Friday, 28 April 2017

Testing the waters in Year 2

Tom Trengrove: life as a medical student.
Tom Trengrove turned up at ICU at Sale hospital on Wednesday morning last week feeling a little tentative. He’s one of 16 Year 2 students on placement in Sale for a fortnight. That day he was the only one of the group scheduled on ward rounds, but it all turned out OK. The Year 3B students who were there explained what was going on until they had to leave. And then the registrars and consultants slowed down sometimes to explain.

It’s not his first experience in a hospital though. Tom’s part of the John Flynn Placement Program and spent some of his summer break in Gympie, a town of about 20,000 people 160 km north of Brisbane and one hour’s drive inland from Noosa. Tom was placed in the emergency department of the hospital. “I didn’t spend all my time with my mentor and got to see a lot of the eight doctors who work in the emergency department.” From them he learned a lot, especially when they gave him the non-urgent cases to assess before they came to talk to the patient.

Tom hails from Auckland and applied to Monash because there are no direct-entry medical courses in New Zealand. And he’s been making the most of Melbourne’s proximity to some great surfing. “I used to surf in Auckland,” he said, “but Australia has much better surf.” He and friends travel to Phillip Island on weekends.

Where is he thinking about going for Year 3B? “I’m thinking about Traralgon – it’s closer to Melbourne and will make it easier to stay in touch with my friends there.” But Sale might be on the agenda. “Is it far from Phillip Island?” he asked.

Monday, 24 April 2017

Paediatrician leaves large educational legacy in Latrobe Valley

Some of Associate Professor Joseph Tam’s career pathways may be the result of his inability to say no to a good cause, but many people have certainly benefited from his “weakness”!

Numerous children and their families in the Latrobe Valley have received his expert care over the last 19 years. And in parallel to his clinical role, the Traralgon-based paediatrician has spent many years educating younger generations of doctors.

Always a teacher

This teaching has included working as an instructor for the Acute Paediatrics Life Support program and examining for both the Royal Australian College of Physicians (RACP) and the Australian Medical Council. He is also a member of the RACP General Paediatrics Advanced Training Committee and the Overseas Trained Paediatrician Sub-committee.

Monash Rural Health will remember him for his long contribution to the rural medical education program, particularly in Gippsland.

Dr Tam has stepped down as the Clinical Lead in Paediatrics at the Latrobe Regional Hospital after 12 years on the job, and as director of Monash University’s Latrobe Valley & West Gippsland after three years at the helm. But his involvement with Monash goes back much further.

A long involvement with Monash

Professor Roger Strasser, who was instrumental in establishing Monash Rural Health in the early 1990s, approached Dr Tam to teach on an honorary basis soon after he arrived in Traralgon 19 years ago. In 2003, he was engaged as a Senior Lecturer at the then Gippsland Regional Clinical School. Subsequently, Dr Tam was appointed as an Honorary Senior Lecturer, Department of Paediatrics, Monash University. In 2005, Dr Tam became the Discipline Lead in Children Health, Monash Rural Health Latrobe Valley & West Gippsland - a position he held until 2015 when he was appointed as an Associate Professor in Rural Medicine (Hospital Education) and the Director of Monash Rural Health Latrobe Valley & West Gippsland.

Dr Tam has seen many changes over that time including the duration of placements. Students would come from Clayton Melbourne for nine weeks; now they can spend a year or more in the region. “A lot of progress has been made providing education, teaching and training in rural areas. I think we’re heading in the right direction,” he said.

Teaching with Monash was an extension of work Dr Tam was already doing at the hospital. When he arrived at Latrobe Regional Hospital in 1998, many international medical graduates (IMGs) were studying for the AMC exams. “I always enjoyed teaching and sharing my knowledge and experience with the younger doctors,” said Dr Tam. Before long he was running tutorials for IMGs to help with the paediatric component of their clinical exams. In 2009, Dr Tam became a clinical examiner in paediatrics for the Australian Medical Council (AMC); seven years ago he became a Regional Examiner and in 2014 a member of the National Examination Panel for the FRACP clinical examination of the Royal Australasian College of Physicians (RACP).

Choosing regional practice

Traralgon is a long way from the large teaching hospitals in Sydney where the Hong Kong born doctor had worked since his internship. After completing two years in paediatric nephrology training at the Children’s Hospital at Westmead, Dr Tam faced the choice between a self-funded trip to Canada to complete a PhD as part of his training or a clinical role in regional general paediatrics practice. The decision was made easy when he was approached about the position at Latrobe Regional Hospital. “I came down to have a look and said to myself: ‘this is too good to be true'. There was no paediatrician and all the work was waiting for one. So I came.”

Dr Tam became the only visiting consultant paediatrician at Latrobe Regional Hospital and oversaw the growth of the small paediatric service into a department of five paediatricians, two paediatric advanced trainees and five paediatric hospital medical officers, who provide 24-hour, seven-day on-site paediatric services at the hospital.

Regional recruitment - the social dilemma

During his tenure, Dr Tam has seen trainees and junior colleagues return to work in regional and rural areas. “It’s rewarding especially when they turn out to be good ones,” he said. While he was delighted to see young graduates return, Dr Tam acknowledged there are challenges in recruiting and retaining health professionals in rural areas. “Most of them like the work in the regional areas although some of them feel a little apprehensive in the beginning. But once they come, they all love the work. It’s just the social factors that stop some of them from coming or returning.”

Most families now have two working parents, he pointed out. Sometimes partners have jobs that are not available in regional areas which makes it difficult for a health professional who might otherwise be interested in working in a rural context. Paediatrics, particularly, is a difficult profession to attract. “The majority of paediatricians are female and quite a lot of them have families,” said Dr Tam. “They cannot come out to work in the regional areas where it involves after hours on-call work. It is not easy when they have young children and have no extended family to provide support.” The solution he suggested – only half in jest – is to ensure students meet and marry local people.

The future is regional

Dr Tam plans to continue working in paediatrics in a regional area, and to teach both within and outside hospital settings. “We just have to keep on pushing the boundary so that hopefully we can teach and train the workforce entirely in a rural area. That would certainly be the ultimate success,” he said. Given his track record, it’s unlikely Dr Tam will say no to any opportunities to be involved in educating and supporting future doctors.

Monday, 3 April 2017

Coming home to Mildura to study medicine

After two years studying in Clayton, Tanzina Kazi is rediscovering a different Mildura to the one she grew up in. Tanzina is one of 14 Monash medical students undertaking their first year of clinical training at Monash Rural Health Mildura.

Tanzina Kazi is enjoying her first year of clinical training in Mildura

“We’re a very tight-knit group, which is a big positive,” said Tanzina. “We do a lot together.” Exploring local markets, picnic spots, Orange World and local restaurants, her fellow students look to her to act as tour guide. “We have a really, really good food culture in Mildura, so we do a lot of eating” she laughed.

Mildura is a long way from Tanzina’s birthplace, Bangladesh. Her parents left for Melbourne when she was six months old, so she doesn’t remember it then. But a trip back to visit family when she was seven made a deep impression on her. “There’s a lot of poverty in Bangladesh. Everywhere you go, you see people who are living on the streets. A few of those people just stuck in my mind. That’s when I decided that in my future I want to do something where I’m helping people,” she said.

She was also well aware of the issues people outside Melbourne face trying to access health services. A couple of years after arriving in Australia, Tanzina and her family moved to Mildura. Over the years, both her parents have had health problems. She remembers that her mother had to travel to Melbourne for an MRI as they weren’t available in Mildura at the time.

Deciding on a career in medicine was a gradual process influenced by that early trip, her parents’ experiences and her enjoyment of biology. “When I went into medicine I wanted to be a GP. I like the idea of being able to track someone’s medical process from when they’re a child to when they’re an adult,” she said. “But now I’m not sure what I’d like to specialise in.” That decision is some way off yet and her clinical training will expose her to a variety of specialties, but she would like to come back to a rural area to do her internship when she graduates.

She’s not the first in her family to choose to study medicine: her brother is currently studying medicine in Queensland. “Unfortunately he’s beaten me to the punch and he’ll be the first doctor in the family, although my Dad’s got a PhD so technically he’s the first doctor” she joked.

Tanzina, on the other hand, was well aware of the Extended Rural Cohort stream in Monash’s medicine degree by the time she was applying for a place in a medical course. “Monash does a really good job in Mildura: they invite the year 11 and 12 students over to the School of Rural Health and do a few workshops and an information night,” she said. “And all the medicine students that I talked to before I started doing medicine were ERC students. They all just raved about how good ERC is and how much they get to do compared to their city friends. And I thought, well if I get to do a lot and I get to be back home for a year, then why not? So it was my first preference.”

She agrees studying medicine in Mildura is a great experience and comments on how well the staff look after the students. “We feel we have a really good connection with them. The other day it was someone’s birthday and Kris [Pinney] baked them a cake. It’s a great community feeling here.”

After two years’ foundation studies at Clayton, Tanzina is enjoying the hands-on learning in Mildura. “It was a difference experience and I did enjoy it. I was staying at college so I got to meet a lot of new people. But, at the same time, it was just sitting in lecture theatres for lots of hours during the week. And when I compare it to what I’m doing now in Mildura, I’d much rather be here than sitting in lecture theatres.”