Medical student newsletter, Issue 5, September 2023

Contents

• Message from the Chair
• Graduating soon? Be ready to start work – register now
• Resources: helping you be the best doctor you can be
• The truth about mandatory reporting
• Informed consent and physical examination
• Cosmetic surgery reforms
• What do trainees think about medical training?
• Professional pitfalls
• Want to know more?

Message from the Chair

One of the important jobs of the Medical Board of Australia is to set the standards of entry to our profession. We set a high bar, to keep patients safe. As a medical student, you’re well on your way to joining our profession. If you’re about to graduate and start your intern training – welcome!

Dr Anne Tonkin AO Chair, Medical Board of Australia

Graduating soon? Be ready to start work – register now

If you’re set to complete medical school in the next three months, you can apply for registration now. We’ll start assessing your application while we wait for your medical school to confirm your course completion.

Before you can start your internship as a medical practitioner you need to be registered.

Easy steps to apply online

1. Create your account using the online services portal and complete your application.
2. Upload your documents and pay the required fees. Check that you have provided all required documentation to prove you’ve met the registration standards, including certified copies of your photo ID.
3. Wait for your medical school to confirm your course completion with Ahpra.

Need help applying?

Check out our graduate video to get your application right.

You’ll find helpful advice, tips for avoiding common causes of delay and downloadable information flyers on the Graduate applications page of the Ahpra website.

Get your photo ID certified correctly

It's important that you provide correctly certified photo ID documents with your application – the wording is very specific.

‘I certify that this is a true copy of the original and the photograph is a true likeness of the person presenting the document as sighted by me.’

To get it right the first time, download the Certifying documents guide and take it with you to the authorised officer. For the full list of authorised officers, see the guide.

In addition to JPs, registered health practitioners, teachers, lecturers, police officers and members of the legal profession can certify photographic ID documents.

Meeting the registration standards

You may need to provide supporting documents with your application to prove that you meet the Medical Board’s registration standards including meeting the English language skills requirements. Make sure you provide all the documents we need with your application so we can assess it quicker.

How long does it take to get registered?

We aim to finalise your application within two weeks of receiving confirmation of your course completion, provided you have submitted everything we need to prove you’ve met the requirements for registration.

Get your application right and submit it to us before you finish studying, so we can be ready to go when your course completion is confirmed.

Look out for an email from Ahpra inviting you to apply for registration.

Resources: helping you be the best doctor you can be

We want you to become the best doctor you can be. To help, we’ve drawn on our experience of patient complaints and created some resources to support your transition to a career in medicine. Our four-part education package on regulation and professionalism is designed to strengthen your understanding of what experience tells us you need to know.

You can access the resources online at no cost and they complement what you’re learning in medical school. The modules focus on professionalism and good communication in practice, because strong skills in these areas are at the heart of being a good doctor. Gaps in these areas also feature in most complaints to the Board.

The education modules also dispel myths and misconceptions about regulation, help you understand what regulation in medicine in Australia is all about and outline how it affects your professional life.

All modules are available on the Medical Board website and are:

• Module 1: Protecting the public – the purpose of medical regulation
• Module 2: Replacing fear with facts – understanding notifications
• Module 3: Listening – what matters to patients?
• Module 4: Navigating professional challenges.

The truth about mandatory reporting

There’s a lot of misinformation doing the rounds about mandatory reporting. The facts are clear: managing your health condition by seeking care and help when you need it, is the best way to avoid a mandatory report.

We are disturbed to hear that students are putting off seeking medical care, out of fear they will face a mandatory report to the Medical Board. Worse, we’ve heard some health practitioners are wrongly warning students that consulting a health practitioner risks a mandatory report.

The opposite is true. It is much riskier to avoid seeking care than to get care when you need it. Not treating a health condition increases your risk of impairment – which is the only reason a student would need to be reported to the Medical Board.

Under the Health Practitioner Regulation National Law (the National Law), health practitioners and education providers only need to notify us when they have a ‘reasonable belief’ that a student has an impairment that, when they are doing clinical training, may place the public at substantial risk of harm.

The threshold for reporting is very high. It is not reached by a student with anxiety, depression, diabetes, an eating disorder and most other health conditions. These conditions may impact on your academic studies, but they won’t put the public at risk.

More information is in the Guidelines: Mandatory notifications about registered students on the Medical Board’s website.

Informed consent and physical examination

You can’t overestimate the value of good communication with patients. Giving them information in a way they can understand and seeking their informed consent before you examine them, is a great way to prevent misunderstandings.

Many complaints to the Medical Board are the result of poor communication. Often, there is a gap between a doctor’s view of adequate communication and a patient’s expectations, especially when the examination or procedure involves physical contact.

A well-conducted physical examination, preceded by clear communication and informed patient consent, is fundamental to meeting patients’ expectations. In contrast, it can be distressing, alienating and harmful for patients to have a poorly conducted examination or procedure, without clear communication and prior consent. In rare cases, these interactions can be considered assault and have serious consequences, including police investigations and prosecutions.

Informed consent is individual. Each patient needs different amounts of information and time to consider what you’ve told them. It’s always best to use simple language to explain what is involved in the physical examination, and check that the patient has understood. What has worked in the past with one person may not be effective or appropriate for another.

Informed consent is a person’s voluntary decision about their medical care, made with knowledge and understanding of the benefits and risks involved.

Lessons and tips from our experience

Patients often complain to us about physical examinations that weren’t what they expected. They report feeling uncomfortable about the way a physical examination was done and sometimes believe it was sexually motivated. Most often, these concerns arise from skin checks, respiratory examinations and breast examinations.

Skin checks

Sometimes, skin checks involve doctors touching and/or examining intimate areas. Complaints are common when skin in an intimate area is being checked, but the doctor has not clearly told the patient beforehand what to expect or explained why the examination was needed.

Even experienced doctors who can work quickly and methodically may fail to inform the patient about what they are doing and why they are doing it.

Respiratory examinations

Complaints about respiratory examinations are often made by female patients who have not been clearly told why their doctor has asked them to remove their shirt and/or bra, to listen to their lungs.

Breast examinations

Patients can be very distressed after or during a breast examination, if they feel they were touched inappropriately or groped. If a patient hasn’t been told why an examination is needed, or if the examination is not done well, their distress can be more acute. Good clear communication about why an examination is needed and what it will involve prevent misunderstandings that can lead to complaints. Of course, all breast examinations must be clinically indicated.

Physical examinations

Physical examinations are an important part of many medical consultations and provide valuable information to inform diagnosis. All physical examinations must be clinically indicated and performed after obtaining the patient’s informed consent. When doctors touch and or examine a patient’s intimate areas without first clearly explaining what they need to do and why, patients (quite rightly) often make a complaint.

The Board’s Guidelines: Sexual boundaries in the doctor-patient relationship include the following guidance.

Before conducting a physical examination, good medical practice involves:

• explaining to the patient why the examination is necessary, what it involves and providing an opportunity for them to ask questions or to refuse the examination
• obtaining the patient’s informed consent
• obtaining the patient’s permission if medical students or anyone else is to be present during an examination or consultation
• assessing whether a patient who is a child or young person or who is impaired is capable of giving informed consent and if they are not capable, seeking consent from their substitute decision-maker
• allowing the patient to undress and dress in private. A doctor should not assist a patient to undress or dress unless the patient is having difficulty and asks for assistance
• allowing a patient to bring a support person who may be a parent, carer, guardian, spouse, family member or friend.

When conducting a physical examination, good medical practice involves:

• being aware of any verbal or non-verbal sign that the patient has withdrawn consent
• not continuing with an examination when consent is uncertain, has been refused or has been withdrawn
• providing suitable covering during an examination so that the patient is covered as much as possible, to maintain their dignity
• using gloves when examining genitals or conducting internal examinations

Note: Gloves may not be necessary when conducting external examinations of neonates, infants and young children. When conducting external examinations of these patients, doctors are expected to follow the accepted standards of practice described by accredited specialist medical colleges and expected by their peers. They must also follow accepted standards of hygiene and infection control.

• not allowing the patient to remain undressed for any longer than is needed for the examination.

There is also guidance in the Board’s Good medical practice: a code of conduct for doctors in Australia on effective communication (section 4.3) and informed consent (section 4.5).

Cosmetic surgery reforms

Australia’s cosmetic surgery industry has been under the spotlight after reports of serious patient safety concerns including allegations about hygiene breaches, poor patient care, unsatisfactory surgical outcomes, and aggressive and inappropriate advertising.

To get a clear view of the problems and how to address them, the Medical Board of Australia and Ahpra commissioned an Independent review of the regulation of medical practitioners who perform cosmetic surgery.

After receiving the review report, we’ve worked to implement the recommendations. We’ve rolled out reforms that aim to clean up the industry and improve patient safety. We’ve brought in higher standards and tougher advertising rules. There is a new endorsement for cosmetic surgery for doctors who have done accredited training, to help patients know which doctors have met high standards.

There are new safety measures to better protect patients considering or undergoing cosmetic surgery, which apply to doctors providing both cosmetic surgery and non-surgical cosmetic procedures.

Other industry reforms include an advertising crackdown, new advertising rules (including on using influencers), mandatory GP referral for cosmetic surgery and action from health ministers restricting the title ‘surgeon’ so it can only be used by doctors with specialist registration in surgery, obstetrics and gynaecology, or ophthalmology.

Other professions involved in the cosmetics industry are soon for the spotlight. Dentists and nurses involved in cosmetic procedures will soon be covered by new rules being drafted by other National Boards. Consultation is coming soon.

You can read more about cosmetic industry reforms and what they mean for doctors on our Cosmetic surgery hub.

What do trainees think about medical training?

The MTS takes the direct experience of doctors in training and converts it into reliable, publicly available data that is already being used to improve training.

The MTS is an annual, longitudinal survey that tracks doctors’ feedback about the quality of medical training in Australia. Stringent privacy controls make it safe and confidential for trainees to take part. The MTS is run by the Medical Board of Australia. All doctors in training in Australia are invited to take part.

When you’re an intern, look out for your invitation to do the MTS. The MTS is one of the important ways we ensure medical training in Australia keeps producing doctors who are among the best in the world.

Past MTS results are published online and you can tailor your own report with the online reporting tool on the MTS website. The 2023 results will be accessible as a static report in December 2023 and from February 2024, you’ll be able to create your own reports through the online data dashboard. You can access trainee feedback by training site, jurisdiction and specialty.

Professional pitfalls

Most doctors do a great job and provide great medical care to their patients. But sometimes, things don’t go well and in rare cases, the Board refers doctors to a tribunal because it is so worried about the risk to patients from the doctor’s practice.

Tribunals operate like courts and have significant powers, including to stop a doctor’s practice by cancelling their registration. The Board only refers very serious matters to a tribunal.

Tribunal hearings are public and decisions are published. You can read about professional pitfalls and how to avoid them by reading these tribunal decisions.

Court and tribunal summaries are accessible on the Ahpra website. You can also view recent hearing summaries on the Board’s website in the news section.

Want to know more?

For more information, see the Medical Board of Australia website and the Ahpra website.

Comments on the newsletter are welcome, send your feedback and suggestions to newsletters@ahpra.gov.au