Thursday, 30 June 2016

Medical training travels to Ouyen

Some of Ouyen P-12 College's students were given medical “treatment” recently, but it was all part of a clinical skills day at the school, presented by Mildura Rural Health Mildura. Monash Rural Health delivered an outreach program to students across the college, thanks to a grant of $2000 from Mildura Rural City Council’s community grants scheme.

The clinical school delivers Mini Medical Academy days to Mildura secondary schools as part of its Future Doctors program however felt rather than expecting Ouyen students to travel the hour to Mildura, it would take the program to them.“The Ouyen students don’t have the opportunity to participate so we saw no reason for them to be disadvantaged because of location,” Monash Rural Health Mildura Manager, Kendall Livingstone, said. “Council supported our submission for funding and we are very grateful.”

Tour: Ouyen students got a close look at a stretcher transport.

Six medical students and three staff took a stretcher transporter with them and gave the college students a tour of the vehicle. They also ran some clinical skills stations where they demonstrated suturing and plastering as well as providing an information session on careers in medicine for Year 11 and 12 students.

Clinical simulation: students took part in hands-on training sessions.

The Mildura site was established in 2003 and Ms Livingstone said it had earned “an excellent reputation” for providing hands-on clinical experiences to medical students, as well as good student outcomes in terms of assessment.“Monash Rural Health's footprint extends across Victoria with its main focus being to provide the rural base for undergraduate medical education programs and research at Monash University,” she said. “It is important that we tell our local children that there are many opportunities in medicine and Monash Rural Health offers opportunities for them to study and work in rural and regional areas.”

Wednesday, 29 June 2016

Students grill Bendigo member on medical school policy

Federal member for Bendigo, Lisa Chesters, took questions from students about  the proposed new medical school and Labor health policy.
Medical students concerned about a proposed new medical school in Bendigo took their questions directly to local federal member, Lisa Chesters, on Monday night.

Students have been campaigning for more postgraduate training places rather than an increase in undergraduate places in rural and regional areas. Ms Chesters agreed that the major issue in retaining doctors in rural areas was lack of specialist training places outside metropolitan Melbourne.

The argument for establishing a new medical school rests on evidence that students with a rural origin who train in a rural and regional areas are more likely to stay and practice. But medical students must complete up to six or seven years of further training after graduating and there are few opportunities to train in specialities outside Melbourne. So students are forced to go to Melbourne to train in their chosen specialty.

Ms Chesters acknowledged that the evidence was “compelling” around training nurses and allied health students in regional areas, but the statistics don’t reflect the reality for medical graduates who have to return to Melbourne.

“This is a time of life when you’re likely to be settling down and if your partner has a job in Melbourne, then you’re likely to stay there as well,” she said.

Evidence about medical students is lacking, said Ms Chesters, and is a good reason that a body like the Australian Institute of Health and Welfare which used to conduct research into health and welfare but was dissolved in 2014, should be refunded.

“There is a need for long-term public health research. We need to invest in rural and regional areas because there are real issues there,” she said. “But it needs to be properly funded and to do that you need the research.”

Closer to home, Ms Chesters wanted to focus on Bendigo’s strengths. “It’s unrealistic to expect that we’ll be able to offer every specialty, but there are many that could build on existing community needs,” she said.

Students suggested opportunities might exist in Bendigo for graduates to train as general surgeons, or as physicians specialising in renal medicine or oncology.

Ms Chesters said expanding postgraduate training into regional areas would need support from a range of stakeholders. “We need to start conversations with the specialist colleges,” she said. “And it’s not just a federal issue, the state government is a big stakeholder.” She emphasises that it also needs long-term strategies drawing together the education and health portfolios.

Students raised concerns about the “attacks” on general practice through issues like the Medicare freeze. The continual attention on GPs was making it a less attractive career prospect. They were also worried about the effect of Medicare funding on general health. The threat of GPs charging fees due to an ongoing freeze would see the burden on hospital emergency departments increase as poorer people avoided seeing a doctor until a health issue became urgent.

Ms Chesters agreed and said the debate needs to be turned around. “GPs are an easy cut in a debate focussed on waiting lists and emergency departments. We need to turn that around. We have a brilliant primary health care system – there needs to be less emphasis on hospitals.”

Although pressed by students, Ms Chesters did not make a commitment that there would be no new medical schools. But she did repeat that her priority was to ensure medical students have options after graduation.

Head of Monash Rural Health, Professor Robyn Langham, quickly outlined a proposal by a partnership between Deakin University, the University of Melbourne and Monash University for a state-wide postgraduate training network which aims to support specialty training in regional areas by building on existing medical school capabilities.

“I’m keen to read that paper about next steps,” said Ms Chesters. “I’m keen to have it funded.” But she said it needs to wait until after the election, so it gets the non-political respect it needs.

“I’m serious about ongoing dialogue with students,” she said. “Changes need to happen otherwise we’ll just keep spinning in this space.”

Tutors living with disability teach medical students

Medical students from across Gippsland recently learned about living with a disability from those who understand it best: nine clients who acted as tutors and four carers from Cooinda Hill, a disability services and support organisation based in Traralgon.

Learning: tutors living with a disability helped medical students learn how to communicate appropriately with patients.
For some years now, Monash Rural Health has partnered with Cooinda Hill and the Centre for Developmental Disability Health Victoria (CDDHV) based in Dandenong to teach Year 4C medical students about living with a disability and working with patients with a disability.

A developmental disability is defined as a permanent cognitive and/or physical impairment that can occur any time before the age of 18 years. Children diagnosed with developmental disabilities are referred to paediatric services, but sourcing support for adults living with developmental disabilities is more complex.

In addition to any health challenges associated with the disability per se, individuals living with developmental disabilities typically experience more illness and have poorer quality of life and a shorter life expectancy than the rest of the population. These vulnerabilities create a definitive need for healthcare that is appropriately targeted and focused to provide optimal outcomes.

Director of the CDDHV, Dr Jane Tracy, who is the mother of an adult son with a developmental disability, facilitated the day. The morning was devoted to teaching about developmental disabilities, illustrating the challenges typically experienced by people diagnosed with a developmental disability presenting to a healthcare provider and for the healthcare provider in such a consultation. Strategies to facilitate effective communication between patients and, when necessary, carers, and doctors were outlined, and resources for further support were identified.

Then it was down to work, with tutors and students interacting in small groups to practise their communication skills. The first task was to learn something about each other, and the second was to construct a medical history, or for students to provide information to the tutor about a medical condition.

Students reported feeling better equipped to attempt to meet the needs of patients presenting with developmental disabilities. The tutors’ said they also enjoyed the session, and meeting and working with the students. They look forward to contributing to this aspect of medical education again next year.

Students from all Monash Rural Health's south-eastern sites (Bairnsdale, Sale, Leongatha, Warragul and Traralgon) participate in a mega day devoted to this topic which takes place at Monash Rural Health Traralgon.

Tuesday, 28 June 2016

Growing our own: Gippsland showcases pathways to medicine

A local collaboration aimed at ‘growing our own’ medical practitioners in Gippsland recently attracted more than 30 senior secondary school students from across the region to an information session on medical pathways.

Pathways: secondary school students from across Gippsland took part in a clinical skills session during a recent information day.
The day session included a hands-on clinical experience for students and was initiated through a partnership between Monash Rural Health Latrobe Valley and West Gippsland and the Gippsland Medical Students Network. It formed part of a widespread effort to encourage local students to study medicine locally and consider returning to rural practice.

Monash Rural Health Latrobe Valley and West Gippsland Director Dr Joseph Tam said the number of students who came from all over Gippsland to attend the session – the first of its kind to be held locally - was “very encouraging” and had prompted organisers to plan for further sessions.

Dr Tam said there was compelling evidence to show that increased recruitment of medical students from rural backgrounds, and the provision of training in rural settings, improved the chances of those students returning to practice in rural areas after graduation. “This is vital to ensuring the local medical workforce is supported into the future,” he added.

During the information session local secondary students learned about pathways into medicine and heard from local medical professionals and current medical students about why they chose a medical career.

Advice on the UMAT, a test used specifically to assist with the selection of students into medicine, and study tips for enhancing students’ ATAR scores were provided, as was a description of the multiple mini interview format (another selection tool). Personal stories of journeys into and through medicine from students and qualified doctors were followed by a hands-on clinical skills opportunity in the MRH simulation ward.

Monday, 27 June 2016

3-university partnership welcomes coalition's rural announcement

The Victorian Rural Medical Training Network welcomes Minster for Rural Health Fiona Nash’s announcement of a plan to develop pathways for rural medical practitioners to address the shortage of doctors outside major metropolitan centres.

The Victorian Rural Medical Training Network (VRMTN) is a partnership of the three Victorian medical schools – Deakin University, the University of Melbourne and Monash University – formed to expand rural and regional postgraduate vocational medical training.

Head of Monash University’s School of Rural Health, Professor Robyn Langham, said that the best way to encourage medical graduates to practice in rural and regional areas is to provide pathways that enable them to train in the bush.

“The real problem is that graduates are forced back to capital cities for up to seven years of postgraduate training in their chosen specialty because training programs are limited or non-existent in rural and regional areas,” said Professor Langham

“This is the time in their lives when they start to put down roots and if they’re training in a major city, that’s where they tend to settle.”

Deakin University’s Executive Dean of Health, Professor Brendan Crotty agreed that the Minster’s announcement would provide the support needed to successfully implement the government’s Integrated Rural Training Pipeline for Medicine announced in December 2015, which the VRMTN supports.

“Deakin is delighted at the recent announcement of Australia’s first Rural Health Commissioner,” said Professor Crotty. “This is good news for rural communities dealing with medical workforce shortages.”

Head of the Melbourne Medical School at the University of Melbourne, Professor Geoff McColl, also welcomed Senator Nash’s announcement and the investment in the development of rural health workforce. “The future of building this workforce is the purposeful construction of training pathways. In this context the VRMTN model represents a cost effective and sustainable long-term solution to the rural and regional medical workforce shortage”

Students embrace Gippsland-based surgical workshop

Around 55 Monash medical students descended on Latrobe Regional Hospital recently to learn the basics of surgery from some of the region’s most experienced surgeons and specialists.

Though it was a cold and wet night, the students, who included first year graduate entry students studying at Monash Rural Health Churchill and year three students undertaking their rural placements with Monash Rural Health in Warragul and Traralgon, bought a healthy dose of enthusiasm with them.

Suturing: students were able to learn new skills at the workshop

The Gippsland Surgical Skills Workshop was a student-led initiative co-ordinated by the Monash University Surgical Interest Group (MUSIG), a committee of medical students formed eight years ago to promote the field of surgery to fellow Monash medical students.

While the workshops are held regularly in metropolitan locations this was only the second of its kind to be hosted in Gippsland and the first at Latrobe Regional Hospital, said MUSIG Gippsland representative Michael Zhang. Mr Zhang said that while students were taught the basics of suturing during the workshop, it was an opportunity to experience laparoscopic simulation on a number of simulators, some loaned from the Royal Australian College of Surgeons in Melbourne and some local laparoscopic equipment purchased from a Better Teaching Better Learning grant, that proved to be the highlight of the night.

Mr Zhang said local students, most of whom had never sutured before, had embraced the chance to learn new skills and “experience the wonders of laparoscopic keyhole techniques.” The event’s success has led to plans for a more advanced workshop during semester two, he added.

Keyhole simulation: a laparoscopic simulator was part of the worksnhop

The workshop was supported by local surgeon and specialists including Dr Narelle Mackay, Mr Neil Jayasuriya, Mr Siva Ravindran, Mr David Birks and surgical registrars Dr Thomas Suhardja and Dr Simon Bazaadut. A contingent of Monash Rural Health Latrobe Valley and West Gippsland staff also helped to facilitate the event.

Monday, 20 June 2016

More postgraduate training places should be a priority

Much has been written recently about the imperative for a Bendigo-based medical school.To avoid any confusion in this discussion, there is already a medical school in Bendigo. The Monash Medical School site at Bendigo was established by Monash University in 2002, and now in partnership with the University of Melbourne, is an important part of Monash Rural Health.

It has a proud record of delivering a world-class medical education to a significant (indeed growing) cohort of rural origin students, including local students, with around 100 students undergoing their clinical training in the region at any one time. Across Victoria, Monash Rural Health delivers nearly three times the Federal Government required level of rural-based clinical positions, with our follow-up data showing around 20 per cent of this region’s graduating students practising in rural locations.

Proponents of the Murray Darling Medical School say they would provide local opportunity by admitting more Bendigo students and address the need for more local doctors. However this is not possible.Frustratingly for rural regions such as Bendigo, current legislation prevents all publically funded medical schools from being selective – there is a legal requirement to admit students from all backgrounds and regions in a transparent fashion.

Monash University has a number of programs in place to increase enrolment of rural based students in the medical degree - currently 27 per cent of the nearly 2000 students in the Monash University Medical School are of rural origin. And we are seeing many of these students return to work in rural and regional areas.

The solution to rural and regional workforce shortages is certainly not creation of yet another regional medical school but rather it is to establish viable, affordable, regional medical postgraduate training programs, which allow regional medical school graduates to complete specialist training in regional locations.

In Victoria, we already have one of the highest rates of medical graduates per capita in the world. There are also more medical students (and postgraduate year 1 doctors (interns)) per capita in regional Victoria than in Melbourne. The real problem is that the students and interns are forced back to capital cities for prolonged (4-7 years) postgraduate training programs because these are limited in rural and regional areas.

These programs are where newly minted doctors experience and learn in a specific vocational area, be it in general practice, surgery, psychiatry or any one of a number of postgraduate training areas.These young doctors require training that is appropriate to the needs of rural and regional communities, predominately in general practice and general specialisations.

This is why three Victorian medical schools at Monash University, the University of Melbourne and Deakin University, have developed a proposal to establish four regional Victorian postgraduate training networks, a proposal we hope to implement with support of Commonwealth funding over the coming year, including one in Bendigo.

However, the goals of this regional training pipeline will be put at risk by establishing another medical school in our region. This will only dilute the scarce resources, energies and supervisors, taking precious capability away from postgraduate training to service the new school. It will further increase pressure on rural graduates and interns to move to a capital city, where they will enrol in highly specialised training programs, not necessarily appropriate for rural and regional practice.

The medical school system is not failing. There have been significant gains in the long term accrual of rural doctors. But the job is only half done. It simply makes no sense to waste money on reinventing the wheel. There is a clear imperative to channel resources towards supporting postgraduate training programs that will improve pathways for our rurally educated doctors to stay and complete their vocational training in the region.

Professor Robyn Langham
Head, School of Rural Health

Monash University 

Wednesday, 15 June 2016

How cricket and rural health are linked

Using cricket as a tool to promote infant health in South Asia may seem an odd public health program, but as Dr Naj Soomro explained, it neatly taps into social realities and draws on his many research interests.

Cricket life: new Mildura staff member, Naj Soomro brings an interest in sports medicine to his research and teaching role.

In Pakistan, for example Dr Soomro explained, only 37.8 per cent of mothers exclusively breastfeed their babies. The rest rely on formula which leads to either malnutrition or obesity, and is very expensive. In households where all decisions are made by men, indirect approaches such as tapping into the national love of cricket, can be an effective way to change grocery buying behaviour.

Taking their lead from a South African program that used soccer as a means of promoting HIV awareness, Naj and his fellow researchers at The University of Sydney, hope to replicate its success if their grant application is successful.

In the meantime, as a new appointment with Monash Rural Health, he’s busy in Mildura working three days on clinical education and two on his current research projects which revolve around his interest in sports medicine, especially cricket.

His research interests include injury epidemiology and prevention, sports performance and technology to aid sports research. In the past he’s used GPS units to measure levels of activity in sports players during a game. He is currently working on a project that uses sweat sensors to measure levels of hydration. But the interest in technology extends beyond sport.

Dr Soomro is currently working to establish relationships to facilitate research well suited to his current location: using drones to deliver medicine in remote areas. It will be a cross-disciplinary project drawing on both medical and engineering expertise.

But this recent PhD graduate from the University of Sydney is always attracted to “something different”. That’s what attracted him to this Mildura-based role in the first place: finding out how things work in smaller cities. While he recognizes that a rural base throws up logistical and partnership challenges, he’s open to the challenge. And they do play cricket in Mildura.

Sports medicine: Naj Soomro has taken part in sport at the highest level including as a medico at the 2014 FIFA Asian Cup