Tuesday, 22 November 2016

Simulation learning showcase

Simulation-based research projects, with a focus on teaching medical students, were showcased by Monash Rural Health Bendigo lecturers at the recent Australasian Simulation Congress. The work of senior lecturers Dr Cameron Knott, Pam Harvey and Adele Callaghan was presented at the inaugural congress. The event bought together three simulation conferences for the first time - SimHealth, SimTech and the International Simulation and Gaming Association (ISAGA).

Monash Rural Health (MRH) has long researched, developed and practised the use of simulation as a teaching modality for medical students and other healthcare workers and students. It is delivered across the school’s numerous regional sites, often within dedicated simulated suites.

“Simulation, as a teaching method, involves students practising skills relevant to their profession while being in a safe and supportive simulated learning environment,” Ms Harvey said.

Patient safety and the deteriorating patient

At the congress, staff members discussed research projects which look at the impacts of simulation on students. Ms Callaghan’s research focused on final year medical students and their experiences participating in a ‘Patient Safety’ module consisting of team-based clinical scenarios based around a patient with worsening symptoms.

Her subsequent report was co-authored by Dr Knott, an intensive care physician at Austin Health and Bendigo Health who is also an academic lead at MRH Bendigo’s Clinical Skills and Simulation Centre.

“Recognising the deteriorating patient is a crucial skill for junior doctors,” Ms Callaghan said, “so we focus on the communication and procedural skills that need to be applied in the time before the response team arrives.”

Initial findings showed students had applied the skills learned through simulation, in clinical practice – a result Ms Callaghan said would help to inform curriculum for future students.

Breaking bad news

Ms Harvey’s research studied the effect of a series of simulated workshops teaching communication skills associated with breaking bad news. Students practised breaking bad news before being videoed performing this in a mock exam situation where they were assessed by doctors.

She said the research showed the effectiveness of this teaching approach. “Gaining a perception of what the patient understands about their situation is very important when the news you need to deliver is not good,” Ms Harvey said. “Unless you know where the patient is at, you can’t empathetically and appropriately communicate at a time when we know communication influences patient outcomes.”

Laparoscopic surgical model

Monash medical student Sam Alexander, who has completed numerous placements with Monash Rural Health across Gippsland, also gave a presentation on a new laparoscopic surgical model he is developing with Monash Children’s Hospital paediatric surgeon Mr Ram Nataraja.

The congress was also attended by Marnie Connolly, senior lecturer at MRH East and South Gippsland and winner of the 2015 Achievement Award presented by Simulation Australasia, which recognised her “significant contribution to the advancement of modelling and simulation within Australasia.”  She was accompanied by fellow East & South Gippsland researcher Casey Stubbs.

Friday, 18 November 2016

Local researchers take out top British book prize

Local Monash researchers have taken out a prestigious British Medical Association (BMA) book prize as they prepare to expand their ‘recovery model’ project, for parents with a mental health illness, across Gippsland next year.

Prof. Darryl Maybery & Assoc. Prof. Andrea Reupert.
Professor Darryl Maybery, director of Monash University Department of Rural Health in Moe, and colleague Associate Professor Andrea Reupert, director of Professional Psychology Programs at Monash’s Krongold Clinic, were barely aware they had been nominated for the major, medical book prize when word came recently that, together with three international co-editors, they had won the BMA President’s Award.

Their book, Parental Psychiatric Disorder: Distressed Parents and their Families, was commended for its “innovative approach to thinking about and working with families where a parent has a mental illness”.

“With the soaring impact of adult mental and emotional ill health on clinical services and on society generally this outstanding book is timely in addressing a neglected area in a comprehensive way,” said BMA President Professor Sir Al Aynsley-Green Kt. in his commendation.

The recognition has been welcomed by Professor Maybery, who – together with fellow researchers Associate Professor Reupert and Dr Melinda Goodyear – plan to expand their four-year research project known as Let’s Talk About Children, across Gippsland from early next year.

The project, funded through the Victorian government Mental Illness Research Fund, is trialling specific interventions to engage with families and children within specialist mental health and family services. It aims to implement a recovery model for parents.

The project evolved after Professor Maybery, a practising psychologist for 15 years, completed his PhD and decided to focus on the impact of a parent’s mental health on their children. “I had worked in prisons and with drug and alcohol support services for many years so I understood the significance of parental mental illness in the lives of children,” he said.

The project will enter its third and final phase from next year and Professor Maybery said data collected from 28 agencies across Victoria so far indicated that the new approach “really improves relationships between clinicians and parents”.

“By talking about ‘real issues’ such as parenting and children and not just confined to the parent’s illness, connections are enriched and conversations can become positive and empowering.

“The project also aims to create positive change in workplaces to improve clinicians’ skills and, in turn, support the longer-term recovery of people with severe mental illness by addressing their parenting role as a core part of the treatment,” he said.

Let’s Talk About Children has benefited from international research collaborations, the input of Monash PhD students and the support of partner agencies. In Gippsland, it has secured the support of Latrobe Regional Hospital’s Adult Mental Health Service, which Professor Maybery said would be critical to implementing a randomised control study with hundreds of parents in Gippsland in the first half of next year. Other key local agencies will also come on board.

The partnership approach will ensure Let’s Talk About Children can be embedded in a variety of settings, with clinicians supported to trial its implementation.

“We know that almost one quarter of all children will, at some stage, have a parent with a mental health problem and that a proportion of these children are at risk of developing similar problems of their own,” Professor Maybery said. “So the critical priority, and the goal that drives us all, is the wellbeing of these kids and we look forward to expanding this project locally.”

Tom wins 2016 Rural Engagement Award

Monash University medical student Tom Ponsonby has taken out Monash Rural Health (MRH) East & South Gippsland’s prestigious Rural Engagement Award for his many and varied contributions to the local community.

Dr David Iser presents Tom Ponsonby with the 2016 Rural Engagement Award

The 28-year-old South Gippsland-based student, who is part of Monash’s graduate entry medicine course, has spent his second year of clinical training with Monash Rural Health in Leongatha.
He was recently announced the recipient of the school’s 2016 Rural Engagement Award (REA) after being nominated by academic coordinators and professional staff.

“This is a great way to publicly recognise and celebrate a student who has made an extraordinary contribution to rural engagement in the community,” said MRH East & South Gippsland academic coordinator Jennie Casey.

Tom was awarded a medallion, certificate and $200 as part of the initiative which commenced last year for MRH East & South Gippsland students.

The keen student, who grew up in Tasmania, has made his mark in South Gippsland across diverse settings. He has visited the local secondary college to talk with year nine to 12 students about careers in health and pathways into medicine and participated in health promotion activities run by the Leongatha hospital including a women’s health night run by the community health centre.

As a trainer for the Foster Football Club, Tom has also immersed himself in the South Gippsland sporting community, attending weekly training sessions and games at the club where he said he was made “very welcome”.

“Tom has also become part of the Foster Medical Centre team,” said Ms Casey. “He has readily integrated into all aspects of the practice, not only in the clinical setting but he has often been seen on study days helping out at the front desk.”

“Winning the award means a lot to me,” said Tom, “especially knowing the genuine commitment and enthusiasm the Monash Rural Health South Gippsland team has for rural health and educating future doctors in this region.”

“I've had a fantastic year in Foster, been taught by doctors who I really admire and been given many opportunities to develop and apply my medical skills.”

Tom said staff at MRH South Gippsland, the Foster Medical Clinic and the South Gippsland Hospital had all taken him under their wing and patients had been “kind enough to see the student doctor.”
“The real prize I've received for rural engagement this year has been getting to know the people and get involved in the community, and I hope to be back in the future,” he added.

Tuesday, 8 November 2016

John Flynn Placement Program and international students

As part of my work as a committee member of the Australian Medical Students’ Association (AMSA) Rural Health team, I had the privilege to speak to representatives from the Department of Health and the Australian College of Rural and Remote Medicine (ACRRM). Together with Skye Kinder, Co-Chair of AMSA Rural Health, we discussed the benefits of including international students in the John Flynn Placement Program (JFPP).

Promoting rural practice: Zee Lim (centre) and Skye Kinder (third from right) are advocating for John Flynn Placements to be opened to more international medical students.

The JFPP, funded by the Department of Health, aims to act as a catalyst to promote regional and rural health to all medical students, including those who do not come from a rural background. By providing such placement opportunities, the JFPP hopes to encourage future medical practitioners to work in rural Australia.

Personally, I am grateful that the School of Rural Health has allowed me to undertake a year-long clinical placement in Latrobe Regional Hospital, where I have thoroughly enjoyed my first clinical year. Furthermore, I appreciate the financial assistance given to us in the form of rural elective bursaries.

However, many universities do not provide such opportunities to international medical students, often excluding them not only from rural clinical allocations, but from elective bursaries as well. These students end up missing out on experiencing rural medicine, which is an integral portion of an Australian medical degree.

AMSA Rural Health conducted a nationwide online survey in 2016, where international medical students shared their opinions about rural health in Australia. The results were overwhelmingly positive. Out of 287 responses, 83% were interested in working in regional and rural Australia, while 88.8% were interested in the JFPP. This underscores the high level of interest international medical students have for rural and regional health.

Many positives came out of the discussion, with ACRRM acknowledging the benefits of international student involvement in the JFPP, and the Department of Health agreeing to continue discussions with the respective policy makers. I hope that the JFPP will be made available to future batches of international medical students in Australia.

Zee Lim, Year 3B student 2016

Monday, 7 November 2016

Teaching medical students with simulation

Simulation-based research projects, with a focus on teaching medical students, were showcased by Monash Rural Health Bendigo lecturers at the recent Australasian Simulation Congress.

The work of senior lecturers’ Dr Cameron Knott, Pam Harvey and Adele Callaghan was presented at the inaugural congress. The event bought together three simulation conferences for the first time - SimHealth, SimTech and the International Simulation and Gaming Association (ISAGA).

Monash Rural Health has long researched, developed and practised the use of simulation as a teaching modality for medical students and other healthcare workers and students. It is delivered across the school’s numerous regional sites, often within dedicated simulated suites. “Simulation, as a teaching method, involves students practising skills relevant to their profession while being in a safe and supportive simulated learning environment,” Ms Harvey said.

Deteriorating patients and junior doctors

At the congress, staff members discussed research projects which look at the impacts of simulation on students. Ms Callaghan’s research focused on final year medical students and their experiences participating in a ‘Patient Safety’ module consisting of team-based clinical scenarios based around a patient with worsening symptoms.

Her subsequent report was co-authored by Dr Knott, an intensive care physician at Austin Health and Bendigo Health who is also an academic lead at Monash Rural Health Bendigo’s Clinical Skills and Simulation Centre.

“Recognising the deteriorating patient is a crucial skill for junior doctors,” Ms Callaghan said, “so we focus on the communication and procedural skills that need to be applied in the time before the response team arrives.” Initial findings showed students had applied the skills learned through simulation, in clinical practice – a result Ms Callaghan said would help to inform curriculum for future students.

Breaking bad news

Ms Harvey’s research studied the effect of a series of simulated workshops teaching communication skills associated with breaking bad news. Students practised breaking bad news before being videoed performing this in a mock exam situation where they were assessed by doctors.

She said the research showed the effectiveness of this teaching approach. “Gaining a perception of what the patient understands about their situation is very important when the news you need to deliver is not good,” Ms Harvey said. “Unless you know where the patient is at, you can’t empathetically and appropriately communicate at a time when we know communication influences patient outcomes.”

Laparoscopic surgical model

Monash medical student Sam Alexander, who has completed numerous placements with Monash Rural Health across Gippsland, also gave a presentation on a new laparoscopic surgical model he is developing with Monash Children’s Hospital paediatric surgeon Mr Ram Nataraja.


The congress was also attended by Marnie Connolly, senior lecturer at MRH East and South Gippsland and winner of the 2015 Achievement Award presented by Simulation Australasia, which recognised her “significant contribution to the advancement of modelling and simulation within Australasia.”  She was accompanied by fellow East & South Gippsland researcher Casey Stubbs.

Local connections sponsor Solomons nurses

Nurses at the Solomon Islands’ largest hospital will soon be provided with much-needed kits to help them perform their work thanks to a partnership between the Bendigo Strathdale Rotary Club and Monash Rural Health.

A series of coincidental connections and a shared commitment to assisting the under-resourced hospital has seen the local service club raise funds for 11 ‘nurse starter’ kits, worth around $1000, which will soon be delivered to the National Referral Hospital (NRH) in the country’s capital, Honiara.

Sponsorship partners: Mary Preston (Rotary), Pam Harvey (Monash Rural Health), Ken Longford (Rotary) and Liz Longford (Rotary)
While members of the Bendigo Strathdale Rotary Club travelled to Solomon Islands several years ago to provide financial support for a number of programs, club secretary Mary Preston said their efforts were complicated by ‘not really having contacts on the ground over there.’

Nevertheless, the club remained open to finding ways to ease health challenges in the Islands, which include a rise in non-communicable diseases and premature deaths. In recent months, a practical opportunity emerged through Bendigo clinical specialist nurse Lynne Wanafalea who has travelled to the Islands to spend 12 months as an emergency nurse advisor at the NRH as part of an Australian federal government project.

Mary said the local Rotary club already knew of Lynne, who worked in Bendigo Health’s emergency department and at Monash Rural Health Bendigo, teaching clinical skills to medical students.
Lynne has her own connection to the islands, being married to a chief of an area of Malaita, one of the main islands. She and her husband have six children and have lived in Bendigo for the past 23 years.

Within her first month at the NRH Lynne was struck by the urgent need for basic nursing tools including stethoscopes, blood pressure monitors, thermometers, scissors and penlights.  She contacted her Monash colleague, senior lecturer Pam Harvey praising the hard working NRH emergency nurses but raising concerns about the poorly resourced facility which was contending with cases including dysentery, malaria and tuberculosis.

Monash Rural Health staff and medical students pledged their commitment to helping, via a ‘Sponsor a Solomon Island Nurse’ project and as part of this effort Pam contacted the local Rotary club which quickly supported the cause. “We saw this as a really practical way to help out - we know the nurses will be able to use these kits for a long time to enhance their work - and also a safe option, knowing that someone will be travelling to the islands and delivering the kits,” Mary said. With the support of Bendigo-Waverley South, the local club ran a raffle with the proceeds subsequently donated to purchasing the nursing kits.

This month, a friend of Lynne’s will hand deliver the kits to NRH nurses including Florence Aluta, who shared her story as part of the ‘Sponsor a Solomon Island nurse project.’

“My favourite role in the emergency department is triage…this can become very frustrating at times though, when we have no equipment to do patient assessment,” she said. “Nearly half of our patients are babies and children who can deteriorate very quickly – any equipment to help us would be fantastic.”

Thursday, 3 November 2016

Rural placement introduces metro students to Helimed

Monash University medical students learned about the significance of an air ambulance service to rural and remote areas during a recent visit to Helimed as part of a two-week rural placement.

Ambulance Victoria paramedic Ben Meadley spent time with the Clayton-based year two students at the Helimed air ambulance base at Latrobe Regional Airport in Traralgon. He shared stories about the work of Helimed in Gippsland, which includes hospital transfers, airlifting critical patients from remote locations and search and rescue missions on both land and water.

The rural placements are facilitated by Deborah Hewetson, Year 2 program coordinator at Monash Rural Health Latrobe Valley & West Gippsland.

Clinical skills educator Lane Johnson said the local visits are designed to introduce the students to rural communities and rural health practice. She said the placements focused on clinical practice and involvement in community activities and included visits to local pharmacies, hospitals and Indigenous sites.

The students, based in Warragul and Traralgon for their two-week placement, also participated in a clinical skills education session which saw Monash Rural Health Traralgon-based staff and years three and four medical students teach them skills including basic life support, plastering, wound dressings and the use of a laparoscopic simulator.

Tuesday, 1 November 2016

Long and unconventional road to a medical career

Sam Alexander is not one for adhering to convention. Born and bred in Churchill, the aspiring surgeon who is soon to graduate from his medical degree, spends weekends tending to an unusual side project – an emerging equestrian centre on the fringes of Morwell.

The passionate Monash University medical student, who hopes to eventually create a niche for himself as a visiting surgeon - with a paediatric interest - in the Latrobe Valley, has trod his own path from a very young age. As a baby, Sam survived a life-threatening lung condition thanks to surgery at Monash Health. As a Kurnai College, and later St Paul’s Anglican Grammar, student he developed a desire to study medicine. When the motivated teen found himself falling short of the very high ATAR required for direct entry to medicine, he ‘came in the back way’ by first completing a Bachelor of Science in Queensland followed by an honours year in Tasmania.

In 2011 Sam was accepted into Monash’s graduate entry medical course but, following completion of his first year in Churchill, he deferred in order to ride more than 5,000 kilometres on horseback from Victoria to far north Queensland to raise funds for the Royal Flying Doctor Service and promote rural medicine.

Testament to his resolve, Sam did not come from a ‘horsey’ background but instead he discovered a passion for riding as a ‘release’ from the claustrophobic conditions of city-based study. “I bought two inexpensive horses near the end of my first year of studying medicine, learned how to break them in over a few weeks, packed them within a week and set off,” he said. The epic journey set the scene for a longer-term commitment which has seen Sam more recently expand an agistment project on local, family-owned property, fencing numerous paddocks in order to accommodate a growing waiting list of horses in need of land. The project, which Sam intends to develop into a thriving equestrian centre including an undercover arena, provides a welcome break from his intense university schedule which has this year included multiple placements, including a stint in paediatrics at London’s renowned Great Ormond Street Hospital as well as local and Melbourne-based rotations.

His experiences this year, particularly at the UK’s largest paediatric centre, have affirmed Sam’s passion for surgery. The keen student has also embraced an opportunity to work on a laparoscopic research project this year under the supervision of Monash senior lecturer Dr Ram Natraja, who is also Director of the Paediatric Surgical Simulation Department at Monash Children’s Hospital. The research has convinced Sam of the need to see basic ultrasound and laparoscopic skills embedded in the medical bachelor degree. “I think some early exposure to these skills would be so valuable,” he said.

Unsurprisingly, Sam’s plan is to pursue a diverse career path. “I don’t want to be just good at one thing,” he said. “One of the biggest driving factors for me is being able to work in a regional areas and I would like the challenge of being a general surgeon but certainly with a focus on paediatrics.” Sam’s ambition to eventually practice locally, at least in a visiting capacity, was cemented through a series of Gippsland-wide placements facilitated through Monash Rural Health. “I have now spent time in metropolitan and rural settings and I believe that, hands-down, you have better clinical exposure in rural areas in a friendlier atmosphere with interested doctors and better medical practitioner-student ratios,” he said.

While city-based placements also provided valuable learning experiences and improved access to some specialist teaching, Sam insisted rural placement were superior, with receptive patients offering many opportunities for observation and practical experience.

Monday, 31 October 2016

Medical students for a day

East Gippsland secondary school students found out recently what it is like to be a medical student … even if it was only for a day. Monash Rural Health Bairnsdale, in conjunction with Gippsland Medical Students’ Network (GMSN), hosted 22 students from years 10, 11 and 12 at Bairnsdale Secondary College, Orbost Secondary College, Gippsland Grammar and Maffra Secondary College.

East Gippsland secondary students get a taste for life as a medical student.

The students were involved in an ‘Envenomation’ tutorial with the Bairnsdale Year 4C medical students, delivered by Director of the Emergency Department at Bairnsdale Regional Health Service (BRHS), Dr Mark Pritchard. This was followed by a morning tea, where the school students chatted with current medical students, clinical staff at BRHS and academic staff about all aspects of medical education, from entry and selection, selection tests, life as a medical student and pathways to a career as a rural doctor.

A clinical skills session saw students divided into groups. Under the direction of Monash clinical academic staff and Year 3B & 5D medical students, they were introduced to Basic Life Support, Basic Airway Management, anatomy of the heart, introduction to heart and lung sounds and mothercraft skills. These sessions were conducted in the Monash Bairnsdale Simulation Learning Environment with use of adult, child and obstetric mannequins.

Organisers said the students found the whole day interesting, especially the clinical skills session which they described as “a fascinating and stimulating learning experience”.  

Friday, 28 October 2016

Bendigo hosts clinical skills weekend

A group of 30 young Monash medical students from Melbourne were given “hands-on” experience at a clinical skills weekend in Bendigo. Organised by students from the WILDFIRE Bendigo subcommittee at Monash Rural Health Bendigo, the weekend is held annually by the student-run rural and Indigenous health Club.

WILDFIRE member and fourth year medical student, Tiffany Tie, said a full weekend involved sessions in the simulation lab and workshops.“The students practised some hands-on skills such as putting in IV cannulas (drips) and put their basic life support skills to the test in workshops run by senior Bendigo lecturer Adele Callaghan,” Tiffany said. “Well respected Bendigo Health radiologist, Dr Damien Cleeve, gave an X-ray interpretation tutorial.”

Tiffany said other MRH volunteers and local junior doctors also assisted with the program. “Our WILDFIRE Bendigo members organised accommodation and meals which were included in ticket prices which makes the weekend very affordable,” she said. “The event is really popular with the first and second year medical students. It gives them exposure to the great program run here at MRH Bendigo.  Hopefully they will enjoy their experience so much that they will decide to continue their medical studies here in the future.”

Thursday, 27 October 2016

‘Real-world’ insights for Monash medical students

Real-world insights into occupational hazards were provided to Monash medical students during a recent visit to Loy Yang B, one of Victoria’s largest coal-fired power stations.While touring the Latrobe Valley-based power generator, year 3B students from the Monash Rural Health Latrobe Valley & West Gippsland site heard first-hand from station personnel about workplace injuries and safety measures.

Year 3B students Rachel Van Zetten (right) and Emily Malia tour Loy Yang B in the Latrobe Valley.

“This trip occurred in the context of the occupational medicine component of our course,” said student Adam Bisiani. “Initially we were run through various cases about occupational hazards that may arise, which gave a ‘real-world’ feel to the theory we have learnt.”

“This was not too dissimilar to learning medicine in the classroom and applying it on the wards,” he added.

Students toured the power station and also learned about the nature of the national energy grid before taking in views of the Latrobe Valley from the station’s 19th floor.

Wednesday, 26 October 2016

Traumatic scenarios provide valuable learning

Traumatic scenes similar to those more commonly experienced in a hospital emergency department faced Monash Rural Health Bendigo medical students recently when they fronted up to class.

Luckily, the critically injured man they encountered in the school’s auditorium was a simulated patient volunteering his time to help the third year students build their clinical skills.

A simulated emergency started Trauma Day.

A series of simulation-based activities continued into the afternoon, with students rotating through skills stations requiring them to attempt a range of novel tasks, including airway management skills using simulation mannequins and sheep carcasses to learn how to insert thoracic drain tubes to treat a punctured lung.

The range of scenarios were presented to students as part of Monash Rural Health’s annual Trauma Day, coordinated by senior lecturers at the school and made possible by senior surgical consultants and anaesthetists from Bendigo Health who volunteer their time and expertise to help lead the activities.

Monash senior lecturer Adele Callaghan said student feedback following the day was uniformly positive, with all of them welcoming the opportunity for hands-on experience, saying each session supported key learnings in their course and encouraged reflection.

Clinical simulation is used as a powerful learning and teaching tool, providing structured opportunities for students to practice new skills in a safe environment.

Ms Callaghan said Trauma Day provided the chance for students to bring their skills together to work through one scenario, but from many perspectives. “In this case, we had a young man who had fallen from a ladder and sustained a chest wound which could not be seen, however his condition deteriorates as students move through their assessments and it ends up being diagnosed as pneumothorax (where air leaks into the space between the lung and chest wall causing the lung to collapse),” she said.

All sessions are built around addressing this condition, including the problem-based scenarios hosted in tutorial rooms.

Students Zena Barakat and Mark Fogarty learn how to insert a thoracic catheter in a sheep carcass

“This is such an exciting introduction to trauma assessment using simulation,” Ms Callaghan said, adding that ‘fully immersive’ simulation and skills-based teaching is embedded in the year three curriculum continuum.  “However, having this level of simulation engagement with the senior doctors and surgeons from Bendigo Health is really valuable,” she added.

Consultants who volunteered their time to participate in the day were Dr Andrea Noar, Dr Simon Smith, Mr Tony Gray, Mr Manny Cao and Mr Graeme Campbell.

Tuesday, 20 September 2016

Rural study leads two graduates to practice in Traralgon

The two newest faces at Traralgon’s Breed Street Clinic are proof that studying medicine rurally motivates students to opt for rural futures. Doctors Lisa Gilbert and Danielle Winkelman-Stothard have commenced a six-month GP training placement at the Traralgon clinic, with both expressing the intention to stay local once their training is complete.

Support network critical to young doctor

Dr Danielle Winkelman-Stothard: rural support has been invaluable.
Danielle is no stranger to the Latrobe Valley. Raised and schooled in Morwell, she attended secondary school at Kurnai College before completing a science degree at Melbourne University. When Monash University introduced its graduate entry medical program in Churchill back in 2008, the self-confessed “country bumpkin” jumped at the chance to leave Melbourne behind and return home, to the fold of her family, and embark on studying medicine.

“After four years living in Melbourne, I knew I wanted to come home,” the accomplished mother of twin toddlers said. Danielle undertook most of her ‘rotations’ in rural settings while completing medical studies, embracing the “hands on” and supportive nature of her placements in hospitals and clinics all over Gippsland. "I think things would have been immensely harder for me had I not been studying rurally,” she said. “Everyone locally has gotten to know me, they know my twins and they have gone above and beyond to support me.”

An initial GP training placement at Heyfield medical centre convinced Danielle that general practice could “offer me the best of everything”. “I was interested in respiratory, cardiology, paediatrics and the holistic nature of medicine, getting to know patients,” she said.

Danielle’s enthusiasm for learning has seen her complete numerous additional diplomas covering areas including obstetrics and gynaecology and child health – and she has no intentions of stopping there, citing dermatology and sexual health as other areas of interest.

Danielle has firm plans to stay in the Latrobe Valley. She said the personal and professional support offered to her through a local doctor’s Mums network had been invaluable in helping her to cope with the competing demands of motherhood and general practice.

An aspirational message

Dr Lisa Gilbert: it's important to live near where I work.
A series of fateful events lead to Melbourne-born and Albury-raised Lisa Gilbert arriving in Gippsland to study medicine back in 2001. Lisa is passionate about spreading a message of aspiration among students who fear their previous schooling experience or own lack of opportunity prevents them from exploring medical studies.

“My high school was a ‘poor performer’ and my ENTER score would not have allowed me direct entry to medicine but that doesn’t mean I didn’t have the aptitude or intelligence required,” she said.

Initially, Lisa completed a biomedical degree at RMIT. “I never thought I could be a doctor but I really liked science and the idea of research,” she said. Despite having no previous awareness of the Graduate Medical School Admissions Test (GAMSAT), Lisa decided to join her RMIT peers in studying for, and sitting, the test - with no expectation of a positive outcome.

Post-graduation, while working as a medical scientist, her career direction shifted gears upon news of a good GAMSAT result – but not before she headed overseas with her British partner for 12 months to work a series of unskilled jobs while they waited for his permanent visa to come through. Returning to Australia, Lisa attended an open day at Monash Rural Health Churchill and was immediately won over. “The campus is beautiful, everyone was so welcoming – they really care about who you are, your story and how they can support you,” she said.

Given the rigours of life as a medical student, and young doctor, “it became very important to me to live near where I work,” said Lisa. “I like the simple life, I hate traffic and commuting – it makes everything so much harder.”

A series of supportive local placements during her studies, particularly at the Heyfield hospital, coupled with the opportunity to specialise in GP in Gippsland convinced Lisa and her partner to establish their lives in the region. “We have put down our roots here and we are happy to stay,” she said. “GP is a great fit for me, I love the variety, independence, responsibility and the feeling that we are building relationships and making a difference.”

As she continues her training next year, Lisa hopes to spend more time working locally and will undertake a stint in Latrobe Regional Hospital’s emergency department.

Monday, 19 September 2016

Student volunteers time in Tonga

Bendigo medical student Katie Blunt will pursue her interest in global health after her first taste of volunteering overseas. Katie, in her first clinical year with Monash Rural Health Bendigo, spent two weeks on the Tongan island of Vava’u with TeamMED, a student-led organisation providing Monash University students with a chance to experience and contribute to global health. TeamMED makes health trips to Tonga, Uganda and Nepal every year.

“I have wanted to go on one of these outreach programs since my first year of medicine,” Katie said.
She joined three fourth year students, a second year student and a first year student on the island which had a 40 bed hospital for the population of 15,000 people. Tonga has an endemic of obesity and the chronic diseases that come with it,” Katie said.

“Food is a large part of the culture. People grow their own food and have wonderful feasts but there is little health promotion or understanding about what constitutes a healthy diet. There are also a number of barriers to health care for those affected by chronic disease, including lack of education, geographic isolation and financial restraints.  Our aim was to develop an awareness and appreciation for chronic disease like diabetes and high blood pressure, as well as to promote healthy living in a culturally-sensitive manner.”

Katie and the TeamMED team visited the Prince Wellington Ngu Hospital’s general, maternity and children’s wards as well as conducting free health clinics in and around the town of Neiafu. The language barrier was difficult with the older generations however Katie said younger people spoke English which made communication with patients much easier.

“At times the experience was confronting but very rewarding,” she said. “We are a fortunate country and while we hear about many global health problems, we often don’t realise that our Pacific neighbours need help too.”

Katie, from Melbourne, is relishing her year in Bendigo, spending time in the Bendigo Base Hospital as well as the Monash Rural Health clinical school. “This is the best year of my course,” she said. “I’m finally working in a hospital and getting hands-on clinical experience which is invaluable.”

Although Katie grew up in Melbourne, she lived in America for five years until her teens. Her interests “aligned” and pointed in the direction of medicine as a career. “It always felt like a natural fit and I’m loving it,” she said.

A keen water polo player, competing at a high level, she gave it up which freed up time for other interests, including global health. And while she hasn’t decided on a medical specialty yet, more volunteering is definitely on her agenda.

Friday, 16 September 2016

Health & human rights links explored by medical students

Medical students at Monash Rural Health have been challenged to explore the links between health and human rights in a unique way during recent seminars. Moral philosopher and Adjunct Professor, Dr Dean Cocking, addressed the local students as part of their personal and professional development curriculum.

Dr Dean Cocking: health care and human rights promote one another.
The freelance academic and author from Castlemaine has been talking to medical students in the local area for the past four years about the relevance of ethics in medical practice. Dr Cockings said his approach was underpinned by the principle that treating patients and consumers with respect leads to professionals practising good judgement and investigation, ultimately making them better at their jobs.

The philosopher, whose background includes working with the Australian Defence Force Academy, Australian National University and the Victorian Police Academy, takes a grounded approach to his teaching.

“I think it is really important when you are teaching professionals about their ethical responsibilities that what you say is relevant to their everyday practice rather than asking them to focus on the most unusual or extreme cases,” Dr Cocking said. “What I emphasise is that health care and human rights promote one another and that if you respect people – patients, clients, the public – that should be the rule of thumb; but then it’s important to explore what is this notion of respect and what does respect mean to them as health professionals?

“Because of the demanding workloads medical professionals face, they can become jaded and miss certain things so I tell some everyday true stories from a range of areas of professional practise about how remaining open minded, paying attention and not assuming too much are not only markers of respect but they lead to good investigation as well, hence, in the case of medicine, better patient outcomes,” Dr Cocking said.

“I am presenting values as a means of getting better, technically, at their jobs - and this seems to resonate. As a medico these students will not be the patients’ friend or family member but they will not be a complete stranger either; they will have an institutional role and body of knowledge and it is important how they use this – I try to show them that what they are doing in everyday practise is a moral enterprise.”

Monash Rural Health Bendigo lecturer Pam Harvey said student feedback following Dr Cocking’s seminars was positive. “He challenges students to think about ethics on a deeper level and provokes reflection in a way that I think will stay with them as they embark on their careers,” she said. “We always talk about the uncertainty of medicine and how you never find a textbook case of anything so you need to learn to cope with the uncertainty and stay open minded,” Ms Harvey added.

Dr Cocking is the author of two books, Virtue Ethic and Professional Roles, (with Justin Oakley), Cambridge University Press, and Evil Online, (with Jeroen van den Hoven), Wiley-Blackwells, which is forthcoming at the end of this year.

Thursday, 15 September 2016

Passions & Pathways introduces students to health professions career

A group of local year six students became familiar faces around Monash Rural Health’s Bendigo site as part of an innovative primary school and workplace partnership program. Passions & Pathways, an initiative of local businesses, paved the way for a seven young Eaglehawk Primary School students to spend time at Monash Rural Health over four weeks.

Eaglehawk Primary School students suit up for a session in the simulation lab.

Goldfields Local Learning and Employment Network (GLENN) Executive Officer Anne Brosnan said Passions & Pathways helped to raise the aspirations of students from disadvantaged schools by immersing them in workplace environments and “teaching them new things.”

While the program relies on the co-operation of industry partners such as Monash Rural Health, Ms Brosnan said participation also provided benefits to employers of the workplaces involved.

“The industry partners who have come on this journey with us say that they love the chance to engage with these students before they transition to adolescence,” she said, adding that as the program progressed it was attracting increased attention from Bendigo employers.

Monash Rural Health Bendigo Lecturer Pam Harvey said this was the second year the clinical training site had been welcoming students and in 2016 participation in the program has been embedded into the paediatrics curriculum of its medical students.

“This program opens the primary students’ eyes to job and career opportunities but it also provides valuable teaching moments for our own students,” Ms Harvey said.

The primary school students’ visits to Monash Rural Health included time spent in its simulation laboratory, where they ‘suited up’ in appropriate medical attire and learn about identifying germs, bodies and the tools of the doctoring trade, as well tours of the training site and Bendigo Health.

Pam Harvey at the students' expo
“We hope that, through having these authentic experiences in local workplaces, students can see that these employers care about them and that this, in turn, helps students to value the ideas of learning, training and employment,” Ms Brosnan said.

During their time at Monash Rural Health students collected information for a presentation at their school in mid-September, attended by industry partners. “The feedback we hear is that this is a highlight for our own staff who attend,” said Ms Harvey. “This provides evidence of the connections and relationships which are formed as part of the program.”

Wednesday, 14 September 2016

Summer scholarships offer regional students a taste of research career

A research scholarship program  run by Monash University over the summer break offers tertiary students from any university the chance to try out a career in research.

Monash Rural Health summer scholarships coordinator, Associate Professor Rebecca Kippen said deciding whether to pursue a research degree is hard when you’re not sure if you’ll enjoy a research career. “These scholarships are rather like a work experience placement – you work with real data, on real research projects with real researchers to see if it’s a career option you want to choose,” said Associate Professor Kippen.

“We have a number of projects on offer in Mildura, Bendigo and Gippsland for students interested in rural health research,” she said. Projects include looking at:

  • how to retain rural GPs
  • how to reduce unnecessary presentations to regional emergency departments 
  • community awareness of cancer risk factors
  • sports injury prevention in cricket
  • improving medicine information for lactating women about infant risk
  • presentations and clinical outcomes of patients at a rural early psychosis team

Scholarship students are trained in a particular aspect of research and spend two or three weeks working under the supervision of a researcher. Projects run between December 2016 and February 2017 with students paid a weekly stipend of $200.

“It’s as genuine an experience of research as we can make it and we provide a lot of support for students,” said Associate Professor Kippen. Associate Professor Kippen knows well the value of summer programs like this – she decided to pursue a PhD in demography after attending a summer school in Canberra.

The scholarships are open to undergraduate and coursework postgraduate students at any Australian university and are awarded based on academic merit.

Applications are currently open and close on Friday 7 October 2016.  See the summer scholarships website for details.

Policy signals from 5th Rural and Remote Health Scientific Symposium

The 5th Rural and Remote Health Scientific Symposium in Old Parliament House of Canberra on 5-7 September 2016 was an excellent event which brought together leading voices in rural health policy and research. The opening address by Matilda House of the Ngambri-Ngunnawal clan introduced the Hon Dr David Gillespie, the new Assistant Minister Rural Health, who provided a strong overview of the Australian government’s shaping agenda in rural health.

Dr Belinda O'Sullivan presented a Lightening Talk  about models to deliver specialist services in rural and remote Australia. (5:36 mins)
The government’s agenda is clearly focused on getting the right mix of health workers with relevant skills in rural and remote Australia, focusing on delivering accessible, cost-effective and sustainable health care to rural and remote people.

A new Rural Health Commissioner signals the government’s commitment to improve rural health. Research and evidence are emphasised as critical to help shape the government’s agenda, specifically informing Medicare reform, the use of overseas-trained doctors, workforce programs, commissioning via the Primary Health Networks and healthcare homes. The government is committed to expanding the use of technology for more convenient and efficient care, not replacing services on the ground.

Other presentations spanned policy, practice and research. Prof Duckett overviewed research from the 2016 Grattan Report Perils of Place which diverged into a range of discussion about place-based amenity and indicators to signal medical workforce need, service gaps and the need for better planning.

The five minute lightning talks are a very digestible format to get the flavour of work being done in rural health nationally. (View Dr O'Sullivans's talk 5:36 mins.) Excellent panels and plenaries went into more depth as to indigenous health research, the use of small hospitals, re-instituting rural maternity services and building rural health research capacity.

Dr Matthew McGrail and Dr Belinda O’Sullivan enjoyed the chance to present emerging research from their work using MABEL data. This symposium was short, sweet and perfectly pitched to enthuse passion in rural health policy, practice and research. See the presentations on the National Rural Health Alliance website.

Monday, 5 September 2016

Taste of research life in Bendigo

Three students spent time at Monash Rural Health Bendigo in December 2014 and January 2015 working with Senior Research Fellow, Dr Bernadette Ward, on current research projects.

Jarrod Verity

I want to thank Dr Bernadette Ward and staff at the School of Rural Health for making my time there so enjoyable and valuable.

Being able to actually apply the skills I’ve been taught in classes to real research was extremely satisfying, and my proficiency in SPSS has greatly improved as a result. Being able to live in another city was also a highlight, and something I’m sure many students would love to have in the future.

Finally, the chance to go to Mildura fulfilled one of my biggest goals for the trip; to go out and see the countryside and life away from Melbourne.  I won’t ever forget that trip, even if it was for only two days.  I’ll definitely be telling my friends to keep their eyes open once new scholarships are released next year - many of them were quite amazed a program like this was available.

Kate Xu

My research experience at the School of Rural Health in Bendigo provided me with a great opportunity to get involved in analysing survey data using SPSS software; I have learnt a lot from the hands-on experience under the supervision of Dr Bernadette Ward and Dr Rebecca Kippen. It was exciting to reveal some interesting results.

The research environment at Bendigo was very supportive and inspiring, allowing me to extend my professional network. Besides academic support, my supervisors and the team also hosted me warmly throughout my stay. I stayed at a big, modern student resident house close to Monash University. In summary, the Summer Research Scholarship provided me with invaluable experience of researching, learning, travelling and networking. I truthfully wish to join the team again in the future.

Hannah Punton

My project involved cleaning and analysing secondary data. It was the second biggest excel sheet I have ever seen! Yet with the help of Dr Bernadette Ward and another student, I was able to power through while developing some keen skills on the number pad.

I very much enjoyed my time here, I met great people, and learned more about the School of Rural Health, which I hope to remain a part of for some time. Furthermore, this experience has enabled me to get involved in a medical research project at my placement in Traralgon.

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

3D printing technology aids anatomy learning

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.

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.

Friday, 22 July 2016

The poetics of illness stories

As a lone qualitative sociologist in a mostly hard science-based, quantitative field of teachers and researchers, the opportunity for Dr Marg Simmons to present her work at a recent conference in Italy was a welcome one.

Based at Monash Rural Health Churchill, Dr Simmons’s current project is focused on collecting stories of illness from survey participants. Her conference presentation offered a voice to these participants through ‘poetic representation’, where she chose to explore some of the responses on illness narratives, in poetic form. “This conference took an interdisciplinary approach to the ‘broken narrative’ which occurs when people become ill and the narrative structure and stability of their life stories are disrupted.”

Transformative: poetry can convey ideas and emotions more powerfully than prose text. (Image Deviant Art.)

Dr Simmons’s presentation also referenced authors whose research on illness refers to the loss of a ‘roadmap’ for a person’s life when illness strikes, the non-discriminatory nature of illness such as cancer, the shock and acceptance around diagnoses, the use of military metaphors to describe illness, the perpetual interruption to life which comes with illness and the gratitude expressed by some people with illness.

A series of poems were constructed and presented by Dr Simmons, each of which sought to capture the stories of her participants. One collective poem, ‘No particular words’ - in response to a survey question about language or words used to describe a participant’s illness – explored the irony of there being many words to describe illness yet often no words for the suffering.

Dr Simmons said the act of constructing poetic-like representations of her data was “careful and thoughtful transformative work” with the analysis process demanding that she ask herself constantly ‘what is this poem trying to tell me?’ “I think poetry can sometimes convey an idea or emotion more powerfully than text and is certainly very evocative and moving,” she said.

“I hope my research will add to the body of knowledge which can help to translate illness experiences into important stories that highlight the connections and similarities in those stories as well as the challenges and disruptions that illness brings to people’s lived experience, to hopefully make a difference for patients,” she said.

The local researcher also hopes her work will help to better inform health professionals about the use of language around illness.

Dr Simmons’s study is ongoing, with her survey still open to anyone who has an experience of illness, whether they are a patient, carer or professional.

The survey, which takes about 30 minutes to complete, is available online. For more information, contact Dr Marg Simmons by phone  (03) 5122 7527 or email margaret.simmons@monash.edu.

Wednesday, 20 July 2016

Learning to talk with seriously ill patients

A partnership between Monash Rural Health and Gippsland Region Palliative Care Consortium is teaching local medical students critical communication skills for dealing with palliative care patients. The two local organisations have come together in recent years to share the facilitation of annual workshops for Monash University year 4C medical students on GP placement in West and South Gippsland and the Latrobe Valley.

Communication skills: the joint workshops teach students how to communication with patients in palliative care.
Dr Cathy Haigh, Deputy Director and Year 4C Academic Coordinator at MRH Latrobe Valley and West Gippsland, said the partnership between MRH and the GRPCC had been fostered through sharing space alongside one another in cottages on the West Gippsland Hospital grounds. “Then, when funds became available several years ago, the consortium was proactive in initiating the idea of a communication skills workshop for our students and we were very open to the idea,” she said.

The workshops include talks by palliative care experts from Melbourne who inform students about appropriate ways to manage the impacts of palliative care drugs, for example. Another key part of the learning is centred on teaching students to effectively and empathetically manage and respond to patients across a range of scenarios involving the personal and psychological impacts of their situations. Led by local psychologist Dr John Reeves, West Gippsland Palliative Care Consortium nurse Anny Byrne and professional actress Veronica Pocaro, who plays the role of a patient, this component of the workshop is particularly welcomed by students.

Dr Paul Brougham, Head of General Practice with Monash Rural Health Latrobe Valley & West Gippsland, said the workshops were “as much about communication skills as they are about palliative care”.  He said they had been instrumental in helping students to develop critical communication skills in a safe environment. “Within this environment, it doesn’t matter if the students make mistakes because if they don’t do something well they have an opportunity to try again, without causing any offence, and learn from their mistakes. The small group sessions are also an advantage, allowing everyone to participate and to critique and learn from one another,” he said.

Dr Brougham said that patients would be the ultimate beneficiaries of teaching students to convey empathy, speak to them without jargon and consult in a way that encourages them to express themselves. “Although this teaching is done in a palliative care context, it really has the potential to benefit patients and students across all areas of clinical practice - these social and communication skills are so important and yet they are not always taught,” he added.

Student feedback on the program is invariably positive with one student from a recent workshop saying the opportunity had provided “one of the best sessions of the year thus far for me.” Another praised the “underlying principles of hypothesis testing, self-critique and self-improvement” as being “important life and career skills.”  Dr Haigh said the success of consecutive workshops, which cater for a total of around 25 students across three sessions each year, has seen both parties commit to continuing with the arrangement into the future.