The 30th anniversary of the code of ethics of the Royal Australian and New Zealand College of Psychiatrists–a worthy milestone

Objective To appraise the evolution of the RANZCP’s Code of Ethics on the occasion of its 30th anniversary. Method We scrutinised its five editions, focussing on the revision procedure and changes made, and reviewed relevant literature. Results The procedure of revision has remained constant: incorporating feedback from college members, committees and faculties, and consulting professional medical bodies and mental health advocacy organisations. Seven major themes of change have emerged with respect to patient exploitation, recognition of family and carers, the special place of Indigenous Peoples, confidentiality, engaging patients in decision-making, multidisciplinary collaboration and the well-being of psychiatrists. Conclusions The code has proved to be a dynamic instrument in keeping abreast of changes in psychiatry and society, and promises to maintain a prominent role in promoting high ethical standards in the profession.

Critique of the Royal Australian and New Zealand College of Psychiatrists Psychedelic Therapy Clinical Memorandum, Dated May 2020

Objective: The Royal Australian and New Zealand College of Psychiatrists (RANZCP) has positioned itself against medically controlled patient access (at this current time) to 3,4-methylenedioxymethamphetamine (MDMA) and psilocybin-assisted therapies in its Therapeutic Use of Psychedelic Substances Clinical Memorandum, May 2020. The main reason given by the RANZCP for its stance is safety concerns. Methods: Every reference in the clinical memorandum (CM) was checked against the original publications used by RANZCP to justify its position. In addition, the search engines Google Scholar, PubMed, ScienceDirect, the Multidisciplinary Association for Psychedelic Therapies (MAPS) website, the Therapeutic Goods Administration (TGA) website, relevant Australian and New Zealand legislation were searched for pertinent and up-to-date- information. Results: There is no scientific or medical evidence from the last 70 years to suggest that either psilocybin or MDMA, when administered as an adjutant to therapy in a controlled clinical setting, are linked to either mental illness or negative health outcomes. On the contrary, MDMA and psilocybin have been shown to be safe, non-toxic, non-addictive, and efficacious when administered in a medically-controlled clinical environment. All associated risks are apparent in an uncontrolled setting. Conclusion: The RANZCP’s position is based on outdated, irrelevant, misinterpreted, and misinformed evidence. With the recent positive media coverage of the efficacy of these medicines when used as an adjunct to therapy, there is an intrinsic risk of self-medication or underground therapy. This means that any medical discussion must also purvey the ethical responsibilities and social duties associated with these substances.

A report on virtual ‘Can’t intubate, can’t oxygenate’ conference workshops at the 2021 Annual Scientific Meeting of the Australian and New Zealand College of Anaesthetists

The COVID-19 pandemic has had profound implications for continuing medical education. Travel restrictions, lockdowns and social distancing in an effort to curb spread have meant that medical conferences have been postponed or cancelled. When the Australian and New Zealand College of Anaesthetists made the decision to commit to a fully virtual 2021 Annual Scientific Meeting, the organising committee investigated the viability of presenting a virtual ‘Can’t intubate, can’t oxygenate’ workshop. A workshop was designed comprising a lecture, case scenario discussion and demonstration of emergency front-of-neck access techniques broadcast from a central hub before participants separated into Zoom® (Zoom Video Communications, San Jose, CA, USA) breakout rooms for hands-on practice, guided by facilitators working virtually from their own home studios. Kits containing equipment including a 3D printed larynx, cannula, scalpel and bougie were sent to workshop participants in the weeks before the meeting. Participants were asked to complete pre- and post-workshop surveys. Of 42 participants, 32 responded, with the majority rating the workshop ‘better than expected’. All except two respondents felt the workshop met learning objectives. Themes of positive feedback included being impressed with the airway model, the small group size, content and delivery. Feedback focused on previously unperceived advantages of virtual technical skills workshops, including convenience, equitable access and the reusable airway model. Disadvantages noted by respondents included lack of social interaction, inability to trial more expensive airway equipment, and some limitations of the ability of facilitators to review participants’ technique. Despite limitations, in our experience, virtual workshops can be planned with innovative solutions to deliver technical skills education successfully.

Reflections on, and responses to, managerial adverse reactions to healthcare advocacy by psychiatrists and trainees

Objective: For psychiatrists and trainees, to reflect upon adverse managerial reactions to healthcare advocacy about patient care and safety, drawing upon examples from general healthcare settings, and to share approaches to addressing these reactions. Conclusions: Psychiatrists and trainees engaging in healthcare advocacy may face adverse responses from healthcare management, with personal and professional consequences. Advocates need to consider counterstrategies to negative actions by management that may include workplace incivility, bullying and harassment. Health advocacy is more effective within a network of peers, patients and the broader community, including medico-political professional organisations, such as the Australian Medical Association, Royal Australian and New Zealand College of Psychiatrists, and Unions. These organisations should advocate openness to doctors highlighting healthcare safety and quality, as well as prevention of workplace bullying.

The Jewel in the Crown: a Case Study of the New Zealand College of Midwives Standards Review Process in Wellington

<p>In 1990 New Zealand midwives regained the legal right to practice autonomously Large numbers of midwives exited the hospital system to provide continuity of care both in the community and in the hospital. These midwives practise independently and are funded by the state to do so. The New Zealand College of Midwives has developed and promoted a midwifery model of partnership, incorporating this model into its Code of Ethics and Standards for Practice. In its commitment both to professional development and to accountability, and in partnership with consumers of maternity care, the College developed the Midwifery Standards Review Process. This process involves the midwife in an annual review of her practice. The midwife gathers and collates her statistics, and measures her practice against the NZCOM Standards for Practice. Consumer feedback forms are sent directly to the review co-ordinator. All this information is presented to a panel consisting of two midwifery peers and two consumer representatives. Together with the midwife they discuss her year's work and develop goals for the coming year. The purpose of the review is to provide the midwife with a supportive, educative environment in which to reflect on her practice while at the same time providing an avenue for professional accountability. This study describes the Midwives Standards Review Process in detail using a case study approach. It finds that the process is a unique and innovative addition to the ways peer review and reflective practice can be provided. It identifies the issues of quality assurance, reflective practice, supervision and competence as being of most relevance. In particular it develops the ideas of how reflective practice can be enhanced within a quality assurance model. It recommends that further research is undertaken to ascertain whether midwives using the process find it useful, in particular how it has assisted them in their professional development. Further research may also increase the body of knowledge on the nature of reflective practice and how it is best facilitated.</p>

The Jewel in the Crown: a Case Study of the New Zealand College of Midwives Standards Review Process in Wellington

<p>In 1990 New Zealand midwives regained the legal right to practice autonomously Large numbers of midwives exited the hospital system to provide continuity of care both in the community and in the hospital. These midwives practise independently and are funded by the state to do so. The New Zealand College of Midwives has developed and promoted a midwifery model of partnership, incorporating this model into its Code of Ethics and Standards for Practice. In its commitment both to professional development and to accountability, and in partnership with consumers of maternity care, the College developed the Midwifery Standards Review Process. This process involves the midwife in an annual review of her practice. The midwife gathers and collates her statistics, and measures her practice against the NZCOM Standards for Practice. Consumer feedback forms are sent directly to the review co-ordinator. All this information is presented to a panel consisting of two midwifery peers and two consumer representatives. Together with the midwife they discuss her year's work and develop goals for the coming year. The purpose of the review is to provide the midwife with a supportive, educative environment in which to reflect on her practice while at the same time providing an avenue for professional accountability. This study describes the Midwives Standards Review Process in detail using a case study approach. It finds that the process is a unique and innovative addition to the ways peer review and reflective practice can be provided. It identifies the issues of quality assurance, reflective practice, supervision and competence as being of most relevance. In particular it develops the ideas of how reflective practice can be enhanced within a quality assurance model. It recommends that further research is undertaken to ascertain whether midwives using the process find it useful, in particular how it has assisted them in their professional development. Further research may also increase the body of knowledge on the nature of reflective practice and how it is best facilitated.</p>

Indian psychiatrists in the Australian workforce – From brain drain to brain exchange

Worldwide doctors have been migrating from low- and middle-income countries to high-income countries for decades. This contributes to dearth of doctors, especially psychiatrists, in low- and middle-income countries – often referred to as ‘brain drain’. Australia has a fair share of psychiatrists of Indian origin in its workforce. This article endeavours to re-formulate the migration phenomenon as ‘brain exchange’ through the experiential insight of the authors along with published literature and discusses the contribution of substantial number of psychiatrists of Indian origin to the Australian society. Furthermore, the article highlights the potential for the Royal Australian and New Zealand College of Psychiatrists to be a leader in this area by facilitating globally responsible practice by giving back to countries from which psychiatrists originate. The key observations and recommendations are transferrable to other similar countries and equally to other medical specialities.