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Cutting edge in skin cancer training
James Cook University’s GP registrars and medical students are receiving gold standard education in skin cancer diagnosis and removal in a pilot program that recognises the crucial role of rural doctors in melanoma detection and treatment.
Dr Jeremy Hudson, JCU Senior Lecturer in Skin Cancer Medicine and Surgery, is involved in developing the RACGP’s national clinical standards and education for dermatology in his role as Chair of Dermatology. For the past year, he has been reviewing the curriculum and clinical skills training for GPs at post-fellowship specialty, fellowship and registrar levels.
“At JCU, we’re bringing up the skills of GP registrars and signing them off with the clinical skills to a level that isn’t really done anywhere else in Australia,” says Dr Hudson.
“This is a really robust form of teaching that keeps JCU registrars in line with what’s going to come through nationally for expectations for GPs. It also recognises JCU’s role as the predominant university with rural graduates. I’ve been working with JCU on this because the people who are dying from melanoma are rural people without access to good skin cancer care. It’s filling a recently acknowledged gap in service care.
“Because we have the highest skin cancer rates in the world here and we have so many doctors who practise rurally and stay on rurally, it’s of supreme importance. Skin cancer kills more people in Australia than car accidents, and we’re trying to give it the same priority that we do things like road safety and seatbelts.”
Dr Hudson assisted with the latest State of the Nation Melanoma report and Cancer Council Australia guidelines, successfully pushing for recognition of general practitioners as frontline experts in melanoma detection and diagnosis. He says GPs manage about 90 per cent of skin cancer cases.
“GPs are not only doing the majority of skin cancer work, but there are a good number of GPs who are practising really advanced stuff like flaps and grafts and melanoma management that is not usually expected of GPs,” he says.
“The whole system nationally would crash if they weren’t doing this. There’s no way that dermatologists and plastic surgeons would cope. So the decision was we needed to recognise this formally.”
JCU GP registrars participate in a cutaneous surgery workshop, learning how to sample and cut out spots on the body and close the wound, before completing an advanced clinical skills session on techniques such as creating flaps and grafts. Registrars practise on prosthetic skin created by University of Adelaide PhD student Ryan Campbell, who worked in film and television special effects: “He has developed fake skin based on his movie making, and that’s what we’ve been using for the clinical skills sessions. Instead of using pork and pig skin, we’re using synthetic artificial skin that you can keep reusing.”
Dr Hudson teaches dermoscopy, a visual identification of melanoma and skin cancer, to third-year students in JCU’s Bachelor of Medicine, Bachelor of Surgery. “JCU is ahead of its time in terms of giving that training to its medical students,” he says. “We’re already teaching people at a level beyond which most Australian universities teach skin cancer. We’ve been trying to align some of the JCU education with the RACGP new standards, as the first university to do that.”
As Clinical Director of North Queensland Skin Centre, Dr Hudson is involved in testing prototypes that use artificial intelligence (AI) to detect melanomas, and is leading a group that has $8.5 million in industry funding to build a cutting-edge skin cancer research facility in Townsville. He is an adjunct Associate Professor for skin cancer research with Southern Cross University.
“There are exponentially more AI machines now in Australia. We have these really interesting lenses where we can zoom in to the level of a slide so we can now see the melanoma cells without cutting anyone's skin. We've got a lot of fun things like that we're working with at the moment,” he says.
“We’re modifying military technology that enhances visual features so when you look at a mole, it will outline melanoma features.”
Canadian-born Dr Hudson did his medical training in New Zealand, his parents’ home country, and worked in Christchurch and Fiji before landing a job at Townsville Hospital. He spent much of his career running remote hospitals in northern Queensland and worked with the Royal Flying Doctor Service in Aboriginal and Torres Strait Islander communities in Cape York Peninsula as part of his GP training.
He said in overseeing the new clinical standards for GPs, “We don’t do that in isolation. We want to know what's the level of knowledge at different phases: when someone goes through medical school, years after graduation, entering as a GP registrar to being a fellow and specialising even further after fellowship.”
Dr Hudson says patients need to be on the lookout for spots on their skin which stand out or change: “It's very important that they get those checked within a two-week timeframe. People need to be self-checking their skin and opportunistically getting skin checks done by their GP or a skin cancer specialist.”