Monday, 18 September 2017

Rural exchange in Balclutha, NZ

Each year, a Monash medical student based in East Gippsland for their second clinical year heads off to a New Zealand rural region and a student from Otago University takes their place here. James Davey reports on his experiences in New Zealand during the 2017 exchange.

Cold arrival

I was bursting with excitement as I left Melbourne destined for New Zealand to start my fortnight long exchange between Monash's School of Rural Health (East and South Gippsland) and Otago University's Rural Immersion Program (RMIP). Flying from Melbourne to Christchurch in the early hours of Saturday morning, I was treated to an amazing little look back on the Gippsland. As it was my first time visiting New Zealand my excitement only grew as I flew Christchurch to Dunedin. When I arrived it was dark, cold and rainy, but I was met at the airport by the warm smiles of my two new flatmates Dan and Grace. Their kind welcome instantly put any uncertainty I had aside as we headed out to for a dinner at the local pub over an exciting rugby game between the All Blacks and The Lions.

Sunday’s weather was again wet, cold, windy and rather miserable, but I dragged Dan and Grace out to brave the weather to explore some of the Catlins region. They were excellent tour guides and I was impressed with their depth of knowledge about the region, flora and fauna. We visited the Nugget Point Lighthouse to take in the rugged but beautiful coast, as we were hit with icy winds coming off the Southern Ocean. We ventured on to Cannibal Bay where I got to see sea lions play fighting on the beach. The water is a beautiful shade of blue though far too cold to swim, besides I forgot my "togs". That night we enjoyed a great dinner full of laughs with the Clutha Health First clinic’s administrator, my first introduction to Balclutha’s lovely small town hospitality.

Warm welcome - Clutha Health First

The following day I received an incredibly warm welcome to the Clutha Health First Clinic and a tour of the great facilities. Clutha Health First integrates a General Practice clinic, a fifteen bed inpatient ward, outpatient services for visiting specialists, a midwife run maternity unit, a medical assessment unity (a practice nurse run mix between ED and GP) and multiple allied health services like X-ray and a basic pathology service. Clutha Health First has an incredibly unique set up and an interesting backstory behind it. Balclutha originally had a hospital, but as Health Care Otago moved to retract funding from rural areas, it left the town with only general practice services. The dissatisfied community, rallied and marched in Dunedin demanding that their region have more. As a result, Clutha Health First opened in December 1998 funded and owned by the community of Clutha; an achievement that they are rightly very proud of.

My time spent at Clutha Health First during the first week was spent in a mix of general practice, outpatient psychiatry, the inpatient ward and the medical assessment unit. This gave me the opportunity to work with and learn from an incredibly multifaceted team in a hands on way.  Working with the team at Clutha Health First, I gained further insights into the challenges of rural practice in a smaller setting than I am used to, for example only having access to X-ray rather than a CT scanner. It was great to see the way that different areas of the clinic came together to handle some challenging medical problems. I really enjoyed my time in the Medical Assessment Unit with exposure to a great mix of GP and ED cases; I was really impressed that all of this was handled by incredibly capable nurse practitioners rather than doctors.


During the weeks I spent my moments of free time making the best of the weather by exploring the town and surrounds. On sunny days I’d take a walk at lunch or in the evening through the main street of town or to check out the Clutha River (New Zealand’s largest volume river) and the Clutha River Bridge. When the temperature dropped, I’d be up early to take a walk through the frost and break frozen puddles as the sun rose over Balclutha. Although I got excited for snow a couple of times with freezing temperatures, we received no more than a minimal dusting, but got plenty of ice and sleet instead. Despite this my excitement over the ice and frost remained high and my flatmates jokingly likened me to a child as I continued to smile until my teeth literally hurt from the cold.

I celebrated the end of an amazing first week in Balclutha with with a fun filled Friday night at the Kaka Point Pub’s ‘open mic night’. My very talented flatmate Grace joined a number of excellent performances and we all had an absolute ball. I spent Saturday morning working alongside another fantastic nurse practitioner in the Medical Assessment Unit. On Saturday afternoon Grace and I left for Queenstown to go stay with some of the other RMIP students who are based there.  Despite stopping for a number of photos and needing to slow down for some icy roads, we made it in time for the final rugby game between the All Blacks and the Lions over dinner with some of the other students. It was great to hear about some of their experiences and challenges they were facing treating a population dominated by tourists.

Riding through a winter wonderland

On Sunday Grace and I set out exploring on an ambitious bike ride along the Queenstown trail which ran around lake Hayes, out to Arrowtown and back along the Kawara River. The scenery set to a backdrop of mountains was breath-taking, and I was in absolute awe! We rode through the most incredible ‘winter wonderland’ like thick frost coming into Arrowtown. Despite running relatively short on remaining daylight, we were confident in our riding ability so decided that making it home before sundown was still possible even if we took the longer scenic route. This would have been perfect had we not taken a wrong turn and added an extra 8km to our trip with a detour. We were still riding when the sun set and the temperature began to drop, we pushed on to eventually make it back to the car exhausted as the moon rose overhead.

Multidiscplinary week two

 Like my first week at Clutha Health First, my second was split with time across multiple disciplines and teams. I was fortunate enough to even spend some time parallel consulting with Dr Branko Sijnja who heads the entire Otago University RMIP program and Dr Rebecca Canner who runs the teaching for the RMIP students in Balclutha; both coming from an incredible wealth of knowledge that I had the privilege of learning from. I also got to spend some time with the Balclutha midwifery team and gained some valuable insight through discussions about the differences between a midwifery run centre with no theatre like Clutha Health First, and Sale with its large obstetric team. Additionally, I spent an amazing day with a GP in Milton, one of the small towns near Balclutha, gaining some exposure to the aged care system and having the opportunity to do some suturing. Although the presenting complaints and core medicine are similar, it has been interesting to see how the Australian and New Zealand health care systems manage patients slightly differently; something I will continue to reflect on in future practice.

I’m incredibly grateful to have been given this unforgettable and invaluable experience. Without hesitation I’d recommend this opportunity to broaden your perspective, gain insight and overall grow as a future doctor to everyone!! Throughout my journey I was generously welcomed and supported by so many incredible people! They all played a part in making this the enriching experience it was, I could never thank them enough for what they have given me!

I’ll definitely have to return to New Zealand real soon! Maybe even to spend some more time at Clutha Health First in the future.


Friday, 8 September 2017

Stronger guidelines needed for alcohol at school events new study recommends

Schools should consider what message they're sending young people when providing alcohol at events where children are present. Image: Kimery Davis (CC BY 2.0)

An Australia-first study has found a strong correlation between explicit education department guidelines and reduced availability of alcohol at school events where children are present.

The study found the rate of temporary liquor licences issued in Queensland was more than twice that of Victoria, five times that of WA and sixty times that of NSW; while that average annual licences per hundred schools was highest among the independent and Catholic school sector.

Lead author, Dr Bernadette Ward of Monash University, said that licensing legislation alone in the various jurisdictions does not explain the disparity in the number of liquor licences issued for school events, rather that clear education department policies may be the reason

“In Queensland those relatively high rates of licences may reflect the lack of education department policy,” said Dr Ward. “Similarly, the relatively high rates in Victoria may reflect the devolution of decision making to school principals and councils, while the restrictive NSW policy is consistent with the relatively low rates of temporary liquor licences issued to schools in that state.  Across all jurisdictions, independent and Catholic schools are not subject to education department guidelines, if they exist, with school principals and councils making the decision to offer alcohol at school events where children are present.”

Early initiation to drinking and risky use of alcohol by children and adolescents is associated with significant harm and alcohol dependence in adult life.

“In Australia, alcohol at social occasions is normalised,” said Dr Ward. “Having alcohol-free events at schools shows children that they can have fun without alcohol. It also reduces the risk of alcohol-related violence that has been reported by some school principals.”

While parents play a critical role in teaching young people about alcohol, schools play a role generally embedding messages about responsible use in the curriculum. However, the study’s authors say, schools can also influence children’s alcohol perceptions and possible use when adults consume alcohol at school events in the presence of children.

“We’re definitely not saying that you shouldn’t have a drink at school events,” said Dr Ward. “We are saying you need to be aware what message this sends to children who are present, and explicit policy guidelines seem to be helpful for schools in deciding what is appropriate. It also seems that schools find it helpful where strong guidelines exist to guide decisions suggesting that there’s an important role for education department policy.”

The study examined temporary liquor licensing data in NSW, Queensland, Victoria and WA, as well as licensing legislation and education department guidelines in the four jurisdictions. The aim of the research was to identify the conditions under which Australian schools must apply for a liquor licence and the associated prevalence of liquor licences for these events where children were likely to be present.

The paper, ‘Liquor licences issued to Australian schools’ is available online at BMC Public Health.

Thursday, 7 September 2017

High turnover of remote health workforce puts patients' health at risk

Staff turnover in remote health centres is unsustainable new research finds.

Half the staff working in a remote NT healthcare clinic leave after four months on the job, two thirds leave remote work altogether every year and any one clinic can see a 128 per cent turnover of staff each year, putting patient health at risk, new research shows.

On the tenth anniversary of the UN Declaration on the Rights of Indigenous Peoples, the study raises concerns about how the rights to health of Aboriginal and Torres Strait Islander people living in remote communities are compromised by an unstable remote health workforce.

Lead author Dr Deborah Russell of Monash University said that there was considerable anecdotal evidence about the difficulties remote communities face attracting and retaining suitably skilled health staff and their increasing reliance on agency nurses.

“This is a landmark study that actually measures turnover from the perspective of a particular remote health service,” said Dr Russell. “It shows extreme fragility of the remote workforce, confirming that there is a heavy reliance on agency nurses to provide primary health care in NT remote communities. Lack of continuity of care has serious implications for both patient health and staff safety in remote communities across Australia. Constantly having to recruit and orient new staff is also a serious drain on resources and can make it very difficult for these health services to participate in quality improvement.”

The study was a collaboration between Flinders University, Monash University, Macquarie University, the University of Adelaide, the University of Sydney and the Northern Territory Department of Health. It is part of a larger program of research investigating the impact and cost of short-term health staffing in remote communities to determine whether ‘FIFO’ is the cure or the curse. The study looked at data provided by the NT government payroll and account system from 2013 to 2015 covering 53 remote clinics.

While the study looked specifically at NT health services, the authors say that extremely high turnover and heavy reliance on short-term agency nurses for supply has important implications for remote health services anywhere in Australia.

“There’s good evidence that primary health care is critically important for achieving equitable population health outcomes,” said Dr Russell. “A chronic lack of continuity of care sees people less likely to access primary health care in a timely way and to disengage from their health care altogether. And, ultimately, that results in poorer health outcomes.”

The study’s Chief Investigator Professor John Wakerman, Associate Dean Flinders NT, says there is no one simple solution to this issue.

“The work to date suggests a number of possible strategies. These include increased investment in recruiting and retaining local Aboriginal Health Practitioners and consideration of utilising remote nurse practitioners where there are no doctors to provide higher level care and stabilise the nursing workforce. We can also learn from successful strategies used for training and retaining doctors and apply them to nursing and allied health professionals,” said Professor Wakerman. “This would entail prioritising remote and rural origin and Aboriginal students in undergraduate courses; early exposure and training in remote areas and developing clear career pathways for these remote area health professionals.”

The paper “Patterns of resident health workforce turnover and retention in remote communities of the Northern Territory of Australia, 2013-2015” is available online at Human Resources for Health.

See also an editorial on Croakey.

Wednesday, 6 September 2017

Cancer campaigns need rethinking new study finds

Traditional cancer awareness campaigns may need rethinking to target at risk groups a new study suggests.

Research conducted by Monash University in collaboration with Cancer Council New South Wales shows that young people and men have poor awareness of common cancer risk factors such as UV exposure and tobacco smoke.

While there's awareness of some cancer risk behaviours, more work is needed.

Lead author, Monash University’s Associate Professor Rebecca Kippen said there was a need for more carefully targeted social marketing campaigns to get the message through to these groups.

“In Australia around one third of cancer cases are due to modifiable lifestyle factors,” said Associate Professor Kippen.

“We know that awareness of these risks is an important influence on people’s attitudes and behaviour about cancer prevention.

“This research shows that, in particular, young people and men don’t seem to be aware of these common risk factors and so they’re not engaging in protective behaviour.”

The study analysed the responses of 3,301 adult residents across New South Wales to a survey conducted by Cancer Council New South Wales in 2013.

Respondents were asked to rate seven risk factors – UV exposure, smoking and passive exposure to smoke, alcohol consumption, not eating enough fruit and vegetable consumption, and high body weight – and report on their own protective behaviour.

The study shows that, overall, there is high community awareness of the cancer risks of UV exposure, smoking and passive smoking, but much lower awareness of the link between cancer and being overweight, alcohol intake and low fruit and vegetable consumption.

Women were more likely than men to practise all the “protective” behaviours, except for being “sunsafe”.

Respondents over 50 were more likely than those aged 18-39 to be sunsafe and non-smokers, drink less alcohol and eat two or more fruit serves daily, but they were also more likely to be overweight.

There were also correlations between higher educational levels and protective behaviours.

“Historically, the largest cancer prevention campaigns in Australia have focussed on UV exposure and smoking, and they’ve been successful in raising community awareness of these risk factors,” said Associate Professor Kippen.

“But community understanding of other risk factors remains poor and it’s clear that campaigns targeted at specific audience segments, such as young people and men, are needed.”

The study is one of the first of use multiple variables to analyse the association between awareness of risk factors and health behaviour. The paper is available online at BMC Cancer.

Friday, 26 May 2017

Locals learn the ropes in Gippsland hospitals

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

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

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

Others were influenced by personal experiences as they grew up.

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

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

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

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

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

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

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

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

Friday, 28 April 2017

Testing the waters in Year 2

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

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

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

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

Monday, 24 April 2017

Paediatrician leaves large educational legacy in Latrobe Valley

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

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

Always a teacher

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

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

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

A long involvement with Monash

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

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

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

Choosing regional practice

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

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

Regional recruitment - the social dilemma

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

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

The future is regional

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

Monday, 3 April 2017

Coming home to Mildura to study medicine

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

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

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

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

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

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

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

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

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

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

Monday, 6 March 2017

PNG placement motivates medical student

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

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

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

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

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

Music for Cambodia

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

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

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

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

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

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

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

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

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

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

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

Many disciplines make productive research

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

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

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

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

Complementary skills

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

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

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

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

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

Advanced Care Planning close to home

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

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

Staying focussed

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

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

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

Tuesday, 28 February 2017

First cohort of medical students starts in new Bendigo hospital

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

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

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

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

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

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

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

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

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

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

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

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

Monday, 27 February 2017

A summer interest contributes to safe drug repository

Yi Sien Koo thought he might be bored during the summer holidays so he applied for a summer research scholarship at Monash Rural Health Churchill. The final year medicine student might joke about his reasons for wanting to undertake a short research project, but this wasn’t the first time he’d applied and he was pleased to be awarded the scholarship.

Over the course of his studies, Yi Sien developed an interest in women’s and children’s health. So the project – Milking the evidence: improving medicine information for lactating women about infant risk – supervised by Associate Professor Shane Bullock and Dr Adelle McArdle felt like a natural fit.

Creating an evidence repository

The project involved reviewing the evidence available for women and clinicians about the safety profiles of medications while breastfeeding. Working with another student, Jacoba van Wees, Yi Sien looked at the kind of evidence available, and what level of recommendations, if any, the literature offers. In addition, they wanted to know where people were looking for information and the factors driving their behaviour.

Reviewing one drug group can take up to several days, and in some cases there may be no end to the availability of literature to scour through. Nonetheless, they tried to compare the types of evidence offered across the drug groups. “For example, there was more literature on antibiotics use for mastitis during breastfeeding as compared to say drugs for asthma, and this is possibly because of the relationship breastfeeding has on the incidence of mastitis in the post-natal period,” he explained. The students found there  were differences in the type of information available to guide clinical judgement across the drug groups, and hence had to arrive at a consensus and agree on certain parameters to assess their safety profiles. This would allow a more targeted literature search and a focused agenda.

Communication and collaboration

It quickly became clear to Yi Sien that collaboration and communication skills in research are important at all levels. “Communicating with Adelle and Shane was really important. They did guide us a lot, but they gave us a lot of freedom as well,” he said. “It’s something that Jacoba and myself benefited a lot from because it allowed us to explore different drugs, or even different areas of parameters that we might not have focussed on. I learned to think, not solely of the project but of certain things we can do in the future too.”

“Shane and Adelle have been brilliant supervisors, not just in this project, but they’ve offered help beyond the project as well,” he said.

Learnings beyond the literature

Reading so much literature in a concentrated time gave Yi Sien more than an overview of medication evidence. “We also got the flavour of population health such as barriers to information that patients may encounter. I also read about cultural practices that have been ongoing which could influencehow women feel about lactation and drugs. On top of the medical information you get to understand how and why people behave in particular ways and the  aspects influencing people’s access to health information.”

He also developed skills in reviewing literature itself. “Going through tons of information over time allowed me to gradually learn to pick things up that were more relevant.”

Developing a mobile app

Collating the important information into an easily accessible source was the desired aim of the project. Associate Professor Bullock thought a mobile application that would be user friendly and convenient for both mothers and clinicians might achieve that. He drew on the expertise of another Monash Rural Health researcher in Mildura, Dr Naj Soomro, who has expertise in mobile apps for research and was very willing to help.

An app is a major project in itself, but by the end of the scholarship project, Yi Sien and Jacoba had at least drawn designs for a prototype application with Naj’s help: the home page, a drug page, the important parameters, and how a user might interact with the app.

While designs for a prototype were underway, Associate Professor Bullock approached an academic colleague from Monash Rural Health - Anne Leversha, an experienced senior pharmacist - to seek guidance from a contact of hers - another pharmacist at the Monash Medical Centre, who is one of the learning experts in lactation drugs, to review the parameters the students had developed.

Continuing the work beyond summer

Five weeks’ work established a good base for the evidence repository, but there’s a lot more to be done. Unsurprisingly, Yi Sien feels he’s invested a lot in the project and would like to continue working on it when his studies allow. And he’d certainly recommend the experience to other students. “As health professionals we always have to go into some sort of research these days,” he said. “But for students, it’s important to find something that interests you because it may not go as you expected.”

It’s a busy year for Yi Sien. His first rotation is in Frankston, he heads overseas for an elective and travels to Bendigo later in the year for another rotation. Coming from metropolitan Melbourne he really enjoyed his stay in the Monash Rural Health accommodation in Moe which is a short drive from Churchill where he was based for the project over the summer. “I really enjoyed staying in the rural setting coming from a metro life the past few years. So that’s something I was looking forward to when I applied for the project. I actually like the countryside, living there was great.”

And he certainly wasn’t bored over his summer break.

Friday, 24 February 2017

Final year student gets back in the swing of things in Leongatha

Susan Lee is doing a surgical rotation at Leongatha hospital
My name is Susan, and I’m a fifth year student doing my surgical rotation at Leongatha Hospital.

I was really nervous about starting this rotation – I’d taken two years off from medicine after fourth year, so I knew I’d be quite rusty. Fortunately, Leongatha has been such a wonderful place for me to get back into the swing of things. Everyone has been so welcoming and encouraging - staff are willing to teach, and patients are happy to give me a chance to learn.

The amount of hands-on experience I’ve had in the three weeks I’ve been here has been phenomenal, from assisting in surgeries, or cannulating and suturing, to seeing patients in the GP clinic.

To top it all off, there’s the gorgeous Gippsland beaches and scenery to soak in at the end of the day. The only downside of this rotation has been my cooking - but I’m working on it!

Tuesday, 21 February 2017

Jessica goes back to her roots for GP placement

Jessica Paynter returned to Swan Hill to learn from the GP who delivered her 21 years ago.
Not many medical students can choose to go and study with the obstetrician who was present at their birth, but Jessica Paynter figures she can learn a lot from the Swan Hill GP who delivered her, Dr Ernan Hession.

Jessica is one of eight Monash medical students doing an 18-week placement under the guidance of Dr Hession at the Swan Hill Primary Health Medical Centre.

Growing up in Nyah and Swan Hill, Jessica understands both the down- and upsides of living in a close-knit community. “That’s what rural medicine is all about: seeing your patients in the supermarket,” she said. “I’m sure it’s a challenge that doctors may feel that they never leave their profession.

“It’s a nice community though; I know a lot of people and I’ll probably see a lot more people than I expect while I’m here.”

The 21-year-old is the first in her family to study medicine; it was childhood experiences of the local medical workforce that got her thinking about medicine as a career. There weren’t many female GPs in Swan Hill when she was growing up, she remembers. “There’s a lot more now, but I has the impression when I was young that there weren’t many female doctors at all.”

Seeing an opening, enjoying physical activity and with an interest in science, Jessica thought medicine was a good fit, and she likes the Monash model. “I picked the ERC [Extended Rural Cohort stream] because I wanted to study rurally. I knew I had the option to come home and do a placement.”

She’s well aware of the importance of maintaining connections in sustaining a community. “If you don’t keep connections with a community, it just dies,” she said. Many of her friends also studied health sciences and some are returning to Swan Hill now. “One of my friends got a graduate nursing position in Swan Hill this year and another has got a new job as a speech pathologist.”

Will she be back too? She’s not sure yet where her career interests lie, although this placement is a “little trial” return to Swan Hill. “I’ll probably do a few junior years in a bigger centre and come back when I’ve specialised.

"I came in [to the medicine course] thinking I wanted to do general practice. I like the look of the GP lifestyle, especially rurally. It’s a lot more hands-on and keeping your skills up-to-date is important. A lot of GPs in Swan Hill do a lot of work in ED and have paediatric and other specialist diplomas.”

This semester studying with Dr Hession will certainly give her hands-on experience of working as a rural GP before she returns to Bendigo for the rest of the year.

While it’s a big year for a medical student returning home for a placement, it won’t be all hard work. The netball club she used to play for is trying to recruit her to come and play again while she’s in Swan Hill. It might be hard to resist those old connections.

(See story about the Swan Hill clinic where Jessica is studying...)

Swan Hill clinic works on solution to rural doctor shortage

Eight Monash University medical students have just begun an 18-week placement with the Swan Hill Primary Health Medical Centre as part of an ongoing program to alleviate the shortage of doctors in rural Australia. This year’s cohort of eight students is the most Swan Hill has hosted in its many years of educating students in a rural setting.

Local GP Dr Ernan Hession and Monash Hub Director, who has been involved in teaching Monash students in Swan Hill since 2010, said the whole community has a role to play in encouraging students to consider a career in rural practice.

Bridge over the Murray River at Swan Hill
Eight medical students will spend 18 weeks in Swan Hill learning from GPs and staff at the Swan hill Primary Health Medical Centre. Photo: Marcus Wong (wikimedia)

“The Swan Hill Primary Health Medical Centre was established with a culture of teaching, but students learn a lot from patients too. Many of our students are from country areas and it’s great that we can train them in the same environments they are used to – and hopefully also will return to.

“Being willing to see a student when you visit the clinic provides them invaluable opportunities to learn,” he said. “A welcoming community makes a huge difference to the experience students have on a clinical placement and our town has been very supportive of the programme over the last six years.

“The program is expanding in our area and this is a result of all of us – educators, community placements hosts, hospital and most of all our patients – have supported it.”

Director of Monash Rural Health Bendigo, Associate Professor Chris Holmes, agreed that the time students spend in centres like Swan Hill is a vital part of their clinical education and pivotal in career choices.

“We know that a positive rural experience during their training can have a big influence on students’ decision to pursue a career in rural practice.

Jessica Paynter grew up new Swan Hill and came back to learn from the GP who delivered her 21 years ago.
Read her story...
“Swan Hill has become a priority choice for students because of the wide variety of clinical opportunities available – and the high quality teaching support provided by educators like Dr Hession, Dr Julia Coshan and all the other wonderful teachers who give freely of their time.” said Associate Professor Holmes.

The eight students are in their second year of clinical training and will spend a significant portion of their time working in the medical clinic under the supervision of a GP. Here they have an opportunity for a wide range of clinical experiences both in the clinic and the hospital, especially in obstetrics, procedural general practice, Aboriginal health and emergency medicine.  They also attend formal tutorials and teaching sessions run locally and via videoconference facilities at the clinic.

The students come from regional Victoria and New South Wales, and include two from Melbourne.

Friday, 17 February 2017

Beyond the Bunsen burner

Over the summer, Jacoba van Wees learned that research in medicine doesn’t just happen in a lab with a test tube and a Bunsen burner. With a research scholarship in biochemistry under her belt already, the Biomedical Science graduate, who started the graduate entry medicine course this year, applied for a summer research scholarship that was more medicine related.

Jacoba van Wees undertook a Summer Research Scholarship project before starting her medicine studies.
Milking the evidence: improving medicine information for lactating women about infant risk was supervised by Dr Adelle McArdle and Associate Professor Shane Bullock at Monash Rural Health Churchill. The project looked at what evidence is available about the safety of medications for women who are breastfeeding with the ultimate aim of making it easier to access information.

Collating evidence for an app

Jacoba worked on the project with another student, Yi Sien Koo, for five weeks. “Our job was to do a bit of the grunt work of going through the literature to work out what was important when you’re trying to prescribe a drug.”

With epidemiological evidence suggesting that people aren’t making good prescribing decisions, Jacoba didn’t expect to find much research on the effects of medications on infants who were being breastfed. “I was thought it was all going to be very quick, but what we actually found after hours and hours trawling through online databases is that there’s a lot of evidence out there.” The difficulty, she learned, is that it’s hard to find. “We found heaps and heaps of data but it took us hours and hours of work to find it, and that’s obviously going to impact clinical practice if clinicians can’t find the information that’s available.”

Shane thought a smart device application would make the information accessible faster and more easily than trawling through texts. So Jacoba and Yi Sien investigated how other medical related apps framed their data and presented information; how they kept it professional, but still user friendly. At this stage, Shane contacted a colleague in Mildura, Dr Naj Soomro, who had experience developing apps for use in medicine.

More like a researcher than an underling

With broad collaboration like this, Jacoba found this project a lot more “connected” than the first one she did. “I felt very official compared to my last experience as a research student. Here I was having a phone conference with someone who’s pretty much an expert in that field and actually being able to input ideas.”

Jacoba enjoyed working with Adelle and Shane. “It was really nice to feel that even though we’re students, we were able to put our own ideas in and have Adelle and Shane say: well we think you should include this. When you’re used to sitting in a lecture theatre with 400 other students being talked to for an hour, it was nice to feel a little bit more equal. That was probably one of the highlights – I felt more like an actual researcher than an underling.”

Getting research results to clinicians

Originally from Gippsland, Jacoba moved to Melbourne to complete a degree in Biomedical Science, but is moving back again to start her studies in medicine this year. She felt doing the scholarship project would be a good way to get to know Churchill where she’ll spend her first year.

She certainly knows her way around the Churchill campus now and the research project confirmed her passion for medicine. “It helped me think beyond assessments and learning to take patient histories. It’s more getting to look at the numerous ways that medicine and research can combine to improve health care.”

She’s also learned that improving how the results of research are delivered to clinicians is vitally important. “It was really nice to feel that the work we were doing had an end goal that was going to make an immediate impact. When we wrapped up the five-week project, we actually had an online template of what we hoped the app would look like with some sample data in there. The hope is that eventually that’ll get outsourced and become a fully-functional app.”

There really is a world beyond the Bunsen burner.

Wednesday, 1 February 2017

Monash Rural Health and Bendigo Bank launch new community award for medical students

A new collaboration with Bendigo Bank will enable Monash medical students on placement in rural towns to link up with those communities on health-related projects.

The initiative will see students work with representatives of local communities to develop and implement a project relevant to the health needs of those communities or link in with existing projects. At the end of the students' placement they will make a presentation to members of the local community and one project will win the Bendigo Bank Community Award.

Year 4C students at the Community Award launch. (Photo courtesy Bendigo Bank)

Bendigo Bank's Scott Elkington and John Siroli (Photo courtesy Bendigo Bank)
The award is the brain child of Bendigo GP Dr Dennis O'Connor, Bendigo Bank's Scott Elkington, and Castlemaine Health's Jen Oxley. Speaking at the launch of the Community Award on Monday, Scott Elkington said the Bendigo Bank understood partnerhips and the importance of social capital. Dr O'Connor who is also Monash Rural Health Bendigo's Year 4C Academic Coordinator, said the aim of the initiative was to give students a chance to give something back to the communities who generously supported their placements.

Linking with passionate community representatives through the Bendigo Bank will make certain the projects filled a genuine need and give students real links into the people who live in the regions.

East Gippsland training site welcomes 2017 medical students

Health services across East Gippsland have been gearing up to host 70 Monash medical students throughout 2017, in placements lasting from two weeks to a full academic year.

Welcome: some of the medical students who are starting studies in Bairnsdale this year, with Associate Professor David Campbell (far right).

Director of Monash Rural Health East & South Gippsland and local GP, Associate Professor David Campbell, said it was an exciting time for students as they embark on various stages of their medical studies. “Our staff will ensure a smooth start to the year for the students, many of whom will be coming to East Gippsland for the first time”, Associate Professor Campbell said.

The Monash Rural Health Bairnsdale site will host nine students in their second year of clinical studies, including two at Bairnsdale Medical Group, one at McLeod Street Medical Centre, two at Cunningham Arm Medical Centre, two at Gippsland Lakes Community Health and two at Orbost Medical Centre. Students will be in tutorials at Monash Rural Health Bairnsdale most Mondays and Fridays and in their allocated medical practices on Tuesday, Wednesday and Thursdays.

Throughout the year, Bairnsdale Regional Health Service will host 11 final year medical students who will undertake six-week placements in aged care, emergency or surgery. Ten students in their first year of clinical training will also be rotating - four at a time -  through Bairnsdale Regional Health Service from Sale. They will spend four weeks at a time in surgery and medicine.  

An additional forty students in their second year of study will undertake two-week placements in May and September.

“Monash Rural Health East Gippsland provides many opportunities for medical students to develop their knowledge and skills, and to engage with the East Gippsland community. Students are exposed to a variety of learning experiences under the supervision of local clinicians and clinical supervisors within teaching facilities at our academic sites, in local general practices and the local hospitals,” Associate Professor Campbell said. 

East Gippsland's integrated clinical education program is unique within the University, and students value the opportunity for the one-to-one supervision and mentorship from experienced rural doctors that is a feature of the program. Students here for the full academic year will have the opportunity to contribute to local sporting, arts, environmental and other community activities, as well as seeking local part-time employment.

“In East Gippsland we have an established track record of our students returning as doctors to work in the area. We are proud of our contribution to the health of the East Gippsland community and our contribution to the local medical workforce,” said Associate Professor Campbell.

Monday, 30 January 2017

Scholarship gives chance to experience sports medicine

With a history of playing competitive softball, Singapore-born medical student Nina Chua knows too well about sports injuries. “I did a lot of training and as a result had an overuse injury.” So while she visited a sports doctor and physiotherapists during rehabilitation, she did a lot of research. The more she read, the more interested she became in sports medicine.

Nina Chua and Dr Naj Soomro
It’s a very small field and the medicine program doesn’t give students any exposure to sports medicine during their clinical training years. So a summer research scholarship in sports medicine in Mildura offered an opportunity to gain some experience. Nina had been to Monash Rural Health in Mildura during her Year 2 rural placement. “That’s why I was comfortable coming here.”

For two weeks she’s been working on a project with Dr Naj Soomro which explore injury prevention training for fast bowlers in cricket. “I’ve never played cricket, I only learned the rules this week,” she laughed. But she figured it was similar to softball and baseball and was keen to take it on.

The project involved writing a research protocol for an evidence-based cricket-specific injury prevention program, which she and Dr Soomro hope to submit in the Journal of Physiotherapy. During this process she has learnt how to design of a cluster randomised control trial.

The injury prevention program is still under development. Among the first “guinea pigs” were Nina, Dr Soomro and one of the Mildura staff members. “We trialled the program in the hallway which was quite hilarious,” she said. That resulted in some modifications to the program before they took it to weekly training for the cricket team that Dr Soomro plays for. The team’s feedback resulted in further modifications and the altered program will go back to their next training session.

Dr Soomro is a keen advocate of the use of technology in research and plans to develop a website similar to FIFA’s online warm-up program for soccer players. That’s outside the scope of Nina’s two weeks in Mildura, but she’s keen to continue her involvement. This year will be a major one for Nina. She begins her clinical training back in Melbourne and also plays on the Monash baseball team. Squeezing research work into that requires a big commitment. “I’m interested in this and I like it, so it will be fine,” she said confidently. “And I might try out some of this on the baseball team too.”

Friday, 27 January 2017

Crunching numbers to find out why people become GP proceduralists

The main lesson Jeremy Day learned from working in Bendigo on a summer research scholarship project is that research is not always a straightforward process. He started out looking at associations between personality and becoming a GP proceduralist using data from the longitudinal MABEL panel study. “It was promising, but there wasn’t enough association there to produce a really interesting article,” he said. “So we’ve gone on to see if we can find other variables we can add into it.”

Originally from central Queensland, Jeremy moved to Melbourne to study medicine where he completed Year 4C in 2016. “I was getting a bit sick of Melbourne and wanted to do something in the country.” So he applied for a two-week research scholarship in Bendigo.

Having never worked in research, Jeremy wasn’t sure what to expect. “I thought we’d be a bit of a lackey just doing data entry. I’ve been surprised that we get to do lots, and work on our own a lot.”

Research scholarship students work for two or three weeks with Monash researchers on their projects. Jeremy’s supervisor, Dr Deborah Russell, gave him a crash course in statistical analysis software, Stata®, “which can be a bit of a minefield for beginners” according to Jeremy. But it wasn’t the software that proved the most challenging aspect of working on the project.

“My project’s been a bit different [to those other students were working on] because it’s shifted around so much,” he explained. “They’ve worked with very strong guidelines. My literature search for personality turned into a dead end, which is sometimes what happens.” And so the direction of the project changed, though the focus remained on procedurally active GPs.

Jeremy knew nothing about research when he applied for a scholarship. He did know that postgraduate training programs are very competitive. “Research is so important with the way medicine is going; I thought it would be good to get some research experience under my belt.”

The summer research scholarship proved to be a “perfect” introduction to research. Some of his friends have completed a Bachelor of Medical Science (Hons) year. “They’ve had to work on a whole project by themselves and it’s taken a whole year. That was their introduction to research. This is a much better introduction: you get to try before you buy.”

Jeremy’s decided he wouldn’t want to pursue research as a career. “But I definitely want to do more research. It’s been a good experience.”

Wednesday, 25 January 2017

Summer research scholarship tackles rural ED presentations

A two-week placement in the Bendigo emergency department during Year 3B brought Samara Cua face-to-face with the often overwhelming demand on the service and staff feeling that some of the cases didn’t belong there.

While the problem was apparent, a clinical placement didn’t provide any opportunities to explore the reasons. So when a summer research scholarship was offered in Bendigo looking at how to reduce unnecessary presentations to regional emergency departments, she applied without hesitation.

Meeting the services: Samara Cua (front right) met staff at the Maryborough urgent care centre as part of the research project she worked on with Dr Bernadette Ward (standing beind her).

“In my first clinical year, I was interested in learning how to apply theory in a clinical setting,” said Samara. She’d never had any experience with research but was interested to learn how theory-to-practice works in a research setting. “I had a really positive experience in Bendigo in 2016 and thought I might get the same out of research.”

Under the supervision of Associate Professor Rebecca Kippen and Dr Bernadette Ward, Samara researched and wrote a report on the policy environment in which after hour primary health care services have operated from the mid-1990s to the present. “One of the hypotheses is that that [environment] could affect the number of presentations at ED,” she explained. “I learned that you have to be quite patient and persistent looking for the right articles and reading through big documents to tease out exactly what you’re looking for.”

Samara wasn’t tied to her desk for two weeks though. She and fellow students working on this and other research projects toured four health services to learn how they manage after hours and emergency presentations. Bendigo ED was a short walk away, but Mildura involved a long road trip. They also visited Maryborough and Heathcote which have urgent care centres rather than emergency departments. It broadened her understanding of the different approaches taken to provide such services. “I didn’t know about urgent care centres before this,” she said.

She’s also gained an appreciation of other factors that contribute to the problem. “Sometimes other issues within ED might be the cause of blockages and overcrowding. And I’ve learned that politics can determine which services are supported with funding.”

The summer research scholarship is a good way to gain exposure to research and Samara would definitely recommend it to other students. And she’s definitely planning to work on further research projects once she completes Year 4C.

“It ties in well with evidence-based medicine,” she said, harking back to her interest in how theory applies in clinical settings. “With a summer research scholarship you can start learning more about research and what you can do in it as a student and in the future as a doctor.”

Tuesday, 24 January 2017

Learning the research process

Aun Chian Yeoh is used to squeezing extra-curricular interests into his busy schedule as a medical student. An interest in research led to stints working on data collection for short research projects based at Frankston hospital last year. His appetite whetted, he then spent two weeks of his summer break in Bendigo as a summer research scholar working on advanced care planning for primary care patients over 75 years-old.

Bendigo research team: Aun Chian Yeoh with Pam Harvey, Dr Bernadette Ward and Dr Dennis O'Connor

Aun Chian first visited Bendigo with the Year 2 rural program. “Pam Harvey and Michelle Moon did an amazing job showing us around rural health.” Comparing the Malaysian and Australian rural health systems continues to interest him, so, thinking he might not get another rural rotation, he applied to come back to Bendigo for a summer research scholarship working with supervisors Dr Bernadette Ward and Pam Harvey.

While he’s worked on projects after hours, two weeks dedicated to research gave him the chance to learn more about the research process. “I haven’t been involved in the planning process before or defining the research questions and I’m learning this is the tough bit,” he said. “But it’s a skill I wanted to learn.”

Far from spending his days in front of a computer, Aun Chian has also learned more about general practice in regional towns. Sitting in on sessions with Bendigo Year 4C academic coordinator, Dr Dennis O’Connor at the Bendigo Primary Health Centre, Aun Chian been working on over-75 health assessments as this is the cohort research subjects will come from. “Last Friday Dennis put me in a room by myself with a patient,” he said, still surprised at the experience. “This is what’s expected of a Year 4C student!” (Dr O’Connor did keep an eye on him as he would with Year 4C students.)

He’d definitely recommend the experience to students interested in research. “I’m lucky that I’ve been able to learn about the research process and have my contribution appreciated.

“The School of Rural Health staff were very encouraging and friendly, and always there to help. And the clinicians have time to speak to you – even medical students!”