Dear colleagues

I am writing to update you on some of the major transitions in the Flinders University Medical Program, perhaps best exemplified by the move to programmatic assessment for learning.

In order to support ongoing effective delivery of the Medical Program, there have been changes in the professional and academic staffing teams involved. This document provides you with information about key staff supporting the medical program, recent appointments, and the governance structure.

A key priority of the Medical Program over the last 18 months has been to ensure the excellence and workforce readiness of our students as future medical practitioners. We have received feedback on our students and graduates – via clinicians, the national Australian Medical Council/Medical Board of Australia intern survey, and clinical training directors at Flinders Medical Centre and hospitals in the Northern Territory – all of which has been invaluable and has informed priorities for the course. This document also provides examples of how we work to ensure that our students are well prepared to contribute to the profession.

1. Who’s who in the MD
2. A new governance structure for the medical program
3. Ensuring excellence and workforce readiness of our graduates: prescribing skills assessment international benchmarking
4. Ensuring excellence and workforce readiness of our graduates: the progress test as the primary test of knowledge in the MD
5. Academic status

 

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1. WHO’S WHO IN THE MD

Head of the Medical Program: Associate Professor Tina Noutsos

I work with the College of Medicine and Public Health leadership, relevant professional and academic staff across all sites to:

• lead and manage the medical program
• steer and integrate all the components of the course (teaching, curriculum, assessment, admissions etc.)
• act as a key external face of the course
• ensure quality education, evaluation, review and external accreditation of the program

In recognition of the significant workload associated with this important role, it has been expanded from 0.2FTE to 0.6FTE. As part of this transition, my existing role leading the NT Medical Education and Training with oversight of the NT Medical Program and Regional Training Hubs will be advertised.

Key staff supporting the Medical Program

Head of Medical Program	A/Prof Tina Noutsos
Curriculum portfolio lead	Dr Maxine Moore
Associate Professor of Medicine Chair Foundation Phase Committee	A/Prof Anna Vnuk
Clinical Phase Coordinator Chair Clinical Phase Committee	A/Prof Jordan Li
Medicine 1A and 2B topic coordinator	A/Prof Anna Vnuk
Medicine 1B and 2A topic coordinator	Prof Rainer Haberberger
Medicine 3A and 3B topic coordinator	Dr Kate Starr-Marshall
Year 4 Coordinator	A/Prof Stephen Hedger
Doctor and Patient Clinical Skills theme lead	Dr Michal Wozniak
Knowledge of Health and Illness theme	Prof Rainer Haberberger, Prof Arduino Mangoni
Health Professions and Society theme	Dr Maxine Moore
Advanced Studies Team	Flinders Medical Centre: Dr Scott Morris

New academic appointments as of August 2019

Significant progress on recruitment to new academic roles has been made, and we warmly welcome some new faces to the course:

• 2 full-time teaching specialists – Physiology: Dr Voula Gaganis and Dr Helen Harrison
• 1 full-time teaching specialist – Molecular Medicine and Pathology: Dr Nicola Wood
• 1 balanced academic – Clinical: Dr Sarah Thompson
• 1 teaching specialist – Medicine (0.6FTE): Dr Kate Starr-Marshall
• 1 teaching specialist – Clinical Educator (0.2 FTE): Dr Amara Seabrook
• 1 full-time teaching specialist – Mental Health: Andrea Morello

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2. A NEW GOVERNANCE STRUCTURE FOR THE MEDICAL PROGRAM

The current committee responsible for decision making and policy setting for the Medical Program is the Medical Course Executive. From October, the Medical Course Executive will convert to a Medical Program Board. This will report directly to the Vice President and Executive Dean of the College of Medicine and Public Health, with a side reporting line and distribution of minutes to the College Education Committee, which in turn reports to the Flinders University Education Quality Committee. The Program Board will be chaired by the Dean, Education for the first 6 months, and then reviewed.

The drive for this change is to galvanise the relationships between decision making and resourcing for the Medical Program and the College Executive. This new model will preserve the autonomy and leadership of the Head of Medical Program, with the Head of the Medical Program accountable to the Board. The Head of the Medical Program will take strategic direction from the Board. The independence of the Dean, Education as the Chair will enable the Head of the Medical Program to better contribute to decision making, and present plans and proposals to the Board. Decisions with large resourcing or policy implications will be determined by the Board for recommendations to go to College Executive. A culture where all members will have clear lines of accountability will be set. Sub-committees and working groups with this new model will be determined as necessary.

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3. ENSURING EXCELLENCE AND WORKFORCE READINESS OF OUR GRADUATES: PRESCRIBING SKILLS ASSESSMENT INTERNATIONAL BENCHMARKING

Prescribing is a fundamental part of being a junior doctor. It is a complex task and requires a broad knowledge of medicines and the risks and benefits of treatment. Widespread evidence exists (both Australia and worldwide) suggesting that prescribing by interns is suboptimal and interns often feel unprepared and anxious about prescribing.

The Prescribing Safety Assessment (PSA), developed via collaboration between the UK Medical Schools Council and the British Pharmacological Society, is a now well-established part of medical assessment in the UK. It aims to ensure a minimum standard for prescribing exists across a wide range of common situations. The PSA is a 2 hour online open book exam of prescribing across a range of common situations for junior doctors. It offers automated marking of candidate prescriptions and other items and can provide feedback to students and supervisors.

The Prescribing Skills Assessment has been adapted from the UK based Prescribing Safety Assessment (PSA) to fit the Australasian setting. Flinders University is contributing to a pilot study (being coordinated from Monash University) of the PSA, joining with over 10 other medical schools across Australia and NZ. During the exam students have online access to the Australian Medicine Handbook (AMH). Students are sitting the online exam in late June/ early July. For more information have a look at some practice questions under the “resources” tab at the PSA website: https://prescribingsafetyassessment.ac.uk/

We thank Dr Tilenka Thynne and Dr Cyle Sprick for their drive in seeing this to fruition for 2019.

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4. ENSURING EXCELLENCE AND WORKFORCE READINESS OF OUR GRADUATES: THE PROGRESS TEST AS THE PRIMARY TEST OF KNOWLEDGE IN THE MD

The progress test is a quarterly multiple choice question paper, targeted at exit graduate level of difficulty, and continually tests medical students against all the expected knowledge – both basic sciences and clinical sciences. As such, each student’s performance is expected to increase as they progress through the course and can be analysed longitudinally over time, and it can be standardised against their own year level cohort.

The progress test is providing a rich source of data to make decisions. For the first time in 2018, year 4 students also sat written knowledge tests, ensuring the quality of our students with respect to knowledge acquisition at their transition to internship.

From 2019, Flinders joins many other Australian universities in incorporating national benchmarking questions from the Medical Deans of Australia and New Zealand/AMC. From 2019 we are incorporating images and figures in our question papers. Important feedback, from AMC/MBA internship surveys and the directors of clinical training supervising our graduates as interns, has shaped our inclusion of specific questions on key concepts including ECG interpretation, electrolyte disturbances, arterial blood gas interpretation.

Want to contribute to exam items? We always welcome new ideas and draft multiple choice questions: across the whole span of the medical course, including clinical and the important foundation sciences e.g. anatomy, physiology, biochemistry. For more information please email MD ASSESSMENT EMAIL. Sample questions can be found here. 

Example progress test questions: drawn from 2017 papers*:

 

*These questions remain the intellectual property of the Progress Test Item Review Committee.

 

The oxygen dissociation curve is pH-dependent and indicates the relationship between haemoglobin saturation and oxygen tension in the blood. When CO2 is released into the blood from tissue, the blood pH is:

1. increased and the curve shifts to the right;
2. reduced and the curve shifts to the left;
3. reduced and the curve shifts to the right;
4. increased and the curve shifts to the left.

Paula, aged 22, has a lymph node in her neck that feels firm to the touch and is not painful. The node is removed and examined. Reed-Sternberg cells are found on pathological examination. This finding is typical of:

1. chronic lymphatic leukaemia;
2. Hodgkin’s lymphoma;
3. metastasis;
4. non-Hodgkin’s lymphoma.

Mr D. is 70 years old and has central chest pain, which gets worse when he coughs or swallows. If he bends forward the pain is slightly less. The symptoms described are most consistent with:

1. dissection of the thoracic aorta;
2. pleurisy;
3. pericarditis;
4. pharyngoesophageal (Zenker’s) diverticulum;
5. acute myocardial infarction.

Which of the following groups of drugs is relatively contraindicated in a patient with renal artery stenosis?

1. ACE inhibitors.
2. Beta-blockers.
3. Calcium channel antagonists.
4. Diuretics.

A study of prophylaxis for urinary tract infections comes up with a relative risk of 0.86 (95% CI = 0.71-1.04) for eating cranberries compared with the control group. By how many percent is the risk of a urinary tract infection reduced by eating cranberries according to this study, and is the result statistically significant?

1. 14%; no statistical significance.
2. 14%; statistical significance.
3. 86%; no statistical significance.
4. 86%; statistical significance.

In a randomised placebo-controlled study one group of patients are given simvastatin to reduce blood cholesterol and one group of patients a placebo. In the simvastatin group 8.4% of the patients are found to need revascularisation of the coronary arteries, as against 12.4% of the patients in the placebo group. How many patients need to be treated with simvastatin to avoid one cardiovascular revascularisation procedure: in other words, what is the number needed to treat (NNT) in this study?

1. 5
2. 13
3. 21
4. 25

Where is most of the iron from the diet absorbed?

1. Caecum.
2. Colon.
3. Duodenum.
4. Ileum.

A 25 year-old man presents with1 week of diarrhoea, commencing after an overseas trip. He has tenesmus and is passing frequent, small volume stools with visible blood and mucous. Which of the following microorganisms is the most likely cause of these symptoms?

1. Clostridium difficile.
2. Giardia lamblia.
3. Shigella species.
4. Vibrio cholera.
5. Norovirus.

Which of the following findings is NOT consistent with cirrhosis of the liver?

1. Palmar erythema.
2. Spider naevi.
3. Splinter haemorrhages.
4. Splenomegaly.

In pituitary diabetes insipidus the production of a particular hormone is less than normal. Which hormone?

1. Adrenocorticotropic hormone.
2. Vasopressin.
3. Brain natriuretic hormone.
4. Thyroid-stimulating hormone receptor.

Thiazide diuretics inhibit sodium reabsorption in a particular part of the kidney. Which one?

1. Proximal tubule.
2. Loop of Henle.
3. Distal tubule.
4. Collecting duct.

A 72 year-old man is admitted to a nursing home for rehabilitation after a hip fracture following a fall in the street. He displays fluctuating confusion with impaired attention, Parkinsonism and vivid recurring visual hallucinations. The geriatric consultant suspects that the problems are caused by dementia. Which type of dementia is most likely to be the cause of this patient’s problems?

1. Frontotemporal dementia.
2. Lewy body dementia.
3. Vascular dementia.
4. Alzheimer’s disease.
5. Creutzfeldt-Jakob disease.

Prader-Willi syndrome is caused by deletion on chromosome 15 of paternal origin. The same deletion on maternal chromosome 15 causes Angelman syndrome. What phenomenon explains these different phenotypes?

1. Anticipation.
2. De novo mutation.
3. Genomic imprinting.
4. Germline mosaicism.
5. Variable expression.

Genetic changes in oncogenes and tumour suppressor genes are associated with the uncontrolled growth of tumours. In most of these cases, which of the following genetic changes is associated with insensitivity to growth-inhibiting signals?

1. Oncogene amplification.
2. Tumour suppressor gene amplification.
3. Oncogene deletion.
4. Tumour suppressor gene deletion.

A 78 year-old woman presents to her General Practitioner reporting shoulder problems for the last few weeks. Her shoulders are stiff and painful. It is most noticeable in the morning when she first wakes up. She is experiencing difficulty getting dressed. On examination her shoulders show symmetrical decreased range of movement particularly abduction. Upper limb motor examination is normal. Her shoulder X-ray is normal. Blood tests show:

Haemoglobin: 109g/L (Reference range 115 – 165 g/L)

White cell count and differential: normal

Platelets: normal

Erythocyte sedimentation rate: 62mm/hr (Reference range < 20mm/hr)

Which of the following treatments is indicated?

1. Colchicine.
2. A glucocorticoid.
3. Hydroxychloroquine.
4. A non-steroidal anti-inflammatory (NSAID).

Non-selective beta blockers also antagonize the beta-2 adrenergic receptors, resulting in a greater risk of certain side effects than with beta-1 selective blockers. This needs to be taken into account when prescribing these drugs to certain patient sub-groups, e.g. chronic obstructive pulmonary disease (COPD) patients. Which of the following beta blockers is least selective?

1. Atenolol.
2. Bisoprolol.
3. Metoprolol.
4. Propranolol.

A 46 year-old man presents to the Emergency Department with severe back pain radiating into his left leg. The pain started three months ago but has got worse during the past few days. He has also had a bout of fever, headache and general malaise. The patient uses intravenous heroin on a regular basis. Physical examination reveals an unwell man. His temperature is 38.2°C. He also has throbbing pain in the lumbar spine. There are no clear signs of loss of function. What is the most likely diagnosis?

1. Infectious transverse myelitis.
2. Ankylosing spondylitis.
3. Vertebral osteomyelitis.
4. Guillain-Barré syndrome.

Mitochondrial encephalomyopathy, lactic acidosis and stroke-like episodes (MELAS for short) are caused by mutations in the mitochondrial DNA. Which grandparent is the source of a MELAS patient’s mitochondrial DNA?

1. Maternal grandmother.
2. Maternal grandfather.
3. Paternal grandmother.
4. Paternal grandfather.

Complete unilateral peripheral facial palsy (Bell’s palsy) is characterised by:

1. contralateral loss of function in a complete half of the face;
2. contralateral loss of function in only the lower facial quadrant;
3. ipsilateral loss of function in a complete half of the face;
4. ipsilateral loss of function in only the lower facial quadrant.

A 50 year-old man has a tumour in the left lung apex. What symptom is most likely to be found?

1. Reduced sweat secretion in the left half of his face.
2. Left pupil larger than right pupil.
3. Diplopia when looking towards the side.
4. Right sided ptosis.

A preoperative spirometry test is carried out on a 45-year-old woman, yielding the following results: tidal volume 450 ml, expiratory reserve volume 1,100 ml, vital capacity 4,500 ml and FEV1 3.13 L. What is her inspiratory reserve volume?

1. 1,550 ml.
2. 2,250 ml.
3. 2,950 ml.
4. 3,400 ml.
5. 4,050 ml.

A 36 year-old man is admitted to the Medicine ward with suspected pneumonia. He is known to be human immunodeficiency virus (HIV) positive. For the past 10 days he has had fever, shortness of breath and a dry cough. The chest X-ray shows bilateral interstitial opacities. Blood tests show a high viral load with a low CD4+ T cell count (<200 cells/µL).What pathogen is at the top of the differential diagnosis list?

1. Pneumocystis jirovecii.
2. Pseudomonas aeruginosa.
3. Streptococcus pneumoniae.
4. Haemophilus influenza.
5. Mycobacterium tuberculosis.

Physical examination of a patient with fever and dyspnoea does not reveal any abnormal respiratory findings. The chest X-ray shows an indistinct right heart border. You consider the possibility of pneumonia.In which lobe is the pneumonia most likely to be?

1. Right upper lobe.
2. Right middle lobe.
3. Right lower lobe.
4. Left upper lobe.
5. Left lower lobe.

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5. ACADEMIC STATUS

The College values the significant contribution made to the Medical Program in teaching, quality supervision of our students and research. The policy for academic status can be found here.