The Technology Edition - Australian Medical Students` Association

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panacea
Official Magazine of the Australian Medical Students’ Association
The Technology Edition
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CONTENTS
President’s Letter
From the Editor
The Facts
The Quantifed Self
Wearable Technologies
Doctor’s On Call
Can we give sight to the blind?
Running an IT Business
Videoconferencing in Medical Education
Is he the perfect man?
Useful Websites
National Convention Photos
Global Health Conference Photos
Creative costumes
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5
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WE WOULD LIKE TO THANK OUR
MAJOR SPONSORS FOR THEIR
ONGOING SUPPORT
FOR MORE INFORMATION
Website: www.amsa.org.au
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Panacea is proudly produced by the Australian Medical Students’ Association Limited (ABN 67 079 544 513) for all
medical students around Australia. Address: 42 Macquarie St, Barton ACT 2600
EDITOR Jennifer Tang
GRAPHIC & ILLUSTRATIONS Jennifer Tang
ACKNOWEDLGEMENTS: http://zanimation.com/ for permissions to use photoshop brushes
ADVERTISING ENQUIRIES Andrew Silagy and Danielle Panaccio - sponsorship@amsa.org.au
3
President’s Letter
“There is a way to do it better - find it” ~ Thomas Edison
The goal of the doctor is to heal the sick. As
our knowledge about the body grows, and
instruments are developed and evolved, these
new advances increase our capacity to perform
this fundamental duty.
However, not all new discoveries are effectively
implemented into medical practice. A new
technology, even if it improves outcomes, has
to be carefully weighed against a number of
measures; such as cost, practicality, accessibility,
and in some cases a potential privacy risk. It
then still has to be successfully integrated into
clinical practice, and becoming familiar with a
new technology can be difficult. I assume it is for
these reasons, that there are a number of areas
in medicine where practice has been surprisingly
slow to change. The use of hand-written notes,
in spite of good literature showing this method
to be directly responsible for a large number of
medical errors, serves as an example of an area
slow to change.
Within medical practice, some areas are far more
receptive to change than others. Evidence-based
medicine is an example of a movement within
medicine promoting receptiveness to change in
treatment regimens to align with evolving best
practice.
Conversely, cultural change can be a much slower
process. There are many ways to impact cultural
change, but it often occurs from the bottom-up;
beginning with the youngest constituents of a
community. We see many examples of this trend
in Medicine. From Global Health to Mental Health,
AMSA has commonly been at the forefront of
cultural change
within the medical
profession. Medical
students were the
first to formally
acknowledge
the impact of
Pharmaceutical
Sponsorship
on prescribing
behaviours
and implement
guidelines to
regulate exposure to pharma marketing. AMSA
was first to take a stand on marriage equality due
to the adverse mental health consequences of
institutionalised discrimination; this position has
since been later reflected in policy statements
from an array of other medical organisations.
Henceforth, where new technology has been
shown to improve outcomes, perhaps it is the
medical students that should be pushing for
change.
The continued evolution of medicine is a shared
responsibility. We should strive to be adaptive
in our practice, so that our patients have the
opportunity to receive the best possible care. It is
in these areas where cultural change is required;
that we, as the next generation of doctors, have
the opportunity to champion these changes and
carry them forward.
4
Words from the editor
Dear Readers,
In the last ‘Hx Edition’ of Panacea we looked into
the past and explored the beginnings of AMSA,
the history of medicine and medical history. In
this edition, we look into the future and discover
how technology is used in medicine and medical
education.
I enjoyed reading the submissions for the edition
of Panacea and encourage people to think widely,
to think about how technology is used in medicine
and keep updated with medical research.
Every single day, new discoveries are made and the
medical knowledge pool expands. Knowledge is
infinite and it is an exciting and challenging aspect
of learning medicine. We begin our journey within
the classrooms - through lectures and tutorials.
Then as we venture into our clinical years we start
seeing the incorporation the incorporation of this
knowledge into the clinical environment. How we
teach someone how to act in this environment
is inenvitably the question we need to answer.
Yes, experience with patients is great - but how
do we teach those emergency situations? The
introduction of Sim technology and revolutionised
the way that many subjects are taught and allows
us as students to experience scenarios in the
safety of the Sim Room. This edition will explore
Sim Technology and how it has evolved as well as
what else there may be in store.
Learning also extends beyond the realms of the
classroom. Never before has it been so easy to
quickly search up the treatment of a medical
condition. We are in a priveleged age where
information is literally at the tips of our fingertips.
We need to make the most of this. The majority
of us have smartphones and with that a myriad
of apps installed. Amongst these are likely to also
be medical apps to help us learn - going through
scenarios, basic anatomy and MCQs.
We also learn from
each other and the
multiple forms of
communication now
available mean we
can not only learn
from each other at
university and in
the hospital but ask
each other questions
minutes before the
exam.
We are also seeing
new technology within medicine. It has allowed
us to reach people beyond those you can see
physically and helped with access in rural and
remote areas. This edition explores telemedicine
and how this has impacted those in rural areas and
what the future of telemedicine may be like.
New technologies have also enabled individuals
in rural areas of developing countries to access
healthcare. Low cost, simple technologies have
been a pivotal factor in enabling community health
workers to provide their communities with the
healthcare they require. There is an increasing
interest in Tech for Good and later on in this
magazine I will be discussing this.
Finally, I would like to say a big thank you to
everyone who has contributed. In particular, many
thanks to the AMSA executive who have all worked
very hard this year.
I hope you enjoy the read and that it encourages
you to think “What else?”.
Best Wishes,
Jennifer
5
Technology in Medicine
66%
56%
Of internet users
look online for
information about a
sepcfic disease
Of internet users
seek information
about a medical
treatment
From 2012-2015, Global internet
usage will more than double mostly due to mobile users
By 2016
142 Million
3 Million
Healthcare
App Downloads
Will use a remote
monitoring device that
uses a smartphone
as a hub to transmit
information
6
Tom Scodellaro, Melbourne University
The Quantified Self
Does Medical Technology Empower or Hinder Patient Health?
Describing 19th Century Frenchman René Laennec’s
newly invented stethoscope, contemporary John Forbes
once infamously proclaimed ‘that it will ever come into
general use, notwithstanding its value, is extremely
doubtful’. Citing ‘its hue and character’ to be ‘foreign
and opposed to all our habits and associations’; Forbes
typified the contention that often accompanies new
technology within the medical profession.
In the technological age that has followed the industrial
revolution, medical technology has driven change in
medicine fare beyond that of the stethoscope. The World
Health Organization defines Health Technology as ‘the
application of organized knowledge and skills in the form
of devices, medicines, vaccines, procedures and systems
developed to solve a health problem and improve quality
of lives’.
Such new innovations have equally attracted both praise
and criticism. The effect of technologies on patient
care, professional practical, healthcare systems and
the culture of medicine are all settings for such debate.
As students we bear a unique perspective that bridges
the gap between the old and new, educated history and
examination, yet exposed everyday to objective and
emerging medicine.
Medical technology can profoundly benefit and empower
patient health. Relatively recent imaging techniques,
biochemical tests and genetic assays all convey an
improved ability to readily and accurately diagnose
an array of conditions. Likewise vaccines, monoclonal
antibodies, surgical techniques and implantable devices,
to name a few, continue to improve patient morbidity and
mortality.
more information and therefore consolidate evidencebased care.
This is however not without hindrances to patient
care. The reliance on new technologies and deskilling
of medical professionals is a criticism many medical
students will hear. Clinically speaking, technology can
be impersonal, and may narrow doctors’ views when it
comes to diagnoses and treatment options. The trust
placed in innovative, presumably better, technology may
mislead medical professionals and instill inaccurate
expectations in patients alike.
Ethically speaking, the rapid progression of technology
and its burgeoning cost raise questions about the need
and motivations for new techniques and products. When
we can’t afford all the cutting edge technology, which
should we choose and for whom? Not to mention the
consequences for ongoing global health disparities.
As medical students, future leaders and children of
the technological age, the contentions surrounding
medical technology are pertinent. The defining effect
of innovations on our own practice and of course the
wellbeing of our patients will be career-long. Yet it is
worth considering that such technology is without its
own pitfalls. Accordingly whilst new technology may be
for the better, keeping an open mind would be just as
prudent. Indeed it might be worth channeling a little bit
of John Forbes after all.
To expand on one example, UWA academic David
Glance recently wrote about the importance of new
technologies to facilitate better evidence based practice.
Highlighting the inherent professional and economic
bias of medical research, Glance proposes that the use
of new and existing technologies to evaluate immense
amounts of healthcare-derived data stands to provide
7
Hailey O’Neil, Bond University
Wearable Technologies
The future of wearable technologies in medicine for doctors and patients
We are in the midst of a technological revolution. The
rise of the smart phone has enabled one to streamline
every facet of their life - banking, renting, cooking,
shopping, dating, reading, and communicating. With the
aid of new smart watches and other wearable devices,
our health and wellbeing now too can be optimised.
In our data driven society, wearable technology is
becoming the latest coveted commodity. Improvement
in sensor technology combined with a reduction
in production costs have led to a boom in health
monitoring gadgets. It is projected in excess of 100
million wearable medical devices will be sold annually
within the next two years. As these devices come to
market they have the potential to transform medical care
in unimagined ways, from managing chronic disease
to optimising, tracking and improving health and wellbeing.
Significantly revolutionising healthcare delivery and
management, these devices will allow seamless delivery
of
patient’s data. They will
also allow for remote
supervision,
and enable
health
care
providers to identify patterns and potential problems
earlier so that complications can be avoided. A growing
number of medical devices are becoming more
wearable, including glucose monitors, ECG monitors,
pulse oximeters and blood pressure monitors. Additional
devices are able to program medication reminders, track
elderly patients movements or detect if a patient has
had a fall.
A plethora of wearable’s (e.g. Fitbit and Jawbone up24)
allow consumers to take a more proactive approach to
looking after their own health. The functions of these
gadgets include assisting in weight loss by tracking
digital data about lifestyle habits, calories consumed,
steps walked and hours slept. Over time patterns
of behaviour can be mapped and areas that require
improvement identified, with the intent to motivate the
wearer to make healthier choices.
While lodging our stats will play a significant part in the
future of healthcare, here are some pitfalls. Amidst the
unfathomably large ocean of collected data, privacy
of personal information and data ownership will be
key issues. The companies who devise these tracking
technologies find your personal data as enthralling as
you do.
Finally, a tracking tool is only valuable if the results
can be interpreted and applied in a meaningful way to
individual patients. Tracking stats alone is not adequate
to ensure long-term behaviour changes. A study of
diabetic patients who used tracking devices alone
showed after a honey moon period of having a new
gadget, gradually self-tracking became a burden. In
some cases, the act of tracking became something they
dreaded doing, and worried looking at.
Regardless, it is an exciting time for both patients and
physicians. Keep an eye open as these technologies
expand to figure out which apps and wearable medical
technologies might best aid in your clinical decisionmaking and improve the care of your patients.
8
Nathan Abraham, Monash University
Luke Fletcher, Monash University
Doctors on Call
How telemedicine has allowed us to reach many more than before.
One of the first things that we ever learn in medical
school is the basics of interacting with patients.
Everything from the introduction with a handshake and
a smile, to sitting at eye level with patients - ensuring
to remove barriers between you and the patient, and
making sure to sit at an angle rather than face on with
the patient. All these steps are taken to ensure that the
medical conversation can be relaxed, and try to replicate
normal interaction and communication. With this
background, the increasing push for telemedicine and
online health solutions in the clinical setting may seem
odd.
Telemedicine and telehealth refer to the use of
technology and telecommunications infrastructure
to deliver healthcare at an extended distance. This
can range from something as small as in-home vital
signs monitoring via telecommunications networks
to performing surgeries via a DaVinci robot. While this
sounds very futuristic, a recent article in The Economist
reports the use of television links to facilitate patient
consultations in 1924. With many advances being made
in the interim, such as biotelemetry (used for space
missions in the 60s), telehealth has the potential to
transform the way we interact with patients and deliver
healthcare.
In Australia, telemedicine usually refers to of the use of
video-consulting for specialists in remote areas. There
are many benefits to the use of this technology, primarily
by reducing the need for face-to-face consulting.
This saves a great deal of resources and time for
governments, patients, and doctors alike. Indeed, with
the issues faced in attracting doctors to practice rurally;
telehealth solutions could provide a way of serving
remote communities, while allowing doctors to maintain
the comfort and convenience of a metropolitan life. In a
country as sparsely populated as Australia, this would
mean a specialist in Sydney would be able to serve
patients in Broken Hill and Orange, without the need to
leave their life and family in the eastern suburbs.
However, there have been questions around whether
telemedicine can truly replace the need for in-person
consultations. Indeed, despite being available for many
years, there are many complex issues that stop it being
from rolled-out and becoming mainstream. Simple
issues such as lack of ability to conduct an adequate
physical examination, something we are taught is
a cornerstone of clinical medicine, may stop this
technology from realising the dreams many people hold
for it.
Other issues include the lack of a reliable backhaul
infrastructure. Most notably, networking and
telecommunications in Australia is a big inhibitor, and
indeed, one of the selling points of the former Labor
Government’s FTTH NBN proposal was its potential
telehealth benefits to clinical medicine. In addition, the
significant initial capital investment in installing remote
technology devices means there is a short-term pain
that governments must swallow in order for the potential
savings to be realised in the future.
Concerns have also been raised around the additional
issues of relying on e-health solutions in general.
People are often anxious about how internet and data
security can pose a significant threat to their private
and confidential information, especially when relying
on public telecommunications system to transmit
sensitive information. However, as we move into the
video-consulting arena, it may be difficult to ensure
consultations cannot be recorded or intercepted. This
has significant consequences if a video-consultation
requires the patient to remove clothing for examination.
As it stands, Medicare subsidised telehealth
consultations are available those who are living in RA
2-5 classified regions; as well as those who are in eligible
residential aged care facilities, and ATSI health services.
Also, there are Commonwealth subsidies available to
practitioners, to assist with the initial set-up costs of
telehealth facilities.
However, while telemedicine can be revolutionary in
the delivery of healthcare to remote locations, the role
of doctors working in rural areas has not been made
redundant (yet). The Federal Government continues to
encourage doctors to practice rurally in-person, and
support the training of Rural Generalists. Ultimately,
a Rural Generalist’s ingenuity, flexibility, and unique
skillsets will still be needed to support, and compliment
telehealth delivery. Regardless of the distribution and
robustness of telemedicine; there will always be a need
for a doctor’s presence to examine patients, and a
doctor’s presence in case the power fails.
9
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Matthew Palladino, University of Western Australia
Can we give sight to the blind?
How machine-brain interfaces are bringing us closer to this
We’ve all seen a sci-fi movie where the character has
some form of augmented vision. Most of them need a
suit of armour over the top (al la Tony Stark/Iron Man)
or a set of nifty glasses (al la Star Trek). And then there
are those with bionic eyes; the Terminator with his robovision, Robocop or The Six Million Dollar Man. Video
games are rife with these characters and we’re led to
believe that this is something far, far in the future. But
is it? With products like Google Glass now becoming
available to the average consumer, it begs the question
– what can modern medicine and technology do to
restore vision to those without?
The most well-publicised example of a brain-machine
interface restoring sight to the blind is in the case of
retinitis pigmentosa, one of the more common forms of
inherited retinal degeneration.2 As with many conditions,
prognosis is variable, but irreversible blindness is not
uncommon in those with the condition. As the pathology
is confined to the outer layers of the retina, it is possible
to create a photosensitive device that electrically
stimulates the nerve cells of the inner retinal layers.2
Perhaps the most exciting of these is the Alpha IMS,
a subretinal implant that is placed in the same plane
as the no longer functioning photoreceptors.3 An array
of electrodes on the back of the panel stimulate the
bipolar cells below.2,3 From this point onwards, normal
visual processing occurs.3 Currently, the resolution
provided is limited and colour perception is in greyscale.3
However for these patients, the effects are profound.
In early trials, 5 of 8 patients reported “useable visual
experiences in daily life,”3 including identification in
the near-vision range of gross facial features such as
smiles,3 an ability to differentiate people based upon
their outlines,3 cutlery,3 door knobs3 and telephones.3 For
people who previously could only perceive the presence
of light (they were unable to localise it)3 or in one case,
complete blindness,3 these outcomes are tremendous.
In addition, the use of a subretinal implant allows natural
eye movements2,3 and a higher density
The alpha-IMS subretinal implant.1
of pixels (currently 1,500 in a 9mm by 9mm diamond)2,3
than alternative methods that transmit an image from
an external camera through to electrodes implanted
epiretinally.2
Progress has been made in creating light perception
non-invasively by stimulation of the cortex as well,4 and
was recently used to conduct the first ever transmission
of thought directly from one person to another via
brain-to-brain transmission without the use of invasive
methods.4
If you’ll allow me the indulgence of ending on a pun, I
think we can safely say that whilst we’re certainly in the
early stages, the future of machine-brain interfaces for
vision is bright.
References:
1. Stingl K, Bartz-Schmidt KU, Besch D, Braun A, Bruckmann A, Gekeler F, et al. Artificial vision with wirelessly powered subretinal electronic implant alphaIMS. Proc Biol Sci [Internet]. 2013 Apr 22 [cited 2014 Oct 10];280(1757):20130077. Figure 2: The alpha-IMS subretinal implant. Available from: http://rspb.
royalsocietypublishing.org/content/280/1757/20130077.full
2. Stingl K, Zrenner E. Electronic Approaches to Restitute Vision in Patients with Neurodegenerative Diseases of the Retina. Ophthalmic Res. 2013 [cited 2014 Oct
10];50(4):215-220. Available from: http://www.karger.com/Article/FullText/354424
3. Stingl K, Bartz-Schmidt KU, Besch D, Braun A, Bruckmann A, Gekeler F, et al. Artificial vision with wirelessly powered subretinal electronic implant alpha-IMS. Proc
Biol Sci [Internet]. 2013 Apr 22 [cited 2014 Oct 10];280(1757):20130077. Available from: http://rspb.royalsocietypublishing.org/content/280/1757/20130077.full
4. Grau C, Ginhoux R, Riera A, Nguyen TL, Chauvat H, Berg M, et al. Conscious Brain-to-Brain Communication in Humans Using Non-Invasive Technologies. PLoS ONE
[Internet]. 2014 [cited 2014 Oct 10];9(8):e105225. Available from: http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0105225
11
So you’re a doctor running an IT business?!?
Dr Andrew Yap is the Panacea Technology Edition guest writer. Dr Andrew Yap (Monash University Alumni
2011) is a medical doctor and co-founder of an IT company. He writes about how his experiences of getting
involved with healthcare technology.
I’ve always been a very driven individual. When I decided
that I wanted to be a doctor instead of a ski instructor,
I spent countless hours studying for the UMAT instead
of hitting the ski town pubs and clubs. Then when I
figured out that I loved the thrill of emergency medicine
and trauma, I set out to immerse myself within it –
working as a ward clerk at an emergency department,
volunteering as a medical student at music festivals and
raves with St John Ambulance and finally undertaking
2 month trauma elective at The Bara in Johannesburg.
Maybe I’m an adrenaline junkie, or maybe I like helping
people when they’re in a dire situation, but I never
thought I’d ever do anything other than clinical medicine.
That was until I finished internship. As an intern, you are
the hub of care coordination. The one who translates
plans into actions. You organise patients to be reviewed
by specialty teams, discharged with Hospital in the
Home for a Clexane-Warfarin crossover or sent to theatre
emergently with an acute abdomen. Despite all that you
have learned at medical school, it won’t prepare you for
the coordination act to follow because unfortunately
hospitals aren’t inherently efficient.
Towards the end of my internship, I was reflecting
on what I could have done differently or better. I
realised that I spent a lot of my time on the phone, or
more accurately, waiting for phone calls. I would call
switchboard and after waiting for three or so minutes, I
would eventually have a number to page. I would then
find a free computer, send the page, then wait … wait …
and wait. Every other clinician I knew carried a mobile
phone, yet the pager was still the main method of
initiating communication. I knew there must be a better
way.
Doctors hating pagers isn’t new. In fact, until the
very minute you have one, you’re craving it and
the associated recognition that you’re now a fullyfledged doctor. I find the TV series Scrubs eloquently
demonstrates how quickly the pager becomes the bane
of your existence. You’re on ward round … it goes off.
You’re in theatre … it goes off. You’re assessing a
patient with chest pain … it goes off. But guess what …
someone’s only left a call-back number. Maybe it’s really
urgent so they didn’t have time to type a message? So
you leave your patient with probable acute coronary
syndrome only to find out that you’re being hassled for
the discharge summary of a patient leaving later that
day. Why?!??!?
Did you know a tertiary Australian hospital runs on a
budget of between 600 – 900 million dollars? I certainly
didn’t until recently. Unfortunately however, upgrading
the communication infrastructure from a 1970s
technology is a low priority. It simply isn’t as sexy as
putting money towards researching a cure for cancer or
buying a new MRI machine. I am of the belief that if we
as healthcare professionals could work more efficiently,
effectively and safely then we could do more for our
patients. Isn’t that a worthwhile investment?
That’s why I decided to move from full-time clinical
medicine to running an IT business. I wanted to do more
than help the 20 – 40 patients I was directly responsible
for. It took me a while to come up with a solution to this
12
paging problem, but I knew from internship that I wanted
to be the one to solve it. The thing is, if the people that
live and breathe the problem don’t do something, then
unfortunately things will never change.
We suck it up for a few years as junior doctors. “Yes sir,
no sir, three bags full sir” we say as we do the grunt work.
We donate our spare time to doing research to get some
publications under our belt and some like me work unpaid
overtime to keep on top of discharge summaries so that
we get good references… all because we know that this
predicament is only temporary. As we progress, we know
that some poor intern or resident will come and take
over. It’ll be their turn to pay their dues. It was at the end
of internship that I started to question this mentality. I
however encourage you to this now. Just because things
have always been a certain way doesn’t mean it should
continue to be that way.
I tried for months within the hospital to improve hospital
communication. Ultimately I needed to speak to the
deputy CEO in order to really be heard. Thankfully I
was given an opportunity to implement some changes
at that hospital, however the progress was slow and
bureaucratic. I realised that one of the biggest challenges
was the disconnect between the hospital administrators
(the people who control the money), IT staff and clinicians
like you and I. Over the past 18 months I’ve worked
amongst all of these groups to try and understand their
motivators and perspectives, but ultimately I came to
the conclusion that it was faster and easier to build a
solution on the outside and bring a finished product back
to hospitals.
From the start of 2014, I’ve dedicated myself to
improving communication in healthcare. There is no
medical or surgical specialty for this, and one day I
hope to complete my ED training, but for now I’ve put
my clinical career on hold. I still locum about eight to
ten days a month to pay bills and I choose to work in as
many hospitals around the country as possible to see
what works and what.
In a time where job security is becoming more difficult
for junior doctors, I thought long and hard before
jumping off the full-time clinical train. It’s easier to go
from medical school, through internship and residency
and get on a training program, but what happens at
the other end? Medicine like most professions is a
funnel. There are less positions the more senior you
get and it’s getting harder and harder to find ways to
distinguish ourselves and get consultant jobs. Some
people do further research and education, some don’t.
What I suggest however is that you find an issue you’re
passionate about. It doesn’t have to be off the beaten
track, it just has to be a problem that really irks you and
that you truly care about. Then go do something about
it. Don’t settle for “that’s the way it’s always been, so
that’s the way it always will be”. I challenge you to go
out and make a difference. After all, it’s a core part of
the profession we’ve all chosen.
-----On a side note, if you’re interested in health technology,
improving communication in healthcare or are
considering something of the beaten track, please feel
free to reach out. The best way is via andrew@yconsult.
com.au.
13
Stephen Pannell, The University of Western Australia
Videoconferencing in medical education
I’ve been very lucky this year to have been selected
for the highly competitive Rural Clinical School of
Western Australia (RCSWA). Most Australian medical
schools have an equivalent programme[1]. The RCSWA
programme is spread across Western Australia, from
Derby and Broome in the north, to Kalgoorlie in the
east and Esperance and Albany in the state’s south[2].
Students in the programme spend their penultimate year
of medical school living in a rural town attached to a
rural hospital.
Whilst there are a number of programmes and incentives
being implemented to address the shortage of doctors
in rural areas, the Rural Clinical Schools around Australia
are contributing a great deal to educating future rural
doctors. The RCSWA programme has been successful
with high rates of participants from urban backgrounds
now working in rural areas[3]
Our curriculum covers obstetrics and gynaecology,
paediatrics, surgery, ophthalmology, oncology, internal
medicine, Aboriginal health and general practice. We
learn through clinical placements with local general
practitioners, hospital medical officers and visiting
consultants and we have weekly small group tutorials
and videoconferences.
Over the last few years the RCSWA has been increasing
the utilisation of videoconferencing for both content
delivery and content assessment.
We have frequent videoconference tutorials with
the other 85 medical students spread over 14 sites
around rural WA[2]. A consultant, either from a
secondary hospital at one of the larger sites, or from
a metropolitan tertiary hospital, will deliver lectures
via videoconference. An online web-form, known as an
eClicker, with a number of MCQ’s and SAQ’s is distributed
prior to the lecture to gauge our current understanding
of the topic.
There’s also a number of videoconference ‘case based
discussions’ throughout the year that are a part of our
assessment for paediatrics and oncology. We dial in and
present a case to a consultant who then assesses our
presentation and asks us content specific questions.
At our rural sites, there is always access to the
videoconferencing system for students to dial into
extra-curricular lectures and presentations that are
based in Perth. Our local hospitals use the same
videoconferencing system and this is utilised by local
consultants each week to discuss complex cases
with multi-disciplinary teams (MDT) based in Perth.
For a medical student to be able to attend these MDT
meetings whilst being in a rural area is a valuable
learning experience.
Videoconferencing technology, telehealth, is becoming
an increasingly important part of the delivery of health
to Australians. Doctors working in both metro and rural
settings will need to be able to use the technology, they
should understand videoconferencing etiquette and
they’ll be required to be proficient with consultations
and patient interaction via videoconferencing links.
It is for these reasons that the further integration
of videoconferencing technology into the medical
curriculum is so important.
Reliable and fast data connectivity is also an important
factor that many rural areas in Australia are yet to
attain. Videoconferencing quality, both audio streams
and video streams require fast data download and
upload bandwidth. Even with our current advanced data
compression protocols, satellite connections are too
slow. With high-resolution video, clear audio, and fast
access to pathology and radiology images, optic fibre
connections with fast and reliable peak and off-peak
upload and download speeds are necessary.
As medical students and health advocates, it is
important that we see first hand how this technology
is improving patient outcomes. By facilitating
communication between rural and urban colleagues we
are contributing to a more equitable health care system
for all Australians regardless of geographic location.
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Brad Richardson, Deakin University
Is He the Perfect Man?
Some people describe him as the perfect man. He
has the perfect heart to auscultate, the perfect set of
washboard abdominals to palpate and the perfect veins
for a novice to cannulate. A man this perfect could only
be a SimMan found in medical schools across Australia.
SimMan, a full-scale anatomically realistic interactive
manikin, has allowed many medical students to struggle
through clinical skills and scenarios before being
released out into the real world. Much like the modern
man, he is attractive due to his adaptability to all
situations. This makes SimMan a much sort after piece
of equipment for both students and practical examiners
wishing to inflict pain on medical students.
emergency scenarios rehearsed without fear of harming
a patient.
So the next question is what is the future for SimMan.
There is no doubt the current model will be upgraded
to a younger, better looking, 3D interactive manikin in
the virtual reality. It is just a matter of when. Simulation
training is applicable to our future training and it is
likely to continue to be a routine part of our future
professional development. With big business involved in
advancements in robots and virtual reality technology,
it will be no time before we are practicing our first
sub-cutaneous stitch on a simulated abdomen whilst
drinking coffee in our medical schools clinical rooms.
SimMan was born to bridge the gap between the
classroom and clinical environment. In the last two
decades, medical educational institutions in Australia
have relied more and more on simulation training to
help medical students acquire the required clinical skills
to be competent in the hospital. Although nothing can
truly simulate the beads of sweet streaming down your
forehead as you try to cannulate your first real patient,
simulation training has been shown to reduce the
anxiety for the transition between preclinical to clinical
training.
Is He the Perfect Man?
Medical simulators range from simple replications of the
perfect ‘posterior passage’ for DRE practice, to complex
pathophysiological computer models like SimMan worth
more than $70 000 for the base model. So why would
our universities spend that much on a manikin, given it
could provide 17 500 café lattes for medical students?
A recent meta-analysis of 3 742 articles identified that
simulation training is superior to traditional clinical
medical education in achieving specific clinical skill
acquisition goals (1). Articles describe simulation
training as ‘exciting’ and ‘innovative’, but most of all for
young doctors it allows clinical skills to be practiced and
Reliable
Helpful
Listener
Easy to listen to
References:
1. McGaghie WC, Issenberg SB, Cohen MER, Barsuk JH, Wayne DB. Does simulation-based medical education with deliberate practice yield better results than
traditional clinical education? A meta-analytic comparative review of the evidence. Academic medicine: journal of the Association of American Medical Colleges.
2011;86(6):706.
15
Acknowledgements: Photo (Gene Hobbs)
Deets Raut, University of Sydney
Useful Websites
for the (slightly dorky) aspiring doctor
Please enjoy my brief compilation of websites that you probably haven’t heard of but should definitely bookmark. As
a preface, I should warn all you purists out there that this list may not be for you. Indeed, you are more than welcome
to continue to use Best Practice on your shiny technological screen whizzing through facts at lightning speed but
this post is directed for those of you who use a textbook as a comfy pillow to contemplate the meaning of life hours
before your barrier; the oddballs that look for histology patterns in Messina flavors; those that need to see medicine
in a different light to let it sink in.
Geeky Medics
1
2
URL: http://geekymedics.com/
Surely the pixelated graphics and adorable accents should help this website speak for itself
but if you remain skeptical, allow me alleviate your fears. This UK based website highlights
some excellent OSCE techniques with full text! It’s quite rare to find instructional videos
with accompanying text for OSCE prep and I find this one really does the trick. It’s adorably
awkward as it’s clearly filmed by students with good technique so it makes the clinical
situation relatable and accessible. It also has a number of clinical concepts boiled down and
reduced to their basic flavors. Simply divine for the repetitive learner!
Sketchy Medicine
URL: http://sketchymedicine.com/
Just a gal and her pen taking you through the world of medicine! I find this website particular
helpful for complex concepts where you scrunch your forehead desperately trying to see
the whole pattern but just can’t. This website affords you that luxury with all the foreheadscrunching done by someone else so you can spend your time “aha!”-ing instead. Ideal!
Well, that’s all. And, I should really highlight that these are the websites that are odd and help me. Everyone has a
different style of learning and you should certainly find things that cater to yours. As you can imagine, my notes are
very colorful and image-based. I have probably purchased enough from Smiggle to fund the CEOs summer cottage.
Just make sure you find something that works for you because learning medicine need not be boring!
16
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17
2014 National Convention
Adelaide
18
2014 Global Health Conference
Sydney
19
Alex Hanson, James Cook University (AMSA Representative)
The perfect convention costume
As I write this article, I am surrounded by an array of colourful fabrics and a random assortment of items that to the
untrained eye don’t seem to have any purpose or work together at all. My study has been turned into a production
line complete with sewing machine, hot glue gun, glitter and paints. This is a common scene around the country at
this time of year as 1000 medical students prepare costumes for the greatest week of the year – Convention.
Costuming is one of the most famous parts of Convention and an aspect that is well remembered by those who
have long since graduated. The costumes seen at Convention are well above the average standard of any other
themed party in existence (well, at least the top 1%). This exceptional level of costuming does not always come with
ease; many a ranger has been known to spend many sleepless nights in the lead up to Convention to ensure their
extravagant costumes are up to standard.
For most Conveterans, costuming now comes naturally, with experience comes the wisdom to create a great
costume on a tight budget and a timeframe. I hope that this simple guide may help to ease the nerves of Convirgins
when it comes to creating their first Convention costumes.
There are a few key steps to consider in order to create the perfect costume.
1: Costume with a group or fly solo?
Group costumes can make an otherwise fairly simple costume look impressive. Some costumes can only be done
as group costumes, for example, could you really go as a single dalmatian? However, when creating an individual
costume you can really go all out and do something spectacular. A mix of the two throughout the week is a good
compromise.
2: The Idea
Get creative and brainstorm a list of ideas. You need to find the balance between fitting the theme and lateral
thinking. While you may be able to find some trivial connection to the theme, explaining your costume to everyone
you meet will get tedious. Costume within the theme, if you have a great idea in mind that doesn’t fit, save it for next
year.
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3: Design
You have a brilliant idea, but how are you going to pull it off? There are many things to take into consideration when
designing a costume - budget, transportability, level of modesty or lack of, availability of supplies and your level of
construction skill. Channel your inner fashion designer and do some sketches so you can visualise what works.
4: Sourcing the materials
Spotlight is the go-to place for budding sewers (and body painters), while op shops and Supre can be a great place
to find costume bases for those who didn’t pay attention in home economics class. The Reject Shop is great for
accessories and hardware stores such as Bunnings can be surprisingly useful. eBay is also an amazing resource –
though you need to plan your costumes early to be able to rely on items arriving from China in time. An additional
level of difficulty in this area can be added for students on rural placement during the costume-creation period.
5: Making the costume
This is the best part! There are many options for methods for creating costumes. Sewing machines are useful, but a
simple needle and thread, safety pins and a hot glue gun can suffice for most costumes. Have fun with this part.
21
Melbourne University
2014
University of
Queesnland
22
University of
Western Australia
University of Wollongong
2014
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panacea
the official magazine of the
australian medical students’ association
the Hx edition
volume 48 issue 2
October 2014
© 2014 All rights reserved
Australian Medical Students’ Association
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