OUM Student Magazine: Issue May 2023

Oceania University of Medicine Student Magazine

Issue: May 2023

ISSN 2653-6706

'If we do not dream, we will not dare.

If we do not dare, we will not realize what we have dreamed.' - Taffy Gould

Welcome

The Student Magazine Team

Founder Profile: Mrs. Taffy Gould

OUMSA: Meet The 2023 Student Association Delegates

Student Ambassadors

Peer Support Officers

Vice Chancellor's Trip To New Zealand

OSCE's: February 2023

Clinical Skills Course: March 2023

Student Profile: Jack McKevitt

Graduate Profile AUS: Dr Tom Dalton

Faculty Profile: Dr David Mountford

Clinical Profile: Dr Tri Slater

Advice from an OUM Graduate: Dr Tim Jones

Quote of the Issue Networking: AMA Queensland Careers Expo

Research Projects

Student: Lisa Cornforth

Title: Do older adults in Oklahoma have awareness of and adherence to nationally recommended guidelines for physical activity?

Student: Hanna Hagose

Title: Effect of early antibiotic administration on patient outcome in sepsis patients: a retrospective cohort study

Welcome back to the Student Magazine!

Editor-in-Chief'sMessage

Welcome to the May Issue of the OUM Student Magazine! We hope that you have all settled into the curriculum and are prepared for the year ahead! We would like to strongly encourage you all to attend the Annual OUM Student Conference and Graduation Ceremony held May 26th-28th, in Brisbane, Australia This year, there are a lot of exciting things organised for the students, further to this the conference always provides excellent opportunities to socialise and network in a relaxed professional atmosphere So, we hope that you are all able to joinus.

JessicaBell Editor-in-Chief

ViceChancellor'sMessage

HelloagaintoalltheOUMstudentsasyoucontinueyourjourneyand welcometothe2301cohortjustbeginningthejourney.

The Annual Student Conference and Graduation Ceremony is just aroundthecorner,andIencourageyoualltoattend TheTaffyGould Oration will be presented on Saturday morning by a high-profile indigenousUniversityacademicandisamusttohear OntheSunday, ourkeynotespeakerisaworldleaderinbody-partregeneration,which is a new and exciting field producing advances, particularly in treatment of burns and severe orthopaedic injuries. Another new feature this year will be ' a consult with Grandpa and/or Grandma ' where students will be asked to explain a complex medical to their grandparentintermswhicholderpeoplecanunderstand.

Ofcourse,thehighlightoftheweekendisthegraduationceremony If lastyearisanythingtogoby,itisaneventnottobemissed;especially aswewillbefortunatetohaveourleader,TaffyGould,presentthe MD certificates. So, I hope you all register, and I look forward to meetingyouallinthisrelaxedatmospherewherewecelebratelivesas membersoftheOUMfamily

Professor Athol Mackay Vice Chancellor

OUM Student Magazine

The OUMSM TEAM

Editor and Content Creator

Phillip Prosia

Phillip is a thirty-five year old student in his third year at OUM and also an experienced Podiatrist in Melbourne, Australia. Phillip has completed a Bachelor of Chemical Engineering from RMIT University in Melbourne; and a Bachelor of Health Science/Master of Podiatric Practice at Latrobe University in Melbourne (dual degree) In his spare time, Phillip is also a budding chef, drawing from experience passed down to him from his Italian Nonna.

Editor and Content Creator

Billy Waters

Billy was raised in Ohio, before moving to Australia where he graduated from the University of New England (UNE) with a Bachelor of Software Engineering (Honours) Billy is currently in his fourth year at OUM and continues to work for the Australian Defence Force as a Reservist. As an editor and content creator for the magazine, he hopes to provide a platform that will educate and inform others

If you are interested in joining the Student Magazine team, or you would like to submit an article for publication; email: studentmagazine@oum.edu.ws

What would you like the students to know about yourself?

I was born and grew up in Miami, Florida USA After high school, I went to Smith College (a university, in America), where I majored in French and spent my third year studying at The Sorbonne in Paris, graduating with honors After Smith, I took a job as a computer programmer, and then later switched to teaching French and Math at The Everglades School for Girls, in Miami Following marriage and the birth of my two children (Greg Beber being the second), I worked for Public Television, later spending six months traveling around the world interviewing American women married to foreign men who lived in their husband's countries

What is something that the student body wouldn't know about you?

I am part of a number of US Think Tanks, focusing on security, defense, foreign affairs, and education

What do you like to do in your spare time?

I never have spare time! Though, I used to be a tennis player, and I used to read a lot Now I mostly only find time to read when I travel

The Student Magazine recently wrote an article on physiological benefits of music, which you responded to, how has music played a role in your life?

Classical Music plays a large part in my life, and I always recommend the book, 'This is Your Brain on Music' by Daniel Levitin (MD), whom I met and interviewed many years ago Did you know the tempo of Baroque Music stimulates the brain, and setting a metronome to that tempo will assist with learning? To me, the composing of a pre-20th century symphony represents the greatest genius in the world

OUM Founder

You wrote a book ‘White Woman Witchdoctor'. Could you tell us a little bit about it?

As a radio talk-back host, I was invited as 'an opinion former' by the Government of South Africa, to see for myself what was going on there. This was in 1989. Most people took it as a free holiday, but I had already been to South Africa twice, so I wanted to pursue interviews I completed almost 100 in 35 weeks, culminating in my first book, 'South Africa: Land of Hope', which became a source book on the country. I later returned to Africa for a six-week book tour, and I planned to write another book on the women of varied South Africaan communities It was during that trip that a woman I interviewed mentioned 'Rae Graham', the Vice Mayor of Johannesburg, who was a Witchdoctor. I made an appointment with her, and she recommended that we speak in her home At that time, I was President of the Tribal Arts Society of the Lowe Art Museum at the University of Miami. So, when I entered her house and saw all the various African artifacts, I knew exactly what they were, and it created an immediate bond I spent two hours with her, hearing her stories, and as we walked to my car, I told her that I thought her stories should be written down and that I would like to be the one to do it I ended up spending two months there, hearing her stories, and we decided to call the book, 'White Woman Witchdoctor'. It ended up #1 on the Sunday Times Best Seller List, in South Africa. As the subtitle 'Tales of the African Life of Rae Graham' indicates, the book is in Rae’s voice, not mine, and according to her daughter I was able to capture Rae perfectly as I recounted her tales.

What was your greatest experience from your time in Africa, and how did it impact your life?

My greatest experiences in South Africa were

the meetings and interviews that I did while working on 'South Africa: Land of Hope' The dedication of that book reads, “For all my South African Friends May they, one day, come to know one another.” I found that problems stemmed largely from the fact that people only read the newspapers from their own community, so they really didn’t know a lot about other groups' thoughts While I was there, I learned that there were radicals on both the Far Left and the Far Right, and the vast majority of groups (Blacks, Whites, and Indians) wanted peace and collegiality The original title of the book had a question mark at the end, but when Nelson Mandela was released from jail, I chose to remove it. One of the great thrills I have experienced in my life was when some South Africans, visiting in Florida, told their South African hosts that my book, 'South Africa: Land of Hope', changed South Africa. They said that before the book was written, no one knew what anyone else was saying (The book included narratives, interview questions and quotes from a dozen South African newspapers that I had been reading. I even hired a young South African, living in Miami, to teach me the Afrikaans language and made myself 2500 flash cards with words and phrases So, when I was honoured by the Johannesburg City Council, I was able to provide my response in Afrikaans and I shocked the entire auditorium!

You have accomplished so much in your life. So, in honour of International Woman’s Day, what is one piece of advice that you would give to your younger self?

Never be afraid to be a pioneer Learn to be a good listener Make empathy a major part of your personality. Read about history (even historical novels). Explore new places. Be grateful for your talents and opportunities and give back to your wider community and the world

Why did you decide to open a medical school?

I learned about the global shortage of doctors and the advantages of distance learning, so I decided that we could make a difference if we made it possible for people to study medicine remotely. It was pure coincidence that the

Consul General for Samoa, in Sydney, heard what I had envisioned and contacted the PM of Samoa

We were advised to submit our curriculum to the Samoan Medical Council, and if they accepted it, we would be welcomed there. I give the (now former) PM full credit for his vision and loyalty, as OUM grew to accept students from almost 60 different countries, whilst adding significantly to the number of doctors in Samoa

What are some struggles you have overcome with OUM over the years?

The initial struggle was the fact that no one, especially doctors, thought that medicine could be taught this way. The challenges were the same as with any start-up educational institution, finding good faculty, good students, and of course, finding suitable clinical placements I’ve always been grateful to our students, who have proved their competence, their worth and made those who took a chance with us, surprised but also eager to accept more mature and serious medical students

Where do you see OUM in the future and what are some of your goals?

Knowing of the ongoing global shortage of doctors, I have always hoped to expand OUM to work with other governments to increase their medical forces. We are happy that we have been able to work with the National University, and their National Hospital, to create a programme that answered their needs

MEET THE NEW 2023 OUMSA DELEGATES

President

Jessica Bell

jessbell@oumeduws

Jessica is a 3rd year student who served as the OUMSA VP in 2022 Jess is passionate about improving university morale and elevating student potential This year, Jess hopes to expand opportunities available to OUM students and engage them in activities that will enhance their CV prospects

Advocacy Officer

Junaid Minhas

junaidminhas@oumeduws

Junaid is a 4th year student who is passionate about advocacy and driving positive change at OUM. This year, Junaid would like to empower students to take an active role in shaping university policy in collaboration with staff, especially in the clinical phase. Advocacy is important to Junaid. He wants everyone to feel that their voice matters.

Membership Officer

Jason Quick

jason.quick@oum.edu.ws

Jason is a 3rd year student undertaking clinical rotations. Having served as a Student Ambassador, Jason is an advocate for the student experience. As the Membership Officer, Jason is keen to identify new ways to 'add value' for students within the OUMSA, with a view to positively amplify their journey throughout the University.

Finance Officer

Garrett Quill

garrett.quill@oum.edu.ws

Garrett is a 3rd year student who is married, has two children, and a border collie/kelpie cross. As the Finance Officer, Garrett has plans to use his skills and knowledge to make a positive impact on the OUM community. Garrett believes in the power of responsible financial management and is excited about the opportunity to apply his expertise to help the OUMSA achieve its goals.

oumsa@oum.edu.ws

WHAT IS THE OUMSA?

OUMSAisaninternationalchapterofthe American Medical Student Association (AMSA) Collaboratively, the elected OUMSA delegates advocate for the student body by providing a unified voice to the OUM administration The OUMSA representatives are here to support the students and collaborate to reach mutualgoals.

The OUMSA also work with the Country Liaison to target issue specific to your geographicallocation

How do students join?

AMSA offers two different international medical membership options and installment plans on four-year and single year memberships.

$754-yearInternationalMedical Membership

$351-yearInternationalMedical Membership

https://www.amsa.org/member/intern ational-medical-student/

DISCOUNTS

AMSA partners with businesses and organizations to offer our members discounts and deals to make life a little more affordable. Check back often as new partners are added frequently.

Australia

Billy Waters billywaters@oumeduws

New Zealand

Lorelei Hennessy

loreleihennessy@oumeduws

Samoa

Uila Laifa-Lima

uilalaifa-lima@oumeduws

50% off for AMSA members ($104 off annually)

Student Ambassadors

The Student Ambassador Program was founded by the 2022 OUMSA delegates with the hope of providing an opportunity for students to gain valuable mentoring and leadership experience, while networking with newandprospectivestudents

Australia:JasonQuick

The 2022-2023 Student Ambassadors have done an exemplary job and we would like to commend each of you for your professionalismduringyourservicetoOUM Remember, applications are open for 20232024positions!

A StdentAmbassador,Jasonlooksforwardtoconnectingwithnew offeringthemtipsandtrickstokeepthemengaged,tohelpthem earning,andtocomeouttheotherendwithabigsmileontheir

ck@oum.edu.ws

Australia:NormanChu

AsaStudentAmbassador,Normanislookingforwardtomakinglasting relationshipswithprospectivestudentsHewantsstudentstoknowthathis en,andheisalwaysupforachat

m.edu.ws

Bains assador,Manuhasthreetipsforprospectivestudents; edu.ws

ggerpictureandbemotivatedbytheendgoal candsurroundyourselfwithpositivepeople. tthewheel.

Samoa:UilaLaifa-Lima

UilawasarecipientoftheTaffyGouldScholarshipwhoispassionateabout theStudentAmbassadorsprogramandwillbecontinuingherservicetothis programasaqualifiedMD,tobenefitthepeopleofSamoa

uila.laifa-lima@oum.edu.ws

USA:ElizabethMills

AsaStudentAmbassador,Elizabethlooksforwardtoassistingprospective studentsmatriculatetoOUM.

elizabeth.mills@oum.edu.ws

Peer Support Officers

t Program is a new student-led initiative to support students' mental health and well-being throughout their medical school journey. The Peer Support Program is under the leadership of Student Mental Health Ambassador, Junaid Minhas, Graduate Mental Health Ambassador, Dr. Brownie Tuiasosopo, and Faculty Sponsors, Dr Andrew Lee-Lovick and Associate Dean A/Prof Nicolette McGuire

WalterIkealumba

Peer Supporters are trained to guide their peer interactions and provide appropriate support assistance Where possible, students will be matched with Peer Supporters in their state/country to provide assistance through both the pre-clinical and clinical phases of study. Peer Supporters will be available to listen and provide support on various issues faced by students

WalterIkealumbaisa4thyearstudentatOUM.Asamedicalstudent,Walter canempathisewithothermedicalstudentsandthechallengestheyface. He wishestoprovidesupportandguidancetohispeers,allowingthemtobetter managethesechallenges

walter.ikealumba@oum.edu.ws

JustinWong

JustinisstartinghissecondyearatOUM Asapeersupporter,Justinis ortfellowstudentsthroughmedicalschool He's tingwithmorestudents OutsideofOUM,he'sa crisissupporterandtechconsultant.Feelfreeto ReetDhaliwal

Reetfeelsthatmentalhealthisveryimportant,especiallyasastudentBeing fromaculturally,linguistically, &ethnicallydiversebackground,aswellasa motheroftwochildrenwhoworkspart-time,studyingfull-timecertainly wasn'teasyforReet.But,nowsheisinherfourthyearandishappytoshare iencesandsupportanyonewhoneedshelp. iwal@oum.edu.ws

TasniaRafi

TasniaknowsthattheOUMjourneycanbechallenging,whichiswhyshe wants to offer advice, support, and encouragement to as many OUM studentsaspossible.

tasnia.rafi@oum.edu.ws

New Zealand FEBRUARY 2023

OUM's Vice Chancellor, Professor Athol Mackay and Clinical Placement Officer, Heather Moore, travelled to Auckland in February to invite discussion regarding the New Zealand (NZ) student journey and provide OUM students with an update on recent discussions regarding NZREX and clinical placements.

The VC and Mrs. Moore arrived in Auckland Tuesday afternoon 21st March. That evening they met with Dr Ann Kolbe, who is both a personal friend of Prof Mackay and a practicing Paediatric Surgeon in Auckland. Dr Kolbe provided OUM with a wealth of knowledge regarding key clinicians in NZ to recruit for future clinical placements.

On the 22nd of February the VC and Mrs Moore met with a few of OUM's NZ pre-clinical students This provided an excellent forum to meet the students in person The first activity involved students introducing themselves and providing the group with an overview of their background The students had never met each other before so this was a great chance for them to get to know each other and OUM faculty The students were then provided with an opportunity to provide feedback on their personal journeys.

The students conceptualised the possibility of organising additional workshops, discussion forums, and student social events The students who attended the event found it informative and beneficial.

That evening, a student representative presented faculty with cards and gifts to show their appreciation for the opportunity

(Pictured left to right: Avinash Jeyashankar, Saraf Chowdhury, Joata De Souza, Sneha Indiran, Prof Mackay, Eunice Louvin De Leon).

(Pictured left to right: Eunice Louvin De Leon, Prof Mackay, Heather Moore, Sneha Indiran).

OUM Student Joata De Souza said, "It was a fruitful meeting. Prof Mackay and Mrs. Moore were lovely and assured us that they would do everything in their power to expand OUM in the coming years, particularly in New Zealand".

(Pictured left to right: students Diva Gopalan and Eunice Louvin De Leon).

OSCEs FEBRUARY 2023

The 2023 Objective Structured Clinical Examinations (OSCEs) were held on the 18th day of February in Brisbane, Australia.

OSCEs, as we know, are a form of assessment used across all medical schools to accurately assess varied clinical competencies, communication, and practical skills

The OUM OSCEs are held several times a year, once students have completed all of the mandatory requirements.

One of the key advantages of the OSCE is its standardized and objective nature. Each candidate encounters the same stations, faces the same challenges, and is assessed using predefined criteria. This ensures fairness and consistency in evaluating the performance of

all candidates Moreover, the use of trained actors portraying specific medical cases adds authenticity to the examination, creating a realistic and immersive environment

As the OCSE's continue to grow, new examiners are joining the ranks at OUM OUM is very fortunate to have Dr Greg Comandira, Dr Cecilia Lander, and Dr Andrew Lee-Lovick join Dr Janet Clarkson, Professor Paddy Dewan, and Dr Tri Slater

These OSCE finals were assessed by our distinguished OUM faculty who ensured that the assessments were above board.

(Pictured below left to right: Vice Chancellor Professor Athol Mackay, Dr David Mountford, OUM students Mercy Zengeni, Fariba Daniel, Hanna Hagose, Thelma Boshoff, Stephen Cokim, Elsy Allen, and COO Carmel Sang)

The OSCE covers a wide range of medical disciplines, including internal medicine, surgery, paediatrics, obstetrics and gynecology, and more. Candidates must demonstrate competence in history-taking, physical examination, diagnostic reasoning, treatment planning, and communication skills. Each station presents a unique case or scenario, testing different aspects of clinical practice

Beyond assessing clinical skills, the OSCE also evaluates other important attributes such as professionalism, ethical decision-making, and teamwork These qualities are crucial for effective medical practice and are carefully evaluated during the examination. Candidates must demonstrate empathy, respect for patients' autonomy, and the ability to work collaboratively within a healthcare team.

Preparing for the OSCE requires diligent study, practice, and honing of clinical skills. Candidates must review their medical knowledge, familiarise themselves with common clinical scenarios, and refine their examination techniques. Mock OSCEs, practice sessions, and feedback from experienced clinicians and educators are invaluable in preparing candidates for the demands of the examination Graduates often attribute Dr Mountford's OSCE Prep Course to their success, so ensure that you utilise his knowledge

As always, the stations, facilitated on the day, were specifically designed to challenge a student's knowledge of clinical reasoning and medical examinations. But our students lived up to the school tagline, with each of them individually excelling in their OSCE scenarios!

OCSE candidate Thelma Boshoff said, "the OSCE experience was extremely well organised and equally supported by OUM academic staff, Vice Chancellor Mackay, Dean Dewan,

and the examiners on the day Dr Mountford took the time to invest in our success, leading up to an OSCE, providing well-balanced feedback during the OSCE preparation course. I highly recommend attending Dr Mountford's sessions. Ultimately, it was clear that the aim of the OUM OSCE is to ensure we are prepared for the AMC examination & Australian medical workforce"

Successful completion of the OSCE is a significant milestone It signifies students' readiness to graduate and embark on their professional careers, highlighting their competence in delivering patient-centered care.

For those of you that are yet to face the OSCE's, trust in your abilities and believe in the knowledge and skills you have acquired Embrace the opportunity to showcase your clinical competence, professionalism, and empathy towards patients. Remember that this examination is not just a test, but an opportunity to demonstrate your readiness to embark on a fulfilling career in medicine.

Congratulations to all the final year medical students who have successfully completed their studies and have passed their OSCEs This is a remarkable achievement that reflects your dedication, hard work, and commitment to becoming competent and compassionate healthcare professionals

Clinical Skills MARCH 2023

Education plays a critical role in shaping the future physicians who will provide healthcare to individuals in our communities. As OUM medical students progress in their training, it becomes increasingly important to bridge the gap between theoretical knowledge and practical clinical skills A well-designed Clinical Skills Course (CSC) serves as a cornerstone in their journey towards becoming competent and compassionate healthcare professionals

In addition, the CSC includes professional education sessions and suturing workshops These sessions aim to further enhance students' practical skills and expose them to specialised procedures commonly performed in clinical settings. This comprehensive curriculum ensures that students are wellrounded and capable of delivering patientcentered care.

h h 2023 Cli i l Skill C h ld

Student Jason Quick said, "The Clinical Skills Course certainly exceeded our expectations The content was appropriate, stimulating, and fun. The facilitators were supportive and engaged We all walked away feeling inspired, and itching to move into the next phase towards becoming doctors. Oh, I nearly forgot the catering best food ever!"

Student Skye Demmler said, "Travelling to Brisbane for clinical skill was amazing. Our cohort is pretty close, yet a lot of us have never met face to face The Clinical Skills Course really amplified the feeling of connection with our fellow students The actual course itself was also very interesting We were told to think of ourselves as junior doctors and were treated as such. Dr Clarkson, Dr Mountford, and all the other OUM crew were lovely, and very supportive. The actual day were complied with learning about how to be a good doctor, combined with some fun clinical skills The specialist lectures were fascinating. All up, I found the week really helpful in boosting my confidence before starting in clinical rotations"

(Pictured: student Ari Rajamani suturing)

(Pictured: student Ben Chiu suturing).

(Pictured: Vice Chancellor Professor Mackay demonstrating suturing technique).

J a c k M c K e v i t t

4th Year Medical Student

What would you like the students to know about yourself?

Honestly, students are welcome to know practically anything about me! I am pretty much an open book. In short, I grew up in Brisbane, Australia as the eldest child of a family of 6 I have 2 younger brothers and 1 younger sister I went through school loving all of the sciences, but when I finished school, I didn’t really have any direction, so ended up studying a Bachelor of Pharmacy I love to run, bike ride, and surf My girlfriend and I live together with our 11-monthold golden retriever puppy named Teddie He always keeps us on our toes, surprising us with eaten socks, shoes, and pillows

What is your educational and work background?

I attended Brisbane Grammar School from grades 6-12 and finished in 2013 I worked as an orderly in a couple of private hospitals in Brisbane before beginning my pharmacy degree I completed a Bachelor of Pharmacy at UQ, graduating with honours, and then started OUM in June 2019 I also started my Pharmacy intern year in June 2019 and became fully qualified pharmacist thereafter and have been practicing as a community pharmacist ever since.

What

led you to OUM?

I tried pursuing a career in medicine through the conventional Australian pathways I sat GAMSAT four times, however, neither my exam scores nor my undergraduate grades qualified me for the traditional programs I had heard about OUM a year before I began my application process and my father had helped teach a couple of OUM students and was happy with their level of learning and their dedication to their medical education It was his suggestion that led me to OUM

What are you most proud of?

I am most proud of the professional relationships that I have developed during my clinical years As a student, I have never been an over achiever, and generally sit in the middle of the cohort in terms of grade performance I am however very comfortable with social interactions and find it exceedingly easy to talk to patients, other medical students, allied health professionals, and doctors. This ability alone has provided me with extra opportunities that even the traditional Brisbane medical students have not been offered during their clinical years I believe that it's the relationships that you form during your medical career that influence your success as a doctor, and that is what I am most proud of

A close second includes the time when I was awarded the title of “best medical student” at the Wesley Hospital, and I was asked to speak to the Uniting Care staff and students about my experiences while on rotation

How do you find studying at OUM compared to a traditional university?

I find studying at OUM to really suit my learning type and lifestyle The pre-clinical years allowed me to work full-time as a pharmacist while also studying full-time at OUM. Now, with the preclinical years completed, I find that my learning is not too dissimilar to that of a traditional university While on rotation I have normal working hours at the respective rotation locations.

You are one of the first students to trial rotations with the Wesley Hospital, how is that going?

I have greatly enjoyed my time at the Wesley Hospital. I think that the Wesley (Uniting Clinical School) is one of the top places in all of Queensland to undertake rotations The administrative staff

were always so accommodating. The ward staff, theatre staff, doctors, and even the patients were all exceedingly kind and understanding. I felt like a junior doctor, not just a student The Uniting Care also provides medical students with opportunities to a broader group of doctors and other med students on case reports I felt respected.

Why do you want to be a doctor?

Growing up with a doctor as my father, I've always been inspired by his dedication to patients. Despite enjoying my work as a pharmacist, I'm limited in counseling patients and the pay isn't great I'm a team player with an interest in science and helping people, so I feel becoming a doctor is the best fit for me With my father as my role model, I'm ready to take on the challenges of the profession and make a positive impact on the lives of others

Would you encourage OUM students to attend the annual conference and why?

I would highly recommend attending the annual conference. The conference will feature outstanding speakers and impressive research projects, as students compete for the Second Annual OUM Research Prize The highlight of each Conference is the opportunity to congratulate graduates and celebrate with colleagues and their families during the Graduation Ceremony and Reception.

What advice would you like to give to students reading this issue?

Stay organised. Medical school can be overwhelming and there is a lot of information to cover, so it's important to be organised Create a study schedule and stick to it Keep track of your assignments, deadlines, and exams

Stay motivated. Medical school is challenging, so it's important to find what motivates you Remember why you decided to pursue medicine and keep your goals in mind. Focus on understanding. Instead of just memorizing information, focus on understanding the concepts This will help you to retain the information better and allow you to apply it in real-life scenarios.

Collaborate: Medical school can be a collaborative experience, so make connections with your peers Study groups can help you to stay motivated and learn from one another Take care of yourself: Medical school can be stressful, so make sure you take care of yourself Eat well, exercise, and get enough sleep

Seek help when needed: Don't be afraid to ask for help if you need it. Whether it's from a professor, a tutor, or a counsellor, seeking help can make a big difference

Stay curious: Medicine is constantly evolving, so stay curious and keep up with the latest research and developments in the field.

Remember, medical school is a challenging but also a very rewarding experience By staying organised, motivated, and focused, you can succeed, and you can make a difference in people's lives

You can make a difference in people's lives.

Graduate Class of 2021, Australia

Tell us a little bit about yourself?

I was once a mature age student at OUM from a mixed educational and working background, who had always wanted to be a doctor and with the assistance of OUM am now Dr Tom

What is your educational background?

I have completed a Bachelor of Education, a Diploma of Training and Development, Graduate Diploma in Education (Special Ed), and a Master of Education (Special Ed., Behaviour and Emotion). So, I was fully prepared for a curriculum in Basic Sciences and Medicine (not)

Where did you work prior to joining OUM?

Before OUM I had worked as a primary school teacher across QLD and NSW, a Special Education teach in NSW, and then as a primary school principal in NSW (Millbank, Mid North Coast) and QLD (Trebonne, far North QLD) I then joined the Australian Army and completed 15 years in various positions, finishing as a 2nd InCharge (2IC) for 5 Engineer Regiment So again, well placed to work within the medical world

What led you to OUM?

In 2012, I decided to try and commence studies in Medicine and started on the Graduate Entry pathway applications At that point I was in Sydney and, like many of you, I did GAMSAT and applied. Initially I gained an interview with Flinders, however failed to gain a position. I was told my GPA was not competitive (in my defense, I was a 16-year-old country boy, who was in the ‘big city’ for the first time, who had a great time and passed everything. No one ever told me that my scores during that initial period of study would be needed some day 30+ years later) That is what lead me to study a Bachelor of Training and Development Post graduation, with a much better GPA, I sat GAMSAT again and applied to study medicine I received an interview with

Notre Dame, Sydney During this process, my mother became unwell, and my sister wanted me to assist her in caring for her, on the Sunshine Coast in QLD, until she was well and fully independent It was this situation that led me to apply to OUM, the flexibility of the first few years allowed me to relocate to the Sunshine Coast as well as study – something I couldn’t have done if I accepted a position at Notre Dame

What are you most proud of?

I am proud to have worked with so many dedicated and inspirational young people, who were also studying medicine at OUM Paramedics who were working alternative terms to ensure they were providing for their family and young mothers who were struggling to balance work/life/family/and study

What was your experience with AMC1, do you have any advice for the students?

I personally struggled with AMC1, although I know quite a few who prepared for it in a serious and planned manner, and they passed on their first attempt My initial attempts (3 in total) were hampered with travel restrictions and attempting to manage full-time work and part-time AMC study Two of my colleagues dedicated several months of solid study and preparation for AMC1 and both succeeded on their first attempt On my third attempt I took 6 weeks off and studied full time – OUM also provided me with a developed study plan, aimed at successfully completing the AMC, after they became licensed with Lecturio

My advice for AMC1 is don't wait too long after finalising your MD and be prepared to dedicate adequate time to prepare for it

Did you complete AMC2 or the WBA?

Not as yet, but the Central Coast Local Health District (CCLHD) where I am currently located

does offer WBA. So, I hope to undertake that next year

How did you gain an internship?

I applied through the Annual Intern Campaign run by all states earlier in the year. IMG Applications are accepted in QLD, SA, and sometimes TAS; so, it’s always a good idea to check your state NSW, VIC, and usually WA don’t allow IMGs to apply I also submitted applications through the Private Hospital Scheme and JMO Supervised Practice; both of which are aimed directly at IMGs and are the same as an internship

I was accepted through the JMO Supervised practice at Gosford Hospital. However, at the end of the year the names of any applicants who applied through the State Internship process, who were not recorded as receiving an offer are then sent to all hospitals and the hospital can then make offers directly - this occurs in all states; so that is something to keep in mind After accepting the offer from Gosford, I had direct phone calls from TAS, ACT, NT, WA, and Rockhampton with offers of a placement - so be strong - there are currently a lot of internships available

Where are you currently working, and what are your goals for the future?

I am currently working at the CCLHD, which includes Gosford and Wyong Hospitals These are both semi-rural hospitals and are extremely supportive, intern friendly, hospitals.

Would you encourage OUM Students to attend the annual conference and why?

The annual OUM conference is the place to gain important knowledge about AMC1, placements, and much more. Last year, we met the Intern Placement and Education Officer from Caboolture Hospital, who is extremely supportive of OUM graduates and has helped many IMGs find placements.

Tell us about the OUM Alumni Committee?

I dedicated 18 months to the committee, which involved suggesting updates on teaching

delivery and curriculum content, as well as attending an online meeting every 3 months

Lastly, what advice would you like to give to students reading this issue?

Stay positive, there are going to be difficult times and hard decisions to be made along the way, but in the end, it will be all worth it

Try not to ‘data dump' all that you learn in the basic sciences and preclinical systems-based modules; believe it or not, the doctors actually know all that stuff and they love asking questions about it Being prepared and knowing the answer is of course far less humiliating than saying you aren’t sure and need to look it up.

When the time comes, patients and nurses will look to you and call you Doctor So, ensure that you are prepared to be in a position to ‘do no harm’ and help them through a difficult time. Remember we will see people in their worst hour, and they need to feel respected and well cared for; no matter what, their attitude reflects in that moment.

Is there anything else you would like to add or like us to know?

Don’t be concerned about the occasional episode of ‘imposter syndrome.’ It’s amazing how quickly it all falls into place

Associate Dean, Australia and New Zealand

What would you like the students to know about yourself?

I am an easy-going introvert with a wicked sense of humour. I am a strong believer in the patientcentred approach and have converted to a medical educator who is student-centred

What is your educational background?

I undertook my primary and secondary education in State schools and my medical education at the University of Queensland 1971 -1976 inclusive

Where did you work prior to joining OUM?

I had retired from general practice and had spent the previous 35 years as a Case Based Learning tutor at UQ

What led you to OUM?

OUM had a strong vision of the future, and I agreed with it, so I was very happy to join the team

What are you most proud of?

My four wonderful daughters

What is your role at OUM?

Presently, I am Associate Dean for Australia and New Zealand; I am responsible for the OSCE process including writing the exam cases, and have been greatly supported by the team, especially Dr Janet Clarkson, in building up the Clinical Skills Course and Workshop.

Could you tell us about the clinical skills course?

There is a common misunderstanding amongst medical students that clinical skills is about taking a history, doing a physical examination, and coming up with a diagnosis There is simply

much more to it than this Clinical skills involves self-growth and reflection in order to become the best doctor you can actually be The linchpins are active listening and active observing, along with other interpersonal skills, and communication skills, that are taught at the 5-day face-to-face workshop Somebody asked me once where inserting a drip would be included in a list of clinical skills “out of 25." My answer was (and remains) 26th. Come to the Workshop and find out why!

Could you tell us about your OSCE prep course?

The original idea came from Derek Ross in September 2021 Derek was Dux at last year’s Graduation Ceremony and gave the Valedictory address Derek thought that if students got together and practiced OSCE cases they would all benefit I suggested that I could moderate the sessions and give feedback The basic format is that cases are done by students approaching their OSCEs. The cases are run on the strict 2min/8min process of the OSCE – two minutes to read the case and 8 minutes with an actor and examiner to do the case

There are two major facets: firstly, students are taught examination techniques, as OSCEs are surprisingly difficult to go through if you have no idea of the process and why it is done The second, and major, factor is honing and refining the students’ clinical skills. Demonstration of good clinical skills will always get a pass mark.

The OSCE Prep Class runs every Monday night (except for 3-4 times a year), from 5pm to 7pm Brisbane time. It is open to anybody in the clinical years, and students can “drop in and drop out” as they please I think students who are due to

do their OSCEs should join at least 7-8 weeks before their exam and become involved with the cases and the discussion of the cases

The class is totally free. The Zoom Number is 84801157125.

Could you tell us a little bit about your history with the AMC?

Many years ago, I established two courses for the RACGP designed to help IMGs pass the AMC exams There was a class devoted to using past MCQs as a basis for learning, how to correctly read a MCQ, and 2 sample exams. The other course taught clinical skills as required to pass the AMC exam

Where do you see the future of OUM?

I see the future as being very bright for OUM students. Although we are based in Samoa and graduates are treated as IMGs, the education provided in the pre-clinical and clinical years are built around the requirements of practice in the Australian Medical System. With Australia’s need for doctors becoming more acute (especially regional and remote doctors), I believe this will impact on the AMC, and the pathways to internship may change Either way, I believe we adequately prepare our students for both AMC1 and 2. We are presently having a surge of enrolments, and the quality of students entering OUM is extraordinary

Would you encourage OUM students to attend the annual conference and why?

The Conference is a wonderful, relaxed, and enjoyable way to meet all of your colleagues and the staff of the University There is a palpable sense that “we are all in this together." Australia is well known for the egalitarian nature of our culture, and overseas visitors find this very refreshing The highlight for me was seeing students that I had met along the way graduate as doctors, and the smiles of students, family, and friends and the sense of achievement that all felt was very rewarding

Is there anything else you would like us to know?

I love playing bass guitar in a band full of old rock-and-rollers, and, like most bass players, I have more guitars than I need!

Lastly, what advice would you like to give to students reading this issue?

1 Congratulate yourself for enrolling in OUM

2. Be diligent in your studies, but still find time for the people and things that are valuable in your lives

3 Listen, listen, listen, and observe, observe, observe – the two greatest clinical skills.

4. OUM will help you become the best doctor that you can be

OUM will help you become the best doctor that you can be.

A L P R O F I L E D r . T r i S l a t e r

Queensland Rotation Coordinator, Emergency Physician & Clinical Educator

What would you like the students to know about yourself?

I’ve lived in Scotland, England, New Zealand, and Australia. My current home is in a beautiful part of the world, Bribie Island in Moreton Bay, Queensland, Australia. I knew I wanted to be a doctor at the age of 6 years old I’ve taken a rather ‘scenic route’ through my career, including taking breaks for health reasons. I LOVE my current roles in hospital practice and with the university, but there’s more to me than medicine I enjoy gardening, kayaking, cooking, and am an active member of my local church where I sing and play viola.

What is your educational background?

I completed an undergraduate medical sciences degree at St Andrews University in Scotland in 1992, and my clinical degree at the University of Manchester in England in 1995 I have had a sustained interest in Medical Education throughout my career, working in teaching fellow and education positions alongside my clinical positions. I didn’t actually discover that I wanted to be an Emergency Physician until I was 5 or 6 years postgrad!

Tell us about your role as an Emergency Physician and Director of Clinical Training?

I am an Emergency Physician (FACEM) and work at Caboolture Hospital, just north of Brisbane in Queensland I am also the Director of Clinical Training (DCT) there The DCT role involves overseeing the working and learning environment for the interns and other junior doctors working at Caboolture Hospital –across the whole hospital I’ve also recently taken up a secondment in offender health

What led you to OUM?

An OUM student was on placement at Caboolture Hospital and I learned about the university from her She was asking questions around internship and, to better understand the

course, I contacted the Dean at OUM. One thing led to another, and I was invited to assist in the OUM OSCE examinations in Brisbane, which I did for 2 years, before joining as a faculty member and clinical coordinator for Queensland last year

What are you most proud of?

That’s a difficult question to pin down If we put aside professional matters for the moment, probably my veggie patch! It represents not just what I can grow but the fact that I make time and space to do so and thereby ‘practice what I preach’ in terms of having a functional work/life balance.

What is your role at OUM?

As Clinical Coordinator for Queensland, I assist in sourcing student rotations and oversee student placement into the various rotations. The role is mainly focused on the core rotations, although I have some involvement in elective placements, as well. I liaise with clinical supervisors where needed, and clinical leads in private hospitals who accommodate OUM students. I meet weekly with the student administration team

Where do you see the future of OUM?

There is a clear upwards trend in Australian and New Zealand student numbers. I would hope that the profile of OUM continues to increase in the

ANZ marketplace and that our students become further known as passionate, compassionate, and skilled doctors who are excellent candidates for internship positions

Could you tell us about your experience interviewing and hiring interns, and do you have any advice for our students?

I have been interviewing internship candidates and running an intern program for over 7 years and have had a wide variety of experiences!

1 First and foremost, do what you can to be yourself in an interview/selection process The more you can genuinely connect on a human level, the more we will see your interpersonal skills

2 Try and learn something specific about the facility or service you are interviewing with and integrate this into your interview answers. Remind yourself which hospital you are interviewing with (I’ve had interviewees tell me how much they would love to work at ‘Caloundra Hospital’, when I’m interviewing them for Caboolture!) If you can link it to a personal attribute, value, or goal, that is even better The organisational values are a good place to start.

3 Remember that an interview is not an exam If you are asked a scenario question, and don’t know a particular fact or approach, state you don’t know and then state how you would go about finding out But DO brush up on your knowledge of management of simple ward-type intern-level tasks such and fluid and electrolyte management, pain management, in advance of the interview A great resource is an on-call type handbook.

4 If you are asked in an interview about a difficult situation, such as conflict or error management, ensure you answer the question in such a way that demonstrates you are a reflective practitioner who learns from experiences and can apply their learnings in the next encounter

5 For situational questions, consider the big picture as well as the immediate situation – i.e. not only the basic situation in front of you but the staffing and use of the whole team, systems issues or hospital-level approaches, reflective practice, quality improvement

6 If you are unsuccessful in an application –respectfully request feedback on how you could improve your application or interview performance, and gratefully accept the feedback. Humble and grateful interactions sometimes result in recommendations being made to other facilities who may be seeking staff, even if you haven’t secured a position during the original process

7 If the state you wish to work in allows IMG applicants to the Intern recruitment process –read up about this process, prepare your documentation and apply early, even if you don’t have your AMC1 yet. In Queensland, you can add evidence at a later stage Alongside this, enquire to hospitals independently as well, and keep in touch with them especially towards the end of the year when they may have unexpected vacancies to fill.

What attributes do you think are most important for students to possess when seeking employment post-graduation?

A logical and legible CV, great references, an ability to think on your feet and describe your processes when dealing with situations, demonstrating continuation of medical learning in any ‘gaps’ between end of studies, graduation, AMC 1 and employment, and finally, resilience, self-confidence, and an optimistic attitude.

Would you encourage OUM students to attend the annual conference and why?

Absolutely! It is a great place to meet peers and faculty, putting an ‘in person’ face to the image on the screen or voice on the end of the phone I attended my first OUM conference last year and found it to be a positive and supportive environment, and if you want further advice about internship applications – I’ll be there and will happily talk to you!

Lastly, what advice would you like to give to students reading this issue?

Although the study of medicine is currently a huge focus for you, remember it is not the be all and end all Enjoy your family and friendships, make time for relaxation, fun and laughter, and don’t lose your humanity in the process of study and career progression.

OUM Graduate Class of 2022, PGY1/Intern Caboolture Hospital, Queensland

Congratulations, you ’ ve finished your degree … So, what now?

I was surprised to hear from some of my fellow alumni that they had not yet completed their post-graduation assessments.

So, to simplify matters, and hopefully streamline the process for you, I have documented some of the things that may make the process smoother for you, post-graduation.

First things first, when you approach the end of your degree (ie you have completed your clinical assessments, the FCE, and OSCE) start completing your AHPRA paperwork and begin looking at the dates for upcoming Australian Medical Council (AMC) Exams. To be eligible to sit AMC1, at a minimum, you will need your academic transcripts from the university It is important to remember that you do not need to wait until your graduation ceremony has taken place to begin this process.

Something to note, AMC application is a tedious process, and it can be quite challenging to pass the examination You only need to pass Part 1, the Multi-Choice Questionnaire (MCQ), to start working However, that does not mean that you can’t start applying for jobs prior to passing the examination. Personally, I was issued a provisional contract from a hospital that would take effect once I passed AMC1.

The AMC hurdle can prove quite bothersome, due to its difficulty. From experience, I would advise you to utilise multiple resources, don’t think that the AMC handbook alone will be sufficient iMeducate, CanadaQBank, and study groups are also highly valuable preparation resources.

One of the benefits of being an International Medical Graduate (IMG) is that we are able to bypass the usual “ballot” process that Domestic Medical Graduates must comply with. This provides IMGs with greater application flexibility From a practical perspective, rather than entering the ballot ranked against domestic graduates, who are ranked higher on the prior scale, IMGs are able to apply to the hospitals directly Applying later in the training year can also have its benefits, as tertiary hospitals regularly have issues with staffing. This provides IMGs with a secondary opportunity to junior training positions.

As I stated earlier, AMC Part 1-MCQ is the only additional requirement in order for IMGs to obtain provisional registration Many of my peers have spent considerable time and money attempting to pass AMC Part 2-Clinical Examination prior to securing a job. Although AMC2/Work Based Assessment (WBA) will be required to gain 'general registration,' they are not required for 'provisional registration,' which is all you need to gain employment as a PGY1/intern The downside of AMC2 is the significant cost (approximately $6,000) and the low pass rate (somewhere around 12%, last time I checked)

There are a number of Australian hospitals that are accredited Workplace Based Assessment (WBA) hospitals This accreditation entitles these hospitals to facilitate Part 2 with their IMGs, without having to undertake AMC2 Although there is still a significant cost associated with this method (approximately $10,000), there is a much higher pass rate

I know that I found it difficult trying to navigate this process post-graduation, so I hope you found this information helps to streamline the process for you Best of luck with your studies

- Dr Tim Jones

Quote OF THE ISSUE

Successinnotfinal;failureis notfatal.Itisthecourageto continuethatcounts.

-WinstonS.Churchill

Where will your career pathway take you?

Event Date: 18 Mar 2023

Location: Brisbane Convention and Exhibition Centre, Australia.

The 2023 Australian Medical Association (AMA) Medical Careers Expo was attended by OUM students Jessica Bell and Ellie Taylor

As students pursuing a career in medicine, attending the AMA Medical Careers Expo was an invaluable experience. We were fortunate to attend this event with complementary tickets, as part of our AMA medical student membership, which is also free for students

The expo, held annually, is a platform for students to engage with representatives from various medical colleges, hospitals, and recruitment agencies, all of whom provide valuable insights into the various pathways available to aspiring medical professionals

One of the highlights of the expo was the presence of several stalls from the Royal Australasian Colleges. The representatives

provided information on the different specialties and training programs available, as well as the requirements and eligibility criteria for each This was particularly helpful for students who were unsure about which specialty to pursue or were seeking clarification on the training requirements

In addition to the stalls, the expo also featured presentations from hospitals and recruitment officers about internships and medical career pathways. These sessions provided a valuable opportunity for students to learn about the various options available to them and to ask questions to clarify any doubts or concerns.

Some of the most informative presentations were by representatives from our major hospitals, who spoke about the recruitment process and what employers look for in candidates This was helpful for students who were preparing to apply for internships or residency programs

Another interesting session was a panel discussion by practicing doctors who shared their experiences and insights on various aspects of medical practice. This session provided valuable insights into the challenges and rewards of a career in medicine, as well as practical advice on how to navigate the various stages of training and practice

OUM student, Jessica Bell, was fortunate to be the recipient of a gift basket, containing an iPad and chocolates, which was presented by the HDC Recruitment Team at the expo.

Attending the AMA Medical Careers Expo is an invaluable experience for any student considering a career in medicine. The expo provided a wealth of information and resources, including information on training programs, career pathways, and recruitment processes, as well as an

opportunity to interact with representatives from various medical colleges, hospitals, and recruitment agencies I would highly recommend attending this expo to any student considering a career in medicine.

(OUM student, Jessica Bell, pictured in the center of the HDC Recruitment Team)

International Women's Day

International Women's Day is celebrated globally on the 8th of March, and is even a public holiday in several countries

International Women's Day is the focal point of the women's rights movement and brings attention to gender equality, reproductive rights, and abuse against women.

Collectively, we can do our parts to celebrate women's achievements while raising necessary awareness For a moment, imagine the world free from inequality, disparity, bias and discrimination; for one that is equitable, accepting, diverse, and inclusive That is the world I want to live in

Gloria Steinem

"The story of women's struggle for equality belongs to no single feminist nor to any one organization but to the collective efforts of all who care about human rights."

-

So, help us to forge equality! Take every opportunity to celebrate, and elevate, the women in your life and help us work towards a better tomorrow. Every step is meaningful no matter how trivial it may seem.

Some of the women of OUM

Holi, also known as Festival of Colours, is a popular and significant Hindu festival, symbolising love and spring. This festival celebrates the eternal and divine love of Krishna and the god Radha. Holi signifies the triumph of good over evil, as it commemorates the victory of Vishnu, as avatar Narasimha Narayana, defeats Hiranyakashipu Those who partake commemorate the arrival of spring in India, the end of winter, agriculture, and the blossoming of love. It is also an invocation for a good spring harvest season. Holi is celebrated on the last full moon day of the Hindu Calendar month between February and March.

Spiritually, Holi festivities mark an occasion to renew ruptured relationships, end conflicts and rid themselves of accumulated emotional impurities from the past.

Holi initially originated in India, but it is now celebrated in many other parts of the globe, like Nepal, Fiji, and parts of the Western world.

There is some variability in the way people celebrate Holi, depending upon their culture, and the primary significance behind their reason to celebrate it In general, the night before Holi, bonfires are lit in a ceremony known as Holika Dahan (burning of Holika), where people gather near the fire, sing, dance, and share meals This part of the festival is

The following day is the main day of Holi

On this day of Holi, people take to the streets to celebrate with their neighbours and friends, carrying coloured powders, liquid colours, and water balloons Entire streets and towns turn red, green, blue, orange, and yellow as people celebrate Holi with each other by throwing these coloured powders or splashing coloured water on each other. Each colour carries an individual meaning. For example, red symbolises love and prosperity, while green stands for new beginnings. The festival is concluded by sharing meals, dancing, and singing activities.

Holi is loved by people of all ages. During this time of colour, people forget their age and their worries, reveling in the joy and carefree nature of this popular Indian festival. When the celebration comes to an end, we all wait desperately for Holi to return in the following year.

- Reet Dhaliwal OUM Clinical Student & Peer Supporter

Happy Easter

Easter is a holiday that is celebrated worldwide. For Christians, it marks the resurrection of Jesus Christ, who died on the cross for the sins of humanity, and his ascension into heaven. The holiday falls on the first Sunday following the first full moon after the vernal equinox and is typically observed between late March and late April.

Though Easter has religious origins, it has become a cultural and secular celebration in many places around the world

Celebrating Spring: Easter falls during the spring season in the Northern Hemisphere, and many people celebrate the holiday as a way to welcome the arrival of spring. This can involve

decorating with spring flowers, such as daffodils or tulips, and enjoying outdoor activities like picnics and Easter egg hunts.

Easter can be a time when families come together to celebrate and enjoy each other's company This can involve gathering for a meal, playing games, or simply spending time together

Many cultures have traditional foods that are associated with Easter, such as hot cross buns, Easter eggs, or lamb. Even if you don't celebrate the religious aspects of Easter, you can still enjoy these foods as part of a cultural or family tradition

Giving gifts, such as chocolate Easter eggs or small toys, is a common part of Easter celebrations and this can be a way to show appreciation for loved ones.

Many regions host Easter parades, festivals, or other community events that are open to everyone. These can be a fun way to get involved in your local community and enjoy the holiday with others.

Easter can be celebrated in many different ways, and it's up to each individual or family to decide how they want to observe the holiday Whether you choose to focus on the cultural, secular aspects of the holiday, or incorporate religious traditions, Easter is a time to celebrate and enjoy the arrival of spring with your loved ones.

Effectofearlyantibioticadministrationonpatientoutcome insepsispatients:aretrospectivecohortstudy

HannaHagose OUMmedicalstudent

ABSTRACT

Background and objectives: Earlier sepsis studies with antibiotic use demonstrate mixed findings. Also, some section of literature revealed that delay in antibiotic administration is considered as risk factor for mortality among sepsis patients Hence, this retrospective study is undertaken to evaluate effect of antibiotic administration among sepsis patients within 1hourandtocompareitwithantibioticadministrationtill6hoursinED

Methods: A retrospective study was conducted among randomly selected patients treated at ED between 2016 to 2019 Antibioticsadministrationwithin1hourwasevaluatedincomparisontotheantibioticadministeredtill6hours Theprimary outcome was adjusted mortality rate. Logistic regression was used to estimate the odds of hospital mortality dependent on timing of antibiotic administration and patient factors Association of hospital mortality and timing of antibiotic administrationwascomparedamongpatientswithsepticshockandwithoutsepticshock

Results: A total of 1462 patients were recruited in the study and 1182 patients were included for data collection and analysis 20%patientswereidentifiedwithsepticshock Mortalitywas1785%(211patients)duringthisstudy Mediantime for administration of antibiotic was 22 hours which remain same for all the years Adjusted odds ratio for hospital mortality for all patients was 1.07 (95% confidence interval [CI] (0.95-1.16)) for patients with early intervention while odds ratiofordelayedinterventionwas138;95%CI,(129-160)p=0045

Conclusion: Well-timed antibiotics administration proved to be beneficial in patients with septic shock However, it can be arguedthatearlyantibioticsadministrationanditsclinicalbenefitsarenotclearinpatientswithoutsepticshock

Keywords:Sepsis,Septicshock,Mortality,Antibioticadministrationtiming

Introduction

Itisestimatedthatcurrentlyapproximately50million casesofsepsisexistworldwidewithdeathsaccounts forabout11millionpeopleworldwide(Ruddetal,2020)

Mortalityratesare10%and40%inpatientswith sepsisandsepticshockrespectively(Singeretal,2016)

Sepsisisaseveresyndromecausedduetoinfection and marked with alterations such as physiological, pathological and biochemical abnormalities Sepsis is usually linked with multiorgan abnormality including organfailureandhighmortality(Singeretal,2016)

Despiteadvancementintheresearchforelucidating pathophysiology of sepsis, issue of identifying more effective treatment regimens for sepsis remains unanswered. Hence, it is indispensable to recognize sepsisasmedicalemergency(Ranierietal,2012)Issues associatedwithsepsistreatmentmightbeduetoarise of multidrug-resistant (MDR) pathogens which limit existingtreatmentoptions

In such scenario, timely administration of antibiotics could be more beneficial in timely management of infection spread. Convincing evidence demonstrate that delayed antibiotic treatment could increase mortality Hence,earlyantibiotictreatmentcouldbe regarded as the crucial factor in sepsis treatment (Ferreretal,2014;Liangetal,2015;Peltanetal,2015; Gaieskietal.,2010).Accordingtoguidelinesforsepsis treatment,hour-1bundleisprimarilyrecommendedto minimizeriskformortalityandmorbidityamongsepsis patients(Rhodesetal,2017;Levyetal,2018)

However, existing evidence is still contradictory which demonstrate correlation between time of antibiotic therapy and mortality among patients with sepsis and septic shock It is still questionable whether antibiotic treatmentwithin1hourcouldenhanceclinicaloutcome among sepsis patients (Kahn et al., 1990; Gaieski et al., 2010) TheInfectiousDiseasesSocietyofAmericastated thathostileantibiotictreatmentinthefirsthourmight not be beneficial and could lead to unnecessary exposure to broad spectrum antibiotic (Force et al, 2018;Rheeetal,2020) Inaddition,TheAmericanCollege of Emergency Physicians argued that there is scarcity of evidence for the threshold timing for antibiotic administrationforthesepsispatients(Yealyetal,2021) Also, it can be argued that antibiotic administration within the stipulated timing could be time consuming; hence,itwouldbedifficulttoadministerantibioticstoall the patients within the stipulated time. Hence, this retrospectivestudywasundertakentoassesseffectof antibioticadministrationwithin1hourtosepsispatients in ICU Based on the previous literature, it could be hypothesizedthatantibioticadministrationwithin1hour couldreducemortalityrateamongsepsispatients

RetrospectivestudywasconductedfromdurationApril 2016 to Dec 2019 at Alfred Hospital, in Melbourne, Victoria Patient participation and data collection

protocols were followed according to hospital guidelines Patients presented in the study were with diagnosis of sepsis and septic shock Criteria for the diagnosis of sepsis or septic shock was based on International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3) (Singer et al, 2016) Following patients were excluded from the study: patients not admitted to hospital or emergency department (ED) or intensive care unit (ICU) and antibiotics not administered according to the guidelines Informed consent was not considered for this study because this study is noninterventional observational Ethical approval was taken from the institutional review board of hospital

Clinical data collection

The following data was collected for the patients: demographic traits, comorbid conditions, severity of disease condition, treatment, and clinical outcomes

Following demographic data was collected for the patients: age, sex, comorbidities, measures of illness severity using the Sequential Organ Failure Assessment (SOFA) score, 48-hour change in SOFA score, which reflects recovery from organ failure (delta SOFA=SOFA at ED recognition - SOFA after 48 hours), recognition of sepsis by physicians in the emergency department, infection data including site of infection (eg, respiratory, abdominal, urinary, or skin/soft tissue), appropriateness of antibiotics, and time to administration of antibiotics, and clinical outcomes, including length of in-hospital stay, in-hospital mortality, and admission/transfer to the ICU Time for antibiotic administration was calculated from the time admission in ED to the time of antibiotic administration

Statistical analysis

Baseline variables were represented as median and interquartile range (IQR) Wilcoxon rank sum test was used for comparisons Chi-squared test was used for category-based variables Odds ratios (ORs) with 95% confidence intervals (CIs) for in-hospital mortality was estimated through logistic regression model. Relationship between in-hospital mortality and time considered as continuous variable was appraised individualistically among patients with antibiotic administration below 1 hour, 1-2 hours, 2-4 hours and 46 hours All the tests were two-tailed and p-value<005 was considered as statistically significant Analysis was conducted using SAS® Visual Analytics.

Results

Study population

A total of 1462 patients with diagnosis of sepsis or septic shock in the ED between 2016 to 2019 were enrolled in the study 160 patients were not admitted to the wards of ED and 120 patients were not administered antibiotics according to guidelines Hence, finally 1182 patients were included in the study for data collection (Table 1).

Baseline characteristics of patients

Patients age was 68(102) which expressed as mean (standard deviation) Male and female patients were 5752% and 4248% respectively Out of 1182 patients, 20% patients were identified with septic shock (Table 1) Severity of illness (based on vital signs) was higher among patients with early antibiotic administration as compared to the patients with delayed antibiotic administration No statistical difference was evident for vital signs such as MAP, hear rate and respiratory rate among patients with early and delayed antibiotic administration However, statistically significant difference (382°C vs 371°C, <001) was evident for body temperature among patients with early and delayed antibiotic administration. Highest comorbidity was observed with malignancy 6582% (778 patients) followed by hypertension 3401% (402 patients), diabetes 2216% (262 patients), neutropenia 1878% (222 patients), congestive heart failure 1505% (178 patients), myocardial infraction 1421% (168 patients), chronic hepatic disease 1142% (135 patients), chronic renal disease 7.36% (87 patients) and chronic lung disease 6.59% (78 patients) (Table 1).

Antibiotic timing, In‑hospital mortality, SOFA score and hospital stay

Median time to administration of antibiotic was 22 hours which remain same for all the years However, median time to antibiotic administration was different for patients with septic shock (16 hrs) and sepsis (22 hrs, P˂0001)

Mortality was 1785% (211 patients) during this study Results revealed that there was no significant difference in mortality rate among patients who received antibiotics within one hour (1609%) and who did not receive antibiotic within 1 hour (2102%) Baseline SOFA score was higher in early intervention group (7.5) as compared to all patients (73) and delayed intervention (7) SOFA score at 48 hrs for all patients, early intervention group and delayed intervention were 5, 5, and 5 respectively Delta SOFA score was higher for all patients and early intervention group (2 each) as compared to the delayed intervention group Duration of hospital stay was lower for early intervention group (101 days) as compared to the delayed intervention group (135 days) Percentage of hospital admission was higher in early intervention group (7340 %) as compared to all the patients (6505 %) and delayed intervention group (5070 %) Length of hospital stay was same in all groups of patients (Table 2)

Adjusted odds ratio for hospital mortality for all patients was 1.07 (95% confidence interval [CI] (0.95-1.16)) for patients with early intervention while odds ratio for delayed intervention was 138; 95% CI, (129-160) p = 0045 Odds ratio for hospital mortality were 109; 95% CI (097-118) and 119; 95% CI (109-128) p = 0298 respectively for early and delayed intervention for patients without septic shock Odds ratio for mortality in

patients with septic shock, 134; 95% CI (131-165), was higher as compared to the patients without septic shock Odds ratio for mortality was higher among patients with delayed intervention with septic shock 148;95% CI (124179), p = 0047 as compared to the early intervention with septic shock (Table 3).

Adjusted odds ratio for mortality was increased with increase in time to antibiotic administration Adjusted odds ratio for mortality for different time to antibiotic administration such as 1-2, 2-4, 4-6 and ˃6 hrs were 108(096-117); 95% CI, p = 0159, 118(103-134); 95% CI, p = 0.088, 1.46(1.21-1.75); 95% CI, ˂0.001 and 1.51(1.351.69); 95% CI, ˂0.001 respectively. Probability of mortality also increased with increase in the time to antibiotic administration Probability of mortality for different time to antibiotic administration such as 1-2, 2-4, 4-6 and ˃6 hours were 261, 281, 319, 329% respectively (Table 4)

Statistical comparisons were made among early and delayed intervention p ≤ 005 was considered as statistically significant

Statistical comparisons were made among early and delayed intervention. p ≤ 0.05 was considered as statisticallysignificant

Early interventions – Antibiotic administration within 1 hourofICUadmission.

Delayedinterventions–Antibioticadministrationafter1 hourtolessthan6hoursafteradmissiontoICU

Note–Valuesarepresentedasn(%)exceptAge(yrs), vital signs and Initial serum lactate (mmol/L) which are presentedasrespectivevaluesalongwithitsrange

Statistical comparisons were made among time to antibiotic administration (0-1hrs) and other time points p ≤ 005 was considered as statistically significant

Discussion

This retrospective study evaluated impact of timing of antibiotic administration on mortality among sepsis patients Administration of antibiotic within 1-hour resulted in less mortality among patients with septic shock as compared to the patients with shock who received delayed antibiotic intervention No difference was seen between early and delayed intervention in patients without septic shock It indicates that time of antibiotic administration demonstrated variable impact on the patients with septic shock and without septic shock Patients with septic shock who receive antibiotic treatment at 4-6 hours, exhibit statistically significant increased mortality rate as compared to administration at 0-1 hours Kumar et al, (2006) also reported relationship between timing of antibiotic administration and risk of mortality These findings aligned with statement from the Infectious Diseases Society of America and American College of Emergency Physicians which stated that patients with septic shock might be greatly benefited from the early antibiotic administration (Rhee et al., 2020; Yealy et al., 2021). Surviving Sepsis Campaign guidelines similarly advised for antibiotic administration among septic shock patients before 1 hour Nevertheless, attention should be given to potential infection among patients without septic shock post antibiotic administration before 1 hour (Evans et al, 2021)

Statistical comparisons were made among early and delayed intervention p ≤ 005 was considered as statistically significant

Effect of delayed antibiotic administration was studied for the first time in community-acquired pneumonia patients McGarvey and Harper, (1993) reported that antibiotic administration within four hours to the patients with community acquired pneumonia improved condition of the patients Large number of patients did not receive outpatient antibiotic agent and received antibiotic agents within four hours which led to reduced mortality in hospital and mortality within 30 days of admission (Houck, 2004) Kahn et al, (1990) showed that administration of antibiotic within 4 hours and appropriate supply of oxygen reduced mortality within

Highlight of these findings that in addition to the early administration of antibiotics process of care is also responsible for reducing mortality rate Gaieski et al (2010) also established linear correlation for timing of antibiotic administration and mortality rate among severe sepsis or septic shock patients. A prospective observational study carried out in 77 ICUs for severe sepsis or septic shock patients reported that antibiotic administration within 1 hour reduced mortality rate after adjustment with other treatments

It could be argued that findings for the patients with septic shock for administration of broad-spectrum antibiotic within 1 hour could be biased because earlier most of the data was based on patients from the septic shock (Ferrer et al, 2014; Kumar et al, 2006; Gaieski et al, 2010; Barie et al, 2005; Ferrer et al, 2009) A multicenter study carried out among 149 New York hospitals, reported 7% increase in mortality every hour delay for antibiotic administration among patients with septic shock However, such effect was not evident among patients without septic shock (Seymour et al. 2017). In another retrospective study among patients from 21 hospitals in Northern California, it was evident that mortality rate was more among patients with septic shock (Liu et al, 2017)

Aggressively initiating treatment of broad-spectrum antibiotics among all patients with risk of sepsis could cause unintended exposure to antibiotics for patients without requirement of antibiotics. It could lead to unwanted outcomes such as adverse effects associated with antibiotics, resistance development for antibiotics, and financial burden on the patients (Patel et al, 2019; Nelson et al, 2021; Force et al, 2018) Furthermore, it could be argued that antibiotic administration before 1 hour is basically problematic for many hospitals Despite having set up for early antibiotic administration, many hospitals could not administer it for higher number of patients Study from the 149 New York hospitals, reported antibiotic administration to less than half of patients within 3 hours (Barie et al, 2005) Hence, it is recommended to select subpopulation of patients to prioritize effective management of sepsis patients with shock or without shock

Early antibiotic administration could be beneficial not only for septic shock but also for other multiple distinguishing characteristics Early antibiotic administration also proved useful in patients with higher SOFA score (Kumar et al, 2015; Im et al, 2022) It indicates, early antibiotic administration among severely ill patients could improve survival rate Accurate identification of sepsis by physicians is also important criteria for early administration of antibiotics. It can be argued that physicians might diagnose sepsis patients with severely ill condition in comparison to the diagnosis of patients with sepsis according to their site of infection It would be thought-provoking to educate physicians for the identification of sepsis at the earliest before clinical deterioration of patients (Kumar et al, 2015).

Outcome from this study could be considered as unbiased because those patients not received appropriate antibiotics were excluded from the study Possible limitation of this study could be patient population from the limited geographical area Hence, outcome of this study could not be generalizable to othergeographicalregions Moreover,generalizabilityof this outcome is limited due to smaller sample size Anotherlimitationofthisstudy,studycenterwhichwas Universityaffiliatedstudycenter Patientsinthisstudy were sepsis patients admitted to emergency department; hence, these findings could not be generalizable to sepsis patients admitted to other hospitaldepartments

Conclusion

Well-timed antibiotics administration proved to be beneficialinpatientswithsepsis.Withincreaseintimeof antibiotic administration, there was increased odds mortalityrateamongsepsispatients Findingsfromthis study highlights significance of early identification and treatmentofsepsispatients Itiswellestablishedthat sepsisisprogressivecondition;hence,earlyrecognition and immediate response could be beneficial in the managementofsepsispatients.

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tonationallyrecommendedguidelinesforphysicalactivity?

LisaCornforth OUMmedicalstudent

ABSTRACT

A pilot study survey was conducted at an Oklahoma senior activity center that assessed older adults' awareness and adherence to nationally recommended physical activity guidelines. Participants who were younger than 50 years were excluded 414% of the older adults surveyed (n=29) were aware of the nationally recommended guideline of 150 minutes of weekly exercise The age group that most commonly defines older adults in published national surveys is age 65 to 74 This pilot survey showed that 50% of the age group of 65- to 74-year-olds (n= 8) did meet the national recommended activity guidelines 483% reported that their physician does talk with them about exercise Of note, these participants reported more minutes of activity per week than their counterparts Based on a literature review, it was hypothesized that participants who exercised in groups would be more likely to meet the minimum guidelines However, only 345% of those surveyed reported participating in group exercise. The survey also revealed that the two most influential factors for exercise were the pleasure of the activity and to relieve stress.

KEYWORDS: older adults, adherence, physical activity.

Introduction

Getting enough physical activity is reported to be a difficult lifestyle habit The problem is that modern conveniences and transportation vehicles have decreased the amount of physical activity The older adult American population know that they should be physically active but choices for leisure time activities more often assume the role of a spectator. The question is how many older adults are considered inactive and what are some motivators that help them to be more active?

The US Centers for Disease Control (CDC) has collected health information that is made available through the National Center for Health Statistics (NCHS). One of the ways health information has been obtained since 1957 is through the National Health Interview Survey (NHIS) Household interviews are conducted in all 50 states to administer the survey Participants respond to a set of questions about various aspects of health which includes measures of physical activity Another survey used in the US is the National Health and Nutrition Examination Survey (NHANES), which has reported health information since 2000 This survey collects more specific details about activity by asking about different intensity levels of exercise The survey results have revealed a widespread deficiency of physical activity in all age groups which led to the formation of a national health policy on activity, the 2008 Physical Activity Guidelines for Americans (2008 Guidelines)

Prior to the 2008 national policy, there had been some recommendations for physical activity from the US Preventive Services Task force, the President’s Council on Fitness, the American Heart Association, the American Cancer Society, and the American Diabetes

Association The 2008 US guidelines recommended 150 minutes per week of moderate intensity activity, or 75 minutes of vigorous intensity activity, and 2 or more days per week of strengthening exercises of all major muscle groups. Despite these activity guidelines in 2008, the national health surveys have revealed very marginal increases in reported activity levels Ten years later, a second edition guideline for physical activity was released by the US Department of Health and Human Services This is commonly referred to as “Healthy People 2020” One year later, in 2019, a study revealed that only 2.5% of U.S. adults were knowledgeable of recommended physical activity guidelines (Hyde et al., 2019)

The “Healthy People 2020” guidelines published in 2018 included the same recommendation for physical activity as in 2008 One finding in the new report is that a single exercise period can have an immediate benefit on blood pressure, sleep, anxiety, and insulin sensitivity (Healthy People, 2020). The second edition also revealed that there is a strong relationship between inactivity and allcause mortality (Healthy People, 2020)

Only a few chronic conditions were known to benefit from exercise at the time of the first edition of 2008 These were cardiovascular disease, diabetes, colon cancer, and breast cancer. The second edition in 2018 has a more extensive list of chronic conditions now known to have exercise-related benefits The increase was due to more published research studies on exercise benefits The CDC reported that 4 in 5 of the costliest chronic conditions among older adults can be managed or prevented with regular physical activity (cdcgov) These additional chronic conditions in the second edition are Parkinson’s disease, cognitive decline, vascular dementia, depression/anxiety, ADHD, fibromyalgia, fall prevention, intermittent claudication/peripheral vascular

occlusive disease, multiple sclerosis, vestibular disorders, chronic pulmonary diseases, osteoporosis/osteopenia, osteoarthritis, rheumatoid arthritis, Alzheimer's, and eight different types of cancer (Healthy People 2020) This is relevant in that about 50% of the US population, which includes all ages, has a chronic condition (Boersma et al, 2020) In the older adult population, 67% have multimorbidity, or at least two chronic conditions (Boersma et al., 2020). In the 2020 US population census the age 65 and older category grew by a third, which was more than any other age groups (censusgov 2020) Thus, healthcare providers in the US are caring for more older adults with chronic conditions

We sought to determine older adults’ awareness of national recommended guidelines for physical activity. Based upon the national average of 25% awareness we hypothesized that less than five percent of the senior facility members would be aware of the national activity guidelines (Hyde et al, 2019) We also sought to determine the physician’s influence on exercise

We hypothesized that the individuals in this study would report engaging in more weekly activity if their physician discussed physical activity levels at clinic appointments (Bowen, 2019) Finally, the literature revealed that older adults are more active when they have social involvement during activities (Beauchamp et al, 2018) We hypothesized that more participants would meet the weekly guidelines if they had a greater proportion of their weekly activity with group activities

Methods

We conducted a small pilot study of older adults to assess their awareness and adherence to nationally recommended guidelines for physical activity We surveyed an Oklahoma City community of male and female adults, aged 50 and older, in the northwest region of the city. Persons younger than 50 years of age were excluded 29 participants completed the survey in August 2022 Random members of a senior community center could choose to participate in the survey which was made available in a digital format via a social media group (See Appendix)

Attendance records were also obtained from this senior facility. The monthly attendance for group fitness activities was compared with the attendance in the individual workout room In addition, the survey queried how many days a week the member participated in a group physical activity versus the number of days they exercised alone in a typical week, and the minutes of cardio and number of days per week of strength training Members are issued a card with a barcode for digital check-in to the fitness center Upon check-in, members click a box to designate what activity they plan to participate in This check-in design allowed us to obtain data on attendance and whether members exercised alone in the fitness room or with a group

Participants also reported on factors that were motivators to influence their physical activity They were also asked about their awareness of the nationally recommended physical activity guidelines The survey included a question on whether their physician had discussed their physical activity with them Ethics approval was granted by the Oceania University of Medicine and informed consents were obtained from the participants.

Results

The survey found that those who met the minimum recommended 150 minutes per week for physical activity reported exercising alone more days per week than exercising within a group Even for those who did not get 150 minutes in a week, 18 of the members exercised more times per week alone than in a group, and they reported that they exercise at least one hour per week There was no proportional difference between ages The survey did not collect data about males versus females of the population In the 75 and older age group (n=5) only one out of the five was considered inactive (See Table 1) In this 75 and older age group of participants, four out of the five also met the guidelines for 2 days per week of strength training

There were 5347 total check-ins for group exercise classes and which included participants who exercised in a group in the gymnasium. This is compared with 5281 check-ins for exercising alone in the weight room

There was one question that was not answered by all participants which was the motivating factors The two participants who did not answer the question were also noted to have less than 30 minutes per week of physical activity. Additionally, out of the nine motivating factors the most frequently chosen by members surveyed was

the motivating factor “pleasure of the activity”. See Table 2

Data obtained from the NHIS surveys showed that the state of Oklahoma is one of five states in the US with the highest rates of adult inactivity The prevalence of inactivity in these five states is 30% or more (NHIS, 2018) Oklahoma also ranks in the top three states for obesity and deaths due to cardiovascular disease In the Oklahoma older adult population, 423% of seniors are inactive Oklahoma also ranks high in falls and hip fractures for seniors. Oklahoma’s rate of falls is 226% higher than the lowest state in the nation (NHIS, 2018)

48.3% of the survey participants reported that their physician had asked them about their physical activity Six participants did meet the weekly 150-minute guidelines and eight reported either one or two hours of weekly physical activity There were also three participants who had met the weekly guidelines but had reported that their physician did not talk with them about exercise

Discussion

In 2019, a nationally conducted study revealed that only 25% of US adults were knowledgeable of recommended physical activity guidelines (NHIS, 2019) 414% of this Oklahoma study's participants reported that they were aware of nationally recommended guidelines for physical activity.

A problem with a survey question about exercising in the gymnasium is that there is a possibility that part of the gymnasium attendance check-in count may have been used for walking which might have been reported in this research survey as exercising alone At the time of the survey, the gymnasium was being used primarily for Pickleball group activity, basketball, or group exercise classes The survey could have been improved by asking a question about participants walking alone for exercise

6897% reported exercising less than the recommended 150 minutes per week This percentage is higher than the Oklahoma report of 423% inactive senior adults In the 2018 national NHIS surveys, the percentage of adults who had met the guidelines for activity was 16.4% of the 65- to 74-year-old group, and 102% of those 75 years and older In comparison, this survey showed that 50% of those aged 65 to 74 met the minimum recommended amount of cardio activity In those aged 75 and older, none had met the minimum recommended guidelines for 150 minutes It would be beneficial to survey a larger sample of older adults in a future study This data also has the limitation in that it only represents older adults who are already members of a fitness center versus the general population The reason for choosing to survey this sample population was to compare the participants with the fitness center monthly attendance reports

Oklahoma City received a grant to help address infrastructure problems that are barriers to increased physical activity The construction of new sidewalks connecting neighborhoods to shopping areas has been under way for the past two years In 2021, the population of Oklahoma City was 687,725. The percentage of adults aged 65 and older is 126% Other demographics that characterize this city are 659% white, 144% African American, 200% Hispanic, and 507% female 315% have a bachelors degree or higher The rate of poverty is 152% (wwwcensusgov)

The clinical impact of this study could be to encourage physicians to communicate frequently with patients regarding their physical activity and to educate about the benefits of exercise for the prevention of chronic disease (Lee, 2017) The Healthy People 2020 initiative has an objective to increase the proportion of physician office visits that include recommendation for exercise A journal of sports medicine had reported on prescribing exercise as therapy for 26 different chronic diseases (Pedersen, 2015). There was an initiative in 2007 called Exercise is Medicine, EIM, which encourages physicians to chart physical activity like a vital sign (Bowen, 2019) The large Kaiser Permanente health group in California includes assessment of physical activity in patient charts similar to assessing for smoking status (Thompson, 2020)

The barriers to physical activity that are most reported by older adults are fear of falling during an activity, physical pain or disability of knees/hips/back, selfconscious of body image, ability to perform an activity compared with peers, cost to participate in activities, and transportation costs In the literature review of older adults’ adherence to physical activity guidelines, there has been an increase in adherence when there has been noticeable progress and improvement in activities of daily living, competence in performance, use of technology devices and fitness apps, attending a fitness center exclusive to older adults, knowledgeable about benefits, absence of unpleasant experiences, enjoyment of an activity, encouragement and support from family, communication and feedback from peers, monitoring by a variety of professionals, insurance benefits such as the free membership Medicare Silver Sneakers program, feeling of belonging to a group, setting goals, and if exercise was prescribed by their physician ( ColladoMateo et al, 2021)

There are many aspects of this Oklahoma City senior activity center that have helped to overcome common barriers to activity It has a low monthly membership fee of $30, it participates in the national Medicare Silver Sneakers program, and partners with five health insurance companies with plans that provide free fitness center memberships The center is within walking distance to several neighborhoods which also includes renovated paved sidewalks with new ramps at intersections There is a golf cart to assist in transporting members from the parking lot to the entrance The center is open from 5:30am to 9pm six days a week

Conclusion

The survey revealed that pleasure of a physical activity was found to be the most influential motivator for participating in physical activity Older adults need to keep trying new exercise activities until they find ones that are pleasurable and will help keep them motivated to get the national recommended guidelines for physical activity Having a variety of weekly activities provided at senior facilities and continuing efforts to raise awareness about the recommended guidelines for physical activity are great investments towards the health of a community

Appendix

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Special Thanks

We would like to thank A/Prof Nicolette McGuire, Rebecca Morris, and the OUM Marketing & Communications Team for their continued support.

Issue: May 2023

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