GP Journey Issue 14

GP Journey ISSUE 14 FREE May – August 2014

Dr Mark Wenitong Leading by example Also in this issue: Your career GP profiles Clinical cases

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GP Journey

Welcome to this issue of

GP Journey magazine, proudly

brought to you by General

Practice Registrars Australia (GPRA). GP Journey aims to give

you a glimpse into the lives of

doctors working in the specialty

of general practice. We hope our

inspiring stories of GPs and GP trainees will entice you to consider general practice as a career.

Our cover story profiles Associate Professor Mark Wenitong.

Mark’s account of how he overcame obstacles and difficult circumstances to become a GP is truly inspiring. Mark is co-founder of the Australian Indigenous Doctors’ Association, Patron of the Indigenous General Practice Registrars Network, and was named by Australian Doctor as one of medicine’s 50 most influential people. Mark is one of many doctors truly making a positive impact in Indigenous communities.

You really can go places with the skills of a GP, as demonstrated

by Dr Meg McKeown and Dr Jeff Ayton. Imagine getting a prophylactic appendicectomy just so that you can go to work!

They share their experiences working with the Australian Antarctic Division’s Polar Medicine Unit.

Tasmanian GP, Dr Alexandra Smith, tells us how she transitioned from a registrar into being part owner of a practice, Dr Caitlin O’Mahony shares her experience as a GP registrar and deputy chair of The Water Well Project, and South Australian junior doctor, Dr Charlotte Forrest, explains what influenced her decision to become a GP. Dr Andrea Gomes demonstrates how Published by General Practice Registrars Australia Ltd Level 4, 517 Flinders Lane Melbourne VIC 3001 P 03 9629 8878 F 03 9629 8896 E enquiries@gpra.org.au W gpra.org.au ABN 60 108 076 704 ISSN 2203-2657

Staff General Manager – Operations Sally Kincaid sally.kincaid@gpra.org.au Medical Editor Dr Chia Pang Editor Denese Warmington denese.warmington@gpra.org.au

you can work in general practice through the Prevocational General Practice Placements Program, and First Wave Scholarship recipient, Mark Aicken, tells us about his eye-opening general practice placement on the New South Wales south coast.

How time flies, and the 2015 AGPT (Australian General Practice Training) application season is upon us! Applications to the program open on 14 April 2014. In this issue we provide some valuable tips from regional training providers on how you can be successful in your application.

The most recent Health Workforce Australia report showed that there is an increased demand for GPs in the midst of a national shortage, especially in the outer metropolitan, rural and remote areas of Australia. The AGPT program plays an important role in selecting the best and brightest candidates to be trained into well-rounded and competent doctors to fill this need. If you are interested in a career in general practice and want to find out more, I urge you to speak to your local representatives. For junior doctors, you can speak to our Going Places Network Ambassadors. For medical students, get in touch with your university General Practice Students Network club chair.

I hope you enjoy the magazine!

Dr Chia Pang – Medical Editor GP registrar – Bogong Regional Training Network

Going Places Network Manager Emily Johnson emily.johnson@gpra.org.au General Practice Students Network Manager Alex Kirby alex.kirby@gpra.org.au Writers Laura McGeoch Jan Walker Denese Warmington

Graphic Designer Peter Fitzgerald Sponsorship & Events Coordinator Natalia Cikorska natalia.cikorska@gpra.org.au Produced with funding support from

©2014 GPRA. All rights are reserved. All materials contained in this publication are protected by Australian copyright law and may not be reproduced, distributed, transmitted, displayed, published or broadcast without the prior permission of General Practice Registrars Australia Ltd (GPRA) or in the case of third party material, the owner of that content. No part of this publication may be produced without prior permission and full acknowledgement of the source: GP Journey, a publication of General Practice Registrars Australia. All efforts have been made to ensure that material presented in this publication was correct at the time of printing and is published in good faith.

With you on your journey

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Issue 1 12c

GP Journey in this issue...

Upfront

Dr Mark Wenitong is one of Australia’s leading Aboriginal doctors. As a role model for a new generation of Indigenous medical students and junior doctors, Mark talks to GP Journey about the value of never giving up and his role as an advocate for national change.

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Student profile Nicola Campbell is a young woman getting things done. She chats to us about juggling different roles and getting involved.

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PGPPP profile Dr Andrea Gomes explains how doing two PGPPP rotations in palliative care taught her the value of a patient centred approach.

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Junior doctor profile Dr Charlotte Forrest tells us why the people factor is what really excites her about a general practice career.

24 Going Places 20 How to apply to Network update the AGPT program

26 General Practice Students Network update

6

Cover story 11

First Wave profile Mark Aicken shares with us some tales about his somewhat unusual placement in a NSW coastal town.

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GP registrar profile Dr Caitlin O’Mahony explains that providing continuity of care while practising holistic, preventive medicine makes general practice the choice for her.

Regulars

22 Applying to the AGPT program – tips for success from regional training providers

GP profiles

Clinical cases

25 Going Places Network GP Ambassadors

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34 Rectal bleeding in pregnancy 36 Clinical corner

Back pages

29 It takes 2 Dr Meg McKeown and Dr Jeff Ayton

27 General Practice Students Network Chairs

Dr Brett Montgomery is an academic GP. He explains how the two roles inform each other, enhance each other and invigorate his working week.

32

Dr Alexandra Smith tells us how buying into a practice is allowing her to take direction of her general practice journey.

38 #fgp14 conference 41 Reviews 43 The PGPPP

With you on your journey 5

co v er s t ory

The big gig

6

Dr Mark Wenitong worked his way through med school playing music gigs by night and studying by day.

As one of Australia’s leading Aboriginal doctors, he is a role model for a new generation of Indigenous medical students and junior doctors.

“Believing in yourself is really important for our mob …”

Dr Mark Wenitong likes nothing better than to riff on his guitar after work. But, somewhat reluctantly, he has given up moonlighting as a part-time professional muso.

His daytime gig is just too big. In fact, for this Indigenous GP and public health advocate it’s more than a job, it’s a calling.

“My motivation is just better health for Indigenous people,” Mark explains. “That’s the reason I did medicine.”

Before deciding to become a doctor, Mark worked for more than 10 years in a Cairns pathology lab as a laboratory technician. “We were getting pathology from Cape York, the Torres and the Gulf, and just seeing how unwell people were. And I wanted to do something about it,” he recalls.

“I went to what I thought was an information day about studying medicine at the University of Newcastle. There were three selection people sitting there and they started asking me questions, so I just rolled with it. And I got in!”

He reflects on this life-changing scenario with a self-deprecating chuckle, as if the whole thing happened to him by accident.

Mark’s decision meant years of study and “being broke” as a 30-something father with a wife and four children. It was to be a daily struggle to pay the rent, put food on the table and study at the same time.

That’s where Mark’s second job as a muso in reggae bands with his former wife suddenly went from a sideline to a financial lifeline.

“We’d often play until three in the morning and then I’d get up and study the next day, which was challenging,” he says.

As with many Indigenous medical students, going to university was beyond the experience of his family circle. Mark was the only one of six siblings to finish high school. He then went on to study laboratory science at tertiary level.

When he decided to go back to uni to study medicine, Mark says his family were his greatest allies. His mother, who was one of the first Aboriginal health workers in Queensland, was a great encourager, as were the rest of his family. “My kids especially were really supportive.

They knew they were going without, but they were fine with it because they knew why I was doing it.

“I also had uncles and aunties who were pensioners and they would send me handwritten notes and $15 towards the rent.” These touching gestures spurred Mark on. “That kind of support really helps to re-energise you and get round the stuff about whether you belong here or not.”

Feeling like you don’t belong in the university and medical world can be a serious issue for Indigenous medical students and junior doctors. “Believing in yourself is really important for our mob because the first time you face any adversity or fail an exam the immediate thought is: Oh, I don’t really belong here,” Mark explains.

Indigenous medical students and junior doctors often carry a weighty burden of responsibility, he adds. If they fail a test, they feel they’ve failed for the nation.

The old way of “teaching by embarrassment” didn’t help either, Mark says with a laugh. “You know, medical students and junior docs clustered around a patient’s bedside with a consultant who says: ‘Can you explain this, you idiot?’ That’s not the Aboriginal way. You learn by example.”

Throughout his career, Dr Mark, as the sign reads on his office door, has been an example of the Aboriginal way.

He names his heroes as Jesus Christ and Muhammad Ali – reflecting the Christian values he grew up with combined with a fighter’s tenacity.

Most Aboriginal doctors tend to focus on the clinical side of medicine, but Mark has also worked extensively in the public health, policy, workforce planning, academic and mentoring space.

So why did his career head in that direction? “Policy and politics and public health is where big national change happens and you’ve got to be at the table,” Mark says.

Those tables currently include the board of the Australian Institute of Aboriginal and Torres Strait Islander Studies, the Andrology Australia Aboriginal and Torres Strait Islander Male Health Reference Group, headspace and several others. Early in his career he co-founded the Australian Indigenous Doctors’ Association (AIDA) and was named

by Australian Doctor as one of medicine’s 50 most influential people.

Right now, Mark is settling back into Cairns after a year in Canberra with the National Aboriginal Community Controlled Health Organisation (NACCHO).

He currently has a mixed bag of roles – and he’s loving it. At James Cook University he is an Associate Professor [Adjunct], collaborating on research projects, lecturing and mentoring Indigenous students.

Then there’s his work as a public health medical officer at Apunipima Cape York Health Council, involving the application of evidence in primary healthcare, staff leadership and clinical work.

Mark is also the patron of GPRA’s Indigenous General Practice Registrar Network (IGPRN).

He particularly enjoys seeing patients for fly-in fly-out men’s health checks in the Cape York communities, which usually wind up with a barbecue, a yarn, a good laugh and maybe a strum on the guitar – the Aboriginal way.

The muso in the medico still finds an outlet. When Mark is not working, he can often be found having a jam with his musically talented adult children.

Mark’s achievements have been recognised with an AMA President’s Award for Excellence in Health Care in 2011 and a Queensland Aboriginal and Torres Strait Islander Health Council Hall of Fame Award in 2012.

As the ranks of Indigenous doctors grow, with more than 200 Indigenous medical students across Australia – one of them Mark’s son Joel – does Dr Mark have any advice for Indigenous doctorsto-be? “Just believe in yourself, let others believe in you, and never give in to the negative stuff,” he says.

Written by Jan Walker

With you on your journey 7

M E D I C A L S T U D E N T P RO F I L E

Getting it done GPRA’s General Practice Students Network Vice-Chair, Nicola Campbell, prides herself on getting things done efficiently while juggling a range of different roles.

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“I’m a firm believer in the saying, If you want something done, give it to a busy person,” third year Griffith University medical student, Nicola Campbell, tells GP Journey.

Nicola has held a variety of positions on different student societies and working groups while successfully balancing her studies, social life and extra-curricular activities. Her ability to manage these commitments, coupled with a positive attitude and bubbly personality, is what held Nicola in good stead leading up to elections for the 2014 GPSN National Executive.

In her election campaign video, Nicola said she knew what it took to make a committee run and that she had had experience working with a diverse range of groups. These characteristics evidently appealed to voters when Nicola took out the coveted position of national vice-chair.

Nicola expressed a desire to become more involved in GPSN than in previous years as one of her reasons for applying to the national executive. “I’ve had a truly amazing time being involved in my local club as well as on my First Wave scholarship placement in first year,” she stated,“I would really love to do more on a national level and see a better connection between the local GPSN clubs and the national executive.”

Last year Nicola was chair of the GPSN Community Working Group and vice-chair of her Griffith University GPSN club, which took her to Canberra in March for GPRA’s annual conference.

“It was a fantastic experience. As the Griffith University club vice-chair I helped organise and run events and really enjoyed promoting general practice to my colleagues through the clinical skills events, seminars and workshops.”

Nicola says she’s looking forward to tackling her new role on the national executive and has already spent the first month updating a handbook for club leaders and developing some new policies for GPSN. “It’s a nice break from university and I’m feeling quite productive at this point, although I’m still finding my feet as the role has only just begun.”

Nicola will join nine other student leaders that make up the GPSN National Executive Committee, which has grown from five student members to 10 in 2014 in an attempt to tick off GPSN’s expanding list of national priorities.

Nicola says she can’t wait to work with all the new portfolio holders. In 2014, the committee comprises a chair, vice-chair, secretary, working group officer, national events officer, internal communications

Find out more about the General Practice Students Network at gpsn.org.au or turn to page 27 for a list of GPSN club chairs at your university.

officer, sponsorship officer, local events officer, promotions and publications officer and an online officer.

“I think a larger committee is a great way to keep things moving and will help improve communication between local clubs and the national executive. They’re a great bunch of people which is fantastic – it’s all really exciting.”

When Nicola is not studying or promoting the benefits of a career in general practice, she can be found baking, playing the cello or tutoring maths and science to boarding school girls.

“I recently joined the Queensland Medical Orchestra and have played at a few concerts, which has been great fun,” she says.

“I also love tutoring – it’s an awesome job. There are lots of girls who want to study medicine and it’s great to see them so keen and eager.”

This year Nicola is putting the knowledge she has learned at university to the test as she embarks on her first clinical year at Queensland’s new Gold Coast University Hospital.

“I’m still getting lost at the hospital but it’s been great so far. Everyone has been absolutely lovely and the consultant is happy to teach and answer all my questions.”

Nicola is currently working in women’s health, and although it’s not on her shortlist of career prospects, she’s still enjoying the hospital placement.

“It was a bit scary and intimidating at first, but my team has been so welcoming,” she says.

“We’ve been seeing our own patients in the gynaecology clinic, and initially that was intimidating, but it’s been a great learning experience.”

Nicola says she’s responsible for greeting the patient, taking a full history followed by an examination before “grabbing someone more senior to take over”. She describes the placement as a “steep learning curve” but says “the patients have been great in allowing us to practise so it’s a really good experience.”

Following a successful GPSN First Wave Scholarship and John Flynn placement, Nicola is eager to sign up for general practice training when she completes her university studies.

“I’ve been lucky enough to have lots of incredible exposure to general practice through my two placements,” she says.

“Getting involved in GPSN has also helped in the decision making process.”

Written by Alex Kirby

“I’ve been lucky enough to have lots of incredible exposure to general practice through my two placements.”

With you on your journey 9

F irs t W a v e profile

Quirky cases and endless opportunities Before embarking on his First Wave Scholarship Program placement, third year medical student, Mark Aicken, had never heard of the extreme sport of ‘rock running’.

With you on your journey 11

“It was an amazing experience and has shown me the range of areas available to me in general practice.”

It wasn’t until a man presented to the local general practice clinic with a foot full of spines that Mark learned of this bizarre activity, which is designed to increase lung capacity.

Led by Dr Brett Thomson, a GP obstetrician and anaesthetist, the clinic employs nine doctors and eight nurses as well as a range of administrative staff.

“When I asked what had happened, the patient explained to me that he had stepped on a sea urchin while rock running.

During his placement, Mark spent time observing many of the clinic’s GPs. He says that although each doctor had their own unique style they were all friendly and helpful.

“He was so casual about it, as if it was general knowledge, but I had no idea what rock running was,” says the University of Notre Dame Sydney student. (Mark soon discovered that rock running involved holding a giant rock underwater while running along the sea floor.)

Mark said the case was one of the most interesting he had seen walk – or in that instance limp – through the practice doors during his placement.

“We spent a good couple of hours digging all these needles that were about half a centimetre long out of his foot. It was actually fun – probably not for the poor guy though!”

But the quirky cases Mark encountered didn’t stop there. Towards the end of his week-long placement at Milton Medical Centre, a coastal town about three hours south of Sydney, a woman presented having injured her shoulder after falling over her chook pen while she was feeding her chickens!

Mark, along with an intern who was on a general practice rotation at Milton, helped put the patient’s dislocated shoulder back into place. Mark put a towel around the woman’s arm and pulled it forward, while the intern simultaneously pulled another part of it backwards. “Then it just popped back into place – it was very satisfying,” Mark recalls.

Other highlights of Mark’s First Wave placement included helping out with hospital ward rounds, putting in cannulas, taking blood and perfecting his suturing skills.

“I got so much hands-on experience – it was fantastic,” Mark says.

“The first time I sutured, my hands were shaking. But then I got the hang of it and it was a great feeling to be able to perfect the technique.”

Milton has a population of about 15 000, and the Milton Medical Centre, which is conveniently positioned across the road from the hospital, comprises 13 general practice rooms as well as a nurse’s station and a small pathology room.

“It looked like a little old house at first glance but I soon discovered a huge practice spread over three blocks behind its humble façade.”

“I was with a different GP almost every day and they were all absolutely amazing,” he says. “Everyone was so friendly – they took me under their wing to show me new things and let me practise my skills.”

He particularly praised the work of Dr Lian ‘Eliza’ Zhao, who explained everything so clearly and thoroughly. “Dr Eliza is fantastic with people, smart and, most importantly, thorough. She could quite easily explain to a patient what the presenting problem was, what she was going to do about it, and what the patient should be doing at home.”

Mark also acknowledged the great work of Dr Thomson.

“He was hilarious and had the ability to say the most politically incorrect things and somehow get away with it! The patients really respected him and he was a great supervisor.”

Mark says one of the highlights of working with Dr Thomson was being tested on his clinical knowledge during the ward rounds. “He would shoot questions at me and the interns at a patient’s bedside and there were many answers I didn’t know – but it was a great way to learn,” he says.

Mark described the practice’s atmosphere as relaxed but also efficient and professional. “I loved my whole week at Milton – I want to go back there.”

Outside the practice, Mark was treated like a long-lost relative.

“They took me out for dinner and lunch a few times – I don’t think I paid for a meal the whole time I was there!”

Although Mark is still undecided about what career he wants to pursue when he finishes medicine, he’s leaning more towards general practice following his First Wave Scholarship Program placement.

“The experience has really developed my enthusiasm for general practice and has opened my eyes to the possibility of pursuing a career as a GP in a rural community,” he says.

“It was an amazing experience and has shown me the range of areas available to me in general practice.”

Written by Alex Kirby

The GPSN First Wave Scholarship program offers first and second year medical students the opportunity for a positive and inspiring experience in general practice under the guidance of a dedicated general practice supervisor.

Third and fourth year medical students from universities in South Australia and Western Australia can also apply for a clinical placement with an Indigenous health provider.

Applications for the First Wave Scholarship program open 30 May 2014 and close 30 June 2014.

Visit gpsn.org.au for more information.

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a re

of c y it u n i t n o C

C h a lle n g e

Life sty le

D ive rs ity

Fulfilling work, challenging experiences, lifestyle choices, medical specialisations - there is so much to consider when choosing your medical pathway.

Have it all with General Practice Find out what General Practice on the beautiful north coast of NSW can offer you at www.ncgpt.org.au

Where

Will

your

path

take

You?

PP

PGP

Want to see if General Practice is for you?

You can do a 10 week PGPPP term as one of your hospital rotations. Scan the code to hear some of our PGPPP participants talk about their experience at one of our North Coast Practices.

P G P P P and me

Making a difference For Dr Andrea Gomes, working in palliative care taught her the value of a patient centred approach and provided insight into the vital role GPs play in managing health in the community.

In 2013, Andrea was awarded the WAGPET Prevocational Community Medicine Award for her work with Silver Chain Hospice.

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Andrea’s top three tips for someone doing their PGPPP: 1. Ask the stupid questions.

2. Get as much procedural experience as possible.

3. Engage wholeheartedly: you only get 10 weeks (20 if you’re lucky).

What stage of your training are you at?

PGY4 and doing my advanced term at Canning Medical Centre in Fremantle.

You spent two terms working as a community resident in palliative care as part of the PGPPP. Tell us a little about why you chose this area of practice.

I’d never formally undertaken a palliative care term before so I was keen to see what it would be like. I didn’t expect to attach to it the way I did. I came to realise just how important it is to families to have a GP that can manage end of life care, or at least one that feels comfortable with symptom management. I’m glad to have picked up the skills to be able to offer support and hopefully improve quality of life when life quantity is no longer an option, and this has greatly contributed to my own job satisfaction.

Did working in palliative care influence what you want to do in your career?

I have to admit I was very tempted to go down the palliative care training path after my experience and even now I haven’t ruled it out. On the same token, working in the community reinforced my decision to go into general practice and now that I’m there I have no regrets. It’s quite liberating to know that I’m still able to pursue special interests such as palliative care should I choose to in the future and be able to incorporate these into my own practice.

What did you learn from your supervisors?

My two main supervisors were fantastic. They arranged for scheduled weekly teaching and topics were prepared with pre-reading ahead of time. What inspired me the most was their contagious passion and commitment to their work. They were incredibly welcoming and supportive and the same can be said of the doctors, nurses and staff on the Silver Chain team.

Describe an average day during your PGPPP terms.

I’d usually head into the Silver Chain base in the morning to meet with the nurses and coordinator, see what their plans were, identify if there were any patients needing urgent doctor review, and note down any new referrals that needed admitting to the service. Once I’d accumulated a few new referrals I’d schedule regular home visits or phone calls to check in on them. I carried a work mobile and would respond to calls throughout the day from nurses requesting medical review of patients or other advice. I spent a lot of the time on the road, but I found it a welcome change to be out and about with a driving break between patients. If I ever ran into trouble or needed advice assistance was only a phone call away.

What are some of the important lessons you have learned about patient care?

Patients and doctors often have different priorities with regards to what is important in their medical care. Working in community palliative care taught me the value of a patient centred approach and the importance of being able to tailor individual care. No two patients are alike and there’s no such thing as a one-size-fits-all management plan.

What have you learned about general practice?

So far? Never underestimate the value of a good practice nurse.

And children will play with anything in your office, including vaginal speculums! Also, always be aware that what the patient presents with is not always what they actually want help with and if you don’t ask, they won’t tell.

Did anything surprise you about the PGPPP experience?

How often patients told me I was too young to be a doctor, yet allowed me to treat them anyway!

Did the experience make you want to pursue a general practice career?

Definitely. It gave me a taste of community medicine and the opportunity to make a meaningful contribution to the lives of other people. The opportunity to practise medicine fairly independently was hard to let go of when it was time to return to hospital work!

What was the best part of the experience?

The ability to work in the community while still being part of a fun, friendly and supportive team.

What was the most challenging or difficult?

Making the transition from protected hospital environment to open plan, independent community medicine work and making clinical decisions. Adjusting from treating in a hospital setting and having all the resources that go along with that, to treating in quite variable home settings was challenging at times. On the other hand, I found it much easier to develop a connection with the patient when they were feeling at ease in their own environment and to provide more holistic care.

Would you recommend the PGPPP to others?

I would definitely recommend a PGPPP term to anyone considering general practice as a career. It also makes a nice break from hospital work while providing great insight into the vital role GPs play in managing health in the community.

To find out more about the PGPPP talk to the junior doctor manager at your hospital or visit gpet.com.au With you on your journey 15

J U N I O R D O C TO R P RO F I L E

The people factor Seeing how the “day-to-day interactions” between GPs and their patients can lead to life-changing outcomes has helped convince Dr Charlotte Forrest to embark on a general practice career.

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“I think you need to be well-rounded in the different areas of medicine but also confident at identifying your limits and seeking specialist advice and referring when appropriate.”

The patient was an overweight middle-aged man who lived in the town of Clare, a couple of hours drive north of Adelaide. To help him become healthier, his GP had given him some basic advice – perhaps as simple as to go for a walk every day and stop eating in front of the television.

Some months later, the man returned to the clinic. He proudly told how he had lost 40 kg and could recall the exact moment his GP had made him realise that he needed to change his life. Junior doctor Charlotte Forrest was completing a “fabulous” Prevocational General Practice Placements Program (PGPPP) term at the clinic during the time the man returned.

“The funny thing was that the GP couldn’t even remember exactly what he had advised the patient!” Charlotte recalls. “But the patient did.” Whatever it was, Charlotte tells GP Journey, it was enough to “spark” an interest in his own health and change his life.

The experience revealed to Charlotte “… just how much the patientdoctor relationship can mean to patients and what a positive impact they [GPs] can have on a patient’s mental and physical wellbeing.”

The 11-week placement, which Charlotte completed during her internship at the Royal Adelaide Hospital, also showed her what life could be like as a GP. “It [the PGPPP] reiterated everything I liked about general practice,” she says.

“The practice was really dynamic … lots of doctors and allied health staff were based there. It was a very inclusive and vibrant clinic, a fun group of doctors. They were used to having interns and training doctors, and were particularly good at being very inclusive.”

Charlotte recalls social dinners and trips to the wineries dotted along the Clare Valley.

Each of the doctors supervising Charlotte had a special interest and this helped expose her to a range of clinical settings and situations.

“Some were anaesthetics trained, others had a background in general surgery so I was able to join them in theatre. A couple were obstetricians so there were lots of C-sections that I got to assist with.”

The clinic was also attached to a hospital where the GPs spent time seeing their in-patients. “If I was on call overnight I got to admit a patient … then I would get to follow up their progress in hospital and also see them back at the clinic.” This enabled her to experience the “continuity of care” that underpins general practice work.

These positive experiences have helped to set general practice apart from the other specialties that she first began to explore as a medical student at Adelaide University. “Throughout med school I really tended to enjoy every rotation that I did and was never set on a particular area because I wanted to remain open to all of the specialties,” Charlotte explains.

“It was probably in my fifth year that I did a short general practice rotation (three weeks in an urban practice in northern Adelaide).

Then in sixth year I did a rural rotation at a town called Cummins on the Eyre Peninsula, and I think that’s when general practice became even more of an interest.”

While placed with a solo GP at Cummins, a town of about 800 people, Charlotte says she got her first real sense of responsibility through “parallel consulting” – seeing her own patients and then reporting to the GP. “We would also see in-patients from the hospital. We’d start the day with a ward round in hospital and see our in-patients and then go to the clinic and see out-patients.”

She also got hands-on exposure to emergency medicine by taking part in simulation training with local volunteer paramedics during call-outs. The call-outs were usually in response to car accidents on the road between Cummins and the nearby and larger town of Port Lincoln.

Charlotte has been accepted on to the Australian General Practice Training (AGPT) program and is taking the general pathway through Adelaide to Outback. This year she will primarily be based at the Royal Adelaide Hospital and also plans to work in paediatrics at the Women’s and Children’s Hospital.

Although her rural experiences have been excellent, at this stage Charlotte plans to work in an urban setting in her hometown of Adelaide, where she lives with her Canadian boyfriend, also a junior doctor.

Regardless of the setting – city or rural – it is the personal element of general practice that strikes a chord with her. Add in the opportunities for medical variety, and the specialty becomes even more attractive. Charlotte lists dermatology, paediatrics, mental health, women’s health, nutrition and disease prevention medicine and the procedural side of general practice as areas she wants to develop in.

She realises that, like any specialty, there will be challenging days, but believes general practice has the essentials to ensure the good moments far outweigh the bad. “Obviously some days are bound to be better than others, as in general practice your experiences are never the same day to day,” Charlotte says. “You are always having unique presentations and no two people are the same.

“But even if the day has been more challenging there is always a positive experience in that day too. It’s up to you what you take away from that experience.”

There are some key qualities that GPs need to possess to get the most out of themselves and do the best for their patients, Charlotte believes. “You need to be committed to learning throughout your career and have strong communication and listening skills,” she says. “I think you need to be well-rounded in the different areas of medicine but also confident at identifying your limits and seeking specialist advice and referring when appropriate.”

When it comes to what really excites her about general practice, Charlotte returns once again to the people factor. “Building a rapport, earning a patient’s trust and developing a working relationship,” she says. “Yes, that’s it. Absolutely.”

Written by Laura McGeoch

From left: Scaling the heights in South America Charlotte with her boyfriend on a recent trip to Japan

With you on your journey 17

G P R E G I S T R A R P RO F I L E

A story to inspire Dr Caitlin O’Mahony is Deputy Chair of The Water Well Project and a former Victorian Junior Medical Officer Forum Chair. Having recently embarked on her first GP registrar term, she credits the story of another female doctor with inspiring her path.

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Opposite page: On top of Mt Kilimanjaro with husband Lee This page from left: The book that started it all Caitlan and her son, Chris Water Well Project Healthy Eating session When general practice registrar Dr Caitlin O’Mahony knew she would be talking to GP Journey, she thought long and hard about where her own GP journey began. She remembered a book she couldn’t put down.

“My mum gave me a book called The Hospital by the River by Dr Catherine Hamlin when I was 15,” Caitlin recalls. “Catherine is an extraordinary Australian gynaecologist who established a fistula hospital in Ethiopia for women suffering terrible injuries due to obstructed labour. The book had a deep impact on me. It definitely ignited my interest in medicine, particularly women’s health, and the power of healing.”

Early in her hospital training, Caitlin considered a career in obstetrics.

After two stints at The Royal Women’s Hospital in Melbourne, she completed a diploma through the Royal Australian and New Zealand College of Obstetricians and Gynaecologists. She developed a greater understanding of where her medical career was heading when she realised she enjoyed the antenatal clinics more than the adrenalin rush of the labour ward.

“I wasn’t originally attracted to general practice,” Caitlin says. “I spent some time discussing various paths with mentors, colleagues and family. But the opportunity to experience continuity of care for patients of all ages, backgrounds and medical conditions, while practising holistic, preventive medicine in the community, made general practice an excellent career choice for me.”

The flexibility of GP training has enabled Caitlin to spend time with her young family and continue to pursue her interests in women’s and refugee health.

“At my current clinic [Mackie Road Clinic in Melbourne’s Bentleigh East] I am employed two and a half days a week, and fully supported,” Caitlin says. “My supervisor has worked in this community for over 30 years and the amount of energy he still has to teach registrars and look after his patients is inspiring. I’m sure there are many GPs like him and they deserve more recognition than they receive.”

Despite the influence of Dr Catherine Hamlin’s book, Caitlin did not pursue medicine straight from school but commenced a science/law degree at Monash University. During her fourth year, while undertaking honours research at Peter MacCallum Cancer Centre, she realised that the day-to-day work of being a laboratory scientist or lawyer was not the career she wanted. So, undeterred by four years of study already completed and the daunting prospect of starting again, she was accepted into medicine at the University of Melbourne as a postgraduate student.

Caitlin believes her circuitous route to medicine had a positive effect. “I managed to experience many different aspects of life, study and travel before starting medicine. This certainly influenced my maturity and journey compared to if I had taken a direct route from school,” she reflects.

By the time Caitlin started hospital training, she had the drive and confidence to challenge herself, especially through volunteering. “I have always enjoyed extra-curricular involvement and working with like-minded volunteers,” Caitlin says.

As an intern at St Vincent’s Hospital in Melbourne she became involved with the medical education unit on a project called ROVER, or Rolling Handover. Caitlin developed a template for a concise, up-to-date orientation document to be completed by interns at each rotation change. ROVER has since been implemented in a number of hospitals across Victoria.

The following year, Caitlin extended her extra-curricular activities by becoming the Co-Chair of the Victorian Junior Medical Officer Forum. “I loved it. There is so much that junior doctors can do to improve their own education and training,” she says.

There were other formative medical experiences for Caitlin. During her time in the Northern Territory at the Royal Darwin Hospital as a medical student and at Katherine Hospital as a junior doctor, she first encountered the complexities of Aboriginal health. “Unless you visit [the Aboriginal communities], it is really difficult to comprehend the complex issues surrounding the poor health of Aboriginal people. It was encouraging to see an increase in small projects and ground support to improve access to medical assistance and resources,” she observes.

More recently, Caitlin’s interest in the socially marginalised has been further developed with voluntary work in refugee health as Deputy Chair of The Water Well Project. Based in Melbourne, it’s a not-forprofit organisation that aims to improve the health and wellbeing of migrants, refugees and asylum seekers through better health literacy and usage of the Australian healthcare system.

It’s called The Water Well Project because in traditional communities a water well was a place where people met to gather water and talk about their daily lives.

Volunteer health professionals deliver free, interactive, culturally sensitive health education sessions to groups across Melbourne within their community settings. Topics range from navigating the Australian health system to healthy eating, sexual health and mental health.

“Since its inception in 2011, I am proud to see The Water Well Project grow from a few volunteers and the delivery of two health sessions to over 150 volunteers and 50 sessions last year,” Caitlin says.

The most memorable feedback Caitlin has received was after a session with a group of teenage boys who were unaccompanied minors from Sri Lanka. “They were into exercise and keeping fit but drinking a lot of Coca Cola and Red Bull for ‘energy’. The volunteers demonstrated that there were 15 teaspoons of sugar in a 600 mL bottle of Coke. The boys were so shocked that they now only drink water or milk.”

So how is Caitlin finding her GP training so far? “Sometimes when I’m driving home after a day at my GP clinic I reflect and think, that was pretty cool. I saw a mix of patients with a variety of medical conditions and I’m starting to develop my own continuity of care.

I feel my journey has culminated in the perfect career for me.”

Written by Jan Walker

Find out more about The Water Well Project at thewaterwellproject.org

With you on your journey 19

M y C areer

How to apply to the AG Applications for the 2015 Australian General Practice Training (AGPT) program will open at 10 am AEST Monday 14 April 2014 and close at 10 am AEST Friday 9 May 2014.

Application and selection process

Selection into the Australian General Practice Training (AGPT) program is a national, merit-based, competitive and multi-phased process used to determine which applicants are best suited to general practice. The application and selection process is managed

by General Practice Education and Training Limited (GPET), the Australian Government-funded organisation responsible for the funding and management of the AGPT program.

Applying to AGPT

Applicants apply online via the GPET website. Applicants will need to upload supporting documentation and identification together with their online application. Upon submission, each applicant will receive an emailed PDF of their application. The supporting documentation required varies for Australian medical graduates (AMGs), overseastrained doctors (OTDs) and foreign graduates of accredited medical schools (FGAMS). Visit the GPET website for details at gpet.com.au The AGPT application and selection process is made up of three stages:

1. Application and eligibility check Once applicants have submitted their online application it is assessed by GPET for eligibility to join the AGPT program and, if eligible, the pathway through which the applicant may train (general or rural) using established eligibility criteria. Refer to the 2015 AGPT Applicant Guide on the GPET website (gpet.com.au) for eligibility criteria. Applicants will receive an email from GPET advising if they are ineligible.

2. National assessment Eligible applicants will be invited to participate in the national assessment and shortlisting process for the 2015 AGPT program cohort.This process will include undertaking two assessments at two separate locations:

• The online Situational Judgement Test (SJT) at a National Testing Centre between 26 May and 16 June 2014 • Multiple Mini Interviews (MMIs) at a National Assessment Centre

between 6 and 29 June 2014.

These assessments are not focused on clinical knowledge, but rather the applicant’s aptitude for general practice as a medical specialty.

The standardised results of these two assessments will determine each applicant’s total AGPT selection score. Based on their total AGPT selection score and the availability of shortlisted places at their preferred regional training provider (RTP), it will be determined

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whether applicants will be shortlisted to their highest available preference. Applicants will be notified of the outcome by email.

For details regarding the national assessment stage including shortlisting phase, please read the 2015 AGPT Applicant Guide available on the GPET website at gpet.com.au 3. RTP selection and placement offers RTPs will use the results from the SJT and MMIs and any further requested information, which may be obtained through a placement assessment or by contacting nominated referees, to determine appropriate allocation of places. Applicants will be advised of the outcomes of the allocation, and suitable applicants will be offered training places. Written acceptance of an RTP’s offer of an AGPT place, within seven days of the offer being made, will confirm selection into the 2015 AGPT program.

To find out more about the application and selection process, visit the ‘Junior doctors’ section of the GPET website and click on the ‘New applicants’ page at gpet.com.au What do I need to do to prepare my application?

There are a number of things you can do now to prepare for your application.

Supporting documentation Clear, colour scans of original official documents (eg. citizenship) must be included with your online application. Applicants who do not provide all the required documentation will not be included in the selection process. The full list of documents required can be found in the 2015 AGPT Applicant Guide, available on the GPET website.You can prepare this documentation prior to the opening of applications.

Referees All applicants must provide the details of two referees in their online application. Referees ideally should be a medical practitioner who has directly supervised the applicant for a period of at least four weeks within the past three years. Applicants need to select referees who are able to confidently make judgements about the applicant’s professional capabilities and suitability for general practice, and who can be contacted during the selection period.

Selecting a preferred RTP Applicants are able to nominate up to four RTPs to train with.

Applicants are encouraged to contact the RTPs they are interested in training with, prior to applying, to assist them in determining where they would like to train. A map of RTPs and contact information is available on the GPET website at gpet.com.au under ‘Training providers’.

What is an SJT? The SJT is an online multiple choice test undertaken at a National Testing Centre. It consists of a number of clinically-based scenarios that applicants are asked to assess and either rank the responses in order of correctness or select the most appropriate responses to the situation. Examples are available on the GPET website.

PT program What is an MMI? MMIs involve applicants being rotated between interview stations with each interviewer asking the same question to each applicant individually. The questions are based on the competencies required to practise as a GP, for example, communication skills.

Applicants will have two minutes to read the question before entering the interview room, then eight minutes to answer the question from the interviewer. The applicant is then rotated to the next interview station and the same procedure applied for the next question. There are a total of six MMI questions. Applicants sit the MMIs at a National Assessment Centre.

Keep an eye on the GPET website for detailed and up-to-date information about the selection process and application requirements.

Please contact AGPT Selection for further information via email at selection@gpet.com.au or call 1800 DR AGPT (1800 37 2478) or if calling from overseas +61 2 6263 6776.

Key dates Applications open 14 April 2014 Applications close 9 May 2014 National Testing Centres – SJT online: 26 May to 16 June 2014 National Assessment Centres – MMIs: 6 to 29 June 2014

Please visit gpet.com.au for the most up-to-date information on dates.

Applying to the AGPT program?

Tips for success from regional training providers

The following RTPs have provided their top three tips and useful advice to help you be successful in your application.

Check out what they have to say.

Adelaide to Outback GP Training Program 1. Get to know your first preference RTP – understand the region in which they operate and the benefits of training with them.

2. Sign up to the Going Places Network – it’s a great opportunity to learn more about general practice training and provides invaluable tips on the application process at ‘how to apply’ dinners.

3. Understand exactly why you want to join the training program and what you can offer the communities in which you will practise. Then articulate this clearly during the application process.

General Practice Training Queensland 1. Think about patients and their care before and after their hospital admission, and ask patients about these experiences.

2. Prepare yourself to show honesty and humility in the nervous environment of Multi-Mini Interview (MMI) stations.

3. Have a good night’s rest prior to the interviews; tiredness can come across as apathy.

General Practice Training Tasmania 1. Take part in the Prevocational General Practice Placements Program (PGPPP) to get real life experience in general practice, hands-on opportunities including procedural skills and supervision and mentoring by experienced GP supervisors.

2. Find out what common illnesses GPs see. This will help with the MMI and Situational Judgement Test (SJT).

3. Be strong with communications.

General Practice Training – Valley to Coast 1. Do a PGPPP term.

2. Speak to GP registrars about their experiences.

3. Learn what general practice is really about by chatting to an experienced GP and reading broadly.

Southern GP Training 1. Be very organised. Read all information thoroughly.

2. Meet all the required activities and outcomes that the RTP of your choice specifies in a timely fashion.

3. Be enthusiastic, dedicated and prepared to be flexible.

Tropical Medical Training 1. Ask yourself why you want to be a GP – make sure you are clear in your own mind about your motivation for becoming a GP. 2. Take positive action on your interest in general practice – take part in general practice activities and find out about current issues, talk to as many GPs as you can.

3. In your current role try to practise holistic patient centred medicine – if you are not sure how to do this see Tip 2 (ask a GP).

Victorian Metropolitan Alliance 1. Be organised – start early, check out the paperwork needed, collect all your feedback forms, know what is involved in the process.

2. Get a variety of experiences – if unsure about applying, a PGPPP is a great idea. If you’re certain, then do a range of hospital posts that will be relevant to general practice and help build your skillset and knowledge.

3. Do your research – talk to others such as RTP staff and GP registrars, look at the fellowship options, explore what you can do in the program and find out what general practice is all about.

Western Australian General Practice Education and Training 1. Attend a general practice hospital information session to learn about the program, application process and what it’s like to be GP registrar.

2. Read the AGPT Applicant Guide several times and make use of the MMI and SJT practise questions.

3. Remember that the MMI is an interview, so brush-up on your interview skills and consider practising with a friend or colleague.

WentWest 1. Show a genuine enthusiasm for general practice training and future general practice.

1. Ensure you have the correct dates for the application process and the required documentation ready.

2. Obtain some experience in general practice as a junior doctor.

Many hospitals offer the PGPPP, which allows general practice exposure with plenty of supervision and support. It’s a great way to learn about the challenges and highlights of general practice.

2. Research the RTPs to find out who has the best-fit training program for you.

3. Ensure you have the relevant paediatric experience for general practice training.

Queensland Rural Medical Education

3. Get feedback from registrars who sat the process last year.

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Is general practice the specialty you have been looking for?

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Join the Going Places Network today and find out more about general practice.

• More than 3500 junior doctors have already joined us • Network with experienced GPs and meet other peers interested in becoming a GP

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• Attend free networking and educational lunches and dinners • Access free tools and resources • Get key information from your local GP ambassador in your hospital

gpaustralia.org.au Online support for junior doctors interested in general practice

Taking a fresh look at general practice 23

Going Places Network

Update

The Going Places Network ambassadors who have volunteered to work with us to promote general practice within goes from strength-totheir hospitals. It’s great that you are able to make the time to fulfil this role; we hope you strength and now boasts find it rewarding. over 3500 members. After a flying start to the year, QLD 2014 looks set to be even In January, Queensland ambassadors and GPN coordinators were invited to meet bigger than 2013! Check interns from 12 training hospitals. It was out what’s going on in your heartening to see how many young doctors are interested and positive about a career in state. Not a member? Join general practice. As one MEO commented, us now and get a head start “Our brightest doctors are considering general practice nowadays!” Of course they to your GP career. are – general practice is a specialty that NSW/ACT With new ambassadors and a new coordinator due on board soon, interns and RMOs in NSW can expect to attend some great events this year. Keep your eyes and ears open for details throughout the year.

Are you applying to the AGPT program in 2014? Doctors keep asking us about that “great little proforma” for planning stories for the Multiple Mini Interview (MMI). The proforma was created and shared by former GPN ambassador, Dr Kerry Summerscales.

Remember – it’s a tool that may assist in jogging your memory on the day and doesn’t replace your own common sense and experience when given the question for the MMI. How does it work? Criteria across the top; your own examples down the side; tick the corresponding criteria that the story most reflects. Get the proforma at gpaustralia.org.au/news/applying-agpt-yearheres-great-tip

VIC/TAS Victoria and Tasmania both had busy starts to the year with lots of orientation sessions and 66 new members joining the network.

Welcome to all those new members – we look forward to bringing you news and views, events and publications throughout the year. We’d also like to extend a very warm welcome and thank you to the 10 new

24

throughout the year. Topics include dermatology, joint injections and how to apply to GP training. Keep an eye out or ask your hospital GP ambassador about these outstanding events.

provides variety, flexibility and a chance to really get to know your patients.

In February, the new ambassadors had a planning day to nut out events for 2014.

The hot topics for 2104 are: Variety and life of a GP; Academic and special interest options in general practice; Hands-on GP experiences; Why go rural? Also in 2014, will be the very popular, AGPT selection process. Details of events can be found at gpaustralia.org.au or follow us at facebook.com/goingplacesnetwork

Of course, it wasn’t all just talk – participants got to know the speakers and each other better over the wine tastings and local artisan food stops. It could be easy to get used to this sort of life!

SA/NT SA and NT kicked off the year with a series of intern orientation sessions. It was great for the new interns to have a chance to meet their hospital ambassadors. Judging by the numbers of new members it is fair to say that general practice really is becoming the specialty of choice.

All new members from SA went into the draw to win a new stethoscope.

Congratulations to Caitlin Sum. We hope you enjoy this great prize.

The SA network will be presenting a number of dinner and workshop events

WA We are excited to welcome two new GP ambassadors, Dr Cory Lei at Joondalup Health Campus and Dr Beverly Teh at Fremantle Hospital. Cory is an AGPT registrar currently undertaking his extended skills in emergency medicine and Beverly has just started her PGY2 and plans to apply for GP training later this year.

We are pleased to confirm that Dr Kevin Fontana and Dr Elyne Fontana will stay on as ambassadors while they complete their hospital training time at Sir Charles Gairdner Hospital before embarking on their rural general practice journey next year.

The WA ambassadors are looking forward to another exciting year ahead and are already busy planning the first event for 2014.

If you are interested in becoming a GP ambassador we are currently looking for a new ambassador for Royal Perth Hospital.

If you are interested, please email royalperthgp@gpra.org.au

Going Places Network

GP AMBASSADORS

NSW John Hunter Hospital Gosford Hospital Bankstown Hospital Royal North Shore Hospital Westmead Hospital Royal Prince Alfred Hospital St George Hospital The Canberra Hospital Hornsby Hospital Network Tamworth Hospital Wollongong Hospital

Contact johnhuntergp@gpra.org.au gosfordgp@gpra.org.au bankstowngp@gpra.org.au royalnorthshoregp@gpra.org.au westmeadgp@gpra.org.au royalprincealfredgp@gpra.org.au stgeorgegp@gpra.org.au canberragp@gpra.org.au hornsbygp@gpra.org.au tamworthgp@gpra.org.au wollongonggp@gpra.org.au

QLD Cairns Base Hospital Gold Coast Hospital Logan Hospital Mackay Base Hospital Nambour Hospital Princess Alexandra Hospital Redcliffe Hospital Rockhampton Hospital Toowoomba Hospital Townsville Hospital

cairnsgp@gpra.org.au goldcoastgp@gpra.org.au logangp@gpra.org.au mackaygp@gpra.org.au nambourgp@gpra.org.au princessalexandragp@gpra.org.au redcliffegp@gpra.org.au rockhamptongp@gpra.org.au toowoombagp@gpra.org.au townsvillegp@gpra.org.au

SA and NT Flinders Medical Centre Lyell McEwin Hospital Modbury Hospital Royal Adelaide Hospital The Queen Elizabeth Hospital Royal Darwin Hospital

flindersgp@gpra.org.au lyellmcewingp@gpra.org.au modburygp@gpra.org.au royaladelaidegp@gpra.org.au queenelizabethgp@gpra.org.au darwingp@gpra.org.au

VIC Eastern Health Shepparton Hospital St Vincent’s Hospital Austin Hospital Ballarat Hospital Geelong Hospital Northern Health Southern Health Western Health

boxhillgp@gpra.org.au sheppartongp@gpra.org.au stvincentsgp@gpra.org.au austingp@gpra.org.au ballaratgp@gpra.org.au geelonggp@gpra.org.au northernhealth@gpra.org.au southernhealthgp@gpra.org.au westerngp@gpra.org.au

Want to get involved?

Going Places Network GP Ambassadors are junior doctors who have a real passion for general practice.

To find out more about becoming a GP ambassador, email goingplaces@gpra.org.au

TAS Royal Hobart Hospital Launceston Hospital

royalhobartgp@gpra.org.au launcestongp@gpra.org.au

WA Royal Perth Hospital Sir Charles Gairdner Hospital Fremantle Hospital Joondalup Health Campus

royalperthgp@gpra.org.au charlesgairdnerGP@gpra.org.au fremantlegp@gpra.org.au joondalupgp@gpra.org.au

With you on your journey

25

General Practice Students Network Update

Council meeting and #fgp14 wrap On 5 March, GPSN members from all over the country came together at GPRA’s Future of General Practice (#fgp14) conference – held at Parliament House in Canberra – to discuss health-related issues and how to help shape the future of general practice in Australia. The conference was a massive success, and our members had a great time interacting with some of the most influential figures in general practice.

I had a great time meeting all of our university club representatives and am excited about GPSN’s future. During the GPSN council meeting, student delegates heard from all 10 national executive portfolio holders, and were hopefully motivated to drive the organisation to new highs in 2014. In the midst of study and exams, I hope the students can remember the end goal and the importance of delivering quality primary healthcare. Thanks must be given to GPRA staff and our amazing national events officer, Jessica Deitch, for all the hard work that was put in behind the scenes to help make the conference such a great success.

If you have any questions about the working groups, or would like to recommend projects for consideration, please email Amer Mitchelle at wgo@gpsn.org.au Amer Mitchelle, Working Group Officer

Around the clubs GPSN clubs around the country have already hosted 30 events to educate and inspire medical students to pursue a career in general practice. Events have covered topics such as Indigenous and rural health, and clinical skills and orientation activities designed to promote the student network around university campuses.

In 2014, GPSN secured 1000 new student members following the success of the network’s annual membership drive. This year, every student club gave away a Kogan espresso coffee machine to one lucky member who joined the network or updated their details in 2014.

The promotion was a huge success and praised by medical students around universities.

Rajdeep Ubeja, National Promotions and Publications Officer

GPSN working groups GPSN working groups were set up in April 2013 to develop national initiatives that tackle important issues facing medical students. The aim of the groups is to provide experience and a pathway for students wishing to pursue further roles in policy making, research and public health, as well as increasing the productivity of GPSN at a national level.

There are currently four groups, comprised of medical students from across the country, focusing on the following areas: rural, close the gap, community, and policies and procedures. In response to needs identified by local clubs, working groups undertake consultation and research in order to effectively address these needs. They then develop projects, strategies or events, and feed these back into the clubs for implementation. This year there will also be a focus on integrating research with the aim of publishing significant findings.

I would like to congratulate the new working group chairs for 2014: Helena Chan (CTG), Claire Chandler (Rural) and Raj Ubeja (Policy).

Community working group chair voting is currently underway.

With the framework in place and the teething issues out of the way, the working groups have a clear path towards completing valuable, sustainable projects.

GPSN Above and Beyond Award University of Melbourne GPSN club chair, Sophie Dunn, has been awarded the prestigious Above and Beyond Award in recognition of her assistance, energy and enthusiasm in spreading the word on general practice and support for others in the network.

Sophie was acknowledged for her hard work and dedication to her GPSN club at the #fgp14 welcome function, held at Canberra’s Park Hyatt Hotel.

Sophie, who is in her third year of involvement with GPSN, said she was honoured to receive the award. She has previously held the roles of year representative and inaugural joint events coordinator, as well as pioneering multiple events, including a joint rural event involving other medical student societies.

Sophie has displayed exceptional organisational skills and has been a great asset to the network. Congratulations Sophie!

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General Practice Students Network chairs

NATIONAL COMMITTEE University University of Melbourne Griffith University University of Melbourne Notre Dame Fremantle Monash University University of Notre Dame Sydney Notre Dame Fremantle University of Western Sydney University of Western Sydney Monash University

Position National Chair National Vice Chair National Secretary Working Group Officer National Events Officer Internal Communications Officer Sponsorship Officer Local Events Officer Promotions and Publications Officer Online Officer

Name Joesph Monteith Nicola Campbell Danielle Todd Amer Mitchelle Jessica Deitch Emma Thompson Anmol Khanna Likhitha Sudini Rajdeep Ubeja Emily Jenkins

Contact chair@gpsn.org.au vc@gpsn.org.au ns@gpsn.org.au wgo@gpsn.org.au neo@gpsn.org.au ico@gpsn.org.au sponsorship@gpsn.org.au leo@gpsn.org.au publications@gpsn.org.au media@gpsn.org.au

Name Yvonne Nguyen Jarrod Bradley Emma Gordon Aaron Chu Natalie Campbell Hayley Morgan Sofia Dominguez Jenny Chen

Contact undsyd@gpsn.org.au westsyd@gpsn.org.au newengland@gpsn.org.au unsw@gpsn.org.au wollongong@gpsn.org.au newcastle@gpsn.org.au undsyd@gpsn.org.au anu@gpsn.org.au

UNIVERSITY CLUB CHAIRS NSW and ACT University of Sydney University of Western Sydney University of New England University of New South Wales University of Wollongong University of Newcastle University of Notre Dame Sydney Australian National University

SA and NT

Flinders University Shauna Madigan flinders@gpsn.org.au University of Adelaide Christopher Le adelaide@gpsn.org.au

Jennifer Dang adelaide@gpsn.org.au Northern Territory Medical Program (Flinders University) Harley Stratton ntmp@gpsn.org.au VIC Deakin University Alex Drucker deakin@gpsn.org.au Monash University Amanda Tan monash@gpsn.org.au University of Melbourne Sophie Dunn umelb@gpsn.org.au TAS University of Tasmania Saranga Jinadasa utas@gpsn.org.au

Caitlin Cannan utas@gpsn.org.au WA University of Western Australia Erin Bock uwa@gpsn.org.au University of Notre Dame Fremantle Emma Price notredame@gpsn.org.au QLD Bond University Frank Dorrian bond@gpsn.org.au

Chloe Tyson bond@gpsn.org.au James Cook University Lawrence Ling jcu@gpsn.org.au University of Queensland Johnson Huang uq@gpsn.org.au Griffith University Jenna Weetman griffith@gpsn.org.au

With you on your journey

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If you are interested in general practice, or just considering your options, GPSN is a great way to kick start your career.

•

Free networking events — meet others who share an interest in general practice.

• • • •

Free professional development events – attend student-focused general practice seminars, workshops and skills sessions Regular e-news and other resources providing all the latest on all things GP Free publications – GP First guide to general practice, GP Journey magazine and GP Companion – a handy pocket reference for GP rotations Opportunity to apply for a GPSN First Wave Scholarship and a chance to win some great prizes and places at conferences

Join online today – it’s free

Contact your university club GPSN chair

gpsn.org.au

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Online support for medical students interested in general practice

It takes Dr Meg McKeown is an ACRRM registrar working with the Australian Antarctic Division’s Polar Medicine Unit.

Dr Jeff Ayton is Chief Medical Officer at the unit and Meg’s supervisor.

Meg:

I didn’t realise that the type of doctor I wanted

to be fitted into the role of a GP. But I did a John

Flynn placement at uni and discovered that ACRRM suited all my professional desires because it was so flexible and catered to the remote setting. I wanted to be able to work remotely and be comfortable looking after a community, including emergency situations.

Jeff is my supervisor at the AAD, where I am also training to do a 12-month term on Macquarie Island. In preparation I’ve had my appendix removed and been to dental, physiotherapy, neurosurgical, general surgery and anaesthetic training sessions to improve my skills in the areas required for a lengthy remote deployment.

Jeff has been a superb supervisor. He is contactable by email, text message and when the need arises, satellite phone 24 hours a day 7 days a week. This is no doubt exhausting, but I have never heard him complain about this availability. He also gets involved in GP training at different levels from ACRRM down to GPTT so he is a wealth of information.

Anyone who has worked with Jeff would admire his ability to know what everyone is doing, even though there are often 10–12 doctors in up to eight locations. He is also very good at pre-empting problems and is quite intuitive when it comes to our personal wellbeing; he knows when to ask if we are doing okay. Jeff has great enthusiasm for promoting the role of the remote doctor in Australia and is a great role model to a whole generation of doctors.

As a GP, I think it’s important to offer your patients patience and the ability to listen, but you also need to offer availability and time.

As a remote GP, I want to be able to manage complex medical problems for patients in their own hometown rather than sending them away for management or procedures. I want to do as much as I can myself. I see a great role for telemedicine to enable this type of practice and the chance to live on Macquarie Island for 12 months will give me the chance to experience this.

In 5–10 years, I hope to be working remotely and staying closely networked with other remote doctors. And I will still be studying … there is always so much to learn.

Do you know a pair who could feature in a future It takes 2?

A GP and a patient? A practice manager and a registrar?

Your mentor? A GP who inspired you? Let the team know by emailing goingplaces@gpra.org.au

Jeff:

I graduated from the University of Melbourne in 1987 and undertook general practice training in

regional and rural Victoria – Geelong, the Bellarine Peninsula and Lorne, with a stint in Antarctica wintering at Casey Station in 1992.

I chose a career in general practice because I wanted to provide comprehensive whole-of-life care to my patients without giving up the aspects of healthcare, such as procedural and emergency skills, that I enjoyed. As a result, I have worked as a GP obstetrician and GP anaesthetist in rural and remote settings that have included Apollo Bay, Norfolk Island and Papua New Guinea.

24/7 support and supervision by the Polar Medicine Unit of AAD registrars is core to the success of Australia’s Antarctic program, given the reliance on telemedicine and working in some of the most isolated and extreme environments on earth. I have been supervising registrars and junior doctors at the AAD since 2002.

The ability to train and support colleagues and provide remote and extreme medicine has been satisfying and challenging, both professionally and medically.

If I had to describe Meg in five words I would say she is resilient, resourceful, rigorous, respectful and a registrar! As Meg trained as a veterinarian prior to medicine, she has the ability to apply and adapt relevant skills across the disciplines, including diagnostic and therapeutic processes, and she brings with this an enthusiasm to learn and rise to both the challenges and the benefits of working in remote and extreme environments.

The ability to practice generalist medicine across whole-of-life care without giving up aspects of medicine such as procedural and emergency skills is one of the biggest career benefits of general practice. On a personal level, working at the frontiers of medicine, including e-health and telehealth strategies and research, and the ability to influence and improve both individual and population health outcomes for rural and remote patients, provides me with enormous work satisfaction.

My advice to junior doctors wanting to be a GP would be to maintain the broadest scope of training and generalist practice, and don’t give in to pressure to give up aspects of medicine that you enjoy because of training or health system barriers. This is especially important if you wish to work in the rural or remote setting. At the end of the day, the single most important quality that GPs can offer to their patients is compassion, safety and quality of medical care whilst meeting their needs, and this can be achieved no matter where you choose to practice.

With you on your journey 29

G P profile

From clinic to campus

“I got this sense that there was this creature called an academic GP.�

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As an academic GP, Dr Brett Montgomery divides his time between seeing patients in the community and teaching medical students on the campus of the University of Western Australia. He finds that each job complements the other to create a richer whole.

Leading a double life is a daily routine for Dr Brett Montgomery.

Identity number one: the friendly neighbourhood GP seeing patients at a family practice in East Fremantle. Identity number two: the dedicated university professor educating fifth-year medical students in general practice at the University of Western Australia.

Such alternating roles form the work pattern for many academic GPs – and Brett enjoys the way the two inform each other, enhance each other and invigorate his working week.

“The balance that it [academic general practice] gives me between the quintessential work of medicine – seeing patients – and the academic side of medicine helps to recharge my batteries for my clinical work,” Brett says.

“I enjoy the students’ enthusiasm and eagerness to learn. It keeps me challenged and up-to-date. And when it’s going well, it makes me feel I’m making a positive difference to future doctors. ”On the other hand, seeing patients keeps me in touch with the complexities of clinical practice.”

So what originally steered Brett towards medicine, and specifically academic general practice? “I always wanted to do medicine from a very young age,” Brett says. “My earliest memories of this impulse are of thinking: It’s really interesting how the body works. I remember as a kid looking through the pages of an encyclopaedia that showed pictures of the body. It had these little folding cellophane overlay things and you’d sort of peel back the different layers of organs.

It was fascinating.”

After growing up in suburban Perth, Brett entered medical school at UWA and weighed up a number of career paths during his training.

“I was tempted by psychiatry, and tempted by paediatrics, but eventually general practice won me over. I was interested in too many things, and you get a bit of everything in GP land. It’s not just about the variety; it’s also about knowing my patients over time and taking a whole-person perspective on things,” Brett says.

His interest in teaching and research – an ideal milieu for his “sceptical, enquiring frame of mind” – came later.

“I don’t think I’d made the link between general practice, academic work and being an academic GP until early in my GP training,” Brett says. “There was something called the Registrar Research Workshop run by GPET (General Practice Education and Training), and that was quite inspiring. There were several GPs there actively involved in research, and they helped us work up a mock research idea. And I got this sense that there was this creature called an academic GP.” As part of his general practice registrar training, Brett opted to do a term as an academic registrar at UWA. It involved teaching medical students – a similar job to the one he holds now as an associate professor – as well as his first taste of a real research project. Later he took on a part-time job as the Registrar Research and Development

Opposite page: Brett the academic at the University of Western Australia This page: Brett the GP with a young patient Officer at GPET, which nurtured Brett’s growing interest in research and evidence-based medicine (EBM).

Since being fellowed in 2006, Brett has completed several research projects including a thesis for a Master of Medical Science which explored statin prescribing by GPs in Australia and Ireland.

The qualitative research involved interviews with GPs across both countries.

Brett was able to conduct the Irish interviews while working as a locum there. It was part of an extended overseas adventure for Brett and his wife Melanie. “I was able to get a non-tourist experience by working as a doctor in another country, but we had plenty of time off to travel around Europe,” he says, looking back on the experience fondly.

There have been other recurring themes in Brett’s research work, such as the effects of pharmaceutical company marketing on GPs’ prescribing patterns and the application of EBM in general practice.

The research side of Brett’s work has recently been put on hold due to the time pressures of having two demanding half-time jobs and a young family. But his passion for evidence-based medicine is undiminished, and he has been instrumental in setting up an EBM journal club for GPs across Perth.

Brett explains that this EBM journal club for GPs has a different slant to typical journal clubs. “In a traditional journal club, people will scan the latest prominent journals and go: What’s interesting here?

They’re depending on publication in a big journal and then select stuff of interest from that.

“In our EBM journal club, we start by saying: What’s my question?

What am I curious about? Then the person who is really interested in that question will search for the best papers – either free online or we get the RACGP library to send an electronic copy. Then we read it, discuss it, and ask: How is this going to change what I do in my room with my patients?”

If Brett had to choose between seeing patients and teaching, which way would he go? Now that’s a really curly question.

“Seeing patients allows me to appreciate the real-life challenges of general practice, reminding me of the gap between theory and practice. It’s what I first wanted to do in medicine. And I’m often taught a lot by patients who I see surviving in the face of adversity – whether that’s adverse health situations, or adverse social or economic situations. It reminds me of how privileged I am, and that I shouldn’t take things for granted.”

But Brett gets immense satisfaction from teaching as well. He jokes that perhaps he has inherited the “teaching gene” from his father, who was a tertiary-level teacher in another field.

“When I’m teaching and I see students understand something – there’s that sort of light bulb moment when something clicks – I just find it intrinsically rewarding to help switch that light bulb on,” he concludes.

Written by Jan Walker

With you on your journey 31

G P profile

Owning it For Dr Alexandra Smith, buying into a practice before she turned 30 was an ambitious step, but it is now allowing her to take direction of her general practice journey.

Image courtesy of RACGP

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“We felt that by forming the partnership we’d be able to better dictate our own terms and conditions and give ourselves the working environment we wanted to work in.”

Twelve months ago, things were ticking along nicely for new GP, Dr Alexandra Smith.

She had spent the previous two years completing her registrar training and working at the Huon Valley Health Centre in Huonville, a riverside town of around 8000 people located about 40 km south of Hobart.

She was enjoying the centre’s patient mix and working with the centre’s six other doctors.

Outside work, Alex and her husband Aaron, who live in Hobart, took opportunities to kayak along the Huon River and spend time with their dog, Marlin. After years of study and shift work in her prevocational years at the Royal Hobart Hospital, Alex was realising the work and lifestyle benefits of being a GP. But things were about to step up a gear, or two. Just after she had gained her RACGP fellowship, Alex was given the chance to make the transition from practice employee to practice part owner.

The sole owner GP of the Huon Valley practice was retiring and Alex’s colleagues were forming a partnership to take over the practice. They approached Alex to become a partner. It was a huge decision, but the opportunity to make her workplace her business and to have more say in her career was too good to refuse.

“A lot of general practices in Tasmania were being bought by larger corporations, by which case the GPs kind of become an employee almost,” Alex tells GP Journey. “We felt that by forming the partnership we’d be able to better dictate our own terms and conditions and give ourselves the working environment we wanted to work in.”

As well as being able to work for herself, the move was aligned with Alex’s other professional and personal interests, including her intent as a Tasmanian local to stay in the area. “I really liked the practice and the patient population,” Alex explains. “I didn’t have any desire to move around a lot.”

Alex continued exploring general practice while at university.

“In our fourth year we did advanced studies ... which was basically a six-month block of training where you organised your own placements anywhere in the world,” Alex explains. “So I did a couple of general practice placements in Tasmania and went to the Solomon Islands and had some hospital experience as well.”

When asked about the moments that she realises general practice was the right choice for her, Alex answers: “Probably when I get to lunchtime and I say to myself, so far I’ve done some antenatal care, managed someone’s diabetes, removed a skin lesion and done some counselling. And that’s just the morning!”

And the more challenging days? “Sometimes it’s just the mental fatigue you get from talking to 30 – 40 people a day and hearing their stories,” she says.

This is where being part of a team – with both colleagues and business partners – provides important debriefing opportunities.

“At our practice we have a weekly clinical meeting and talk about cases and share knowledge,” she says. “General practice can be quite lonely if you are in an office by yourself. It’s important to get together and have a chat and talk about difficult cases.”

“But while not every consult involves a long and involved story, to provide good care to people you need to sit and listen to their stories and hear who they are and what is impacting on them,” Alex adds.

“The crux of general practice is forming one-on-one relationships or even relationships with whole families. It’s all about treating the person’s whole life.”

Alex also notes that a GP’s ability to form these relationships plays a key role in them making a positive contribution, which she believes is sometimes underrated, to their local community.

Alex is enthusiastic about the step, but knows she has taken a lot on.

“It is a big commitment buying a business,” she says. She then adds with a laugh: “Sometimes I think it was a bit more of a commitment than I thought it would be!”

“I really love having an effect at a grassroots level,” she says. “I think that’s where the biggest impact can be made … if we can impact on an individual person’s life I think we can have the potential to impact on the community.”

Alex works as a GP three and a half days a week and dedicates the remaining days to the business. “I’m also the managing director so I’m doing a lot of the administration work, which involves mostly liaising with the practice manager,” Alex says. “We decided as a group that instead of the practice manager having to discuss small decisions with all of us, it would be easier to work with just one of us.”

So, what’s the next step for a young doctor who has already bought into a practice? “We’re planning to renovate and expand the practice and add on some consultation rooms – so I’ll be working there to pay that off!” Alex jokes.

Working out how to do her best as a GP and as a business owner is a constant learning curve. “I really try and keep the two separate,” she says. “But it is sometimes hard to separate being a doctor and being a business owner … at the end of the day you need to pay all the staff and make decisions that are in the best interests of the practice.”

General practice was on the radar relatively early during Alex’s medical journey. She had started medical school at the University of Tasmania with the intent to become a forensic pathologist. However, a rural general practice placement in her third year at a town called Nubeena in southeastern Tasmania set her on a new path.

“I really liked the range of work the GPs did,” she recalls. “One GP was doing a variety of things, including acupuncture, antenatal care and paediatrics ... I think the variety was helped because of the rural setting. It was just the whole unknown of what was going to walk through the door next.”

“It’s all about consolidating the business and learning the business side of things, trying to grow the business, while maintaining our patient focus.”

A focus on patients should be at the heart of anyone considering the specialty, she says. “People often choose general practice because it’s the default or because they can’t think of anything else to do … but there’s actually a fine art to getting it right.”

For now, Alex is also trying to re-establish the right balance between being a business owner, a doctor and a 30-year-old, but admits this may take a while.

“At the moment I’m quite busy with the business stuff, but before then it was definitely a great lifestyle!” Alex jokes. “I don’t want to put anyone off buying a practice, but it is a big responsibility. It’s not for everyone but it certainly adds another interesting dimension to the variety of general practice.”

Written by Laura McGeoch

Taking a fresh look general practice 29 With youaton your journey 33

C linical cases

Rectal bleeding in pregnancy: Don’t assume it’s benign © zephyr zephyr/getty images

A pregnant woman presents with intermittent rectal bleeding.

What could be the cause, what are the appropriate investigations and when should these investigations be carried out?

also contribute to constipation and may need to be ceased if the constipation is severe.

Anal fissures tend to be accompanied by marked pain (as opposed to haemorrhoids that are usually painless) and generally result from straining. When haemorrhoids are painful a degree of prolapse, thrombosis or strangulation may be present.

A number of factors are associated with the development of haemorrhoids during pregnancy. These include: • mechanical compression of veins because of the enlarging uterus • straining as a result of worsening constipation, and

CASE SCENARIO Angela, a 28-year-old woman who is 14 weeks pregnant, presents to her GP with a two-month history of intermittent rectal bleeding.

Over this period, she has been passing bright blood on to her toilet paper, and at times into the toilet bowl. In addition, her stools are looser than in the past and she reports occasional urgency. There has been no abdominal pain or weight loss. Her general health is good and she is not taking any regular medications. There is no relevant family history.

Does Angela require investigation at this stage or can this be deferred until after her baby is born?

COMMENTARY Possible causes Rectal bleeding at any time requires consideration of the underlying cause (see Table for a list of possible causes). The passage of bright blood suggests a source in the rectum or sigmoid. Minor rectal bleeding as a result of small tears, fissures or haemorrhoids is not uncommon during pregnancy as constipation develops at some stage in up to 40% of pregnant women.1 In most cases, constipation responds to an increase in dietary fibre and fluid intake. Iron supplements may

• hormone-related vascular changes.2 In Angela’s case, her stools have been softer and her urgency raises the question of rectal pathology.

Although infectious forms of gastroenteritis can cause bloody diarrhoea, this is unlikely in Angela’s case, particularly given the duration of her symptoms and the intermittent nature of her rectal bleeding. A rapid onset of symptoms, particularly in the presence of nausea, vomiting, abdominal pain and fever does, however, raise the possibility of an infectious cause. In such instances, stool microscopy and culture should be requested. It is important to remember that parasitic infections such as giardia do not cause rectal bleeding.

Inflammatory bowel disease (eg. ulcerative proctitis) can occur for the first time during pregnancy, especially in the first trimester and Angela’s symptoms are in keeping with this.3 Apart from urgency, mucus may be passed, as well as blood and the stool volume is generally small in such cases. Specific questioning about extra intestinal manifestations is sometimes of help – for example, peripheral arthritis, low back pain, red eyes (episcleritis, uveitis), erythema nodosum and aphthous ulcers. There may also be a family history of inflammatory bowel disease.4

This article originally appeared in Medicine Today 2012;13(6):73–74 and is reprinted here with permission.

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CAUSES OF RECTAL BLEEDING IN PREGNANCY Common

• Haemorrhoids • Rears and fissures

Uncommon

• Infectious colitis • Inflammatory bowel disease • Diverticular disease • Colorectal malignancy/polyps • Ischaemic colitis Figure. An example of rectal cancer viewed at sigmoidoscopy

Given Angela’s age, a rectal or distal colonic malignancy or polyp, diverticular disease or ischaemic colitis are much less likely. In addition, ischaemic colitis generally occurs in the context of significant vascular disease or atrial fibrillation. However, these conditions need to be considered in the differential diagnoses, although rectal bleeding from more proximal malignant lesions tends to be dark in colour and diverticular bleeding usually is profuse.

Investigations Gentle digital examination of the rectum with careful inspection of the perianal area should be performed at the time of consultation.

Initial investigations should include a full blood count, but anaemia is not unusual in pregnancy. There is absolutely no point in faecal occult blood testing as this is only of potential benefit in asymptomatic individuals.

The next investigation should be direct visualisation by flexible sigmoidoscopy after an enema to evacuate the rectum and sigmoid.

In the first trimester, it is best to avoid sedation with midazolam and propofol. Flexible sigmoidoscopy without sedation is generally well tolerated and allows the mucosa to be inspected and biopsies to be taken.5 If these tests fail to provide the answer as to the cause of Angela’s rectal bleeding, she should be monitored. If her bleeding persists, full colonoscopy will need to be considered, although if possible this should be deferred until after her baby is born. However, if necessary before then, it can be safely performed, especially in the later stages of pregnancy.

CASE OUTCOME In Angela’s case, flexible sigmoidoscopy was performed and sadly revealed a rectal cancer (see Figure). Although rectal bleeding is not uncommon in pregnancy, this case highlights the need to investigate appropriately. However, in the vast majority of cases the cause will be benign.

Author Christopher S Pokorny MBBS, FRACP, FRCP, FACG, is Conjoint Associate Professor of Medicine, University of New South Wales; and Visiting Gastroenterologist, Sydney and Liverpool Hospitals, Sydney, New South Wales.

Competing interests: None.

References 1. Anderson AS. Dietary factors in the aetiology and treatment of constipation during pregnancy. Br J Obstet Gynaecol 1986;93:2452.

2. Avsar AF, Keskin HL. Haemorrhoids during pregnancy. J Obstet Gynaecol 2010;30:231–237.

3. Korelitz BI. Pregnancy, fertility and inflammatory bowel disease in pregnancy. Am J Gastroenterol 1985;80:365.

4. Hanauer SB. Inflammatory bowel disease. N Engl J Med 1996;334:841–848.

5. Cappell MS. Sedation and analgesia for gastro­intestinal endoscopy during pregnancy. Gastrointest Endosc Clin N Am 2006;16:131.

Medicine Today provides GP Journey with selected articles from its archive of peer reviewed clinical content.

To view the full archive, visit Medicine Today’s website at www.medicinetoday.com.au or download the new Medicine Today for iPad, available from the App Store at https://itunes.apple.com/app/id666623264 Registration is free to all members of GPRA, GPSN and GPN.

With you on your journey

35

Clinical

CORNER

Clinical Corner case studies and tips for treating patients are provided courtesy of Medical Observer. The following case studies are by Dr Ian McColl.

Field treatment of solar damage

In Australia we are seeing more and more elderly patients with diffuse solar damage.

Most of the damage shown in this image is solar keratosis type rather than full thickness SCC in situ, but it is difficult to be certain.

Freezing multiple lesions like this is not realistic

to clear the damage, much of which may

still be subclinical in the apparently normal

looking skin. Consider a field treatment such as fluorouracil cream, imiquimod cream, photodynamic therapy (PDT) or radiotherapy.

epidermolysis bullosa simplex, a genetic disease with a defect in the proteins that hold the epidermis and dermis together.

Generally you would expect one of the parents to have the condition, as it is an autosomal dominant disorder. Treatment involves avoiding trauma and sweating.

For more images, see medicalobserver.com.au/clinical-review/ dermatology

Clue to this condition is in the nails This man was thought to have bilateral cellulitis because of the ascending red areas with a sharp upper edge on both calves.

The latter is especially effective on men with bald scalps because it causes permanent hair loss. Fluorouracil is cheap, but gives poorer long term clearing than imiquimod. PDT is expensive and painful compared to the others, but gives good longer term clearing. Regular sunscreen use is imperative.

For more images, see medicalobserver.com.au/clinical-review dermatology

Blistering conditions

Blisters on the hands and feet of an infant are not expected.

Small vesicles might be a result of hand, foot and mouth disease, a viral infection, or vesicles and pustules might be seen in an infant with scabies.

However, these were larger blisters rather than vesicles, occurring on a non-inflammatory base and healing without scarring. This is likely to be the Weber-Cockayne variant of

He had some oedema from cardiac failure, which added to the impression. However, the clue to the correct diagnosis is in the thick great toenail, which suggests a subungual tinea infection.

The rash on both lower limbs was a gross tinea infection of the skin and nails slowly moving up his legs. It is unusual to see this condition so symmetrically.

Skin and nail scrapings were taken for KOH microscopy and culture and he was started on oral terbinafine 250 mg daily for three months to clear the nail infection. The skin should clear after about a month of therapy.

For more images, see medicalobserver.com.au/clinical-review/ dermatology

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Future of General Practice 2014 Conference Review

6

Opposite page: The Hon Peter Dutton speaking at the conference From left: Passionate discussions during the Indigenous health and wellbeing panel Michael West presenting a message stick from Aboriginal and Torres Strait Islander peoples to the conference Dr Liz Marles getting involved in the discussing of ideas for transformations in the general practice training program More than 200 medical students, prevocational doctors, GP registrars and leaders of general practice converged at The Great Hall at Parliament House in Canberra on 6 March to join the discussion and to share ideas and investigate new ways to support the next generation of Australia’s GPs. The event kicked off with an address from the Minister for Health, The Hon Peter Dutton, who praised GPRA for continuing to look for innovative ways to improve the quality of Australia’s healthcare by ensuring high standards of education and training are delivered across the country.

He also highlighted the importance of the conference theme – Transforming Communities – and commended GPRA for adding the role of technology to the agenda.

“New technology and social media have been transformative forces in modern Australia, touching virtually every aspect of our daily lives,” he said.

“The many new young registrars we have coming through will be the GPs of the future in communities throughout our country and are high users of online technology, both personally and, increasingly, professionally.

“You are part of a new generation of physicians who use online technology and social media tools that will greatly influence professional lives.”

During his address, Mr Dutton also flagged an overhaul of the nation’s health system, vowing to transform the current 1980s model into an “effective and efficient system of health that delivers to all Australians”.

He highlighted Australia’s ageing population, the rising cost of new technology, dementia and obesity as some of the health system’s “pressure points”.

“To reduce the impact we have to improve efficiency, reduce duplication and red tape and continue to build a highly skilled health workforce,” he said.

Mr Dutton also declared he was committed to rebuilding general practice and putting GPs back at the centre of the healthcare system.

“Now more than ever the role of the GP is evolving and patients’ health needs are becoming increasingly complex as our population ages,” he said.

An Indigenous health and wellbeing panel to discuss ways to close the gap in health outcomes for Aboriginal and Torres Strait Islander peoples followed Mr Dutton’s address.

Led by television journalist Jenny Brockie, the panel comprised the National Aboriginal Community Controlled Health Organisation chair, Justin Mohamed; Co-Chair of Reconciliation Australia, Dr Tom Calma; Indigenous General Practice Registrars Network Chair, Dr Aleeta Fejo; KPMG’s head of corporate citizenship, Catherine Hunter; and Guwaali CEO, Michael West.

The panel examined the vision behind a range of Indigenous health programs, regularly pausing to answer burning questions from a dynamic audience.

During the discussion, Dr Fejo urged GPs to venture outside their office and into Aboriginal communities “to participate in community planning, decision making and interaction so that community has input from a health aspect”.

She encouraged doctors to work with the community and not just sit in the office “churning patients out”.

“We need to participate in the community so we can be seen as role models and so we teach what it means to be a GP,” she said.

A second panel comprising RACGP and ACRRM presidents, Dr Liz Marles and Professor Richard Murray; GPET and RVTS chairs, Professor Richard Matthews and Dr Ayman Shenouda; and WAGPET’s CEO, Dr Janice Bell, addressed the critical nature of the future of Australia’s general practice education and training.

In closing, each panelist was asked what transformation they would like to see to the general practice training program.

Professor Murray said he would like a “clear and obvious pipeline” into rural generalist medicine, while Professor Matthews said he would develop a workforce plan to meet the needs of a national health delivery plan for all sized communities and “not the other way around”.

Dr Marles said she would like to see more community based training, while Dr Shenouda called for vertical and horizontal integration in training as well as team-based training.

Dr Bell said she would like to “map every single medical job that exists” and find out who could do that job and under what conditions, and then make those positions available across all the medical craft groups.

In the afternoon session, former First Wave Scholarship recipients, Nicola Campbell and Amer Mitchelle, shared their experiences and highlights of working with GPs in general practices in Perth and rural Queensland.

Delegates also heard from four inspirational speakers who are successfully transforming their diverse communities – from aged care in Australia to laboratories in Congo, Ethiopia and East Timor.

General Practice Students Network Chair, Joseph Monteith, said the conference was “truly inspirational”.

“It did more than make me want to be a great GP. It has inspired me to make a difference in our community and gave me a few tools I can use to make that change,” he said.

He applauded the Indigenous health panel, labelling the discussion as “captivating and educational”. “#fgp14 showcased the future of Australian healthcare, and the future looks bright,” he said.

“It was fantastic to see so much enthusiasm and involvement coming from the audience, both in person and watching the live feed and those following #fgp14 on our social media platforms.”

With you on your journey

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Train in the Northern Territory "Training in the Territory has helped me rediscover what 'real' medicine is about and given me the opportunity to better understand the world my patient's live in beyond the walls of the consulting room."

Dr Iyngaranthan Selvaratnam NTGPE offers highly supported, flexible and challenging vocational training opportunities for GP Registrars keen to experience something a little different to what is otherwise available. You can choose from a variety of locations, ranging from urban mainstream general practices to remote Aboriginal community clinics.

There are excellent opportunities for training in Aboriginal health and understanding the complexities and interaction of individual care with a population health approach. A network of experienced GP Supervisors provides practice based teaching, mentoring and professional development.

For more information email registrar@ntgpe.org www.ntgpe.org @ntgpe

registrar.ntgpe.org 40

Reviews Australian Bites and Stings Although definitely not strictly an app for medical professionals, Australian Bites and Stings is certainly a handy resource for medical students, GPs and the general public. Australian deadly creepy crawlies are renowned the world over, and this app provides a succinct and easy to use guide in sticky situations involving our unique wildlife.

The app has been designed by bioCSL, one of the world’s few manufacturers of antivenoms, in close consultation with the Australian Venom Research Unit. So you can rest assured that the information is consistent with the most current knowledge and research.

Some of the features of the app include:

• Clear instructions on what to do if you are bitten or stung • Specific signs and symptoms you may expect according to each venomous creature • A ‘be prepared’ checklist, which includes information on basic first aid and pressure bandaging and immobilisation • A direct emergency services call button.

Overall, this app would be very worthwhile to have on hand yourself, and to recommend to patients who may come into contact with the nasties that lurk in our great outdoors.

Pros: It is appealing to the eye, very easy to navigate and best of all, it’s free!

Cons: My only criticism would be that it is a little TOO easy to hit the emergency services button and call 000 … whoops!

Price: Free Compatibility: iOS5 or Android devices Rating: ★★★★ out of 5 Reviewed by Lauren Mann Fourth-year medical student, Griffith University, Qld

Mastering Medical Terminology: Australia and New Zealand Sue Walker, Maryann Wood, Jenny Nicol From the start, Mastering Medical Terminology makes its intentions clear. It does not set out to be a medical dictionary, or provide all a medical student needs to know about anatomy, physiology, pathology and clinical medicine.

Rather, the book provides a foundation on which to learn new medical terminology.

The first two chapters describe how a medical term is built from its separate components and spelling conventions, and how medical terms are pronounced. It also introduces the reader to the presence of eponyms, where a disease has been named after the person who initially identified and discovered the disease, for example, Parkinson’s disease.

The book then describes terms used in referring to the human body as a whole, which can be applied to discussion of any body system. The subsequent chapters go through each body system and describe in tabular format how relevant medical terms are put together from separate components. They also provide examples of medical terms pertaining to the body system accompanied by a description of each term, giving sufficient context in which the term is used.

The book is nicely formatted, well presented and uses illustrations effectively. Moreover, the review exercises at the end of each chapter help to consolidate and reinforce one’s understanding and learning of the content in each chapter. I would recommend this book for undergraduate students considering applying for graduateentry medicine, as well as first-year undergraduate entry medical students and first-year graduate-entry medical students from a non-science background.

Mastering Medical Terminology: Australia and New Zealand is published by Elsevier, 2012.

Price: $99.95 Reviewed by Rowena Penafiel Second-year medical student, Australian National University, ACT

With you on your journey

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Mechanisms of Clinical Signs Mark Dennis, William Talbot Bowen and Lucy Cho Mechanisms of Clinical Signs has been designed as an easy-to-follow reference guide for all levels of medical trainees and professionals.

The authors, Mark Dennis, William Talbot Bowen and Lucy Cho go beyond the many textbooks that offer definitions and guides to the diagnosis of clinical signs by exploring and explaining the pathophysiological mechanisms underpinning these clinical signs.

It is a well-written, complete guide to the clinical signs found throughout medicine and surgery. The book’s index is set out in two parts, Contents by System and Contents by Condition, which enables it to be successfully used as both a study guide and as a quick reference tool. Each sign is explained simply and concisely using a uniform set of subheadings: Description, Conditions associated with,

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Mechanisms and Sign value and most include a diagram which assists to explain the key features.

My favourite section by far is the Neurological Signs chapter, which presents neuroanatomical and pathophysiological concepts in a succinct and clinically relevant manner. In this section, the authors have realised that in most cases, understanding the anatomical pathways is key to the mechanisms of these signs and have thus included relevant neuroanatomy and ropographical anatomy boxes, which I found most helpful.

We spend our days looking, listening and feeling in an effort to elicit clinical signs that will help us target our investigations and narrow down the list of differential diagnoses for the cause of our patients’ illnesses. Understanding the mechanisms and evidence behind these signs is crucial to knowing whether their presence (or absence) is significant and greatly improves our ability to communicate our findings to both our patients and peers.

Mechanisms of Clinical Signs is published by Elsevier, 2012.

Price: $79.95 Reviewed by Dr Frances Knight GP ambassador, Qld

Discover the opportunities within the Prevocational General Practice Placements Program The Prevocational General Practice Placements program (PGPPP) is managed by General Practice Education and Training Limited (GPET) on behalf of the Australian Government. PGPPP is facilitated through regional training providers (RTPs) and delivered by accredited practices and medical services throughout Australia.

The aims of the program are to:

•

Enhance participating doctors’ understanding of general practice and the role GPs play in the delivery of health services at the primary and secondary healthcare levels understanding of the integration between primary and • Increase secondary healthcare by participating doctors.

Why do a PGPPP placement?

The PGPPP provides junior doctors with unique general practice experiences through:

“There were many rewarding aspects of PGPPP but I think the overall theme was that it challenged me.”

Dr Jessica Reagh, PGPPP placement – Groote Eylandt Island, NT

real life experience in general practice over and above that of • Aundergraduate training • Exposure to a variety of health services that may include Aboriginal and Torres Strait Islander health, general practice surgery, migrant health and aged care

and personal mentoring by respected and dedicated • Ongoing GPs in the field patient contact in a range of primary care settings such • Direct as general practice, Aboriginal Medical Services, drug and alcohol services and community-based facilities

• Enhanced understanding of the Australian healthcare system opportunities to network with community-based GPs, • Great other health professionals, and local communities Increased confidence and independence to take into future • training and work environments An opportunity to have some autonomy with support • and supervision.

“Having so much responsibility for patient care was initially daunting but became a major attraction of the PGPPP term as the weeks progressed. Whatever career junior medical officers are interested in pursuing, a PGPPP term is a highly valuable opportunity to develop one’s independence, clinical reasoning and practical skills. I would highly recommend it!”

Dr Anna Sambell, PGPPP placement – Central Coast, NSW Want to know more?

Talk to the junior doctor manager at your hospital or go to gpet.com.au to contact your local RTP.

With you on your journey As a GPSN or GPN member we support you on your journey toward general practice.

To find out more go to:

gpaustralia.org.au GPRA180314525