On The Wards: On The Pods Medical Podcast for Doctors

James chats with Commander Chloe Ryan from the Royal Australian Navy about underwater medicine. As a result, you will learn more about diving medicine and what a career working as a medical officer in the Navy can look like.

Summary Writer: Eloise Sobels

Script Writer: Carla Roscoe

Editor: Angus Pagett

Interviewee: Chloe Ryan

About Commander Chloe Ryan

Commander Chloe Ryan joined the Navy in 2004 as an Undergraduate Medical Officer. Subsequently, she graduated from James Cook University in 2007. Moreover, Chloe has enjoyed a range of postings both at sea and ashore. For instance, she has deployed extensively in both RAN ships at sea and in the joint land environment.

Chloe has served as:

the Officer in Charge of the Submarine and Underwater Medicine Unit – East, and

Senior Medical Advisor for Diving Medicine, J07 HQ JTF633.

She is currently the Senior Clinical Advisor to the Director of Navy Health and SO1 Health Policy and Governance.

Furthermore, Chloe’s qualifications include:

a Bachelor of Medicine and Surgery,

Master of Health Administration, and

a Master of Military and Defence Studies.

Chloe is a graduate of the Australian Command and Staff College. Further, she is a Fellow of the Royal Australian College of General Practitioners. She is currently working toward attaining Fellowship of the Royal Australasian College of Medical Administrators. Additionally, Chloe has developed deep expertise in Diving Medicine during her career as a Navy Medical Officer. And she also holds qualifications in Aviation Medicine.

In addition, Chloe is a recipient of the following medals:

the Australian Defence Medal,

Australian Operational Service Medal – Border Protection,

Australian Operational Service Medal – Greater Middle East, and

the Defence Long Service Medal.

Elie Matar chats with Abhijit Pal about completing medical fellowships overseas. We specifically look at the highlights, challenges, and logistics to expect when considering taking on such a fellowship.

As a medical student, you will usually undertake a clinical fellowship in the third year of specialty training. It'll be after the completion of two core clinical training years in Australia. A fellowship can be undertaken either in Australia or overseas. It might depend on the nature of the training program.

About fellowships overseas

Overseas fellowships would usually be non-core training. But, check this with your college as there are exceptions.

There are many factors to consider when thinking about a fellowship overseas. For instance, where to go, who to contact, and getting the job. This podcast explores these factors and looks at the highlights, challenges, and logistics. We will also discuss the wealth of experiences you gain by throwing yourself into a new and different healthcare system on an overseas fellowship.

About Dr Elie Matar

Dr Elie Matar is a Neurology Advanced Trainee and a NHMRC postgraduate scholar based in Sydney, Australia. He is a Clinical Lecturer with the University of Sydney and has a strong passion for medical education and clinical research. Having co-founded a hospital clinical redesign committee, Elie believes junior doctors have an important responsibility in pioneering innovation to improve the healthcare systems within which they work.

About Dr Abhijit Pal

Dr Abhijit Pal is a medical oncologist currently completing the second year of his fellowship in drug development and early phase anti-cancer trials at the Royal Marsden Hospital, Sutton in the United Kingdom. In his non-existent spare time, he is completing a part-time Ph.D. through Sydney University in informed consent and clinical ethics during communication with patients with advanced cancer. Abhijit has a strong interest in drug development, clinical trials, communication and also in hospital culture, burnout and doctor welfare.

James sits down with Brigadier Michael Reade from the Australian Defence Force (ADF) to discuss combat medicine and blood preservation. Above all, Brigadier Reade has a wide range of expertise and experience in this area. His ambition is to establish the ADF as a major contributor to military trauma research and to ensure the ADF’s policies, training and equipment lead world best-practice.

In this podcast, you will learn more about combat medicine and the interesting and varied career options in the Defence Force.

Summary Writer: Divya Iyer

Script Writer:  Carla Roscoe

Editor: Angus Pagett

Interviewee:  Michael Reade

Brigadier Reade holds the following positions:

Australian Defence Force Professor of Military Medicine and Surgery, Joint Health Command,

Assistant Surgeon General – Army,

Director of General Health Reserve-Army, and

Specialist Anaesthetist and Intensive Care Physician.

About Brigadier Michael Reade

Michael is the inaugural ADF Professor of Military Medicine and Surgery. This is a Defence-Industry co-operation position established in 2011 as part of a programme to increase the number of senior specialist doctors in the permanent ADF.

In addition, Michael is anaesthetist and intensive care physician. Also, he holds a clinical appointment at the Royal Brisbane and Women’s Hospital. Moreover, he has military appointments at Joint Health Command and Army Headquarters. Finally, Michael also holds an academic position as a Professor at the University of Queensland.

Brigadier Reade has first-class honours degrees in medicine and science from the University of Sydney. Additionally, he has a Doctorate of Philosophy in clinical molecular biology from the University of Oxford, UK. Finally, he has a Masters in Public Health, in statistics and clinical trials, from the University of Pittsburgh, USA.

Michael's contribution to the practice of intensive care medicine was recognised in 2017 with a Higher Doctorate from the University of Sydney. And in 2018, he received a Fellowship of the Royal Institution of Australia. He holds subspecialist qualifications in disaster management and aeromedical retrieval as part of his combat medicine expertise. His specialist clinical training began at Royal North Shore Hospital in Sydney. Then, the John Radcliffe Hospital in Oxford, the Austin Hospital in Melbourne, and University of Pittsburgh Medical Center. Also, during his leave from the ADF, Michael worked as an attending critical care physician in Pittsburgh for 18 months.

Military history

Brigadier Reade was commissioned as a Reserve General Service Officer in 1990 through Sydney University Regiment. As a result, he received a Prince of Wales Award. Hence, he commanded a platoon of US Regular Army soldiers of the 2nd Armoured Division during their National Training Center rotation at Fort Irwin, CA. In 1995-1996, he was a project officer at the Reserve Staff Group. There, he analysed the employment of reserve medical personnel. In 1996 Michael completed medical studies and was posted as Regimental Medical Officer and instructor, University of NSW Regiment 1996-1997. This is where his journey in combat medicine began. And subsequently Sydney University Regiment 1997-1999. From 2000-2004, he was studying in Oxford. Whilst he was there, he was posted to 144 Parachute Medical Squadron RAMC(V).

When he returned from the UK he was a specialist anaesthetist in the Parachute Surgical Team of the 1st Health Support Battalion. He settled in Melbourne in 2007 and he became the OC Clinical Advisory Group, 3rd Health Support Battalion. Further, Michale is a graduate of the Logistic Officer and Land Warfare Centre Staff Officer series of courses. In addition, he also holds the British Army-sponsored diploma in conflict medicine. He has deployed to Bosnia and Kosovo on attachment to the British Airborne Brigade. He has also deployed to East Timor and the Solomon Islands.

NATO and ADF hospitals

In ...

James chats to Squadron Leader Nicola Boyd about her experience in the Royal Australian Air Force, specifically around aviation medicine, education and career path options available for aviation medicine.

Summary Writer: Eloise Sobels

Script Writers: Carla Roscoe and Angus Pagett

Editor: Angus Pagett

Interviewee: Nicola Boyd

About Squadron Leader Nicola Boyd

Squadron Leader Nicola Boyd commissioned into the Royal Australian Air Force in January 2008 under the Graduate Medical Program. Previously, she had a career as an Occupational Therapist. On completion of her medical degree in 2011, she completed two years of civilian hospital training.

Squadron Leader Boyd attended Officer Training School in 2014. After that, she has enjoyed postings as an Aviation Medical Officer to 2 Expeditionary Health Squadron (2EHS) and 1 Expeditionary Health Squadron (1EHS). Furthermore, Nicola spent a period as Officer in Charge at 1EHS Detachment East Sale. She later returned to 2EHS as Senior Medical Officer.

Nicola deployed to the Middle East on OP ACCORDION in support of OP OKRA in 2015. During that time, she enhanced heat illness prevention and management through the development of a heat illness training program.

Education, degrees and experience

In 2018, Nicola was selected to attend Kings College London. This was to undertake the Postgraduate Diploma in Aerospace Medicine. Additionally, she was also awarded a Diploma of Aviation Medicine from the Faculty of Occupational Medicine, Royal College of Physicians London.

Nicola returned from the UK in 2019. Now, her posting is at the Institute of Aviation Medicine. There, she is undertaking a range of duties in clinical, research and training.

Squadron Leader Boyd holds the following:

A Bachelor of Occupational Therapy, a Bachelor of Medicine, and a Bachelor of Surgery.

A Diploma of Child Health.

A Postgraduate Diploma of Aerospace Medicine.

A Diploma of Aviation Medicine.

She is a Fellow of the Royal Australian College of General Practitioners. Moreover, she is currently a Registrar of the Australasian College of Aerospace Medicine. Finally, Nicola is commencing a Masters in Forensic Medicine part-time due to a special interest in aviation crash investigation.

Nicola and her partner Steve are proud parents to their daughter, Charlotte. In her free time, Nicola enjoys hiking and photography. She is also passionate about training in a variety of dog sports with her three dogs.

James Edwards does a two-part chat with Dr. Sean Lal. Sean’s clinical and research interests are in heart failure.

In this second part of the podcast, we look at:

how best to investigate heart failure,

the difference between systolic and diastolic heart failure,

what are the common precipitants,

what type of drugs are used, and

when to escalate care.

In Part 1 we go through what heart failure is and it's common causes.

Summary Writer:  Divya Iyer

Script Writer:  Kate Kearney Graham

Editor:  Sean Lal

Interviewee:  Sean Lal

Systolic and diastolic heart failure

Heart failure (HF) is a clinical condition. It's a result of an impaired ability of the heart to provide output to perfuse organs sufficiently. This is due to abnormalities of heart structure and function. There are two main mechanisms by which heart failure can occur.

Systolic heart failure results in impaired contractile function. Thereby, it reduces the output to the body.

Diastolic dysfunction results from abnormal cardiac relaxation. And this happens where a stiff ventricle is not able to fill adequately. These two pathological processes often coexist together.

About Dr. Sean Lal

Sean Lal is a clinical academic cardiologist at Royal Prince Alfred Hospital and the University of Sydney, NSW, Australia. He undertook his training at:

the University of Sydney,

Royal Prince Alfred Hospital, and

Harvard Medical School.

James Edwards does a two-part chat with Dr. Sean Lal. Sean's clinical and research interests are in heart failure.

Summary Writer:  Jane McDonnell

Script Writer:  Kate Kearney Graham

Editor:  Sean Lal

Interviewee:  Sean Lal

Heart Failure

In Part 1 we go through what heart failure is. You will learn what diastolic dysfunction is and why it causes heart failure. And we will also go through an example case.

In Part 2 we look at how best to investigate, what are the common precipitants, what type of drugs are used and when to escalate care.

Broadly speaking we have two types, heart failure with preserved ejection fraction (HFpEF) and with reduced ejection fraction (HFrEF).

HFrEF and HFpEF

HFrEF is systolic dysfunction of the left ventricle (LV).

HFpEF (where EF ³50%) is becoming increasingly more common. In such a setting, the LV is stiff and non-compliant and there is diastolic dysfunction so the LV doesn’t fill as easily. The classic example is a patient with LV hypertrophy (LVH). For example, in the setting of aortic stenosis with comorbidities such as hypertension, obesity, and diabetes.

This is a common cluster of symptoms in the community.

About Dr. Sean Lal

Sean Lal is a clinical academic cardiologist at Royal Prince Alfred Hospital and the University of Sydney in NSW, Australia. He undertook his training at the University of Sydney, Royal Prince Alfred Hospital and Harvard Medical School.

James Edwards chats to Dr. Katherine Spira about stroke mimics. A stroke is an acute neurological deficit lasting greater than 24 hours, caused by cerebrovascular pathology. Stroke calls are common. However, there are numerous conditions that may manifest in a similar way. Stroke mimics are non-vascular conditions that can also present with similar neurological deficits. It is important to know of some key stroke mimics. Especially how they may be differentiated from an acute stroke on history and physical examination. For example, Bell's palsy is a stroke mimic.

In this podcast, you will also learn about the dangers of diagnosing a stroke mimic and steps to learning which cases can be de-escalated.

Summary Writer:  Divya Iyer

Script Writer:  Katherine Spira

Editor:  Katherine Spira

Interviewee:  Katherine Spira

About Dr. Katherine Spira

Katherine Spira is a neurologist working in private practice and at Prince of Wales Hospital, NSW. Further to this, she has special interests in headache and obstetric neurology. She completed her training in February 2018. Katherine has previously worked as a Junior Medical Officer at Liverpool Hospital, a Basic Physician Trainee in the Prince of Wales Network, and an Advanced Trainee at Blacktown, Prince of Wales and Royal Prince Alfred hospitals. Katherine loves looking after patients, medical education and being a mum to two beautiful baby girls.

James Dent chats to Dr Robert Rawson about clinical pathology.

Summary Writer:  Divya Iver

Script Writer:  Elizabeth Campbell

Editor:  Robert Rawson

Interviewee:  Robert Rawson

About clinical pathology

Clinical pathologists are specialists in the anatomical, biochemical and physiological processes that maintain a healthy body and the pathological mechanisms that disturb this balance. Through the examination of the changes in tissue architecture caused by disease, pathologists are able to provide critical information regarding diagnosis, prognosis and appropriate treatment modalities.

In this podcast, we explore the field of clinical pathology. Particularly, anatomical pathology. Further, you will gain an insight into some of the techniques pathologists use. Most importantly, you will hear critical information that junior doctors should know about this fascinating specialty.

About Dr Robert Rawson

Robert Rawson completed his Fellowship with the Royal College of Pathologists of Australasia in 2016. Further, he was appointed the Cameron Pathology Fellow at the Melanoma Institute of Australia and Royal Prince Alfred Hospital for 2016. In addition, he held a position as a staff specialist at Royal Darwin Hospital. After that, in 2018, Robert returned to Royal Prince Alfred.

Robert's primary interests include dermatopathology, particularly melanocytic pathology, and gynaecological pathology.

Secondly, he is involved in numerous research collaborations within the Melanoma Institute Australia Translational Research Group at Sydney University. Moreover, he won the Premier’s Award for Outstanding Cancer Research in 2016. And he received the Sydney Research Clinical Researcher Scholarship in 2019. In addition, Robert is committed to the medical education of pathology registrars and medical students.

In his spare time, Robert is a volunteer lifesaver and a keen triathlete. Recently, he was selected to represent Australia at the 2019 Triathlon World Championships in Switzerland.

James Edwards chats to Associate Professor Stephen Adelstein and Dr Brian Fernandes about the medical training survey. All junior doctors have been asked to complete the National Training Survey. This is in order to ascertain the quality of postgraduate medical education in Australia and how it can be improved.

Script Writer:  James Edwards

Interviewees:  Associate Professor Stephen Adelstein and Dr Brian Fernandes

Summary Writer:  Divya Iver

Reviewer:  James Edwards

About Stephen Adelstein

Associate Professor Stephen Adelstein is the Chair of the NSW Board of the Medical Board of Australia and a practitioner member of the National Medical Board of Australia. He has been involved in medical regulation since 2008, initially as a member of the former New South Wales Medical Board, and a past member of the Medical Council of New South Wales.

Associate Professor Adelstein is Head of the Department of Clinical Immunology and Allergy and Director of the Central Sydney Immunology Laboratory at Royal Prince Alfred Hospital, New South Wales, Australia. He is Clinical Associate Professor of Medicine at the University of Sydney where he teaches medical and science students. In addition to his clinical and academic practice, he oversees undergraduate and postgraduate research.

He is the Chair of the Steering and the Advisory Committees of the Medical Board of Australia that are tasked with the delivery of the National Training Survey that all junior medical officers have been asked to complete in order to ascertain the quality of postgraduate medical education in Australia and how it can be improved.

About Dr Brian Fernandes

Dr Brian Fernandes is a medical registrar at Royal Prince Alfred Hospital, NSW, Australia. He has a Masters of Health Policy from the University of Sydney and completed his capstone project on the proposed Medical Training Survey. In his spare time, Brian enjoys watching, playing, and talking about the cricket.

A special podcast "Addressing uncertainty - does it matter which career path you choose?" recorded at the 2019 onthewards conference - Future. Ready. You. on Saturday 18 May 2019, in Sydney, Australia. In this podcast, the panel will discuss the pros and cons of their career path choices.

Panel Chair:  Chris Elliot

Panel:  Ken Liu, Rhea Liang, Bridget Johnson, Clare Richmond, Belinda Gray

About the panel members

Chris Elliot, Consultant General and Developmental Paediatrician, Chairs the panel session consisting of Dr Ken Liu (Transplant Hepatologist), Dr Rhea Liang (General and Breast Surgeon), Dr Bridget Johnson (Consultant Palliative Care Physician), Dr Clare Richmond (Emergency Physician and Prehospital and Retrieval Medicine Specialist), Dr Belinda Gray (Cardiologist), who discuss the benefits and challenges of their career path choices.

The panel also discusses the importance of mentorship, fostering strong collaborative networks, developing your skillset, and more.