Category: Articles

Categories
Original Research Articles

Australian medical students’ desire to become a general practitioner: has it changed between 2009 and 2019?

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.

Download (PDF, 300KB)

Categories
Case Reports

A case of abdominal pain with a diagnosis of epiploic appendagitis

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.

Download (PDF, 124KB)

Download (PDF, 109KB)

Download (PDF, 55KB)

Download (PDF, 56KB)

Download (PDF, 11KB)

Download (PDF, 10KB)

Categories
Letters

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”

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.

Download (PDF, 201KB)

Categories
Feature Articles

Electives closer to home: pre-hospital and retrieval medicine at MedSTAR, South Australia

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.

Download (PDF, 119KB)

Download (PDF, 560KB)

Categories
Case Reports

Post-Operative Wound Infection in the Context of Immunosuppression.

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.

Download (PDF, 183KB)

Download (PDF, 9KB)

Download (PDF, 142KB)

Download (PDF, 173KB)

Categories
Case Reports

Metastatic Cutaneous Prostate Cancer – A case report of a rare presentation

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.

Download (PDF, 125KB)

Download (PDF, 95KB)

Categories
Feature Articles COVID

Social distancing and domestic violence: an exploration of the paradoxical impact of our public health response to COVID-19

Public health responses and policies implemented during the COVID-19 pandemic have had a substantial impact on the incidence of domestic violence globally. Whilst regulations are in place to protect lives and livelihoods, an evaluation of these reveal the paradoxes embedded within such actions and the effects on vulnerable individuals. A consideration into the catalysts which prompt such a rise in rates of interpersonal abuse due to increased psychosocial pressures are discussed. Furthermore, strategies which could be implemented on a legislative and social level to counter these issues are deliberated.

Download (PDF, 168KB)

Categories
Editorials

Editor’s Welcome

Dr Mabel Leow MD, PhD | Editor-in-Chief, AMSJ

Welcome to Volume 10, Issue 2 of the Australian Medical Student Journal.
This has been and unprecedented year with Covid-19.

In this issue, we have included a Covid-19 section for medical students to share their thoughts on issues associated with the pandemic. This is in addition to our usual wide range of medical and surgical topics. Of mention are two papers which will be relevant to all medical students. One is a case-based discussion on oxygen delivery, as it is commonly prescribed therapy. The second is a research study on microbial contamination in medical students, a problem which all of us face with in our everyday work.

Over the last 12 months, the AMSJ has taken steps to raise the standards of our editorial team to ensure that we publish quality studies. We have started an Understudy team to provide a platform to train pre-clinical medical students with minimal research experience, but aspire to be editors. As part of being a student journal, it is our mission to train medical students. Hence, if you have an interest in being an editor but lack the experience, please do join our team!

Last but not least, I would like to express my gratitude to various parties who have made this issue possible. First, the editorial team is grateful to the authors who have chosen to publish their work to AMSJ. We are privileged to be part of your research journey, in which you have put in many hours and months of hard work. At a personal level, I am thankful to my entire editorial and proofreading team who have been the backstage workers making this issue possible. To acknowledge their work this year,
we have included the names of the editors and proofreaders who have been working on the manuscripts.

Moving forward, we want to increase the visibility of AMSJ. This would take in the form of advertising our manuscripts on Facebook and Twitter. We would greatly appreciate if authors and readers could also share your articles with your friends and colleagues.

Correspondence: mabelleowqihe@yahoo.com

Categories
Uncategorized Book Reviews

Book review – Are you passionate about paediatrics?

Over the last half century, the practice of primary care for children has evolved tremendously. Although paediatrics is a relatively young field compared to other specialties, like a child, it has grown to become an integral part of the heath system. The previous international award-winning third edition, Paediatrics and Child Health [1]is succeeded by the latest edition Essential Paediatrics and Child Health [2], which includes twenty-six chapters that are covered in a 520-page textbook. This beautifully presented book combines Prof. Mary Rudolf’s four decades of experience as a consultant paediatrician and Professor of Child Health at Leeds University with that of Prof. Anthony Luder and Dr. Kerry Jeavons who both are experts in the field of paediatric medicine.

Download (PDF, 416KB)

Categories
Feature Articles

Continuity of care; a final year medical students professional and personal experience in rural Australia whilst on a longitudinal placement in Broken Hill, New South Wales.

Abstract: A final year medical students professional and personal experience of a longitudinal rural placement in Broken Hill, New South Wales, Australia. The placement was 18 months in duration and highlighted some of the hardships of working and living in a rural area. The particular area of note was the accessibility to services and the continuity of healthcare in this isolated location. Continuity is a difficult concept to teach and one that hopefully all medical students will be able to appreciate through rural and remote placements.

Download (PDF, 139KB)