Challenges and possibilities Will COVID-19 change the way we learn and practice? - The Australasian College of Dermatologists
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POLICY IN THE TIME OF COVID
The effects of the COVID-19
pandemic on dermatologists
FOSTERING TRAINEE
WELFARE AND ENGAGEMENT
Welfare Officers continue
to expand this focus
Challenges and
possibilities
Will COVID-19
change the way
we learn and
practice?
ISSUE 124
AUTUMN 2020
From the editor
W
elcome to the Autumn informed communications; as a turn in all facets of the dermatology
2020 edition of The trusted source of truth. With this in landscape including training,
Mole. Never have mind, we have decided to publish research, outreach, patient support
communication and news been this edition of The Mole as a and advocacy, while at the same
more important to College softcopy only, enabling us to deliver time we find new and innovative
members and associates than in the latest updates from College, ways to go about our work.
these unprecedented times, where members, government and the Thank you to all contributors
the news cycle evolves not just broader skin care community at the for this edition. Your articles and
daily, but hourly. time we distribute it. reports help to inform and shape
College firmly believes it is our Aside from news and our activities, focus and efforts
place to keep you informed and up commentary relating to COVID-19, today and in the future.
to date with the latest news and we are pleased to present important
information relating to COVID-19. reports from faculties, our partners,
Throughout the pandemic we strive and community. It is a timely Associate Professor Anna Braue
to provide relevant, timely and reminder that the cogs continue to Honorary Secretary
EDITORIAL TEAM
EDITOR EDITORIAL PERSONNEL
Associate Professor Anna Braue Sarah Stedman
Honorary Secretary Haley Bennett
ACKNOWLEDGEMENT
The Australasian College of Dermatologists acknowledges the Wangal
people, the Traditional Owners of the lands upon which the College head
office is located. The College also acknowledges and pays our respects to
the Traditional Owners of the lands upon which Australian dermatology
services are delivered, and Elders past, present and future; for they hold
memories, traditions, cultures and hopes of Aboriginal and Torres Strait
Islander peoples of Australia.
Disclaimer: The Australasian College of Dermatologists wishes to encourage debate and exchanges of ideas amongst Fellows through The Mole.
Nevertheless, the opinions expressed in articles in The Mole are those of the authors and are not necessarily those of the College.
Contents ISSUE 124
AUTUMN 2020
NEWS & INTRODUCTION
02 President’s report
03 CEO’s report
BEING THE REPRESENTATIVE VOICE IN SKIN HEALTH
10
04 Policy in the time of COVID
06 How have dermatologists been affected during the COVID-19 pandemic?
08 Antimicrobial stewardship
10 Parliamentary Morning Tea by Eczema Support Australia
LEADING SKIN HEALTH EDUCATION & TRAINING
11 Keeping education on track in times of crisis
13 Fostering trainee welfare and engagement
13
15 The National Skin School Program – COVID-19 related changes
16 From the Faculties
DELIVERING HIGH QUALITY MEMBER SERVICES & SUPPORT
19 Adapting to COVID-19 in a rural setting
20 Top End dermatology outreach 23
23 AMA revised Guide to Social Media and Medical Professionalism
25 South Australian Dermatologists visit Indian Dermacon 2020
26 Obituary notices
DRIVING DERMATOLOGY RESEARCH & INNOVATION
27 Study – atopic dermatitis in Australian general practice
29 Melanoma risk in young Australians
30 Annual Scientific Research Fund grant awarded
31 Our partners
35
THE MOLE | Autumn 2020 | 1
NEWS & INTRODUCTION
President’s report
S
ince our last edition of The Mole, to other agencies opinion. At the time of
dramatic events have taken centre writing, a weekly teleconference of CPMC
stage. Fire, rain and COVID-19 have concerning COVID-19 developments
had profound effects on not only Fellows has been instituted. Also, your College
but also many other Australians. On behalf has started a COVID-19 webpage on our
of all Fellows, College wishes those well website, which will work in concert with
that have been impacted by these events our own taskforce to best navigate the
over the holiday period and the time since circumstances that are unfolding. Practical
then, and in the future. issues relevant to Dermatology will be
During this period, I attended the addressed and updated, endeavouring
CPMC meeting in the earlier stages of to give optimum outcomes for patients,
the COVID-19 situation. Clearly, major Fellows and Trainees, their staff, families,
developments have occurred since then! and the community in general.
Daily updates from Government and other Our Strategic Plan has been produced
institutions have given some evidence earlier this year which gives us framework
based guidelines for Fellows and health and guidance to go forward as a College.
workers to help them get through this Represent, Lead, Deliver and Innovate
unusual crisis, as well as information for are the Strategic goals, with the ultimate
College to use in making decisions. At that outcome of optimum care for our patients.
meeting, this issue shared time with other Thanks to staff and a wide range of Fellows
topic such as antibiotic resistance that who gave their time and effort to build an
is particularly relevant to us, the Medical overarching document to which we can
Training survey and Medical Workforce come back to when required.
Strategy, as well as Trainee parity of leave Beginning with this ASM, which will now
and pay throughout different jurisdictions. take place from 10-13 April 2021, I wished
I queried the significant cost of the AMC to embed in our conference a session that
accreditation process on, particularly, small makes us better teachers, but also better
Colleges such as ours. able to interact with staff and patients
At CPMC and other venues, a number etc. by improving feedback techniques.
of social responsibility issues were raised Scenarios involving Consultant and Trainee
which reinforced your Board’s decision perspectives should be fruitful. I encourage
last November to form a Committee to you to attend when we can reconvene
look at the increasing number of topics on our major meeting, whether a supervisor
which we are asked to comment, which or not, as this is a major area that can be
may or may not be our core business. A improved, aligning with our strategic goal
call to Fellows to join this committee and of excellence in producing high quality
create a charter and a structure that can Dermatologists.
better inform the Board on whether to Thank you to all involved for their input
engage or not, and associated risks, was at this unsettling time. It is our job to be
repeated in March. I hope by the time this positive, stay calm, and make evidence
edition is published we will have a number based clinical and practical decisions as we
of Fellows who are keen to get involved have been trained to do, and do everyday.
and strengthen our relevance by balanced Good health and stay safe.
dialogue on appropriate issues. Your
Board unanimously felt it was better for
us to prosecute any issues after our own Associate Professor David Francis
careful consideration rather than attach President
2 | THE MOLE | Autumn 2020
CEO’s report
O
ur thoughts have been with all • Develop contingencies for cancelled
those impacted by drought then activities
fire, floods, and storms over this • Business modelling of the financial impact
catastrophic spring and summer of 2019/20. • Adjust 2020 activities
Witnessing the grief and loss, resilience • Be mindful of mental health supports and
and fight has been sobering. Is it a turning issues as changes occur.
point for living differently? But right now, Central to coming out of this intact is to
we are being sorely tested as the COVID-19 maintain solidarity and support, helping
pandemic bites hard in each State. Looking everyone to adjust. Collegiality will be tested,
back to the 29 February Board meeting but we must hang in there together. We are
it’s hard to imagine how the whole picture being forced to think and work differently.
looks so very different. We were clearly on a For instance, and it’s a relatively minor issue
precipice that day! in the current context, we can do an AGM
Move forward to mid-April 2020 and almost differently. As a Charity, under the ACNC
everything now looks different. It was a hard Act, an AGM is not a requirement. Its high
decision to postpone the ASM, but it was Fellow attendance we value and want to
closing itself before our eyes. Participation maintain. So we will remain accountable, just
was never going to be viable. Daily stock electronically. We can’t hold the usual CV
market plunges have made our reserves weekend (selection) so this will be electronic.
thinner, but luckily, we have them! Business It might be a good time for major house
continuity has been activated so that the staff cleaning and finding new ways to do
in Rhodes work from home as do those in our work.
Melbourne. Clearly, as cases rose the hospital Now that the incidence has fallen, minds
system came under increasing duress. must turn to the way we go forward, how we
Private practices faced rapidly changing recover and structure ourselves. When the
threats to business, staff, and patients. The time comes, we might even see opportunity,
impacts on all health professionals has been try new approaches and decide on bold
profound. We hope Fellows and registrars, changes so we come back with strength and
your staff and colleagues get through this at purpose.
the front line. Our investment policy setting must be in
Whatever happens from here, the impacts place when the bounce comes. The training
will reverberate for many months ahead. Our business model that relies on face to face
ambitions for 2020 as per the Strategic Plan might need to flip to be less reliant on that,
will undergo a re-assessment. Our priorities in somehow. Can we find how to be less reliant
the immediate future are: on the ASM for College revenue? Could this
• Accurate communications about COVID-19 be a good time to increase training in private
• Support our Fellows on the many impacts practices?
today and ahead As we absorb the meaning of the impacts
• Monitor the impacts on training and on the months ahead, we have the immediate
support trainees and SoT, HoDs, DoTs in need to get through the weeks ahead. What
the short and medium term a strange time for us all. We will do all we can
• Ensure College staff working from home as a college to support fellows and trainees in
are managing/supported this difficult time.
• Work with other Colleges to develop
clear positions to government on matters
impacted e.g. CPD, accreditation, STP, Tim Wills
MBS Chief Executive Officer
THE MOLE | Autumn 2020 | 3
BEING THE REPRESENTATIVE VOICE IN SKIN HEALTH
Policy in the time
of COVID
Responding to the challenges posed by
the COVID-19 pandemic has been no
small task for Australia’s Federal and state
/territory governments. In the absence of
any actual sport to watch, the writing and
rewriting of legislation and policy over the
last several weeks has been fascinating
enough for any keen spectator.
Putting in place effective safeguards for the health system to
deal with a potential onslaught of cases was understandably
prioritised, followed by a suite of financial subsidies and rebates
to protect individuals and businesses.
HALEY BENNETT, DEPUTY CEO
O
verlaid with this was the need to billing requirements has caused undue stress
protect the community through the to those working privately and legitimate
staged implementation of social concern for the viability of their practice.
distancing measures. At the time of writing, While these changes were measured in
these have been effective and it is with great response to the evolving crisis, the unintended
relief that we are observing the flattening curve. consequences on practice sustainability was
It has been astounding the speed at which heard by the Department; we now seem to
policy changes occurred, especially when such have reached some stability and hope that this
shifts usually progress at a snail’s pace and will improve the situation for dermatologists.
with much deliberation. It has been pleasing to As far as corporate buzzwords go, ‘pivot’
see that these decisions have not been heavily is in its heyday and certainly reflects the
politicised – although no doubt we will see this experience of most sectors. Doctors have
re-emerge when the storm calms. experienced this firsthand, with the shift to
From the heath policy perspective, the quick telehealth driving an upskilling of many across
response of government to expand MBS the medical profession, which in itself is not
telehealth items has provided a safe way to a bad thing. It has ushered in creative and
allow many medical practitioners to continue profession-wide thinking about patient triaging
to deliver care in some form. However the for digital health, but has also highlighted
almost daily changes in eligibility and bulk- the reality of technological challenges,
4 | THE MOLE | Autumn 2020
administrative burdens and modality for delivery of care. College’s COVID-19 Taskforce,
compliance and privacy matters. Throughout this period, advocacy chaired by Dr Bruce Tait, has been
We are observing the response for dermatologists and their patients essential in College’s efforts not only
of the tech industry in that many has been essential. The Council for clinical and practical guidance
are optimising their platforms and of Presidents of Medical Colleges for Fellows, but to help direct our
working towards better integration (CPMC) has met weekly, facilitating advocacy response. We hope that all
with existing software. It has a unified voice to government on Fellows have visited the COVID-19
expedited the work of College’s many issues including impacts on section on College’s website and
E-Health Committee in developing medical workforce and training, have found the information helpful.
guidance, tools and resources to elective surgery restrictions, infection We thank all Fellows who responded
equip dermatologists and patients control, and PPE and medicines to the COVID-19 survey; half of
for telehealth consultations, which availability. A/Prof David Francis and the membership did so which is an
can be drawn upon now and Tim Wills have been unwavering outstanding response. It provided
post-COVID. In some training sites, in raising issues pertinent to critical insight into the most pressing
telehealth has provided a good dermatology, supported by College’s issues amongst dermatologists
solution to supplement registrar Policy and Advocacy team. Some and informs ongoing work for the
training. Taken together, these issues remain unresolved and Taskforce. We look forward to the
experiences provide opportunities we continue to work on these – day of ‘business as usual’ but are
for improvement and refinement of hydroxychloroquine supply for very grateful to the hard work of the
telehealth and may help it develop example, despite implementation of Taskforce during this time and of the
into a mainstream complementary TGA and PBS restrictions. support of Fellows.
College thanks the members
of the COVID-19 Taskforce.
The Taskforce, chaired by Dr
Bruce Tait, has been essential
in College’s efforts not only for
clinical and practical guidance
for Fellows, but to help direct
our advocacy response.
COVID-19 Taskforce
Dr Bruce Tate (Chair)
Associate Professor Marius Rademaker
Dr Clare Tait
Associate Professor Gillian Marshman
Associate Professor Chris Baker
Associate Professor Peter Foley
Dr Edward Upjohn
Associate Professor Andrew Miller
Associate Professor Stephen Shumack
Dr Erin McMenimen
THE MOLE | Summer 2020 | 5
BEING THE REPRESENTATIVE VOICE IN SKIN HEALTH
Policy
How haveindermatologists
the time
been affected during the
of COVID
COVID-19 pandemic?
A total of 264 Fellows – or 48% of our members actively practising – responded
to our survey in early April. The sample was encouragingly representative of the
membership, with proportional representation broadly seen across Faculties,
gender, career stage and public/private sector.
F
indings revealed that the majority of Fellows’ are involved in registrar teaching, almost all stated
practice has been impacted to some degree during that they will continue to teach during COVID-19,
this time. Almost half thought that normal practice although there were mixed responses regarding
would resume within 6 months. For many, patient whether teaching hours will be affected.
bookings have been reduced either due to required Of concern, 35% of Fellows responded that they
triaging or by booking cancellation or postponement. are just coping or not coping during this time. This
The vast majority are using telehealth as well as seemed to not be indicative of any particular group
maintaining face to face consultations; and while over – rather the negative impacts of COVID-19 have not
half are using telehealth for fewer than 20% of their discriminated. Fellows are encouraged to contact
patients, others are using this modality considerably Converge International, the appointed Employee
more. Almost a quarter of metro-based Fellows Assist Program provider for the College available
indicated that they provide rural service, and of to all Fellows and trainees. Services are free,
these, two-thirds indicated that they will continue to confidential and private. Please visit https://www.
do so during the pandemic. dermcoll.edu.au/for-fellows-and-trainees/support-
Of the 65% of Fellows who indicated that they welfare-services/ or call 1300 687 327.
Percentage of working week (average) Consultation methods
dedicated to each craft
100
Cosmetic 7%
80
Percent of Fellows
60
40
Surgical 31%
Medical 62%
20
0
Currently seeing Currently Currently
patients face performing stopped seeing
to face teledermatology patients completely
6 | THE MOLE | Autumn 2020
“We (the Taskforce) Percentage of patients being seen via
teledermatology
are encouraged that our
efforts thus far have been 100
targeted appropriately, 80
Percent of Fellows
providing information 60
and guidance on topics 40
of greatest relevance.” 20
A/Prof David Francis 0
0-20% 21-40% 41-60% 61-80% 81-100%
Mode of teledermatology Platforms
Telephone
Telephone only Whatsapp
Facetime
Telephone + photos
Skype
Videoconferencing Conviu
only
Health Direct
Videoconferencing
+ photos Other
0 20 40 60 80 100
0 20 40 60 80 100 Percent of Fellows
Percent of Fellows
Zoom; Doxy.me ;
GP consults ;
Conference meet ;
Coreplus; Webex; Pexip ;
What were your top 3 priority issues for the Vidyo; Microsoft teams ;
COVID-19 Taskforce? Amazon Chimes
Advice on best practice for face to face patient contact
Recommendations on procedural dermatology
Guidelines for specific clinical scenarios
Practical infection control in the practice
PPE availability and use
Practical management and financial support
Welfare and support for fellows and trainees
General pandemic information
Other
THE MOLE | Autumn 2020 | 7
BEING THE REPRESENTATIVE VOICE IN SKIN HEALTH
Antimicrobial stewardship
Antimicrobial resistance (AMR) continues to be a substantial risk to
patient safety. Not only does it reduce the range of antimicrobials
available to treat infections, it also increases morbidity and mortality
associated with infections caused by multidrug-resistant organisms
and limits a range of other life-saving treatments.
CAROLINE ZOERS, POLICY MANAGER
T
he Australian Commission on Safety antibiotics for skin and urinary tract infections as
and Quality in Health Care’s 2019 an area for action. Concerns about the use of
AURA report found that antimicrobial amoxicillin–clavulanic acid and cefalexin in both
resistance shows little sign of abating and community and hospital settings were raised.
poses an ongoing risk to patient safety, Reducing inappropriate prescribing of these
with common pathogens such as E. coli, antibiotics and promoting use of narrower-
Salmonella, Neisseria gonorrhoeae and spectrum antibiotics such as amoxicillin, should
Neisseria meningitidis becoming increasingly contribute to preventing and containing AMR.
resistant to major drug classes, and some Indeed, the Government has been keen
organisms resistant to last-resort treatments. to act on this issue, accepting the PBAC’s
Because of their consistent use, utility, and recommendations to amend the maximum
availability, antibiotics are susceptible to overuse quantity and repeats for the top five most
in the treatment of dermatological conditions. commonly prescribed PBS-listed antibiotics
College has promoted appropriate prescribing (amoxicillin, amoxicillin with clavulanic acid,
through the Choosing Wisely initiative. cefalexin, doxycycline and roxithromycin)
The AURA report identified reducing commencing 1 April. For details see:
inappropriate prescribing of broad spectrum http://www.pbs.gov.au/info/news, March 2020.
8 | THE MOLE | Autumn 2020Surgical prophylaxis also remains
high on the list of inappropriate We all have a role to play in reducing
antibiotic prescriptions. The AURA
findings show that whilst there was
overuse of antibiotics.
an improvement in appropriateness
of surgical prophylaxis between LOOK FOR OPPORTUNITIES TO INCREASE AWARENESS
2013 and 2018, almost a third OF COLLEGE’S CHOOSING WISELY AUSTRALIA®
(28%) of surgical prophylaxis was RECOMMENDATIONS.
inappropriately given for longer than Three out of the five recommendations aim to ensure appropriate
24 hours. use of antibiotics: in lower limb bilateral redness and swelling;
Improvements are needed in epidermal cysts; and acne vulgaris.
documentation, data collection and
surveillance mechanisms to support
ongoing quality improvement in
the prescribing of antibiotics. The KEEP UP-TO-DATE WITH THE MOST RECENT GUIDELINES
Antimicrobial Stewardship Clinical FOR ANTIBIOTIC PRESCRIBING AND STEWARDSHIP:
Care Standard and Therapeutic
• Therapeutic Guidelines: Antibiotic
Guidelines: Antibiotic set out
best practice. • Antimicrobial Stewardship - Clinical Care Standard and key
The importance of high quality resources (ACSQHC)
data was highlighted by the findings • Antibiotic resistance - latest information, data and guidelines
of a systematic review and meta- (ACSQHC)
analysis of surgical site infection • Antimicrobial e-learning modules (NPS MedicineWise and ACSQHC)
following Mohs surgery without
prophylactic antibiotics by ACD
Fellows Dr Harvey Smith, Dr Kate
Borchard, Dr Paul Cherian and A/
Prof Carl Vinciullo published in the KEEP UP-TO-DATE WITH THE LATEST INFECTION
AJD last year.[1] The review found CONTROL GUIDANCE:
the range for the mean surgical • NSQHS Preventing and Controlling Healthcare-Associated
site infection rate after Mohs when Infections Standard (second edition) for antimicrobial
prophylactic antibiotics are not used stewardship in relation to surgical prophylaxis
seemed likely to be fall between 1.4
• NHMRC’s Australian Guidelines for the Prevention and Control
and 2.7%. However, the authors
of Infection in Healthcare (2019)
noted the reliability and utility of
this data would be improved if the • WHO’s Global guidelines on the prevention of surgical site
literature had routinely commented infection – see Chapter 4 recommendations on topical
on the use of antibiotics, repair decolonisation preoperatively to reduce surgical site infection
elsewhere, follow-up of patients and and overall use of antibiotics
clearly defined staged Mohs over • College’s own updated infection control guidelines will be
days and non-Mohs. Developing a available soon.
standardised way to report Mohs
research data would help build
the future evidence base relating
to Mohs and contribute to quality CONSIDER THE QUALITY OF YOUR OWN
improvement in antimicrobial DOCUMENTATION, DATA COLLECTION AND
stewardship. SURVEILLANCE MECHANISMS.
View the AURA 2019 report. This will support ongoing quality improvement in the prescribing
and use of antibiotics.
Many thanks to Dr Harvey Smith
for his assistance with this article.
Harvey S, Borchard K, Cherian P,
[1]
SHARE THE LATEST RESEARCH AND EVIDENCE ON BEST
Vinciullo C. Systematic review and
PRACTICE IN ANTIBIOTIC PRESCRIBING IN DERMATOLOGY.
meta-analysis of surgical site infection
Share these with College by emailing Caroline Zoers,
following Mohs surgery without
Policy Manager at carolinez@dermcoll.edu.au.
prophylactic antibiotics. Australasian
Journal of Dermatology. 2019 Nov;
60(4); 340-342.
THE MOLE | Autumn 2020 | 9BEING THE REPRESENTATIVE VOICE IN SKIN HEALTH
Parliamentary Morning Tea
by Eczema Support Australia
On 27th February 2020, College attended the
Parliamentary Morning Tea at Parliament House
Canberra, hosted by the Eczema Support Australia as
part of their “SOS – Save Us from Eczema” campaign. Caroline Zoers, Dr Diana Rubel
and Mariam Zahid
MARIAM ZAHID, ENGAGEMENT OFFICER
E
czema Support Australia’s and Dr Mike Freelander. Eczema Eczema Support Australia’s “SOS –
campaign aims to challenge patients, their families and carers Save Us from Eczema” campaign by
the perception that eczema from all over Australia attended and visiting their Facebook page.
is “just an itch” and calls for the spoke, providing moving accounts Given the significant unmet need
Federal Government to support the of how physically, psychosocially for better and safer treatment
eczema community by making new and mentally debilitating living with options for this condition, College
treatment options available on eczema is. Those fortunate enough also lodged a submission in support
the PBS. to have been able to access better of the listing of dupilumab on the
Eczema Support Australia is treatments through clinical trials and PBS earlier this year.
one of the patient support groups compassionate access schemes The PBAC released its positive
that College works with to advise relayed how transformative that has recommendation on 24th April – to
Australians who are significantly been for them. list dupilumab for the treatment of
impacted by eczema and other Dr Diana Rubel was among the patients 12 years and older with
atopic conditions. The event, powerful speakers at the event severe atopic dermatitis who are
which was supported by a strong providing her perspectives on inadequately controlled on topical
media and advocacy campaign, the impact of the condition and therapies. This is an excellent result
gathered significant attention from newer treatment options. College for the eczema community, and we
several MPs including Shadow lent support to Eczema Support look forward to providing further
Minister for Health Chris Bowen Australia by connecting them with information on this in the coming
and Allergies and Anaphylaxis Fellows and their patients to assist months, once the listing process
Inquiry members Trent Zimmerman with media enquiries. You can view is complete.
Given the significant unmet need for better and safer treatment options
for this condition, College also lodged a submission in support of the
listing of dupilumab on the PBS earlier this year.
10 | THE MOLE | Autumn 2020LEADING SKIN HEALTH EDUCATION & TRAINING
Keeping education and College staff have been working
hard to ensure that the Training
Program continues to operate
on track in times
given the demands placed on
Trainees and Fellows. I have been
reassured by the many thoughtful
emails I have received offering
of crisis
suggestions on ways to manage
the crisis. We have tried to maintain
regular communication with trainees
through the Connect platform and
with Fellows through the COVID-19
I love a good sports quote. Mario Andretti, the great website section on the variations
and updates to the Training
Formula 1 car driver once said, “if you have everything program. I would encourage you to
under control, you’re not moving fast enough”. review this information for an update
on where we are up to. Ashleigh
BRETT O’NEILL, DIRECTOR EDUCATION SERVICES
and Caterina, our Wellbeing and
Engagement officers, have also
been working overtime since
I
am sure that in the current climate from this experience and become starting in January with enquiries
we all feel like we are moving better individuals and professionals tripling in the last few weeks. It
extremely fast. COVID-19 has through it, in order to better serve has been great to have them on
caused a call to arms that has not those around us. As C.S. Lewis said: the team. The curriculum review
been seen in most of our lifetimes “hardships often prepare ordinary continues to progress under the
and it is great to see so many taking people for an extraordinary destiny.” leadership of Dr Adriene Lee (Dean)
up the challenge. Thank you for all Throughout the COVID-19 and Dr Catherine Scarff (Associate
your work. crisis College has endeavoured to Dean).This has been progressing
We are being pushed and pulled maintain some level of normality and given the current climate has
in all directions when it comes to in the services that have been given new meaning to a review of
work, family and general wellbeing. offered. I am thankful for the many how provide a learning environment
I hope and pray that you all remain Fellows and Trainees who have and ways to learn. I would
safe and well as we gather around put their hands up to provide encourage you to consider how
each other and our families and support and advice during this you can play a part in participating
friends to support each other (at time. Committees such as the NTC, in the curriculum review either as a
a distance) through these times. I NExC, NAccC and TRC, along with once off or in an ongoing capacity.
am confident that we will all benefit the Supervisors, HODs, the Dean Please contact the College if you
are interested.
Throughout the
COVID-19 crisis
College has
endeavoured to
maintain some
level of normality
in the services
that have been
offered.
THE
THE MOLE Autumn 2020 | 11
MOLE || SummerLEADING SKIN HEALTH EDUCATION & TRAINING
During the crisis College has continued to run a range of education
activities. I am pleased to report that College has received close to
100 applications for 2021 entry into the program.
At the time of this article we are still College when the business returns to normal
intending to run the Fellowship Examinations and education requirements of GPs and
(delayed by three months). College will other professionals increase again. We want
consider ways to ensure these run and remain to be in a strong position to offer opportunities
consistent and reliable. College will continue to learn.
to work with trainees and supervisors to Updated information on CPD were
monitor the clinical and training component announced in a recent newsletter and can
on the program. Thank you to the many also be found on the COVID-19 section of the
Fellows who have volunteered to run College website.
additional online webinars for trainees. During the next period, IT services will also
During the crisis College has continued be considered. These have been tested with
to run a range of education activities. I am staff working from home and the introduction
pleased to report that College has received of a range of tools to assist in this process.
close to 100 applications for 2021 entry into The Education team remain available for
the program. This is an increase from previous meetings and can be contacted through the
years and may reflect the decision to remove normal channels
the 4 attempts rule. Interviews are expected The Education team will continue to work
to continue as planned and will most likely on a variety of projects during the current
occur using video conferencing tools. We crisis in order to ensure College is in a better
have conducted some interviews like this in position at its conclusion. Building more online
the past, but it will be a big change to adapt modules, repurposing content for Fellows and
to. I am confident we will overcome any a wider audience are some of the tasks that
issues to be ready to offer positions for 2021. will continue to be completed.
College has had to postpone any face to I am sure that many people will be able
face teaching for GPs, but it has continued to to look back on this crisis and reflect on the
run and support those enrolled in the online many good things they have done to help
components of the GP courses. College others. If you do wish to assist College in any
continues to work on this content and further education tasks, or have thoughts on further
develop educational content for this group activities, please feel free to contact me at
of professionals. This will be critical for the the College.
12 | THE MOLE | Autumn 2020Fostering trainee
welfare and
engagement
The wellbeing of all Trainees and Fellows is a key focus for College.
Following on from the Trainee Welfare and Engagement Officer pilot
study conducted in Victoria in 2018, College has now appointed
two Welfare Officers to continue and expand this work.
DR CATE SCARFF, ASSOCIATE DEAN
T
hese two positions, which are based advocate for all trainees. Their work will also
in Sydney and Melbourne, cover involve exploring and developing wellbeing
trainees and supervisors in all Australian initiatives and programs to assist and support
states and territories. those in the training program and they will
The Officers, Ashleigh and Caterina, are be active participants in Wellbeing working
able to provide proactive and coordinated groups from other Colleges and areas of
pastoral care and support to trainees and their Medical education. You can contact them for
supervisors, so facilitating effective responses any enquiries relating to welfare matters!
to a variety of individual circumstances – Though based in Victoria and NSW,
both personal and educational. They can Caterina and Ashleigh will undertake visits
provide support during a trainee performance to all states during the year, so look out for
improvement process and help to mobilise when they are coming to your area, once
additional educational or other support as travel is allowed. If you have any suggestions
required. Caterina and Ashleigh will work with to make about wellbeing initiatives and work,
the Trainee Representative Committee and to please be in touch with your ideas.
THE MOLE | Autumn 2020 | 13LEADING SKIN HEALTH EDUCATION & TRAINING
Introducing Caterina De Meneghi
My name is Caterina and I am the and issues surrounding academic trainees throughout the course of
Wellbeing and Engagement Officer misconduct. I have also worked as their training. I love a good chat
for VIC, TAS, WA, NT and SA. a welfare professional with non-for- over a cup of coffee, so if you share
My professional background is in profit organisations such as YWCA, my love of coffee, please don’t be
Counselling and Higher Education. Windermere and Workbridge. My shy and reach out.
I have worked as a counsellor career has focussed on improving Aside from my work, I enjoy
with local and International the wellbeing of my clients, whether travelling and learning about various
students completing TAFE it be from helping to connect to cultures. I was born in Colombia,
courses and University degrees. their community, to finding specific so I have grown up with a great
I ran workshops and activities support agencies and emergency appreciation for cultural traditions,
as part of the wellbeing program services, to simply helping with and love learning about art and
and greatly enjoyed connecting time management, study skills and music from different countries. My
with people from all walks of life. mindfulness. I aim to empower little family takes up most of my
I also worked as a manager of people to help them live more time now, so I spend a lot of time
International student support and fulfilling lives. I have learned so in parks and libraries or hiking.
experience, where I assisted staff much from the ACD already and However, I still enjoy some salsa
and students with grievances look forward to working with dancing every now and then.
IMAGE GOES HERE IMAGE GOES HERE IMAGE GOES HERE
Caterina De Meneghi – Wellbeing & Engagement Officer Ashleigh Thomas – Wellbeing & Engagement Officer
Introducing Ashleigh Thomas
My name is Ashleigh and I am the My time in regional NSW was to working with Caterina, Dr Cate
Wellbeing & Engagement Officer for also instrumental in developing Scarff and the TRC to deliver
NSW & QLD. I started my career my interest in Aboriginal & Torres relevant and meaningful wellbeing
as a high school visual arts teacher Strait Islander education – this led initiatives to trainees. Aside from
in Dubbo, NSW. After encountering me to my most recent role where working at ACD, I am a potter by
many students with complex I ran an Aboriginal & Torres Strait trade, so most of my spare time
circumstances, I transitioned into a Islander scholarship program at is spent with my hands covered
student wellbeing role for NSW DET. an independent school in Sydney. in clay. I work predominately with
In this role I supported students Working with adolescents has porcelain, making jewellery and
from K-12 in Central Western NSW. shown me the importance of wheel thrown forms. The thing I love
During my time in the state school empathy and patience. I hope I can most about working with clay is the
system, I was also a Women’s bring these things to my new role. infinite potential – there are so many
Representative for the New South I have enjoyed meeting trainees variables at play with clay bodies,
Wales Teachers Federation. This at the 1st and 3rd year workshops glaze composition and kiln firings.
was an advocacy role where I & hope to meet all NSW & QLD I might be biased, but if you’re
supported female teachers with trainees at some point this year looking for an activity to help you
gender-based workplace issues. through site visits. I look forward unwind, this is a great one!
14 | THE MOLE | Autumn 2020The National Skin School Program
– COVID-19 related changes
The COVID-19 pandemic has led to profound changes in many aspects
of our lives. The College-run National Skin School (NSS) program, which
previously presented one webinar per month aiming to supplement local
teaching opportunities, is one such example.
W
ith the realisation that the virus Thank you to all who have contributed so far.
would lead to long-term changes Many Fellows have created new presentations
in how we work and so significantly or modified existing one to suit the online
impact on both tutorial programs and trainee platform. Those previously unfamiliar with
exposure to patients in clinics, the decision webinars have learned how to run them,
was made to expand the NSS. As sessions supported by College staff members Lucy
would no longer supplement teaching, but and Jacqui. There is scope to add more, so
become a primary source of training for any Fellows who would like to contribute are
many, information was sought from trainees asked to please contact Cate Scarff,
and Fellows to guide the process. As such, cate@dermcoll.edu.au.
the program now aims to provide a variety While this initiative started as a short-term
of session types and cover all aspects of the plan to supplement the learning opportunities
curriculum. The CPCs from previous ASMs available to trainees during the pandemic,
were identified as a way of rapidly providing it will likely have a much longer term effect.
trainees with clinical vignettes. The hosts of The current aim is to develop a library of
the sessions were contacted, as one of them resources which spans the curriculum, and is
put it, to “get the band back together” and permanently available for trainees to access.
re-present their session to trainees through Organisations such as the Association
the webinar format. The Victorian Skin School for Medical Education in Europe (AMEE),
program, which runs sessions for all levels encourage us to use the current COVID-19
of trainees as well as ones aimed specifically situation as a springboard for innovations in
for juniors, have kindly made their sessions medical education. To think about new and
available nationally. In addition, sessions better ways to teach – not to just “get through
covering further topics from the Medical and this” – but to come out the other end with
Procedural parts of the curriculum are under better and more effective ways of educating
planning with many Fellows from around our next generation of dermatologists.
the country contributing to this. Pathology See AMEE website for free COVID-19
teaching is currently being conducted online resources https://amee.org/covid-
by states individually, and additional resources 19#resources. A summary of the webinar
have been generously offered by several “Adapting to the impact of COVID-19: Making
Fellows. The NSS program can be viewed the most of digital and online presenting and
on the e-portal along with other resources. teaching” is available from Cate Scarff.
THE MOLE | Autumn 2020 | 15LEADING SKIN HEALTH EDUCATION & TRAINING
From the Faculties
NSW Faculty
The new academic year has just Finally, the Faculty welcomes our Yiasemides as Head of Department
started, and the Faculty welcomes IMG trainee Dr Simone Goldinger. (HoD) and Supervisor of Training
our new registrars’ Drs Stephanie Simone is a dermatologist from (SoT) respectively. This position
Blake, Alex Coe, Geoffrey Lee, Switzerland, who has already is linked to another STP-funded
Rose Liu, Thomas Stewart, Kirsty been attending faculty meetings regional position in Port Macquarie,
Wark, Anes Yang and Rudy Yeh, and sharing her experiences with with Drs Ian Hamann and Katie
into the training program. A belated advanced onco-dermatology Le, again as HoD and SoT, where
welcome to Dr Swaranjali Jain, who treatments. We wish all trainees registrars will spend 6 months in
commenced her training towards success in their training and future each position. These positions offer
the end of last year, in a second careers! (But Rudy, please take it a broad range of medical, surgical,
newly accredited and funded easy with the steak competitions…) and cosmetic training, along with
position at the Royal Canberra Speaking of new positions, a new the rural exposure, and the faculty
Hospital. This position is the result private practice-based Specialist hopes that trainees will appreciate
of a lot of hard work and lobbying Training Program (STP)-funded and gain from the experience.
on the part of the Dermatology position has commenced this year
Department there, led by A/Prof at SouthDerm, in southern Sydney, Dr Keng Cheng
Andrew Miller – well done Andrew! with Drs Rob Rosen and Eleni Chair, NSW Faculty
VIC Faculty
The Victorian Faculty AGM was program overseen by Cate Scarff. will become even more important.
held on February 21 and departing We welcomed 6 new registrars Service provision to Bright was
members from our committee - to our Victorian training program interrupted by the devastating
Vanessa Morgan, Fiona Bruce and in the summer edition of the Mole bushfires in the high country
Hugh Roberts - were thanked for and since then have added Smriti highlighting further that Dermatology
their sterling service. New members Tandon to an everlarging cohort like all areas of medicine is facing
to the committee include Anousha of registrars. We now have 36 unprecedented challenges this year.
Yazdabadi as DoT, Rebecca registrars in our training program. The COVID-19 pandemic is
Dunn and Tim Rutherford and we We thank Alvin Chong and his impacting significantly on all
look forward to working together team – Matheen Mohammed, Aaron Victorian Faculty activities including
during the trying months ahead in Robinson and supporting cast – for service provision to outpatients,
the shadow of COVID-19. Thank their ongoing provision of junior and the cancellation of clinical meetings
you in particular to Anousha for senior skin school. This formalised and updates and modifications to
accepting the role of DoT with teaching program is highly valued teaching arrangements to protect
its complex and time consuming by our registrars and consolidates registrars, consultants and staff.
demands of rostering, service the experience provided in We are sure the same issues are
provision and registrar wellbeing. outpatient clinics. being experienced Australia wide
We welcome and look forward to Our service provision to country and we look to College for ongoing
working with Caterina de Meneghi areas has been enhanced by the guidance and leadership at this
who is our new trainee engagement addition of the telehealth registrar challenging time.
and wellbeing welfare officer for at Royal Melbourne and with the
Victorian registrars - this important worsening situation with COVID-19 Dr Paul Curnow
role carries on from the original pilot this form of patient consultation Chair, VIC Faculty
We look to College for ongoing guidance and
leadership at this challenging time.
16 | THE MOLE | Autumn 2020QLD Faculty
Queensland has cracked into are genuinely thrilled to have him and to have an excellent afternoon of
2020 with expanding services, thank him again for his ongoing work. vulval dermatology with Prof Gayle
academic energy, and a peppering of The inaugural Junior Skin School Fischer in March, presented by the
memorable social gatherings. was run in Brisbane on Feb 29/March Mater Hospital. The session covered
Dr Aaron Boyce has joined us and 1. Our 1st and 2nd year registrars case based teaching spanning the
is already working hard at optimising enjoyed a full weekend of teaching most complex of cases to common
his new department in Townsville. and discussions, with education being scenarios, and was attended by a
Possibly invigorated by the beautiful provided by both junior and senior multidisciplinary audience including
January Townsville weather, in his consultants. Special thanks to Dr Lisa many Dermatologists, registrars,
short time with us he has engaged the Byrom and Dr Sarah Morton for putting Gynaecologists and nurses.
hospital, both individually and through the weekend together, and the South
College, with a view towards creating East Dermatology team for hosting. Dr Dougal Coates
a top tier department in The North. We The QLD faculty was fortunate Chair, QLD Faculty
WA Faculty
In Western Australia, like our friends teledermatology in public and private as our new Faculty Secretary and I
and colleagues in other states and services where it was not available congratulate her on this appointment
around the world, we are attempting before. Hopefully there may a ‘silver and look forward to working closely
to adapt to the rapidly changing lining’ to what is a very large grey with her over the next two years. Dr
clinical environment created by the cloud over our service at present and Anne Halbert will be representing our
COVID-19 pandemic. Whist our this may in the form of expansion of Faculty on the AMAWA Council and
educational events for the year are teledermatology services in our state. we are excited to have her respected
postponed, I am heartened to see our We welcome Dr Arif Aslam, from the voice at this important table. Thank
registrars and fellows working together United Kingdom, and Dr Rochelle Gild, you to our immediate past Chair, Dr
to keep ourselves safe and healthy from Victoria, to our Faculty this year. Tony Caccetta for an outstanding
whilst aiming to continue dermatology We also welcome two new registrars; term as a cohesive and visionary
service provision to the people of Dr Georgia Farrah who has transferred leader for our Faculty. I look forward
Western Australia as best as is from interstate, and Dr Jasmin Korbl to continuing to work with the Faculty
possible in very difficult circumstances. to our training program. We hope to aim to deliver the best Dermatology
Whilst a teledermatology pilot you find our Faculty engaging and service possible to the people of
program in rural Western Australia professionally stimulating and look Western Australia.
has been temporarily put on hold due forward to your contributions to
to the COVID-19 situation, we are Western Australian Dermatology. Dr Austen Anderson
being forced to rapidly adapt and offer Dr Rachael Foster has been elected Chair, WA Faculty
SA Faculty
Unfortunately, with the evolving the very important State Examiner job arranged and run the student prize
COVID-19 situation the ASM which to Dr Emma Haverhoek who is wished again (won by Katherine Moore) and
was to be held in May has been well for the future in this. Dr Karen Koh we are grateful to him for his efforts.
postponed until April 2021. The huge has put a significant amount of time Dr Matthew Cho is welcomed as a
efforts of ASM organizers Dr Sally and effort over many years into this new Fellow starting work in South
Ball and Dr Emma Ryan are much including previously running the Part Australia. Dr Sachin Vaidya will
appreciated, and we look forward 2 Fellowship examination in Adelaide. continue with the Vitiligo clinic at
to their interesting programme when She is greatly thanked by the Faculty the Queen Elizabeth Hospital and
permitted. for all her work. has arranged for the excimer lamp
The Annual General Meeting in Dr Stuart Murray has stepped down to be available to patients in private
February was attended by College from the role of longstanding Treasurer as funding was withdrawn for the
CEO Tim Wills who gave a good run as per the new State By-laws and technician at the hospital.
through the Strategic Plan for College we thank him for his work as well
that has been approved. Dr Karen as Dr Christopher Tyson taking on Dr Romuald Czechowicz
Koh is now handing over the reins of this job. Dr Christopher Ross has Chair, WA Faculty
THE MOLE | Autumn 2020 | 17ASM ADELAIDE
2020, MOVED
TO APRIL 2021
X I I I X II IN
I ITNET ERRN
N AAT T
I OI N
OA N
L A L
CONGRESS OF
CONGRESS
DERMATOLOGYOF
DERMATOLOGY
MELBOURNE AUSTRALIA
MELBOURNE AUSTRALIA
CALL FOR ABSTRACT
SUBMISSIONS
NOW OPEN!
XIII INTERNATIONAL
CONGRESS OF
DERMATOLOGY
The 13th International Congress of Dermatology
(ICD 2021) Local Organising Committee invites
MELBOURNE AUSTRALIA
The College Board after careful consideration has decided the submission of abstracts for original work
to postpone the 2020 Annual Scientific Meeting until for consideration as an oral presentation, mini
10-13 April 2021 at the Adelaide Convention Centre. oral with digital poster and/or digital poster
The decision is due to the escalating and dynamic nature presentation
X I I I I N TinEthe
RN Congress
A T I OProgram.
NAL
of the COVID-19 pandemic and its ramifications on the
ability of fellows, trainees, guest speakers, international CONGRESS OF
The key themes are Common skin diseases
and their treatment, Translational dermatology,
guests, sponsors, exhibitors, and other attendees to
commit or be able to attend the meeting. College believes DERMATOLOGY
Global health and Technology which showcases
the opportunities and challenges in the world of
this is the most responsible course of action. MELBOURNE AUSTRALIA
dermatology.
We are looking at opportunities to present a number of Please register to create an account to upload your
webinars throughout the year on key topics including submission, by using this link.
XIII INTERNATIONAL
those focussing on supervising training. We will create
an opportunity for Trainees to present their posters as CONGRESS OF
If you have any questions regarding the abstract
well, again in webinar format. DERMATOLOGY
submission process, please visit the website or
contact the
M EProgram
L B O U R N Coordinator
E A U S T R A L I Avia email or
Ph: +61 3 8888 9500
10 – 13 APRIL 2021
18 | THE MOLE | Autumn 2020
XIII INTERNATIONALDELIVERING HIGH QUALITY MEMBER SERVICES & SUPPORT
Access of remote Top End
dermatology
residents to the spectrum
of health services is
notoriously difficult,
and despite indicators of
health disparity overall outreach
Medicare funding spent
on urban Australians
vastly exceeds that of
remote and Aboriginal
populations.
During my most recent quarterly Dermatology visit
to Katherine Region 300km south of Darwin I was
joined by new FACD graduate Dr Dana Slape. With
her assistance to manage the load of patients and
educational activities I was able to reflect on the time,
cost commitments, validity and outcomes of this type of
service to rural and remote areas.
DR LACHLAN WARREN
N
orthern Territory Health funds SONT and more recently Dev Tilakaratne have
(Specialist Outreach NT) to enable provided valued services to Nhulunbuy and
regional access to a range of visiting Aboriginal communities of Gove Peninsula and
health services to Top End communities and surrounding locations. SONT funding facilitates
regional centres. Whilst many specialties administration, logistics, transport (flights and
(including paediatrics, gynaecology, renal, road), accommodation and sessional medical
psychiatry, ophthalmology etc) regularly salary support.
service smaller communities, Dermatology Access of remote residents to the
SONT is limited to East Arnhem and Katherine spectrum of health services is notoriously
regions. For the last 11 years I have provided difficult, and despite indicators of health
3 monthly visits of 2-day duration to Katherine disparity overall Medicare funding spent on
Hospital and Wurli Wurlinjang Aboriginal Health urban Australians vastly exceeds that of
Service, whilst Jenny Menz, Ian McCrossin remote and aboriginal populations.
THE MOLE | Autumn 2020 | 19DELIVERING HIGH QUALITY MEMBER SERVICES & SUPPORT
DERMATOLOGY OUTREACH
CONSULTATIONS
During our recent 2 day visit 34 Illustrative patients
referred patients were seen at
• Previously longstanding (many years) undiagnosed cutaneous
Katherine Hospital outpatients and
lupus referred for assessment of “unusual psoriasis” (photograph).
23 at Gudbinji Aboriginal Health
Stigmatised and isolated from community and family, this proud
Service. Clinics are deliberately
and sensitive man had avoided any contact with his 2-year-old
heavily overbooked with the
grandson for fear of transmitting the condition. Prior biopsy
expectation of 30-40% failure to
was inconclusive presumably due to sampling error, his referral
attend rate, especially those who
was initiated 6 months prior to his visit and this was his first
need to fly in from more distant
opportunity for dermatologist input. With education and treatment
communities during Wet Season.
major benefits are anticipated
Coronavirus concerns also restricted
some travel. If by some miracle • Infected scabies – whilst in endemic areas pyoderma, tinea and
everyone attended these clinics it scabies are often overdiagnosed (“confirmation bias”), when
would be nigh impossible to cope. features are atypical or when inadequate treatment fails the
Despite transport and time issues correct diagnosis may be discarded, as in this case. Being able to
resulting in schedule disruption there provide a specific and confident diagnosis with dermoscopy and
is gratitude and no sign of anger microscopy facilitates curative treatment, and guides community
at waiting times, with tolerance of health initiatives
delays generally accepted with
• Severe progressive acne accompanied by androgenisation in a
good humour.
female bodybuilder is a consultation which requires investigations,
Case mix includes many with
care and follow-up extending beyond what irregular Dermatology
numerous difficult and neglected
visits can provide. Colleague assistance required!
skin tumours (including in the many
local immunosuppressed transplant • Opportunistic consultations and input are encouraged in aboriginal
recipients), socially and lifestyle- health services such as the accompanying child with years of
related infective conditions and a untreated tinea capitis
smattering of the worried well.
Care and follow-up
extends beyond
what irregular
Dermatology
visits can provide.
Colleague assistance
Cutaneous lupus, scabies dermoscopy
required!
20 | THE MOLE | Autumn 2020EDUCATION AND HEALTH previous dependence on the engine would not start!), minor
PROFESSIONAL SUPPORT uncertainty of diagnoses and discomfort (poor sleep), different
At our clinics a Charles Darwin observations of chronic scabietic food ……
medical student provided valued complications.
local and IT (“Communicare”) help IS DERMATOLOGY OUTREACH
and perspectives. Hospital morning OUTREACH – LOTS OF WORTH THE BOTHER?
handover including resident and PROBLEMS TOO! Without visible activity and input
locum consultant physician liaison I explained to Dana our dependence the specialty of Dermatology
assists recognition of the roles and reliance on relationships becomes progressively irrelevant
and credibility of dermatology. with administrative, clinic and in health care. Providing periodic
As requested by health service medical staff on the ground, and Outreach to remote areas takes
staff whilst I continued afternoon the problems of loss of expertise us out of our comfort zone,
consulting Dana gave a 90-minute when local staff move on, as induces new complexities, and
presentation on indigenous skin they frequently do. For surgical is not lucrative. To me provision
disease to 25 captivated medical, procedures reliance on inadequate of services to the most severely
nursing, pharmacy and aboriginal disposable instruments and underprivileged, disadvantaged and
health workers and students. compromised suture and other needy especially in our rural and
With such a spread of experience materials often turns a simple indigenous population is our duty.
ensuring audience needs are met operation into frustration! Result and Support to those rural and remote
is a major task but the universal outcome follow-up and duty of care health care workers who spend
request transmitted to me was for are constant issues. Documentation, their life committed to this goal is
more such input. Clinic nursing and measuring activity and duty of care important and greatly appreciated.
medical officers were especially are special burdens but without Opportunities to provide
interested in dermoscopy - to some form of audit our quest for Dermatology Outreach are worth
see living scabies mite got them continuation of dermatology funding seeking out and a privilege in which
quite excited, given their enforced is unlikely. Transport delays (plane to be involved.
Dr Dana Slape gave a 90-minute presentation on
Indigenous skin disease to 25 captivated medical, nursing,
pharmacy and aboriginal health workers and students.
THE MOLE | Autumn 2020 | 21You can also read
