#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.”

[Perspectives] Breaking the rules

Disobedience, the first novel by Naomi Alderman, author of The Power, which won the Baileys Women’s Prize for Fiction in 2017, has been made into a film directed by Sebastián Lelio, and co-written by Lelio and Rebecca Lenkiewicz. It is set in the orthodox Jewish community in north London, but its themes have a more universal resonance. Is community stronger than love? Are rules more important than individual expression? Who is allowed to express their true sexuality and what happens to those who do?

Being heart smart could prevent cognitive decline in women

New research has revealed that cardiovascular risk factors, particularly high cholesterol, play a role in the development of cognitive decline, further highlighting the importance of kickstarting healthy heart habits earlier in life.

Professor Cassandra Szoeke, director of the Healthy Ageing Program at the University of Melbourne and lead researcher, said the results showed that strategies to target vascular damage are vital to prevent brain cell loss.

“Neurodegenerative brain disease works insidiously for decades before people are diagnosed with dementia – we need to stop it in its tracks, or ideally before it starts.”

“What you do now affects what you will be decades later.”

What did the study involve?

The Australian study, published in Brain Imaging and Behaviour, included 135 participants from the Women’s Healthy Ageing Project. These women had completed midlife cardiovascular risk measurement in 1992, followed by an MRI scan and cognitive assessment in 2012.

The researchers found that higher midlife Framingham Cardiovascular Risk Profile (FCRP) score was associated with greater White Matter Hyperintensity (WMH) volume two decades later, and was predominantly driven by the impact of HDL cholesterol level.

Structural equation modelling demonstrated that the relationship between midlife FCRP score and late-life executive function was mediated by WMH volume.

“We saw those with low brain volume lost even more volume over the next 10 years,” Professor Szoeke said.

The authors wrote that their results indicated that intervention strategies targeting major cardiovascular risk factors at midlife might be effective in reducing the development of WMH lesions and thus late-life cognitive decline.

Massive exercise changes aren’t needed – but being active every day is key

“We all know we should eat healthily and exercise, but we also know many people who start up a program are not participating 3 months later, and 12 months later even less are still participating,” Professor Szoeke said.

Going into the study, her research team had expected that women who did intense physical activity would have the best cognition down the track.

“We found it was those who did activity every day over the 20 years of follow-up. It could be walking the block or gardening or a mix of Saturday dancing, Sunday walking home, and Monday walking to work – but it is each and every day for 20 years.”

Professor Szoeke said the impact of the research should be a greater recognition that vascular risk is modifiable, If it’s left unchanged, this will lead to brain damage in the form of WMH, low brain volume and poor cognition.

She said modifying this risk doesn’t mean a huge lifestyle change. In fact, the benefit can be obtained from just being more active.

“Move often and eat healthily. Choose what works for you, change it as you need, and do it each and every day.”

Women are disproportionately affected by dementia

Women account for around two-thirds of all dementia cases. Understanding the reasons behind this is an issue close to Professor Szoeke’s heart.

She said while women generally live 3 to 4 years more than men, it is not just an effect of age. The fact that the symptoms, assessment, treatment, management and prevention of heart disease differs between men and women suggested that cardiovascular risk also plays a role.

“Last year, the Australian Hidden Hearts report was released, showing that women have more heart disease, heart failure and stroke than men,” Professor Szoeke said.

“The Health Minister Greg Hunt has announced an update of women’s health policy. There has been $18 million announced for research to fill these gaps in knowledge, particularly highlighting issues not often focused on in traditional women’s health.”

She said the strategic areas for the new update reflect key issues for women, including mental health, dementia, chronic disease and healthy ageing.

“I hope we can quickly see major improvements with investment in these areas.”

Key to chlamydia control is better management, not screening

Stark results from a new study on chlamydia screening have prompted calls for a greater emphasis on management and re-infection prevention.

The Australian study, published in The Lancet, did not find a significant reduction in the overall proportion of the population contracting chlamydia in a randomised group of sexually active peopled aged 16 to 29 years undergoing opportunistic testing compared to controls.

Lead researcher, Professor Jane Hocking, from the Centre for Epidemiology and Biostatistics at the University of Melbourne, told doctorportal that “our recommendations are that GPs should continue to test young men and women for chlamydia in line with clinical guidelines, but we need a greater emphasis on the management of chlamydia once diagnosed to reduce the risk of repeat infection.”

“This includes getting sexual partners tested and treated, and making sure that people treated for chlamydia are re-tested again 3 months later, as guidelines recommend, to detect any repeat infections early to minimise the risk of complications arising from infection.”

Research was needed to determine the effectiveness of a chlamydia screening program

Professor Hocking said that “chlamydia has been the most commonly diagnosed bacterial STI over the last 15 years and if left untreated, about 10% of cases of chlamydia in women will develop into pelvic inflammatory disease (PID) which increases a woman’s risk of future infertility”

She said that due to this, a number of high-income countries including Australia, have recommended screening for young adults.

“However, there isn’t any clear evidence that introducing a chlamydia screening program in general practice would reduce the burden of chlamydia in the population.”

This prompted the Australian government to fund this trial to determine whether chlamydia screening in general practice was effective at quelling chlamydia rates.

Chlamydia is a common infection – so why doesn’t opportunistic screening work?

The study was a cluster-randomised controlled trial. Clusters were rural towns in Australia with a minimum of 500 women and men aged 16–29 years, and no more than six primary care clinics.

Each cluster was randomised to either a clinic-based chlamydia testing intervention or to continue usual care. The intervention included computerised reminders to test patients, an education package, payments for chlamydia testing, and feedback on testing rates

Overall the findings, in conjunction with evidence about the feasibility of sustained uptake of opportunistic testing in primary care, indicated that sizeable reductions in chlamydia prevalence might not be achievable. Professor Hocking said the probable reason for this was due to testing rates not reaching high enough levels, for a long enough time.

“Previous modelling suggests that we need to test over 20% of young people for 10 years to reduce prevalence by 65%. In our trial, testing rates reached over 20% per year, but were only at this level for one year.”

Professor Hocking said that the trial aimed to demonstrate the likely impact of achievable levels of chlamydia testing in general practice.

“General practice is increasingly busy and young people, in particular young men, just don’t visit the GP often enough, or when they do attend, chlamydia testing isn’t discussed because of the time pressures or other clinical needs.”

“So, it is difficult to reach those target testing levels that are likely to make an impact on the burden of chlamydia in the population. Nevertheless, our trial increased chlamydia testing by over 150% in the intervention group.”

Call to focus more on improving chlamydia management

Professor Hocking highlighted that better case management will reduce infection rates and reduce the risk of complications arising from infection.

“The aim of chlamydia control is really to reduce the reproductive health complications associated with chlamydia – and if PID can be prevented, then that would reduce the risk of infertility in women.”

A key factor that results in chlamydia-associated PID is re-infection. In fact, having two or more past chlamydia infections can increase a woman’s risk of PID by up to 4-fold.

“About 15-20% of young adults will acquire a repeat chlamydia infection within 6 months of treatment for a past infection – so if we can reduce repeat infection, this suggests that we will reduce the risk of PID”, Professor Hocking said.

[Perspectives] Yvonne Sylvain: women’s health pioneer in Haiti

In the mid-20th century, a remarkable woman used her medical prowess and social prestige to address inequalities in Haitian society and raise the profile of public health. Born in Port-au-Prince in 1907, Yvonne Sylvain was the sixth of seven children of the poet, diplomat, and lawyer Georges Sylvain and his wife Eugénie. Both parents were part of a progressive intellectual elite that campaigned against the US occupation of Haiti, which lasted from 1915 to 1934. With a staunch feminist for a mother, the four Sylvain sisters all pursued either PhDs or medical training and furthered the cause of women’s rights.

[Comment] FIGO position paper: how to stop the caesarean section epidemic

Worldwide there is an alarming increase in caesarean section (CS) rates. The medical profession on its own cannot reverse this trend. Joint actions with governmental bodies, the health-care insurance industry, and women’s groups are urgently needed to stop unnecessary CSs and enable women and families to be confident of receiving the most appropriate obstetric care for their individual circumstances.

[Comment] Offline: It’s time to hold the private sector accountable

Once a central focus of global development goals, the field of women’s, children’s, and adolescents’ health has now been pushed to the margins of international concern. Maternal and child health advocates have been victims of their own success. Steep declines in under-5 mortality and steady progress in reducing maternal mortality have suggested the job is done. While advances in reproductive, maternal, newborn, and child health should be celebrated, this week’s report by the Independent Accountability Panel for Women’s, Children’s, and Adolescents’ Health (IAP) proves that such complacency is a grave mistake.

[Correspondence] Saudi visa trainees called home from Canada in diplomatic dispute

Saudi Arabia’s decision to recall its students in response to the Canadian Minister of Foreign Affairs’ tweet1 about two women’s rights activists has sparked a crisis in hospitals and communities that rely on Saudi visa trainees. Canada is the third most popular destination for Saudi-sponsored medical trainees in resi-dences and fellowships, after the USA and the UK.2

[Comment] Women making medical history: introducing A Woman’s Place

In December, 2017, The Lancet issued a call for papers for its special theme issue on women in science, medicine, and global health.1 The Comment outlined the gender inequalities in medicine that still persist, long after many overt barriers to women’s participation have fallen. While that theme issue will be forward-looking, I believe we can also gain insights from looking to the past for examples of women who have made their mark against the odds, and by asking what it was about their particular circumstances that enabled them to do so.

[Correspondence] Canadian Women in Global Health #CWIGH: call for nominations

A groundswell of attention and support for the need to recognise and advance women’s leadership in global health has arisen since the issue was brought to light in 2014 by Ilona Kickbusch. She launched a Twitter campaign asking people to nominate women working at the forefront of global health around the world.1 Subsequently, the Women in Global Health organisation was formed to advance gender equality in global health leadership, and many similar initiatives and chapters have developed.