As a reaction to the medical workforce shortage in Australia, a large expansion of undergraduate medical education has occurred through the provision of funding of additional medical student places. As a consequence, the number of medical graduates is anticipated to increase by as much as 90% with a peak in numbers anticipated in 2012. With ED already under pressure, this increase has serious implications for ED, particularly the delivery of intern and student teaching. This integrated review describes potential challenges that might arise from the predicted increase in intern numbers working in ED. A structured literature search was conducted from which 44 directly relevant articles were identified. We discuss the possible impact of an increased number of medical graduates on emergency medical staff, education, supervision and feedback to interns, and given the potential impacts on the education of junior doctors; we review the purpose and implementation of the Australian Curriculum framework for Junior Doctors in relation to their learning requirements. Although there is consensus by most postgraduate bodies that the core emergency term in emergency medicine should be retained, the impact of increased intern numbers might dramatically affect the clinical experiences, supervision and educational resources in the ED. This might necessitate cultural changes in medical education and ED function.

No abstract

Purpose: Cholangiocarcinoma arising from biliary duct epithelial cells, is the second most common primary hepatic malignancy. Although surgical resection is the definite curative option for earlystage disease, only a minority of patients qualify for this procedure. Percutaneous microwave ablation is a minimally invasive procedure widely used for hepatocellular carcinoma and colorectal cancer metastasis to the liver. In this study, we aim to describe the safety and efficacy of percutaneous microwave ablation for the management of intrahepatic cholangiocarcinoma. Materials and Methods: A retrospective review of patients undergoing hepatic microwave ablation for cholangiocarcinoma at our center was performed. Eleven patients (66.5 ± 7.4 years, 55% males) with 30 tumors (20 ± 16 mm, max is 78 mm) were treated between 2014 and 2020. All procedures were performed under CTguidance using a high-power microwave ablation system. Patient's medical history, procedure technical information, outcomes, and follow-up data were reviewed. All statistical analyses were performed with SAS (v9.4). Results: Median imaging follow-up was 4 (2, 15) months. Tumor differentiation (9% well, 27% moderately, 9% poorly, and 55% unknown) and staging (45% T1a, 18% T1b, and 36% T2b), and receiving neoadjuvant/adjuvant chemotherapy (73% received). Two of eleven patients were initially treated with surgical resection. Complete ablation rate was 96.7% with local tumor control rate of 90%. All patients were discharged the next day without major complications. Conclusions: Percutaneous microwave ablation is safe and effective and may be a good second line alternative to surgery for treating early-stage intrahepatic cholangiocarcinoma of the liver with good short-term results despite a relatively complex cohort. Longer term follow-up is needed to validate survival benefit of this study.