Monday, 19 February 2018

Horse vet turns to medicine

Final year Monash medical student Carl Barker is adamant that he’s not interested in obstetrics and gynaecology. “I've done enough foalings!” Carl worked as a horse vet – largely in the racing industry based in Geelong treating Melbourne Cup winners – before deciding on a change of career.

Carl Barker worked as a horse vet for eight years before deciding to study medicine

A draining occupation

“[Being a horse vet is] a ridiculously physical, mentally draining occupation. Just being out in the sun, handling 500 kg horses, getting kicked … being exposed to radiographs. We'd take more x-rays some days than what they would do in Bendigo Health.” As difficult, he found treating million dollar horses for millionaire owners unfulfilling. “I'd much prefer to treat a little sick pony who'd got colic; something that actually needed to be seen as opposed to making race horses win races.” Recognising signs of burnout, his partner helped him realise that he couldn’t continue. Why don’t you study medicine? she asked.

Medicine not possible for people of my background

Growing up one of eight kids on a Queensland vegetable farm, medicine was not a career he’d ever considered. “I didn't think being a doctor was even possible for people with my background.” Carl’s parents still don’t understand why he’s doing medicine so he feels it’s really important that rural medical training programs target kids with his background to show them it’s possible.

But Carl knew he didn’t want to take up farming. At 13 he went to Brisbane to play soccer at Cavendish State High School and boarded with seven families until he completed year 12. One particularly difficult situation was a turning point. “I just stayed in my room and I started to study. I went from getting average marks to getting super high marks.” Despite a guidance counsellor telling him he wasn’t smart enough, he’d decided he wanted to be a vet and he succeeded in getting into a veterinary course.

Learning to learn again

Going back to study medicine after eight years as a vet, he’s had to learn how to learn again. “I walk into the hospital and know that I might be older than a lot of the doctors there, but I just have to accept that I don't know anything compared to what they know.”

But he hasn’t yet walked away from being a horse vet. Continuing to work weekends and university breaks has been a boost to his self-esteem as much as his finances. “You know you help a lot of clients, they really respect you, you're an authority on your area of interest.” And he enjoys being part of the team he works with at the Bendigo Equine Hospital despite his ambivalence about the industry. “I feel kind of bad for leaving the veterinary industry because I'm needed as a horse vet … but all my friends who are horse vets, they're really happy for me that I've got out of it.”

Doing what I love and getting paid for it

With an interest in urology, general surgery and general practice, he’s considering being a GP proceduralist. He’s also looking forward to earning in his new career after five years of study. “The truth is as an intern I will be on the equivalent of what I was on as a vet who had eight years of experience.”

He’s quite pragmatic about his motivations. “Money is important and I think anyone who says that money's not important obviously has never had a need for money. Am I going into medicine for the money? Yes, but I'm also doing it because I'm doing what I love and I'm going to get paid for it.” He has no interest in a big city. “I feel like I'm not needed down there. I can relate to farmers.”

Tuesday, 28 November 2017

Opportunities for families needed to encourage GPs to work rural study shows

Regional investment in strong local secondary schools and supporting professional employment opportunities are just as important as individual financial incentives to encourage GPs to work in rural areas a new study by Monash University researchers shows.

The needs of children and partners are a major factor in whether GPs choose to work in a rural location

The study was the first systematic, national longitudinal study of Australian GPs to show that the needs of children and partners rank highly in GPs’ choice of work location – and the influences on their choice vary depending on the GP’s gender.

Study author, Dr Belinda O’Sullivan, said Australian, Canadian and US studies consistently identify these two non-professional factors – children’s education and partner employment – as major barriers to GPs choosing rural locations to work. “This study supports those findings and shows further that their influence is dynamic over the course of a GP’s career,” said Dr O’Sullivan. “Most GPs have a partner and school-aged children at some stage during their career, so these factors need to rate highly in policy efforts to redress the maldistribution of GPs.”

Drawing on data gathered between 2008 and 2014, the research found that 45 per cent of GPs had at least one school-aged child, 30 per cent had at least one child of secondary-school age, and two-thirds had a partner in the workforce. The interesting thing was how their school-aged children and partners in the workforce affected male and female GPs' decisions to work in a rural location differently.

Male GPs were just as likely to work rurally whether or not they had pre-school or primary school children. However, those with at least one child in secondary school were consistently much less likely to work in rural areas. Female GPs with children, on the other hand, were consistently less likely to work in a rural location no matter what age their children were.

“It seems likely that female GPs make a choice about their work location when their children are younger, perhaps to enable better access to family and other supports,” said Dr O’Sullivan. “Enabling improved professional employment opportunities for their spouse or partner also seems to be a factor.”

Here again, gender differences were apparent. Having a partner in the workforce was not associated with work location for male GPs; however, the opposite was true for female GPs. They were less likely to work in smaller rural or remote towns than female GPs without a partner in the workforce.
“It is possible that partners of female GPs have less flexible professional roles, or have specific skills and interests more suited to work in metropolitan or larger regional towns than partners of male GPs, who may be more flexible with career skills and interests,” said Dr O’Sullivan.

The study’s implications for attracting GPs to rural areas and keeping them there are broad-ranging. “While it is still important for rural workforce planners and employers to pay attention to meeting the professional needs of GPs, they also need to think about meeting the changing educational and employment needs of the GP’s family which vary by gender and the age of their children,” said Dr O’Sullivan. “Having a deeper understanding of the likely family needs of different GPs may enable rural communities to better target their marketing, recruitment and retention of doctors. Where those needs can be met by existing community employment and educational infrastructure, chances are the GP will stay longer.”

‘Family effects on the rurality of GP’s work location: a longitudinal panel study’ was published in Human Resources for Health.

Thursday, 23 November 2017

New training pathways aim to keep doctors in north-west Victoria

Dr Tim Chimunda thinks ADHD traits can be put to good use and as the new director of the north-west Victoria regional medical training hub, he’s out to prove it.

Dr Tim Chimunda is working on ways to keep young doctors working in the region.
To his work as an intensive care specialist at Bendigo Health, he adds a family, a full agenda of networking and study, and his new job with Monash University supporting new training pathways to keep junior doctors working in the region.

Regional pathways for specialist training

Monash has been training students in Bendigo for 25 years. Many have chosen to come back and work. Others find it hard even if they want to stay as training opportunities in their chosen specialty often aren’t available here, so they go back to Melbourne and often don’t return. Tim’s role is to create linkages and clear pathways for students who want to stay right through their undergraduate years into specialty training opportunities. He’ll be working with local health services, medical colleges, government and community stakeholders to develop training positions in areas of specialist need and supporting those services to develop the education and supervision skills they’ll need to nurture students and junior doctors.

The new training hub that he heads up is based at Monash University in Bendigo and the work extends up to Monash’s training site in Mildura. The hub itself is an expansion of Monash’s existing Commonwealth-funded role hosting medical, nursing and allied health students on rural placements to make sure rural and regional Australia has the health workforce it needs.

From Zimbabwe to Australian medical education

Tim has wide experience working in regional Australia. “I’ve been everywhere,” he laughed. “I feel like the song!” But he started his working life in Zimbabwe where he was born. For political reasons he found he had to leave the country which had become very difficult. Through the efforts of his patients he finally arrived in Australia in 2005.

Australia’s training requirements saw him travelling up and down the east coast working and training in emergency medicine and intensive care – and discovering an interest in medical education. “During that time I was looking after the international medical graduates and working with AHPRA [Australian Health Practitioner Regulation Agency] to get them enmeshed into the Australian environment. I’ve been doing that for the last ten years with a lot of IMGs that would come across. I was active with assisting them with their AMC [Australian Medical Council] exams.” He was also working with Australian medical students as a lecturer with the University of Queensland and later with the University of Melbourne.

Research can keep young doctors engaged with regional centres

But it was while studying for a postgraduate critical care fellowship certificate in intensive care medicine at the University of Toronto in Canada that Tim discovered his other passion: research. An important aspect of Monash’s work, Tim also sees research as another means of getting students and young doctors engaged with regional centres like Bendigo.

“If you join a new ecosystem and it’s a food chain, you need to know where you fit in. And if there’s no space created for you, there’s no fodder… you’ll starve out and therefore you’ll move on just like a herd on the savannah.”

But as the owner of a clinical research project while a member of a clinical team, he suggests junior doctors are more likely to stay. “When you feel that you are just there as a paper handler or clerk, there is no pull to keep you there. Whenever you are valued, you feel appreciated, you feel like you belong and therefore you can visualise yourself staying longer.”

Tim cited the student who has been working with the ICU team. “As a result of the relationships that we’ve built up with her, she now wants to do ICU or emergency. Now the question is asked: How do I create a pathway for her to stay, train and then go and have some tertiary time and then come back to us – because that doesn’t exist [at the moment]?” That’s precisely the challenge the regional training hubs have been set up to meet, building on Monash’s long-time work introducing students to rural practice.

A commitment to bring two "kingdoms" together

Tim doesn’t see his roles at the hospital and university as separate, but rather intertwined and interlinked approaches to the same goal: keeping doctors by training them in the region from undergraduate to specialist. And he’s working to bring the two institutions closer together through this relationship. “I’m like a hybrid child married from one king to another to ensure the kingdom’s longevity.”

In the meantime, he and his wife are expecting another child and looking to build in Junortoun. For a few years at least, Tim is committed to Bendigo, but the frenetic pace fuelled by those ADHD traits is unlikely to slow.

Wednesday, 22 November 2017

Medical student on an education mission

Zak Doherty
Zak Doherty is on a mission to bridge the gap between public and private schools – one student at a time.

The Hamilton-born medical student has spent his first clinical year in Bendigo gaining experience in the Bendigo hospital. In his spare time, he’s also been tutoring Bendigo secondary students as part of The Smith Family’s senior secondary tutoring program. Along with a core group of four other medical students, once a week he’s been helping Year 11 and 12 students who receive Smith Family scholarships with their homework.

The public school disadvantage

From his own experience, he knows that students in public schools often lack access to specific exam strategies. “In my high school, we didn’t have those teachers who knew exactly what to teach for the exam because they had never marked them. The teachers were great, but if you don’t have that extra bit of knowledge, you don’t have it.”

He remembers asking a chemistry teacher from Melbourne, who was in Hamilton for revision lectures and who had written and marked VCE exams, to look at a practice exam that Zak had attempted and marked himself based on published marking criteria. The results were quite different. That was when he realised that other – unwritten – criteria were at play. “I thought: well I’d better try and work out all these things. I worked out some of them, and I figured I’ll teach the [Smith Family] students that sort of thing to try and close the gap.”

“I know that students everywhere get lower marks than students at private schools. They might be smarter, they might work harder, but they just don’t have that education environment or that teacher that marks exams. I’ve got the knowledge, I guess I can impart it to them. It’s just a little thing that I figure kind of reduces that inequality.”

Secondary students gain confidence

The secondary students did gain confidence over the course of the year. At the start of the year, Zak recalled that two girls he’s tutored in biology wouldn’t know how to approach a question about a topic they weren’t sure of, or they’d simply give up. “Now it’s nice when they do practice exams, they don’t just switch off when they see something they don’t know. They actually have a crack at it. And they think about things differently. I think that because of that, they’ll do better than they may have otherwise.”

Zak said he loves teaching and even considered it as a career. His favourite day in Year 11 was when his maths methods teacher was absent. “I loved maths and I was pretty good at it because I loved it and worked hard.” His fellow students asked him to take the class and reported that they’d learned more in his session than the rest of the year. “I know – it sounds like I’m pumping up my own ego,” he said chuckling.

Love of numbers leads to a research year

His love of numbers has led him to take a year off from his medicine studies to undertake an honours research year in 2018. He’s investigating a question of his own interest using the code blue database to look at the long-term outcomes of patients who have suffered a cardiac arrest in hospital. It’s already known that only one in six patients who experience a cardiac arrest will leave hospital. “But the data once you leave hospital is a bit patchy. No one cares about leaving hospital; they care about what their life will be like when they leave. And that’s what matters.”

After three years of study, he’s looking forward to the change. “I get to do placements in the ED and ICU, which is where I hope to work in the future, so it’s something I’m very excited about. I kind of got sick of just learning and doing exams. It’s nice to actually create something.”

Tuesday, 21 November 2017

Warragul paediatrician heads new push to keep young doctors local

As a young paediatrician, Michael Nowotny, and his new wife Jo, wanted to do something fun. So they moved to Darwin.

Dr Michael Nowotny
It’s perhaps not so surprising a decision given his peripatetic childhood. With his diplomat father, Michael spent years travelling between the UK, Switzerland, and Thailand where he went to school with the children of American service personnel during the Vietnam war.

A long way from Vietnam, Darwin still had its own challenges. While Jo studied law, Michael worked as one of three junior registrars at the Royal Darwin Hospital. “It was a very busy unit and in the wet season it was crazy because we had really, really sick Aboriginal children come into the hospital all the time. We worked really hard, but developed good independence, problem solving skills, and learnt how to deal with finite resources.”

Stemming the doctor drain

It’s those sort of learning opportunities that the Warragul-based paediatrician wants available to junior doctors in Gippsland. It’s why he agreed to head up the Gippsland Regional Training Hub, one of Monash University’s two new regional training hubs that are working to create clearer pathways for medical graduates to do their specialist training in rural and regional Victoria. “Despite being fully committed, I couldn’t pass it up,” he said.

The drain of junior doctors from regional areas takes place between their second and fourth years after graduation he explained. “That's where we really lose most trainees. There are really good opportunities for interns in Gippsland through a couple of well set up intern training programs.” But after that training opportunities all but vanish.

“Junior doctors who would like to stay in a regional area can't because there aren’t many training opportunities for them. These are really, really committed young doctors who have often have come from the region that they're working in, who would like to stay, and who would potentially like to work in the region long-term. Unfortunately once they're attracted out of the region and move to alternative regions, meet people in the region and partner those people, it's very hard to get them to come back.”

A passion for rural practice

It was an opportunity twenty years ago – and family ties – that eventually drew Michael and Jo to Warragul from Darwin after seven years. With Charles Hamilton, Michael established a paediatric practice that quickly grew from the two of them to five practitioners. Education was an important focus of the practice right from the start.

With his practice co-located with the Warragul hospital he teaches in both his rooms and the hospital. Monash University medical students in their second clinical year, advanced trainees, two senior registrars, a general practice trainee and a rotating basic trainee from the College of Physicians are all there gaining experience in a “really busy training space”.

“I think it's important to try and encourage young doctors to come to rural places because the experience and enjoyment of being in a rural place is just wonderful. It's very different to working in the city. I'm really passionate about that component of what I do.”

As well as teaching in his practice and the hospital, Michael is head of paediatrics assessment with the College of Physicians. “I felt that it was important to be involved in the college because it has given me a lot over my training. And mentoring young doctors is really important to me particularly in the rural space. I am trying to be a rural voice to assist in making people understand how good it is to be working in a rural area.”

It’s an enjoyable lifestyle as well. Squeezed around his paediatric practice and teaching commitments, Michael plays the odd game of golf, and runs cattle on a 40-acre farm near Warragul where he and Jo raised their three children. The farm might see a little less of him as he sets the foundations for the postgraduate training hub.

Training hub to draw networks together

The initial phase has established a number of new advanced training positions in the region, but Michael sees the hub’s role as much greater: attempting to draw together existing groups who have been working to set up regional training networks. “That's what I feel is probably my most important role if we can do it: to try and get all the various groups around the table and see what we can do to advance networking of – not only existing training opportunities – but trying to create new ones.”

Education at all levels is close to his heart. “My son is a Monash medical student and I have tried to instil in him and to my students how important it is for them to pass on their knowledge to the next generation. I was beautifully mentored when I was a student and a trainee, and hope that my trainees feel mentored and supported. I want the next generation to feel that is part of their role.”

Friday, 3 November 2017

Medical students help raise secondary students’ aspirations

Bendigo-based Monash University medical students have been recognised for their voluntary contribution to The Smith Family’s senior secondary tutoring program this year at special presentation in late October.

Confidence inspiring: Monash medical students have been working with Smith Family scholarship students to raise marks and aspirations. L-R Ravali Gaddam, Lachlan Elliott, Zakary Doherty,  Dayle Howlett, Liam de Vries.

The program provides Smith Family scholarship students in years 11 and 12 with homework support and ultimately aims to lift students’ aspirations and improve their confidence. Up to 23 secondary students took part in this year’s tutoring program in Bendigo, working with a core group of five Monash medical students.

From a solid fail to a pass

Year 11 student Tia Hendry said without the tutoring program she’d have struggled this year. “You’ve helped me go from a solid fail to a pass,” she said of the medical student tutors. Although she’s not certain what she’d like to do on finishing school, Tia is now thinking about studying health professions at La Trobe University.

Year 12 student Reza Azimi knows exactly what he wants to do. Reza sought help in Maths Methods to lift his ATAR result so he can get into law and global studies at Monash University. Year 12 student Genevieve Somerville is also focused on her goal: to study a Master of Dietetics at La Trobe University. She was grateful for the exam tips the medical students were able to pass on.

Why should regional students be disadvantaged?

Medical student Zak Doherty, who volunteered his time for the tutoring program, is determined to pass on exactly that kind of information. Hamilton-born Zak has spent his first clinical year in Bendigo gaining experience in the Bendigo Hospital and he remembers very well how disadvantaged country high school students can be. “Why should those students be disadvantaged because they don’t go to that flash private school in Melbourne?” he said. “In medicine you typically require really good marks to get in and I see people who didn’t get in from my school that probably should have because they didn’t have that teaching advantage. It’s just a little thing but if I can reduce that inequality … close the gap a bit, that’s a good thing.”

A previous Smith Family scholarship student herself, Dayle Howlett grew up in Rosedale in Gippsland. She has also spent the year studying medicine in Bendigo and tutoring in her free time. “A lot of it is encouraging them to keep going because it’s very tiring being a VCE student,” she said. “I really enjoyed teaching – it’s a stress release for me to be able to explain something I’m comfortable with.”

Investing in education benefits everyone

Bendigo program coordinator Lia Comodo said one in seven Australian children and young people grow up in disadvantage, which can limit their opportunities and outcomes in life. “Investing in education support gives students from all backgrounds the chance to succeed in their studies and opens up their future pathways,” said Ms Comodo. “A program like this not only delivers long-term benefits for the student but also their family and the wider community.”

Tuesday, 31 October 2017

Finding the courage to shift careers

Yiran ZHANG realised early in an economics degree that she really wanted to study social work.
Two years into a  master’s degree in economics at the University of East Anglia in the UK, Yiran ZHANG decided that what she actually wanted to study was social work.

She had seen two videos by social work researcher Brene Brown which aroused her interest and she started to realise that there were many vulnerable people who need help. But while she could see a need, the courage to make the change came from her Christian faith, ignited while she was studying in the UK. “It changed my way of thinking about a lot of things. This faith made me stronger, there is a voice in my heart to encourage me during these years,” she said. She could see a future for herself that didn’t involve working in a bank or a consulting firm.

Concerned that it was just a whim, her parents encouraged her to continue with economics. If she still felt strongly when she completed her master’s, they said, then she should follow her dream. “When I finished my Master of Economics I still had really strong feelings that I want to be a social worker in the future and help people. So here I am in Australia studying my second master’s – in social work,” she said.

When you’re in your early twenties, she feels, you’re going through a process of self-discovery and she’s very glad she persisted. “I’m settling down, I know what is the purpose of my life, what I want to do in the future. I’m not worrying about what I’m going to do.”

Now four weeks into a three-month research placement in Moe, Yiran will be working with Monash University Department of Rural Health researchers mainly on the Hazelwood Health Study. She’s not daunted by the prospect of three months in a small country town.

She was keen to go to a rural area when she saw this opportunity. “I kind of want to explore a different place. When I was in the UK I lived in the countryside, so I really wanted to go to a rural area because I’m really quite new to Australia. I want to know how people live in a rural area and also the small community makes me feel really safe.”

Her research topic for the master’s theory unit that preceded her placement explored post-disaster and gender inequality. “This is the sort of thing I always wanted to do Here we’re doing the Hazelwood mine fire study. It’s also related to this area.”

So far, the placement has been focussed on learning the practical aspects of research but she’s looking forward to going to the local schools to start interviewing students in the next couple of weeks. “Here everyone is really friendly and there’s a lot of support. If you have questions, you just ask – it’s really good.”

Long accustomed to studying away from home, Yiran sees the positive in spending three months on placement. “I think you spend three months in a rural area you’re going to be really close to your colleagues and friends around you. You get more of a chance to know each other,” she said.