Murmur - 2020, March by Griffith University Medicine Society (GUMS)

murmur Carpe Diem

MARCH 2020

Contents 04

Editor's Note

Yashaswini Makkoth

Machine Learning Rogges Anandarajah Designed by Maheen Khan Shahid

President's Note Wadie Rassam

Our Journey: The Ups, Downs, & Stagnancies Toby Redler

Latin Dreams and Philosophers Mitchell Fungrani Designed by Maheen Khan Shahid

The Wonders of AMSA Kiera Stanmore Designed by Eesha Bajra

The Enemy Varshini Chandrasekar

22 Research Experiences Wasim Awal, Julia De Groot, Adithya Sharanya and Leona Mak Designed by Shae-Lee Hourigan

SAVE New Year's Resolutions Ashraf Docrat

Vegetarian Lasagna Recipe Deepti Rajguru Designed by Neha Vatnani

Confessions of Clinical Years Madeline Dick Designed by Astha Dhungana

Scrub Crawl 2020 Julian Lang-Lemckert

The GUMS Puzzler Designed by Vinuri Abeygunawardana

Editor's Note YASH WAASDW I EI NRIAM SS AA KM KOTH I have a confession to make: I’ve never watched Dead Poets Society. Technically, I’ve seen bits and pieces, just never from beginning till end. Before you raise your pitchforks, know that I don’t have a Netflix subscription and rely solely upon this undeniably weak excuse. But I digress. I admitted to such a grave sin to enlighten you all on how the theme for this issue came about. Unlike most people, I was first introduced to the phrase “Carpe Diem” in a school assembly during Year 12 - our new principal finished her introductory speech with these famous words. Unfortunately for me, she did not bother to expound upon them, and I certainly didn’t ask my classmates, lest I be subject to their incredulous outcries. Instead, I relied upon a good friend, who never acted “holier than thou” despite my endless supply of questions - I’m referring to Google in case that wasn’t clear to anyone. And just like that “Carpe Diem” became a theme for our Year 12 cohort, echoing through our classes, exams and assignments. However, like most motivational quotes, the less I heard it, the quicker it faded into the background of my life. But fate would have it that almost five years later I would be reminded of these words once more. On a visit to India last summer, my cousin gushed about Dead Poets Society. She had watched it for the first time a few months prior with my Aunty and absolutely loved it. They often quoted the famous phrase to each other in their daily lives. Keeping in mind that English is not their first language, even they had felt the weight of those prolific words. And so, the theme for this issue was born. “Carpe diem - it’s about making the most of each day. It’s about living in the present. It’s about chasing your dreams and making your life extraordinary, right?” I exclaimed to a good friend (and writer on this issue of Murmur). However, she wisely reminded me that even two words could have a wide spectrum of interpretations. So, I hope in these pages you find a diverse range of interpretations of a seemingly simple phrase. You may find yourself feeling nostalgic as you read about the joy (and fear) that comes with stepping

onto the hallowed grounds of G40 for the first time or inspired as you read about the incredible research of our own Griffith med students. Whatever it is, I challenge you to ask yourself– “What does carpe diem mean to me?”. And as you answer that question, I hope you find at least one thread in this rich tapestry of stories that resonates with you. Now, I may not have watched Dead Poets Society, but I was as much of a fan of Robin Williams as the next person (an oxymoron some of you may say). So, I’ll end this piece with his wise words: “Make your life spectacular.”

Acknowledgements Chief Editor: Yashaswini Makkoth Chief Designer: Maheen Khan Shahid Publications and Design Team: Vinuri Abeygunawardana Rogges Anandarajah Eesha Bajra Varshini Chandrasekar Astha Dhungana Ashraf Docrat Mitchell Fungrani Shae-Lee Hourigan Toby Redler Neha Vatnani Front cover image: https://www.pngguru.com/free-transparentbackground-png-clipart-bchna/download Canva template: Vinuri Abeygunawardana

President's Note WADIE RASSAM Seize the opportunity before you Hello everyone! A big welcome to our new students and welcome back to everyone else. I hope adjusting to the start of the year has been going well for you - whether thatâ&#x20AC;&#x2122;s figuring out self-directed learning, memorising 700 brainstem nuclei or finding your feet on the ward or clinic. Looking back on the last 3 years of my journey through med school, there have been so many wonderful opportunities that I have been fortunate enough to have presented before me. But really, there was one opportunity, that if seized, has the potential to unlock so many more. This is getting to know the people around you. For our first years, it is a very exciting (and overwhelming) time meeting so many people, and for returning students there are still many people in our year and other years we have the chance to meet/get to know better! I want to challenge everyone to get to know whoever they can, and here is why: Firstly, medicine is unlike our undergrads. There are not many other degrees which accept a 30+ year age range with over 20 different undergrad degrees. Hearing everyone else's journeys so far gives us new perspectives and helps us grow our level of maturity. Compared to my undergrad where everyone had just finished high school, having a bigger variety of personalities and backgrounds was certainly refreshing. Now, let's think about all the opportunities we can take up throughout medicine and beyond getting dressed up with 500 other students in scrubs for a night out in Surfers, exploring the beautiful South East Queensland for those of us who have moved here, showcasing artistic talent (or lack thereof) at Med Revue or Coffeehouse and coming up with a diagnosis for a patient who will now be able to receive treatment (not to mention 500 other things that could be listed here). Through meeting this diverse pool of people who are now our colleagues, they can push us to attend events and strive for goals that we normally wouldn't be comfortable with. They can

become our study partner. They can be part of a team who play sport together every week. They can be who we share our hardships with and seek advice from. Coming off the back of this, we will create memories we will all cherish. We will be able to look back fondly on moments from our PBL sessions or Scrub Crawl. We can look back and recite the funniest lines from Med Revue and appreciate the talent of our singers and dancers. We can discuss our best and worst moments as practitioners down the track, where we will all inevitably have cases which don't turn out well. Having people to experience all these things with and reflect on all these things with is the best part about being in medicine, and in life really. All of our experiences are enhanced through having some others there to accompany us. And it just happens to be that we are lucky enough to have a student body of over 800 people, all with VERY diverse backgrounds and stories, that we can all get to know - and it starts with one simple hello. Everyone is shy to some degree - even those amongst us who come across as loud and vibrant are often shy when it comes to meeting new people, even though some people don't see this at first. In saying this, whilst we may look away from a peer who is walking past us in the corridor out of shyness, both people are often thinking the same thing - I want to say hi to this person and see how they're going. Keeping this in mind, let's all challenge ourselves to make more effort to say hi to people we see around - most of the time it will make someone's day! Even for those who find a close friend group, don't stop there - keep pushing yourself to meet whoever you can. If we can all do this, it will make our experiences and memories of them so much richer. And of course, we are all going to be working together for most our lives - the friends we start making now will be who get us through the rollercoaster that is medicine!

Our Journey: the Ups, Downs, and Stagnancies TOBY REDLER The first day of Medical School actually brought with it a great surprise: the G40 escalator was operating; both sides at that! Was this perhaps a sign of fortune heading into our first, daunting week as physicians in training? Or was it just the escalator trying the whole “new year, new me” thing? My holiday-mode optimistic brain told me it was the former. However, surely the recommencement of late nights with my head buried in textbooks would trigger that relentless realism that is far too often mistaken for coldheartedness. And sure enough, it was the latter. Day two saw one side of the escalator (of course the ascending side) already at a stand-still. And, perhaps coincidentally, it was around the time that we were told “you are now, no longer, the smartest person in the room.” Ok. Interesting start to day two; realism starting to prevail. Day three brought another interesting comment from our cheerful leader that half of us would now be below average. And just like that, both sides of the escalator ceased to operate. Maybe I am reading too much into this whole escalator thing. But the realism had definitely set in. Despite sounding daunting and slightly pessimistic, perhaps our lecturer’s words were intended to prepare us, rather than frighten us. Perhaps he was actually an incredible mentor. Someone with the skills to allow us to interpret the take-home messages from his teachings, without simply revealing them forthright. Kind of like Harvey Specter in his moments of wisdom whilst teaching his intern, Mike, “You do what they say or they shoot you, right? Wrong. You take the gun. You pull out a bigger gun or you call their bluff, or you do one of 146 other things,” (and, no, I am not here because I didn’t get into law school).

The first message that I interpreted from those comments was that cooperation will be vital to our success as a cohort. Even in the short time I have been a part of this group, I have met paramedics, nurses, pharmacists, doctors with theses in neurobiology, nutritionists, and many other professionals and students passionate to learn. Yes, we have all had to compete throughout our whole lives to make it to where we are. But now, with such a strong, multifaceted team, it is the time to work together, use the skills brought to the table by all members, and help each other to become great doctors of the future. As Raymond Reddington would say, “In this world there are no sides, only players”. And our guest speaker during orientation reiterated this point. We were extremely fortunate to have Professor Martin Wullschleger as our guest speaker for 2020. I have had the pleasure of hearing him speak at a conference last year and have heard

"in this world there are no sides, only players"

stories about him by other healthcare professionals. Martin is obviously an incredibly intelligent man, with titles of Clinical Director of Surgical, Anaesthetics & Procedural Services and Medical Director of Trauma Service at Gold Coast University Hospital. However, when studying for the gruelling fellowship exam that he was forced to sit again on entrance to the Australian healthcare system, he utilised a study group. Instead of viewing the process as competing against his fellow (pun intended) applicants, Martin viewed the exam itself as the competition, and his study group as his team. This is exactly the mentality that will mould us into well-rounded physicians. The second message that I took from that initial address was to be humble. Being open to learning from others, despite their background, will lead to an optimal learning environment. No one is at an advantage coming into this course. The collective knowledge accumulated from a wide range of experiences, including life experiences, greatly benefits all members of our cohort. Being humble and showing humility is at the core of this principle.

Even Martin failed his fellowship exam a number of times, but there is no doubt that he is one of the greatest surgeons in the country. His humility kept him grounded, and he eventually passed those exams. We need to follow the same philosophies and understand that we all have much to learn. By following these two pieces of advice (if I have correctly interpreted them), we will enjoy an amazing four years together with a lot of fun in between. Be the escalator, carry people to where they need to be. And when you need assistance yourself, jump on board. If your escalator ever comes to a halt, just remember, this is a common occurrence in the G40 precinct. Just like the stairs and elevator, there are a multitude of people and resources around you that will assist you to your destination. I’ll stick with my TV show theme and leave you with an important piece of medical advice from Jake Peralta. When you encounter a patient with internal bleeding, they’ll be fine because, “that’s where the blood’s supposed to be.”

"JUMP ON BOARD"

The Enemy Meet your dreaded adversary...

Before you ask, no this article is not about the girl that stabbed you in the back last summer. Or that lecturer that was dead-set on failing you. It’s not even about your own selfdestructive behaviour that includes binging ice-cream at 2am in the morning (definitely not speaking from personal experience). No – today, we’re going to expose an enemy you probably didn’t even realise was stalking you: Burnout. I know who you are. You’re that person who has spent the last few years of your life running around between lectures, placements, your job and a million other things. And now you’re finally here. A medical student, and soon a doctor. But imagine this. Lately, you’ve been dragging yourself to classes, barely keeping up with coursework and dreading another day at uni. You feel tired all the time and have started losing interest in Medicine. Little things have started to tick you off and your patience is wearing thin whilst your cynicism is running high. What’s going on? You worked so hard to get this far. So now why do you hate being here? Chances are, you’re experiencing burnout. Burnout is a feeling of mental and physical exhaustion that develops from long-standing stress. It can make you feel as if the life has been sucked out of you. You might start feeling indifferent towards work you once enjoyed, find it increasingly difficult to be patient with others as well as concentrate whilst studying. And often, it can feel as if you just stop caring. Scary, right?

By Varshini Chandrasekar

You’d be shocked by just how many doctors experience burnout (Hoffman & Bonney, 2018). But it makes a lot of sense when you consider the years of hard work, late nights and pushing yourself to the limits that’s an accepted practice within the profession. Medical school is no different. It’s a rocky mountain that we’re still in the process of climbing. And burnout can often manifest on our way to the top. So, it’s important to check in with yourself regularly. Ask yourself – am I tired all the time? Have I lost motivation? Have I reverted to listening to angsty 2000s music even though I’m not actually an emotional 16 year-old? If your answers to any of those questions was yes – then never fear, a fellow exhausted medical student is here. So now you realise you’re burnt out, what do you do? As someone who’s been through burnout before, let me give you some tried and tested advice that you won’t find on those How To Wiki pages. When I realised that I was burnt out, the first thing I did was consult Google. And what did I find? Well, Google told me to exercise, eat healthy and get eight hours of sleep amongst other things. Sure, that’s doable right? I was also told to prioritise self-care and create more balance in my life by getting involved in things outside of Medicine. Funnily enough, this was all advice that deep in my subconscious, I already knew. But they’re often easier said than done.

Rather than setting yourself unrealistic goals that include upheaving your entire schedule to start going on 5am runs, or taking up a new activity that you definitely don’t have the time or money for, just listen to what you want. Take a minute to think about what it is that makes you feel happier and more in control of your time. And then do it. Take a nap. Go to the zoo. Watch a lecture (but only if you want to). Whether it be immersing yourself in an exciting new project or simply spending time doing nothing at all - to each their own. You don’t have to be perfect. Besides – as they say, ‘The time you enjoy wasting, is never wasted time.’

I recall trying to wake up earlier in the mornings to exercise – but ironically, this meant that getting eight hours of sleep (or close to it) each night, became near impossible. It also meant I spent the rest of the day not only looking like a raccoon, but feeling crabby as well. It was like Google didn’t understand that I was a busy uni student that would choose watching my favourite TV show over meditation any day. And of course Google didn’t understand. Each of us is different. The truth is, life is hectic. And time is a fixed commodity. Being a medical student means that free time can often be scarce and stress often awaits you just around the corner. So, not all of the generic advice that you may find on the internet may feel tailored to you or be practical for your lifestyle. But that doesn’t mean that recovering from burnout has to be hard. It’s all about tackling your enemy in your own way. For me, what helped was taking time out of my schedule to do things simply because I wanted to and not because I had to. I started to spend more time talking to old friends. I began to engage in hobbies that I had neglected for a very long time. I started writing again. And it really went to show that there’s no one solution to get back on track.

For some, doing things just for themselves, can really work wonders. But for others, talking to someone about how they feel, is truly the best medicine. If the latter resonates with you, that’s A-okay (check out the numbers provided at the end of this article). Sit down with a friend, loved one or confidante and tell them about how you’re feeling. Let it out. Asking for help and support isn’t a sign of weakness but rather an indication that you’re on the path to feeling yourself again. So folks, I hope this article has opened your eyes to an enemy that’s often lurking in the shadows. If this enemy ever starts rearing its ugly head, know that this article will always be here for reference and support. And remember - there’s no set prescription for battling burnout. What’s important is that it makes you feel more content with your life. So, don’t complicate things. Just do you. If you, or someone you know, needs help please contact: Lifeline: 13 11 14 Beyondblue: 1300 22 4636 Eve De Silva (Griffith University School of Medicine): e.desilva@griffith.edu.au Hoffman, R., & Bonney, A. (2018). Junior doctors, burnout and wellbeing: Understanding the experience of burnout in general practice registrars and hospital equivalents . Australian Journal of General Practice .

Research Experiences WASIM AWAL (4TH YEAR)

JULIA DE GROOT (3RD YEAR)

What made you get into research? I enjoy getting to learn about a specific topic in detail and the fact that your research may one day make a small (or big) change to medical practice. It may also give you opportunities to travel interstate or internationally to present your research which is a great excuse to travel! Tell us a bit about your research. My current projects are mostly in orthopedics and musculoskeletal health. What have you learnt? First thing I’ve learnt is that projects take a long time and a lot of hard work. From the ethics application to data collection, data analysis, writing up, journal submission, peer reviews, etc. it can take anywhere between one year to several years. If you’re looking to be a first author, especially for bigger projects, be prepared to sacrifice a lot of your personal time after uni, between classes and on weekends. That said, the larger your contribution to a project, the more you’ll learn and the more opportunities you’ll get in the future! How do you find a supervisor? Find a field you’re interested in. Then reach out to doctors or researchers in that field and ask if they have any ideas for projects or current projects that they need help with. You can meet doctors through clinical rotations, conferences or other events, personal connections, or even cold emails. Show that you have a keen interest in that field and if you have prior research experience, that’s even better. Feel free to reach out to me if you have any questions. What advice would you give to anyone who may be considering participating in research during the MD program? If you’re dedicating so much time to a project, make sure you find the topic interesting and that it makes a meaningful contribution to the scientific or medical field. The first one is so you don’t lose motivation during the long process and the second is so that you can be eventually rewarded for your work (e.g. through publications or presentations). When you’re looking for a supervisor, make sure it’s someone who can support you and guide you through the process, especially if you’re less experienced.

What made you get into research? Nowadays, you need published research papers to be competitive in the majority of specialty training programs. However, some only consider research published within 5 years prior to applying to that specialty training program. The logical alternative for me was to gain accreditation with an additional degree, whilst also learning how to perform research independently for later on. Research can be quite hard to wrap your head around, so I wanted to learn how to do it within a structured curriculum and with the support of a supervisor. Tell us a bit about your research. I started the Master of Medical research in 2019, my 2nd year of MD. It is a 1.5year full-time course, which I will complete part-time over 3 years. If all goes well, I will graduate with MD/MMedRes in 2021. My research focuses on the efficacy of type 2 diabetes interventions and I will be submitting 2-3 papers, including a meta-analysis and RCT. What have you learnt? It can be a very draining and frustrating process, but surely rewarding once completed. If you want to formulate your own research topic/question, it would likely take a year of planning. You could instead find a supervisor with ongoing research which is what I did; a huge time-saver! What advice would you give to anyone who may be considering participating in research during the MD program? If research isn’t for you, a masters by coursework would be a good alternative (eg. Master of Public Health) and this could be done part-time as a junior doctor if you prefer. Biggest piece of advice is that if you choose to do multiple extracurricular activities on top of the MD, be prepared to sacrifice your holidays and a lot of free time to keep on top of everything!

OUR GRIFFITH STUDENTS SHARE WHAT IT'S LIKE DOING RESEARCH ALONG WITH THE MD PROGRAM ADITHYA SHARANYA (3RD YEAR)

LEONA MAK (2ND YEAR)

What made you get into research? It gave me a way to feel like I contributed to the improvement of the quality of life of a wide range of people through my passion for science. Tell us a bit about your research. It started off very molecular—gene mapping in congenital heart disease, molecular targets in HIV. Eventually I moved towards more epidemiological studies: Sex differences in COPD-related quadriceps muscle dysfunction and fibre abnormalities, Successes and Challenges of HIV/AIDS Program in Oman: 1984–2015. Most recently I have started working on research in cervical cancer exploring the impact of screening disparities in the middle east. The shift towards more people-oriented research is what helped me transition into medicine and I still continue to see value in pursuing it alongside medicine. What have you learnt? Ask the questions no one wants to ask. It may seem crazy to you but innovation is born out of people pushing boundaries. If you’re wondering if the outcome related to a variable is being influenced by a confounding factor that no one else seems to have brought up, it could be because they thought of it and realised it has no impact, or perhaps they haven’t even considered it yet. This could be within your research group or within the wider scientific community. What advice would you give to anyone who may be considering participating in research during the MD program? Keeping in mind how challenging our program is, my suggestion would be to pursue research in an area you see as an indispensable part of your future. This doesn’t mean it has to be around your potential area of specialty. If you see yourself as someone who will advocate for women’s health in the future, your research could be in a disease with gender differences. You will feel like you are making a difference; bonus point you also become an expert on the disease if it ever comes up in an OSCE or exam. As someone who was on the outside of the doctor-patient relationship as a clinical researcher, I truly appreciate the privilege clinicians and medicals students have of speaking to people affected by disease. Looking at numbers on a screen or protein in a test tube doesn’t allow you to be continuously inspired to innovate to eradicate suffering in real time. My advice is please do research. Not just because it will look amazing on your CV but because being a scientist will make you a better doctor and vice versa.

What made you get into research? I was first exposed to research during my first undergraduate year. Our course required us to find a suitable supervisor and write a 5000word essay. My supervisor was very knowledgeable and passionate about research - he avidly shared his research with me and taught me many things. While I enjoyed writing the paper, my interest in research stems from my pleasurable working experience with my supervisor. Tell us a bit about your research. Last year, I was fortunate enough to be offered the opportunity to work with Dr Mcalister, on the topic of Postoperative pain control after standard corneal cross-linking techniques. Corneal crosslinking (CXL) is used to halt the progression of keratoconus, a vision disorder that occurs when the normally round cornea thins and becomes irregularly cone-shaped, distorting vision. CXL is very painful and currently, there is no universally accepted standard of post-operative pain control. The study aimed to compare two analgesic regimes: the historical non-opioid regime to the new opioid regime. What have you learnt? Working with Dr Mcalister, I learnt a lot. I learnt how to access patient records and transfer data into an excel spreadsheet, and to analyze data using SPSS. Dr Mcalister also provided me with the opportunity to do a poster presentation at the annual Royal Australian and New Zealand College of Ophthalmologists conference. He taught me how to format a poster and he provided me with tips on how to present professionally. What advice would you give to anyone who may be considering participating in research during the MD program? One opportunity leads to the next opportunity. By presenting at the annual Griffith MD Research Forum last year I became acquainted with a wonderful academic. She offered me a summer scholarship as her research assistant. I encourage everyone who has an interest in research to begin actively pursuing opportunities from year one of medicine.

CONFESSIONS

CLINICAL YEARS

MADELINE DICK

It has finally begun. Day one of clinical years, of what feels like the homestretch to the end of my medical degree. I am ready to goclinical outfit sorted, lunches and snacks prepped for the week, stethoscope sitting shiny in my bag ready to be useful for once. Visions of saving patients’ lives, inserting cannulas with ease and sharing coffee with my team of registrars and consultants flashes before my eyes as I step through the automatic hospital doors into a wave of freezing air-conditioning. Let the real learning begin. Flash forward a few weeks. Reality has set in. I am yet to save someone’s life, cannula attempts have been fairly few and far between… however I have managed to score a coffee shout from a resident who took pity- still a win in my books. My first few weeks in the hospital were certainly not as I expected them. A whirlwind of feeling lost – both physically and mentally – initially shocked me and there have been many days where I have left feeling quite useless.

Speaking my peers, it seems like a lot are in a similar boat. We all have had days where we felt like we have constantly been in someone’s way, answered incorrectly to ALL of the consultant’s questions or just felt like a bit of a kook trying to put into practice our examinations on real patients. It is those days, I believe, that are probably the most meaningful to our learning. At the times when I have felt stupid for not knowing an answer to a question, in hindsight it has actually taught me more about what I should focus on. On the occasion where I felt frustrated at being unable to get a proper history from a patient, I have later been humbled to think they have trusted me to tell me as much as they did. The moments where I have felt scared or nervous about performing a procedure, I have felt proud that I have made it to where I am now.

Sure, at the time no one likes feeling silly or useless, I’ll be the first to admit that. But as I think back and take the time to reflect on the moment that made me feel that way, I realise there was actually something deeper I could take away from the situation. It is not always easy to do so when the imposter syndrome sets in. Throughout med school I have heard this term floating around, never really taking the time to look into its meaning until now. Imposter syndrome can be defined as “a collection of feelings of inadequacy that persist despite evident success” (Corkindale, 2008). There are numerous theories as to the root causes of these feelings. It certainly varies from person to person depending on their own experiences and values. Personally, this feeling of being unworthy or doubting myself becomes more apparent when I am handed more responsibility. It is as though I don’t feel I deserve the privilege of being trusted to examine the patient or hearing the intimate details of a patient’s history. It is a strange, overwhelming mix of gratitude and apprehension at the same time, that I am still trying to make sense of. I don’t feel alone in these doubts though. I think it comes down to the fact that our future careers as doctors is one that carries with it great responsibility. The opportunity we have to directly impact the lives of people at their most sick and vulnerable is not something to be taken lightly.

As the weeks fly by and my first rotation is drawing to an end, these feelings are still there. However, taking the time to acknowledge my feelings and reflect on them has actually made these situations feel less overwhelming. As I am starting to get a feel for the rhythm of the hospital, the important role that each and every member plays in this complex network of healthcare, I feel I am slowly, with baby steps, starting to find my own feet. There are still many days where I find myself lost and full of doubts. And it is on these days I cast my mind back to my bright-eyed expectations of day one and try to remind myself of the real reason I am here… to learn. To learn not only the art of medicine, not only the ins and outs of the hospital but also to learn about myself, my weaknesses and my strengths, my values and my passions for my career ahead.

I urge any of you who might be feeling in a similar way to me, when those impending misgivings of imposter syndrome creep in, to ask yourself this verse from Dead Poet’s Society: “That you are here - that life exists, and identity; that the powerful play goes on and you may contribute a verse. What will your verse be?”. Medicine is by no means an easy path, but as doctors what a truly meaningful verse we can contribute to our patient’s lives.

THE GUMS PUZZLER 1 2

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C R O S S W O R D 13

ACROSS: 3. Functional unit of the kidney 5. Foregut pain is referred to the __________ region 8. _____ volume is the volume of air that is inspired during rest 9. Most potent vasoconstrictor known 10. Type of shock where the skin is warm 11. Type of heart block where the PR interval gets progressively longer until a beat is dropped 13. Major cation of extracellular fluid

DOWN: 1. Yellow discolouration of mucous membranes/skin/sclerae due to bilirubin deposition 2. Innermost layer of a blood vessel 4. Cellular component containing DNA 5. Type of hypertrophy where the sarcomeres are added in series 6. Condition in which the lower oesophageal sphincter fails to relax 7. Functional zone of the respiratory tract that is not involved in gas exchange 12. Major anion of extracellular fluid

C O M I C S @myhumeruslife

@thecomicalanatomist thecomicalanatomist.com

@theawkwardyeti

Send your answers to yashaswini.makkoth@griffithuni.edu.au and be in to win a 4-month Osmosis Prime Membership!

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Can you find these words? Malaria Fibroblasts Typhoid Platelets Progesterone Pancreatitis Atelectasis Hypertension Allergy Adrenaline Miosis Amoxicillin

S E A R C H

CLINICAL QUESTIONS

The primary actions of cholecystokinin include all of the following EXCEPT: A) Stimulation of intestinal motility B) Inhibition of gastric emptying C) Contraction of gallbladder D) Stimulation of glucose production

Which of the following is a clinical feature of left sided heart failure? A) Paroxysmal nocturnal dyspnea B) Distended jugular veins C) Ascites D) Peripheral pitting edema

All of the following mediastinum EXCEPT:

are

found

the

superior

A) Trachea B) Oesophagus C) Thoracic duct D) Pericardium

Interpret the following ABG (from ABG ninja): pH: 7.28 PaCO2: 23 mmHg [HCO3-]: 10 mEq/L

A) Fully compensated respiratory acidosis B) Partially compensated respiratory acidosis C) Partially compensated metabolic acidosis D) Fully compensated metabolic acidosis

Machine Learning ROGGES ANANDARAJAH

The prospect of Artificial Intelligence and Machine Learning in Medicine, and frankly many other fields, evokes the image of human practitioners being replaced by algorithms and machines. While there’s an element of truth in that, the more realistic picture is one where a capable individual utilizes those algorithms and machines for domainspecific purposes. One such example is Dr. Paul Lee, an Interventional Cardiologist affiliated with the Mount Sinai School of Medicine in New York. Dr. Lee used Convolutional Neural Networks to automatically analyze coronary angiograms and detect coronary blocks all to help reduce and prevent heart attacks (Rita et al, 2020). He even took his work a step further and made it deployable to mobile phones for easier usage (Rita et al, 2020). While his work is certainly impressive, his path to that point is equally as impressive if not more so. Approximately 2 years prior to his presentation of his work, Dr. Lee first became acquainted with the Python programming language (Rita et al, 2020). He took an introductory course on Python and then went straight into Deep Learning and Computer Vision courses. He would then develop his model with a very standard Python Machine Learning setup. There are several takeaways from his story; many for other medical practitioners, and one for the AI/Machine Learning community.

The previous description of Dr. Lee’s Machine Learning journey probably makes it seem easier than it is; after all, it was a 2-year education. However, applied machine learning is not as difficult as it seems from the outside either. Many of the algorithms and procedures that people like Dr. Lee use have already been implemented and are available for immediate usage. More simply, think of applied machine learning as driving a car. Learning to drive a car can be challenging but it’s far easier than building a car and then driving it. Furthermore, Dr. Lee’s choice of programming language couldn’t have been better. The Python programming language is beloved by software engineers; data scientists; and scientists from other fields for its simplicity and beginner-friendly ethos. It’s still not terribly easy but it’s a far gentler experience than competing languages. One significant lesson from Dr. Lee’s work is that applied machine learning is a skill that even busy physicians can acquire, and one that can help them improve their work-life. In Dr. Lee’s case, he aims to have his work reduce the time he spends on diagnostic imaging so that he can spend more time with his patients (Rita et al, 2020). Applied machine learning can be learned and successfully implemented by those in the medical field but is it worth doing so? After all, there are plenty of data scientists and software engineers with PhDs and

years of work experience with the same technology. The answer is a resounding yes. Pure machine learning and artificial intelligence is a mathematical and statistical pursuit. Applying the tools developed in those pursuits requires domain-specific knowledge that mathematicians, and statisticians almost always lack. Suppose you want to build a model that determines if a patient is at significant risk of having a stroke. Someone with medical knowledge would either collect or search for data that includes significant risk factors such as: hypertension; atrial fibrillation; and diabetes.

Domain-specific knowledge is what allows identification of areas for applying machine learning to yield the greatest positive impact on a field. Even if developing models isn’t an interest, it is certainly a useful skill for a physician to have a working understanding of these tools going into the future. The reason for this is twofold, and both relate to large technology companies. One reason is that large tech companies realize that their employees lack domain-specific knowledge. As such, they often hire medical practitioners as consultants for a fair amount of money; having a working understanding of these tools makes for a better consultant. The second reason, however, is much more applicable to almost all doctors. Companies seek to market their products to their target demographics as soon as they’ve made it to production. When companies make health-care related data products, the target demographic will be the healthcare field and significant focus will be paid to doctors and hospital administration. Some of these data products will be beneficial to daily practice and certainly worth considering. Others still, will be close to useless and a waste of money. Only an appropriate understanding of the tools will equip those in the healthcare field to make sound decisions.

Someone without such domain knowledge may use these predictors or may use other ones that are significantly less helpful. This raises one of the key limiting factors of Artificial Intelligence in practice; domain-specific knowledge. Having algorithms and machines that are capable of making predictions is well and good but without an appropriate guide-hand they will not be as effective as they could be. References: Rita, Rosebrock, A., Ahmed, Z., Kudjie, R., Achmad, H., Mohanad, … Koala, A. T. 2020, February 22). An interview with Paul Lee - Doctor, Cardiologist and Deep Learning Researcher. Retrieved from: https://shorturl.at/pKMZ7 Ai Anatomy. (n.d.). Retrieved from https://pixabay.com/vectors/a-i-ai-anatomy-2729782/

Machine learning and AI are growing fields with wide and far-reaching applications including healthcare. It only seems reasonable that doctors and medical students become familiar with cutting edge tools as they’re likely to be the new frontier of patient care. Even if that seems daunting, it’s worth considering the following; it’s easier for a doctor to practice machine learning than it is for a machine learning researcher to practise medicine.

Latin, Dreams and Philosophers Mitchell Fungurani

The paramount reason for choosing medicine "Why do you want to be a doctor?" This is probably one of the most frequently asked questions in interviews and throughout medical school. Whilst it may be one of the easiest questions to answer for most medical students, it has been the biggest mystery of my life for the past decade. I have always found myself providing a range of diversified responses from the established phrase "I want to help people" to a more creatively spun retelling of my life story. Perhaps all these reasons are true, but none are as profound and eloquent as expressed by the words of one of the greatest philosophers, Horace, in his poem titled "Carpe diem". In other words, my ultimate reason for choosing medicine was to ensure that I live what I hoped to be an extraordinary life. Seize the day and make most of your life how wonderful this sounds. Isn't that one of the main reasons we sacrifice so much to become doctors?

We have had inspirational quotes such as "live in the moment", and the more popularly hijacked versions of this 2000-year-old philosophical motto such as the hashtags Yolo (you only live once) and slogans like "just do it" beam at us from those incredibly annoying YouTube advertisements. At first glance, some of these seem to be prompting an impromptu way of living, which would be completely impractical in the field of medicine, but they collectively echo the message Horace expresses of making the most of each day to avoid regret at the end of life. As clichéd as it may sound, my dream has come true by getting into medical school. I am one of those typical medical students who excitedly responded "doctor!" when confronted with the question of my future career choice in early childhood. That being said, there is a myriad of professions that others will claim are the best.

Recently, I came across this ceaseless question again at the beginning of the second year and I couldn't help reflecting upon the first time I decided to be a doctor. I was 10 years old when I mistakenly toppled over my father's bookshelf in our home in South Africa. Halfway through the tedious process of rearranging everything, I decided to take respite as I picked up an open biology book. I remember reading anatomy terms with Latin origin such as cerebellum and fornix, aligned with their translations. The intrigue was short-lived as I was soon overwhelmed by all those biological terms and I immediately shut the book and continued my self assigned task. It was then, as I returned the remaining books that I started to think that about how doctors could memorise all those absurd terms and even make sense of that knowledge to cure people. It was something that I believed to be an astronomical goal that I could never achieve, but I decided then I wanted to be doctor anyways.

Benjamin Franklin once said that there were only two things certain in life: death and taxes. Whilst the latter is somewhat debatable, death is undoubtedly guaranteed. It also happens to be the other part of the classic life formula invented by Latin philosophers, which is often neglected by pop culture and Western society. "Memento Mori" which translates to "remember that you will die" is a Latin expression considered grim and depressing. Quite plainly, it reminds us that everyone dies, including our patients. It is an aspect of medicine we easily forget in between all the study.

Carpe Diem In light of all this, can it be used to instil an inclination to aim for a better and more fruitful life for ourselves or our patients? Fortunately, the answer boils down to perspective, but ultimately many people are more afraid of a meaningless existence than talking about death is not a particularly pleasant experience. It is anxiety-inducing and distressing to most. However, acknowledging death reminds us that our days on Earth are finite, and must be acknowledged in our quest to be remarkable in our daily lives.

Flash forward 7 years, despite the self-doubt, preconceptions and mediocre targets that traditional society had mapped out for me as a little clueless girl growing in a third world country, I applied for Medical school on the other side of the planet in Australia and seized the day in my way.

The simple truth is that our life is filled with distractions - be it Netflix or social media. It is a lot easier to succumb to these distractions than do something worth doing. However, we owe it ourselves to not just exist but truly live. As medical students and future doctors, we have the great task of making the most of every day and championing the essence of seizing the day in our daily lives References: In Our Time, Horace. (2018, November 15). Retrieved from https://www.bbc.co.uk/programmes/m00014jt

The Wonders of For the last time, no we are not the Australian Maritime Safety Authority #AMSAGate AMSA. When you first hear the word, it sounds like a weird disease, or a complex from the electron transport chain that a first year would memorise at 2am (Life Pro Tip: don’t). If you google it, you could be forgiven for confusing it for the Australian Maritime Safety Authority, or the wildly popular Australian Mens Shed Association. To clear up the confusion, AMSA (for the purposes of most medical students, except those who are enthusiastic about sheds) stands for the Australian Medical Students Association, and is one of the largest student representative bodies in Australia, with a powerful reputation for hosting events, advocacy campaigns, special interest groups, wellbeing initiatives, projects and publications. Not bad for an electron transport chain complex. But I knew none of this in first year. My first introduction to AMSA was when my housemate pressured me into attending the infamous Convention. “It’s a student run conference where we go to lectures in the day and wear costumes to the parties at night,” he said, enthusiastically describing how he sprayed himself green and stuck baubles all over his body like a Christmas tree last year. It was weird. I was intrigued. “Come, you’ll have fun,” he said, his fingers twitching as if reaching for that green paint pot already. And just like that I was peer-pressured into coming to my very first medical conference. But this was no ordinary conference. The first thing you notice about convention is the sheer number of medical students. Hundreds of students from all 22 medical schools across Australia attend the opening ceremony, each dressed in an outfit that represents their university. Bond University walks around in penguin tuxedo onesies, emphasising the cash they like to splash. University of Queensland are down for a fight in their Viking outfits. Griffith (Griffindors) wear an iconic red college jacket and Gryffindor scarf, with the diehards also wearing glasses and an ECG scar across their forehead. It’s a striking sight when we hit the streets. Locals ask us if Comic-Con is in town. But while the outfits may be tongue in cheek, convention is no joke. It’s an event that mirrors how AMSA first started: in 1960, a group of medical students from around Australia met up in Brisbane to discuss ideas and get to know each other… and when they did, it was magical. Today, convention is the largest student-run conference in the world attracting over 1000 medical students nationwide. Convention, like medical school itself, is a race of endurance. There are 8 hours of lectures in the day, hosting guests from Talley and O’Connor to the Dolly Doctor. The socials at night are straight out of a warped fairytale, with costume party themes like ‘Into the Fires Below’ where you’ll see everything from firefighters to chlamydia. But underneath the chaos of academics and socials, there’s an energy, a buzz that draws you in. It’s incredibly easy to meet people because of the common thread that binds us together - the shared experience of medicine with all its hardships and joys. Getting involved with AMSA is a bit like falling in love. At first, you’re drawn in by the glitz and glamour of events like convention, but the deeper you get, the more you discover just how much substance there is. Think Tanks were the next thing that drew me in. These are university run discussions about the issues currently impacting medical students. It surprised me how much people cared...how much I cared.

By Kiera Hope Stanmore

Australian Medical Students Association

I listened to a friend I’d just gossiped about the Bachelor with, suddenly articulate with great detail their feelings on voluntary assisted dying The whole room exploded into loud discussion when we realised there was a law that required mandatory reporting of mental health conditions in medical students seeking psychiatric help, shocking in a population that were at a greater risk of suicide than the general population (a law that has since been abolished). I felt myself speaking up for the first time. I attended council next, and it was intimidating, at first. AMSA councils are held thrice yearly, hosting an open forum for medical students across the country to discuss advocacy positions AMSA should take on controversial topics. We debated everything, from questioning why there are ever-increasing medical school spots when there are finite numbers of available internships, to strategies for dealing with sexual harassment in hospitals. The debates are fierce, the questioning rapidfire. But at lunches and breaks, and especially at the fondly named “Succulent Chinese Meal” (a traditional celebration on the last night of council - it involves a lot of dumplings), it became clear that these were people who genuinely wanted to hear your opinion, no matter how different it was from their own. Councils ceased to be intimidating as these people became my friends. Through their stories, I learnt the changes that AMSA was making, and it was impressive. In 2018, AMSA achieved reforms to the contracts of bonded students and doctors, with considerable improvements for Return of Service and support for students. When AMSA took a firm stance on supporting voluntary assisted dying in Australia, it opened re-discussion on the issue in the media. Most recently, AMSA marched for climate change, and hit the newspapers, again. These are just a few of the things AMSA has done in the last two years alone, and everyday there are more stories, more advocacy… and more changes. Now in my fourth year of AMSA, I know that it isn’t just about fun events or interesting debates. Every day, we’re making changes. Students from all over Australia are involved in portfolios that cover every aspect of medicine, from mental health to gender equity. The set-up of our med society, something I’d taken for granted before AMSA, has been modelled on this national collaboration of projects. Today, every single medical student is affected by the things AMSA has created - that WE have created. As a loyal Griffith at heart, I’m proud that AMSA was born in Queensland. This August, AMSA returns back to its state of birth, with Global Health Conference (GHC) hitting the Gold Coast from the 21st to the 25th of August. GHC takes AMSA to an international level, leading to a discussion of issues that affect healthcare all over the world. It’s the final capstone in an incredible network of students who have been building connections on a national, and now global, scale since the 1960s. And that’s really what AMSA is all about. Connecting incredibly passionate students together to create not just our future, but the future of our world. So while we may only be the second group to come up on Google when you type in AMSA, Australian Maritime Safety Authority, you’ve got nothing on us. The Australian Mens Shed Association on the other hand….

SAVE New Year’s Resolutions New Year’s resolutions can be really hard to keep going, but there may be a better way of going about it. At the end of each year, somewhere between the Christmas parties and Boxing Day Sales, we are encouraged to evaluate what part of us needs improvement. In a world filled with temptations, the colloquial New Year’s resolutions are one of the few vestiges of real sociallyencouraged self-improvement. In fact, it may also be one of the oldest, with records indicating that the even the Ancient Babylonians made New Year’s resolutions some 4000 years ago (Pruitt, 2018). In the modern era however, New Year’s resolutions seem to be more effective at providing mildly stimulating conversation as opposed to actually producing real change. And we’ve heard them all before. For many people it’s something exercise related: “I’m going to run 5km four times a week this year!” or (worse), “this is the year I’m getting abs!” For others who may have noticed their bank account not having as many digits as before, you might hear: “I won’t be online shopping this year” or, “I won’t spend more than $25 a week on uni lunches and coffee” (let’s see about that around exams)

ASHRAF DOCRAT Sure, many of us intend to do what we say. Some of us may buy that gym membership and even go there for a few weeks. Fewer still may make it to February. But by now, at the end of March, the vast majority of New Year’s resolutions are burning wrecks by the side of the highway. Perhaps you can just see yours flickering in your rear-view mirror as you speed away. By the end of the year it’ll be nothing but a memory – just in time for you to start on a new one. Nothing speaks to the collective realisation that these resolutions don’t work like the fact that at New Year’s, no one ever asks you how you achieved your ones from last year. It’s like we almost subconsciously know it never happened. I know I’m painting a dire picture about the state of New Year’s resolutions; that we as humans are just weak animals whose advanced prefrontal cortex is only capable of giving us the illusion of forwardplanning and willpower. And yes, some of that is true, we are human. We are biological creatures that ultimately favour the known and comfortable. Evolutionarily, if it’s something that’s worked for a while it probably means it isn’t going to kill us, so why change? Change is difficult, particularly when the change itself is challenging – hence why we make it our New Year’s resolution.

And that’s the problem, these highly rigid and quantified annual goals are ultimately not conducive to the selfimprovement we seek. We don’t actually care if we run 5km four times a week. We do care that we feel fitter and healthier and that if we’re forced to, we’ll be able to make it up the stairs to Level 10 without struggling too much. We don’t care if we’re drinking kale smoothies every morning, but we do care if we feel nourished and energised. Get the point?

resolution, July 17th you has failed. But under new-style New Year’s resolutions, your focus would’ve been on healthier eating and you would’ve been well on track.

Somehow in the process of New Year’s resolutions becoming a feature of our pop-culture, we lost the initial ideal behind it: that self-improvement – any amount of it all– is ultimately good for us. So how do we address our burning wreck? Let’s start by extinguishing the flames of expectations. A lofty and specific goal, while admirable, is more conducive to frustration than progress. And if we plan to keep this up for a year, frustration is not conducive to continuation. Then we look at what we can salvage: the original direction we wanted to go in. This can be as simple as swapping a resolution to run 5km four times to “improving fitness”, or swapping kale smoothies every morning to “being more aware of what I eat”. Now these may seem intentionally vague to you and thus easy to dodge. Yes, they are vague but not so you can avoid them, it’s so you can be active in your self-improvement and be open to the many different ways to achieve your change. What we often neglect to realise is that a year is actually a long time. A very long time. In a year, we gain new knowledge, meet new people, experience new things and make memories. And that can mean that December 31st you who decided they wanted to drink a green smoothie every morning is not the same person as July 17th you, who after much trial and error, has realised that eating salads for lunch is what makes them feel good. Under an old - style New Year's

So now that we’ve perhaps gotten this year on track, how do we avoid falling into the trap of unrealistic New Year’s resolutions again? Well, (since we love acronyms here in Medical School) I say we need to SAVE New Year’s resolutions.

NEW YEAR’S RESOLUTIONS SHOULD BE:

S incere Use this as a genuine exercise for selfimprovement not just so you can write “new year, new me” on the first insta post of the year.

A chievable Don’t kid yourself into thinking that the clock striking midnight will give you infinite amounts of willpower. You know who you are and you know your limits.

V ague The more specific and narrow your goal, the likelier it is to fail, even if you do improve.

E lementary Choose the overarching, basic theme of the area of your life you want to improve. And if we do this, on New Year’s Eve 2020 we just might be able to reflect on the journeys we’ve experienced along the paths of “fitness”, “healthy eating” or whatever path you chose to go down. Inspired by ‘Your New Year’s Resolution Has Already Failed’ by CGP Grey - Youtube References Grey, C. (Director). (2020). Your New Year's Resolution Has Already Failed [Motion Picture]. Pruitt, S. (2018, August 31). The History of New Year’s Resolutions. Retrieved from History: https://www.history.com/news/the-history-of-newyears-resolutions

vegetarian lasagna BY DEEPTI RAJGURU A tasty treat that you can make once per week. Just bake it, store it, reheat it and eat it!

Ingredients MAKES 16 PORTIONS

3 tbsp

Olive Oil

3 cups

Pasta Sauce

1 package

Lasagna Noodles

Carrots

Onions

1 clove

Garlic

Zucchini

450-500 grams 2 cups 5-6 3 cups

Ricotta Cheese

Mozzarella cheese Cremini Mushrooms Whole leaf spinach

1 tsp

Basil

2 tsp

Oregano

To taste To Taste

Salt and pepper Chili flakes

Recipe 1. Preheat oven to 175 C/350 F (with fan) or 190 C/375 F (without fan) 2. Set a pot of water to boil for the lasagna noodles. Once the water is boiling, add the lasagna noodles to the water and boil for half the time that is recommended for pasta as per instructions on the box. 3. Thinly slice onion and peeled carrots and set them aside in a bowl. Add olive oil to a pan and set the pan to medium/low. Place onions in the pan. After the onions start to get translucent, add crushed clove of garlic. 4. Let the garlic cook for about 2 – 3 minutes, stirring it while making sure it does not burn, then add in sliced carrots. 5. At this point thinly chop the mushrooms. After letting the carrots cook until they are tender, add in the mushrooms to the pan. Continue stirring to coat the mushrooms. 6. Add in pasta sauce, basil, oregano, salt, pepper and chilli flakes. 7. Cook the sauce for about 5 minutes all together and then turn off the heat. 8. Chop spinach finely and add ricotta to it. Mix together until well combined and place this mixture aside. Then slice your zucchini into round, thin slices and place them aside as well. 9. Now for the assembly. Take about a tablespoon or two of the pasta sauce and add it to the bottom of the dish you will be assembling the lasagna in. 10..Lay a layer of cooked lasagna noodles to your lasagna tray. 11. Add spoons of your pasta sauce on top of the lasagna noodles until they are fully coated. 12.Take half of the ricotta and spinach mixture and spread this evenly on top. 13.Take your zucchini slices and place them evenly on top of the ricotta and spinach mixture. 14.Evenly add your pasta sauce on top of the zucchini layer. 15.Finally, make another layer of lasagna noodles and add pasta sauce on top of them. 16.Repeat steps 11-15. 17. Take your shredded mozzarella and spread it on top of the final layer of lasagna noodles. 18.Bake in the oven for 40 minutes or until cheese is melted and golden. Take out of the oven and let it sit for 5 – 10 minutes before slicing it and serving it.

Scrub Crawl 2020

Taken by Julian Lang-Lemckert

GUMS Publications and Design Team Chief Editor: Yashaswini Makkoth Chief Designer: Maheen Khan Shahid