Surgical News] PAGE 3 August 2010

urgicalVol: 11 No:7 August 2010 STHE ROYAL AUSTRALASIANnews COLLEGE OF SURGEONS

THE DEADLY EARS PROGRAM Helping children to hear, learn and talk. PAGE 22

[8] [14] [40] EDSA TRAINEES A NEW EYE CORNER ASSOCIATION PROGRAM Clear lessons can be The College has much The College’s East Timor’s The College of drawn from the Jayant to gain from a Trainee Eye Program is soon to be Surgeons of Australia and Patel case in Queensland. voice on Council. modelled in Sumba. New Zealand It’s easy Medfin makes finance easy with: • Appointments at a time and place that suits you • Fast response • Minimum paperwork • A service designed for surgeons • No deposit finance, with no additional security1

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Medfin – finance for your: Car • Equipment • Practice • Cash flow needs medfin.com.au

Important information: 1. Approved customers only and subject to credit assessment. Terms and conditions apply. Fees and charges may apply. Medfin Australia Pty Limited ABN 89 070 811 148. A wholly owned subsidiary of National Australia Bank Limited an part of the NAB Health specialist business. (RACS8/10)

Royal Australian College of Surg1 1 13/07/2010 10:22:31 AM PRESIDENT’S PERSPECTIVE

It’s easy Post Fellowship Training Where appropriate, the College will acknowledge post Fellowship training programs Medfin makes finance easy with: • Appointments at a time and place that suits you • Fast response • Minimum paperwork • A service designed for surgeons • No deposit finance, with no additional security1 Ian Civil President Want more information?

Contact your local Medfin Relationship Manager ost Fellows would be aware that on 1300 361 122. it is common these days for newly Mqualified surgeons to spend some time doing additional specialised training after Don’t have time to phone? completing their Fellow of Royal Australasian College of Surgeons (FRACS). Indeed it has Visit medfin.com.au and request a quote online. been common for many years for young surgeons to spend time overseas in formal or informal positions before coming back to work in Australia and New Zealand. Over recent years, increased surgical spe- cialisation within the major urban areas of Australasia and decreased access to the job markets of particularly United Kingdom and United States of America has meant more post- FRACS training is undertaken here. When surgeons have completed this add-on experience they usually highlight this as a component of their scope of practice when being credentialed As with the University relationship, the for their definitive appointments. What can be quite difficult, given the extent and diversity “College has no interest in restricting the of post-FRACS training, is determining the availability of any post-Fellowship trainingnn real quality of that additional education and training and ensuring that it is appropriately ” understood, particularly in credentialing and lege. It is a key component of the College ef- for a specific specialty through that Specialty’s employment processes. fectively partnering with other educational Training Board.Recognising the crucial relation- Realising that “post fellowship (FRACS) providers to ensure increased educational op- ship the College has with the nine disciplines training” was a reality, the College determined portunities for all of us within a framework of that comprise its Fellowship, any post Fellowship that it would be helpful for Fellows and Train- educational standards and reliable delivery. program has to have the support of at least one ees completing their training, the surgical of these disciplines. Sometimes if the surgical pro- community and potential employers if such Determining quality gram impacts a number of disciplines they may training was to be accredited and then, if the As with the University relationship, the College have the support of more than one discipline. standards were appropriate, to be co-badged has no interest in restricting the availability of However, that is not essential to proceeding for with the College’s quality standard. any post-Fellowship training. Rather the College accreditation. While a number of subspecialty Medfin – finance for your: Car • Equipment • Practice • Cash flow needs This is a very similar approach to the Col- purely seeks to determine the quality of the pro- groups run post Fellowship training programs, medfin.com.au lege now working with a number of education- grams that are submitted to it and accredit and the College has no wish to enter into independ- al providers particularly Universities, where co-badge those that meet the required standard. ent relationships with them. On the other hand, Memorandums of Understanding (MOU) will These relationships need to build on the strengths where proposals originate from a subspecialty govern the relationship between the two (or of the College and so the relationships with Uni- group and are supported by one or more socie- more) organisations and the specific courses versities work under the oversight of the Educa- ties representing the nine disciplines then, if they will be accredited and co-badged by the Col- tion Board through the Skills training area or meet the standard, the College will accredit them. u Important information: 1. Approved customers only and subject to credit assessment. Terms and conditions apply. Fees and charges may apply. Medfin Australia Pty Limited ABN 89 070 811 148. A wholly owned subsidiary of National Australia Bank Limited an part of the NAB Health specialist business. (RACS8/10) [Surgical News] PAGE 3 August 2010

Royal Australian College of Surg1 1 13/07/2010 10:22:31 AM PRESIDENT’S PERSPECTIVE Monash University > Medicine, Nursing and Health Sciences > Surgery > Cabrini > Info

Increasing pressures The Sir Edward Hughes The standard is determined by a post Fellow- Memorial Clinical Research ship training program assessment committee. This is comprised of a majority of surgeons Prize in Surgery 2010 from non-interested specialties, but crucially involves representatives from not only the spon- soring discipline, but also the other disciplines The Cabrini Monash University Department of Surgery with potential crossover interests in the area of together with the Cabrini Institute - Education and Research the proposed subspecialty training program. and Johnson and Johnson Pty Ltd are pleased to advise that The College recognises the increasing and the competition for the prize will be held at Cabrini Hospital, conflicting pressures of generalism and spe- 16th October 2010. The prize is open to application by all cialism in surgical practice and is not driving surgical residents and registrars who have entered or intend surgery towards specialism. In fact, the College entering an accredited surgical training program. recognises that both effective generalism as well Successful completion of the Primary examination of the RACS (or as skilled specialism is needed to deliver quality equivalent) is a prerequisite for application. The trainee must be the principal surgical care in each of the nine disciplines. Post author, and have contributed the majority of research work for the project. Papers must relate to a topic of predominantly clinical significance in surgery. Fellowship training has long been with us and, The abstract should be arranged as follows: Purpose, Methodology, Results because of various pressures on the training and Conclusions. process and the workplace, seems to be increas- An abstract of no more than 250 words will be required to be submitted by ing. The College does not intend its post Fel- 5pm Friday 27 August, 2010. The ten finalists selected will be contacted and lowship process in any way to drive specialism, names listed on this web site by 20th September 2010. but rather to put such post Fellowship training Ten finalists will be selected for presentation of a seven-minute paper with as does exist into a quality framework, if the three minutes to respond to questions. An objective pre-formatted point providers of such training so prefer. system will be employed to determine the winner. Judging will be along the guidelines of the Surgical Research Society, with special emphasis given to the It is on this background that the informa- clinical significance of the topic. The panel of invited judges will be selected tion about the College accrediting courses and from clinical surgeons, physicians, academics, basic researchers and ethicists. more importantly newly accredited post Fel- The prize is sponsored by Johnson and Johnson Medical Pty Ltd and consists lowship training programs must be considered. of AUD$6000 and a shield. Firstly that, in line with the College policy, the program must have the support of at least 2009 Dr Tarik Sammour: Warming and humidification of one of the nine specialty groups. Secondly, the insufflation gas in laparoscopic colonic surgery - a double- PREVIOUS blinded, randomised, controlled trial. quality of the proposed program has been as- WINNERS 2008 Dr Michael Wyatt: TOUGHEN UP – too high a price sessed as adequate and that required reports to pay for the best lamb in the world? which will be defined in the subsequent Mem- 2008 Dr Anubhav Mittal: Proteomic Changes in Mesenteric orandum of Understanding will ensure it is de- Lymph Secondary to Haemorrhagic Shock 2006 Dr Alkis J Psaltis: An animal model for the Study of livered effectively. Finally, in those areas where Biofilms in Rhinosinusitis there are overlapping areas of interest from 2005 Dr Sebastian King: Colonic Manometry in Paediatric Abstracts and/or { more than one specialty group, the College will Slow Transit Constipation Shows Consistent Deficiencies approve more than one post Fellowship pro- presentations must in Propagating Contractions: Manometric Evidence of a be submitted by New Disease gram if suitable quality applications for such disk or email with 2004 Dr Mehrdad Nikfarjam: a contact phone Hyperbaric oxygen therapy programs are received. improves survival and reduces severity of acute severe number and pancreatitis address to: 2004 Dr Naeem Samnakay: Morphology & Apoptosis Clinical Assistant In The Ovine Fetal Kidney In Prenatal Bladder Outflow Cabrini Monash Obstruction University SPECIALIST CONSULTATION 2003 Dr Adam Stewart: A pain control infusion pump for Department of post-operative analgesia following inguinal hernia repair: a ROOMS IN SYDNEY AVAILABLE Surgery double-blind, randomized controlled trial. Cabrini Institute FOR SESSIONAL RENTAL. 2002 Dr Shomik Sengupta: Cabrini Medical Butyrate delivery to the distal Centre colon suppresses colorectal tumorgenesis in rats. 2001 Dr Paul Moroz: Targeting liver tumors with Chatswood. Archer Street. Very close to 183 Wattletree hyperthermiz: arterial embolisation hyperthermia in a trains and buses. Recently renovated. Road, Malvern, small animal model. Victoria 3144 Car space available. 2000 Dr Marins Pirpiris: Australia Iatrogenic crouch gait: an avoidable complication of calf lengthening. Email: institute@ For more information, contact cabrini.com.au 1999 Dr Charles Douglas: A randomised trial of P: +61 3 9508 1651 ultrasonography in the diagnosis of acute appendicitis 0410482838 or 0410246554, incorporating the Alvarado score. F: +61 3 9508 1657 or email [email protected].

[Surgical News] PAGE 4 August 2010 RELATIONSHIPS & ADVOCACY

Politicians face the hard questions The College has asked the major parties to respond on health policy issues

tected time and appropriate remuneration for The College is opposed to the recognition of the training function. cosmetic medical practice and podiatric sur- Keith Mutimer We also argued that government must gery as medical specialties, believing that they Vice President work with the College on a sustainable model constitute a serious risk to patient safety. for the adequate funding of the College’s role in The document also stresses that systematic n the last several state elections, the Col- assessing and accrediting new and established auditing of processes and outcomes in Austral- lege has written to the major political par- training posts. ian health systems is fundamental to ongoing Ities seeking their responses to key health improvement in patient care, as is peer review of policy issues relevant to surgery. Patient safety health professionals’ work. Among our recom- We are now expanding this concept to the The Manifesto reminded the Government and mendations is that government work with the forthcoming Federal Election. To provide guid- Opposition that the College has been at the fore- College on a nationally coordinated and proper- ance to the parties, the College prepared a doc- front of patient safety initiatives including the ly resourced approach to audit and review proc- ument which highlights the important health Correct Patient, Correct Procedure, Correct Side esses to enable comparisons of performance issues pertaining to the practice of surgery. The and Correct Site Surgery protocol and, more within and between health jurisdictions. issues canvassed were by no means exhaustive, recently, the Surgical Safety Checklist. These We also called on the Government to en- but are those the College believes will, if ad- initiatives, among many others, demonstrate the sure certainty of funding for the Australian dressed, deliver the best outcomes for patients College’s commitment to this vital issue. Safety and Efficacy Register of New Interven- through improved surgical practice. The College asserted that the recognition of tional Procedures – Surgical (ASERNIP-S). As has been our custom in state elections, the surgical specialties is a critical patient safety issue, This unit is ideally placed to assist the Govern- College will assess the political parties’ responses and only those with a medical degree and special- ment in establishing and maintaining rigorous and make them and our commentary publicly ist surgical training can safely perform surgery. and transparent methodologies to ensure that available to our Fellows and Trainees in the last International Medical Graduates (IMGs) the healthcare dollar is spent in the safest and week of the campaign. The aim is to ensure that are key to addressing workforce shortages. It most effective manner. Fellows and Trainees have a clearer understand- is therefore imperative that IMGs seeking em- ing of the policies and drivers of the major parties ployment are thoroughly assessed, properly Regional and Rural Australia and can cast a more informed vote on election supported and adequately resourced and that As Australia’s population ages and demands on day. The College’s 2010 Election Manifesto identi- government strongly supports the College’s as- the health system increase, Australia’s surgeons fied five key areas in the election campaign. sessment processes. also age, with an increasing number of surgeons Recent tragic events in Bundaberg illustrate contemplating retirement. An already critical Future Workforce what happens when trained clinicians do not have situation in regional and rural Australia is about This covered key issues such as the need for the opportunity to determine who is, and who is to deteriorate further. Measures must be imple- more training posts and the extension of train- not, capable of operating safely on Australians. mented to address this developing crisis. ing into the private sector. We argued that gov- However, it is not just in the assessment of The relatively insufficient funding of region- ernment must support trainers, ensuring pro- IMGs that clinician advice is being overlooked. al and rural hospitals resulting in inadequate u

Correspondence to Surgical News should be sent to: Surgical News Editor: David Hillis [email protected] © 2010 Royal Australasian College of Surgeons Letters to the Editor should be sent to: All copyright is reserved. [email protected] The editor reserves the rights to change material submitted The College privacy policy and disclaimer apply – www.surgeons.org Or The Editor, Surgical News Royal Australasian College of Surgeons The College and the publisher are not responsible for errors or consequences from reliance on information in this publication. Statements represent the College of Surgeons Gardens views of the author and not necessarily the College. Information is not 250-290 Spring Street intended to be advice or relied on in any particular circumstance. East Melbourne, Victoria 3002 T: +61 3 9249 1200 F: +61 9249 1219 Advertisements and products advertised are not endorsed by the College. W: www.surgeons.org The advertiser takes all responsibility for representations and claims. Published for the Royal Australasian College of Surgeons by RL Media Pty Ltd. ISSN1443-9603 (Print) ISSN 1443-9565 (Online) ACN 081 735 891, ABN 44081 735 891of 129 Bouverie St, Carlton. Vic 3053.

[Surgical News] PAGE 5 August 2010 RELATIONSHIPS & ADVOCACY

infrastructure and leave arrangements has ren- some of these problems can be addressed by a dered them an unattractive workplace for young- commitment to greater efficiency, there can be er surgeons. Inefficient management structures no denying the need for greater investment in within hospitals, and the often top-heavy and our public hospital system, and in its workforce. overly bureaucratic management of Health Areas No matter how well governments resource COCHLEAR IMPLANTS by government, has exacerbated the problem. commitments to preventative health, integrated It was also noted that educational and primary care, and aged care, this decline in bed training arrangements are such that the option numbers represents a dangerous under invest- PROFESSIONAL STANDARDS of working in regional and rural Australia is ment in the health system. The problem will only inadequately encouraged. become more pronounced as our population ages. FELLOWS IN THE NEWS Support for the further development, ca- Following on from its work on the Emer- reer coaching and mentoring of IMGs working gency Surgery Consensus Statement, the COLLEGE AWARDS as surgeons in regional and rural Australia is College sought Government support to be- essential if they are to be a sustainable resource gin the process of reviewing and redesigning INTERNATIONAL DEVELOPMENT to Australia. The Commonwealth should facil- emergency care. The College also stated its itate access by IMGs to educational up-skilling support for the establishment of separate The current Federal Government’s health opportunities either through existing College structures for elective and emergency sur- RELATIONSHIPS & ADVOCACY reforms fall short of the single funder model. training programs or specifically developed gery. This may involve physically separate Rather, they have merely rebalanced the pro- IMG education/up skilling programs. facilities or, at the very least, separate streams portions of health funding provided by the There needs to be greater provision of allied within the one facility. state and federal levels of government. This medical services, such as nursing, anaesthetist, will not end the so-called blame game. pathology and radiology services, in rural and Funding While the College acknowledges that sin- regional areas in order to attract the interest of The parties were reminded that the College has gle funder is a longer term objective, we would younger surgeons. long been on the record as a supporter of a sin- support any sensible reform that indicates that Where possible, increased resourcing of re- gle funder health system. It remains so. this model is its ultimate goal. gional and rural hospitals should include per- Previously, blame and cost shifting be- The Election Manifesto represents an excel- sonnel to recruit surgeons and help manage their tween federal and state governments was rife. lent opportunity for the College to put forward transition into the hospital and local community. With both tiers of government providing some its position on a range of important surgical The accreditation of base hospitals as regis- funding for the health and hospital system it issues in the context of an election campaign. trar training posts would have a beneficial effect was inevitable that each would blame the other on surgeon numbers in regional and rural areas. when things went wrong. Experience suggests that surgeons trained in a The Rudd Government was elected with a regional or rural hospital are more likely to re- mandate to “end the blame game”. While the main there once their training is complete. AUSTRALIA DAY College recognises that the reforms introduced I look forward to sharing the parties’ in this term of Government are a step in the right feedback and the College’s response Access to Care direction and have many laudable aspects, they to it closer to polling day. In the The Manifesto argued that elective surgery wait- do not go far enough to deliver the certainty of meantime, the full Election Manifesto ing lists are symptomatic of longstanding prob- funding and the transparency and accountabil- is available on the College’s website, lems in Australia’s public health systems. While ity which patients and tax payers require. www.surgeons.org

RAMSAY FELLOWSHIP - PROVINCIAL SURGEONS - 2010 The Ramsay Fellowship was established through a bequest following The Fellow must spend a major part of each week at the appropriate institution donations made in 1986 and 1993 by Mr James Ramsay, AO, and subsequently and give a guarantee to continue in practice in his local area on completion of through the generosity of Mrs Diana Ramsay, AO. This Fellowship is only the Fellowship. There is no application form. A letter of application should be available to provincial surgeons in Australia or New Zealand and is designed forwarded before the end of September 2010 to the Scholarship Coordinator, to enable such surgeons spend time developing their existing skills or acquiring PO Box 553, Stepney SA 5069, or by email to [email protected]. new skills away from their provincial practice. The Fellowships can be taken for a period of two weeks (one Fellowship The following details should be included: of $5,000); or a period of one week (three Fellowships each of $2,500); or a • The intended Fellowship duration; combination of the above. • An outline of the experience or skills you aim to gain through the The Fellowship grant is intended to contribute substantially to: Fellowship and how • Return airfare to city (cities) of choice; this will benefit your current practice / hospital; • Daily living allowance (travel, meals, accommodation, ongoing practice costs); • The locations to be visited in order to achieve your aim; No additional amounts are payable for travel or accommodation for family, • A written confirmation from the institution where you are to gain your skill locum costs, insurance, or any other unspecified costs. or experience. • A brief outline of the costs associated with acquiring the skills & experience. The Fellowship does not incorporate payment for or arrangement of a locum. • Two written supporting references. However, assistance in arranging a locum, if required, can be obtained from the Rural Services Department at the College on +61 3 9276 7407. NB: This Scholarship is open for travel in 2010.

[Surgical News] PAGE 6 August 2010 NEW TO COUNCIL

Long service to the College Some proper respect to people with special talents

his/her allotted nine years (did you all notice the she has probably contacted a quarter of the “her” in there showing that I am not a chauvin- Fellows to ask for verification. I hope that you ist). Each of these persons has more experience could do so if she phones you! in their area than any councillor. Lastly Kathy Hickey – she is master of all. Her I.M.A Newfellow Now Toula is usually known as Toula, as her official title is Director of Education, Develop- last name can challenge some of us to pronounce ment and Assessment. In essence, this is exams have been discourteous, disrespectful, im- it properly, although the President did make a val- and courses. This area of the College activities is polite and inconsiderate. I have shown a iant effort at the morning tea. Unless you are an the very core of our functions. Ilack of praise where praise is due, I have International Medical Graduate (IMG) you may So there we have it – 50 years of service in not acknowledged achievements and I have not know her. She is the person who organises four persons. But there are others in our em- ignored them all too long. They are largely fe- the Australian Medical Council assessments of ploy who have given two years, five years, 10 male, so I have also been a chauvinist. This is IMGs, runs the assessment and supervision proc- years or more. There are 180 of them all over a little of what Mrs Newfellow said to me after ess of the College. About 100 such assessments our two countries doing the many tasks that my entirely innocent remark following the last are done per year and about 70 active assess- we set them, running our organisation. It is Council meeting. ments are being followed at any one time. they who really run surgical training and ed- My error was that I had mentioned that some If you are a New Zealander, the name of ucation, surgical outreach and international staff members were acknowledged for their long Justine Peterson may strike a little fear into your programs, surgical CPD. Many are women, but service to the College during morning tea on soul, but always respect. Justine has run the some are men; many are younger, but some are Friday. I think that I may have said that a few of New Zealand (NZ) office for 15 years and there older; many are in Melbourne, but some are “the girls” had had a bit of a function. “Girls, they is not a thing that happens in NZ that she does elsewhere. We acknowledge and thank you all. are not girls! They are a mature group of women not know about. If you are a NZ based Trainee So you see, Mrs Newfellow, that I am not with special talents and you should show them and think that you can fudge your log book – a chauvinist. Indeed I could never have been due consideration and respect.” don’t. She knows about it before the thought one as the meaning of the word has been cor- So here I go with due respect and considera- even reaches your consciousness. If you are a rupted. Nicholas Chauvin was a semi-mythical tion. The “girls”, as I so wickedly named them, NZ Fellow and need some information about soldier who was said to have served under were Toula Panagopoulos, Justine Peterson, the College, just ask Justine – she will know. Napoleon Bonaparte in the French Revolu- Kylie Mahoney and Kathleen Hickey. Many Fel- Two and half per cent of College Fellows tion and the Napoleonic Wars. This means he lows may only vaguely know these names, but should know the name of Kylie Mahoney as was on active service for at least 26 years. The in some areas their names are well known and she has been involved with the running of the French word “chauvinsme” meant a blind and perhaps invoke a slight amount of fear. Between Continuing Professional Development (CPD) unwaveringly zealous devotion to a nationalist them they have 50 years of service to the Col- program and that is the percentage of Fellows cause, and not a gender based bigotry. But then lege. That is 50 years of experience, more than who are asked each year to verify the data that along came those chauvinistic feminists and five times what any Councillor can achieve in they have submitted. In her 10 years of service hijacked the term. Inventors stories wanted! If you or someone you know has invented the self retaining abdominal retractor or something We like that we would like to hear from you. It can be a successful or not so successful invention need in surgery. We are interested in the ideas. stories

T: +61 3 9276 7430 E: [email protected]

[Surgical News] PAGE 7 August 2010 EDSA CORNER

Preventing another Patel incident Jayant Patel should have been assessed by the College and the Australian Medical Council

John Quinn Executive Director, Surgical Affairs

FELLOWS IN THE NEWS ast week’s verdict in the criminal trial of former Bundaberg surgeon Jayant Patel Lis not, regrettably, the end of this tragic matter. There will most likely be an appeals INTERNATIONAL DEVELOPMENT process, much of it turning on questions as fundamental as criminality within clinical care and the liability of a surgeon who has obtained the consent of a patient to operate. It is prema- ture to say that victims and grieving relatives now have closure. Irrespective of the outcome of any appeals ernment. This is what happened in the case new national system for registering doctors and process, however, there are clear lessons that can of Patel. So precipitate was the process of his accrediting health-related training courses came and must be drawn from the Patel case so far. appointment, his CV and references were not into effect last week. Essentially an attempt to First, trained clinicians should determine thoroughly checked; had they been, this whole centralise the process by which health profes- who is, and who is not, capable of operating sorry mess might have been avoided. sionals are registered, it will facilitate the move- safely on Australians. In the Patel case, it was bu- The second lesson to be drawn from the ment of these professionals across state borders. College Conferences and Events Management reaucrats, answering to politicians in search of case is the importance of clinical governance While the College of Surgeons has been Contact Lindy Moffat / [email protected] / +61 3 9249 1224 expedient solutions, who oversaw the appoint- in our hospitals. It is the responsibility of em- generally supportive of the reforms, it did cam- ment of the surgeon to Bundaberg Hospital. ploying hospitals to ensure that surgeons when paign successfully for some key amendments. As a foreign-trained surgeon, Patel should appointed are correctly credentialled; that their One of these was to ensure that clinicians, not have been assessed by experienced surgeons appointment is to an appropriate position at bureaucrats, sit on the committees that de- as part of a thorough and proven process an appropriate level of experience and senior- cide who does, and who does not, become a conducted by the College and the Australian ity; and that the range and scope of their clini- registered doctor. Another was to ensure that Medical Council. cal privileges are clearly defined. experts, not politicians, decide which teaching International Medical Graduates, or IMGs, Hospitals must also ensure that the per- institutions have developed medical courses of with a specialist surgical qualification may ap- formance of their surgeons is formally and reg- sufficient rigour to be accredited. ply to the college for assessment to determine ularly monitored by way of continuing clinical Interestingly, however, one of our proposed their comparability to an Australian or New audit and peer review. amendments was met with stony silence by Zealand-trained surgeon. Anthony Morris QC, who chaired the the politicians. This was to do away with the If the assessed IMG is deemed comparable, original commission of inquiry into the Bun- mechanism whereby politicians or their del- he or she is supervised for a period of time be- daberg Hospital affair, which was brought to egated bureaucrats can, without reference to fore achieving a College Fellowship. Sometimes an end before delivering its findings, notes that clinicians, declare a given area or hospital an passing the College’s Fellowship examination Queensland Health’s quick-fix became seri- “area of need’’. may be required to demonstrate comparabil- ously problematic when Patel was appointed Such a declaration enables the appointment ity to an Australasian Fellow. If the IMG is as- director of surgery. As highlighted by Morris, of a surgeon who has yet to be deemed fully com- sessed as not comparable, it is recommended this was in direct contravention of an express parable with a locally trained surgeon. While dec- that he or she apply for the College’s Surgical condition of Patel’s registration by the Queens- larations of area of need are sometimes a neces- Education Training Program, just as an Aus- land Medical Board that Patel be supervised by sity, the College of Surgeons believes they should tralian or New Zealand (NZ) medical graduate the director of surgery. be made in consultation with clinicians. wishing to become a surgeon does. So Queensland Health’s credentialling proc- It is sadly ironic that existing arrangements, This process of assessment acts as a safe- ess was also flawed. Not only was Patel appoint- and the threat they pose to patient safety, were guard, ensuring that IMGs seeking to work ed without restriction of his scope of practice, enshrined in a supposedly new and improved or train as surgeons have achieved the same but the condition that he be supervised was system of registration in the very week that required standards as their Australian or NZ apparently ignored. The presence of a more ex- their potential to do harm was brought home counterparts. perienced surgeon would have meant a second so forcefully. Unfortunately this process of assessment opinion was always available before surgery. This article appeared in Brisbane’s Courier is not mandatory and can be avoided by gov- Readers may not be aware of the fact that a Mail, 7th July 2010. . [Surgical News] PAGE 8 August 2010 Pub: CMC TOTS Page: 9 Date: 28-NOV-2009 Plate:CMYK Manly, NSW Manly, 2010 Manly Pacific Pub: CMC TOTS Page:Novotel Sydney 9 Date: 28-NOV-2009 Plate:CMYK 2-4 September 2010 NeckNeck Neck 12th Annual Scientific Meeting 12th http://asc.surgeons.org Annual Scientific Congress Perth Convention & Exhibition Centre, Perth, Australia 4 –7 May 2010 Pub: CMC TOTS Page: 9 Date: 28-NOV-2009 Plate:CMYK 9 August 2010 [Surgical News] PAGE Australian and New Zealand Australian and New Zealand Head and Neck Cancer Society Royal Australasian College of Surgeons perth’10 & & & & Pub: CMC TOTS Page: 9 Date: 28-NOV-2009 Plate:CMYK

Pub: CMC TOTS Page: 9 Date: 28-NOV-2009 Plate:CMYK – LIFE BALANCE” “WORK Mr Andrew Thompson Convener Conference Further information and sponsorship opportunities contact: Australasian College of Surgeons Royal E: [email protected] T: +61 3 9249 1260 F: +61 3 9276 7431 Royal Australasian College of Surgeons Register online: www.anzhns.org Register online: 2 – 6 May 2011 2 – 6 May Annual Scientific Congress Scientific Annual Australia Centre, Adelaide, Convention Adelaide Head Head Head 2010 Pub: CMC TOTS Page: 9 Annual Scientific Congress Perth Convention & Exhibition Centre, Perth, Australia 4 –7 May 2010 Date: 28-NOV-2009 Plate:CMYK Annual Scientific Congress Perth Convention & Exhibition Centre, Perth, Australia 4 –7 May 2010 AUSTRAUMA Dr Valerie Malka Dr Valerie Animal Injuries Animal Emergencies Orthopaedic Surgery General Emergency Damage Control Nightmares Care Critical Royal Australasian College of Surgeons perth’10 ✱ ✱ ✱ ✱ ✱ Royal Australasian College of Surgeons perth’10 Contact Lindy Moffat / [email protected] / +61 3 9249 1224 / +61 / [email protected] Contact Lindy Moffat 11 – 13 February 2010 February – 13 11 Conference Themes: Emma Thompson Emma Contact: “WORK – LIFE BALANCE” “WORK Mr Andrew Thompson Convener Conference Further information and sponsorship opportunities contact: Australasian College of Surgeons Royal E: [email protected] T: +61 3 9249 1260 F: +61 3 9276 7431 Conferences and Events Department Events and Conferences Royal Australasian College of Surgeons of College Australasian Royal Trauma, Critical Care and and Care Critical Trauma, PROVINCIAL SURGEONS SURGEONS PROVINCIAL AUSTRALIAOF +61 3 9276 7431 3 9276 I F: +61 1139 3 9249 T: +61 Trauma Radiology Trauma Humanitarian Aid Humanitarian Conference Convener: Emergency Surgery Conference Surgery Emergency Neurotrauma Injuries Paediatric Mass Casualties Mass “WORK – LIFE BALANCE” “WORK Mr Andrew Thompson Convener Conference Further information and sponsorship opportunities contact: Australasian College of Surgeons Royal E: [email protected] T: +61 3 9249 1260 F: +61 3 9276 7431 ✱ ✱ ✱ ✱ ✱ 2010 College Conferences and Events Management and Events College Conferences Sydney Convention & Exhibition Centre, Darling Harbour, Sydney. Harbour, Darling Centre, & Exhibition Sydney Convention [email protected] I www.austraumaconference.org E: [email protected] 2010 46TH ANNUAL SCIENTIFIC CONFERENCE ANNUAL 46TH 1-4 SEPTEMBER 2010 BROOME BEACH, CABLE WESTERN AUSTRALIA Annual Scientific Congress Perth Convention & Exhibition Centre, Perth, Australia 4 –7 May 2010 +61 3 9276 7431 3 9276 +61 AUSTRAUMA AUSTRAUMA Dr Valerie Malka Dr Valerie Animal Injuries Animal Emergencies Orthopaedic Surgery General Emergency Damage Control Nightmares Care Critical ✱ ✱ ✱ ✱ ✱ Annual Scientific Congress Annual Scientific Centre, Perth, Australia Perth Convention & Exhibition 4 –7 May 2010 AUSTRAUMA Dr Valerie Malka Dr Valerie Critical Care Nightmares Care Critical Animal Injuries Animal Emergencies Orthopaedic Surgery General Emergency Damage Control ✱ ✱ ✱ ✱ ✱ Contact Lindy Moffat / [email protected] / +61 3 9249 1224 / [email protected] Contact Lindy Moffat 11 – 13 February 2010 February – 13 11 Conference Themes: College Conferences and Events Management and Events College Conferences Emma Thompson Emma Contact: Contact Lindy Moffat / [email protected] / +61 3 9249 1224 Contact Lindy Moffat / [email protected] 11 – 13 February 2010 February – 13 11 Conference Themes: Contact Lindy Moffat / [email protected] / +61 3 9249 1224 / [email protected] Contact Lindy Moffat Royal Australasian College of Surgeons Emma Thompson Emma Contact: perth’10 Conferences and Events Department Events and Conferences Royal Australasian College of Surgeons of College Australasian Royal Trauma, Critical Care and and Care Critical Trauma, PROVINCIAL SURGEONS SURGEONS PROVINCIAL AUSTRALIAOF +61 3 9249 1139 I F: 1139 3 9249 +61 Royal Australasian College of Surgeons perth’10 Conferences and Events Department Events and Conferences Royal Australasian College of Surgeons of College Australasian Royal Trauma, Critical Care and and Care Critical Trauma, PROVINCIAL SURGEONS SURGEONS PROVINCIAL AUSTRALIAOF T: +61 3 9276 7431 3 9276 I F:+61 1139 3 9249 T: +61 Humanitarian Aid Humanitarian Radiology Trauma Conference Convener: Emergency Surgery Conference Surgery Emergency Mass Casualties Mass Neurotrauma Injuries Paediatric 2010 September Humanitarian Aid Humanitarian Radiology Trauma Conference Convener: Emergency Surgery Conference Surgery Emergency Mass Casualties Mass Neurotrauma Injuries Paediatric ✱ ✱ ✱ ✱ ✱ ✱ ✱ ✱ ✱ ✱ Perth Convention & Exhibition Centre, Perth, Australia 4 –7 May 2010 Annual Scientific Congress College Conferences and Events Management and Events College Conferences College Conferences and Events Management College Conferences and Sydney Convention & Exhibition Centre, Darling Harbour, Sydney. Harbour, Darling Centre, & Exhibition Sydney Convention [email protected] I www.austraumaconference.org E: [email protected] Sydney Convention & Exhibition Centre, Darling Harbour, Sydney. Harbour, Darling Centre, & Exhibition Sydney Convention [email protected] I www.austraumaconference.org E: [email protected] “WORK – LIFE BALANCE” “WORK Mr Andrew Thompson Convener Conference Further information and sponsorship opportunities contact: Australasian College of Surgeons Royal E: [email protected] T: +61 3 9249 1260 F: +61 3 9276 7431 17-19 Cove, Gold Coast, QLD Hyatt Regency Sanctuary PROVISIONAL PROGRAM NOW AVALIABLE Contact: Emma Thompson 3 9249 1139 T:+61 E: [email protected] www.generalsurgeons.com.au W: GSA ANNUAL SCIENTIFIC MEETING SCIENTIFIC MEETING GSA ANNUAL DAY AND TRAINEES’ The Cutting Edge Emergency Surgery: 1-4 SEPTEMBER 2010 BROOME BEACH, CABLE WESTERN AUSTRALIA 46TH ANNUAL SCIENTIFIC CONFERENCE ANNUAL 46TH Conference Convener Mr Andrew Thompson Convener Conference Further information and sponsorship opportunities contact: Australasian College of Surgeons Royal E: [email protected] T: +61 3 9249 1260 F: +61 3 9276 7431 “WORK – LIFE BALANCE” “WORK 1-4 SEPTEMBER 2010 BROOME BEACH, CABLE WESTERN AUSTRALIA 46TH ANNUAL SCIENTIFIC CONFERENCE ANNUAL 46TH

Royal Australasian College of Surgeons perth’10

2010 2010 F: +61 3 9276 7431 T: +61 3 9249 1260 E: [email protected]

Further information and sponsorship opportunities contact: Australasian College of Surgeons Royal Conference Convener Mr Andrew Thompson Convener Conference “WORK – LIFE BALANCE” “WORK

AUSTRAUMA AUSTRAUMA Malka Dr Valerie AUSTRAUMA Damage Control Nightmares Care Critical Orthopaedic Emergencies Orthopaedic Surgery General Emergency Animal Injuries Animal Dr Valerie Malka Dr Valerie Critical Care Nightmares Care Critical Emergency General Surgery General Emergency Damage Control Animal Injuries Animal Emergencies Orthopaedic ✱ ✱ ✱ ✱ ✱ ✱ ✱ ✱ ✱ ✱ Contact Lindy Moffat / [email protected] / +61 3 9249 1224 9249 3 +61 / / [email protected] Moffat Lindy Contact 11 – 13 February 2010 February – 13 11 Conference Themes: Emma Thompson Emma Contact: Contact Lindy Moffat / [email protected] / +61 3 9249 1224 / +61 Contact Lindy Moffat / [email protected] 2010 11 – 13 February 2010 February – 13 11 Conference Themes: Emma Thompson Emma Contact: Conferences and Events Department Events and Conferences Royal Australasian College of Surgeons of College Australasian Royal Trauma, Critical Care and and Care Critical Trauma, PROVINCIAL SURGEONS SURGEONS PROVINCIAL AUSTRALIAOF Conferences and Events Department Events and Conferences +61 3 9276 7431 3 9276 F: I +61 1139 3 9249 T: +61 Royal Australasian College of Surgeons of College Australasian Royal Trauma, Critical Care and and Care Critical Trauma, PROVINCIAL SURGEONS SURGEONS PROVINCIAL AUSTRALIAOF Humanitarian Aid Humanitarian Radiology Trauma Conference Convener: Emergency Surgery Conference Surgery Emergency Mass Casualties Mass Neurotrauma Injuries Paediatric +61 3 9276 7431 3 9276 I F: +61 1139 3 9249 T: +61 ✱ ✱ ✱ ✱ ✱ Trauma Radiology Trauma Humanitarian Aid Humanitarian Conference Convener: Emergency Surgery Conference Surgery Emergency Mass Casualties Mass Neurotrauma Injuries Paediatric ✱ ✱ ✱ ✱ ✱ College Conferences and Events Management Events and Conferences College Sydney Convention & Exhibition Centre, Darling Harbour, Sydney. Harbour, Darling Centre, & Exhibition Sydney Convention [email protected] I www.austraumaconference.org E: [email protected] AUSTRAUMA AUSTRAUMA Dr Valerie Malka Dr Valerie Orthopaedic Emergencies Orthopaedic Surgery General Emergency Damage Control Nightmares Care Critical Animal Injuries Animal College Conferences and Events Management College Conferences Sydney Convention & Exhibition Centre, Darling Harbour, Sydney. Harbour, Darling Centre, & Exhibition Sydney Convention ✱ ✱ ✱ ✱ ✱ [email protected] I www.austraumaconference.org E: [email protected] 46TH ANNUAL SCIENTIFIC CONFERENCE ANNUAL 46TH 1-4 SEPTEMBER 2010 BROOME BEACH, CABLE WESTERN AUSTRALIA 46TH ANNUAL SCIENTIFIC CONFERENCE SCIENTIFIC ANNUAL 46TH 1-4 SEPTEMBER 2010 BROOME BEACH, CABLE WESTERN AUSTRALIA Contact Lindy Moffat / [email protected] / +61 3 9249 1224 / +61 3 9249 Lindy Moffat / [email protected] Contact 11 – 13 February 2010 February – 13 11 Conference Themes: Emma Thompson Emma Contact: Conferences and Events Department Events and Conferences Royal Australasian College of Surgeons of College Australasian Royal Trauma, Critical Care and and Care Critical Trauma, PROVINCIAL SURGEONS SURGEONS PROVINCIAL AUSTRALIAOF +61 3 9276 7431 3 9276 I F: +61 1139 3 9249 T: +61 Humanitarian Aid Humanitarian Radiology Trauma Conference Convener: Emergency Surgery Conference Surgery Emergency Mass Casualties Mass Neurotrauma Injuries Paediatric ✱ ✱ ✱ ✱ ✱ College Conferences and Events Management and Events Conferences College Sydney Convention & Exhibition Centre, Darling Harbour, Sydney. Harbour, Darling Centre, & Exhibition Sydney Convention [email protected] I www.austraumaconference.org E: [email protected] 46TH ANNUAL SCIENTIFIC CONFERENCE ANNUAL 46TH 1-4 SEPTEMBER 2010 BROOME BEACH, CABLE WESTERN AUSTRALIA LAW COMMENTARY

FELLOWS IN THE NEWS Mandatory Reporting Mandatory reporting requirements now apply nationally INTERNATIONAL DEVELOPMENT

Michael Gorton in his or her practice because of impairment; stitutes misconduct, and the relevant Board College Solicitor • places the public at risk of harm in his or her would decide what, if any, sanctions apply. practice in a way that constitutes a significant new national regime for mandatory departure from accepted professional standard. Exceptions reporting of health professionals will General exceptions apply to information which Aapply from 1 July 2010. The Health When to report is obtained in the course of actions relating to Practitioner Regulation National Law makes A registered health practitioner is required to insurance claims for professional indemnity all health professionals liable to make manda- report another registered health practitioner insurers, if the information is obtained in re- tory reports in relation to the conduct of other if the first person forms a reasonable belief, in lation to legal proceedings or providing assist- health professionals. the course of his or her practice, that notifiable ance or advice in legal proceedings. An exemp- For the first time, mandatory reporting re- conduct has occurred. That is, if you are a reg- tion applies for a health practitioner who is a quirements apply nationally. Additionally, it istered health practitioner you must report if lawyer, for providing legal assistance. applies across the 10 health professions regulat- you believe that another registered health prac- An exemption applies to registered qual- ed under the new legislation (doctors, nurses, titioner has behaved in a way that constitutes ity assurance committees or bodies, registered dentists, optometrists, osteopaths, pharmacists, notifiable conduct. under State or Territory legislation or under physiotherapists, chiropractors, podiatrists and Under these circumstances you are re- Commonwealth legislation. These statutory psychologists). quired to notify the Australian Health Practi- schemes provide statutory confidentiality for Mandatory reporting is not new. Exist- tioner Regulation Agency (AHPRA) as soon information obtained pursuant to the regis- ing legislation in Queensland and New South as practicable. There is no set time limit, but tered activities. If statutory confidentiality ap- Wales requires mandatory reporting by doc- clearly reports of notifiable conduct should be plies, then a mandatory report is not necessary. tors in relation to the conduct of doctors. How- made at the earliest practicable opportunity, A report is not required if a health practition- ever, the significant difference under the new once a reasonable belief has been formed that er knows or reasonably believes that AHPRA has law is that any health professional in the 10 notifiable conduct has occurred. already been notified in relation to the conduct. professions may be required to report in rela- Notification is also required in relation to Thus if another health practitioner or the em- tion to any other health professional. students. Students, who are required to regis- ployer of the person involved has already notified ter under the new law, must also be notified if AHPRA, then no further report is required. Notifiable conduct they are placing the public at substantial risk The trigger for reporting is if “notifiable con- of harm because of impairment. What is not excepted duct” occurs. This is where a registered health There is no exception for information which practitioner: What if i don’t notify comes to a health practitioner as a treating • practices while intoxicated by alcohol or It is not an offence or criminal act if a health doctor or treating health professional or for in- drugs; practitioner fails to make a mandatory report. formation obtained in the course of a health • engages in sexual misconduct in connec- However, the failure to make a mandatory re- program for health practitioners (unless the tion with practice; port can be referred to the relevant Board for program is registered under the statutory • places the public at risk of substantial harm consideration as to whether the failure con- schemes referred to above). [Surgical News] PAGE 10 August 2010 The significant difference under the new law is that any health“ professional in the 10 professions may be required to report in relation to any other health professionalxx”

Employers public and health professionals can make vol- Can I be sued if I fail to report If an employer reasonably believes that an untary notifications if they believe that there There is some case law which suggests that employee health practitioner has behaved in has been any misconduct or any cause of con- if a person fails to make a mandatory report, a way that constitutes notifiable conduct, a cern in relation to a health practitioner. which they are required to make, and other mandatory report to AHPRA must be made. Voluntary notification can certainly be people are injured after that time, the injured Many health professionals are not employees made for a range of expanded grounds, for ex- parties could sue the person who failed to of hospitals or aged care facilities, and accord- ample: make a mandatory report. This issue is not ingly the report is only required in respect of • any impairment of a health practitioner; clearly determined, but leaves open the ques- health professionals who are employees. • conduct of a health practitioner that is of a tion as to whether a civil claim of this nature If AHPRA becomes aware that an employer lesser standard than expected; could arise. has failed to make a mandatory report, AH- • if the health professional is not a fit and PRA is required to report that failure to the proper person; General responsible State or Commonwealth Minister • if there is any legal contravention. There is much more information regarding for consideration and action. the new national registration and accredita- Protection tion scheme on the AHPRA website http:// Education providers Section 237 of the new law gives protection from www.ahpra.gov.au AHPRA is also maintain- An education provider is required to notify in civil, criminal or administrative process where a ing telephone advice lines during this period relation to its students, if the education provider notification is made to AHPRA “in good faith”. If to assist all health professionals, employers reasonably believes that the public is at substan- a notification is made for malicious or vindictive and health bodies to understand their rights tial risk of harm arising from impairment of the purposes, this protection may be lost. The protec- and responsibilities under the new scheme. student. tion would prevent any action for defamation, and the protection applies whether the notifica- Michael Gorton is a Principal of Russell Voluntary notification tion to AHPRA is made on a mandatory or vol- Kennedy Solicitors, and is a member of the As with existing legislation, members of the untary basis, so long as it is made “in good faith”. Agency Management Committee of AHPRA

PhD in 4th National Pelvic Floor & Anorectal Disorders Course Clinical GI Physiology A Multidisciplinary Course

The Department of Surgery at The University Auckland, 1-2 October 2010 of Auckland and the Auckland For further information Bioengineering Institute, in collaboration Convened by: A/Prof. Ian Bissett contact: Administrator ACSC with the Mayo Clinic, are seeking a International Guest Lecturer: Phone: high-quality PhD candidate for a world class Sue Markwell +64 9 373 7599, ext 89304 research opportunity in clinical Email: gastrointestinal physiology. The course is designed for [email protected] The candidate will receive expert supervision surgeons, physiotherapists, Registration from Professor John A. Windsor and gastroenterologists & nurses. Registration fee includes Professor Andrew Pullan and work with a It will allow insights into the GST: Full Course $360.00 multi-disciplinary team of surgeons, management of patients with Day 1 only $288.00 gastroenterologists and engineers, to faecal incontinence & obstructed Day 2 only $90.75 develop and translate new devices for the defaecation. Registration closes on diagnosis and treatment of gastric motility Day 1 1 September 2010 disorders. This research is funded by the US Presentations & discussion A course manual and full National Institutes of Health (NIH) and the catering are provided. Health Research Council of New Zealand including Ventral Rectopexy, Biofeedback and SNS Please register online at: (HRC), and will involve opportunities to travel www.acsc.auckland.ac.nz to the US for conferences and collaboration. Day 2 If you require assistance For more information, please contact: Interactive Physiotherapy with accommodation, Scott Aitken, [email protected] Workshop with Sue Markwell please contact us. Ph: +64 9 923 6929

[Surgical News] PAGE 11 August 2010 Pelvic floor Ad_2010_02.indd 1 6/07/2010 1:01:37 p.m.

SNews ad Jul10_B&W_03.indd 1 9/07/2010 1:33:36 p.m. EDUCATION & TRAINING ADMINISTRATION

Specialist Training Program (STP) The STP provides funding to support accredited surgical training rotations beyond traditional public teaching hospitals

Simon Williams wealth funding in 2011. Of these, 17 applications Online Training in Goal Setting Chair, Board of Surgical Educa- could not be supported by the College, as the and Self-Assessment tion & Training FELLOWS IN THE NEWS training facilities did not submit an accredita- This project has been formed in response to tion application. All of the remaining 73 ap- the demand from Trainees, IMGs, and Super- here is growing recognition that spe- plications were supported by the College, and visors for the College to provide more online cialist training in Australia needs to 53 of these have been short-listed by the Com- learning resources. It will develop the resources adapt to changes in the way health care INTERNATIONAL DEVELOPMENT T monwealth to receive funding in 2011. Forty-five to improve knowledge and skills associated is delivered, as more services are now provided applications are for existing training positions with goal setting and self-assessment. outside the public sector. This has resulted in which had previously received funding in 2010, procedures either not being performed in the while the remaining eight applications are for Rural Career Coach/Advocate public sector or performed rarely, therefore new training positions commencing in 2011. This project is a package of career support and pas- depriving surgical Trainees of important learn- toral care designed to secure Trainees and IMGs ing experiences. To facilitate the expansion of Infrastructure Projects to Increase working in rural areas or contemplating a surgical training the Commonwealth Government has Doctors Progressing to Fellowship career in a rural area to commit to rural surgery. made funding available to create posts in the In addition to establishing specialist training private sector. positions, the STP also provides funding for Process Communication Model The College has signed an agreement with the development of infrastructure projects that (PCM) Workshops the Commonwealth Department of Health and support the expansion of training into non-tra- This project involves piloting two ‘Introduc- Ageing to engage in the Specialist Training Pro- ditional settings, particularly in rural areas, and tory PCM’ workshops to assess whether PCM gram (STP) Administration and Support Project. improve service delivery to Trainees and Inter- can assist rural surgeons to communicate bet- There are two components to this Project. national Medical Graduates (IMGs). The Com- ter with clinical colleagues, hospital adminis- monwealth has provided over $500,000 in fund- trators, and patients in order to improve mo- Assessment of Private Hospital ing for the College to develop and implement rale and performance. Posts for Surgical Training projects which meet these objectives and are The STP provides funding to support accred- achievable by the end of 2010 (the conclusion of Establish a Network of IMG ited surgical training rotations in an expanded the Project Period). A College Steering Commit- Surgical Educators/Coaches range of settings beyond traditional public tee, consisting of the Censor in Chief, the Treas- This project involves sourcing a network of teaching hospitals. The aim is to increase the urer and the Chair of the Professional Develop- Fellows to act as Surgical Educators/Coaches capacity of the health care sector to provide ment and Standards Board has approved seven for IMGs undergoing specialist assessment. It high quality training opportunities which pro- projects for implementation this year. will also include the development and delivery vide the required educational experiences for of a program for Surgical Educators/Coaches surgical Trainees. Train the Trainer -Introducing the including a background in the content of the Private hospitals may apply for Common- Non Technical Skills for Surgeons Fellowship Examination and methods used to wealth funding of up to $100,000 (excluding (NOTSS) System to Australia assess surgical competencies. GST) per FTE for each post. To be able to be con- This project is part of the suite of Supervi- sidered for funding, the post must be accredited sors and Trainers for Surgical Education and IMG Clinical Assessor & Mentor Workshop as suitable for training by the College, on the rec- Training (SAT SET) courses provided by the This project involves preparation and delivery ommendation of the relevant Specialty Training College for Supervisors and Trainers to en- of two half-day workshops to instruct and assist Board. The College makes an assessment of each hance their skills in teaching and assessing the Fellows involved in IMG and/or Area of Need post that has applied for funding and advises the non-technical competencies. specialist assessments. All seven proposals have Commonwealth regarding the suitability of the recently gained final approval and College staff potential post, including its accreditation status. Self-paced Online Learning are now working to implement the projects. The Surgical training positions funded under the STP Program in Anatomy current Agreement with the Commonwealth is are approved by the Department of Health and An@tomedia is an anatomy resource available in place up until the end of 2010, however, it is Ageing, the College and Jurisdictions and are to members of the College via the website as a hoped that further funding from the Common- therefore fully integrated with and complement reference, or to assist in their exam preparation. wealth will continue for future years. training at the major public teaching hospitals. This project has been developed in response For more information on PCM workshop The College recently assessed 90 applica- to the continuing concerns about the anatomy please contact the professsional development tions from training facilities seeking Common- knowledge of surgical Trainees. department on +613 9249 1106

[Surgical News] PAGE 12 August 2010 SURGICAL SERVICES

I procrastinated and Specialist Training Program (STP) “rushed out to buy the newspaper & read what it was that I had ‘said’xx geous. Suddenly I remembered media training” – why hadn’t I enrolled to do that workshop at the College? The Minister’s office rang – an urgent meeting was required. Alas I had a busy operating day ahead of me and the Minister’s availability was limited. Do I cancel my operating, thus compounding the situation I was “complain- ing about”? And did I really want to meet with the Minister today? I procrastinated and rushed out to buy the newspaper and read what it was that I had “said”. Describing elective surgery as the “soft underbelly” of the Health Service didn’t seem too bad to me and was in fact accurate. Chal- lenging the assumption that elective surgery equates with optional surgery was also in line with my everyday thinking. And blaming surgeons for inadequate throughput when cancellations for admission due to lack of beds was Poison’d a daily occurrence was clearly missing the point. The sticking point was the Headline – Chalice “Surgeon accuses Minister”. The sub-editor responsible for the headline had landed me in the proverbial. And it wasn’t accurate – I knew My words fly up, my thoughts remain below: Words without the Minister wanted the Health system that thoughts never to heaven go.” Hamlet (III, iii, 100-103) he presided over to be the best, I knew that he went to Cabinet and Treasury and argued Professor U.R Kidding served but no story. So they wrote another story for more money. No, my divergence from the based on my comments of inadequate beds in Minister and other politicians was more sub- may have made a slight miscalculation to- the public hospital sector. It was not intended tle – constant side stepping to deflect criticism day, or rather yesterday. She was a rather at- as a criticism of the Minister, but the juxtaposi- and unrealistic promises to a voting public. On Itractive lass, a reporter with the major daily tion of his comments and mine clearly placed one hand telling them that they had the right newspaper. My comments were “off the record” us at odds. It might not have been so bad if it to access whatever they wished or required and or so I thought. I was wrong. hadn’t been an election year and as the CEO on the other, telling health care providers to cut My first inkling of the issue was the 6am pointed out, funding negotiations between the costs – sorry, achieve productivity increases! phone call was from the Chief Executive Of- Government and our health service were at a Of course the furore eventually blew over, ficer (CEO) – “Do you realise that you are the rather delicate point. but it did cause me to reflect on the power of page one story in the newspaper today!” As if She rang of course – my attractive contact, words and the role of the press in health care. to verify the veracity of this statement other to apologise. Her defence was that I had killed Alas, only bad news sells newspapers – the news outlets, radio and television stations were her article and she needed another one in a sensational, the medical mistake, etc. And wait- ringing at minutely intervals - no doubt hop- hurry. She would make it up to me (?). ing lists – perennially. But the press does catch ing for further sensationalism. The Shadow Health Minister rang to con- the attention of politicians. Unfortunately, I It had begun innocently enough. The news- gratulate me on my courage. I was reminded am not convinced that it motivates better out- paper had prepared an article on waiting list of the “Yes Minister” episode when Sir Hum- comes. More likely it creates a shoring up of manipulation by surgeons and hospitals. They phrey congratulates Jim Hackett on his cour- entrenched positions. Advocacy for improve- decided, at the last minute to “run the story age! – a comment which reduces poor Jim to ments requires the provision of positive op- by me” before publication. Alas I thought that a sniveling mess wondering what on earth he portunities rather than mere negative criticism. they had got it wrong – and said so. That killed has done. I wonder how the reporter plans to make the article, but now they had page one space re- What courage? I didn’t mean to be coura- it up to me… [Surgical News] PAGE 13 August 2010 TRAINEES ASSOCIATION

A Trainee Voice on College Council It is no secret that Trainees perceive the College as an intimidating organisation

Council? At 1200 members, the Trainee body the Council table. It is no secret that Trainees comprises a substantial portion of the College, perceive the College as an intimidating organi- and we certainly absorb a disproportionate share sation. However, having represented Trainees for Greg O’Grady of the College’s time, energy and attention. Surgi- three years in several roles within the College, Chair, RACSTA cal training in Australasia continues to undergo including now at the Council table, I have ob- he June meeting of the College Coun- change, and Trainee input is vitally important to served a very different reality, which is perhaps cil was a historic one for Trainees, be- ensure that the best decisions are made for train- lost on most Trainees. At every level and on Ting the first time that we have held a ing, and that transitions are managed well. every board within the College, you will find a voting position at the highest level of our Col- Accordingly, Trainees are increasingly being dedicated group of Fellows devoting substantial lege. This followed the successful change in looked to for leadership in managing the chal- time and energy pro bono, because they are pas- the College constitution at the Perth Annual lenges facing our training, especially with re- sionate advocates of Trainees and training. General Meeting this year, when the Chair of gard to modern generational issues, including While Trainees may not always agree with the RACSTA (Royal Australasian College of Sur- working hours, standards and flexible training. outcomes, there is no dispute that College deci- geons Trainees’ Association) was elected as a With Trainee representatives now established sions are made with the highest standards of fair- co-opted College councillor. in every specialty, region and level in our Col- ness, with a relentless focus on maintaining stand- This achievement represents a major mile- lege, RACSTA is ideally positioned to present ards, and with the Trainee body’s interests in mind. stone for RACSTA. Now nearing our fifth the perspective from the training coalface, and Overall, our College has much to gain from birthday, it is great to see how our Association’s to facilitate dialogue between the College and a Trainee voice on Council. Besides the insights profile has grown, earning the respect of the the Trainee body. So, Trainees, don’t hesitate to we can provide, I hope that the move to engage Fellowship, and the credibility to assume a sig- be in touch and contribute. Trainees at the highest level will further help to nificant role in the College leadership. Perhaps most important is the symbolism dissolve the perceived barriers between Train- What value does a Trainee voice bring to associated with a Trainee being able to vote at ees, the College and its Fellows.

The Sir Edward Huges memorial Clinical research Prize in Surgery 2010 is open to application by all surgical residents and registrars who have entered or intend entering an accredited surgical training program. For more information see page 4. PHOTOGRAPH COURTESY OF CELEBRATE WA

to Associate Professor Robert Pearce AM RFD WellASSOCIATE PROFESSOR PEARCEdone RECEIVED THE CELEBRATED WA CITIZEN OF THE YEAR, PROFESSIONS AWARD. Associate Professor Pearce is a highly qualified and experienced reconstructive plastic surgeon. He is currently a consultant plastic surgeon at Hollywood Private Hospital where he has had a private practice since 1975. A clinical lecturer in Surgery at the University of Western Australia and Clinical Associate Professor since 2007. He is also an Adjunct Associate Professor at Edith Cowan University and a foundation member of the Western Australian Melanoma Advisory Service. Mr Peter Mott, He is the Director of the Perth Melanoma Clinic which has treated Chief Executive over two thousand patients in WA. Officer, St John Robert exemplifies integrity and commitment to his patients. of God Hospital Murdoch and He inspires those under his guidance to maximise their potential. Associate Professor He always finds time for his students and patients and is happy to Robert Pearce. assist colleagues and friends at all times.

[Surgical News] PAGE 14 August 2010 professional development A Trainee Voice on College Council 2010 workshops

In 2010 the College is offering exciting new learning opportunities designed to support Fellows in many aspects of their professional lives. PD activities can assist you to strengthen your communication, business, leadership and management abilities.

AMA Impairment Guidelines Level 4/5: Difficult Cases (NEW) 19 August 2010, Sydney The American Medical Association (AMA) Impairment Guidelines inform practitioners as to the level of impairment suffered by patients and assist with decisions about a patient’s return to work. While the guidelines are extensive, they sometimes do not account for unusual or difficult cases that arise from time to time. This evening workshop professional provides surgeons with a forum to review their difficult cases, the problems they development encountered and the steps applied to resolve the issues. Proudly supported by eScheduler workshops DATES: JULY – OCTOBER 2010 Polishing Presentation Skills 20 August 2010, Darwin NSW Want to develop an attention grabbing presentation to deliver your message more 19 August Sydney effectively? Whether you are a beginner or an experienced presenter, join this whole day AMA Impairment Guidelines Level 4/5: Difficult Cases, workshop to advance your presentation skills. You will learn a step-by-step presentation 3 September, Sydney planning process and practical tips for delivering your message. It is equally applicable to Supervisors and Trainers for SET (SAT SET), presentation sessions in hospitals, conferences and international meetings. 29-31 October, Sydney Proudly supported by Kimberley-Clark Process Communication Model 19 November, Sydney Practice Made Perfect Occupational Medicine: Industry site visits 8 September 2010, Melbourne 14 October 2010, Adelaide 20 November, Sydney Writing Reports for Court This whole day workshop is a great opportunity to improve your business outcomes by developing your practice staff, giving them the tools for building strong practice processes. NT 19 August, Darwin They will learn about the six P’s of sound business and practice management; purpose, Polishing Presentation Skills, planning, promotion/marketing, people, performance and problem solving. Participants will take away a practical action plan to apply what they have learnt to their workplace. QLD Proudly supported by Health Communications Network 17 September, Sanctuary Cove Supervisors and Trainers for SET (SAT SET)

Surgical Teachers Course SA 21-23 October 2010, Adelaide 14 October, Adelaide Practice Made Perfect The Surgical Teachers Course, consisting of two and a half days of challenging and 21-23 October, Adelaide interactive activities, enhances the educational skills of surgeons responsible for the Surgical Teachers Course teaching and assessment of surgical trainees. Experienced faculty members employ a 17-19 November, Brisbane range of teaching techniques to deliver the curriculum including Adult Learning, Teaching Process Communication Model Technical Skills, Feedback and Assessment, Change and Leadership. VIC 8 September, Melbourne From the Flight Deck: Improving Team Performance Practice Made Perfect 29-30 October 2010, Melbourne 11 September, Melbourne This two-day workshop is facilitated by an experienced doctor and pilot. It examines the Supervisors and Trainers for SET (SAT SET) 25-26 September / 11 November, Melbourne lessons learned from the aviation industry and applies them to a medical environment. Preparation for Practice (see page 16) The program combines rigorous analysis of actual airline accidents and medical incident 29-30 October case studies with group discussions and an opportunity to use a full-motion airline From the Flight Deck training flight simulator. You will learn more about human error and how to improve 12 November, Melbourne individual and team performance. Occupational Medicine: Industry site visits Proudly supported by Kimberly-Clark 13 November, Melbourne Communication Skills for Cancer Clinicians 19-21 November, Melbourne Leadership in a Climate of Change

Further Information: Please contact the Professional Development WA Department on +61 3 9249 1106, by email [email protected] 20 October, Perth Supervisors and Trainers for SET (SAT SET) or visit the website at www.surgeons.org - select Fellows then click on Professional Development.

[Surgical News] PAGE 15 August 2010 EDSA CORNER Does your Rigid Sigmoidoscope meet TGA Guidelines? Code of Conduct Breaches The College will not process or investigate anonymous claims

FELLOWS IN THE NEWS John Quinn tions of such matters may come to the College The MBA has formally announced that Executive Director of Surgical Affairs from various sources ranging from patients (or they will not identify “whistleblowers”, but their relatives), nurses or other hospital staff, or will not look kindly on malicious claims. It ollowing formalisation of how the Col- doctors from all levels. However, if notifications should be noted that the MBA has regulatory INTERNATIONAL DEVELOPMENT lege deals with breaches of the Code of are anonymous they will lapse. Nevertheless if and registration powers. It can deregister, place FConduct, there have been a number of a complaint is made then the identity of the conditions on practice and control doctors’ notifications of potential breaches. These have notifier will not be circulated or made known, performance and practice overall. The College been investigated and whilst some have result- but the issue concerned will be followed up has no such regulatory authority. However, it ed in requests to sign a statutory declaration to and proceed in the normal way. may rescind Fellowship for serious breaches An agree to abide by the Code of Conduct, others Of note also is the commencement of the of the Code of Conduct and is bound by the eASy-TO-uSe have been dismissed. Medical Board of Australia (MBA) as the regu- regulations of the MBA concerning mandatory pATenTeD Recently a notification of a potential breach latory authority in Australia and as part of that, reporting of surgeons if practice is dangerous AuSTrAliAn inVenTiOn of the Code of Conduct was received making the legal requirement to notify to the MBA if or harmful to patients. very serious allegations against a Trainee. The doctors know, or ought to know, actions or be- The landscape with respect to monitor- TM Trainee was named, but the notification was haviours whereby doctors endanger patients ing of practice is changing in line with com- SafeScope eliminates the risk of cross-contamination anonymous. The College will not process or or break the medical practice code of conduct munity expectations. However, whilst those TM investigate such anonymous claims no matter (more generic, but essentially the same as the notifying genuine concerns will be protect- SafeScope is the first completely closed rigid sigmoidoscope system which eliminates the how serious. College Code of Conduct). However, there ed, those who make malicious or vexatious risk of cross-contamination from the bellows or light source head. The unique Coupling One of the concerns in this process has are some exemptions which may be viewed complaints will not be so treated. Those Device Adaptor ensures the light-source head is physically separated from the scope shaft, been around malicious, vexatious or frivolous at www.ahpra.gov.au/en/Health-Professions/ who make anonymous complaints will be removing the need to sterilise the light source head after each procedure. SafeScopeTM complaints. This is always a danger as notifica- Medical.aspx ignored. addresses safety alerts surrounding cross-contamination/sterilisation as outlined in the Optical Coupling Device TGA guidelines, as well as guidelines in Australian/New Zealand Standard No. 4187 2003. (TGA Bulletins No.29, Apr 2006; No.28, Oct 1995)

features benefits

Sealed at one end, no gas transmitted to Optical coupling device ROOMS WITH STYLE coming soon contaminate bellows and light source. Visible markings on a Provides easily visible markings starting at 5cm Easily visible markings Preparation For Practice clear scope shaft from the tip. 25-26 September 2010, Melbourne Disposable, integrated bulb & tubing Easy inflation. Scope and bulb all disposable. A ONE STOP SHOP OF The Preparation for Practice workshop aims to provide Scope shaft is slightly smaller in PRACTICE SERVICES! Fellows with information and practical skills for setting Easy insertion. High quality optics. up private practice. The workshop is being convened by diameter than most existing products We Provide the Younger Fellows Committee in partnership with the Tear-down poly bag Doubles as disposable bag for after use. – Marketing Victorian Regional Committee. Disposable bulb & tubing – Renovation Project Management LOCATION: College of Surgeons, Spring Street – Practice Management REGISTRATION FEE: $137.50 AUD – HR & Recruitment TIME: 8.30am – 5.30pm, Sat / 8.30am – 2.30pm, Sun – Legal & IR Advice Please contact the PDD on +61 3 9249 1106, – Ergonomic & OHS Work by email [email protected] Plantinum sponsor - Direct Control For Your free Consultation Gold Sponsor – Ramsay Health Care, Bongionro 1300 073 239 or [email protected] & Partners and Rooms with style FOR MORE inFORMATiOn OR TO plACE An ORDER COnTACT MED-ChEM SuRGiCAl TODAy. tel 02 9699 6460 fax 02 9699 6494 toll free 1800 888 090 web www.safescope.com.au [Surgical News] PAGE 16 August 2010 Does your Rigid Sigmoidoscope meet TGA Guidelines? Code of Conduct Breaches

An eASy-TO-uSe pATenTeD AuSTrAliAn inVenTiOn SafeScopeTM eliminates the risk of cross-contamination SafeScopeTM is the first completely closed rigid sigmoidoscope system which eliminates the risk of cross-contamination from the bellows or light source head. The unique Coupling Device Adaptor ensures the light-source head is physically separated from the scope shaft, removing the need to sterilise the light source head after each procedure. SafeScopeTM addresses safety alerts surrounding cross-contamination/sterilisation as outlined in the Optical Coupling Device TGA guidelines, as well as guidelines in Australian/New Zealand Standard No. 4187 2003. (TGA Bulletins No.29, Apr 2006; No.28, Oct 1995)

features benefits

Sealed at one end, no gas transmitted to Optical coupling device contaminate bellows and light source.

Visible markings on a Provides easily visible markings starting at 5cm Easily visible markings clear scope shaft from the tip.

Disposable, integrated bulb & tubing Easy inflation. Scope and bulb all disposable.

Scope shaft is slightly smaller in Easy insertion. High quality optics. diameter than most existing products

Tear-down poly bag Doubles as disposable bag for after use. Disposable bulb & tubing

FOR MORE inFORMATiOn OR TO plACE An ORDER COnTACT MED-ChEM SuRGiCAl TODAy. tel 02 9699 6460 fax 02 9699 6494 toll free 1800 888 090 web www.safescope.com.au YOUNGER FELLOWS 2 011 Huntingdale Beach at sunset, California Professional Development Opportunities

FELLOWS IN THE NEWS

INTERNATIONAL DEVELOPMENT

It’s time to start planning for 2011 to ensure you get your application in on time.

Steven Leibman the College and Association for Academic in Adelaide with Robert Whitfield, a recent Chair, Younger Fellows Committee Surgery (AAS). Younger Fellow. The purpose for this exchange is to provide The Forum is a channel for extensive dis- Covidien Travelling Fellowship professional development for a Younger Fellow, cussion on ‘hot College topics’ and a chance to Educational Grant, 2011 particularly in relationship to leadership. The relax and network with your colleagues. With Younger Fellows face many challenges when goal is to promote an exchange of ideas and both convenors’ enthusiasm and input from undertaking post Fellowship studies or train- possible solutions for common issues affecting the Younger Fellows Committee, I am sure this ing. The Younger Fellows Committee in part- Younger Fellows in both organisations. It also unique opportunity to share ideas and experi- nership with Covidien offers two Travelling aims to identify opportunities for our Younger ences will affect your professional and personal Scholarships annually which can help to offset Fellows to access International Clinical Fellow lives. Applications are open from 1 September the cost of studying overseas. You are eligible positions in the United States. to 1 December 2010. to apply if you are planning to train overseas The Exchange covers airfares, accommo- within the next 12 months, but returning to dation, transfers and conference attendance Australasia to practice. Applications will be ac- expenses for the College representative. Inter- cepted from 1 August – 30 September 2010. ested Fellows are encouraged to apply from 1 September to 30 September 2010. Younger Fellows Leadership Exchange: AAS Academic Younger Fellows Forum, 30 April Surgical Congress, 1-3 February – 1 May 2011, Adelaide SA 2011, Huntington Beach Last, but not least, I am pleased to inform all If you have any further inquiries California Younger Fellows that the development of the or require more information, I am sure that you would have read Richard program for 2011 Younger Fellows Forum is please contact the Younger Hanney’s article in previous Surgical News is- well underway. Christine Lai, the South Aus- Fellows Secretariat at Younger. sue about his experiences in America as a del- tralian/Northern Territory representative [email protected] or on egate for the Leadership Exchange between on the Committee, will convene the Forum +61 3 9249 1122. [Surgical News] PAGE 18 August 2010

for Younger Fellows EDUCATION

A new resource for learning anatomy

An@tomedia, a new resource for learning anatomy in a clinical context, is now available to Fellows and Trainees via the web

it as a “fresh approach to anatomy” and as a “dissection-based learning resource” which, whilst not a substitute for dissection experiences, provides medical students and surgical Trainees with access to multi-layered information through which they can learn to understand and appreciate the complexity of the human body. An@tomedia has received highly sought awards in Australia and overseas. These include awards for their conception and development as a teaching and learning package as well as the quality of the images and as a multi-media resource. As it is now available on the College website, the on-line application is a comprehensive, self-paced learning program that explores anatomy from four perspectives. These perspectives teach how the body is con- structed (regions and systems) and how to analyse and visualise the body (with dissection and imaging techniques). The user can navigate between these four different perspectives: REGIONS: includes surface and functional anatomy SYSTEMS: includes conceptual and clinical anatomy DISSECTION: includes practical procedures and post-mortem IMAGING: includes sectional and endoscopic anatomy. So far six of the planned nine modules have been completed. They are: general anatomy; back; abdomen; thorax; pelvis; and upper limb. The other three – lower limb, head and neck – are currently in different stages of de- Mark Edwards velopment. The lower limb module being scheduled to be released this year. Censor-in-Chief Each module provides: – detailed serial dissections of real human bodies he development of this learning resource – originally published – coloured overlays of individual structures in text format – has taken many years of detailed work by Associ- – multiple perspectives to explore anatomy and compare Tate Professor Norm Eizenberg and his team. Beginning in 1988 – flexibility for each individual to choose their own approach, rate, with the development of a new program for teaching anatomy at Mel- sequence and depth of learning bourne University, Norm aimed to put together a program that would – interactive text, labels and clinical questions encourage his students to develop an understanding of anatomical prin- – new concepts in anatomy and relevant clinical applications ciples which could be utilised in future clinical contexts. – capacity to “build” systems, “map” regions, “dissect” layers and Through researching the education literature of the time, plus evalua- “trace” images tion feedback from his students, he recognised the limitations of using a – a self learning resource with a solid educational basis, and textbook as a learning resource. By 1991, he had begun to prepare his first – a simple and consistent navigation system. CD-ROM. More recently his materials have been made available on-line. For many years Norm has been a member of the Anatomy Com- Throughout development, the critical design factors in the content mittee, the group which has been responsible for preparing the anatomy and organisation of an@tomedia is that the linking between anatomical component of the basic sciences examination for Basic Surgical Train- details and clinical perspective has been extended and enhanced. This ing and, more recently, for the generic component of the early Surgical has been done by the use of: Education Training examinations. He is currently Associate Professor in – high quality images (e.g., radiographs, detailed dissection images the Centre of Human Anatomy Education at Monash University, Adjunct from real human bodies, and graphics with coloured overlays highlight- Professor of Anatomy at the University of Notre Dame and Honorary As- ing key anatomical details), sociate Professor at the University of Melbourne. – integration of clinical questions and answers, and Norm has kindly offered to work with College educational advisors, – the facility for the student to examine anatomical concepts from mul- and the Speciality Boards, to further enhance the learning and teaching tiple perspectives using multiple pathways. of anatomy, avoiding rote learning and guiding Trainees to employ a clin- In the ANZ Journal of Surgery 2006 (76; 709) Peter Field described ical, deep approach to their learning.

[Surgical News] PAGE 19 August 2010 LAW COMMENTARY

Protection of College intellectual property

FELLOWS IN THE NEWS

INTERNATIONAL DEVELOPMENT Michael Gorton College Solicitor

n years gone by, medical colleges have freely shared educational materials without re- Igard to security and ownership. They were simpler times. Today, the educational environment is more complex and the need to protect the creative work of the College has assumed greater significance. “Competition” from universities, government and the private sector has increased. The College’s intellectual property (IP) has greater value and commercial appeal. The College now has a sophisticated IP Policy dealing with contributions from College staff, College communities, individual Fellows and the Specialist Surgical Societies. The fact that the College operates a bi-national training program, and the fact that the College is answerable to the Australian Medi- ership are therefore less clear. However, the cur- responsible for the development of curriculum, cal Council, the Medical Board of Australia and rent IP Policy of the College makes it clear that instruction and assessment in the Specialty for government generally, necessitates the need for the College is either the owner of, or is entitled approval by the College in accordance with the the College to have control of its intellectual to use, all intellectual property rights relating Statement of Principles”. property relating to the training program. This to education and training materials. The MoU repeats the Statement of Princi- intellectual property is within all our educa- ples, including that “the College and the Soci- tional material including curriculum, policies, Intellectual Property Rights ety will respect each other’s autonomy”. processes and all types of assessment. At law generally, ownership of copyright vests Clause 10 of the MoU confirms that “The The College has developed a number of with the creator. In the first instance, this is the Society will be responsible, through the Col- policies dealing with intellectual property particular individual who has created the ma- lege, for the development of agreed programs rights in materials created by and for the Col- terial; although if they did so as an employee, in education, training and standards of prac- lege. The latest College Intellectual Property then ownership will vest in their employer. tice, health policy and any other agreed areas in Policy has been well circulated, and forms the relation to training and education ...” basis of the relationship between the College College Contractual 2. The Service Agreement between College and the Specialist Surgical Societies. Arrangements and the Societies also reflects the philosophy of In the past, the College (and the Societies) Intellectual property rights are also governed the MoU and, in particular, provides: have been less clear about intellectual property by contractual arrangements:- 2.1 that the “Material relevant to the Training rights, and the division of ownership. Some of 1. Under the Memorandum of Understand- Program owned by the College at the time of en- the material is clearly created by employees of ing (MoU) between College and the Specialist tering this Contract remains vested in the College” the College or the Specialty Societies, and vests Surgical Societies, the College is the principal 2.2 that the “Material relevant to the Training with their employer. Some material is created body for training and education (including Program owned by the Society at the time of by Fellows, potentially as representatives of the continuing education) of surgeons in Australia entering this contract remains vested in the College and/or the Societies, and issues of own- and New Zealand. The Societies are “the agent Society” [Surgical News] PAGE 20 August 2010 The fact that the College operates a bi-national training “ program, and the fact that the College is answerable Protection of College intellectual property to the Australian Medical Council, the Medical Board of Australia and government generally, necessitates the need for the College to have control of its intellectual property relating to the training program.”xx

2.3 that ownership of intellectual property in through the College itself, or through the Soci- College’s Power To License material (being material created pursuant to ety, provide pro-bono assistance and input into The College is able to sub-license the intellec- the contract) shall vest in the party or parties a range of work produced by the College. This tual property rights in its training and educa- responsible for its creation, unless otherwise work includes the development of curricula, tion materials, including curriculum materials, agreed expressly in writing; policies, position statements and the develop- to others involved in the training program in 2.4 that each party in whom intellectual ment of other educational assessment material. Australia and New Zealand. The College has a property vests grants to the other party a per- 3.3 Work provided under the umbrella of the general right to “sub-license” in connection with petual, royalty free, irrevocable and licence fee College means that the College (and where the College’s training and education activities. free, non-exclusive licence (including the right agreed and appropriate, the Society) has a right to sub-license on the same terms) to use, copy, to publish and use these materials as required, Conclusion modify and exploit such Intellectual Property provided such use is within the parameters Accordingly, the College’s need to ensure that in Australia and New Zealand for the purpose defined by its key direction statement and the it has control of its intellectual property rights of this Contract, and for the ongoing training values and in accordance with its other agree- in its training and education materials, is fully and education activities of the other party, or as ments with the Society. supported by the contractual arrangements otherwise agreed. This includes work developed by Fellows of currently in place. 3. As an annexure to the Service Agreement, the College working within their Society when Fellows can access the College IP Policy the College’s Policy on intellectual property is such work is developed under the direction of, on the College website (www.surgeons.org). It included as applicable to the contractual ar- or when acting specifically as an agent of, the is reassuring that the College has taken these rangements between the parties. In that policy: College. Such work is described as being for the steps to ensure that its educational and train- 3.1. The College acknowledges that the Soci- College, and therefore owned by the College. ing materials are protected, and appropriately ety may wish to express and develop its own The position is that both the Fellows who are available to all of those involved in the Col- position or policies relating to its own intel- develop educational material, and the Society in lege’s important role of training and education lectual policy. This policy is expressed to deal the development of educational material, act as in Australia. with the College’s intellectual property. agents for the College in that development and Michael Gorton is a principal at Russell 3.2 It provides that Fellows of the College, such material therefore belongs to the College. Kennedy Solicitors

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[Surgical News] PAGE 21 August 2010 FELLOWS IN THE NEWS

FELLOWS IN THE NEWS

INTERNATIONAL DEVELOPMENT

Happy to hear again Deadly Ears Program Ninety per cent of indigenous children are suffering from some form of middle ear problem

health program in Queensland de- gram, Mr Matthew Brown, said news of the by communities. signed to reduce the incidence and continued funding had been welcome. “One of the reasons for the invitation is that Aseverity of chronic ear disease in in- “Ear disease is the most significant chronic ear disease has become such a common prob- digenous communities recently received State disease affecting the indigenous community lem in some places it has been normalised as a Government funding to allow it to continue to with up to 90 per cent of children suffering fact of life rather than as a problem that can be operate until 2013. some form of middle ear problem,” he said. entirely prevented,” he said. The program, called Deadly Ears, grew out “The World Health Organisation has stated “That is easy to understand when a of a combined push from Queensland ear, nose that a rate of four per cent in any community number of generations have been affected, but and throat (ENT) surgeons and Aboriginal is of concern, so this is very significant. Deadly if a community asks for our assistance they un- and Torres Strait Islander (ATSI) health work- Ears not only provides screening, support and derstand that it’s a problem that can be tackled. ers to develop a fully-funded state-wide system education, we offer a service, at the invita- “That allows us then to work with everybody to tackle ear disease which is believed to affect tion of communities, called Hospital Walking interested in dealing with the problem from kin- up to 90 per cent of ATSI children. Country in which ENT surgeons, anaesthetists dergarten teachers, to mums-and-bubs groups, The only one of its kind in Australia, Dead- and nurses visit various towns to conduct the to local councillors, teachers and nurses.” ly Ears not only provides surgery for the chil- required surgery. One of the driving forces behind Deadly dren who need it, but also provides audiology “So far we have assessed, repaired damage Ears is Associate Professor Chris Perry who testing to pick up impairment earlier, speech and restored hearing to more than 2000 children. has spent years lobbying both State and Fed- and occupational therapy for children who al- “As well as that we work with children, par- eral Government’s for the funding to address ready have irreversible hearing loss and train- ents and teachers to provide strategies to help ATSI ear disease which he describes as a na- ing for teachers of hearing impaired children. the kids make the most of the hearing they still tional disgrace. Since its expansion in 2008, more than have by advising on how classrooms can best Yet, he said, there were many pioneers be- 3,500 children have been screened for hearing be arranged in terms of boosting the acoustics fore him who tried their utmost to help af- impairment, with Deadly Ears staff now hav- so that children remain engaged.” fected children in past decades including John ing worked with 70 health services across 20 Mr Brown said a key element of the pro- Quayle, who made his first trip to the remote indigenous communities to provide ear health gram’s success was both the number of ATSI township of Cherbourg in 1971, Professor Bill training and support. The Director of the Pro- staff employed and the need for an invitation Coman, Alan Dugdale, the Head of Paediatrics

[Surgical News] PAGE 22 August 2010 Speech Pathologist Andrea Coleman and Aileen McKinley Deadly Ears’ Coordinator Sarah Boyne and Arnold Cobbo in Woorabinda, Queensland.

at the Mater Hospital and Dr Gerry McCaffer- to help the greater proportion of children that He called on both State and Federal Govern- ty, a driving force behind the original outreach. surgery isn’t suitable for.” ments to fund programs across Australia based Deadly Ears Program Associate Professor Perry began his visits Associate Professor Perry said the reasons on the Deadly Ears model but appropriate to to remote communities in 1982 and still makes for the high incidence of ear disease in indig- each state’s needs. two such outreach surgical visits each year. enous children included the presence in re- “We now know that many ATSI children “There have been a number of incarnations mote towns of tropical bacteria, overcrowding have an otitis media infection by the time they of Deadly Ears with many committed ENT and contaminated water and said the main are 12 months old,” Mr Kong said. surgeons participating, but each time the fund- culprit was a suite of infections of the middle “If you think of the ear drum as a musi- ing was either insufficient for the task or ran ear called otitis media, some of which cause no cal drum, these children have ear drums filled out when we’d only had a chance to scratch the symptoms until the damage has occurred. with fluid or pus and that is what their hearing surface of this massive problem. “Whenever you talk to people in these is like, like a drum filled with fluid. “Ear disease and hearing impairment are the communities it’s all about ears, ears, ears with “If that is not treated early, the children most pressing health issues confronting indig- daylight between ear disease and other press- grow up knowing only that muffled sound, enous communities with the widest social and ing health concerns,” he said. then it worsens, they can’t hear at school, they educational ramifications for the most vulner- “There you have kids screaming with pain become disengaged and frustrated and the rest able at the most important time in their lives, so at night and others just going quietly deaf and if of their lives are affected by this preventable that has been frustrating to say the least. they can’t hear, they can’t learn which adds pro- and treatable infection. “But finally we seem to be getting some- foundly to the lifelong impact of these diseases. “There is a great dichotomy in health serv- where and now Deadly Ears has the services of “Deadly Ears works to teach parents about ice provision in Australia, but if there was the around 30 surgeons from across Queensland hygiene, teachers to teach hearing impaired political will and sufficient funding this could conducting around 17 to 20 volunteer ENT children and health workers to know how to be changed. We need to make sure the infra- trips into remote towns each year. screen and the ideal time to send these children structure and medical supports are in place “Yet it remains a complex problem because to the ENT surgeons.” so that kids don’t slip through the net and the of the 90 per cent of children that have suffered Associate Professor Perry is now in the proc- model of Deadly Ears, with its ATSI staff, its al- hearing loss, we can only operate on five to ten ess of lobbying the Federal Government for lied health professionals, surgeons and nurses per cent of the most serious cases and after more on-going funding and said those Queens- all working within and for a community is careful selection because otherwise they can land ENT surgeons involved in Deadly Ears what makes it so special. be made worse. would be happy to pass on their knowledge to “It would be great to see specifically fund- “We can’t put grommets in for example other surgeons or health authorities wishing to ed projects in each state that follow the lead of if the children are then going to play in con- establish a similar program in other states. Deadly Ears in recognising the enormous se- taminated water for then they’ll become deaf One such ENT surgeon is Kelvin Kong from verity and impact of ear disease in indigenous because of a discharge so we had to find ways NSW, the first Aboriginal surgeon in Australia. communities across the country.”

[Surgical News] PAGE 23 August 2010 SURGICAL TRAINING

Mind, body and soul How to manage when you are at the end of your tether

Dr Ina Training OF DEVIN KHO PHOTOGRAPH COURTESY

here are times in our careers where we lose focus on what we are doing and Tforget why we became doctors. Often it is because we no longer enjoy what we do, or don’t get the satisfaction from a job well done anymore. If you have read Samuel Shem’s “The House of God”, you’ll know exactly what I mean. You get tired, frustrated, even blasé or cynical with the constant merry-go-round of the public hospital system. Disillusioned, dis- enfranchised, disenabled; you start to question your own sanity because you CHOSE to train in this particular vocation, in this particular system. Patong Beach I am in the first few days of a two week stretch of holidays, and all I have thought about so far is why I am not enjoying my career Each morning at 05:30, I get up and run along anymore. I have been finding it difficult to con- centrate at work lately, forgetting patient details “the beachfront, before the weather gets too hot. for the first time in my life. We get sent on fool’s The humidity makes you sweat profusely, but errands – to get a test arranged you write form the gentle breeze at this hour feels like the soft one and take it to one department, who give you form two to take to a second department soothing caress of a protective parent.vvv on the other side of the hospital, they then give ” you a third form to fill in and return to another on the bed to dry under the cool flow of the relationship between the ripples and the in- department, who then give you form one and air-conditioner, before dressing and heading visible guidance of the breeze. One of the last ask you to take it back to the first department downstairs. satisfying things I did at work was on a very again. “There’s a hole in my bucket, Delilah, Breakfast is supplied in the hotel, and I sit busy cover shift; there were several sick admis- Delilah….” I might as well go searching for a drinking bottomless cups of tea while looking sions and reviews, a patient taken to emergency set of fallopian tubes. out at the expansive, opulent and luxurious theatre, urgent stressful phone calls to senior My surroundings are blissfully beautiful; pool. My mind drifts and again I am think- staff, etc. During all of these pressing issues, I the resort I am staying in is in the rebuilt area ing about running around in meaningless cir- stopped to put on an anxious little old lady’s of Patong Beach in Phuket, after the Tsunami cles. The pool plays on my subconscious and slipper, which had fallen off while she was ly- came through and razed everything. The peo- I slowly become aware of the ripples traveling ing in bed. This is not in my job description. I ple are friendly and pleasant, but not pushy as over the water. They are driven by the same do not get paid for this. But it was the most re- I had previous experienced in Asian countries. gentle breeze. Initially, it looks quite chaotic warding experience of my evening, a highlight I haven’t been sleeping that well for the last few with one set of ripples going one direction, and in the sea of my personal hypertensive crisis. months, and have become an early riser. Each several others in different areas of the pool go- And I remember why I chose this particular morning at 05:30, I get up and run along the ing others. A pattern emerges, you can’t quite vocation, this particular burden. beachfront, before the weather gets too hot. predict where the ripples will go to next, but I thank the attentive breakfast waiters and The humidity makes you sweat profusely, but you can see the flow when you follow each set. slip out the door, back up to my room. I thank the gentle breeze at this hour feels like the soft You can see that they are meant to go where Phuket for reminding me of the resilience and soothing caress of a protective parent. My arms they do. beauty of humanity in the face of adversity. and legs burn, and my lungs ache, but I feel This is exceptionally reassuring. I feel my- And I vow to continue to let the omniscient more alive now, recharged. I shower, then lie self relax a little bit more. I contemplate the breeze guide me. Working together for a healthier country WA Community | Compassion | Quality | Integrity | Justice [Surgical News] PAGE 24 August 2010 Our Values:

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WACHS A4 medical ads.indd 6 25/06/10 6:31 AM RESEARCH, AUDIT THE GARNETT PASSE AND RODNEY ACADEMIC SURGERY& WILLIAMS MEMORIAL FOUNDATION AWARDS FOR 2011 PROJECT GRANTS Applications are invited for Project Grants for research in Otorhinolaryngology or the related fields of biomedical science to commence in 2011. Project Grants are for a period of up to three years and must be conducted in an Australian or New Zealand institution. Please note that a current awardee whose fellowship, scholarship or grant is due to conclude after 30 June 2011, is ineligible. The annual level of support will be up to AUD100,000 and, within this FELLOWS IN THE NEWS cap, grants must include the salary of the applicant and/or research assistant(s), on-costs, equipment, maintenance and all other costs. Usually commitments will not be INTERNATIONAL DEVELOPMENT made in which continued support over many years is implied. Closing Date: 27 August 2010

GRANTS-IN-AID Applications are invited for Grants-In-Aid for research in Otorhinolaryngology or the related get your savings and overdraft fields of biomedical science to commence in 2011. Grants-In-Aid are for a period of up to join forces, why wouldn’t you? to two years and must be conducted in an Australian or New Zealand institution. Otolaryngologists Do you currently have access to a savings and overdraft facility in a or Trainees in the Specialty are single account, at some of the best rates available? Investec Experien eligible to apply. Please note that a current awardee whose fellowship, Audit of Surgical Mortality specialises in providing innovative financial and cash management scholarship or grant is due to solutions to healthcare professionals. conclude after 30 June 2011, I would like to thank you for your ongoing commitment is ineligible. The annual level of support will to the mortality audit process Put our unique online savings and overdraft POD+ account to be up to AUD50,000 and grants are restricted to equipment work for you. Contact your local banker, call 1300 131 141or visit and maintenance only. Usually www.investec.com.au/professionalfinance. FRONTIERScommitments will not be made in2010 Guy Maddern system is controlled by user name and pass- The Art,which Science continued and Future support of Otorhinolaryngologyover many Chair, ANZASM Steering Committee word. Each user’s access to data is limited to 28 – 30 Julyyears 2010, is implied. The Langham Melbourne, Australia their operational needs. All communication Closing Date: 27 August 2010 he Australian and New Zealand Au- is encrypted using current industry security Further details concerning the dit of Surgical Mortality (ANZASM) standards (HTTPS). All you will require is in- above awards together with the program has been operational for over ternet connection (preferably Internet Explorer current application forms can be T eight years, beginning in Western Australia and 8, Safari 4 or Mozilla Fire fox 3.6) for optimum INTERNATIONALobtained KEYNOTE from:- SPEAKERS: Professor David Howard now is operating nationally, with all states and security. ProfessorThe Valerie Secretary Lund CBE territories contributing from 2010. Development of the interface is now com- ProfessorThe Jay GarnettRubinstein Passe and Rodney The College has a strong commitment to plete and each regional office has undertaken Williams Memorial Foundation PO Box 577 improve the quality of health care. I would like rigorous testing of the system, which will FOR FURTHEREAST INFORMATION, MELBOURNE VIC 8002 to make you aware of the imminent introduc- shortly be deployed into a pilot phase where CONTACT HELEN DAVIS: tion of the ‘Fellows Interface’, an extension to small groups of Fellows will begin to enter live P +61Telephone: 3 9419 0280 +61-3-9419 0280 F +61Facsimile: 3 9419 0282 +61-3-9419 0282 the existing in-house Web-based Mortality Au- data. You will be notified when the system is Email: [email protected] E [email protected] dit IT system (BAS). Current project staff enter available for general use. audit information into BAS for case assessment This new initiative will provide users with W www.gprwmf.org.au/frontiers Experien purposes. a dynamic, user-friendly tool to enter Surgical The new interface will provide Fellows with Case Forms and complete First-line Assess- the means to enter information directly into an ments online. Completing audit forms will electronic template of the Surgical Case Form, be more convenient. The process will be more as well as first-line assessments. This has been streamlined with less paperwork. Deposit Facilities • Asset Finance • Commercial Property Finance • Goodwill & Practice Purchase Loans • Home Loans THE GARNETT PASSE AND RODNEY WILLIAMS configured for both PC and Mac users. I am hoping that this initiative will benefit Income Protection & Life InsuranceExperien • Professional Overdraft MEMORIAL FOUNDATION The web-based Audit and Fellows Interface you as a user and will encourage your input of Investec Experien Pty Limited ABN 94 110 704 464 (Investec Experien) is a subsidiary of Investec Bank (Australia) Limited ABN 55 071 292 594 AFSL 234975 (Investec Bank). system ensures data security. All access to the cases through the online system. Deposit products are issued by Investec Bank. Deposits made with Investec Bank are guaranteed by the Australian Government as part of the Financial Claims Scheme for amounts up to AUD$1 million per client. The terms and conditions for Investec Bank deposit accounts are set out in the DPOD, POD+ and Term Deposit Accounts Product Disclosure [Surgical News] PAGE 26 August 2010 Statement (“PDS”). You should obtain a copy of the PDS before you apply for this product and consider your personal needs and circumstances before investing. All finance is subject to our credit assessment criteria. Terms and conditions, fees and charges apply. We reserve the right to cease offering these products at any time without notice. get your savings and overdraft to join forces, why wouldn’t you?

Do you currently have access to a savings and overdraft facility in a single account, at some of the best rates available? Investec Experien specialises in providing innovative financial and cash management solutions to healthcare professionals.

Put our unique online savings and overdraft POD+ account to work for you. Contact your local banker, call 1300 131 141or visit www.investec.com.au/professionalfinance.

Experien

Deposit Facilities • Asset Finance • Commercial Property Finance • Goodwill & Practice Purchase Loans • Home Loans Income Protection & Life InsuranceExperien • Professional Overdraft

Investec Experien Pty Limited ABN 94 110 704 464 (Investec Experien) is a subsidiary of Investec Bank (Australia) Limited ABN 55 071 292 594 AFSL 234975 (Investec Bank). Deposit products are issued by Investec Bank. Deposits made with Investec Bank are guaranteed by the Australian Government as part of the Financial Claims Scheme for amounts up to AUD$1 million per client. The terms and conditions for Investec Bank deposit accounts are set out in the DPOD, POD+ and Term Deposit Accounts Product Disclosure Statement (“PDS”). You should obtain a copy of the PDS before you apply for this product and consider your personal needs and circumstances before investing. All finance is subject to our credit assessment criteria. Terms and conditions, fees and charges apply. We reserve the right to cease offering these products at any time without notice. REGIONAL NEWS

The Four Hour Rule in Western Australia Only one hospital in Western Australia has achieved its target

Jessica Yin • Increasing 24 hour coverage Competitive Health Knowlege System Western Australian Regional Chair • Earlier consultant/senior registrar review at triage (CHKS): “there is no obvious clinical reason why • Increased use of General Practioners (GP) growth in emergency admissions should differ n an attempt to improve Emergency De- in Emergency Departments between UK countries… the four hour target in partment (ED) waiting times, ramping and • Enhanced roles for nurses with more England has clearly had an impact and poten- Iambulance bypassing the Department of ‘defined’ nurse practitioner roles tially cost the taxpayer more than £2 billion” Health Western Australia (DOH WA) intro- • Utilisation of allied health services duced the four hour rule based on a model Other concerns: used in the National Health Service (NHS): It has potential advantages: • Reduced relevance of Emergency Medicine • The issue of access block is formally as a profession. Rapid patient processing, Definition of the Four Hour Rule: addressed and burden shared by the whole less diagnostic evaluation and procedural Ninety-eight per cent of patients arriving at hospital intervention all leads to poorer training of the ED are to be seen and either admitted, dis- • Theoretically speeds up delivery of emergency personnel. charged or transferred within four-hours from specialised care by fast tracking to the • Reduction in the standard of emergency the time of triage. appropriate unit care delivered. “Stay and play” becomes “The Four Hour Rule Program is based on a • “Enhancing the use of clinical judgement “load and g o ”. similar model used in the United Kingdom, which rather than waiting for test results • The setting of ‘targets’ has lead to ‘gaming’ has been successful in delivering benefits to pa- of figures and the creation of “virtual beds tients and staff” – DOH WA Gov How successful has it been? “ in CDUs (clinical decision units). These A group of health clinicians from WA In the UK: are often poorly staffed areas . Health visited 12 NHS sites to look at how the • Fundamental concerns still exist with the • Left to Surgical registrars to “finish the job” – system worked in the United Kingdom (U.K). time and percentages of the ‘Four Hour to confirm the diagnosis and either commence The policy commenced in April 2009 in the Ru l e’. The College of Emergency Medicine treatment (after they emerge from theatre) or four major teaching hospitals and was progres- in the UK has suggested that ‘a 95 per cent re-refer to a more appropriate specialty sively rolled out to the rest of the state. six hour target would be more sustainable, • Patient perception of faster care will contrib- and cost effective ute to more presenting to ED than the GP The policy was to be achieved using the • Evidence suggests it may actually increase • Time in ED has a higher priority than following strategies: admission numbers overall and cost to patient care • Review and overhaul of the five tier health care: two million extra patients “Patients are no longer known by their Australasian Triage Scale (ATS) [triage admitted through ED in England over names or by their conditions, they’re not even system used to determine the priority for the five year period that the 4HR was known by a number…patients are referred to treating emergency patients]. introduced with >25 per cent discharged by their time. By this I mean how long they’ve • Enhanced use of discharge lounges the same day1 been in the department…as soon as a patient

[Surgical News] PAGE 28 August 2010 ticks past three hours their name lights up like a and often emerge from theatre to face a The Final Word: Christmas tree…If their stay approaches three barrage of admissions As many may be aware the four hour rule has hours 30… the managers start to appear… • If they are on call for a number of hospitals recently been scrapped in the UK following they don’t actually care…about Mr Jones who (as are the smaller surgical specialties) they the report on the Stafford Hospital showing is having a heart attack…he’s got to go, wher- are often woken several times a night as multiple failures of the trust with associated ever it may be, as long as it’s not ED…”(UK patients approach the four hour limit. increased morbidity and mortality. 2,3 Medical Student 2008) • If admissions are inappropriate or badly managed the surgical team will have to In Western Australia: “tidy up” or re-refer patients themselves. Despite the statement that the policy will There is no avenue to feedback to ED be more successful in WA due to better directly and patients cannot be returned to resourcing we have seen the following: ED if a mistake has been made. • Only one hospital (Princess Margaret • A culture of clock watching is already We can only hope the same Hospital for Children) has achieved its pervading EDs resolution occurs in WA before we target • There is a growing alienation between ED too see the same increase in poor • Admissions have increased (as have and surgical staff patient outcomes. discharges of patients the next day) • In WA both the immediate past and current • Patients are often admitted before results of State Presidents of the AMA are ED physi- The Four Hour Rule in Western Australia investigations are known cians supportive of the four hour rule. 1.Emerg Med J 2006;23:2 doi:10.1136/ • The workload for Surgical Staff has • WA has a liberal government. The four hour emj.2005.031948 increased significantly rule is considered by the National Labor 2. www.cqc.org.uk/_db/_documents/Investigation_ • Surgical Registrars are particularly Health department as a good thing. There- into_Mid_Staffordshire_NHS_Foundation_Trust.pdf disadvantaged since they often cannot see fore we have seen little criticism of the policy 3. www.guardian.co.uk/society/2009/mar/17/nhs- a patient within the prescribed time frame from the Opposition Health Spokesman hospital-mid-staffordshire-findings

[Surgical News] PAGE 29 August 2010 FOUNDATION FOR SURGERY INDIGENOUS HEALTH SURGICAL TOTS CMC Pub: RESEARCH SOCIETY Thank you for donating Kelvin Kongto speaking the to students Foundation about surgery as a career for Surgery 47th Queensland Western Australia Mr J Lancaster Mr I Thompson ANNUAL Dr T Porter Victoria SCIENTIFIC New South Wales Mr B Dooley

Mr G Coltheart Mr J Elder 41 Page: MEETING Dr K Merten Scotchman’s Creek Golf Club Mr K Prabhakar will be held in New Zealand Adelaide Mr A Merrie on Friday 19th Total November 2010 Singapore Mr H Chng $6 6,720 The FoundationThis for Surgery meeting helps towns is open where theseto children live all those involved in or interested in research, including surgeons, surgical or medical trainees, researchers and scientists. Surgery as a career YES, I wouldInterest like to indonate the College’s to our Foundation Indigenous program for Surgery. to explore JEPSON LECTURER: With every donation oversurgery $1000, theas College a career is able to has support already Research &attracted International Outreach24 Aboriginal Programs. Professor Michael Solomon “Surgical RCTs: Past, Present and medical students and doctors

Future” 10-AUG-2009 Date: Name: Kelvin Kong Speciality:held in Ipswich, Queensland in April and Chair, Indigenous Health Committee GUEST SPEAKER Address: the 66 riders, mostly Fellows, raised an im- Professor Herb Chen, past President, pressive $9,000. Association for Academic SurgeryTelephone: hanks to fundraising by Founda - Facsimile:The College’s program to promote sur- “Targeting Notch in Neuroendocrine tion Board for Surgery member gery as a career to Indigenous communi- Your Cancers:passion. Bench to Bedside” My cheque or Bank Draft (payable to Royal Australasian College of Surgeons) for $ . TDr Michael McAullife, Aboriginal ties has already attracted 24 Aboriginal and Torres Strait Islander doctors and medi- medical students and doctors from across CALL FOR ABSTRACTS: Please debit my creditcal students card account will learn for $more about surgery. Australia. Many of these students and YourThe skill. call for abstracts will be open as a career at the annual symposium of the doctors will be in attendance at the career on Monday 2nd August 2010 and must be submitted no later than Mastercard VisaAustralian AMEX Indigenous Diners Doctors’ Club Association NZ Bankcard expo, providing the first opportunity to en- YourWednesday legacy. 29th September 2010. (AIDA). The Foundation for Surgery is pro- gage as a group and with the Committee. Abstract forms will be availableCredit Card No: viding funds to support the efforts of the The Committee Expiry is very grateful/ to the from the email address below Indigenous Health Committee (IHC) to Foundation for Surgery and especially to from mid July. promote surgery as a career to Indigenous Michael McAuliffe, for his support of this Card Holder’s Namecommunities - Block Letters at the AIDA symposium. Card Holder’sprogram Signature and to the College for Dateits commit- CONVENOR: A College surgical career expo will inform ment to advancing the status of Aboriginal Your I would like my donation to go to: Professor Guy Maddern Aboriginal doctors and medical students at- and Torres Strait Islander people in the General College Bequests International Development Program tending the annual symposium of AIDA in medical profession. It is hoped that our pro- Plate: Foundation.PRESIDENT: Scholarship andLaunceston Fellowship in program October., Members International of the IHC Scholarship gramme Program will be successful in converting In- Professor John McCall I have a potentialand contribution local Fellows to will the Culturalbe available Gifts to Programtalk digenous interest in surgery as a career into I do not give permissionabout surgery for acknowledgementand the Mobile Surgical of my Simu gift- in anyTrainee College applications Publication and future surgeons.

FURTHER INFORMATION: C lation Unit will be on site for students to trial

Sue Pleass Please send your donations to: M Foundation for Surgery their laparoscopic surgical skills.

Scholarship Co-ordinator Y The funding was made possible by the Tel: +61 8 6363 7513 AUSTRALIA & OTHER COUNTRIES NEW ZEALAND K Fax: +61 8 82162 2077 Royal Australasian Collegeefforts of Surgeons of Dr MichaelPO Box 7451 McAullife who con- GGSS College of Surgeons Gardens Wellington South New Zealand Email: [email protected] - 290 Spring Street ceived and organisedTel: +61 4 385 the 8247 inaugural Foun- EAST MELBOURNE VIC 3002dation for SurgeryFax: +64 Bike 4 385 Ride. 8873 The ride was

[Surgical News] PAGE 30 August 2010 SURGICAL NEWS P41 / Vol:10 No:7 August 2009

COLLEGE AWARDS

Congratulations on your achievements

FELLOWS IN THE NEWS Erwin Thal - Honorary Fellowship Citation by Michael Hollands Erwin Thal receiving his Honorary rwin Thal is a great friend of this College Fellowship from Ian Gough and has made an enormous contribution INTERNATIONAL DEVELOPMENT Eto the care of injured patients in Australia and New Zealand. He is Professor of Surgery, Trauma, Burns and Critical Care at the Univer- sity of Texas, Southwestern Medical School. He studied medicine at Ohio State Univer- sity School of Medicine and served his intern- ship and general surgical residency at Parkland Memorial Hospital in Dallas, Texas. He joined the staff as an instructor in the Department Of Surgery and a year later, in 1970, was appointed Head of the Surgical Emergency Room. He became Associate Professor of Surgery in 1975 serving in this capacity until 1982 when he was geons. He was appointed the Scudder Orator national faculty including Stephen Deane to appointed Professor of Surgery. He chaired in 1992, his presentation was entitled “Out of develop the Definitive Surgery for Trauma Care post-graduate education in his department Apathy”. In 2000 he was the Minnie Stevens Course, a course devoted to teaching advanced from 1981 until 2001. Piper Professor recognising “superior teaching” surgical techniques in trauma care. He contin- Erwin’s list of publications is extensive. His at college level. In 2000 he was the visitor for ues to teach the course all over the world with first paper, on arterial injuries, appeared in 1971. the Military Section at the Annual Scientific his Australian and New Zealand colleagues. Erwin has contributed to over 40 book chap- Congress (ASC) presenting four excellent pa- Now run by International Association for Trau- ters and authored four books. He has served as pers on the care of injured patients. ma and Intensive Care (IATSIC), the course is a consultant reviewer for the Journal of Trau- He has made substantial contributions not taught in nearly 20 countries around the world. ma and Archives of Surgery and was Editor of only to surgical education and trauma but also Erwin’s other major contribution to the care Postgraduate Surgery from 1989 until 1992. to his community especially the American Red of injured patients in Australia and New Zealand Erwin has served on many university, hos- Cross. was to trauma verification. Erwin was commit- pital and college committees over the years, ted to the holistic care of injured patients. This reflecting his interest in surgical education Training in trauma care meant not only their surgical care, but also a full and trauma/acute care surgery. Erwin joined It is Erwin’s many contributions to trauma understanding of the trauma system, and the the American College of Surgeons Committee care in Australia and New Zealand that this hospital trauma service. He played a major role on Trauma in 1981, remaining a member until Honorary Fellowship seeks to recognise. Many in developing a verification program for trauma 1994 and served as Chair between 1986 and Australasian surgeons have visited Erwin’s units attesting to their overall ability to care for 1990. He was Vice President of the American unit at Parkland. As Chair of the Committee injured patients. He was a member of the CoT’s Association for the Surgery of Trauma, and of on Trauma (CoT), Erwin played a major role trauma verification committee from 1988 un- the Western Surgical Association. In 1980 Er- in the successful negotiations between the til 1995 and remains a senior reviewer for that win joined the Advanced Trauma Life Support CoT and the College which led to the prom- program. Working closely with Peter Danne and Faculty serving in various capacities up to the ulgation of the Advanced Trauma Life Support Damien McMahon Erwin, he assisted in de- present. He was Governor of the North Texas Course in Australia and New Zealand. Erwin veloping a trauma verification program here in Chapter of the American College for six years was a member of the faculty of initial Provider Australia and New Zealand. between 1998 and 2004. Course and the subsequent Instructor Course Erwin’s many contributions to the care of He has received many honours throughout in 1988. Locally known as Early Management injured patients worldwide, and especially his a long and productive career. These include a of Severe Trauma (EMST) it is now an integral contribution in Australia and New Zealand, Distinguished Service Award from the Ameri- part of the training of all surgeons in Australia make him a worthy recipient of Honorary Fel- can Trauma Society and an Outstanding Serv- and New Zealand. lowship of the Royal Australasian College of ice Award from the American College of Sur- A decade on, Erwin worked with a multi- Surgeons. [Surgical News] PAGE 32 August 2010 calling creative surgeons Do you have an hobby a r ti s ti c ? Like painting, photography, glass blowing, sculpture, woodwork, ceramics or jewellery making. If so and you’d like to take advantage of this opportunity please contact Lindy Moffat [email protected]

We expect to repeat the very successful art exhibition held at the 2002 Adelaide ASC.

Space has been reserved at the Adelaide Convention Centre for Fellows to display artworks for purchase or for display.

THE ASC RETURNS TO ADELAIDE IN 2011 – a city with a fine reputation for the arts. ADELAIDE ASC & THE ARTS TRAINEES ASSOCIATION

Nominations for the John Corboy Medal It is once again time to invite nominations for the prestigious John Corboy medal

FELLOWS IN THE NEWS Greg O’Grady Chair, RACSTA

he John Corboy medal is the only Col- lege medal for Trainees, and is awarded INTERNATIONAL DEVELOPMENT Tup to annually at the Annual Scientific Congress. The award is named for Dr John Corboy (1967-2007), who selflessly devoted his time and wisdom in energetic services to the College, despite personal adversity. All current Trainees are eligible for the medal, and nominations are welcomed for any Trainee having demonstrated outstanding achievements inside or outside of surgery. It is desired that the nominee will show some or all of those qualities for which John was particularly admired: leadership, selfless service, tenacity, and service to fellow Trainees. service to the College, in which time he has be- ers out there, so please do not hesitate to nomi- In addition to awarding of the medal, the come a forthright and highly respected advocate nate a Trainee who you think might be deserv- recipient will also be invited to present at the of Trainees within the College. Dr Peters has ing of this award. Trainees Forum at the College Annual Scien- played an integral role in improving the profile tific Congress (ASC). This tradition was started of Trainees in the College, particularly through in fitting fashion by the inaugural recipient of his substantial contributions to leading the Roy- the John Corboy medal, Dr Matthew Peters, a al Australasian College of Surgeons Trainees’ As- plastic surgical Trainee in Brisbane. Dr Peters sociation (RACSTA) from 2008 to 2009. Please contact Fiona Bull (fiona. was awarded the 2010 John Corboy Medal at We are looking forward to hearing reports [email protected]) for details on the Perth ASC for his five years of outstanding about all those highly talented Trainee achiev- how to make a nomination.

Extended format for Occupational Medicine Course

Edward M Schutz comprehensive overview of the return-to-work Convener, Occupational Medical (Bridging) Course for issues that are experienced by each industry. Surgeons Site visits are being organised for 2010 he Occupational Medical (Bridging) so note these dates in your diary: TCourse for surgeons is proving very suc- • Melbourne, Friday 12 November cessful. Building on the success of visits to the • Sydney or Wollongong, 19 Friday Ford Assembly Plant, Melbourne and the Coal November Services Training Facility, New South Wales, the half day program is being expanded to a The location of the visits is currently being whole day format. Participant feedback has in- finalised and details will be available soon. If dicated that this format is preferable as it will you would like to register for the course, have enable surgeons to visit two or three factories an industry connection or would like to help in one day. organise a visit, please contact the Professional During the visit, participants observe first returning to work. In addition return-to-work Development Department. Email: PDactivities hand the challenges that patients face when co-ordinators and worksite doctors provide a @surgeons.org or call +61 3 9276 7441.

[Surgical News] PAGE 34 August 2010 Established since 1977

Specialist Consultants in permanent and temporary medical staff placements. Contact Carol Sheehan

Telephone 03 9429 6363 Facsimile 03 9596 4336 Email [email protected] Website www.csmedical.com.au Address 22 Erin St Richmond 3121

Echuca Regional Health, Echuca, Victoria General Surgeon • Integrated sub-regional health service with 153 acute, sub-acute and residential aged care beds entering a major rebuilding and expansion phase • Visiting Medical Officer contract with underwritten income, or salaried staff specialist appointment • Unrivalled lifestyle in Victoria’s prime tourist region, only 2½ hours’ drive from Melbourne Echuca Regional Health (ERH) is seeking a suitably qualified General Surgeon to join its team of specialists at a pivotal time in the Service’s development. The appointment would enable ERH to consolidate the provision of surgical services to the rapidly expanding regional community it serves. The local catchment population of 40,000 and extended catchment population of 70,000 are swollen by 1.8 million tourist visitors a year. ERH is an integrated health service made up of an acute hospital, an aged care residential facility and a primary care centre. A major redevelopment of the hospital is at the approved Master Plan stage. The recently completed state- of-the art operating suite has three operating theatres (one doubling as an endoscopy suite) and day procedure facilities. Diagnostic facilities include on-site pathology, general radiology, ultrasound, CT and nuclear medicine. A 24-hour teleradiology reporting service is provided for CT scans. The hospital has over 16,000 emergency attendances, treats 8,000 in-patients, delivers 300 babies and performs over 3,600 surgical procedures annually. Candidates should have a primary medical qualification registered or registrable with the Medical Board of Australia. Their specialist background should include FRACS (General Surgery) or a postgraduate clinical qualification in General Surgery assessed by the RACS as suitable for this position; a recognised qualification in gastrointestinal endoscopy; and appropriate specialist experience. Echuca is a vibrant and attractive tourist destination on the Murray River, only 2½ hours’ drive from Melbourne. Its colourful history as Australia’s largest inland port has been preserved through its still-active paddle steamers as the main tourist attraction backed by a solid rural and light industrial economy. Echuca offers an extraordinarily wide range of recreational, sporting and other leisure activities for all the family. It also has excellent educational and shopping facilities. Further information may be found on www.mycareer.com.au, www.erh.org.au and www.echucamoama.com Initial enquiries and applications may be sent in confidence to Les McBride at:

Email: [email protected]

Tel: +613 / 03 9486 0500 Fax: +613 / 03 9486 0200 L34505 Health Recruitment Mail: Suite 4, Level 4, 372 Albert Street, East Melbourne, Victoria 3002

[Surgical News] PAGE 35 August 2010 SUCCESSFUL SCHOLAR

Surgical training overseas Mr Eng Hooi Ooi enjoyed the chance to work within a different culture and health system

earning the skills to be able to conduct It has an active both endoscopic and open surgery to Ltreat tumours arising from the sinuses academic“ program and brain was the greatest benefit to flow from with weekly grand a University of Toronto Rhinology Fellowship according to Adelaide Otolaryngology surgeon rounds for the entire Mr Eng Hooi Ooi. department with a Mr Ooi spent a year in Toronto from June topic comprehensively 2009, an opportunity made possible through the financial assistance provided via the Col- presented by residents, lege’s Margorie Hooper Scholarship which faculty staff or invited funds Fellows and Trainees from South Aus- tralia wishing to further their training overseas. visiting academics.xx Mr Ooi worked in Toronto under the su- ” pervision of Professor Ian Witterick, a rhinology expert and vice-chair of the Department of Otolaryngology Head and Neck Surgery at the University of Toronto. He also spent time also greatly enjoyed teaching and mentoring the with Dr Allan Vescan, another experienced en- Otolaryngology residents and acting as a faculty doscopic skull base surgeon. member for several sinus surgery courses. Over the course of the year he divided his time With the support of Professor Witterick, between Mount Sinai Hospital, Princess Margaret Mr Ooi also attended a number of meetings Hospital, Toronto Western Hospital and St Joseph’s including those of the American Rhinology Health Centre, each of which specialised in either a Society, American Academy of Otolaryngology particular type of surgery or technique. Head and Neck Surgery, the North American “Toronto has become renowned in recent Skull Base, World Congress on Thyroid Cancer years for the Head and Neck and Skull Base and the World Congress of the International surgery conducted there through the dyna- Eng wtih his family at Niagara Falls Academy of Oral Oncology. mism of the department of Otolaryngology He said he had enjoyed the chance to work surgery at the University and the leadership of His endoscopic skull base surgery involved within a different culture and health system Professor Witterick,” Mr Ooi said. the repair of brain fluid leaks and the removal and said he would not have been in a position “It has an active academic program with of sinus cancers, pituitary tumours and brain to take up the Fellowship and support his wife weekly grand rounds for the entire depart- tumours such as meningiomas and crani- and children in Canada without the Scholar- ment with a topic comprehensively present- opharyngiomas. ship provided through the College. ed by residents, faculty staff or invited visit- “It was this combination of rhinology and “The support of the Margorie Hooper ing academics. head and neck surgery that was of greatest Scholarship was extremely valuable in allow- “There are also weekly head and neck tu- value in that generally rhinologists are experi- ing me to take up this opportunity as the sal- mour board meetings where difficult cases are enced with endoscopic approaches whereas the ary of a fellow there is not sufficient to get by discussed from various hospitals and it seemed to head and neck surgeons are experienced with in Toronto,” he said. me that it would be a significant advantage to fol- open approaches and I thought it would be val- “I was both delighted and surprised to re- low such a system in Adelaide with staff from the uable to have experience in both,” Mr Ooi said. ceive it and we had a great time, my two sons en- Royal Adelaide Hospital and the Flinders Medi- “Working alongside both specialists meant joying the experience of going to school in a dif- cal Centre meeting to discuss complex cases.” that I was able to learn the skills needed to be ferent country and climate and we have agreed Mr Ooi said that over the year he per- able to tailor the surgical approach to the pa- that this was the best year of our lives,” he said. formed anterior craniofacial resections, orbital tient’s pathology rather than offering only one The Scholarship has been made possible exenterations, and treated a large number of type of surgery.” through a generous bequest from the late Mar- other head and neck cancers including thy- Mr Ooi said that while he had particularly gorie Hooper of South Australia and carries a roidectomies. relished the chance to learn new skills he had stipend of $65,000. [Surgical News] PAGE 36 August 2010 RELATIONSHIPS & ADVOCACY

Donald Murphy giving a tour of the skills lab Discussing the Australian health system Young American leaders visit the College Fostering international ties between younger politicians, political staffers and lobbyists

Keith Mutimer of Australia’s political system and the ways in After the presentation, delegates were given Vice President which it resembled, and differed from, that of a guided tour of the College and its Skills Cen- the US. They were also told that, like its politi- tre by its Clinical Director, Don Murphy. ight delegates from the United States, cal arrangements, Australia’s health system is touring Australia as guests of the Com- something of a hybrid, with features reminis- The College was pleased to host: Emonwealth Government, visited the cent of disparate systems around the world. The Hon. Vicki Englund, Missouri House of ” College on 21 June to learn about Australia’s The meeting then explored the structure of Representatives (Democrat). health system and, in particular, the advocacy Australia’s health system as well as the many The Hon. Michael J. Moran, Massachusetts House efforts of the College. advantages and challenges it faces. These in- of Representatives (Democrat). The Hon. Rahn Mayo, Georgia House of Part of a global program to foster interna- cluded closing the life expectancy gap between Representatives (Democrat). tional ties between younger politicians, politi- indigenous people and the broader Australian The Hon. Anna Tovar, Arizona House of cal staffers and lobbyists, participating coun- population, the inadequate provision of mental Representatives (Democrat). tries also include the United Kingdom, Japan, health and the sometimes long delays patients Ms Alicia Hughes, Alexandria City Council, Vietnam, New Zealand, Papua New Guinea face in accessing emergency or elective care. Virginia (Republican). and the Philippines. The delegates were interested in drawing Mr Jeffrey Rabren, Office of the Governor of The visiting Americans were addressed by comparisons between their own health system Alabama (Republican). the College’s Director of Relationships and Ad- experiences and that of Australia with a view Ms Jennifer Spall, Senior Public Affairs Manager, vocacy, Mr James McAdam, himself a former to understanding potential solutions that may Wal-Mart Inc. (Alaska, Oregon and Washington). delegate to the United States. The College CEO, reap benefits in their own jurisdictions. The Ms Jessica Monroe, Director, State Government Dr David Hillis, also spoke to the delegates. discussion was lively and engaging and many Affairs, Johnson & Johnson (Alabama, Louisiana, The visitors were given a broad overview perceptive questions were asked. Mississippi and Tennessee).

LEADERSHIP IN A CLIMATE OF CHANGE 19-21 NOVEMBER, MELBOURNE

Change provides an ongoing challenge to surgical According to Prof Clifford Hughes FRACS, CEO of leaders. Understanding your own style of leadership and the Clinical Excellence Commission who enrolled in adapting it to the situation and personalities of others in the diploma and helped facilitate this workshop, “I the workplace is crucial in today’s dynamic world. was mightily impressed with the way the presenter This workshop encourages a journey of self- worked with a group of clinicians, not known discovery by undertaking a psychometric behavioural for their ready acceptance of some of the issues profiling exercise, indicating an individual’s preferred raised. It was great fun…. The informal discussions leadership style. Group discussions identify alternative illustrate the way in which the presenter engaged leadership styles, the value of emotional intelligence each member of the group and developed their and a range of appropriate management styles that enthusiasm, including me. More importantly, I think can enhance workplace relations. there is still a lot to learn.” Please contact Professional Development Department. T: +61 3 9249 1106 F +61 3 9276 7432 E: [email protected]

[Surgical News] PAGE 37 August 2010 LETTER TO THE EDITOR

Surgical workforce 2009 – a call to arms

RELATIONSHIPS & ADVOCACY

Dear Editor hospitals.4 Within their own institutions Keith Mutimer’s article in Surgical News our colleagues need to be convincing (Vol:11 No:5, Page 5) and the College advocates for the local surgical care of The 2009 Census Findings… enclosed 2009 census of surgeons makes for so- older children and adolescents with bering reading indeed, especially for appendicitis, minor lacerations and paediatric surgeons likely to be in prac- abscesses. Surgeons need to counter the 1, 2 tice for the next 10 to 20 years. administrative temptation to transfer Keith Mutimer Vice President Whilst the Vice President highlights these patients, together with the costs s you are aware the College census some of the key issues confronting and responsibilities of their care, of the Australian and New Zealand Asurgical workforce was conducted in 2009. An excellent response rate of just over 80 per cent was achieved, providing a robust paediatric surgery in particular which ‘elsewhere’, for their paediatric surgical data set and a valuable tool for advocacy. Un- der the strong leadership of my predecessor arise from the report, there remain colleagues to manage. as Vice President, Dr Ian Dickinson, the data was refined to provide illustrative findings in an easy to read format. I would like to take this several important additional points. Secondly, our speciality enjoys opportunity to thank you for taking the time to participate in this important project and I am pleased to release the findings in this edi- First, paediatric surgery remains a far higher proportion of female tion of Surgical News. Key Findings numbers of active surgeons in both Australia The Surgical Workforce 2009 report (up 16.7 per cent) and New Zealand (up 15.0 covers Fellowship, Working Patterns and Workforce per cent) between 2005 and 2009. Of note is the College’s smallest speciality, consultants, 22 per cent in Australia Aging and Retirement Plans. Your responses Key findings in the Surgical Workforce 2009 the increased number of women in the surgical regarding the issues of work-life balance report included an overall increase in the workforce (up 61.5 per cent in Australia and 42.9 and workplace stressors will be explored number of surgeons per population across per cent in New Zealand). On a yearly average, representing just two per cent of the and 27 per cent in New Zealand, through Surgical News articles. For example, Australia and New Zealand. In Australia the one female entered surgical practice for every 3.6 you may recall that a census related article, ratio has changed from 1:6000 in 2005 to males between 2005 and 2009. Fellowship compared to 34 per cent compared to just 11.6 per cent and 3.6 “Threat of Litigation – An Unavoidable 1:5000 in 2009. In New Zealand the ratio On a more sobering note, nearly a quarter Stress?” was published in the last edition of changed from 1:7000 in 2005 to 1:6000 in 2009. of Fellows intend to retire from public on-call Surgical News. These ratios are attributable to increased within the next five years. for general surgery and 26 per cent for per cent in general and orthopaedic u orthopaedic surgery. Disappointingly, surgery respectively. As some may Correspondence to Surgical News should be sent to: Front cover photograph courtesy Bing Nguyen [email protected] Surgical News Editor: David Hillis Letters to the Editor should be sent to: © 2010 Royal Australasian College of Surgeons the situation would appear to be chose to work part-time, perhaps [email protected] All copyright is reserved. The College privacy policy and disclaimer apply – www.surgeons.org Or The Editor, Surgical News Royal Australasian College of Surgeons The College and the publisher are not responsible for errors or consequences further exacerbated by the fact that more than their male compatriots, this College of Surgeons Gardens from reliance on information in this publication. Statements represent the 250-290 Spring Street views of the author and not necessarily the College. Information is not East Melbourne, Victoria 3002 intended to be advice or relied on in any particular circumstance. paediatric surgery was the only one of has clear implications on the actual T: +61 3 9249 1200 F: +61 9249 1219 Advertisements and products advertised are not endorsed by the College. W: + www.surgeons.org The advertiser takes all responsibility for representations and claims. Published for the Royal Australasian College of Surgeons by RL Media Pty Ltd. nine specialities by examination which number of potential new consultant ISSN1443-9603 (Print) ISSN 1443-9565 (Online) ACN 081 735 891, ABN 44081 735 891of 129 Bouverie St, Carlton. Vic 3053. has failed to increase its workforce colleagues that need to be trained and [Surgical News] PAGE 5 June 2010 per 100,000 population in the last five then gainfully employed.5 Anecdotal References years. In New Zealand, the number of data from current students and 1. Mutimer K: The 2009 census findings...enclosed. surgeons has actually declined. residents suggests that our future Surgical News 11:5-6, 2010. That two per cent of the Fellowship consultant colleagues will expect 2. The Royal Australasian College of Surgeons. will not be able to provide all general a more even approach to balance Surgical Workforce 2009. Melbourne: The Royal surgical, urological, trauma and burns between life and work, with the need Australasian College of Surgeons; 2010. care for 20 per cent of the population to modify traditional work patterns 3. Australian Bureau of Statistics. Population by age and sex, would appear self evident.3 Indeed, to and practice styles.6 Perhaps the next Australian States and Territories, Jun 2009. achieve the same population ratio as census could better address this issue www.abs.gov.au/Aussstats/[email protected]/mf/3201.0. general surgery to those aged over 15 by reviewing current and preferred full 4. Drake D, Boddy S-A, Haddock G, et al: Paediatric surgical years would require an immediate, but time equivalent employment status of training for general surgical trainees: a trainee’s experience. equally implausible quadrupling of the fellows rather than focusing on the split Ann R Coll Surg Engl (Suppl) 92:214, 2010. number of paediatric surgeons. 2, 3 between private and public work? 5. Troppmann KM, Palis BE, Goodnight JE, Jr., et al: These statistics should alert our Finally, that 57.8 per cent of Women surgeons in the new millennium. colleagues with a general surgery paediatric surgeons perceive their Arch Surg 144:635-42, 2009. fellowship, especially in metropolitan level of on-call work as heavy or 6. Hebbard PC, Wirtzfeld DA: Practice patterns and career areas, of the need to continue to extremely heavy, compared to 30.4 per satisfaction of Canadian female general surgeons. provide at least a proportion of the cent and 25.7 per cent of general and Am J Surg 197:721-7, 2009. standard surgical care required for orthopaedic surgeons, should serve school-age children and adolescents. as a clarion call to the College and This issue has already been clearly Fellowship for urgent action if the high identified in the United Kingdom, standards of surgical care provided for with moves to incorporate a period of our children are to be maintained. Correction paediatric surgical training for general The Younger Fellows article (Vol: 11, No: 6, surgery trainees as one approach to Yours sincerely, page 20) last paragraph should have read – promoting the surgical care of children Andrew Holland “I hope at least some of our recommendations will in district and non-paediatric teaching New South Wales Paediatric Fellow appear in future editions of council highlights.” [Surgical News] PAGE 38 August 2010 Dear Mr Andrew Holland Order of Australia I concur with your summation of the escalating problem which exists in both metropolitan and Congratulations to Rowan Nicks who was regional Australia and New Zealand in respect to the appointed an honorary Officer (AO) in the management of children and adolescents with surgical problems. General Division There are many complex inter-related issues which exacerbate this work force problem. General surgeons and urologists, despite having a training syllabus containing significant sections on the surgical care of children and adolescents appear reluctant to be involved in this area. This is due in part to the increasing work load for these specialities in caring for the ageing population. In addition some of the training positions previously reserved for general surgeons in paediatric units are now being used for training paediatric surgeons. Many recent Fellows from these specialities have no confidence in managing common paediatric and adolescent problems. Paediatric units have become the after hours repository for many older children and adolescents whom could and should be managed by general surgeons and urologists. A classical example is a recent report where a urology registrar refused to see a 95 kg 16-year-old with an acute scrotum and demanded that this patient be transferred to a paediatric unit some distance away where the patient was assessed and managed by a paediatric surgical registrar who had in fact no experience in a “child” of this size. Despite increasing the number of paediatric surgical Trainees (there were eight Trainees in 2000 compared to 24 in 2010), there has been no significant increase in the number of consultant positions in the public hospitals. The surgical workforce figures demonstrate that paediatric surgeons give more time to the public “For service to medicine in the field of South-East Asia. hospital system than any other speciality spending more cardiothoracic surgery and by provid- Dr Nicks is a highly respected time in public consulting, public ward work, public ing training and education opportuni- member of the Royal Australasian administration and teaching. In addition there are now ties for young Indigenous and interna- College of Surgeons. In 1991, he es- less paediatric surgeons to provide greater supervision tional surgeons in Australia.” tablished and financed a scholarship for the increasing number of surgical trainees and program that provides opportuni- medical students. r Rowan Nicks, respected ties for young surgeons from devel- I am encouraged by Keith Mutimer’s comments in cardiothoracic surgeon, pio- oping countries, who show surgical the June Surgical News where he explained that “The D neered many operations for congen- ability and leadership qualities, to College now has a clearer awareness of the current ital and valvular heart disease, and learn skills alongside Australian sur- gaps in the surgical workforce and areas of current in 1957, was involved in the first case geons before returning to their com- and future need.” The Australian and New Zealand of open-heart surgery in New South munities to develop and promote Association of Paediatric Surgeons look forward to Wales. In the early days of open- their knowledge. being invited by the College to assist them “to develop heart surgery, he established safe use Recently, in association with the plans that can be taken to the Australian and New of cardiac bypass techniques and as- University of Sydney and the family Zealand Governments. sisted in developing pacemaker sur- of the late Russell Drysdale, he es- Yours sincerely, gery in Australia. He designed the tablished the Rowan Nicks Russell TONY SPARNON first automatic pacemaker. Drysdale Fellowship. This has been President Following his retirement from an inspirational scheme to encour- Australian New Zealand Association clinical practice in 1973, Dr Nicks age the development of future lead- of Paediatric Surgeons spent much time and energy teachers in Australian Indigenous health ing and working in Africa, India and and welfare. [Surgical News] PAGE 39 August 2010 INTERNATIONAL DEVELOPMENT

The beginning of an eye program in Samoa Given the small population it is possible to set up an efficient and effective eye program

asmanian ophthalmologist Dr Nitin Verma, recently awarded an Order of TTimor Leste and an Order of Australia for his work in establishing the East Timor Eye Program, has entered preliminary negotiations to establish a similar project in Western Samoa. Dr Verma and a volunteer team of eye spe- Pterygium cialists including his optometrist daughter causing blindness as it has grown Miss Surabhi (Sib) Verma, worked in Samoa over the cornea. in June as part of the College’s Pacific Islands Project, following a request from the National Health Service. While there the team saw more than 100 selected patients and conducted 83 operations to treat cataracts and pterygium, a growth over the surface of the cornea caused by exposure to sunlight and wind and the con- sequent drying of the eye. Dr Verma said all surgeries were successful and gave particular given the fact that most of the disease was ad- Burnie, Tasmania, Mrs Andrea Shuurmans, a praise to the local eye care nurses who assisted vanced, with patients virtually or totally blind, nurse from the Royal Hobart Hospital and Dr the team at the Apia hospital, Mrs Line Auriese it was greatly rewarding to do this work to help Robert McDonald, an ophthalmologist from and Mr Sua Mailie. the people of Samoa.” Sydney. The team was supported by Mrs Jane “The eye Clinic at the General Hospital in Dr Verma said that plans were now under- Haybittel and Mrs Anu Verma. Dr Verma said Apia was very well organised and the level of way in consultation with the Samoan Minis- the team took over consumables generously pre-screening conducted by both Mrs Auriese try of Health to establish a comprehensive eye provided by pharmaceutical companies Alcon, and Mr Mailie was excellent. Their choice of program linked to the limited services which Bausch and Lomb and praised the interna- patients for surgery was appropriate and the currently exist, possibly based on the model tional projects team at the College for the well advice they gave to patients post-operatively as established to help the people of East Timor. organised visit. well as their plans for follow-up care for these “The basic principles would be the same. patients was very satisfactory,” he said. We would offer training to assist with man- Well-oiled machine “I have seen eye-care nurse practitioners in power, volunteers from Australia to provide a When asked what it was like to work along- many countries and have found that those in regular presence to make sure the backlog of side his daughter Dr Verma said: “We’ve done Apia were perhaps the best and because of their patients does not become insurmountable, this many times now so it is no novelty for us. efforts we had some spectacular results like while advising the health authorities on the It simply means we work together like a well- those that we’d expect to achieve in Australia.” infrastructure required,” he said. oiled machine.” Dr Verma said that many of the patients who “Western Samoa has a population of about Sib Verma said she enjoyed working with attended for treatment were suffering advanced 180,000 people. The prevalence of cataracts her father on such outreach visits given that she disease with some people made completely blind and pterygia as well as diabetic eye disease is now lived on the Australian mainland while from either cataracts or pterygia. Therefore, he high but given the small population and easy her father worked in Hobart. said, the impact on the sight-restoring surgery accessibility to health care facilities on both is- “I started going on dad’s outreach trips upon their quality of life was considerable. lands of Samoa, it is eminently possible to get when I was still in my teens and have partici- “One of the patients was a local general rid of the backlog of cases and help set up an pated as a team member for the past six years. practitioner who was having problems car- efficient and effective program. His volunteer work has always been an inspi- rying out minor surgery and he underwent “We would help set up the equipment ration to me so it was probably not surprising phacoemulsification with insertion of a flexible needed and offer training in the use of it and that I ended up deciding on optometry given intraocular lens with a very good result. He had then, as in East Timor, step back and allow that it combines my interest in public health been referred to New Zealand for surgery so we them to provide the surgeries and eye care to and eye care,” she said. were pleased to be able to carry out his treat- their own people.” “It could be tricky working alongside a ment in-country,” he said. Other members of the team who partici- member of the family but we work well togeth- “Cataract surgery is known to be one of the pated in the June visit to Samoa included Dr er and it’s nice to have the chance to spend time most effective interventions in medicine and Michael Haybittel, an ophthalmologist from with each other while helping other people.”

[Surgical News] PAGE 40 August 2010 The beginning of an eye program in Samoa The 8th Cowlishaw Symposium THE SPEAKERS ARE: Mr Wyn Beasley, Mr Felix Behan, Mr Ross Blair, Mr Geoff Down, Hon Prof Sam Mellick,

Mr John Royle, Mr Sharp has been invited to Mr Phillip Sharp, deliver the eponymous address { Prof Alan Thurston, (the{ Russell Memorial Lecture). Saturday 6 November 9:30am

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Your passion. My cheque or Bank Draft (payable to Royal Australasian College of Surgeons) for $ . PROfESSIONAl INSURANCE SERVICES Your skill. Please debit my credit card account for $ . Enjoy complete peace of mind Your legacy. Mastercard Visa AMEX Diners Club NZ Bankcard BRW Women’s Health National Geographic Let Member Advantage take care of your insurance needs. Cover price: $7.95 Cover price: $7.20 Cover price: $10.95 * Credit Card No: Expiry / RACS (12 mth): $235.00 RACS (12 mth): $69.95 RACS (12 mth): $59.00 Protect your assets with our wide range of insurance services , Save: $146.60 Save: $16.45 Save: $72.40 providing you with reliable cover at great rates within the market. Card Holder’s Name - Block Letters Card Holder’s Signature Date Member Advantage Insurance products include: Your I would like my donation to go to: General College Bequests International Development Program Ò Car Insurance Ò Critical Illness Foundation. Scholarship and Fellowship program International Scholarship Program Plate: Ò Home & Contents Ò Income Protection I have a potential contribution to the Cultural Gifts Program Gardening Australia InStyle Better Homes & Gardens Cover price: $5.95 Cover price: $7.95 Cover price: $6.20 Ò Key Person Ò and many more I do not give permission for acknowledgement of my gift in any College Publication RACS (12 mth): $52.00 RACS (12 mth): $79.00 RACS (24 mth): $139.90 C Save: $19.40 Save: $16.40 Save: $21.30 Ò Life Insurance Please send your donations to: M Foundation for Surgery Y

Visit www.memberadvantage.com.au/login/racs AUSTRALIA & OTHER COUNTRIES NEW ZEALAND K Royal Australasian College of Surgeons PO Box 7451 or call Member Advantage today on 1300 853 352 Call MA Insurance & Superannuation on 1300 365 152 GGS S College of Surgeons Gardens Wellington South New Zealand 250 - 290 Spring Street Tel: +61 4 385 8247 Your Member Advantage discount will be calculated automatically in the purchase process and or visit www.memberadvantage.com.au/login/racs EAST MELBOURNE VIC 3002 Fax: +64 4 385 8873 is not available in conjunction with any other discount or for the purchase of iSUBSCRiBE Gift Vouchers. The discount is taken off the listed price as displayed on the site. All prices are current *Only available to Australian residents. Terms and conditions apply. as at the 1st July 2010 and are subject to change without prior notice. Visit the Member Advantage website for more details. SURGICAL[Surgical NEWS P41 News] / Vol:10PAGE No:7 43 August August 2010 2009

PM PHOTOGRAPHS COURTESY BINH NGUYEN PHOTOGRAPHS COURTESY HERITAGE REPORT

Memorabilia of Sir Sydney Sunderland

In 1952 Sir Sydney was elected to Honorary Fellowship of the College

Mike Hollands and exhibitions along the way. He joined The two pieces of memorabilia, a plate and Honorary Treasurer the Faculty of Medicine at the University of a bowl, were donated to the College by Don Melbourne in 1939, when he succeeded Wood Grant, a psychiatrist and Adelaide graduate. ate in May 2010 the College was pre- Jones as Professor of Anatomy, a position he He acquired them several years ago at a subur- sented with two pieces of memorabilia held until 1961. In that year he was appointed ban auction in Melbourne. Neither piece had Lrelating to Sir Sydney Sunderland. Sir Professor of Experimental Neurology, holding attracted any interest, but Dr Grant felt that Sydney was one of the most eminent men in this position until 1975. items associated with someone as eminent as Australian medicine, and for an older genera- He was at Oxford when war broke out in Sir Sydney should not be left to languish, so tion of Fellows he will need no introduction. 1939, but managed to return to Melbourne. he bid a modest sum and claimed them. On 6 Sir Sydney is best remembered as a brilliant During the War, in addition to his academic May, Dr Grant attended a lecture by the Cura- medical administrator. He was a member of duties, he was put in charge of the Peripheral tor on the College of Surgeons Museum, one of numerous government and academic boards, Nerve Injuries Unit at 115 AGH Heidelberg. a series of lectures on the medical collections most prominently as Dean of the Faculty of The results of his work on gunshot wounds to of Melbourne presented at the University of Medicine at the University of Melbourne 1953 the nerves were published as a series of clini- Melbourne. As a result he decided to offer the - 1971 and as a member of the University Coun- cal studies in 1944 - 45. His classic work Nerves pieces to the College, feeling that this would be cil 1951 - 1967. But in practice he was a neurolo- and Nerve Injuries was published in 1968. He a more appropriate home for them, and the of- gist, with a special interest in the peripheral gained his Fellow of the Royal Australasian fer was gratefully accepted. nerves. In taking up this field of research he College of Physicians (FRACP) in 1941. was influenced by several outstanding identi- He was awarded many honours and dis- The plate is a plain circular dish 27.7cm in ties, most notably Frederic Wood Jones, Hugh tinctions in the course of his long career. In diameter, made of pewter. In the centre is Trumble and Sir Hugh Cairns. 1952 he was elected to Honorary Fellowship inscribed: Sydney Sunderland was born in Brisbane of this College. He received honorary degrees Sir Sydney Sunderland on 31 December, 1910. He began a science from the Universities of Melbourne, Monash, Visiting Professor in Hand Surgery course at the University of Queensland in Queensland and Tasmania. He was appointed to the Raymond M. Curtis Hand Center [sic] 1930, but came to Melbourne in order to pur- CMG in 1961, and created Knight Bachelor in The Union Memorial Hospital sue a degree in medicine. His undergraduate June 1971. In the early 1980s the international Baltimore, Maryland career was stellar, coming top in every year Peripheral Nerve Study Group renamed itself In Recognition of Your Contribution to and graduating MBBS as top in medicine in The Sunderland Society in his honour. Sir Syd- Surgery of the Hand 1935, having been awarded numerous prizes ney died on 27 August, 1993. 1981

[Surgical News] PAGE 44 August 2010 His undergraduate career was stellar, coming“ top in every year and graduating MB BS as top in medicine in 1935, having been awarded numerous prizes and exhibitions along the way.”

The bowl is also plain, 23.1cm in diameter and 11.4cm high, made of pewter. On the outside is the inscription: ToSir Sydney Sunderland, M.D. With Appreciation, Tenth Anniversary Surgery and Rehabilitation of the Hand Symposium Philadelphia, Pa., March 1986

It is interesting to note that in his later years he was acclaimed as a leader in the surgery of the hand, even though he was not a surgeon. His major contribution to the repair of the hand was his long-term studies of the recovery of sensorimotor function. These significant pieces, associated with an Honor- ary Fellow of the College, will be put on display in the Hailes Room.

By Geoff Down, College Curator

[Surgical News] PAGE 45 August 2010 www.cancerlearning.gov.au Cancer Learning is a professional development website designed specifically for all health professionals working in cancer care, supporting them to build their knowledge, progress their careers & enhance their skills in providing optimal patient care.

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Back to the FutureAGSFM 2010 September 10 - 12 Victorian Annual General Scientific & Fellowship Meeting Royal Australasian College of Surgeons Rydges Bell City - 125 Bell St, PRESTON VIC 3072

For more information and registration please contact Denice Spence +61 3 9249 1254 or [email protected] Accommodation at Rydges Bell City 215 Bell Street. Preston, Victoria 3072. Visit www.rydges.com/cwp/RACS or email [email protected] or contact Claire Monatgna on +641 3 9485 0046 or email [email protected]

Definitive Surgical Trauma Care Course (DSTC) DSTC Australasia in association with IATSIC (International Association for Trauma Surgery and Intensive Care) is pleased to announce the courses for 2010. DSTC is recommended by The The DSTC course is an invigorating and exciting opportunity to focus on: Royal Australasian College of • Surgical decision-making in complex scenarios Surgeons for all Consultant • Operative technique in critically ill trauma patients Surgeons and final year trainees. • Hands on practical experience with experienced instructors (both national and international) • Insight into difficult trauma situations with learned techniques of haemorrhage control and the ability to handle major thoracic, cardiac and abdominal injuries To obtain a registration form, please contact Sonia Gagliardi on In conjunction with many DSTC courses the Definitive Perioperative Nurses Trauma Care Course (DPNTC) is (+61 2) 9828 3928 or email: [email protected] held. It is aimed at registered nurses with experience in perioperative nursing and allows them to develop these skills in a similar setting. 2010 COURSES: The Military Module is an optional third day for interested surgeons and Australian Defence Force Personnel. Melbourne: 16-17 November 2010

[Surgical News] PAGE 46 August 2010 INTERNATIONAL DEVELOPMENT

Prepared for trauma Samoa was able to set up an effective system after the tsunami due to the skills learned at the Primary Trauma Course

ast year, the serendipitous timing in the provision of AusAID -sponsored, LCollege-managed trauma training to Samoa assisted local medical staff to cope with the unprecedented stresses caused by the Sep- tember 30 tsunami that devastated the small island nation. The emergency response plan that grew out of the trauma course - now known as the “Savaii model” after the Samoan island upon which it was developed - enabled the Samoan health authorities to set up an effective triage and management system before international aid arrived. It was defining moment for the local people as it represented the first time that international medical teams could start work immediately within a crisis management system already in place. Such has been the enthusiasm in Samoa for the success of the Savaii model, that this year two more Primary Trauma Courses (PTC) “The best part of this education package, “Both aspects empower people and give have been held there to provide further train- is that the PTC combines both knowledge them the skills and the confidence to know ing to a broader range of emergency respond- and experience for the participants who get a they can cope with what can be infrequent but ers such as fire officers, police and remote clinic chance to practice the theory of resuscitation in frightening events.” nurses. a range of well-developed scenarios. Dr Curran said the PTC course was also of The wider professional selection was made “People’s imaginations were captured in Sa- great value in that it encouraged team build- this year because medical personnel are not al- moa by their capacity to cope with the tsunami so ing and boosted networking opportunities be- ways the first on the scene at many accidents, this year we provided an hour-long disaster simu- tween local health workers in different parts of given that Samoa does not have a national am- lation session on how to manage mass casualties.” the country. bulance system. Dr. Curran said the main techniques pre- “The people of Samoa are fantastic and The main course presenters this year were sented in the course were in stabilising patients, hugely enthusiastic and keen to learn,” he said. Dr Loudeen Lam and Dr Tapa Fidow, both lo- managing air-ways, breathing and circulation, “It’s all very well for overseas aid programs cal surgical registrars, and Dr Bryce Curran, an otherwise known as the ABC of trauma care. to come in and build a hospital or a clinic but anaesthetist from New Zealand, with the train- He said that in the absence of a national education and training are the key and I like ing provided at the Tuasivi Hospital on Savaii. ambulance service, the transport of trauma pa- being involved in that. The PTC program was developed to pro- tients was mostly undertaken by nursing staff “It’s particularly rewarding to help people vide affordable emergency and trauma skills while remote clinic nurses were also frequently introduce systems that they can then finesse to health workers in developing countries, the prime responders. to fit within their own geographical and social presenting similar principles to the Advanced “This year we particularly focussed on their framework like the Samoans did with the Sa- Trauma Life Support (ATLS) program. needs in terms of teaching the participants how vaii model.” Dr Curran said it was particularly effective they can start to treat patients from the minute because the skills taught could be applied to of their arrival,” he said. This year’s provision of the PTC To obtain a registration form, please contact Sonia Gagliardi on any situation, and any patient, and gave people “We go into that in great detail; what to course was a joint effort between (+61 2) 9828 3928 or email: [email protected] a common language of emergency response look out for, how to treat shock, how to recog- the College-coordinated Pacific 2010 COURSES: through-out the world. nise internal bleeding. Islands Project (supported by Melbourne: 16-17 November 2010 He said this was his third international trip “We also looked more broadly at what lo- AusAID) and the Health Ministry to teach the course, and his second to Samoa. cal disaster management plans might look like. of Samoa.

[Surgical News] PAGE 47 August 2010 For the sensitive touch. Be Ansell sure. K Y M C Plate:

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INTERNATIONAL DEVELOPMENT Date: 10-AUG-2009 Page: 44

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