Tuesday, 24 April 2018

Length and type of rural experience shapes graduate doctor destinations new research shows

When it comes to attracting graduate doctors to the country, new research has found a link between the length of time and place that students undertake rural placement, and their longer-term decision to consider a rural career.

As part of the curriculum across all Australian medical schools, students are required to undertake rural immersion programs designed to steer graduates into the rural workforce. But until now there has been limited research about how the design of these immersion programs affects rural work outcomes.

Monash University research published today in Medical Education has revealed the impact of these programs – showing the longer students spend undertaking rural medical school training, the greater their chances of choosing a rural career. Students who completed up to three years of rural placement were significantly more likely to pursue rural work.

The study also found a positive correlation between student placements in both regional hospitals and rural general practices. More than one years’ immersion in a mix of regional hospitals and rural general practices was associated with the increased likelihood of students going on to rural work.

The study’s lead author, Dr Belinda O’Sullivan, Monash School of Rural Health Bendigo, said a combination of longer rural immersion and experience in both regional hospitals and rural general practice was a good model.

A new study shows a link between students who spend time in both rural or regional hospitals and GP clinics and those who choose a rural or regional career. 

“The evidence suggests that getting students to do longer placements where they gain experience in both regional hospitals and rural general practice has the strongest outcome in terms of graduates going on to work in rural and regional Australia,” Dr O’Sullivan said.

"It might be that diverse clinical, rural and regional exposures over time helps in developing a stronger sense of security in rural practice, giving them the networks and professional mentors they need for effective rural practice.”

Dr O’Sullivan said that findings could inform government in the design and structure of rural immersion programs as it outlines the most effective strategies for encouraging graduating doctors to ‘go rural’.

“We knew that medical students often returned to rural areas given some rural immersion, but we weren’t able to pin down the effects of longer duration and immersion in different settings, or whether these factors affect students working in smaller communities. This study drills down into this nuance and will help universities and government in program design, as it points to the most effective strategies for encouraging graduating doctors to ‘go rural’,” Dr O’Sullivan said.

Head of Monash Rural Health, Professor Robyn Langham, said the findings were highly relevant given that rural medical workforce issues will continue to be a major challenge in the coming decades.

“This study supports the understanding that rural medical school immersion programs play a key role in bolstering doctors for rural and regional communities. By better understanding the variety of pull and push factors influencing medical workforce distribution, including the impact of student rural experience and rural program design, educators and policymakers are in a better position to make informed decisions that bring benefits to all,” Professor Langham said.

Thursday, 19 April 2018

Summer research students help Latrobe Health Assembly

Three Monash University students have given up six weeks of their summer break to build community understanding of health issues in the Latrobe Valley. The two medical and one humanities students helped conduct interviews with school children for the Hazelwood Health Study late last year and returned in January to provide the newly-formed Latrobe Health Assembly with information about specific health issues in the Valley.

Research relevance: One humanities and two medical students prepared reports on nine topics requested by the Latrobe Health Assembly. L-R Naish Gawen, Esther Johns, Melissa Bruerton (students), Dr Matthew Carroll (supervisor), Monique De Carli (LHA Projects Coordinator), Ian Needham (LHA Executive Officer)

Filling an information need

Latrobe Health Assembly Executive Officer, Mr Ian Needham, said the issues the students worked on had been identified by the Assembly’s working groups and strong community-led discussion looking at local health concerns in the Latrobe Valley and possible solutions. “We gave the students a variety of topics to help us find out find out what was known and background data and information,” said Mr Needham. “They presented us with reports on each topic and the information will be really useful.”

The topics were: asthma, chronic disease, dental waiting times, ice use, young mothers, community-led playgroups, community safety and domestic violence, public housing and barriers to internet access.

Talking to a non-academic audience

After a week’s training in November in interviewing and research skills, the students got to work. In writing their reports, the students had to learn new ways to communicate health information to a non-academic audience. One of the medical students, Melissa Bruerton, remembered the first report she wrote was very formal and complex. “But we made summaries to make it accessible to all members of the community,” she said.

Taking part in the research project also proved a revelation for her. “I've lived in the Latrobe Valley my whole life pretty much, but to actually do this research, look at the statistics and see what's going on, it's been really eye-opening,” she said.

Naish Gawen brought a different perspective to the work, drawing on his background in humanities and the interest he’d developed in interviewing people. Once again, the need was to make complex topics accessible.

“Especially with the sorts of topics we were doing, it's as much about being able to communicate issues as it about any kind of knowledge of statistics. Just about being able to read academic articles and process that information in a way that's going to be meaningful to people,” he said.

Latrobe Health Assembly: community involvement

Formation of the Latrobe Health Assembly was one of the key recommendations from the Hazelwood Mine Fire Inquiry. With a very strong community cohort on the 45-person Assembly, the concept is to have much more community involvement in identifying health and wellbeing issues, with community taking a lead role in also seeking long term solutions. The Latrobe Health Assembly plans to employ a planning and research officer this year and Mr Needham said the reports will give them an excellent starting point. “But we’re also happy to continue this relationship with Monash if the resource is available in the future,” he said.

Learnings about research

For the moment, all the students are focussing on this year’s study demands.Melissa is spending the year at Sale hospital undertaking her first year of intense clinical training, while Naish is doing honours in English literature. The experience this summer has caused him to reflect on the purpose of his research.“It has made me realise the importance of meaningfully connecting academic research work with people's lives,” said Naish.

Wednesday, 18 April 2018

Year 1 medical students: meet Bendigo and Mildura

A new generation of prospective rural doctors made their first visit to Bendigo and Mildura on Wednesday 18 April 2018, as part of Monash University’s long-term program to fill rural doctor vacancies.

Taste of Bendigo: Year 1 students take part in a simulation training exercise.
The 32 medical students began their studies in Melbourne in March, and will spend up to three years training in Bendigo, Mildura and towns throughout north-west Victoria.

Director of Monash Rural Health Bendigo, Associate Professor Chris Holmes, said the Extended Rural Cohort program which the students are part of particularly targets applicants who are from regional or rural Australia or have an interest in working there.

“It’s well known that medical students who come from rural areas, and any who are provided rewarding rural and regional placements are more likely to consider a career in rural practice,” said Associate Professor Holmes.

Mildura Academic Coordinator, Jenny Timmiss agreed.

“This visit aims to start that rewarding experience very early in their student career.”

Hosted by Monash medical students on placements in the Bendigo and Mildura hospitals, the new medical students will tour the hospital and student accommodation, take part in a simulated exercise in Monash’s high-tech simulation centres, and go on a walking tour through popular parts of Mildura and Bendigo.

Taste of Mildura: Year 1 students toured some of the sights as well as the hospital and Monash training facilities.


“In this short visit we want to make them feel part of the Monash Rural Health family right from the start of their studies,” said Ms Timmis.

“While these students are focussed on their foundation theory studies for the next two years, they’ll know what sort of welcome and opportunities await them here.”

Monash Rural Health has been training medical students in Bendigo for over 25 years and Mildura for over 17, with many of its graduates taking up rural practice all over Australia.

The aim of Monash’s regional and rural programs is to showcase the rewarding career and lifestyle opportunities available outside metropolitan cities and encourage graduates to return.

Friday, 23 February 2018

$1.25 million keeps VicMeth study going for another five years

Since 2016 Monash Rural Health has been working with the Burnet Institute on the VicMeth Study. Now the study will continue for another five years with an NHMRC grant of $1.25 million. Monash Chief Investigators Dr Bernadette Ward and Dr Keith Sutton have been overseeing data collection in northern Victoria and Gippsland respectively.



There has been a lot of media coverage regarding methamphetamine (ice and speed) use and related harms in Australia in recent years, with a particular focus on regional and rural areas. However, an overall lack of data limits understanding of what is actually happening in the community. In the Murray PHN catchment for example, there are no population data about patterns and prevalance of use. It’s also not clear if the characteristics of meth users in rural areas are the same as capital cities. Nor is there much evidence to support media reports about an “ice epidemic”.

The VicMeth Study was set up to collect data on long-term patterns of methamphetamine use, including what causes people to start and stop using over time, the types of services that they use (e.g. GPs, ambulances, drug rehab), and the types of services they wish to access for help. Without these details, services can’t be improved and we don’t know the best time to intervene and prevent people transitioning to more problematic use patterns.

While the regional data from phase one of the study is being analysed, and in the absence of peer reviewed literature, Dr Ward and researcher, Madeline Clark, published a review in August 2017 for the Murray PHN of “grey literature” to gain some sense of meth use and demand on services. The report is available online.

Med-Toring opens a world of health careers

Bella Collett thought she was working hard towards a career in medicine until last year’s Monash-sponsored mentoring program for secondary students opened a world of other options. While she’s now settling into a business administration traineeship with Monash Rural Health Mildura having deferred a place in a radiography course, a year ago she was feeling anxious about her future.

The Med-Toring program gave Bella Collett a new look at health careers - much to her relief.

What do I do if I don't get into medicine?


“It's so hard to get into medicine. I thought if I don't get in, what am I going to do with my life? I didn’t know until the Med-Toring program that there are other options.”

Med-Toring invites Year 11 and 12 students at Sunraysia secondary schools to a monthly session that provides information about health careers.

“I absolutely loved it and met these incredible med students that I ended up looking up to.

“At school, we had presentations from people from university saying, medicine's a really great thing to do, how you get in, whatever. But these are students who are actually doing the course right now. They could tell us exactly how it is right now. They're just like us. They're a bit older but, we can relate to them a lot more.”

Passionate radiographer: could this be for me?


The program gives students a taste of clinical skills such as wound stapling using ham steaks and plastering, and helps them with study strategies and university applications. But it wasn’t only fun clinical activities and encouragement from the medical students. Nor was it only about medicine.

At the start of each session a different health professional practising in Mildura would give a presentation; among them, paramedics, audiologists and, importantly for Bella, a radiographer. Isobella remembers that the visiting radiographer talked passionately and happily about her job, telling exciting stories.

“My ears kind of perked up and I thought, maybe this could also be for me?”

“I remember coming home and just sort of breathing a sigh of relief and going - thank gosh there's other options out there for me that I genuinely think I'll love.”

There are other health careers out there


It was an eye-opener for someone who’d aimed diligently for academic excellence in pursuit of a medical career.

Bella grew up on a farm in Nangiloc about 50 km south-east of Mildura, but the family moved to Mildura when she started high school so she didn’t have to catch two buses to get to school.

“Mum always said: what we put into life is what we get out,” she recalled. So she’s always thrown herself into study and sport. A keen tennis player, she represented Victoria at national events, but she was always committed first to her studies, even when she was away playing tournaments.

Dedication alone wasn’t enough to show her alternative career pathways, though. She’s not sure radiography will be her final career, but it’s a good start.

“I can’t say how much the [Med-Toring] program benefited me. All year I was kind of tossing and turning about medicine, but I kind of stuck with it. I thought it would be the only fulfilling job for me. But you know, there are other things out there.”

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.