JDN-NEWSLETTER-ISSUE06-2014

1
JDN
The World Medical Association, Inc.
L’association Medicale Mondiale, Inc.
Associación Médica Mundial, Inc.
r
JUNIOR DOCTORS NETWOR
Young Doctors Fighting against Ebola
Discovering the missing pieces –
Worldwide Survey on Transition
from Secondary to Medical
Education – Page 5
News from Korea –
Page 11
Newsletter

Issue-6
October 2014
ISSN-2312-220X
Junior Doctors Network Hellas
Online Campaign –
Page 7
2 3JDN
Editorial
The last few months have been intense activity in the JDN. We ex-
panded our communications to include the participation of the Af-
rican countries in the developed projects, as we seek to partici-
pate in various medical meetings around the world. The increased
global participation is the main objective to strengthen the JDN.
Among the other activities developed have been working in the JDN Well-
Being Working Group, with extensive work to discuss the various situa-
tions involving medical education during residency and medical activities.
The performance of JDN members, guided by the board, ex-
pands the relationship between WMA and young doctors. New pro-
jects are emerging and improving medical training around the
world. Be part too. Enjoy the newsletter and send your articles.
Written by Dr.
Nivio Moreira
Chair , WMA
JDN
Dr. Wunna Tun
Communication
Director
JDN, WMA
Editor in Chief,
JDN Newsletter,
WMA
Starting from last issue, colleagues wirh smart phone can decode the
newsletter QR code and redirect the phone’s browser to all WMA JDN
newsletter links. After scanning QR code in this newsletter, readers
may receive text, add link to their devices, open a Web
hyperlink, and share it to other colleagues via smartphones.
This 3rd Year Anniversary of WMAJDN issue includes:
–
Nivio make chair address
– Ahmet Murt, MD highlights our commentary for international col-
laboration among junior doctors.
–
Sam Wing Li shares WMAJDN, WHO, IFMSA joint survey on
medical education
– Mustapha Thaim MBChB reports on Young Doctors fighting
against Ebola in Sierra Leone
– Fehim Esen, MD discuss about Turkish Young Doctors Annual
meeting.
– Roy Shen, MD recounts Holistic approach in community health
in Malawi.
– Joanna Xanthaki, MD share about Online campaign regarding
working hours in Greece.
– Deborah Shin, MD presents Recent update from Korea.
I am sure you will enjoy the stories in this issue.
The JDN is an initiative of individual Associate Members of the WMA. The information and opinions expressed in this
newsletter represent the opinions of the authors and do not necessarily reflect those of the WMA. WMA and WMA, JDN
assumes no legal liability or responsibility for the accuracy, completeness, or usefulness of any information presented
Acknowledgements
Dr. Lawrence Loh
(Founding Member,JDN)
Editors:
Dr. Wunna Tun
(Communication Director)
Dr. Hyunyoung Deborah Shin
(Publication Director)
Save the date! Upcoming meetings in 2014-2015
• October 6 – 7 , 2014 :WMA Junior Doctors Network Meeting Durban, Africa
• November 2014: EMR JDN Meeting, Lebanon
• April 15 , 2015 (tentative): WMA Junior Doctors Network Meeting Oslo, Norway
• May 16- 17, 2015 (tentative): JDN Working Meeting in WMA, France
• September 23-25, 2015 (tentative): CMAAO meeting, Yangon, Myanmar
WMA JDN OFFICERS 2013/2014
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Doctors’ health and wellbeing
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Contact: jdn@wma.net
4 5JDN
The globalization of today’s world makes
the lifes of people living in miles of dis-
tance alike and the needs of societies start
to show big similarities. The consequence
of such trend is application of identical
job sat- isfaction or educational outcome
indicators worldwide. However, suggest-
ing one type of solution does not gener-
ally fit into different national or regional
contexts. The most probable explanation
of this discrepancy is the failure of peo-
ple to share their vision although their
real-life experiences are almost similar.
I believe that we can find ways to share vi-
sion among healthcare providers worldwide
which will help our attitudes to develop
hand in hand. When our ideas have the op-
portunity to evolve in an interactive envi-
ronment with our colleagues worldwide, we
will most probably come up with policies
and systems that will serve the global com-
munity. This kind of an approach is much
better than implementing a policy which
was composed far away from home. We all
should work for taking a step towards stand-
A Commentary for International Collab-
oration among Junior Doctors
ardization instead of borrowing from each other.
If we are eager to be successful to work in a global
harmony, we should implement the concept of mem-
bership to a multinational mechanism which will set
the agenda, define the rules and build the conscious-
ness among its members. A second sub-mechanism
we need is instituting regional operating units which
will provide signals to the multinational mechanism.
And the third, we all need an explicit process in or-
der to make all the steps understood by involving
parties. JDN is aware of the importance of these
3 requirements and tries to accomplish them all.
TherearethetraditionandexperiencesofWMAwhich
enlighten our challenging road to form shared vision
among junior doctors. We are also putting big efforts
to be successful according to our defined framework.
Early experience of junior doctors in this area will
be serving for tomorrow’s healthier global commu-
nity and we will be working to offer opportunities
for junior doctors to improve themselves in the field.
Dr. Erica Wheeler, technical officer in WHO responsible for
Education and Training for Health Professionals,
is leading an online survey to explore the unanswered questions.
With the able suppofrom WMA JDN (World Medical Association Junior
Doctors Network) and
IFMSA (International Federation Medical Stu- dents’ Association),
young doctors and medical students around the world are invited
to participate in this survey.
The results will contribute to the development of a
global health workforce assessment tool.
Discovering the missing pieces –
WHO Worldwide Survey on Transition
from Secondary to Medical Education
World Health Organization needs to hear from you:
How were you selected to medical school?
How would YOU select people? Do non-academic attributes matter?
Were you satisfied with the career advice given?
Get to know more about this project. Spend 10 minutes to fill out the survey:
https://extranet.who.int/dataform/index.php/331487/lang-en
The survey generates evidence to inform policy makers and improve future
medical education around the world. Every opinion counts. This is why we
need to hear from everyone of you and your colleagues.
Written by
Dr. Ahmet Murt (Secre-
tary of WMAJDN)
President, Turkish Young
Doctors Platform
Written by
Sam, Wing Sum Li
6 7JDN
Junior doctors have to learn how to deal
with long shifts, lack of sleep, study hours,
increased responsibilities, and unrelent-
ing competition in addition to a personal
and social life. The amount of pressure on
junior doctors can affect their physical and
mental wellbeing. In Greece, residency is
considered to be a full-time and exclusive
occupation, but it is not yet determined how
residents view their working envionments.
JDN-Hellas organized a week-long online
awareness campaign raising the issue of
physician wellbeing on its official page on
Facebook, as well as on its official twitter
account from June 17 till June 24, 2014.
During the campaign, interesting facts
originating from the results of a survey per-
formed by JDN-Hellas among Greek resi-
dents entitled “How satisfied do you feel
in our working environment?” were shared
with junior doctors all over the country,
as well as junior doctors of Greek origin
working abroad. These were organized in
slides, two for each day of the campaign.
The campaign was very well received by
Facebook as well as Twitter users, reaching
more than 500 daily views on Facebook for
each slide, while on Twitter JDN-Hellas’ fol-
lowers increased by 200% during the week
of the campaign and the campaign’s posts
were retweeted by local news agencies.
Campaign slides were also translated in
English and reached fellow young doctors
abroad through the IFMSA and EMSA channels.
Lastly, the initiative was concluded with the com-
pilation of a scientific paper entitled “”How satis-
fied do you feel in our working environment? A
survey to assess job satisfaction among Greek
junior doctors,” which will be presented by JDN-
Hellas representatives as a poster at the up-
coming “Zagreb International Medical Summit
– ZIMS 2014” taking place in November 2014
in the city of Zagreb, Croatia. The abstract will
be published in “Lijecnicki vjesnik”, the official
journal of the Croatian Medical Association.
This is the second online awareness rais-
ing campaign organized by JDN-Hellas
since its establishment in February 2014,
which followed the previous one organized
on the occasion of World Health Day 2014.
Young doctors in Greece face lots of difficul-
ties while training in their specialty with bu-
reaucracy being one of the major problems,
leading to diminished work efficiency and
teaching by senior faculties. JDN-Hellas will
continue advocating for more healthcare in-
vestments and a better working environment
with competitive salaries, as we believe good
health is the foundation for a stable society
and Greek public health is in part the result of
the work of hardworking Greek junior doctors.
WMA congratulates junior doctor on top
international resident award
Press Release
(10.09.2014)
Dr. Xaviour Walker,
former chair and
founder of the World
Medical Association’s
Junior Doctors Network,
has been awarded the
Royal College of
Physicians and
Surgeons of Canada
International Resident
Leadership Award.
The Royal College
citation states that the
award was given annually
to an international
resident who has
demonstrated leadership
in specialty education and
encourages the
development of future
leaders of medicine. Dr.
Walker will collect his
award at an international
resident leadership
summit in Toronto
Canada next month.
Written by
Sam, Wing Sum Li
Junior Doctors’ Network Hellas
Online Campaign
“Working Conditions of Young Doctors”
WMA Chair of Council
Dr. Mukesh Haikerwal
acknowledged the
significant role of Dr.
Walker in setting up
the Junior Doctors
Network within the
WMA and his work in
progressing important
health issues to all
doctors across the
world in particular the
junior doctors group.
He said that the award
was richly deserved
and Dr. Walker was a
very worthy recipient.
Dr. Walker, a former
President of the New
Zealand Medical
Students Association,
and now an internist
resident in Cambridge,
Massachusetts, was
instrumental in setting
up the JDN in 2010,
since when it has
grown to represent
juniors doctors from all
parts of the world.
As Junior Doctors
Network (JDN)
celebrates the 3rd
year anniversary
by this month, we
have proudly heard
that Dr. Xaviour
Walker, the founder
and former chair of
JDN, has been
awarded the Royal
College of
Physicians and
Surgeons of Canada
International
Resident Leadership
Award. The JDN
management team
wants to
congratulate Dr.
Walker for
receiving this well-
deserved award.
Written by
Dr Joanna Xanthaki, MD
8 9JDN
Newly qualified doctors in Si-
erra Leone spend their first two
years of practice in Freetown as
‘housemen’, where they undergo
hands-on intensive training in
Surgery, Medicine, Obstetrics/
Gynecology and Pediatrics on a
six months rotation. After this pe-
riod, most of them are posted to
the provinces as medical officers.
Like in many other countries,
junior doctors are the first line
of contacts for patients coming
to the health facilities for medi-
cal care. However, there is a gap
in training of doctors in Sierra
Leone because almost obso-
lete postgraduate medical pro-
gram. As a result, the teaching
hospitals lack residents, leaving
‘housemen’ to do most of the
work, with the more specialized
roles left for the more experi-
enced physicians. Although this
may foster confidence and ex-
perience in a very short period,
the workload is very unforgiving
and the mistakes may be many,
ultimately hurting patient care.
After months of rumors of Ebola
in Sierra Leone, the Ministry of
Health and Sanitation reported
the first confirmed case of Ebo-
la on May 25th, 2014. As of Au-
gust 7th, the number of deaths
due to this fatal disease is 223.
Drastic measures have been
put in place by the authorities
to counter the spread of the
disease, declaring a state of
‘public health’ emergency and
quarantining epicenters, and
grounding of all government
officials. At present, the num-
ber of laboratory confirmed
cases is 613. The epicenters of
the disease are in the eastern
province, namely Kailahun and
Kenemadistricts.However,few
cases have been confirmed in
the capital city, Freetown, and
other provinces in the North
(Kambia, Bombali, Tonkolili,
and Port Loko districts) and
South (Pujehun, Bo, Moyamba
and Bonthe districts). Koinadu-
gu district is the only district in
the northern province that has
not registered confirmed cas-
es of Ebola in Sierra Leone.
In the midst of this epidemic,
junior doctors have stayed
on the ground in their normal
routines that include morning
rounds, inpatient and outpatient
duties. Doctors have expressed
how cautious they have to be in
their roles as health providers
these days. For example, one of
the junior doctors at the military
hospital in Freetown mentioned
that he had treated a patient
weeks back with signs and symp-
toms of Ebola, but the patient ful-
ly recovered and returned home.
He, however, emphasized that
he uses full protective gear only
when there is a strong suspicion
of an ebola case presenting, while
attending to the rest with non-
sterile gloves. In Connaught, the
main teaching hospital in Sierra
Leone, another house officer that
is working in the surgery depart-
ment mentioned that there have
been a drastic reduction of cases
coming into the surgical depart-
ment. Attention is given only to
emergency cases of pure surgi-
cal nature. This, he says, is a re-
lief for him, as it makes his post-
ing somewhat safer. However, he
mentioned that outpatient clinics
Written by: Mustapha
Thaim Buya Kamara, MB, ChB
“At present, the number
of laboratory confirmed
[Ebola] cases [in Sierra
Leone] is 613.”
Young Doctors Fighting against Ebola
in Sierra Leone
and on-call duties are still going
on, and as these are run mainly
by ‘housemen’, one have to be
careful in differentiating a surgical
case from a medical one, espe-
cially those of haemorrhagic ori-
gin in their earliest clinical pres-
entation, with minimum contact.
However, not all of us are as
fortunate, the death of Dr Sheik
Umar Khan, the doctor that was
leading the fight against the epi-
demic, has spurred some inter-
est among young doctors to
form an organisation that will
represent their interest. De-
tails of this organisation have
not been been finalized yet,
but a Facebook group called
JUDASIL, an acronym for Jun-
ior Doctors Association of Si-
erra Leone, has been formed.
Nonetheless, we continue to
fight this epidemic with ob-
stacles that may seem im-
possible to overcome.
10 11JDN
News from Korea
Written by
Dr Hyunyoung Deborah Shin
Publication Director, WMAJDN
Director of Public Relations and Spokesperson,
I In October 2013, the Korean government dis-
regarded the concerns and opposition voiced
by the medical community and went forward to
announce its plans of introducing tele-medicine
between physicians and patients, expanding
non-medical services allowed for medical corpo-
rations and permitting non-profit medical corpo-
rations to establish for-profit subsidiaries. Even
though the medical community emphasized that
tele-medicine be adopted prudently only after
verifying its effectiveness, safety and appropri-
ate medical fees through a pilot project, and that
various government policies intended promote
the medical service industry be decided through
consultation with medical organizations such as
KMA in order to not harm the nature of medicine
as a public service, the government refused to
accept any changes to its original policy plan.
Accordingly, as the very last resort, KMA decid-
ed to take collective action on March 10, 2014
and suspended medical care for one day in or-
der to fight for proper public health poli-
cies and medical systems in Korea.
Essential services in emergency
rooms and ICU were excluded
from the collective action, but
about 60% of all clinics and
about 7,000 intern and resi-
dent doctors participated in
the collective action. Even af-
ter the one-day suspension,
physicians continued to dem-
onstrate their position by main-
taining 40-hour work weeks, and
the number of interns and residents
joining the collective action actually
increased over time. Under such pressure,
the government finally agreed to talk with the
medical community in search of a solution. Jun-
ior doctors played a pivotal role in the collec-
tive action not just because of problems in the
tele-medicine policy but also because they were
driven by a strong aspiration to re-vitalize pri-
mary care institutions, to improve the national
health insurance system, to reform the medi-
cal system and to change medical regulations
that infringe upon the autonomy of physicians.
Meaningful progress was achieved in im-
proving the training environment of interns
and residents. Thanks to continued efforts
by the Korea Intern Resident Association
and KMA, the govern announced a presi-
dential decree requiring training hospitals
and institutions to establish written rules on
key factors that influence the training envi-
ronment such as training time, number of
days on duty and break times and to keep
such rules available for the access by med-
ical trainees. Training hospitals that vio-
late such training rules may be sanctioned
by having their designation as a training
hospital cancelled or having the number
of interns and residents decreased. The
presidential decree also provides interns
and resident with ways of seeking relief if
their training hospital or institution under-
goes change during their training period.
The amended bill is a positive develop-
ment in that it is the first legal device that
addresses the training environment of in-
terns and residents.While the controversial
government proposal to require interns or
residents to repeat training years if they fail
to meet certain training standards was
withdrawn, penalties against hospi-
tals that do not comply with training
guidelines were strengthened and
the Korea Intern and Resident
Association will participate in
the assessment and disciplinary
decisions of such violating hos-
pitals. The Korean Intern Resi-
dent Association welcomed such
progress, but expressed that it will
continued to focus its energy on
the enactment of a Special Law on
Interns and Residents that would pro-
vide a legal basis for a humane and profes-
sional environment for work and training.
Lastly, KMA announced the list of its new
leadership last June, and Dr. HyunYoung
Deborah Shin has been appointed as the
Public Relations and Spokesperson for
KMA. KMA’s bold choice of inviting Dr.
Shin to join its top leadership shows that
KMA places greater weight on the capa-
bilities and potential of Korea’s young doc-
tors, especially with their voices and roles
increasing in Korea’s medical community.
Holistic Health in Community Approach
– Our experience in Malawi
In our previous article, Stepping
into the Warm Heart of Africa –
Malawi, we introduced our on-
going work. In briefing, we are 2
young doctors trained in Malawi,
under program ofTaiwanese Min-
istry of Health and Luke-Interna-
tional-Norway (LIN). About 80%
of the staff are local Malawians.
As medical doctors, there are
many things we can do in our
local community to strengthen
holistic care. We would like to
share two of our experiences.
Titemwanenge
This word mean “let’s love each
other” in Tumbuka. The main
source of income for people liv-
ing with AIDS in certain areas
is through soy. They make soy
milk, soy muffin and many other
soy products. Soy product is a
good nutrition supplement since
maize/sima is the main food here.
Therefore, Lin guided them to
initiate and coach their business.
Besides medical attention, hav-
ing jobs and regular income are
also crucial for this population.
These sup- ports could hardly be
provided by hospital, but can be
provided in community projects.
Kanyika
Kanyika is a support group of
people with disabilities. Accord-
ing to their coordinator, they
were sometimes called beg-
gars, and viewed inferiorly in
the past. They gathered to show
that they can work as ‘normal’
people, and hope to end the
discriminations they face daily.
They have their farm, paper-
coal production, weaving de-
partment, and library to keep
learning. LIN helped the start-
up,andkeepscollectinginterna-
tionally donated books to them.
We know some governments
are still developing their poli-
cies in helping the citizens with
disabilities. As young doctors,
we can encourage our patients
and their families to learn about
and join support groups. Also,
we can support these groups
by personal strength, or link
resources for them. Good
support plays no second role
than the medical attentions.
Written by: Dr. Jen-Hsiang Roy Shen
Thinking back to the JDN
concepts, we know medical
treatments are not the whole
of medicine. Our patients
need holistic care and sup-
port. Community, medical
facilities, medical staff, gov-
ernment and society are all
pillars for the welfare of our
citizens. Starting from our
doctor career, we can pay at-
tention to all the pillars. In this
globalized era, we could use
this JDN platform to strength-
en our capability, and connect
our view and power together.
son, the moment we look into
the direction of making peo-
ple pay for their placement
of internship training instead
of being paid allowances.
some of these short comings
have to be ironed out. For
that matter therefore, dis-
cussing internship matters
and posting interns in meet-
ings where they have no
representation will continue
to harvest hassles like what
we have all experienced in
July 23rd – August 2014 and
consequences that ensued.
12 13JDN
More than 200 residents represent-
ing 55 medical schools and teaching
hospitals came together in Konya (an
ancient Anatolian city) to attend An-
nual General Meeting [AGM] of Turk-
ish Young Doctors Platform (TYDP) on
12th-13th April 2014. AGM was pre-
ceded by a workshop organized con-
jointly by TYDP and Konya Necmettin
Erbakan University for the residents to
discuss their problems with colleagues
from different regions of the country
and to be able to compare their con-
ditions and unite their voices to be
stronger. Many of the addressed na-
tional problems also remain as global
problems affecting many countries.
We believe that formal addressing of
these issues and seeking for the best
solution together in a global effort is
important. Here are some highlights
from the Turkish national workshop:
There is no regulation that directly de-
fines the upper limit of resident work-
ing hours in Turkey. An upper limit of
70 hours per week was suggested at
the previous TYDP work-
shop in Istanbul in Feb-
ruary 2014. This limit is a
reachable target for the
country to begin with.
There is no regulation
that directly defines how
long a resident can work
without a break. The sug-
gestion of the previously
mentioned national TYDP
workshop was implement-
ed. An upper limit of 30
hour of continuous working
is suggested and minimum
5 hours of uninterrupted
sleep should be ensured
during overtime work.
Duties not directly related
with postgraduate medi-
cal education (PME) take
an important proportion of
the residents’ time in the
hospital, causing unneces-
sary exhaustion and loss
of educational time. Other
healthcare profession-
als (nurses, secretaries
etc.) should be employed
to reduce the amount of
such work. This would
also make the suggested
upper limit of the work-
ing time more reachable.
At some institutions, resi-
dents are not allowed to
take their legal holiday
time fully and may not be
allowed attend scientific
meetings because they
are expected to contribute
workforce more. These
breeches of law should
be followed closely and
proper action is need-
ed to prevent this issue.
Residents may not be en-
couraged to contribute
medical research and may
not have proper support,
time and equipment. Resi-
dents are commonly ex-
pected to do research at
their “free time” after work
in order to keep the amount
of service delivered at the
same level. Every resident
should be encouraged to
do research, should get
proper research training,
supervision and have some
dedicated time during work
hours if the resident de-
sires to engage in research.
Residents are seen as
workforce before their po-
sition as trainees. Educa-
tion should prevail in the
entire residency process to
ensure the quality of PME.
Trans and interdisciplinary
clinical rotations, which are
an important part of the core
curriculum, are neglected in
some institutions to threaten
thequalityofresidenttraining.
Proper inspection of teach-
ing hospitals is emphasized
to ensure quality of PME.
Resident admissions at
teaching intuitions are not
stable across semesters and
this imbalance ad- versely
affects the distribution of
work among residents while
impairing standardization
of clinical educa- tion at the
same time. Proper planning
is needed by relevant author-
ities to overcome this chaos.
In this meeting junior doctors
representing different regions of
the country had the opportunity
to formally describe their prob-
lems in a detailed report acces-
sible at http://www.genchekim-
platformu.org/tr-tr/in- dir_event.
asp?Loc=e&sID=9&dID=b (in
Turkish). The official report was
also shared at the same day
with the university rectors, medi-
cal school deans, and executive
representatives from ministry of
health, higher education coun-
cil and local medical chamber
at the end of the conference.
This union of the all stakehold-
ers about residency at the end
of the same room was impor-
tant for the delivery of the mes-
sage to the ones who have the
authority to solve the problems.
The annual general meeting also
served to improve the structure of
TYDP with some minor improve-
ments with national consensus.
TYDP continues with national and
international partner organiza-
tions to serve junior doctors better.
Written by Fehim Esen, MD, Resident in
ophthalmology,
Secretary General, Young Doctors Plat-
form, Istanbul, Turkey
Residents across Turkey came together to discuss
their problems and suggest solutions at Turkish
Young Doctors Platform Annual General Meeting