Friday, 26 May 2017

Locals learn the ropes in Gippsland hospitals

Nine students who grew up in Gippsland are among 94 first year students doing placements in hospitals across Gippsland during 2017. The students, all studying the graduate entry medicine course, spend their first year based in Churchill and their reasons for studying medicine are as varied as their postcodes.

Local learning: eight students who grew up in Gippsland are now studying medicine based in Churchill. L-R: Niharika Ojha, Melissa Bruerton, Olivia Ferretti, Holly Rennie, Tumi Yusuf, Stephanie Wall, Jacoba van Wees, Max McKenzie.

Tumi Yusuf’s father is a doctor working in Warragul where she grew up. “My dad was a doctor, so I thought that was pretty cool. But I got to the end of high school and started to rebel,” she said. “I thought, I don’t want to do what my dad does.” In the end she decided medicine did provide useful skills.

Others were influenced by personal experiences as they grew up.

Olivia Ferretti’s father was in a serious truck accident when she was ten years old, and spent four weeks in intensive care followed by another six or seven months rehabilitation in Melbourne. It was a long way from Bairnsdale where the family lived. “We were involved in his recovery and he’s still getting ongoing treatment now. I’ve been heavily involved with his treating team,” she remembered.

Melissa Bruerton was originally from Hazelwood North. Guidance from good teachers and how moved she was by the needs of people living in poverty when she travelled overseas led to her choice.

Some students started out on a career in medical research, but found they wanted a closer relationship with the people they were working to help. Max McKenzie of Sale wanted to give back to the community on a more personal basis. Jacoba van Wees, who’s lived all over Gippsland, came to the same conclusion. “I didn’t like how distant research felt from people. I wanted to have the opportunity to have direct impact even if it’s only in a small way.”

They are certainly discovering the personal side of medicine while on placement. Warragul locals, Holly Rennie and Tumi Yusuf, are both based at Warragul hospital. Running into people they know is common and, though they laugh about it, it’s a positive part of studying locally. “You just see everyone and I find it comforting,” said Tumi.

Stephanie Wall’s interest in medicine started when she found herself enjoying looking at the pictures in nursing textbooks as a kid. Like Holly and Tumi, she’s fond of her home town, Warragul, and the community there. “It’s really important to do what we can to keep that community together. I’d really like to be able to facilitate people staying in their community for help,” she said.

Holly also wants to stay rural. “There’s a need in rural areas that I could jump in and fill. That’s really attractive to me and giving back to the community as well. People wouldn’t have to travel all the way to Melbourne if I was a specialist there,” she mused.

Once they complete this year the students may stay in Gippsland, be placed in other parts of regional Victoria or go to Melbourne to finish their medical course. And while their path will take a couple more years to complete than if they’d stepped in straight from secondary school, they all agree that a first degree was excellent preparation for the medicine course and gives them something else to fall back on.

Niharika Ojha, who originally hailed from Traralgon, and Jacoba van Wees both said they felt more equipped to deal with the course then if they’d gone in straight from secondary school. Holly Rennie is quite sure her biomedical studies and a few years spent out of school will make her a better doctor. She started out studying education, then moved into biomedicine. “It was through that and working with the YMCA – which was really hands-on and helping people – that I decided I wanted to go into medicine. Coming into this after six years of working in the outside community, I know I have a whole different outlook on medicine.

Friday, 28 April 2017

Testing the waters in Year 2

Tom Trengrove: life as a medical student.
Tom Trengrove turned up at ICU at Sale hospital on Wednesday morning last week feeling a little tentative. He’s one of 16 Year 2 students on placement in Sale for a fortnight. That day he was the only one of the group scheduled on ward rounds, but it all turned out OK. The Year 3B students who were there explained what was going on until they had to leave. And then the registrars and consultants slowed down sometimes to explain.

It’s not his first experience in a hospital though. Tom’s part of the John Flynn Placement Program and spent some of his summer break in Gympie, a town of about 20,000 people 160 km north of Brisbane and one hour’s drive inland from Noosa. Tom was placed in the emergency department of the hospital. “I didn’t spend all my time with my mentor and got to see a lot of the eight doctors who work in the emergency department.” From them he learned a lot, especially when they gave him the non-urgent cases to assess before they came to talk to the patient.

Tom hails from Auckland and applied to Monash because there are no direct-entry medical courses in New Zealand. And he’s been making the most of Melbourne’s proximity to some great surfing. “I used to surf in Auckland,” he said, “but Australia has much better surf.” He and friends travel to Phillip Island on weekends.

Where is he thinking about going for Year 3B? “I’m thinking about Traralgon – it’s closer to Melbourne and will make it easier to stay in touch with my friends there.” But Sale might be on the agenda. “Is it far from Phillip Island?” he asked.

Monday, 24 April 2017

Paediatrician leaves large educational legacy in Latrobe Valley

Some of Associate Professor Joseph Tam’s career pathways may be the result of his inability to say no to a good cause, but many people have certainly benefited from his “weakness”!

Numerous children and their families in the Latrobe Valley have received his expert care over the last 19 years. And in parallel to his clinical role, the Traralgon-based paediatrician has spent many years educating younger generations of doctors.

Always a teacher


This teaching has included working as an instructor for the Acute Paediatrics Life Support program and examining for both the Royal Australian College of Physicians (RACP) and the Australian Medical Council. He is also a member of the RACP General Paediatrics Advanced Training Committee and the Overseas Trained Paediatrician Sub-committee.

Monash Rural Health will remember him for his long contribution to the rural medical education program, particularly in Gippsland.

Dr Tam has stepped down as the Clinical Lead in Paediatrics at the Latrobe Regional Hospital after 12 years on the job, and as director of Monash University’s Latrobe Valley & West Gippsland after three years at the helm. But his involvement with Monash goes back much further.

A long involvement with Monash


Professor Roger Strasser, who was instrumental in establishing Monash Rural Health in the early 1990s, approached Dr Tam to teach on an honorary basis soon after he arrived in Traralgon 19 years ago. In 2003, he was engaged as a Senior Lecturer at the then Gippsland Regional Clinical School. Subsequently, Dr Tam was appointed as an Honorary Senior Lecturer, Department of Paediatrics, Monash University. In 2005, Dr Tam became the Discipline Lead in Children Health, Monash Rural Health Latrobe Valley & West Gippsland - a position he held until 2015 when he was appointed as an Associate Professor in Rural Medicine (Hospital Education) and the Director of Monash Rural Health Latrobe Valley & West Gippsland.

Dr Tam has seen many changes over that time including the duration of placements. Students would come from Clayton Melbourne for nine weeks; now they can spend a year or more in the region. “A lot of progress has been made providing education, teaching and training in rural areas. I think we’re heading in the right direction,” he said.

Teaching with Monash was an extension of work Dr Tam was already doing at the hospital. When he arrived at Latrobe Regional Hospital in 1998, many international medical graduates (IMGs) were studying for the AMC exams. “I always enjoyed teaching and sharing my knowledge and experience with the younger doctors,” said Dr Tam. Before long he was running tutorials for IMGs to help with the paediatric component of their clinical exams. In 2009, Dr Tam became a clinical examiner in paediatrics for the Australian Medical Council (AMC); seven years ago he became a Regional Examiner and in 2014 a member of the National Examination Panel for the FRACP clinical examination of the Royal Australasian College of Physicians (RACP).

Choosing regional practice


Traralgon is a long way from the large teaching hospitals in Sydney where the Hong Kong born doctor had worked since his internship. After completing two years in paediatric nephrology training at the Children’s Hospital at Westmead, Dr Tam faced the choice between a self-funded trip to Canada to complete a PhD as part of his training or a clinical role in regional general paediatrics practice. The decision was made easy when he was approached about the position at Latrobe Regional Hospital. “I came down to have a look and said to myself: ‘this is too good to be true'. There was no paediatrician and all the work was waiting for one. So I came.”

Dr Tam became the only visiting consultant paediatrician at Latrobe Regional Hospital and oversaw the growth of the small paediatric service into a department of five paediatricians, two paediatric advanced trainees and five paediatric hospital medical officers, who provide 24-hour, seven-day on-site paediatric services at the hospital.

Regional recruitment - the social dilemma


During his tenure, Dr Tam has seen trainees and junior colleagues return to work in regional and rural areas. “It’s rewarding especially when they turn out to be good ones,” he said. While he was delighted to see young graduates return, Dr Tam acknowledged there are challenges in recruiting and retaining health professionals in rural areas. “Most of them like the work in the regional areas although some of them feel a little apprehensive in the beginning. But once they come, they all love the work. It’s just the social factors that stop some of them from coming or returning.”

Most families now have two working parents, he pointed out. Sometimes partners have jobs that are not available in regional areas which makes it difficult for a health professional who might otherwise be interested in working in a rural context. Paediatrics, particularly, is a difficult profession to attract. “The majority of paediatricians are female and quite a lot of them have families,” said Dr Tam. “They cannot come out to work in the regional areas where it involves after hours on-call work. It is not easy when they have young children and have no extended family to provide support.” The solution he suggested – only half in jest – is to ensure students meet and marry local people.

The future is regional


Dr Tam plans to continue working in paediatrics in a regional area, and to teach both within and outside hospital settings. “We just have to keep on pushing the boundary so that hopefully we can teach and train the workforce entirely in a rural area. That would certainly be the ultimate success,” he said. Given his track record, it’s unlikely Dr Tam will say no to any opportunities to be involved in educating and supporting future doctors.


Monday, 3 April 2017

Coming home to Mildura to study medicine

After two years studying in Clayton, Tanzina Kazi is rediscovering a different Mildura to the one she grew up in. Tanzina is one of 14 Monash medical students undertaking their first year of clinical training at Monash Rural Health Mildura.

Tanzina Kazi is enjoying her first year of clinical training in Mildura

“We’re a very tight-knit group, which is a big positive,” said Tanzina. “We do a lot together.” Exploring local markets, picnic spots, Orange World and local restaurants, her fellow students look to her to act as tour guide. “We have a really, really good food culture in Mildura, so we do a lot of eating” she laughed.

Mildura is a long way from Tanzina’s birthplace, Bangladesh. Her parents left for Melbourne when she was six months old, so she doesn’t remember it then. But a trip back to visit family when she was seven made a deep impression on her. “There’s a lot of poverty in Bangladesh. Everywhere you go, you see people who are living on the streets. A few of those people just stuck in my mind. That’s when I decided that in my future I want to do something where I’m helping people,” she said.

She was also well aware of the issues people outside Melbourne face trying to access health services. A couple of years after arriving in Australia, Tanzina and her family moved to Mildura. Over the years, both her parents have had health problems. She remembers that her mother had to travel to Melbourne for an MRI as they weren’t available in Mildura at the time.

Deciding on a career in medicine was a gradual process influenced by that early trip, her parents’ experiences and her enjoyment of biology. “When I went into medicine I wanted to be a GP. I like the idea of being able to track someone’s medical process from when they’re a child to when they’re an adult,” she said. “But now I’m not sure what I’d like to specialise in.” That decision is some way off yet and her clinical training will expose her to a variety of specialties, but she would like to come back to a rural area to do her internship when she graduates.

She’s not the first in her family to choose to study medicine: her brother is currently studying medicine in Queensland. “Unfortunately he’s beaten me to the punch and he’ll be the first doctor in the family, although my Dad’s got a PhD so technically he’s the first doctor” she joked.

Tanzina, on the other hand, was well aware of the Extended Rural Cohort stream in Monash’s medicine degree by the time she was applying for a place in a medical course. “Monash does a really good job in Mildura: they invite the year 11 and 12 students over to the School of Rural Health and do a few workshops and an information night,” she said. “And all the medicine students that I talked to before I started doing medicine were ERC students. They all just raved about how good ERC is and how much they get to do compared to their city friends. And I thought, well if I get to do a lot and I get to be back home for a year, then why not? So it was my first preference.”

She agrees studying medicine in Mildura is a great experience and comments on how well the staff look after the students. “We feel we have a really good connection with them. The other day it was someone’s birthday and Kris [Pinney] baked them a cake. It’s a great community feeling here.”

After two years’ foundation studies at Clayton, Tanzina is enjoying the hands-on learning in Mildura. “It was a difference experience and I did enjoy it. I was staying at college so I got to meet a lot of new people. But, at the same time, it was just sitting in lecture theatres for lots of hours during the week. And when I compare it to what I’m doing now in Mildura, I’d much rather be here than sitting in lecture theatres.”

Monday, 6 March 2017

PNG placement motivates medical student

His two-week placement in Papua New Guinea over the summer break, was the most confronting thing medical student, Tim O’Hare, has ever done. But while it was emotionally exhausting, it was also motivating. “Having the opportunity to do a medical degree in a place like Australia, you want to make the most of that because it’s such a privilege and you just get such valuable skills from it.”

Confronting: Tim O'Hare spent two emotionally-exhausting weeks in PNG over his summer break based at Garoka hospital, and spent New Year with a local family.


Now in the third year of his studies with the University of Melbourne, raised in Gisborne Tim spent last year with Monash Rural Health Bendigo as part of a unique partnership between the two universities. Students from both institutions complete their first year of clinical training together at Bendigo Health.

During that year, Tim decided he wanted to expand on the cultural safety training that was part of his studies and organised a cultural awareness seminar for students. “We did cultural safety online modules, but nothing that involved actual people.” So he contacted the Bendigo District Aboriginal Corporation (BDAC) who were delighted to have someone ask for their help.

Tim had tried to gauge students’ prior knowledge of Aboriginal health. Some of the responses questioned the need for an Aboriginal co-op: why can’t they just go to a normal GP? A social worker and family counsellor from BDAC came for an afternoon and talked about local issues. “It’s really close to home, but a lot of people in Australia don’t fully understand yet. It doesn’t get taught in high school that well,” he said.

Music for Cambodia

For many years Tim and his family have organised the annual Macedon Ranges Music Festival in March to raise money for the Cambodian Kids Foundation.

All the performers donate their time (including the band that Tim plays in) and all ticket sales go to the Foundation.




Growing up, Tim never had plans to study medicine. Then about four years ago, he accompanied a local Gisborne doctor to Cambodia as a volunteer and saw what you can do with a medical degree. “I kind of thought you worked as a GP or you worked in a hospital, but then saw the breadth of it and that got me interested,” he remembered.

He’s since been to a few countries in Asia and back to Cambodia volunteering. It was to Cambodia he wanted to return over his summer break. “But the timing wasn’t right.” So through a contact of his mother’s he learned about PNG. “I look into it and learned more about the highlands and the history of PNG. It sounded really interesting. I’d read about PNG back when I was doing my science degree. It’s really interesting in terms of anthropology; there’s over 600 languages still spoken there.”

The Highlands Foundation put him in touch with Garoka hospital. “They were rapt to have me visit and help out and learn, and teach if there was anything I could teach,” said Tim. “You had complete freedom to work wherever you want. You could introduce yourself to the doctor or the surgeon or the nurses or the midwives. So I just tried to do a bit of everything. I met the Public Health Director of the hospital and that’s who I went out to the rural clinics with.”

In the emergency department he saw extreme presentations that you wouldn’t see in Australia. “Ill kids were the hardest to see, especially when most are cases that would be easily treatable if the resources were there.”

He saw that the problem was not lack of skill on the part of doctors or staff, but lack of money. “It might have only been a couple of dollars for a certain drug but the hospital ran out and they just couldn’t get it. You’d see kids with something like typhoid or meningitis – they’d only get partially treated one day and the next day they wouldn’t have any drugs, so they’re just suffering and not getting better. That was pretty hard.

“Seeing such extreme suffering and poverty as the cause, not necessarily any other cultural thing. All these complicating things play a role, but at the end of the day it was just an equity thing.”

He found it hard coming back. “You can get there in a day. You learn the history a bit. PNG was a part of Australia and then got independence in the 70s. And then just seeing how poor access is for so many people to just really basic healthcare. That was pretty challenging.

“Doing something in global health or education or development have always interested me. But it [PNG] has definitely made me sure that’s something worth doing.”

As he gets further into his studies, his PNG experience keeps things in perspective. “There’s a lot of stress in medical school which is a shame because it makes people feel busier than they need to be. But it’s actually been really relaxing to get back to medical school. Every day I think: wow, what a great opportunity I’ve got!”

Many disciplines make productive research

Only medical students get summer research scholarships in the medicine faculty goes the thinking, but Biomedical Science/Law student, Katherine Allman, thought she’d have a go applying anyway.

The project she was offered, looking at advanced care plans for patients in a regional primary care setting, appealed to an interest awoken during a public health unit offered by Dr Helen Ackland. Far from being a disadvantage, the project’s supervisors, Dr Bernadette Ward and Pam Harvey, welcomed the legal perspective Katherine could bring to the project. She was in.

Through an audit of patients who had had an over-75 health check at the Bendigo Primary Care Clinic, the project team was looking for a correlation between chronic diseases and where advanced care plans were in place.

Multi-disciplinary team L-R: Pam Harvey, Katherine Allman, Nidhushie Tilak Ramesh, Dr Bernadette Ward, Dr Dennis O'Connor


Complementary skills

Interdisciplinary skills led to a natural split in the research tasks as Katherine worked closely with a final year medical student. “It was great fun. Nidhushie [Tilak Ramesh] was fantastic.” During the audit, Nidhushie was able to group patients into one of the eight chronic disease categories identified by the Australian Institute of Health and Welfare. “Having her able to do that and me not having to Google everything was brilliant.”

Katherine brought a completely different perspective. “We were reading through the literature, not just looking at the patients medically, but also legally: Who were the patients? Were they more vulnerable people?”

On the clinic’s side she was asking: “What are the obligations of a GP under the new legislation that will be introduced in March next year? What are the implications for best practice? Really trying to understand the tension between the demands of working in a GP clinic, but also trying to do the best thing for your patient,” she said.

Her ability to interpret legislation was valuable as was her training in statistics. “I basically become the stats monkey because I’d done quite a bit of stats training through my biomed degree. I did a lot of work with SPSS doing the data analysis, so I got very familiar with that. That was good to refresh those skills.”

Her law skills came into play most in the final analysis looking at how it all fitted into the framework. How do they make this meaningful?


Advanced Care Planning close to home

Katherine has firsthand knowledge of advanced care planning. “My mum has just been through making an advanced care plan. She’s had a few unexpected turns with her health in the last 12 months. So we’d gone through the medical power of attorney, all the ‘person responsible’ things as well as looking at getting an advanced care plan put into place for her. So it was something that was quite close to home, but because of that it had really inspired me to learn more about it because there’s not a lot of public awareness there.”

The research project also tapped into what she’d learned during a student project on euthanasia and the law. In Australia, she points out, death is a big taboo, so there is not much research around death. “The heavy lifters are really the US and Netherlands. When you come to Australia, everything is in the ICU and a little bit in emergency, which is where you’d expect it to be because they’re more the end of life stages. Nothing’s been done in a GP setting.”

Staying focussed

It’s a new field in Australia and as someone whose interests are so broad, Katherine found it easy to stray into related areas that intrigued her. “It’s very important to have a clear idea of what you want to achieve,” she laughed. “The time you’ve got, the funding you’ve got; you’ve got to come back to that one original idea.”

That focus enabled the team to come to some conclusions based on the data they'd collected. “Despite a government push for ACPs, medical powers of attorney are still predominant,” she said. They were also able to make recommendations about the need to review advanced care plans all along a patient’s health journey. Katherine’s final task was to draft an article for possible publication. “We’ve written the method we used in a way that we hope can be replicated in other clinics,” Katherine said.

While she’s leaning towards a career in health policy, Katherine has always been interested in medicine. Now she’s considering extending her studies to tackle graduate entry medicine. Whether she does end up in medicine, Katherine has at least proved that the “closed shop” reputation of research scholarships in the Faculty of Medicine, Nursing and Health Sciences is undeserved. Other disciplines have a lot to contribute to health care research.

Tuesday, 28 February 2017

First cohort of medical students starts in new Bendigo hospital

Thirty medical students have embarked on a full year of  clinical training  in the new Bendigo hospital.

Director of Monash Rural Health, Associate Professor Chris Holmes, said the students are part of a total cohort of over 150 second to fifth year students who will undertake placements in Bendigo this year, which also includes students from the University of Melbourne.

Thirty students from Monash Univesity and the University of Melbourne have started a full year's clinical training at the new Bendigo hospital.


“We have a unique program in Bendigo where students from Monash University and the University of Melbourne spend their first year of clinical training together at the Bendigo clinical school and in the Bendigo hospital,” said Associate Professor Holmes.

“University of Melbourne students also undertake shorter placements in Bendigo later in their training, once again learning alongside Monash students.”

The program introduces students in their second year to rural and regional medicine, and runs clinical training placements for students right through to the end of their studies.

“We know that a positive experience training in regional and rural areas does influence where students choose to practise when they qualify,” said Associate Professor Holmes.

“We hear so often that students love their regional placements; they get lots of hands-on experience and are treated as part of the team by clinicians who know their names and are willing to spend time with them.

“They enjoy it so much we see many of them come back as interns once they graduate.”

Of the 39 interns who began at Bendigo Health this year, 15 are Monash students and six, University of Melbourne students who studied at Monash Rural Health Bendigo.

As well as Bendigo Health, Monash Rural Health partners with hospitals, GP clinics and community health providers from Mildura all the way to Orbost.

The current program delivered by Monash Rural Health Bendigo and Bendigo Health is now in its fourteenth year.