May 2019

• Medical Board of Australia news
• Vaccination
  • Reminder to support public health campaigns
• Clinical advisors reflect
  • Case study: Where was that lesion again?
• Medical Training Survey
  • Progress on the 2019 Medical Training Survey
• Intern survey
  • Survey closing soon
• Competent Authority pathway
  • Revised wording for Category C (Canada)
• Consultation
  • Tell us what you think about our draft guidelines on complementary and unconventional medicine and emerging treatments
• Board vacancies
  • Do you want to be on the Queensland or Northern Territory medical board?
• Medical regulation at work
  • Latest tribunal decisions published
• Contacting the Board

Medical Board of Australia news

Reminder to support public health campaigns

Don’t forget your responsibility to support public health programs, including vaccination. We know the vast majority of doctors actively support their patients to understand the evidence-based information on vaccination available. However, mounting concerns about a five-year high in measles cases and an early spike in flu cases this year have made us want to do everything we can to support public safety.

Read more about our message to all doctors and other registered health practitioners on the Board’s website.

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Case study: Where was that lesion again?

AHPRA’s team of clinical advisors reviews every notification made to the Board. Clinical advisors are registered medical practitioners who provide clinical advice on the assessment and management of notifications about medical practitioners. We asked them for some reflections on common notifications.

Mrs A, 45 years, attended her GP because she had noticed a change in a mole. The GP took a relevant history and suggested a full skin check. The GP found three other lesions of concern and recommended four biopsies at a future appointment. At the next appointment, the GP took four biopsies and sent them for histopathology. Test results showed one malignant melanoma, one solar keratosis and two benign skin fragments. The GP referred Mrs A to a surgeon for excision of the malignant melanoma. After reading the referral and pathology results and examining Mrs A, the surgeon said he would need to excise all four lesions, as the lesions had not been labelled adequately. Mrs A made a notification about the GP.

AHPRA often receives complaints from patients who have had the wrong lesion excised or, due to inadequate labelling or anatomical description, required additional excisions.

It is not unusual for a time delay to complicate care, or for multiple similar lesions in the field to make identification of a specific lesion difficult. It is easy to understand how this can happen when small biopsy sites heal quickly or lesions are in close proximity. Anatomical descriptions can lack clarity and left/right confusion remains a common source of error. The patient may be concerned about a particular lesion but the practitioner sees another of more significance. Sometimes the lesion is just not visible by the time the patient reaches the practitioner who performs the surgery, especially when it is for microscopic margin clearance.

So, what can you do to minimise the potential for error?

• An adequate history, examination and documentation are a good start.
• Providing a detailed anatomical description, including measurement, of a concerning lesion is very important. This can be supplemented by a body map diagram and clinical photography.
• Any histopathology forms and specimens should always match and convey the relevant clinical information, including an orientation marker (stitch or ‘nick’) if the size of the specimen allows.
• Documented informed consent before the procedure and discussion of post-procedural care are really important.
• Confirmation by the patient that the correct lesion is being excised is sometimes, but not always, possible and does not remove the need for the doctor to have adequate systems of identification and documentation.
• Good communication at all stages of patient care, including when transferring care to a colleague, is important.

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Progress on the 2019 Medical Training Survey

The first national Medical Training Survey (MTS) will be going live on 1 August 2019. This survey will give doctors in training the opportunity to provide feedback on their experience of medical training. The data will be invaluable for shaping the future of medical training in Australia.

The MTS – set to run from 1 August to 30 September 2019 – will ask Australia’s 35,000 doctors in training about the quality of their training and identify issues that could impact on patient safety, including environment and culture, unacceptable behaviours and the quality of supervision.

The MTS will be safe, confidential and accessible online. Survey results will be used to improve medical training in Australia and be reported publicly, while protecting individual privacy.

We are excited to announce the appointment of EY Sweeney as the external provider who will administer the MTS, analyse the results and develop the reports which we will publish. EY Sweeney is an Australian research company with more than 40 years of experience.

With three months to go before the survey goes live, we are testing the survey questions with some doctors in training and developing the online survey portal and the website that will host results. In August, most doctors in training will be able to do the survey when they renew their annual medical registration online. We will be emailing interns and international medical graduates their unique survey link separately, as their registration cycle is different.

Developing the survey has been a fantastic team effort from doctors in training, health departments, specialist medical colleges, the Australian Medical Association, postgraduate medical education councils, the Australian Indigenous Doctors’ Association, doctors’ health services, Australian Private Hospitals Association, Australian Medical Council, Medical Council of NSW and the Medical Deans Australia and New Zealand. In the months ahead, we’ll be asking you to do the survey if you’re a doctor in training, or to encourage your trainees to join in.

We invite doctors in training who are interested in being involved in testing the survey questions, to contact EY Sweeney at medicaltrainingsurvey@au.ey.com. We are hoping to get interns, prevocational trainees, accredited and non-accredited trainees and international medical graduates with limited registration to volunteer. EY Sweeney will randomly select doctors in training from each category to participate in testing the questions. 

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Survey closing soon

We are asking interns how well they felt ready for practice when they graduated from medical school, in the annual intern survey which closes on 31 May 2019.

The survey is a joint effort between the Australian Medical Council (AMC) and the Medical Board of Australia, which set standards for medical school programs and the intern year. We want to know how well interns think their medical training prepared them for their internship, so we can keep improving training.

The survey is short, anonymous and confidential. AHPRA, on behalf of the Board, has sent the survey link to all 2019 interns and the AMC will analyse the responses.

De-identified and aggregated results data from this third year of the survey will be published on the Board’s website and shared with training and standards organisations, to shape future medical training improvements.

If you are an intern:

1. Please take 10 minutes to do the survey – just look for the survey link in an email the Medical Board sent you on 16 May.
2. Tell us how well prepared you felt for your internship when you graduated from medical school and what we can all do better to make you feel ready for practice.
3. Encourage other interns to do the survey!

If you work with interns, please encourage them to do the survey, which will close on Friday 31 May 2019. For more information read the news item on the Board's website.

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Revised wording for Category C (Canada)

The Board has updated its description of Category C of the Competent Authority pathway. There has been no change in policy and no change in the length of practice required, but we have explained more clearly what is involved in the experience component of this pathway.

The Competent Authority pathway is for international medical graduates who have completed:

1. a qualification or assessment through an approved competent authority where that qualification or assessment has been approved by the Board, and
2. a prescribed experience component in a competent authority country.

Category C is the Licentiate examinations of the Medical Council of Canada (LMCC). The competent authority for Category C is the Medical Council of Canada and applicants must have successfully completed the LMCC, which consists of two exam parts and a period of supervised practice.

The change makes it clear that the Board will only accept practice completed in Canada or another competent authority country (the United Kingdom, United States of America, New Zealand or Ireland). The period of supervised practice can be done as part of the LMCC or before or after it.

The Board has changed the wording because we have received applications for the competent authority pathway from doctors with the LMCC who have not actually practised in Canada or another competent authority country.

The revised category wording is published on the Competent Authority pathway webpage.

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Tell us what you think about our draft guidelines on complementary and unconventional medicine and emerging treatments

We have received a record number of submissions to our consultation on options to more clearly regulate medical practitioners who provide complementary and unconventional medicine and emerging treatments.

So far, we have heard from thousands of patients supporting the practice of complementary medicine. We are also keen to hear from all doctors including those working in this field and from doctors whose patients might seek these treatments.

We are consulting on options to best protect patients and minimise the risk of harm to them, without stifling innovation, making a judgement about specific clinical practices or limiting patients’ right to choose their healthcare. We have asked for feedback on the terms and definitions we have suggested and are interested in the perspectives of all our stakeholders.

We want to make sure patients have the information they need to make informed decisions about their care.

The Board has no intention to restrict doctors from using safe and effective treatments and no intention to shut down any areas of safe and effective practice. We are concerned that some members of the public may have become unduly anxious or distressed as a result of misunderstandings about the intent and effect of the proposed guidelines.

The consultation paper, including a discussion paper and draft guidelines, is published on the Board’s website or read more in this news item. We are keen to hear from you.

Please email written submissions to medboardconsultation@ahpra.gov.au, marked: ‘Consultation on complementary and unconventional medicine and emerging treatments’.

The consultation closes on 30 June 2019.

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Do you want to be on the Queensland or Northern Territory medical board?

Applications are invited from medical practitioners and members of the community to fill vacancies on two state and territory medical boards.

Queensland medical board (applications close 14 June 2019):

• five practitioner members
• four community members
• Chair

Northern Territory medical board (applications close 7 June 2019):

• one practitioner member
• Chair

Further information is available on the Statutory appointments page.

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Latest tribunal decisions have been published online

There are important lessons for registered medical practitioners from tribunal decisions. The Medical Board of Australia refers the most serious concerns about medical practitioners to tribunals in each state and territory. These cases were published recently:

• the Tasmanian Health Practitioners Tribunal has reprimanded and suspended a medical practitioner and imposed conditions on his registration for comments made online (Medical Board of Australia v Lee)
• the Queensland Civil and Administrative Tribunal has reprimanded and suspended a general practitioner and imposed conditions on her registration for engaging in a relationship with a patient (Medical Board of Australia v D)
• a tribunal has upheld a decision of the Medical Board of Australia to impose conditions on a medical practitioner prohibiting the practitioner from treating family members (name withheld).

Publication of panel, court and tribunal decisions

AHPRA, on behalf of the 15 National Boards, publishes a record of panel, court and tribunal decisions about registered health practitioners.

When investigating a notification, the Board may refer a medical practitioner to a health panel hearing, or a performance and professional standards panel hearing. Under the National Law¹, panel hearings are not open to the public. AHPRA publishes a record of panel hearing decisions made since July 2010. Practitioners’ names are not published, consistent with the National Law.

Summaries of tribunal and court cases are published on the Court and tribunal decisions page of the AHPRA website. The Board and AHPRA sometimes choose to not publish summaries, for example about cases involving practitioners with impairment.

In New South Wales and Queensland, different arrangements are in place. More information is available on AHPRA’s website on the Raise a concern page.

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Contacting the Board

• The Medical Board of Australia and AHPRA can be contacted by phone on 1300 419 495.
• For more information, see the Medical Board of Australia website and the AHPRA website.
• Lodge an enquiry form through the website under Contact us at the bottom of every web page.
• Mail correspondence can be addressed to: Dr Anne Tonkin, Chair, Medical Board of Australia, GPO Box 9958, Melbourne, VIC 3001.

More information

Please note: Practitioners are responsible for keeping up to date with the Board’s expectations about their professional obligations. The Board publishes standards, codes and guidelines as well as alerts in its newsletter. If you unsubscribe from this newsletter you are still required to keep up to date with information published on the Board’s website.

Comment on the Board newsletter is welcome and should be sent to newsletters@ahpra.gov.au.

For registration enquiries or contact detail changes, call the AHPRA customer service team on 1300 419 495 (from within Australia).

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