AMSA Panacea Volume 51 Issue 1 2017

Official Magazine of the Australian Medical Students' Association

EDITION

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about the

australian medical students’ association AMSA is the peak representative body for medical students in Australia. AMSA exists to connect, inform and represent each of the 17,000 medical students at Australia’s 21 medical schools. Each of the 21 medical schools in Australia elects a representative to sit on AMSA Council.

Advocacy// AMSA advocates for medical students through policy development, advocacy campaigns and representation to governments, universities and relevant medical and medico-political bodies. AMSA has a strong grass-roots approach to policy development, whereby ThinkTanks produce and review policy and other initiatives.

Events// The events calendar kicks off with the first National Council. With three councils per year, there’s plenty of opportunities to attend - this is the best way of staying connected and informed of how AMSA represents you. Next in the event calendar is The National Leadership Development Seminar (NLDS), held in May. NLDS brings together 90 of Australia’s budding health leaders.

There is focused upskilling in leadership, advocacy, and political engagement.

In July, AMSA runs its famed National Convention, which has been held annually since 1960. Convention sees over 1,200 Australian medical students unite for the world’s largest entirely student-run event. AMSA’s Global Health Conference (GHC) runs each August, with over 700 delegates passionate about innovation and equity in global health. There is also AMSA Rural Health’s Rural Health Summit (RHS) in September, filled with jam-packed academic days and socials, which brings together medical students from across the country all sharing a passion for rural health.

Projects// AMSA’s projects cover a diverse range of topics including rural health, refugee health, LGBTIQ health and climate change. The Mental Health Campaign aims to improve medical student mental health and wellbeing.

Vampire Cup unites AMSA and the Red Cross to pit medical schools against one another in a race to donate blood, registering 1800 donations in a year and counting. AMSA Academy is an online educational platform with courses on topics including global, sexual and mental health.

Publications// AMSA produces various publications, such as this magazine, that are distributed both online and in hardcopy. These publications are an important conduit through which AMSA connects and informs Australian medical students.

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PANACEA MAGAZINE VOLUME 51 / ISSUE 1

CONTENTS 03 06 08 12 18 22 24 26 28

About the Australian Medical Students’ Association

Acknowledgements Balancing The Books Tarren Zimsen Crazy Socks for Docs // Student Docs Dr Eric Levi Letter to a Young Female Physician Dr Suzanne Koven Artwork Thomas O’Donnell Be Bold, Don’t Talk Yourself Down Erika Strazdins (UNSW) Predicting Challenges In Internship Jeffery Wang On Two Ends Kirsty Whitmore

A Fudgy Brownie Recipe Maddi Taylor Gender Equity in Medicine Jesse Ende Mental Health Musings Elise O’Connor Gut Microbes Amelia Skaczkowski A Marshmallow In Medical School Rose Worthington Photography Robin Wei Doing Everything We Can Keyur Doolabh Happy Birthday and Good Luck Gretel Whiteman

AMSA Representative Reports

31 34 38 40 42 44 48 50 53

MAJOR SPONSORS We would like to thank all our major sponsors for their ongoing support.

Special thanks to RACGP for sponsoring this edition of Panacea, and to the AMA for their extensive support of AMSA.

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PANACEA MAGAZINE VOLUME 51 / ISSUE 1

Editor-In-Chief Michelle Kim (UQ) Contributors Maddi Taylor (Griffith) Tarren Zimsen (JCU) Jeffery Wang (Monash) Proofing Nicole Georgiadis (Griffith) Alice Aitkenhead (Bond) Chris McKenna (UQ) Phoebe Macintosh-Evans (UNSW) Isabella Gosper (UQ) Sponsorship Nicole Georgiadis (Griffith) Special Thanks The New England Journal of Medicine Dr Suzanne Koven Dr Eric Levi All the students who have submitted their work for Panacea Volume 51 Issue 1 2017.

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BALANCING THE BOOKS Tarren Zimsen (JCU, VI) Tarren is the Treasurer and Executive Director of the Australian Medical Students’ Association, he is also a final year Medical Student at James Cook University and an enthusiastic competitor in multiple sports including: Ironman Triathlons, touch footy, cricket, as well as all the outdoor exploring that Far North Queensland allows. He is more than happy to chat to anyone via email or on the phone if they have any questions or points of discussion.

Just like delivering a surplus to the boardroom, balancing your life is no easy task. There are numerous debits and credits and until you really test yourself, you will never really find where the net positives and negatives lie.

Below I have outlined 4 key strategic areas that I strongly focus on to ensure that I keep everything in line and at the end of the day deliver a surplus that I can take into the future.

Goal Setting: Setting SMART and realistic goals for multiple aspects of your life is something that is commonly discussed at leadership seminars. Goal setting isn’t easy, but it is such a valuable exercise. Carrying out these goals and making yourself accountable to them is even more challenging. How you define what success is should be closely aligned to your expectations. For example, before I go out and compete in an Ironman I have 3 goals in mind: 1.

Don’t die 2.

Finish the race 3.

A time that I would like to

complete the race in This structured, step-down approach means that I am not upset at the end of the day, should I fall just 30 seconds short of my time goal. This is important and can be carried through to so many other aspects of life.

Goal setting for your life outside of medicine is essential, it makes you accountable. Sign up for the 10 km fun run, join a social netball team, join a debating society, whatever it is that you use as your escape from medicine requires personal goals to aim towards otherwise the study grind is an infectious

beast and can take over your life.

Having different compartments of your life running parallel goals is such a useful tool in keeping your physical and mental health in perspective. The human body is so interconnected that looking after your physical health only has positive implications on your mental health, and therefore retention and efficiency when it comes to study. Focusing on this global pan-life perspective is incredibly important when you want to balance the books.

Practice: The second piece of advice is to practice.

The more you practice managing your time, the better. Someone that inspires me every day is the Vice President Internal of AMSA, Maddi Taylor. I am one of the incredibly fortunate people to call Maddi a friend.

Her ability to juggle multiple portfolios as well as family and clinical medicine inspires me every day. But her skills didn’t develop overnight. It takes years to develop the resilience and ability to manage her time to this degree. As such copious amounts of practice are required to adequately manage these portfolios as an individual you really need to get stuck in early.

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Once you get into medicine, every single year just gets more and more difficult.

Putting goals outside of medicine on hold can only be detrimental to your personal development. In the words of the current AMSA president Rob Thomas, “with the pace of change accelerating, doctors with a worldview that extends beyond medicine are needed now more than ever”. For me this speaks volumes for my involvement

in student leadership, sports, travel and volunteer work. It can be very easy to get carried away with hours upon hours of medical study, but skills beyond medicine are essential in your ability to be effective medical leaders as well as understanding and advocating for your patients.

Abuse your strengths: You will never find your limits if you don’t push your boundaries. A mate told me this in 2nd year, probably a few too many tins into a carton of beer. But once again there is a lesson to be learnt. Once your strengths are known, you can abuse them. History is the best indicator of future outcomes. Maybe it is best to check your emails in the morning.

If you can write an assignment in 48 hours don’t spend weeks on it. If you think you are better student on the wards after morning exercise then do that. Find what works for you and jump the system. These little tricks are your own cheat codes to get through the day and maximise your own efficiency.

An example of how I cheat my days is by ensuring that I exercise every day, and sometimes multiple times a day. The more stressful and busy the day, the greater the need for exercise. I function more efficiently, and think clearer when I have exercised; it is my meditation. Understanding that there is a net benefit associated with the practice regardless of the time pressure ensures that it is incredibly rare that I miss this part of my day. The short-term benefits of exercise to my mental and physical health assists me in doing my best in all the other stresses of life, and hence it sits as a priority number one.

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Maintain and cultivate your safety net: Super simplifying your life into a few core principles will make decision making a whole lot easier. You don’t always have to stick to these principles, but having them there means that when life gets stressful, and it certainly will, you already have a crutch to lean on. In addition to this you want to ensure that there is some fat in your life. An agile and reactive schedule is required to ensure that you can take advantage of all opportunities. Being arduously regimental and predetermined in your time management is incredibly detrimental to being able to achieve net benefits. Remember that an opportunity can present in the strangest of ways. I met Rob Thomas (current AMSA president) over a beer in Sydney and 6 months later we were elected as the executive together. Keeping your baseline at about 80-90% capacity ensures that when opportunities present themselves, there is still space to take advantage of them. Make yourself your own safety net.

The interconnection between mind and body is irrefutable. It is essential to understanding that there are net benefits to be made to your academics by prioritising other aspects in your life such as sport and your peers. More hours at the study table doesn’t necessarily mean better results. I use the strategies discussed above every single day, but they may not work for everyone. Find what works for you and surround yourself with a supportive management team, group of friends and family, and you will be onestep closer to balancing the books.

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CRAZY SOCKS FOR DOCS

What a day 1 June 2017 was for doctors, nurses, dentists, pharmacists, social workers, physiotherapists, psychologists, dietitians, speech pathologists, audiologists, respiratory therapists, anaesthesia techs, paramedics, medical students, veterinarians and all other specialties that work in the health care industry for patients.

In raising awareness for physician suicide rate, Dr Eric Levi and Dr Geoff Toogood set up #CrazySocks4Docs, which was a huge success all over the globe to say the least.

It was absolutely inspirational to see health workers from all over the world come together and see their mission come alive: 1. To remember the many health professions who had died by suicide or in the line of duty 2. To raise awareness of physical and mental health issues among health professionals 3. To reshape the culture of the health care industry with hope and humanity, so that health care workers are given the space to care for each other.

All whilst having a bit of fun getting amongst our craziest socks!

Read on for Dr Levi’s article on what it all means for us - the student docs.

ABOUT THE AUTHOR

Dr Eric Levi is a Melbourne-trained Australian Specialist Otolaryngologist, Ear Nose & Throat, Head & Neck Surgeon currently undertaking subspecialty Fellowship training in Paediatric Otolaryngology in Australia.

Dr Levi and Dr Geoff Toogood sparked a social media phenomenon not long ago on June 1st with their creation of “Crazy Socks Day” a.k.a. #CrazySocks4Docs #Socs4Docs The following article originally appeared on Dr Levi’s personal blog, and he has generously given AMSA the permission to reuse the articles on his blog. We strongly recommend visiting ericlevi.com/blog to read the collection of his work!

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CRAZY SOCKS FOR STUDENT DOCS

I was between operating theatres and juggling a couple of emergency cases today. I was invited to speak to a group of Medical Students about #crazysocks4docs and #mentalhealth for docs. In the flurry of the moment-to-moment medical madness I had to formulate a few thoughts to share.

The elevator only gave me enough time for 3 points.So if you are one of the 50 or so medical students in the Auditorium this afternoon, I’m sorry for my 5 minute long babbling. This was what I really wanted to say if I had been more coherent: Hi, I’m not here to sell socks. I’m here to start an honest conversation. About 4 weeks ago, Dr Andrew Bryant, a senior

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Dr Eric Levi

gastroenterologist committed suicide. Early this year, Dr Chloe Abbott and 2 other junior doctors in New South Wales ended their own lives. Suicide and mental illness is a subject that is very real and very close to you as a future medical practitioner. I only have 3 things I’d like to share.

1.You signed up for a tough job You’ve had to do a lot to get to where you are, and you’re still going to have to do a lot to get through. If you think medical school exams are tough, wait till you get to specialist exams. Your days are going to be long. Your resilience is going to be tested. You will be seeing bullying and harassment first hand or you may even experience it first hand. You

will be put under enormous pressure and you will be pushed. Your patients, your bosses, the nurses, administration and the community expect a lot from you. You will miss many significant days, birthdays, anniversaries, and family reunions because of your work. If you have an underlying mental health condition, your job will exacerbate it. If you don’t have one, you will most certainly experience it at some stage during your career in medicine.

You will see mental illness first hand during your psychiatry rotation, and you will have to learn to also see it in your colleagues. This is the reality of the current climate of Health Care today. It’s a harsh environment to be a medical practitioner. But it’s absolutely worth it.

2.There is formal support available Your medical school, University, Hospital, Specialty Colleges and State Health Departments all have formal support services available from staff clinics to confidential phone in and counseling services. Be aware that these services are there to help and support you. Access them because they’re there to help you play your best game. Find a GP whom you trust. Build a therapeutic relationship with a professional. But sometimes those formal systems are not enough. This leads me to the next point.

3.Strengthen your informal support system This is the impetus for #crazysocks4docs.

We want to talk openly about the difficult subjects. We want to reshape the culture of medicine. We doctors don’t treat each other well enough. We inherently compete and compare ourselves against another

instead of collaborating. We eat our own.

We belittle those who struggle. When you’re going through dark seasons, and trust me you will, it may not be easy for you to talk to an anonymous counselor. You need to talk to people you know who understand what you’re going through. This means being human to each other. This means learning to build your support network within medicine and outside of medicine. Adopt some nontraditional support systems such as social media. One of the best things I ever did was to join twitter where I engaged with a lot of great doctors who have become my virtual mentor and friends.

Reshaping the culture of medicine demands us to be honest, humble and vulnerable.

Talk to someone. Engage your circle. Have lots of coffee together. The idea behind #crazysocks4docs is to remove the stigma of the distressed doctor. We need to change the language and culture of medicine to allow us to be more human and compassionate to each other. I hope the environment you practice in will be much kinder to you than the medical environment I grew up in.

I know the reality of social media trends.

People will forget this within the week. This is not about fund-raising or policy-making. This is about idea-sharing. I hope you can begin an open conversation about being human in our Health Care System. Perhaps your conversations might just stop someone, or yourself, from suicide. Look after each other.

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Letter to a Young Female Physician Suzanne Koven, M.D.

The New England Journal of Medicine

Dr Suzanne Koven’s article was originally published in The New England Journal of Medicine on 18 May 2017. The Australian Medical Students’ Association has permission from NEJM to republish this article in Panacea Volume 51 Issue 1.

“

This past June, I participated in an orientation session during which new interns were asked to write self-addressed letters expressing their hopes and anxieties. The sealed envelopes were collected and then returned 6 months later, when I’m sure the interns felt encouraged to see how far they’d come.

This exercise, in which the intern serves as both letter writer and recipient, both novice and veteran, offers a new twist on an old tradition. In 1855, James Jackson published Letters to a Young Physician Just Entering Upon Practice. More recent additions to this epistolary canon include Richard Selzer’s Letters to a Young Doctor, which appeared in 1982, and Treatment Kind and Fair: Letters to a Young Doctor, which Perri Klass published in 2007 on the occasion of her son’s entry into medical school.

When I started my internship 30 years ago, I wasn’t invited to share my hopes and anxieties in a letter — or anywhere else, for that matter. In fact, I recall no orientation at all, other than lining up to receive a stack of ill-fitting white uniforms, a tuberculin skin test, and a hasty and not particularly reassuring review of CPR. Perhaps the memory of my own abrupt initiation explains my response as I sat at the conference table watching the new interns hunched earnestly over their letters: I was filled with longing. I wanted so much to tell them, particularly the women — more than half the group, I was pleased to note — what I wished I’d known. Even more, I yearned to tell my younger self what I wished I’d known. As the interns wrote, I composed a letter of my own.

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Dear Young Female Physician: I know you are excited and also apprehensive.

These feelings are not unwarranted. The hours you will work, the body of knowledge you must master, and the responsibility you will bear for people’s lives and well-being are daunting. I’d be worried if you weren’t at least a little worried.

As a woman, you face an additional set of challenges, but you know that already. On your urology rotation in medical school, you were informed that your presence was pointless since “no self-respecting man would go to a lady urologist.”

There will be more sexism, some infuriating, some merely annoying. As a pregnant resident, I inquired about my hospital’s maternity-leave policy for house officers and was told that it was a great idea and I should draft one. Decades into practice, when I call in a prescription, some pharmacists still ask for the name of the doctor I’m calling for.

And there will be more serious and damaging discrimination as well. It pains me to tell you that in 2017, as I’m nearing the end of my career, female physicians earn on average $20,000 less than our male counterparts (even allowing for factors such as numbers of publications and hours worked)1; are still underrepresented in leadership positions, even in specialties such as OB–GYN in which we are a majority2; and are subjected to sexual harassment ranging from unwelcome “bro” humor in operating rooms and on hospital rounds to abuse so severe it causes some women to leave medicine altogether.3

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But there’s also a more insidious obstacle that you’ll have to contend with — one that resides in your own head. In fact, one of the greatest hurdles you confront may be one largely of your own making. At least that has been the case for me. You see, I’ve been haunted at every step of my career by the fear that I am a fraud.

This fear, sometimes called “imposter syndrome,” is not unique to women. Your male colleagues also have many moments of insecurity, when they’re convinced that they alone among their peers are incapable of understanding the coagulation pathway, tying the perfect surgical knot, or detecting a subtle heart murmur.

I believe that women’s fear of fraudulence is similar to men’s, but with an added feature: not only do we tend to perseverate over our inadequacies, we also often denigrate our strengths.

A 2016 study suggested that patients of female physicians have superior outcomes.4 The publication of that finding prompted much speculation about why it might be so: perhaps women are more intuitive, more empathic, more attentive to detail, better listeners, or even kinder? I don’t know whether any of those generalizations are true, but my personal experience and observations make me sure of this: when women do possess these positive traits, we tend to discount their significance and may even consider them liabilities. We assume that anyone can be a good listener, be empathic — that these abilities are nothing special and are the least of what we have to offer our patients.

I have wasted much time and energy in my career looking for reassurance that I was not a fraud and, specifically, that I had more to offer my patients than the qualities they seemed to value most.

Early on, I believed that displaying medical knowledge — the more obscure the better — would make me worthy. That belief was a useful spur to learning, but ultimately provided only superficial comfort. During my second-year clinical skills course, an oncologist asked me to identify a rash.

“Mycosis fungoides!” I blurted out, since it was one of the few rashes whose name I knew and the only one associated with cancer. My answer turned out to be correct, causing three jaws to drop at once — the oncologist’s, the patient’s, and my own — but the glow of validation lasted barely the rest of the day.

A little further on in training, I thought that competence meant knowing how to do things. I eagerly performed lumbar punctures and inserted central lines, and I applied for specialty training in gastroenterology — a field in which I had little interest — thinking that I could endoscope my way to selfconfidence.

My first few years in practice, I was sure that being a good doctor meant curing people. I felt buoyed by every cleared chest x-ray, every normalized blood pressure.

Unfortunately, the converse was also true: I took cancer recurrences personally. When the emergency department paged to alert me that one of my patients had arrived

unexpectedly, I assumed that some error on my part must have precipitated the crisis.

Now, late in my clinical career, I understand that I’ve been neither so weak nor so powerful. Sometimes even after I studied my hardest and tried my best, people got sick and died anyway. How I wish I could spare you years of self-flagellation and transport you directly to this state of humility!

I now understand that I should have spent less time worrying about being a fraud and more time appreciating about myself some of the things my patients appreciate most about me: my large inventory of jokes, my knack for knowing when to butt in and when to shut up, my hugs. Every clinician has her or his own personal armamentarium, as therapeutic as any drug.

My dear young colleague, you are not a fraud.

You are a flawed and unique human being, with excellent training and an admirable sense of purpose. Your training and sense of purpose will serve you well. Your humanity will serve your patients even better.

Sincerely, Suzanne Koven, M.D. Harvard Medical School Massachusetts General Hospital Boston, MA

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A R T // “Your mental health in medicine is your number one priority. Hold it with great importance.”

Artwork by Thomas O’Donnell (UNDS, II)

BE BOLD Erika Strazdins (Women in Medicine, UNSW)

Being bold for change is the leading theme of International Women’s Day 2017. Just think about the last time you were in front of people, perhaps in a tutorial at hospital, a group project, at an interview, or answering questions at a seminar. How often did you minimise your abilities, attribute your achievements to luck, or downplay your success? Did you talk yourself down?

This pattern of thinking has two implications; Firstly, who will believe a person who doesn’t believe in themselves? Your words will flavour the impression of your peers, teachers, and employers. Secondly, this attitude may diminish self-confidence and self-efficacy.

Recently the institutional obstacles that women face in medicine have received attention. However, also important is addressing the barriers that may come from within. In traditionally male dominated professions like medicine, women are particularly vulnerable to negative self evaluations.1 Female medical students undervalue their performance compared to their male counterparts,2,3 even when they were assessed as out performing them.3 However these detrimental patterns may not be gender dependent as it has been

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on’t Talk Yourself Down

noted that both female and male surgical residents underestimate their performance when compared to external measures.4 Hence, talking yourself down and believing less of yourself may be something common to male and female medical students alike.

Humility is a virtue, and we have the great fortune to be born in this time in history, study in Australia, and have the support of family, friends, teachers, and mentors along the way. However, in order to grow professionally as doctors and personally as people, we need to start believing in our own unique and valuable abilities and be bold enough to share them with others.

REFERENCES 1. Beyer S. The effects of gender, dysphoria, and performance feedback on the accuracy of self-evaluations. Sex Roles. 2002 Nov 1;47(9-10):453-64.

2. Blanch-Hartigan D. Medical students’ self-assessment of performance: results from three meta-analyses. Patient Education and Counseling. 2011 Jul 31;84(1):3-9.

3. Lind DS, Rekkas S, Bui V, Lam T, Beierle E, Copeland E3.

Competency-based student self-assessment on a surgery rotation.

Journal of Surgical Research. 2002 Jun 1;105(1):31-4.

4. Minter RM, Gruppen LD, Napolitano KS, Gauger PG. Gender differences in the self-assessment of surgical residents. The American journal of surgery. 2005 Jun 30;189(6):647-50.

5. Hardy J. Speaking clearly: A critical review of the self-talk literature. Psychology of Sport and Exercise. 2006 Jan 31;7(1):81-97.

6. Creswell JD, Dutcher JM, Klein WM, Harris PR, Levine JM. Selfaffirmation improves problem-solving under stress. PLoS One. 2013 May 1;8(5):e62593.

BE AWARE Talking yourself down can come unconsciously and naturally. The first step is to note when and how you are doing it.

Do you have favourite phrases like “I was just lucky” or “this could be a bad idea but…” or “this might be a stupid question…”?

Is there a particular environment in which you are more prone to talking yourself down?

BELIEVE IN YOURSELF Before you next have to speak in front of people, practice talking yourself up. Telling yourself positive statements may prime you to be more confident and even perform better. (5) Remind yourself about something you have achieved and that this was because of your abilities.

DON’T APOLOGISE FOR BEING AMAZING When you receive praise do you reflexly discount it with “it’s nothing” or “anyone could have done it” and quickly avert your eyes?

Next time practice saying a simple “thank you” with a smile.

POSITIVE AFFIRMATIONS On the surface this seems simple, but repeatedly exposing yourself to a positive affirmation can convince you of its truth and contribute to a better sense of self esteem and improve performance. (6) “I have many talents which I will use to the full today" “I love challenges. They bring out the best in me”

Predicting Challenges In Internship: a medical student’s perspective

Jeffery Wang (Monash, V)

I was recently asked what challenges I, as a final year medical student, predict for my internship year. The transition from medical school to working as an intern can be complex and fraught with challenges. A new intern must deal with greater responsibility, an even greater increased need for selfdirected learning and the ever-present risk of burnout.

Responsibility The role of the medical student is to learn and practice with supervision, assisting in patient care where possible. The role and responsibilities of the intern are very different. Often an intern may be called on to make medical decisions that may be outside of their knowledge-base – all the more challenging if it occurs during a sparsely-staffed night shift, as these stories tend to go. The intern’s increase in responsibility does not end at direct patient care. A medical student is very much a team member, not a leader. The intern, however, finds themselves leading and directing nurses, the majority of whom are far more experienced and knowledgeable than themselves.1

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Navigating the increase in responsibility inherent in the transition from a student to a doctor role can be difficult, but should be easier than for our predecessors. The stories we hear from our consultants of being alone on night shift with no senior guidance inspires fear in the most competent of medical students, however we are not doomed to repeat the mistakes of past. In this age where everyone carries a mobile phone and answers from therapeutic guidelines or the clinical decision support system of your choice are instantly available at your fingertips, the intern ought to feel more confident in their practice, even though their personal knowledge may be just as limited.2 Furthermore, the strictly hierarchical nature of healthcare is all but behind us. While medical decisions still ultimately rest on the medical officer, interns and residents should never feel too embarrassed or proud to seek the guidance of an experienced nurse or allied health professional in shared decision making.1 Ultimately, it is this greater clinical responsibility that serves in part to drive our own learning and development as healthcare practitioners.3 Self-Education The medical student’s primary focus is to learn; absorb as much information as they can and then help out with ward jobs and patient care as a secondary priority.

Conversely, an intern’s role is to work, and learn as they do so. The conflict between a junior doctor’s service and learning responsibilities may often place the latter in jeopardy.4 The intern must therefore navigate the workplace while ensuring they participate fully in all educational

opportunities presented– ranging from the clinical setting (bedside teaching and ward rounds, clinics, theatre), to meetings (handover, multidisciplinary team meetings, morbidity and mortality meetings) and formal teaching (grand rounds, journal club, simulation).5 Attendance at protected teaching time may be particularly beneficial for an intern’s education, while the use of eLearning facilities both at home and during protected time may also contribute to a junior doctor’s knowledge.6,7

Medical Association’s Council of Doctors in Training and the specialty colleges have been instrumental in reducing the stigma surrounding stress, burnout and poor mental health.

Burnout and Mental Health It is no secret that poor mental health and burnout are particularly common in internship, with burnout experienced by up to 70% of Australian interns.8 Psychological distress as a junior doctor has been reported to occur as a function of exhaustion due to long work hours, poor work-life balance and social isolation.9 Given this, the peer support of fellow interns undergoing the same experience is invaluable, as is the support of other junior and senior medical staff.

Interns should be reflective practitioners, and maintain an awareness of their own psychological state, as well as that of their peers, so as to intervene in times of need. The social isolation faced by interns from their peers outside of medicine may be minimised through optimal time management, and activities organised by RMO/HMO societies may provide a social avenue fitting the medical work schedule. Ultimately there is no substitute for psychiatric help, and interns should not be afraid to seek help where necessary. Work by bodies such as the Australian Medical Students’ Association, Beyondblue, the Australian

Jeffery is the founding Chair of the AMSA Medical Education Committee, the AMSA National Executive IT Officer and a final year medical student at Monash University.

Conclusion The challenges of internship and indeed a career in medicine are numerous. Perhaps reflecting on the challenges that lie ahead may allow medical students to avoid and surmount hurdles as they appear.

REFERENCES 1. Muller-Juge V, Cullati S, Blondon KS, Hudelson P, Maître F, Vu NV, et al. Interprofessional Collaboration between Residents and Nurses in General Internal Medicine: A Qualitative Study on Behaviours Enhancing Teamwork Quality. PLoS ONE. 2014 04/25;9(4):e96160. Available from: PMC 2. Patel R, Green W, Shahzad MW, Larkin C. Use of Mobile Clinical Decision Support Software by Junior Doctors at a UK Teaching Hospital: Identification and Evaluation of Barriers to Engagement.

JMIR mHealth and uHealth. 2015 08/13;3(3):e80. Available from: PMC 3. Cantillon P, Macdermott M. Does responsibility drive learning?

Lessons from intern rotations in general practice. Med Teach.

2008;30(3):254-9.

4. Hore CT, Lancashire W, Fassett RG. Clinical supervision by consultants in teaching hospitals. Med J Aust. 2009 Aug 17;191(4):220-2.

5. Williamson JM. Learning opportunities within the clinical workplace. British Journal of Medical Practitioners. 2016;9(4).

6. Kabir S. Addressing the Barriers to Clinical Education in Emergency Medicine. Australian Journal of Clinical Education.

2017;1(1):3.

7. Brooks HL, Pontefract SK, Vallance HK, Hirsch CA, Hughes E, Ferner RE, et al. Perceptions and Impact of Mandatory eLearning for Foundation Trainee Doctors: A Qualitative Evaluation. PLOS ONE. 2016;11(12):e0168558.

8. Willcock SM, Daly MG, Tennant CC, Allard BJ. Burnout and psychiatric morbidity in new medical graduates. Medical Journal of Australia. 2004;181(7):357-360.

9. Gunasingam N, Burns K, Edwards J, Dinh M, Walton M. Reducing stress and burnout in junior doctors: the impact of debriefing sessions. Postgraduate Medical Journal. 2015;91(1074):182-187.

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O n Tw o Ends Kirsty Whitmore (Griffith, III)

Before my life was consumed by learning objectives, PBL and medical school, I was a nurse. I have always loved working in health care, in all shapes and forms. Even now, I continue to nurse on the weekends, both to financially support myself through study, and for pure enjoyment. I am incredibly proud to be a nurse. I have had an overwhelmingly positive experience as a respected member of the clinical team. I know that my experience of nursing will shape the doctor I will become.

However, in the past six months of fulltime clinical placement, I have seen a less positive side of health care. I have seen doctors ignore nurses’ concerns, and speak to them like they lack any clinical acumen or knowledge. I have heard impatient words spat across hallways as doctors rush through overloaded ward lists and overbooked clinics. I have felt ashamed by the conduct of my team when they devalued the role of nurses.

But at the same time, I have felt ashamed of my nursing colleagues. I saw nurses trawling Facebook when there was work to be done.

They snorted and shoved charts at the intern when they forgot to prescribe antiemetics.

They tapped their feet impatiently, while they waited for the med round to be finished.

They spoke scornfully to us as students, for mistakes we did not know we were making.

I had my own personal experience of this recently. I had scrubbed in for an operation, and was trying to suture laparoscopic wounds under the guidance of the registrar.

This was my first suture, and I was as clumsy

and slow as expected. The scout nurse, growing impatient, started packing away things loudly and proclaimed, “We don’t have time for this. She is too slow. We are out of time.” I felt incompetent and embarrassed.

Often, my colleagues and I felt unwelcome, like an inconvenience or a burden. It felt like we had no place in the clinical team.

It has been a strange situation to have been on both sides of this interaction. The literature on relationships between nurses and medical students demonstrates a lack of positive interactions, despite the prominence of inter-professional learning in our medical school curriculum. We struggle to recognise one another as part of our clinical team.

So often these conflicts arise from a lack of understanding each other’s role, level of experience, or external pressures. I have no doubt that the way we interact with one another across professions is predominantly decided by our experience as students, and shaped by the culture in which learn. Now is the time to push against that tide.

Having failed on both sides of the interaction, as both a medical student and a nurse, I urge you to consider how you as a doctor of the future will respond.

1. Don’t judge a profession based on one person. Each of us are going to encounter some pretty average, uncooperative or even bullying nurses. Likewise, we will all work with a difficult, hard-to-please, impatient doctor.

Neither of these should be the standard by which we judge our future colleagues. We need to find and select our role models

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carefully. We must find those that inspire us, from all professions, and cling to them. We need to treat one another with patience and respect, as people with the shared goal of caring for patients.

2. Take the time to learn from and about your future colleagues, ranging from nurses, to allied health staff, to wards staff. I recall nursing on a ward when the registrar became frustrated that none of the nurses were putting in nasogastric tubes when she put them in her management plan. She complained to the senior nurser, suspecting they were deliberately avoiding the task to make her life difficult, not realising it was standard policy in this ward for doctors to complete this task. The lack of communication on both sides of the fence fostered such avoidable animosity between two professionals that are inherently dependent upon one another. You aren’t expected to know everything; you just need to ask.

3. Recognise that your colleagues are facing pressures that you have no awareness of. Until I started medicine, I had no idea that residents attended clinics multiple times a week! I didn’t realise doctors went to MDT, or mandatory education, or audits, or had to organise journal clubs.

Nurses, like all other staff, face challenges too, whether this is understaffing, or multiple discharges, or difficult, complex patients. We all have shifts that just don’t go to plan. The way we treat each other often determines if this day will be simply busy, or a complete disaster!

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4. Have the courage to stand up for one another. When I say this, I do not only mean your fellow medical students (although this is absolutely necessary), but for whomever in your team needs support. My greatest disappointment out of this has been the times when doctors on my team were rude to a nurse, and I did not speak up for them.

I did not even turn back to apologise. We must not let behaviours that should remain in the past determine the way that we will treat our colleagues in the future.

Kirsty Whitmore is a third-year medical student at Griffith University. She procrastinates from study by writing articles for magazines, and perfecting the art of ‘study snacking’. When Kirsty isn’t busy confusing carbamazepine with carbimazole, she enjoys coming up with outlandish ideas to annoy the GUMS team, who patiently tolerate her as President.

The

Best Brownies

For your PBL/CBL A Recipe by Maddi Taylor Maddi is the Vice President Internal of the Australian Medical Students’ Association and a final year student at Griffith University.

A Fudgy Brownie Recipe The best PBL sessions I have been to involve baked goods. There is no better way to create camaraderie and trust between you and your PBL members than a good brownie. And when you get to clinical years some delicious baking can ensure that when on O&G the midwives enjoy having you around and will make sure you can be involved in your first baby catch!

There are five basic ingredients to any brownie recipe and they are chocolate, butter, flour, sugar and eggs. By varying the amount of chocolate, butter and flour you can change the consistency of your brownies. If you prefer a slightly ‘cakier’ consistency then change the ratios listed below: using 750g butter, 100g chocolate and 1 cup flour will make for a more fluffier brownie.

Baking can be something you do to unwind and relax. Make sure you keep the little things in life that help you to relax. Whether that be team sports, painting, cooking, music, dancing or stamp collecting; whatever it is that makes you, you, keep doing it. It’s what will keep you sane throughout med school and what will ensure that you are a happy, healthy junior doctor who can take the very best care of your patients possible.

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Ingredients 150g Chocolate (Dark chocolate will give you a slightly more bitter and richer brownie) 125g Unsalted butter 510g White Caster Sugar (1.5 cups) – You can use brown sugar in order to achieve a chewier consistency) 3 eggs 85 g Cocoa powder (1/4 cup) Pinch of salt 200 g Plain white flour (sifted) Method 1. Preheat the oven to 180 degrees and line your baking dish with baking paper. Tip – if you find you run out of baking paper when trying to bash these out before class the next day then do not fear. Take some paper towel and wipe your baking tray with butter on all surfaces and then sprinkle flour over the top to lightly coat.

2. With a pot of simmering water on the stove place your chocolate and butter in a silver mixing bowl which sits over the water. Stir occasionally in order for the chocolate and butter to melt, taking care not to burn the chocolate to the bottom of the bowl.

3. Once fully melted take the chocolate and butter off the stove. Add in the sugar, continuously stirring with a whisk.

4. With the sugar fully combined begin to add the eggs one at a time, ensuring it is well combined each time. Now whisk in your sifted cocoa powder with a pinch of salt.

5. Add in the sifted flour to the mix. Now using a spatula fold in the flour to the brownie mixture. You don’t want to overmix this, just enough to fold in the flour until it is combined.

6. Place your mixture into the pan and pop them in the oven for 35-40 minutes until they come out with a crispy outside and are just cooked on the inside.

Tip: You can add in any extra’s after step 5 such as chunks of chocolate, hazelnuts or frozen raspberries. Another wicked twist includes adding in two tablespoons of powdered liquorice root with the cocoa powder. You can usually find this at the health food store.

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What can male medical students do for gender equity in medicine?

Written by Jesse Ende (UNSW, VI) Special thanks to James Kane (V), Bahaven Jeyaratnam (VI), and James Deacon (V) for their input and ideas, and to Women in Medicine UNSW and AMSA for their guidance.

The issue of gender inequality in the medical profession is big — it is now well known that women in medicine face a harder time achieving their professional goals, while also balancing this with their personal goals1-4.

As students going into the hospitals for our learning, we are in the very environment where this sexism, discrimination, and bullying all occur. Some of you may have heard stories about it in the common room, or you may have witnessed it. Maybe it was was in theatres. Maybe it was a comment from a tutor, or even a patient. One thing for sure however, is that this generation of medical students is becoming more aware of gender inequality in the workforce, and we are now challenging the old-style attitudes towards gender discrimination and bullying.

1. Identify It

As a male medical student in a cohort of more than 50% females, this got me thinking: how can males, as students, make a positive change to ending these behaviours, and support females in achieving the goal of gender equity in medicine? Something to keep in mind though, is that as a male standing up for gender equity you are being an ally for women who have been struggling for the same recognition for a great deal longer, and have faced the harms of a system which has historically favoured men. Standing up for gender equity should become the status quo, not something deserving of praise. It is important to recognise that in order for us all to reach gender equity, men will have to concede some of their current standing in the medical field. With that in mind, there are quite a few things you can do every day to make a change for the better.

These are common, daily occurrences in a

“I don’t think it takes a genius to recognise we don’t currently have gender equity, and have a long way to go. It’s just part of being a decent human being and realising that you’ve benefited from a societal system which favours men.

Realise that it’s not about you, and you don’t deserve a reward for actively fighting gender inequality as a man. It’s something women do every day, and often get derision and abuse for.”

— James Kane (V)

When you first think about sexism and harassment in the hospital it is often the overt examples that come to mind, like the recent media reports suggesting sexual favours are necessary for positive supervisor reports5. The real challenge for us is to identify the more subtle ones. Have you ever heard a tutor introduce the bedside tutorial group with “I’ve brought these pretty young doctors to see you”? Have you ever had a patient call a female student a nurse? Have you ever heard a doctor make an offhand joke about a female colleague — “she’s such a bitch at early morning meetings”? Have you ever seen a female student get passed over for extra opportunities, for example in theatres?

Sometimes, it might be something we do ourselves but don’t realise, like talking over a female colleague in a tutorial.

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hospital. However, it is important to recognise them objectively for what they are: bullying, discrimination, and sexism. Unfortunately, many of these have become so common that they are practically ingrained in the day-today of hospital life. The first practical step however, is to identify when these things occur. It will surprise you just how common they are.

“I think that it is easy for inequality and sexism to become normalised. People might say that men and women have very similar opportunities in the work force, but it is simply not true.

Men need to be aware of sexism and prejudice both in a verbal form and in actions. Only then can we recognise it around us.”

— James Deacon (V)

2. Call it out, be an ally As a male student, it is powerful to stand up for a female colleague in these situations.

This can be as simple as being the first to politely point out that “no, my colleague is not a nurse, but is in fact one of the brightest in our medical cohort”. Or perhaps it could be by gently reminding a tutor that their latest sexist joke isn’t really that funny, and it would be helpful if they could stick to the planned content — even the act of not laughing with them can send a strong message. Or if you see female medical students missing out on opportunities, point it out and give them a place, “She hasn’t had a lot of experience

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in suturing, maybe she could close this one” or “She is fantastic at performing a cardiovascular examination, I think our tutorial group would learn a lot from their example.” In tutorials, be conscious of who is dominating the conversation, and who might not be getting their chance to speak.

Of course, it is important to consider the best way to achieve your goal. Is a public forum appropriate when patients are around?

Would it be better to approach someone in a quieter situation when they are more likely to respond positively? Maybe the clinical school can help advocate for you? As students however it sends a strong message: these aren’t issues women have to face alone.

Another thing you may have heard are these excuses for unprofessional behaviour: “but they’re such a good surgeon”, “but they’re head of the department”, “but they’re one of the hospital’s top earners”? Likewise, the excuse “it’s just a joke” doesn’t cut it when what’s been said has constituted bullying or sexism. It’s sad that allowances like these allow unprofessional behaviour to become ingrained in the medical culture, and they should be recognised as serious barriers to eradicating unprofessionalism.

“Gender equity is necessary to promote healthy workplace culture.

It will create a safe environment to ensure that both women and men feel empowered to achieve their career goals.”

— Bahaven Jeyaratnam (VI)

Sometimes, it can be challenging to call this behaviour out. If you can’t find a way to do it directly, you can support your female colleagues. Simply acknowledging that treatment was unfair and providing an opportunity to debrief is a strong way of showing support and care.

as allies. As students in the hospital environment we have the opportunity to identify and stand up to instances of sexism and bullying. Our generation of medical students has great potential to shift the status quo and achieve a medical culture where gender equity is not only valued, but also achieved.

“Specifically what I try to do to combat gender inequity, is trying to notice in everyday life what my biases are and combat those.”

— James Kane (V)

REFERENCES 1. Modern LJ, Austin DE, Yong SA, et al. Female representation at Australasian specialty conferences. 2014 [Internet].

Medical Journal of Australia; 2016; 204 (10): 385. Available from: https://www.mja.com.au/journal/2016/204/10/ female-representation-australasian-specialty- conferences 2. Australian Bureau of Statistics. Doctors and Nurses, Australian Social Trends [Internet]. 2013 [cited 2017, May 30]; ABS cat num 4102.0. Available from: http://www.abs.gov.au/AUSSTATS/abs@.nsf/ Lookup/4102.0Main+Features20April+2013 3. Crolla E, O’Sullivan H, Bogg J. Gender and Medical Leadership. Journal of Primary Care & Community Health.

2011;2(4):225-228. Available from: http://journals.sagepub. com/doi/abs/ 10.1177/2150131911409413 4. Cheng TC, Scott A, Jeon SH, Kalb G, Humphreys J, Joyce C. What factors influence the earnings of general practitioners and medical specialists? Evidence from the medicine in Australia: balancing employment and life survey. Health economics. 2012 Nov 1;21(11): 1300-17.

5. Lillebuen S. Senior female surgeon urges trainees to stay silent on sex abuse in hospitals. The Sydney Morning Herald.

[Internet]. Date of publication 2015 Mar 7 [cited 2017 Jun 1]. Available from http://www.smh.com.au /national/ senior-female-surgeon-urges-trainees-to-stay-silent-onsex-abuse-in-hospitals-20150307-13xusq.html

3. Get Support Because of the way medicine is structured it can be a huge challenge to confront someone in a senior position, especially when they may be the ones evaluating your performance. Don’t forget that there are always people who are there to support you in these situations. The clinical school can advocate on your behalf. Your peers are a great support network to discuss issues, strategies, and debrief. In other cases, a counselling service (at hospital, university, or outside) can do wonders. People often think their issues are too trivial to get help for, but that is exactly why these resources are there.

Another option is to find a senior champion for gender equity in the hospital. They could be a great mentor in these situations, and can provide practical support and advice.

In conclusion Male medical students have a large role in working towards gender equity, and supporting their female colleagues

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M

U

S N S I G

Elise O’Connor (JCU, VI) As a final year medical student I am as much aware of my own mental health as the patients I see on a daily basis. In my first year of medicine I was hit by a car. A young student drove into me as I walked across the road, flipping me into the air.

Bouncing off the windscreen but not losing consciousness, I remember the split second glimpse of the starry night sky before my body came full circle, crashing down on the road. That night I learned about the pain relieving effects of morphine, the way local anaesthetics sometimes don’t work; no matter how much you inject. I learned about skull fractures, extradural haematomas, how you can still walk with a fractured fibula and still lift your arm with a fractured clavicle and how lengthy and confusing the neurological exam appeared.

I remember lying on the bed in the resuscitation bay as emergency doctors and nurses hurriedly conducted their secondary survey. After my clothes were cut off I began to shiver from head to toe and recall the sense of pain and loneliness being in this

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circumstance. I managed to ask one of the doctors if he could wipe under my eyes.

He shouted “Are your eyes hurting?” but I whimpered “No”. I just wanted gentle human touch, an indication that everything would be ok. Weeks later and feeling like I had life itself knocked out of me, I was grateful for the support of friends helping me get back on my feet. If there is one thing I learned after that life-shaking experience, it was importance of taking it easy once in awhile.

Now I recall the advice of an energetic Buddhist nun, full of life and determination.

She said “We’re all mentally ill, it’s just a matter of degree.” This statement could be interpreted as meaning we all have moments of exhaustion and fragility. Whether we’re aware of it or not, it’s the adversarial thoughts of our wandering mind, carrying on in the background while we study and apply ourselves diligently on placement, that lead us to breaking point - we may be physically attending ward rounds daily but our thoughts might be far away. A wiser person than myself once described the mind as a wild

elephant and we, as the elephant trainer, run after it. The uncontrolled elephant mind wreaks havoc - bumping into things as it runs through the forest, forging its path. Without paying attention we live out our lives at its mercy, wherever it decides to take us.

As a healing profession it would be reasonable to assume doctors have a good grasp of the power of the mind. However, sometimes I feel uncertain about the importance placed on mental health during training in this profession. Patients can remain in hospital beds for weeks at a time.

When multiple teams visit on a daily basis, the focus is on appearances of bed sores, whether the patient was febrile overnight, their creatinine levels and weight. There is little focus on connecting with people or understanding their suffering. The spirit becomes irrelevant and instead our hospitals and research endeavors focus on keeping bodies clinically alive. There are few tender hands on shoulders during ward rounds, or comments such as “It must be hard, being in hospital for such a long time”. If a patient is flagged as having mental health issues the mental health team are engaged as part of ‘multidisciplinary care’. But often they have their own agenda, deciding whether a patient needs admission to the mental health ward. Perhaps it will be easier to care about the wellbeing of our patients if we take better care of our own mental health and understand the workings of our own minds.

accumulated sleep deprivation. I believe we all need to take it easy once in a while - to clear our mind. For that reason I sit here and reflect on the importance of rest and the wild elephant mind, indulging in luxurious laziness and wondering how I should greet the day on my terms with self-preservation in mind.

Today I take the morning off after a week’s

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Do your gut microbes determine your personality?

Amelia Skaczkowski (Flinders, I) The most underrated organ in your body could be the driving force behind your personality.

There is an increasing amount of data showing that our gut microbes influence not only our behaviour but also change our brain chemistry and neurochemistry. Links have been made between gut pathology and mental health conditions such as depression, anxiety and schizophrenia. While these may currently be just links they uncover a realm of research possibilities that were previously not dreamt of.

One study showed that irritable bowel syndrome was a risk factor for depression and anxiety. There are specific little bugs in our guts which promote serotonin production in the cells lining the colon, and these cells account for 90% of the peripheral serotonin in humans. If we lose some of these digestive critters our serotonin levels may be reduced, leading to mental health concerns.

In one study, researchers transplanted gastrointestinal microbes between mice and demonstrated that bacterial strains were linked to specific behavioural traits, this behaviour being transmitted along with the strain. For example, shy mice would engage in more curious behaviour when

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they were transplanted with the microbes of more confident mice. Moreover, mice studies have shown us that gut microbes influence the integrity of the blood brain barrier, as gut microbes can break down complex carbohydrates into short chain fatty acids. The fatty acid butyrate fortifies the blood brain barrier by creating connections between cells hence a lack of this fatty acid, or a disruption of its creation may have implications for our brain.

There are tantalising links hypothesizing how gut microbes interact with the central nervous system, but no solid answer has emerged. One idea is that the vagus nerve communicates from our gut bugs to the CNS. Changes to gut microbes can modulate the peripheral nervous system as well as the CNS with consequent changes in brain function.

For example, when a mouse is infected with citrobacter rodentium there was a consequent increase in neuronal activation in the hippocampus and vagus ganglia which hints that perhaps the brain to gut signals are through the vagus nerve. However, antibiotic disruption of gut microbes causes behavioural changes which do not involve use of the vagus nerve. This proposes that the brain-gut connection could occur through a variety of pathways.

The gastrointestinal tract is a mind field of medicine, holding within it yet to be discovered therapeutic avenues and innovative ways of thinking about the body.

Medical Leadership Program

For more information UQ Faculty of Medicine T +61 7 3346 4774 E med.leadership@uq.edu.au W www.medicine-program.uq.edu.au/MLP

A M a r s h m a l l low i n Medical School Rose Worthington (Notre Dame, I) Long known as the family ‘marshmallow’, I find witnessing or hearing of the suffering of others pretty difficult. In my professional life thus far it’s been a sense of empathy that drove me to firstly work for social justice, and secondly to pursue medicine. So, I am, despite the wussy reputation, largely ok with the title. However, in the two years since my daughter was born I find myself (like all new parents!) even less able to tolerate other people’s trauma, particularly children.

If I hear of something bad happening to any child, anywhere, I am overwhelmed by it for days or weeks. This sensitivity is my biggest concern about my suitability for medicine.

My first encounter with subject matter that ‘triggered’ a strong emotional response was in Week 9 of my first year of studies after a conversation with my tutor about suspecting child abuse or domestic violence as a GP. I became quite upset by both how often one might come across such a thing and the sense of powerlessness of being unable to do something immediate (beyond mandatory reporting) to help that suffering person. So, recognizing that I need to be proactive I’ve since been on a bit of a fact-finding mission on ways to build ‘emotional resilience’.

Firstly, to what extent is a strong sense of

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empathy useful in medicine? In ‘The Baby in the Well: the case against empathy’, Paul Bloom (2013) wrote “Empathy has some unfortunate features – it is parochial, narrowminded, and innumerate. We’re often at our best when we’re smart enough to not rely on it.” Do I need to learn how to ‘restrain’ mine in order to be a good practitioner?

Does allowing strong feelings in practice potentially skew care against those who don’t inspire such emotion? Regarding also the “narrow-mindedness” that Bloom refers to, I recognize the paradox of egocentrism in empathy – it can almost be a way of immersing oneself in an experience for the sensory indulgence alone. In addition advocates, or campaigners (my professional background) are used to feeling justified in trying to influence, shift, and move others according to their own passions or beliefs of what is ‘right’. This is all potentially problematic with the idea of patient-centered autonomy and care.

Yet it’s clear that current education focuses on keeping the ‘person’ in the doctor. Notre Dame’s own Objects reflect this, as does the entry process which screens for people interested in social justice and the wellbeing of others. In some ways, this is an obvious strategy to address more authoritarian and

patronizing techniques of the past and form more equal therapeutic partnerships.

One of my tutors said to me that there is no necessary equation between emotional sensitivity and a lack of resilience, and this has already helped me to consider how empathy could be thought of as an asset – not just a risk factor. In a touching article entitled ‘tenderness and steadiness: emotions in medical practice’, Coulehan (1995) wrote about the fundamentally emotional and human connections that are central to medicine, and instead of praising a more modern ideal of a ‘barrier’ or ‘distance’ from this reality, reminds readers of Thomas Percival’s 18 Century virtues-based approach to care: a balance of steadiness – the intellectual “virtue[s] of objectivity (reason) with the moral virtue of courage [fortitude]” when paired with “tenderness- humanity, compassion, fellow-feeling and sympathy”.

A more contemporary but similar concept is my PBL tutor’s characterisation of the Doctor as a ‘facilitator’ rather than a decisionmaker. A facilitator can consider a person’s situation with sensitivity, but ultimately with an eye to the best possible outcome. They are not necessarily removed or cold, but recognize that their effectiveness relies on their ability to function in a different way to the patient.

Universities everywhere now consider emotional resilience a “behavior to be acquired during training” (Passi, 2014). There is a glut of self-care resources targeted towards medical students which recommend almost universally a combination of

mindfulness, exercise, social and familial relationships, and sleeping well (see, for example AMSA, [undated]) in order to protect oneself from the potential emotional costs of being a doctor. But there is, of course, much more to say about structural features of the profession that makes it difficult for Doctors to maintain ‘resilience’, and we’ve heard recent terrible news of these impacts on suicide rates.

I attended an RACGP webinar (April 19th) on “Vicarious Trauma” which mentioned a few structural mechanisms for GPs beyond the usual self-care mantra. In particular, establishing a workplace that has realistic expectations, flexibility and staff acknowledgment, and leave allowances/ limits to overtime and taking work home.

Debriefing with peers was time and again reinforced as vital to coping with the emotional pressures of the work, yet it was always described as a casual or informal structure, rather than common practice.

My project continues, but for now I’m armed with some useful thoughts and ideas about the skill of balancing feeling and objectivity in medicine, and a bit of a sense of some of the structural supports needed.

REFERENCES AMSA (undated). Keeping your grass greener – a wellbeing guide for medical students. (Pamphlet).

Bloom, P. (2013). The Baby in the Well – the case against empathy.

Retrieved from http://www.newyorker.com/ magazine/2013/05/20/the-baby-in-the-well Coulehan, J. (1995). Tenderness and Steadiness: Emotions in medical practice. Literature and Medicine, 14(2), 222-236. doi: 10.1353/ lm.1995.0027 Passi, V. (2014). Developing resilience throughout the continuum of medical education. Perspectives on Medical Education. 3(5), 329331. doi:10.1007/s40037-014-0140-1.

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P H O T O G R A P H Y // ROBIN WE

EI

Robin Wei (UQ, II)

R.Wei. (c)

DOING EVERYTHING WE CAN: ON EFFECTIVE ALTRUISM & MEDICINE Keyur Doolabh (Monash) Ask any medical student why they decided to go into medicine, and at some point you’ll hear the phrase ‘I want to help people.’

Human motivation is a complex thing, but I don’t doubt that it’s true -most of us want to give back to the world. And on face value, medicine is a pretty good career for it; those same medical students will probably be involved in many life-saving efforts that have earned the medical profession a reputation for doing good.

But as well as being philanthropists, doctors are also scientists at heart. So what’s the evidence about how much good your average doctor will do over their career?

Research by the career-optimising organisation 80,000 Hours shows that

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although doctors are directly involved in saving lives day-in and day-out, the marginal utility of the average doctor’s career is only 20 lives. What does that mean? It means that if you hadn’t chosen to do medicine at uni, someone else with slightly worse grades would have taken your place – that’s a safe assumption, given how competitive medicine is to get into. That person with slightly worse grades would probably have been a slightly worse doctor than you, and when you add that difference up over a whole career, twenty people would have died that you would have saved. If you chose to open a lemonade stand instead of studying medicine, twenty people would eventually die who would have lived.

Now that’s nothing to be sneezed at – after all, we’re talking about twenty graduations, twenty loving partners, twenty contented retirements. But at the end of the day, that’s a lot less good than most of us like to think we do; over a forty-year career that’s one life every couple of years. That might make us think twice about all the sacrifices we make in the name of doing good.

So am I saying that you should consider dropping out of medicine and open up that lemonade stand you’ve always dreamed of?

Of course not, and thankfully there’s a way to turbocharge the amount of good you do with your medical career: rather than doing good directly through your work, do good through charitable giving. The average doctor’s salary is $105,000 ten years after

graduating, and donating even 10% of that could make a huge difference in people’s lives without significantly decreasing your quality of life (and that’s a research-backed fact).

The title of this article is ‘Doing everything we can,’ so how can we grow our altruistic impact as much as possible? One way would be to give a higher proportion of your salary.

That would be admirable, but thankfully there are other, less painful options. You don’t have to go into the highest-paid, most competitive specialties for the sake of maximising your salary, either. Perhaps the most effective way to do the most good is through some good old-fashioned bargain hunting.

Let’s crunch some numbers: you could go into the most highly paid speciality in Australia, neurosurgery. You might decide to give away 10% of your $600,000 annual income to Guide Dogs Australia, which can provide a seeing-eye dog to someone for $40,000.

Alternatively, you could decide that the slog to get into neurosurgery is too much, and pursue your childhood dream of opening a lemonade stand. You might earn $10,000 a year, and again decide to give away 10%. But rather than going for Guide Dogs Australia, you do some bargain hunting, and give to the Fred Hollows Foundation, which can restore sight through a $25 cataract operation. As the neurosurgeon, you’d help 1.5 people work around their blindness each year, but running a lemonade stand you’d actually cure 40 people of their blindness each year. These

figures, based on Peter Singer’s famous TED talk ‘The Why and How of Effective Altruism,’ are fairly back-of-the-envelope, but they’re only meant to show that with a bit of bargain hunting, you can multiply the impact of your giving by orders of magnitude.

Now let’s be honest, bargain hunting is hard.

It’s not necessarily that we’re lazy (though that could be a part of it), but maybe we just don’t know what to look for in a charity. Thankfully there are some fantastic organisations out there that not only find the absolute most effective charities in the world, but also provide fully transparent reports on how they come to their decisions. Givewell. org is one of these organisations, or if you think that we shouldn’t be speciesist and also consider giving to charities for animals, Animal Charity Evaluators is for you.

The idea of marginal utility should make us rethink how we go about pursuing altruism through medicine. Doing everything we can doesn’t have to mean going the extra mile for all of our patients. It can be as simple as a small, regular and well-targeted donation.

This article has been resubmitted to AMSA for Panacea after originally appearing in the Monash Medical Students’ Magazine, The Auricle.

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Happy birthday and good luck Gretel Whiteman (Griffith, III)

Another morning, another Caesarean section in operating theatre two. Preparation for this fairly major operation was underway and staff were busy everywhere.

I had learned that what looks like a vaguely organised chaos (on first impression) is, of course, incredibly methodical. As surgical instruments are counted and recorded in one corner, a crib is prepared in another; as the registrar enters details into the computer, the consultant speaks to the patient.

I engaged in the usual student practice of trying to help and trying not to get in the way (a surprisingly tricky balance). I had a quick look at the patient’s notes: it was a planned Caesar due to the patient’s previous baby having been born by emergency Caesar, and this one was brought forward by her waters breaking the evening before. This was baby number eight in the family. Thankfully the 38-week pregnancy was uneventful despite

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several missed antenatal appointments, but some notes in the pregnancy record suggested that a few different doctors had found this woman to be a difficult patient, and she’d had various referrals for social and psychological help in the past. I left that thought in the back of my mind.

The anaesthetic room received the mother – wheeled in on a theatre bed and wearing her purple hospital gown, she was desperately uncomfortable with a huge belly bursting at 38 weeks’ gestation and already experiencing contractions: that baby was waiting for no-one. We needed to get him out soon or he would arrive on his own.

I introduced myself to the patient while her cannula went in. Despite the odd painful contraction, she was not overly distressed and was easy enough to talk to for a fiveminute conversation. Looking beyond the bursting abdomen it was clear that she

was incredibly thin – perhaps malnourished.

She had at least three missing front teeth.

When her heavily tattooed partner arrived soon afterwards, I noticed that he was also missing several teeth.

It is incredible that a person’s appearance and just a small bit of their personal history can spark so many internal queries or assumptions. I don’t know if they’ve faced difficulties in the past, or what they might be. I don’t know if I can assume that they’ve struggled with alcohol, drugs, money, violence or whatever else. But I do know that lifestyle problems like the ones that jumped to mind are horrendously difficult to shake off from one generation to the next. A vicious cycle tends to ensue. Yet here in this room, we were about to bring a baby of the next generation into the world.

The operation went smoothly and a healthy baby boy was born at 9:11am. He was beautiful, if a bloody, mucoid, crying infant is beautiful. He was everything a newborn needed to be and his APGARs were 9 and 9. The obstetric consultant methodically continued his usual procedure, delivering the placenta and stitching the layers of uterus, fascia and skin one by one. Being not particularly useful in the final stages, my own contribution naturally waned as the incision grew smaller. I was allowed to “un-scrub” and step back from the operation.

At the back of the operating theatre, I got to

hold that baby boy then. He was just twenty minutes old. Although undoubtedly special and unique in his own way, he could have been any perfect newborn baby. I would have been much the same as him when I was half an hour old. He was so malleable; a completely clean slate that was incredibly open to influence. His future and potential were entirely flexible at this stage. I rocked him and stared at him, and wondered what he was going home to; with seven older siblings in an area well known for socio-economic difficulties, and with parents showing likely signs of a difficult past.

I held him, knowing that I was lower than the lowest rank in the medical team and with limited power over the patients’ experiences at the hospital. I also reflected that the obstetric team at this hospital was here to provide a particular service to a mother – that is, a Caesarean – and not a holistic lifestyle intervention. Of course, it is also easy to fall into the trap of making assumptions from the appearance of this newborn’s parents and some brief notes on an antenatal chart; maybe we can’t draw any conclusions from the collective number of teeth of a child’s parents. However, I felt so strongly for that 20-minute old baby boy that I had to pretend there weren’t tears in my eyes. I hoped that there would be someone in his life that is a strong positive influence, whether that is a teacher, a coach, an older sibling, or anyone else. That clean slate of his needs some positive influences.

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My time in the hospitals so far has taught me that we can’t fix everything. We can try, and we can look for the struggling people and organise extra help for the patients who need it, but we can’t fix the world. That’s a very tough lesson to learn, and a very difficult pill to swallow when holding a perfect newborn with a hazy future. This medical team had provided an impeccable obstetric service and offered comprehensive antenatal care (regardless of whether or not it was accepted). The midwives and paediatrician took excellent care of the baby in its early life. From the mother’s medical notes, I knew that referrals had been made for social and psychological support in the past. It’s quite possible this family will need extra help in the future – and that’s about all we can do. We can’t fix the world.

A medical school might teach its students that, and we could understand their message. We could grasp that our medical service is the best we can offer, and we could recognise when to look out for patients that need us to organise extra help or a serious intervention (such as child safety services).

But there is a limit to how much the team can do for someone, and a medical school can’t make you feel the real weight of that lesson until you experience it. In the hospital, holding a newborn with a potentially murky future, and knowing that the team has done its best, I experienced the weight of that.

On a more practical level, I also felt that it

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might be beneficial for myself and my peers to be taught more about pathways to help patients beyond the medical issue at hand, and to receive some information on the serious difficulties that some people face and the services we can guide or refer our patients to. Like many of my peers, I know I am very blessed to have lead a sheltered and privileged life. I am quite innocent to the harsh reality of those who are struggling with a range of social difficulties, and at a loss as to how to help them. After this experience, I will keenly research the services on offer to aid in areas such as child protection, social support networks, and the help of social workers.

As I put that baby boy back in his cradle, I wished him a happy birthday and good luck.

I don’t know what he went home to. He was wheeled out behind his mother and the operating doors closed.

AMSA REP REPORTS 17

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Bond University Flinders University Griffith University James Cook University Monash University University of Adelaide University of Melbourne University of Newcastle University of New England University of Notre Dame Fremantle University of Notre Dame Sydney University of Queensland University of Sydney University of Western Australia University of Wollongong University of Western Sydney

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BOND UNIVERSITY AMSA Representative: Haleem Mohammed Abdul

BEST MEDSOC EVENT SO FAR MedCamp! This was the second year we ran MedCamp and with last year’s feedback on board, this was absolute banger of a weekend.

Held in Byron, it was a weekend full of fun for everyone from partying to surfing and chilling at the beach. A hard weekend to recover from but with all the banter and bonds that bloomed from it, it’s a weekend that no one will forget.

MEDSOC HIGHLIGHT OF THE YEAR We held our inaugural Women in Medicine Breakfast with 4 guest speakers from different fields of medicine including Marianne Vonau, Australia’s first female neurosurgeon! Tickets were sold out in a matter of minutes and we had a full house on the morning. Everything ran smoothly and we received only positive feedback. Shout-out to the MSSBU crew involved in making this possible especially our Community health and Wellbeing Officer, Chaithanya Jeganathan!

BIG NEWS FOR THE UNI Our newest cohort has increased by 25 spots! (with the internship pipeline in mind, not really the best thing but hey more friends) The medical faculty is currently working on improving its own policies surrounding the mental health of students through new mentoring programs, hopefully we can see this being implemented in the near future!

WHY I LOVE AMSA I love the upskilling and networking opportunities that AMSA provides.

It’s awesome to meet like-minded medical students from all across Australia at its various events throughout the year.

HOW TO GET INVOLVED WITH AMSA AT BOND You can either email me (Haleem) at haleem.mohammedabdul@ student.bond.edu.au or like our Facebook page at facebook.com/ AMSAatBond/ and keep your eyes peeled for regular updates!

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FLINDERS UNIVERSITY AMSA Representative: Nicola Robinson

Flinders Medical Students’ Society has had a riotous start to 2017, welcoming in our new First Years with one of our most successful O-weeks and Med Camps of all time! FMSS is also trialling Snapchat to engage more with our members, feel free to add us at: flindersmedss.

As AMSA representative, especially in the difficult times South Australia is facing, I find it great to be on the ground, doing what I can to represent and advocate for the issues that affect Flinders University medical students. There are heaps of ways to get involved, from simply donating in Vampire Cup, to vastly more in-depth roles such as applying for AMSA committees. Get in touch with me, or check out the AMSA website if you’d like more information on how to get involved.

I leave you with a report from our stand-out event of this year so far, our annual Mental Health in Medicine seminar. The report is from Vicky, our FMSS Health, Wellbeing and Anti-Discrimination Director: “And as we know, Winter is well and truly coming. May; the month for mental health. A month to think about how we are thinking. Do you hear it? Slithering over those last two sentences. The resounding clang of uncomfortableness, which even the kindest of tones cannot conceal. Mental health in Medicine, arguably the most important yet most stigmatized part of our education.

Aside from the confusing experience of formaldehyde-induced-hunger around cadavers, learning how to be a doctor brings with it unique stressors. Although this issue has attracted more attention recently, little is being done to help medical students prepare for a career in medicine and navigate the very real personal and professional challenges that may lead to mental health challenges.

To address this issue, FMSS annually holds a highly successful Mental Health in Medicine Seminar.

The event aims to provide medical students with an insight into the challenges of medicine and improve help-seeking behaviour. This year the evening ran on the bravery of 9 student speakers and 3 professionals. Professor Wade spoke about perfectionism; Dr. Nguyen spoke about life outside of medicine; and Dr. Baigent spoke of the shocking findings of BeyondBlue research.

The students spoke openly; letting everyone in the room know that they weren’t alone. They were loud in reminding us that everyone feels stress differently, that every person is fighting a battle we know nothing about and they were delicate in showing us that everything is surmountable.

We had 150 people in the audience that evening and 150 people left talking. And that is exactly what mental health in medicine needs, more light, more noise, more unashamed conversation.”

That’s all from me, take care of yourselves!

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GRIFFITH UNIVERSITY AMSA Representative: Tyron March BEST MEDSOC EVENT SO FAR Whilst GUMS hosts many events each year, it is hard to look past the Med Ball as our premiere event. Featuring glammed up medical students, incredible live entertainment and delicious food, it’s the one event every year that leaves lasting memories.

MEDSOC HIGHLIGHT OF THE YEAR In April this year, GUMS, in collaboration with a number of medical student based societies, hosted the inaugural Women in Medicine event. This was a statement of support for empowering women to achieve their goals in leadership and development. The event was held in the wonderful Sky Lounge on the Gold Coast Campus and was met with warm welcome by a large number of both women and men.

BIG NEWS FOR THE UNI In 2019, Griffith University will be opening a new medical program on the Sunshine Coast. Whilst the advocacy in this area has mostly occurred at a national level, GUMS has been hard at work locally in this area. Our focus is now on ensuring the quality of the program on the Sunshine Coast matches that of our Gold Coast campus. We are deeply looking forward to getting involved in this process over the coming years.

WHY I LOVE AMSA My earliest forays into AMSA came about through in interest for student wellbeing. Throughout my involvement over the past 3 years, I have loved representing the views and concerns of our students at a national level. It is an awesome practice is being taken in key areas for our medical students: Internships, bullying and harassment, and mental health.

HOW TO GET INVOLVED WITH AMSA AT GRIFFITH Contact your friendly neighbourhood AMSA Rep (Tyron) at tyron.march@ gums.org.au - involvement in AMSA is an incredible experience, and the more people that are able to get involved in student advocacy at the national level, the better!

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JAMES COOK UNIVERSITY AMSA Representative: Reece Tso

BEST MEDSOC EVENT SO FAR

JCUMSA hosts many events - however, one which we always find to be a hit students and lecturers is our annual med revue. Our medical students bring much more than just their brains to the table and this is the perfect opportunity to showcase the myriad of our students’ talents. “The Intubation Game”, held in 2015, was a incredible show of talent, leaving a hard show to follow. Brace yourselves for Med Revue in 2017, “The Game of Crohns”!!

MEDSOC HIGHLIGHT OF THE YEAR

The best MedSoc event of this year would have to be our annual, much anticipated, and well-behaved MEDCAMP!! This year we braved the heat and packed our bags for a two day adventure at Echo Creek. Where is that you may ask? Think rural, and then add in a pond, couple of hay bales and beautiful hills that overlook the picturesque greens. Now fill it with 80 first year Medical students havin’ a yardie and you’ve got yourself the perfect medcamp, JCU style. We took advantage of our beautiful weather with many activites such as backyard cricket, slip n slides, to plastering and Rhythms Bhangra workshops. Team building was our main focus for the day finished off with none other than an outdoor dance party.

BIG NEWS FOR THE UNI

This year we have introduced a new vaccination campaign for our medical students. This student led campaign was started to not only protect students from the flu but also get student involved as our clinical students gave jabs to other students. We teamed up with Doctors in Cairns and JCU health to supervise and assist with the program. Each vaccination cost significantly less than at external health clinics. The campaign ran with amazing success, with over 120 students participating! We hope to continue this program next year with the hopes to only make it even better!!

WHY I LOVE AMSA

Where to even begin. There is nothing better than being apart of this amazing AMSA family. You surround yourself with amazing people from all over the country who have truly unique stories, and are driven and motivated to make a difference in our medical school experiences. I absolutely love representing my uni and sharing our voices to AMSA. It’s experiences like these that make my role the most enjoyable.

HOW TO GET INVOLVED WITH AMSA AT JCU

The possibilities are endless. Getting involved in JCUMSA doesn’t mean you have to be an executive member. Attending events, signing up for our gold membership and volunteer lists, being apart of subcommittees are just several ways you can get involved. Come have a chat to any of our JCUMSA team members about any concerns or suggestions as this can help us help you make your time at JCU better!

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MONASH UNIVERSITY AMSA Representative: Anuj Krishna

BEST MEDSOC EVENT SO FAR A tie between two events – MUMUS’ inaugural ‘What’s an AMSA’ evening, and the annual Monash Leadership Development Seminar.

Our information evening on opportunities and pathways into AMSA saw our preclinical students learn about AMSA’s major conferences, various projects, and the advocacy and policy arms of the organisation.

MLDS was also a highlight, featuring the Hon. Mayor Robert Doyle, and continues to be celebrated as an inter-university and inter-faculty event.

MEDSOC HIGHLIGHT OF THE YEAR Other inaugural initiative – the MUMUS Full Committee Retreat, held on the beautiful beachfront in coastal Victoria. This weekend helped our committee to get to know each other better, and gave us the opportunity to establish our goals and strategic direction for the year.

BIG NEWS FOR THE UNI • AMC report submission: MUMUS submitted their report to the Australian Medical Council, emphasising our academic priorities of consistency of teaching across clinical sites, improving quality feedback, and encouraging students to be involved in curriculum design.

• New Gender Equity Officer: This officer will sit on the Full Committee from 2018, with the aim of raising awareness about gender inequity in medicine, working with faculty to improve education in this sphere, and working with other organisations to run gender-related events.

WHY I LOVE AMSA AMSA is an amazing organisation. Not just for what it does. Not just for the amazing people that are part of it. But for what it stands for, and the views they seek to represent – your views!

AMSA at Monash has an amazing culture. Every year we see more and more students involved, whether it be proudly flaunting VicPride at Convention, writing and shaping policy, or as volunteers on AMSA’s many subcommittees and event teams.

HOW TO GET INVOLVED WITH AMSA AT MONASH Join our Facebook Group (‘AMSA AT MONASH’) and talk to anyone on our leadership team!

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UNIVERSITY OF ADELAIDE AMSA Representative: Letti Sweet

BEST MEDSOC EVENT SO FAR

The best MedSoc event of this year so far would have to be our MedFooty event, which came as part of our health and wellbeing week. As part of MedFooty, our critical care society (the Adelaide Students’ Society for Critical Care) runs an emergency medical challenge, which this year reached new heights. The EMC this year consisted of some amazing new stations that pushed the participants to the limits of their medical knowledge and made for an exciting and challenging competition. With teams from a number of societies including the AMSS, OGSoc (the Adelaide O&G society), Insight (our global health group), Flinders University and Flinders University Paramedics - the competition provided a fantastic opportunity for friendly rivalry between universities and disciplines. Hats off to the AMSS Health and Wellbeing officers and the ASSCC for such a fabulous event!

MEDSOC HIGHLIGHT OF THE YEAR

The MedSoc highlight of this year for AMSS is not one particular occasion but the general proactivity from the committee and wider medical student community on a number of behavioural and social issues to do with event-culture. The AMSS has made strides this year in aiming to improve the culture of our events, making proactive decisions so as to have a happier and more respectful community spirit. Massive kudos to the AMSS Executive for their bravery in confronting some of the issues with our culture head on. As well as aiming to improve the culture at our events, the committee has been making a concerted effort to review the way we approach equity within our MedSoc. Discussions on how to best promote equity in the AMSS are ongoing, however, one major step forward came in a decision to introduce an LGBTIQ officer for 2018 onwards. A big shout out must go to Ricky Stocker-Johns (MBBS II) for advocating so strongly and passionately on this issue.

BIG NEWS FOR THE UNI

Our spectacular new Health and Medical Sciences building is the news of the year! This building is located a hop, skip and a jump from the brand new Royal Adelaide Hospital and SAHMRI and is very groovy. Make sure to check it out when you’re down in Adelaide for Global Health Conference in 2017!

WHY I LOVE AMSA

The AMSA community is very special to me and has been since I first became involved as a freshfaced first year. As an AMSA rep, coming to council provides a great opportunity to connect with many like-minded individuals, who are equally passionate about student representation and the wellbeing of medical students. We are hugely privileged to have access to an organization that listens to us through our AMSA reps, and provides fantastic opportunities to connect with students from across Australia. AMSA has given me and other students so many opportunities, both professional and personal, and will always welcome new faces with open arms.

HOW TO GET INVOLVED WITH AMSA AT UNI OF ADELAIDE

Contact your friendly AMSA Rep or Junior AMSA Rep and keep an eye out on the AMSS and AMSA Facebook pages for new opportunities available. Even coming along to Convention, GHC or NLDS is a fantastic opportunity to get involved so GAI!

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UNIVERSITY OF MELBOURNE AMSA Representative: Eloise Silvester

BEST MEDSOC EVENT SO FAR The new UMMSS Emergency Medical Challenge Workshop has definitely been the most exciting event so far! Students from all year levels worked together to save our actors from impending doom.

Having that inter-year level collaboration and unknown situations with all the props is I think what made it so exciting and valuable.

MEDSOC HIGHLIGHT OF THE YEAR // BIG NEWS FOR THE UNI This year the wellness program has well a truly taken off, with two mental health practitioners, one rotating through our metro sites, the other in rural areas. Working together with UMMSS and our Community and Wellbeing Committee, the practitioners are a key triage point for students and able to provide advice for wellbeing activities our MedSoc can provide and key areas to advocate!

With a full day at our MD Student Conference dedicated to Mental Wellbeing and upcoming Blue Week events, there is lots going on in this increasingly important space!

WHY I LOVE AMSA AMSA give you the opportunity to work collaboratively with students from around the country who are passionate about what they believe and dedicated to making a difference! It is forever inspiring and a great opportunity to upskill.

HOW TO GET INVOLVED WITH AMSA AT UNI OF MELB Come along to any local AMSA events particularly to think tanks! Or join one of our policy working groups in the lead up to council. And definitely keep an eye out for AMSA Council subsidy applications early next year! Or just email the rep at asma@ummss.org.au

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UNIVERISTY OF NEWCASTLE AMSA Representative: Joshua Darlow Junior AMSA Representative: Ashley Bailey

BEST MEDSOC EVENT SO FAR One of the best UNMS events so far this year has to be our Blue Week! This was organised by our Community and Wellbeing Officers, Pratik and Nyan, along with their awesome team. Blue Week started on a raining Monday this year but it still managed to get crowds out with a petting zoo - If you attended either Tacovention or NewGHC last year, you would have seen how excited medical students are for baby animals!

MEDSOC HIGHLIGHT OF THE YEAR At the time of writing, Newcastle students have just finished the best exam prep/procrastination (dealer’s choice) – the RACGP’s Intervarsity Challenge between NSW and ACT universities. Since Round 3 (of 6) we have remained in first place, and drawn the best and brightest from across all of the Newcastle campuses and clinical schools. Fingers crossed for a strong finish!

BIG NEWS FOR THE UNI You may have seen in the news that the University of Newcastle has decided to end its involvement with Broadspectrum at the end of the year. Broadspectrum is a company responsible for the running of Australia’s detention centres on Nauru and Manus Island. While the university declined to comment on the rationale behind the move, Students Against Detention believe that staff and student opposition was a key motivator due to strong campaigning.

WHY I LOVE AMSA I think the best thing about being an AMSA rep is being able to connect with like-minded individuals passionate about more than just their degree. That and all the orange!

HOW TO GET INVOLVED WITH AMSA WITH UoN The best way to get involved with AMSA@UNMS is to make sure you have joined our Facebook group where we post all AMSA opportunities and upcoming events.

But the best way to get involved is to attend AMSA conferences, get amongst the Newy delegates and other like-mind students and attend think tanks to express your opinion on issues that matter most to you.

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UNIVERSITY OF NEW ENGLAND AMSA Representative: Kate Penfold

Hey there! It’s Kate, the AMSA Rep from UNE (which is in Armidale, NSW in case you don’t know. And I promise we are a real med school, as I had to assure a fellow delegate at Convention last year). 2017 has been a cracker of a year so far, and our medsoc has been very busy. Our best medsoc event of the year so far, would have to be our annual Med Week! The week included a Trivia Night, a fierce interyear netball competition, a Bowl’n’Skate party at the local rink, a Graffiti Pub Crawl, a Scavenger Hunt, and finished with a Golf Pros and Tennis Bros Party!

My personal highlight of the year so far (which may be slightly biased, seeing as I ran the event), was our local Blue Week. And while the whole week was great, the standout activity of the week was our “Puppy Therapy”. We were blessed to have two golden retrievers and two beagles visit us on campus for an hour of cuddles and slobbery love. I could definitely feel the study blues sliding away while I had my hands full of canine cuteness.

Having the opportunity to run events like Blue Week and Puppy therapy is one of things I love about AMSA. Being an AMSA Rep has given me a range of truly diverse events and opportunities to be involved in. Blue Week is definitely a personal favourite of mine of the AMSA initiatives, but I have also discovered a passion for policy and advocacy that I didn’t know existed. Meeting other students at AMSA Councils, Convention and GHC is also definitely one of the most rewarding aspects of being part of the AMSA family.

If you want to get involved in AMSA@UNE, firstly you need to hit up our facebook group, where you will find regular updates regarding callouts and info from all aspects of AMSA. You can also email me, your friendly AMSA Rep, at amsa@unemsa.org and I will be happy to talk to you about all things AMSA and how you can get involved.

Other than that, get your voice heard at our Think Tanks, come along to our local events like Blue Week and join our delegations at Convention and GHC!

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UNIVERSITY OF NOTRE DAME FREMANTLE AMSA Representative: Ruby Osman-Mulraney

BEST MEDSOC EVENT SO FAR Our annual May Soirée party. It was so well organised, everything came together like a dream. Once again it was sold out. We have quite a divide between pre-Clinical and Clinical students that we’re trying to break down, and university wide events like this brings everyone together and facilitates inter-year bonding.

MEDSOC HIGHLIGHT OF THE YEAR Deciding to re-write out Constitution. It might sound dry and boring, but it’s incredibly important to the long term functioning of our MedSoc. So lots of hard work has been put into refining current policies, and including really important ones like Gender Equity and Sexual Harassment. We’ve also decided to review the current MedSoc Executive and Committee roles to make sure we’re best representing the needs of our members.

BIG NEWS FOR THE UNI We are still transitioning to the new MD program and adjusting to the new requirements of the course. We sadly farewelled our outgoing Dean, Dr Shirley Bowen, but expect that she will still remain involved with Notre Dame.

WHY I LOVE AMSA The people. Orange Cult, it’s not a joke. I love that I get to represent my university, and discuss policy with people all across Australia.

We’re incredibly fortunate to be part of a national fraternity that is so well represented. The connections I’ve made and the skills I’ve learnt are invaluable.

HOW TO GET INVOLVED WITH AMSA AT UNDS Come to a ThinkTank! I want to know your thoughts. To be able to represent Notre Dame Freo students, I have to know what you think!

Coming to Council is another great way to get involved and see what it’s all about on a National scale.

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UNIVERSITY OF NOTRE DAME SYDNEY AMSA Representative: Nadine Sexton

BEST MEDSOC EVENT SO FAR Med Camp has been the best medsoc event so far because it got all the first and second years together early in the year. It also included the Emergency medical challenge, fancy dress costumes, sports activities, mentoring and trivia which everyone enjoyed. The feedback was incredible and turnout was bigger than ever.

MEDSOC HIGHLIGHT OF THE YEAR We have our highest number of medsoc memberships in UNDS history and reached the highest number of AMSA memberships in Australia!

We also had our biggest turnout ever at the AMSA ThinkTank which was very exciting. UNDS also had a very successful NLDS experience with our president winning best speaker and our AMSA rep and president in the winning project team!

BIG NEWS FOR THE UNI UNDS School of Medicine had a very successful AMC visit, where the intimacy of the course and the positive culture was identified between students and between staff and students. Mentoring was a big focus of the student body this year, where we have run a bridging basic clinical science intensive course, anatomy tutoring, and wellbeing and professional development mentoring sessions for first years. This was to promote university achievement, welfare and friendships between year levels. Lastly, UNDS’s very own, Liam Mason, as part of NSWMSC, was also involved in supporting the marriage equality policy movement by the AMA.

WHY I LOVE AMSA The thing I love about being AMSA rep is that I get to meet likeminded individuals Australia wide. I love all the councils, running ThinkTanks and making friends all over Australia. The best part is advocating to other medical students why they should get involved.

I enjoy encouraging them to challenge themselves in ways they may not have otherwise.

HOW TO GET INVOLVED WITH AMSA AT UNDS Nadine is always free for a chat to discuss ways to get involved.

Attending ThinkTanks and council is probably the best way. I am also free to chat about getting involved with policy writing which is another way to get involved in AMSA.

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UNIVERSITY OF QUEENSLAND AMSA Representative: Chris Simpson

BEST MEDSOC EVENT SO FAR The 80th Annual UQMS May Ball! Over 800 delegates, the biggest (and arguably best) ever. Absolutely epic times.

MEDSOC HIGHLIGHT OF THE YEAR Med Camp 2017 at Moogerah Dam was absolutely awesome. Bloody good time. Not a bad word said about it!

BIG NEWS FOR THE UNI Major changes inbound for the med school in general! Exams, exams, and more exams for now.

WHY I LOVE AMSA AMSA gives us the ability to connect with med students around the country and to represent our peers on the national stage on the big issues. I get to meet and work with some brilliant people on things I really care about, what else could you want!

HOW TO GET INVOLVED WITH AMSA AT UQ Come to ThinkTanks! Join the Policy Working Group. Get in touch with me, Sarah Twomey, or Josh Sheehy as your 2017 AMSA representatives.

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UNIVERSITY OF SYDNEY AMSA Representative: Alex Yip

BEST MEDSOC EVENT SO FAR So hard to choose! Med Camp still gets rave reviews from our firstyears (despite the 40-degree heat), and our winter masquerade Med Ball was a classy and enchanting evening, but my favourite events were during our Mental Health month of May. In particular, the Mental Health Forum saw students from across all stages share their stories, struggles and successes in a supportive environment, and I definitely think that it’s the most valuable event on the Medsoc calendar every year.

MEDSOC HIGHLIGHT OF THE YEAR Taking out the Semester 1 crown in the university inter-faculty sport competition! With the final event being a 3km run where participation was key, our brilliant sports reps got together an immense turnout that clinched the victory!

BIG NEWS FOR THE UNI No major news comes to mind, but I’m excited about the development of a health and wellness curriculum for next year.

WHY I LOVE AMSA I love the people! AMSA brings together so many unique perspectives from across the country, and getting to work together with so many passionate people is the best part. Plus, having friends all over the country is a great incentive to travel – added bonus!

HOW TO GET INVOLVED WITH AMSA AT SYDNEY UNI Come and have a chat with Connor (Junior Rep), or me; follow the AMSA at USyd Facebook page; come to as many events as you can, and meet the people that make the AMSA community so special!

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UNIVERSITY OF WESTERN AUSTRALIA AMSA Representative: Emma McCormack

BEST MEDSOC EVENT SO FAR

Definitely the MD1 (First Year) Orientation Camp! This is a popular annual event and sold out quickly. It promotes academic and social activities amongst first year students and is an inter-year event with leaders from senior years.

MEDSOC HIGHLIGHT OF THE YEAR

Our many associate members events, including quiz night, suturing and plastering The engagement with associate members (undergraduate students, non-med or assured med) is an increasing priority for WAMSS as a Medsoc due to upcoming changes to the UWA course structure. We have always had means of communication and engagement with our associate members but this has been amped up in 2017, and so far the subcommittee is doing an amazing job!

This is an exciting initiative/movement for WAMSS and will ensure the longevity of the Medsoc.

BIG NEWS FOR THE UNI

Our course structure changed four years ago and will be changing again next year. This will impact both student numbers and the length of time students are in medicine (was previously 6 years, currently 4 years, soon to be 3 years).

WHY I LOVE AMSA

AMSA is able to dedicate time and energy to national campaigns which we benefit from at the local level. Alone we would never have had the benefit of the International Internship Guide, a suite of mental health resources nor the opportunity to learn from AMSA Reps and medical students from around Australia. AMSA is our opportunity to contribute to the challenges facing medical students as a community and to ensure that our students at home are able to thrive.

HOW TO GET INVOLVED WITH AMSA AT UWA 1. Attend ThinkTanks 2. Attend Footprints Leadership Workshop 3. Get involved in the Perth 2018 Convention team 4. Get involved in AMSA Central:

- Attend AMSA Council

- Attend Convention

- Join an AMSA policy writing team

- Apply for an AMSA role

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UNIVERSITY OF WOLLONGONG AMSA Representative: Henness Wong

BEST MEDSOC EVENT SO FAR It is rather hard to choose between the WUMSS Inspiration Evening 2017 and the Women in Medicine and Surgery Evening. If we must decide, it’d be the former. We confess our tears during Dr Kathleen Thomas’ sharing on her experience inside the MSF Kunduz Trauma Hospital, when 2000+ US Military bombs attacked on October 3, 2015.

MEDSOC HIGHLIGHT OF THE YEAR UOW AMSA hosted a #stopadani documentary screening & forum with Doctors for Environment Australia (DEA) and Fossil Free Universities during the Global Divestment Mobilisation week of action in May. Not only did the organisation achieved event sustainability according to the Climate Change & Health Policy 2017, but it also engaged a variety of participants from the local, non-healthcare community.

The health impacts of mega coal mines do raise attention, even in Wollongong.

BIG NEWS FOR THE UNI A new beginning is here when not one, but two AMSA Junior Reps are elected to keep up with the healthy growth of UOW AMSA. We are very excited to welcome Sebastian and James, Year 1 students to #GETAROUNDTHEGONG!

WHY I LOVE AMSA The diversity in all things AMSA - there really is something for every talent and personality to contribute to a healthier society. For what AMSA doesn’t yet offer, there is a supportive national network of incredible leaders to help establish what’s good. Second to the opportunities, Henness is thankful to be connected with the AMSA Reps and executives from all over Australia.

HOW TO GET INVOLVED WITH AMSA AT UWA AT UOW If catching the AMSA reps in person or online does not sing to your heart, our Instagram @uowamsa and facebook.com/wumssamsa are great platforms to engage with the local happenings.

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WESTERN SYDNEY UNIVERSITY AMSA Representative: Jessica Yang

BEST MEDSOC EVENT SO FAR WSMS’ Twilight Festival is a night of performances, art and good food held in first semester every year. Students from every cohort participated in vocal performances, cultural dances and showed off their instrumental prowess. Audiences huddled with picnic blankets on the cold first of May and enjoyed the lively MCs, baked goods and good vibes. Scrubs Crawl is coming up on 16th June and is sure to be rowdy.

MEDSOC HIGHLIGHT OF THE YEAR This year, the newly-formed Wellbeing Committee introduced Wellbeing Days to our SoM. These are days separate from sick days that are for students to occasionally used to be mindful of their mental health and take time to keep themselves level-headed. These do not need to be remediated like usual sick days and don’t need medical certificates. This initiative shows great collaboration with the SoM to combat the issue of poor mental health among med students and is being received well by clinical schools.

BIG NEWS FOR THE UNI Western Sydney is joining the big guns and transitioning into MD. We’re expecting our first MD cohort in 2019.

WHY I LOVE AMSA It’s an amazing opportunity to meet people from around Australia while helping out your peers at a local level. There’s nothing better than the uni pride you have with your delegation at Convention, even when you’re catching up with people out of state you haven’t seen since the year before. It’s a really broad group of people all passionate about making medschool fun and inclusive for everyone.

HOW TO GET INVOLVED WITH AMSA AT WSU Like the AMSA @ WSMS Facebook page and keep an eye on your year group’s pinned posts for opportunity call-outs to get involved with mental health, gender equity, rural health, international advocacy, AMSA’s events and all our other initiatives. Vampire Cup, AMSA’s National Blood Drive, is coming up soon too, so keep your ears open for that. Send a message to your rep, Jess (Y3), or your Junior rep, Thu (Y2), to get more info on what’s happening within AMSA.

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NATIONAL EXECUTIVE TEAM

stayconnected website amsa.org.au facebook facebook.com/yourAMSA twitter twitter.com/yourAMSA instagram @yourAMSA newsletter amsa.co/embolus membership amsa.co/joinamsa

Don’t Le ave Yo ur Career To Fort une

The AMA Career Advice Service, however, seriously understands the profession and its challenges. It can help you prepare for your post-graduation years. It will assist YOU to achieve your goals by providing you with advice and support on: l l l l l

Surviving medical school and your intern year Looking after yourself Building and maintaining a current and relevant CV Addressing selection criteria Preparing for and performance at interview

For more information contact: Christine Brill (Career Adviser) careers@ama.com.au 02 6270 5483 Career Advice Hub: ama.com.au/careers/ Career Counselling: careers@ama.com.au