From the Dean
Professor Nicholas Glasgow, Dean, ANU Medical SchoolVolume 3 Issue 1 of the Medical Student Journal of Australia continues to build on the excellent foundations laid in the previous issues. For the first time, articles are included from beyond our own current student body - two from students studying in other schools and one from an alumnus of ours. I welcome this development.

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From the Associate Dean
The ANU Medical School (ANUMS) has been training students and GP registrars in the region for the last six years. The rurally trained students have achieved significant academic success, and although this is early days, a number are returning to work as keen and committed interns, junior hospital doctors and as General Practice (GP) registrars in South East New South Wales (SE NSW).

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Notice Board
The editorial committee will be active from February to May and From July to October 2011.
Editorial Team
W elcome to Volume 3 Issue 1(June 2011) of the MSJA, which focuses on the unique scope and nature of Rural and Remote Health. This volume is an extension of The ANU Medical School's commitment to support rural health and we are pleased to support discussions on this critical area of healthcare.

Rural and remote medicine play an important role in the life of Australian medical students and doctors. Many of the articles in this journal reflect this importance. From John Flynn placements and rural conferences to the battle with the Clinical Education and Training Institute (CETI) for rural internship places and a case study set in Townsville, we hope you enjoy hearing about the variety of experiences students have had in rural medicine around Australia.

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Red earth of the desert near Maralinga in outback South Australia, 2007
Devil's Marbles Tennant Creek
Image Credit:
Y. Soon, MSJA

Elective Experiences
Elective in Cambridge, England
Kiran Atmuri
Ihad the privilege of completing my medical elective with the University of Cambridge, England, United Kingdom (UK). When I commenced medical school I had not planned on completing my elective in a western setting, especially where I would be forgoing the Australian summer for a region of the globe where it would be the peak of winter.

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A taste of the Pacific: a third year elective
Jennifer Porteous
When thinking about travelling to any country in the world for my third year elective I can't say the tiny kingdom of Tonga in the south pacific was the first option that jumped to mind.

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Exploration into Tanzania's Health Care System
Michael Tan
As a final year student, our cohort is granted the opportunity to take part in a six week elective rotation anywhere in the world. With the realisation that this may be my last decent chance to witness medicine practiced abroad, I seized the opportunity to visit Tanzania, a distant country located on the continent of Africa.

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Student Education
Clinical Education and Training Institute (CETI) and The Australian National University Medical School (ANUMS)
Michael J McGee
The Australian Capital Territory (ACT) is girt by New South Wales (NSW) like Australia is girt by sea. Consequently all rural placements undertaken by The Australian National University (ANU) medical students are done in rural NSW.

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Global Rural and Indigenous Health
Report from the 11th National Rural Health Conference
Thomas Gleeson
Four ANU medical students (Daniel Heard, John Sullivan, Nushin Ahmed and myself) were very fortunate to receive funding from Rural Health Workforce Australia (RHWA) and the National Rural Health Alliance (NRHA) to attend the 11th National Rural Health Conference (NRHC) which took place in Perth, WA, from 13 to 16 March 2011. The opportunity to join around one hundred other students as part of the 1300 strong delegation was wonderful.

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Five days in Charleville
Deborah Smith
"If we once dream it, the rest is easy" - wrote the Reverend John Flynn in his pioneering publication 'The Inlander' (1). Certainly Flynn's dream is being realised every day across the vast inland of Australia, and I was privileged enough to experience the incredible work done from the Charleville Royal Flying Doctor's Service (RFDS) base in June 2010.

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A doctor short in the paddock
Melinda Swan
Ask me what it is that I love about rural life and I will respond: the fresh air; the friendly people; the beautiful land. Ask me what it is that takes away from this and I will tell you without a moment's pause: waiting so long to see a doctor!

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Careers
Choosing to be a Surgeon – Personal Reflections of a Female Surgeon
Dr. Carolyn Cho
Many people including medical students, junior doctors, patients and even friends have often asked me why I chose to be a surgeon. The answer is simple: since I was a third year medical student in my very first surgical bedside tutorial, I have wanted to be a surgeon. Indeed, I have never considered any alternatives.

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Annecdotes
A drooping eye
David Mathew
The ophthalmologist greeted me as I entered, guiding me to look at the next patient on the list. I scanned the name and age, she was only 8. My mind numbed at the age, and I prayed silently that it was not something unpleasant. How horribly wrong I was.

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Another sore throat
Kate Rampe
Every medical student is told about the importance of taking a thorough medical history from one's patients; and this is all well and good, but the complete, textbook medical history is just so long! Is it really necessary to do the whole thing for every patient? Well I hate to say it, but yes, yes it is. Most of the time, true, a lot of those extra details will turn out to be irrelevant, but there will be the patient in a thousand for whom that random extra detail will have major implications for their diagnosis and treatment. To prove it, I present a story told to me by an erstwhile clinical supervisor, an experienced GP and ED doctor.

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Research Papers
An overview of liver trauma
Christian Beardsley & Dr. Sivakumar Gananadha
The liver is the largest solid organ within the abdominal cavity, and combined with the great surface area of the trunk, explains why this critical organ is often injured. Liver injury is a significant cause of morbidity and mortality in trauma patients, both in the civilian and military context.

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Treatment of Dog Bites in the Emergency Department of the Canberra Hospital 2006-2008
Adam P Gaudry & Associate Professor Drew Richardson
Dog bite injuries are a common and important problem in emergency medicine. It is of particular concern for children where it is estimated that close to 50% of children will experience a dog bite at some point in their lives. This study was undertaken to determine the impact of dog attacks and examine the management issues. Demographic data was collected on both the victim and the dog responsible, rates of hospital admission, wound characteristics and site, as well as information related to the treatment of the injuries.

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News and Topics of Interest
Social media and medical students
Geoffrey D Balean & Jennifer Truong
The human desire to be remembered has ironically Organ transplantation has revolutionised modern medicine. It is one the most effective treatment options for many otherwise fatal conditions. Australia, with one of the most sophisticated healthcare systems in the world is currently ranked 17th globally for the number of transplants performed per annum. This equates to only 200 transplants per year, which is one of the lowest rates in the developed world.

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What medical students should know about Australia's Immigration Policy
Ingrid Fewings
The 2010 federal election once again brought the public's attention to Australia's Immigration policy. Both sides of politics called for control of population growth and claimed to be tough on immigration. The resultant focus of the media and politicians on boat people was hugely out of proportion to the small impact these people have on Australia's population growth.

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Menopause and the Mind: the Effects of Menopause and HRT on Cognition and Dementia
Talia Fuchs
Physiological alterations in hormone levels during menopause have long been theorised to affect cognitive function and brain chemistry. The effects of oestrogen on the central nervous system may account for the neurological changes associated with menopause. Hormone replacement therapy is believed to modulate these changes and thus confer protection against age-related cognitive decline in postmenopausal women.

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What to do with the evidence? CAM and EBM in the spotlight
Stephen Marti
Homeopathy provides nothing more than a placebo effect and it should not be part of public funded healthcare in the U.K. These were the blunt findings of a recent U.K. government report into the efficacy of homeopathy, and it provides an extreme example of the conflict between two important and influential movements in medicine, namely Complementary and Alternative Medicine (CAM) and Evidence-Based Medicine (EBM).

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Telemedicine in Australia – are we truly ready for it?
Yan Zhuang
Once upon a time, doctors were well travelled individuals. From the early days of visiting ill patients in their homes, to more modern times where doctors are called to fly out to various regions in the world, seeking to provide their expertise in areas where they were needed, such as disaster relief. Services such as the Royal Flying Doctor Service of Australia were a breakthrough in bringing much needed care to rural and remote areas in Australia.

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Concealed motivation and the clinical interview
Phillip Gaughwin & Steve Longford
P atient-centered models of care require physicians to give wide consideration to emotional and psychosocial, as well as biomedical, causes. Evaluation of emotional states contributes positively to the interaction between physician and patient, building rapport in a manner that associates with improved outcomes.

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Case Reports
Primary intraosseous meningioma
Martin Dempsey
In October 2009, a 53 year old woman presented to the Neurosurgical Outpatient Clinic at The Canberra Hospital. She had noticed slow enlargement of her right frontal skull; the calvarial prominence had been particularly evident over the two years prior to her initial presentation. She had also begun to notice slight proptosis of her right eye. Questioning at the initial clinic assessment revealed no history of diplopia or other potentially related neurology.

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Rupture of Arteriovenous Malformation in an obstetric patient with Hereditary Haemorrhagic Telangiectasia: a case report
Harris Eyre et al
This case commentary discusses a 26 week gestation obstetric patient with hereditary haemorrhagic telangiectasia, who was retrieved from a rural centre after suffering an intracranial haemorrhage. The article then reviews and discusses the most recent literature pertaining to this scenario, and concludes with suggestions and recommendations to increase awareness of this condition and help facilitate informed management decisions in such patient groups. Lessons from this case are particularly relevant to the rural setting.

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Student Life
Global health – an innate responsibility shared by all
Mushira Mokhtar & Joseph Choi
TEnSIGN (Engaging Students in a Global-health Network) is the Global Health Group of the Australian National University (ANU) which aims to provide opportunities for medical students to engage themselves in global health matters.

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Insert amusing pun here: the medical revue
Elizabeth Paver
The medical revue has become a favourite event in the Australian National University (ANU) Medical School calendar, celebrating its fifth year in 2011. Breaking from the traditional 'sketch show' format of faculty revues elsewhere, the ANU medical revue has created its own unique style, following a themed storyline into which songs, dances, sketches - and of course many jokes - are incorporated. 

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