RCS Wagga newsletter - June 2016

Newsletter June 2016 Medicine

Today is another cold, drizzly day in Wagga Wagga, indicating that it is now winter time and we are exactly half way through the academic year! All of our students are extremely grateful for the wonderful learning opportunities that are available to them. From early July our sixth year students will be building towards their final exams and our focus will be on bedside teaching and preparation for management vivas. To assist with exam preparation, the Clinical School staff have access to examples of questions. If any academic staff require these to assist with their teaching, please don’t hesitate to contact our administration team.

UNSW has decided to move the Graduation ceremony from December at the end of Year 6 to June of the following year which is essentially half way through Internship. With this in mind, I think the Graduation Dinner that we hold for our students each year (this year on Thursday 28 October) has gained greater importance. Invited to the Dinner are graduating students, partners, parents, other students in Phase 3 (essentially the fifth year students in our campus) and academic staff including conjoints who may wish to attend. The event is held at Magpies Nest restaurant and the cost is approximately $100 per person including limited alcohol.

I am indebted to Dr Paul Mara from Gundagai who recently took 2 of our students on a wonderful aerial trip around outback Queensland evaluating and accrediting GP practices. This gave the 2 students a wonderful opportunity to experience firsthand remote primary care and expectations of service delivery in remote communities. Dr Mara is also hosting some of our students at the Airlee Beach yacht races in August, which is not strictly educational but will give them a wonderful and Unique experience.

On a political note, UNSW is collaborating with the University of Notre Dame (UND) in a bid to establish a rural training hub in Wagga Wagga to coordinate regional training for specialty medical practices. We are also in discussions with CSU and UND to put in a bid for a University Department of Rural Health in Wagga Wagga to coordinate rural and regional research and expand training placements across medicine, nursing and allied health. These applications will probably not be received till after the upcoming Federal election.

John Preddy, Head of Campus

In this issue: Research + ILP Student Presentations Social + Gold Cup Summary Teaching + Simulation Learning Centre Student Award + Golden Heart

Student Travel + North Qld Accreditation Report

2015 Independent Learning Project (ILP) Presentations Emma Gorman Year 4 student Emma Gorman’s ILP Research topic was “Improving Parents Understanding of Extremely Preterm Infant Outcomes”. On Tuesday 24th May 2016, Emma attended the Perinatal Society of Australia and New Zealand Annual Conference in Townsville, Qld where she presented her poster and a 2 minute oral segment on her findings.

Anna Fernon Anna’s research was titled “A User Centred Approach to Designing an eTool for Gout Management”. Anna will present results of her research at the Health Informatics Conference in Melbourne on July 25, 2016 where she is shortlisted for the Branko Cesnik Scientific Award for the best scientific student paper 2015. Anna will describe her findings in a 20 minute oral presentation at the Informatic Conference and her research paper will be published in the open sourced IOS press series— http://www.iospress.nl/

Maggie-Kate Minogue “In April 2016, I had the pleasure of attending the Caring for Country Kids Conference, a national conference focusing on the quality of healthcare for children and adolescents living in rural, regional, and remote areas throughout Australia.

The conference was a multidisciplinary event and featured medical professionals, allied health professionals, educators, and government representatives. The major themes throughout the conference included mental health, telehealth, early diagnosis and intervention, foetal alcohol spectrum disorder, and closing the gap.

During this conference I presented my research on “The outcomes of babies whose mothers have diabetes”, as a poster.

This trip to Alice Springs was the first conference I had attended as well as my first time in central Australia. The overall experience was amazing, both on a professional and personal level. I was able to network with other healthcare professionals living throughout Australia and learn what strategies they were involved with that aimed to enhance the health and wellbeing of children and families living in rural and remote areas. Furthermore, I gained an appreciation for the dramatic difference between regional and remote areas, both the breathtaking landscape and the drastically different means of providing healthcare services. My time in Alice Springs has fuelled my passion for rural health and I am now even more driven towards a career working in rural and remote areas of Australia. “ Maggie-Kate

Most Outstanding Medical Student Recently, a Pre Internship Clinical Skills Day was organised by Junior Doctors, Hannah Kempton and Jamie Cham with valuable assistance from A/Prof Joe Suttie at Riverina Cardiology. The Skills Day was intended to replicate clinical exams for Year 6 students from the RCS Wagga Wagga campus and Notre Dame students with the focus on General Medicine. They were assessed by Junior Doctors through to senior clinicians in exam like conditions. Lucy McMullen, Year 6 RCS Wagga campus student, was announced as the inaugural winner of the Golden Heart Award for most outstanding student!

On behalf of the participating students, the RCS extends a huge thanks to Hannah, Jamie, A/Prof Suttie, Riverina Cardiology and all those involved for making this terrific opportunity available to RCS students.

Congratulations Lucy!

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GOLD CUP BRUNCH 2016 The RCS Gold Cup Brunch was a colourful and fabulous event with students from all year groups and visiting alumni attending.

Fashions on the Floor winners were: Best Dressed Filly - Emma Gorman (Yr 5) Best Dressed Colt - James Kane (Phase 2) Best Dressed Couple - Nathan Crabtree and Shirley Mo (Phase 2) Best Hat—Colt - Dr James Ulrick (Resident, WWRRH) Best Hat—Filly - Elizabeth Reid (Phase 2) Best Borrowed Hat - Dr Matt Binks (Resident WWRRH)

CALENDAR OF EVENTS JUNE Medicine Information Evening GRAND ROUNDS Thurs 23 June JULY Phase 2 Recess 27th June-18th July GROUND ROUNDS Thurs 28 July AUGUST Phase 2 Recess 29th Aug-9th Sept GROUND ROUNDS Thurs 25th Aug

SEPTEMBER MCQ Clinical VIVA PORTFOLIO

Exams Year 6 12 Sept 13 Sept 14 Sept 19 Sept

OCTOBER Year 6 Graduation Dinner 28th Oct NOVEMBER BIOMED AWARDS NIGHT MCQ 21st Nov – ICE 22nd Nov -

Exams Year 5 9th Nov 9th Nov Exams Phase 2 Phase 2

Flying High—North Queensland GP Accreditation Trip Year 6 students Jessica Elmasry and Elaine Ng recently spent 5 days flying throughout remote and regional Queensland with Dr Paul Mara and his accreditation team.

Below is their report on this fantastic opportunity which highlights some of the unique challenges in the delivery of healthcare in this region of Australia.

“We were provided with the opportunity to travel with Dr Paul Mara around rural and regional Queensland with his accreditation team. This report details our experience at the various clinical practices we visited.

Day 1 – Wagga Wagga – Brisbane – Kingaroy – Rockhampton We met Dr Mara and co-pilot Chris at Wagga Wagga Airport early on Monday morning. After a quick briefing on emergency procedures, we were on our way to Archerfield Airport in Brisbane to pick up the quality auditor for the accreditation team and were soon back and on our way to Kingaroy, Qld. GP Practice 1 (GPP-1): Kingaroy GPP-1 is a newly built practice located in the CBD of the town. The practice principal has been working in Kingaroy for 15 years. This practice is modern with 4 consultation rooms and a large 2-bed treatment room. One to two GPs work in the clinic from 8:30am to 6:00pm Monday to Friday, with no after-hours services. Although the practice is large enough to accommodate two more doctors, Dr K has had difficulties with employing more doctors and GP registrars. He feels it is due to the Queensland government recently taking Kingaroy off the list of “area of need” (AoN). An AoN is declared when there are insufficient medical practitioners practicing in that area than that of the national average, and allows employment of Australian and New Zealand trained doctors as well as international medical graduates (IMG).

Day 2 – Rockhampton – Cairns GP Practice 2 (GPP-2): Rockhampton The 7-storey Rockhampton Base Hospital was completed in May 2015, and has 400 beds. Several specialist services are provided by visiting doctors from Brisbane, including day surgery, interventional radiology and cancer care services. There are also several private specialists in town.

We visited GPP-2 in the morning. Dr F, practice principal, has worked in the practice since the 1980s. The practice is located in the CBD. It is old but well equipped and employs 2 nurses and 2 doctors, but no allied health professionals. Dr F was kind enough to allow us to sit in his consultations for the morning. We took histories from a number of patients and were impressed by the complexity and variety of patient presentations.

These ranged from cancer palliative care to well-managed Addison’s disease. It was also great to see the respect each patient had for Dr F, who has been managing them long before Rockhampton had visiting specialists.

GP Practice 3 (GPP-3): Edmonston, Cairns Cairns Hospital is the major hospital for the Cape York Peninsula region, and now has 531 beds after its redevelopment in 2015. Cairns is also a base for the Royal Flying Doctor service. We made our way inland to a suburban Aboriginal Medical Service (AMS) in Edmonston. GPP-3 is a newly opened branch of the main AMS located in Manura, and was built to provide care for a rapidly growing indigenous community. The AMS is part of a large local organisation of 200 employees, providing holistic healthcare to the Indigenous population in Cairns. There are 4 consulting rooms and a modern 2-bed procedure room with 3 resident doctors, 2 Aboriginal health workers, a psychologist and 2 practice nurses. The practice uses Communicare for its documentation, with the advantage of layered access for different users (e.g. medical professional vs. administrative staff) providing a good overview of a patient’s chronic disease profile. It has a sophisticated recall and alert system for chronic disease management.

Dr J is an Indigenous doctor who has worked in the practice more than 4 years. He states that an AMS is operated differently to a private GP practice. Appointments are at least 30 minutes long and often run beyond the scheduled time as most of an AMS doctor’s work is opportunistic, for they never know when they will next see the patient. Each doctor in GPP-3 sees only 10 to 15 patients a day, unlike most private practice. The patient health profile in an AMS is also vastly different from a patient in general practice. Many patients have complex histories and poor health literacy and don’t see specialists. Not only is it clinically difficult to manage these patients, it takes time and effort to gain their trust and respect.

Cultural sensitivity and awareness is an important aspect of care in the AMS. Dr J sees male patients, and occasional paediatric patients. A cultural orientation program has been designed for newly arrived GPs. Dr J is concerned that issues of cultural sensitivity and awareness are not well taught in medical schools and feels many medical graduates may be too intimidated to work in an AMS, leaving IMGs to take up employment opportunities.

Day 3 – Cairns – Mount Isa GP Practice 4 (GPP-4): Redlynch, Cairns GPP-4 is a large practice with a lot of facilities and health services. They are affiliated with the Independent Provider Network, which has 280 centres across Australia, to ensure a standardized approach to general practice. There are usually 8 doctors at any one time in the practice, with a mix of full-time and part-time staff. GPP-4 uses Best Practice for their electronic documentation, which has multiple back ups due to regular cyclones. There is an Aboriginal health worker and several nurses and educators, and all the tools, brochures and posters have been designed to cater for the needs of Indigenous patients.

The first practice visited was a Sonic Health practice located at the mine site exclusively for its workers and their families. This small centre has 2 full-time GPs and several nurses, and is open 24/7 to cater for occupation health issues and (as a side) regular GP consults. Most of the encounters in this practice are related to health assessments, such as pre-mining medicals, regular check ups and monitoring for occupational health hazards. For example the miners have regular bloods taken to test lead levels, serum osmolality and specific gravity, as lead exposure and dehydration are the two major health risks associated with mining. Other occupational health problems frequently encountered at this practice are chemical burns, smoke inhalation, musculoskeletal injuries, foreign bodies and hearing loss. It was really interesting visiting the practice pathology lab and learning about the different blood tests that are ordered for occupational health screening. Although the medicine is quite interesting, the major drawback to working here is that the practice is owned by Glencore, a private mining company, hence GPs may have to compromise what’s best for the patient in order to meet certain practice policies.

Next we headed into town to visit the Mount Isa GP super clinic, which certainly lived up to its name. This was a huge complex, recently renovated, with huge consult rooms and treatment areas fitted with the latest medical equipment. This practice has at least 6 full-time GPs working at any one time, several part-time GPs, 5 receptionists manning the front desk and many allied health services, including an OT, exercise physiologist, psychologist, dietician and chronic care worker.

The practice cost $5 million to build, and employs mainly doctors from overseas. We spoke to a few of these doctors, who all seemed to love working at the practice and claimed that Mount Isa was a good place to live and raise a family. Despite this, there is a scarcity of local doctors willing to work at Mount Isa, and all the specialists are locums from Cairns or Townsville, who have huge waiting lists (for example there is a 2 year waiting list to see a Dermatologist!).

During this visit, we had the chance to review the medical records with Dr Mara, which were documented on the Monet system. Like most of the other practices we’d been to, documentation was not always up to scratch, with gaps in social history, and a lack of sufficient background history in the GP referrals. This was one of the main learning points for us during this trip, the importance of being thorough with note-taking, not just to pass GP accreditation (and to avoid getting sued!), but also for the sake of patient handover and multi-disciplinary management.

Day 5. St George – then Home!

St George is a small, isolated rural town of about 3000 inhabitants and a 2-2.5 hour drive from the nearest town. It has a GP practice with 9 doctors (5 full time, 2 registrars and 2 part-time) as well as a small hospital with 4 generalist doctors. The hospital only has x-ray imaging and a “dodgy” ultrasound service, with the nearest CT scanner about 2 hours drive away. At this GP practice we met a med student on a rural GP placement from the University of Queensland. We soon became friends with Kate, who drove us around town, showing us the local vineyards, rivers, sports clubs, pubs, schools and gave us a great tour of the hospital. We learnt a lot about what it was like being a med student in rural Queensland. We then went back to the GP practice where we ate homemade scones, biscuits and met some really young and cool doctors who we were reluctant to say goodbye to. We felt that of all the places we’d visited throughout the week, St George was the most attractive, with its friendly people, young community and variety of patient presentations.

“We would like to thank Dr Mara and his fantastic co-pilot Chris for taking us on this incredible journey! We learnt so much by seeing a variety of practices all around rural Qld, and in the process we were able to meet many wonderful people and see so much of our beautiful country! Probably the most salient learning point for us was that there is SO much variety in rural and regional medicine. No one practice is the same and there are many wonderful opportunities to grow and learn as a doctor, not to mention to give back to communities in need.” Jessica Elmasry and Elaine Ng, Year 6