JDN-NEWSLETTER-ISSUE-09-2016

March 2016
ISSN (print) 2415-1122
ISSN (online) 2312-220X
KampoTraditional and complementary
medicine re-emerging in Japan
CARRER IN
MEDICINE
Chair
ADDRESS
YOUNG DOCTOR IOF
MacedoniaHow do Greek junior doctors perceive
their professional future?
JDN has shown progress during the
last year
MMA, has been admitted as a full member of
our National Medical Society.
World Medical Association
Junior Doctor Network
Newsletter Issue 9
2 / JUNIOR DOCTORS NETWORK
SUMMARY
A new idea of JDN is about to be changed to a global
project by offering international electives rotations
to junior doctors.
Expediente
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Acknowledgements
Editors:
Dr. Wunna Tun (Communication
Director)
Dr. Ricardo Corerea
(Publication Director)
Diagramação
Logo – Suport
AMB – Associação Médica Brasileira
Join the group of
Junior Doctor Network of World
Medial Association Contact: chair.
jdn@wma.net
White Paper
Social media and medical
professionalism
Relevant Junior Doctor Policy Ethical
Implications of Collective Action by
Physicians
Current projects
Doctors’ health and wellbeing
Global health training and its ethical
im- plications
Quality in postgraduate medical
education and training
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 WMAJDN assumes
no legal liability or responsibility
for the accuracy, complete-ness,
or usefulness of any information
presented.
news
JDN
Careers in Medicine
Resident Doctor’s National
Council
Physician Wellbeing
JUNIOR DOCTORS NETWORK /3
Editorial
Dr. Wunna Tun, MBBS, MD
Communication Director
JDN, WMA
Editor in Chief, JDN Newsletter,
WMA
and
Dr. Ricardo Correa, MD, Es.D
Publication Director JDN, WMA
6th year of
foundation
Another year has passed since WMA-JDN started in
2010. It is now in its 6th
year of foundation and there
is an increasing numbers of members worldwide.
The last election occurred in theWMA-JDN meeting
in Moscow in October 2015. Dr Ahmet Murt from,
Isatambul, Turkey has chaired the new team. This
team comes from different regions: Africa, Asia-
Pacific, Eastern Mediterrean, Europe,NorthAmerica
and LatinAmerica and has balanced gender ratio.
This newsletter is the official publication of WMA-
JDN. On it, you can find what WMA-JDN and
regional/local JDN around doing. Also you can use
this newsletter as a source of networking and start
project with other junior doctors that have the same
goal and objectives. We really want that you thank
advantage of it and start contributing with articles
so we can expand our organization and other
physician in-training can learn what you are doing.
This issue includes:
– Ahmet Murt, MD make his chair address
for the new term.
– Konstantinos Roditis, MD, MSc and
Irene Kefalidi, MD recounts How do Greek
junior doctors perceive their professional
future.
– Tomomi Kishi. reports Kampo, herbal
medicine: Traditional and complementary
medicine re-emerging in Japan
– Agostinho Moreira de Sousa discuss about
Conselho Nacional do Médico Interno
(CNMI) – Resident Doctor’s National
Council.
– Sead, Zeynel MD highlights newly
established Young Doctors of Macedonia.
– Ricardo Correa and Wunna Tun talk
about physician wellbeing and mention
a proposal
We are sure that you will enjoy the stories and
articles published in this issue.
4 / JUNIOR DOCTORS NETWORK
Chair
Address
Written by Dr.Ahmet Murt
JDN has shown progress during the last
year with on-going projects and many new
initiatives. This was possible by efforts
of members/organizations and close-
monitor from the JDN management team
(governing council). We should never forget
the WMA officials as our facilitators and
WMA secretariat that has provided support
to our work.
JDN is a developing and improving
organization since its foundation. The
potential has now reached a level that
should be further utilized for broader
projects. JDN has the vision to be the main
key body of young medical professionals
worldwide. This has already been achieved
in some parts of the world. This role should
be intensified by close partnerships with
other physician organizations locally and
nationally.
Unconditional inclusion of junior doctors
as a member of the decision-making
mechanisms is quite important. This
should also happen in all segments of the
hierarchical management of healthcare
institutions (i.e. Junior Doctors should have
such opportunities in their departments,
JUNIOR DOCTORS NETWORK /5
We hope, all
the members
of our
profession
will keep
themselves
up-to-date
with what the
JDN is doing.
at their institutions, at
a regional and national
level). We should once more
underline the fact that the
junior doctors are forming
the main medical workforce
inmanyregionsoftheworld
and their expectations from
the healthcare systems
should be well understood.
Experience sharing between
different organizations and
countries is quite important
and JDN has the vision to
offer such opportunities
both to its members and
to other organizations.
While this can be about
the regulation of medical
profession by inclusion
of junior doctors, it may
also happen by providing
educational opportunities
to junior doctors across the
globe.
A new idea of JDN is about to
bechangedtoaglobalproject
by offering international
electives rotations to
junior doctors.
This will give our
colleagues the chance to
analyse a healthcare
system of another
country and to
understand how
similar the challenges
are in different parts of
the world.
Last month, we were
happy to witness that
the governments are well
aware of the health related
consequences of climate
change. A new era in this
aspect will be opened
when the governments re-
consider their obligations
on the right to health of the
humankind. Junior doctors
were quite active during
the negotiations and this
was a clear message to our
distinguished profession that
the future will be in the saving
hands of today’s junior doctors.
We hope, all the members
of our profession will keep
themselves up-to-date with
what the JDN is doing.
Save the date! Upcoming meetings in 2016
March 1st
– 8th
2016: IFMSA Alumni Meeting, Malta
April, 27th
, 2016: WMA Junior Doctors Network Meeting Buenos Aires, Argentina
May 13th
2016 (tentative): JDN Regional Meeting for Middle East and North Africa, Kuwait
May 13th
– 14th
. May 2016: EJD Spring Meeting, Vilnius, Lithuania
May 21st – 22nd, 2016: JDN Working Meeting in WMA, France
October 17th
-18th
2016 (tentative): WMA Junior Doctors Network Meeting Taipei, Taiwan
Continuing last year’s
tradition, JDN-Hellas
celebrated this year’s June 24th
– World Young Doctors’ Day by
designing and conducting an
online survey targeting young
physicians who live and work
in Greek public Hospitals.
An online questionnaire was
created, based on existing
literatureonthesubjectaswell
as current issues that affect
career choices and decision-
making of Greek junior
doctors. The questionnaire
which stayed available online
for 30 days (22 May-21 June
2015) was disseminated
through social media, mailing
lists, oral announcements
and word of mouth to various
teaching hospitals in Greece.
The survey provided some
very interesting results.
Answering to the question
“How do you imagine your
career in medicine after 15
years?”, junior doctors who
participated in the survey
answer: as a specialized doctor
in private practice (45%), as a
consultant in a public hospital
(21%), as a consultant in a
private clinic (12%), as the head
professor/chairman of a clinic
(10%), as a research doctor in
a research center (5%), as a
doctor of public health (2%)
and as a trainee doctor (2%). A
low percentage of interest was
observed in the research field,
as only 31% of the participants
in the survey expressed
that they very interested in
research.
Another important finding of
this survey is the geographical
allocationoftheanswerstothe
question“As long as you decide
to stay in Greece after the
completion of your specialty
training, in which district of
the country you would work?”
The vast majority of the
participants (59) choose the
district of Attika (Athens), 16%
choose the district of Central
Macedonia, 10% the South
Aegean district, 9% the district
of Western Greece, 5% the
North Aegean district and 2%
the district of East Macedonia
and Thrace.
The factors that affect the
selection of the workplace of
the participants are many,
such as: quality of the working
environment (acceptable/
good infrastructures,
satisfying equipment),
mentioned by 86% of the
participants, wage/salary
elevation, mentioned by 59%,
cooperation opportunity
with capable colleagues,
mentioned by 59%, working
load, mentioned by 48%,
magnitude/size of the town/
city /village they work,
mentioned by 47%, health
personnel access to special
equipment, mentioned by
47%, professional standards
(ex. working environment
with advanced medical
services,such as telemedicine),
mentioned by 44% and access
to “harder” or demanding
medical/patient cases,
mentioned by 34%.
Two other parameters were
examined in the survey, the
perception/belief of Greek
junior doctor about the
workload and the work-life
balance ratio for a specialized
doctor. The attitudes seem
to differ depending on the
medical specialty. Workload
of a trainee in General
Medicine (33% unmanageable,
59% heavy /demanding ,
9% as needed/mandatory,
0% manageable), working
6 / JUNIOR DOCTORS NETWORK
Careers in Medicine:
HowdoGreekjuniordoctorsperceive
their professional future?
Written by: Dr. Konstantinos Roditis, MD, MSc, JDN-Hellas Chair
and Dr. Irene Kefalidi, MD, JDN-Hellas Substitute Executive Board Member
“The factors
that affect the
selection of the
workplace of
the participants
are many, such
as: quality of
the working”
load of a trainee in General
Surgery (29% unmanageable,
66% heavy/demanding, 2%
as needed/mandatory, 3%
manageable), working load of
a trainee in Anesthesiology
(12% unmanageable, 57%
heavy/ demanding, 26%
as needed/mandatory, 5%
manageable), of a trainee
in General Practice (6%
unmanageable, 28% heavy/
demanding, 38% as needed/
mandatory, 28% manageable).
Work-life balance ratio
of a trainee in General
Medicine(0% outstanding,
5% good, 21% satisfactory,
52% bad, 22% unacceptable),
General Surgery trainee (2%
outstanding, 3% good, 19%
satisfactory, 50% bad, 26%
unacceptable), Anesthesiology
trainee ( 3% outstanding,
14% good, 41% satisfactory,
38% bad, 4% unacceptable),
General Practitioner trainee
( 16% outstanding, 28% good,
29% satisfactory, 24% bad, 3%
unacceptable).
In conclusion, following the
general “flow” of the young
Greek scientist abroad, the
majority of Greek junior
doctors (at least 59%) think
to abandon the country after
the completion of specialty
training and work abroad,
38% of the participants would
choose United Kingdom as a
future working destination,
15% would choose Sweden,
12% Germany, 6% USA, while
29% of them would choose
another country.
The survey is to be presented
soon to medical students
and junior doctors as a
poster presentation at the
42nd
Panhellenic Medical
Conference in June 2016 in
Athens.
JUNIOR DOCTORS NETWORK /7
8 / JUNIOR DOCTORS NETWORK
Written by
Sead Zeynel, Young Doctors of Macedonia
Following the Young Doctors Leadership
meeting held in Ohrid, Macedonia, 8th
of
August,thefoundationoftheYoungDoctors
Network in Macedonia has been initiated
and upon the application submitted to the
executive board of the Macedonian Medical
Association (MMA), our association has
been admitted as a full member of our
National Medical Society.
The aim of the newly founded association
named ‘Young Doctors of Macedonia’ is
to establish a common ground for young
doctors in Macedonia, which will represent
a network that shall foster collaboration
opportunities both nationally and
internationally.
As the founders of the young doctors’
association are already an active
participants in WMA JDN activities, one of
our objectives is the formation of stronger
bonds between the regional Young Doctor’s
Networks, as well as promoting locally
and nationally raised activities in an
international setting, and implementing
international campaigns and projects in
our community.
Last but not least, it must be emphasized
that this initiative of the founding
members is in step with the global trend
of formation of youth networks within
the existing National Medical Societies all
over the world. Moreover, after 70 years of
the existence of the Macedonian Medical
Society, there is such a bold initiative raised
out of a group of enthusiasts that have had
envision it at the very beginning of their
foundation with a strong conviction of its
necessity and furthermore, the full energy
to carry out the process up to reaching the
ultimate goal.
For all the above-mentioned events that
unfolded in the period behind us, on behalf
of the Young Doctors of Macedonia, we
extend out deep appreciation to the Chair
of the WMA JDN, Dr. Ahmet Murt and the
President of the MMA, Assoc. Prof. Dr.Goran
Dmitrov, for the unreserved support they
have provided.
YOUNG DOCTORS OF MACEDONIA
JUNIOR DOCTORS NETWORK /9
Kampo: Traditional and
complementary medicine re-
emerging in Japan
Written by Tomomi Kishi
Japan Medical Association,
Junior Doctros Network
(JMAJDN)
Think back to your childhood. When you
caught a cold, what did your parents do
for you? In my case, my mother gave me
plenty of grated apples and a mysterious
“nutritional drink” with a distinct whiff
of garlic; she then tucked me into a warm
bed. I am grown up now and work as a
family physician. I have prescribed dozens
of medicines whose benefits have been
confirmed by research, but I have not
found any evidence suggesting that garlic
and apple can be used to treat a cold.
Nevertheless, I believe that those nutritious
foods relieved my symptoms in some way.
Modern medicine has advanced,
but some symptoms are not yet fully
understood. In other words, there are some
illnesses for which the best cure is still
unknown. Traditional and complementary
medicine (hereinafter referred to as T&CM)
can contribute in these areas.
In the last few decades, the use of
T&CM to supplement modern medicine has
become popular in Japan. There are three
kinds of traditional medicine in Japan:
Kampo, acupuncture, and acupressure.
Kampo is an herbal medicine, which was
originallyintroducedfromChina1500years
ago. Each formula is a mixture of several
plants and is used for several purposes. Due
to the complexity of the formulas, Kampo
hasforalongtimebeenprescribedbyonlya
limitednumberofhealthcareprofessionals.
Recently however, several pharmaceutical
companies,suchasTsumura,havestartedto
produce Kampo formulas in factories under
standardized and regulated conditions,
precisely following the descriptions in the
classical literature of Chinese traditional
medicine. In 2000, the Ministry of Health,
Labor and Welfare of Japan decided to
include Kampo under the national health
insurance program, and now nearly 84% of
doctors prescribe Kampo in daily practice.
One example of a commonly
prescribed Kampo formula is Daikenchuto
(DKT)—the best-selling Kampo medicine
in Japan. It is a mixture of carrot, Japanese
pepper, and ginger that is quite popular
among surgeons as it reduces the risk of
post-operative ileus. Furthermore, it has
recently been shown that DKT prevents
ileus by improving the vascular supply to
the intestinal mucosa.1)
Another example
is Mao-to, which is made from ephedra,
cinnamon, licorice, and apricot; it reduces
the duration of fevers in children with
influenza A. Specifically, in one controlled
trial on children aged 5 months to 13
years who had fever and influenza-like
symptoms, the time of defervescence
was faster in the group taking Mao-to for
more than 48 hours than in those taking
Oseltamivir or both Oseltamivir and Mao-
10 / JUNIOR DOCTORS NETWORK
to for the same duration.2)
Although it is
generally hard to confirm the effectiveness
of herbal medicine using the commonly
accepted theories of modern medical
science, evidence for the efficacy of Kampo
is increasing, and it is now widely used by
physicians to treat symptoms that modern
medicine lacks an effective treatment for.
Similarly to Kampo in Japan, other
types of T&CM are used all over the world;
namely, Unani, Ayurveda and Chinese
traditional medicine. In Cuba, T&CM was
the savior of the healthcare service. Because
of economic sanctions imposed by the USA,
it became extremely expensive to import
healthcare equipment and medicine,
especially after the fall of the Soviet
Union. Therefore, Cuba urgently needed to
increase domestic production of medicine.
In the 1990s, the Cuban government built a
research center for T&CM; they also created
nationwide policies that pressured the
domestic healthcare institutions into using
T&CM. In Cuba, students spend 200 hours
on T&CM in medical school; the curriculum
includes herbal medicine, trigger-point
injections, massage, heat therapy, magnetic
therapy, moxibustion, yoga, and music
and art therapy. Most Cuban physicians
prescribe herbal medicine. 3)
Indeed, one
topical herbal medicine is produced in Cuba
that can reduce the pain of arthralgia.4)
T&CM in Cuba helped to reduce healthcare
expenditure with good health outcomes.5)
As described above, T&CM is
widely used throughout the world. In fact,
T&CM education was provided at medical
schools in approximately 30% of countries
worldwide in 2012, and an increasing
number of universities teach T&CM in
their official curriculum6)
. To maximize the
power of T&CM, it is essential to improve
both safety and the qualifications of those
who practice the method. I believe that
integrating appropriate T&CM into the
healthcare system would help people live
healthier lives, as well as reduce medical
bills.
Conflict of interest statement none declared
References
1. M et al, Effect of daikenchuto (TU-100) on gastrointestinal and colonic transit in humans, American Journal of Physiology 2010;298(6):G970-975
2. Kubo T and Nishimura H.. Antipyretic effect of Mao-to, a Japanese herbal medicine, for treatment of type A influenza infection in children.
Phytomedicine 2007;14(2-3):96-101.
3. Dresang L et al, Family Medicine in Cuba: Community-Oriented Primary Care and Complementary and Alternative Medicine, J Am Board Fam Med
2005;18(4):297-303.
4. Applebaum D et al. Cuba, Natural and Traditional Medicine in Cuba: Lessons For U.S. Medical Education, Academic Medicine 2006:81(12);1098-1103.
World Health Organization, Cuba. (http://www.who.int/countries/cub/en/, Accessed Nov 9, 2015)

5. World Health Organization 2013.
WHO Tr
aditional Medicine Strategy 2014-2023. (http://apps.who.int/iris/bitstream/10665/92455/1/9789241506090_eng.pdf)
JUNIOR DOCTORS NETWORK /11
Written by Agostinho Moreira de Sousa
It is our great pleasure to share with you the
work of the Conselho Nacional do Médico
Interno (CNMI) – Resident Doctor’s National
Council.
CNMI is a council within the Ordem dos
Médicos (Portuguese Medical Association).
It is composed by a team of 18 Junior
Doctors, elected for a term of 3 years, who
represent all the resident and junior doctors
in Portugal
This body is responsible for following up
the quality of graduated qualification of
residents. It represents the Portuguese
Medical Association in different
commissions of the Ministry of Health on
matters related with the residency and
graduated medical education. CNMI also
provides support for any issues that arouse
for young physicians in Portugal.
Alongside those tasks, CNMI organize a
handful of activities for residents and junior
doctors, regionally and nationally and work
in specific advocacy actions, such as:
– mostrEM (Show your specialty)
Every year, about 1300 young doctors
participateinthreeregionalconferences,
where around 40 senior residents and
speakers present their specialty and
training to those who are about to
choose one. There are also additional
workshops and lectures happening
in the conferences, such as – this year
– work in the ER and communication
with patients. The conferences attract
a significant amount of national media
coverage and we seize the moment to use it
for opening up about the existing problems
in education of young professionals.
– Medicine National Congress/
Residents National Congress
12 / JUNIOR DOCTORS NETWORK
Conselho Nacional do Médico Interno (CNMI)
Resident Doctor’s National Council
The annual National Medicine Congress is
organized jointly by Portuguese Medical
Association and CNMI, where CNMI has
a special National Residents Congress.
The Congress has a different theme
every year. Among the speakers one can
find representatives of civil society and
renowned international figures. Questions
of everyday Portuguese reality are usually
addressed in the Congress.
● Doctors’ Demographics and Medical
Workforce Changes
For the first time in decades, recent
graduates didn’t have a place in Residency
programs in Portugal. We are following
up the integration of doctors without a
specialty, since this scenario isn’t common
in the Portuguese Health System.
This situation can lead to a decrease of
working conditions and salaries of young
doctors in the near future and difficulties in
establishing a long term career.
CNMI is closely following the process of
specialty selection for recent graduates,
which will happen in June of 2016. We have
also organized a lecture to spread out more
information and address all concerns.
●
● Survey regarding burnout
In a scenario that is happening all over
the world, more and more residents are
complaining about burnout. To measure
it in order to have a clear picture of the
current situation, CNMI-OM is preparing
a survey regarding the working and
educational conditions to be distributed to
all residents in Portugal.
● Residents’ Representation Teams
CNMI is investing on a closer collaboration
with the residents at local level. We are
providing them support and motivating
residents that don’t have a team that
represents them at local level to create
that team. All the resident doctors that
are present in the location where they are
getting their training elect the teams in an
annual basis.
CNMI also worked in the creation of a
manual to those teams, in order to support
their work. We also transmit their concerns
to the national bodies and they share the
information that is happening at national
level to the residents in that location.
For more information,please check our new
website ( www.cnmi.pt) and our facebook
page (www.facebook.com/cnmi.om)
JUNIOR DOCTORS NETWORK /13
14 / JUNIOR DOCTORS NETWORK
Physician
Wellbeing
By Dr. Ricardo Correa, MD, Es.D and
Dr. Wunna Tun, MBBS, MD
Physicians especially
residents and fellows
experience high
levels of work-related
A WMA-JDN priority
© Africa Studio – Fotolia.com
#78810321
JUNIOR DOCTORS NETWORK /15
burnout, and mental health disorders. During
this stage, trainees are more susceptible to
developing dehumanizing traits, and stigmatizing
attitudes (1). This is very important because
it translates to poor patient care and/or patient
safety. Physician wellbeing is defined as the
presence of positive emotions and moods, the
absence of negative emotions, satisfaction with
life, fulfillment and positive functioning” in the
context of “physical wellness.” (2).
Physician wellbeing can be divided in two
dimensions: 1. Stress, Burnout and Sleep
Deprivation (SBSD); 2. Substance Abuse
Disorder (SAD). SBSD is not a new phenomenon
but in the last years prevalence has been
increasing (3). It is define as a syndrome of
emotional exhaustion, depersonalization and
reduced personal accomplishment that can
affect quality of care and productivity with dire
consequences for health systems (4). Besides
this statement, sleep deprivation has been
linked to a greater risk of surgical complications,
medical errors, increased rate of needle-stick
injuries and post-shift car accidents (5). SAD
might be more common than one would imagine.
The most commonly abused substance is
alcohol but sedatives, stimulants or opiates and
psychedelics are also used by physicians (6).
Over the past years, physician wellbeing has
become a hot topic among patients, providers and
national and international medical organization.
Several systematic reviews and meta-analyses
have consistently found higher suicide rates
among medical professionals (7). Some of
them found that the suicide rate ratio for male
physicians, compared to the general population,
was 1.41; for female physicians, the ratio was
2.27 (8).This year wretched events happen in
New York City where 2 residents committed
suicide with few weeks different one from
another. This are not isolated events but more
the tip of the iceberg of a bigger problem that
involve graduated medical education, humans
and medicine as an organization.
The Junior Doctor Network (JDN), the voice of
junior doctors worldwide, released in 2014 a
white paper to the World Medical Association
(WMA) that proposes an informed and universally
applicable approach across specialties and
career stages that will help shape future
discussions on these important issues globally
(9). This white paper after a lot of work became
a resolution that was approve in the WMA 2015
General Assembly in Moscow.
As you can see, we can make the change at
a local, regional and national level. We are the
frontline of medicine and our voice need to be
heard.
The authors of this article are proposing the
“white campaign” to promote physician
wellbeing at all level (i.e, medical student,
resident and fellows, attending physician, etc).
In our next newsletter issue we will explain
more about this campaign.
References
1. Institute of Medicine, To Err is Human: Building a Safer Health System. 2000. Available at http://www.iom.edu/Reports/1999/To-Err-is-Human-
Building-A-Safer-Health-System.aspx
2. Centers for Disease Control & Prevention. Health-related Quality of Life: Well-being Concepts. 2013. Available at http://www.cdc.gov/hrqol/wellbeing.
htm
3. urnout During Residency: A Literature Review. J Grad Med Educ. Dec. 2009.
4. Dewa C et al. How does burnout affect physician productivity? A systematic literature review. BMC Health Services Res 2014; 14:325.
5. Olson E et al. Sleep Deprivation, Physician Performance, and Patient Safety. Chest 2009; 136(5):1389-96.
6. Oreskovich M et al. The prevalence of substance use disorders in American physicians. Am J on Addictions 2014; doi: 10.111/j.1521-0391.2014.12173.x
7. Schernhammer E & Colditz G. Suicide Rates Among Physicians: A Quantitative and Gender Assessment (Meta-Anay, Am J Psychiatry 2004;
161(12):2295-2302
8. Gong, Y. et al. Prevalence of anxiety and depressive symptoms and related risk factors among physicians in China: a cross-sectional study. PLoS One,
2014; 9(7).
9. Ahn Y, Stanford F, Berry T, Correa R, et al. Draft physician well-being. Junior Doctor Network. World Medical Association 2014. Personal communication
with senior author Elizabeth Wiley.
Junior Doctor Network Meeting Moscow 2015