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.