Sunday, April 13, 2008

Australian trainee doctors miss out on experience at childbirth

They now learn little about anatomy so I suppose this is the next step. I am sure that they learn a lot about multicultural "sensitivity", though. I am glad my doctor is an older guy

MEDICAL students might graduate without ever having witnessed a natural birth or delivering a baby. A survey of Australian medical schools found rising caesarean rates and a dramatic rise in the number of trainee doctors and midwives competing to be in the birth suite meant opportunities to be involved in labour and delivery were diminishing. It also found many women would not consent to a medical student performing the delivery, even under supervision of a midwife or doctor.

The survey by Professor Caroline de Costa, of Queensland's James Cook University - published in the latest issue of medical journal O&G - found some medical schools had dropped or scaled back the mandatory requirement for students to attend a delivery. Yet the Australian College of Midwives requires its students to have performed 40 normal deliveries.

Australian Medical Students' Association president Michael Bonning said: "We believe it compromises patient safety and is inconsistent with community standards for medical graduates not to be exposed to the normal birthing process."

But some universities have decided it is no longer practical to have a fixed quota of births to attend. Simon Broadley, from Queensland's Griffith University, said that, while it recommended students observe all types of deliveries, including instrumental (forceps or vacuum) and caesarean, teaching hospitals were already full of training nurses, midwives and paramedics and didn't have room for the hundreds of new doctors coming through universities. Almost 11,000 students were enrolled in 18 medical schools in 2006. Three new medical schools have since opened in NSW.

Associate Professor Broadley said most interns were not usually expected to deliver a baby. But Michael Chapman, head of the School of Women's and Children's Health at the University of NSW, said the public expected a doctor to display a certain level of competence when faced with labour emergencies. "I think the community would have an expectation that a doctor who has graduated from a medical school and is confronted with a lady in labour in a taxi would be able to deliver it," Professor Chapman said.

Requirements range from nothing at universities such as Newcastle to Melbourne's Monash University where students must experience three normal births, a birth using forceps and a caesarean. Professor de Costa said experiencing childbirth also encouraged junior doctors to choose a career in obstetrics. UNSW student Natalie Ammala said delivering a baby was "a powerful experience" that had pushed her towards becoming an obstetrician. "The experience has given me much more confidence than just learning from a textbook," she said.


Mad to tinker with our great system

Whenever I ask critics of Australia's constitutional arrangements to name one country anywhere that has a better set of overall arrangements than we do, I am inevitably met with dumbfounded silence. Taken as a whole, they wouldn't swap our constitutional arrangements with Canada, the US, New Zealand, Britain or anywhere else.

This isn't too surprising. Canada has a wholly appointed upper house full of hacks and political party placemen. It has a virtually unusable amending procedure and a newish constitution to which one province, Quebec, has yet to sign up. The US has bad gerrymandering as regards elections to the House of Representatives, political campaigns that go on for years and philosopher king-like judges who make far too many of the line-drawing calls for society. (The last point applies to Canada, too.)

New Zealand has about the worst voting system going, a list-based proportional system that just this past week brought about the absurd situation in which their Foreign Minister opposes the free trade agreement with China negotiated by the Prime Minister and the Government of which he is a member. And Britain is daily handing more and more decision-making powers to European institutions that are, frankly, undemocratic bodies in the extreme. Even the recent European Union constitution (oops, minor amending treaty, to give it its new name) had to be snuck in the back door without consulting a single one of Europe's 300 million voters. That and the difficulties with devolution and the West Lothian question hardly make Britain's constitutional set-up a prime candidate for emulation.

In Australia, by contrast, we have a world-best voting system; we have compulsory voting; we have real bicameralism with a genuine house of review with an elected upper house; we have an amending process that (unlike those in the US and Canada) does not bypass the voters; we have good campaign finance rules; and the list goes on. Is everything perfect here? Of course not. But ask the sensible question of whether any country has a better set of arrangements and the answer I and many others would give you is no. At the very least that indicates that any moves to push for radical changes in Australia ought to be met with extreme scepticism.

But let's play a different game. Let's have a bit of fun and see if we could bring together a group of people who were likely to think the future of Australian governance required some pretty big overhauling: one of those newfangled bills of rights that give lots of power to unelected judges, say, and maybe a move to a republic. What group of people might be likely to push for change, change, change?

To start, you'd probably want three retired High Court justices. Not just any retired justices but the ones who gave us the execrable implied rights jurisprudence. Those were the cases from the 1990s where the High Court discovered (or, more honestly stated, made up) some implied rights, and it did this even though the founders of our Constitution explicitly rejected any US-style bill of rights. And it did this despite Australian voters consistently rejecting such proposals in referendums. The trick was to treat the idea of an implication as divorced from any actually held intentions of any real human beings, which is another way of saying it was judicial redrafting.

Anyway, for the purposes of our little game, find three of the retired High Court justices at the heart of that implied rights stuff, but make sure you avoid any retired High Court justices who may bring to the table the sort of interpretively conservative outlook that characterises the present High Court. We don't want any authoritative people who may mess up our game. Then find a few legal academics who strongly support bills of rights. Maybe get one who has had a hand in bringing one in at the state or territory level. And make sure to include a few more strong and vocal supporters. Maybe even get one of them to announce in advance that he's going to push for a bill of rights.

So far our little game is going pretty well. Maybe we should throw in a well-known newspaper and magazine columnist and broadcaster with a long-standing preference for the mob in power, one who uses a photo that may make you think of the sculptor Rodin. Of course you'd need to throw into the mix a few figleafs of balance. So make sure you get a conservative who is also a strong republican: for the flavour, as Dean Martin used to sing.

Then you can fill out the numbers and sit back and wait for what you knew you'd get going in. There'll be calls for a bill of rights. There'll be calls for Australia to become a republic. And such authoritative calls could prove mighty useful down the road, especially if that was what you wanted before you started this little charade. Of course, when we play this game, we would have to concede, were we honest, that the group we had assembled was nowhere near being representative of the views of Australians as a whole. Whenever Australians have been asked, they have recognised that the constitutional status quo is, as I noted above, comparatively excellent. But with any luck we can finesse that uncomfortable truth.

There's another point worth making. The issues of whether to have a home-grown head of state, or whether to hand lots of decision-making power to an aristocratic judiciary, are not issues on which expertise should trump numbers. Letting the numbers count is a dumb way to pick a top physicist or malaria expert. But letting the numbers count is a supremely excellent way to decide whether we pay the costs involved in moving to a republic or whether we want to take power away from our elected representatives and give it to committees of ex-lawyers (which is what judges are and which is why there is something so self-serving about judges calling for a bill of rights).

Now some of you may well think this little game was all my own invention. But I can assure you I have copied the idea lock, stock and barrel. If you don't believe me, just check out the panel on the future of Australian governance at the 2020 Summit. Nice one, Prime Minister.


Church-school students urged to fight ban on homosexual partners

It's a private school. If they don't like its rules, they can go elsewhere. The school will lose a lot of enrollments if it caves in

ANGLICAN Church Grammar School students have been urged to confront the administration over a ban on boys taking gay partners to the senior formal. A Year 12 student, who said he was not gay but that he took up the issue on behalf of his gay friends, told The Courier-Mail: "Let's take this to the administration on the first day back next term. "Demand an end to this oppression of the only remaining minority that is still legal to oppress."

The student said when he first raised the subject with a senior Churchie teacher, he was told the rules would quietly be changed provided he did not make a big deal about it. Several students at Churchie have made it known they want to escort boyfriends to the June 19 formal, but the school is insisting they take a member of the opposite sex. Churchie headmaster Jonathan Hensman said none of the students had approached him directly, but a staff member had raised the issue on their behalf.

"The senior dinner dance is an opportunity for our young men to escort a young woman in a formal school environment," Mr Hensman said. "We don't intend to change our practice. As well as being a social occasion, it's an education forum and to that end the school decides what is appropriate behaviour and what is not." Mr Hensman said the issue had not "formally" arisen in the past, that he could recall, but the question was not unexpected given "the changing times". "Not all students take their girlfriends. Some take a female friend. It's about protocols and decorums," he said. But Mr Hensman said if any of Churchie's seniors approached him formally, he would consider taking the request to the school council. State schools made their own decisions on guidelines for school formals, a Queensland Education spokesman said.

Queensland's Anti-Discrimination Commissioner Susan Booth said sexuality discrimination was unlawful, and that applied to private and public schools as well as other organisations. However, Churchie is not alone in its stand against same-sex couples attending school formals, with Queensland Catholic Education Executive Director Mike Byrne saying their schools would not allow it either. Mr Byrne said Catholic schools were committed to modelling behaviours in keeping with the values and principles of a Catholic institution. "As such we would not see it as appropriate for couples in a same-sex relationship to attend an event such as a school formal," he said. "Where young people are concerned, there are often matters associated with sexuality and relationships - both heterosexual and homosexual - where schools provide a range of support services for students."

Although Ms Booth could not comment specifically on the Churchie case because it was "a potential complaint", the Anti-Discrimination Commissioner said schools should not treat students differently on the basis of their sexuality. "What we hope is that there can be a discussion about the issue, that's what happens in the commission, and that's where we hope the matter can be sorted out."

The Queensland Education spokesman said schools "consider the Inclusive Education policy when planning a range of activities, including school formals . . . and that requires schools to foster learning environments where all students are valued for their diverse backgrounds".

Queensland University of Technology School of Justice lecturer Dr Angela Dwyer said Churchie's stand on the issue of same-sex formal partners would be "devastating" to those involved. "We're talking about someone's identity here. The way that they feel and the way that they express themselves is basically being squashed by the school," said Dr Dwyer, who is writing a research paper on "How queer young people are policed". Another expert on sexuality and education, Iain Hay from the University of Canberra, said it would be very stressful for gay students prepared to come out in front of their peers, to then be told it was "inappropriate".


An affirmative action meltdown in an Australian police force

Bias and bigotry in favour of a woman did nobody any good

FROM senior constable to superintendent in one jump, Megan McGowan's meteoric rise within NSW's police ranks was unprecedented. At the time, she felt like she was on top of the world. But after leaving the job she loved, disillusioned and dejected, in 2006, the former fraud squad commander and child-abuse campaigner has launched legal action against her former employer, seeking damages in the millions. The claim, based on Ms McGowan's assertion that she was elevated too far, too quickly and beyond her ability, has the potential to stir as much controversy in policing circles as her promotion did, police insiders say.

Five days into her new $90,000- a-year role in April 1998, then superintendent Megan Hungerford confidently said: "I feel humble but I can do the job." But speaking from her home on the Central Coast last Thursday, Ms McGowan, 46, said she had more recently struggled to cope with life after policing. "I've been very sick with stress-related illness and right now my only option is to take it easy and await further instructions from my legal team," she said. "I can confirm the case is going ahead but I have placed everything in the hands of my lawyers and their advice is that I shouldn't make any comment at this particular stage." A court date for the action is still to be confirmed.

Ms McGowan's promotion at the age of 36 came via her appointment as chief of staff to the force's crime agencies commander and assistant commissioner Clive Small. Beating two vastly more experienced inspectors and two detective-sergeants to the prized job, she emerged as the state's youngest superintendent of police. To do so, she faced what was described as a rigorous selection process. The system, which replaced a long-standing tradition of seniority-based promotion, was touted by then commissioner Peter Ryan as more fair, equitable and transparent.

But what it was not was overly resistant to malpractice. Within two years of Ms McGowan's promotion, exam cheating by her fellow officers was widespread and in 2001 the NSW Police Integrity Commission launched its Operation Jetz inquiry, which left nine officers facing disciplinary action. Further changes were foreshadowed the following year, signalling a return to the age-old emphasis on street credibility rather than police looking good on paper. Promotions are now only allowed one rank at a time.

Ms McGowan, whose father Brian was a former ALP state MP, graduated as a probationary constable at Balmain police station in 1985. Two years later, she found herself working at the force's criminal investigations bureau and became a first-class constable in plain clothes after transferring to Hornsby in 1988. By 1991, she was specialising in child protection and then media and marketing and spent several years relieving for more senior officers. Then came the big jump: "If I get the least bit jaded, I move," she was quoted as saying in mid-1999. "But it would have to be something pretty amazing to compete with here," she said. Earlier, she had campaigned vigorously for a central police agency to investigate pedophilia and in 1996 had attracted some attention after heavily criticising the force while testifying on the subject as an expert witness at the Wood royal commission on the NSW police.

Yesterday, a spokesman for Police Commissioner Andrew Scipione said: "As this matter is now the subject of legal proceedings, it is inappropriate for the NSW Police Force to comment." Police Association of NSW secretary Peter Remfrey said he had not spoken to Ms McGowan and was unaware of her civil action. "For that reason, it would be wrong for me to comment."


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