ISSUE 03 AUGUST 2021 MDOK MATTERS Celebrating Concord Clinicians In This Issue Feature articles Project StepOne Meet the DPETs! Reflections of an AT MDOK update Welcome New MDOK Team Members JMO Audit Presentation Night StepUp4Cancer Challenge August is Nature Month Shoutout of the Week Resilience: Trees in Conjola Park 8 months after catastrophic fires, 2020, Dr Meng Ngu The above image beautifully captures an example of resilience in nature, with emergent new growth within months of devastation. The picture captures not only resilience, but also hope, with each Regular Features RMOA Message Getting to know you Caption Contest new cycle of nature welcoming growth and new opportunities. Welcome to August, where we celebrate nature as integral to our wellbeing. Despite cancellation of National Tree Day planting events, we encourage everyone to find ways to connect with nature this month - spending time outside, gardening, and taking time to enjoy the beauty nature provides. Please enjoy this month's newsletter, with a feature article highlighting international Covid volunteer work undertaken by one of our Cardiologists, a review of the successful JMO audit presentation evening, profiles of 2 stepup4cancer teams, and an introduction to first-in-line JMO support staff. Finally, frontline Email for future articles SLHD-MDOK@health.nsw.gov.au Covid workers are recognised in the regular caption contest. Congratulations Sean Riminton (I know, my friends keep winning, I swear it's a panel decision), winner of the June competition. Warm regards to all, Sandhya MDOK MATTERS | ISSUE 3 Meet the DPETs! Dr Probal Roy has shared the duties of Director of Prevocational Education and Training at Concord Hospital with Dr Robert Russo (Director of Medical Education) for close to 10 years. Dr Roy is a staff Cardiologist at the hospital and is also a college supervisor to advanced trainees . The DPET is an advocate for JMO welfare and career progression. Dr Roy's focus has been the provision of pastoral care to junior doctors in difficulty. He works closely with the team at MADU on junior doctor welfare. Other aspects of the role include performance review, general registration approval, allocation of DPET funds, conducting of exit interviews and vocational training guidance . Dr Roy is part of the General Clinical Training Committee that oversees all structures in the hospital that support junior doctors. Dr Roy was an intern and resident at Concord rotating thorough Canterbury and Broken Hill Hospitals in the late nineties, and thus brings personal experience to the role. Dr Roy, Dr Russo and the MADU team are always ready to listen to concerns from the junior medical staff. Dr Roy can be contacted directly through the hospital switchboard or via the team at MADU. 2 MDOK MATTERS | ISSUE 3 Meet the DPETs! Dr Robert Russo is the Director of Medical Education, which is a role that supports the Director of Prevocational Education and Training, by developing and implementing an education program for our Doctor in Training workforce. In addition, the role supports our Term Supervisors, including their educational needs in undertaking their role. Dr Russo is also employed in the district as Director of Nuclear Medicine and works privately as a Rheumatologist. He has been involved in prevocational education and training for many years, including being a member on various committees at HETI, extending back to his own prevocational training years. He is currently the Chair of the Network Training committee, where he looks forward every year to his site visit to Broken Hill. Robert otherwise enjoys sport, where sadly these days involves him only having time to play squash on a Saturday morning and prior to COVID, going to the wonderful Concord Hospital gym, where he would always enjoy mentoring the many JMOs he would see there on how to do a proper bench press. He is always welcoming to support our JMOs and is willing to chat with you whenever needed. His number is 0401 032 604. Letter to Term Supervisors Thank you for fulfilling your role as term supervisor, which is an important one for the hospital, junior doctors and patient care. In these challenging times your role in JMO supervision and welfare is even greater. There has been a gap in term supervisor training and support at the hospital. We are reaching out to all term supervisors to provide guidance, support and helpful resources. Some key points that will be of assistance are as follows: Term Orientation: New JMOs to the team need an in-person orientation to the term. This can be carried out by either the term supervisor/senior clinician or fellow/advanced trainee. JMOs are expected to be familiar with the workings of the term prior to commencement by reading the term descriptions/ROVER documents, and by seeking verbal handover from the outgoing JMO team. Term supervisors should periodically review the above documents and update as required. Education and Supervision: The level of supervision provided throughout the term should be reviewed to ensure JMOs at all times have ready access to a more senior medical staff member for guidance. 3 MDOK MATTERS | ISSUE 3 Letter to Term Supervisors JMO Education sessions are conducted from 12.30 -1.30pm on Tuesdays and 3.30pm 4pm on Wednesday's on site at Concord. We strongly encourage all term supervisors to ensure their JMOs attend these sessions. For our surgical colleagues, this may require your engagement with the Pre-Admission clinic to ensure there is no barrier to attendance at education. Exit interviews of last year’s intern cohort revealed poor attendance , with workload cited as the most frequent barrier. Needless to say, a great amount of effort is invested by MADU staff and senior clinicians to ensure such sessions occur, which are a HETI requirement for hospital accreditation. Term Assessments and Feedback: Term assessments need to completed in a timely fashion (week 5 and 10). This facilitates identification of issues to address so that there is sufficient time for rectification. Feedback is sought from JMOs regarding their experience in each of the JMO accredited terms at Concord on a rotational basis during the termly GCTC meetings. This feedback is summarised and sent to term supervisors. JMOs in Difficulty: There is a well-established pathway to handle JMOs in difficulty at Concord. The term supervisor may be able to resolve the issue “in-house” without escalation. In the event this cannot be achieved, notification to Ms Carolyn Marsh in MADU is the next step. The matter will then be forwarded to the DPET, Dr Probal Roy, and in most cases resolution can be achieved at this level. For matters requiring greater input, further assessments are made by the Assessment Review Committee. Access to mental health support via St John of God, Burwood is also available to Concord JMOs and they also benefit from engaging with the Employee Assistance Program (EAP) and MDOK. Unrostered Overtime: JMOs are in general encouraged to claim unrostered overtime hours within reason. This also allows MADU and hospital executive to monitor which terms may need greater support going forward. Strategies to minimise unrostered overtime hours for JMOs are beneficial to JMO welfare. JMOs at orientation are given reassurance that there is plenty of support at Concord for their learning, career progression and general welfare. Equally, the team at MADU and those clinicians involved in JMO training and welfare will be more than happy to provide any assistance to you as term supervisors to fulfil your important role. Please feel free to contact either of us via hospital switch with any queries. Please refer to the following resource to provide further guidance: https://www.heti.nsw.gov.au/education-and-training/courses-and-programs/prevocationaleducation/supervisors-and-hospital-staff-resources Best wishes, Dr Probal Roy, Director of Prevocational Education and Training, Staff Cardiologist Dr Robert Russo, Director of Medical Education, Head of Department of Nuclear Medicine 4 MDOK MATTERS | ISSUE 3 Meet the MADU Manager! Carolyn Marsh is the Manager of the Medical Allocations and Development Unit (MADU) and has worked in the health industry in public, private and not for profit for over 37 years. Prior to joining Concord Hospital in 2020, Carolyn was the Medical Workforce Manager for St Vincent’s Hospital for the past 10 years which included St Joseph’s Hospital Auburn as well as Parklea Correctional Health. Carolyn brings a wealth of experience to JMO Management and human resources and health management in general which is where her tertiary qualifications lie. She works closely with both DPETs to ensure that JMOs are educated and trained to the highest standards and to ensure that the prevocational experience sets JMOs on the career path of their choice. The MADU looks after rostering, pays, term allocations and leave and relief management as well as Accreditation for not only prevocational trainees but for specialty services as well. As manager of MADU, Carolyn and her team work closely with the Director and Deputy Director of Medical Services to plan and manage staffing for both junior and senior doctors as well as liaison with Heads of Departments. Carolyn has experience in working with doctors in difficulty and works closely with Dr Roy to help guide and nuture these JMOs and has very much an open door policy. Nothing pleases her more than seeing her interns become consultants in the career of their choosing. Outside of work, Carolyn runs a netball club of over 500 players and coaches and mentors up-and-coming umpires. The MADU team can be contacted on 9767 7097. 5 MDOK MATTERS | ISSUE 3 JMO Audit Presentation Evening The first annual Network 3 JMO Audit Presentation Night, presented by The Concord Quality and Risk Committee, was held on Thursday, July 15. What was originally planned as an evening soiree showcasing quality audit work at Concord, Canterbury and Broken Hill Hospitals, was pivoted to a lively zoom evening due to current restrictions. Spirits were not dampened, and 10 fabulous audits were presented! Our expert panel of A/Prof Nicole Phillips, Prof Lewis Chan, and Dr Robert Russo guided discussions and intriguing questions between each presentation. It was fantastic to see the clinical governance work being undertaken, and inspired talks of further avenues to be explored. A very big congratulations to all those who presented, and further congratulations to the presentations selected as ‘highly commended’ by the expert panel. Presenters and topics were as follows: Dominique Denniss: Management of infants of mothers with thyroid disease: an audit Sarika Suresh and Gabriella Charlton: Audit of rational ordering of pathology tests Jonathan Kuo: Reducing length of stay in concord hospital coronary care unit - an audit on the duration of cardiac monitoring post STEMI Joel Winny: Antimicrobial prophylaxis in patients with haematological malignancies Gabriella Charlton: Preoperative investigations audit Jessie Zhang: Urology OPD in a Covid19 setting Angela Au and Sarika Suresh: Advanced care planning and advanced care plans in deceased patients at a tertiary hospital Ashley Creighton: MDOK Nutrition and Hydration audit Shubash Quazi: Concord and Canterbury hospital VTE risk assessment and prophylaxis audit Nicholas Presgrave: A retrospective review of patients presenting to Canterbury Hospital with minimal trauma hip fracture Highly commended - Dominique Denniss, Gabriella Charlton, and Angela Au with Sarika Suresh (joint presentation) A very big thank you to Sandhya and the MDOK team who kindly sponsored the awards for all our presenters on the night. We look forward to the next event, and can’t wait to see the next round of projects! Dr Gabriella Charlton Anaesthetics SRMO 6 MDOK MATTERS | ISSUE 3 Shoutout of the Week! Show your appreciation with a Shoutout of the Week! Thank you JMOs! Add a little bit of body text Our JMOs are working harder than ever and morale can sometimes be low. Yet in the midst of the challenges, there are always those who go above and beyond, work hard for their patients or simply make a gesture to help out a colleague in need. The shoutout of the week initiative aims to acknowledge and applaud JMOs for the big and little things they do in the course of their working week. Shoutouts can come from all hospital staff and will be published in the weekly JMO bulletin. Shoutout a JMO who has covered a shift for you, brought you a coffee or snack when you're run down, or (for senior staff), who has worked hard for your team and your patients. SHOW and remind our JMOs how much we value their input. Please send your shoutout to the MDOK Team at: SLHD-MDOK@health.nsw.gov.au 7 MDOK MATTERS | ISSUE 3 Welcome (new) MDOK Team! Josh Elliott Josh has recently joined the MDOK team to provide support in the role of Director of Physical Wellbeing. After close to 10 years working with the Sydney Swans AFL team as Athletes Support Services Manager, Josh has decided to pass on his skills and knowledge to healthcare workers. He has a keen desire to help workers achieve optimal wellness through self care techniques such as mobility and self-massage. Josh's interests include golf, running and cooking. Lisa McCrohon Lisa has joined the team as the MDOK Program Manager at Canterbury Hospital . She comes to us with 17 years experience working in Medical Administration and JMO Management for NSW Health. She has a strong passion for the wellbeing of medical staff and is so excited to be part of the MDOK initiative and in particular the delivery of health and wellness support for all doctors. Her interests include netball, painting, reading and music Moneisha McKenzie Moneisha has been with the program since its inception in 2017 and understands the challenges and constraints physicians face trying to incorporate healthy lifestyle behaviours into daily lives. She combines her passion for health and fitness with her 15+ years professional experience in the private sector to pursue both organisational and individual interventions that promote healthy lifestyle behaviours and self-care rituals. “In the face of ever increasing pressure and fatigue, it has never been more important to provide doctors (and all healthcare workers) with opportunities to safeguard their energy and find that which energises, restores and nourishes them as a person.” 8 Moneisha returns part-time and will be supported by Josh Elliot over the next couple of months. MDOK MATTERS | ISSUE 3 Staying Connected in Isolation Increasingly, staff across the district hospitals may require a period of isolation or quarantine due to exposures at work or elsewhere in the community. MDOK is keen to support staff in isolation, with the provision of exercise options and online social activities. Beginning Monday 16th August, you can stay connected with others via a virtual morning tea at the below link. Share isolation routines, chat with others about their experiences and enjoy the opportunity to meet new people in your hospital. Concord and Canterbury staff in isolation can connect for a virtual catch-up from 11am - 12pm on weekdays on the below link. Stay tuned for other activities scheduled on the same link throughout the day. If you know of any staff in quarantine or isolation, please send them the details. Thinking of you all in these challenging times. 9 MDOK MATTERS | ISSUE 3 Project StepOne Project StepOne is a telehealth platform that started as a small WhatsApp group and has since grown into a service with 7,000+ doctors and 10,000+ non-medical volunteers. This is primarily a COVID triage helpline, active in 24 States and Territories in India run in conjunction with the respective State Governments. I joined as a medical volunteer in May 2020. When a doctor picks up a virtual patient, they check medical history, symptoms, and vital parameters. We then assess the clinical severity and initiate actions according to whether the patient has mild, moderate or severe illness. If medical review is required, a Medical Officer on the ground is notified who then visits the patient for assessment. In the second and more severe surge that occurred from mid-March 2021, it fell upon the virtual doctors to help patients buy time until beds and oxygen could be found. As an example: I looked after a 58 year old diabetic patient with worsening respiratory compromise and progressive hypoxia 5 days after diagnosis with COVID-19. While the Emergency Response Team searched for a hospital bed, my job was to teach a family member to wear appropriate double masks/gloves, give the patient steam inhalation, use nebulised steroids, and position the patient prone or in a lateral position. I calmed the patient as much as possible and advised him to practice deep breathing until help arrived. In this case the story ended well as he was admitted and survived. Unfortunately, not all cases have a positive outcome. As a physician, I also assist patients and their families with complex issues including medications and mental health problems. Many are unable to access their “usual” doctors due to lockdowns, illness of the doctors, and sheer numbers of COVID patients in the hospitals. Whilst a number of individuals have been impacted, I am proud that Indian society has come together to help each other. On one occasion, I called a local volunteer about an elderly Covid+ man living alone. All nearby shops were closed, he was illiterate and could not order food online. Within 2 hours, young volunteers had ordered food, arranged a hot meal and extra supplies to help him manage over the next few days. This was heartwarming to hear. The main challenge for me is the time difference between India and Sydney. I start making calls after I get home, have walked my dog, and then settle down until about 2 or 3am most days of the week. There are some days that I don’t take as many calls due to work commitments here. I have completed 2000+ calls and counting. I speak 3 of the Indian languages fluently; hence have stuck with those 3 states only. The next big job is also to help get everyone motivated to get vaccinated. Dr Suchitra Chandar Cardiologist 10 MDOK MATTERS | ISSUE 3 RMOA Update The RMOA would like to extend a welcome to all our new and returning registrars and residents starting the second half of this year - although things are restricted with COVID at the moment, we're glad that you're here, and look forward to seeing you around at lunch! If you're a new or returning registrar, the RMOA is currently looking for another SRMO or registrar rep to join us. Email concordrmoa@gmail.com with an EOI and a short paragraph about yourself if you are interested! Just a reminder to the interns that you should all be assigned a 'rescue resident' that you can reach out to if you're having trouble on the ward, or need a hand - like, "what's the right dose of this medication!" or "how do I get neuropsych for a patient (what even IS neuropsych?)" or even a tricky cannula. They're here to help for any questions or for any support on the ward and are more than happy for you to reach out via text or phone call if you need. If you haven't been assigned a rescue resident, please let us know and we can make sure you're linked up with someone. Dr Elaine Cheng President | Concord RMOA Welcome Matthew Welcome Matthew BraileyBrailey In our last newsletter, we farewelled Chris Patchett, EAP Manager across SLHD. We take this opportunity to welcome Matthew Brailey and other new member of EAP, Caleb Winch. EAP offer free and confidential counselling services to all SLHD staff and their families. Contact EAP during office hours (8am - 4:30pm) on 9767 6726 or after hours via the hospital switch 9767 5000 and ask for the "EAP Counsellor On Call". slhd-intranet.sswahs.nsw.gov.au/slhd/eap 11 MDOK MATTERS | ISSUE 3 Reflections of... an AT We are in strange times at the moment and it's all too easy to get bogged down in the 11am public health announcements, drowning in hand sanitiser, and making sure that your LGA hasn’t been added to the 72hour swab list between when you went to bed yesterday and when you rolled out this morning. I am currently in iso, video calling my wife who is in our guest room with the door shut while I inhabit the upstairs bedroom and bathroom zone. It seems a miracle that I even have a wife, after we moved our wedding from last year to this year and just squeezed in our rescheduled second effort and re-arranged honeymoon before Delta shut everything down again. Several friends and family were less fortunate with their wedding timings, and I can’t imagine the wild festivities that will come out of 2023 when we can all finally expend our pent up social energy! Nevertheless, while the lockdowns and frequent sense of uncertainty have made things frustrating and anxiety-provoking for us all, it has provided an opportunity to reflect on how we manage wellbeing in the hospital system. While I have only been back at Concord for 6 months this year since my last stint as an SRMO in 2016, I have enjoyed so much about it. 12 MDOK MATTERS | ISSUE 3 Reflections of... an AT My department has been extremely supportive around the chaos of weddingplanning, rostering, and claiming of unrostered overtime. A notable source of low morale in JMOs has been in the overtime claims process, and I encourage all JMOs to request written approval for claims from your heads of department on those days when the clinical load keeps you on the ward and away from your happy spot on the couch at home. We have all seen your hard work and don’t want it going unrecognised, so please make sure you do this! There is such a strong sense of community amongst the Concord JMOs that is always great to be a part of, and hopefully the tail end of the year will allow some of the usual catch ups over food and beverage both inside and outside the hospital grounds. Back in the time of social activities, I was absolutely ecstatic about the JMO vs Consultants cricket match earlier this year. Perhaps there was less ecstasy in the Consultants’ camp as they left with a defeat. Regardless, what a fantastic day it was, out in the sunshine with a cricket ball in one hand and a Subway sandwich in the other while the banter flowed. Certainly, the doggies’ day out and the orienteering outing provide great promise for many other fantastic MDOK events ahead. It is encouraging to see how the spotlight is swivelling onto the JMO experience and the momentum shifting towards asking ourselves how our system can support us in keeping us fulfilled, motivated, and content. Having listened to the recent Grand Rounds presentation and being a part of our Zoom discussions around this topic, it is heartening to be a part of a group who realises the enormous importance of wellbeing and in being proactive about addressing it. I hope you’re all staying active, staying connected however you can, and finally recognising the top half of each other’s faces. Let’s all look forward a little normality over the next few months, and until then, nothing quite says wellbeing like sitting on the couch with your feet up in front of the Olympics – so get to it! Dr Manik Mayadunne 13 MDOK MATTERS | ISSUE 3 Step Up! 4 Cancer Survivorship The Med Oncs Prunella Blinman, Janette vardy Increasing physical activity after a cancer diagnosis has been shown to improve symptoms, quality of life and psychological wellbeing, and decrease long term side effects of treatment. Increasing evidence suggests exercise can probably decrease the risk of a cancer recurrence. Motivation: Many cancer patients benefit greatly from seeing an exercise physiologist (EP) to get individualised exercise programmes to help them increase their physical activity levels and then join group classes in our Survivorship gym. Janette and Prunella are keen to be able to offer EP sessions to more of our cancer patients. Janette’s challenge is to take her puppy (Coco the Step Up Mascot) for a walk every day, aiming for 10+ kms a week, and riding 17+ kms a week on her e-bike. Might sound a bit tame but due to mobility issues it will be a challenge! Prunella’s aim is to run 20+ kms a week doing the Bay Run. 14 MDOK MATTERS | ISSUE 3 The Poo Walkers matt rickard, anil keshava, michael suen Our colorectal surgery team have Stepped Up for Cancer Survivors. Since registering, Team captain Matt Rickard has undergone ACL surgery – so wont be doing too much stepping but still helping out and dreaming of getting back to running as in the (pre-COVID) picture below! Michael Suen is aiming to run 10 kms a week and Anil Keshava’s challenge is to work on the Tour de France virtually!! Motivation: We particularly have noticed the improvement in our CRC patients participating in the PREHAB-GI study. Even just a 2-week exercise program prior to surgery seems to be beneficial – with more confidence in getting out of bed post op and keen to get back to exercising. Noticing improvement even in people who have previously not been exercisers. 15 MDOK MATTERS | ISSUE 3 Getting to know you... Vascular Surgery Bethany Stavert (Vascular Unaccredited and Research Registrar) My favourite aspect of work is... spending time with people who are doing what they are good at. Passion is infectious. In my spare time I enjoy… a glass of wine. I wish I could… have more hours in the day. My ideal holiday destination is.. sitting in front of the fire at my parent's house with family. I am inspired by… people who are fulfilling their potential. Something you don't know about me is… I once met the Queen Mother. I look after my wellbeing by… spending time with family. My tip for being well-balanced is… remembering who and what is important, not just what you hear as the loudest voice. I often wonder… why scrubs have to be light blue, it is very impractical and not a particularly nice colour. Cathie Cincotta (Vascular CNC) My favourite aspect of work is…. Team work in the 3N family. In my spare time…. shopping and Netflix. I wish I could….. travel sooner rather than later. My ideal holiday destination is..... anywhere but here, Canada. I am inspired by..... My 90 y/o grandmother, came to Australia with nothing and worked hard for everything. Something you don't know about me is..... I’m 1 of 57 cousins and second cousins. I look after my wellbeing by..... building miniature houses and puzzles to relax. My tip for being well-balanced is..... Family and friends. I often wonder...... where I will be in 20 years’ time. 16 MDOK MATTERS | ISSUE 3 Getting to know you... Vascular Surgery Hamid Hajian (Vascular SET Trainee) My favourite aspect of work is .. to save one leg at a time as part of a great team. In my spare time...I enjoy playing rapid chess online. I wish I could live in the ’70s! My ideal holiday destination is… Queenstown, NZ. I am inspired by....my wife coping with me and Irvin Yalom as a teacher. Something you don't know about me is...I easily get lost without google map, GPS etc! I look after my wellbeing by....doing or contemplating 30 push-ups a day and a ten min meditation. My tip for being well-balanced is .....to try to discover tiny joys and fun in daily chores. I often wonder..... if we could live without the internet like we did before. Maritta Serrano (Vascular CNC, Theatres) My favourite aspect of work is…. When I see the smiles on patients' faces. In my spare time…. I divulge in the world of inspiring novels. My ideal holiday destination is..... sightseeing the natural beauty of New Zealand. I am inspired by..... having the opportunity to pursue nursing and continue my education out of India from a family where women were predominantly forced to live in the boundaries of filial piety. Something you don't know about me is.....I used to take part in drama plays during my undergrad nursing school. I look after my wellbeing by..... watching comedy shows. My tip for being well-balanced is..... having a positive mindset, never give up as everything is possible when you put your mind to it. I often wonder...... what it’s like to win the lotto😁 17 MDOK MATTERS | ISSUE 3 Getting to know you... Vascular Surgery Dr Sarah Aitken, Vascular Surgeon My favourite aspect of work is…. the long-term caring relationships we have with our patients and colleagues. In my spare time…. dream about when we can travel again. I wish I could.... have a time machine! My ideal holiday destination is..... photographing puffins in the Scottish Outer Hebrides. I am inspired by..... Maya Angelou ‘No human being can be more human than another human being. I liberate you from my ignorance.’ Something you don't know about me is.....I’m the eldest daughter of the eldest daughter for six generations. I look after my wellbeing by..... spending time in my garden. My tip for being well-balanced is..... take time to process and reset each day, learn to celebrate small wins. I often wonder..... about the world my nieces will grow up in. 18 MDOK MATTERS | ISSUE 3 Concord Caption Contest! What is the collective noun for a group of anaesthetists? June finalists: A sudoku of anaesthetists Dr David Heath, BPT A slumber of anaesthetists Dr Rohan Merani, Ophthalmologist A snooze of anaesthetists Dr Ian Cox, Anaesthetist Winner: Illustrationof by Dr Elaine Ng, Rheumato A sleepover anaesthetists - A/Prof Sean Riminton Immunologist Illustration by Dr Elaine Ng, Rheumatology Advanced Trainee August Caption Contest s What is the collective noun for Covid frontline workers? Illustration by Dr Elaine Ng, Rheumatology Advanced Trainee 19 MDOK MATTERS | ISSUE 3 20 MDOK MATTERS | ISSUE 3