BY SEAN FLINTOFT — PUBLICATIONS PROJECT MANAGER
How many times have you heard the following statement:
“I would like to acknowledge the Wurundjeri people who are the Traditional Custodians of this Land. I would also like to pay respect to the Elders both past and present of the Kulin Nation and extend that respect to other First Nations peoples present.”
If you haven’t heard this or any of its variations yet, you certainly will. This Acknowledgement of Country is a key step that The University of Melbourne and many other organisations are taking to move this country in the right direction. As you progress through your education, you too will speak these words and champion the cause. However, I recently had the pleasure of learning that, for many years, the respect I had hoped to communicate through my use of this phrase was being lost in translation. You may be making the same mistake too.
The Melbourne Museum currently has an exhibition within the Bunjilaka Aboriginal Cultural Centre. It is named First Peoples, and it has been designed by the First Peoples Yulendj Group of Elders and community representatives. This exhibition provides its visitors with a raw and beautiful recount of Aboriginal culture and history, aiming to help museum goers understand what is often left out of traditional Victorian education. I was among a group lucky enough to be invited to the First Peoples Exhibition, to tour it and to speak with some of the First Peoples Yulendj Group of Elders who designed it. Here is the moment I was shown my error:
We sat in a circle. Our eyes were met by the kind gaze of an Elder. They asked us each where we grew up. I had previously been told that the area in which I grew up was actually Bunurong Country, so when it was my turn, I told the Elder: “Hello! My name is Sean, and I grew up in Hampton, which I believe is Bunurong Country!”.
“Okay, tell me about Bunurong Country” the Elder said.
I was stumped. As was everyone else that told the Elder what country they grew up on. The Elder then went on to implore us to learn about the country we live on, and to learn about the history of its people. That way, when we acknowledge country, we can do so from a place of deeper understanding and appreciation. That way, we can really express our respect for the opportunity to be where we are.
I am grateful to this Elder for showing me that identifying the traditional name of the land I inhabit is a good first step, but learning about it is the next. Naturally, the next question that was asked of this Elder was: “Can you recommend any good resources to begin deepening our understanding of First Nations people, land and history?”.
Despite our ineptitude, we couldn’t help but chuckle when the Elder replied with “Google.”
Amusing as it was, they were only half joking. Many of us do not take the time to google our questions about First Nations history, despite agreeing that it is a good thing to do. There are many valuable online resources that we can use to deepen our understanding about the land we live on, and with the diversity of the many First Nations communities and countries that exist around us, it is difficult to recommend any one resource. However, the Elder did have some more specific suggestions for Victorians. Here they are:
- The First Peoples Exhibition at the Melbourne Museum
- Dark Emu, an eye-opening book by Bruce Pascoe
Both these resources provide an overview of the history and culture of First Nations communities within Victoria that you can use as a starting point. From there, deepen your understanding by searching the web for answers to the questions you discover. You may be surprised by how easy it is to find them.
While we’re on the topic of searching the web for answers, I would like to remind you that if you can’t make it down to the Melbourne Museum, perhaps due to the pandemic that shall not be named, you can always take an online tour of the First Peoples Exhibition. It is an incredible way to better your understanding of the place you call home, and to ensure that you don’t make the same mistake as I.
I wish you luck on your journey of understanding and discovery. Stay safe and best of luck for the year ahead.
Writing from Bunurong Country, down along Nairm. ●
BY LAURA KALITSIS — PUBLICATIONS OFFICER
The mental health status of university students is a growing public health concern. Students in the higher education system are susceptible to mental health struggles. Rates of mental illness, such as anxiety and depression, as well as states of emotional exhaustion and burnout are greater in the student population compared to the general population. Despite the recognition of the stressors that university students face, prevention and treatment of the consequential mental health struggles remain unclear and inadequate.
An introduction to student mental health
According to the World Mental Health Survey conducted by the World Health Organisation (WHO), university students have a significantly higher proportion of mental health illnesses compared to the general population. Students participating in this survey were screened for six different mental health conditions (major depression, generalised anxiety disorder, panic disorder, mania/hypomania, alcohol use disorder and substance use disorder). Results from this survey indicate that 35% of students suffer from a mental health condition. Similarly, the National Youth Mental Health Foundation conducted a National Student Wellbeing Survey in collaboration with Headspace. This questionnaire investigated the impact of academic, financial, transitional and health stressors on the university experience of Australian students. It was observed that 65% of students reported high or very high psychological distress during the academic year and 67% of students rated their mental health as fair or poor at times.
The results of both studies clearly show that whilst the student experience is an exciting and growth inducing phase of life, instability and stress accompany it. Navigating the transition to independence introduces financial and housing instabilities. Exploring one’s identity may lead to changes in social groups and relationships. Selecting courses and careers is a daunting process that many students find distressing. There are also several academic stressors such as meeting high-stake assessment deadlines, understanding large content loads and inadequate academic support. Although such experiences are important learning opportunities, the associated stress is a causative factor of mental health struggles in the student population.
The impact of COVID-19 has only heightened stress and mental health challenges faced by students. The necessary lockdown policies induced feelings of isolation and loneliness as social activities came to a halt. Academic teaching moved to online modes and many internships and work experience opportunities were cancelled. Additionally, loss of jobs enhanced financial distress and created difficulties for students to meet accommodation and tuition fees.
What is burnout?
Psychologists describe burnout as a state of mental and physical exhaustion. Currently, burnout is not recognised as a diagnosis as it is not listed in the Diagnostic and Statistical Manual of Mental Disorders (DSM). Therefore, it is difficult to develop treatment plans and management guidelines. Furthermore, this lack of a formal diagnosis creates challenges in understanding the prevalence and distribution of burnout amongst students. To assist in it’s recognition, burnout can be broken down into three components: emotional exhaustion, depersonalisation and reduced sense of personal accomplishment. Emotional exhaustion is characterised by physical and psychological symptoms of fatigue and feeling depleted from academics or work. Depersonalisation is the feeling of detachment from oneself, as if one is watching their life from the outside. Lastly, reduced sense of accomplishment describes a lack of internal motivation and reduced satisfaction from study or work.
Stress is both a predictive factor and indicator of burnout. Due to increased levels of instability and psychological distress associated with the university experience, students are at risk of developing burnout during their academic years. Academic burnout has a plethora of consequences. Students working with burnout are less effective in academic and professional settings. Additionally, failure, absenteeism and dropout rates are higher in chronically stressed or burnout students. Burnout increases the risk of future mental health problems such as depression, substance abuse, suicide and suicidal thoughts.
Preventing and treating burnout
Both the management and treatment of burnout currently remains unclear. However, there are several strategies students can implement to prevent burnout. Motivation is a force that drives learning and sustains behaviours towards a particular goal. For students, it can be difficult to recognise and find motivation, which can make academic tasks and deadlines more daunting and stressful than they should be. Therefore, it is important for students to reflect and identify what is motivating their academic study. Intrinsic motivation is an internal drive to study or work because of one’s inherent interest in the course content and their future career. Whilst it can be challenging to find intrinsic motivation, studying with intention is associated with higher levels of accomplishment.
Developing stress management techniques is vital in preventing burnout during the academic year. Self-care strategies vary from student to student, but it is important that students implement such techniques within their routines. Meditation is an effective way of monitoring and supporting mental health. Practising mindfulness is demonstrated to decrease stress and improve student wellbeing. Organisations such as Headspace and Calm provide guided meditations to reduce stress and anxiety and improve sleep quality. Alternatively, regular physical activity has multiple mental and physical health benefits. Studies show that physical inactivity is associated with poorer mental health, self-harm and suicidal thoughts. Thus, it is important that students are encouraged to find an enjoyable form of exercise, especially if this exercise takes place in natural environments, as additional research has demonstrated that exercise in nature or green spaces can improve mental wellbeing.
Building emotional support systems also plays a significant role in preventing and treating mental health struggles. Discussing problems with friends and family or participating in social activities are great mechanisms of psychosocial support. Additionally, asking student mentors and alumni questions can aid in relieving academic and career stress. However, in circumstances where one’s support systems are insufficient, seeking help from professionals can provide struggling students with the necessary care and treatment plans. Unfortunately, several barriers prevent students from seeking professional help. According to the WHO World Mental Health International College Student Initiative, only 24.6% of students reported that they would definitely seek treatment for future mental health issues, and many students would prefer to handle mental health problems on their own or discuss with friends and family. There are an abundance of reasons that prevent students seeking necessary care, including stigma surrounding mental health issues, the high cost and extensive wait times for psychologist appointments, failure to recognise problems, or perception that treatment is not necessary. Universities endeavour to support the mental wellbeing of students by encouraging discussion about mental health and providing counselling services. However, the number of students in need of treatment well exceeds the psychological and counselling services available.
The student mental health crisis is a multifaceted issue that involves solutions from various sectors. Improving mental health literacy and accessibility to treatment is necessary for students to prevent, recognise and manage any mental health issues. Discussing mental health aims to break down associated stigma and hopefully allow students to feel comfortable seeking treatment. For students battling mental health struggles, you are not alone. There is always someone to talk to whether that be a friend, family member or professional. ●
1. Auerbach R, Mortier P, Bruffaerts R et al. WHO World Mental Health Surveys International College Student Project: Prevalence and distribution of mental disorders. J Abnorm Psychol. 2018;127(7):623–638. https://doi.org/10.1037/abn0000362.
2. Rickwood D, Telford N, O’Sullivan S, Crisp D, Magyar R. National Tertiary Student Wellbeing Survey 2016. Headspace.org.au. https://headspace.org.au/assets/Uploads/headspace-NUS-Publication-Digital.pdf.
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4. Lyons Z, Wilcox H, Leung L, Dearsley O. COVID-19 and the mental well-being of Australian medical students: impact, concerns and coping strategies used. Australasian Psychiatry. 2020;28(6):649–652. https://doi.org/10.1177/1039856220947945.
5. Parker G, Tavella G. Burnout: modeling, measuring, and managing. Australasian Psychiatry. 2021;29(6):625–627. https://doi.org/10.1177/10398562211037332.
6. Ishak W, Nikravesh R, Lederer S, Perry R, Ogunyemi D, Bernstein C. Burnout in medical students: a systematic review. Clin Teach. 2013;10(4):242–245. https://doi.org/10.1111/tct.12014.
7. Kilic R, Nasello J, Melchior V, Triffaux J. Academic burnout among medical students: respective importance of risk and protective factors. Public Health. 2021;198:187–195. https://doi.org/10.1016/j.puhe.2021.07.025.
8. Rehman A, Bhuttah T, You X. Linking Burnout to Psychological Well-being: The Mediating Role of Social Support and Learning Motivation. Psychol Res Behav Manag. 2020;Volume 13:545–554. https://doi.org/10.2147/prbm.s250961.
9. Ryan R, Deci E. Intrinsic and extrinsic motivation from a self-determination theory perspective: Definitions, theory, practices, and future directions. Contemp Educ Psychol. 2020;61:101860. https://doi.org/10.1016/j.cedpsych.2020.101860.
10. Wu H, Li S, Zheng J, Guo J. Medical students’ motivation and academic performance: the mediating roles of self-efficacy and learning engagement. Med Educ Online. 2020;25(1). https://doi.org/10.1080/10872981.2020.1742964.
11. de Vibe M, Solhaug I, Tyssen R et al. Mindfulness training for stress management: a randomised controlled study of medical and psychology students. BMC Med Educ. 2013;13(1). https://doi.org/10.1186/1472-6920-13-107.
12. Meditation and Sleep Made Simple – Headspace. Headspace.com. https://www.headspace.com.
13. Calm – The #1 App for Meditation and Sleep. Calm.com. https://www.calm.com.
14. Grasdalsmoen M, Eriksen H, Lønning K, Sivertsen B. Physical exercise, mental health problems, and suicide attempts in university students. BMC Psychiatry. 2020;20(1). https://doi.org/10.1186/s12888-020-02583-3.
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17. Ebert D, Mortier P, Kaehlke F et al. Barriers of mental health treatment utilization among first‐year college students: First cross‐national results from the WHO World Mental Health International College Student Initiative. Int J Methods Psychiatr Res. 2019;28(2):e1782. https://doi.org/10.1002/mpr.1782.
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BY BRIANNA HEINKEN — DIRECTOR OF COMMUNITY ENGAGEMENT
Australia is one of the safest places in the world to give birth. In fact, Australia consistently ranks in the top 10 countries to be a mother world-wide. However, despite the safety of being a mother in Australia, recent data has shown that the maternal mortality rate for Indigenous women remains a concern.
A maternal death is defined as the death of a woman while pregnant or within 42 days of the end of pregnancy. Maternal deaths are divided into two categories: direct and indirect. Direct maternal deaths are caused from obstetric complications of pregnancy. Indirect maternal deaths are caused from diseases or conditions that were not due to an obstetric cause, but were aggravated by the physiologic effects of pregnancy. The number of direct and indirect deaths each year are used to calculate Maternal Mortality Rate (MMR), which is the rate of maternal deaths per 100,000 women giving birth.
The Australian Institute of Health and Welfare (AIHW) reported that the MMR for non-Indigenous women was 5.5 per 100,000 women giving birth between 2012 and 2019. The report also revealed that Indigenous women are dying from pregnancy complications at a much higher rate, with an MMR of 17.5 per 100,000 women giving birth in the same period. These poorer health outcomes can be attributed to a wide range of risk factors, including a higher rate of substance abuse among Indigenous women and difficulty accessing health services.
HOW DID WE GET HERE?
Substance abuse during pregnancy, including smoking, harmful use of alcohol, and drug abuse are all associated with poor birth outcomes. Smoking and drug abuse during pregnancy causes major developmental disorders in babies and labour complications for the mother. Harmful use of alcohol during pregnancy causes abnormal development and increased risk of Sudden Infant Death Syndrome (SIDS). Substance abuse behaviours are more common among Indigenous women than non-Indigenous women, which must be understood as a result of displacement from traditional lands, limited education, economic disadvantage, marginalisation, and other associated losses. For example, about half of all pregnant Indigenous women smoke during pregnancy, compared to one eighth of non-Indigenous pregnant smokers. High rates of smoking, alcohol abuse, and drug use are contributing factors that make Indigenous women more susceptible to pregnancy complications than non-Indigenous women and helps explain the higher Indigenous MMR.
In addition, Indigenous women are less likely to access prenatal care during the first trimester of pregnancy, a time when many risk factors can be addressed. About half of Indigenous women accessed prenatal care at some point in their pregnancy, compared to the national average of two thirds of pregnant women. In addition, compared with non-Indigenous women, access generally occurred later in the pregnancy and less frequently. Without the early intervention of medicine, Indigenous women have a higher risk of pregnancy complications and maternal death.
Most importantly, Indigeous women face a number of barriers to accessing health services, including cost, distance from services, and culturally unsafe healthcare providers. Access to maternity health services varies between remote and non-remote areas, with cost being a more significant issue in urban Indigenous communities and distance being more significant in remote areas. Indigenous women in remote communities are required to travel to larger centres for maternity care, causing isolation and dislocation from their communities. This travel is also associated with inappropriate accommodation for women while in towns and lost wages if a partner has to stop working to care for the family. In addition, culturally unsafe healthcare providers can intentionally or unintentionally diminish the cultural identity and wellbeing of an individual, making them feel unsafe and rejected.
Where to from here?
In order to improve the MMR in Indigenous communities, it is important to recognize that the birthing experience of Aboriginal and Torres Strait Islander women is culturally different from that of non-Indigenous women. In many communities, birthing continues to be a cultural rite of passage where links are established to land, connections with country are celebrated, and knowledge is passed from older to younger women. Many Indigenous communities have specific birthing rituals and desire to give birth on country, rather than travel to metropolitan settings. Improving access to culturally sensitive health professionals in Indigenous communities is an important step to decrease maternal deaths among Indigeous women. Indigenous women often desire access to safe and high quality care in their own community and are more likely to access services that are provided in culturally-safe places. It is important to recognize the importance of culture and country for Indigenous women, and work with cultural leaders to create successful birthing programs.
Pilot programs across Australia have focused on midwives and Aboriginal Health Care workers, which provide culturally-appropriate care in community-based settings. The New Direction Mother and Babies Service is an example of an initiative being piloted for Indigenous families in areas of high risk. This program, funded by the Federal Government, aims to increase access to, and use of, child and maternal healthcare services for Aboriginal and Torres Strait Islander families in three remote communities. If successful in its trial, it is important that this program is expanded to other remote communities throughout Australia.
Increasing the use of midwives providing care throughout a pregnancy and after birth in remote areas is also an important strategy to decrease maternal deaths among Indigenous women. An example of this is the Malabar Community Link Service, which offers midwifery care for women during pregnancy, labour, and six weeks after birth. This service cares for Aboriginal women and their families, women from culturally diverse backgrounds, young mothers, and women with limited resources. So far, results from this program consistently show decreased use of medically-necessary interventions for women who received midwife-led care compared to women who received other models of care.
Although recent data about maternal mortality in Australia remains concerning, we are equipped with the tools to improve health outcomes and birthing experiences nation-wide. In coming years, it will be crucial to incorporate culturally-safe healthcare services, especially in remote communities, to increase access to medical care and decrease the maternal mortality rates in Indigenous communities. ●
1. Save the Children. “State of the World’s Mothers 2015: The Urban Disadvantage.” Save the Children’s Resource Centre, Save the Children International, 2015, https://resourcecentre.savethechildren.net/document/state-worlds-mothers-2015-urban-disadvantage/.
2. Australian Institute of Health and Welfare. “AIHW: Maternal Deaths Low in Australia, but Indigenous Women Remain at Greater Risk.” Indigenous.gov.au, 2015, https://www.indigenous.gov.au/news-and-media/announcements/aihw-maternal-deaths-lowaustralia-indigenous-women-remain-greater-risk.
3. Australian Institute of Health and Welfare. “Maternal Deaths.” AIHW, Australian Government, Dec. 2021, https://www.aihw.gov.au/getmedia/8b25ea27-7304-441c-b708-48c65ce5bb55/Maternal-deaths.pdf.aspx?inline=true.
4. U.S. Department of Health and Human Services. The Health Consequences of Smoking—50 Years of Progress: A Report of the Surgeon General. Atlanta: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2014.
5. Walker, R.C., Graham, A., Palmer, S.C. et al. Understanding the experiences, perspectives and values of indigenous women around smoking cessation in pregnancy: systematic review and thematic synthesis of qualitative studies. Int J Equity Health 18, 74 (2019). https://doi.org/10.1186/s12939-019-0981-7.
6. Australian Institute of Health and Welfare. “Aboriginal and Torres Strait Islander Health Performance Framework 2008 Report.” AIHW, 2008, https://www.aihw.gov.au/getmedia/ee2f1311-a955-45f6-871f-bd606076826d/aatsihpf08r-da.pdf.aspx?inline=true.
7. Save the Children Australia. “State of Australia’s Mothers.” Savethechildren.org.au, Save the Children, https://apo.org.au/sites/default/files/resource-files/2016-05/apo-nid63692.pdf.
BEN SMYTH — COMMUNITY ENGAGEMENT PROJECT OFFICER
HENRY SUNDRAM — COMMUNITY ENGAGEMENT PROJECT OFFICER
Centre for cOMMUNITY cHILD hEALTH (CCCH) — THE ROYAL CHILDREN’S HOSPITAL
At the Centre for Community Child Health, we’re striving for equitable health and developmental outcomes for all children. The Centre has been committed to improving the lives of children and families for the past 25 years and we will continue to lead efforts to achieve equitable outcomes until this vision becomes reality.
The Centre provides leadership on the health and wellbeing of children aged 0–8 years. It aims to:
- improve development outcomes for Australian children;
- advance equitable health for disadvantaged children;
- and promote positive early life conditions for children.
Ben Harkin is a Fellow in Community Child Health, undertaking The Victorian Training Program in Community Child Health at CCCH.
This program provides clinical and theoretical training in developmental-behavioural paediatrics. Fellows develop individual learning goals for the year, and are paired with mentors who have expertise in clinical practice, population child health research, public health and policy development, and program development and evaluation. Moreover, an emphasis is placed on clinical training that occurs within community and specialist outpatient clinic settings.
What was your educational and career path like, and how did you eventually transition into medicine and paediatrics?
I had a very unusual path into medicine. I came to medicine much later in life as a mature-age student (early to mid-30s). Before that, I did a Masters of Public Health—which I embarked upon because I needed to do more tertiary education closer to applying for medical school and it seemed to be a logical thing to do.
But prior to my Masters, I hadn’t done any science or anything in that field since I left school. I went to Melbourne University and did an arts degree, then as I had an interest in the performing arts, I auditioned for different drama schools in Australia and attended the Western Australian Academy of Performing Arts. Following which, I worked for about 10 years as an actor, director and producer.
Then when I was in my early 30s, I was thinking about my future and what I would be doing in 10 years time, and I thought, ‘the thing I’m doing now, I’m done.’ And then I thought: ‘what am I going to do with the rest of my life?’ I rang some mates who were doctors and said, ‘I’m in my mid-30s, how do I become a doctor? Is it possible?’ They said, ‘sure, you have to sit the GAMSAT and can apply as a mature age student.’’ So that’s what I did. Remember that it’s never too late to shift to something else and that skills you have in one career can also be transferred to other careers.
Being a doctor isn’t just having a knowledge base—it involves patient relationships, working in management teams and hospitals.
I attended medicine at the University of Western Australia and they had a version of the course where we crammed in all the basic science stuff as a cohort of 60 mature-age students in seven months and then joined the undergrads in the clinical years. What was interesting about that cohort is that about a third of them were from non-science, non-medical backgrounds.
For me and others who don’t come from a medical background, the first seven months were just crazy—it felt like my brain was exploding every day, getting around concepts like the Krebs cycle and biochemistry. But once we hit the wards and began clinical work, those of us who had non-medical backgrounds started to feel a bit better and do quite well because our patient interactions were influenced by our life experience.
The moral of the story is that if you would like to change your pathway, be aware that you bring a lot of different things to your practice as a doctor. Being a doctor isn’t just having a knowledge base—it involves patient relationships, working in management teams and hospitals.
What advice would you give to medical students who are unsure about which fields they would like to pursue? More generally, what advice would you give to those who are unsure about which career path to follow?
The experience of a med student is that you never know anything because you’re always being asked by someone who knows more than you. I remember saying to one of these senior people, ‘I’m so sick of just feeling stupid all the time’ and he said, ‘Don’t worry, that’s your entire life in medicine; there’s always going to be someone in the room who knows more than you.’
What’s interesting about medicine though is that there’s a niche for every personality type and interest; it’s so broad. Because of that breadth, it’s impossible to know everything about everything. People have different approaches to this: some people prefer a more generalist approach where they get to do a lot of different stuff and have a certain level of knowledge across a broad base, such as general pediatricians and general practitioners, and then other people like to drill down and know everything about a particular field and subspecialise.
A useful thing to ask is: how does your brain work? Do you like to know a lot about a specific thing or do you prefer a more general approach? Then what type of medicine do you like to do: the kind of procedural-based, practical stuff; or more patient interaction?
The other important thing is to look at other people in the career that you’re wanting to pursue. This applies to everything in life, but with medicine, certain personality types are drawn to certain specialties. But also those specialties create a world that encourages that personality type. You can look at the physicians or surgeons that are in the area of medicine you want to go into and think, ‘Are these my people?’
Find something that you’re interested in and talk to people who are in the field. What’s their daily experience? What are the good things and what are the crappy things about the job? Because there will always be good things and bad things. For me, before working in developmental paediatrics, I couldn’t quite find my niche in medicine. When I started working more specifically in developmental paediatrics, I kind of thought, okay, here are my people. This is where I fit.
This applies to everything in life, but just to talk about medicine: certain personality types are drawn to certain specialties. But also those specialties create a world that encourages that personality type. You can look at the physicians or surgeons that are in the area of medicine you want to go into and think, ‘Are these my people?’
What is your typical day like? Does it vary or do you have a particular structure that you follow?
I’ll talk very briefly about a day in the hospital, which is not what I’m in now but what I’ve done for many years. As a junior doctor, you’re the one that often gets all the jobs done, you’re the engine that makes the team work. There are more senior doctors who are making management decisions and discussing with colleagues and deciding what investigations or other tasks might need to be organised by the junior doctors. They also coordinate the team and make sure everyone works well together. So that’s your basic nine-to-five day. There is also an after hours component in big hospitals, where you will be covering the care of patients from a number of teams that you may not necessarily be involved in on a day to day basis.
The work I’m doing now is more outpatient-based and so I see kids and families from a range of cultural backgrounds with very complex social backgrounds, lower socioeconomic status and trauma. These kids may have developmental/behavioral difficulties such as delayed speaking, autism spectrum disorder, behavioral dysregulation, ADHD, a whole lot of things. Basically, if someone identifies a kid who’s at risk of not developing, they come to me for an assessment and I try to work out what’s going on. I have a couple of days in a community clinic, one day involved in cases where children have a background of Child Protection involvement and another day working with mental health services.
So my current work is not about sick kids in the hospital. It’s not just getting them in, making them well and sending them home, it’s a much longer process. This is stuff where I see kids over months to years and try to slowly make improvements. Since every kid’s different, each child is a bit of a detective case to suss out and a large part of that is working with the families to understand their experience, and the child’s experience within the context of the family, school, larger society.
What was your journey like through training and how have these experiences influenced your practice?
For those readers who might be medical students, your exams are ongoing and you always continue to study and learn. Certainly, there are people in medicine who have incredibly bright minds and think in incredible ways, but there are also people who have different strengths. I don’t think you have to be a genius to be a doctor but you must be smart enough to know how to study and particularly be able to apply yourself consistently. One thing you need to get through medicine is to be able to persist because it’s a long slog.
In order to work well in this area of medicine, you have to recognise the toll it takes, and be able to offload and accept that. This is an important part of your training. It’s very enjoyable, but it’s also very intense.
In terms of training once you have graduated from medical school, most of our basic pediatric training is geared towards acute medicine (although interestingly enough, many general pediatricians working in the community will not see these acute presentations). The first part of training is fascinating but also very challenging. There are certainly some difficult times along the way in terms of really hard exams you need to pass, challenging patients and family interactions, and really sick kids.
Therefore it is important that you have people who support you and ways you can balance your working life. Certainly many of us have found ourselves at points where we feel burnt out. It used to be a problem that people didn’t want to address but now we are becoming more aware that, in order to work well in this area of medicine, you have to recognise the toll it takes, and be able to offload and accept that. This is an important part of your training. It’s very enjoyable, but it’s also very intense. Therefore, make sure you take care of your own mental health so that you can work and take care of others.
Advanced training is where you become more specialised and where you try to become the type of doctor you want to be now that you have a solid foundation of knowledge. This is where you can work out what areas of medicine you want to work in. I’m currently a part of the Victorian Training Program for Community Child Health, which focuses on development and community pediatrics, which basically means I just get to play with kids all the time whilst assessing their development!
You mentioned that this year is giving you a chance to hone in on the areas you’re interested in. I was reading up on the training program and it said that the trainees set personal training goals, and they work with a mentor to realise them. So my question is how did you go about setting those goals and the mental challenges that were associated?
One aspect is, you need to meet the training requirements. There are certain things you’ve got to tick off so some of those goals are about, ‘Okay, I need to do X, Y, and Z to make sure that I’ve done these specific things for these six months so that I’m accredited.’
Typically, minimum training time is probably about six years but most people spend more than that because you can’t really string everything together nicely. Often there are times within the training where you need to work in a particular area of pediatrics to progress but you might not be able to pick up the specific job to fulfil that requirement. So although you’re working as a doctor, it doesn’t necessarily progress your training. So you need to be setting goals and having your mentor keeping you on track to fulfil the training requirements.
Then the other consideration is more about what sort of things do you want to get out of your time? This is where you and your mentor get to have a bit of a philosophical discussion about life in medicine, what is your area of interest and how are you managing the work/life balance, because it becomes pretty all-consuming. That’s one of the biggest challenges that you’re going to talk to your mentor about. If you can, try in your current studies to find a really good way of working effectively and efficiently. It’s a great skill to have—the more efficient you are, the more downtime you’ll have in the future.
It’s always important to remember that you’ve got a rotating roster of doctors in the hospital and part of that reason is so that people finish on time and can hand it over to the incoming team. So don’t feel that everything has to be perfect before you leave. Remember the perfect can definitely be the enemy of the good!
From your meetings with those more senior physicians and supervisors/mentors, were there any gems that you’ve incorporated into your practice?
That’s a great question. I think one of the things to remember about medicine is that you can’t know everything and what is important to know and the way in which you work varies depending on the area of medicine you work in. So for working in an ICU or an ED, there is an immediacy to this area of medicine. There are emergencies that happen and you need to be able to react, and think quickly and efficiently. In lots of other types of medicine, particularly physician’s training, you generally have time to consider the options, research, and plan your approach.
So a great bit of advice I got was recognising that you don’t have to have all the answers immediately. Often in medicine, you recognise that you’ve got some time to consider the issue and knowing how to get the information that you don’t have is the more important skill.
Also knowing that you don’t necessarily need to be the one with all the answers. It’s important to remember that it takes a team to effectively manage a patient, whether that’s an acute medical team or in an outpatient setting, the best way to practise medicine is always in a team.
If the lighting guy is asleep then the stage is dark and it doesn’t matter what you do as an actor, no one’s going to see you.
Forgive the comparison, but this parallels with a performance of a play. It takes a team. If the lighting guy is asleep then the stage is dark and it doesn’t matter what you do as an actor, no one’s going to see you. You’ll find that this applies to most aspects of life.
Although one aspect of medicine is about acquiring knowledge and applying it to patients, the other aspect is effectively communicating to both your team and the patient as well. So another gem is that as a junior doctor, the best residents are the ones who know how to communicate well and get stuff done.
When it comes to medicine or any other career pathway, always try to find ways to venture outside your comfort zone and expand your thinking. I spent the last two years working in remote Western Australia in the Kimberley Region traveling to small Aboriginal communities. I had to adjust and reset my mind to working in clinics there. Adapting to these different environments definitely informed my practice and made me a better doctor. It was a great experience and I would encourage you to always find that opportunity to venture to greater depths because we grow by pushing ourselves to our limits. ●
BY STELLA LIU — DIRECTOR OF COMMUNITY ENGAGEMENT
Biomedical research is a high-impact field with large returns to society that merits consideration as a career pathway. Biomedical researchers endeavour to improve health by investigating how the human body works. Those who pursue this career pathway can find themselves in academia, where they improve tools and techniques, study healthy biological processes, and interrogate the causes and progression of disease. Others land roles in industry, which generally involves generating and evaluating treatments for human diseases and disorders, for commercial applications. Although the road to becoming a biomedical researcher is long and arduous, it is incredibly fulfilling and offers highly interesting work for the intellectually curious.
What is Biomedical Research?
Biomedical research can broadly be divided into several categories:
Improving tools and techniques
- The process of conducting research is the crux of a biomedical research career, wherein there is a consistent need to improve current tools and techniques or develop new ways to understand biological processes. A notable example of this is CRISPR gene editing, for which Emmanuelle Charpentier and Jennifer Doudna were awarded the Nobel Prize in Chemistry in 2020. CRISPR is now commonly used to generate genetically accurate mouse models of disease, which has direct treatment applications.
Studying healthy biological processes
- Knowledge of the most basic human processes, such as how cells function or how the immune system operates, is critical to the progress of biomedical research. University of Melbourne alumni Macfarlane Burnet is considered a scientific hero in this area. He developed the theory of clonal selection, which continues to serve as the foundation of immunology research. However, funding and support for this avenue of research is difficult due to ambiguous real-world applications.
Studying diseases and conditions of interest
- Biomedical research primarily involves studying a particular disease/condition and the mechanics behind disease progression. This includes research to discover the causes of disease (e.g. bacteria, genetic mutation). Studying the interplay between diseases or conditions of interest and normal biological processes is crucial to determining treatment options.
Generating possible treatments
- Knowing the cause of a particular disease/condition doesn’t guarantee that we will find an effective treatment. Generating treatment options can be based on knowledge of the disease/condition, but it can also rely on trial and error. For example, a promising approach to developing a new COVID-19 vaccine involves screening tens of hundreds of nanobodies to find one which can block SARS-CoV-2.
Preliminary evaluation of possible treatments (preclinical research)
- Potential treatments are first examined “in vitro” outside of living organisms. This is an isolated environment which does not represent the complex interactions of a living being. Treatment options can then progress to the “in vivo” stage where tests are conducted on laboratory animals such as mice. This can recapitulate complex human biology, which gives valuable information about the effectiveness of a treatment before it progresses to clinical trial.
- Highly rigorous treatment studies are conducted in humans before a treatment can become widely available. Clinical trials come in different phases, with early phases being focussed on safety and later stages on the efficacy of the treatment. The goal of biomedical research is to generate information from the above categories and bring treatment options to clinical trials.
Why Biomedical Research?
Beyond the processes themselves, biomedical research offers the chance to make a tangible impact on society. Through research, we can offer significant improvements to health with a comparatively small investment of resources (time, money, effort etc). For example, it is estimated that reducing cancer deaths by 1% will save the US an estimated $500 billion. We are commonly exposed to organisations or events promoting support for biomedical research, such as Daffodil Day or MS Walk, but this can skew public perception of how research works. Research that involves studying foundational biology or improving research techniques is essential to treating these highly popularised diseases, but it can often be underfunded or understaffed. These “neglected research areas” have the capacity to offer massive returns in the form of quality adjusted life years (QALYs). For example, anti-aging research tackles issues such as cancer, neurodegenerative disease and cardiovascular disease from the foundation and aims to increase healthy lifespan. This is a far better approach to solving age-related deaths compared to mainstream research which typically promotes prolonging unhealthy lifespan. However, this is not as attractive for public funding or well-intentioned individuals who enter research to “cure cancer”.
Being a biomedical researcher is extremely satisfying, especially for anyone with a curious mind who is up for an intellectual challenge. Biomedical researchers spend most of their career doing self-directed work. Researchers, as early as Honours students, have the opportunity to work and direct their own project. They maintain their independence, creatively develop their own unique experiments and have substantial input on what they do. Furthermore, every day presents a new opportunity to satiate curiosity, whether that be investigating a new question, using different techniques or technologies, or collaborating with researchers across the world from different disciplines. The most successful researchers have intense intellectual curiosity, but also display high levels of resilience. Academia is highly competitive, and researchers must overcome setbacks, which can include a failed experiment or a rejected paper. A good researcher is also able to position themselves to build strong professional relationships and collaborations, which will help with securing funding, publishing ground-breaking papers in top journals, or working in the most prestigious labs. Although intelligence is important in a multitude of careers, it is particularly crucial for success in the interdisciplinary and complex field of biomedical research.
Good researchers are hard to come by, but without dedicated scientists and innovative minds, no amount of funding will solve the world’s most pressing biomedical issues.
Seeing as biomedical researchers often come from science or biomedicine degrees, medicine can be seen as an attractive career alternative which offers a similar intellectual challenge and a general sense of helping society. However, whilst doctors create a tangible impact in the lives of the patients they treat, they are limited in their ability to scale up their impact to match that of research breakthroughs or major policy changes. It is widely accepted that the “social determinants of health” (e.g. education, social-economic status) plays a far greater role in health outcomes than medical professionals do. Furthermore, doctors and health resources tend to be concentrated in areas of least need, a concept summarised by the “inverse care law”. As such, the incremental addition of an extra clinician into an oversaturated field has diminishing marginal returns. Shockingly, Dr Gregory Lewis from Cambridge estimates that an additional doctor will only add 4 QALYs for every year that they work, an impact which can be matched 30 fold by simply donating 10% of their salary to effective organisations that fight global poverty.
People likely to succeed in medical school have the potential to make a far greater impact outside medicine. 80,000 hours — an organisation which researches careers with the largest positive social impact — recommends that for those interested in medicine, the highest impact opportunities can be found in biomedical research. Good researchers are hard to come by, but without dedicated scientists and innovative minds, no amount of funding will solve the world’s most pressing biomedical issues. Dr John Todd, a Professor of Medical Genetics at Cambridge believes that “The best people are the biggest struggle. The funding isn’t a problem. It’s getting really special people” and would rather turn down substantial funds in exchange for a good researcher for his lab. This suggests that large grant options are still unable to attract top researchers, and that top researchers are more valuable than any state-of-the-art lab equipment purchased with grants. If you have the potential to succeed in biomedical research, this is a highly effective career pathway where you will likely have more impact than alternative pathways with the same degree. ●
BY SRESHTA SHERI — PRESIDENT
Food has long been a part of the story of humanity. Our relationship with food has changed in significant ways over thousands of years but perhaps the most dramatic changes have occurred only in the last 50 years. Food has gone from merely a means of survival to a key aspect of the human experience with a huge role in culture, comfort, and health. Even though diets hold a sacred space in the story of humanity, they may also be underpinning what is turning out to be one of the most destructive healthcare challenges of the modern era — the rise of overweight and obesity.
Increased adiposity and obesity are increasingly linked to many other diseases such as type 2 diabetes, cardiovascular disease, and some types of cancer. The challenge that these non-communicable diseases (such as heart disease, diabetes, stroke, and cancer) present are vast and significant, representing a great burden on resources not only in Australia but across the globe, with the epidemic spreading to developing nations. Amongst the plethora of environmental changes that have arguably contributed to this crisis, a marked nutritional transition stands out.
Ancient Bodies in a Modern World
In many ways, our bodies are engineered for a world of scarcity, now struggling in a world of abundance. Food scarcity was something we had to deal with for much of human history — every meal was crucial in ensuring our survival. It was in our biological best interests to be hard-wired to seek out calorie-dense foods and optimise our fat storage for times of food shortage. It was not unusual for humans to go without food for long periods of time throughout much of human history. Our biology has evolved over thousands of years to optimise for this food scarcity by having metabolically advantageous genetic adaptations that allow for the deposition of fat as an efficient store of energy.
However, the past 50 years — a blink of an eye in evolutionary terms — have seen significant changes to our diet in industrialised economies. The presence of ultra-processed, high fat, high sugar foods is ubiquitous and worryingly accessible. Bodies that were fundamentally wired for scarcity are today placed in a world of full fridges and pantries. With the effects of increasingly sedentary lifestyles compounding the problem, poor diets have arguably wreaked havoc on human health. Two-thirds of our nation’s adults are overweight or obese and the challenge of non-communicable diseases is one of the biggest burdens on the healthcare system. Our bodies being out of their depth in this modern food landscape only scratches the surface of this problem — the challenges of the ‘obesogenic’ environment are underpinned by economic, political, and sociocultural factors that are deeply ingrained in our society.
In many ways, our bodies are engineered for a world of scarcity, now struggling in a world of abundance.
How did we get here?
The obesity epidemic is more than just a diet problem, it is a deeply rooted systemic issue that plagues the lower socioeconomic classes. Increased adiposity and obesity are diseases that disproportionately affect those in the lower socioeconomic classes. From a nutritional perspective, the lower socioeconomic classes are often deprived of access to affordable, fresh, and nutrient-dense produce whilst being inundated and often targeted by fast food and unhealthy options — which may be the only options in some cases.
Big Food (corporate food and beverage companies) represents some of the most powerful and destructive entities in the world when it comes to public health. Funding scientific research, financing political campaigns, lobbying, and financing campaigns are some of the ways in which these large companies yield their power. Ultimately, the problem with our diets is hardly an individual one — it is deeply intertwined with political, social, and economic factors that need to be considered.
Where to from here?
The future presents significant challenges not only for our diets, but food sustainability globally. By the year 2050, we will have 10 billion mouths to feed. Rethinking our global food system will be inevitable as new challenges emerge concerning agriculture and sustainability. From a health perspective, addressing our diet is perhaps one of the most important issues to tackle in the journey towards a healthier human population and reducing the burden of non-communicable diseases. The sociological challenges are many in this arena, but huge strides of progress continue to be made nonetheless. From huge changes such as the plant-based movement to the work of grassroots organisations that are involved in health promotion, fixing our diets is a shared responsibility that must be championed for a healthier society. ●