Wednesday, 24 August 2016

How a long rural stint landed an exciting Melbourne job


Be willing to try anything: Dr Tom Brough and friends
It saddens Monash graduate, Dr Tom Brough, that many students worry that a stint outside a big city will damage their career prospects.

“It’s really about merit, not geography,” he said. “If you’re interviewing someone who’s experienced a whole range of things, they’re going to be a far better employee than someone who’s never left Prahran.” If you’re good enough, he tells students, you’ll get the job you want.

A willingness to step outside his comfort zone and try new things characterises Tom’s career so far. You’ve got to grow your wings, he tells medical students. You’ve got to exercise all your muscles or you’ll find the ones you’re not using have atrophied. It’s advice he takes to heart.

A crooked career path

Not long before he started his first post-internship job with a city hospital, Tom Brough received an offer from the army to accompany Operation Astute to East Timor. “I never actually went to the city,” he said. “I ended up in Dili for nine and half months instead.”

After his stint as a senior military medical officer with the stabilisation force, he found himself back at Bendigo Health where he’d completed his internship and much of his student training. Working in the emergency department he realised his “calling” was in emergency medicine. So he joined the Australian College for Emergency Medicine.

In the past, trainees could only do 12 months in Bendigo. Now the college recognises that the hospital has a good case mix, so most of his training can be done in Bendigo. The long-time Bendigo resident, only needs to spend a minimum of six months in a tertiary hospital. “Which is not a bad thing,” he said.

As well as his studies to become an emergency physician, Tom is working on a Master of Clinical Ultrasound with the University of Melbourne. “It’s a bit of a cliché – the Monash graduate is always learning – but it’s true.”

Teaching what it's really like to practise

His interest in learning extends to mentoring students. This year he took time out from full-time work to teach Monash students in their first and final years of clinical training about managing deteriorating patients. He wanted to share his enthusiasm for clinical medicine and what’s actually being practised – which can often differ from text books – through simulation learning.

“You definitely get more hands-on experience in a regional hospital. But a hospital isn’t able to have lots of medical students around all the time,” he said. “A simulated training environment is safe and welcoming. You can make mistakes that you can’t in the real world, so you don’t miss out on learning that lesson. And it’s fun!”

Originally from rural Queensland, Tom started a law degree in Brisbane before switching to medicine at Monash. That experience of moving interstate away from his family to study developed a strong sense of independence and confidence in taking on new experiences. He recognises that stepping outside your comfort zone is hard. “But if you’re starting from scratch, the world’s your oyster because you’ve got no baggage.”

Follow your heart

Ever keen to take on new experiences, Tom successfully applied for job in adult retrieval services earlier this year. It meant a move back to Melbourne, but he took that in his stride.

You’ll be a doctor for a very long time, he advises students who worry about whether a decision to go rural will damage their career prospects. You should do what your heart wants.

Friday, 5 August 2016

School pincipals face alcohol dilemma

School principals need support to manage tensions over whether to make alcohol available at events where children are present.
School principals are torn between their duty of care to students and a strong culture of alcohol consumption at social gatherings when deciding whether to allow alcohol at school events where children are present a new study has revealed.

Lead researcher, Dr Bernadette Ward of Monash Rural Health, said the study of 14 Victorian schools (half in Melbourne, half in rural/regional Victorian) showed it was a serious challenge for principals to operationalise their role in contributing to changing the alcohol culture in the Australian community.

“One of the principals reported receiving death threats from a parent over the school’s policy to run a dry deb ball,” said Dr Ward. “The situation became so ugly, the school stopped running deb balls.”

In Victoria, the Department of Education and Training has guidelines, but ultimately the decision whether to serve alcohol at school events rests with the principal or school council and it is not only parents who make it difficult.

“Several principals reported concerns expressed by staff about changes to alcohol policies,” said Dr Ward. “In one school some staff insisted that banning alcohol was denying them a basic human right.”

The dilemma schools face is that allowing alcohol consumption at school events was seen to reinforce the perception that alcohol is a “usual” or “necessary” component of any gathering of adults.

In its June response to the new child safety Victorian code of conduct [The Age 15 June], the Australian Education Union raised concerns that banning alcohol will result in parents no longer being willing to volunteer at school events.

“One of the principals agreed that alcohol can be consumed in a responsible way, but asked if that means you have to serve it at all?” said Dr Ward.

The researchers suggest that, in the face of strong social pressure, strategies need to be identified to give principals support in making decisions about whether to allow alcohol at school events where children are present.

The research was conducted for the Alcohol and Drug Foundation and funded by the Victorian Health Promotion Foundation. The paper is publicly available at BMJ Open.

For more information contact Dr Bernadette Ward: T (03) 5440 9064,  M: 0427 059 205
E: bernadette.ward@monash.edu

Melbourne love affair ends in ... a great time in Sale


Ali Groves cried when told she was heading to Sale for her placement this year.
I’ll be honest; I wasn’t thrilled when I received the email announcing my impending placement in Sale for my fourth year of medicine. I cried to my housemates, I cried to my friends, I cried to my boyfriend and I called my Mum and I cried to her too. I had come from a small rural town and I had no interest in living in one again.

I had grown up in Western Victoria and although I absolutely loved living in Hamilton, I had well and truly grown out of the place by the time I was heading off to university. I began my medical degree with intentions of being a rural practitioner. I had always loved the rural lifestyle and although I had intentions to train in Melbourne, I wanted to return to the relaxed environment of the country later in life. That plan changed pretty quickly. I fell in love with Melbourne. My life was in Melbourne now. It was where my friends were, close to Chadstone shopping centre and there was always something to do. I loved it and never wanted to leave. Then I got moved to Sale.

Reluctantly, I packed my car and made the trip across Victoria, further east than I had ever been, 514 kilometres from Hamilton and 215 kilometres from Melbourne. And since this day I have not looked back. I am writing this, so embarrassed that I ever thought moving to Sale was the end of the world. In fact, it is somewhere I would strongly consider living in the future.

Sale has an integrated program in fourth year, which involves swapping and changing between GP, women’s health, paediatrics and psychiatry on a weekly and even daily basis. Although I was initially hesitant about the lack of structure, it has been wonderful now that the year is coming to a close to be constantly revising all topics in the lead up to exams.

At the GP practices in Sale, unlike some of the metro clinics, we have our own patient lists and consulting rooms. This has been particularly beneficial for learning both real life skills and those we need for the exams and OSCEs. For our other rotations, we have one-on-one time with the registrars and consultants, which is unheard of. We even have four paediatricians for the eight students here! Furthermore, it is these consultants that we are working with every day that provide us with tutorials. Therefore, they are always of the highest quality and the relationships we build with the doctors will be beneficial for years to come.

Socially, living in Sale has been fantastic. I go involved with the local football-netball club the first week we arrived in Sale and this has been a fantastic outlet from medical student life. There are also so many great bike trails and day-trips around the area, which keep the weekends really interesting.  I had made more friendships with nursing staff and interns in the first week of going to Thursday night trivia in Sale than I had in a whole year in Melbourne in 2015! This is another aspect of studying in a small town that makes it so wonderful. The lifestyle in general is very relaxed; with each morning consisting of either a 5-minute walk to the hospital or a 5-minute drive to the GP clinic where you never have to sit in traffic!

I could not recommend studying rurally in third and fourth year more highly. It has been a wonderful experience that has completely changed my perspective on being a rural doctor and will strongly influence where I practice in the future.

Thursday, 4 August 2016

Medical students at Monash Rural Health (MRH) Churchill now have access to a 3D-printed anatomy kit that is revolutionising medical training around the world. The 80-90 first year students at Churchill have weekly classes in anatomy locally and travel to Monash University’s Clayton campus fortnightly to access the anatomy facilities and human specimens located there.

Professor McMenamin with one of the printed anatomy models.
Director of Centre for Human Anatomy Education at Monash University, Professor Paul McMenamin, presented MRH Churchill with a permanent kit of its own to enhance students’ anatomy studies. The printed body parts, which look almost exactly the same as the real thing, can be used to replace difficult to get and expensive cadavers that are crucial for training doctors.

Professor McMenamin and his team developed a collection of full coloured, 3D printed anatomical models created from CT and laser scans of real specimens. The 3D printing captures realistic detail of a dissected specimen in ways that traditional moulding and casting techniques cannot.

“We printed out the first replicas two and a half years ago and finished the entire series only nine months ago,” he said. “Since then, we are getting interest from all over the world as it is now a commercially available anatomical teaching tool. We are the leaders in this field.”

The 57 components are replicas of the entire human body. Printing a hand can take three to four hours however the larger components can take as long as a week. The printed body parts are falsely coloured to help students distinguish between the different parts of the anatomy including the ligaments, muscles and blood vessels.

According to Professor McMenamin, not everyone has access to real cadaver specimens for a range of reasons including cost and the strict guidelines around handling, storing and using them. There are also religious and cultural barriers for some students and countries in dissecting cadavers for education. The kits, valued at more than $250,000, can be used in many different environments including the classroom or hospitals.

“Students still have exposure to traditional methods of anatomy however this kit will definitely enhance their training,” Professor McMenamin said.

Director of MRH Churchill, Associate Professor Shane Bullock said the kit would have tremendous benefits for students. “Owning a set of detailed models of the entire human body will complement the range of teaching resources we have in Churchill and will definitely enhance student learning in anatomy,” he said.

Wednesday, 3 August 2016

Bike mechanic keeps medical education rolling

Bendigo bike mechanic, Mark Slater, presents Adele Callaghan and SimMan with a pump for the simulation centre's wheelchair
A Bendigo bike mechanic has stepped in to help get a medical simulation roadshow to Monash University’s Clayton campus for Open Day on Sunday 7 August.

The Monash Rural Health Bendigo Clinical Skills and Simulation Centre is taking a mannequin to Clayton to demonstrate the learning opportunities available at Monash’s regional training sites. But a trial run became difficult when staff discovered the wheelchair’s tyres were flat and they had no means to pump them up.

Bike mechanic, Mark Slater, said he had fixed many flat wheelchair tyres in his time. “I know how hard it can be for wheelchair users and carers to get around town,” he said. “A simple thing like properly inflated tyres can make life so much easier – even if you’re just moving a training mannequin.”

Senior Lecturer in Clinical skill and Simulation, Adele Callaghan, was delighted with the pump donation. “It’s fabulous to be able to keep all our equipment running properly,” she said.

The simulation learning centre trains medical students from Monash University and the University of Melbourne in clinical skills and simulation patient scenarios before they see patients, and helps hospital staff maintain vital clinical skills. The centre has a simulated ward, a high-fidelity suite that can be set up as a ward, emergency department or surgical theatre, and a range of training aids including sophisticated mannequins.

“SimMan can be used to simulate a range of illnesses and scenarios,” said Ms Callaghan. “He breathes, he has a pulse, he moans, you can hook him up to an intravenous drip. "With the use of aides like this, we provide a safe place for students to learn clinical and important team communication skills.”

Monday, 1 August 2016

New Zealand exchange broadens health horizons

Each year two students from East Gippsland swap places with two New Zealand students at the University of Otago for two weeks to experience a different health care system. In July, Mariam Hassan, a Year 4C student based at Bairnsdale, was one of two Monash students who travelled to New Zealand. Here is her reflection on the experience.


Mariam Hassan enjoyed her exchange to Blenheim.

It was on the plane from Auckland to Blenheim that I was first introduced to the friendly, small town nature of Blenheim. Bursting with both excitement and uncertainty, my apprehension was immediately put at ease. I was sitting next to a social worker from the hospital who gave me a comprehensive overview of Blenheim and Wairau Hospital, pointing out that one of the paediatricians (who I worked with later that week) was on our flight. Flying over the Marlborough Sounds at sunset I had spectacular aerial views, my first glimpse of New Zealand’s beautiful landscape.

Wairau Hospital is comparable in size to Sale Hospital, with 65 beds, including a paediatric ward and permanent obstetricians/gynaecologists.  Tailored to my interests, it was arranged for me to spend two days on women’s, three days on paediatrics, three days at a GP clinic and two days in ED. As one of only two medical students at Wairau Hospital, there was no shortage of opportunities for me to get involved. Within the first two hours of my arrival on Monday morning I was scrubbed in and assisting in theatre. The doctors were all very keen to teach, during down time the paediatricians would spend time giving me detailed personalised tutorials- with butcher’s paper and all. I was writing admission notes, attending ward rounds and clinics (where I saw my first case of Henoch-Schonlein Purpura).


Wairau Hosptial, Blenheim South Island of New Zealand

Over the weekend we drove through the mountainous countryside up to Nelson. To satisfy my Lord of the Rings fandom we stopped in Pelorus where a scene from The Hobbit was filmed and visited the jeweller who crafted The One Ring.  After visiting the Nelson Saturday market, where I tried the traditional Maori deep fried bread, we were greeted by two large fur seals at the beach.

‘Light up Nelson,’ similar to Melbourne’s ‘White Night’, was running that week- illuminating the town by night and showcasing the work of local artists.

On Sunday we drove to Picton with absolutely breathtaking views of the Marlborough Sounds. Hiking the Queen Charlotte Track through pristine native forest, alongside an intricate maze of waterways, bays, coves, inlets and mountains was certainly a highlight of my trip. Here I was introduced to New Zealand bird life, spotting Pukeku, Fan Tails and Shags. My housemates were fantastic and generously dedicated their entire weekend to showing me around the region.

The following week started at Renwick Medical Centre, where Dr Buzz and his team are full of energy. As the coordinator of the RMIP program in Blenheim, Dr Buzz is a passionate teacher and is well accustomed to the parallel consulting model. With an incredible depth of knowledge and genuine dedication to patient centred care, Dr Buzz was the perfect mentor.

My final two days were spent in ED at Wairau Hospital. Here I was able to assess and work up patients before presenting to a consultant. Under the guidance of the doctors, I was writing discharge summaries, prescriptions and imaging request forms. I was also able to practise cannulation, venepuncture and using a slit lamp.  Blenheim is surrounded by the Wither Hills and extensive vineyards, creating a picturesque backdrop that even made chilly morning walks to the hospital enjoyable. Expecting wild and woolly weather, I was pleasantly surprised to discover that Blenheim boasts the title of the sunniest town in NZ. Nights were cold but the days were mostly sunny and crisp (a stark contrast to the flooding experienced in Gippsland while I was away).

This was my first experience in health care delivery outside of Australia. While the hospital system was largely similar to Australia, there were some key differences. For example, the midwives play a more prominent and autonomous role, with no GP obstetricians.

My time coincided with Maori language week, giving me a unique insight into Maori culture, history and language. It was refreshing to see how celebrated and deeply engrained the Maori culture is in New Zealand. It was encouraging to learn that last year a major milestone, demographic proportionality, was achieved, with the number of Maori students entering medical school proportionate to the Maori population.

A massive thank you to everyone involved in coordinating my trip- I know that my experience was so positive because of all your hard work and organisation.

I am incredibly grateful to have been given this invaluable experience. It has truly been a once in a lifetime opportunity and I would highly recommend this opportunity to all. I met so many wonderful people and was welcomed with genuine warmth and generosity. These two weeks have certainly broadened my horizons and enriched with a wealth of knowledge, experience and perspective.

I have no doubt I will be back to visit New Zealand in the future.

Wednesday, 27 July 2016

Soccer connects student to community

Champion links: Rachael Shirlow (right) found it easy to immerse herself in the local community, especially once she joined the local soccer team.
Monash medical student and soccer enthusiast Rachael Shirlow had established herself in Melbourne after moving from NSW to complete her first three years of study when she found out she was headed for year-long rural placement in Gippsland.

While she was not opposed to the news Rachael said she hadn't opted for a rural placement so the ‘random allocation’ was somewhat unexpected.

"This will work for me"

Despite some trepidation, it took just a few short weeks for the young student to realise “this was going to work for me”. While she had spent her initial years studying medicine in Melbourne, Rachael is a country girl and she found herself quickly immersed in the Leongatha community, both in and out of the workplace.

“What really contributed to the ease of the transition for me was the Monash Rural Health group in South Gippsland,” she said. “It is so organised, the tutors were so friendly and the orientation was very welcoming and relaxed so the nine of us students who were placed in South Gippsland, between Leongatha, Foster and Wonthaggi, were able to quickly get to know one another.”

Rachael shared a Leongatha house with some of her fellow students and between them they rotated through a series of GP placements across the region as well as shorter ‘intensives’ in the areas of community psychiatry, women's health and paediatrics.

Sporting links

She soon found herself connected in more ways than one after she joined the local soccer team, Leongatha Knights, which went on to win the South Gippsland League grand-final. “I found that I made friends so easily in this environment, I have even attended the wedding of one of my friends from the club since then,” she said.

Rachael relished the opportunity to return to the sport she loves. “I had played soccer right through my schooling years but in the first years of medical studies in Melbourne I found I had to take a break,” she said.

The simplicity of country life lent itself to a better balance. “It's so much easier to get around than in the city, so that leaves more time for sleep, study and leisure – a lot of students can get quite anxious by the fourth year of this course but being in a rural area gives you an opportunity to escape city stressors,” Rachael said.

More opportunities

The advantages were so many that Rachael opted to return to South Gippsland this year for her six-week surgical rotation as a fifth year student. Much of the appeal lay in the level of support she said students experience in a smaller environment, and the extra opportunities for practical experience.

“We absolutely had more opportunities that our metro-based counterparts,” Rachael said. “The ratio of students to teachers is less so it is actually a lot more engaged and interactive than sitting in a lecture with say 100 people; there is a general feeling of being valued.”

“When I was doing my women’s health round, for example, I could be called at 2am (by the staff) because they knew I wanted to attend and be part of what was happening,” she added.

Returning to a familiar area for her surgical rotation was “a fantastic experience,” Rachael said. “I had gotten to know the GP anaesthetists really well so they would get me to do drips and airways and assist wherever practical; I also gained valuable experience in suturing and they really helped to talk me through things.”

Her experiences in South Gippsland have cemented Rachael’s intention to return to a country area to practice medicine upon graduation. “My main interests lie in general practice and paediatrics but either way I can take either of those specialties to the country and that’s what I intend to do,” she said.