Series: In Press
The patient is a 36-year-old G2P2 female with a complex gynaecological history, including a previous diagnosis of Asherman’s syndrome. She presented to an outpatient clinic with complaints of increasing pelvic pain, intermenstrual bleeding and subfertility. The patient detailed a 12-month history of increasing pelvic pain. She also reported intermenstrual bleeding, lasting up to one week. The patient reported that her menstrual flow had significantly decreased over the last 12 months. The patient and her husband had a strong desire to have a third child and the ongoing implications of Asherman’s syndrome could be seen to have a significant emotional impact on the couple.
Abstract
Background
There is major concern given the reduction in junior doctors applying for general practice training positions, which has considerably dropped in recent years. It is possible that medical student perceptions of a career in general practice influence the later decision to choose general practice as their first-choice specialty and apply for general practice training positions.
Aim
To examine the changes in Australian medical student perceptions of a career in general practice by a cross-sectional analysis of student cohorts in 2009 and 2019.
Methods
Two identical cross-sectional studies were administered in 2009 and 2019 via an online quantitative survey to understand medical student perceptions of a career in general practice.
Results
Almost 6% of all Australian medical students responded to the survey (1129 in 2019 and 1227 in 2009). Medical students’ positive perceptions of a career in general practice increased by 6.5% from 2009 to 2019 (p<0.0001). Over the same period, the proportion of respondents who agreed that general practice provides the opportunity to pursue diverse special interests increased by 12% (p<0.001), while there was a 9.8% increase in respondents who agreed that general practitioners have a healthy work-life balance (p<0.001). One in five respondents reported not knowing or feeling neutral towards the ability for general practitioners to earn a sufficient income. General practice was perceived to be as challenging as other specialties in both surveys.
Conclusion
Medical students’ positive perceptions of holistic patient-centred care, ability to pursue special interests, and work-life balance are important in ensuring a sustainable primary care workforce. Further education regarding the ability of general practitioners to receive appropriate remuneration is crucial to encouraging medical students to pursue a career in general practice. Given the consistently high levels of interest from medical students, future interventions should shift to focus on promoting general practice to junior doctors.
Abstract
Introduction
In Australia, the coronavirus disease of 2019 (COVID-19) pandemic led to the formation of a new and unique role within the medical system, known as the Assistant in Medicine. The Assistant in Medicine program involved a group of selected final-year medical students joining the workforce as a government initiative to expand and reallocate hospital resources.
Summary
This reflection explores the unique opportunities in professional development as an Assistant in Medicine. Similar pre-internship models seen in New Zealand reported higher levels of competence and preparedness for internship compared to other final-year medical student placement models (92% in New Zealand, compared to 58% and 64% in the UK and Australia, respectively). These positive outcomes lead to an interesting question: could the Assistant in Medicine placement or a modified version be integrated into Australia’s final-year medical student curriculum?
This is a response to the new draft document created by the Medical Deans Australia and New Zealand titled “Inclusive Medical Education: Guidance on medical program applicants and students with a disability” urging strategic action to be taken.
Introduction: Surgical site infections remain one of the most common complications associated with surgery in Australia and the world. Many factors contribute to infection risk, however, immunosuppressive and immunomodulatory drugs such as DMARDs, biological DMARDs and glucocorticoids pose a unique risk.
Case Overview: A 70-year-old female developed a surgical site infection post-repair of a ruptured achilles tendon. She had a background of psoriatic arthritis treated with immunosuppressive agents which were not ceased prior to the surgical treatment.
Discussion Overview: The current literature suggests that biologic DMARDs and glucocorticoids increase the risk of surgical site infections in patients undergoing a procedure. It is therefore imperative to emphasize the importance of careful medication histories and recognition of medication side effects with a risk versus benefit balance.
Abstract
Introduction: Prostate cancer is a leading cause of cancer morbidity and mortality in Australian men. Though prostate cancer is common, rarely does it present with cutaneous manifestations. Metastatic cutaneous prostate cancer represents less than 1% of all cutaneous metastatic disease and occurs in 0.06% to 0.3% of prostate cancer cases. This case report explores the rare presentation of cutaneous metastatic prostate cancer.
Case overview: An 83-year-old male with a history of metastatic castration-resistant prostate cancer presented with nodular chest lesions. The patient had been diagnosed with prostatic adenocarcinoma eight years earlier, and had received a radical prostatectomy, adjuvant radiotherapy, palliative chemotherapy, and androgen deprivation therapy. He was receiving palliative treatment at the time of presentation. The patient reported an eight-week history of firm, fast-growing flesh-coloured nodules over his right pectoral region which were otherwise asymptomatic. A prostate specific membrane antigen positron emission tomography scan demonstrated avidity within cutaneous lesions and was highly suspicious for cutaneous metastatic castration-resistant prostate cancer. The patient declined targeted radionuclide therapy and was managed with palliative superficial radiotherapy. The patient passed away six weeks after diagnosis of cutaneous metastases.
Discussion overview: Metastatic cutaneous lesions can result in diagnostic dilemmas for clinicians due to the rarity of presentations. Most cases will present with a known history of metastatic disease, however, a small number of cutaneous metastases may be the first indication of a clinically silent prostate cancer. Cutaneous metastasis is associated with a poor prognosis as there is often systemic disease present. Treating clinicians, including radiation oncologists, medical oncologists, dermatologists, urologists, and general practitioners, should consider the diagnosis of cutaneous metastasis in the case of skin lesions in prostate cancer patients.
Introduction
The COVID-19 pandemic radically changed the nature of elective placements undertaken over the summer of 2020/2021. With an international travel ban in place, students were forced to cancel overseas placements and look closer to home to find opportunities. This resulted in the discovery of world-class elective experiences within Australia that may have otherwise been overlooked by the allure of international travel. This was the case with the placement I undertook at the Medical State-wide Trauma/Transport Advice and Retrievals (MedSTAR) service in South Australia.
Summary
MedSTAR is unique amongst pre-hospital and retrieval units, given the breadth of opportunities available to medical students. Participants have full access to both adult and paediatric cases across all three forms of transport: road, helicopter, and fixed-wing aircraft. The high-acuity nature of the patient population seen by MedSTAR guarantees access to numerous interesting, complex, and unusual cases that are typically not seen by medical students, providing fantastic educational experiences. This article will introduce the subspecialty of pre-hospital and retrieval medicine, detail the work undertaken by MedSTAR in delivering care to critically ill patients across South Australia, and provide an account of the student experience undertaking an elective placement in such a unique environment.
Abstract
Introduction: Abdominal pain is a common presentation in general practice and a systematic approach is required to exclude serious pathology and achieve an accurate diagnosis.
Case overview: We present a case of a 76-year-old male who complained of left lower quadrant abdominal pain to illustrate a systematic approach to managing diagnostic uncertainty. The patient was subsequently diagnosed with epiploic appendagitis (EA).
Discussion overview: Epiploic appendagitis can mimic other acute abdominal conditions including diverticulitis, omental infarction, and appendicitis. The recognition and early diagnosis of epiploic appendagitis helps to avoid unnecessary investigations and treatment.
Learning points
- Abdominal pain is a common presentation in general practice and a systematic approach is important to exclude serious pathology and achieve an accurate diagnosis.
- Murtagh’s diagnostic framework and safety netting are effective strategies in managing diagnostic uncertainties.
- Epiploic appendagitis is a benign condition and an early diagnosis can prevent unnecessary investigations and treatment.
A reflection of my experiences of the physical examination This is an excerpt from an essay that won the 2020 UWA Quality and Safety Essay prize.
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