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Preference: Education

190

Department updates guidelines for young children’s physical activity

New national guidelines on physical activity, sedentary time and sleep for young children have been launched by Health Minster Greg Hunt.

Australian 24-Hour Movement Guidelines for the Early Years (Birth to Five Years): An Integration of Physical Activity, Sedentary Time and Sleep differs from the previous guidelines in covering the entire day, including recommendations on how to help children get good quality sleep. 

The Guidelines also provide ideas and examples of how to incorporate adequate movement in an infant, toddler or preschooler’s day – and how parents can fit these into their own busy days.  

Mr Hunt said following the Guidelines was associated with better growth, stronger muscles and bones, better learning and thinking, better mental, emotional and social well-being, better motor skills, healthier weight, as well as reduced injuries.

The 24-Hour Movement Guidelines have been developed by experts across Australia with input from national and international stakeholders, and in partnership with Canada, which developed the world’s first 24-hour movement guidelines.

University of Wollongong (UOW) early childhood expert Professor Tony Okely, who led the project to update the guidelines for the Health Department said the decision to include sleep recognised its importance in optimising health, development and learning. 

“Sleep plays an essential role in a child’s growth and development and shares an interrelated relationship with physical activity,” he said. 

“If a child receives good quality sleep, they will have the energy to be active, and an active child is a well-rested child.

“These Guidelines also acknowledge that the whole day matters and individual movement behaviours, such as physical activity, sedentary behaviour and sleep need to be considered in relation to each other when examining their associations with health and developmental outcomes in children.”

Limited access to sedentary screen time is also an important part of the 24-Hour Movement Guidelines. The recommendation of no sedentary screen time for children under two, and no more than one hour for those older than two.

“Screen time while sitting can counteract the health benefits of physical activity, leading to language delays, reduced attention, lower levels of school readiness and poorer decision-making,” Professor Okely said.

“The revised Guidelines incorporate the effects of screen time on a child’s growth and development and provide recommendations to parents or carers in how to mitigate these effects through an emphasis on increasing movement, and limiting sedentary behaviour and use of screens. 

“A child can do sufficient physical activity to meet the guidelines, yet still be considered sedentary if they spend a large amount of their day sitting, lying down or restrained, especially in front of a screen.  

“When a child is sedentary, try to incorporate quality behaviours such as reading, storytelling, playing with playdough and puzzles into their routine to enhance their cognitive development.”

The Guidelines also recommend that all screen use at these ages be educational. 

Professor Okely says that meant co-viewing with a child, discussing content, and using it in ways that help a child make understandings of the world around them, such as to investigate, problem solve, create knowledge.

Other notable changes from the previous Guidelines include a recommendation for 60 minutes of moderate to vigorous physical activity included as part of the 180 minutes of total physical activity per day recommended for preschoolers.

30 minutes of tummy time for infants (spread over the day) is also a part of the new recommendations.

More information on the Guidelines can be found on the Department of Health’s website: http://www.health.gov.au/internet/main/publishing.nsf/Content/health-pubhlth-strateg-phys-act-guidelines.

MEREDITH HORNE

What do you want from your CPD?

 

Although continuing professional development (CPD) is a requirement of your medical registration, it’s not always easy to fit it into a busy practice life. At doctorportal Learning, we want to get a clearer idea of how we can best tailor our comprehensive CPD offering to your needs. To do that, we’ve put together a medical education survey that you should have already received in your inbox.

The survey should only take you around 15 minutes to complete. It will help us understand your CPD motivations and preferences in terms of access, pricing, learning interests and other key areas. We’ll use this information to better match our offering to your needs and help you meet your medical education requirements as easily as possible.  An example of how new content responds to feedback is doctorportal Learning’s soon to be launched online CRANA Plus Advanced Life Support course. Requested by members, it’s the only completely online, accredited delivery of ALS certification in Australia and supports time poor and remotely located professionals who need to access this often mandatory piece of learning.

We’d appreciate if you could complete the survey by 10th of January, 2018. If you have any questions, please don’t hesitate to contact our team at memberservices@ama.com.au, or by phone on 1300 133 655.

[Comment] Hidden conflicts of interest in continuing medical education

Continuing medical education (CME) is an integral part of postgraduate training for medical professionals in the USA and globally. CME enables physicians to maintain and gain knowledge and skills that ensure optimal medical care and outcomes for patients. For these reasons CME is a required component of licensure in the USA.1,2 Since most physicians regularly complete CME hours, conflicts of interest that could introduce bias into CME must be avoided to prevent potentially detrimental downstream effects on patient care.

Fearmongering with doctors in training

BY DR KATE KEARNEY, CO-CHAIR AMA COUNCIL OF DOCTORS IN TRAINING

Over the past decade, there’s been a remarkable development of companies and offerings for doctors in training (DITs) to help them pass their exams, get selected onto a program or generally get ahead in an increasingly competitive environment. The range of companies putting forward these type of services has developed from opportunistic small businesses to, now, prestigious universities looking for their piece of the DIT panic money pie. These courses have a significant logistical impact on service provision within hospitals as well as financial and stress impacts on trainees.

What is the appeal of pursuing these type of extracurricular activities? DITs are afraid, of not passing exams, not getting onto a training program, not getting a job at the end of many years training. Fear about the state of the Australian medical workforce is drilled into us from the first year of medical school.

As students, we hear about it from stressed interns and residents. As interns and residents, we hear about it from panicked registrars and fellows. Ceding control over how, where and in what capacity we’ll be able to practise medicine – and live and raise our families – to the whims of medical system that isn’t investing meaningfully in medical workforce planning would raise the heckles of most in the community. Getting a little self-direction back is pitched as, as easy as signing up to our course, which will definitely get you through your exam, or improve your chances of selection.

Exams are challenging and in an uber-competitive job market, failure appears untenable. It seems insurmountable, career-defining, and not enough of those on the other side talk about their own challenges and how they faced them on the journey of their medical careers. If everyone else is doing it, and it purports to be necessary to pass – you don’t want to be the only one left behind.

Aside from the monetary cost, which is reaching new heights especially for exam years beyond even the expense of college annual and exam fees, the message that DITs allow in their mind is that this is legitimately necessary. My education provided by my hospital, my supervisors and my College aren’t enough. I have to spend significant chunks of my own hard-earned income to be able to do this. This feeds impostor syndrome – that little voice that says I’m not good enough to do this, I’m not meant to be here. Separately, it drives the CV arms race where a Masters Degree is rapidly becoming a necessity, not a standout.

So, what can be done? We can take notice. Colleges and hospitals and supervisors can take notice. We can look at our curricula and educational strategies. Are they really effective if this is happening? Are we testing the right knowledge and the right skills if it has to be delivered at such cost and outside of the workplace? The RACP advocates for both fellows and trainees to follow the 70:20:10 model of learning – where 70 per cent is experiential, 20 per cent social and 10 per cent formal learning. This is the type of sensible approach that DITs need to reinforce in their own thinking and see demonstrated in the workplace. Supervisors and mentors are an important part of modelling realistic behaviour.

There’s a place for some of these courses, as complementary educational strategies, but which are truly beneficial and which are exploiting trainee fear, under a guise of empowerment? I would ask DITs to consider how any course aligns with their educational aims and assess as objectively as possible the cost-benefit in terms of time, money and stress. 

Democracy Inaction

BY ROB THOMAS, PRESIDENT AUSTRALIAN MEDICAL STUDENTS’ ASSOCIATION

“The tyranny of a prince in an oligarchy is not so dangerous to the public welfare as the apathy of a citizen in a democracy.” – Montesquieu

The position of AMSA President has been rewarding in many ways for me. I’ve had the opportunity to learn and be inspired by those around me, and come to high-level meetings, often several decades younger than the next person in the room. I get to hear the many views of my peers and on my best days, hope to represent 17,000 young people.

It’s fair to say that this year has been an incredible learning curve, beyond that of an average medical school year. I’ve learnt more about health and the education systems and have advocated for improvements in both. But perhaps most interestingly, I’ve learnt much more about leadership and the democratic process.

I find young people in general get a bad rap when it comes to political engagement. It’s true, there is less identification with traditional party politics among young people, but engagement through petition-signing or demonstrations is much higher. I find this very interesting in an age where political leaders are torn down just as quickly as they emerge. Perhaps we demand too much from our leaders, particularly if we’re not engaging them in traditional ways.

With the information revolution also comes the need to be discerning, and to protect oneself. I’ve seen this myself in the marriage equality debate, one that I have a stake in and at times need to actively block from my mind. On issues such as climate change and health inequity overseas and at home, young people can be discouraged by inaction from our leaders and in so doing disconnect.

One very interesting thing I’ve found about the advocacy sphere is how lonely it can be. Organisations such as the AMA and AMSA, and of course the Government, rely on facts and opinions from their constituents. We do this through survey or election, but often we only get half the picture. Worse still, some representatives receive feedback only when it’s negative, and I feel for those who don’t get the thanks they deserve.

On the other hand, representing any large group of people will involve strong differences of opinion, especially when it may involve life and death. The success of the National Rifle Association in America depends on the simplicity of their message – “no” to any information or regulation on gun ownership. The larger the organisation and more diverse its mandate, the more power it may hold; but it may start to represent more differences of opinion than similarities. On leadership, it’s important to be aware of these differences, as I believe it only legitimises your stance to show respect to the other side. As health professionals, we need to be able to flex and adapt to new information, and that only comes when we refuse to switch off. By our very nature we should challenge our assumptions and our preconceived notions to achieve the best for the public.

At the top I left a quote about the danger of apathy. Yes, democracy has its flaws, as we seem to witness time and time again. However, the only answer I can come up with is to engage in it – for those in power to make themselves available to opinion, and for those not in power to realise that there is power in that too. There is no good in burying one’s head in the sand. Democracy inaction is democracy in disaster.

Email: rob.thomas@amsa.org.au
Twitter: @robmtom

What will the next health reform agreement bring?

BY ASSOCIATE PROFESSOR SUSAN NEUHAUS, CHAIR, HEALTH FINANCING AND ECONOMICS COMMITTEE

The Health Financing and Economics Committee (HFE) has a very keen interest in the likely direction and detail of the next public hospital funding agreement that will take effect from 2020. 

Negotiations between the commonwealth and State Health Ministers will begin in earnest in 2018 but early signs of the likely reform agenda are emerging, with some consistent themes coming to the fore.  Unsurprisingly, most of these themes are a continuation of the changes to public hospital financing agreed by all Australian Governments in June 2017 as documented in the National Health Reform Addendum.[1]  Whether States and Territories agree is hard to predict and will likely depend on how much new funding, and over what period, the Commonwealth Government is prepared to offer it.

The themes in the Addendum we would expect to see considered as part of a 2020 agreement are:

        i.            improve patient outcomes;

      ii.            decrease avoidable demand for public hospital services;

    iii.            improve the coordination of care for patients with chronic and complex conditions to reduce avoidable demand for hospital admissions for this group;

   iv.            incentives to reduce preventable, poor quality patient care; and

     v.            incorporate quality and safety into hospital pricing and funding to reduce poor quality patient care: sentinel events, hospital acquired complications and avoidable readmissions.

Recent media speculation[2] [3] suggests Minister Hunt will seek COAG agreement to reward jurisdictions that can demonstrate improved patient outcomes, with the goal of readmissions over the short term being avoided. 

Such a move may also represent the first step towards ‘outcome based’ hospital funding.  Media speculation[4] also suggests the government will frame the push as a reduction in ‘low value care’.  It is likely not coincidental that the Productivity Commission released a report on 24 October 2017 that recommends low value care in public hospitals should not be funded[5].  Of course, what is finally argued by the Commonwealth in the lead-up to the negotiations with State Ministers is yet to be seen – but it is clear they are laying the groundwork.  

On the topic of coordinated care, it is worth noting that jurisdictions already have the ability to enter bilateral agreements to trial coordinated care initiatives, for the 2017-2020 period.  These are intended to inform the development of an evidence-based national approach in the 2020 funding agreement – but clearly we are also in early days of this work.

The National Health Reform Addendum reforms might be worthy in the abstract – it is hard to argue against improved patient outcomes, a reduction in preventable poor quality patient care, better care coordination across the boundary of admitted/non-admitted care – especially for patients with one or more chronic conditions. 

But whether they are they worthy in practice depends entirely on how they are implemented.  For example, shifting public hospital funding away from payments based on cost and quantity to a formula based on patient outcomes represents a massive organisational change for the public hospitals delivering the care.  They will require substantial additional funding to build the necessary organisational capacity.  And this will take time. 

Outcome-based funding will also require substantial new government investment in data infrastructure to collect and measure robust clinical patient outcome data – not just patient reported outcomes, which may or may not be clinically relevant.  It must include patient outcomes in the non-admitted setting.  This capacity does not yet exist.  We first need robust, consistent primary healthcare data definitions used and recorded by all primary healthcare providers.  The primary and tertiary outcomes data must be linked.  And if the Government is serious about linking outcomes to funding and ‘quality’ then it would need to develop an entire framework of quality-adjusted life year (QaLYs) per episode of care. Overcoming the constraints and barriers inherent in a health system that is structured within a federated system of government is no small feat, nor will it be cheap.

So far, the AMA has been bitterly disappointed in the Government’s opportunistic use of the ‘improved safety and quality’ agenda to do little more than reduce the Commonwealth’s share of public hospital funding.  My Australian Medicine article published on the September 18, 2017 summarises this.  The AMA will be carefully examining the detail of the 2020 health care agreement to ensure it is a genuine effort to empower public hospitals, including in providing them with the resources they will need to successfully transition to outcomes based funding with improved care-coordination. These are massive reforms that will require time, a clearly articulated evidence-based pathway and substantial new Commonwealth investment, not less.

[1] Schedule I – Addendum to the National health Reform Agreement:  Revised Public Hospital Arrangements, p1, 2017.

[2] Parnell S GP Patient Incentives – Rewards to reduce crush in hospitals Weekend Australian 29/7/2017 p10-11

[3] Avoiding hospital admissions a priority, The Pharmacy Guild of Australia, 27 September 2017

[4] Martin P Education, health face shake-up, The Age, 23 October 2017 p 4

[5] Shifting the Dial:5 Year Productivity Review, Productivity Commission, 2017  

[Articles] A multifaceted intervention to improve treatment with oral anticoagulants in atrial fibrillation (IMPACT-AF): an international, cluster-randomised trial

A multifaceted and multilevel educational intervention, aimed to improve use of oral anticoagulation in patients with atrial fibrillation and at risk for stroke, resulted in a significant increase in the proportion of patients treated with oral anticoagulants. Such an intervention has the potential to improve stroke prevention around the world for patients with atrial fibrillation.

[Correspondence] Medical education: what about the barefoot doctors?

Medical education aims to cultivate effective and essential medical human resources for protecting people’s health and the nation’s sustainable development. On July 11, the State Council of China introduced bold plans to deepen the reform and development of medical education, which were summarised in The Lancet (July 22, p 334).1 Facing the increasing needs of health care and medical education, the Chinese Government is struggling to change the current situation and improve educational programmes, financial welfare, career promotion mechanisms, and ethical decision-making.

[Obituary] Sir David Todd

Haematologist who transformed medical education and training in Hong Kong. He was born in Guangzhou, China, on Nov 17, 1928, and he died from pneumonia in Hong Kong on Aug 16, 2017, age 88 years.