Tuesday, 20 January 2015

Education a passion for Moe surgeon

David Birks: 30 years of teaching.
Education is a passion for Moe surgeon, David Birks.

Now retired from full-time surgery, Dr Birks has been teaching medical students in the Latrobe Valley for more than 30 years and hopefully will continue teaching for some time to come.

He was there at the beginning of the Monash School of Rural Health, together with Anne Lerversha  who is still with SRH Latrobe Valley.

It was the school’s founder, Professor Roger Strasser, who had no trouble in persuading his colleague to join him. Professor Strasser was then in general practice in Moe with Dr Birks.

“We had many discussions in the tea room about attracting doctors to the Latrobe Valley,” Dr Birks recalled. “All training then was city-based.

“Roger approached Monash University about it and a professor at the Alfred agreed to send some students.

“It was semi-official for three years then Roger got things going. He led the first Centre for Rural Health in Australia, possibly in the world, from the old Moe Hospital.”

Dr Birks combined work as a consulting surgeon at the hospital with lecturing in surgery.

 David Birks' father was a surgeon in Moe but Dr Birks, as a school student, was unsure about a future in the medical profession. He attended Albert Street Primary School and then Geelong College.

“When I was a kid, I didn’t think about it too much. I had no strong feelings although it seemed a reasonable proposition. Then at the end of secondary school, I had to make some sort of decision.”

The next few years saw Dr Birks completing medical training at Melbourne University.

Then he and his wife Kaye, also a doctor, travelled to Canada with their baby son to take up medical internships. While in Canada their family expanded with the birth of their daughter and another son.

They spent six years in Vancouver where Dr Birks trained in surgery before working in England and then returning to Australia in 1977.

“I was okay with working in a rural area but initially didn’t want to work where I had grown up,” he said. “I thought I needed to be more independent. But I gradually lost that concern and an opportunity came up here.”

When the Birks arrived in Moe, the Latrobe Valley Hospital was relatively new. Dr Birks worked as a general surgeon and joined the Moe Medical Group where he met Professor Strasser.

“It is all credit to Roger who worked through the system to set up a university centre here,” Dr Birks said.

“We started to secure placements. The students were guided by specialists, GPs and nurse educators.

“There are great advantages studying in a place like the Latrobe Valley with lots of patients with interesting conditions and fewer students than in Melbourne. They (students) get a huge range of experience…they have a wow of a time.”

Dr Birks said technology was the biggest difference between medical study today and in his undergraduate years. He marvels at the use of simulation training. “In my day (as a student), you practised on the patients.”

He believes one of the biggest challenges is that medicine is now far more complicated. As the population ages, people have multiple illnesses such as diabetes, heart disease, stroke, blood clotting and then possibly pneumonia.

“Patients are therefore rarely looked after by one doctor. It is a medical team where communication is essential. That is the biggest challenge for modern medicine.”

According to Dr Birks, there is a need to get more Gippsland students into health professions. He said there was strong evidence that students from a regional area were more likely to return to that area. His son Robert is a Moe GP.

However he said there needed to be more emphasis on education locally. “We need to change the culture that exists in some schools,” he added.
“Medical students also needed to be committed.”

Initially appointed as a .2 lecturer with Monash SRH, Dr Birks has increased his time to .4. He and fellow general surgeon Peter Burke both teach anatomy to students. Together with local orthopaedic surgeon George Owen, they were recently honoured by the Royal Australasian College of Surgeons for their contribution to the profession.

And Dr Birks shows no signs of slowing down. He is also chair of the college’s Surgical Teachers Group which runs teaching courses for young surgeons.

Education is definitely a passion.

Study tracks medical graduates

Monash University's School of Rural Health (SRH) has mounted a major longitudinal study tracking rural medical graduates to demonstrate that rural training opportunities and placements influence the location outcome of graduates.

Speaking after the recent publication of a University of Queensland study which found medical students from a rural background were more likely to pursue careers in rural and regional areas, Monash SRH Head of School Professor Judi Walker said the Monash study had a number of objectives.

“The study seeks to establish the intention of students to practise in a rural location, examine their origins and to correlate the outcome of rural location of professional practice to rural placement during undergraduate training,” she said.

Monash SRH operates multiple sites across rural and regional Victoria, providing undergraduate clinical training placements for medical students - in the last three years of their Monash medical course - at major regional centres including Mildura.

Professor Walker said the first cohort of medical students through SRH sites was in 2004.

“As it takes about 10 to 13 years to complete medical training we are only just beginning to be able to provide data on the whereabouts of doctors who have undergone part of their undergraduate medical training at our rural sites,” she said.

Professor Walker said anecdotal evidence showed that in Mildura in 2012, eight junior doctors at the Mildura Base Hospital had spent time at SRH Mildura as undergraduates. Last year five of the junior doctors had spent time as SRH Mildura students with one staying on as a GP registrar.

Formal data developed so far for commencing Monash cohorts 2004-2008 – including Australian Health Practitioner Authority figures – shows 10 percent of medical graduate from these cohorts were now practicing in a rural area.

Professor Walker said the severely uneven distribution of doctors between urban and rural areas was compounded by “extremely limited” post graduate training opportunities, forcing graduates back to capital cities for four to seven years at a critical time in their careers. “It is unlikely that they will then return,” she said.

“In 2014 more than 80 percent of Victorian rural and regional intern posts were taken up by Monash, Deakin and University of Melbourne graduates and a number are working at regional hospitals in other states,” Professor Walker said.  “However regional hospitals vary in the number of intern and registrar training posts available.”

Professor Walker said there was broad policy consensus that one solution to the shortage of doctors in rural and regional Australia was to establish programs providing ‘end to end training’, meaning medical school to completion of postgraduate training in regional settings.

“The three medical schools in Victoria are working together on strategies to address this but in the meantime it is critical to develop and maintain a strong evidence base through medical graduate tracking studies,” she said.

Tuesday, 13 January 2015

Ageing farmers underestimate heat threat to their health

Churchill-based Dr Matthew Carroll is interviewed by the ABC Rural about a heat research study he conducted with Dr Margaret Loughnan that shows farmers are sceptical about the threats of climate change.

School of Rural Health settles into South Gippsland

It has taken a while for the Monash University School of Rural Health South Gippsland to settle into its new home but after six months, its presence is being felt.

Training our doctors of the future, the facility started life in one room at the old Leongatha Hospital in 2010 before being relocated to the old Leongatha Primary School in rooms next to the gym.

In July 2014, once the new hospital was completed, School of Rural Health staff moved into an existing facility on site. The pre-fab rooms, adjacent to the carpark, were used by the hospital’s allied health team before being taken over by Monash for the three rural health staff and Year 4C medical students.

Leading the team is Foster GP David Iser who supervises the cluster. He is supported by clinical administrator Marlene Archbold and academic coordinator Jennie Casey.

The Monash School of Rural Health offers medical students the opportunity to train and work in Gippsland. It has regional sites in South Gippsland as well as Warragul, Churchill, Traralgon, Sale and Bairnsdale. In fact its footprint extends throughout regional Victoria with students forming part of a rapidly growing multi-site school within the Monash Faculty of Medicine, Nursing and Health Sciences.

“A number of our students have returned to work in various roles in our region,” Dr Iser said. “They become fine young doctors, a tribute to all those people who help train them.”

The South Gippsland cohort comprises 10 Year 4C students each year. Year 5D students also do rotations in core emergency medicine and surgery at both Leongatha and Wonthaggi Hospitals

The Year 4C curriculum consists of four disciplines: women’s health, children’s health, medicine of the mind and general practice. South Gippsland runs an integrated program, covering all areas throughout the year

Two students each are based Foster, Leongatha Health, Korumburra and Wonthaggi Medical Group at South Gippsland Family Medicine in Wonthaggi. Experience in women’s health is largely gained at local hospitals, with the four Wonthaggi-based students attending Bass Coast regional Health Wonthaggi.

The four Leongatha/Korumburra students are attached to Gippsland Southern Health service Leongatha, with the two Foster students at South Gippsland Hospital, Foster.

All students spend time at West Gippsland Hospital, Warragul to gain experience in paediatrics while ‘medicine of the mind’ is studied at Korumburra and Wonthaggi community mental health services as well as Latrobe Regional Hospital’s Flynn Ward.

According to Ms Archbold, a retired educator from Leongatha, the new facility meets all their needs. “We have a designated tutorial room for students to attend lectures,” she said. “There is also a clinical room, much needed storage, three offices, a kitchen and toilet facilities.”

Ms Casey is an experienced academic who has worked at both Warragul and Sale sites. Also a local resident, she relished the opportunity to be based at the new site.

Lectures are delivered by both specialists and GPs as well as a range of community health workers, depending on the lecture focus.

The South Gippsland school also hosts an annual women’s health forum and other special events for students.

Dr Iser sees a “huge benefit” in Monash University providing opportunities for medical students to study and train in regional areas.

“Many of these students don’t want to spend the length of their course in a major “city,” he explained.

“The school is committed to improving rural health and developing a sustainable rural health workforce by delivering excellence in education, research and research training.

“We can see this is making a difference.”