Hate blood but want a career in medicine? Don’t worry, there’s a job for you

Written by Ian Wilson, Professor, Associate Dean – Learning and Teaching at University of Wollongong.

Some students come into medicine with a fixed idea of what they want to do – but this often changes. uonottingham

Just before I finished high school, my local general practitioner suggested I consider medicine. But the thought of blood made me feel squeamish, so I went to university to do maths and physics, and to try the new field of computer science. Needing a fourth subject, I opted for biology so that my friend who also did biology could give me a lift to campus.

I ended up becoming fascinated with biology, so much so that I wanted to study neuroscience, and I felt the best way into a research career was through medicine. Luckily, I was successful. As an undergraduate I discovered patients and shifted my focus to a career as a psychiatrist.

I was called up for National Service and ended up on a Defence Force Scholarship. During this time I became interested in trauma surgery and after discharge joined the surgical training scheme. After six months of surgery, I was bored with the technical side but still enjoyed the patient contact and interaction. Being married with one child and another on the way, I opted for general practice with a mental health and procedural focus.

I tell this story in some detail to highlight the meanderings that many students undertake in their career decision-making. Some students come into medicine with a fixed idea of what they want to do and spend their time achieving that goal.

But the majority are more like me and develop multiple interests. Where they end up generally depends on a number of factors such as available training posts, skill levels, controllability of lifestyle and to a very small extent, salary.

The Medical Schools Outcome Database and Longitudinal Tracking Project (MSOD) asks students about their career intentions on entry to and exit from medical school, and as interns (their first year working in a hospital) and residents (their second year of work). On entry to medical school in 2011, 25% of medical students had a first preference for surgery with paediatrics and general practice the next most frequent.

The preferences of those exiting medical school in 2011 were a little different: internal medicine and surgery were the most common career choices (18% each) followed by general practice and then paediatrics. Towards the end of the internship, the preferences changed again, with internal medicine the most frequently chosen (19%) followed by general practice and then surgery.

The least preferable career options tend to be rehabilitation, public health and palliative care – most students come into medicine to save lives, making these specialities less appealing.

With the growing number of medical graduates and the relative shortage of intern and specialist training positions, we have noticed a change in student behaviour.

Increasingly, students are attempting to ensure their undergraduate experiences provide them with the best advantage for their career selection process. Honours degrees or the publication of papers will add a few extra points in some speciality selection processes and students are working hard to achieve these goals.

Hospital choice is also seen as important, as there is a perception among medical students that undertaking an internship in a specific hospital increases their chances of being selected into a specific specialist training program. But these beliefs aren’t necessarily based on facts.

Some experts have suggested using career counselling to increase the number of students entering careers that are less appealing or where there are significant shortages. But there’s no evidence to show career counselling works in this way.

The best way to deal with this issue is around student selection and undergraduate experiences. Choosing students who are more likely to enter a given profession and providing them with experiences that are positive will work much more effectively in promoting careers in the generalist professions (medicine, surgery and rural general practice).

But often the impact of changes does not stop at the school level. Many professionals, including doctors, invest so much of their time and energy into their careers they are surprised that their practice takes on a sameness. Once you have delivered 200 babies or conducted 100 gall bladder operations the procedures lose their excitement.

This is the point at which many doctors start looking for something new and engage in medical politics, education, research, business ventures or artistic endeavours.

Some, like me, become dissatisfied with individual care and want to have a bigger impact on the world. Moving into academia to train the next cohorts of doctors seemed a logical step. In light of my original interest in research, this was a hugely positive for me.

Originally posted on The Conversation

Agency ignores those on front line: self-regulating advertising industry

Prof. Sandra Jones

ADVERTISING in Australia has been self-regulated since 1996.

Self-regulation is the process whereby the advertising industry participates in and is responsible for its own regulation, as opposed to government regulation or co-regulation by government and industry.

The Australian Association of National Advertisers’ advertiser code of ethics covers all forms of advertising and is administered by the Advertising Standards Bureau. There are also separate codes for some specific product categories such as alcohol and for specific audience groups such as the AANA code for advertising to children.

Still, repeated studies of self-regulatory systems in Australia and overseas have concluded that industry self-regulation tends to be largely ineffective in protecting people — particularly young people — from inappropriate advertising messages. They also find that an effective system requires an independent body with the power to veto advertisements and impose sanctions.

That’s why public health advocates often express concern about the role and nature of advertising in Australia, and the influence of this advertising on the health of Australians. For example, there’s a large body of evidence showing that food advertising to children encourages consumption of unhealthy foods, that alcohol advertising encourages young people to drink alcohol at an earlier age and in greater quantities, and that advertising for pharmaceutical products encourages reliance on medication rather than healthy lifestyle changes.

Unfortunately, despite repeated reviews of the self-regulatory system, which have consistently found that it’s ineffective in preventing young people from being exposed to inappropriate messages about alcohol, food and other health-related products, the government has declined to take action on the regulation of advertising.

The Advertising Standards Board is the agency responsible for addressing consumer complaints about advertising. The ASB recently undertook a review “to understand community and industry perceptions about the independent reviewer system as it currently operates, so that ASB may improve and enhance the system and ensure compliance with international best practice as foreshadowed in 2008″.

Those fortunate enough to receive an invitation to participate had until October 22 to respond to the issues paper. They were also told that others invited to participate included all individuals and organisations that requested a review of a board decision or who had contacted ASB regarding the process; other organisations or people who’ve expressed interest in this system, including other industry bodies, government agencies, incorporated bodies, media, educational institutions; and independent reviewers.

It’s, well, peculiar that I wasn’t invited to participate given that I’ve frequently expressed interest in the self-regulatory system, have published several articles on problems with the process and outcomes, and am well-known to the ASB.

Yet I found out about the review only when one of my students happened across it on the ASB website and forwarded the information to me. However, I did contact the ASB and obtained an extension of time to enable me to submit comments. But I was surprised at my omission from the list of invitees in the first place.

I was even more surprised when I mentioned this review to a group of colleagues at a roundtable on alcohol advertising on October 22, the due date for responses.

None of my colleagues were aware of this review being undertaken. And they’re a group of high-level representatives from government agencies, incorporated bodies and educational institutions, all of whom also had publicly expressed interest in the self-regulation process.

Meanwhile, the ASB assures us on its website that self-regulation “ensures consumer protection”.

The subject of the recent review — possible changes to the independent reviewer system — is of great importance to consumers and to organisations focused on protecting consumers from inappropriate advertising.

Topics covered in the issues paper included the cost of applying for an independent review — presently $500 for community members, $1000 for nonprofit organisations– the timeframe for review and the grounds for review. These are issues that have a serious effect on the general community’s ability to seek review of an ASB decision that they think is flawed.

For instance, nonprofit organisations such as the Cancer Council Victoria cite the $1000 fee as a significant reason for not seeking review of a questionable decision on a complaint regarding food advertising.

When high-profile individuals and organisations with a long history of interest in, and commentary on, self-regulation of Australian advertising are not invited to comment — despite the inference in the ASB’s communications that this was the case — I can only wonder how other, less well-resourced members of the community will have been able to contribute their opinions.

If, as the ASB tells us on its website, “the aim of self-regulation is to maintain high advertising standards and ensure consumer trust and protection for the benefit of all of the community”, then once again what’s been demonstrated is that the present system is inherently flawed.

Sandra Jones is director of the Centre for Health Initiatives and a professor at the University of Wollongong.

New Approach to Dementia Care

Dr Nancy Humpel

Dementia is one of the fastest growing sources of major disease burden in Australia and will overtake coronary heart disease in its total wellbeing cost by 2023. Without a significant medical breakthrough, the prevalence of dementia is estimated to increase from around 257,000 people in 2010 to about one million in 2050.

Dementia is a term that encompasses a range of conditions characterised by impairment of brain functions including language, memory, perception, personality and cognitive skills. Dementia is a fatal condition and there is currently no cure.

This distressing disease is presenting a significant challenge to the nation’s health system, and needs to be tackled on many research and clinical fronts. One of these is the support and training provided to residential aged care facility (RACF) staff.

In 2010 it is estimated there are approximately 82,000 residents in these facilities across the country who suffer from dementia. Due to the characteristics of the disease, caring for people with dementia is particularly demanding. To better cope with future demands, there is a clear need to support care providers and staff in RACFs through the development of sustainable models of care.

One area that clinicians and the research literature suggest needs addressing in dementia is the recognition of, and approach towards, end-of-life care. In many cases, staff in aged care facilities do not feel empowered or confident to initiate a change in the direction of care towards a palliative approach.

From research to date, it is evident that funding additional staff members for each of the many facilities may help provide the human resources needed to tackle the issue, but that is neither sustainable financially nor in terms of staff recruitment.

Rather, the ability of existing staff within aged care facilities to recognise the end-of-life stage, and to make appropriate, shared decisions about taking a palliative care approach, needs to be enhanced. This has been recognised via a $600,000 grant to the Illawarra Health and Medical Research Institute to deliver the REACH Out In Dementia Project.

The purpose of this project is to implement, and assess the impact of, an evidence-based best practice palliative approach in providing care to late stage dementia residents in aged care facilities. It will educate care providers, staff and families of residents about the clinical features which might predict an opportunity to move in the direction of palliative care.

There is already an abundance of evidence of the quality of life benefits that taking a ‘comfort’ palliative care approach can bring at end of life stage. On the other hand, there is also evidence of many barriers to providing this approach.

A major factor leading to avoidance of the necessary end-of-life conversations with residents and families in aged care facilities may be that health care providers feel unskilled at this task. They are unlikely to initiate end-of-life discussions when they believe they lack the needed interpersonal skills.

Although this type of conversation would help identify the resident’s wishes about their ongoing care, education alone may be insufficient to fully empower doctors and care providers to initiate the needed changes.

Addressing the barriers to initiating end of life conversations is where the REACH project stands out from previous work, and is leading in this area of research.

While the project aims to ensure a more appropriate approach for residents with late stage dementia, what are the implications for reducing the burden on an already overstretched health care system?

Currently, many residents with end stage dementia frequently end up in the Emergency Department. This could be a result of staffing shortages within these facilities or other reasons, none the less the ‘casualty ward’ is clearly not the ideal place for end-of-life symptom management.

With an improved model for end of life care delivered in the residential aged care facility by professional care staff and GPs, the number of dementia patients presenting at emergency could be reduced significantly and residents can spend their final days in their own home.

For these reasons, the experience of professional care staff and GPs will be pivotal to the program that is implemented and the collaboration between researchers and clinicians in the REACH Out In Dementia project. This focus on end stage dementia is what sets the project apart from others underway in the delivery of dementia care.

There has been plenty of enthusiasm from both RACFs and GPs in the local area to participate in the project and to embrace new models of care. This will include psychological education and workshops to improve their interpersonal and confidence skills when communicating with residents who have dementia and their families.

The project will take a collaborative approach involving REACH nurses working with RACF staff, visiting clinicians, and residents and families at 12 aged care facilities in the Illawarra and Shoalhaven over the next nine months. It will also trial the provision of a local guideline called the REACH Toolkit to empower them to care holistically within the facility.

Designed with a range of features and training resources to ensure acceptable and sustainable change within the participating aged care facilities, it is also critical that the program developed is transferable to other facilities in the region and across the country.

With so many people and their families living with dementia now and into the future, we hope this project will make a positive and significant impact on their lives. This will come through a more consistent and open approach to discussing and recording the person’s, and their family’s, desires for ongoing care as the person approaches the end of life.

Making a difference will require the experience and willingness of RACF staff and GPs to recognise the need for a new model, and to participate and support its implementation. Already, the collaboration has been fruitful.

Finally, the literature on geriatric care will be enhanced with the reporting of results from the project implementation and evaluation. We hope the REACH Out In Dementia project will impact and improve the care of our elderly across the nation for many years into the future.

*Dr Nancy Humpel is the Project Manager of the REACH Out In Dementia Project (Recognise End-of-life And Care Holistically in Dementia) based at the Illawarra Health and Medical Research Institute. Her PhD was in health behaviour change and she has extensive experience in the management of clinical trials and other cancer and health related projects. The REACH Out In Dementia Project is funded by a grant from the Commonwealth Department of Health and Ageing.

Everything I need to know about my health is on TV – but most of it is wrong

Professor Sandra Jones, Director of the Centre for Health Initiatives, UOW

The average Australian home has 2.6 people & 2.8 televisions. We watch TV for more than 2 hours a day, and between 7.00pm and 8.00pm, 44% of us are watching TV. We spend 16 hours each week on the Internet, 9 hours listening to the radio, 5 hours watching DVDs, 3 hours reading the newspaper and 2 hours reading magazines. There is now so much media in our lives that we often use them at the same time, with almost two-thirds of Australians watching TV while they use the Internet.

Much of what we know – or think we know – about our health comes from watching television, reading newspapers and magazines, and surfing the Internet. However, decades of research into health information in entertainment programs, news coverage, and advertising shows that most of this information is confusing, misleading or just plain wrong.

If you talk to many people about autism they will tell you that it is caused by vaccination. This is not correct. There have been lots of well-designed and carefully controlled studies that have proven for certain that the MMR vaccine does not cause autism. So, why do so many people believe that vaccination ‘makes children autistic’? Most of them saw it on TV or read it in a book.

Those scientific studies were published in leading academic journals, so they were probably read by a few thousand academics. When television stations around the world broadcast an episode of Eli Stone in which the fictional lawyer represented a mother suing a pharmaceutical company for ‘causing’ her child’s autism more than 5 million Americans and more than 1 million Australians were watching. When Jodi Picoult wrote in ‘House Rules’ that vaccination caused the young Jacob to develop autism almost overnight, millions of people around the world were reading (and even more will watch if they make it into a movie). In America, an actress named Jenny McCarthy is attracting a huge amount of media coverage, even appearing on the Oprah show. Ms McCarthy is not a doctor or a scientist – she is Jim Carrey’s girlfriend – but when she claims that vaccination causes autism, millions of women around the world will be convinced not to vaccinate their children.

So why does this matter? It matters because high rates of vaccination had virtually eliminated diseases like mumps, measles and whooping cough in countries like Australia. Each time stories like this appear in the media, parents stop getting their children vaccinated. Some of these children will develop preventable diseases and become extremely ill. Others will spread the infection to babies who are too young to be immunized and some of these babies will die.

Cancer is another popular topic for news and entertainment media. Women’s magazines frequently provide in-depth coverage of celebrities’ battles with cancer. Soap operas kill off characters by having them develop fatal cancers, or show their strength by having them survive cancer (often so they can be struck down with another fatal disease in the next season). Newspapers and magazines tell us every month of another ‘cause’ of cancer, and at the same time report another ‘scientific breakthrough’ that will eliminate cancer.

Unfortunately, much of what the media tells us about cancer is misleading or just plain wrong. The biggest risk factor for breast cancer is increasing age – the older you are the greater the risk – but readers of women’s magazines are regularly presented with stories of very young women with breast cancer and, as a result, many women believe that risk is highest when they are young.

Why does the media get it wrong? Sometimes its because journalists, editors or authors sensationalise stories to get our attention. Sometimes its because scientists and researchers provide the media with confusing or misleading information. Sometimes its because there is conflicting evidence, with ‘experts’ arguing for different points of view.

 So what can we do to sort the good information from the misinformation? Professor Jones will be speaking at the Uni in Brewery on 25^th August from 5:30 at the Five Islands Brewery. In her presentation she will discuss some of the misinformation in the media, reasons why the media gets it wrong, and how we can more critically interpret the information we receive. For more information visit http://www.uow.edu.au/research/unibrewery/UOW075583.html

PhD student Kate Williams – Values as predictors of well-being in emerging adulthood

PhD student Kate Williams

Values are stable, general beliefs about what is desirable; goals are the specific objectives towards which our values guide us. Asking people to clarify and act upon their values can improve outcomes in public health, education and clinical psychology.  But are all values equally beneficial?  One view is that success at any personally important goal will improve well-being.  Others argue that it doesn’t matter what one aims for, as long as one does it for the ‘right’ reasons.