2016 Edition 1 April

Surgery: A Cutting Edge Career Deakin Medical Student's Association HEAD bLy aIuNthoEr

Welcome to The Pulse 2016. interview with Dr. Elysia The Pulse is MeDUSA?s Robb of the Victorian Medical quarterly student newsletter Women?s Society, and an written by students, staff and elective report from Corey medical professionals alike. It Thompson (Class of 2015) aims to engage minds, provoke outlining his experience at discussion and stimulate The Victorian Institute of interest in all things medical. Forensic Medicine. We will be kicking off the Thanks is given to all those year with Surgery: A Cutting that have contributed to this Edge Career. Surgery has a first edition, with particular long and rich history, filled thanks to 2nd year student with both extraordinary Kate Thimbleby who advances and devastating illustrated the front cover. complications, making the Now sit back and enjoy field one of great interest and reading The Pulse. discussion. In this edition, we have a range of articles based Benj amin Paul on experience, insight and Editor (3rd Year) opinion. We also have feature articles, including an A Student's Guide to Surgery 10 tips for surviving theatre By Pippin Freeth (4th Year)

1. Be a wall 5. Sterility. 2. If you can?t be a wall, be very close Don?t touch anything. to the wall. If you want to touch something, maintain nervous eye contact with the local theatre Unless there is something important on nurse and move your hand very slowly that wall and then you should find a new towards the desired object, you will be patch of wall. Alternatively, hide behind a informed if you are about to break large machine. If they ask you if you are sterility. having trouble seeing, lie and say you have perfect visibility! 6. Breaking sterility. 3. Scrub longer than anyone else (by You will do it. You will break gloves, about 10 secs). break gowns, touch lights, touch your face and brush your arm too close to They will think it?s because you care so someone?s back. This is fine, look startled much about sterility. In reality, it will like a rabbit and don?t move until enable you to mimic everything that the someone explicitly tells you what to do or Surg Reg does. Follow at about 2 metres. physically moves your body. Try some Repeat everything they do, including apologetic eyes, it may diffuse some of the saying the same glove size. If you are red hot rage currently directed at you. quick enough they may be there to help you do your little gowning swirl; and it 7. Eat food. will always be the wrong piece of string There is food in the staff room, eat as that you offer. Then stand in the most much as you like! If you feel guilty about obvious ?I?m not touching anything? it or are up to your 17th sandwich, position and wait to be directed. mention loudly that your blood sugar 4. Gloving. must be a little low. They won?t want you passing out into someone?s abdomen, you The hardest thing you will ever do. Do it are just being sensible. facing a wall if the judging eyes of experienced theatre staff put you off. 8. Passing out. Going so very slow? Don?t worry, on If you feel like passing out, stand close to average it does in fact take longer than your beloved friend the wall, and casually your standard D&C and that?s fine, you slide down it as if you were just feeling wouldn?t be doing anything anyway. like a nap. Not near a wall? Try and aim your slumping body away from the patient, sterility IS more important that your wellbeing! 9. Be helpful. You are useless at the actual surgery and your presence is a burden to everyone. So be helpful in other ways. Is the Reg?s phone ringing? Don?t feel awkward, put your hand in their pocket, answer it and gently cradle it against their cheek. Take messages for them with your best grown up voice. Be their lackey; if they ask you turn up their music? Do it. If the anaesthetist asks you to turn it down, don?t. The Surg Reg can fill out miniCEX forms and you don?t have anaesthetics till 4th year. I can guarantee you the anaesthetist will not remember you at all The second edition of The Pulse (thanks theatre masks! ) is just around the corner and we 10. Anatomy knowledge. want you to get involved! Not as important as you think! As an ambiguous Our next edition will be titled masked student, you can usually just take a stab Medicine: Art vs Science. We are and act interested in the right answer. In Ortho, looking for article submissions you should know the four X-ray signs for on this hotly debated topic. to osteoarthritis and you?re golden! In O&G, know be sent to what a ureter is/looks like and don?t act [email protected] disgusted when your shoes get soaked in blood and amniotic fluid. In Gen Surg, mention Calot?s Articles on current research, triangle and nod interestingly as different personal experiences, opinion noodle-like structures are pointed out to you. pieces or anything else related And finally, if someone asks you if you are to the core theme are interested in surgery, lie and say of course you encouraged. If you have are! anything else that you wish to be published in The Pulse feel free to send it through as well. The Pulse relies on student contributions to stay alive and stay relevant so get typing and send in your submissions. Get involved, inspire others and write something to make a difference! Surgery in A frica: A First Hand Ex perience By M adison Phung (1st Year)

Lying on a wooden plank in an under-staffed and poorly funded hospital, the doctors have just cut open her abdomen and uterus and delivered her two beautiful babies. Suddenly, there is a complication ? her placenta had detached from her uterine wall and she?s bleeding excessively. Her blood pressure drops and heart beat slows almost reaching a halt. The doctors are pushing on her chest in an attempt to revive her. My immediate thoughts were ?Please live, for your children.? After some time, her heart beat manages to creep back up to normal, she has been resuscitated. There is a sigh of relief. What I have just described to you is the very first surgery that I saw during my time in Tanzania. I spent 2 weeks in Tanzania during my gap year and could probably say that it was one of the best experiences of my life. I was given the Tanzania, Africa opportunity to shadow the doctors over there and spent most of my time on ward rounds or scrubbing in on surgeries. My experience in Tanzania allowed me to truly understand the large disparities between surgery and just health care in general, in developing countries and the Western world. The surgical beds were essentially wooden planks almost the same width as the patient. I could only imagine how uncomfortable it would be for the larger patients that we encounter in Australia. They did not have elaborate machinery or technology - they had the bare minimum that would allow a surgery to be performed. At times, the unreliability of power in the hospitals meant many individuals relying on life support would die because of a power outage. And these were only a few of the shortfalls that were presented in the infrastructure and physical Open reduction and internal structure required to provide basic surgical fixation of femur care. Nonetheless, the medical screws in order to realign the staff over there do such an two bones and then suturing incredible job with what they everything back together to are provided. allow it to heal. Of the other many surgeries I have always had a strong that I saw, there was one that interest in surgery ever since truly resonated with me. I had wanting to do medicine and scrubbed into an orthopaedic look forward to learning more surgery of a man who had about it as I progress through fractured his femur. Due to the course. We are very lack of education and the fortunate to be able to study difficulty and cost of and train in such a medically transportation, he had waited advanced and well-developed an entire year before he country like Australia. I managed to get his femur would encourage us medical repaired and as a result, the students to increase our two broken bones had fused awareness on issues such as together side-by-side leaving X-ray of the fractured femur the unmet surgical need in him with a shortened limb. countries like Tanzania so we This had impacted gravely on scenario for someone living in able to promote global change his overall quality of life and Australia. He underwent an as future doctors. Ultimately, its almost hard to believe that Open Reduction and Internal we can help prevent a he had endured that for a year Fixation of the femur which situation like what I have without any medical involved the surgeons described above from attention as this is an unlikely hammering in steel rods and occurring.

Surgery: Quick Statistics - Australia

Cataracts - Most common reason for elective 2.4 million - Number of hospitalisations surgery (followed by skin cancer and knee requiring surgery per year disorders) 26% - Percentage of hospitalisations that 36 days - waiting time for 50% of patients on included a surgery (59% private, 41% pubic) public hospital elective surgery waiting lists 12% - Percentage of surgeries that were (90% admitted within 252 days) emergencies (83% elective, 4% child-birth $350,383 - The average taxable income of a related) surgeon per annum 55% - Percentage of emergency surgeries 5-6 years - Time to complete the surgical performed on males training program (following completion of a Acute appendicitis - Most common reason for medical degree) emergency surgery (followed by hip fracture and 53 hours - The average time worked by a myocardial infarction) surgeon per week Opinion Piece Bullying in Surgery: M y Ex perience By Pooj a K rishnasw amy (3rd Year)

There is no doubt that From a personal perspective as constrained to a grey area. bullying in medicine is rife, a medical student currently in There will always be a fine particularly towards students a surgical rotation, I have line tread between a sarcastic and trainee physicians. Albeit heard of the difficulties comment that could be taken hidden from the public eye doctors had to endure before as a joke, or instead most of the time, the recent they reached where they are interpreted as something far inflammatory reports of today. Many had to work long more sinister. The interplay of bullying and sexism described gruelling hours, while others people?s individualised by the media last year were forced to tolerate perceptions and reaction highlights just how prominent constant demoralisation from towards these very situations an issue it is for all doctors, their predecessors. ELPD and remarks makes it even regardless of their seniority. teaches us that there should be more problematic to judge and Not only is this a no tolerance policy towards interpret. psychologically taxing on bullying. I also agree that Not only that, there is an doctors, it poses a major there is a trend for the better, existing perception of some impact on patient safety and where junior doctors are doctors that bullying acts as a quality of treatment for establishing a less hierarchical test of emotional strength and patients. system and in retrospect more power. The aim, to weed out of a working-teaching As medical students, our role and separate the weak from relationship. The problem in the clinical setting is the strong. The result, to with a no tolerance policy is unclear in how we can help select individuals that excel that they are increasingly advocate for bullied doctors. I past these difficult and difficult to implement when was curious to find out gruelling ?trials.? The added bullying is so subtle and whether we have the right to and most concerning elusive. step in and what boundaries difficulty is in proving that we could cross. As someone Bluntly, there are cases that these inappropriate who surreptitiously wants to can be effortlessly experiments occur. The fear pursue a career in surgery, I distinguished as bullying. implanted into a victims mind thought I would share my own However, the difficulty lies in of reprisal, impact on career opinion of the current the situations where the and minimization of the perplexing situation that is bullying is not as black and situation only perpetuates bullying. white but instead endemically a never ending cycle of silence, receiving victim can be clearly defined as one might anguish and cruelty. tortuous and ultimately think. You always hear about life-ending. As medical students we have surgery-related bullying It should be noted that the potential to change the allegations in the media; scalpel bullying and harassment is not current toxic culture. We have throwing doctors, intellectual unique to the surgical the chance to learn from past humiliation of junior doctors profession, but rather to the situations and prospectively and students during operations, medical profession as a whole. mould our future practise harassment and propositioning In fact, we have to accept that towards changing our approach for sex, and undermining or bullying is everywhere and in to these difficult and belittling of junior doctors. I most aspects of our daily life. emotionally charged ordeals. It was recently exposed to the From a young age, we try and is only a matter of time before hazing and demoralisation of a fit into established norms and we ourselves are confronted junior doctor and I have to groups, but there is always with these situations. admit it was difficult to watch, someone that we all distinctly As human beings, I think we and even more difficult to stand remember made our life have a duty of care to protect up and say something about it. difficult at one point in time. our colleagues and friends. No It only reminded me that snide Bullying has infiltrated many repercussions should be held and off-hand remarks that you different work sectors, one of against those who advocate and might think nothing of can the worst being the health care speak up for victims of this markedly imprint on another system. It is an underlying toxic culture. Mistreatment individual?s impression of you. issue that needs to be should be reported and You may be competent and addressed. Although there is sanctioned, and culprits held reliable at your job, but other general consensus and accountable. It is our health professionals and acknowledgement that responsibility not only to colleagues are less likely to bullying has become rampant ourselves, but exceedingly to respect and trust you. As in the medical profession, the our future patients to medical students, this is a vivid main challenge is addressing appropriately confront, address reminder that we ourselves and dealing with these and most importantly change should not take our own actions abhorrent situations. and take action against these and words for granted. Unfortunately, the realm of ugly practises. A reminder that the influence tackling bullying appears to be that these words bare on a challenging as it is not as Deak in Surgical Interest Group

Who we are: - Surgical skill workshops which will provide We are a special interest group consisting of opportunities for students to learn and practice Deakin medical students, democratically their skills such suturing, knot tying and elected under M eDU SA, dedicated to catering removing sutures to the anatomy and surgical interest of students studying a Bachelor of M edicine Bachelor of Upcom ing events: Surgery at Deakin University. Anatomy Workshops When: Every Tuesday at 6:30 pm, starting 12 T he team : April 2016 DSIG Chair ? M organ Short Where: Geelong Clinical School DSIG clinical Representative ? Andrew Awad DSIG Preclinical Representative ? John A Cutting-edge Career: DSIG Surgical careers Kefalianos seminar When: Tuesday 26 April 2016, 5:30 pm What we do: Where: Geelong Clinical School DSIG provides opportunities for students to engage with each other, practicing surgeons, DSIG Presents: Women in Surgery and clinical staff in an extra-curricular environment through organised events. When: August 2016 We also liaise with other surgical interest Where: Geelong Clinical School groups inside and outside of Australia to bring you other valuable learning opportunities Surgical skills workshop: including national and international conferences. When: October 2016 DSIG plans to host numerous events Where: Geelong Clinical School throughout 2016. These include: - Weekly anatomy tutorials hosted by surgical Keen to know m ore? trainees from University Hospital Geelong Like us on Facebook to keep up to date with open to any students wishing to strengthen the latest news, events and opportunities. Feel their anatomy free to post any questions or email us at - Seminar evenings where surgeons are invited [email protected] to share stories about their careers and experiences; aimed to advise, inspire and challenge medical students Histor ical Figur es In Medicine

William Stewart Halsted Halsted: A surgeon, pioneer and addict 1852-1922 By Benjamin Paul (3rd Year) William Stewart Halsted was a von Esmarch, amongst others. pioneer of modern surgery in the Armed with new teachings and a US. His life was both intriguing fresh outlook, Halsted returned and complex, filled with daring to the US in 1880 and worked at surgeries, a meticulous work four different New York ethic and hidden addictions. hospitals, where he was a bold Halsted was born into a wealthy and original surgeon, as well as a family from New York, and went demanding teacher. on to study at Yale where he was During this time he performed the captain of the football team. two of his more audacious He furthered his studies at the procedures. The first involved his College of Physicians and sister who was having a Surgeons Medical School in New postpartum haemorrhage York City, where he graduated following the birth of her first near top of his class in 1877. By child. Unable to control the all accounts he was an bleeding, and with his sister enthusiastic, charismatic young approaching a rapid death, man whose knowledge of Halsted transfused his own blood anatomy was second to none. directly into her, saving her life As the House Physician at both and in the process probably Bellevue Hospital and New York performing the first transfusion Hospital he envisioned and in America. A year after this created the very first bedside incident, Halsted again operated charts to track and observe vital on a member of his family, this signs. He then broadened his time on his mother and her skills by travelling to Europe to infected gallbladder. Under learn from the leaders in lamplight at 2am on the kitchen academics and the medical table, he drained pus and profession. This included the removed 7 stones from her likes of Theodor Billroth, Hans gallbladder, again performing one Chiari, Richard von Volkmann, of the first gallbladder surgeries Edoardo Bassini and Friedrich in the US. In 1884, Halsted discovered Osler, and gynaecologist ?Watching Halsted operate was the use of cocaine as a local Howard Atwood Kelly. Here, the first time I ever saw the anaesthetic from which a Halsted was appointed Surgeon upper half of an incision heal story of addiction began to in Chief, and eventually, after before the lower end was unfold. He and his colleagues gaining the trust of the closed.? experimented with cocaine, hospital board following his Amongst his many using themselves and their rehabilitation stint, Professor achievements, Halsted is also medical students as guinea and Chairman of Surgery. surreptitiously credited with pigs. Unfortunately, this led For the next 3 decades, Halsted introducing the use of rubber to the ultimate demise of most worked at John Hopkins gloves during surgery. Caroline involved, Hospital, Hampton, head theatre nurse of and those although the John Hopkins Hospital and wife that were ?Watching Halsted audacious of Halsted, developed dermatitis left, operate was the surgeon he to the mercuric chloride used as including had once been disinfectant during surgeries. Halsted, first time I ever was now but a To avoid this, Halsted wrote to were left vivid memory. Goodyear Rubber Company and with severe saw the upper half During these requested a pair of thin rubber cocaine of an incision heal years, Halsted gloves for Hampton to wear. addictions. became more These gloves proved popular This before the lower reclusive, amongst the other nurses, and hampered started taking eventually the surgeons, though his ability to end was closed.? extended surprisingly, the connection to adequately holidays and asepsis was never considered by perform his began Halsted. duties, and after the operating in a more delicate submission of an almost It was not until some 5 years and precise manner than other later that Dr Bloodgood, one of incomprehensible journal surgeons of the time. His gentle article, Halsted admitted Halsted?s residents, suggested handling of tissue, vigilant that everyone wear them as a himself into Butler Hospital, a reapproximation of tissue rehabilitation centre for drug planes and meticulous care for addiction. He spent the best organs led to great advances in part of the next two years surgical technique. here, finally relieving himself of his cocaine addiction, only Halsted developed new to replace it with a lifelong methods for hernia repair, addiction to morphine. radical breast cancer surgery, bile duct and thyroid surgery, 1889 saw the opening of John as well as teaching the future Hopkins Hospital, one of the generation of exceptional most prestigious and doctors including Harvey influential hospitals in Cushing, Walter Dandy and medical history. Halsted was Hugh Hampton Young. His recruited to start up the new slow and meticulous approach hospital as part of the ?Big did however draw some Four?; four outstanding criticism, such as from Charles physicians including Mayo, who upon visiting John pathologist William Henry Halsted & Cushing Hopkins and observing one of operating at John Hopkins Welch, physician William Halsted?s surgeries noted, matter of aseptic technique. The irony was not post-operative bronchopneumonia and lost on Halsted who quipped, ?Operating in consequently died on the 7th of September gloves was an evolution rather than an 1922, leaving behind his wife Caroline and inspiration or happy thought ? it is remarkable their two dachshunds, ?Nip? and ?Tuck?. that ? we could have been so blind as not to William Stewart Halsted?s life and career will have perceived the necessity for wearing them be forever remembered for shaping the world invariably at the operating table.? of surgery. He has been the feature of many In 1919, Halsted developed obstructive biographies and documentaries, as well as the jaundice and cholecystitis, and underwent a source of inspiration for the current TV show cholecystectomy and choledocholithotomy. He ?The Knick? on Cinemax staring Clive Owen. recovered well from this, however, three years Through his heroic acts and debilitating later in 1922, he once again became severely addictions, influential teachings and changing unwell with marked jaundice. After travelling personality, Halsted certainly remains one of to John Hopkins, where his residents the most interesting and intriguing individuals successfully operated on him to remove stones to ever grace the field of medicine. in his common bile duct, he developed

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During my surgical rotation in third year, I was involved in the auditing of surgical complications that had occurred within my unit. Unfortunately, surgical complications are inevitable. However, we should ensure that we reflect on and understand these complications so that we may minimise the risk of them occurring from them. This principle is not specific to surgery and can be applied to any medical speciality. As part of the audit, I retrospectively analysed a patient?s case and attempted to identify complications that might have caused an adverse outcome in this patient. Through this process, I was able to learn about systems for classifying and communication surgical complications. The Clavien-Dindo system for classification of Clavien-Dindo Classification System: surgical complications was born from a lack of consensus on how to categorise and grade Grade I - Any departure from the standard post-operative course that did not require any surgical complications. In 1992, Clavien-Dindo pharmacological, surgical, endoscopic or et al. proposed a new classification system that radiological intervention. appeared to be valid and highly reproducible for quality assessment in surgery.1 It is based on Grade II ? A pharmacological intervention was used that would not otherwise be used as part of the type of therapy that was required to rectify standard post-operative care is used to rectify a a complication and is the standard for surgical complication. auditing world-wide.2 Grade III ? A surgical, endoscopic or radiological The Patient intervention was required for a complication. A 70 year old woman presented to the IIIa - The intervention did not require emergency department with nausea, general anaesthesia. post-prandial vomiting and declining food and IIIb - The intervention required general fluid intake in the setting of a localised anaesthesia. squamous cell carcinoma of the distal oesophagus diagnosed two years ago. Her Grade IV - A complication occurred that was symptoms had been present over the past year life-threatening. but had worsened to intolerable levels over the IVa - Single-organ dysfunction occurred. past week. She reported regular night sweats IVb - Multiple-organ dysfunction occurred. but had no fevers, abdominal pain, bowel or Grade V ? The complications resulted in the death urinary changes. of the patient. Her past history included chemotherapy and radiotherapy for her oesophageal cancer a year prior and an oesophageal dilatation performed earlier that year. She had a significant and extensive smoking history which had not been quantified at any point during her previous admissions. She also had a long-standing history of depression and anxiety, exacerbated by her cancer. On examination, the patient appeared unwell, dehydrated and cachectic. Vital signs were within normal ranges and she was afebrile. There was no evidence of lymphadenopathy, masses nor any other remarkable findings. The unit?s slipped oesophageal stent. This represents a impression was of a patient who was grade IIIa complication (general anaesthesia dehydrated and malnourished as a result of an was not used). obstructive distal oesophageal SCC. The gastrotomy was performed to remove the Management, Complications and Outcome same stent. This demonstrates a more invasive grade IIIb intervention under general Shortly following admission under the anaesthetic. The atrial fibrillation and medical surgical team, a gastroscopy was performed intervention for this was a deviation from the with a stent inserted in the oesophagus to standard post-operative course and is thus a relieve obstruction. However, an X-ray grade I complication. The final two showed that this stent had migrated distal to gastroscopies performed to reinsert, reposition the gastro-oesophageal junction. This and fasten the stent represent two more rendered it ineffective and a threat to the examples of grade IIIa complications. distal gastrointestinal tract. Two days later, another gastroscopy was performed to rescue Discussion the stent but failed. Communication is essential to all aspects of Three days later, a laparoscopic gastrotomy medicine. Universally used systems are often was performed to remove the rogue stent. The devised to ensure information is next day, the patient was found be febrile and communicated in a clearly understood and tachycardia. She had developed new-onset reproducible way. The Clavien-Dindo system atrial fibrillation. It was believed that this one such example of these. may have been caused by an underlying Complications and adverse events are an infection. Tazocin and metoprolol were unfortunate reality. When they do occur it is prescribed. However, the patient remained in imperative that we reflect on these incidents. asymptomatic atrial fibrillation. This allows us to better understand why they Four days following her gastrotomy, the have occurred and develop methods to prevent surgeons made another attempt at them from happening. We should use these gastroscopic insertion of an oesophageal stent. events as opportunities for improving patient However, once again, an X-ray found that this care and providing teaching and assistance stent had slipped out of place. Another those that need it. For example, in this gastroscopy was performed the next day to instance, I presented these findings to a reposition the stent and hold it in place with surgical unit. After some discussion it was resolution clips. agreed that resolution clips to hold the stent in Eleven days after her presentation, the patient place should have been used earlier in the was discharged the next day following three patient?s care, after the first stent slipped out gastroscopies, two oesophageal stents, a of place (side note: these stents are also laparoscopic gastrotomy and persistent atrial exceptionally expensive! ). fibrillation. Conclusion Application of the Clavien-Dindo System In terms of direct relevance to the Deakin to this case medical student, in their surgical rotation, 3rd years are expected to submit an assessment on We can apply this system to the complications a patient who has encountered post-operative encountered along the patient?s pathway of issues. The Clavien-Dindo system might be a care introduced earlier. Firstly, gastroscopy good framework to reference when reflecting was performed, but failed to retrieve the on how complications unfolded. Vict orian M ed ical W om en' s Societ y (VM W S) Prof iles: Dr. Ely sia Rob b Int erv iew b y Sy lv ia Ye (4 t h Year)

Dr. Elysia Robb is a mother of two, partner of one, daughter and sister of many and part-time intern. She completed her MBBS, graduate-entry at Melbourne in 2014. She grew up in the country and before medicine had been busy ? including a yearlong exchange in Panama, a BBiomedSci degree and Honours and a career in Alzheimer's Disease research. She has a keen interest in public health and was previously involved in Teach the Teacher, a program aimed at bettering sexual education in schools and hence sexual health in our community. She is currently an active member of the Victorian Medical Women?s Society, as a general committee member and plays a role in coordinating the VMWS student representatives. Elysia is a proud feminist and equalist and is grateful for the ability we have in Australia to choose to work or to stay-at-home. Elysia had her two beautiful kids while at med school and since becoming a mother, Elysia has become even more passionate about equality for women and men. Elysia has faced many challenges juggling babies, breastfeeding and medicine. In her spare time - for the most part, her past-life - she loves listening to music, playing the guitar, dancing and teaching salsa and dancing flamenco. What does VMWS mean to you and why do you believe it is important to have a medical society dedicated to women? I became involved in VMWS as a student; I attended some events that included presentations about disempowered groups such as women, refugees and asylum seekers. Then I became a student representative and started attending committee meetings and most VMWS events, where I interacted with and was supported by a large group of difficulties have lessened with time and I established medical women. predict that when I have finished my internship at the end of the year, I will feel VMWS means support for me personally and like I have had an excellent experience. professionally. It means supporting minority groups who need it, which applies to me both Part-time internship is an excellent, and very personally and professionally as well. I find rare, opportunity. Although it has many women-only events to have a personal disadvantages, mostly because it is very new, vibe, very different I believe there are many ways to to open events. improve the program and that it can Although it may 'Part-time only get better from here. I hope seem exclusive, I part-time junior doctor positions, for really appreciate internship is an both women and men, increase in the opportunity to numbers in the coming years, and I experience such think this will positively and greatly women-only excellent, and influence the nature of part-time events, whereby I junior medicine. In an ideal world I feel safe to express very rare, would like to have as much time with myself honestly my family as I currently do, and to and others seem to work full-time at the same time! also. I like hearing opportunity' factual and evidence-based Is there a particular specialty or area information, but I really enjoy hearing that you would like to go into and why? personal and anecdotal stories at VMWS Although I am still unsure, currently I am events and feeling the emotional most interested in obstetrics and atmosphere. Women admit and discuss gynaecology, oncology and palliative care. things in our spaces that they perhaps These interests stem from my interest in wouldn?t otherwise. As a part-time intern, the women?s health, locally and globally, and first and only one at my hospital and only one probably my own wonderful personal of eight ever in Victoria, I really benefit from experiences in gestating, birthing and debriefing in the VMWS. parenting. How has intern year treated you so far? Can Due to my previous career in biomedical you tell us a little bit about the part-time science, I really enjoy molecular based internship and how have you juggled two research and hope to re-enter this field one children and a busy job? day. Perhaps this influences my oncology I am very grateful for and lucky to have the interests. Recently I have also become very opportunity to do my internship part-time. interested in general practise. In particular, I There are many positive aspects of this. First like the continuity-of-care and the lifestyle and foremost, having plenty of time with my friendly training program and consultancy it family ? making for a very manageable and offers. happy home life. Yet it has been quite a As a junior doctor, what do you believe are difficult year so far for many reasons, some of the biggest issues regarding especially since I am the only part-timer. In women's health or women in medicine? particular it is difficult to not be totally immersed in medicine in my first year out With regard to women in medicine, I think the and it is an extremely difficult way to attempt biggest issue is trying to mix work with to establish a career. I.e. I imagine going back family, finding a partner and/ or having to an established/ specialist job part-time children. This is probably one of the major would be far easier. Progressively, these reasons that there is a relative lack of women in senior positions in medicine, and hence can Do you have any advice for female doctors to account for some of the sexual harassment balance work, family, friends and finances? and bullying that has recently been a focus in medicine. It is extremely difficult for a Choose what is important to you and do not woman or man to find a part-time job as a worry about what others are doing or junior doctor. Little paternity leave thinking. I realise this is easier said than done. entitlements for men puts the obligation on Don?t hesitate to ask for things that you need, women to take time off to look after their or to ?rock the boat? as they say, for things like children and in the meantime neglect their flexible training, maternity leave, careers. Also, society often expects women to breastfeeding rights etc., and don?t be afraid do the majority of childcare and household to do them. Don?t hesitate to ask repeatedly tasks, and doesn?t expect, encourage and/ or for things you really need. Get help, support allow the same of men. and advice the whole way through. VMWS is great for this! As a junior and female doctor, are you worried at all about bullying or having your If you?re thinking about having children, or work and achievements acknowledged thinking about thinking it, there is no best or equally? worst time in our medical careers to do so. The only worst time is when it is biologically As a junior doctor I do worry about the difficult and in a highly demanding career like expectations placed on us by our seniors. I do medicine, we can easily get side-tracked. think there is a difference in how men and women are perceived in the medical workforce however I am not aware of having For more information about VMWS, go to: experienced this firsthand. I haven?t worried http://afmw.org.au/vic about not being acknowledged equally due to being a woman, but I am very junior in my career so perhaps I haven?t got to a point yet where this exists. I have been in situations where patients have seemed to trust my male colleagues more than me. Once as students, a patient mistakenly asked me where the male doctor was. He was not yet a qualified doctor, but the patient had assumed he was ? perhaps because he was male, probably also because of his demeanour. In addition to this, I am part-time so I worry a lot about not having my work and achievements acknowledged equally. I am the first one and the only one at my hospital, so a bit of a guinea pig and have no one to compare myself to or to be compared to. I have had some difficult encounters at work relating to this, I think this is because some people don?t understand that I have other priorities. Elective Report: The Victorian Institute of Forensic Medicine By Dr. Corey Thompson (Class of 2015)

The elective rotation is one of the (VIFM) in Melbourne gaining may be explaining to a jury most exciting things to look insight into forensic pathology how a patient died in a murder forward to for fourth year. and clinical forensic medicine. trial or a detailing extent of Unfortunately it is something Whilst this might seem like an injuries and how they might that requires reasonably great odd choice when many are occur (e.g. bruises) in a preparation with a tiny bit of choosing to pursue electives in domestic violence hearing. It is soul searching. It is important to tropical locations, pathology is a interesting to see when the decide what kind of elective highly important area of defense gives the doctor a hard experience you are trying to medicine which underpins time and tries to refute their achieve (observational vs hands EVERY medical speciality. You findings or question their on, full time attendance and will be better prepared to appear knowledge. expectations vs no real in court, write medical reports, I commuted from Geelong expectations, contact and death certificates and documents throughout this elective, interest building for future which are often overlooked in which did have its downfall of career vs exploring unique fields conventional medicine teaching. very long days. Many aspects of medicine). When most people think of are also confronting, however I spent 6 weeks at the Victorian VIFM they think autopsies, of the quality of teaching and Institute of Forensic Medicine which 8-20 are completed every supervision was amazing. day. There is ample opportunity Motivation is essential to get for the interested student to be involved, with all staff very involved in processes such as the approachable and receptive to weighing of organs, preparing the student learning samples for photographs and experience. It is recommended dissections. Police reports, case you apply early at least one files, pathology and radiology year ahead of your predicted meetings are also accessed on site time, as VIFM is a popular to pull together information and choice for students across determine cause of death to Victoria. Most of the places are present to the coroner. reserved for Monash University selective students There were also many offsite as VIFM forms part of the activities such as courts, clinics Monash University and toxicology meetings. department of medicine. Be Pathologists and clinical sure to have a read of the medicine physicians are elective reports from myself 9 way teaching microscopy ? I frequently summoned to court to and other students who have bet you haven?t seen one of be an expert witness and detail been to VIFM. these before! their findings to the court. This Thank s f or read ing ! M ak e sure t o f ollow M eDUSA f or t he lat est up d at es

http:/ / www.medusa.org.au/ https:/ / www.facebook.com/ medusa.deakin/

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References for article page 6 http://www.aihw.gov.au/hospitals/surgery-2010-11/ http://www.smh.com.au/national/surgeons-make-the-cut-as-our-highestpaid-20130503-2iyma.html http://www.surgeons.org/becoming-a-surgeon/ http://www.surgeons.org/media/21893722/2015-06-05_rpt_-2014_census.pdf References for article pages 12-13 1) Dindo D, Demartines N, Clavien P. Classification of Surgical Complications: A New Proposal With Evaluation in a Cohort of 6336 Patients and Results of a Survey. 2004. Annals of Surgery; 240(2):205-213. 2) Clavien P, Barkun J, de Oliveira M, Vauthey J, Dindo D, Schulick R, de Santibanes E, Pekolj J, Slankamenac K, Bassi C, Graf R, Vonlantehn R, Padbury R, Cameron J, Makuuchi M. The Clavien-Dindo Classification of Surgical Complications: Five-Year Experience. 2009. Annals of Surgery; 250(2):187-196. Image Credits Front Cover Illustration: Kate Thimbleby (2nd Year) Page 4: http://brightone.org.uk/wp-content/uploads/2015/02/we-want-you.jpg https://uccomm2004.files.wordpress.com/2014/09/patrick-dont-touch-me-im-sterile.png Page 5 & 6: https://upload.wikimedia.org/wikipedia/commons/thumb/8/83/Tanzania_in_Africa.svg/1084px-Tanzania_in_Africa.svg.png Madison Phung Page 7: http://www.theage.com.au/content/dam/images/1/3/x/v/l/a/image.related.articleLeadwide.620x349. gh9rt5.png/1441796080874.jpg Page 9: http://www.newyorksocialdiary.com/legacy/i/partypictures/02_09_10/halsted.jpg http://www.uchicagoartsalumni.org/images/article_images/6.jpg Page 10: http://media.trb.com/media/photo/2011-07/63405614.jpg http://40.media.tumblr.com/tumblr_ma3iby7Z0D1qzcf71o1_1280.jpg Page 14 & 16: Alysia Robb (& Sylvia Ye) Page 17: Corey Thompson Page 18: http://www.toonpool.com/user/15633/files/brain_surgeon_1630445.jpg