MONASH UNIVERSITY FACULTY HANDBOOKS

Medicine Handbook 1996

Published by Monash University
Clayton, Victoria 3168, Australia

Caution Copyright © Monash University 1996
ISBN 1037-0919

Authorised by Academic Registrar, April 1996


FACULTY INFORMATIONPart 2

CONTENTS

  1. Advice to medical students
  2. Student advisers
  3. Assessment
  4. Code of Practice
  5. Unsatisfactory progress
  6. Cheating
  7. Leave of absence or deferment
  8. Special consideration - deferred examinations
  9. Grievance procedures
  10. Enrolment and re-enrolment
  11. Resources, including computers, available to students
  12. Student societies
  13. Professional accreditation

Advice to medical students

Ethics for medical students involved in clinical work

When in contact with patients, the student bears the same responsibilities as does the doctor in regard to professional conduct. An understanding that the ethical and legal obligations involved in the doctor-patient relationship will be observed is implicit in all clinical work. The `ground rules' which govern the professional conduct of doctors are of great antiquity and can be traced to what is usually called the Hippocratic Oath which had its beginnings in the school of medicine founded by Hippocrates in the fifth century BC. A modern version of this oath was adopted at the First Assembly of the World Medical Association held in Geneva in 1948 and was subsequently amended at meetings in Sydney in 1968 and in Venice in 1983. The World Medical Association version of the Hippocratic Oath now reads as follows:

`At the time of being admitted as a Member of the Medical Profession, I solemnly pledge myself to consecrate my life to the service of humanity. I will give to my teachers the respect and gratitude which is their due. I will practise my profession with conscience and dignity.

The health of my patient will be my first consideration. I will respect the secrets which are confided in me even after the patient has died; I will maintain by all the means in my power the honour and the noble traditions of the medical profession; my colleagues will be my brothers.

I will not permit considerations of religion, nationality, race, party politics or social standing to intervene between my duty and my patients; I will maintain the utmost respect for human life from its beginning even under threat and I will not use my medical knowledge contrary to the laws of humanity.

I make these promises solemnly, freely and upon my honour.'

Professional ethical codes are not immutable and slowly change with time as the morals and structure of a society change. New moral and ethical issues arising from modern biotechnological advances were among the subjects debated by the World Medical Association at its meeting in Venice during October 1983 and the assembly changed the sentence in its version of the oath which then read

`I will maintain the utmost respect for human life from the time of conception É' to read: `I will maintain the utmost respect for human life from its beginning É'

The Australian Medical Association has paraphrased the ethical requirements of both the Hippocratic Oath and the Declaration of Geneva as follows:

(a) to live a pure and moral life and to pay due respect to his teachers, to share a knowledge of medicine with the rest of the profession and to have no secret remedies or processes;

(b) to do no man any harm by the misapplication or criminal application of a knowledge of medicine;

(c) to undertake only such things as are within the competence of the individual practitioner;

(d) to keep secret anything learned as the outcome of professional relationship with a patient which should not be divulged;

(e) to avoid abuse of the doctor-patient relationship.

The `Code of Ethics' of the Australian Medical Association is reproduced in full as Appendix II of the second edition (1991) of the textbook Ethics, legal medicine and forensic pathology by V D Plueckhahn and S M Cordner.

On the presumption that students have embarked upon the MB BS degree with the intention of practising as a doctor, it is important to be alerted to the role of the Medical Practitioners Board of Victoria and, well ahead of time, to the legislation which pertains to medical registration in Victoria. The prime purpose of the Medical Practice Act is to protect the public. The Act stipulates that the board is to refuse to register as doctors persons:

+ who are not of good character;

+ who have been convicted of a serious crime;

+ who are ill in a manner which may put the community at risk; or

+ who are not able to complete the training and clinical experience required under provisional registration (ie internship).

After you complete the final year of your course and graduate with the degree MB BS, you will be required to apply for provisional registration with the Medical Practitioners Board. You will be asked to sign a statutory declaration attesting (1) that you have never been convicted of a serious crime and (2) that you are not presently under treatment for, or suffer from, any condition or illness which may impair your ability to practice and which may put the community at risk. This statement is provided to you to:

+ remind you of the vocational nature of your course and the strict requirements laid down for registration of medical practitioners by the Parliament of Victoria, and

+ give you the opportunity to consider your position, and seek appropriate advice, if you suffer from an illness or condition which could prevent you from being granted provisional registration or if you have been convicted of a serious crime.

Further information or advice can be obtained from the dean of the faculty.

Professional secrecy

Students are reminded that they are ethically and legally obliged to maintain the confidential nature of any knowledge they obtain about patients. It is fundamental to proper doctor-patient relationships that patients know that they may disclose intimate things to treating doctors and that the doctors in turn will observe strict confidentiality about such personal matters. Patients must not be afraid to seek the advice of doctors and the doctors in turn must be free to ask patients whatever questions they consider are necessary for proper diagnosis and treatment. Strict medical confidentiality, once inviolate, has been substantially eroded in modern medical practice by various statutory enactments at both State and Federal levels. For example, medical records may be seized by court order and communications by patients to doctors are not generally protected from disclosure to courts of law. Statute law also lays down circumstances under which information gained in doctor-patient relationships must be disclosed. Included are the reporting of `notifiable diseases,' the notification of venereal disease, provisions related to the consumption of alcohol and road-traffic accidents, the reporting of births, and the stating of the causes of death in death certificates. Such legal responsibilities of modern doctors have considerably dented the Hippocratic requirement for the doctor to `preserve absolute secrecy on all he knows about his patient because of the confidence entrusted in him.'

Liability of students

Students in their third, fourth, fifth and sixth years, and for some aspects of the education provided in earlier years of the course, are required to undergo clinical teaching in hospitals or clinics associated with the university. Normally students are under the control of clinical teachers which affords some protection to them in the event of them incurring liability towards any patient with whom they may have come into contact. In certain circumstances, however, this indemnity is not provided and students should make themselves aware of their responsibilities towards patients during these years of training. In cases where a student may incur personal liability without indemnification, the Medical Defence Association of Victoria and the Medical Indemnity Protection Society will provide a service to them.

Attitude to patients

During contact with patients, students will realise the need to develop sensitivity to patients' varying personalities and needs. Learn to listen patiently, not only to what patients are saying but also to what they are not saying, perhaps because they are afraid or embarrassed. Courtesy, kindness and sympathetic understanding are just as important in the care of the sick as are the technical skills which you will also be learning to acquire.

Personal conduct

Students must conduct themselves in a manner which is acceptable to patients and which does not undermine their confidence or endanger their health. A neat appearance and a quiet and sympathetic demeanour inspires the patients' confidence and will be helpful in your work.

Gratuitous advice given by medical students

Do not practise medicine before you are qualified to do so, and then only in professional surroundings. Your friends and acquaintances - and the inevitable party pest - may try to induce you to practise medicine casually or on social occasions. It is dangerous to give medical advice without taking a complete history and doing an adequate examination, and very foolish to do so in most circumstances unless you are legally qualified. A thoughtless or ill-informed word of reassurance may lead someone to postpone seeking medical advice properly and lead to tragedy. Learn to rebuff these advances courteously.

The total care of the patient

The total care of the patient is a team effort requiring not only doctors but nurses and various health-supporting personnel, for example physiotherapists, dieticians, occupational therapists. Hospital chaplains and spiritual advisers also contribute to the care of patients, especially in certain circumstances such as the care of the dying patient. Students are urged to learn as much as they can from, and cooperate with, these various members of the team.

Reference

Health requirements

In order to meet health requirements for working in the wards of affiliated teaching hospitals and for protection of other students and themselves, students in the MB BS course need to comply with certain precautionary procedures. These consist of confidential tests for immune status (including blood tests and skin tests), receiving vaccines and having X-rays where the evidence indicates these are appropriate and there are not specific contraindications in individual cases.

This policy is in accord with the National Health and Medical Research Council advice that educational institutions training students in health sciences should ensure that such students are protected as far as possible by vaccination against risks of infection.

The faculty recommends that all students accept responsibility for having up-to-date immunisations before commencing the medical course. Immunisations recommended are diphtheria, tetanus, polio, measles, mumps, rubella, tuberculosis and hepatitis B.

Prospective students should note that on enrolment, students are provided with detailed written information and, as appropriate, counselling about the effect that HIV or hepatitis B infection may have on the ability of health care workers to practice their profession. In addition, arrangements will be made by the faculty for every student to have a personal consultation, early in the first year, with an infectious diseases physician. At this time, a check for each student's immunity to diseases such as tuberculosis will be conducted and students will be offered personal advice and counselling about infectious diseases and their personal health.


Student advisers

Students who require academic advice or guidance concerning the subjects studied should initially contact the relevant teaching staff or the subject coordinator. In addition, students may consult with the semester or year coordinators. In years 4-6 the offices of the clinical subdeans should be consulted.

Students experiencing general problems which are affecting their academic performance may seek advice from the faculty office. The assistant dean, faculty manager and the administrative officers (campus and teaching hospitals) are available to provide assistance. The University Counselling Service should be consulted for problems of a general nature.

In special circumstances a student may wish to make an appointment to see the dean.


Assessment

The assessment procedures for each subject in years 1, 2 and 3 and for the programs taught in years 4, 5 and 6 are described more fully in the appropriate manuals made available to students prior to the commencement of studies each year.

The board of examiners for each year level considers all results from examination and other assessment procedures at the end of each semester and/or year.

Students must obtain a passing grade in all subjects attempted in a given calendar year in order to proceed to the subsequent academic year of the course.

The board of examiners may, at its discretion, grant repeat or supplementary examinations to students who have not satisfactorily completed all required assessment procedures.

In years 1-3 at the end of first semester, the board of examiners may grant a repeat examination in any subject where a student has an unsatisfactory performance. The results of the repeat examination are considered at the second semester board of examiners when supplementary examinations may be granted.

In years 4-6, boards of examiners may, at their discretion, grant supplementary assessments where students have an unsatisfactory performance in components of the course.

Repeat examinations are generally held during the second semester and supplementary examinations are generally held in December or January.

The faculty informs students of the assessment procedures at the commencement of each semester/year. Students who are required to complete repeat or supplementary examinations are notified on the posted publication of results or individually by letter from the faculty office.

The Faculty of Medicine uses the grades fail, pass, credit, distinction and high distinction and reports marks for some components of the course.


Code of Practice

Students are referred to the Student Information Handbook for information on the university's codes of practice for teaching and learning as set out in its education policy. It also contains other essential information on university policies and procedures.

All Monash University students have a responsibility to make every effort to maintain satisfactory progress in their courses.

Academic staff have the responsibilities of preparing and presenting material at an appropriate standard with the resources available; assessing students' work fairly, objectively and consistently across the candidature for the subject.


Unsatisfactory progress

In the case of a student's unsatisfactory progress, the board of examiners may recommend:

+ that the student be allowed to repeat the year of the course;

+ that the student be recommended for possible exclusion from the course.

Where a student has been recommended for exclusion, a faculty exclusions committee will review the case and determine whether the student should be excluded or be allowed to repeat the year. The faculty office will in writing inform the student of the procedures to be followed including documentation required and the student's opportunity to present their case before the committee. An excluded student may appeal to the university's Appeals Committee.


Cheating

Students should note that cheating at the university is regarded as a very serious offence which is likely to lead not only to failure in the subject concerned but also to additional penalties including exclusion. Students should carefully note that the taking of any unauthorised material into examinations such as notes or unauthorised dictionaries will be regarded as cheating.

Plagiarism is an attempt to obtain undeserved academic advantage. Students should note that essays, assignments and other work are generally understood to be the student's own work. This does not mean that students may not make use of the work of others. However in quoting or paraphrasing material from other sources, those sources must be acknowledged in full. Where submitted work is identical with, or similar to another student's work, an assumption of cheating may arise. Where students wish to undertake work in conjunction with other students, it is suggested that the matter be discussed with the lecturer concerned.


Leave of absence or deferment

Under special circumstances students may seek deferment once and for up to one year during the medical course.

All applications for deferment must be made in writing to the dean who is the only person who may grant a deferment, and decisions will normally be made following an interview with the dean.

In considering applications the dean will take account of any medical, financial, social, emotional or psychological problems that could potentially be remedied by deferment. The deferment must therefore be used to assist the student to satisfactorily progress through the medical course.

Deferments are not granted automatically. However, students seeking deferral for one calendar year between school and the commencement of first year will be treated sympathetically. Application for the deferment of first year must be made in writing following receipt of an offer of a place in the medical course and must be lodged by the date of enrolment specified at the time of offer.

Because of the regulation requiring students to satisfy all the requirements of each year of the medical course within one calendar academic year, any student granted a deferment at any time through the year will be required to return to studies at the start of the following year and repeat work already completed, unless specific exemptions from parts of work (eg practical classes) are granted by course conveners. Returning students will be required to enrol as full-time students, with HECS and other fee liabilities.


Special consideration - deferred examinations

A student whose work during the academic year or whose performance in an examination or other assessment has been affected by illness or other serious cause may apply in writing on a `special consideration form' to the faculty office for special consideration by the examiners or board of examiners concerned.

The application must be accompanied by appropriate evidence and must be made not later than forty-eight hours after the last examination scheduled for the candidate. The faculty manager, where satisfied that the student was unable to make application by the required date, may accept a late application.

The board of examiners may allow a student to sit for a special examination or deferred examination where:

(1) the student has been prevented by illness or other serious cause from presenting for all or part of an examination; or

(2) the student's work during the academic year or performance in the examination has been gravely affected by illness or other serious cause.

Further details are available from the faculty office.


Grievance procedures

Student grievance procedures are available within the Faculty of Medicine for any student who believes he or she has a grievance against the faculty, and where procedures for the resolution of that grievance are not provided for by other means.

If a student is unable to resolve a grievance by other means, he or she should contact the dean of Medicine or the faculty manager and explain in writing the basis of the grievance.

The dean or faculty manager will attempt to negotiate a successful resolution to the grievance. If required, a complaint will be heard and resolved by the faculty's grievance committee.

The details of the formal procedures relating to grievances are available from the faculty office.


Enrolment and re-enrolment

Students enrol in person at the faculty office prior to the commencement of the first year of the course. In later years the faculty office automatically processes re-enrolment into the appropriate year of the medical course. The university administration mails out re-enrolment information and requires forms to be returned and payments to be made before the re-enrolment process is completed.


Resources, including computers, available to students

Throughout the course, the medical curriculum encourages the development of clinical and communication skills. Students are encouraged to utilise specified teaching areas in order to improve their proficiency in these skills.

Several laboratories are equipped with computers for student use. All students now have the right to obtain a Novell network account which will allow them access to IBM-style PCs around the campus. This facility gives students access to electronic mail (e-mail) for easy communication with fellow students and staff. Students wishing to register for an account will need to report to the Computer Centre with their student ID card and obtain a copy of Computer Centre regulations from the reception counter before attempting to access the network computers.

The Biomedical Library is one of five major branch libraries of the Monash University Library, and supports the teaching and research activities of the medical, biological sciences and psychology departments of the university. Online public access catalogues (OPACs) provide information concerning the materials held in the library, and a local area network (LAN) and stand-alone computers provide access to numerous CD-ROM databases, including Medline, PsycLIT and Biological Abstracts. Library tutorials are provided for all first-year medical students to familiarise them with the library, and provide instruction in the organisation and retrieval of scientific information. The tutorials include a CD-ROM component.

The Biomedical Library is located near the Anatomy department of the Faculty of Medicine, and is open seven days a week during term.

Students who are located at the Alfred Hospital, Box Hill Hospital or Monash Medical Centre have access to Biomedical Library materials located in libraries in these hospitals. These Monash University materials are listed on the OPACs, and are available to students at the Clayton campus through a `hospital loans' system.


Student societies

Monash University Medical Undergraduates' Society

Membership

All undergraduates enrolled in the Faculty of Medicine shall automatically (without cost) be members of the society.

Aims

The society aims to foster generally the interests of students enrolled in the Faculty of Medicine, to implement their views and demands with regard to the place of medical students within society and within the faculty, and to cater for their social needs.

Structure

Three persons are elected from each year to act as MUMUS representatives. Together, these representatives form the MUMUS committee, from which is elected the executive, consisting of president, vice-president, secretary and treasurer. MUMUS also fosters the development of subcommittees, whose activities cover a wide variety of interests. Currently these include AMA student representatives, magazine committee and orientation committee. The MUMUS office is on the ground floor adjacent to lecture theatre M3. The telephone number is 9905 4329.

Activities

Throughout the year, the MUMUS committee is responsible for varied events, including organisation of orientation activities, the annual cabaret and ball, convivium, and inter-year sporting challenges and barbecues. MUMUS windcheaters are produced annually, and occasionally, ties. There is also a collection of old exams and lecture notes available to all students. MUMUS represents students' views through representatives on faculty board and other faculty committees, including those dealing with selection, exclusion and education. As a student society, MUMUS is affiliated with AMSA (Australian Medical Students' Association), and the committee appoints two delegates to AMSA council, where policies concerning all Australian medical students are decided.

Clinical committee

All fourth, fifth and sixth year students in the Faculty of Medicine are eligible to be members of the clinical committee. The aim of the committee is to organise facilities and activities relating to aspects of students' lives at all teaching hospitals. The clinical committee operates from the Union office located on the lower ground floor, Monash Medical School, Alfred Hospital and is open from 10 am to 2 pm during fourth-year term dates. The telephone number is 9276 2356; after hours messages may be recorded on 9511 892.

International Medical Student Association

The International Medical Student Association (IMSA), formed by international students, is involved in a variety of educational and social activities and provides valuable support to incoming medical students. All medical students are eligible to join IMSA. The association maintains an office near lecture theatre M3.

The association aims to represent the education and welfare rights of Monash University international medical students and to ensure that the views and opinions of these students are sufficiently represented within the faculty and international student movements. IMSA also aims to increase interaction between international and local students through social activities, working with and alongside MUMUS.

IMSA organises orientation activities, a first-year study support system, information sessions, barbecues, an Asian lunch, an annual dinner and dance and also a sports day with Melbourne University's medical students. Other activities including seminars, talks and forums touching on international medical student issues are also held from time to time.


Professional accreditation

The following is presented for the information of potential graduates.

Hospital appointments

The Medical Practitioners (Amendment) Act 1973 demands a preregistration year in an accredited hospital. Many graduates seek appointment as interns in one of the teaching hospitals affiliated with the university in which they had their clinical training. Others gain this experience in other hospitals in Victoria or even interstate or overseas. Graduates receive their final registration after completion of the compulsory preregistration year and are eligible for registration in another State of Australia.

It is understood that (i) interstate hospitals accepted by their medical boards for the purposes of a preregistration year will be recognised for accreditation; (ii) graduates in their preregistration year will not be able to prescribe outside their accredited hospital; (iii) emergency treatment may be given by a graduate in his or her preregistration year but only as a person with expert knowledge and not as a medical practitioner (this provides protection against any complaint of malpractice); (iv) graduates spending their preregistration year overseas should inquire from the Medical Practitioners Board of Victoria whether they will receive Victorian registration.

Affiliated teaching hospitals

In every appointment the hospital takes into consideration the association of the applicant with that hospital, including the general character and disposition of the applicant evidenced during his or her training there, the performance of each applicant at his or her final examination and such other matters as appear to be relevant.

It is anticipated that the accepting hospitals affiliated or associated with the university and other appropriate hospitals in the State of Victoria whether or not associated with Monash would offer, at the end of 1996 for a period of one year, an internship for all graduates who seek such appointments, with the exception of full-fee paying international students.


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