Wednesday, 22 November 2017

Medical student on an education mission

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

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

The public school disadvantage

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

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

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

Secondary students gain confidence

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

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

Love of numbers leads to a research year

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

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

Tuesday, 21 November 2017

Warragul paediatrician heads new push to keep young doctors local

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

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

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

Stemming the doctor drain

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

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

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

A passion for rural practice

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

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

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

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

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

Training hub to draw networks together

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

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

Friday, 3 November 2017

Medical students help raise secondary students’ aspirations

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

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

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

From a solid fail to a pass

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

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

Why should regional students be disadvantaged?

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

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

Investing in education benefits everyone

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

Tuesday, 31 October 2017

Finding the courage to shift careers

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

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

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

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

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

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

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

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

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

Monday, 23 October 2017

Social work students gain insight into rural research

Diana and Kang enjoyed their recent research placement with the Hazelwood Health Study in Moe so much, they’re both back working as casual research assistants.

Applying social work skills in new ways

The two are among seven social work master’s students who’ll each spend three months working on the Hazelwood study and other research projects with Monash Rural Health and they both faced the challenge of learning new ways of applying their social work skills. “It was an opportunity to think outside the box; you have the skills, here’s an opportunity to put them into practice,” said Diana. It was also an opportunity to learn about themselves. “I realised I enjoyed working with children – working with children was not something I’d thought seriously about before starting the placement.”

Rural research: (L_R) Diana, Selina and Emma are among seven social work master's students who will complete a 14-week placement this year in Moe with Monash Rural Health

Going back to school

For Selina who’s only recently started her placement, working with the Hazelwood Health Study is a chance to go back into schools. One of the students’ tasks is interviewing school children about their experience during and since the 2014 mine fire. “I used to be a teacher,” she explained. “Some children come to school with problems, they’re very distressed and I can’t help them.” While she started reading around working with families, she realised that as a social worker she could really help those children. It was through that early reading that Selina realised the importance of evidence-based practice, so the research placement resonates with her. It’s also bringing the research process to life. “Working with researchers who talk about real experiences is much more vivid than the theory,” said Selina.

Researcher and one of the students’ supervisors, Sarah Lee, said she sees students grow in confidence over the 14-week placement. “They have great skills and ideas and I have learned a lot from them also.”

Discovering life outside Melbourne

Emma who is also just starting on her research placement had lived in the countryside in the UK, so she was keen to see how people outside Melbourne live. “I like that small community feel, it feels really safe.”

Although the three-month placement was the first time Kang has lived in a rural place he loves the atmosphere. “Most parts of Australia are not like big cities like Melbourne,” he said. “It’s a good learning experience of other perspectives in Australia.”

City bred Natalie has long held the desire to move out of town. “I’ve always wanted to buy a little farm and keep alpacas,” she laughed. The placement has done nothing to dim her enthusiasm. “Living in a rural area is not as bad as what people make it out to be,” she said of advice she been given before spending three months in Gippsland.

The absence of distractions is a boon for Selina. “You get rid of the noise,” she said. “You can concentrate in the quiet.” And being one of only two students working with a lot of research staff is also a bonus: “You get to talk to them.”

Opportunities to network

The staff were also happy to help students explore their research interests and make connections with agencies and practitioners in the region. “There was a lot of flexibility to network with people and Sarah was always happy to facilitate networking,” said Natalie who was grateful for those opportunities.

Sarah Lee affirmed that part of the aim of placements like this is to support students who are considering working in rural areas. “One way to do this is to allow them to see what opportunities are out there and to meet with other agencies and network. Placements can provide a really valuable opportunity for students to explore pathways they may be interested in, and giving students the time and support to do this is really important,” she said.

Gains for staff and students

For their part, the students walk away from the experience with a good grounding in the research process. “I’m much more confident in research now,” said Kang.

It’s not only the students who gain from the placement. “All the staff really enjoy having students here and the valuable contribution they make while on placement,” said Sarah. The feeling must be mutual if Diana and Kang’s return to work on the Hazelwood project is any indication.

Wednesday, 18 October 2017

Social work placement a chance to trial the dream

Natalie Cignarella is unequivocal: the Master of Social Work changed her life.

Social Work master's student Natalie Cignarella: her research placement in Moe allowed her to sample life outside a big city. 

A promise made good

She was in and out of hospital for many years with an illness.  “It wasn’t a really pleasant experience,” she said. “But every time I’d go into hospital, the social workers were floating around the place. I had an inkling that I wanted to do social work but I didn’t pursue it until I was exposed to social workers in a hospital setting.”

After years working in immigration, she moved to Victoria from her native New South Wales and promised herself that if she started to feel better, she would study social work. She’s made good on that promise to herself.

Working on LIFE

This year, she’s done a three-month research placement with Monash University Department of Rural Health in Moe. Natalie worked on two projects during her placement: the Hazelwood Health Study and the LIFE (Local Inclusive Fitness for Everyone) project. LIFE is an exercise program established for people of all abilities in partnership with the Moe Life Skills Community Centre. “For me the LIFE project was a big part of the placement experience and an opportunity to work on another project at the same time as the Hazelwood Health Study.”

She helped on the literature review, spent time on Fridays at the community centre where the exercise program was run, and met some of the support workers who gave her valuable insight into their role. At the end of the 16-week program, Natalie helped with interviewing the participants and analysing the data. “Building rapport with the people at Moe Lifeskills – it was just a really beautiful experience,” she remembered.

Space to learn

LIFE project supervisor Dr Eli Ristevski, and Moe Lifeskills staff Carole and Sharyn encouraged her to work through her ideas. “They provided a safe space for me to ask a lot of questions because when I first started working on the LIFE project I wasn’t really sure how something like that would work. It helped me break through a lot of barriers.”

With a heavy research focus, this was not a straight social work placement, but Natalie found social work theories were still applicable. She urges other students looking at a placement like this to be patient. “It may not be what you expected, but there’s always something to learn. There is really so much to gain from doing a research placement.”

A chance to network

And while she was learning new ways to apply the skills she had, she made the most of the flexibility the placement gave her to network with Gippsland health professionals. Placement supervisor Sarah Lee was always happy to facilitate networking and it gave Natalie an insight into how her chosen profession might also allow her to follow another dream.

The dream of a country life

“I’ve always been a city person,” she said. “But I would really love to move out to the country. So I thought this would be a good opportunity to see what it would be like.” Sharyn of Moe Lifeskills lives on a small farm and owns alpacas. “And I really, really want alpacas,” Natalie declared. “So she’d give me some insight on what it’s like to own a few alpacas.”

Natalie knew little about Victoria and the Latrobe Valley but some of her friends were dubious about her choice of placement. “Living in a rural area isn’t as bad as what people make it out to be,” she said looking back on her three months. Natalie enjoyed learning the history of the valley, what had happened to people who lived there and why. “And I really enjoyed the peace and quiet to be honest.”

While she still has two subjects to go to complete her studies, Natalie is already reflecting on the personal influence of her chosen course. “I can see things from different points of view, I’m a much better critical thinker. Before this course I was a bit of a fiery person, but this course has helped me manage myself a lot better. And I really hope I can get a social work job out of it!”

Tuesday, 17 October 2017

Public health researcher settles in Central Victoria

After years working in public health programs in Papua New Guinea and Myanmar, Dr Claire Nightingale finds it hard not to buy eight packets of couscous when she sees it in the supermarket – just in case it’s missing next time. It’s one of the many cultural adjustments she’s had to make since returning to Australia recently to have her second child.

Now with a new role with Monash University based in Bendigo, she’s developing community research partnerships much as she was doing overseas.

Public health researcher, Dr Claire Nightingale, is looking forward to working with central Victorian communities to define their research priorities.

Lab work with a purpose

Central Victoria where she now lives is a long way from the Burnet Institute in Melbourne where the young Monash University science graduate – then Claire Ryan – followed an interest in infectious diseases and public health into an honours project. “I don’t love lab work,” she confessed. But the honours project looking at HIV sub-types among Vietnamese drug users in Melbourne used lab techniques to answer an important public health question. “That year really did change everything for me. I loved the research focus where you actually get time to focus on one question.”

She loved it so much, she also did a PhD with Burnet through Monash University looking at the way HIV is transmitted around Papua New Guinea, Indonesia and the Pacific islands at the molecular level. It was the start of her overseas career. Her PhD work landed her a role at the Papua New Guinea Institute of Medical Research. As the laboratory lead with the Sexual and Reproductive Health unit, Dr Nightingale worked with a group of eight PNG scientists. Much of the team’s work influenced PNG health policy and led to Wellcome and other grants which enabled further work there.

An incredible history in PNG

“The Institute has an incredible history with Nobel Prize winners. It’s the kind of place that just hits you in the face with its potential and it’s so exciting when you’re there. It’s full of really bright Papua New Guineans who really do care about the health of their communities.

“It really full on, but it was great. We built the lab up to be highly functioning and worked very closely with the community implementing point of care testing for sexually transmitted infections amongst pregnant women. We also did some novel work around cervical cancer and implementing screening for it in PNG. “

A return to Melbourne after three and a half years saw her working in the implementation team for Victoria’s first community-based HIV testing service for gay men. The Department of Health and the Victorian AIDS Council were close partners and the PRONTO service is still running.

Public health in Myanmar

Soon she was overseas again. This time she accompanied her English-born partner and future husband whom she met in PNG. He now had a job with Save the Children in Myanmar. Initially Dr Nightingale worked in research development, as well as advising on the establishment of harm reduction drop-in centres which were offering HIV testing for people who used drugs. There she helped set up the labs and diagnostic processes. “It was a very different team [from PNG] and my role there was very different. They already had enormous capacity; the level of education there was impressive.”

After the birth of her first child she went back to Myanmar to work on a range of projects with various organisations: HIV testing during pregnancy, helping establish HIV viral load testing and looking at the quality of testing in decentralised facilities, and the Burnet Institute’s Hepatitis C program. That project helped develop a national Hepatitis C strategy and aimed to make sure that community-based Hepatitis C therapy would be allowed so treatment was available outside specialist hospitals.

The end of concrete

Dr Nightingale had gone back to work in Myanmar four weeks after the birth of her first child, but by the time she was expecting her second, she and her husband decided they needed a tree change. “As much as we love travelling, we didn’t want to look at concrete anymore and in Yangon there’s a lot of concrete and it’s hard to get out of the city.” They took a risk and moved back to Australia, settling close to family in Castlemaine, in a Harcourt house surrounded by orchards.

Community-focused research

Her new role with Monash University gives her scope to continue doing what she loves. “A lot of work I did in Myanmar was training people for research and then working with senior academics in Melbourne to get their research off the ground in Myanmar. I’ve always been involved in research but with a really strong public health, community focus. I love working with communities and doing some work around the priorities defined by the people who live there.”

With two children and new job she’s also studying a Master of Public Health focussing on health promotion. “I really want to maintain that outward focus of why are we doing this and what are the results of this going to tell us and how can we use this to change policy to change things.”

She’s also learning that she no longer needs to stockpile each time she visits the supermarket.

Tuesday, 10 October 2017

Tailored interventions support healthy lifestyle for cancer survivors

A West Gippsland based project for cancer patients and survivors aims to move tailored health eating and active lifestyle programs out of institutions and into the community.

“Eat Well, Move Often, Live Better” is a 12-month project funded through a $100,000 grant from the Victorian Department of Health and Human Services. Partners West Gippsland Healthcare Group, Gippsland PHN and Monash University UDRH will develop an evidence-based program that can be translated into other regions and models of care.

Building community capacity to support health lifestyles for cancer survivors is one of the main aims of the program.

Monash researcher, Dr Eli Ristevski said significant weight gain can have a detrimental effect on cancer survivors’ quality of life and increases the risk of their developing other chronic diseases. And, alarmingly, nearly half the population in West Gippsland is overweight or obese. The new program aims to encourage a shift towards a healthier lifestyle.

“While diet and exercise programs are not new, this program tailors the intervention for each individual’s need, which results in more successful outcomes,” said Dr Ristevski. “The next step that moves it out of the hospital and builds capacity within the local community to support health eating and activity is the really exciting part.”’

Participants include those with existing as well as newly diagnosed cancer. At the moment they are invited onto the program by their oncologist. Each person sees a hospital-based dietitian first who provides tailored coaching on a healthy diet. Next, they see an exercise physiologist, also hospital-based, who provides tailored coaching on exercise. Once they’ve been through the hospital-based coaching, they will be linked with community services for ongoing support. This might include local walking or bike riding groups for example. Information hubs in community centres such as the library are also being established.

The second aspect of the project is connecting with GPs through the Gippsland PHN to upskill them to refer participants to the program. GPs are well placed to identify risks factors among cancer survivors. They will be able to refer patients to sessions through a chronic disease management plan .

Friday, 6 October 2017

Moe LIFE program opens to more people with new funding

More people in the Moe region will have the chance to take part in a tailored activities program with Bank Australia contributing additional funding to phase 2 of the project.

The LIFE (Local Inclusive Fitness for Everyone) program aims to promote health, wellbeing and social inclusion for people with disabilities. Phase 1, also sponsored by Bank Australia and run in partnership with Moe Life Skills Community Centre, offered an inclusive 16-week pilates program to clients with high or complex needs, and members of the local community. The ultimate aim is to develop an evidence-based physical activity program that is inclusive of people of all abilities.

Monash University research partner, Dr Eli Ristevski, said people with profound or severe disabilities often miss out on vital physical and recreational activities because daily activities focus on health needs or communication difficulties. “But it’s been shown that physical activity has numerous benefits for physical and psychological wellbeing,” said Dr Ristevski. “The opportunity to take part in activities with other members of the community also enhances social connectedness and community inclusion for people who are often isolated.”

Inclusiveness team (L-R): Carole Broxham, CEO MLSCC; Anna McKenzie, pilates instructor; Sharyn Thompson, MLSCC; Dr Eli Ristevski, Monash University.

The sessions were run by an accredited physical education instructor. Each session was followed by morning tea and an opportunity for all participants to socialise. At the end of phase 1, all participants were interviewed, with an adapted interview tool used for people with limited communication. And the results were promising.

Moe Life Skills Community Centre clients all enjoyed the program and wanted to continue in the future; so much so they were willing to pay for it themselves now that NDIS funding can be used for physical activities. They were also happy to recommend it to others. Community participants also enjoyed the program. It gave them an increased sense of purpose and an opportunity to give back to the community. They too were happy to continue and to recommend it to others.

While phase 1 focussed on clients with high or complex needs, phase 2 will be open to anyone with a disability and all members of the Moe community to join in.

In the meantime, results from phase 1 evaluation are being analysed and the team hopes to present their findings at conferences next year and publish their results, which will also contribute to establishing a research profile for Moe Life Skills Community Centre.

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.