Saving skins Making sun protective clothing mandatory in kids and teen sports
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EMBRACING AI
Defining the future role of College
and the dermatology profession
DERMATOLOGY IN THE
KIMBERLEY
Harnessing huge educational benefits
for trainee and non-trainee doctors
Saving skins
Making sun protective
clothing mandatory in
kids and teen sports
ISSUE 127
SUMMER 2021
From the editor
I
In response to the challenges were very successful in 2020 and of your experiences, innovation
of 2020, College has been provided a strong foundation for and adaptability that are vitally
working hard to prepare for the our ongoing work this year. College important for the future direction
unpredictable environment we now also continues to make headway of our profession. Thank you once
find ourselves in. We are looking with our advocacy activities, again to all contributors to this
forward to being able to connect and our agility to adapt to our issue. As ever, it is a wonderful
with you for our first virtual ASM, changing professional environment reflection of College’s dynamic and
which is fast approaching. is showcased in this issue with diverse membership.
Our education team have a tried details of the expansion of our GP
and tested way of moving forward training program. Associate Professor Anna Braue
with our trainee programs, which We continue to share stories Honorary Secretary
EDITORIAL TEAM
EDITOR EDITORIAL PERSONNEL
Associate Professor Anna Braue Anita Allen
Honorary Secretary Caroline Zoers
Haley Bennett
ACKNOWLEDGEMENT
The Australasian College of Dermatologists acknowledges the Wangal
people, the Traditional Owners of the lands upon which the College head
office is located. The College also acknowledges and pays our respects to
the Traditional Owners of the lands upon which Australian dermatology
services are delivered, and Elders past, present and future; for they hold
memories, traditions, cultures and hopes of Aboriginal and Torres Strait
Islander peoples of Australia.
Disclaimer: The Australasian College of Dermatologists wishes to encourage debate and exchanges of ideas amongst Fellows through The Mole.
Nevertheless, the opinions expressed in articles in The Mole are those of the authors and are not necessarily those of the College.
The inclusion of advertising in this publication does not constitute College endorsement of the products or services advertised.
Contents ISSUE 127
SUMMER 2021
NEWS & INTRODUCTION
02 President’s report
03 CEO’s report
BEING THE REPRESENTATIVE VOICE IN SKIN HEALTH 04
04 Embracing AI – future role of College and the dermatology profession
07 Government advocacy
09 National Skin Cancer Action Week 15- 21 November 2020
10 Protective clothing for kids and teen sports – advocating for change
LEADING SKIN HEALTH EDUCATION & TRAINING
18
14 Welcome to education in 2021 – A new year with new challenges
From the Faculties
VIRTUAL
16
DELIVERING HIGH QUALITY MEMBER SERVICES & SUPPORT
18 A place for College in GP education
21
21 The 53rd ASM is almost here and it’s gone virtual!
22 Practice management and stress – A balancing act
DRIVING DERMATOLOGY RESEARCH & INNOVATION
26 Mapping dermatological disease in the Kimberley
29 5 years in London – Professional highlights
32 Obituary
34 Our partners
26
THE MOLE | Summer 2021 | 1
NEWS & INTRODUCTION
President’s report
L
et’s go with the positives! (CPMC), who have met at least (ASSC) Sun Exposure Summit.
I am sure all Fellows are monthly since February 2019, I am A component of this involves a
pleased to welcome a new also on the new Medical Workforce round table discussion (distanced
cohort of registrars and to wish Digital Capabilities Advisory I presume!) at which I represent
our finishing registrars, now fully Group to the government, which College. Hopefully it will proceed
trained dermatologists, good luck is a project in association with the as an important forum to combine
at the start of their specialist career. Australian Medical Council (AMC) research, clinical and community
All candidates in the viva exams and the Australian Digital Health resources to clearly identify
were successful. Their mentors, Agency (ADHA). It is assessing guidelines for sunscreen use and
teachers, College education all things “digital” in the health sun protection in general.
officers, family and friends community with a view to directing The Christmas break like no
congratulate these graduates, all stakeholders in efficient, safe other is now over. As with most of
and should also congratulate and appropriate use of digital you, my family and friends were
themselves as part of the support components in health delivery. affected by isolations, quarantines
network to make this happen in As you may realise, your Board and restrictions. I hope all Fellows,
difficult times. and College committees have trainees and College staff were
Your College, and the various continued to hold regular virtual able to catch up in some way with
cogs in its wheel, showed meetings. While not perfect, this at least a portion of their family,
determination, flexibility, has provided some efficiencies friends and colleagues.
adaptability, and understanding and cost savings to College, and Your ACD website, including
that will underpin improvement to thus its Fellows. Our Strategic the COVID-19 page, along with
assessment, exam processes, and Plan continues to guide us. It is the weekly e-bulletin, continues
teaching in the future. Well done to of little surprise that not long after to inform and support you. The
all involved! the Board electing to meet in platform for this support comes
Teledermatology, and digital February face-to-face, there have from Fellows who get involved in
health in general, have come been various outbreaks, including College and its various activities,
under sharp focus and are now Sydney, Brisbane, Perth and and College staff who have done a
recognized as essential parts of the Melbourne which have directed us mighty job in 2020 and into 2021.
health platform by government and back to our virtual meetings. On As we welcome CEO Tim Wills
the wider community - a positive this note, your ASM will be virtual back from leave, and Dr Haley
after some years of College work. this year, to be held in April, and Bennett continues as Deputy CEO,
While the digital health tools have the AGM will follow suit soon after. I ask all Fellows, and particularly
been part of our remit for some College Fellows and staff are well our most recent graduates, to give
time, progressing acceptance has advanced in organising these, back in some way to your College.
been sped up under the pressure of with the ASM lining up as exciting College is an essential part
the continuing pandemic. From the in concept, as well as being of the foundation which allows
simplest telehealth consultation, interesting and informative. I look us to call ourselves “Specialist
right through to being a leader and forward to you all joining me for Dermatologist” and provide highly
relevant in the Artificial Intelligence these landmark events in College’s skilled care to our patients, no
debate, College is advocating 2021 calendar. matter what challenges we face!
at all levels, as Fellows would Another meeting that was
expect in these spaces. As your postponed from 2020 to 2021 Associate Professor
representative to the Council of is the Australian Skin and David Francis
Presidents of Medical Colleges Skin Cancer Research Centre President
2 | THE MOLE | Summer 2021
CEO’s report
W
elcome to 2021! I have be remotely possible in March 2020 opportunity. In November the
returned to work and am when a sudden drop of planned International Society of Dermatology
eagerly looking forward to revenue through ASM enrolment holds the International Congress
what is ahead. I have been fortunate and sponsorships created an or ICD 2021. This too will be a fully
to have a long break thanks to the alarming scenario. Government online event. As the President notes,
Board’s approval. I feel fortunate intervention provided part of the these are landmark events.
to have such an understanding rescue. We qualified for Job Keeper One thing we learned through
and supportive group of Directors. with over 35% revenue loss. 2020 was that College needs to even
Well done and thanks to Dr Haley Management put on hold the plans out its cash earnings. In order to
Bennett who admirably acted as for staff expansions as budgeted, do that, the member subscriptions
the CEO for 4 months. Haley had and with online work, notable process will change to a 12 month
the support of all staff who were amounts were saved in basic costs. period from July to June. Fellows
also affected by these changes. Together this achieved a good result. have been invoiced in late 2020 for
They pulled together superbly. Many Through all of this, many 6 months to 30 June 2021, then the
thanks to every individual for their processes went rapidly online by new invoice cycle will commence.
role. College HQ has a great group necessity. Often this is the best way Secondly, the ASM revenue crash
of committed and skilled staff and to deliver change – the ‘no choice’ in 2020 highlighted the single point
we have some newcomers bringing route. The AGM, Board meetings, of failure risk we have. Following
fresh insights and perspectives. and trainee selection adjusted well the digital ASM, we will assess the
Many good things came out of and for 2021 we anticipate the new development of an ongoing digital
2020. A lot of effort over many trainee and 3rd year workshops will learning strategy across the year.
months was put in by Fellows be similar. Staff adjusted to remote We are booked for Adelaide 2022
and staff alike to assist Fellows’ working and we made rapid changes but having some digital options too
practices in those foggy months to how we work. Keeping step with may carry forward. To avoid the
after the lockdowns. The COVID-19 government policy making meant Meeting losing State-based flavour,
taskforce was essential. Well done we were making changes on the and to create an ongoing learning
to the Taskforce members and run. Now with our lease at Rhodes through digital events at other times
to chair Bruce Tate who all put in concluding, an opportunity is being in the year, the Scientific Meetings
long hours. The same can also be explored to take advantage of high Steering Committee may need to
said regarding the many months commercial vacancy rates and move to a scientific committee who
of effort by Fellows and education depressed commercial rents to make guides the broader strategy and
team staff on the exam process. It a ‘new start’ at a new location. There every ASM, incorporating State
is heartening to know the exams will be more on this in due course. based research and papers. There is
ran so well. Not only this, but all Despite the success of remote no reason why, as College grows,
who sat the vivas passed. Through working and meeting we all need to that Faculties or subspecialty
regular communications and some have some face to face meet ups as areas cannot hold update meetings
flexibility, we got through, as did subtleties get missed over screen- throughout the year.
many 4th years, which is no small based meetings. Office culture is For many 2020 was not a great
achievement given the uncertainty. harder to keep when everyone is year. It started with the country on
This was neither the style nor timing remote and you get to appreciate fire. One calamity was followed
of the exams of the past. Trainees how corridor conversations add by another, then a pandemic hit.
coped well with the ups and downs glue to the workings. I am sure the But the resilience shown to work
of 2020. Where we go in 2021 is up Board feels the need for face to face through these periods and face
to the committees but knowing we get togethers too. changes stands us in good stead as
can conduct exams a different way To cap off the changes, the ASM we face whatever is ahead in 2021.
provides options. will be an online event for the first
Financially College had a good time. College is still learning as Tim Wills
year. It did not look like that would we go but again, this provides Chief Executive Officer
THE MOLE | Summer 2021 | 3
BEING THE REPRESENTATIVE VOICE IN SKIN HEALTH
Embracing AI – future
role of College and the
dermatology profession
It is not a question of whether artificial
intelligence (AI) will interact with or disrupt
the dermatology profession. The future is
now and changes to the specialty – thanks
to accumulating data and images and the
development of “deep learning” algorithms
– have already begun. The question is
what role will we and our College take in
shaping how AI is used and that it is fit-for-
purpose for the Australian context?
On 30 November 2020, College’s E-Health Committee hosted a
virtual forum with 35 Fellows and two trainees to hear their views
and insights on roles for College and the profession in relation to
development, uptake and support for AI in dermatology.
A/PROF ROB MILLER, E-HEALTH COMMITTEE CHAIR, PROF H PETER SOYER,
E-HEALTH COMMITTEE MEMBER AND CAROLINE ZOERS, POLICY MANAGER
T
hank you to all who attended practice standards, reliance and about how AI for dermatological
our virtual forum. It produced liability, communication of accuracy, conditions will impact on the
a lot of excellent insights and and privacy. Of course, AI also poses future role of dermatologists, other
recommendations, many of which unfamiliar risks, or rather makes old health professionals and patients
are summarised here. risks manifest in new and challenging themselves.
The future potential for AI to ways - from data quality and bias, What was clear from the Forum is
augment patient care is significant. to technology interoperability/ that both College and the profession
However, as with the adoption of failure, and consumer and clinician need to be actively involved – with
all new technologies and models acceptance - creating new industry, researchers and regulators
of care, there are new clinical, legal responsibilities and making robust to lead and shape the way AI is used
and ethical issues to be navigated risk management crucial. in dermatology in a way that delivers
including consent, data control, There are many questions best possible care for Australians.
4 | THE MOLE | Summer 2021
THE FUTURE ROLE OF in the Australian context. There was clear
DERMATOLOGISTS consensus that it is for College and the
So, what does the future look like? That profession to set the quality and safety
remains to be seen but is open for us to standards for AI in dermatology here in
determine. Australia.
While there is the potential for AI to offer
GPs and other gate keepers more specialist
services in the absence of a dermatologist, it Radiology, ophthalmology
is also possible that AI will streamline referrals
to dermatologists and make dermatologists
and pathology are also
better at what we do. seeing very rapid advances
As smartphone-based data entries are
expected to be the most popular among in the ability to train
consumers, it is very likely more people
will present in the near future to doctors
software to recognise
for evaluation of suspicious lesions and visual patterns. However,
management advice. As the best trained to
evaluate pigmented lesions, the volume of dermatology may be more
patients presenting to dermatologists could
in fact rise. AI has the potential to ease the
context specific than other
burden of long waiting lists filled with patients image classifier models
with benign lesions by pre-screening away
these patients and allowing those who need given the significant
specialist care to be identified and referred for
quicker diagnosis and treatment.
diversity in skin types.
It is important to remember that image- As Australia is likely to be a net importer of AI
based diagnosis is also just one part of the technology, it will be especially important that
dermatologists’ role: taking into consideration our context-specificity needs are considered.
a complete medical history, physical We need to look at how we work with the
examination, communication, tailoring Therapeutic Goods Administration (TGA) to
treatment and surgery are all fundamental encourage our domestic regulator to play a
aspects contributing to quality care. more prominent role in assessing AI systems
AI could relieve us of a lot of the and algorithms and avoid undue reliance on
documentation we are doing today. Dr international regulators.
Halpern of the International Skin Imaging We can be working to help design what the
Collaboration noted in a 2019 article that assessment framework looks like. Could this
“In the future, an acne patient might enter form the groundwork for consultative services
the practice and, with facial recognition, to AI vendors to test the quality and safety of
the computer would open his or her chart their systems in the future? These are all valid
and determine if the acne improved from questions.
the previous visit” adding that “we could, as
doctors, spend more of our time talking with TRAINEE AND CONTINUING EDUCATION
the patient about optimal care versus feeding Working together to improve our collective
our computer information.”i AI could help us understanding of how AI works is imperative
determine a patient’s eligibility for particular to our goal. We need to open the ‘black
therapeutics or reimbursement schemes. box’ starting with a dedicated session at the
A clear message is that it is critical that upcoming ASM.
as a profession we need to get involved in Looking ahead, our dermatologists and
AI development to help determine what its registrars will need training and guidance in
role is and to be vocal in talking about how these technologies as it is likely they will be
dermatologists can and are working with AI to contacted frequently by ‘app’ developers and
improve the accessibility and quality of care. technology companies in the future.
We also need to be mindful that variable
REGULATION AND STANDARD SETTING adoption of AI by teaching hospitals in the
AI systems and algorithms need to be future may pose a challenge for consistency
assessed as being safe and fit-for-purpose of teaching and exposure for trainees.
THE MOLE | Summer 2021 | 5
BEING THE REPRESENTATIVE VOICE IN SKIN HEALTH
LEADING RESEARCH To lay the groundwork, the Committee is
It is evident we need to be at the forefront of commissioning a scan of the environment
research. If as a discipline, dermatologists to better understand the AI systems,
drive the research, engaging with industry, applications and research already underway,
College and the profession will be well placed the key issues and key players.
to have a say about its clinical use in Australia To find out more about AI in dermatology
and TGA approvals. and to get involved in the conversation, join
us for a dedicated session at the upcoming
ASM or contact the E-Health Committee by
Only by getting involved emailing Caroline Zoers, Policy Manager at
can we ensure the carolinez@dermcoll.edu.au.
representativeness and College would like to thank Prof H Peter
Soyer, Dr Lisa Abbott and from UQ Centre
quality of datasets for for Online Health, A/Prof Liam Caffery
for presenting and A/Prof Rob Miller for
use here in Australia and facilitating the Forum.
that clinical variation
that pre-dates AI, such as
overdiagnosis of melanoma,
is not perpetuated.
The clear message from our Australian
colleagues already involved in dermatology
AI research is that having the opportunity to
contribute data and test algorithms is a great ABOUT OUR E-HEATH
way of demystifying AI and alleviating some of COMMITTEE
the concerns around its use. College’s E-Health Committee
Offering grants specifically for an AI project advises on matters related to
related to dermatology may be a means to advances in technology – including
encourage young dermatologists and ‘would teledermatology, diagnostic
be trainees’ to think AI and the potential to technologies, e-health, AI and other
commission AI related articles for the AJD can emerging technologies – and their
keep us all informed. impact on the profession, models of
care, research and health policy.
LEADERSHIP AND ENGAGEMENT The Committee also contributes
We will need to engage with a broad range to our e-health related education,
of stakeholders on this issue - the TGA, resources and guidelines for
Australian Digital Health Agency, specialist our members, trainees, health
industry leaders, AI experts, and other professionals, patients and the
medical colleges e.g. RANZCO, RANZCR, community; partnership opportunities
ACRRM, RACGP, as well as our own Fellows and our government advocacy.
and trainees.
As well as one-on-one engagement, the Current committee members are:
suggestion of hosting or co-hosting a summit A/Prof Rob Miller, Chair
on the future of AI in dermatology may be a Prof H Peter Soyer
way of demonstrating leadership and bringing A/Prof Stephen Shumack
together this broad group of stakeholders to Dr Tony Caccetta
inform our future policy position and facilitate A/Prof Pascale Guitera
a conversation on the governance needed for Mr Chris Arnold (Invited member)
its use in Australia. This is something we will Prof Monika Janda (Invited member)
look at in due course. Dr Lisa Abbott (Trainee representative)
i https://www.dermatologytimes.com/view/should-dermatologists-embrace-ai
6 | THE MOLE | Summer 2021
Government advocacy
In December 2020, College met with the Hon Mark College continued with
consultation work over the
Coulton, Federal Minister for Regional Health, Regional December/January period,
Communications and Local Government and his providing feedback on the final
draft of the Department of Health’s
advisers at The Skin Hospital in Sydney where we have National Medical Workforce
a number of Federally-funded STP trainee positions. Strategy. We have also taken the
opportunity to lodge our 2021-22
CAROLINE ZOERS, POLICY MANAGER Pre-Budget submission highlighting
that the Federal Government’s
support for rural and private practice
T
he meeting, which was at the remote and regional Australia. training has been beneficial in
request of the Minister, builds The Hubs are working with enabling us to expand the training
on our previous engagement local health services to help program by 25% and calling
with him and we would like to move medical students through for investment in four additional
thank CEO Brenda Ainsworth and a rural “pipeline”, enabling them dermatology training positions in
her team, Dr Nicholas Stewart, Dr to continue rural training through these expanded settings.
Penny Alexander and registrar Dr university into postgraduate With the COVID-19 expanded
Kirsty Wark at The Skin Hospital for medical training and then to work in telehealth items extended to 31
hosting the visit at short notice. rural locations as doctors. Attention March, we continue to advocate for
It was a wonderful opportunity for is now turning to how to integrate their retention and to input into the
the Minister to see College Fellows specialist training into this model. Government’s broader digital health
and trainees in action. The meeting was an excellent strategy. Indeed, as part of our Pre-
The Minister was particularly keen opportunity to reiterate dermatology Budget submission, we have also
to discuss the Regional Training workforce shortages and advocate called on the Federal Government
Hubs established by the Federal for Federal workforce funding, to specifically incorporate
Government under its Integrated namely STP positions and telehealth into specialty training
Rural Training Pipeline for Medicine telehealth, and other strategies funding schemes as a means of
Initiative and funded through the for supporting young doctors leveraging COVID-19 learnings
Rural Health Multidisciplinary through the training pipeline and and embedding telehealth into the
Training (RHMT) program aimed for delivering training, education health system.
at boosting the number of health and services in rural and remote December 2020 also saw the final
professionals working in rural, settings. report and recommendations from
the Medicare Benefits Schedule
(MBS) Taskforce published following
Dr Haley Bennett, Deputy CEO the conclusion of its review of
ACD, Hon Mark Coulton MP, Brenda the more than 5,700 items on
Ainsworth, CEO The Skin Hospital the MBS which commenced in
2015. The Taskforce’s reports
and recommendations have now
been sent to the Government
for consideration. A number of
Fellows contributed to the MBS
Review on behalf of College and
representatives from College
attended a Department of Health
Roundtable in late February
to discuss the final report and
recommendations, including those
related to consultation items and
telehealth models.
THE MOLE | Summer 2021 | 7
BEING THE REPRESENTATIVE VOICE IN SKIN HEALTH
While gains have been made in some areas, the challenges in securing
and maintaining funding for registrar and consultant positions continue.
STATE AND TERRITORY shortages in a way other specialties While gains have been made
ADVOCACY are not able to. With many in some areas, the challenges in
At a State and Territory level, our jurisdictions keenly focused on their securing and maintaining funding for
workforce advocacy has continued. digital health strategies in light of registrar and consultant positions
College and QLD Faculty Chair, Dr COVID-19, incorporating telehealth continue.
Dougal Coates met with QLD Health into training position proposals There are also challenges in
A/Deputy Director-General Prof can prove advantageous (provided effectively bridging College’s
Keith McNeil to discuss funding for the communications infrastructure national priorities to expand regional
a teledermatology registrar position exists to support it which sadly is workforce and training with the
at Townsville University Hospital. not the case for all communities). approach to trainee selection, welfare
QLD Health funding for this position In NSW, our submission to a and accreditation of training positions
has since been approved which is NSW Parliamentary Inquiry into and we are actively exploring
an excellent result. Health outcomes and access opportunities for better coordination
The advocacy efforts of the WA to health and hospital services and cross-committee collaboration
Faculty towards the rollout of a in rural, regional and remote across College to bridge this.
teledermatology service are proving New South Wales highlighted Recent meetings with Faculty
equally fruitful. regional workforce shortages Chairs and with the Regional and
What is clear from both these and maldistribution. It called for Rural Services Committee have
examples is that telehealth, investment in public dermatology provided the opportunity to discuss
particularly hybrid models services and training positions these challenges and where the
incorporating SAF, are an area including telehealth models. We best opportunities for successful
where dermatologists can have lodged a similar submission workforce advocacy lie for the year
distinguish themselves - providing to the Tasmanian Government’s ahead. We’d like to thank all those
solutions to the problems of recent Health Workforce 2040 involved for their contributions and
workforce maldistribution and strategy consultation. their ongoing advocacy efforts.
Dermatology in Regional Australia
– a practical guide for trainees
College is pleased to launch a new resource for registrars: ‘Dermatology in Regional
Australia – a practical guide for trainees.’ This toolkit is designed to give current and
future trainees the information they need to get started on the process of considering,
experiencing and choosing to pursue a career in a regional community.
HALEY BENNETT, DEPUTY CEO
The toolkit is an interactive pdf, designed to
be easy to navigate. It brings together existing
College developed this toolkit to address findings of our
and new resources on a range of practical topics
2019 member consultation to inform our Regional and Rural
to support regional and rural placements and
Workforce Strategy. We found that for trainees, there is a
outreach visits.
need to:
This project was funded by an Australian
• access information that allows trainees to prepare well Department of Health’s STP Project Support grant.
ahead of time for their experiences in regional, rural and College would like to thank the Regional and
remote communities Rural Services Committee members, chaired
• create clear expectations among trainees about the by Dr Michelle McRae, for their oversight of the
rewards and challenges of practice outside of major cities development of this toolkit.
• provide links to resources and supports available to To view the Dermatology in Regional Australia –
trainees while they are working in a regional, rural or a practical guide for trainees toolkit, log in to ACD
remote area. e-Learning or visit the Publications section of our
website.
8 | THE MOLE | Summer 2021It’s been 40 years since this guy
came onto our screens...
National Skin
Cancer Action
Week 15-21
You might’ve grown up,
November 2020 but some things never change.
It’s still the same sun.
DON’T FORGET TO
Each year Cancer Council
Australia and College come
together to promote National Skin
Cancer Action Week. The week is
a reminder about the importance
of early skin cancer detection National Skin Cancer
Action Week
and the necessity of using sun 15- 21 November, 2020 A partnership between
protection for all Australians. still the same sun on cancer.org.au
MARIAM ZAHID, ENGAGEMENT OFFICER
T
his year’s campaign, It’s still College, the Cancer Council and
the same sun focused on other key stakeholders have been
reminding those in the 25-44 engaged in joint advocacy efforts to
age group of the original Sid the have skin cancer included in the next Print coverage of
Seagul Slip, Slop, Slap campaign, iteration of the Federal Government’s
released when they were children, 10 Year National Preventive Health the National Skin
and encouraging them to continue to Strategy. Coverage of the launch of Cancer Action Week
follow the SunSmart rules as adults. National Skin Cancer Action Week
To launch the week, a joint press saw a statement from the Minister included:
conference with Cancer Council for Health, Greg Hunt, that skin • 8 print articles
Australia was held at the Andrew cancer should be included and • 272 radio mentions
(Boy) Charlton Pool in Sydney, with we await the next iteration of the • 18 TV interviews
A/Prof Stephen Shumack speaking strategy with interest. • 48 online news stories
on behalf of College. National Skin Cancer Action • 1 media publication social
In a joint media release with the Week provided an excellent launch share
Cancer Council, College President pad for Cancer Council Australia’s • 1 podcast inclusion
A/Prof David Francis reminded summer awareness campaign
Australians of the importance of involving a number of our Fellows. Cancer Council secured a
using sun protection to reduce their It is a valuable opportunity to work national print exclusive run
family’s risk of skin cancer. The with the Cancer Council and a across Sunday News Limited
campaign was actively promoted broad community of stakeholders mastheads with 51 pieces
through College social media. to encourage a national across print.
As well as working together for conversation about the importance
National Skin Cancer Action Week, of prevention and early detection.
THE MOLE | Summer 2021 | 9BEING THE REPRESENTATIVE VOICE IN SKIN HEALTH
UV protective clothing for kids and teens
sports – time for a regulatory approach?
My two youngest children started the Junior Life Saving (nippers) program five
years ago. They were young enough to be compliant with my plan that they wear
long sleeved rash vests (rashies) and hats, with sunscreen of course.
DR VANESSA MORGAN
A
s I stood on the sidelines in my own long sleeves The next year as Chair of the Victorian Faculty I had
and hat I felt anxious about the majority of other a platform from which to launch my campaign. I am now
children participating in the program wearing four years into lobbying Life Saving Victoria to make
bikinis and singlet tops. It was a feeling similar to it mandatory that long sleeved rashies and hats are
seeing a toddler standing near the edge of busy traffic. required for participation in their Nippers Program.
The club we are involved with had mandatory pink Progress is slow. Our Faculty sponsored long sleeved
singlet tops for safety in the water but no club long rashies three summers ago for one of the clubs – they
sleeved rashies available. sold out on the first day and it was great to see a
Life Saving Victoria have done a fantastic job with their moderate percentage of the younger children with better
adult lifesavers – all the lifesavers wear long sleeved tops sun protection. In the teenage group the percentage was
with collars and shorts plus broad brimmed hats. This has still worryingly low – and this was in a club with subsidized
been a great achievement, changing the iconic image of rashies, sun protection reminders before each session,
the bronzed speedo or bikini wearing Australian lifesaver, an education session during the season provided by the
and I could not understand why their Nippers were still Cancer Council and an obsessed dermatologist trying to
being exposed. drive change.
Meanwhile the summers have ticked by and each
year I still have that feeling standing on the beach. Not
just me either – one of my preteen patients commented
about sitting near some teenage girls sunbaking in their
bikinis, “I just couldn’t look at them, it was like they
were smoking and no one was doing anything about it”.
Things are not happening fast enough and it is too slow
and resource heavy to approach the problem sport by
sport, club by club.
Melanoma alone kills 1,400 Australians per year and
16,000 are diagnosed. We are the skin cancer capital of
the world. According to Cancer Council Australia, skin
cancer costs the health system an estimated $1 billion
each year - the highest cost of all cancers. The only
modifiable risk factor is sun exposure yet there is clear
evidence that education alone has not had the impact
we need it to have in the teenage group. Over 60% of
teenagers still think it is good to have a tan1 and 1 in 4
report sunburn after a summer weekend2.
Whilst no one likes to be seen as telling people what
to do, in other health areas system change has been
imposed to save lives - bike helmets and seat belts are
mandatory, smoking is not only illegal for under 18’s but is
not allowed near schools. Australia led the way with world
first legislative measures related to seatbelts and other
road safety measures from the 1970’s to great effect and
I think it is time to view the loss of life related to melanoma
in the same way.
We know the skin is particularly vulnerable to UV
damage under the age of 18 and given the evidence that
best effort education alone has not led to mitigation of this
10 | THE MOLE | Summer 2021As the leading health experts in this area we need
to drive this change just as the trauma surgeons
have done with the road toll. It is no less urgent.
risk, sun protective equipment should become participation that appropriate sun protective
a requirement rather than a recommendation clothing be worn (usually long sleeves and a
for children and teenagers in sport and at hat). My impression is that there is support
school. When the push back comes that it from many parents and also that many
‘doesn’t feel as good’ and that the teenagers teenagers would be relieved to be protecting
‘don’t want to’ a reminder that there were their skin properly – but not at the expense of
similar sentiments about bike helmets and being different from everyone else. The sun
seatbelts. Nevertheless, bike helmets have protective clothing suggestions are also more
been mandatory since 1990 with cyclist culturally inclusive and gender neutral than the
fatalities of only around 60 per annum prior to current situation.
this – the skin cancer death toll is much higher. To not act on this situation constitutes lack of
There are certain sports that require provision of a safe environment for our children
prolonged exposure to sun usually in summer and teenagers and as a community makes us
– cricket, rowing, junior lifesaving (nipper culpable for future morbidity and mortality. It is
program), sailing, athletics. I would like to clear that regulatory or policy change is needed
see it eventuate that it is a requirement for alongside education to change behaviour.
[1] Cancer Council, Tanning teens still seek the sun. Media release, Nov 2018. https://www.cancer.org.au/
news/media-releases/tanning-teens-still-seek-the-sun.html
[2] Cancer Council, Half a million Australian teenagers sunburnt on summer weekends. Media release,
Nov 2019. https://www.cancer.org.au/news/media-releases/half-a-million-australian-teenagers-sunburnt-
on-summer-weekends.html
What can you do?
We all have an opportunity to advocate on this
issue within our own States and Territories.
• Find out what regulatory requirements
or recommendations already exist for
community sports clubs
• See whether the criteria for government
sports grants refer to sun protective clothing
or to codes with sun protective clothing
requirements
• Where codes and guidelines already exist,
which organization were they developed by,
Sun protective equipment should how prescriptive are they and how are they
become a requirement rather than enforced?
a recommendation for children and • Seek out opportunities to raise this issue with
your local MP, would they be willing to help
teenagers in sport and at school. sponsor change in this area?
THE MOLE | Summer 2021 | 11BEING THE REPRESENTATIVE VOICE IN SKIN HEALTH
Advocating
for change in
sun protection
policy
A
recent Victorian Government consultation on its
Youth Strategy provided an opportunity for the
ACD and AMA Victoria to support Cancer Council
Victoria in calling for a comprehensive policy addressing
behaviour, environment and education to become mandatory
in all Victorian schools and for sun protection policies to
be a requirement of all Victorian Government sports grants
recipients when the sport takes place outdoors.
College has updated our position statements
on Skin cancer in Australia and Sun
protection and sunscreens with the latest
data and information.
ACD SKIN CANCER POSITION STATEMENTS
• Skin cancer in Australia aims to provide information to the community
about skin cancer in Australia, raise awareness of the risk factors and
encourage individuals to know their own risk. It provides guidance on
how to check your own skin and when and where to seek advice from a
health professional.
• Sun protection and sunscreens provides guidance on sun protection
and its benefits in reducing the risk of skin cancer, and informs the
community about sunscreens, how they work and how to use them
safely and effectively.
Both position statements can be accessed on our website.
of Queensland Health
on sunglasses
12 | THE MOLE | Winter 2020LEADING SKIN HEALTH EDUCATION & TRAINING
Welcome to
education in 2021
– A new year with
new challenges
In 2020 College came together to work its way through COVID-19.
This required Fellows, trainees, staff and stakeholders to communicate,
respond, adapt and grow in order to succeed.
BRETT O’NEILL, DIRECTOR EDUCATION SERVICES
I
believe this is something that everyone with Fellows on confocal training and we hope
did and because of it we were able to to be able to develop this further in 2021.
maintain our programs, run exams, conduct Offering Fellows education in specialty areas is
interviews and accreditation, hold workshops something that College would like to explore
and conduct assessments remotely, build more, whether this be in a certificate form
and launch new products and employ new or other and we seek your thoughts on this.
staff. Thank you again for all your work. The Please contact College if you have any queries
College education team is committed to the on these topics.
goal of College to be the unifying leader in skin I also take this opportunity to remind
health education and training for specialist Fellows of the CPD Category 3: Workplace
dermatologists, other health professionals, behaviour - A Way Forward online module
students, communities and patients. To that is a requirement for Fellows and trainees
continue this success, we will need to work to complete as part of their CPD. 2020
together in 2021 as we progress through certainly created different types of pressure
COVID-19 and any other challenges we may on Fellows and trainees. It is important to
face. This leads into our plans for 2021. remember our role in ensuring our behaviour
is appropriate. College has relevant
FELLOW TRAINING policies on the website on Anti-Bullying/
With the Professional Performance Framework Discrimination/Harassment. The Professional
(PPF) delayed in 2020, but still coming, Code of Ethics also covers the standards of
2021 must be the year that College makes dermatology practice, care for doctors who
clear its position and how it will look to roll are specialist dermatologists or doctors-in-
out the revised CPD program. Programs for training, and the conduct and behavioural
Fellows continue to be offered, with Mohs and expectations of Fellows of College and
Cosmetic Dermatology continuing with small doctors-in-training. Please contact College if
numbers. There has also been some work you wish to discuss these matters further.
14 | THE MOLE | Summer 2021The College GP Taskforce has been
working to assist in the education
of GPs and their role in the
collaborative care and treatment
process.
TRAINING PROGRAM (TOP) has served its purpose and we are
While the training year now has many looking for a more flexible and comprehensive
‘start dates’, a cohort of around 12 new system (a CRM) that can adjust to the
trainees commenced in February. Overseas variations in the training program. The I.T
placements have been put on hold in 2021 steering committee will be involved in this
and COVID-19 is still making its presence process and we will no doubt be engaging
felt, with 1st and 3rd year workshops being with stakeholders throughout the process.
conducted online this year with the practical We hope to have this work ready for gradual
component rescheduled for later in the year roll out towards the end of 2021. The last
or managed more locally. With exam dates time such work was attempted was in 2013.
set, we will continue to monitor this, and will
make more information available as the year GP TRAINING AND OTHER HEALTH
progresses. We have learnt a lot from the EDUCATION
2020 experience and feel confident we can There is no doubt that GPs are a critical
respond to changes and challenges as they component of the dermatology story. They
arise. The curriculum review will come to an are primary care providers and an important
end in 2021, and while we hope that this will part of the referral process to dermatologists.
be the start of a ‘rolling curriculum review’, The College GP Taskforce has been working
we expect to be able to release the new to assist in the education of GPs and their
curriculum in time for 2022. role in the collaborative care and treatment
2020 marked the introduction of wellbeing process. During 2020 College built its
and engagement officers. They have capabilities (staff) to better manage this. In
endeavoured to bring mental health, wellbeing, 2021 College will continue to build (website,
advocacy support and awareness to front of marketing/comms) and offer skin cancer
mind for ACD staff, members and trainees. courses and general dermatology courses
They have developed and delivered information to GPs via a mixture of face to face and
and resources that have had a positive impact online programs. Elsewhere in this edition
on trainees. Following a review of the year and of The Mole, Dr Ben Carew writes more on
feedback from various stakeholders, they aim this. Please contact Magda Dickerson at
to develop programs that will connect trainees College (Madga@dermcoll.edu.au) if you have
and members to enhance the ever-growing any questions or wish to participate in the
community of dermatologists in Australia. If teaching and learning process.
possible, they plan to travel interstate to provide College continues to offer training in
trainees, SoTs and DoTs with one-on-one melanography and for Aboriginal and Torres
support, wellbeing training and face to face Strait Islander health workers via online and
workshops. College is also spending some time workshop formats.
reviewing the various State Workplace Awards If you have any education questions or
trainees are employed under to see how they wish to be involved with education activities,
impact the Training Program. you can contact me at College at
In 2020 College will be embarking on a brett@dermcoll.edu.au or 02 8741 4199.
review of our I.T Database. Our current system I’d love to hear from you.
THE MOLE | Summer 2021 | 15LEADING SKIN HEALTH EDUCATION & TRAINING
From the Faculties
Banan, Dr Deanne Choi, Dr Carolina In addition, Dr Stephen Donoghue has
NSW Faculty Cordoba, Dr Ludi Ge, Dr Shelley stepped down from his role as Director
Hwang, Dr Rashi Malesu and Dr Vivian of Training. The faculty would like to
At the time of writing, many Fellows Tng. The faculty would particularly thank Stephen for the years served
would be ushering in the new year, after like to thank the hard work put in by as DoT, and as Treasurer before this.
a somewhat more muted and unusual College staff and the examinations Fellows might not be aware that with
festive season. Unfortunately, COVID-19 committee to organise a safe and the increasing number of trainees, and
cases continue to arise in different areas successful examinations process. the complexity of the training program
of the country and the faculty wishes Dr Elizabeth Dawes-Higgs has and its requirements nowadays, just
college staff, Fellows and registrars stepped down as one of our two NSW how much personal time, effort and
well in coping with restrictions as they censors, and the faculty would like to energy goes into fulfilling these roles,
change to deal with these outbreaks. express our thanks for the enormous and the gratitude of the faculty can
The faculty would like to congratulate effort and time she has put in during her never be overstated.
all trainees who were recently term. The faculty welcomes Dr Penny
successful in the Fellowship exams, Lim into the role of NSW censor, and Dr Keng Cheng
including from NSW, Dr Parastoo wish her the best for the task ahead. Chair, NSW Faculty
graduate class of 2020 – Dr Francis The Royal Children’s Hospital
Lai, Dr Priska McDonald, Dr Rowena hosted a successful clinical meeting
VIC Faculty Meani, Dr Diana Norris, Dr Charles Xie, via Zoom with input from interstate
Dr Sudha Anish and Dr Sarah Smithson. dermatologists being a most welcome
With 2020 mercifully drawn to a close Special mention to Dr Francis Lai for addition to the shared learning. It will
us Victorians are taking a big breath and taking out the Travelling Fellowship award be interesting to see the evolving role
looking forward to better times in 2021. and the Harvey Rotstein Registrar award. that online platforms will provide in
Our best wishes for the New Year go out We hosted a well attended education and communication in a
to all our colleagues around Australia. presentation evening via Zoom to post-COVID-19 world.
The Victoria faculty has kept busy celebrate the contributions and The Victoria faculty continues to explore
over the past 3 months with the retirements from amongst our ranks. ways of improving dermatology services
following activities: Dr Con Meehan is to be congratulated to the country (including Tasmania).
The finalisation of new registrar places on his Distinguished Service to Victorian This includes applying for funding and
for 2021 with Dr William Berry, Dr On Dermatology Award. We wish Dr Peter organising new registrar positions and
Bon Chan and Dr Sarah Ringin to be Sinclair, Dr Ana Catona, Dr Rodney looking to boost telehealth services.
congratulated on gaining places. O’Keefe and Dr Barbara Breadon well in
We congratulate our hard working their retirement and thank them for their Dr Paul Curnow
registrars and particularly our successful contributions during their careers. Chair, VIC Faculty
Perera, and Dr Lucy Pitney. Considering Health, we are hopeful we will be able
QLD Faculty the unique circumstances of their year, to send him some company in the form
a herculean effort by all. I would like to of a new registrar this year. Keep up the
Having not hosted a clinical meeting thank Dr Nerilee Wall and Dr Lauren good work Aaron.
since January 2020, the Queensland Buchanan for organising the evening. Finally, many thanks to the
Faculty have planned a virtual clinical January also sees the return of four contributions of all Queensland Fellows
meeting later this month, immediately registrars from overseas or interstate, to the Faculty, but in particular the
preceding our AGM. We are excited including Dr Matthew Hishon, Dr Faculty executive Dr Lauren Kunde,
about the academic and I.T challenge Antonia Laino, Dr Benny Yau, and Dr Dr Samantha Conias, Dr Godfrey
this day will bring. In keeping with the Conrad Morze. We hope they had a Wagner and Dr Erin McMeniman
calendar from previous years, the day will safe journey and tolerable quarantine, for their countless time, energy, and
conclude with our annual Faculty dinner. and are excited to have them back on support during 2020. I look forward to
This year we will receive and congratulate the team for 2021. continuing to work with you all in 2021.
seven new fellows – Dr Sarath Bodapati, Dr Aaron Boyce continues to beaver
Dr Shikha Chugh, Dr Jesse Johnston, Dr away solo in Townsville, and after many Dr Dougal Coates
Natalie Ling, Dr Casey Rowe, Dr Eshini months of meeting with Queensland Chair, QLD Faculty
16 | THE MOLE | Summer 2021has taken a lifetime of searching but will provide general dermatology,
WA Faculty I think I may have finally found my paediatric dermatology and a
sporting calling as evidenced by the monthly vulval clinic. At Royal Perth
We welcome a New Year with accompanying photos! we are working towards roll out of
hope and excitement and look back After feedback sought from a teledermatology service at the
upon a year that has challenged us Fellows in WA, we will continue to beginning of 2022 which plans to
all in many ways but has also offered hold some virtual clinical meetings fund 0.4 Consultant and 2 full time
some opportunities. in 2021, and alternate these with equivalent registrar places.
We enjoyed a fantastic end of year ‘in person’ events. This will allow We welcome back registrar Dr
function to say goodbye to 2020 increased attendance for those Anna Schauer from Singapore and
organised by Dr Gary Moloney at the outside of the metro area and wish our final year registrars Dr
Mosman Park Bowls Club. For those also those who have difficulty Justin Bui, Dr Sarah Strathie-Page
who don’t know Perth, this is a casual attending due to work and family and Dr Andrew Swarbrick all the best
venue with stunning views across the commitments. as they prepare for their fellowship
Swan River to the city and Darling Dr Alan Donnelly has been working examinations.
Ranges. Much fun, bowls, drinks and hard with Fiona Stanley Hospital to
delicious Mexican fare was enjoyed deliver an extra clinic to this service Dr Austen Anderson
by all until the close of the venue. It planned to commence in 2021 which Chair, WA Faculty
The WA Faculty farewell 2020 at the Mosman Park Bowls Club
A huge thank you to Dr Emma will be somewhat smoother and we
SA Faculty Haverhoek as State Examiner look forward to the modified Annual
and Dr Emma Ryan as Director of Scientific Meeting which has involved
The Faculty congratulates all 5 Training for their extraordinary efforts, considerable hard work for Dr Sally
candidates from South Australia who as well as those involved in the Ball and Dr Emma Ryan.
sat and passed the Fellowship exam exam process and teaching of the Thanks to Dr Jeffrey Wayte as
in 2020: Dr Cassandra Chaptini, Dr registrars. Secretary for the Faculty over the
Charlotte Forrest, Dr Aakriti Gupta, As luck would have it just as the last two years for his assistance and
Dr Chloe Lim and Dr Fiona Menz. To Faculty was about to have its first sage advice to the Chair, as well as
say this has been been a very difficult face to face clinical meeting of Dr Stuart Murray and Dr Chris Tyson
year would be an understatement 2020, the state went into another in the role of Treasurer. Best Wishes
and they should all be very proud lockdown and the meeting had to to all in 2021.
of their achievements. We wish be cancelled at the last moment
them all the best in their futures in and has been rescheduled Zoom Dr Romuald Czechowicz
dermatology. style in early 2021. Hopefully 2021 Chair, SA Faculty
THE MOLE | Summer 2021 | 17DELIVERING HIGH QUALITY MEMBER SERVICES & SUPPORT
We all welcome 2021
and are hoping for
positive steps towards
a COVID safe future. I
would like to thank Dr
Haley Bennett and the
staff at the College for
the significant work done
in the last 12 months
adjusting to a frequently
changing business and
health environment.
A place
I would also like to
acknowledge the work for College
in GP
done by Fellows involved
in any capacity, I know
that many have put in
extra work during this
period to help us all. Education
While COVID-19 has been an unavoidable focus for all of us,
College has continued to work towards achieving our strategic
goals outlined in the strategic plan.
DR BEN CAREW, BOARD DIRECTOR
A
s part of working towards our goals Practice and medical education. I saw this
of leading skin health and education as an opportunity to contribute given my
and being the representative voice previous role as a GP medical educator for
in skin health, College has developed a a regional training provider prior to training
number of education courses with a focus in dermatology. I am sympathetic to rural
on skin cancer. These have been very well and regional GPs and GP registrars who
received and this year College will release benefit greatly from further training in general
the Dermatology for General Practice course dermatology and skin cancer, having been one
as well as expanding the delivery of skin myself.
cancer courses. These courses promote It is easy to think that our position as
our profession as key opinion leaders and specialist dermatologists and the status of
education providers in skin health. College as the leader in skin health would
In early 2020 I joined the Board of the remain unchallenged however this is not the
College. College at the time was seeking a case. Most Fellows make great sacrifices
Board member with a background in General to complete our training and then battle to
18 | THE MOLE | Summer 2021contain waiting lists and manage workloads.
Busy Fellows may not be aware of the skin
cancer education landscape and how it has
changed, with increasing dominance by
primary care providers with little Australian
dermatologist involvement.
It is widely acknowledged
that issues related to GP
skin cancer and general
dermatology education have
arisen due to:
1. An undersupply of dermatologists
to meet demand
2. Limited training of undergraduate
medical students and General
Practitioners in general dermatology
and skin cancer.
We continue to advocate for funding to
expand our own registrar training program,
however the rate at which we can graduate
new Fellows does not keep pace with the
demand of the Australian population for
skin cancer care. Much of this care is ably
and appropriately managed in the primary
setting, and the College is fully supportive
of ensuring that patients who should be
treated by GPs continue to do so, and that
those requiring specialist care are referred as
required. Upskilling of the GP workforce will to members who have completed short course
assist in ensuring standards in primary care requirements. It is concerning to me that some
dermatology are met. courses have little or no hands-on component
However in this high-demand environment, yet cover surgical flaps and grafts in the syllabus.
multiple organisations (universities, corporates That completion of these courses may
and other colleges) have developed and lead to self-accredited “Fellowship” adds to
monetised models of skin cancer training for public confusion and gives the perception
GPs which are aggressively promoted and of specialisation. Medical Fellowship in my
some extend beyond general upskilling. The opinion implies specialisation and to be clear
skin education space is increasingly crowded the only Australian Medical Council-accredited
by primary care providers. skin specialty is Dermatology. A simple Google
Over time as numbers of the GPs trained by search for skin cancer specialist directs you to
these groups have increased, there has been more GP clinics than it does to dermatologists.
an increasing push to recognise / accredit the I am sure most Fellows have had patients who
skin cancer practitioner. This is leading to a think that the skin GP they have seen was a
number of organisations offering “Fellowships” “Skin Specialist”.
That completion of courses may lead to self-accredited
“Fellowship” adds to public confusion and gives the
perception of specialisation.
THE MOLE | Summer 2021 | 19You can also read
