core values.

    Our fourth ASM will be at the Adelaide Convention Centre from Sunday, 20 October to Wednesday, 23 October 2019. Drs Zoe Adey-Wakeling and Kirrily Holton are keenly driving the process forward, with the cooperation of Tory Smith from DC Conferences and the tireless work of the Scientific Committee. Professor Ian Cameron’s capable chairing of this Committee is an important ingredient in the final meal that we see on the table.

    Planning for the Gold Coast ASM 2020 is also well under way and Dr Ben Chen has been doing a lot of organisation two years out from that meeting.

    In 2022 in Sydney we will hold our co-hosted International Society of Physical and Rehabilitation Medicine (ISPRM) Congress and RMSANZ ASM. We are grateful for Associate Professor Steve Faux and his team’s very successful efforts in securing the ISPRM meeting. With the potential for a large roll-up, there comes a degree of complexity of which we had only a foretaste in Auckland. RMSANZ will be starting the process of identifying the conference organiser in the next few months and we also need to establish a company (via the Australian Securities and Investments Commission) for this event. This is a standard procedure.

    As the Society has matured, it has become apparent that the ASMs are a critical part of the Society’s work. It is therefore essential that the RMSANZ Board has close ties to the organisation of the ASMs. The ongoing work of the Board will reflect that emphasis.

    The potential benefits from a link between the RMSANZ and the Journal of Rehabilitation Medicine (JRM) are significant and an agreement between the two entities is still being worked upon.

    Dr Lee Laycock
    RMSANZ President

    A message for you

    Warmest thoughts and best wishes to all (members and staff and their families) for a wonderful holiday season and a healthy, peaceful and prosperous New Year.

    Thank you everyone who volunteers their time for their hard work and contribution to the RACP. Your support is invaluable, and It has been a pleasure to work with you. 

    We look forward to achieving further success in 2019.

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