Tuesday, 31 May 2016

Graduate trains to practise in Bendigo

If you’d told Kerry Jewell in 2008 that less than ten years later she and three of her fellow dorm mates at Farrer Hall student residence would be responsible for a large chunk of the admissions to Bendigo Hospital, she wouldn’t have believed you. Yet that’s exactly where this Monash graduate finds herself.

Monash graduate, Dr Kerry Jewell, would love to settle in Bendigo once she finishes her specialist training.

Now a medical registrar with Bendigo Health (on rotation from Austin Health), and in her second year of training to be a physician, Kerry has had a long affair with Bendigo. So she’d like to stay, but the realities of specialist training make that challenging.

Originally from Wodonga, Kerry’s first contact with Monash in Bendigo was when her father drove her to the application interview in 2007. “We ended up lost as I was reading the map and was so nervous,” she remembered.

The next two years were spent in Clayton before she headed north again to spend most of her clinical training in Bendigo and north-west Victoria. Then she faced a dilemma in deciding where to do her internship. In the end she opted for the familiar setting of Bendigo Hospital.

“There’s a lot to worry about when you start an internship; it’s more than just having rote learned knowledge and clinical skills,” she said. “So it was reassuring doing internship in a place where you didn’t also have to worry about how to get to the wards, or radiology, or who to talk to.”

Kerry is convinced that students in regional settings become ingrained in a team and feel that they’re more than just students.

“You get really good at bread and butter general medicine and surgery presentations, which is what you’ll see when you practise,” she said.

Beyond a grounding in essential clinical skills, regional placements have much more of a community atmosphere than metropolitan placements.

“You’re living and breathing medicine – at work, at tutes – you’re together more often. It’s hard to be isolated because everyone is looking out for one another. They’re tough years to go through, so having a big support group is great,” she said.

While she’d prefer to settle in Bendigo, Kerry can only do a limited part of her physician’s training at Bendigo Hospital. The Royal Australian College of Physicians requires time in a tertiary hospital to ensure trainees see specialities they would not be exposed to in a regional hospital. So that means training in Melbourne.

“Ideally, I would have loved to stay in Bendigo for all my training,” said Kerry.

“If prospective physicians candidates could do the majority of their training in the new Bendigo Hospital when it opens that would open up a lot of opportunities for candidates who would prefer to be regionally based.

“Even if you could do two or three years here and trade with another hospital…but I’m not sure if that’s realistic in the next five to ten years.”

For the moment, Kerry is happy completing her first rotation as a medical registrar with Bendigo Hospital. “I can’t think of anywhere more appropriate to do it. I’m working with the same team I was as an intern, which is really nice, but possibly a little scary for the consultants who taught me as a first-year clinical student!”

Monday, 30 May 2016

Researchers ask: why go rural?

The Monash University Department of Rural Health is part of a large research collaboration currently working to discover which factors convince nursing and allied health students and graduates to come and work in rural and regional areas.

The Rural Health Workforce Australia-funded research project is being undertaken as part of wider efforts to address an undersupply and maldistribution of health professionals in rural and remote areas, including Gippsland.

Monash UDRH has joined forces with Flinders and Charles Darwin universities and the University of Newcastle’s Department of Rural Health to find out what lies behind a student’s decision to ‘go rural’.

Keith Sutton, a researcher with Monash UDRH – based in Moe - said collaborating with other university departments of rural health across Australia provided an opportunity “to present a broad picture to the Federal Government of the sorts of supports and processes required to encourage students and graduates to consider rural practice in a positive light”.

Why go rural? Melbourne-based allied health students visiting a Gippsland-based service during a vacation school program run by Monash UDRH which aims to showcase rural and regional practice to students.

As one of 11 researchers working on the six-month project, Dr Sutton said he hoped the findings would inform future policies aimed at alleviating historical shortages of nurses and allied health workers in regions like Gippsland, particularly in some of its more remote pockets.

Poorer access to quality healthcare providers has been cited as one of the primary causes of health inequity and poorer health outcomes for Australians living in rural and remote areas, with a 2014 Australian Institute of Health and Welfare study showing that the life expectancy of these Australians was up to seven years less than those in our major cities.

Allied health workers include occupational therapists, social workers, physiotherapists, dietetics, speech pathologists, pharmacists and radiographers. The challenge of attracting these professionals to rural areas is complicated by the need for many of them to undertake city-based study for four to six years, according to Dr Sutton.

Research interviewees include current students, recent graduates and industry stakeholders from across the nursing and allied health sector.

They are being asked about the motivations and advantages to working in both rural and urban locations and the barriers and obstacles associated with each, as well as their decision making processes, ways in which health service models and strategies could improve to enable them to work rurally and whether they undertook rural placements as part of their course.

“To date we know that coming from a rural background is the biggest single predictor of a student’s decision to work in a rural area after graduating but we also know if urban students have had long-term exposure – a minimum of six months – to rural placements within their courses, this is also influential however most placements are shorter than this,” Dr Sutton said.

While Monash Rural Health’s rural clinical training sites, including those in Bairnsdale, Sale, Traralgon Warragul, Leongatha, Bendigo and Mildura provide longer term placements for medical students, the same opportunities don’t yet exist for nursing and allied health students – although Dr Sutton said plans were afoot to facilitate this.

The evidence around the influence of longer rural clinical placements has been predominantly drawn from medical literature and Dr Sutton said it was vital to expand this research to encompass nursing and allied health students.

“There are so many factors which come into play in terms of these decisions, including where training is located for those who wish to specialise, and this project aims to add valuable insights for policy makers as they look at health system reform,” he said.

Friday, 27 May 2016

Year 2 students check out East Gippsland

Monash medical students enjoyed a “rural experience” on a two week placement at Sale and Bairnsdale. The second year students from Monash University Clayton campus are hosted by Monash Rural Health East & South Gippsland twice a year.

Year 2 medical students gather outside Monash Rural Health in Bairnsdale as they prepare to set off to experience life in the East Gippsland and Wellington Shires.

Director, Associate Professor David Campbell, said the busy program included placements at Bairnsdale and Sale hospitals, spending time on different wards; in local medical clinics; and with various East Gippsland health practitioners and health service organisations.

At Central Gippsland Health Service in Sale, the students spent time in the Sale Hospital, shadowing a nurse and participating in ward rounds. They also took part in patient consultations at a Sale GP clinic. Outside their medical activities were visits to a dairy farm, during milking, the Maffra car museum, a local water treatment plant, a vegetable picking/packing farm and the Glenmaggie Weir.

The students based in Bairnsdale visited Lindenow Primary School to demonstrate basic life support techniques to grade six students and spent time at an Indigenous farm where they learnt about zoonoses – diseases that can be transmitted to humans from animals.

The two cohorts went on a field trip to a local Indigenous centre to learn more about indigenous health.

Dr Campbell said feedback from the students was how much they enjoyed the two weeks, especially the varied program.

“This is a great opportunity for these students who complete their first and second year of medical studies at Clayton, to experience a taste of rural practice and exposure to rural communities, in anticipation of them taking up the opportunity to spend the remaining years at our various schools across regional Victoria, including Bairnsdale and Sale,” Dr Campbell said.

Monash Rural Health East & South Gippsland has year three, four and five students for either a full year or shorter periods.

 “The school is committed to improving rural health and developing a sustainable rural health workforce by delivering excellence in education, research and research training,” Dr Campbell added.  “Some will hopefully return as doctors to the rural workforce.”

Wednesday, 18 May 2016

Medication safety course overcomes the "tyranny of distance"

Monash Rural Health pharmacy lecturer Hanan Khalil has developed a new online teaching tool which overcomes the tyranny of distance. Senior lecturer at the Monash University Department of Rural Health (UDRH) in Moe, Ms Khalil has developed the program for teaching medication safety to allied health professionals.

Hanan Khalil is teaching medication safety to regional and rural allied health professionals who can't get to lectures. 

The impetus for the project came when Ms Khalil worked with Latrobe Community Health last year, educating community health nurses around medication management in a community setting.

“I recognised a need for this training to be accessible to people in rural and remote areas who find it hard to attend lectures and also to provide training that could be done at their leisure,” she said.

In conjunction with an e-learning designer from Monash University in Clayton, Ms Khalil developed the online teaching module.

“Obviously the module doesn’t cover everything however from the Latrobe Community Health partnership, I gained an insight into the most important aspects needed,” she said. “I demonstrated it to a local GP who was very excited about it.”

Ms Khalil will use the new teaching tool when she delivers the medication training to LCH nurses later this month. She will be conducting face-to-face sessions but the new program will allow those not onsite to join the training.

She also lectures in pharmacy to local Monash medical students and provides advisory, mentoring and developmental support to pharmacy students, and pharmacists practising in the Monash UDRH areas in collaboration with Melbourne University. She also spends time with local pharmacy preceptors who take students on placement.

Director of the Centre for Chronic Disease Management, Ms Khalil has undertaken research into medication management, chronic diseases and evidence based health care across rural health settings. These include settings as diverse as aged care, hospitals and community health centres.

Monday, 16 May 2016

Joint Sim lab trains Leongatha students & practitioners

Students and staff from Monash Rural Health Leongatha and Gippsland Southern Health Service staff will benefit from a new simulation training facility. A partnership between the two has seen the training area established adjacent to Monash Rural Health’s teaching site, in the grounds of Gippsland Southern Health Service, Leongatha.

Medical student, Max -William Ubels with local lecturer, Dr Trevor Andrews, in the new sim lab shared with staff of the Gippsland Southern Health Service.
Existing simulation equipment from both organisations has been pooled and additional equipment purchased including an Advanced Life Support (ALS) mannequin and ‘Sim Mom’, a birthing simulator. SimMom is an advanced fully body birthing simulator with accurate anatomy and functionality to facilitate obstetric training of birth management. The ALS mannequin is designed to meet the training needs of students and staff in emergency care from basic assessment to advanced life support skills.

Monash Rural Health Leongatha Academic Coordinator/Lecturer, Jennie Casey, said the benefits of simulated learning environments were now well documented.

“Educators in rural areas are utilising simulation as a teaching modality for more comprehensive learning experiences,” she said.

“Not only can our medical students use the facility but hospital medical staff, nurses, allied health staff and local general practice staff can all take advantage of the equipment.”

“This equipment is very costly however through our partnership, we can now provide our students and local health workers with this simulation technology to enhance their training,” Ms Casey said.

Friday, 13 May 2016

Radiography leads to country GP career

If it hadn’t been for the opportunity to study medicine in Gippsland, Sharon Johnson says she would never have pursued the path that led her to general practice.

Born and bred in Churchill, Dr Johnson was schooled locally and always harboured an interest in medicine. A year 10 work experience placement, however, swayed her toward radiography, which she eventually studied at Monash University Clayton.

Country practice: Dr Sharon Johnson moved from radiology to medicine to get to know her patients better
During the course Dr Johnson engaged with several peers who, like herself, found themselves increasingly drawn to the prospect of medicine. “I loved radiography but I realised that I wouldn’t have the opportunity to follow-up on a patient’s treatment in that role and I knew I wanted to be able to get to know patients better and contribute to their ongoing treatment,” she said.

The turning point came for Dr Johnson when she realised she could return to her home town and embark on four years of graduate entry medicine studies through Monash Rural Health, commencing her first year in Churchill and undertaking the bulk of her placements in the surrounding region.

“I didn’t want to stay in the city long term, I can’t stand time wasted in traffic, so I was very happy to return home and enjoy the support of my family,” she said. Sharon’s placements included stints at the Leongatha hospital, Maryvale Hospital in Morwell and full years in Sale and Warragul followed by some final year placements in Clayton and Frankston.

“I really enjoyed my rural placements; particularly in Sale with Jennifer Casey as co-ordinator, I felt we were allowed a lot of input as students in terms of what we wanted to learn more about and this was catered for, so we could tag along with paramedics or district nurses, for example.

“I also spent 10 weeks at the Heyfield Medical Centre which was a real highlight for me; I did ward rounds with doctors at the hospital there, saw nursing home patients regularly and reported back to the doctors.

“We were able to take the lead in their care with the assistance of supervisors who helped us finalise patient plans, this was invaluable; we had lots of responsibility but were still so well supervised and supported.”

The benefits of working with smaller cohorts were also appreciated by Dr Johnson. “I liked being able to get to know my colleagues well; we were on first name basis with our tutors and the staff at the rural schools as well as the doctors who supervised us and allied health staff; it was a friendly environment,” she said.

Dr Johnson said the hands-on opportunities available to rural students were a “definite bonus.”

“This was really evident to me when I did a metro-based final year placement in obstetrics and I realised how difficult it was for some students and even junior doctors to get opportunities for procedural learning, while in rural clinics we were sometimes the only students and were doing these things over and over.”

After 10 years of intense study, including completing a Masters in Bioethics as well as her internship and resident year (the latter at Wangaratta hospital), Dr Johnson is now getting to know her patients at a GP clinic in Lavington, New South Wales.

Her appointment in Lavington, a suburb of Albury, followed six months of overseas travel which provided the dedicated doctor with some much-needed respite and perspective after a decade of having her nose to the grindstone.

The new GP registrar is now confident she is where she wants be. “The hospital component of our training is an important part of the process but I was always wanting to be a GP and now that I am settling in here, it is a great reminder of what I wanted all along,” she said.

Dr Johnson said she is keen to remain working in rural and regional settings. “I just think the style of practice is nicer,” she said.

Thursday, 12 May 2016

Simulated skating accident provides clinical communications training

Students worked with paramedics during the simulated emergency.
Skaters at Henderson Park in Mildura who fell and broke limbs in early May had plenty of help close at hand. Fortunately for the “patients”, the accident was simulated as part of the training for second year medical students at Monash Rural Health Mildura. Monash Rural Health supervisors and Ambulance Victoria were also part of the scenario created for the two students.

The simulated incident was important training for the students, particularly for building skills in reacting to an outside emergency and working closely with paramedics in handover protocol.

The students, playing the roles of doctors, were first on the scene, had to treat the ‘patient’ then do the face-to-face handover to the paramedics. The ambulance then transported the patient back to the school, where all students participated in an educational session about plastering.

The students followed the ISBAR model of patient care and clinical handover: Introduction, Situation, Background, Assessment and Recommendation.

A close look at the inside of the ambulance before handing over to Emergency Department doctors
The scenario gave students the opportunity to ask the paramedics questions about their roles and responsibilities in rural communities, and to get a close-up look inside the ambulance.

Back at the Monash Rural Health Mildura, there was a simulated demonstration of a paramedic handing over to the Emergency Department doctor and then a plastering session in the Sim Lab.

“This type of training is not only great for developing effective communication but it helps to give students an understanding of the approach to clinical communication and community handover in a health care setting,” Kendall Livingstone, Manager Monash Rural Health Mildura,  said.

The students were in Mildura for two weeks to experience some aspects of rural health services. They joined 33 other medical students who were already in Mildura on longer placements of between six and 38 weeks.

Wednesday, 11 May 2016

Africa influences a career decision

It was a life-changing moment in Africa that convinced Morwell’s Carly Jennings that she wanted to study medicine.

Children in a Malawi village
Now an obstetrician and gynaecologist working at Monash Medical Centre in Melbourne, Carly had just finished a degree in biomedical science and about to do an honours year when she and sister Nicole went to Africa for a holiday. They were only 21 and 19.

“It was a random decision,” Carly recalled. “We decided as part of the holiday to do some volunteer work at an orphanage for babies in small community in Malawi. There was a really sick baby named Rejoice. She was struggling so we took her to hospital in a nearby town but getting a diagnosis was difficult. We were there a month until she recovered.”

Carly made her mind up to study medicine while she was still in Africa.

“The deadline to sit the GAMSAT (Graduate Australian Medical School Admissions Test) was close so I emailed a friend back home who enrolled me,” she said. “Fortunately I was accepted.”

Born and raised in Morwell where her family owned a butcher shop, Carly attended Crinigan Road Primary School and later Kurnai College.

After completing her first year at Monash Rural Health Churchill, she spent her second year at Frankston, third between Sale Hospital and Maffra Medical Group and her fourth year on rotations with Latrobe Regional Hospital in Traralgon.

Always keen to specialise in obstetrics and gynaecology, Carly returned to Africa and did an elective in the field in Rwanda with the largest maternity hospital in the capital city of Kigali. “It was a really different experience,” she said. “Not many staff at all but they were happy with both me and my friend who was also studying medicine.”

Carly and Nicole with Rejoice
When she returned home, Carly applied for specialist training and was fortunate in gaining one of 22 places from 250 applications. She completed her internship at the Royal Melbourne Hospital, her second and third years of training at the Royal Women’s Hospital and is now at Monash Health.

Looking back, she would never consider doing anything else. “My field is so incredibly special. And delivering babies is the best part. You get to spend the most amazing time of people’s lives with them.”

However despite her demanding schedule, she still gets back to the Latrobe Valley regularly to visit family and friends…and her hairdresser.

And is still in contact with little Rejoice, now six. Carly and Nicole, now a midwife, have returned to Malawi to visit her. “She is in an orphanage with other children and is very happy and healthy,” Carly said. “Nicole sponsors her so we get regular updates.”

Tuesday, 10 May 2016

Rural taster in Gippsland

Monash medical students in their second year of study have had the opportunity to learn more about local health challenges during their recent two-week placement in Gippsland.

While the placement, facilitated through Monash Rural Health’s local sites, provides students with valuable clinical experiences in rural and regional settings, it also includes a number of visits to areas of local significance.

Year 2 students visited the Hazelwood Power Station during their recent Gippsland placement

During their recent placement the cohort from Monash Clayton toured the Hazelwood Power Station and the Morwell open cut mine and learned about a host of occupational health and safety issues, first aid processes, first response measures and the 2014 mine fire.

Students were also briefed by Monash Rural Health Senior Research Fellow, Dr Matthew Carroll on the progress of the Hazelwood Health Study, the long-term study being led by independent researchers from Monash University to identify potential health outcomes for people who may have been impacted by smoke from the mine fire.

Among a range of other activities, students also visited Ellinbank farm, the National Centre for Dairy Research and Development in West Gippsland, to learn more about OH&S issues facing rural industries and the community and industry impacts of emergencies as well as social and financial issues facing farmers.

Monash Rural Health Gippsland Director Associate Professor Joseph Tam said the two week placements provided a valuable introduction to rural and regional areas for medical students.

“For some of these students this is their first real exposure to rural and regional areas so we use the time to ensure the students enjoy rural hospitality and a diversity of experience,” he said.

“Monash Rural Health is committed to improving rural health and developing a sustainable rural health workforce,” said Dr Tam. “Providing students with positive rural clinical experiences during the course of their degree is a proven strategy to increase the likelihood of rural practice.”

Monday, 2 May 2016

Nursing career: from Careflight to clinical skills educator

It's a long way from the vastness of the Northern Territory, administering emergency treatment in small planes between remote outposts, to teaching medical students in rural Victoria, but for Lane Johnson the opportunity to work with Monash Rural Health in Traralgon was too good to pass up.

Lane Johnson's nursing career has taken her from outback NT to teaching clinical skills to Monash medical students 
The energetic midwife first swapped nursing life in Sydney’s North Shore for her dream job as a Careflight registered nurse in the Northern Territory but now, three years later, she has settled locally and embarked on a role as a clinical skills educator working with Monash medical students undertaking placements in Gippsland.

It’s a challenge she is relishing. As the youngest ever Careflight crew member, Lane gained valuable experience helping doctors to find their feet -  in a simulated laboratory - as they ‘came and went’ from Darwin and Gulf of Carpentaria Careflight bases.

These interactions helped sow the seeds for her new career direction. “I really enjoyed that teaching opportunity so this role seemed too good to be true,” she said.

As a clinical educator Lane teaches medical students a variety of skills including basic life support, cannulation and catheters as well as other practical skills outside of the curriculum, some through the practise of ‘hybrid simulation’ which involves using simulation mannequins and students as patient; all of which she said “helps them to be the best doctors they can be”.

Lane comes to her new role with an impressive pedigree. She won a scholarship to do her Graduate Certiļ¬cate in critical care nursing while working in the emergency department in her home town of Hornsby followed by a scholarship from the Australian College of Nursing to complete her graduate diploma of midwifery while working in Manly, before heading to the NT.

Her years as a Careflight nurse saw her, with a pilot, prepare each day to attend anything from premature births to car accidents in some of the most isolated communities in Australia.

“It was an amazing experience,” she said. “From births in flight to traumas, to meeting the locals and the tourists, getting to know the elders in the indigenous communities and learning so much from them and from those in the rural farming communities.”

Lane has spent the past few months discovering the spoils of rural life for herself, having moved to Trafalgar with her partner who, inspired by his exposure to Lane’s work and study materials, is studying biomedicine.

Though she had never stayed in Victoria until now, the move has been a positive one. “I am enjoying this rural lifestyle so much, I couldn’t be happier,” she said. “This is such an inclusive team, it feels like a family, and the students are so enthusiastic that I am bouncing off their energy.”

Lane said she was impressed with the keenness of local medical students to engage in peer education support by organising events such as the student-led surgical session, supported by local surgeons, which is being planned for May.

It is Lane’s mission to convince as many medical students as possible of the benefits to living, studying and staying rural.

“I really hope these rural placements encourage medical students to consider staying on, or returning, to practise in rural and regional settings; there are so many personal, professional and lifestyle advantages to that choice,” she said.