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Preference: Men's Health

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#GoodDoctorsTeach Australian Medical Students’ National Teaching Awards

BY ALEX FARRELL, PRESIDENT, AUSTRALIAN MEDICAL STUDENTS’ ASSOCIATION

Every day, great doctors around Australia go above and beyond to teach students, and role model what medicine is all about. This year the Australian Medical Students’ Association (AMSA) celebrated those teachers in medical schools and hospitals with the National Awards for Teaching Excellence.

The AMSA National Awards are the highest honour bestowed on a teacher by medical students across the country. They are based on nominations from around the country, and represent students’ appreciation and recognition of teachers who have made an especially positive impact on their studies. There are a number of award categories including excellence in teaching, in rural education, teaching by a junior doctor, and as well as teaching by a member of an allied health profession.

Although it is such an important part of the doctor’s role, the teaching culture across different hospitals varies widely. Despite the recent focus and positive steps in the last few years, bullying, harassment, and teaching by humiliation are still too common an experience. These awards are part of AMSA’s #GoodDoctorsTeach campaign, acknowledging those who tackle this by actively creating a positive teaching culture within medicine.

AMSA received close to 100 nominations for the awards. Reading those nominations was heart-warming, as student after student shared stories of the teachers who have inspired, motivated and challenged them. It was a reminder of just how significant the impact of teaching is on the lives of students, and of how many exceptional teachers there are.

On behalf of Australian medical students, I’d like to thank all the doctors and allied health professionals who make it part of their daily work to make medicine a welcoming and exciting place for students and junior doctors, and nurturing their passion. Consultant or intern; metropolitan or remote; doctor, midwife or echocardiographer: the way you treat your students is making for better future doctors, and a better medical culture in Australia.

Excellence in Teaching winner: Dr Zafar Smith (James Cook University)

Quote from students: “Dr Smith has gone above and beyond teaching us Emergency Medicine in our 3rd year. He completely re-vamped the course making it much easier to learn and more enjoyable. Every single person I know has enjoyed his lectures, tutorial and approachability. He uses interactive methods of teaching which engage the class, such as gosoapbox and kahoot quizzes to test us, and has even created a deck of cards with Emergency medicine case studies that we were all able to get our hands on and use for our exams. As this is his first year of coordinating and lecturing this course, he has outdone himself and on behalf of Med 3 at James Cook University, we would like to recognise his efforts and generosity, and the fun spirit he has brought to sometimes difficult topics.”

Excellence in rural education winner: Dr Elizabeth Kennedy (University of Melbourne, Goulburn Valley Region)

Quote from student: “Dr Kennedy has provided me with outstanding mentorship over 2018, cementing my passion for rural medicine … She is consistently motivated to include students in the extracurriculars of the medical profession, including education events in the Goulburn Valley Region, attending Youth Forums regarding young women’s health, and promoting student engagement in the community. She constantly provides me with the mentorship and support to strive for more, and to be the kind of person and doctor that is needed in a rural area. She constantly gives her medical knowledge, emotional support and more to her patients and I learn from her each and every day.”

Excellence in teaching by a junior doctor winner: Dr Kenneth Cho (University of Sydney and University of Western Sydney, Nepean Hospital)

Quote from selection panel: “Kenneth’s work developing a JMO-led bedside tutorial program and a JMO-led Friday lecture series, run by Junior Medical Officers for medical students is an example of the way anyone, despite age or experience, can lead by example to create a culture of teaching where they work.”

Excellence in teaching by a member of an allied health profession winner: Mr David Law (Echocardiographer, University of New South Wales, Coffs Harbour Hospital)

Quote from student: “David- Coffs Harbour’s most prized sonographer- is probably the only teacher I’ve had who has been able to explain ECGs in a way that makes sense. But more important than that is how he has made the hospital such an inclusive place for medical students to be, welcoming us to catheterisation lab, and always taking the time to explain things to us.”

 

New studies give greater understanding on menopause

One year of hormone replacement therapy may be able to prevent development of depressive symptoms in women who are in the menopause transition, a study published online in JAMA Psychiatry has shown.

The double-blind, randomised controlled trial, conducted by University of North Carolina (UNC) School of Medicine found certain women would be more likely to experience the greatest mood benefit of hormone replacement therapy during the menopause transition, which are women early in the transition and women with a greater number of recent stressful life events.

Women are two to four times more likely to develop clinically significant depressive symptoms during the menopause transition, according to the study.

“We know that midlife for women, particularly in the transition to menopause, is a time of substantial elevations in risk for depression,” said Professor Susan Girdler, who helped lead the research.

“During the menopause transition, our risk for depression actually increases two to four times. And that’s true even for women who haven’t had a history of depression early in life.”

The participants were randomly selected and put into two separate groups. Over the course of a year, one group received transdermal estradiol on a daily basis, the other a placebo.

The study found more than 30 percent of the placebo group developed clinically significant depression. However, only 17 percent of women who received estradiol developed the same depression symptoms.

Other research published by The University of Illinois (UI) in the journal Sleep Medicine suggests addressing menopausal symptoms of hot flushes and depression may also address sleep disruptions.

The UI study also gives women hope that their sleep symptoms may not last past the menopausal transition, said Professor Rebecca Smith, from the Pathobiology Department at the University of Illinois. Professor Smith conducted the study with Professors Jodi Flaws and Megan Mahoney.

“Poor sleep is one of the major issues that menopausal women seek treatment for from their doctors,” Professor Mahoney said.

“It’s a huge health care burden, and it’s a huge burden on the women’s quality of life. Investigating what’s underlying this is very important.”

The study used data from the Midlife Women’s Health Study, which followed 776 women aged 45-54 in the greater Baltimore area for up to seven years.

The study found no correlation between the likelihood of reporting poor sleep before menopause, during menopause and after menopause. Meaning, for many women in the study, their reported sleep problems changed as they transitioned to different stages of menopause. For example, women who had insomnia during menopause were not more likely to have insomnia after menopause.

“That’s a hopeful thing for women who feel like their sleep has gone downhill since they hit the menopause transition: It might not be bad forever,” Professor Smith said.

“Your sleep does change, but the change may not be permanent.”

The researchers found that hot flushes and depression were strongly correlated with poor sleep across all stages of menopause.

Those two risk factors vary in reported frequency across menopausal stages, which might help explain why poor sleep also varies across the stages, the researchers said.

Professor Smith believes that the study has shown sleep disturbances in menopause are part of a bigger picture that doctors should be looking at.

“It indicates that when dealing with sleep problems, physicians should be asking about other symptoms related to menopause, especially looking for signs of depression and asking about hot flushes,” Professor Smith said.

MEREDITH HORNE

[Correspondence] Women’s health in Israel

We congratulate The Lancet for its Health in Israel Series, which takes a broad and unprecedented look at Israeli health and health care, and applaud the effort to focus on women’s health. We read with interest the Viewpoint by Leeat Granek and colleagues (June 24, 2017, p 2575),1 in which the authors state that the health of women in Israel is affected by the political situation in Israel. Although it might be true, this statement needs more support.

[Perspectives] Natalia Kanem: lifelong advocate for women’s health and rights

”My big disappointment is that women’s rights are still not at the centre”, says Natalia Kanem, echoing her lifelong “passion and hope” for women’s health and rights. Her interest in these issues started in 1975 when, as an undergraduate at Harvard University, she attended the first UN World Conference on Women. Appointed as the Executive Director of the United Nations Population Fund (UNFPA) in October, 2017, Kanem hopes she “can really affect the fate of some of the poorest and most vulnerable women and girls in the world”.

[Viewpoint] Women and health in Israel

WHO defines health as “a complete state of physical, mental and social wellbeing, and not merely the absence of disease or infirmity”.1 This broad definition includes physical and mental health, but also socioeconomic standing and access to resources such as health care and safety. In this Viewpoint, we present a holistic picture of women’s health within the Israeli societal and cultural context, taking these factors into account.

Yemen cholera outbreak claims one life every hour

The rising number of suspected cases of cholera resulting from a severe outbreak in Yemen has passed 100,000, the World Health Organization (WHO) reports.

Cholera is affecting the most vulnerable. Children under the age of 15 years account for 46 per cent of cases, and those aged over 60 years represent 33 per cent of fatalities.

Cholera, an acute enteric infection, is caused by the ingestion of food or water contaminated with the bacterium Vibrio cholera. It can kill children within just a few hours. Cholera should be an easily treatable disease when there is access to functioning medical services. 

WHO believes that cholera is primarily linked to insufficient access to safe water and proper sanitation and its impact can be even more dramatic in areas where basic environmental infrastructures are disrupted or have been destroyed.

Humanitarian partners have been responding to the cholera outbreak since October 2016.  However, Yemen’s health, water and sanitation systems are collapsing after two years of war. The risk of the epidemic spreading further and affecting thousands more is real as the water hygiene systems are unable to cope.

The UN Office for the Co-ordinatior of Humanitarian Affairs (OCHA) Jamie McGoldrick said the fast spreading epidemic in Yemen was “of an unprecedented scale”.

Mr Goldrick also fears that hundreds of thousands of people are at a greater risk of dying as they face the “triple threat” of conflict, starvation and cholera. He believes the cause is clear.

“Malnutrition and cholera are interconnected; weakened and hungry people are more likely to contract cholera and cholera is more likely to flourish in places where malnutrition exists,” Mr Goldrick said. 

More than half of Yemen’s health facilities are no longer functioning, with almost 300 having been damaged or destroyed in the fighting.

Systems that are central to help treat and prevent outbreaks of the disease have failing in Yemen. Fifty per cent of medical facilities no longer function. Some have been bombed and others have ground to a halt because there is no funding.

The International Committee of the Red Cross (ICRC) Director of Operations Dominik Stillhart said: “Hospitals are understaffed and cannot accommodate the influx of patients – with up to four people seeking treatment per bed. There are people in the garden, and some even in their cars with the IV drip hanging from the window.”

Local health workers, including doctors and nurses have not been paid for eight months; only 30 per cent of required medical supplies are being imported into the country; rubbish collection in the cities is irregular; and more than eight million people lack access to safe drinking water and proper sanitation.

UNICEF is reported to have flown in over 40 tonnes of medicines, rehydration salts, intravenous fluids and other life-saving supplies to treat approximately 50,000 patients in Yemen.

Meredith Horne

Medical role models honoured at AMA National Conference

AMA Woman in Medicine

Dr Genevieve Goulding, an anaesthetist with a strong social conscience and a passion for doctors’ mental health and welfare, has been named the AMA Woman in Medicine for 2017.

Described by her colleagues as a quiet achiever, ANZCA’s fourth successive female President, Dr Goulding has used her term to focus on professionalism, workforce issues, advocacy, and strengthening ANZCA services for Fellows and trainees.

Dr Goulding is a founding member of the Welfare of Anaesthetists Group, which raises awareness of the many personal and professional issues that can affect the physical and emotional wellbeing of anaesthetists throughout their careers.

Dr Michael Gannon, who presented the award at the AMA National Conference, said that Dr Goulding was a role model for all in the medical profession.

“She has raised the profile and practice of safe and quality anaesthesia. She is committed to ensuring patients – no matter their background or position – can rely on and benefit from our health system,” Dr Gannon said.

Dr Goulding continues to effect change with her work on the ANZCA Council and on the Queensland Medical Board, her numerous positions with the Australian Society of Anaesthetists, and her current work with the Anaesthesia Clinical Committee of the MBS Review.

Excellence in Healthcare Award

This year, AMA recognised a true medical leader Dr Denis Lennox, who has made an outstanding contribution to rural and remote health care in Queensland, and to the training of rural doctors.

Dr Lennox has had an extraordinary career since starting as a physician and medical administrator in his home town of Bundaberg in the 1970s. 

Dr Gannon said that Dr Lennox had earned this award through his vision and revolutionary training of rural general practitioners and specialist generalists.

“Dr Lennox has been responsible for real workforce and healthcare improvements in all parts of Queensland, particularly through the Queensland Rural Generalist Program which has delivered more than 130 well-prepared Fellows and trainees into rural practice across Queensland since 2005 – an incredible achievement,” Dr Gannon said when presenting the award.

An Adjunct Associate Professor at James Cook University and Executive Director of Rural and Remote Medical Support at Darling Downs Hospital Health Service, Dr Lennox prepares to retire from 40 years of public service.

AMA Women’s Health Award

A nurse and midwife in Darwin, Eleanor Crighton has been awarded the Women’s Health Award – an award that goes to a person or group, not necessarily a doctor or female, who has made a major contribution to women’s health.

Ms Crighton won the award for her outstanding commitment to Indigenous women’s health. 

Dr Gannon when presenting the award to Ms Crighton said that she had made a real difference to the lives of Aboriginal women in the greater Darwin region through them gaining access to affordable family planning.

“As an obstetrician, I know the importance of the work of women’s health teams, particularly in Aboriginal community-controlled organisations like Danila Dilba,” Dr Gannon said.

As the Women’s Health Team leader at Danila Dilba Health Service, Ms Crighton has shown her commitment to Indigenous health by pursuing additional studies and gaining personal skills with the aim of filling gaps in health care services.

Ms Crighton has also worked tirelessly to raise awareness of Fetal Alcohol Spectrum Disorder, and has started training Danila Dilba’s first home-grown trainee midwife, at the same time as pursuing her own Nurse Practitioner studies. 

Meredith Horne 

[Editorial] Gynaecological care: delivering the real essentials

Nearly 50% of women with fibroids and endometriosis in the UK were not told about the short-term or long-term complications from their treatment according to a survey of 2600 women published in a new report on barriers to women’s health care. The report, published on March 28, 2017, by the UK’s All Party Parliamentary Working Group on Women’s Health, also describes how 42% of women surveyed who had fibroids and endometriosis felt that they were not treated with dignity and respect. The experiences of patients with these common gynaecological conditions could potentially affect millions of women in the UK.