The increased rates of depression and suicidal ideations experienced by this population depict a bleak future for the medical profession in this country. Of great concern is the fact that the barriers preventing medical students from accessing support are not only unique, but despairingly fraught with immeasurable difficulty and stigmatisation; stigma that is entrenched and perpetuated through the core of the medical culture. [2] Despite our existence in an apparently enlightened and diverse cultural framework, the disconcerting stigma branded upon mental health exists and it is truly deplorable…

In recent years, the mental well-being of medical students has received increasing publicity and coverage. This was previously a somewhat taboo topic within the medical community, but it has transitioned to become an issue that is now widely discussed and debated amongst students, faculty and the wider medical community. The outcome has been fruitful with a multitude of new initiatives highlighting the importance of mental health in health professionals. Nevertheless, there continues to be a worrying disparity in the prevalence of mental illness between medical students and the wider Australian population.

Nguyen outlined key factors that could contribute to this problem, including the fact that the medical course inflicts on students immense stressors including an overwhelming workload, rigorous examinations and lofty aspirations. [2,3] There is no doubt that this places an increasing burden on medical students. However, it must also be acknowledged that medical students generally have limited constructive coping strategies to deal with such stressors in the first place. Consequently, this may lead to a downward spiral involving concomitant behavioural problems; for example, excessive alcohol intake and the use of recreational drugs. [4]

The recent suggestions of a national curriculum and a national examination have created important discussions about Australian medical education and its future. [1-2]

The debate surrounding their merits and disadvantages is likely to remain ongoing without reaching a consensus amongst all involved stakeholders. [3] With the significant increase in the number of medical graduates and heterogeneity of current and future medical curriculum and programmes, [4-5] there is an urgent need for regulatory authorities of medical practitioners (such as the Medical Board of Australia and the Australian Medical Council (AMC)) to ensure all Australian medical graduates have reached agreed standards of delivering adequate and safe patient care. [6]

One of the most practical and effective measures that can be immediately taken by the AMC is to conduct an annual external review and audit of each medical school’s final examinations. This will serve the important function of ensuring that valid and reliable assessments are being put into place. The final examinations should be properly “blueprinted” to check that the medical graduates have truly met important learning outcomes and have achieved the competencies set out in their curriculum or programmes. [7] It will also provide opportunities for the AMC to maintain the national agreed standard for Australia. [8] The current key issues here are social accountability and patient safety, both of which are extremely important topics amongst the Australian medical education community and all state health services. [9]

The annual external review and audit of final examinations can also strike a balance, allowing medical schools to maintain autonomy over curriculum development,the AMC is to conduct an annual external review and audit of each medical school’s final examinations. This will serve the important function of ensuring that valid and reliable assessments are being put into place. The final examinations should be properly “blueprinted” to check that the medical graduates have truly met important learning outcomes and have achieved the provided they can demonstrate that their graduates meet the national agreed standard.

The Royal Australasian College of Physicians’ (RACP) Clinical Examination takes a full day and for medical registrars is the barrier between basic and advanced training, including subspecialty training. My experience was as an ‘examination assistant’ (or ‘bulldog’ in colloquial terms) for the candidates. I had been on my general medicine rotation and the consultant of my medical unit was looking for volunteers.

The clinical examination day comprises a morning and an afternoon session. Each session is comprised of two short cases and one long case. Short cases each take fifteen minutes. Candidates have three minutes before they enter the station to read one sentence which provides the name of the patient, presenting complaint and body system to examine. The candidate introduces themselves, examines the patient, presents their findings, is questioned by two examiners and walks out at the bell, remembering to wash their hands before they leave. In contrast to medical school OSCEs, candidates do not speak to the examiners while examining the patient. Instead they present afterwards, which is when they start scoring marks. My candidate asked me to signal him at six minutes (by tapping on my watch, coughing or clearing my throat) so he could spend the next nine minutes presenting and thus scoring marks. The examiners can also ask for investigations to be interpreted. For example, “What would you like to order for his murmur?” or, “You said ECG, tell us about this ECG and chest x-ray.” Fortunately, the short cases are assessed ‘blind’ by the examiners who have not examined the patients themselves. This is not so for the long cases.

For the long case, the candidate spends one hour alone with the patient. During this time, they take a thorough history, perform an examination, determine the patient’s medical and psychosocial issues and construct a management plan. After this, candidates have ten minutes before seeing the examiners. In these ten minutes, the candidate can think of potential questions and collect their thoughts. The long case assessment occurs over 25 minutes with two examiners. The candidate begins by presenting the case followed by non-stop questioning on anything from the history (“What were the circumstances of the fall you mentioned?”), physical examination (“What do you mean by nerve compression, what level?”), investigations (“How do you determine if the asthma is mild, moderate or severe?”), and management (“What if this person were to go to surgery?” or, “How might you educate this patient?”).

While the examination represents an artificial construct, particularly in respect to the short cases, the format does allow for assessment of a candidate’s ability to perform at a physician level, to analyse, interpret information and to deal with the inevitable dilemmas presented by real patients. “Under the pressure of the exam, candidates generally revert to their normal level of everyday practice,” says successful candidate Dr Luke Vos of Launceston General Hospital.

He advises budding physicians, “Preparation for clinical examinations really begins as soon as you enter physician training. The essential elements of history taking, physical examination, construction of a differential diagnosis and the establishment of a plan for the investigation and management of each clinical problem are skills you can continue to refine from day one. While somewhat daunting, a willingness to expose yourself to constructive criticism from colleagues and mentors will help improve your approach and can prove invaluable. The skills you develop in preparation for the clinical exams will continue to serve you throughout your career.”

From a bulldog’s perspective, I could see how medical school trains us for these types of exams, but also prepares us for days when we just need to remain calm and focused on the next patient. And given that the clinical examination fee was $3,780 this year, there was definitely good motivation to pass!

More information can be found at the RACP PREP Basic Training Program website: http:// www.racp.edu.au/page/basic-training / examinations/clinical-examination.

Healthcare provision and access to effective healthcare for young people (aged fifteen to 24 years) has long been a debated issue. [1,2]

The law is clear regarding the conditions under which a person under the age of eighteen (a ‘minor’) may consent to medical treatment. Yet there is a remarkable lack of clarity, and lack of legal precedent, over the right of minors to control the confidentiality of their medical information. This deficiency includes the extent to which disclosure should occur between medical professionals and the parents or guardians of the minor in question.

In Australia, adults have a right to complete confidentiality of all of their health information. The few exceptions to this occur when the doctor does not identify the person, when disclosure is in the public interest or in the case of forced disclosure. The right to confidentiality is a cornerstone of the nature of healthcare provision in Australia: if it did not exist, it is likely that the confidence of the public in seeking health care would be diminished. So why is it that minors are not afforded this right?

Ethically, the focus must be the minor’s interests, not those of the parent, and it should be remembered that the treating doctor is the final judge of a minor’s capacity to consent. In some cases, the doctor will maintain a minor’s confidentiality in accordance with their wishes, but also encourage them to involve their parents in their treatment. This approach often leads to improved outcomes for the minor, as parent involvement is on the minor’s agenda (and not that of the parent or doctor). It also establishes a more effective ‘team’ (the family-doctor unit) approach to their ongoing healthcare.

Of particular concern, parents and guardians are now able to access Medicare and pharmaceutical benefits scheme (PBS) claims for minors under the age of sixteen. [3] This allows parents to access information outlining when and from whom minors have received medical treatment, and what medications have been prescribed. If the minor is aged fourteen or fifteen, a form must be signed by the minor in order to release the information to the parent or guardian. Despite this, the ability of parents to potentially access the Medicare and PBS records of their child creates a potential deterrent for the minor to access future healthcare. Children under fourteen years, who may be deemed capable of consenting to a medical treatment, are not able to restrict parental access to their Medicare and PBS record at all. This situation also places the healthcare provider in a difficult situation.

There is little legal clarity as to the point at which a young person gains the right to confidentiality. Should a young person’s ability to gain confidential healthcare be linked to their ability to consent to their own treatment (the Gillick competence)? There is a strong argument for this case. Research into minors with chronic ongoing illnesses such as diabetes has found that they may be Gillick competent from as young as the age as six. [4] Many of these minors self-manage complex conditions with little parental involvement, and perhaps should, in some cases, also have the right to confidentiality if deemed appropriate by the doctor, the minor and the parent. However, there are situations where confidentiality is not in the best interest of the minor. This may occur, for example, when a minor refuses treatment or is unable to comply with an agreed treatment without external assistance.

Perhaps the nature of health information should be an important consideration in this discussion of confidentiality? A minor may regard some types of health information as ‘private,’ while considering other issues to be suitable to discuss with their parents. For example, vaccination records would likely fit into the latter category, whilst a prescription for the oral contraceptive pill may be a more sensitive area over which the minor may wish to retain confidentiality. The difficulty with such a requirement, whereby the law is to classify the nature of the information and whether it should be confidential, is to effectively apply criterion to different ‘types’ of healthcare information. Furthermore, different minors are likely to have different opinions about what types of information could be freely ‘shared.’

Alternatively, should privacy be linked to a specific request not to disclose that information? This may be an effective way of balancing individual opinions and relationships between minors and their guardians. Should the expectation be, however, that for every piece of information shared the doctor asks the minor whether they wish it to remain confidential, or vice versa? What about information that the doctor may assume not to be private? Of course, in many ways this is the system currently in place, with doctors respecting minors’ decisions to maintain privacy, with several notable exceptions as previously discussed.

This issue will continue to be a topic of debate and discussion within the community. Ultimately it is fundamental to put the best interest of the minor first, ensuring the best possible health outcomes. If the importance of privacy is not appreciated, we create the risk of discouraging young people from seeking healthcare – which is usually contrary to the intention of the parent or guardian in the first place. Current policy and medical practice should be evaluated to ensure that doctors have appropriate guidelines surrounding when privacy should be maintained with respect to minors. Finally, it is crucial to communicate to young people seeking care their right to privacy (and the limitations upon this right), in an upfront and honest way. This will ideally result in optimum healthcare provision for young Australians.

Acknowledgements

The author wishes to thank Sara Bird, Emily Jenkins and David Taylor for their general assistance.

I am writing in response to the review article by McMullen (AMSJ Volume 1, Issue 1). [1]

The major cause of gynaecologic-related cancer mortality in women in developed settings is ovarian cancer. [2] Recent research findings in this field provide hope in relation to both screening and early treatment – even though randomised controlled trial evidence in most screening techniques is still not available.

Serum CA125, which is the most commonly used tumour marker for ovarian cancer, is not suitable for population-based screening as it has been found to be elevated in only five to six out of ten women with stage I epithelial ovarian cancer. [3] Screening and diagnosis may therefore have to incorporate a variety of other tools. Primary prevention also needs to be considered.

Primary prevention is aimed at risk factors for ovarian cancer. A study of Australian women found an increased ovarian cancer risk related to high dietary intake of red and processed meat and fat. [4]

A meta-analysis found that smoking may increase the risk of developing mucinous ovarian cancer twofold. [5] Other studies have shown reduced serous ovarian cancer risk with hormonal contraceptive use, breastfeeding duration and increasing parity. [6] Health care workers could contribute to primary prevention by encouraging patients to quit smoking, change dietary habits and breastfeed their babies.

Screening is a type of secondary prevention. Screening will have a higher yield if it is targeted at people at increased risk. Multiple primary cancer links were found in an assessment of South Australian Cancer Registry data which suggested screening for ovarian cancers in patients with colon cancer or cancer of the uterus. [7]

Genetic counselling and testing is a good screening tool in persons at high risk of ovarian cancer and persons with familial ovarian cancer history. [8] Carriers of BRCA1 and BRCA2 mutations account for up to 15% of ovarian tumours. [9] Genetic advances have also identified GTF2A1 and GTF2A1 plus HAAO as principal markers in ovarian cancer diagnosis. [10]

As for the actual screening test to be used, urine angiostatin levels are elevated in patients with epithelial ovarian cancer and have been shown to be a superior marker in detection of epithelial ovarian cancer as compared to CA125. [11] Differentiation of cancer from healthy controls had a sensitivity of 88% and specificity of 92%; while differentiation of benign from neoplastic lesions had a sensitivity of 84% and specificity of 84%. When used in combination with CA125, 91% of ovarian cancers were identified.

Transvaginal ultrasonography has also been shown to be of use in diagnosis, especially in augmentation of CA125 screening. [12] Multimodal screening, on the other hand, involving CA125 and ultrasonography in a pilot randomised trial has a positive predictive value of 21% with prolonged survival rates. [13]

In conclusion, serum CA125 is an inadequate solitary predictor in the diagnosis of ovarian cancer. Upcoming diagnostic methods provide an unprecedented opportunity to combine methods and thus improve diagnosis in Australia.

References

[1] McMullen D. Ovarian carcinoma: Classification and screening challenges. Australian Medical Student Journal 2010;1(1):35-7.

[2] Costi M, Zeillinger R. Drug resistance in ovarian cancer: Biomarkers and treatments. Highlights from the DROC meeting held in Modena (Italy) on the 19th and 20th of February 2009. Scientific topics discussed at the meeting are reported in the present issue. Gynecol Oncol 2010;117(2):149-51.

[3] Moore R, MacLaughlan S, Bast Jr. R. Current state of biomarker development for clinical application in epithelial ovarian cancer. Gynecol Oncol 2010;116(2):240-5.

[4] Kolahdooz F, Ibiebele T, Van Der Pols J, Webb P. Dietary patterns and ovarian cancer risk. Am J Clin Nutr 2009;89(1):297-304.

[5] Jordan S, Whiteman D, Purdie D, Green A, Webb P. Does smoking increase risk of ovarian cancer? A systematic review. Gynecol Oncol 2006;103(3):1122-9.

[6] Jordan S, Green A, Whiteman D, Moore S, Bain C, Gertig D, et al. Serous ovarian, fallopian tube and primary peritoneal cancers: A comparative epidemiological analysis. Int J Cancer 2007;122(7):1598-603.

[7] Heard A, Roder D, Luke C. Multiple primary cancers of separate organ sites: Implications for research and cancer control (Australia). Cancer Causes and Control 2005;16(5):475-81.

[8] Petrucelli N, Daly M, Feldman G. Hereditary breast and ovarian cancer due to mutations in BRCA1 and BRCA2. Genet Med 2010;12(5):245-59.

[9] Despierre E, Lambrechts D, Neven P, Amant F, Lambrechts S, Vergote I. The molecular genetic basis of ovarian cancer and its roadmap towards a better treatment. Gynecol Oncol 2010;117(2):358-65.

[10] Huang Y, Jansen R, Fabbri E, Potter D, Liyanarachchi S, Chan M, et al. Identification of candidate epigenetic biomarkers for ovarian cancer detection. Oncol Rep 2009;22(4):853-61.

[11] Drenberg C, Saunders B, Wilbanks G, Chen R, Nicosia R, Kruk P, et al. Urinary angiostatin levels are elevated in patients with epithelial ovarian cancer. Gynecol Oncol 2010;117(1):117-24.

[12] Hennessy B, Coleman R, Markman M. Ovarian Cancer. Lancet 2009;374(9698):1371-82.

[13] Jacobs I, Skates S, MacDonald N, Menon U, Rosenthal A, Davies A, et al. Screening for ovarian cancer: A pilot randomised controlled trial. Lancet 1999;353(9160):1207- 10.

As the article reports, there is a conspicuous lack of solid data investigating the relationship between pharmaceutical companies and medical students, particularly in Australia. Clearly there are both positive and negative aspects to this relationship, and I think the main concern many students hold is, at its roots, an ethical one. Can these companies exert an influence over our opinions about drugs, and subsequently affect our future prescribing practices? More importantly, does this have any relationship at all to accepting free gifts which might benefit our education?

The ethics regarding this issue is a veritable maze of should, should-sometimes and should-nots, and as with many issues, ethics often takes a second place to convenience, and sometimes even third place behind convenience and greed. Naturally, this is not to say that medical students are either indolent or opportunistic, but the importance of this issue is undeniable, with many Australian medical students uncertain about how to deal with pharmaceutical gifts and promotions.

From ethical principles, all moral individuals are bound by the Law of Reciprocity, which unequivocally states that we are disposed, as a matter of moral obligation, “to return good in proportion to the good we receive” – but how does this fit into the situation today? [2] Can a moral person, regardless of whether they are a medical student, accept a gift, be it a pen, mug, lanyard or free sandwich, and not feel a sense of ethical obligation towards the giver?

Carmody and Mansfield report that both doctors and students believe they possess a certain ‘invulnerability’ to any such nefarious ploys of inducing a reciprocal obligation, and as such feel free to accept small gifts without fear. Yet this is acting in direct opposition to the moral law of reciprocity, and consequently, does this mean we are acting unethically?

While medical students may think that getting something for free is an obvious win-win situation, in reality nothing could be further from the truth. If anything, it’s one of those infuriating lose-lose situations. Accepting a gift means the beneficiary takes on a debt which may lead to a conflict of interest in the future, and in doing so acts unethically, something which is frowned upon quite seriously within the medical profession.

Some might argue that medical principlist ethics is not dictated by the moral law of reciprocity, but we all know that few things in this world come free, and in all seriousness, what are the odds that pharmaceutical companies are spending money on gifts for purely altruistic reasons? The Review Article mentions that each doctor in Australia is subjected to an estimated $21,000 worth of pharmaceutical company promotion each year. [1] Certainly, this is a pittance when compared to the US $11 billion that are spent on pharmaceutical marketing and promotions each year in the United States; yet the implications remain clear. [3]

With that said, there are positive sides to an early association between those studying medicine and the pharmaceutical industry. Disregarding the free pens, free food and other little (or not so little) gifts, pharmaceutical companies sponsor educational seminars, social outings and even travel costs to conferences. Surely this can only have a beneficial effect on our medical education. Or, should these too be considered ‘gifts’ of a different kind – gifts that will enrich us intellectually rather than materialistically? If nothing else, such an early relationship will help to prepare medical students for how to deal with the pharmaceutical industry after they graduate.

The path ahead is not clear, for the relationship between pharmaceutical companies and medical students has both positive and negative effects. Barack Obama is reputed to have said that “If you’re walking down the right path and you’re willing to keep walking, eventually you’ll make progress”; yet how can we know where to place our feet if the ‘right’ path is hidden from us within a murky quagmire of ethical principles? Carmody and Mansfield suggest more research studies on this issue regarding Australian medical schools, and while I am not convinced this will make a pronounced change in clearing the fog obscuring the way forward, surely it cannot be a bad place to start.

References

[1] Carmody D, Mansfield P. What do medical students think about pharmaceutical promotion? Australian Medical Student Journal 2010;1(1):54-7.

[2] Becker L. Reciprocity. 2nd ed. Chicago: Routledge & Kegan Paul; 1990.

[3] Wolfe S. Why do American drug companies spend more than $12 billion a year pushing drugs? Is it education or promotion? Characteristics of materials distributed by drug companies: four points of view. JGI Med 1996;11:637-9.

Prof. James Angus

It appears that all the students who graduated at the end of 2010 and are now doing their intern year did find a place. But that is unlikely to be the case for all students finishing this year, and in the immediate future.

All medical students who qualify in Australia must be guaranteed access to an intern place, irrespective of how their study was funded or, indeed, which country they are from. This is a critical element to ensuring the ultimate goal for our medical workforce: that it be selfsustaining by 2025. [1]

Medical Deans, which represents all eighteen medical schools in Australia and the two New Zealand medical schools, has been actively seeking a commitment from governments over the past two to three years that there be sufficient and quality intern places available for all medical school graduates.

Unfortunately, while the significant increase in medical student places since 2005 has been well-publicised, it would seem State and Federal governments have only recently undertaken forward planning to accommodate the impact of these increased numbers as students graduate into the intern year, or indeed, move into later post-graduate training.

The increase in the graduating group began to be felt in 2009, but the real pressures on the health system will be in the next two to three years with 3,786 graduates projected for 2014, 1,400 more than in 2009. About 17% of these graduates are likely to be international fee paying students.

A year ago, Federal and State government Health Ministers met and guaranteed places only for Commonwealth-funded students, leaving about one-quarter of our medical students without certainty. By far the significant majority of these are international fee paying students.

International students must continue to be seen as an integral component of Australian medical schools. They are part of the longer term goal of self-sustainability. The impact of not guaranteeing an internship on both the individual student as well as the Australian higher education sector has already been summarised in the first edition of this journal. [2] For Medical Deans, while that impact will be significant on each medical school, it will be felt far beyond: a significant downturn in the number of international students will compromise the wonderful diversity these students bring to our broader community, the value-add they can make to the Australian health care system by already knowing how the system works, and the ability of these students to take their place in the increasing global workforce.

Medical Deans acknowledges that it needs to work in partnership with government and the newly established Health Workforce Australia (HWA) to ensure that there is an agreed national training plan in place as soon as possible to underpin the self-sustainability goal for 2025. Without reliable data, no systematic planning can be undertaken. As Deans we recognise that a national plan will assist us to establish our enrolment targets, particularly with respect to international students, with a level of certainty able to be provided to each student surrounding their internship. We are encouraged that HWA will soon commence the development of that training plan and look forward to working with them.

This current bottleneck at the intern year will of course replicate itself through to vocational training over the next five to ten years. It is critically important therefore that every point across the medical education continuum is addressed through the training plan and sufficient resources for training allocated at each point. Setting targets at each point will enable each level of training to be prepared.

The Medical Schools Outcomes Database and Longitudinal Tracking Project (MSOD) will be most useful in informing the national training plan. This very successful project of Medical Deans will provide much-needed data on whether first year medical students act on their intentions with respect to type and location of future practice, and whether particular initiatives or programs undertaken during their studies have influenced the student’s eventual choice. The data will greatly benefit the targeting of government resources and provide much-needed understanding of future areas of likely workforce gaps.

The Australian Government’s national health reform agenda, to be implemented through the National Health and Hospitals Network, provides a timely opportunity for a number of critical issues in medical education to be addressed. These include the recognition of the true cost of teaching and clinical supervision, the need for better planning and co-ordination of medical education across the whole spectrum of training, ensuring quality teaching continues to be delivered and the current high quality of our graduates is not diminished, and the importance of embedding translational educational research.

These are issues that Medical Deans will continue to address with vigour. In our view, they are critical to ensuring a self-sustaining workforce by 2025 and one which we can continue to proudly promote as outstanding.

References

Students take home the importance of systematic reviews and highly populated, well-powered trials, to the apparent exclusion of all else. That these trials often have landmark effects is not disputed, but there remains a paucity of data for many aspects of clinical practice. EBM is well equipped to handle this and hence it is worth re-emphasising the principles at the core of EBM.

In a well known BMJ Editorial, Sackett et. al. defined EBM as “the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients”. [1] A core principle that is seemingly becoming confused in medical education is that EBM involves utilising the best available, not necessarily the best possible, evidence.

It is essential medical students understand that EBM consists of three strands: several levels of published research, core scientific knowledge, and individual clinical experience. Whilst landmark trials, such as the S4 trial, [2] are easy for students to appreciate as quintessential EBM, smaller general publications, such as John Murtagh’s Practice Tips, [3] equate to a distilled clinical experience that cover many areas of practice and should certainly be considered part of the EBM framework, particularly for students who have limited personal clinical experience.

The challenge is to successfully integrate EBM’s three strands into clinical practice, particularly in scenarios where there is insufficient evidence in one area or even disagreements between data. In these situations, it is imperative to understand EBM’s hierarchy of evidence and to critically appraise evidence; both of which require a sound understanding of the scientific method.

To achieve an optimal outcome in scenarios with conflicting or limited evidence is the hallmark of good EBM practice. As more data is gathered, disagreements are resolved and gaps filled. However, today’s patients cannot wait for this to occur and medical students must develop thorough knowledge of EBM, including statistical analysis and philosophy of science, to allow them to confidently deal with such occurrences.

EBM lies at the core of modern medical practice; we who become doctors also become scientists. Our clinical decisions, based on experience and core knowledge, are moulded by the guiding hand of research. Indeed, it is our duty to integrate the strands of EBM to ensure the best possible outcomes for patients. We applaud the AMSJ on its inauguration as a vehicle to encourage medical students into well-rounded, evidence based clinical practice.

References

[1] Sackett DL, Rosenberg WM, Gray JA, Haynes RB, Richardson WS. Evidence based medicine: what it is and what it isn’t. BMJ 1996;312:71-2.

[2] Pedersen TR, Kjekshus J, Berk K, Haghfelt T, Færgeman O, Thorgeirsson G, et. al. Randomised trial of cholesterol lowering in 4444 patients with coronary heart disease: the Scandinavian simvastatin survival study (4S). Lancet 1994;344(8934):1383-9.

[3] Murtagh JE. John Murtagh’s Practice Tips. 5th ed. Sydney: McGraw-Hill; 2008.

Ross Roberts-Thomson

Research is an important part of a medical education and to be able to accurately interpret, contribute to and even publish research is something all medical students should be able to do.

Thus, it is a pleasure to be able to welcome you to the first edition of the Australian Medical Student Journal.

Medical students have made some significant discoveries over time, including heparin, insulin, Ether anesthesia and even the sinoatrial node. Furthermore, a significant proportion of medical students would like to have research as part of their future career. Thus it makes sense for medical students to have and run a journal to showcase their work.

Over the past number of years, AMSA has conducted the AMSA Medical Education Survey. This survey looks at what medical students think about medical education in Australia and what their future intentions are. Governments, non-government organisations, lobby groups, universities and researchers around the world have used these data for various purposes and they are, of course, infinitely useful for AMSA itself.

In the current paradigms of science, politics, and education, being merely a representative body is no longer sufficient. Representation must be backed by robust evidence and thus AMSA must be the true authority on medical students if it is to be successful into the future. It is in this light that AMSA is pursuing a more evidence-based approach to medical student advocacy, something we like to call Evidence-Based AMSA.

As part of this initiative we are looking to collect qualitative as well as quantitative and anecdotal evidence to help further our advocacy and shed light on issues affecting medical students. Evidence-Based AMSA will be conducted in consultation with epidemiologists and education experts. It will allow us to better direct our arguments on issues affecting medical students, and subsequently enhance AMSA’s influence over Governments, university institutions and non-government organisations.

AMSA will also be forming ties with one of the world’s biggest pools of data on medical students – the Medical Deans of Australia and New Zealand Medical Student Outcomes Database (MSOD). The MSOD collects a variety of data including where medical students come from, what rotations they do and their respective career intentions. The Medical Deans Longitudinal Tracking Project even follows these students beyond university to see where they actually end up practicing.

Linking the AMSA Medical Education Surveys with the MSOD and Longitudinal Tracking Project provides a more solid foundation upon which to base our conclusions and recommendations, and this partnership is one AMSA is extremely excited about.

Finally, to give students the opportunity to publish and be involved in the running of a journal such as this is a great initiative and I very much look forward to future editions of the Australian Medical Student Journal.