ISSUE 18 FREE
September â€“ December 2015
Wild west registrar Dr Sarah Farlow down to earth and in touch
Also inside student-run health clinic | profiles | clinical cases | general practice training
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INDIGENOUS GENERAL PRACTICE REGISTRARS NETWORK
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In this issue...
Feature Published by General Practice Registrars Australia Ltd Level 1, 517 Flinders Lane Melbourne VIC 3001 P 03 9629 8878 E firstname.lastname@example.org W gpra.org.au ABN 60 108 076 704 ISSN 2203-2657 Editorial team Registrar Advisor Dr Mary Wyatt Editor Denese Warmington email@example.com Writers Jan Walker Denese Warmington Graphic Designer Jason Farrugia GPRA staff CEO Sally Kincaid General Manager – Marketing and Communications Wayne Bruton firstname.lastname@example.org Advertising sales Lisa Mugg email@example.com
4 The REACH Clinic Australia’s only student-run primary health clinic.
Profiles 8 Dr Anne Petersen Dr Anne Petersen chats to us about work-life balance in regional Victoria.
14 Dr Caitlyn White
Dr Caitlyn White shares her tips for working in rural and remote areas during training.
16 Dr Sarah Farlow Dr Sarah Farlow is exploring the life of a multi-skilled rural doctor in one of Australia’s iconic outback communities.
18 Dr Oscar Whitehead Dr Oscar Whitehead shares his inspiration and working life with the Royal Flying Doctor Service.
Clinical 21 Murtagh’s tales
22 Clinical case review
Reviews 24 Apps and books 27 The PCEHR
Your networks 28 Going Places Network 30 General Practice Students Network
7 Membership of GPRA Membership of GPRA can provide many benefits on the journey from medical student to GP. Find out more here.
12 General practice training Interested in applying to the Australian General Practice Training program? We give you the facts.
32 First wave Q&A Tara Sasse answers our questions about her John Murtagh First Wave Scholarship placement. Produced with funding support from © 2015 GPRA. All rights are reserved. All materials contained in this publication are protected by Australian copyright law and may not be reproduced, distributed, transmitted, displayed, published or broadcast without the prior permission of General Practice Registrars Australia Ltd (GPRA) or in the case of third party material, the owner of that content. No part of this publication may be produced without prior permission and full acknowledgement of the source: GP Journey, a publication of General Practice Registrars Australia. All efforts have been made to ensure that material presented in this publication was correct at the time of printing and is published in good faith. This publication is intended for medical students, doctors and health professionals and, as such, may contain material of a medical or graphic nature. GPRA does not accept liability for the use of information within this publication.
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Welcome Welcome to Issue 18 of GP Journey, proudly brought to you by General Practice Registrars Australia (GPRA). GP Journey aims to showcase interesting aspects of general practice and inspiring stories of individual general practitioners, general practice registrars and medical students in general practice placements. I hope you enjoy reading about their journeys and consider making your own journey into the specialty of general practice. Our feature story this issue is about the REACH Clinic, the only student-run community clinic in Australia. We talk to Joyce Shi, a final year student from the University of Melbourne who is a volunteer and director at REACH. The medical students working at REACH provide high quality care to some of the more vulnerable members of Melbourne’s inner city suburb of Kensington and are supervised by equally dedicated GP supervisors. In this issue we profile several inspiring GPs. Dr Anne Peterson, a general practitioner from the Macedon Ranges in Victoria who has a passion for art, shares her story of setting up a new practice and tells us how she enjoys a healthy work-life balance. Dr Sarah Farlow, a general practice registrar from rugged Mount Isa, shares her journey as a Rural Generalist Pathway Doctor through ACRRM, highlighting the exciting challenges working and living in a remote rural township (never a dull moment in Mt Isa!). Dr Caitlyn White, a prevocational doctor, talks about her experience in Western Australia’s Kimberly region as both a student and in her second resident year, where the diverse range of patient presentations and the stunning scenery of the region amount to a rich experience in both culture and medical experience. Dr Oscar Whitehead, Registrar of the Year in 2008 and now a GP anaesthetist and medical administrator, talks about mixing general practice with medical leadership as a medical administrator with the Royal Flying Doctor Service in Queensland.
GPRA is a not-for-profit organisation whose primary goal is to advocate for the future generation of general practitioners, and are active in supporting doctors from medical students to recently fellowed GPs. I would encourage you all to join GPRA – it’s free and as a member you will have access to ongoing support, exam resources and special member discount offers. By becoming a member you stay informed and become part of the conversation around the changing landscape of general practice training. General practice offers both a demanding and rewarding career in medicine. The scope of medical conditions is such that there is rarely a dull moment in everyday practice as demonstrated by our GP profiles. If you are interested in a career in general practice (and I hope you are!), I would encourage you to talk to your local GPSN Club Chair or GPN Ambassador. Enjoy this issue of GP Journey. Dr Mary Wyatt General practice registrar – Ranford Medical, Canning Vale, Western Australia
The John Murtagh First Wave Scholarship is now a wellestablished and competitive scholarship for first and second year medical students to experience general practice. In this issue we talk to Tara Sasse from Deakin University about her experience in the program and how it has sparked her interest in general practice. If you are interested in applying for the next round of scholarships, don’t forget to check out this article.
With you on your journey 3
F E AT U R E
outreach A Q&A portrait of the REACH Clinic
The REACH Clinic is Australia’s only studentrun primary health clinic. GP Journey spoke to REACH director, Joyce Shi, a final year medical student, about this unique community initiative. On Saturday afternoons in an old building in a Melbourne inner suburb, Joyce Shi or one of her colleagues plants a sign in the garden outside. “REACH Community Health Clinic”, it reads. It could be any community-based clinic. But it’s not. This is Australia’s only student-run primary health clinic. It’s perhaps best described as a social and educational experiment with win-win results for students and patients alike. The win for students: real-world experience, not only clinically but also with the managerial minutiae of running a community practice. The win for patients: free primary health care for a socially and economically vulnerable clientele. The other defining feature of the REACH Clinic is collaboration between different health care disciplines. REACH is an interprofessional clinic with a focus on learning to be part of a holistic health care team. Medical students from the University of Melbourne work side by side with nursing and physiotherapy students under the watchful eye of qualified supervisors. No one is paid. Everyone’s a volunteer. All take home rich rewards. We questioned Joyce, the director of REACH, about this unique community project.
When and how did the REACH Clinic start? The REACH Clinic started in April 2012. REACH stands for Realising Education and Access in Collaborative Health. It stemmed from an idea that Professor Steve Trumble from the University of Melbourne and a group of students had when they went to America and saw some student-run clinics there. When they got back they created a new model and partnered with cohealth, a community health organisation offering holistic health care to vulnerable people. They’re one of our major partners along with Melbourne Uni.
Who are the clinic’s patients? The clinic is located in Kensington, a suburb in Melbourne’s inner north-west, and it has a big refugee population. There are also lots of older people, people with substance abuse problems and Aboriginal people.
What is the main aim of the clinic? Our aim is to provide high quality care to vulnerable members of the community so all our services are bulkbilled. We try to promote a more holistic approach to health. As part of that we have three disciplines each time we open – medical, nursing and physiotherapy students supervised by GPs, nurses and physios.
When and where does the clinic operate? We are open on Saturday afternoons at the cohealth clinic in Gower Street. We generally run the clinics as two eightweek blocks during the year. There’s a limit to when we can open due to funding. And as students, we have to make
The feedback from “ the medical students has been really positive and they’ve highlighted the opportunity to work collaboratively with professionals from other disciplines.
Joyce Shi and Xiaobei Ye – a final year physiotherapy student – outside the REACH Clinic
sure the blocks don’t run into any important exam periods. It can be a challenge to get enough supervisors to cover the clinic as well.
What’s your role and how did you get involved? I’m now the director of the REACH organisation as a whole, and last year I was director of the clinic. I’ve been involved since my first year of medical school. During orientation week they said there’s this new organisation, so I applied and became the receptionist for the first year in 2012. Later, I became involved in the REACH committees, then went on to become the clinic manager, then director of the clinics and now director of REACH.
Is it voluntary and what hours do you put in? We’re all volunteers, including the clinical supervisors. The students put in so many hours. When I was director of the clinic I was committing at least 10 to 15 hours a week.
How are the clinics run by students? We have several REACH committees with designated roles in organising and planning the clinics. That means getting all the clinical supplies from the university, communicating with cohealth, recruiting volunteer students and supervisors, planning rosters and doing evaluations. And the REACH organisation is getting involved in other community projects too.
How is the REACH Clinic funded? We had a start-up grant and now the clinic is funded by Medicare payments for consultations. Other running costs are supported by our partners, cohealth – we use their premises – and the University of Melbourne. And it’s staffed by volunteers.
How does the REACH Clinic compare with other clinical placements? The feedback from the medical students has been really positive and they’ve highlighted the opportunity to work collaboratively with professionals from other disciplines.
With you on your journey 5
F E AT U R E
While we’re on our placements in the hospital, medical students don’t really get a chance to work together with the nurses and the physios. At the REACH Clinic, students get to lead a consultation. Even though the clinical supervisors make the decisions in the end, the first encounter is by the medical student and possibly another discipline.
What have been the most memorable cases? I would say the refugee patients who have mental health issues stemming from the experiences they’ve had trying to get to Australia. It’s definitely eye opening.
What have you personally got from REACH? I’ve increased my clinical experience and picked up some other really important skills: working in a team, working with other disciplines and developing myself in terms of public speaking, policy writing and grant applications.
How would you encourage others to volunteer? I’d highlight that we’re working with a group of very motivated, like-minded students, and through the organisation we’re making real change in the community.
What’s next for REACH? We are currently in the process of becoming incorporated as a non-profit organisation. To overcome confusion with another prominent organisation with the same name, we will also be changing our name to the Strive Student Health Initiative Inc. Things are always evolving.
Volunteers wanted. The REACH Clinic invites medical students from the University of Melbourne and GP supervisors (at least five years as a qualified GP) to volunteer. Contact firstname.lastname@example.org
with you on your journey GPRA is run by members for members. From GPSN university clubs, to hospitalbased GP Ambassadors and a national general practice registrar support team, GPRA is with you on your journey from medical student to general practitioner.
Member benefits As a prevocational doctor or medical student you automatically become an Associate Member of GPRA when you sign up for membership. As a member you receive regular communications about local events and updates about general practice training. You also receive the following member benefits:
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With you on your journey 7
Heart of the country Busy country GP Dr Anne Peterson has found her niche away from the big city crush, with time for creative pursuits like glass art, singing, gardening and yoga. A colourful fused glass plaque hangs next to the door of Dr Anne Peterson’s consulting room. It depicts a naively drawn tree and a stethoscope. To the casual observer, it’s a cute sign. But the little glass picture holds clues to Anne’s journey in general practice. Firstly, Anne made the plaque herself – she has an artistic side that finds expression in glass and mosaic art, singing and gardening. Fortunately, a career in general practice allows her time to explore her creative flipside. Secondly, the plaque is part of the decor at Ranges Medical, a custom-built clinic that Anne and two colleagues recently opened in New Gisborne in Victoria’s Macedon Ranges. Lastly, the plaque has the feel of an idyllic country scene, and Anne describes herself as “a country girl at heart”. She has spent the past 15 years living and working as a GP in the Macedon Ranges district, with regular locum excursions to remote Aboriginal communities in the Northern Territory. From the time Anne completed her medical degree at the University of Melbourne, she was determined to craft her own niche as a country GP. “I actually graduated top of my year in medicine and could have done anything I liked, but I liked the idea of being a country GP,” Anne says. “I was getting quite strongly pressured to go into one of the hospital-based specialties but I just knew I didn’t really want to do that. “I didn’t want to live in a city, as most specialists do. I wanted
to be in general practice in a country community, not in a hierarchical hospital system.” Anne’s liking for a more relaxed pace of life may have stemmed from her upbringing in Geelong, where her dad was a plumber and she was the first in her family to go to university. After doing her clinical training at Austin Hospital in Melbourne, Anne started work as a GP in the Macedon Ranges, a picturesque region within commuting distance of Melbourne that attracts city types seeking a tree change. She’s been working there ever since, and lives in the little town of Woodend with her husband Peter, a social worker, and two of their three children. “I like the fresh air and having a bit of space,” Anne says. Along the way, Anne completed a Diploma in Adolescent Health and Welfare while running a youth clinic in Kyneton. She also completed her DRANZCOG training, which comes in handy in an area that’s home to lots of young families. “I don’t deliver babies but I look after many expectant mothers on a shared care basis so I see them for their antenatal and postnatal care,” she says. Having worked in several practices as an associate, Anne formed definite views about how she would do things differently if she were the boss. “Numerous places I’ve worked have been dingy and dark and there’s no natural light. They’re not healthy places for patients and staff to even be in. After 15 years of that, my children were a bit older, and I thought I don’t really want to work for other people any more. I want to be involved in creating my own culture.” Two of her male colleagues were thinking the same way, and over dinner and a bottle of wine they hatched a plan to build their own country practice from the ground up at New Gisborne.
“We wanted to create a building that was environmentally friendly with lots of natural light and well-designed spaces – something that was a bit fun and different,” she says. Importantly, the trio wanted a practice that offered the continuity of care synonymous with a traditional country practice, where patients could build a long-term relationship with their doctor. Four years later, and after more work than she ever imagined, the Ranges Medical clinic opened its doors at the end of last year. So has the pace eased for Anne now that the new clinic is open? Not exactly. Being busy is Anne’s natural rhythm, although she says she’d love things to slow down just a little. “Having outside interests is absolutely critical for me. I personally wouldn’t have a lot of energy to give the patients if I didn’t spend time nurturing the other parts of myself – particularly the creative side.” Aside from making glass art and mosaics, Anne sings in an acapella choir, practises yoga and meditation and is an avid gardener when not being the trainer for her son’s football team. While patient numbers build up at her new practice, she also works two days a week at another general practice in Kyneton. And when GP Journey spoke to her, she was preparing to fly to Yarralin and Timber Creek in the Northern Territory to do a regular locum stint for three weeks during her annual leave, mainly in Indigenous communities. “I do it partly because I believe that Indigenous people were the first people in Australia and I don’t think I need to
I actually graduated top “ of my year in medicine and could have done anything I liked, but I liked the idea of being a country GP.
go to the third world to work on third world health problems. I believe we have the third world in our own country. They’re our fellow Australians and I feel I should help them.” After that, she’s meeting her husband in Bali for a wellearned yoga retreat. Then it’s back to the room with the little glass plaque she made herself.
With you on your journey 9
A DV E R TO R I A L
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General practice gives you the freedom to follow your passion, subspecialise and design the career thatâ€™s right for you. Here are just some of the directions you may like to explore.
Aboriginal health Aboriginal health forms part of the AGPT program for all general practice registrars. Training posts in Aboriginal primary health care offer unique and challenging opportunities and allow prevocational doctors to play a hands-on role in improving access and preventing and managing chronic disease in Aboriginal communities.
Academic posts/research Teaching and research can expand your career path in general practice. Research enables you to develop valuable skills to take into your clinical work and could act as a steppingstone towards an academic career. There is widespread agreement that research in general practice is essential for the improvement of patient health care outcomes.
Military medicine Training as a registrar in the Australian Defence Force offers opportunities and challenges. There is a focus on emergency medicine and similar skills to rural general practice, including self-sufficiency in remote locations.
Overseas posts If you enjoy travelling and are keen to gain clinical experience in another country, both ACRRM and the RACGP offer exciting opportunities to complete part of your general practice training overseas. International terms can be taken in countries such as the United Kingdom, Ireland, USA, China, Malaysia and the Middle East. Discuss your interest in overseas training with your training provider early on in your training.
Part-time options The part-time training options and parental leave available to general practice registrars make general practice training
flexible and family-friendly. The flexibility of general practice when it comes to working hours is one of the reasons many people choose it as their career path. Flexible working hours are ideal for those with children, and can also give registrars the freedom to take up opportunities such as becoming a Registrar Liaison Officer, or taking on an academic post.
Rural general practice Doctors undertaking general practice training usually spend some time working in a rural area. Many find the challenging variety of work as a rural GP to be particularly inspiring. As a rural registrar, there is a diverse range of presentations to challenge you and opportunities to broaden your clinical skills.
Sports medicine If you want to get out of the practice and on to the field, and have a particular interest in musculoskeletal injuries and exercise medicine, sports medicine could be for you. You could be providing care to elite athletes through to weekend warriors or the non-exercising person just wanting to improve their exercise level or deal with an injury.
With you on your journey 11
Are you ready to start The Australian General Practice Training (AGPT) program is a postgraduate vocational education and training program for prevocational doctors wanting to become a general practitioner. General practice is a rewarding specialty that provides varied clinical work, continuity of patient care, the opportunity to subspecialise, dynamic team-based medicine and flexible working hours.
“I would recommend being a GP to others, due to the variety of conditions you see, the freedom to develop your own special interests and the flexible working hours.” Dr Liz Bond, Melbourne, Vic The AGPT program delivers the vocational training programs of the Australian College of Rural and Remote Medicine (ACRRM) and The Royal Australian College of General Practitioners (RACGP). It takes 3–4 years to be ready to attempt fellowship of the college(s). General practice training provides valuable practical experience in different training locations, including teaching hospitals, rural and urban practices and specialised medical centres.
Extended skills and advanced specialised training During training a number of extended skill and advanced specialised training posts are available to develop skills relating to your special interests. For example, you can choose to undertake an Aboriginal health training post where you will be immersed in a unique cultural environment and gain experience in Aboriginal health, seeing significant common and uncommon conditions.
“I’ve had the chance to work with the RFDS providing health care to Aboriginal communities in outback South Australia. I was the only female doctor in the group of RFDS doctors, which was a gap in the service I was able to help with. I was known as the ‘kunga’ (a Pitjantjatjara word for girl/female). It used to make me laugh. I’d hear the AHWs or clinic nurses asking patients if they wanted to see Dr so-and-so, or the ‘kunga’.” Dr Crystal Pidgeon, Beaudesert, Qld
Academic posts are also available during training where you can undertake a project in partnership with a university to develop skills in research, teaching, project work and critical evaluation of research, relevant to the discipline of general practice. Other examples of extended skills training include but are not limited to, anaesthetics, palliative care, mental health and dermatology.
“I realised that general practice training would provide a solid and broad base to work from, so I joined the [AGPT] program. From there, my interests developed along the way.” Dr Michael Christmass, AGPT registrar, WA
How to apply to the AGPT program The application process consists of three stages:
1. Application and eligibility check To apply to the program you will need to register online at agpt.com.au and complete the online application form. Your eligibility will be assessed during this first stage. Overseas trained doctors and Australian Defence Force doctors can also apply to the AGPT program.
2. National assessment If eligible, you will be invited to stage two, where you will complete both a Situational Judgement Test (SJT) at a national testing centre, and a Multiple Mini Interview (MMI) at a national assessment centre within Australia. The SJT is an online test comprising 58 multiple-choice questions, which takes 116 minutes to complete. MMIs involve rotations between interview stations. Both of these tests require applicants to draw on their own experiences and assess the applicant’s suitability to general practice.
3. Training provider selection and placement offers On completion of the SJT and MMI, applicants are notified of scores and given the opportunity to change preferences and undertake placement assessments with their training provider if successfully placed into the program.
Further information The AGPT program is managed by the Department of Health and delivered by a national network of training providers dedicated to supporting GP registrars as they embark on a career in general practice.
To find out more about the AGPT program, visit agpt.com.au
Changes to general practice training boundaries On 9 April 2015, the Minister for Health, Sussan Ley, announced the new geographic training regions and the establishment of an advisory committee that will provide advice about the delivery of the Australian General Practice Training program. This means that for those who are considering starting their general practice specialist training in 2016, you will be able to train with one of 11 providers in these new training regions. The Australian Government will soon conduct a tender for new training organisations to deliver the AGPT program from 2016 onwards. If your application is successful and you are offered a place, it is expected that the training organisations in each region will be known before you are asked to make any preference changes. The new training organisations are expected to be in place ready for you to start your training in early 2016.
For further information, including a breakdown of the new training boundaries, visit the AGPT website at agpt.com.au To review the Ministerâ€™s announcement, visit health.gov.au
With you on your journey 13
P R E V O C AT I O N A L D O C T O R P R O F I L E
Red dirt doctor It’s said that the red pindan dirt of the Kimberley gets into everything – your clothes, your hair and ultimately your soul. That’s what happened to Dr Caitlyn White. Dr Caitlyn White is back down south working in Perth, but the red dirt of the Kimberley is not easy to wash off. Caitlyn, a PGY3 prevocational doctor, spent a sizeable part of her medical education and training in Derby. The West Australian town on the Kimberley coast is the western terminus for the legendary Gibb River Road, a bucket list destination for adventurous travellers attracted to the region’s rugged wilderness. “In fifth year medicine I did rural clinical school and actually spent the whole of fifth year in Derby,” Caitlyn explains. “It was really rewarding and I thought I’d love to go back and work there after I’d finished. So as a prevocational doctor, I did. “Last year, which was PGY2 for me, I did a placement for two terms in Derby, where I worked most of the time at the Derby Aboriginal Health Service and some of the time at the hospital, including at the emergency department and the general practice outpatient clinic.” The placement exposed Caitlyn to a sweeping arc of patients, which helped build her clinical confidence. As with many regional posts, Caitlyn was able to assume greater hands-on responsibility than in a typical city prevocational placement.
“That was a big learning experience that gave me a lot of confidence in my clinical skills and management.” The case mix varied from routine general practice cases to “things you rarely see in the city like rheumatic fever and a lot of skin conditions and infections”, Caitlyn says. Around half of Derby’s population is of Aboriginal descent and Caitlyn saw many Indigenous patients. “With the Aboriginal patients there was a lot of chronic disease, diabetes, kidney disease and renal transplant patients. “On top of that I was giving palliative care in the community and working in the emergency department. You get things like trauma from car accidents in the bush, so it was a really wide variety of patients.” A highlight of Caitlyn’s time in Derby was flying out to remote Aboriginal communities along the Gibb River Road for clinics. “It was rewarding being able to deliver health care to people who are really far out of town with the great remote area nurses who run the clinics,” she reflects. Another highlight was the opportunity to learn from multi-skilled rural-remote GPs. “Most of the GPs either do obstetrics or anaesthetics or both. They’re very skilled with those procedural things. They have to be, because they do pretty much everything up there. “There were some GPs who were able to do surgical procedures – appendicectomies and even repair bones. It was very impressive.”
“I would see patients quite independently and I had a lot more responsibility than ever before,” Caitlyn recalls, although she says there were always GP supervisors or other doctors there to offer support.
Equally impressive was Derby’s rich social life. “We went to the school fair, there’d be markets in town, the Boab Festival with art auctions, quiz nights and a theatre restaurant put on by the school teachers.
One patient is etched in her memory. “There was a dialysis patient who came in really unwell with a very low blood pressure, high potassium and he was hypothermic.
“There’d be the races, the rodeo, we’d go out camping on the weekend or go to Broome. I played netball.
“It stressed me out because I hadn’t dealt with anyone so sick on my own before but I was able to stabilise him and call the RFDS and get him to Perth for urgent dialysis.
“Up there you just get involved with anything that’s happening and you make friends very easily.” Caitlyn initially dismissed medicine as a career choice. Growing up in the Perth Hills with a GP obstetrician
I would see patients “ quite independently and I had a lot more responsibility than ever before.
Caitlyn’s tips for working in rural and remote towns Caitlyn has these tips for medical students, prevocational doctors and registrars doing placements in rural and remote towns. 1. Get involved in the community. Life is really rich in small towns. People respect you when you get involved. So say yes when people ask you if you want to do things socially or medically. 2. Watch how you interact with people not only at work but socially wherever you are. People know who you are, they know you’re a doctor and they know where you live, even if you’ve never met them. Word spreads very quickly. 3. Go back to where you’ve worked before. Going back to Derby was really great for me. The community remembers you. They recognise you and appreciate that you came back.
father and a GP mother, she wanted to tread her own path. But learning about Indigenous health in high school ignited her passion to become a doctor and work with Aboriginal people. Currently with the renal transplant unit at Perth’s new Fiona Stanley Hospital, she’s still exploring her career options and “general practice is definitely in the mix, especially in a rural setting”. In the meantime she’s studying the tropical diseases sometimes seen in northern Australia by undertaking a Master of Public Health and Tropical Medicine at James
Cook University through their external and block study program. “I just got back from Cairns after doing a unit in human parasitology. Surprisingly, I really enjoyed looking at stool specimens under a microscope for a week,” she adds with a giggle. Caitlyn says she hopes to return to Derby and would recommend a similar rural-remote posting to any prevocational doctor who wants to fast-track their clinical confidence, see the colours of a northern sunset and get some red dirt underfoot.
With you on your journey 15
The fruits of being a rural generalist As a GP registrar in the Queensland Rural Generalist Pathway, Dr Sarah Farlow is exploring the life of a multi-skilled rural doctor in one of Australia’s iconic outback communities. A ripe pawpaw jostles for space with a bundle of mail in Dr Sarah Farlow’s inbox at Mount Isa Hospital. The fruity paperweight may provoke a double take at some hospitals but at Mount Isa Hospital nobody bats an eyelid. “If one of my patients is successfully growing pawpaws, there will be a pawpaw in my inbox with my mail stuffed all around it,” Sarah says with a laugh. “Mount Isa is a great supportive little place.” Sharing home-grown produce is emblematic of the friendly, informal community feeling at the heart of rural medicine – something Sarah loves about her job. Sarah is a principal house officer in the emergency department of Mount Isa Hospital and a registrar in the Queensland Rural Generalist Pathway training to the Australian College of Rural and Remote Medicine (ACRRM) curriculum. This training program is specifically designed to meet the workforce needs of a vast state with many outback outposts remote from the consultants and infrastructure of a tertiary hospital. The idea is to produce multi-skilled, ‘jack-of-all-trades’ doctors known as rural generalists who can deliver babies, deal with emergencies, give anaesthetics, perform basic surgery and make critical decisions across hospital and community-based practice. “My job at Mount Isa Hospital is completely unpredictable – no two days are
the same,” Sarah says. “That’s part of the appeal for me. “In the last 24 hours, I’ve had two people requiring RFDS transfer – acute medical patients requiring tertiary intervention. We’ve had a motor vehicle accident, children with coughs and colds, an elderly person who’s had a fall – so we’ve had the management of all those different areas in the one day.” The diversity of the people is equally compelling for Sarah. “We have a very multi-cultural population with a high proportion of Aboriginal residents as well as a significant proportion of nomadic FIFO workers who come and go.” What drew Sarah to rural and remote medicine? Flashback to an elective Sarah did while at James Cook University. She found herself as a fifth-year medical student with scant clinical experience delivering babies in a Menang birthing centre in the remote highlands of Papua New Guinea. “It really ‘sold’ rural generalism to me,” she reflects. “People say in Mount Isa we have a lack of resources and access but seeing things from a third world perspective opened my mind to how lucky we really are. “I saw PNG-trained doctors who literally just had their hands and minds to get by and try to do the best for people. “I got to deliver babies and did twin deliveries, a breech birth and a vacuum extraction with an old foot pump vacuum extractor. I did all this as a medical student with a midwife in the middle of the night – things that perhaps a few obstetricians haven’t done.” The experience strengthened Sarah’s resolve to become a rural generalist with advanced skills in obstetrics. “I knew I
I really feel that this job “ keeps you grounded, down to earth and in touch with the lives of your patients.
wanted to be a doctor and I never really imagined myself as a super specialist in an office in Brisbane. My father is a rural doctor so I had exposure to a rural GP’s life early on.” Looking ahead to the next stage of her training, Sarah is excited about developing her obstetrics skills – one of the mainstays of rural generalism. “Next I will be doing my advanced skills training working alongside two obstetrician consultants at Mount Isa Hospital,” she explains. For a coastal girl, Sarah’s move 1000 km west to Mount Isa was a deliberate shift out of her comfort zone. “I grew up on the coast around Proserpine, Airlie Beach and the Whitsundays but I’ve always wanted to do a stint out west. I went as far out west as I could. It was quite an adjustment but I really enjoy living here.” Sarah has grasped the opportunity with both hands, professionally and socially. She is determined to gain as much clinical experience as she can to “learn skills I can take to a community”, she sits on the committee of the Rural Doctors Association of Queensland and plays drums in the Rural Rednecks, a rock band of rural doctors who perform at medical conferences. Out of hours, Sarah is embracing the “wild west lifestyle”. “I’m getting into the things people do here like the local hospital touch football teams, the rodeos, race days, live
local bands and I’m training for the annual Julia Creek Dirt and Dust Triathlon,” she says. If Sarah’s schedule sounds exhausting, she is aware of the hazards of burnout. “You have to have your own personal fatigue alarm,” she observes. Taking regular breaks is a great way to dial down the stress, she says. Only by physically removing herself from the community and the constant connectivity of technology for a few days is she is able to really relax and recharge. “I book a few short breaks in advance – even if it’s just a weekend away with friends somewhere by the beach or in the city.” Future plans? “I want to get through my training and be able to contribute work in Papua New Guinea or somewhere in the third world for maybe a quarter of my career, if I can,” she says. In the meantime, Sarah is enjoying the life of a rural generalist trainee in Mount Isa. “I really feel that this job keeps you grounded, down to earth and in touch with the lives of your patients. They are your community, your neighbours, people who rely on you and you on them. “Every patient encounter is unique and rewarding in some way. Home-grown pawpaws are just one of the job’s added sweeteners.”
With you on your journey 17
Overseeing the systems and stakeholder relationships that underpin a doctor’s clinical work is the job of medical administrator and GP anaesthetist, Dr Oscar Whitehead. We meet him as he takes off in a new role in tropical far north Queensland.
A current priority for Oscar at RFDS is bedding down a robust electronic medical records system. “As a medical professional, you need good systems and tools to be able to do your job,” Oscar explains. When this is missing, there can be high staff turnover and less than quality care, he adds.
How many medical administrators have you met who speak two Indigenous languages as well as Japanese and French, play the jazz ukulele and possess the confidence to take on a medical director role in the Torres Strait while still a general practice registrar?
He recalls one incident when he first arrived in the Torres. “This doctor was working in an old clinic on one of the islands, which was pretty much just a shed. A gust of wind blew in, and notes and results were blown off the desk and mixed up all over the floor. It was the straw that broke the camel’s back and she resigned.”
Medical administrator and GP anaesthetist, Dr Oscar Whitehead, is a former Registrar of the Year and comes across as perhaps a touch eccentric.
Oscar worked hard to improve the systems and morale for doctors in the Torres. During his tenure, the average time in the job for doctors expanded from around six months to four years.
The past eight years of his life have been dedicated to Indigenous health – and setting up systems and policies to support doctors and medical staff who work with Indigenous people.
Oscar is still getting a feel for his new job at the RFDS. But he’s learnt enough to know that today’s RFDS is more than the typical storyline from The Flying Doctors TV program of years gone by.
He recently moved from Thursday Island to Cairns to take on a new position as Director of Medical Services with the Royal Flying Doctor Service in Queensland.
“The typical thought is that someone is bitten by a snake or kicked by a horse, and you fly out there and pick them up. That’s probably a very small part of what we do now.
So why the job change? “It was a bit of a confluence of factors. With the kind of role I had in the Torres, five years is normally a good stint and I’d been there for eight years.
“A lot of our aeromedical work is inter-hospital transfers. Probably only 10 percent are primary retrievals.”
“This RFDS job came up, which was a state-wide role with an iconic organisation. In this position I am able to influence health outcomes for remote Indigenous communities, which is my passion – probably on a bigger scale.” Oscar says his role is often not well understood, even by other doctors. “So what is it you do again?” is a question he’s often asked. When he mentions words like strategy, policy, procedure, protocol and networking, people’s eyes tend to glaze over. But without this behind-the-scenes organisational structure and collaboration with the many government and nongovernment stakeholders in the health system, it’s difficult for doctors to do their job and make a difference.
Regular primary health clinics in remote communities – Indigenous and non-Indigenous – are another important RFDS service. Here Oscar puts on his clinical GP hat and consults with patients whenever he can spare the time. The clinics are a cross between a visit to the doctor and the local CWA community fete. “You turn up at a town hall and there’s usually plates of cakes and scones and cream and cheeses,” he says. Then there’s the medical chest program, where the RFDS subsidises a range of medications for people in remote locations to have on hand, which can be used under the guidance of a doctor via the Telehealth program should the need arise.
As a medical professional, “ you need good systems and
tools to be able to do your job. “One of my colleagues made a joke that it’s going to be the Royal Wifi-ing Doctor Service,” he says with a laugh. “We are sort of moving with the times.”
Oscar’s aptitude for admin stems from his first career in the Commonwealth public service. Born in the United Kingdom, he grew up in Melbourne and completed an arts degree at the University of Melbourne with honours and a double major in Japanese and linguistics. Always interested in Indigenous culture, Oscar moved to Arnhem Land and got a government job working in Indigenous education funding. During this time, he observed many cultural barriers to health care for Indigenous people and learnt to speak the Yolngu Matha language. A departmental restructure saw him re-examining his career prospects in his early 30s.
He enrolled in a four-year postgraduate medical degree – two years in Adelaide and two years in Darwin – and completed twin fellowships with the RACGP and ACRRM as a rural generalist with procedural skills in anaesthetics. On awarding him Registrar of the Year in 2008, the judges remarked on his calm demeanour under pressure. This may be due in part to Oscar’s interest in Japanese philosophies and martial arts – he was once on the Australian team for aikido, which roughly translates as the way of harmonious spirit. Now living with his wife Irene, also a GP, and their young son on a mangosteen orchard on the outskirts of Cairns, Oscar is enjoying the change of scene. When asked about the inspiration for his work, he points to the patients. “Some of the adversities they face and how they overcome them can be huge steps for people with their background. It’s the magic in the ordinary.”
With you on your journey 19
Test yourself with clinical cases from the master of general practice, Professor John Murtagh.
Case 1 Jaundice in a neonate A 2-week-old infant boy was brought in by his mother as she was concerned about his increasing jaundice. He had a normal delivery but became jaundiced on day three. Both mother and baby are blood group O positive. The infant’s blood film was normal. He was treated with phototherapy for two days, but since discharge on day seven the jaundice has persisted, despite the infant being well with satisfactory breastfeeding. On examination the infant was active and clinically normal apart from jaundice. Urine and stools were normal in colour. Investigations were: serum bilirubin 240 µmol/L (conjugated <10 µmol/L), full blood examination normal, urine culture normal.
Questions 1. What is your provisional diagnosis?
3. What is the most common cause of non-physiological neonatal jaundice? 4. What cause of neonatal jaundice demands urgent referral?
Answers 1. B ecause of unconjugated hyperbilirubinaemia the most likely diagnosis is breast milk jaundice. 2. T he mother should be reassured that the condition is selflimiting and requires no treatment. The diagnosis can be confirmed by suspension of breastfeeding for 24–48 hours, which will result in a fall of serum bilirubin. In this situation, temporary expression of milk will maintain lactation. 3. T he most common cause is haemolytic jaundice, especially ABO blood group incompatibility. 4. B eware of conjugated bilirubin, which is pathologic and indicates biliary atresia in the newborn. Also consider neonatal hepatitis.
2. For that diagnosis what is your management?
Case 2 A challenging infection in a refugee A 13-year-old male refugee from Afghanistan, who had arrived in Australia with his family four months ago, presented with a 2-week history of muscle pains in his neck, lumbar spine and legs in particular. He complained also of weakness in his legs with spasms of cramp-like muscle pain and paraesthesia. He described a preceding ‘flu-like’ illness with fever, sore throat, headache, nausea, diarrhoea and neck stiffness. On examination he looked unwell and walked with some degree of discomfort. His vital signs were: pulse 86/min, BP 110/70 mmHg, respiratory rate 14/min, temperature 37.8°C. Neurological examination of the lower limbs revealed muscle weakness, especially of quadriceps muscle of the left leg (level 4, power), reduced deep
tendon reflexes but normal sensation. Mild neck stiffness was elucidated.
Diagnosis In view of the pattern of aseptic meningitis and lower motor neuron signs he was admitted to an infectious disease unit where investigations (cerebral spinal fluid, full blood examination, paired serology, throat swab and stool culture) confirmed the diagnosis of acute anterior poliomyelitis. The responsible picornavirus, an enterovirus that specifically attacks the anterior horn cells of the spinal cord, was identified. The patient came from a region where the infectious disease was still prevalent and immunisation against poliovirus not routinely available or accessed.
With you on your journey 21
CLINICAL CASE REVIEW
Could this vulval lump be malignant? By Ian Jones
A 46-year-old woman presents after noticing a small lump on the vulva. What is this lesion and could it be malignant?
Case scenario Jane, a 46-year-old housewife, presented with a sixmonth history of a vulval lump that she had first noticed when washing herself. The lump was non-tender, 1 cm in diameter and situated on the right labium majus (see Figure 1). It had a red spot over the surface and was mobile, but it was not itchy and had not bled. There was no lymphadenopathy in either groin. The patientâ€™s general health was good. She continued to menstruate regularly and had undergone a tubal ligation five years previously. A recent mammogram had been reported as normal and her most recent cervical smear (taken 12 months previously) was also reported as normal. She was not taking any medications. A general examination was unremarkable and the patientâ€™s vital signs were normal. Apart from the vulval lump, her gynaecological examination was unremarkable.
Commentary A papillary hidradenoma is a benign neoplasm of apocrine sweat gland origin and the vulval counterpoint of the mammary intraductal papilloma.1 It forms a sub-cutaneous mass, usually less than 2 cm diameter, situated on the labia majora, labia minora or interlabial sulci. Papillary hidradenoma uncommonly occurs in the perineum or perianal area. There have been rare reports of lesions found outside the genital area, in the head and neck. Papillary hidradenoma can occur in men. A papillary hidradenoma can be cystic, papillary, fungating, ulcerated or bleeding. Most lesions are painless but they can be tender or itchy. Microscopically, the lesions are circumscribed and are not attached to the overlying skin unless ulcerated. They have a cystic space into which project fibrovascular branching stalks and many tubules and acini lined in two layers by an inner cuboidal or columnar epithelium and an outer layer of myoepithelial cells (see Figure 2).
Jane was referred to a gynaecologist, who recommended excision of the lump. This was undertaken three weeks later under general anaesthesia. The lump was completely excised using an elliptical incision without difficulty and the specimen was sent for histopathology (see Figure 2). A benign papillary hidradenoma was reported. Jane made an uneventful recovery from surgery and was returned to the care of her GP after being informed of the result of the histopathology. What is a papillary hidradenoma and its differential diagnoses, and is it always benign?
This article originally appeared in Medicine Today 2013;14(2):66â€“67 and is reprinted here with permission.
Figure 1. The small lump located on the right labium majus
The list of benign differential diagnoses for papillary hidradenoma is extensive. It includes: • mucinous cysts • Bartholin’s gland and Skene duct cysts • epidermal inclusion cysts (sebaceous cysts) • seborrhoeic keratoses • fibroepithelial polyps • fibromas, fibromyomas, dermatofibromas • lipomas • syringomas • haemangiomas • lymphangiomas • angiokeratomas • pyogenic granulomas • endometriomas • heterotopic sebaceous glands and sebaceous gland hyperplasia • papillomatosis. A papillary hidradenoma is benign but it can be confused for a malignant tumour, especially if the lesion is ulcerated and the protruding vascular papillae appear red and bleed easily. In situ and malignant change is very rare but has been reported.2,3 Papillary hidradenoma is treated by local excision.
Key points • If a lesion on the vulva looks abnormal then it probably is. Biopsy or excision is warranted. Despite the fact that this patient’s lesion had features of a benign cutaneous neoplasm (it was symmetrical, mobile and not associated with bleeding), consultation with a gynaecologist or dermatologist was appropriate. • Malignant lesions may initially be non-descript in appearance. Squamous cell carcinoma, basal cell carcinoma and melanoma all occur rarely on the vulva and all can have the morphology of nonspecific red nodules.
Author Ian Jones AM, ChM, PhD, FRANZCOG. At the time of writing, Professor Jones was Professor of Obstetrics and Gynaecology at The University of Queensland. He was also Executive Director of Women’s and Newborn Services at Royal Brisbane and Women’s Hospital, Brisbane, Queensland. Competing interests: None.
References 1. Spiegel GW, Calonje E. Cysts and epithelial neoplasms of the vulva (ch 8). In: Neill S, Lewis F, eds. Ridley’s the vulva. 3rd ed. Oxford UK: Wiley-Blackwell; 2009. p. 168–187. 2. Shah SS, Adelson M, Mazur MT. Adenocarci noma in situ arising in vulvar papillary hidradenoma: report of 2 cases. Int J Gynecol Pathol 2008;27:453–456. 3. Bannatyne P, Elliott P, Russell P. Vulvar adenosquamous carcinoma arising in a hidradenoma papilliferum, with rapidly fatal outcome: case report. Gynecol Oncol 1989;35:395–398.
Medicine Today provides GP Journey with selected articles from its archive of peer reviewed clinical content. To view the full archive, first register to use the website at http:// medicinetoday.com.au/user/register and then browse the content online or download Medicine Today for iPad, available from the App Store at https://itunes.apple.com/app/ id666623264.
Figure 2. The characteristic histological appearance of a hidradenoma
Registration and online access to Medicine Today’s rich knowledge bank of clinical content is free to all members of GPRA, GPSN and GPN.
With you on your journey 23
Bedside Stories – Confessions of a junior doctor Michael Foxton Dr Foxton has collected and linked together his contemporaneously written periodicals from The Guardian newspaper. These are the tales of a junior doctor as he surmounts the challenges inherent in starting a career in medicine. From recurrent themes of feeling in the deep end and being alone looking after sick patients that could die, to the unexpected thank-yous and comically unreasonable demands of patients, there’s the sensation of a friend or colleague debriefing with you. Using pithy insights and black humour his experiences are related with enough laughs
Figure 1 – Medical Image Sharing for Healthcare Professionals Dubbed the ‘Instagram for doctors’, the Figure 1 app is used across 100 countries by thousands of health professionals to share, discuss, and learn from interesting clinical cases via photo uploads.
Pros: • Never seen ‘purple urine bag syndrome’ before? Well now you have! Learning becomes limitless with this app.
Cons: • While strict measures are set in place to safeguard patients’ privacy, this app is freely open to public download. So protect yourself by always getting a patient’s consent before sharing. Compatibility: Requires iPhone iOS 7.0 and later, Android 4.0 and later. Compatible with iPhone, iPad, iPod touch Cost: Free! Rating: 4/5 Reviewed by Chloe Hang Prevocational doctor, Greenslopes Private Hospital, Qld
to keep you entertained through the poor-me moments and the dark realities. I would highly recommend this book as a gift to the bright faced new graduates of medical school or any of the members of the public who use the ‘not-so’ free health care services. Publisher: Atlantic books, 2012 Overall rating: 3/5 Reviewed by Matthew Wagner Prevocational doctor, Rockhampton Base Hospital, Qld
Oxford Handbook of Cardiology 2E The Oxford Handbook of Cardiology 2E is was easy easy enough enough to install to install – if you – ifknow you know you need you need an an app app to run to run thisthis app! app! The visual design is appealing, with a distinctive icon, and the navigation was easy. I could find the information I needed quickly, which meant, meant for example, when I had seen a patient and interpreted an ECG I could go back and have a quick look and remind myself what an atrial node re-entry tachycardia was caused by by, and and what it looked like on an ECG.
AD However, I wasFP reluctant to use this app in a fast paced ward. For the price, I would have liked to get more use out of it.
• Comprehensive information on hand, anywhere, anytime • Includes ‘drugs for the heart’ – great little resource to have.
Cons: • Too many clicks/links to get to a resource (personal issue) • Will require doctor companion to run (an app for an app) • Would have liked actual ECGs in the app to come up in the description rather than another click. Compatibility: Requires Android 3.0 or later Cost: $64.99 Rating: 3/5 Reviewed by Billy Stoupas Prevocational doctor, Eastern Health, Vic
• Updated version includes updates to cardiology clinical practice including interventional cardiology and electrophysiology
The The Royal Royal Children’s Children’s Hospital Hospital MelMelbourne Clinical Practice bourne Clinical Practice Guidelines Guidelines The Royal Children’s Hospital Melbourne Clinical Practice The Royal Children’s Hospital Melbourne Clinical health Practice Guidelines app provides up-to-date and detailed Guidelines provides up-to-date and detailed health informationapp across all medical interests. information across all medical interests.
Pros: Pros: • Easy to navigate, set out in an easy-to-read format with • Easy to navigate, set quickly out in an easy-to-read format with content easy to find content easy to find quickly • Well suited to trainees who may need direction in acute • Well-suited trainees who may need direction in acute situations ortofor exam preparation. situations or for exam preparation.
Cons: Cons: • Could do with a few more images or clinical photos,
• Could dofor with a few more images or clinical photos, however a free product it is excellent. however for a free product it is excellent. Compatibility: Requires iOS 6.0 or later, iPhone, iPad, iPod Compatibility: Requires iOS 6.0 or later, iPhone, iPad, iPod touch touch Cost: Free! Rating: 4/5 Reviewed by Elizabeth Stalewski GP registrar, Townsville Family Medical Centre, Qld
With you on your journey 25
“Filled with practical advice, the GP Companion will add to the richness of your experiences during your clinical rotations in general practice.” Professor Michael Kidd – GPRA Patron
Are you a GPRA member? Get your copy of GP Companion for the special member price of
$19.95 RRP $34.95
gpsn.org.au Prevocational doctors visit
Supported by GPRA
INDIGENOUS GENERAL PRACTICE REGISTRARS NETWORK
What ever happened to the PCEHR? It has been said of technological advances that, ‘Science finds, Industry applies, Man conforms’. In the case of Australia’s online health record – the Personally Controlled Electronic Health Record, or PCEHR – Australian consumers are conforming slowly, but surely. Saul Kamen, the eHealth Program Officer from Eastern Sydney Medicare Local, has followed and contributed to the PCEHR implementation at a grass-root level since the pilot was launched by St Vincent’s Hospital in July 2011. “It was always going to be a long-term project, about 8–9 years in the making,” he told GP Journey.
Now Currently, the PCEHR system is utilised by 2.2 million consumers and 10,800 clinicians, 5000 general practices, 179 hospitals, 144 residential aged care facilities, 1100 pharmacies and 1100 allied health providers.* For the GP, it provides a shared patient health and discharge summary. For patients, it provides a summary of health history,
a record of medications (national prescribing and dispensing) and the ability to provide an accurate record to personally approved health professionals.
The future The PCEHR will soon be able to store pathology and radiology data. In time, the patient’s health summary will lead to savings in duplication costs and other operating costs such as time-on-job (for example, the sharing of medical data between clinicians). These efficiencies will not only improve the patient experience within a general practice clinic, but also where there is a need to involve the collaboration of allied or specialist and ambulatory services which, it is hoped, will lead to improved patient outcomes. The online record is soon to be renamed ‘My Health Record’. An upcoming injection of $5 million over the next 12 months will be spent in line with an opt-out strategy, which will see about one million selected consumers (mostly patients with chronic and complex illnesses) given the opt-out choice in the coming year. For more information on the online health record, visit nehta.gov.au * Information correct as of June 2015
AUSTRALIA’S LEADING PRIMARY CARE EVENT
• Extensive choice of topics delivering the latest evidence, guidelines & best practice • Cutting edge medical products, services and technologies
• Hands-on group learning to enhance your practical skills • Exclusive forum to interact with peers, share ideas and experiences
• Learn from leading local specialists and gain impartial, expert advice • CPR Training Sessions
50% Discount for GP Registrars
REGISTER AT GPce.com.au
13 – 15 Nov 2015 Melbourne Convention
& Exhibition Centre
melbourne. With you on your journey 27
GOING PLACES NETWORK
prevocational What is the Going Places Network? The Going Places Network (GPN) is for prevocational doctors interested in the most challenging and versatile medical career of all – general practice. Joining GPN gives you access to national general practice focused events, publications, online resources and more.
What is a GP Ambassador? GP Ambassadors play a pivotal role in the Going Places Network. As the champions of general practice in their hospital, they have a strong dedication to developing and promoting GPN while being the primary point of contact for other prevocational doctors wanting to find out more about general practice. GP Ambassadors also help us run our GPN events, from hospital-based coffee mornings and educational workshops to larger networking events, such as winery tours and barefoot bowls.
How can a GP Ambassador help me? GP Ambassadors are always willing to give honest and useful advice. Whether you have a question about a career in general practice and the training program, or just simply want to chat, your local GP Ambassador will make time for you and offer you the support you need.
How can I contact my GP Ambassador? Visit gpaustralia.org.au/gp-toolkit/ambassador-directory/ for a state-by-state listing of our GP Ambassadors.
Being a GP Ambassador “ means representing the primary care career pathway. I aim to act as a link to the hospital community in regards to what can be achieved in general practice and how to get there.
Dr Christopher Price
Royal North Shore Hospital, NSW
What are you waiting for? Explore the specialty of general practice while you complete your hospital training and embark on the journey of a lifetime. Join the Going Places Network at
community Have you seen us at these events? Check out some of the recent events GPN has hosted around Australia.
NSW and ACT • Mock interviews session at Maitland Hospital • Lunch time teaching session at the Canberra Hospital • Lunch time educational session at Blacktown Hospital
Being a GP Ambassador “ is an opportunity to be a conduit between the hospital and general practice. It also enables me to be a support for those who desire to undertake general practice training.
Dr Justin Gladman Tamworth Hospital, NSW
• Lunch time teaching session Mt Druit Hospital.
VIC and TAS • Barwon Health network dinner with keynote speeches by Dr Hugh Seward, Dr Cameron Profitt and Dr Yvonne McCartney • Going Places Roadshow – inaugural roadshow showcasing GPRA in Launceston, Burnie and Hobart.
SA and NT • Joint injections workshop and dinner – collaboration with Adelaide to Outback GP Training and Sturt Fleurieu Education and Training.
QLD • Education sessions at the Royal Brisbane Women’s, Mater, Princess Alexandra, Ipswich, Logan and Redland hospitals • GPRA leaders dinner • Great Expectations careers evening at Gold Coast University Hospital • Griffith University Medical Society careers evening • GPSN University of Queensland careers night.
Upcoming events Don’t want to miss out? Discover what’s happening in your state. Visit gpaustralia.org.au for a list of upcoming events.
WA • AGPT Sundowner • Postgraduate Medical Council of WA Medical Careers Expo • WAGPET hospital information sessions • General practice careers information webinar presented by a general practice registrar medical educator.
With you on your journey 29
GENERAL PRACTICE STUDENTS NETWORK
student community The General Practice Students Network (GPSN) is a national network of university clubs based at every medical school in Australia, supported by a national executive committee. Club chairs promote GPSN at their university and are a point-of-contact for medical students with general practice career questions. GPSN clubs host a variety of educational and career-focused events across Australia and provide professional resources to medical students. GPSN is funded by the Department of Health and run by GPRA. Being part of GPSN is being part of a community of more than 21,000 medical students, prevocational doctors and general practice registrars.
Photo courtesy Eclectic Photography
Connect with us There are many ways to get involved in GPSN. At the university level, members have access to events run just for them by their university GPSN club, or become part of the club executive, where they can continue their passion for general practice through advocacy and events. At a national level, members can become involved with national GPSN working groups, attend the GPSN national conference or become part of the GPSN national executive team. Email your university club chair or email@example.com with any suggestions or feedback.
Why join? As a GPSN member, there are many benefits available to you, including access to free events, discounts and free resources as well as national representation on external committees. We are constantly working on new benefits, based on member feedback. Visit gpsn.org.au to learn more. As a GPSN member, you also become an Associate Member of GPRA. Both GPSN and the Going Places Network, which
is for prevocational doctors, are represented on the GPRA Board and on various external organisations. The GPSN National Executive and Council work to ensure you have the right support to assist you on your journey through medical school, your transition in to the hospital system and on to general practice.
National Council The GPSN Council comprises the local clubs chairs and the national executive. The national executive meets frequently throughout the year to discuss, debate and share ideas, and to further develop the network. The final meeting of the year will be held in Melbourne over the weekend 10â€“11 October, in which we will welcome the incoming university club chairs for 2016, as well as the newly elected national executive. With the term for those involved in GPSN this year coming to a close, weâ€™d like to recognise their time, efforts and dedication to the network, and warmly welcome those graduating students to the Going Places Network, where their journey continues.
GPSN National Executive University
University of Western Sydney
National Vice Chair
University of Notre Dame Sydney
Flinders University â€“ Northern Territory Medical Program
Working Group Officer
University of Western Sydney
National Events Officer
Local Events Officer
University of New South Wales
Promotions and Publications Officer
University of Western Sydney
Communications and Online Media Officer
GPSN University Club Chairs University
University of Newcastle
University of New England
University of New South Wales
University of Notre Dame Sydney
University of Sydney
University of Western Sydney
University of Wollongong
James Cook University
University of Queensland
University of Adelaide
University of Melbourne
University of Notre Dame Fremantle
University of Western Australia
ACT Australian National University NSW
NT Northern Territory Medical Program (NMTP Flinders University) QLD
TAS University of Tasmania VIC
Get in touch If you have any questions about a career in general practice or would like to attend a local GPSN educational event, please contact your local university club chair.
To find out about projects the National Executive team are working on, please contact one of the team members.
With you on your journey 31
F I R S T WAV E Q & A
The John Murtagh First Wave scholarship provides early exposure to general practice in a range of settings. Deakin University third-year medical student and scholarship recipient, Tara Sasse, answers our questions about her placement.
Where was your placement? Echuca Moama Family Medical Practice in Victoria.
What did you observe while on your placement? Over the three-day placement, I spent the mornings with my GP supervisor observing a range of patient consultations. In the afternoons, I was placed at the Echuca Hospital operating theatre observing two other rural GPs who have sub-specialised in anaesthetics and obstetrics. Both settings enabled me to observe a great mix of GPs working in the clinic setting and the operating theatre setting.
What was your supervisor like? My GP supervisor was excellent. She was a young, vibrant, female GP who was a great teacher and a fabulous doctor to observe with her patients.
My time spent in the GP clinic also had its highlights. I saw a patient with a possible infarcted inguinal hernia who was referred for an urgent ultrasound, a child being investigated for hearing loss, and I got to remove a wart off a 10-yearold boy and a skin lesion off a farmer. It was a jam-packed three days and I saw so much more than I had anticipated.
Did you do anything interesting outside your placement? Echuca was a beautiful town to stay in. Being on the Murray River it was lovely to go on afternoon walks and reflect on what I had experienced that day.
What did you learn about general practice? I was fortunate to observe GPs in a range of different roles both in the clinic setting and in the hospital. This experience made me realise that rural general practice can provide a great deal of variety. There are opportunities to take your medical career in any direction that you choose and sub-specialising is a great way to mix up your day to see a diverse set of patients and clinical situations.
What was the highlight of your placement? There were so many highlights itâ€™s hard to just pick one! Spending time in theatre with the GP anaesthetist and GP obstetrician was amazing. I was able to scrub-in and assist in delivering a baby boy by caesarean section, and I observed the anaesthetist treat a patient who was having a laryngospasm.
The John Murtagh First Wave scholarship program offers the opportunity for a positive and inspiring experience in general practice under the guidance of a dedicated general practice supervisor.
To find out more about this exciting program, visit
With you on your journey GPRA â€“ proudly supporting medical students and prevocational doctors on their journey to general practice.
gpsn.org.au Prevocational doctors visit
Supported by GPRA
INDIGENOUS GENERAL PRACTICE REGISTRARS NETWORK