Volume 2, Issue 2 | 2011 AM Australian Medical S J Student Journal TIME IS RUNNING OUT 4-Hour targets in the ED Editorial Comparing barrier exams across medical schools Review Treating blood loss in children Guests Fiona Stanley, Ian Frazer and more www.amsj.org GENERAL PRACTICE TRAINING Undertake a salaried research project as a GP registrar The everyday practice of GPs is centred around evidence-based medicine. The Australian General Practice Training (AGPT) program encourages registrars to undertake research and improve critical thinking. As a GP registrar you can undertake a paid academic position, attend research workshops and present at national conferences. Find out more at www. agpt. com. au AM S J Australian Medical Student Journal Volume 2, Issue 2 | 2011 Contents AM S J Grace Leo, Alexander Murphy, Crossing boundaries - the expansion of the AMSJ 4 Praveen Indraratna The great wall of medical school: A comparison of barrier Annabel Ingham 5 examinations across Australian medical schools In and out in four hours: The effects of the four-hour emergency Praveen Indraratna & Ania 9 department target on patients, hospitals and junior doctors Lucewicz National standards in medical education: Being accountable Tom Lee 11 and striking a balance Daryl Cheng, Tran Nguyen & Mental illness and medical students 2 12 Flora Poon 13 The justice of melancholia 5 Elliot Dolan-Evans Onsite and offsite use of computer aided learning in 9 Winnie Chen 14 undergraduate radiology education Maternal attitudes towards breast and bottle feeding in a 20 Jacqueline Koke 19 regional community 25 Exploring barriers to the provision of palliative care in Australia 17 Kieran Allen & Sadid Khan Emergency Department management and referral of self-harm 12 Riza Gultekin 29 patients 34 Early impact of rotavirus vaccination 7 Cassie Rickard 39 Balance and gait stability following sports-related concussion 14 Ann Sunderland 42 Acute blood loss in children 16 Joanna Offord Management of infertility in the setting of polycystic ovary 12 Sophia Wong 45 syndrome 49 Prevention of rheumatic heart disease: Potential for change 6 Jovita Dwivedi Human papillomavirus in head and neck squamous cell 6 Ross Smith 53 carcinoma Intra-vitreal bevacizumab in patients with Juvenile Vitelliform Dujon Fuzzard & Andrew 7 58 Dystrophy (Best Disease) Atkins IVC thrombosis: An unusual complication of metastatic prostate 14 Tim Squire 63 cancer Medical research at the cutting edge challenges society’s Alan Trounson 66 closely held traditions ‘We want you to be our mother’: Research to improve Fiona Stanley 68 Aboriginal child health Samuel Schecter, Laurel How fortunate we are 71 Imhoff & Alden Harken Where do new clinical treatments come from? Translating Ian Frazer 73 knowledge into practice ii Australian Medical Student Journal Volume 2, Issue 2 | 2011 Markets and medicine: Financing the Australian healthcare 4 Iain Law system 76 Is mandatory pre-procedure ultrasound viewing before 16 Maryam Nesvaderani termination of pregnancy ethical? 80 Self-taught surgery using simulation technology 12 Behnoosh Samadi 82 A week in the Intensive Care Unit: A life lesson in empathy 15 Katherine Gridley 84 Should artificial resuscitation be offered to extremely premature 6 Malcolm Forbes neonates? 86 Reflections on an elective in Kenya 12 Hijiri Suzuki 90 A neuroanatomical comparison: Blumenfeld’s Neuroanatomy 8 Joule Li through Clinical Cases vs. Snell’s Clinical Neuroanatomy 92 Tumaini 12 Sarah Philipson 94 6 15 5 2 11 10 18 19 14 13 8 16 12 20 4 1 9 3 7 17 1. Australian National University 8. University of Adelaide 15. University of Queensland 2. Bond University 9. University of Melbourne 16. University of Sydney 3. Deakin University 10. University of Newcastle 17. University of Tasmania 4. Flinders University 11. University of New England 18. University of Western Australia 5. Griffith University 12. University of New South Wales 19. University of Western Sydney 6. James Cook University 13. University of Notre Dame (Fremantle) 20. University of Wollongong 7. Monash University 14. University of Notre Dame (Sydney) Australian Medical Student Journal iii Welcome AM S J Crossing boundaries - the expansion of the AMSJ Grace Leo Internal Director, AMSJ Alexander Murphy External Director, AMSJ Praveen Indraratna Editor-in-Chief, AMSJ From treating acute blood loss in children shaping a national journal, and we were very so please make sure you visit and click ‘Like’ to to palliative care barriers for the elderly, pleased to hear many positive comments and stay up-to-date! this issue truly showcases the enormous suggestions from those who attended the The journal is a massive undertaking, and potential and diverse interests of Australian AMSA National Convention and Global Health we are grateful to have a wonderful and medical students. Our authors have not Conference in July. dedicated volunteer staff of medical students been afraid to address controversial issues and peer-reviewers who work very hard to such as emergency department waiting One of our exciting new initiatives is the AMSJ make this journal a success. Of course we times, healthcare financing and comparisons Blog, updated regularly at our website: www. also thank you, our readers, for welcoming between barrier exams across Australian amsj.org/blog. Authored by staff members, and supporting us as the AMSJ continues to medical universities. We are also privileged it provides personal perspectives on medical display the research abilities of Australia’s to be sharing the insights of four remarkable student life, with articles ranging from medical students. professorial guest authors. Former Australian practical educational posts to lessons learnt of the Year recipients Fiona Stanley and outside the hospital, and tackling the bigger Ian Frazer shed light on future directions questions we all ask ourselves from time of research; the IVF and stem cell research to time (‘So you don’t want to be a doctor pioneer Alan Trounson reflects on progress anymore?’). We hope you take a look at this in his field and Alden Harken, Professor of terrific new forum for student participation. Surgery at the University of California San As always, support for the AMSJ across Francisco reminds us how fortunate we are to Australia’s medical schools has been be in medicine. extraordinary, with the free print copies A core focus of the AMSJ is to become a being in huge demand. Remember that you national journal, that is, one which represents can download the entire journal for free fairly and equally the academic and research from our website. Articles from the AMSJ will achievements of students Australia-wide, soon be available on the EBSCOhost database without ties to a particular university. The and have gained interest from other major journal has expanded widely in recent academic research databases and indexing months, our current editorial team now spans systems. We have also had the pleasant four states, and we are moving towards full ‘problem’ of reaching our friend limit on nationalisation of our staff for future issues. Facebook and are switching to a new AMSJ Meeting our readers is also a key priority in Facebook page: www.facebook.com/amsj.org Some staff of the AMSJ. Clockwise from left: Patrick Teo, Timothy Yang, Matthew Schiller, Chris Mulligan, Praveen Indraratna, Aaron Tan, Alexander Murphy, Grace Leo, Veronica Lim and Helena Jang. 4 Australian Medical Student Journal Editorial AM S J The great wall of medical school: A comparison of barrier examinations across Australian medical schools Annabel I Ingham Associate Editor, AMSJ Sixth Year Medicine (Undergraduate) University of Adelaide From the moment that a medical student receives their university offer until the moment they take the Hippocratic Oath in front of Implementing proud family and friends, they will tread a path only taken by a select (Behavioural: Does) number before them. However, with medical schools now in every ie. Ward Assessment state and territory of Australia, the journey will not be identical for Demonstrating all students. For some, this will be a marathon, with continuous (Behavioural: Shows How) assessment peppering the entire journey, while others will encounter ie. OSCE multiple large hurdles, interspaced with periods of calm. Despite this very different experience of medical school, all will ultimately compete Understanding for an increasingly competitive pool of internship positions, which (Cognitive: Knows How) represent the key to unlocking their future medical careers. ie. SCT The ‘Barrier Examination’ is a common term used for the final set of assessment of a medical student before being allowed to graduate as a Knowing (Cognitive: Knows) doctor. At most medical schools, this is held in the final or penultimate year of study, and often consists of a combination of written (such as ie. MCQ Multiple Choice Questions – MCQ) and clinical assessment (i.e. Viva Figure 1: Miller’s Pyramid of Clinical Competence with Associated Assessment Voce and Observed Structured Clinical Assessment – OSCE). It is Methods. Adapted from [2], with permission. known that barrier examination formats vary widely between medical by clinical examinations held in other years of their course. schools, which raises a number of questions: which examination format is the most accurate at predicting future clinical performance? Which Research supports the notion that the OSCE is an accurate descriptor format is most accurate at assessing knowledge and skills? And can of a medical student’s future performance as an intern, and does so students from different universities ever be accurately compared? A better than other forms of assessment. [4] Yet a recent review states brief survey conducted in June and July 2011 by the author collated the that between fourteen and eighteen OSCE stations are required for details of the Barrier Examinations undertaken at each of Australia’s acceptable reliability. [5] The number of OSCE stations undertaken medical schools. The results are presented in Table 1. Table 2 provides in the Barrier Examinations, according to Table 1, varies between six an example of the different examination formats used at Australian and eighteen.