Surgicalthe royaL Australasian CoNewsllege of Surgeons May 2012

Vol: 12 No:10 Nov/Dec 2011

The College delivers Competency Training Standards, p28

The College of Surgeons of Australia and New Zealand Hearing the next generation Important initiative from the Foundation of Surgery p22 c ntents

12 Wattle & Fern – the New President’s Gown A lighter gown will make If you’re a doctor in presidential travelling easier 14 A Surgeon’s Treasure training interested in A treasured compass has a research placement, made it to the public domain would $25,000 or 16 International Development $50,000 help? Professor David Wood delivering the HPV Avant is delighted to announce the launch vaccine in PNG of the Avant Doctor in Training Research 18 Successful Scholar 42 Scholarships Program. Matthew Hong delivering regular pages Each year we will award two full-time on efficiency 8 Surgical Snips 11 Poison’d Chalice scholarships to the value of $50,000 each and 22 Foundation for Surgery four part-time scholarships of $25,000 each. 13 Dr BB Gloved Important initiatives from 21 Ina Training Let us help turn your dream of that elusive generous donations 25 Law Commentary PD Workshops research placement into a reality. 28 Competency Training 36 27 The College delivers a world first on standards 25 Regional News 28 How New Zealand fares on As a recipient of grants in the past, I would encourage healthcare quality you to put as much detail as possible into the application, and safety it’s worth the time and effort to get it right. 35 Academic Surgery Important for both junior Dr Gareth Crouch and senior surgeons Cardiothoracic Registrar (SA)

SurgicalTHE ROYAL AUSTRALASIAN COLLEGENews OF SURGEONS MAY 2012

Member, Avant’s Doctor in Training Advisory Council Vol: 12 No:10 Nov/Dec 2011 The College Correspondence to Surgical News should be sent to: delivers world first Competency Training [email protected] Standards, p28 Letters to the Editor should be sent to: [email protected] Or The Editor, Surgical News, Royal Australasian College of Surgeons, College of Surgeons Gardens. 250-290 Spring Street, East Melbourne, Victoria 3002 +61 3 9249 1200 +61 9249 1219 www.surgeons.org T: F: W: The College of Surgeons of Australia and Applications open at 9am on 13 February 2012 and must ISSN1443-9603 (Print) ISSN 1443-9565 (Online) New Zealand Hearing the next be received by 5pm on 31 May 2012. generation Surgical News Editor: David Hillis / © 2012 Royal Australasian College of Surgeons / All copyright is reserved. Important Indigenous initiative from the Foundation of Surgery p22 The editor reserves the rights to change material submitted / The College privacy policy and disclaimer apply – www.surgeons.org For more information or to download the application form, The College and the publisher are not responsible for errors or consequences from reliance on information in this publication. Statements represent on the cover: please visit www.avant.org.au/scholarship Australia’s Leading MDO the views of the author and not necessarily the College. Information is not intended to be advice or relied on in any particular circumstance. An important initiative Advertisements and products advertised are not endorsed by the College. The advertiser takes all responsibility for representations and claims. from the Foundation of Published for the Royal Australasian College of Surgeons by RL Media Pty Ltd. ACN 081 735 891, ABN 44081 735 891of 129 Bouverie St, Carlton. Vic 3053. Surgery p22

Surgical News May 2012 / Page 3

AVAINS371_DIT Scholarship Advert_210x297.indd 1 7/03/12 5:26 PM Pagetop

2012 Definitive Surgical Trauma Care (DSTC) and Definitive Perioperative Trauma Nursing Care Courses President’s Perspective

2012 COURSES: Sydney (Military Module): 24 July Nonetheless, our perspective needs to be heard in the corridors of power, be they at jurisdictional Sydney: 25-26 July level or through the workplace. Auckland: 30-31 July + 1 August Anticipation There is no reason why surgeons should Perth: 24-25 October An exciting few years are ahead of us not contribute in a meaningful way to the development of health policy, particularly where it Melbourne: 30 Nov, + 1 December pertains to us. This will be a challenge as we have his President’s perspective is being ‘penned’ just less expertise and are looked upon with caution The DSTC course is an invigorating and exciting before the Annual Scientific Congress in Kuala by many. This is not a reason not to progress this opportunity to focus on: TLumpur, Malaysia. It looks like being a terrific issue, however. • Surgical decision-making in complex scenarios meeting. With a variety of top quality international speakers, The second message from the strategic planning • Operative technique in critically ill trauma patients a record number of submitted abstracts and an above weekend was the importance of the College • Hands on practical experience with experienced average number of early registrations, the 2012 ASC should moving our CPD program into a more meaningful instructors (both national and international) be an outstanding event. space. Almost all of us attend enough educational • Insight into difficult trauma situations with learned techniques of haemorrhage Given that surgeons are somewhat notorious for booking activities to fully comply with the educational control and the ability to handle major thoracic, late and even turning up without prior arrangement, as well requirements. What needs more robust cardiac and abdominal injuries as high levels of interest from our Malaysian Colleagues, monitoring is our commitment to audit both of the College is confident of an outstanding conference in a our practices and within an in-depth peer-reviewed The DSTC course is recommended by the Royal Australasian brilliant venue. I am personally aware of many people taking methodology. College of Surgeons for all consultant surgeons who participate the opportunity of not only contributing in KL, but then This can be achieved in a number of ways in care of the injured and final year trainees. It is considered essential for surgeons involved in the management of major using it is a launching pad for further travel. We are so much including good quality morbidity and mortality trauma and those working in remote, regional and rural areas. closer to many other destinations. meetings. The College has worked incredibly The ASC in 2013 is in Auckland and already arrangements diligently with numerous stakeholders to ensure This educational activity has been approved by the College’s are well in hand for a fantastic event there. By dint of our Mortality Audit function has progressed to CPD programme. Fellows who participate can claim one point per hour (maximum 18 points) in Category 4: Maintenance of circumstance, the ASC in 2014 is now being planned as a The 2014 ASC will now be in Singapore. being well regarded and surgeon friendly. Clinical Knowledge and Skills towards the 2011 CPD totals. parallel meeting with the College of Anaesthetics. It will However, we must be doing more than that. be held in Singapore. Martin Richardson, an orthopaedic CPD and audit of our practices is not an option The Definitive Perioperative Nurses Trauma Care Course (DPNTC) is held in conjunction with many DSTC courses. It is aimed at surgeon from Melbourne will be the coordinator. for the community. They demand it and rightfully Although RACS was aiming to be in Melbourne and His contribution has been extraordinary in times that registered nurses with experience in perioperative nursing and demand that the professional bodies like the allows them to develop these skills in a similar setting. ANZCA in Sydney, circumstances beyond our control have often have been demanding. He has purposefully steered the College ensure it. If the College does not assume colluded to enable parallel meetings – the first since 2000. discussions between the College and the various Specialty this responsibility it will be imposed upon us by The Military Module is an optional third day for interested surgeons and Australian Defence Force Personnel. One to keep free in the diaries! The ASC is the premier Societies through troubled waters. The College’s role in being an outside body with models that will not fit, and event for surgery in South East Asia and with an increasing the accredited body for training in surgery and awarding the not work to improve standards, and certainly will DSTC Australasia in association with IATSIC (International number of multi-disciplinary groups now involved with the FRACS is critical. not be surgeon oriented. Association for Trauma Surgery and Intensive Care) brings you courses for 2012. meeting, there is a very broad program in both the plenaries A new relationship between the College and the 13 Other areas discussed at the strategic planning and the scientific sessions that appeals to all specialties specialty societies is being negotiated and will reflect the weekend were Council Governance and the within the broader ‘surgical church’. Societies’ increasing role in all aspects of College activities, fiduciary responsibility of Councillors, the College DSTC is recommended by The Royal As President, I wish to acknowledge the outstanding especially education. Seeing this incorporated in a principle business model and where surgery might be in the Australasian College of Surgeons for all commitment from my predecessor, Mr Ian Civil. His based Memorandum of Understanding / Service Agreement next decade. Consultant Surgeons and final year trainees. leadership of the College was exemplary, not only in the past needs to be bedded down over the next six months. So my term as President has just started. I look two years as President, but in more than 20 years of service In the Council strategic planning weekend, held just forward to meeting you at the many meetings of before Easter, two clear messages were apparent. The first through courses, especially the EMST Program of which he the College and the Specialty Societies that I hope Please register early to ensure a place! was a “founding father” and CcRISP, Trainee selection and was to emphasise the role of advocacy in College activities. to attend. I am sure together we can progress these supervision, more committees than I can name, professional We need to explore every opportunity to promote surgery three key goals in the coming months. To obtain a registration form, contact Sonia Gagliardi on development and advocacy, and prior to being elected and surgeons. The politics of health is very complex with no Mike Hollands (61 2) 9828 3928 or email: [email protected] President, as Censor in Chief. ready solution that will be acceptable to all stake-holders. President

Page 4 / Surgical News March 2012 Surgical News May 2012 / Page 5 Relationships & Advocacy DECLARE YOUR “There have been some very LOVE FOR THE positive achievements over those two years and several projects which are well advanced” CITY Melbourne Open House

> Decreasing the size of and streamlining Saturday 28 and health and hospital bureaucracy should be a Sunday 29 July 2012 major efficiency drive. > Existing resources can be spent more effectively. > Government initiated changes should not compromise patient care.

And we must confront once and for all the Cementing tired argument that we are somehow a closed shop. This College puts no cap on the number of surgeons it trains. The number of surgeons our place in training is limited by the number of surgical training posts in our public hospitals – a reflection of governments’ unwillingness or inability to invest in public health. Last October, The College will be firm on its healthcare agenda the College issued a media release warning of a A major public event in looming crisis in surgeon numbers in Australia. the calendar of Melbourne. Modelling currently being finalised by our t the last meeting of Council both our countries – increasing demand, President. I would like to acknowledge Workforce Assessment Department seems likely Last year the College opened its I was honoured to be elected yet increasingly limited resources with the fine work of my predecessor, Keith to reach similar conclusions about the surgical doors to the general public as part AVice President. I am aware that I which to perform sophisticated surgical Mutimer, who writes elsewhere in this workforce in New Zealand. These are hardly the of the Melbourne Open House assume the responsibility of this position procedures safely. The ageing of the issue of Surgical News of the committee’s actions of a closed shop. weekend. at a time of significant change, both population is but one of many challenges. achievements over the past two years. But our insistence that Australasian surgeons within the College and externally. Elective surgical waiting lists are a Your College, rightly in my view, be among the very best in the world is not Some 75 buildings not normally Working parties are reviewing both the “thorn in the side” of all governments. sees one of its major roles as advocacy. something we should ever compromise on, open to the public participated. College’s governance arrangements and The stated desire by governments to Effective advocacy requires the issue be or apologise for. Again, it is a reflection of our Over 106,000 people from the way in which our education programs eradicate elective surgery waiting lists is identified and a constructive position commitment to the patient. While it may be the Melbourne, regional Victoria, are delivered. It is too soon to say with welcome, but unrealistic in the absence of determined. Individual Fellows of the view of Government that any surgeon is better interstate and overseas attended. any certainty what models will emerge additional resources. College have an important role in these than no surgeon, as surgeons we know that this from these processes, but they will be In New Zealand some public patients processes – what needs to be said? The is rarely if ever true. The College received about 750 different from those currently in place. are denied elective procedures which are input of Fellows helps to identify issues I will endeavour to attend as many specialty visitors over the weekend. Externally there are significant changes deemed unnecessary even though their and shape the College’s responses. As society meetings and regional ASMs as I can, occurring in public health, particularly in quality of life is profoundly compromised surgeons we are primarily concerned with and I would welcome the opportunity to This year we plan to do it again. Australia where the Federal Government without them. This has given rise to doing the best we can for the individual hear your views on the issues you consider is endeavouring to bed down the changes charity trusts which, with the assistance patients we care for, but increasingly we important. I can always be contacted through The areas of the College which will be flowing from the centralisation of the of volunteer surgeons, perform these have a wider responsibility – to become the College. open to the public are: Council Room, registration and accreditation processes. procedures without charge. active in what might be termed the The next few years will undoubtedly be Hailes Room, Hughes Room, Council challenging. But, unlike governments which The Australian Health Practitioner In Australia some states have been politics of health. Corridor, Foyer and Gallery Skills Lab. Regulation Agency and its medical arm, forced to begin implementing cuts to seem not to see past the next election, our the Medical Board of Australia, seem daily public health services, to rein in health Guiding principles advocacy will be aimed at improving the to issue consultation papers addressing budgets which threaten to consume all By way of initiating debate, let me outline delivery of surgical care in the decades ahead. For more the detail of healthcare delivery. The government revenue within a couple of the guiding principles that I believe I look forward to working with you. information College has been and will continue to be decades. should fashion the College’s advocacy into please contact very active in advocating for surgeons. (I It is in this context that the work the future. Megan Sproule or urge Fellows to look at the advocacy page of advocacy becomes increasingly > Patient welfare remains paramount. Geoff Down of the College website to see just how important. The College’s Governance > There needs to be greater clinician at the College. many we have responded to over the past and Advocacy Committee, or GAC, is input into the formulation of health few years.) charged with overseeing the crucial task policy and into the management of our Michael Grigg +61 3 9249 1200 There is of course one constant, in of advocacy and is chaired by the Vice hospitals. Vice President

Page 6 / Surgical News May 2012 Surgical News May 2012 / Page 7 Surgical Snips Surgical Snips

Skin in demand A shortage of skin donors in Victoria has meant that lives could be at risk in the event of a major catastrophe such as Black Saturday. Despite the increase of organ donation, Victoria, which originally had Appendectomies Australia’s only skin banking facility, is on the way out An article in the British Medical now backed by a Journal claims that operations Queensland unit. to remove an inflamed appendix Director of the Alfred WA will get worse before it gets better should be abandoned.Researchers Hospital’s adult burns at the Queen’s Medical Centre unit, Heather Cleland in Nottingham (UK) studied four said that the skin trials of more than 900 patients in Obesity getting bigger allows the patient to The severe shortage of specialists in Western which patients took a course of Obesity surgery is on the rise and has prompted the establishment of an Australian recover when they Australia (WA) will only get worse in the coming antibiotics to treat the infection. In and New Zealand registry to monitor safety and patient outcomes. don’t have enough two-thirds of cases the antibiotics The registry, currently piloted in Victoria, will track the use of devices such as lap-bands of their own in initial years, and has been likened to ‘global warming’. James Aitken, Clinical Director of the WA Audit of Mortality has said that the were successful. They claim that the as well as inform the risks for the future. Professor Guy Maddern believes that the stages. “The problem is issue of a medical workforce has largely been ignored in recent times and 47,000 appendectomies carried registry is important to evaluate the effectiveness of procedures. And despite surgery that once you’ve got a may affect patient care for up to 15 years. “This increase is more akin to global out in England last year are driven being effective, prevention is always better than cure. “Surgery still is the most effective patient who needs it, warming in that the demand will rise and stay, and go up to a new higher level.” by tradition rather than evidence. way of reducing people’s weight… but clearly it’s not one we should be aspiring to.” they need a lot of it.” West Australian, 11 April. Canberra Times, Adelaide Advertiser, 12 April. The Age, 9 April.

Asian Society for Vascular Surgery

World Federation of Vascular Societies 2012 NSA Provincial Surgeons of Australia www.vascularconference.com Annual Scientific Meeting 48th Annual Scientific Conference

GENERAL SURGEONS AUSTRALIA Vascular 2012 conference Sheraton Mirage Resort and Spa Gold Coast, 1 - 3 November 2012 20 – 23 october ANNUAL SCIENTIFIC MEETING crown conference centre, Melbourne, australia Queensland Mount Gambier BUILDING THE FUTURE OF CANCER CARE ‘Solutions to Challenges in Vascular Surgery’ 4 – 6 October 2012 WREST POINT Save the Date australian & new Zealand society HOBART Further Information for Vascular surgery Invited Speakers: 21 - 23 SEPTEMBER 2012 T: +61 3 9249 1273 coMbined with the E: [email protected] Mr Glenn Guest asian society for Vascular surgery Associate Professor Tim Price and the Dr Frank Voyvodic www.generalsurgeons.com.au www.nsa.org.au world federation of Vascular societies

Page 8 / Surgical News May 2012 Surgical News May 2012 / Page 9 Information for Fellows Surgical Services

My Trainee, well to be honest, one of the many Trainees I knew reasonably now strode purposefully across the stage. I had been struck by her ability to stay Do you need to be registered? calm in the middle of any clinical storm, offer compassion to patients, to staff and The Medical Board of Australia has opted not to change to her seniors when required. How she had juggled the demands of training with the definition of practice and released a statement to guide her family commitments had continued those uncertain as to whether they need to be registered Poison’d to defy description. She deserved all the accolades she received. I looked again at Chalice the pledge, “I agree to continue learning ellows will recall that the College recently a person in that role to comply with the Board’s and teaching for the benefit of my participated in a consultation process, conducted registration standards for professional indemnity patients, my Trainees and my community.” by the Medical Board of Australia (MBA), aimed at insurance, continuing professional development and And there we were, all assembled. F The Council, the newest Fellows and defining medical practice and thereby determining who recency of practice and/or did, and who did not, have to seek medical registration. 5. they are required to be registered under any law to the older Fellows. We rose and recited The College’s submission can be viewed on the advocacy undertake any specific activity. the pledge together. I realised that I was page of the College website. feeling something that I had not felt in a long while. It seemed as if the constant The MBA has opted not to change the definition of Roles for which current practising practice and released a statement to guide those uncertain “Brownian” activity of my world had registration may not be necessary paused. It seemed as if the ghosts of the as to whether they need to be registered. The Medical Board of Australia advises that practitioners For the information of Fellows, those parts of the MBA’s great surgeons who had gone before were engaging in the following activities do not necessarily peering down upon us, listening to us statement pertaining to registration are reproduced below. require any registration or may choose to hold non- Fellows who remain uncertain as to the need for affirming our commitment to ideals. practising registration: The Pledge ended with the words, “I registration are advised to visit www.medicalboard.gov. 1. An examiner or assessor of medical students or medical au under Contact us to lodge an online enquiry form or accept the responsibility and challenge graduates, when the student or graduate is not treating of being a surgeon.” I looked at the new to call 1300 419 495 (within Australia) or +61 3 8708 9001 patients as part of the assessment, provided that the (overseas callers). Fellows. They were smiling, content that organisation on whose behalf they are acting believes they had achieved recognition, a place that current practising registration is not necessary for “I pledge to always act in the best interests of my within the profession. Like myself, the The Medical Board’s advice on who the scope of activity. older surgeons looked like they had just should be registered: 2. A tutor or teacher working in settings that involves patients, respecting their autonomy and rights” reaffirmed their pride in the profession The Medical Board of Australia provides the following simulated patients or settings in which there are no - extract from RACS Pledge. that they belonged to. advice, based on the objectives of the National Law, to patients present, provided that the organisation on As my mind drifted, it began to dawn guide practitioners’ decisions about whether or not they whose behalf they are acting believes that current It had been a few years. So busy being a Mind you Shakespeare was not the upon me that there is a place and a role should be registered. Any practitioner who is qualified and practising registration is not necessary for the scope of Clinical Director of one of the country’s source of great reassurance – most of in society for ceremony and tradition. meets the applicable registration standards may apply for activity. most challenged Surgical Services, that the pledges he referred to were drunken But maybe there is more to it than registration. 3. A researcher whose work does not include any human I my attendance at the Annual Scientific toasts over ‘Rhenish’ wine. The Code of that. Maybe it is the way to start ‘the As the primary purpose of registration is to protect the subjects and whose research facility does not require Conference had been less than impeccable. the Pirate Brethren also flashed into my revolution’ I spoke so passionately for public, medical practitioners should be registered if they them to be registered. This year I had made a point of going. I mind with Captain Barbossa stating ‘the in my last reminisces. A pledge based have any direct clinical contact with patients or provide 4. A person who speaks publicly about a health or felt a need. My exposure to the vapours of code is more what you’d call “guidelines” revolution. A realisation that the best treatment or opinion about individuals. As well, other state medical related topic and who will not be giving any accounting and corporate governance was than actual rules.’ Geoffrey Rush is so place for my loyalty, my efforts was not and commonwealth legislation provides that registration is individual patient advice. becoming toxic. good at Barbossa, but also Shakespeare… hospitals or institutions, but to the ideals required to enable prescribing and in order for a patient to 5. A person serving on a board or committee or A particular motivation was that The new Fellows were now convocating. that form the basis of my profession. be eligible for a Medicare benefit for a medical service. accreditation body, when their appointment is not some of my more promising Trainees It was an impressive sight. There were I thought of my current Trainee. Would For roles beyond direct patient care, the Medical Board dependent on their status as a “registered medical were making the effort to go to the certainly more female surgeons than in he understand the pledge? A bit too much of Australia advises practitioners to be registered when: practitioner”. Convocation. my day, but still not enough. The breadth of Generation Me, I thought. Perhaps I 1. their work impacts on safe, effective delivery of health 6. A person who may be using skills and knowledge I had missed my own convocation of cultural backgrounds was impressive was being unfair. I will need to challenge care to individuals and/or gained from an approved qualification, but is not using having headed off to the UK as a young and this was matched by the efforts of him and see what I can ‘open up’. 2. they are directing or supervising or advising other a protected title, nor claiming or holding themselves man – more intent upon the cut and the Chair of the Court of Examiners in Maybe the revolution is to make the health practitioners about the health care of an out to be registered, such as a person in an advisory or thrust of surgical endeavour, not giving ensuring all the names were pronounced pledge the custom, as Shakespeare would individual(s) and/or policy role. tradition and ceremony a second thought. correctly. That was not an easy task, but say. I think it will need to be for the next 3. their employer and/or their employer’s professional 7. A medical practitioner who is registered overseas and is I looked at the Convocation booklet. one so important to do well. I looked at audit meeting; the topic will be ‘Good indemnity insurer requires a person in that role to be visiting for any role not involved in providing treatment There, with some prominence, was the the words of the pledge again, ‘I will be and bad examples of acting in the best registered and/or or opinion about the physical or mental health of any ‘College Pledge’. I read it carefully – I am respectful of my colleagues, and readily interests of my patients, respecting their 4. professional peers and the community would expect individuals. sorry to say for the first time. The words offer them my assistance and support.’ autonomy and rights – two interesting of Hamlet resonate in my brain. ‘The Yes, the diversity of surgeons is really cases’. I smiled; the revolution was afoot. triumph of his pledge, Is it a custom?’ important to support. Professor U.R. Kidding

Page 10 / Surgical News May 2012 Surgical News May 2012 / Page 11 Heritage Surgeon health

Wattle and Fern – the new President’s gown A new gown will make things easier for future presidents

n the early months of Mr Ian Civil’s Doctor BB G-loved tenure as President, he and his wife “Made of black silk IDenise travelled to Wewak in Papua with gold ribbons Mr N-destruct-able New Guinea to represent the College at and embroidery, it a medical conference. Cutting through the hard issues In temperatures of more than 30 is elegant, light and, degrees and at a time of year when of equal importance, the country regularly suffers 90 per cent humidity, Mr Civil was required represents the College y name is Doctor Double- Even your College’s Code of Conduct N-destruct-able endured febrile episodes, by protocol to don the heavy woollen symbolically” Begloved. Yes, you read it right has its Section 9 on Surgeons’ Health swollen body parts, great pain and travelling gown over his suit when M- it is spelt with a ‘Double B’ which promotes the value of the increasing lassitude. acting in his official capacity. and a hyphen. I am g-loved to protect my same. Recently someone showed me Finally, in desperation, N-destruct-able It was, said Denise, unbearably each sleeve – a Wattle for Australia identity, and allow me to share with you your Competence and Performance consulted Doctor Double-Begloved. In hot and heavy so she decided to do and a Silver Fern to represent New readers some experiences of surgeons as Guide where under the competency of fairness, N-destruct-able had once phoned something about it. Zealand. patients. I would like you to regard me as professionalism it lists as a pattern of (not consulted) Mr Snip who had opined Upon their return to New Zealand, “I based the embroidered badges a confidante with your best interests and behavior, “maintaining health and well- the illness was unlikely to be related to she went into design mode using her on the sleeves on a brooch donated to surgeons’ health at heart. You can even being”. On page 17 of that guide, good the procedure. And now before me was skills as an architect to combine form the College by Mr Bruce Barraclough write and I will respond. This column is behavior is described as: “has a personal a respected specialist, weak at the knees, and function into sketches for a new at the end of his presidency,” she said. offered in good faith and wishes you a general practitioner”. Do you pass that test? lacking in insight, concerned about their light-weight official garment that would “That is also worn as an official long, healthy life. But first, you may find it One recent case I recall was a surgeon, schedule, reluctant to readjust their agenda. better serve future presidents in an era ornament, in that the President’s disturbing. who though nameless, we shall call What could I offer? Well though I lis- of increasing travel, particularly to the partner wears it when the President is Let’s begin with a personal question. N-destruct-able. N-destruct-able was tened with a half-sympathetic ear to all the more sultry climes of South-East Asian wearing the Presidential Medal. Do you have a family doctor? By this I suffering severely from the complications things N-destruct-able really had to do, I and Pacific countries. Previous President Ian Civil in the donated “The badges took quite a lot of work, do not mean, ‘do the other members of of what was expected to be minor surgery was in reality heartless and brutal. I signed travelling gown with his wife Denise. Now, after four months of effort, the about six weeks altogether, while all the your family have one?’ Of course they performed at the end of their own operating N-destruct-able off sick, forced the cancel- new robe is complete and has already ribbons were hand sewn to protect the do, otherwise they’d never survive waiting day by another colleague, Mr Snip. lation of the planned schedule, ordered been given to the College. clothes since I was very young, so I silk and I just hope it makes life easier for you to come home and take their After the procedure N-destruct-able some blood tests including blood cultures Made of black silk with gold ribbons thought a light, breathable gown could be for future presidents in warmer climates and complaints seriously. I mean do you, the got off the operating table and went to and changed the antibiotics to something and embroidery, it is elegant, light and, of our gift to future Presidents.” stands the test of time.” surgeon of the household, have a doctor do postoperative rounds. Complications with a far better spectrum of activity. N- equal importance, represents the College College Presidents have been donning Mr and Dr Civil have already presented whom you regularly consult and who ensued, caused almost entirely by a failure destruct-able rested, slowly recovered and symbolically. a robe of office since the Presidency of the gown to the College for the use of in- coordinates your health issues? to rest and recover like any of N-destruct- was advised to obtain a regular GP. “The President has two official gowns,” Sir Henry Simpson Newland in the mid coming President Michael Hollands while Don’t have a GP? Maybe you’ve never able’s own patients would have been ad- Those of you who have already learnt Denise explained. 1930s after a gown was ordered from Ede the brooch will be returned in May and been seriously unwell? If you’ve got kids vised and Mr Snip’s patients were advised. that you are as mortal as your patients “One is only used in Melbourne and at & Ravenscroft, the royal gown-makers in passed on to his wife Dr Jane Young. and dependants you’re likely to have The old surgical adage, “sutured have probably already got a GP. My advice the Annual Scientific Meeting. It is a very London. Denise described the experience of her applied for life insurance. That’s if your wounds do not travel well”, was ignored to those who don’t is: don’t choose your ornate robe modelled on a previous gown Over time, each robe needs either to be husband’s presidency as a wonderful time, blood pressure is near normal, you don’t or forgotten. For the next few days best friend; and don’t choose your wife, that is now in the College museum. replaced or undergo a major renovation, which was one of the reasons she felt have a threatening chronic disease, and N-destruct-able persisted in operating, husband, father, mother, daughter or son. “The other is known as the Travelling yet each time tradition has called for the inspired to make life easier for those who the serology confirms you are HIV, HCV supervising Trainees, conducting ward Your GP should be someone you Gown and given to the President for his or heavy wool of its early English ancestor. followed. and HBV negative. But having undergone rounds, whilst all the time feeling worse respect, and even be a little afraid of. My her use when they travel as representatives But as Australia and New Zealand – “It was a true delight to travel to such the life insurance medical examination is and worse, but not consulting anyone. blood pressure always rises when I know of the College. and the RACS – become increasingly interesting places and to meet wonderful not the same as having your own GP. Bedbound over the weekend, nothing I have to visit mine. “This one is also of heavy wool and, engaged in the Asian region, Denise made people,” she said. Many of your colleagues are sailing in could deter N-destruct-able from loyally Why shouldn’t we experience the same? while embellished with decoration, had the radical decision to ditch the wool of “It also meant that I got to spend more a GP-less boat. I am not touting for extra attending their operating list the next Choose someone who will treat you like nothing symbolic of Australia or New England for the silk of the tropics. time with my husband than has often work; my own practice is too busy. But Monday morning. Fuelled by antibiotics a patient, but who will also respect your Zealand. It is extremely uncomfortable to The new robe designed by Denise is been the case because we could travel the AMC Code of Conduct to which we (self-prescribed), anti-inflammatories medical understanding and need to be wear in tropical countries. based on the Standard College Gown and together.” are all bound says all doctors should have (over-the-counter), best intentions and informed. “I enjoy design and I have been making features stylish embroidered motifs on With Karen Murphy their own GP. delusions of invincibility (self-imposed), Dr BB G-loved

Page 12 / Surgical News May 2012 Surgical News May 2012 / Page 13 In the News

Pictures courtesy of Museum Victoria eon’s urg trea s su A re

The late Fellow William Wilson had a passion for the George Bass story and his compass.

widely loved surgeon known as “Willie” compass and sundial is made of brass and hunger for adventure that was at the heart Wilson in 2009, the pocket compass has steel, has a glass lid, a blue coloured dial of Dad’s affinity with Bass,” she said. found a new permanent home after a and has a moveable arm hinged to the top “Dad was quite a trail-blazer himself decision by his daughters to donate the of the compass. in plastic and reconstructive surgery, treasure to Museum Victoria. However, despite the fact that it was with a particular interest in hand surgery, His daughter, Dr Meaghan Wilson- manufactured in London by eminent and trained under John Hueston who Anastasios, described the artefact as her optical instrument maker Peter Dolland, was the pre-eminent plastic surgeon in father’s pride and joy. it was far from perfectly suitable for the Melbourne in the 1970s. “Dad cherished the sundial and purposes of the voyage. “Therefore it always made sense to us compass, but in his will he made no Said Museum Victoria curator Martin that he would have such an interest in a mention of it or where he wanted it to go,” Bush: “This was one of the most fellow explorer surgeon.” she said. remarkable and significant maritime Dr Wilson-Anastasios said that even “However, given that he loved it so expeditions in Australia’s early history. though Mr Wilson had security concerns greatly it didn’t feel right to sell it. My “Bass navigated his journey with a regarding the safety of the precious object sisters and I then decided that what did quadrant and this portable compass and over the years, he could never let it out of seem right was to put it in the public sundial made in London. his possession for long. domain for public enjoyment. “Yet, although the sundial could However, she feels sure he would be “We also thought it the best way to be adjusted for latitude differences, happy with the family decision. associate dad’s name with the name of his the compass was actually weighted “Dad treasured the object so much lifelong hero, George Bass.” incorrectly for use in the southern that even though he loved sharing it with A maritime treasure of two surgeons has found a place in the public domain Described as one of the most hemisphere.” people, he could never quite bring himself remarkable and significant maritime George Bass, naval surgeon, arrived in to part with it,” she said. s a boy growing up on a farm the first private practices at the Cabrini Bass in the first European expedition to expeditions in Australia’s early history, New South Wales in 1795 at the age of 24 “But I think he’d be thrilled to see it on along the beautiful Bass River Hospital, Mr Wilson made that interest explore Victoria’s coast, a gem he acquired George Bass sailed almost 2,000 on the same ship that carried Matthew display at Melbourne Museum now – in Ain Gippsland, the late plastic manifest by travelling widely to collect at a Christie’s auction. kilometres from Sydney Cove in an open Flinders. a cabinet with his name forever associated surgeon William Wilson felt a great love objects and documents relating to the life Described as an item of unique whaleboat with a crew of six volunteers Within five years, Bass and Flinders had with the name of George Bass.” of country spreading from the farm itself, of his boyhood hero. national significance to the early maritime and provisions for six weeks. explored the coast south of Sydney and Mr Wilson, who worked out of the to the nearby river system and out to He travelled to England to look upon exploration of Australia, Mr Wilson During the course of the epic journey, circumnavigated Tasmania. Royal Melbourne Hospital and Western Western Port Bay. and photograph his wedding certificate, treasured the compass, taking it to he named Westernport Bay, made Flinders named Bass Strait in honour of General Hospital, had a particular Along the way, he also developed an collected early maps of the Western Port historical society meetings and lending the European discovery of Wilson’s his friend’s heroic whaleboat voyage. flair for hand surgery. He conducted affinity and fascination with the man area, maps showing the charting of Bass it for display to institutions such as the Promontory and proved that Tasmania Dr Wilson-Anastasios said it had been original research which improved who mapped that corner of the world Strait and gathered sundry artefacts Melbourne Maritime History Museum was an island, all by navigating his way that courage and adventurous spirit that surgical outcomes for those suffering and who left echoes of his presence from connected to the intrepid naval surgeon, and the Mitchell Library, which had through unknown waters using only a was always the great appeal of George hand injuries and became a Foundation Gippsland to Tasmania – fellow surgeon sailor and navigator. purchased a number of George Bass’ quadrant and the portable compass and Bass to her father. member of the Australian Hand Surgery and explorer George Bass. But of all these, his great delight was letters. sundial. “I think it was the combination of them Society. Later, after having established one of the pocket compass and sundial used by But now, following the death of the According to Museum Victoria, the both being surgeons and both sharing a With Karen Murphy

Page 14 / Surgical News May 2012 Surgical News May 2012 / Page 15 International Development “Everyone in PNG knows someone who has been affected by cervical cancer so the most common reaction even from the boys is: How can we protect our sisters and our mothers?”

For the next generation Clockwise: Professor Wood at St Josephs Ruango Primary School; Dr Marg Sturdy and Prof David Wood unpacking the first box of vaccines that arrived in Kimbe, West New Britain, all the way from New York; The vaccination team while we were in PNG - from left, Prof Wood, Dr Amos, Jenni Woodhouse, our wonderful nurses, Jess Colliver and Dr Marg Sturdy A surgeon’s goal to deliver the HPV vaccine in PNG will reduce cervical cancer

Western Australian orthopaedic surgeon and often patients with such He said West New Britain had been about 100 pap smear tests are conducted Professor Wood said that while there Professor Wood said that the RACS surgeon who has provided surgical tumours present very, very late,” Professor chosen for the pilot project because of the per year for a population of 300,000.” was initial hesitation in speaking of had provided logistical support in the Aservices to the people of Papua Wood said. keen support of the Governor, the CEO Professor Wood is now a member of sexual health matters, the children had provision of visa and medical registration New Guinea for many years has now “But of all these, cervical cancer is of the local hospital in Kimbe, Dr Victor the Cervical Cancer Working Party which been keen to learn. assistance which allowed him to spend extended the scope of his involvement the most common fatal cancer in PNG Golpek, and the enthusiasm of health and will oversee the pilot program and said “Everyone in PNG knows someone the time needed in PNG to develop the by winning the funding needed to help women. In Australia that rate is seven in education representatives. there was hope that the project could be who has been affected by cervical feasibility study. reduce the high rates of cervical cancer in 100,000 per annum, whereas in PNG it is He said the Gardasil Access program rolled-out in following years as a national cancer so the most common reaction He said that despite the recent political the country. 40 per 100,000 per annum and yet up to would provide 46,000 vaccine doses public health program. even from the boys is: How can we turmoil in PNG there was very strong Professor David Wood has received 85 per cent of cases can be prevented. for girls aged from 9 to 13 years which He said that an initial education protect our sisters and our mothers?” interest in the project. funding to run a one-year pilot program to “Even though I don’t treat these cases represented three vaccinations per campaign had been run in September and he said. “The National Health Department provide Gardasil vaccinations to 15,000 girls it is impossible to be unaffected by such child. October last year to train health workers “Like anywhere there was an initial is taking a keen interest and there are which prevents the transmission of the most unnecessary suffering, so I thought In Australia the vaccines cost $125 per in the provision of the vaccine and the preconception by both boys and girls various funding sources it could approach common strains of the Human Papilloma it important to help prevent this if injection, meaning that the total value of need for consent while teachers were then that people with HPV were dirty or to pay for the vaccines at a discounted Virus (HPV), a precursor of the cancer. possible.” the vaccines donated will be almost $6 offered training to allow them to explain promiscuous, but we simply explain rate for a national program in the future,” The project began in March across the Professor Wood, who is the Winthrop million. the project to children. that it is like the common cold of STD’s, he said. West New Britain province and is funded Professor of Orthopaedic Surgery at the “Developing nations can never afford to More than 2000 school children that most people are exposed to the The Gardasil Access Program is funded through the Gardasil Access Program, University of Western Australia, works out pay such a cost, yet they have the greatest have so far attended such information virus within the first few years of sexual by manufacturers Merck & Co, but designed to provide at least three million of the Hollywood Private Hospital which need,” Professor Wood said. sessions with plans now underway activity. managed by an independent company, doses of the vaccine to developing supported his campaign by contributing “Most women are offered no to make HPV and cervical cancer “We are trying to reduce that stigma Axios Healthcare Development, a non- countries where more than 85 per cent of $20,000 through a charity dinner to help screening and have limited access to prevention an on-going subject within by explaining that if every girl gets the profit organisation which administers the world’s cervical cancer cases occur. cover the costs of the application and pathology which invariably leads to late the personal health component of the vaccine, the result is community-wide the program and reviews and approves “My main involvement in PNG has feasibility study necessary to win the presentation. PNG school curriculum along with prevention and the children understand applications. been as a musculo-skeletal tumour funding. “In West New Britain, for example, only HIV AIDS. that completely.” With Karen Murphy

Page 16 / Surgical News May 2012 Surgical News May 2012 / Page 17 Successful Scholar Professional Development profile Awards > 2012 Melville Hughes Scholarship (University of “This provides access to very rare tissue types Melbourne) and our study has sparked great interest amongst our international collaborators. > 2011 Foundation for Sur- “We have just fully sequenced the whole gery Catherine Marie Enright genomes of matched primary and metastatic Kelly Scholarship (Royal prostate cancer from our first patient which could Australasian College of Sur- well be a world first.” geons) Dr Hong is undertaking his research under the supervision of Associate Professor Christopher > 2010 Foundation for Sur- Hovens, the Scientific Director at the APCRC, gery ANZ Journal of Surgery and Dr Niall Corcoran, Urologist, with the entire Research Scholarship (Royal program overseen by Professor Tony Costello, Australasian College of Sur- Director of Urology at the Royal Melbourne geons) Hospital and Executive Director of APCRC at Epworth. > 2010-2011 Postgraduate Dr Hong said he had been honoured to receive Medicine Scholarship (Na- such support from the RACS and said that the tional Health and Medicine stipends attached to the scholarships meant that Research Council, Australia) he could become fully involved in the ground- Current Projects breaking work. Factory Visit Program “Because of the support, I could fund my own Occupation Medicine Bridging Course > Integrative Genomic Profil- travel to various conferences to become completely ing in Prostate Cancer: Defin- immersed in my fields of interest which I think ing the Lethal Phenotype is important to help generate ideas to overcome urgeons benefit from the opportunity to see a scientific problems,” he said. range of work in different industries. Benefits are > Origins of Lethal Metas- anticipated to flow in terms of guidance to workers, Saving precious time tases in Multifocal Prostate “Instead of having to apportion some of my time S to making an income, I could use that time for factories and insurers and in improved surgical outcomes Cancer This scholar is looking for a more efficient process greater productivity. as measured by satisfactory return to optimal activities. “It has been extremely rewarding to have the The factory visit program is Continuing Professional opportunity to concentrate on pure research Development accredited. n an era of fiscal restraint and over- diagnoses and almost 3,000 deaths “I have found a hint that there are and the process I most enjoy is asking clinically stretched health budgets, Trainee per year. subtle molecular differences in the benign important questions, understanding the Qantas, Sydney Iurology surgeon Dr Matthew Hong Dr Hong said, however, that a parts of prostate glands between those technology available to researchers and then On Friday, 6 July 2012, we have arranged a whole day visit is working to develop a test that can significant proportion of such cancers harbouring high-grade versus low-grade putting the two together by designing and to Qantas Engineering, Catering and possibly Baggage accurately discriminate between lethal never metastasise resulting in a prostate cancer, which could lead to a test performing experiments that answer the questions. Handling. This follows a memorable site visit to the and indolent prostate cancer to allow proportion of patients receiving radical that gets around the problem of sampling “We are now moving towards personalised Heavy Engineering section of Qantas in Melbourne. clinicians to better select those patients treatment including surgery which is errors in biopsy.” medicine at a rate of knots and I believe that At the start of each half day there will be a brief needing treatment. unnecessary. Dr Hong has won considerable support our recently acquired ability to molecularly introduction to the worksite; as on previous factory tours. To do this, Dr Hong is not only He said he began his work, part from the RACS for his work, receiving characterise individual tumours quickly and at This will be followed by workers discussing their injuries investigating the biomarkers that of a PhD through the University both the Foundation for Surgery ANZ a reasonable cost will soon give us an edge over and return-to-work programs. This is followed by an differentiate aggressive and indolent of Melbourne, aiming to screen for Journal of Surgery Scholarship for 2010 prostate cancer. approximately two hour tour of the site during which we tumours, but has also established biomarkers on individual molecules, but and the Foundation for Surgery Catherine “This project has the potential to identify see what the workers do, where injuries have occurred a world-first program to examine had since capitalised on the enormous Marie Enright Kelly Scholarship for 2011. candidate biomarkers for the early discrimination and a selection of suitable duties for return-to-work metastatic prostate cancer tissue. advances made in genomic technologies He has presented his work at of the lethal prostate cancer phenotype, which in programs. We conclude with the opportunity to further Working out of the Royal Melbourne which can now allow scientists to screen conferences in Melbourne, the Gold turn could lead to more effective patient selection discuss injuries and return-to-work with workers and Hospital and the Australian Prostate hundreds of thousands of molecular Coast, Perth, and New Zealand and last for radical treatment by surgeons. management. Finally there are group discussions and Cancer Research Centre at Epworth differences at a time. year gave a presentation on his research “This will mean that clinicians can make you have an opportunity to individually reflect on the (APCRC), Dr Hong has set up a program “The unique approach we have taken is at the European Association of Urology confident decisions regarding the significant visit and evaluate the program. in which men with metastatic prostate to look simultaneously at different levels Annual Congress in Austria. number of patients with biologically indolent cancer undergo a day procedure to donate of genetics,” Dr Hong said. Dr Hong said the establishment of prostate cancer to spare them exposure to the Godfrey Hirst and Ford Motors tissue samples. “We are looking at the underlying the metastatic tissue bank could have a unnecessary risks of radical treatment which In time, this raw data will be made genome, its methylation or regulation and significant global impact. Carpets, Geelong in turn could translate into significant health On Friday, 21 September 2012, we are considering another publicly available to scientists around the the transcriptome, that is the genes being “This unique program allows us to economic savings.” whole day visit by combining two work sites; Godfrey world so that researchers with different expressed to produce proteins. not only collect the lethal cancer tissue, The Catherine Marie Enright Kelly Memorial Hirst Carpets in the morning and Ford Motor Company questions can use the information to expand “The laboratory techniques required but enables us to compare it to a sample Research Scholarship arose from a bequest by the in the afternoon. Depending on demand we may organise knowledge in the field or test new ideas. for this type of multi-dimensional of each patient’s primary tumour given late Dr TD Kelly, FRACS, to support Trainees or a bus from the College. Each of these factory visits will be Prostate cancer is the second most approach have taken the best part of two previously so that we can compare the two Fellows wishing to take time away from clinical a similar format to Qantas. common cause of cancer death in years to refine and I’m only beginning to to understand why metastases develop in a practice to undertake research. Australian men with almost 19,000 new see preliminary data now. given individual,” Dr Hong said. Edward (Ted) Schutz With Karen Murphy Convenor

Page 18 / Surgical News May 2012 Surgical News May 2012 / Page 19 College Purpose Personal Piece

difficulty in attracting and retaining surgeons. We will continue to remind governments of their responsibilities to all citizens, irrespective of where they live. Increasing our voice I was recently a member of a small team of Fellows who made a site visit to Alice Springs Hospital to try to identify means by which its only resident General Surgeon, Dr Jacob Ollapallil, can be supported on a viable and ongoing basis. The burden of disease and the incidence of trauma there is such that at least two more General Surgeons are urgently required. The team is currently preparing a report that will be provided to the Northern Territory government. The Rain The attempt by cosmetic “surgeons” in Australia to gain recognition as a Advocacy remains core College business When summer rain brings a feeling that specialty is another ongoing issue, all is clean and fresh with the Australian Medical Council t the College’s recent Annual In May last year the College wrote to nearing completion and has seen GAC still to reach a decision. The College t has been a quiet, sweltering and outdoors this past few months than General Meeting, held in Kuala health ministers, shadow ministers and consult with relevant specialty societies to continues to argue that such a still afternoon. Humid, hot and I have in years. The water beads over ALumpur during the Annual health department CEOs across Australia ensure their accuracy and persuasiveness. specialty would be spurious as Fellows Ioverpoweringly oppressive. Sweat my greasy sunblock, my arms are Scientific Congress, I officially completed and New Zealand, enclosing a report Another major project involved practising as Plastic and Reconstructive beads across my brow and my shirt, slippery as eels. my term as Vice President. May I take this which establishes beyond doubt that modelling done by the College’s specialist surgeons already do all of the soaked, clings to my body. Slick. As I get to the back door, the opportunity to say it was an honour to the separation of elective and emergency workforce assessment department and work which the cosmetic “surgeons” The thick grass pours over my downpour begins in earnest. Now represent you on Council for the last nine surgical streams in our public hospitals which resulted in a report identifying the pretend is theirs alone. The difference feet as I tread through the verdant so heavy that everything appears years and to have served as Vice President dramatically improves hospital efficiency extent to which Australia’s future surgical of course is that Plastic Surgeons do so front paddock. I had mown the grey with water, I cannot see over the last two years. and patient outcomes. I am pleased to workforce will be able to meet anticipated much more as well, repairing lives and lawn just four days ago, but already more than a metre in front of me. One of the most important report that this reform is being rolled demand in 2025. enhancing the quality of life of those it has grown long and unkempt. Shutting the glass slider behind me, responsibilities of the Vice President is out at several hospitals; a number It found that while the current surgeon severely burned, disfigured or injured. Lush tussocks with long blades of I stand and drip. Steam rises. to chair the College’s Governance and of presentations at the ASC in Kuala per population ratio is adequately and I had the very good fortune to attend grass envelope my boots. I’ll have to The rain thunders down on the Advocacy Committee (GAC). At a time Lumpur addressed the success of the safely servicing the Australian population, a host of specialty society meetings buy more fuel for the mower. tin roof. Rat-ta-tat-tat, like machine when the specialty societies are telling us reform at hospitals ranging from major this population is expected to increase over the past two years as well as many Dark sullen clouds have amassed gun fire; loud and urgent. I lift my we must do more advocacy, and we must metropolitan facilities to smaller country and its average age to rise, resulting in an regional Annual Scientific Meetings. quickly, and tumble over themselves head, eyes to the ceiling, as if I’ll be do it better, the work of GAC is surely hospitals. increasing workload for surgeons. This It was a pleasure to meet hundreds of as they march across the sky. They able to see the onslaught. core College business. GAC is following this up with position will be exacerbated by the fact that a Fellows and I have done my best to appear rapidly, as if they had I am safe. I cannot be hurt. My There have been some very positive papers on medical tourism and bowel large number of surgeons are themselves make sure the concerns raised with me been waiting for the right time to gaze falls. A soaked lock of hair falls achievements over the past two years and cancer screening. The former includes approaching the age of retirement. A at these meetings were subsequently ambush. in front of my eyes as I look down several projects which are well advanced development of a checklist for patients similar report on the future of the New brought to the attention of Council. at the floor. A puddle has grown and which will be brought to fruition considering travelling abroad for surgery. Zealand surgical workforce through to I remain firmly convinced that The raindrops fall around me. by Professor Michael Grigg who has It raises crucial considerations such as 2025 is nearing completion. united we stand, divided we fall. The The first few are sparse, but Fresh, crisp, the world is new and succeeded me as VP. the surgical expertise and the quality Several issues that have occupied GAC specialty societies are being listened suddenly the heavens open and clean. The smell of summer rain Among the former are the FRACS of facilities available in a given country, remain ongoing challenges. The Four to and heard. Much of what they say the water falls from the sky in big hangs in the air. I close my eyes logo which was formally launched at the responsibility for post-operative care, and Hour Rule is to be rolled out across makes sense. But in the corridors of fat droplets. They merge and start and am lost in the roar on the roof Annual Scientific Congress in Adelaide the extent of one’s insurance coverage. It Australian public hospitals despite its power the single voice of Australasian to form sheets of water, bucketing and the luscious aroma that wafts last year and which Fellows can access via is hoped that this brochure will be made failure in the UK, its controversial results surgeons will always be louder and down. Caught in the downpour, around me. the College website. At a time when just available through government channels to in Western Australia and the obvious more authoritative than the disparate I run. “Skedaddle” is the word Erector pili contact, I get goose about anyone with a medical degree ( and prospective medical tourists. objection that you can’t responsibly voices of nine specialties or thirteen that pops into my head. Pistons bumps. Wonderful little tingles a number of podiatrists without one) can The position paper on bowel cancer address crowding in the emergency specialty societies. pumping, arms and legs flailing like dance up my arms. It is not cold. call themselves a “surgeon”, the FRACS screening advocates strongly for two department until you have invested in a bandy-legged colt, I run to the It feels more like the soft touch of post nominal stands for clinical excellence yearly testing of those aged 50 years and beds and staff across the entire hospital. house. a lover marvelling at the smooth of the highest order. Fellows can now use over, something governments in both The College remains acutely aware of My clothing is damp. My skin velvetiness of my skin. A caress. An this brand on their stationery, websites Australia and New Zealand have been the uneven distribution of the surgical is warm, glowing and wet. I have embrace. and the walls and windows of their very reluctant to fund. workforce and the fact that communities developed a light golden tan since I Bliss. rooms. Work on both position papers is in rural and remote areas experience great Keith Mutimer have lived here, spending more time Dr Ina Training

Page 20 / Surgical News May 2012 Surgical News May 2012 / Page 21 Foundation for Surgery

An initiative of Yes, I would like to donate Homestay Turning up the volume for to our Foundation for Surgery Accommodation All donations are tax deductible for Visiting Scholars

Name: Telephone: Through the RACS International Indigenous health Address: Scholarships Program and Project Speciality: The Foundation for Surgery has funded research into Evidence Email: China, young surgeons, nurses and $ . payable to Foundation for Surgery) for other health professionals from Enclosed is my cheque or bank draft ( Based Action Plans to address Indigenous health Otitis Media treatment Different strategies are required developing countries in Asia and the . Please debit my credit card accountIndigenous for $ Health Evidence Based for the non-surgical management Pacific are provided with training Diners Club NZ Bankcard opportunities to visit Australian Mastercard Visa AMEX of OM in Aboriginal and Torres Action Plan – Otitis Media among and New Zealand hospitals. These Strait/ Islander children. New Aboriginal and Torres Strait Expiry visits allow the visiting scholars to Cover Credit Card No: he Foundation for Surgery is Story Islander Peoples research into recurrent acute OM, acquire the knowledge, skills and Date committed to addressing the Otitis Media (OM)Card Holder is a’s Signaturebroad term immunological responses to infection contacts needed for the promotion of Your passion. Card Holder’s Name - block letters health challenges and inequities for infection/inflammation in the and the impact of antibacterial improved health services in their own T Your skill. I would like my donation to help support: country, and can range in duration in Australia’s Indigenous communities. middle ear. It is a Internationalspectrum D ofevelopment disease Prog rams vaccines is contributing to a greater General Foundation Programs from two weeks to twelve months. Your legacy. ams Indigenous Health Programs understanding of OM. As part of this commitment, and Scholarship and Fellwithowship no Prog universalr standard definitions. al Gifts Program through generous donations from I have a potential contributionAs such it to is the difficult Cultur to determine Measures such as building Due to the short term nature of Fellows, the Foundation funded I do not give permissionthe incidence, for acknowledgement prevalence of my gift and in any costs College of publicationswimming pools and new housing, Your these visits, it is often difficult to research into the development of Please send your donationOM toin: both the Indigenous and non- that is, addressing the social find affordable accommodation for NEW ZEALAND AUSTRALIA & OTHER COUNTRIES Indigenous health Evidence Based Foundation for Surgery determinants of health, and new Foundation. Foundation for Surgery Indigenous population. visiting scholars. If you have a spare PO Box 7451 250 - 290 Spring Street Newtown, 6242 Wellington guidelines on antibiotic use have been room or suitable accommodation Action Plans (EBAPs) East Melbourne , VIC 3002 It is a major cause of morbidity in New Zealand The College’s Indigenous Health Australia Australian children. It has a different partially successful in ameliorating and are interested in helping, please Position Statement recognises that the burden of OM in Aboriginal and send us your details. We are seeking disease pathway in Aboriginal and individuals and families who are significant and urgent improvements Torres Strait Islander children, in that Torres Strait Islander communities. able to provide a comfortable need to be, and can be, made to it is more common, presents earlier These programs have not been and welcoming environment for Indigenous health and the provision and lasts longer. It is more severe, is rigorously evaluated and so their our overseas scholars in exchange of health care, and that improvements associated with multiple bacterial effectiveness is not guaranteed. for a modest rental and eternal appreciation. in Indigenous health in Australia strains, is more often recurrent and Follow-up after intervention and New Zealand will require more often results in tympanic is crucial to confirming success. collaborative, cross-disciplinary membrane perforation. As such, Unfortunately in practice there is If you would like to be contacted efforts. often no follow-up, or culturally by the College if the need for research findings from the general accommodation in your area The EBAPs identify how population cannot be easily applied to inappropriate follow-up. Inadequate arises, please register your details improvements in the delivery of this group. post-operative care has been linked to by contacting the International surgical services to Aboriginal and Indigenous children have the highest poor clinical outcomes. Scholarships Secretariat on the details below. We are currently seeking Torres Strait Islander peoples can prevalence of chronic suppurative A coordinated approach involving contribute to better health outcomes accommodation in Melbourne (near otitis media in the world, reaching many services is required to effectively Royal Melbourne Hospital, The in their communities. The EBAPs up to 70 per cent of the Australian treat the broad spectrum of the OM Alfred and St Vincent’s Hospital), are action-orientated overviews Indigenous population. It is a major disease. Services need to be planned Brisbane (near Princess Alexandra developed to help solve identified public health issue requiring urgent to address the current deficiencies Hospital), Sydney (near Westmead problems and involve a review in screening, assessment, treatment Hospital) and Adelaide (near Royal attention. Inadequately treating OM Adelaide Hospital) for visits in 2012. of existing research evidence in and its associated diseases causes and local follow up. A multi-faceted We would love to hear from you. consultation with stakeholders. The a devastating cycle that can result approach is required to treat Otitis research was led by Professor Russell in conductive hearing loss. This in Media in the Aboriginal and Torres Gruen at Monash University and turn leads to language delay, learning Strait Islander population. International Scholarships Alfred Health and Associate Professor difficulties and the associated social Chantel Thornton, Secretariat Kelvin Kong, Chair of the College problems of truancy, early school Foundation for Surgery Board member Royal Australasian College Indigenous Health Committee, in in Surgical News. It focuses on the is a debilitating burden for the patient, leaving and unemployment. of Surgeons College of Surgeons’ Gardens collaboration with relevant research, chronic level of ear disease in children, the health care provider and the wider To date there is very limited evidence The College will soon launch 250 - 290 Spring St clinical and policy experts around which may, if not treated, lead to loss community. new professional development on the effect that surgical intervention East Melbourne, Victoria 3002 activities relating to the Australia. of hearing, which will have profoundly The topics of the three subsequent (i.e. tympanostomy tubes and T: + 61 3 9249 1211 healthcare of Indigenous patients. Otitis Media among Aboriginal and adverse effects on social development, Evidence Based Action plans to be adenoidectomy) has on the outcomes F: + 61 3 9276 7431 An online potal to link to activities E: international.scholarships@ Torres Strait Islander peoples is the schooling, speech development and published in Surgical News are: renal of OM in Indigenous Australians, will soon be available as well as surgeons.org subject of the first of a series of four subsequent long-term employment transplantation, eye diseases and such as hearing loss and incidence of eLearning modules. articles on the EBAPs to be published prospects. If not addressed, ear disease trauma. chronic disease.

Page 22 / Surgical News May 2012 Surgical News May 2012 / Page 23 Law Commentary

1. Criminal offences What are the warning signs of potential Sexual assault, including unwanted physical touching or breaches? examination without consent, and rape. The Guidelines list the following warning signs of potential breaches of sexual boundaries: 2. Sexual activity • Patients requesting or receiving appointments at unusual hours or This includes sexual activity with a patient currently or locations, especially when other staff are not present; formerly under a practitioner’s care or a person closely • Practitioners and patients inviting each other out socially; related to a patient. The fact that such activity is consensual • Doctors revealing intimate details of their lives, especially personal or was initiated by the patient is irrelevant. Sexual activity crises or sexual desires or practices; and with a former patient may be sexual misconduct depending • Patients asking personal questions, using sexually explicit language, on the circumstances, including: being overly affectionate or attempting to give expensive gifts. • The duration of care provided by the practitioner; • Whether emotional or psychological treatment was provided; How can a practitioner avoiding • The level of vulnerability of the patient and degree of misunderstandings, particularly in relation to dependence on the practitioner; examinations? • The time elapsed since, and the manner in which, the The Guidelines note that many issues arise where a patient perceived professional relationship was terminated; and a practitioner’s actions as inappropriate or sexually motivated, only • The context in which the sexual relationship was because of poor communication. A common example of this is where established. a doctor asks questions or conducts an examination which were clinically appropriate, but not adequately explained to the patient. 3. Sexual harassment or sexualised behaviour To avoid this, the Guidelines emphasise using clear communication Sexual boundaries: Sexual harassment or “sexualised behaviour” are quite and suggest professional standards for physical examinations. These broadly stated in the Guidelines as including the use of standards would also be relevant to whether a practitioner has “any words or actions that might reasonably be interpreted engaged in sexual misconduct in relation to a physical examination as being designed to arouse or gratify sexual desire”. and include: Guidelines for Doctors Examples given of specific behaviour include: • Explaining what is to occur in the examination and providing an • Making sexual remarks or gestures, touching patients in opportunity for the patient to ask questions; Be clear on where the line is drawn a sexual way or engaging in sexual behaviour in front of • Obtaining the consent of the patient to conduct the examination, them; or for anyone else, such as a medical student, to be present; • Ridicule of a patient’s sexual preferences or orientation; • Being sensitive to any sign of withdrawal of consent; n October 2011 the Medical Board of Australia (“the Board”) any guidelines released by the Board are admissible in • Making comments or requesting details about a patient’s • Discontinuing an examination when consent is uncertain, has been released the Sexual Boundaries: Guidelines for Doctors (“the disciplinary proceedings as to what constitutes appropriate sexual history or preferences not relevant to the clinical refused or withdrawn; IGuidelines”) relating to sexual boundaries between health professional conduct. The Guidelines provide standards issue; • Allowing a patient to dress and undress in private and not assisting practitioners and patients. The Guidelines do four main things: for what constitutes “sexual misconduct”. These standards • Discussing the sexual problems or fantasies of the unless necessary; would be relevant in disciplinary proceedings where a doctor; • Not allowing a patient to remain undressed for longer than is needed; 1. Provide guidance as to what constitutes conduct which may practitioner is alleged to have engaged in ‘unprofessional • Making suggestive comments about a patient’s • Allowing a patient to bring a support person such as a family be the subject of disciplinary proceedings initiated against a conduct’ or ‘professional misconduct’ of a sexual nature. appearance or body; member or close friend; practitioner under the Health Practitioner Regulation National The second relates to practitioners’ mandatory reporting • Making an unsolicited demand or request for a sexual • Exploring the value of having a chaperone present; Law (Victoria) Act 2009 (“the National Law”); obligations. Under the National Law, practitioners and favour, whether directly or by implication; and • Postponing an examination until a chaperone the patient is 2. Provide guidance as to what constitutes ‘sexual misconduct’, employers of practitioners are under a legal obligation to • Inappropriate conduct during examination such as comfortable with is available; and which practitioners and employers are obliged to report under notify the Board when they become aware that another unnecessary disrobing, inadequate draping and intimate • If the practitioner provides the chaperone, ensuring the chaperone the mandatory reporting requirements of the National Law; practitioner has engaged in sexual misconduct in the examinations without adequate prior explanation. is appropriately qualified or trained and of a gender approved of by 3. Explain the harm which can be caused by a breach of sexual conduct of their medical practice. The Guidelines now the patient, parent, carer or guardian. boundaries and identifies warning signs as to when sexual provide a clearer picture of what constitutes sexual Why are breaches of sexual All doctors should be aware of these obligations, and adopt the boundaries have the potential to be breached; misconduct. boundaries harmful and unethical? suggested practices to prevent misunderstandings and potential 4. Provide guidance for avoiding misunderstandings and suggest The Guidelines explain that relationships between claims. professional standards for conducting physical examinations, What is “sexual misconduct”? practitioners and patients inherently involve a power including the use of chaperones. Previously, the only guidance available as to what amounts imbalance due to the elements of vulnerability and to sexual misconduct were past decisions of state medical dependency. A breach of the sexual boundaries is therefore How do the Guidelines affect the legal boards and tribunals. The Guidelines now specify behaviour an abuse of this power imbalance and the trust which is the obligations and liability of practitioners? which will amount to sexual misconduct and apply nation- foundation of the practitioner-patient relationship. It may Michael Gorton, The Guidelines affect the liability and obligations of practitioners wide. Sexual misconduct under the Guidelines can be also impair a practitioner’s judgment and compromise a College Solicitor in two ways. The first is that the National Law provides that divided into three categories: patient’s care. and Ian Pelekanakis, Law Clerk

Page 24 / Surgical News May 2012 Surgical News May 2012 / Page 25 Professional Development Professional Development

NOTSS in Australasia Workshops & Activities Life long learning through professional development can Collaboration has meant the development of quality courses improve our capabilities and help us to realise our full potential as surgeons as well as individuals. he College is very excited to Traditionally, surgical training primarily • Discussion about leadership in OR announce the launch of the focuses on medical knowledge, clinical with Trainees; dates TNOTSS (Non-Operative Technical expertise and technical skills. However, • Use of graded assertiveness much Supervisors and Trainers for Non-Technical Skills for MAY - JULY 2012 Skills for Surgeons) course which focuses investigations into adverse surgical more often; SET (SAT SET) Surgeons (NOTSS) NEW on some of the non-technical skills events show that underlying causes • Incorporation of a regular time out 29 May, Brisbane; 14 June, Perth 16 June, Auckland NSW underpinning safe surgery.This course often relate to the non-technical aspects and a team debrief. 4 July, Sydney This course assists supervisors and trainers to This workshop focuses on the non-technical skills has been developed as a collaborative of performance (e.g. communication AMA Impairment Guidelines, 5th effectively fulfil the responsibilities of their very which underpin safer operative surgery. It explores Edition: Difficult Cases project between the University of failures) rather than to a lack of technical Overall, the NOTSS course has important roles. You can learn to use workplace a behaviour rating system developed by the Royal Aberdeen, the Royal College of Surgeons expertise. Thus competence in technical been successful and achieved assessment tools such as the Mini Clinical College of Surgeons of Edinburgh which can help 6 July, Sydney of Edinburgh, and the NHS Education and non-technical skills is necessary to Occupational Medicine: Getting positive outcomes both during the Examination (Mini CEX) and Directly Observed you improve performance in the operating theatre Patients Back to Work for Scotland. It is based on extensive ensure patient safety. course and at a six month follow Procedural Skills (DOPS) that have been introduced in relation to situational awareness, communication, research conducted by a team led by Focusing on non-technical skills can as part of SET. You can also explore strategies decision making and leadership/teamwork. Each 20 July, Sydney up. The knowledge and skills Finance for Surgeons Professor Rhona Flin from the University increase the likelihood of maintaining gained from the course appear to to help you to support trainees at the mid-term of these categories is broken down into behavioural meeting. markers that can be used to assess your own of Aberdeen, who is presenting at the high levels of performance over time. have been retained several months upcoming ASC in Kuala Lumpur. Surgeons have always needed to performance as well as your colleagues. NZ post-course. Here’s what some 16 June, Auckland demonstrate skills such as decision- participants have said: Management of Acute Non-Technical Skills for Surgeons NOTSS focuses on four categories How Well Do You Know Your making, leadership and team working, “Outstanding course which should Neurotrauma of non-technical skills: but these have been developed and be mandatory for all the surgeons.” Practice? A game plan for QLD Situation awareness 2 June, Brisbane, 18 August assessed in an informal and tacit manner “Very good for raising awareness. success NEW 29 May, Brisbane Decision making Townsville, 31 October, Adelaide SAT SET Course rather than being explicitly addressed I am motivated to pass my 22 June, Perth Communication and teamwork in training. These cognitive and You can gain skills to deal with cases of acute Leadership knowledge on.” neurotrauma in a rural setting, where the urgency This whole day workshop focuses on how gathering 2 June, Brisbane interpersonal skills underpin the delivery Acute Neurotrauma Management “Excellent course, I thoroughly of a case or difficulties in transporting a patient data and information, in a systemised manner, of safe, comprehensive and high quality (Rural) enjoyed it…relevant and will lead demand rapid surgically-applied relief of pressure through analysis and a willingness to challenge the These categories align with the RACS surgical care to the community. competencies of Judgement and Decision to improvements in my clinical on the brain. Importantly, you can learn these skills status quo, can lead to effective decision making 8 June, Brisbane Strategy and Risk Management for Making; Communication; Collaboration practice.” using equipment typically available in smaller and improved customer service. Practice staff as hospitals, including the Hudson Brace. Surgeons and Teamwork, and Management and 2011 Pilot Courses well as Fellows are welcome to attend. Leadership. In December, 2010, three College 24 July, Brisbane 2012 Courses Keeping Trainees on Track Each category is described by a set representatives went to Edinburgh Keeping Trainees on Track Leadership in a Climate of Ten face-to-face courses are planned in a of elements or behavioural markers to participate in a two-day NOTSS (KToT) Change range of locations during 2012. An eLearn- SA similar to the behavioural marker Masterclass. The first Australasian 5 June, Adelaide ing module is also being developed which 14-15 September, Sydney 5 June, Adelaide system which has been developed for two day Masterclass to train a NOTSS will provide a blended approach to course This 3 hour workshop focuses on how to manage This 2-and-a-half day workshop can help you to Keeping Trainees on Track pilots, anaesthetists (Anaesthetic Non- faculty was held in Melbourne at delivery. The provision of background and trainees by setting clear goals, giving effective feed- understand what it takes to be an effective leader Technical Skills – ANTS) and theatre the beginning of April, 2011, with 19 back and discussing expected levels of performance. TAS core knowledge, complemented by required in this century. It uses the DISC model (DISC scrub practitioners (Surgical Practitioners participants. We were very fortunate You can also find out more about encouraging self- stands for dominance, influence, steadiness and 5 July, Launceston pre-course online activities will prepare List of Intra-operative Non-Technical to have one of the Edinburgh faculty, directed learning at the start of term meeting. conscientiousness) to examine the nature and Keeping Trainees on Track the participants to undertake NOTSS. The Skills – SPLINTS). The concept of Prof George Youngson as a presenter. practice of organisational leadership, through eLearning module content will be enhanced behavioural markers is also integral to the The other faculty members included Strategy and Risk for the exploration of issues such as organisational VIC by involving an advisory group in the framework for definition of competence Bruce Barraclough, David Birks and communication, influence, power and styles of 30 April, Melbourne development of content and activities for the Surgeons NEW SAT SET Course and performance and the associated Brendan Flanagan. Three successful leadership. You can also learn more about working module. 8 June, Brisbane as a team and gaining team commitment. multi-source feedback assessment one-day courses were piloted in 2011 in 21 September, Melbourne Another train-the-trainer workshop tool, articulated in the RACS ‘Surgical Bendigo, Perth and Melbourne with 39 This practical whole day workshop is divided Occupational Medicine: Getting is being organised for 2012. If you are into two parts. Part one gives an overview of Patients Back to Work Competence and Performance Guide’. participants including Fellows, Trainees, interested in finding out more about basic strategic planning and provides a broad Contact the Professional Development You can learn how to identify and rate IMGs and anaesthetists. NOTSS, please visit www.surgeons.org understanding of the link between strategy and Department on +61 3 9249 1106, by WA behavioural skills while watching surgeons A post-course survey has been email [email protected] or call financial health or wealth creation. Part two focuses email [email protected] 14 June, Perth perform in theatre in a series of videos. undertaken with almost all respondents or visit www.surgeons.org SAT SET Course +61 3 9249 1106. on setting strategy; formulating a strategic plan, This allows you to reflect on your own indicating that they have made changes to the strategic planning process, identifying and - select Fellows then click on Professional Development. 22 June, Perth performance and provides a tool for giving their practice as a result of attending the Francis Lannigan achieving strategic goals, monitoring performance How Well Do You Know Your feedback to colleagues and Trainees. course. Some examples include: Chair, NOTSS Working Party and contributing to an analysis of strategic risk. Practice

Page 26 / Surgical News May 2012 Surgical News May 2012 / Page 27 Education

RACS Competency Training Standards: leading the way How do we communicate what stage a Trainee has reached?

urgical supervisors discuss the but no one had tackled it across all the than for some individual procedures The working group also Develop and maintain dexterity and technical skills progress and performance of their specialty training programs provided by or skills. identified progressive development Trainees on a regular basis. The a College. It was a good thing to attempt, In 2011, a working party of senior S through five stages of increasing Pre-vocational – Can perform basic clinical skills such as resuscitation, suturing information shared, and the language but could we achieve it in a way that Fellows and College staff was complexity (from pre-vocational simple superficial wounds, knot tying, maintaining sterile field, Pain used to describe is rarely written down, would be both educationally sound and established to develop a structure and to novice, to intermediate, to management. Refer to Elementary Surgical Skills Document and certainly no agreed framework still employ the everyday language of the sequence of standards. The standards competent, to proficient) for each exists. Despite this, surgeons do know surgeons? were based on the agreed nine RACS competency. These are consistent – Seeks opportunities to learn new skills. how to communicate roughly what We were tasked with something competencies each with three patterns with the concept of competency- Novice – Learns new skills quickly. stage a Trainee has reached. Such that for surgery is leading the world – of behaviour that have been defined based rather than time-based – Aware of the importance of positioning patient for safe surgical access. conversations are usually lacking in identifying and defining the progressive in the RACS Guide to Surgical training, and recognise the need – Can safely and effectively carry out parts of some common an agreed framework for assessment development of competency standards Competence and Performance to assess each of the competencies procedures under close supervision. of progress, or in agreed descriptors for specialist surgical training. http://www.surgeons.org/ and patterns of behaviour – Able to perform basic surgical skills and tasks relating to surgical that have clear meaning and are highly It is more than two decades since the media/348281/pos_2011-06- separately. specialty. relevant to where a Trainee is at. first publication of CanMEDS which 23_surgical_competence_and_ A set of key performance markers – Demonstrates basic use of common surgical tools such as Eighteen months ago, the College introduced a framework of competencies performance_guide__2nd_edition_. were described for each of the three diathermy, suction, retractors. recognised the need to provide a for medical specialty training. Yet, up pdf. A major aim was for the descriptors major patterns of behaviour relat- – Demonstrates understanding of the importance of gentle handling framework and a generic description of until now, the stages and standards for of competency acquisition to maintain ing to the nine competencies. These of soft tissue and of wound care. progress through the stages of becoming the development of those competencies alignment with how the College describe how knowledge, skills and – Aware of how to use surgical instruments and use of local anaesthetic. a surgeon. The AMC encouraged us have not been described within the recommends the performance of attitudes are translated into perfor- Intermediate – Assists effectively at major or complex procedures. to define these standards and stages, clinical context of the workplace, other practicing surgeons should be assessed. mance. Each performance marker – Able to position patient, gain surgical access. had to be observable and thus as- – Can safely and effectively carry out most common procedures or sessable by a surgical supervisor. individual components of major procedures with supervisor in The image below illustrates theatre. the structure and sequence – Can safely and effectively carry out significant parts of more using ‘Technical Expertise’ as the complex procedures under close supervision. example competence. The three – Can anticipate and effectively deal with potential complications in major patterns of behaviour being: the most common procedures. – Develop and maintain dexterity and technical skills; Competent – Adapts their skills in the context of each patient-each procedure and – Recognise conditions for which continues to learn new skills. surgery may be necessary; – Can safely and effectively carry out all common and more complex – Defined scope of practice – procedures as primary operator. Recognise own limitations. – Anticipates and effectively deals with potential complications in all The behaviour markers for one the procedures they carry out. of these (Develop and maintain dexterity and technical skills) at Proficient – Consistently demonstrates sound surgical skills. the level of competence, is then – Has a professional development plan for continuing enhancement delineated. of skills. The full range of performance – Can effectively teach others to perform surgical skills and carry out indicators, from pre-vocational procedures. to proficient for that ‘pattern of – Has appropriate processes for learning or introducing a new behaviour’ is outlined in the Table technique, e.g. visiting a surgical expert or mentor. to the left. u

Page 28 / Surgical News May 2012 Surgical News May 2012 / Page 29 Education From the Archives

Courtesy of the University of Sydney Archives

Technical Expertise Your Trainee has been on the unit for the past five months. During this time he/she has assisted you for the major procedures and performed minor ones either with your assistance or with you observing and advising unscrubbed. Last week you realised it was time to give him/her some further responsibility and so you allowed him/her to perform the exposure for a major case independently whilst you saw some patients in the ward. When you arrived in theatre you found that the patient was in a good position on the operating table for the procedure to be carried out, but that the exposure was compromised by too short an incision. Having scrubbed and extended the incision, and with yourself being an additional assistant, the exposure was then adequate. Your Trainee then proceeded to mobilise the organ for resection, remain in the correct tissue planes and ligate the key vessels.

The defined behavioural markers are not intended to be a has been approved by Education Board and College Council for comprehensive analysis of Trainees’ performance and behaviour, use across the specialties. Each specialty and training board now nor are the identified behaviours expected to be observable in every has the opportunity to decide how this resource can be best used work-based situation. Rather they have been selected because they to advise and assist supervisors and Trainees. The performance represent observable behaviours which are sufficiently important markers could also be used as part of the assessment process to be considered as key indicators of each Trainee’s progression during examinations. towards being judged as a competent and safe practitioner. The first edition contains vignettes for each competency, designed to illustrate the sort of performance that might need As such supervisors and Trainees can use the to be assessed. For example, the following vignette applies to Young Hunter! behavioural markers to: Technical Expertise. – highlight examples of progression towards competent Specialty training boards also have the opportunity to revise Although dying young, John Hunter left an indelible mark performance; the vignettes to make them more specific to their own specialty. – provide a shared framework of steps towards the next or future The distribution of this work marks a significant step in stages of ‘becoming competent and proficient’; meeting the challenge towards defining progressive standards of – enable supervisors to be more confident that their standards competence throughout training, not just in surgery, but across ‘For John Hunter is dead; dead ere his prime, Young Hunter! And hath not left his peer’ and expectations are the same as their colleagues; all post-graduate medical training. Since the RACS competencies – provide a common vocabulary for training, briefing and are closely aligned to the original seven of CanMEDs, these n December, 1924, John Irvine Hunter, in 1919, Hunter was a memorable genius exhilarating, exciting exercise of discovery… debriefing, providing feedback, and communication between competency standards can potentially be adopted and adapted by Challis Professor of Anatomy at the ‘who shone in all branches of medical When Wilson [James Thomas Wilson, first Trainees, supervisors, and training boards about each Trainee’s medical disciplines other than surgery. IUniversity of Sydney, died in London learning.’ An Associate Professorship in Challis Professor of Anatomy], left for performance; The document can be accessed on-line at: http://www.surgeons. at the age of 26. Eulogised by AE Mills as Anatomy had been created for Hunter Cambridge Johnnie Hunter was appointed – clearly identify when a Trainee is performing at, above, or org/media/452878/dft_2012-02-24_training_standards_final.pdf the University’s ‘most gifted son,’ Hunter almost as soon as he graduated in 1920 to the chair at the age of 24. Full of energy, below, the expected standard for their level of training; was universally mourned and in an and Miller found that: ideas and enthusiasm, this life of great – provide a framework for establishing shared meanings unusual gesture, his passing was lamented “His lectures were almost electrifying promise was to be short.” between safety and quality, training, and assessment. in a motion of the NSW Parliament. as he poured forth his words with such While a student at Sydney University, The resultant document, ‘Becoming a competent and proficient David Watters, For Douglas Miller who entered the enthusiasm that he actually used to froth Hunter came in contact with Norman surgeon: Training Standards for the Nine RACS Competencies’ Chair, Performance Assessment Committee University of Sydney’s Medical School at the mouth. To him anatomy was an Dawson Royle, later a Foundation Fellow u

Page 30 / Surgical News May 2012 Surgical News May 2012 / Page 31 From the Archives

researched the forebrain of the apteryx (kiwi) – this formed the typhoid fever, it has been suggested that Hunter and possibly, basis of his MD which was awarded in 1924. Royle may have been exposed to the encephalitis lethargica virus ND Royle c 1920s Hunter also analysed the controversial Piltdown skull and rampant in New York in 1924. other remains at the British Museum and his research, published The theory of double innervation of muscle was refuted within in a monogram in 1922, concluded that when the ‘occipital a few years of Hunter’s death, but remained an active area of region is properly constituted and orientated, it presents a much research. Albert Coates, for example also made a detailed study closer analogy to the condition found in the new-born African of the sympathetic innervation of skeletal muscle tissue and his anthropoids than it does any other human skull’. Although the work (with OW Tiegs) was published in the Australian Journal Piltdown skull was finally revealed as a fake in 1953 when a of Experimental Biology and Medical Science in 1928. Douglas Fluorine Absorption test showed that the cranium was that of a Miller effectively sums up their contribution to medical science: medieval man and the jaw came from an orang-utan, Hunter’s “Though their work was discounted he and Royle had opened research indicates his active and far reaching intelligence. up great interest in the previously ignored sympathetic system and much good came of it.” Sympathetic fibres And Elliott Smith who worked closely with Hunter during his Lecturing and demonstrating at American and Canadian clinical first trip to England bewails the loss of such a young and brilliant schools before his return to Australia, Hunter showed a particular mind and provides this panegyric. interest in Henry Head’s work on aphrasia and according to “It is impossible to convey to those who have not come under the Professor Elliot Smith, Hunter ‘did a great deal’ in making Head’s spell of his personality any adequate conception of the magnitude of work understood. the loss anatomy and in fact medical science in its widest sense have The most important collaboration between Royle and sustained in the death of John Hunter. The great name he bore would Hunter began when Hunter returned to Australia in 1923. While have overwhelmed a smaller man; but it is no exaggeration to claim in London, Hunter had seen some of Professor Kulchitsky’s that he has added fresh lustre to it.” histological samples which indicated that ‘the sympathetic fibres Written by Elizabeth Milford, College Archivist to striated muscles did not go to the same muscle fibres as the medullated nerves’. This combined with experimental work helped inform Royle and Hunter’s hypothesis of double innervation of muscle – ‘the idea that the sympathetic nervous system controls ‘plastic’ (postural) tone’ and that spastic paralysis could be alleviated by sectioning the sympathetic nerves. The Scottish surgeon Sir William McEwan known for his orthopaedic work on bone grafts and pioneer work in Finance for neurosurgery visited Australia in 1923 and he was followed by of the College and the pair collaborated in research, which was to the American physician William Mayo (a founder of the Mayo healthcare professionals seal Hunter’s fame and perhaps even his fate. They investigated the Clinic) in 1924. In the narrow surgical circles of the time, it was regeneration of nerves and muscles, muscle activity, reflex action inevitable that McEwan and Mayo would be aware of Hunter in the spinal cord and the sympathetic innervation of muscles and and Royle’s work. Future College President, Sir Hugh Devine who muscle tone. sponsored Mayo during his visit had certainly met Hunter and Medfin helps make finance easy with: Royle was an unusual character, an orthopaedist who had it was Devine who somehow obtained the memorial plaque to • Appointments at a time and place that suit you • Fast response kept himself afloat as a student by teaching physical education. Hunter which now resides in the College Archive. • Financial solutions designed for healthcare professionals • Minimum paperwork He became interested in how muscles work and are controlled. It was not surprising therefore, that in October 1924, Hunter Influenced by the Dutch histologist Jan Boeke, this led him to and Royle were asked to deliver the John B Murphy Oration in investigate how spastic paraplegia could be alleviated. Initially New York. They were then to travel to England where Hunter Want more information? he performed ramisection on goats, then moved on to cadavers was to lecture at Cambridge (the new home of Hunter’s mentor, Contact your local Medfin Relationship Manager on1300 361 122 and performed experimental surgery on patients returning Professor JT Wilson) and London. As Douglas Miller says, the from World War I. A creative researcher, he trained himself in American part of the trip went well: Don’t have time to phone? “…they were warmly welcomed and their work seemed to be the voluntary control of his own muscles and his observations Visit medfin.com.au and request a quote online contributed to his paper: ‘The Functions of Human Voluntary acclaimed. Harvey Cushing, the great neurosurgeon was tremendously Muscles’, 1938. impressed by Hunter and Cushing was not easily impressed.” Following his graduation in 1920 with First Class Honours However, in England, their work was criticised and later Finance your: Car • Equipment • Practice • Cash flow • Investment Property and the University Medal, John Hunter went overseas for two disproved. And while in England, Hunter became sick and years and engaged in research in the fields of embryology, died in London’s University College Hospital and Royle, who anthropology and physiology. After investigating ovarian had suffered from mild influenzal encephalitis on the voyage to Important Information: Finance subject to credit assessment. Terms and conditions apply. Fees and charges apply. Medfin Australia pregnancy, he also studied the anatomy of the oculomotor England, then developed some sort of brain fever which affected Pty Ltd ABN 89 070 811 148, Australian Credit Licence 391697. Medfin is a wholly owned subsidiary of National Australia Bank nucleus of a tarsius and with Dr Ariens Kappers in Amsterdam, his health in later life. Although Hunter purportedly died of Limited ABN 12 004 044 937, AFSL and Australian Credit Licence 230686 and part of the NAB Health specialist business. (3/12)

Page 32 / Surgical News May 2012 Surgical News May 2012 / Page 33 Medfin 1/2 page horiz 180 x 130.indd 1 12/04/12 10:45 AM Regional News

Rooms Main event categories (minus falls) 2007/08 to 2010/11 Clinical management events 2010/11 With Style Winner of 2011 business excellence award

Rooms With Style probably elderly, exhibiting poor Public Health & Disability Act, was offers 3 core balance, co-ordination or confusion also released in February. This gathered services exclusively (and therefore at greater risk of falling), perioperative mortality data from existing for Surgeons a detailed analysis of each incident may data sources and then examined more identify common additional predisposing closely four surgical procedures (hip >Medical Fitouts factors in the clinical environment and knee arthroplasty, colorectal surgery >Practice and the provision of their care. With and cataract surgery), as well as deaths Management Quality and Safety of Health Care this knowledge, it may be possible occurring within 48 hours of a general How does NZ fare? to introduce measures that are better anaesthetic. This provided national Consulting targeted to protect vulnerable patients. epidemiological information in respect >Recruitment The New Zealand National Board to those procedures and anaesthesia in n 2010 the Health Quality & by the system that exists to protect them… (and private hospitals have not universally is strongly supportive of the work of the public hospitals, but again, did not Safety Commission (HQSC) We should view these events through the accepted the Surgical Safety Checklist), the HQSC and has already established capture information on these in all private Iassumed responsibility for collating eyes of patients and their families, and it is likely that the total number of these a close link with the Chair (Professor hospitals. Call today information about, and reporting on, acknowledge that many of them should events in New Zealand in 2010/2011 was Merry) in an endeavour to obtain more There was no detailed assessment of to find out how serious and sentinel events in New never have happened… It’s not acceptable significantly greater than addressed in the detailed information. (Professor Merry any individual case. The NZ National we can tailor our Zealand public hospitals. Its Serious to keep making preventable errors and report. and Dr Janice Wilson, CEO of HQSC, Board regards the establishment of this services to suit and Sentinel Events Report, released all of us who work in health need to Although the detail is sparse, the attended the March NZ National Committee as a very positive initiative in February, outlines 377 events which redouble our efforts to ensure patients reported 108 instances of serious and Board meeting.) It is anticipated that and recognises that broad epidemiological your practice. occurred in 2010/2011. The report, the receive the best and safest care... It’s not sentinel clinical management events are a careful appraisal of each incident data has its uses. POMRC has asked for fifth collating information provided by about apportioning blame – it’s about likely to include examples of significant involving surgeons will provide greater comment on its future directions and New Zealand’s 20 District Health Boards improving the quality and safety of our failure on the part of individuals and understanding of the circumstances the National Board will continue to urge (DHB), does not capture all adverse events health and disability services.” systems. This larger grouping contains around these adverse outcomes and, POMRC to institute systems to review 1300 073 239 that occurred in public hospitals, only It is of considerable concern to find six sub-groups – errors of diagnosis, through improved education and practice, individual perioperative mortality cases [email protected] those considered by each DHB as serious the report includes 18 episodes specific treatment, monitoring, procedure reduce the risk to surgical patients in the (in common with ANZASM) in order to www.roomswithstyle.com.au or sentinel events. There is no national to surgery – 11 wrong patient, site or associated, investigation, and discharge. future. Recognising that approximately identify areas for clinical improvement. report on such events in private hospitals. procedure and seven retained instruments Surgeons may have contributed to any 50 per cent of elective surgery in New Professor Merry, the Commission’s or swabs. Each of these reflects a failure or all of these sub-groups, and closer Zealand occurs in private hospitals, the Chair, observed that New Zealand has of operating theatre process and is of examination of errors of treatment and National Board strongly encouraged the an excellent health and disability system, direct concern to surgeons. With the procedure associated categories may yield Commission to seek serious and sentinel with more than 2.7 million people treated introduction of the Surgical Safety valuable lessons for us. event information from private providers Scott Stevenson, in public hospitals or as outpatients each Checklist, it had been envisaged that Of the 377 events, 195 arose as a also. Chair NZ National Board year and very few occasions of serious errors of this nature should be avoidable. consequence of patients falling, resulting The first report from the Perioperative With Allan Panting, harm. However, he also said: “The people As approximately 50 per cent of elective in significant adverse consequences. Mortality Review Committee (POMRC), Executive Director for involved in these 377 events were let down surgery is completed outside the DHBs While many of these patients were which was set up in 2010 under NZ’s Surgical Affairs (NZ)

Page 34 / Surgical News May 2012 Surgical News May 2012 / Page 35 Surgical sketches and silhouettes

n the January 2012 issue of Surgical belts and the College was repeated in by Darwin after trans-navigating the News I enjoyed the story about The Age again recently. world. She even invited me to the Darwin’s IRaymond J. Last and his Abyssinian residence. (Ethiopian) adventures. He then became In London At the College, I worked with David A LASTing Impression Professor of Anatomy at the Royal College One day David Conroy said to me: “Felix, Thomsett on the methyacrylate injection of Surgeons in London. I found in this why don’t you go to London? Now that studies on stillborn babies during that article no references to his witticisms (a you have your Australian Fellowship they Bernard Sunley Fellowship year. This How I came across Last term used by Dryden for witty remarks will give you the English one.” It was helped me to develop the concept of the since 1670s). exactly as David said; my viva examiner, angiotome or vascularised segment and We have all enjoyed reading this I think, was Felix Eastcott who spent the it was the basis of these fascial lined flaps textbook for anatomical and functional whole viva discussing Maurice Ewing’s with dynamic in vivo development which interests through our student and transition to the antipodes. led me to the principle of the Keystone Fellowship years. As students of anatomy David had suggested that I also book Island Reconstructive flap which is really and surgery, we have a firm bonding with accommodation at Nuffield College to do a con-jointed or double VY. this readable text and as Bob Marshall the six week English Fellowship course would most likely have observed – it beforehand which enabled me to visit Free parking reduces this important subject of living every major teaching hospital in London The then Warden, Doctor Livingstone, anatomy into what has been described as to meet the experienced surgical minds did not own a car which gave me dynamic realism. of the day – as Bruce Mann is currently the privilege of parking next to the Professor McMinn succeeded Ray Last organising for the FRACS locally. Presidential Rolls, I think owned by Sir as Professor of Applied Anatomy at the On that first morning we were waiting Thomas Holmes-Sellars at the time. College of Surgeons in London. Last also for the bus outside Lincoln Inn’s field; I And my Ford Zodiac (of Z-cars fame) held the Wardenship of Nuffield College remember wearing a standard English did not match the prestigious vehicles of Surgical Sciences at the Royal College club tie – angled burgundy and blue – of the College council members who of Surgeons where I lived for three years. when someone came up to me, extended also used the same car park. It was the How did it all begin? his hand, shook mine quite positively and luck of the draw to get free parking During my time at the VPSU at said to me, “King’s College, Cambridge, at Lincoln’s Inn Fields in the centre of PANCH in 1970 I was finishing my I presume”. I hesitated, caught my wits London. General Fellowship while training in and thoughtfully responded: “No, this The Department of Anatomy after plastic surgery under Benny Rank. I tie comes from Fosseys of Footscray (a Last and now under Professor McMinn can still remember doing essays on clothing store) in Melbourne”. where this work was completed was a abdomino-perineal resections on Benny’s Thanks to Alan MacLeod, I ended reflection of English academic excellence. suggestion, which he would get Alan up working for three years in the Head I had access to the college’s photographic Cuthbertson at Royal Melbourne to and Neck Service at the Marsden with department run by Ralph Hutchings Henry Shaw, at the Westminster with – the author of numerous anatomical MUNCHAUSEN correct (thank you, Alan, after all these SYNDROME years). Charlie Westbury in melanoma and with illustrations with Professor McMinn I passed my Fellowship exam in Ian Wilson at St George’s, Hunter’s old – which was of the highest standard October 1970, a trainee in plastic surgery. stomping ground. I slowly matured in and from him I learnt the importance My first major case as a “qualified the art of reconstruction, focusing on the of photographic reproductions K vascularity of flaps during a concurrent to encompass lighting, tone and Y registrar” was that same evening at research year at the College of Surgeons as M PANCH when I had to do a sigmoid composition. This experience has been C a Bernard Sunley Research Fellow. volvulus with Ken Brearley on call. invaluable in my recent publication. Factitious disordersProfessor McMinn describes Last’s He said: “Son, you have a Fellowship, As the publishers Elsevier told me warm personality and the embracing last week, the 9th edition of Last’s

Plate: Musings about Munchausenyou should be able Syndrome, to handle that.” are Itthere was three types? style of his textbook writing. My three not to be and Ken graciously came in Anatomy – Regional and Applied is the year stay at Nuffield College meant I had from Brighton and got me out of a tight one distributed on the Australian scene privileges few could have dreamed of – corner (or should I say “a twisted loop”). full of anatomical pearls so characteristic, food, accommodation and access to the During my PANCH days, food was whereas the 11th Edition (European) Hunterian collection, even meeting Jessie freely available to Consultants and I dined authored by Chummy S Sinnatamby have Dobson, the curator of the Hunterian these all but deleted. To recapture a few regularlylater that evening with David discharged Conroy herself. and This Gordon clin- As we know musing is gazing meditatively museum. Trinkerical history who stimulated incidentally me to recount would the regularly story and refl ectively in a literary context. This led – the last of Last, we hope not (as said by of some of my other Munchausen experiences me to ponderShe introducedthe Munchausen me tosyndrome. my first Dodo Ed Morrison): OpusOPXIII XXII come in to every motor vehicle accident over the last three and a half decades, and three Whether– theby proxyflightless or direct bird involvementwith vestigial wings at all hours to document the details. And 1. Hilton’s Law – the motor branches of FelixFelix Behan Behan cases in particular spring to mind – I wonder in the presumablypublic or the brought private sectors,back on this the Beagle muscle nearby also supply the joint. VictorianVictorian Fellow Fellow thatif this acknowledgment is the statistical average regarding (one every the ten safety psychiatric disorder is classifi ed as a facti- u years and I would welcome other comments). tious sequence of clinical episodes - fancied, Page 36 / Surgical News May 2012 n a recent theatre list I had an inter- The second case makes an interesting feigned or self-infl icted-. It is interesting how Surgical News May 2012 / Page 37 esting clinical experience even at narrative, in the 1980’s. In those days the medi- this eponym arose: Richard Asher in 1951 was my age. In the Anaesthetic room a cal administrator allowed us to transfer insur- the fi rst to describe such self-harm, recall-

Date: 27-SEP-2009 O patient was awaiting surgery. My registrar was ance patients to the private domain. Over a two ing Baron Munchausen in an article in the not there with me to present the details on his month period a general surgeon and I operated Lancet. He mentioned how the Baron had a line of management. He had mentioned before- on this young man a number of times. He had list of fantastic stories, beyond belief, refl ect- hand that this lady had presented for removal sustained abdominal injuries in a motor vehi- ing daring exploits, quite unbelievable. In his of something off her leg. cle accident, a perfectly credible story until I obituary in the British Medical Journal, it was When I addressed the patient in this later questioned the multitudinous mature mentioned how Asher respectfully dedicated context, my question was “now what am I abdominal wall scars – another warning sign. this syndrome to the Baron removing today?” She said “I have a scar on the leg at a skin graft site and I was told you could possibly fi x it”. Previous attempts at serial scar “As one of my mentors and later colleagues said revision had been unsuccessful. People knew years ago “Plastic surgeons are sometimes described I have successfully closed similar defects in melanoma patients with the usual keystone as psychiatrists with knives” – but not always.” technique. Like any experienced surgeon, I exposed Three days before discharge he asked a The Baron served in the Russian mili- the whole lower limb to examine it and found, young nurse for $15 so that his clothes could tary forces against the Ottoman Empire and to my horror, she had a donor site dressing on be dry-cleaned. I asked the young lady some acquired a reputation for witty and exagger- her upper thigh. On further questioning, it months later whether she had ever received her ated tales and became the subject of numerous Page: 40 transpired, this had been there for six months. money. She was never paid. texts published in 1862 by Gustav Doré, from I then glanced at her notes on the anaesthetic Some years later, I was doing Monday balloon fl ights, to taming wolves to shooting bench. There were fi ve volumes, each about fi ve morning rounds when I encountered the fl ocks of ducks and being mauled by bears (en. inches thick – “a warning sign”. At this stage the same individual, recently admitted again wikipedia.org). alarm bells were ringing and I asked her “why with abdominal trauma. Needless to say he However the idea occurred to me that have you been in hospital so often?” suspect- signed himself out within the hour when I this recollection had a similar ring to another ing some major clinical catastrophe like neph- confronted him. particular person who also wrote about rotic syndrome. She gave a history of repeat A further story relates to a nursing aide fi ctional and fanciful adventures. He was far overdose needing ICU admission. It transpired who burnt her fi nger on a steriliser. The regis- more readable and he became the second most she was seen in our unit six months earlier and trar in the Emergency Department referred translated author of all time, (second only to it was found that she has been putting oven her to me for grafting (which failed), which Agatha Christie). Having written Journey to cleaner on the skin graft donor site. was repeated and failed a second time before the Centre of the Earth in 1864, then 20,000 I took her into theatre and manually debri- doing a cross fi nger fl ap. The resultant stiff Leagues Under the Sea in 1869, and Around the ded the wound under general anaesthesia and fi nger years later resulted in a ray amputation World in 80 days in 1873 – none other than the dressed it with the usual donor site techniques, of the middle fi nger, by another specialist, as great Jules Gabriel Verne (1828-1905) reinforced with soft topical non-removable I discovered when she came back to me for a He lived along the Loire Valley. At the Pub: CMC TOTS dressings, and signed it “not to be removed medico legal report seeking compensation for school of St Donation College, one of his without my permission”. I heard that she had this work related injury. tutors in drawing and mathematics was possi-

SURGICAL NEWS P40 / Vol:10 No:8 September 2009 Surgical sketches and silhouettes

ne Surgery ocri nd e Central E risban in el B e of t rs , S u 12 o 20 C ly te Ju ua 1 ad ay 4th stgr nd Po Su to 2. Flexor skin is more sensitive than Now it is time for a cup of coffee as the the European scene in the 17th century my mind the best in the world (like Petrus Friday 29 June extensor skin. other part of Last’s story embraces that even needing religious approval for wine from Pomerol in Bordeaux). You 3. Flexor muscles are quicker acting and place Ethiopia, where coffee originated. its consumption. It was banned at will have to await my next instalment on more precise with finer fibres which in The story goes that a goat-herder was one stage and needed a Papal Bull coffee drinking, which has become the animals are more tender to eat. hunting sometime in the 10th century in from Pope Clement to reverse this philosophical basis of communication 4. The mandible at birth is in two parts – the hilltops of Ethiopia. He went to round restriction. in a Socratic manner where the didactic so Galen was right after all. up his herd and found them nibbling a Even Bach wrote a cantata in praise of questions and answers lead to the 5. The size of the breast goes from the red berry tree under the midday sun – coffee: “Ah how good the coffee tastes” advancement of knowledge – as the great second to the sixth rib and with age some were more excited than others and I for his regular Friday evening recitals minds say, answer the questions, but more and pendulous descent, the circulation will let you speculate what that means to in Leipzig. Voltaire was even reputed to importantly question the answers. This esteemed three day conference is the culmination of comprehensive planning by the society of Australia and New of the nipple from the intercostal a goat herd! have consumed up to 50 cups of coffee a Strangely at this 11th hour when Zealand Endocrine Surgeons and will showcase the highest perforators must go from medial day for its stimulating effect. And across refining this article on coffee something quality endocrine surgery content delivered by International, to lateral and therefore any breast Start of coffee the channel to the United Kingdom percolated through to my awareness. My reconstruction should be so designed. Australian and New Zealand thought leaders, and world He took some of the tasteless berries where one of the coffee houses in the former surgical registrar at the Western 6. Flexor hallucis longus is defined as renowned Endocrine and Oncologic Surgeon Professor home and threw them in the fire. The East End was run by Mrs Jones and Hospital, Stephanie Tan, gave me a packet beef to the heel with gastrocnemius Doug Fraker. aroma was elevating. He retrieved the was a meeting place for the insurance of Luwak coffee from Indonesia (which used in walking and the long flexors roasted beans from the fire, crushed them, brokers to negotiate the coffee cargos costs $30 a cup in the US). And why is it A full program, along with registration details, is located at for overdrive. made a drink and that was the start of his from Africa, such was its value. What so expensive? The feline sized mammal www.endocrinesurgeons.org.au. 7. And not forgetting, superficial Seventh Heaven experience. was established nearby in Lime Street? the native civet eats the red berries in the lymphatics follow veins, deep ones For further information please contact the Conference Now we recall this Ethiopian story Lloyds of London. jungle, the berries are indigestible and Secretariat Sara McDonald on telephone +61 7 3163 1036 follow arteries. Even Trevor Jones they come out as droppings to produce reminded me recently that the every time we fly over Mocha in Arabia I haven’t time to take this dissertation or email [email protected]. appendix is a tonsil and the ribs are for (part of Yemen), incidentally called across the Trinidad and the story of Blue the finest coffee taste in the world thanks breathing. Arabia Felix. Eventually coffee reached Mountain coffee from the Caribbean – to to the intestinal juices.

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Page 38 / Surgical News May 2012 Surgical News May 2012 / Page 39 Younger Fellows

A Personal Perspective possible to learn something new from value and productivity of the Younger your State representative can develop into almost every consult. For most of us, Fellows, both as individuals and as a recommendations and projects high on Moving on to the next stage… health permitting, we have another 20-25 College committee. Some of the brightest the priority list of our Council. years in practice, enough time to reap the minds and most skilled hands belong to I think it is healthy and important to write this as one of my final duties appearance, freshness, vigour or other rewards from the profession we love, or young surgeons, destined for greatness in stay young at heart. Different people help as chair of the Younger Fellows qualities of youth.” still enough to recognise a desire for a a country where innovation has always us achieve this; medical students and ICommittee. Traditionally, such an This can be translated into the old change in direction and work towards it. excelled beyond the expectations of our residents, junior colleagues, our friends, article would cover my experiences and phrase, “you are as young as you feel”. In College terminology, we have a name small population. and our families. Many like me have accomplishments on the committee; With regards to the definition of Younger for younger surgeons and one for those Over the next few years, one of the young families and delight in coming however, while considering what to write, Fellow, younger is simply a comparative with far more years under their belts, main focuses of the Younger Fellow’s home to them every day and being a kid it occurred to me that despite an extra term, so in some way we are all almost but no term for the group in the middle, Committee will be leadership and again for a while. year as chairman beyond the usual 10 always younger, even if not by College the majority of the Fellowship. Perhaps mentoring, the very thing to nurture and To those like me, no longer Younger years, I am no longer a Younger Fellow! I classification. we should be called the “comfortable develop these talented young surgeons, Fellows in name only, welcome to the have nothing left to associate with being The end of College youth is in fact a fellows?” and to lift others who may not be age of the “comfortable surgeon”. May young! I am the other side of 40 and great time in surgical practice. We have 10 At the same time, we all see patients performing so well to a level where they your careers flourish. To the new Younger heading steadfastly into middle age. I years of experience, and would now feel occasionally with terrible prognoses, too can enjoy the success of hard work Fellows, good luck in your endeavours thought I’d reflect on this instead. competent and confident in our chosen more and more (as we grow older) and dedicated training. and consider becoming part of the I started researching the definitions field of surgery, but not so arrogant that younger than ourselves. These patients Remember that the Younger Fellows Younger Fellows Committee to help of key words and immediately started we don’t feel we still have many things to remind me how precious life is, and put are 1500 in number and have a seat at mould the College into the Future. To the feeling better. For example, “young” is learn, both as surgeons and as people. our own problems in perspective. They the College council and the ear of many College, thank you for the privilege and defined as “being in the first or early stage I find now the thrill of talking to my remind me to make the most of every day College committees. New ideas, whether opportunity I have had. I am certain that of life or growth” which doesn’t actually patients not only about their illness, but we have because the truth really is that generated at the Younger Fellows Forum, you will still see me around. mean much, but definitions go on to add about their lives. So many of them have we don’t know what tomorrow will bring. Younger Fellows Committee meetings, Steve Leibman “not old”, and even better, “having the fascinating stories to tell and it really is Let us also not underestimate the or a chat over coffee or over the phone to Chair, Younger Fellows Committee

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Page 40 / Surgical News May 2012 Surgical News May 2012 / Page 41 04557-Medical Personnel (90x130mm) Advt 04557-Medical Personnel (90x130mm) Advt Indigenous Health

130 patients, followed through on operative candidates (including two cochlear implants), and incorporated an audiology service to enable early detection of ear disease Hearing a community and hearing loss. Sustainability of the service has been achieved without burdening existing staff, resources Surgical ENT outreach clinics at Awabakal Aboriginal Medical Service – and services. Central to the clinic’s operation is regular assessment, review and feedback to the community, and a model of outpatient care for Aboriginal and Torres Strait patients Established since 1977 the inclusion of the community in formulating strategies Established since 1977 for improvement. In medicine, a chronic disease remains a burden of illness to both patient and health care provider. Adequate management of chronic illness reduces the need for acute Newcastle, Lake Macquarie and Hunter Valley regions. Close to hospital admissions, complications of disease, fewer 85 per cent of Awabakal staff is Indigenous. burdens on outpatient services and ultimately better Recently Awabakal AMS, supported by several Fellows working patient outcomes. at the Royal Newcastle Centre and John Hunter Hospital, Otolaryngology (ENT) is not free from long-term established a specialist urban outreach clinic for Ear Nose and illnesses. Aboriginal and Torres Strait Islander people face SpecialistSpecialist Consultants Consultants in permanent in permanent Throat (ENT) services, as an extension to the surgical ENT many barriers to health care access. The need to overcome andand temporary temporary medical medical staff staff placements. placements. services provided by hospitals in the Hunter New England these barriers is essential in the provision of health care Contact Carol Sheehan Contact Carol Sheehan Local Health Network (HNELHN). Dr Rob Eisenberg, Associate from an otolaryngology, head and neck surgery view. The Telephone 03 9429 6363 Professor Kelvin Kong, Dr Toby Corlette and Dr Monique need for a separate and specialised focus on Aboriginal Telephone 03 9429 6363 Facsimile 03 9596 4336 Parkin, participate in community based clinics across the and Torres Strait Islander health is not universally Facsimile 03 9596 4336 Hunter New England region, under the guidance and clinical After hours 03 9596 4341 acknowledged within mainstream health care services. After hours 03 9596 4341 lead of Abawakal’s Aboriginal Ear Health Worker, The Royal Newcastle Centre is undergoing Email [email protected] Email [email protected] Markeeta Douglas (pictured). transformation by capital investment in equipment and Address 22 Erin St Richmond 3121 Address 22 Erin St Richmond 3121 It is well documented that Aboriginal and revision of the delivery of ENT services. This climate Website www.csmedical.com.au Torres Strait Islander people report higher supports a positive re-think, re-design and review of ENT rates of hearing loss than their non-Indigenous utpatient care is recognised as a safe outpatient services, including provision of community counterparts, and that Aboriginal children suffer and effective way of treating patients based specialised outreach services as an integral part of from re-occurring middle ear infection (Otitis without the requirement for hospital a renewed and responsive health care system. Ararat, Victoria O Media) more frequently than non-Aboriginal The experience of Awabakal AMS has demonstrated admission. Many reviews have been performed children. on what constitutes the ideal structure in which new approaches are not only possible, but highly Otitis Media, if not treated adequately, can an outpatient setting can benefit the community desirable if sustainable new benchmarks in service cause significant hearing loss. In children this can VMO in a safe and appropriate manner. While general delivery and health outcomes are to be attained. An lead to linguistic, social and learning difficulties logistics and micro-management issues are of outpatient service, created to complement the services and behavioural problems in school, which General Surgeon on-going concern in both the establishment being provided by hospitals in the Greater Hunter New reduce educational achievement with lifelong consequences for and operation stages, the growing need to increase patient England Local Health District, will assist the delivery of • Co-operative working arrangements, employment, income and social success. turnover rates and yet maintain a structured program of care, is appropriate health care to the communities it serves. assured hospital income Awabakal’s ENT clinics encapsulate a model of outpatient progressively adding pressure to our hospital systems to deliver care, where patient needs, treatment and journey through • Possible part-time academic appointment the standard of health services expected by the community. Active participation the healthcare system is managed within a comprehensive with The University of Melbourne’s Rural One way to alleviate this burden is to provide alternatives to “The benefits of Aboriginal community control and multidisciplinary framework. By “walking in the footsteps of Clinical School traditional hospital based outpatient clinics. Moving an outpa- participation can already have been seen where Aboriginal a patient” those involved and responsible, at every step, for a tient service to the community can be one such viable option. health service and other Aboriginal community controlled • Attractive, historic town in the foothills of the patient’s care, including the surgical specialist, is identified, noted Community based outreach clinics offer the additional benefit organisations exist. The mere fact that community striking Grampians and Pyrenees Mountains and used to guide patient and case management. that they make health care accessible to groups marginalised control shuns dependence on non-Aboriginal systems is In this way the outpatient service is an extension of the Applications are invited for the position of Visiting Medical from the mainstream health care system. Aboriginal and Torres a benefit. It promotes responsibility, understanding and Officer – General Surgeon at East Grampians Health mainstream hospital system. Care is provided in a culturally Strait Islander (ATSI) people, living not only in rural and remote allows communities to be active participants. As a result Service (EGHS) in Ararat. The appointee will provide appropriate setting to maximise patient contact, to ‘close the gap’ services to EGHS for elective and emergency surgery, and Australia, but also in and on the fringes of our urban centres are communities are able to identify health problems and on the prolific ear disease rates and other ENT ailments in both will share on-call cover. Competency at caesarean section marginalised as a result of distance, low socio-economic status or possible solutions, contribute to needs based planning and will be highly regarded. adult and paediatric care. because of the inappropriateness of health care delivery. be involved in ongoing evaluation. Communities become Please see our full-text advertisements on Increasingly, Aboriginal Community Controlled Health active participants rather than passive recipients, and the www.mycareer.com.au and www.generalsurgeons.com.au. Organisations are being recognised as places best suited to host Best outcomes development processes that emerge allows from the design Background information is available on www.eghs.net.au. Imperative to the success of this model is the role of the Enquiries and applications should be sent in the first outreach clinics for the delivery of health care services required of structure to meet the specific health needs of Aboriginal instance to Leslie McBride at: by ATSI people. Community control has been widely accepted as Aboriginal Ear Health Worker and their liaison with the people rather than attempting to ‘fit’ Aboriginal people to patient and health care providers to ensure the best outcomes Email: [email protected] a key requirement in the strategy to overcome Aboriginal health exiting systems”. Tel: 03 9486 0500 disadvantage. for patients. In Abawakal’s case, Aboriginal Ear Health Worker (Source: A National Aboriginal Health Strategy, DoHA, Cleveland McBride Fax: 03 9486 0200 Markeeta Douglas is a critical part of the solution and is Mail: Suite 4, Level 4, L44466 The Awabakal Aboriginal Medical Service in NSW, for example, 1989 page xvi) 372 Albert Street, provides medical services (and other health, education and social extremely committed to the ENT needs of the local community. Kelvin Kong Health Recruitment East Melbourne, Vic 3002 support programs) to Aboriginal communities living in the In 12 months of operation, the clinic has seen more than Chair, RACS Indigenous Health Committee

Page 42 / Surgical News May 2012 Surgical News May 2012 / Page 43 NSW Regional Awards

“It must be remembered that this young upstart had Congratulations arrived in a town where there was one part-time on your achievements surgeon plying his trade and stories” These NSW Merit Awards were presented at the NSW Regional Office End of Year Dinner, held on 16 December 2011 award winner pioneering spirit of Dr Irwin Hanan, who practices have been refined over the years established the first General Surgical but the basis to current practice is easily award practice in Nowra. He worked as a seen in Alan’s work. winner Professor 1972-1985 and Professor of He has trained one to three Fellows per General practitioner to establish himself, Alan was one of the doctors who Surgery and Chairman of the Department year from Asia and Australia in vascular and then used his skills learned in New watched over the establishment of a 1985-2004. and transplant surgery. Many hold chairs Zealand and the United Kingdom to private sector in the area, and was heavily He established the Rural School of in surgery in Australia and overseas further the practice of surgery. Alan also involved in the establishing audit. There Medicine in 2004 at Wagga. In 2004 the including Professors Effeney, Lusby, Jones, wishes to recognise the role played by was the arrival of other specialists and UNSW conferred Emeritus Professor Lynch, Gotley and the late Alex Chao Doctors Pat and Bill Ryan in helping him the largest change of all, the arrival of Status. from Singapore. establish a specialist surgical practice in specialist anaesthetists. This transition The same year he became the first He has been president of the Australian Nowra in 1978. was not the simplest in this GP driven Professor of Surgery at the University of Chapter and Vice President of the Alan had an interest in almost all town, however with Alan’s involvement Western Sydney and helped establish International Society of Cardiovascular aspects of surgery. He was truly a General many of the difficult moments were the Medical School. He was Director of Surgery, Chairman of the Section of Alan Kline Surgeon. A dab hand at Breast disease, smoothed over and possible combatants Surgery at Campbelltown and Camden Vascular Surgery and Military Surgery Biliary disease, and hernia repair, Alan became tennis partners or sailing buddies. Hospitals. R ACS. Presented by would not be daunted by the occasional Alan has one major failure; he likes Martin Jones fracture and hand injury. Children were adventure, but he sometimes gets lost or Reginald Lord His skills in establishing and In 1985 he was invited to serve as maintaining standards in surgery have Colonel of the Royal Australian Army very much part of his operative repertoire, injured. To have Alan as the doctor for Presented by been used in metropolitan and rural Corps. He led a St Vincent’s team to lan has been a friend, colleague and I still remember the intensity of the canoeing trip for his son’s school class Anthony Graham areas throughout Australia by health Vietnam 1971-1972. and mentor for over 20 years. He concentration over the tiny sick babies was in theory an excellent choice, but that authorities where codes of practice and Prizes and Honours are numerous and Ais, even in retirement, the Senior with pyloric stenosis. is theory for you. Alan, being involved as outcomes had been a concern. Professor include Member of the Order of Australia Surgeon of the Shoalhaven Hospital It must be remembered that this always, set out in the canoe only to see the rofessor Reginald Lord AM, MD, Lord has always been a problem solver for 2004. District in Nowra, on the beautiful south young upstart had arrived in a town paddle stick in an underwater rock and FRCS, FRACS, has shown all the community and an advocate for our His scientific contributions include coast of NSW where there was one part-time surgeon his shoulder continue on its merry way Pthe qualities of leadership in the profession. dynamic studies of flow in the thoracic Alan and his wife Pat have been for plying his trade and stories; of GP to dislocation. There at the head waters academic and clinical aspects of surgery Professor Lord is author of over 250 duct, haemodynamics of the vascular steal many years the ambassadors of Rural surgeons removing gallbladders with of the Shoalhaven, thankfully he had an throughout his career to be a worthy publications, mostly related to vascular phenomenon in the cerebral circulation, Surgery both at home and across the the hospital gardener attending to epirb alert device and was eventually recipient of the NSW Merit Award of the disease including the text book Surgery the mechanism of TIAs via alternate many lands they have travelled. They the ether mask. Alan was involved in airlifted out of the canyon, following his R ACS. of Occlusive Cerebrovascular Disease of pathways and defining the syndrome of enjoyed the travel to distant shores an almost imperceptible change to self administration of IVI pethidine – the Professor Lord graduated in Medicine which he is the sole author. carotid paraganglioma. initially as a young couple and, despite specialisation amongst the regions’ other responsible adult had fainted at the from the University of Sydney in 1960. He is a pioneer of extracranial Together with Dr Yuri Bobryshev, the arrival of Chris then Tom and finally doctors and hospitals. Alan’s best man sight of the needle. He trained at St Vincent’s Hospital, arterial and thoracoabdominal aortic Professor Lord postulated and then Amy, their times of camping, walking, at his wedding had been Col Shepherd, Alan has retired from active surgical Sydney 1960-1965, St Thomas’ Hospital, reconstructions. identified dendritic cells in the artery wall biking and sailing all over the world have and the Shepherds have spread their practice and we are hoping that he London with vascular leaders Drs He has been a member of the and defined their role in inflammatory not slowed. influence throughout the practice of will continue in a teaching role in the Kinmonth, Cockett, and Browse 1966- editorial advisory boards of the Journal components of atherogenesis. Alan had his surgical training-wheels surgery in many ways throughout NSW Shoalhaven. His retirement dinner from 1967. He trained at UCSF 1967-1969 of Cardiovascular Surgery, Annals of Professor Lord has encouraged students on in many of the hospitals of the British and Australia. Col was Alan’s anaesthetist, the hospital was in Kigali in South Africa with Dr Jack Wylie the pioneer of Vascular Surgery, Phlebology and ANZ and graduates to be actively involved in Isles, where he worked with many fine a lovable larrikin of a GP and part-time and the only people there were his family. the operation of endarterectomy and Journal of Phlebology. the learning process. He is recognised as surgeons of the time. He was very proud anaesthetist. Together they performed Alan is an intensely private man and proud completed his training in vascular and He has been an invited speaker and a leading academic researcher, teacher of the academic achievements in his the little miracles that defined surgery in of his Queensland heritage (especially at renal transplantation surgery in San visiting Professor in every Australian State, and outstanding vascular surgeon with studies into vascular disease. He also country NSW in those times. time of the State of Origin). The people of Francisco. New Zealand, USA, Canada, Portugal, the equanimity that encourages calmness, worked with the legendary Mr Les Ernest Slowly but surely Alan instigated the country New South Wales, especially the He returned to Australia and St Spain, Brazil, Italy, Monte Carlo, Greece, care, skill and an endless thirst for Hughes. This excellent grounding in protocols to his practice and then the Shoalhaven, have benefited from his love of Vincent’s Hospital to join the Professorial the Netherlands, England, Scotland, Israel, knowledge. He is the complete Professor establishment of logic to investigation has hospital that would be used to establish surgery, simplicity and his genuine respect Unit with Professor Doug Tracy. Singapore, Fiji, China, Japan, Vietnam, of Surgery and deserves recognition by held him in good stead. Breast Cancer treatment, Bowel Cancer of patients, most of whom now count Subsequently he became Associate Indonesia and India. our College. Alan and I both are grateful to the surgery and Trauma treatment. These themselves as his friend. u

Page 44 / Surgical News May 2012 Surgical News May 2012 / Page 45 NSW Regional Awards The Royal Australasian College of Surgeons Member Advantage Benefit Program

award winner intracardiac structural repair. To this day of Wales hospital until 2008 when I strive to achieve an atrial closure suture Queensland Health restructured its line that even attempts to resemble a paediatric cardiac surgical services and Graham Nunn closure! he was approached to lead this service. Graham is not native to NSW. He grew Graham was appointed Director of up in the wilds of Kangaroo Island in Paediatric and Congenital Cardiac South Australia prior to attending the Surgery Queensland. He retired from this University of Adelaide. His university position in March of this year. transcript would make the majority of Graham has both a national and students blush with shame. His lowest international reputation in the paediatric grade appears to have been a credit cardiac surgical community having on a single occasion. Throughout his developed a single patch closure undergraduate years Graham was technique for the repair of atrioventricular Graham R Nunn awarded no less than seven prizes. canal defects. He is visiting professor at On graduation he went on to the the Mafraq Hospital in Abu Dhabi in the Presented by Royal Adelaide Hospital and trained in United Arab Emirates. Robert Costa cardiothoracic surgery under the tutelage Graham was an examiner for the of Ian Ross and Darcy Sutherland. On RACS from 1994 until 2002. In 2006 his Graham Nunn has had a great gaining his FRACS in 1979 he undertook contribution to cardiothoracic surgery influence not only on my own career, but further training in both adult and was recognised by the RACS with the Escape the cold, enjoy the savings that of many other currently practising paediatric surgery in London and Boston Award and Medal for Excellence in cardiothoracic surgeons, both adult as well as research work. He worked with Surgery. Take advantage of your RACS Benefits this winter with great offers on travel and especially paediatric surgeons. Not Professor Magdi Yacoub, Marcus Deleval, His contributions were recognised by one to seek the limelight, outside of the and Aldo Castaneda. the Commonwealth with the award of the cardiothoracic community, Graham’s Returning to Australia, Graham Member of the Order of Australia in 2004. achievements are perhaps little known. was appointed to Westmead Hospital Graham has been an avid supporter Accommodation HotelClub Travel Insurance Range of cover options I first met Graham in the latter stages and the Royal Alexandra Hospital for of the Operation Open Heart Project Explore the world and enjoy up to 15% off accommodation rates at over 71,000 Choose from a range of cover options, including short trip, annual and corporate of my advanced training. I was one of Children as a cardiothoracic surgeon. He of the Sydney Adventist Hospital. hotels worldwide. Compare rates from lists of hotels available at your destination travel insurance. Convenient online quotes and booking facility is available via the the few fortunate Trainees who were subsequently went on to become Head of This project brings cardiac surgical through our easy-to-use reservation facility. Bookings accessible online. Member Advantage website, or call 1300 853 352 for more details. allocated a rotation to the cardiac unit at Department at both these institutions. In services to developing nations where the RAHC at Camperdown prior to its 1992 he was also appointed to the Prince no such services exist. He has been on relocation to the Westmead site. The most of Wales Hospital as a cardiothoracic at least 20 such trips. This has led to Packaged Tours Intrepid Travel Car Rental AVIS striking feature was the absolute attention surgeon. In 1997 he retired from the development of a fledgling cardiac Enjoy a 10% discount on all land tours through Intrepid Travel. 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This applied no matter Emeritus. of Logohu. whether the procedure was a relatively Graham remained at the Children’s Graham Nunn’s personal attributes are Airline Lounge Memberships Qantas Club Accommodation Best Western simple ASD closure or a complex Hospital at Westmead and the Prince too numerous to even attempt to describe. Take advantage of our corporate rates and save hundreds on Qantas Club airline Save 10% off the best available rate at any Best Western location across Australia, lounge memberships. Save $348 (AUD) on new two year memberships, and $247 New Zealand and Fiji. To make a booking, call Best Western on 131 779 (Australia) (AUD) on 1 year memberships. or 0800 237 893 (NZ) and mention the corporate discount number: 01340340.

Airline Lounge Memberships Koru Club Money Transfers Ozforex Enjoy savings of up to $186 (NZD)^ on Koru Club memberships; Air New Zealand’s Ozforex offers a range of money management services to Fellows and Trainees, Surgical News airline lounge. Members enjoy access to both Air New Zealand and Virgin Australia including Travel Money cards and international transfers for business transactions always welcomes letters from readers. lounges across New Zealand and Australia. and bill payments. Please write to The Editor, Surgical News, Royal Australasian College of Surgeons, 250-290 Spring Street, East Melbourne. Victoria 3002 or email: [email protected] Call Member Advantage on 1300 853 352 or visit www.memberadvantage.com.au/racs NZ Fellows & Trainees call +61 3 9695 8997

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Page 48 / Surgical News May 2012 Surgical News May 2012 / Page 49 Foundation for Surgery

thank-you for donating to the Foundation for Surgery Who else... has medical equipment finance specialists? NSW QUEENSLAND Mr Harry Tsigaras IRELAND Dr Renata Abraszko Dr Anthony Ganko Dr Brian Mehigan Mr Geofrey Coltheart Dr Geoffrey Miller NEW ZEALAND Mr Patrick Kevin Assoc. Prof. Benedict Panizza Mr Stuart Gowland SINGAPORE Dr Geoffrey Lee Mr William Widdoson Mr William Tucker Mr Wei Chang Professor James May AC Professor Adrianus van Rij Dr Kenneth Merten VICTORIA WESTERN SAMOA Professor Michael Morgan Mr Michael Bruce ARGENTINA Mr Toga Potoi Professor John Norman AO Mr Robert Carey Professor Abraham Campero Mr James Powell Mr Alan Day Mr Keri Prabhakar Mr William Gilbert HONG KONG Mr John Sheehy Mr Jacob Goldstein Mr Chun-Hung Chow Mr Paul Kierce total TASMANIA Ms Zara Kimpton Mr Albert Erasmus Mr John O’Brien $43,200

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