AMSA Panacea 2011 Edition 1 by The Australian Medical Students' Association

Official Magazine of the Australian Medical Studentsâ&#x20AC;&#x2122; Association Volume 45, Edition 1, 2011

In this edition...

MedCest Medicine Are Muffins just

Ugly Cupcakes? The State of the Nation

The AMSA Rep Reports and heaps more...

The Anatomy of the

21st Century Doctor The Climate Change Care Factor

How to be a Left-Over

masterchef

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contents

2 Andrew Dunn

Editor’s Waffle

3 Robert Marshall

Welcome from the President

4 Rob Thompson

Black Books

6 Hamish Gunn & Bec Ryan

Family Expectations of Medical Students

’

8 Falk Reinholz Wellbeing 10 Greg Leeb

Come Fly With Me

12 Alexander Cox

Specialty Dating

14 Andrew Webster

Cultural and Clinical Lessons in China

16 Kerryn Houghton

MedCest Medicine

panacea

19 Stephanie Cheung

Show me the Money

Volume 45, Edition 1

21 Lee Fairhead

Are Muffins just Ugly Cupcakes?

24 The State of the Nation - The AMSA Rep Reports 36 Jessica McEwan

A Rangers Survival Guide

38 Nick Watts

The Anatomy of the 21st Century Doctor

40 Suyi Ooi and Yota Yoshimitsu

Of Melodies and Maladies

42 Lee Fairhead

The Music Digest

44 Stefan McAlindon

The Lizard-Spock Expansion

46 Dr Jay Meekay

Thats All Folks

48 Falk Reinholz

Going Up?

50 Erica Parker

The Climate Change Care Factor

52 Laura McAulay

How to be a Left-Over Masterchef

54 Kathryn Kerr

Why being a Med Student is Awesome

58 Jayne Schoppe

Who wants to be a Millionaire?

59 Xander Whitfield

Sheep in Wolves’ Clothing

60 Robert Marshall

Speech to the AMA National Conference

62 Dinuksha De Silva

Hey Hey It’s Saturday

major sponsors

July 2011

Editor

Andrew Dunn

Proofing & Design Maya Rajagopalan Robert Hand Tracey McCosh Lee Fairhead Jamie Kuzich Falk Reinholz Alex Cox The AMSA Executive

Advertising Enquiries:

Tracey McCosh and Alex Cox e: sponsorship@amsa.org.au

AMSA would like to thank it’s major partners for their ongoing support.

Edi A

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Words from the Pres Robert Marshall

s a first-year medical student what seems like a lifetime ago back in 2005, I remember picking up a copy of Panacea and having my eyes opened to the world of AMSA. There were two things that struck me at the time. The first is that this organisation called “AMSA” seemed to be doing a hell of a lot of stuff. Flicking through the pages I read about some of the national charity drives, medico-political advocacy, competitions, publications and projects that by all accounts were keeping the Exec, medical student societies, and students themselves very busy. In addition, there seemed to be an awful lot of excitement for something called “Convention”. I hope that in this edition of Panacea, six years later, you get some insight into the remarkable organisation that I am now proud to be a part, and that perhaps you will consider getting involved one day too. The second thing that I remember is that I had no idea what the word “panacea” meant. As I’m sure most of you are aware, a panacea is a cure-all, a remedy to fix any and all diseases. Don’t get too excited though, it is, of course, fictitious, and so you can’t hang up that copy of Therapeutic Guidelines or MIMS just yet. This year we have been pushing strongly for quality medical education in the face of a number of worrying trends that have seen medical student overload, job uncertainty and negative impacts on training become the widely-discussed issues in common rooms across Australia. While we have been talking to the people who make key decisions and highlight these problems in the media, I thought it would be interesting to consider what the panacea, or cureall, for these medical education maladies might be. I think the closest thing we might have to a panacea would be an increase to the funding of Universities, a considered and considerable financial boost to the training of medical students.

Let me explain. This year we have seen the (re)introduction of full-fee paying places for domestic students at the new “MD” course; meanwhile the overloaded number of students in the system has reached a bottleneck that means some Australiantrained graduates will start missing out on an internship; other universities are expanding their medical programmes to offshore programmes from Malaysia to New Orleans; while still more Universities like Curtin and Charles Sturt are lobbying hard to open new medical schools in an environment of resource-stretched clinical training. All of this really makes you stop and wonder: when did medical education become merely a commodity? One might think that the purpose of our medical education system is to train highquality doctors to meet the demands of the Australian healthcare system. But moves by most bodies to differentiate and expand their medical programmes suggest that the bottom line is the top priority. Why else would you accept ever-increasing cohorts of international students when you know there is no guarantee for a job at the end of all that training? It’s certainly not in the best interests of the students, and the Australian healthcare system misses out on locally trained graduates, so it doesn’t make sense from a workforce perspective either. You can hardly blame Universities for thinking about medicine as a commodity when you consider that the funding for medical places is now less than it was two decades ago, in real terms. That shortfall has to be made up somewhere, and unfortunately in this case it is coming from the International medical student market. Perhaps providers of university medical education take the view that it is not their job to take care of the prevocational and vocational training of doctors once they leave medical school, which might

seem to be a reasonable delineation of responsibility. The problem is that in the absence of a coordinated approach to workforce and training, it is the individual within the system who will miss out. Health Workforce Australia has been charged with this task of overseeing and advising the medical training continuum, but the National Training Plan, due to give recommendations by the end of the year, is focused squarely on the numbers. How many students should Australia train to meet the workforce demands of 2025? This is an important question, certainly, and answering it is not an easy task, but the title of HWA’s project is still misleading for the thousands of medical students who are worried about the quality of their university and post-graduate medical education given the current oversupply of students within the system. Perhaps National Training Calculator would have been more appropriate? Being a medical student in the middle of this training crisis often makes you feel like just another model in the assembly line of a doctor-factory. What is clearly missing from the debate is the quality of our medical education system. The most important thing for the sake of the workforce, doctors and patients alike is to ensure the world-class standards of medical education that we have in Australia, which the current approach to medical student training threatens to erode. We should start by giving our public hospitals and universities the funding and resources they need to maintain the high standards of quality clinical teaching. More funding for medical schools may not, in fact, be the panacea for all these problems, but a lack of funding does seem to be at the root of many of the education and training issues we are currently experiencing. If medical education really has become a commodity, than perhaps the best we can hope for is a sound investment in our future doctors. In the meantime, AMSA will continue to look for that elusive panacea. Don’t hold your breath.

BLACK

BOOKS

Rob Thompson (UWS) reminds us that we can often learn more from books found outside of the med library.

hether you are gunning for top spot or scraping by with pass and a hangover, there is one thing that any med student needs for success: books. Obviously we’re more than familiar with the staple text books, but think back to the days before OSCE Practice and Anatomy Spot Tests, when you actually had time for recreational reading. While most students find it difficult to justify prying their nose away from their Guyton or Boron for long enough to pick up something that isn’t just there to teach you science, recreational reading is good for your mental development in other areas, particularly interpersonal communication skills (potential for a research project into the amount of recreational reading in surgeons?) That’s where the following list comes in. Five books that are both interesting to read and have enough medical content or themes that you might be able to trick yourself into thinking you are really learning something. These books are five of the (read “the only five”) books I have managed to read since I started my degree, and didn’t regret any of them. They each have their different attractions, and I have tried to give you an idea of what I got from the book as a student, rather than the standard literary guff of blurbs and newspaper reviews.

Blind Faith – Ben Elton:

A cracking comedy set in a post-apocalyptic world, in the year 56ATF (After ‘The Flood’), where science is outlawed and feelings and beliefs are protected and supported by the law. Elton is probably best known for his writing on the cult British comedy Blackadder, and Blind Faith is equally as funny while also making some social commentary that hits close to home. He deals with the consequences of the prohibition of science, specifically medicine but also brings up a few other “medical student” themes: ignorance is wisdom, nakedness is modesty and anyone who attempts to keep their life private is deemed perverted, so all activities and photos are posted online for all to see. Has Elton not really created a new world, but rather recreated a week at Convention?

First Do No Harm – Leanne Rowe and Michael Kidd:

While not a fiction book, First Do No Harm is a fascinating read about coping as a doctor in the 21st century. It uses the classic notion from the title and reshapes this to remind us that you can only uphold this value if you ensure that you do no harm to yourself in your practice. This book is a gift to each new cohort every year, and at first I thought it was a bit of a waste of space, but after leafing through some of the chapters, I realised just how easy it is to sacrifice our own health for the benefit of our degree. With strategies of prevention, signs to look out for in yourself and colleagues and techniques to cope once things do get difficult, it’s a must read for any aspiring doctor.

House of God – Samuel Shem

Back to the comedy, House of God is a satirical novel which tells the story of Dr Roy Basch and the psychological damage caused to Basch and his fellow interns during their term at the House of God hospital. Incorporating issues such as the excessive hours of work, unexpected increase in responsibility and duties and the failure of the attendings to be bothered teaching, it will give you a new appreciation of your own internship when you reach it, and make you thankful you aren’t training in the Seventies: though the hair was cooler, internships not so much. The author Samuel Shem (a.k.a. Stephen Bergmen) is a guest at this year’s Convention, and is sure to share some of the fascinating insights into this book, as well as his other writings.

Medical Mysteries: From the Bizarre to the Deadly . . . The Cases That Have Baffled Doctors – Ann Reynolds and Kenneth Wapner

I was given this book by a friend when I told them I wanted to go into medicine, and after reading it, I’d never been more certain that I wanted to. The book takes its stories from an American TV show and chronicles various fascinating medical cases. The accounts are sufficiently balanced between medicine and literature to keep you hanging on to find out exactly what the hell is going on. This is definitely for anyone keen for being mildly grossed out or for those gunners who want to be able to diagnose absolutely everything (Note: the likelihood of you seeing someone like The Tree Man on a regular rotation is probably pretty slim)

The Doctor’s Book of Humorous Quotations: A Treasury of Quotes, Jokes, and One-Liners About Doctors & Health Care – Howard J. Bennett The title says everything about this one. Again a gift, I resort to this whenever I feel things are getting a bit too heavy during semester time (pure gold during my neuro block). Filled to the brim with a broad spectrum of medical humour including the classic “Doctor, Doctor…” jokes, specialist stereotypes, famous quotes from movies and TV as well as a decent amount of crudeness and lewdness to satisfy even the most hardened medico.

family expectations of medical students by Hamish Gunn and Bec Ryan (UTas)

Being the studious souls that we are, we have not spent a lot of time watching Modern Family (well not that much time), but thanks to Wiki we think we have the general understanding of what it’s all about (kind of like our medical degree). So, you’re on the way to getting your MBBS. It’s tough, we know. It most likely wouldn’t have been possible without some form of support along the way. This issue of Panacea, we look at your own immediate (modern) family. Type One Dysfunctional Phil and Claire Dunphy, whilst loving parents, often neglect their brainiest spawn. Sound familiar? Your mum and dad fail to recognise your continuous outstanding performances in all arenas – be it sporting, community, or of course, academic. They’re probably too busy attending your younger brother’s Parent Teacher interviews (delinquent), or plotting ways to ensure your promiscuous teenage sister doesn’t have a pregnancy scare (again). Never fear, they will come to recognise your brilliance when the time comes to fund their retirement condo in Noosa. Our advice: Grin and bear it. And it’s ok to feel superior. Type two Progressive parents Perhaps your parents are more like Cameron and Mitchell, gay parents with an adopted Vietnamese daughter. Although not necessarily gay, throughout your life they have surrounded you by a rainbow bubble of love. Ain’t No Mountain High Enough is your theme tune – they won’t let anything stand in the way of their precious caramel baby and their dreams. This leaves you in a bit of a pickle. They would think you were wonderful regardless of how many patients you killed and how many

sexual misconduct tribunals you faced throughout your (most likely short) career. Enjoy it while it’s there but don’t let their rainbow light blind your better judgement. Type Three Pressure cooker Like Jay and Gloria (the older, successful male with a beautiful, young trophy wife), perhaps your own mother has something to prove. She brings more than smoking looks to the family – she can produce a successful heir to the family name, which is where you step in. Digressing from the real story, perhaps your workaholic surgeon father also has something to prove. No child of his will be dancing on Broadway, no matter how well they did in Year 10 Interpretive dance class. In a nutshell, you will pass medicine. Furthermore, you will get HDs. Your name will be inscribed on the Honour Roll for the third generation running. You will hate your life. But hey, your parents will be pleased? And it might even end in a free nip and tuck for your trophy wife mother. Our advice for you? Appease your parents, but only if this degree is really what you want. Pull a few of Ke$ha’s favourite moves – brush your teeth with a bottle of Jack™, have a dirty free for all, and talk about P-Diddy whenever possible. Perhaps they will learn what they should really be worrying about. But let’s be honest – Modern Family is an American sitcom after all. Not exactly real. Our families aren’t like this, and we’re guessing yours aren’t either. So next time your mum makes you unpack the dishwasher during SwotVac, don’t immediately return with “You have NO idea how STRESSED I am right now! Do you WANT me to FAIL?! You are sooooooo inconsiderate!!” – stop, breathe, and remember – it could be worse.

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Wellbeing Falk Reinholz (AMSA Community & Wellbeing Officer) explains yet another reason why medical students are special, and what AMSA is doing about it...

ver the last few months, you may have seen AMSA doing a lot of work around medical student wellbeing. When we talk about wellbeing, we are not just talking about mental health. Indeed, the notion of good wellbeing must also include maintaining your physical, emotional and financial health, to ensure that you have a balanced lifestyle, enjoy what you are doing and set yourself up for a long and rewarding career.

So, why is it such an important issue? It may come as a surprise to know that, statistically, medical students exhibit lower psychological wellbeing than age-matched peers and the general population [16]. Some studies have suggested that almost a quarter of medical students show signs of depression, and of these, a quarter will experience an episode of suicidal ideation [7]. However, wellbeing as an issue for medical students is not new and AMSA has been active on the wellbeing front since itâ&#x20AC;&#x2122;s inception â&#x20AC;&#x201C; it was actually one of the core reasons AMSA was created in the first place! In 2009, AMSA and the New Zealand Medical Studentsâ&#x20AC;&#x2122; Association (NZMSA) conducted a survey which proved to be a watershed in how AMSA, and the wider profession, viewed medical student wellbeing in Australia. The results showed that half of all medical students believe that there is a stigma associated with undergoing stress and distress and only 56% per cent

of students felt that they had received formal teaching on these issues. The survey also found that one-third of medical students have no general practitioner, and this figure rose to 56% for international students [8]. Throughout our time at medical school, it becomes evident that mental health, and wellbeing more generally, has a huge impact on how well we travel through our medical education, and life. It is likely that most people reading this would know a friend or colleague, or perhaps even themselves, who has had to deal with difficult times during medical school. Although we would like to be, medical students are not immune from physical illness, life crises, mental health problems; and just tough times in general. And when you combine this with a demanding degree and a plethora of other commitments, it is no wonder that sometimes things can get a bit much However, perhaps one of the biggest issues among medical students is actually accepting this fact, admitting that we are not immune to problems and knowing when, and how, to ask for help. Alarmingly, 56% of students in the AMSA/NZMSA survey responded that they thought there was a negative stigma associated with medical students experiencing stress and distress [8]. So, as we continue to promote healthy wellbeing, reducing stigma must also be a major focus.

All students in distress must be given easy access to the best and most helpful resources available. However, all discussions about mental health and wellbeing should not be focused purely on crisis management. Medical schools, and their students, should also be concentrating on the task of raising awareness of wellbeing as a topic. It is not about singling out people who are struggling, it is about making sure that all students make wellbeing a priority and not just an after

“statistically, medical students exhibit lower psychological wellbeing than age-matched peers and the general population” thought for when things start to go awry. We should be encouraging everyone to acknowledge that, along with passing exams and dressing up in outlandish costumes, looking after their wellbeing is essential to enjoying their time at medical school. When you think of wellbeing as incorporating all elements of holistic health (physical, mental, social, financial, professional) it is hard to argue with the fact that there is nothing more important in your life than ensuring the wellbeing of yourself and those close to you.

In addition to new wellbeing initiatives mentioned, AMSA continues to foster our existing projects. Recently, the winners of the 2010 AMSA/MDA Healthy Body, Healthy Mind Campaign were announced – congratulations to the winners from Flinders Medical Students Society and the runnersup from Monash University Medical Undergraduates’ Society (MUMUS). AMSA will be continuing the Healthy Body, Healthy Mind in the second half of the year. AMSA also continues to run the Get-A-GP campaign, which encourages all medical students to have a GP that they see regularly, as well as directing them to GPs wiling to bulk-bill medical students. In light of the earlier statistics [8], it is essential that more work is done to ensure that medical students have a GP who they can confidently and confidentially use as a first port of call when they are unwell. Overall though, the most important thing we can all be doing is continue the conversations about wellbeing to ensure that medical students, and their medical schools, appreciate the importance of good wellbeing and take active steps to ensure it becomes part of everyday life at medical school.

Healthy, well-rounded students become healthy, well-rounded doctors who are more likely to impart healthy behaviours to their patients. In the interests of our education, our profession, and our future patients, it is vital that medical schools, student organisations and individual students all recognise, prioritise and To this end, AMSA has been significantly increasing its promote wellbeing so that the medical students of efforts in wellbeing. The first half of 2011 has seen the today can become the healthy doctors of tomorrow. release of ‘Keeping Your Grass Greener: the wellbeing guide for medical students’; the inaugural AMSA References podcast being on wellbeing; the production of a fact 1. Aktekin M, Karaman T, Senol Y, Erdem S, Erengin H, Akaydin M. Anxiety, depression and stressful life events medical students: a prospective study in Antalya, Turkey. Med Edu. 2001;35:12-17 sheet on wellbeing; and the inception of Well Net, the among 2. Henning K, Ey S, Shaw D. Perfectionism, the imposter phenomenon and psychological adjustment in medical, AMSA Wellbeing Network that connects wellbeing dental, nursing and pharmacy students. Med Edu.1998;32:456–64. 3. Lloyd C, Gartrell NK. Psychiatric symptoms in medical students. Compr Psychiatry. 1984;25:552–65. representatives from each and every Australian 4. Toews JA, Lockyer JM, Dobson DJ, Brownell AK. Stress among residents, medical students, and graduate (MSc/PhD) students. Acad Med. 1993;68(10 suppl):S46–S48. medical school to facilitate ideas sharing and project science 5. Toews JA, Lockyer JM, Dobson DJ, et al. Analysis of stress levels among medical students, residents, and collaboration. This year is also the first time the role graduate students at four Canadian schools of medicine. Acad Med. 1997;72:997–1002. 6. Psujek JK, Martz DM, Curtin L, Michael KD, Aeschleman SR. Gender differences in the association among dependence, body image, depression, and anxiety within a college population. Addict Behav. of the Wellbeing Officer has formally featured in the nicotine 2004;29:375–80. AMSA Executive. This focus and public presence 7. Givens J, Tjia J. Depressed medical students’ use of mental health services and barriers to use. Acad Med. 2002; 77: 918-921 on wellbeing is important if we want to increase the 8. Hillis JM, Perry WRG, Carroll EY, Hibble BA, Davies MJ, Yousef J. Painting the picture: Australasian medical emphasis and solidify student wellbeing as an essential student views on wellbeing teaching and support services. Med J Aust. 2010; 192(4):188‐190. focus for both medical schools and students.

Come Fly With Me... Greg Leeb (Bond University) takes us to a place where a new set of D-cups can be arranged while you sit by the in-pool bar; Or how about a cheeky facelift followed by a beach party? It’s not some weird mix between nip/tuck and Baywatch, its medical tourism and it’s been taking off for a while.

stimated to be worth approx. $60 billion a year, the fast growing industry of medical tourism involves people travelling overseas for a go under the knife. It’s pretty popular, with at least one in every three Australians open to the idea of going overseas for a medical procedure. The most common destination choices are low to middle income nations with Thailand, India, Malaysia and Philippines being the favourites for Australians. With the most common procedures by far being cosmetic followed by dental and about 10% more major surgeries. Companies and hospitals have begun putting together special packages to appeal to the medical tourist in all of us. One of the current leaders in this form of holiday is Destiny Meditravel. Starting from the low-low price of $4800 the average punter can have the “Breast Implant Getaway”, a package that includes flights in and out of Phuket, breast augmentation surgery, 10 nights at a 5 star resort. Not a bad move on paper, especially considering the same procedure alone can cost over $10,000 on Australian soil. So far so good, a cheap way to get a new set, mixed with a few mojito filled days by the pool in Phuket, hell, bring the kids along make it a family holiday!

“If you end up coming out looking more plastic than fantastic, there’s often little that can be done”

However, when all is said and done and the patient returns home, follow up contact with the surgeon is likely to be pretty minimal and regardless of any hospital or hygiene issues, surgical complications can arise and if they do, this usually falls on the public health system back in Australia. If you end up coming out looking more plastic than fantastic, there’s often little that can be done. As all of us that have had to sit (sleep) through arduous medico-legal lectures would know; In Australia, the liability and responsibility that doctors have to their patients is very high. Overseas, this often isn’t the case, even more so for foreign patients and most cases of malpractice get dismissed and many patients have found it hard to find a surgeon in Australia willing to work on another’s creation. Ethically, another factor is the implications on the locals of these countries. With the vast amount of money that doctors stand to make from foreign patients, there is the likelihood of the creation of a two-tier medical system. The majority of medical resources stand at risk of being turned away from the local population in the face of higher profits, as doctors of the region are lured away from the public sector and rural health networks. Regardless of where you sit on this one, it’s quite clear what the next step is. The Price Is Right – Medical Tourism Edition, which I predict Larry Emdur to reclaim his throne for.

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With the numbers of medical students increasing every year in Australia, the daunting concept of choosing which path to take can sometimes be too much. For most, being a doctor means you can administer drugs, look important and fix people’s health issues. Little do they know however that Medicine encompasses a plethora of possible courses with which to take such as med or surge, Gynae or gen med, ED or cardiothoracic and the list goes on. Here we have a jibber jab about different specialties and what is the best approach.

“Just when you thought it was becoming easier choosing between vagina, scalpels, drugs and skin, up strolls a specialty that covers more than one.” Choices are everywhere nowadays, do I want a pink sweater with beige pleats or pink pleats with a beige sweater...so many decisions!! Not surprisingly, choices are also found in pretty much every facet of our lives too including work, holidays, family life and social. With the world moving forward as it is, speed dating has become even more popular, finding partners for those sick and tired of waiting for the right man or woman to come along or for those whose biological clock may have ticked a few more times than others. With this approach not only can you meet a huge number of people (a lot of which are quite creepy, or so I read I mean) but you can also dispense with the ones that have no hope and still manage to meet plenty of “opportunities” so to speak. This however is now what it is like when choosing a medical specialty. Each student gets several weeks in each specialty before finishing, kind of like a speed dating service for med students. The problem with this is that well as always (for me at least) it is all too confusing, happens way too fast and as always I am left unsatisfied at the end with a giant mess to take care of on my own.

that extra blood and more screaming is a positive... maybe ED? Others may think that eight hours a day of vagina sounds great. Easy! Obs and Gynae for you. But you can even take it broader than that. Do you like prescribing and Dr House-ing patients to figure out what’s wrong with them? Then physician I knight you, however if you just want to stab someone in their chest and glue parts of their heart together, well my son either complete murdering psycho with a hint of humanity or surgical is where you shall be. This can go on for ages and in fact it does, depending on your degree 2 or more years to be precise. The reason why is because there are so many different specialties and sub-specialties and yep even sub-sub-specialties that it can become quite daunting. I know what you’re thinking, “it still sounds pretty easy really” when you are not only an idiot and your mum is too but you are also so so wrong. Just when you thought it was becoming easier choosing between vagina, scalpels, drugs and skin, up strolls a specialty that covers more than one. General med or internal medicine specialties cover a bit of everything really and so does GP with patients turning up on a day to day basis with everything from psych to fatties, paeds to oldies and warts to diarrhoea. It is not only for this reason but also many others that have made broader specialties such as GP and gen med such an attractive specialty to be a part of, you literally have no idea what the next patient through the door might have. No matter what specialty you decide to take in the future, the speed specialty dating will come, and you, like most will end up at the end confused and with less money for no reason. But when it does happen and you know it will, grab that big fat specialty by the horns and take it for a ride before you decide.

As with any dating regime there are pros and cons depending on the person. Some may say

Cultural and Clinical Lessons in China Andrew Webster (AMSA VP External) recounts his latest adventure to Zhejiang University First Affiliated Hospital, Hangzhou, China

n route to Hangzhou for my 5th year medical elective, I thought it would be a good idea to learn some basic Chinese greetings and phrases with which to impress my hosts upon arrival. Armed with some podcasts and a Lonely Planet phrase book, I set about trying to remember the basics of ‘hello’, ‘where is the toilet’ and ‘thank you’.

areas within the Zhejiang province with a team whose aim is to treat and track patients who are infected with Hepatitis B, tuberculosis and HIV.

These visits are part of a statewide research project that is aiming to model the incidence and prevalence rates of these three important infectious diseases in the Zhejiang province. It is quickly apparent when Of course, in such as short space of time my efforts were participating in these outreach clinics that infectious essentially fruitless and I had learned almost nothing diseases, particularly hepatitis, are a massive public upon touchdown in China. As you might have guessed, health concern for China. It is also clear that there are my complete lack of ability with Chinese was to prove significant issues with access and utilization of health important when a case of ‘Chinese whispers’ meant care among the rural populations in this area. that my date of arrival had been lost-in-translation. Coupled with a phone that was not working and an The reasons for this are complex, though a arrival time in the late evening when no one was in the significant contributing factor must surely be the airport, meant that this soon became an interesting lack of formal primary care services (i.e. no GP situation! Channeling my acting abilities and using props workforce) in much of China. This lack of access such as my stethoscope and lots of gesticulation, I was to health care in rural communities, coupled with able to be pointed into the direction of a bus which was the high personal cost of accessing health care in the cities may be factors that are contributing to hopefully heading towards Hangzhou City. the persistence of these communicable diseases. I eventually arrived in the right area and was greeted by some mortified hosts the following morning. Certainly this initial experience prepared me well to handle the many other culture shocks that were to come in the following weeks. Rural populations often have poorer access to health care but in China this disparity is particularly apparent.

Lesson 2

Lesson 1

Chinese is a difficult language: it’s worth learning the basics before you get on the plane. In the last 20 years, China has undergone a massive population shift from rural areas into the big cities. This has been particularly evident in the highly populous and relatively wealthy east coast of China, where my elective in Hangzhou was based. As a result of this population shift and limited health resources, ‘health care silos’ have been created in the major cities, whereas rural centers and small towns remain largely underserviced. During this placement I travelled to regional

The contrast between the health facilities in rural areas and the city was striking. My base hospital, for example, the Zhejiang University First Affiliated Hospital, is a huge health campus located in the center of Hangzhou. My department alone (Infectious Diseases) was housed in a monolithic 20-storey building that had approximately 400 inpatient beds and a staff of over 500 doctors, nurses and allied health. In addition to the clinical wards, there were also laboratories and research institutes within this section of the hospital. This close proximity of clinicians and researchers, along with the sheer scale of the place, meant that this was a constantly stimulating elective location.

This elective was not only a chance to learn about the practice of medicine in a country outside of Australia, but also a chance to learn about the rapidly changing nature of modern China. During my stay, I was invited into the homes of some of the doctors to celebrate the Chinese Spring Festival (Lunar New Year) – a very memorable experience. The generosity and hospitality of these people was exceptional and on many occasions I was fed and looked-after to the point of embarrassment.

Lesson 3 If you have indigestion from eating too much, don’t tell your Chinese hosts as they might force you to eat cured duck’s stomach as a remedy! Being an observer of medical education in a major Chinese teaching hospital was also fascinating: I have never seen medical students trying to become so invisible during ward rounds! Not only would the students attempt to remain out of the way of the doctors, but they’d also actively try to avoid discussion and examination of patients – this was most obvious when one particular medical student spent the entire 3hr ward round looking at his phone! This is not an exaggeration. I don’t entirely understand the reason for this behavior and perhaps it was partly due to my presence taking focus away from teaching the Chinese students, however, I can certainly say that this behavior would not be conducive to learning.

Lesson 4 Medical students sometimes feel the need to be invisible on ward rounds and constant mobile phone use is even more common among Chinese doctors than it is here. Another striking difference, from a health perspective, is the lack of formal, organized primary care in China. There is currently no national General Practice training program and there is little provision for doctors to work in the community. Because of this, the health system largely functions around triaging patients in hospital emergency departments and treating within the hospital system. As a result, there are significant difficulties with chronic disease management and patient follow-up. This was a fascinating aspect of the health experience in China and surely, the status quo that is highly inefficient and costly, must change in the coming years.

Lesson 5 China is a fascinating place which is just too huge diverse to experience in a single visit. I will certainly be returning to China in the future, and with the current rate of growth and change in this amazing country, it’ll likely be a different place altogether.

“This elective was not only a chance to learn about the practice of medicine in a country outside of Australia, but also a chance to learn about the rapidly changing nature of modern China”

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MedCest Medicine Kerryn Houghton (Notre Dame Sydney) assists the Oxford dictionary by defining this much revered term.

Med school is in many ways simply an extension of high school. As one who attended an All Girls High School – I love nothing more than my morning tea served with a hot slice of weekend gossip. Whilst drunk and disorderly behaviour is fun to relive in the cold harsh light of day, MedCest is oh so much juicier. Whether it be a sneaky pash on the dance Whilst on initial inspection medcest may sound floor or the start of a new med romance. as inviting as a 7am ward round. On closer inspection you may find it to be as inviting By far my favourite medcest moment does as a long weekend. Medcest like all medical not involve the couple at all but rather my encounters has a number of end points. From somewhat naïve friend who for the purpose of those who will go on to marry and have 2.5 confidentiality will be known simply as Ms GC. future doctors, to those which result in much Her highlight of our medball was not our PBL awkwardness and the possibility of Facebook tutor shredding up the dance floor to the beats of our head of anatomy and his “band” but defriending. instead her discovery of two of our classmates Convention week is by far my favourite time in an intimate embrace outside the venue as of the year not only because of the stellar she waited for her ride hidden behind a pillar. academic program but also for the networking But do not despair for GC, she is now engaged that occurs at night. Convention week provides in med relationship of her own. an amazing opportunity for medcest to be observed and if you are game to be engage in, Medcest is something that is present in all medical schools and if you haven’t heard about in all its glory on a truly national scale. it or been involved you are just not getting the Nothing fills my heart with as much joy except most out of your medical education. So don’t perhaps this years amazing Academic Program be shy get amongst it. as using the morning tea break to attempt to determine the identity or at the very least Plus you can help spread the key objectives the university of a friend’s latest conquest. of AMSA to connect, inform and represent. As Interuniversity medcest both your own and well as give me something to talk about on a that of your friends is one of the best forms of Monday morning. See you all at Convention – networking without which I would have much Is it unethical to use my role as Academic CoConvenor to network? less Facebook friends. edcest is a portmanteau of the English word medicine in this instance used to describe medical students and incest a noun used to describe sexual relationships between people classed as being too closely related. Medcest for those of you unfamiliar with the term is used to describe liaisons between medical students both at the same uni and between unis.

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Show me the money: An Incentive based Practice?

Stephanie Cheung (ANU) debates incentive vs evidence based practice In the famous scene from Jerry Maguire, Tom Cruise (Jerry) and Cuba Gooding Jr. (Rod) immortalize the catch-phrase – “Show me the money!” Performance based Return on Investment (ROI) is a key indicator in the economic and business world, and as much as we’d hate to admit it, a notion of which medical practice is not immune.

Program (PIP) was developed, and is administered by Medicare Australia on behalf of the Department of Health and Aging. General practices can apply for as many of these incentives as they are eligible for. In fact, they can pick and choose from a list of 13 incentives available on the PIP. Services range from afterhours and quality prescribing to cervical screening and procedural incentives, as well as practices willing to conduct an annual cycle of care Current fee-for-service arrangements have been found to for patients with chronic conditions such as asthma and encourage quantity rather than quality, where seeing a high diabetes. number of patients means the receipt of higher payments through Medicare reimbursements and is practiced by some at the expense of taking the time required to meet ongoing patient needs. In an attempt to improve the quality of care provided by general practices the Practice Incentives

Are we slowly moving into incentives-based medicine instead of the evidence-based medicine bestowed upon us as medical students? With so much on offer, are we at risk of being “incentivized” into providing a healthcare service based on the promises being made to us? Are we slowly moving into incentives-based medicine instead of the evidence-based medicine bestowed upon us as medical students? The idea of financially rewarding “good medical practice” is not exclusive to the Australian healthcare system. Countries such as the US, UK and Canada are adopting “Pay-for-performance” strategies to drive quality healthcare improvement in their hospitals and general practices. These schemes involve doctors being paid by health insurance companies and funding

bodies according to the quality of care they provide for their patients. Such incentive payments are based on a ranking which reflects how well a doctor is “performing” in terms of patient care, follow-up and outcomes. For example, performance benchmarks such as screening a set proportion of eligible patients with diabetes can earn extra payments based on the number of patients admitted to the program. Rewards then continue with bonus payments being made when specified health outcomes are achieved. In some schemes, penalties are imposed when quality goals for healthcare are not met and doctor ranking goes down. Clearly, medicine has become a serious business and it may well be that in addition to our medical degrees; a business degree would help us navigate better the waters of clinical practice in the 21st century. At this point it would be fair to point out that the incentives proposed by the Australian PIP do play a role in highlighting significant areas of need. In addition to the services mentioned earlier, others such as indigenous health, aged care access and domestic violence incentives can work to support GP clinics in serving their community. There is indeed prime focus on preventive care and care of chronic diseases which are important for improving patient outcomes within the primary care setting. The basis for introducing these schemes stems from an intention which is arguably well-meaning and noble. However, it would be naïve to ignore the additional benefits that medical practitioners are receiving in the process and the affect this has on decisions regarding patient care and treatment. This would surely have an influence on the types of services that some clinics will feel inclined to offer as well as the patients they prefer to see. With the previous fee-for-service scheme, it was recognized that a high throughput of patients resulted in unnecessary prescribing, tests and referrals. On this premise, it is difficult to understand how adding more incentives to the bag is meant to deter the hand of those who are predisposed to undermining patient needs in the face of monetary rewards. The danger lies in the motivations behind medical practice where the patient-doctor relationship is potentially reduced to a business transaction with additional investments on the side. Upholding the clinical maxim “first, do no harm” has

never been more crucial in ensuring appropriate patient care and protecting doctors from moral decline. The ideals of beneficence and non-maleficence are indispensable in clinical practice, especially when practitioners are put into the increasingly difficult position of making decisions between serving patient best interests and their own. Failing clinician morale and discrepancies in health care access are some of the concerns already being voiced amongst the American medical community. Pay-for-performance programs have yet to be introduced in Australia at the primary care level although a pay-forperformance program targeting public hospitals was piloted in Queensland in 2007. Initial installments using pay-forperformance have been given for work performed up until June 2008, however current data on the impact of this new system is limited. Phased approaches to easing Australia into pay-for-performance methods has been proposed by some authors. Suggestions include “payfor-participation” schemes focused on optimizing quality control, standards and measures of performance that would be used to develop pay-for-performance frameworks. It is clear that the existence and development of incentives based programs is certainly well and alive in the Australian healthcare system. Therefore, ongoing debate around the use of pay-for-performance initiatives in augmenting clinical practice will likely persist amongst the less enthused. For every story, there is always an ending. At the end of Jerry Maguire, Jerry finds that his relationship with Rod (his “investment”) has turned from one of business to one of a close, personal friendship. This realization allows him to fulfill what he set out to achieve: his mission statement for honest business in the sports world. For us as future health professionals it is perhaps worth acknowledging that, despite our humblest efforts to provide the best standard of care, none of us are completely safe from the adverse effects that such financial incentives will bring. Nevertheless, hope remains as we remember that to serve in this profession is a privilege and that it really isn’t all about the money. Our true rewards are not reflected by our bank balances but by the integrity of our decisions and sustained relationships with our patients, long after the credits have finished rolling.

are muffins just

ugly cupcakes? The simple answer to that is NO, absolutely not, and Lee Fairhead (UWA) is here to tell us why.

is a common misconception that muffins and cupcakes are the same thing. Firstly just let me tell you a cold, hard fact: they’re not. Muffins are not just ugly cupcakes without the icing. No, they are a distinct and delicious breed of baked good often discriminated against because of their rough, overflowing exterior, in favour of the pretty little cupcake decorated with sugary frosting. I am quite the fan of baking muffins and after sampling one, many people have commented to me that they can’t possibly understand how to make muffins, they never seem to rise properly and are just too difficult. I too thought this until someone took the time to explain the answer: you have to stop baking muffins like cakes. They have their own formula and baking strategy and once you get the hang of it you’ll wonder why you even bothered with anything else. The problem you see is that many people only differentiate between the muffin and cupcake based on its looks or the fact that muffins have fruit and nuts in them and cupcakes are sweeter with icing. But that is not the end of it. There are some very important technical differences, which mean that these two baked products of deliciousness are nothing but distant cousins.

Now, the main difference lies not just in the basic formula but in the way the mixtures are combined. Cupcakes are simply very small cakes, the preparation is largely the same as a large cake and usually involves beating butter, sugar and eggs and then adding everything else until you have a very smooth, runny texture. Traditional muffins on the other hand often call for an oil or melted butter as the fat rather than creamed butter. They also commonly don’t have eggs. The major difference though is how the mixture should be combined. When it comes to mixing muffins, you need to leave the electric beater in the cupboard. Instead, prepare a wet mix and a dry mix separately and then add the dry mix to the wet. The mixture is then stirred gently, preferably with a wooden spoon, until it is only just mixed. This is most peoples’ fatal mistake: the trick is not to batter the poor little muffin mixture into being a cake. Just stir gently and once it is just combined, stop. Over-mixing leads to flat, heavy muffins that no one wants to eat. So, clearly, muffins and cupcakes are very different. In fact, muffins are actually more akin to a quick bread, baked in the shape of a cupcake.

And with that I could leave you here with an Now this may seem to be just a silly academic overdone pun about some French Queen but point, and perhaps it is. But, unlike some sort I will rise above it and simply leave you with a of directional sausage debate, at least there is recipe for some delicious mango muffins which a real and discernible difference between these should give you ample opportunity to see the two food products and, appreciating this is difference for yourself! bound to leave you with a much greater sense of satisfaction next time you enjoy one of these delectable delicacies.

Mango Muffins Ingredients 800g sliced mangoes (tinned with juice or fresh) 125g (4T) melted butter or margarine 1 cup brown sugar, sifted 4 cups SR flour 2 cups of Natural yoghurt Pre-heat oven to 180째C. Combine butter, yoghurt and mangoes as your wet mix. Sift in sugar. Gently fold in flour until just mixed, being careful not to over-mix. Bake in muffin tins until golden brown. You know they are cooked when you lightly tap the top and it springs back. Makes 12

The State of the Nation The AMSA Rep Reports

University of Adelaide by Aakriti Gupta (AMSA Junior Rep). What’s Been Happening: Never a dull moment in the life of an Adelaidean. Since Dec 2010, the AMSS has held the legendary Skullduggery (with all 2000 tickets selling out in one and a half days) and a Harry Potter-themed MedCamp, initiating the first years into the ‘Magical World of Medicine.’ A continuous stream of events have followed including Clinical Welcome Drinks, President’s Keg, Close the Gap BBQ, MedCricket, AMSS-FMSS volleyball, MedFooty, Inter-year debating and the much loved Jazz Night. Something Amusing: Three words: keen first years. Our past president in MBBS V welcomed the first years as ‘Dr. Mark Nicholson,’ offering three prestigious medical student research scholarships. A flurry of enquiries and applications subsequently flooded Dr Nicholson’s inbox. Disappointing for the excited applicants who were informed that “a tragic turn of events has led to Dr. Mark Nicholson contracting Bovine Spongiform Encephalopathy whilst processing postmortem specimens” and that the scholarships on offer would be cancelled until further notice… Big News For Adelaide: AMSS and FMSS conducted a joint survey over Jan/Feb 2011 to gather student opinion on internship allocation in South Australia. A submission from these results was sent to SAIMET (South Australian Institute of Medical Education and Training) in Feb 2011. This resulted overall in positive outcomes for students, achieving one-year internship contracts, non-merit based allocation, and preservation of current priority ranking in optimised preference allocation. The future implementation of network-based internships instead of the student preferred single hospital internships however remains on the agenda. Student concerns with regards to assessment, continuity of education and welfare are actively being addressed.

Bond University by Greg Leeb What’s Been Happening: MedBall, Trivia Night with HMSA, MedEagle ,Scrubcrawl with Griffith, World’s Greatest Shave, Anatomy Challenge (won by the team “three asians and a token white guy”), Elective Night Something amusing: The addition of the word ‘demi’ into the dictionary as the world’s most universal term to describe most any situation. “Hi nice to meet you, my name is shitting cow” – Stephen Shih-teng Kao Dr. Najeeb’s unofficial role as lecturer at Bond University Big News for Bond Uni: Welcome to the new cohort of Bond Uni med students who have begun their long walk to doctorness this semester. Congratulations to the MSSBU team who helped raise $1800 towards Leukaemia Foundations – World’s Greatest Shave.

Deakin University by Amy Wong What’s Been Happening: 2011 kicked off to a smashing start, with a big welcome to all the first years during O-week with a welcome barbeque and market day on campus, followed by a cocktail party by the waterfront where students from all year levels mingled for the first time ever in Deakin’s SOM history. This was followed by med camp a week later where first years were introduced to med student life and practical skills such as suturing and plastering. Elections took place in March, and many enthusiastic first years jumped on board with our medsoc (MeDUSA) bringing new energy and life to the school. We’ve had a handful of academic sessions such as an electives seminar and clinical schools sessions, and fundraising activities such as the Christchurch bake sale by our Global Health Group UHAD (Universal Health @ Deakin). Students in clinical years had their own fair share of fun and socializing as well just before Easter – with a PRN Wonderland Cocktail Night and a pool competition between the 3rd and 4th year students. On a more serious note, we have been going through a long process of accreditation with AMC, and on an even more serious note, preparing our delegates for convention and GHC! Watch out Sydney! Big News for Deakin: Our first lot of 4th years will be graduating at the end of the year – we look forward to seeing them as interns all over Victoria and Australia!

Flinders University by Neville Fields What’s Been Happening: O-week, FMSS 2011 MedCamp, Rubik’s Cube PubCrawl, Quiz Night, FMSS Family Beach Day, Shave for a Cure, 2011 FMSS MedBall – “Under the Cover of Darkness”, FMSS vs. AMSS Volleyball Comp (clearly we won…), 2nd Hand Book Sale, FMSS Strategic Planning Night, Birthing Kit Day in conjunction with HHRG and FUNMSA, HHRG Heat Cocktail Night, FUSS Lawn Bowls Night and far far too many “unofficial” boat racing try-outs. Something amusing: The breakdown of an official FMSS Convoy car on the way to MedCamp held in the Flinders Ranges about 275km away… this occurred at 5PM on a Friday night in peak hour traffic on South Rd. Carrying vital supplies such as the pigs hooves for suturing the next day and yours truly (yes I am vital), multiple med students stood guard next to the car on the side of the road awaiting RAA in shifts… funnily enough that night 4 different med students all went by the same name as per the RAA members card; or so the RAA and tow truck company thought… ultimately a sweet hire car was employed and GLEE was enjoyed by all on the trip up! Big News for Flinders: The official opening of the NT Medical School run by Flinders University in conjunction with Charles Darwin University! With the first group of med students taken on this year, we here at FMSS are very proud to support and represent this wonderful group of students and are extremely excited to see how things progress up in the Territory. Where else can you get first-hand experience with croc bites, box jellyfish stings and blue ring octopus paralysis.

Griffith University by Justine Cain What’s Been Happening: We farewelled our graduating cohort and welcomed in the new year and our new batch of victims first years with a disorientation weekend, complete with a BBQ lunch, jumping castle, barefoot bowls and our guide to medicine ‘Embryo’. We combined with Bond to host a scrub crawl through some fine Gold Coast establishments. We have hosted various academic peer tutorials, professional speakers and a peer mentoring meet and greet. To focus on relaxation we provided some mindfulness sessions and the family event aptly named ‘Parasympathetic Picnic in the Park… to rest and digest’. We participated in Relay for Life, raising much needed funds for cancer research, as well as a blue party to raise funds for mental health. Something amusing: Or most cringe-worthy…a second year student was in a simulated (fortunately!) obs and gynae history taking exercise: Student: How many times have you been pregnant? Patient: Once. Student: Great, boy or a girl? Patient: It was an abortion. Or most embarrassing, to date, by yours truly: Consultant: Now feel for the enlarged lymph node. Me: Err is that it? Consultant: That’s the mandible. Big News for Griffith: For those seeking an update on the common room situation – this is now a beautiful large common room, fitted out with new furniture and even a ‘stress reduction device’ aka a punching bag. Provided by our year 1 and 2 coordinator. Seriously.

James Cook University by Laura McAulay What’s Been Happening: Since the graduation of JCU’s class of 2010, the new JCUMSA executive headed by the wonderful Christine Pirrone has been at the forefront of providing “wholesome” activities for our students including: Sign on BBQ with the launch of the BRAND NEW JCUMSA WEBSITE – check it out at www.jcumsa.org.au! Med camp at Airlie Beach which we mark as a HUGE SUCCESS given that no-one was seriously mauled by sharks or crocodiles, attacked by irikanjies or taken to hospital, despite the first years best efforts! JCUMSA Debating Series in which we saw Med 3’s triumph over the Med 1’s successfully arguing that Medcest DOES NOT equal success. A controversial topic we know – but maybe think about this result next time your caught looking at that girl across the lecture theatre! UN Trivia Night – was an amusing night for all, eventually won, although controversially by the GERMAN TEAM in laderhousen who “conveniently” got the 1st placed team disqualified after a cheating incident with an I-phone that shall not be named! Something amusing: Un-named O&G Resident: “Laura, whats the name for a 3rd-4th degree tear during birth called” Laura: “Isn’t it just a 3rd-4th degree tear” Un-named O&G Resident: “No Laura, It’s a VAGANUS” (pronounced: vag-anus) Laura: “No way – that’s a serious medical term!?” Un-named O&G Resident: “ Of course!” 2 days later: Consultant: “Laura what’s that” Laura: “It’s a Vaganus” Consultant: “You really are a little special, aren’t you laura” Lesson of the story: vaganus is NOT a real medical term for those as gullable as myself!

Big News for JCU: Convention – JCU’s greatest attendance ever! JCU students over mid year break are riding from Townsville to Sydney, raising money for angel flight!

Monash University by Catherine Pendrey What’s Been Happening: O-week Shenanigans – new Monash meddies shared many bright ideas about futures in medicine and memorable night on the town. MedCamp – all survived the weekend in rural Victoria to welcome new meddies World TB/Close the Gap Day – brought together the MUMUS, Ignite Global Health Group and WILDFIRE rural health club to advocate for better world health Pleasant Friday Evenings – have allowed students to let their hair down and enjoy a night away from study ThinkTank - continues to forge ahead, writing policy to develop student skills and advance medical student wellbeing and community health from a local to global level MedOrchestra - harping on and sounding blissful. Good Friday Appeal Volunteering – the MUMUS Community and Wellbeing facilitated involvement in the annual Royal Children’s Hospital appeal. AMA Doctors in Training Carefactor Workshop – took Victorian students through survival skills for personal wellbeing and peer support Year 5 lecture series - provided final year students important skills training for jobseeking and internship Monash University Konvention Enjoyment Group (MUKEG) – is building up for July Something amusing: There is ongoing debate at Monash about the the etymology for the proposed verb ‘ThinkTanking.’ Advocates for policy development argue that ThinkTanking should relate to the noun think-tank, defined by the Oxford Pocket Dictionary as ‘a body of experts providing advice and ideas.’ Opponents have pointed out that clothing would require unconventionally large pockets to fit Oxford’s pocket edition and have instead put forth a definition to describe a sport, inspired by chess boxing, that would combine alternating competitive rounds of thinking and armored conflict. Big News for Monash: The new-and-improved MUMUS has forged ahead with the separation between academic and social functions, allowing improved academic representation and social events alla Vita Bella. Monash University registered record numbers for the Global Health Conference and was in close third, at last standing, behind only two of NSW many medical schools. Monash has also punched above its weight for Convention and looks forward to bringing the force of numbers to the biggest AMSA events of the year.

The University of Newcastle by Rosanna Olsen What’s Been Happening: First Year First Day, Ocamp, ‘First Incision’ cocktail party, Charity Launch Trivia Night, Amazing Beach Race, Cops & Robbers Pub Crawl, Electives Night, The Great Debate Something amusing: Grad Ball 2010 featured as the after dinner speaker none other than the recently appointed University of Newcastle Pro-Vice Chancellor of the Faculty of Health – Dr Nicholas Talley, of textbook fame. Dr Talley was heard to remark during his speech that should such and such an event not occur, “well then I jizz in my scrubs”. Please put that in your next book Talley. Big News for Newcastle: A major review of the BMed course has been announced, and everything is on the table. The next few years could see a big shakeup at Newcastle. Can we again deliver a revolution in the way medical education is delivered in Australia? Can we stop resting on our laurels of 30 years ago? It’s an exciting time for us and our UNEMSA brothers in the JMP.

University of Notre Dame, Fremantle by Kate Hooper What’s Been Happening: MED100 O-Camp, Back to School Uniform Party (Social), Med100 Survival Night (Education), Surgical Interest Group Lecture Night (Surgical Interest Group/Education), Day in the Park (Sport/ Wellbeing), PBL Games (Social), Rural Night (Rural), Suturing Night (Surgical Interest Group/Education), Bed Push (Social Justice), Movie Night (Social Justice), Cocktail Party (Social), SJOG Clinical Skills Night (Education), Women in Surgery Dinner (Surgical Interest Group/Education) Something amusing: Participating in medical trials to earn some cash on the side is a well worn path for many medical students. Trials can ask some interesting things of participants. A trial being run in Perth needed healthy females to test out a new type of lubricant… Testing involved you, a special kind of...rabbit, aforementioned lubricant, 4 hours in a room with some special dvds and at least 30 thrusting movements. You got to keep the rabbit... Big News for ND Freo: Organisation of the West Australian Leadership Development Seminar with UWA has begun and Footy training is well and truely underway (better bring it UWA)! In 2011 we will have our biggest Convention delegation ever at Sydney! We’ve been busily preparing the best group costumes you have ever seen and we’ll be bringing back our day uniform...GG eat your heart out.

University of Notre Dame, Sydney by Kerryn Houghton What’s Been Happening: MANDUS has started the year with a bang! We have had MedCamp, Med2 Orientation and our Circus Freaks Themed Harbour Cruise. But don’t be mislead MANDUS is not all about having a good time with the profits from our Harbour Cruise helping to fund our Birthing Kit Assembly Day later in the year. Whilst our Academic and International Health Teams ensured that they would not be left behind by hitting the ground running with both our Life Beyond Uni Series and our International Health Study Program well underway. Something amusing: My awkwardness following a good 20 minute rant to one of the scrub nurses about why I would hate to become a radiologist. Only to discover whilst scrubbing with my Reg, that he is leaving surgery for radiology. Add to that my pitiful attempt to get out of my hole with “But you are going to do INTERVENTIONAL radiology.” Big News for ND Sydney: Not only do we finally have a Dean and are slowly returning Professor Gavin Frost to Freo but quite possibly more exciting MANDUS finally has its own website! Check it out @ mandus.org.au – hey its only 4 years in the making!

University of New England by Linus Armstrong What’s Been Happening: 2011 kicked off with the annual OCAMP (joint with Newcastle), providing a good opportunity for first years to get to know each other. First incision, UNEMSA’s icebreaker social event of the year was also a huge hit by all accounts. Med week this year consisted of a scribble themed pub-crawl, fluoro bowling and laser tag, sports day (including the commencement of cascade cup practice), and many other social events. The GPSN trivia night was also a massive success, seeing stacks of prizes being won and fun had by all. Finally, our annual Medicine Ball was held on Saturday the 14th of May. It provided us students with a great opportunity to raise money for the Armidale hospital and to the thanks the clinicians and staff for their teaching and support. There were also student performances, raffles and silent auctions, which made the night a highlight of the year. Something amusing: During OCamp, one of our students decided to ‘get in touch with nature’ by going for a midnight nudie run on the beach. Upon being questioned WHY he continued to stay naked afterwards, he promptly replied with “It’s mine, and I will show it to whoever I want!”. Touché Big News UNE: Our search for a new head of school has finally come to an end! Professor Peter McKeown has accepted the position of Professor and Head of the School of Rural Medicine at UNE. Professor McKeown has extensive experience and clinical expertise and is a respected senior surgeon with an international reputation. Welcome Professor McKeown!

The University of Melbourne by Eric Lo What’s Been Happening: UMMSS Careers Night, UMMSS Trivia Night, UMMSS @ Run4theKids 2011, UMMSS Movie Night for the Japanese Natural Disaster Victims, Western PFA (Code Black), Something amusing: While on Psych rotation, the Medical Student Syndrome reared its ugly (sometimes apt) head – Psychiatrist: So do you have any other questions about that? Student: No, I don’t think so. Thanks so much for the morning Psychiatrist: Okay, so you sure you don’t have any other questions for me? Student: No Psychiatrist: because I have time and if you have anything you’d like to talk about, I have time now. Big News for Melbourne: For a couple of years now, we have been bereft of new blood; fresh meat as it were. Thanks to the much talked about Melbourne Model and its medical offering the MD Programme, Melbourne people have been invigorated with their enthusiasm and readiness to join the medical fold. While the MDs are here to stay, one mustn’t forget the importance of the MBBS cohort. At Melbourne, we haven’t. Both cohorts are well represented within UMMSS and with the faculty. The Faculty understands that while the new needs assistance getting up and running, the old needs support to help continue the high standard of education. All in all a great transition period for Melbourne.

University of New South Wales by Henry Ainge Allen What’s Been Happening: Since the year kicked off with the 1st years’ MedCamp we’ve been entertained by the comedic genius of MedRevue, shocked by the debauchery of the annual Pubcrawl, serenaded by the musos of ClassicQuest, and shown our charitable side at the Amazing Raise. (when we aren’t busy preparing for Convention). Something amusing: Paeds OSCE station. Do a basic paediatric examination (Height/weight/HC) on this child. Student walks in: “Hi im....where’s the child” Paediatrician: “%&#$, he must have gotten out again” Big News for UNSW: Our brand new lecture theatres and student area are being torn down to make way for...something.

University of Queensland by Bav Manoharan What’s Been Happening: Welcome back keg, First year welcome BBQ, International student BBQ ( some did the rain dance to well), UQMS Sports Day, UQMS Ashintosh Coffeehouse, Tomfoolery, Family BBQ, UQMS May Ball, UQMS QLd Medical Orchestra Performance- Sinus Rhythmia Something amusing: Our social convenors and academic/community representative elections in February were quite heated this year with some younger candidates taking to posting their GAMSAT & GPA scores on our forums…. Suffice to say, last I checked these individuals had quit UQ med, had name changes and fled to Melbourne, where they felt more accepted. Big News for UQ: The UQMS has launched its brand new website this year! After leading the pack in the AMSA best medsoc website competition every year, failure last year stirred the competitive spirit of our newly formed multimedia team. Following a lot of preparation, testing, abuse, jokes about Canadians and someone trying to hack our old website, we have a brand spanking new, shiny, glimmering, fandanglely smooth new website. Check it http://uqms.org. That trophy is ours. Oh - there’s other stuff that is important as well, like new quotas for grad entry MBBS/undergrad entry BSc/MBBS students (in affect for 2013), the UQMS having new offices, our first group of American students starting their clinical years in our New Orleans Clinical school. I’m sure there’s more, but with days till my O&G exams and just having worked out that ‘synto’ is not some type of alternative music loved by midwives, all I can think about is post exam inebriation.

The University of Sydney by Jessica McEwan What’s Been Happening: MedSoc Re-Structure and Elections, New SUMS Website, New Clinical School Opening, Closure of the SUMS Bookshop, O Week Activities, MedCamp, Delegate Improvement Committee (DIC) Meetings in preparation for Convention, Red Party – Where’s Wally Theme, MedBall – Masquerade, MedSoc Retreat, RAW Surf Weekend, Rural Discovery Bus Weekend, NSW MSC Annual Cocktail Party, World’s Greatest Shave Fundraiser Something amusing: My most amusing time so far this year was the shenanigans that occurred during our first year Med Camp. Being forced to stay sober as a mentor on one of the two nights meant that I was witness to many amusing anecdotes. This is included but was not limited to naked cartwheels, the goon lagoon and sexy loving times in the bush! However my favourite story of the weekend was that of our most outrageous new first year who obliterated himself so much on the first night that we were forced to call an ambulance to take him to hospital. We were shocked when he returned to camp the next day having walked over 20km to get back because he was so determined to keep joining in on the fun! Big News for USyd: It’s our 125th Birthday this year! Happy Birthday SUMS!!

The University of Western Australia by Kaitlin McGinnis What’s Been Happening: Graduation of 100% of last year’s 6th years, Grad Week and the Dedication Ceremony were fabulous, Fresher Camp for our LAST batch of straight-out-of-high-school freshers, Dragonboats, the Freshers lost, again, and the 6th years won, again, Fresher Welcome – no one remembers anything, TEFKAFR (The Event Formerly Known as Fresher Rivercruise) – held at a different, on-land location. Totally awesome, just sayin’, Student Grand Rounds tutorials for 3rd years, Relaxation and Stress Management Workshops, 4th year camp, Global health information and projects nights, Allied Health – the biggest student-run event in WA, AMSA ThinkTank meeting. Something amusing: TEFKAFR was held at SciTech – the WA equivalent of the Powerhouse Museum or Questicon. This is after all the boat companies in Perth decided to ban WAMSS from holding events on the water. Not only were SciTech letting us on site, they also let us loose IN THE EXHIBITS. We got to play with gravity, light, things that move and a bunch of nostalgia inducing displays. WAMSSy good times ensued, lots of dancing, some responsible inebriation and a fair bit of macking, all in a colourful educational backdrop just waiting to be broken. As a testament to the medical professionals of tomorrow, WAMSSunists were very well behaved, only one plush shark toy found its way into an aquarium, and everyone got out alive. And to top it all off, SciTech are open to the idea of potentially maybe having us back. But not Science Union, they are banned forever.

The University of Tasmania by Golsa Adabi What’s Been Happening: First Year Orientation, Med Camp, Societies Day, Med Welcome, International Student Function, TUMSS Cocktail Party - ToyChest, Pre-Clinical Lunches, Clinical MDO Lunches, MedSoccer, MedNetball Something amusing: It’s a full house, Imagine a nightclub filled with characters from your ToyChest, drinks are flowing, dance floor is going off (with excited Lego men), a game of twister is happening near the bar, there is a swimming pool of balls, what could possibly go wrong? Well, only a Fire alarm and the evacuation of the entire nightclub! Big News for UTas: With student numbers at an all time high for our University, and confusion amongst students regarding Clinical School Placements choices, TUMSS has been working on developing a ‘Clinical Schools Information Handbook’. This publication, due to be released in late May has detailed information about each of the three Clinical Schools including details about individual rotations at each hospital. Other new initiatives for the year include the TUMSS Leadership Development workshop and the TUMSS Graduation Seminar. TUMSS Cocktail Party has so far been the highlight of the TUMSS social calendar for 2011 with one of the largest attendance on record. The theme of ‘ToyChest’ was well received by all and resulted in attendance by characters such as Superman, Troll dolls, Little red riding hood, Lego men, Aladdin, Pocahontas, ,Cat Woman, Elmo, The Cookie Monster and even Ken and Barbie! Get set for the next biggest event of the year…TUMSS MedBall.

The University of Western Sydney by Samuel Rajadurai What’s Been Happening: The UWS Medical Society (UWSMS) kick started the year with an edition of eMUWS (mUWS blast), one of our major publications, which is being delivered to all students on a three-weekly basis to keep them “up-to-date with the need-to-knowNOW”. Another publication, “Neoplasm” was released to the new first years before they commenced med school – it is in effect a useful guide containing relevant information about our executive, AMSA, Medcamp etc. After taking over the reins from last year’s UWSMS exec, the new exec have big plans for 2011. Successful events that have already been held including O week 2011, Welcome back BBQ’s for each year, Med Camp 2011 – Pirates of Campbelltown + “Sailing the 7 Seas” Party, PBL Games + Movie Nights, Blue Moon Party, Twilight Festival, UWSMS Electives Night In 2011 the UWSMS is interested in further increasing its services to members via the development of our Membership Benefits Scheme (MBS) and the companion Membership Benefits Card. Experiencing great success in its inaugural year 2010, the MBS established partnerships with many local businesses – allowing students to present their cards and receive a discount on certain goods or services; this attracted students to stores and increased their businesses. Future big events planned for the rest of the year include the Leadership Development Workshop, Halfway dinner for our 2013 graduation, UWS Inter-year Sports Night, AMSA debating series, AMSA vampire cup, Surgical + Medical clinical workshops, First ever UWSMS 2011 Graduation Event. Something amusing: It was during the winter of 2009 that a friend went missing for one of the nights of Brisbane’s AMSA Convention, and couldn’t recall anything from the night. On the flight back to Sydney the next day, he noticed an aching pain in his gluteal region. A little concerned and now curious to find out what was causing the pain, he went to check out this painful region of his body. What he discovered cleared up some of the haziness left from the ‘unrecallable night’. To his surprise, and shock, was a large tattoo of the name of an unfamiliar person (of the female variety)...

Big News for UWS: 2011 has definitely been a well anticipated and exciting year as this is the first time our med school has a full house, with students from years 1 to 5. Especially important is that we will be producing our first ever UWS medical graduates – Huge News!

University of Wollongong by Nishan Yogendran What’s Been Happening: Med Camp 2011, Pub Crawl, Electives Night, Women in Medicine, Clinical Mixer Something amusing: Upon commencing their first day on full-time hospital rotations, a new Phase 2 student was randomly selected by the Professor of Medicine during the orientation pep-talk, and asked what his plan was today. Amongst the nervous cohort and various doctors in the auditorium, the student confidently replied, “I aim to expose myself to as many patients as possible”. Laughter ensued at his unfortunate choice of words. Big News for UoW: It is with great amusement that we welcome (steal) Prof Alison Jones as the next Dean of the Graduate School of Medicine (GSM aka the GiSM). Prof Jones is currently Dean of the School of Medicine at the University of Western Sydney (UWS). She was awarded her MB ChB and MD degrees from the University of Edinburgh Medical School, and later spent 8 years at Guy’s and St Thomas’ Hospital in London where she was a consultant physician and clinical toxicologist as well as Head of Medicine. Before taking her current position at UWS she was at the University of Newcastle where she held the position of Professor of Medicine and Clinical Toxicology. She is an active researcher having published >150 peer-refereed articles and book chapters. Prof Jones will assume the position on June 1, 2011. We thank Prof Don Iverson (Interim Dean) for his amazing support and dedication.

A Rangers survival guide by Jessica McEwan (USyd) Outwit. Outlast. Outplay. I thought about changing the well-known catch phrase of the Survivor TV series but then I realised that these three little words really encapsulate all that is need to survive Convention week. Let me explain....

Outwit This really covers the academic portion of the week although could be applied to other areas. Can you outwit other med students with your witty debating comebacks or the best question in the plenary session? To outwit another med student you need to utilise more than the natural smarts you have always relied on to get you through your barrier assessment. Outwitting at Convention takes the challenge to a whole new level. You know a Ranger is smart, as everyone here has already overcome the barrier that is registration – an often-elusive quest. Outwitting another Ranger requires training, detailed planning and often careful timing – oh and an audience to witness your feat! Outwitting other Rangers often comes in handy in the lead up to Convention especially when it comes to costuming. Many a facebook group has been created by a Uni to give Rangers a forum to throw around costuming ideas only to be infiltrated by another Ranger who takes advantage of them. Rangers must be diligent in the lead up to convention to ensure that their original ideas are kept secret until the big night so that they might win the best costume of the night. Being able to outwit is an extremely important trait to have but other elements are needed. Universities that do this well: UWA – as evidenced by their debating win in Hobart ‘10 UQ and USyd – as evidenced by the zebra and lion costuming that lead to the infamous lion hunt of ’10. Universities that do this poorly: Melbourne – need I say more!

Outlast Convention is all about outlasting whether it is the last man/ woman standing at social or just making it to every event of the week. Many will perish along the way. It takes stamina and determination to be able to survive a Convention week. For those experienced Rangers, think back, how many people do you know that made it to every single event during a Convention week? This in itself is not an easy feat. Newbie Rangers – take note! Getting in training now by going out every night and then attending every lecture at uni (and no you are not allowed to sleep!). Only a well-trained Ranger could pull something like this off – this challenge is for the all-rounder Ranger.

Universities that do this well: The Convention Committee – Always well-seasoned Rangers that manage to do all this and more! Universities that do this poorly: Bond – pretty sure only 3 of them even made it to Convention last year

Outplay Outplay comes into full force during sports day. Sports day requires a combination of physical strength, skill and strategy to outplay other Rangers. All of which can be applied to any activity during the day from EMC to tug-of-war to Cascade and Pipps Cup. Again to outplay on sports day and EMC rigorous training must be undertaken. Universities that do this well: Tassie and Adelaide – As evidenced by their performances in both the Pipps and Cascade Cups over countless years. UQ – As evidenced by their knockout performance in the Tug-of-war at Hobart ‘10 Universities that do this poorly: Unknown Unis – Unknown because they never seem to get on the scoreboard for anything at sport day. Outwit, Outlast, Outplay is a deadly combination and something that every Ranger should posses in order to survive Convention. This can only be achieved by rigorous training in the lead up to Convention and is your only means of survival. A Ranger or a group of Rangers who can harness these traits and display them to the fullest extent would undoubtedly be a contender for the Convention Cup.

For those of you that like to perfect one thing at a time then you should attempt to outlast at the social nights. Many a temptation will try to lure you away from being the last person standing including weariness, the possibility of getting lucky and the 2am kebab run. To outlast you need to anticipate these temptations and work on resisting them in the lead up to Convention. Being able to outlast is a valuable quality in a Ranger.

The Anatomy st of the 21 Century Doctor Nick Watts (AMSA Global Health Officer) outlines the qualities demanded of the next generation of doctors.

and the needs of the patient and population, including: a narrow technical focus without contextual understanding; poor teamwork; predominant hospital orientation at the expense of Primary Health Care; quantitative and qualitative imbalances in the professional labour Acting as ‘Emerging Drivers of Change’, market.2 these challenges take the form of a changing demographic – one which is both ageing, and The education of health professionals (the experiencing an unprecedented prevalence ‘knowledge brokers’) occupies a privileged of chronic disease – increases in societal and unique interface between the generators empowerment, gross health inequities between (Universities) and recipients (patients) of and within countries, and the dire health impacts knowledge in our healthcare system.2 Such a of globalisation, and climate, to name a few. The privilege creates an obligation to train students recent Global Independent Lancet Commission in a way that produces a 21st century medical on health professional education presents the professional capable of strengthening health case that without reform, our medical education systems in a globally interdependent world, system risks falling out of touch with the looking to meet the needs of patients and populations in an equitable and efficient manner. populations it was set up to serve.2,3 Rounding the corner in to the 21st century, we find ourselves both celebrating the centennial anniversary of the seminal Flexner Report on medical education, and facing the rising challenges of modern healthcare.1

Such an imbalance will result in a fundamental mismatch between graduate competencies

AMSA fundamentally believes that health is about people, and with a health system and

health education reform agenda sweeping across the globe, we wonder “what kind of health professional do we need to be to meet the needs of tomorrow’s populations?”

The next question becomes “how?” – how do we ensure we’re trained to best serve our patients and populations? The answer is threefold: clarity about the dynamic challenges in modern healthcare and the kind of professional that Determined to find an answer to this question, can tackle them; an attitude of responsiveness AMSA searched far and wide, and with the help with the curriculum that educates us; and an of the Lancet, universities across the world, and involvement in the extracurricular activities the World Federation of Medical Education, we available to us. may just have an answer for you! A rich engagement in extracurricular activities, This 21st century medical professional is:2-5 as well as a curriculum which espouses the principles of a 21st century medical professional will help to develop a health workforce ready to tackle the future challenges in healthcare. In line They’re responsive to the needs and health with this, AMSA joins a call for a renaissance priorities of the community and capable of towards a “new” 21st century professionalism directing services and resources to areas of — centred around the interests of patients and health inequity. populations, team-based, socially accountable and upholding a strong service ethic. 4,6

Socially Accountable:

A Systems Thinker:

1. Flexner A. Medical education in the United States and Canada: a report to the Carnegie Foundation for the Advancement of Teaching. New York; 1910.

They have a comprehensive understanding of their role within the healthcare system and the community, and are able to apply this understanding to a patient-centred model of care that values a social determinants approach.

2. Frenk J, Chen L, Bhutta ZA, Cohen J, Crisp N, Evans T, et al. Health professionals for a new century: transforming education to strengthen health systems in an interdependent world. The Lancet. 2010;376(9756):1923-1958.

Globally Interconnected:

6. Australian Medical Students’ Association. AMSA policy on Global Health in the Medical Curriculum. Canberra; 2010.

They work towards increasing global interdependence by harmonising health and education systems, embracing international networks and alliances, and harness global flows of educational content, teaching resources and innovations for the local context.

An Advocate and a Leader: They recognise the social responsibility of the medical profession to advocate for the equitable distribution of health. They actively engage with the various political, economic, environmental and social determinants of health, working with key stakeholders from every profession to safeguard the right to health for the populations they serve.

3. The Association of Faculties of Medicine of Canada. The future of medical education in Canada (FMEC): a collective vision for MD education. Ottawa; 2010. 4. Boelen C, Woollard B. Social accountability and accreditation: a new frontier for educational institutions. Medical Education. 2009;43(9):887-894. 5. The World Federation of Medical Education. The Global Role of the Doctor in Health Care. Copenhagen; 2011.

Melodies and

Maladies

Suyi Ooi and Yota Yoshimitsu (Deakin Medical School)

edical school is a challenging time and studying can become an all-consuming passion for many of us. As we gradually morph into a bleary-eyed, two-legged creature living and breathing medicine, it is so easy to forget that all of us have other interests, whether it be baking, sports and the easily forgotten (but not uncommon in the medical fraternity) playing music. “What are your plans for the weekend?”“Nothing much, just heading off to band camp”. After the immediate fears of a 6.00 am wakeup fanfare from the brass section dissipate, one realises that rehearsing in a cold dusty hall in the middle of woop woop with your fellow music nerds is a passion that lies close to many of our hearts. Alternatively, the basis of your so-called passion may be more mundane, when you find yourself digging out the old guitar that you were too lazy to practice in high school, but now suddenly feel like strumming in desperate need for an Activity of Daily Procrastination (ADP).

It is quite clear that music has an intertwining harmony with medicine. And not surprisingly so. Both require focus, some determination (although mostly ambition), dexterity (unless you play the viola*), listening skills and an eye (and ear) for detail. Both can be therapeutic. There is something truly satisfying about a sublime blend of harmonies, which is similar to the euphoria felt when you finally discover you can hear Grade 1 heart murmurs, or the reassuring metronomic beep of the heart monitor – a beautiful illustration of the fact that there is beat, rhythm, volume and character within all of us. History is replete with famous doctors who have managed to combine a love of music and medicine. Fritz Kreisler, born in Vienna in 1875, become a world renown concert violinist before he was 20 years old, but gave this away to study medicine. He went on to become a medical officer in the Austrian

Army, but there must have been some dissonance in this plan because he eventually realised that music was his first love, and went onto become one of the greatest violin virtuosos of all time.[1]

tendonitis, carpal numbness or left forearm pain along the ulnar border[2], you should think “could this person be a muso?”. And vocal cord fibrosis? The treatment ain’t over until the fat lady sings.

“The all-encompassing relationship between music and medicine is relevant not just for Doctors cum Musicians, but also for non-musician doctors”

Aside from all the serious medical stuff, the question begs - why are so many medical students and doctors musical? Henry Wadsworth Longfellow once said “music is the universal language of mankind”. There is nothing quite like the camaraderie, the shared passion and the friendships arising from music which can unite diverse groups of people, medicos included. After prolonged sessions banging your head against Kumar and Clark or sleepless nights on-call, musos have the pleasure of being able to swap their stresses for the soothing caresses of Schubert, Beethoven and Mozart (or, if so inclined, the decidedly less soothing Sonic Youth, Barry Manilow or Megadeth). Some of us actually wanted to study music but needed a key change, not to mention a vocation that doesn’t make us look like chai latte-sipping hippies carrying around machine guns in large cases.

However, interests do not necessarily have to compete and many doctors have managed to make music and medicine co-exist within their lives. Aleksandr Borodin happily led a career as a composer, cellist and a chemist. The pioneering surgeon, Theodor Billroth (remember the c[h] ords of Billroth?), was an accomplished pianist, violinist and music critic. And we cannot forget the towering achievements of Albert Schweitzer, 1952 Noble Laureate, physician, theologian, philosopher, musical scholar and organist. The all-encompassing relationship between music and medicine is relevant not just for Doctors cum Musicians, but also for non-musician doctors. Tickling the ivories is not so fun when 75% of all music-related maladies (like muscle and ligament injuries) arise from pianists (followed, in decreasing order, by string players, guitarists, woodwind players and drummers)[1]. So if you see rotator cuff

We could continue to speculate, but we’d rather leave the issue undiagnosed. Our only recommendation is that before you dust off that old trombone, triangle or harmonica (as therapeutic as it may be), may we suggest that you get the informed consent of your housemates before you unleash your cacophony? * One of the authors (YY) vehemently disagrees with this absurd, violinist-centric notion.

References 1.

Cerda, JJ., Art in Medicine: musicians, physicians and physician-musicians. Trans Am Clin Climatol Assoc, 1993. 104: p. 228 – 34.

Potter, PJ., Jones IC., Medical Problems affected musicians. Canadian Family Physician, 1995. 41: p. 2121 – 28.

THE MUSIC DIGEST Lee Fairhead (UWA) reviews some auditory awesomeness...

Bon Iver – Bon Iver Released June 17, 2011 The wait is over. After producing the truly memorable debut ‘Emma, Forever Ago’, Bon Iver are back with their follow-up self-titled album. Led by Justin Vernon, the loose-knit group has produced a beautiful album described by the lead singer himself as “a little less achy”. Three years in the making, the album has track titles riddled with place names such as Michicant’, ‘Calgary’ and our very own ‘Perth’. Eloquently crafted lyrics and simply beautiful music make this album a winner from the opening track ‘Perth’ to the closing, 1980s inspired, Beth/Rest. While you might find it hard to make sense of some of the lyrics, there is no doubt that Vernon is a poet; and Bon Iver make sublime music. Similar to the surrounds in which it was recorded, ‘Bon Iver’ is best listened to curled up in front of log fire, red wine in hand. But even if you aren’t whisked away to a romantic log cabin, it’s still a great listen.

Hugh Laurie – Let Them Talk Released May 9, 2011 House. Making music? I know, and blues music at that. Apparently earning $400,000 an episode wasn’t enough so Laurie has fulfilled a lifetime dream to make a blues album which was launched by his first live performance in the home of blues, New Orleans, back in March. Clearly this is just a side venture for a middle-aged guy with the means and opportunity to experiment with his talents (Laurie is a classically trained musician with a long history of musical pursuits). With ‘Let Them Talk’, he pays tribute to the music he loves, covering 15 songs along with guest artists Sir Tom Jones, Irma Thomas and Dr John. To be honest though, I only made it through three songs. Maybe it is because it is House, maybe it is the pretty dull song-writing; I don’t know. Either way, it just doesn’t sound right. As Laurie himself explains ‘I am a white, middle-class Englishman, openly trespassing on the music and myth of the American south.’ Well, at least he is honest.

The Wombats - The Wombats Proudly Present... This Modern Glitch Released April 22, 2011 Propelled by their popularity among teenage girls, festival-goers and commercial radio stations, The Wombats have become the indie ‘it’ band of the year. ‘Modern Glitch’ is their sophomore album and offers up more of the same catchy records that made them famous on the indie circuit back in 2008. However, beneath their glossy, up-tempo presentation, the Liverpool natives are actually quite a serious band, with a serious leader. For lead singer Matthew Murphy, the album is particularly personal with some pretty dark and brutally honest lyrics, influenced mainly by his battle with anxiety and depression. In particular, Anti-D chronicles his relationship with the drug citalopram and Jump Into The Fog tells the tale of a sad, lost young man taking a prostitute back to “the kind of place you should bring your own UV ray”. Of course, not every song is as deep and other tracks such as Techno Fan and 1996 just speak directly to twenty-somethings out to have some fun. In the end though, the dark lyrics combined with the festival anthem music doesn’t quite fit, but, as most teenage girls will tell you, it is still worth a listen.

Seeker Lover Keeper – Seeker Lover Keeper Released June 3 2011 Combining the talents of three of Australia’s foremost female songwriters – Sarah Blasko, Holly Throsby and Sally Seltmann – Seeker Lover Keeper was garnering interest well before its official release. Prior to the release of the album, the trio released three songs onto their website along with three theatric and artistic videos featuring acclaimed Australian actors – Barry Otto, John Waters and Aden Young. The artistry defines the project. Throughout the album, each artist alternates as lead vocalist, and, most often, it is singing a song one or both of the others has written. It is a true collaboration that effortlessly incorporates beautiful and dazzling sing-along pop tunes centred around the theme of love and relationships and how difficult it can often be once they’re ours to lose or keep. Bridges Burned and Even Though I’m a Woman are definitely highlights, but the whole album is beautiful, not groundbreaking, but beautiful nonetheless.

The Lizard-Spock Expansion Stefan McAlindon (AKA Baron Von Stefanburg) of Flinders origin, knows that you have to be brainy to be a med student, but some people go that little bit further....

E = MC

“W

hat would you be if you were attached to another object by an inclined plane, wrapped helically around an axis?” The answer is screwed, and a nerd. But that’s ok, geek sheek is in (or so I keep telling myself), with med students all around the country “making it so.” But how does one spot one of these reclusive creatures. Nerds have learnt to leave the pointy ears at home when venturing into the final frontier (human interaction), making them difficult to identify. If you’ve gotten the nerd references I’ve already made, then give yourself the Rimmer salute and get back to your comic books, you’re a nerd. Ok, so I figure about half you reading this have picked up a comic book by now. Unfortunately the rest of you aren’t off the hook just yet. Before you start claiming you’re not a nerd, just a jock that was too cool to play sports, let’s examine what makes a nerd: 1) If you have ever said the phrase: “it’s not cartoons, its anime” 2) You study at Melbourne University 3) You don’t play rock-paper-scissors, you play with the following rules: “Scissors cuts paper, paper covers rock, rock crushes lizard, lizard poisons Spock, Spock smashes scissors, scissors decapitates lizard, lizard eats paper, paper disproves Spock, Spock vaporizes rock, and as it always has, rock crushes scissors” 4) You get the following joke: A neutron walks into a bar and asks how much for a drink. The bartender replies “for you no charge.” 5) You have more than 2 seasons of any TV show on DVD 6) You have been called, or have called another a noob 7) You bear the scars of being pwnt 8) You hang things off your belt (phone etc) 9) You own a Mac because you think it’s cooler than a PC 10) You own a PC 11) You have ever threatened someone with: “Someday you will be cleaning my swimming pool”

“Nerds everywhere can wear their Star Fleet uniform with pride (from the safety of their mothers’ basement of course)” While none of the above are diagnostic (except the Melbourne Uni one), they are positive predictors for being a nerd. Where did the word nerd even come from anyway? It was the brain child of (the-not-a-real) Dr. Seuss, first appearing in his book, “If I Ran the Zoo,” where a nerd features as an imaginary animal. Popular culture has the word nerd originating from the inverse of drunk, knurd, as nerds are considered shy, socially awkward people, unlike an intoxicated person. This seems an almost contradictory statement. I’ve been to convention, and I’ve seen how much med students can (and do) drink, and yet I’ve also met a lot of you med nerds. How can you be both a knurd and a drunk? The answer is that nerds are cool, well not all nerdy characteristics, but popular culture has borrowed several nerdy traits to make people stand out as individuals. 20th century nerds were pioneers for 21st century individualism. Who would have guessed that those 4-eyed, spotty little urchins would actually change modern society? In fact nerds have accomplished some great things in the last 100 years. They took us to the moon, and then tried to convince us that it was all a conspiracy. They invented the computer, and then they invented Windows to get back at Jocks. Yep, the world would be a pretty different place without nerds. Nerds everywhere can wear their Star Fleet uniform with pride (from the safety of their mothers’ basement of course). Finally I’d like to give a shout out to the people that dressed as Dr. Who and the TARDIS (Time And Relative Dimensions In Space – but you already knew that) at convention last year. You sir are a revolutionary, one who sees beyond the restraints of social norms and reaches ever forward towards greatness – and you are also the biggest nerd I have ever seen.

thats all, folks Dr Jay Meekay was asked by Panacea to dictate an article whilstspending time in witness protection. He was told it could be on the topic of his choosing, but instead, appears to have dictated his latest auditory hallucination....

Editor’s Note: If you can’t make sense of this article, you’re not alone...

h, the rushed, last minute, “we can’t print until you submit your article” article. My old friend. Time and age may bring wisdom, but with wisdom comes an increasing apathy towards rectifying ones tardiness and outward disregard for the institution of deadlines. Why is that? Perhaps it’s just me. Perhaps the aging process to which I’ve been subjected, has, rather than endow me with a heightened ability of self-reflection and empathy, instead simply served to enhance my narcissistic qualities, augmenting my indifference to the deadline-stretching angst of one particular publications officer. It is widely supposed that narcissism is inversely proportional to chronological age. Why then, do I find myself scraping against the splinters of my compassion barrel in order to empathise with the torment my constant putting off of writing this article is causing an other? Probably because the shoes I’m supposed to be imagining myself walking in are not particularly nice. His actual shoes. No metaphor there. I don’t like his shoes. They won’t do. I realise that I’m beginning to sound a lot like the protagonist from American Psycho, which is surprising, because I’ve never read the book. But the comparison still occurred to me. Is it wrong or unethical to make a pop culture (is that even pop culture?) reference if one is not intimately acquainted with the actual material, and only the gestalt created by previously absorbed references (hopefully made by people who actually have read/seen/heard the source of said reference). I think it’s OK. A deep dark secret of mine is that I have never seen Star Wars – well, none of the “proper” episodes anyway – however, I don’t feel the slightest bit dirty at making a Star Wars reference or understanding one when it crosses my path.

Are we becoming a society of gestalt? I have to admit, that I don’t know whether that was the best word choice, but it’s a bit of a current favourite word of mine (I have a rotating roster), and I wanted to slip it in more than once in this article. I actually had a semblance of an actual piece of social commentary forming in my head about a paragraph and a half ago, but it has since left, and this article has deteriorated into yet another stream of consciousness ramblings that has most likely done nothing more than to instil a sense of doubt as to the lucidity of my grasp on the world outside my own reflection. Ah, narcissism, that’s where we started this whole thing. Yes - shirking on one’s commitments and openly not caring about it. I actually do care a little though, Mostly because I know that men with eyebrow rings (or bolts? What do you call that?) hide a raging aggression behind an impressive façade of calm and understanding. I won’t be burnt twice. They also tend to do you a whole bunch of favours recently. So, this article comes delivered to you after an epic struggle against my own apathy and inflated sense of self worth. I’ve even resorted to giving my own reputation a flogging in the quest to produce something. As my father always told me – when you think you’ve got nothing on which you can lean, remember that you’ve always got double-negative self-depreciation. Editor’s note: While I do indeed have an eyebrow piercing, any “raging aggression” within will be avoided upon submission of an article that actually makes sense for Panacea 2.

Going up? It’s that classic one liner that we’ve all used at one time or another, but is it really the ideal elevator chatter? Falk Reinholz (UWA) presents a guide to navigating this oft-fraught social dynamic.

n this modern era of multi-storeyed residential and commercial infrastructure., using an elevator is a part of daily life for most of us. In light of their popularity, one might reasonably assume that using the elevator should be a simple matter of getting on at one level and stepping off at the desired stop. Unfortunately though, this short interlude in the day can present many challenges.

awkwardly amongst the poorly selected musical overtures, thoughts come to mind: ‘do I ask a follow up question?’, ‘they didn’t really give me much to work with, should I force the situation further?’ and ‘if a dialogue is actually established, do I really want to tell a complete stranger anything about my life?’ As you both ruminate and wrestle with your inner demons you will probably find you have gotten to where you are going before you even know it.

Now that is one way to negotiate this situation. It is clearly suboptimal. A far better approach is this: akin to asking that pretty girl that catches your train everyday what the time is to get the conversational You are one of two people using the elevator. You are ball rolling, simply ask in a friendly manner ‘hey mate/ on the ground floor of a large building (say, for example, ma’am/sir/dude/friend, would you mind pressing a hospital) and have patiently awaited the elevator. As level four for me?’ This is an ideal opener as it is a nonit opens you notice there is already someone on board intrusive request that immediately breaks the ice and that has made the rookie mistake of getting on an lightens the mood (hence why manner is so crucial). elevator going down with the intention of actually going This should allow for a gentle start of conversation up (something else that really pushes our buttons!). As but remember to keep to superficial topics (who does such they are a little flustered, promptly alight their want to share personal details about themselves with level and take a stance near-ish to the button panel. complete strangers they will never see again, after all?). Some favourite topics include local sporting teams, the weather of late, topical news stories (elections, natural disasters, etc) and the Bristol scale. If things go the other way and you get a cold-blooded button-pressing nontalker then you have not lost out either. The first moment is crucial. One must be figuratively and literally on the front foot to contrive this social And, as tough as this is to admit, at the end of the day construct to achieve a desirable outcome. Firstly, one you could probably just calmly press the appropriate could probe with the tried and true “going up?” and button, do nothing and stand there in silence. I am not variants thereof, like “so, level seven, eh?” This will entirely convinced, but there has been some speculation almost certainly result in an uncomfortable exchange, recently that it will not change your day what so ever. regardless of who has started it. The natural answer and the polite response in essence is ‘yes.’ But where to from there? As that monosyllabic answer is lingering

Setting the scene

Two differing scenarios:

â&#x20AC;&#x153;...allow for a gentle start of conversation but remember to keep to superficial topics...â&#x20AC;?

nce upon a time (quite recently), climate change was cited as the greatest health threat of the 21st century.1 Despite this, the medical profession has not reacted in any significant way. The question now raised is should we, and do we actually need to do anything about it?

The proposed disastrous effects of climate change are difficult to contemplate. Extrapolations in climate data commonly seem like huge exaggerations that are far from legitimate. Indeed, climate change is the bad guy and latest health fad in a recent media explosion, with hypochondriac concerns over the threat of climate change being likened to those of SARS and Swine Flu. In effect, this scare campaign has warped the perception of real threat in the minds of our health professionals, who deal with media hype on a daily basis. Furthermore, the health profession is new to this sort of advocacy, and weâ&#x20AC;&#x2122;re only just beginning to understand it. The idea that humans will respond organically to climate change, adapting to any challenges thrown our way, is not an unjustified one. All organisms need to adapt to their environment to survive. Peak oil production was reached a few years ago and supplies are rapidly declining.2 Eventually, when we run out of oil, there will be a natural shift toward alternative energy sources and an associated incidental reduction in emissions. So should we put efforts into fighting for these changes ahead of time? Debate over the existence of anthropogenic climate change has largely settled. It is now widely agreed that climate change is enhanced by human activities, and is worsening as our greenhouse emissions soar to greater heights. Whether or not the human element of climate change is certain, it cannot be denied that rising global temperatures are already causing havoc, with very real threats to global health.

The World Medical Association has adopted a model that understands the health effects of climate change as primary, secondary and tertiary impacts.3 Primary health impacts include heat waves, injuries after floods or fires, and infrastructure collapse; secondary consequences are spread in vector-borne diseases, food- and water-borne infections, and allergies; and the tertiary consequences include famine, local and regional conflicts, displacement, refugees and developmental failure.3

“this scare campaign has warped the perception of real threat in the minds of our health professionals, who deal with media hype on a daily basis”

storm surges and king tides.7 Many more small island nations are expected to be underwater by 2050.8 A rise in sea levels of 45cm (a conservative estimate) would submerge over 10% of Bangladesh and displace 5.5 million people.8 Indeed, given current rates of rising sea levels, the number of climate refugees is expected to swell to 250 million by mid-century.8 If these things are already happening, and all evidence suggests that they will continue to worsen, should Australian health professionals be outraged at the lack of adequate action on climate change?

I say yes. When considering our climate future, we should hope for the best but prepare for the worst. The proposed effects of climate change, even the conservative ones, are too humbling to simply ignore. Climate change seems like a distant problem here in Australia and it’s easy to just assume that the necessary strategies will be implemented eventually. However we We’re already seeing these effects. In 2010, 42 mustn’t forget that many countries, many of which million people were forced to flee their homes due to are responsible for a comparatively smaller proportion natural disasters.4 We’ve seen glacial lakes flooding of emissions, are already fighting our fight. As health st in the Himalayan region, huge landslides in Uganda, professionals in the 21 century, we should be advocates catastrophic cyclones occurring with increased for the health of all, and we have a responsibility to frequency and severity in the USA and floods in ensure that we advocate for the prevention of further Pakistan. Here at home, continuous drought and suffering in these vulnerable populations. furious bushfires are becoming the norm. The habitat As someone wise once said: “If climate change is as of the Aedes aegypti mosquito has spread further devastating as predicted, the Earth is at stake and we South in Australia than ever before, bringing waves must act now. If it is not and we act now, then we risk of dengue fever in unfamiliar locations.5 Kenya, the accidentally helping the world. There are comparatively world’s fourth-largest tea exporter, faces significant very few consequences of inadvertently creating a threats to livelihoods and economic status as changes cleaner, greener future for our planet.”9 in temperature and rainfall cause crops to fail.6 In early 2009, we saw the first ever ‘climate refugees’ when 2700 people left their homes in the Carteret Islands after battling decades of worsening

References 1. Costello A, Abbas M, Allen A, Ball S, Bell S, et al. Managing the health effects of climate change. Lancet and University College London Commission. 2009. 2. Aleklett K, Höök M, et al. The Peak of the Oil Age – Analyzing the world oil production Reference Scenario in World Energy Outlook. 2010. Energy Policy 38(3):1398-1414 3. Lidegaard Ø, Ricketts M. Climate Change and Health Care. World Medical Association. 2009. 4. Internal Displacement Monitoring Centre. Displacement due to natural hazard-induced disasters. Norwegian Refugee Council, Norway. 2011. 5. Russell R, Currie B, Lindsay M. Dengue and climate change in Australia: predictions for the future should incorporate knowledge from the past. 2009. MJA 190(5):265-268 6. Van de Wal S. Sustainability in the Tea Sector: A Comparative Analysis of Six Leading Producing Countries. SOMO Centre for Research on Multinational Corporations. 2008. 7. Morton A. First climate refugees start move to new island home. The Age, Australia. 2009. 8. Belt D. Bangladesh: The Coming Storm. National Geographic. 2011. 9. Katherine O’Shea, WAMSS’ esteemed Environment Officer. Breakfast, June 2011.

You’re Hot then you’re Cold: How to be a left-over masterchef Laura McAulay (JCU) shows how to cook like a masterchef without that knob Curtis Stone getting anywhere near your kitchen....

“Woman, where’s my dinner”. Although extremely barbaric, this is a phrase my boyfriend (yes, surprisingly still current boyfriend) has used to me (yet more surprisingly) on more than one occasion (although it was said, I must admit, in jest). So it got me to thinking - getting dinner on the table is pretty hard sometimes after a long day at the hospital, university or for those poor soles that have to do so, work! Whilst, I must say, I am a bit of a domestic goddess, I too, struggle to think of things to cook that are not only easy and long lasting but also work well the next day for lunch; because I’m sure that you all know that waking up at 7am and finding something for lunch in a coffee deprived stupor is not only hard, but semi-impossible! To take the hassle out of that horrible early morning food cupboard scramble for tinned tuna, rice crackers or Mee-Goreng, take a look below and check out how to be the King or Queen of the student tea room next lunch hour! (All meals are gluten free – if you use the right ingredients :D)

Tomato Pasta with Chicken

(or without for the vego’s out there)

Ingredients 1 can tinned tomatoes (Coles brand – low low price of 75 cents!) 1 onion – diced/chopped/massacred – however you roll really 1 teaspoon of crushed garlic 1 dash of oil (olive/canola/vegetable – whatever floats your boat) 2 rashers of bacon (OPTIONAL – only for those carnivorously inclinded) 1 chicken breast/thigh (OPTIONAL again) Handful of fresh basil or dried herbs Pasta – depends on how much eat! Gluten free works well too Steps: Place a pot of water on the stove and wait for it to boil. Add a pinch of salt and pasta. Heat oil in a pan on medium heat – add onion, garlic and bacon – cook until onion is soft. Add tomatoes to pan and simmer until they reduce. Add chicken and cover pan (optional, if your pan doesn’t have a lid, don’t stress) until chicken is cooked. Toss through cooked pasta and serve!

Worlds easiest mushroom risotto Ingredients Aborio Rice 1 onion – diced/chopped 1 teaspoon of crushed garlic 1 cupish (depends how expensive mushrooms are!) of sliced mushrooms (button or field are good) Dash of oil (I use olive) 2 rashers of bacon (optional – I think you might have seen by now that I LOVE bacon!) 1 Litre(ish) of vegetable stock (vegeta is pretty awesome and only $3 a box – just add boiling water) Dash of white wine – if you’ve got it left over from the other night Knob of butter (if you want the fatty bombatty option that I eat) Parsley 1 cupish of Grated cheese – parmesan is really nice, but whatevers in your fridge will be just as good Steps: Heat a little oil in a pan over medium heat – add onion, garlic and bacon until onion is soft. Add mushrooms and wine (if wanted) and sauté until the mushrooms are soft. Add all of your rice (read the packet for how much you need for the amount of people you are serving) and stir until well mixed through. Add a little of your stock at a time, stirring until all stock has been absorbed, continue until you run out of stock and the rice is soft (it should nearly triple in volume). The rice should be a creamy consistency. At this point you want to add the butter and half of the grated cheese and mix through (mmmm butter) Mix through some chopped fresh parsley and serve with a sprig of parsley and some grated cheese (you can skip the parsley if you want!)

Left over magic: Store pasta with sauce in an air-tight container in the fridge for next day magic, or slide it into the freezer for a welcome microwave meal in the future.

Why being a med student is by Kathryn Kerr (newcastle) I’m a mature age student, so being asked to write an article about why being a med student is awesome whilst simultaneously referencing MTV Cribs is kind of tough. It would be way easier for me to write an article that references, say, Midsomer Murders. For those who aren’t aware, MTV Cribs is a show that gives you a tour of various celebrities’ homes. Along the way, there’s some celebrity gold: Akon congratulates his chef for keeping him “unhungry”, and Mariah Carey boasts she has completed “like, 500 hours of beauty school”. If you can think of a way to link this admittedly addictive show to the awesomeness of being a med student, you’ve got a better brain than mine (and yeah, I thought about doing a virtual tour of the places med students hang out, but as a mature age student, I am familiar only with the library). In the end I gave up on the MTV Cribs thing entirely, and decided I’d just focus on why being a med student is the best thing ever. Because it is, and I can prove it. So, adopting the typical med student logic that any concept, absolutely any concept at all, can be distilled into five dot-points that fit on an index card, here are my five reasons why being a med student is awesome:

People tell you stuff Private, personal stuff. They trust you, and that’s cool. You learn a lot about life, and about people, without ever having to be more than 500m from the hospital coffee machine. You get to know people you might otherwise never meet, and you find out a bit more about what kind of person you are. And if you don’t like the kind of person you are, there’s always going to be one touchy-feely-type PBL tutor who’ll be only too happy to help you on your journey towards being just a bit less of a knob.

You get to look at gross stuff OH MY GOD CAN YOU BELIEVE THE STUFF THAT CAN GO WRONG WITH YOUR BUM?!?!? Who knew? It’s disturbing, it’s fascinating, and it makes for some great (appropriately de-identified) anecdotes.

You’re not a lawyer/ podiatrist/stripper. These days, a lot of med students used to be Something Else. They’ve had a previous career, or at least studied towards one, and

awesome

so they know just how lucky they are to have made it into this profession. Every day that you’re not getting yelled at by a judge, cutting dead skin off some old lady’s foot or hanging upside down from a pole is a good day.

In fact, you’re going to be a doctor. Do you remember how many kids in your primary school said they wanted to be a doctor at some point? Sure some of them changed their minds, but a lot of them didn’t. A lot of them went on to sit the UMAT or the GAMSAT (or both more than once), and never got as far as first year med. You made it, and you’ll keep making it, and eventually you’ll be a doctor. You had a childhood dream (or a teenage dream, or a quarter-life crisis dream), and you’re going to get to realise it. Yay for you champ.

But best of all: you’re not a doctor yet. As a med student, you get to do a lot of the cool stuff associated with being a doctor – like strutting round with a stethoscope draped round your neck – but at the end of the day, your responsibility is limited, and so are people’s expectations. It’s OK for you to stuff up, faint, hold a CXR upside-down, or laugh at inappropriate times. Pretty cool, yes?

Australian Medical Association

Your voice in the health system of the future Student MeMberShip iS Free so join the AMA todAy And enjoy A lifetiMe of professionAl benefits. the AMA is the only independent, national voice of all doctors in Australia. your membership ensures physicians have a say in the development of the health system you will lead into the future.

Contact details www.ama.com.au/jointheama phone: 1300 133 655 email: memberservices@ama.com.au

Who wants to be a millionaire? by Jayne Schoppe (ND Freo) Even before I knew that I had actually had a chance at getting into med, it has always been a life goal of mine to have a Wikipedia page. And I’m not talking the kind of entry that one of your friends makes about the fact that you ate 12 burgers in one sitting that never gets uploaded because one of the moderators decides that your achievement isn’t ‘notable’ enough, I’m talking the real deal. And after conducting a RCT or two, I know I’m not alone. So, of course, this got me thinking. What does someone have to do to be regarded as notable, to have their name set in history? If we’re just talking Wikipedia (and I say ‘just’ because I can probably think of a few cooler and more exciting things I’d rather have associated with my name than a Wiki page – one of them being a spot in the hot seat opposite Eddie) then all you need is to have ‘received attention from the press or other reliable sources’. So what counts as reliable? – I think that’s another story altogether, you basically just have to have already done something that people might actually care about; Wikipedia is not the place to launch your popularity. There’s also the kind of pivotal issue of the money that one would need to acquire in order to actually become one of Australia’s roughly 200,000 millionaires since no one outside your family is going to remember you for your time in the hot seat and your Wiki page unfortunately isn’t going to bring home the bacon. If we’re talking medicine, I think the obvious thing to do is to make some kind of medical breakthrough; find a cure for a previously incurable illness, discover a new disease (Cushing’s syndrome) (or alternatively just be the first patient to be diagnosed with a new disease [Christmas disease]), discover a new piece of anatomy (pouch of Douglas), or create a better, faster, more accurate surgical technique to replace one that’s currently in practice (the Whipple procedure). A couple of those options are sure to make your bank balance look a little healthier and make you a little better known among your colleagues. Simple, right? Well with a bit (ok, a lot) of planning, time, training and hard work then this could one day be a reality, but if you’re like a lot of our colleagues and have either just started your medical training, can’t think that far into the future or are simply after a quick and easy rise to fame then what are your options? I’m telling you now, they’re limited.

Option 1 You’re probably at least 200 years too late to discover a new piece of anatomy so your next best bet is to find one that hasn’t been named after someone yet and to extensively explore it as Dr. Douglas did with the recto-uterine pouch (although this was way back in the 1700s). Since mentioning that I’ve struggled to find an unnamed possibility, apart from the greater omentum (and there’s probably not much exploring left to do there), but how about getting a bunch of friends together, having a few beverages and doing some exploring of each others’ anatomy? Even if it doesn’t get you anywhere, at least you’ve had some fun.

Option 2 Alternatively you might have to be the first person to be diagnosed with a new disease, but that’s neither something fun, something you can really control or something that will make you rich. So, I guess that’s out. So, unfortunately those two options are kind of it for quick and easy ways to medical eponymy. You might have to stick to some study, research or see if you can come up with a new vaccine. As a final word of advice, just remember that you don’t have to have done something good to be well known (think Jayant Patel), so make sure that on your quest to fame and wealth you don’t end up being famous for all the wrong reasons!

p e e h s

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Xander Whitfield (UNE) shares his tips for misleading a Consultant to think you’re much smarter than you actually are...

he art of deception is integral to the practice of medicine. We will all need to mislead families and patients about prognosis. This is easy, you simply explain that “We’re going to have to run some more tests before we can be confident about what’s going on”, then you step out into the hall and consider whether or not you have time for coffee before having to fill out a death certificate. The real skill, the skill we all must master, is deceiving our teachers. In the pre-clinical years this beguilement is fairly straight forward. A well timed question in a tutorial, knowing something about referred pain before learning the gastro exam is all you need to fool any doctor that you are a student destined to pass with distinction and maybe someday win a Nobel Prize in both Medicine and possibly Peace or Physics. It is the clinical years, those months at the pointy end of the degree, where your lives are governed by the ebb and flow of the ward round and the theatre list, that these small frauds, which had previously sat at the level of a party trick in our repertoire of skills, are elevated to high art. So we all must learn and practice some techniques to appear more knowledgeable than we actually are. In an effort to simplify the process I have here listed a number of methods by which one may achieve the above stated results. These skills are here detailed in no particular order and are based upon the experience of either myself or my colleagues; I hope you find them useful and informative.

g n i h

“A well timed question in a tutorial.... is all you need to fool any doctor that you are a student destined to pass with distinction and maybe someday win a Nobel Prize in both Medicine and possibly Peace or Physics”

1) Look interested and full of knowledge It is simply astounding what some simple body language and tone of voice can do to influence peoples perception of your intelligence. When walking never wander but always move with purpose. In meetings look like you are following the conversation by turning your head in the direction of each speaker, occasionally furrow your brows and nod subtly. When images are put onto a light box move in to study them with everyone else, stand with your arms folded and perhaps place one hand on your chin as if in deep thought. A balance must be struck here, however. If you appear too involved you will be asked questions and your ignorance exposed. Stand at the back but not far off and don’t make eye contact with anyone looking for volunteers.

2) Dress well but not too well Clothes maketh the man, as they say and you want to look professional and capable when you are about the hospital. Dress accordingly, nothing too flamboyant as this will make you stand out and at best mark you in the subconscious of every consultant you meet and at worst make then actively persecute you for your choice of shirt. Conversely you can’t look overly shabby; this means ironed and tucked shirts and no incongruent colours. Strike a balance between French Duke and Street Urchin.

3) Glasses Universally make anyone appear smarter. Buy glasses, even if they aren’t prescription. Do make sure they have lenses though; we don’t need any of this lens-less hipster business. If you’re into that kind of thing you can take your skinny jeans, empty frames and ironic moustache and listen to Pavement in another profession; you won’t cut it in Medicine.

4) Learn Latin No need for the whole language, though if you have the time learning it certainly wouldn’t hurt, just have the odd phrase here and there; drop them in conversation with your consultant or translate any Latin phrasings they use. Anyone who can rattle off the occasional Romantic utterance looks like a genius and it’s guaranteed that your registrar and resident wont be able to match you. Here are a few phrases to look up just to get you started: post hoc ergo propter hoc, entitas ipsa involvit aptitudinem ad extorquendum certum assensum,hic sunt dracones, post coitum omne animal triste est sive gallus et mulier.

5) Questions You can’t be asked things if you are the one doing the asking. A well timed and thoughtful question allows you to appear interested and willing to learn and if asked correctly on the right topic does not expose your ignorance. Furthermore, experts of all kinds love to talk about their field of expertise and by gently interrogating them you will appear smart, learn something and massage your consultants ego all at the same time.

6) Baby sitting Get chummy with your supervisor and score a gig baby sitting their kids, this will most likely be easier in the rural centres which place a greater emphasis on community. Doing this wont so much fool anyone into thinking you’re smart but will give you a better chance of a positive evaluation; you won’t get a bad report from someone who likes you enough to leave you alone with their children. Of course if your end of semester marks are

looking shaky then you can always gently remind your consultant how important your marks are to their kids’ wellbeing. Try something like: “I really hope I go well in my long case today, I’d hate to fail and then be distracted tonight while I baby sit your 4 year old daughter. The home can be such a dangerous place and I wouldn’t want anything to happen to her.”

7) Sex Again this wont so much fool your consultant into thinking that you’re smart as act as a safe guard against failure. When you see a pen hover over the ‘Not Satisfactory’ box in a rating form offer sexual favours or begin to remove your clothes, it’s best to be direct about these things. This approach does of course work best in private rooms; I’ve seen it tried on the ward and while there was a promising start it soon ended in tears and security being called.

8) Haiku Answer all questions posed to you in haiku. This makes you appear mysterious and wise beyond your years. For example: Liver Cirrhosis, Portal hypertension coma, Ammonia, death. It takes practice, especially as most medical terms are polysyllabic but you’ll get there eventually and look like a Poetic Medical Savant.

9) Learn medicine This is actually probably one of the simpler and direct ways to make your consultant think you know things- actually know things. All the time spent learning Latin, choosing your clothes, counting syllables and hiring lawyers for your sexual assault charge could have been spent studying. So put this magazine down and pick up a copy of Harrisons. Go! Do it! So there is a rough guide to passing yourself off as someone competent enough to be part of Australia’s Medical Workforce. I trust you will practice these skills and implement them with care and poise. As I conclude I must point out that everything expressed here is not endorsed by AMSA or even myself. You deploy these deceptions at your own risk and must perform your own risk/benefit analysis on a case by case basis; I trust you possess the necessary statistical acumen to perform these calculations. Thank you and Good Luck.

now go take a history from the whiteboard.. Robert Marshall (AMSA President) recently spoke at the

AMA National Conference.

This is what he had to say on your behalf....

Good afternoon doctors, doctors-in-training and to my medical student colleagues up the back, the doctors-intraining-in-training, Thank you for inviting me to speak to you today on Councillors fly JetStar to our meetings and we put behalf of the Australian Medical Students’ Association. them up in backpackers hostels, so they could hardly say: “for the perks”. It’s my great pleasure to speak to you at the AMA National Conference, and a particular privilege to be But the real reason we get involved, students in AMSA behind the lectern with an audience of doctors, since and doctors in the AMA, is in fact the same. the opposite is what I’m used to at University. It’s because we care. We care about education and If you want to embrace this role reversal, I would training, we care about healthcare delivery and we care encourage those of you up the back to talk noisily about the medical workforce, both current and future. amongst yourselves and if you’re sitting here in the front I expect you to be taking comprehensive notes. I think the reason we care so much about how health is delivered is because we’re taught to. Just as it is the Remember: everything today is examinable. role of the clinician to be an advocate for their patients’ Students often ask us why we get involved in AMSA; health, so too, it is the role of all doctors to be an advocate what motivates us to participate? for health, and for the profession itself. I know Federal Councillors, State AMA Councillors and The reason we demand more is because we expect active AMA members get the same question from their better. colleagues. Why do you get involved? Yes we have world-class medical education and health I guess the main difference is that our AMSA systems, but the only thing it takes for the triumph of

mediocrity is for good men and women to stand idly by. AMSA talks a lot about the quality of medical student training. I don’t need to tell this audience about some of the threats to quality education we are seeing: as you know the overload of students in the system has reached a critical point in training where there is now uncertainty about securing an internship for 1 in 4 Australian graduates, and yet we see the enrolling of ever-increasing numbers of international students when there is no guarantee for these students to complete their registration. We see students overcrowding the hospital system, and yet some universities are still pushing to open new medical schools or remodel the workforce with cohorts of Physician Assistants. We know that we need to make higher education more accessible and equitable, and the Bradley Review calls for participation from students of lower socioeconomic backgrounds, and yet Melbourne University has this year opened its new MD course with full-fee $200,000 places for domestic students. I know you are familiar with these issues because the AMA continues to join us and help us in speaking out about the threats to quality education and training, recognising that today’s medical students are tomorrow’s doctors.

Let me explain: Last week I went to a bedside tutorial. We were to meet a neurologist on the stroke ward in Royal Perth Hospital, the plan was to do some Neuro exams on these patients with the doctor, and to see some of the classical signs of stroke. But when I arrived I was not the only student there. Eight students had been assigned to this bedside tutorial. Eight. The neurologist was baffled. Just five years ago, he said, there were only two students to teach. This was very effective; one student could examine while the other made notes and offered constructive feedback. But eight students? Impossible to fit them around the bedside, let alone the distress and indignity it would cause the patient to be whacked with a tendon hammer by eight people in a row.

So instead of our planned bedside tutorial examining patients, the neurologist had no choice but to take us But still, that question about why we get involved has into a small teaching room, and run through the Neuro not been answered. This is what we talk about, but why exam on a whiteboard. do we talk about it. But as I said, white boards don’t have strokes. Some say it’s because we’re too interested in politics. “Leave the politics to the politicians” one consultant said If training is burdened any more than it is already, I worry to me a couple of weeks ago. Leave the politics to the about the quality of medical education. politicians? No thanks. I worry that eight students is too many to do a bedside The reason we get involved in politics is because that is tutorial, that eight students is not acceptable to the the only way to affect real change with how health and patient, that the increase to 15,000 medical students in education are delivered in this country. the last few years has not been met with a proportional increase in funding, training, teaching, resources and So now you know what we do, and the politics is how we support to our hospitals and our universities and our do it, but this still doesn’t explain why we get involved. doctors. I think the real answer to the question of why we get But most of all I am worried because white boards don’t involved, why I care about the quality of teaching, is have strokes. because whiteboards don’t have strokes. And that is why we get involved. Thank you.

Hey Hey It’s Saturday Dinuksha De Silva (UNSW) teases out how med students go to the extreme.....

edical students - we are a strange breed. Marveled at by onlookers for our intellect and discipline, with a simultaneous and somewhat counter-intuitive reputation for being the hardest partiers at any university. Studying and staggering our way between the extremes of a normal social hierarchy, we seem to have struck a balance (if balance is the right word) between geek and sleek. My definition of ‘geek’, among other things, is loose. Indeed, the closest some of us will ever get to data interpretation is tearing through a case of beer on the weekend and calling it a case study (please refer to the Cascade Cup champions). And we’ve all met those who’ve lost themselves on the other end of the social scale, but that’s another matter. This article is concerned with the (mostly) social life of the med student. It is concerned with those of us who manage to exist in a state of limbo between book-toting and beer-swilling. Do we have the best of both worlds? The multiple personality disorder that is seemingly endemic among young medical students warrants some consideration. And so we explore some of the major symptoms of our condition:

Neural Plasticity It has been seen that the neuron of a typical Australian medical student adapts measurably to suit the periodically alternating requirements of memory formation and ethanol influx.1

Priority Plasticity During semester a medical student is rarely seen by non-medical students. It is not uncommon for us to go into social isolation during the week prior to an examination. Following said examination, we proceed to catch up on a semester’s worth of missed partying. During this time we will call our non-med friends ‘soft’ or insult their sexuality when they refuse to party due to their heavy workload.

Sleep Deprivation Too often we find ourselves functioning on dangerously little sleep. Funnily enough, we find ways to justify this to ourselves. Staying

out until 3am before a 9am ward round is simply ‘practice for the demanding life of an intern.’

Selective Learning We are all aware that alcohol is a significant risk factor for morbidity and mortality. But it does reduce the risk of coronary artery disease. And we only need 10% of our liver to be functional, right?

Empathy Can we honestly be quality health care professionals without having experienced our patients’ concerns first hand? There’s plenty they don’t teach in tutorials, so we feel it is up to us to engage in some independent learning. At least this way we’re better equipped to sympathise with alcoholics. The transformation at will between study machine and party animal is what makes us undeniably the next generation of medical professionals. Because we all know a medical history must be complemented with a social history. How comforting for greater society that the future of their health lies in the hands of such a wellbalanced and rapidly-adapting demographic. AMSA National Convention is a tribute to our effortless ability to swap pen and paper for a paper cup. So whether you prefer to don a tweed jacket and thick-rimmed glasses or lather yourself in body paint, whether you study full-time or part(y)-time, we are one and the same. We are the medical student. 1

You wish this were true.

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Disclaimer: published articles reflect the views of the authors and do not represent the official policy of AMSA, unless stated. Contributions may be edited for clarity and length. Acceptance of advertising material is at the absolute dicretion of the editor and does not imply endorsement by the magazine or AMSA. The material in Panacea is for general information and guidance only and is not intended as advice. No warranty is made as to its accuracy or the currency of the information. AMSA, its servants and agents will not be held liable for any claim, loss or damage arising out of reliance on the information in Panacea. All material in remains the copyright of AMSA or the author and may not be reproduced without permission

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