ISSUE 17 FREE
May – August 2015
Dr Hip Hop In the house with Dr Tu Pham
Also inside our new patron | profiles | clinical cases | general practice training INDIGENOUS GENERAL PRACTICE REGISTRARS NETWORK Supported by GPRA
DISCOVER THE OPPORTUNITIES IN GENERAL PRACTICE
General practice offers the opportunity to subspecialise and undertake procedural work, while becoming an integral part of the community. The Australian General Practice Training (AGPT) program is your pathway to becoming a GP. To discover the opportunities the AGPT program offers visit agpt.com.au
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In this issue...
4
3 Welcome
Feature 4 Professor Michael Kidd Published by General Practice Registrars Australia Ltd Level 1, 517 Flinders Lane Melbourne VIC 3001 P 03 9629 8878 E enquiries@gpra.org.au W gpra.org.au ABN 60 108 076 704 ISSN 2203-2657 Editorial team Medical Editor Dr Chia Pang Editor Denese Warmington denese.warmington@gpra.org.au
Meet GPRA’s new Patron.
Profiles 8 Dr Kali Hayward Indigenous GP, Dr Kali Hayward, dropped out of school at 16. She shares her inspirational journey to respected doctor, medical educator and mentor for the next generation of Indigenous GPs.
18 Dr Tu Pham Brisbane-based GP, Dr Tu Pham, leads a second life as a hip hop artist. He talks to us about the art of communication and the importance of being yourself.
20 Dr Carole Reeve Alice Springs academic GP and public health physician, Dr Carole Reeve, is a fierce advocate for fair care in rural and remote regions. She explains why.
Clinical
Writers Jan Walker Denese Warmington
13 Quiz
Graphic Designer Jason Farrugia
17 Murtagh’s tales
GPRA staff CEO Sally Kincaid
22 #fgp15 conference
General Manager – Marketing and Communications Wayne Bruton wayne.bruton@gpra.org.au Advertising enquiries Natalia Cikorska natalia.cikorska@gpra.org.au
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20
14 Dermatology
Reviews 24 Apps and books
Your networks 28 Going Places Network 30 General Practice Students Network
Also inside
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7 Membership of GPRA Membership of GPRA can provide many benefits on the journey from medical student to GP. Find out more here.
10 General practice training Interested in applying to the Australian General Practice Training program? We give you the facts.
32 First wave Q&A Jessica Jose answers our questions about her John Murtagh First Wave Scholarship placement. Produced with funding support from © 2015 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.
A DV E R TO R I A L
Avant offers Interplast winner unique placement with Fiji surgical team Avant continues its long standing partnership with Interplast supporting the organisation’s vital work training doctors in reconstructive surgery and rebuilding lives across the Asia-Pacific region. We are pleased to offer University of Adelaide medical student, Kartik Iyer, the opportunity to witness Interplast’s volunteer surgical team at work first-hand as the winner of the 2014 Avant Interplast Student Placement Program. Kartik will travel with the team of volunteer plastic surgeons, anaesthetists and nurses to Labasa, Fiji, this month where he will observe the team provide free reconstructive surgery to patients who would otherwise not be able to afford it. Avant’s Head of Strategic Partnerships, Wendy D’Souza, described the relationship with Interplast as a “true partnership”. “Avant is proud to support this unique program for medical students. We receive incredible feedback that this is often a life-changing experience for the winners. Avant also works closely with Interplast to identify programs and forums where we can support doctors across Australia,” she said. Prue Ingram, CEO, Interplast Australia & New Zealand, commented “We are delighted to partner with Avant once again for this terrific initiative that introduces our work to those entering the medical profession. Our purpose of repairing bodies and rebuilding lives is made possible with the wonderful support from partners like Avant.” 2013 Avant Interplast Student Placement Program winner, University of NSW medical student, Dinuksha De Silva, hailed his trip with the surgical team to Fiji last year as an incredibly rewarding and humbling experience.
“It was inspiring to witness how the Interplast team transformed the lives of children and families. Kids came into our operating theatre wide-eyed and trembling; it was really special to see them smiling the next day, freed from the burn scar contractures or cleft palates that had been such a huge part of their lives,” he said. Avant also funded Interplast’s second Applied Reconstructive Surgical Skills Workshop held last year at the University of Tasmania (UTAS), School of Medicine in Hobart. Nine surgical registrars from Vanuatu, Fiji, Kiribati, Samoa, Tonga and the Solomon Islands attended the twoday workshop where they learnt surgical skills in flap reconstruction based on real-life case studies from their home countries. Participants deemed the workshop a great success and reported significant improvements in their technical skills which they could transfer to their home countries. The workshops also fostered strong mentorships that can be helpful when the participants return home. This is particularly valuable where surgeons are working in isolated conditions and do not have access to colleagues whom they can seek advice from. Explaining Interplast’s fundamental approach, Ms Ingram said, “From over 30 years of experience we know that simply performing surgery in developing countries is not the best way to achieve Interplast’s mission. For this reason, Interplast has always focused on building the capacity of local medical staff through training and mentoring activities.”
Visit avant.org.au/About-Us/Corporate-social-responsibility/ to find out more about Avant’s sponsorship programs and our partnership with Interplast.
Welcome Welcome to Issue 17 of GP Journey, a publication proudly brought to you by General Practice Registrars Australia (GPRA). GPRA is a not-for-profit organisation representing over 21,000 medical students, prevocational doctors and general practice registrars. The primary objective of GPRA is to improve the health care of Australians through excellence in general practice education and training. A key feature of GP Journey is the profiles of GPs working around the nation. These wonderful stories recount tremendous commitment and dedication to general practice and their collective experience demonstrates the breadth and depth of this medical specialty. In this issue, we bring you more fascinating profiles of doctors working at the coalface of medicine. Our feature story is on Professor Michael Kidd, who will be taking over the role of GPRA Patron from Professor John Murtagh. The indefatigable Professor Kidd shares with us the passion that drives him to be a trailblazer in general practice, both in the local and international arena. We are delighted that he will be engaged with GPRA to ensure a smooth transition to the new administration of general practice training. Dr Carole Reeve, a GP based in the Northern Territory, tells us about her unyielding determination to make health care equitable for people living in rural and remote areas. Dr Kali Hayward is another example of an inspirational Indigenous GP overcoming significant personal challenges to achieve success in her career. We also profile Brisbanebased GP, Dr Tu Pham, who swaps his stethoscope for the turntable and moonlights as the hip hop artist, ‘Tu P’. There is information about the John Murtagh First Wave Scholarship and how you can apply, and recent scholarship recipient, Jessica Jose, shares with us her experience working in country New South Wales.
General practice is the foundation of an effective health care system. It is a specialty that provides whole person care built on long-term relationships. It deals with a wide scope of medicine that can be complex and challenging. Doctors who work in this field require a broad skill-set to manage issues such as the increasing demand of chronic diseases in an ageing population. I would encourage you to speak to your local GPSN Club Chair or GPN Ambassador and find out more about the exciting specialty of general practice. I hope you enjoy the magazine!
Dr Chris Pang – Medical Editor, GP Journey General practitioner – Princess Park Clinic, Shepparton, Victoria
In this issue we also provide updates on the General Practice Students Network and the Going Places Network, and provide information on the Australian General Practice Training program, including the new training boundaries commencing in 2016. I encourage you to join GPRA. As a member you receive ongoing support and exclusive discounts and offers. You also become part of an organisation that acts as a strong advocate for the next generation of Australia’s GPs – you.
With you on your journey 3
F E AT U R E
GPRA’s new Patron A Q&A portrait
Professor Michael Kidd AM is the new Patron of GPRA. As a leader in clinical and academic general practice for over three decades Michael says he regards his role as successor to Emeritus Professor John Murtagh as “a daunting opportunity”. There is a certain symmetry in Professor Michael Kidd being appointed as GPRA’s new Patron. When a younger Michael was an academic registrar at Monash University, GPRA’s founding Patron, Emeritus Professor John Murtagh, was one of his mentors. Michael went on to establish a luminous career in clinical and academic general practice in Australia – and now the world. As President of the World Organization of Family Doctors (WONCA), Michael travels internationally one week in four. Back in Australia, he is Executive Dean of the Faculty of Medicine, Nursing and Health Sciences at Flinders University in Adelaide, he works on research projects, he sees patients as a GP in HIV medicine and he sits on a long list of boards and committees advising non-profit organisations and governments. He is also past President of the RACGP. As he begins his new role as GPRA Patron, we questioned Prof Kidd on this appointment and his own GP journey.
How do you see your role as GPRA Patron? I’ve been Patron of the General Practice Students Network over the past seven years and I see the role of Patron to be there to provide support, to provide advice when invited and to use my profile to assist in the advancement of the aims of the organisation and its members.
Why did you choose general practice? Like many people, when I graduated I wasn’t sure what specialty I wanted to train in and so I tried a number of areas such as adult medicine, paediatrics, obstetrics, psychiatry, and decided I really liked all of them. I also tried general practice, and I found that in general practice I could practise in all of those areas. I also wanted to work in the community. I had a very strong interest in primary care, health promotion and preventive care, as well as medical education.
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Why academic general practice? When I was a registrar, I had an opportunity to do an academic registrar post at Monash, and I found that in addition to the great joys of being a doctor I also really enjoyed teaching and research. Being a clinician has been really important for my research in that research ideas often come from the interactions you have with your patients, and it’s the same with teaching.
What was your first job after completing your fellowship? It was late 1980s, the HIV epidemic had appeared and things were really awful. As a young gay man I thought I needed to work in this area. So that’s what I ended up doing – working in general practice predominantly with people with HIV.
What personal qualities do you consider important in a GP? The [Latin] motto of the RACGP is Cum Scientia Caritas. John Murtagh once said this translates as “with scientific knowledge and tender loving care”, and I think that describes the qualities of a GP really well.
Do you have one piece of advice for upand-coming doctors? Pick your passions. You can’t do everything, so it’s important to focus on those areas that you’re really passionate about. Direct your attention there and you can actually make a difference.
You write blogs, you’re on Twitter, you list health informatics as one of your interests. Are you a technology nerd? I’ve always had an interest in how technology can assist the quality and safety of general practice. In my early research at Monash in the 1980s, I was part of a team looking at the potential introduction of electronic medical records into general practice. In the 1990s, I worked with the Australian government in leading the process of computerising Australian general practice – using computer software to generate prescriptions. I’m interested in social media. As someone from my era I’ll probably never be a great user of social media, but I’m trying.
What’s your current focus? My big passion at the moment is being President of WONCA. We do a lot of work with the World Health
I believe each of us has a “ responsibility to do what we can to leave this world a better place than it was when we arrived.
”
Organization – globally through their Geneva headquarters but also through each regional office around the world.
What are some the biggest issues in general practice right now? In each country I visit, the penny has dropped about the important investment that needs to be made in primary care. We need to keep people as well as possible for as long as possible. We need to keep people out of hospitals as much as we can. We need to focus on health promotion and preventive care. We need to focus on good chronic disease management – both diagnosis and treatment – and the management of co-morbidities and mental health. This is all part of general practice.
Any underlying philosophy that drives you? I believe each of us has a responsibility to do what we can to leave this world a better place than it was when we arrived. One of the things I’ve tried to take into my role with WONCA is the Australian concept of a ‘fair go’: that we pay attention to fundamental human rights, that everyone has the right to access education and health care and clean water and good government and living in a safe environment. I’m committed to the care of the environment. I think that if we have a healthy environment we’re going to have a healthy community.
Any comments on the future of Australian general practice training? A change in the administration of general practice training is going to be one of the big challenges we face over the next year or so. Part of how I see my role as Patron is to do what I can to ensure the transition is seamless for our registrars.
Written by Jan Walker Photo courtesy Ashton Claridge, Flinders University
With you on your journey 5
A DV E R TO R I A L
1. SALARY SACRIFICE UP TO $25,000 into a low cost
2. 3. 4.
commission free industry super fund such as HESTA. Getting the super snowball rolling as fast and as early as possible.
BUY A HOUSE IN A CAPITAL CITY and rent it out
as a negative gearing strategy. This will hedge you against future house prices, making it easier to buy a home down the track.
BUY A CAR and carry your laptop, patient notes, doctor’s bags,
brief case, and bulky medical equipment and run a log book for 12 weeks showing home to work travel as deductible business travel.
ARRANGE INCOME CONTINUANCE COVER (at least $60k a year)
to age 65 with a 90 day waiting period, using the McMasters Insurance’s commission rebate service. More info at www.mcmastersinsurance.com.au
If you have dependants, arrange up to $1,000,000 of cheap, tax
5. 6.
effective and COMMISSION FREE LIFE INSURANCE by buying extra life insurance in your industry superannuation fund.
ENJOY A TAXDEDUCTIBLE OVERSEAS STUDY TOUR
visiting medical institutions and learning more about the world of medicine & get as much diversity in work experience as you can.
*This is general advice only and is not personal advice. Personal advice is needed before making any decision concerning nancial products or your nancial future.
GPRA...
with you on your journey From GPSN university clubs, to hospital GP Ambassadors and a national registrar support team, GPRA is with you on your journey from medical student to general practitioner.
What is GPRA? GPRA is run by members for members. Our Board of Directors is elected from the membership and includes a prevocational doctor or medical student, up to five general practice registrars and three co-opted directors. Behind the scenes, GPRA advocates for you as the future of general practice.
Member benefits
• Member priced webinars • Member priced products and publications • Discounted McGraw-Hill educational books • Free Medical Observer e-subscription
ook e exam b al practic The gener
As a prevocational doctor or medical student you automatically become an Associate Member of GPRA when you sign up for membership. As a member you receive regular communications about local events and updates about general practice training. You also receive the following member benefits:
• Free registration to Medicine Today’s clinical archive • Free access to a Commonwealth Bank dedicated relationship manager for regular financial health checks. -9
6-1 992453
-0ISBN 978
92 9 7809
gpra.org.au
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onnor Kath O’C rk Robin Pa hwarz Fabian Sc Warby Tammra deh iabadi Za Yashar Al
2015
The esse guide fo ntial students r medical prevocat and doctor s ional
exam b
453619
So go on, what are you waiting for? Membership is free. Join us via our website at
GP First
Inside
Clinical
placemen t tips Internsh ip facts AGPT se lection What yo u can ea rn Surviving it all
GP Companion 2nd edition
eral practice The essential gen ce pocket referen
General Practice alia Registrars Austr RRP $34.95
With you on your journey 7
G P profi l e
Against
the odds
When Dr Kali Hayward dropped out of school at 16, few would have predicted she would go on to become a respected GP and medical educator. Now she is a mentor for the next generation of Indigenous GPs. Dr Kali Hayward understands that one GP appointment has the power to change a life. It happened to her at the age of 16 – in both an obvious and more oblique way. While still at high school, Kali fell pregnant (to the man she would later marry) and went along to see her local doctor. “I always say I got into medicine through spite,” Kali says. “I went to my GP to confirm I was pregnant and the words he said to me are always in my head. He said you should be ashamed of yourself and how could you do this to your father.” Kali’s father was a pastor and prominent member of the Aboriginal community in Redfern at the time. “It brought home to me that as a GP we need to be very careful with the words that we say, and not to place our own judgments on our patients. “I thought then that I could do a better job than that particular GP, and that sort of started me on my path to medicine. I wanted to show that doctor I could do it just to spite him.” The first step for Kali was to go back to TAFE to “get my piece of paper” after leaving school early to give birth to her son. Kali and her husband Donald moved to Mildura with her parents, and Kali successfully completed her Victorian Certificate of Education. After a further move to Adelaide, Kali joined Wirltu Yarlu, an Aboriginal support program at the University of Adelaide, and did a science foundation course designed for people interested in studying science at university level.
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“I met three other Aboriginal medical students, all women, and they really gave me the courage to say I want to do medicine too. “You should never underestimate the value of a role model – people who have walked the journey before you who can let you know that you can do it as well. “I applied to medical school and got in. That was an amazing day when I received the phone call to say I’d been accepted. I think I screamed.” Kali was like many Indigenous medical students – torn between study and family commitments. She went on to have three more children before finishing her degree and helped look after her chronically ill father, so there was always tension between the competing pressures of study, family and putting food on the table. Getting through medical school as a mother of four required strict discipline. “I approached medical school as a job,” Kali explains. “I would do most of my study between nine and five and if I had breaks during the day I would go to the library and study. “When I got home that was time with the kids, then when they went to bed I would study some more.” Kali is quick to acknowledge her husband’s contribution. “I have a very supportive husband who took time out of work to look after the kids,” she says. The life story of Kali’s father, a Warnman man from Western Australia, also spurred her on. As a member of the Stolen Generation, he was removed from his family and sent away to the Moore River mission featured in the movie RabbitProof Fence. “Aboriginal children were only allowed to go to Year 3. Then the boys had to do farm work and the girls had to
We need to have another “ 2600 Aboriginal doctors to reach population parity.”
students through the Indigenous General Practice Registrars Network (IGPRN), administered by GPRA. “We have 204 Aboriginal doctors, we have over 300 medical students and we need to support them with their medical training because we have to look at the retention. We have a high recruitment rate but the retention rate isn’t so great. “We need to have another 2600 Aboriginal doctors to reach population parity.” Kali believes the right support for Indigenous trainee doctors and medical students can help them reach their full potential, especially at exam time. Support includes IGPRN’s twice-yearly exam preparation workshops for Indigenous GP registrars conducted in a “culturally safe environment” as well as one-on-one mentoring, Kali says. “We have medical educators who can support work in the house as domestic help. Yet my father was one of the smartest men I ever knew – all self-taught.”
Indigenous candidates in their exam preparation, and
The academic opportunities denied to Kali’s father were within her grasp, and she felt compelled to grab them with both hands. “I’d started this journey and I was determined to finish it,” she says.
Program.”
Kali completed her fellowship with the RACGP in 2010. Today she wears two professional hats: as a GP at Nunkuwarrin Yunti, the biggest Community Controlled Health Organisation in Adelaide, and as a medical educator teaching Aboriginal and Torres Strait Islander health at Adelaide to Outback.
one registrar wanted child care for the week so she
Giving back to her profession is important to Kali. She is Vice President of the Australian Indigenous Doctors Association (AIDA) and a mentor for Indigenous GP registrars and medical
the RACGP have their Indigenous Fellowship Excellence For those who need to carve out a little me-time before exams, the Honey Ants Program can facilitate an intensive pre-exam lockdown, Kali explains. For instance, could study before the exam. Kali’s key tips for up-and-coming Indigenous doctors? “Don’t be afraid to put your hand up and ask for help. “I think it’s a fabulous journey but it’s a long journey as well. And you can’t get there by yourself.”
Written by Jan Walker
With you on your journey 9
Gp TRAINING
Are you ready to start The Australian General Practice Training (AGPT) program is a postgraduate vocational education and training program for prevocational doctors wanting to become a general practitioner. General practice is a rewarding specialty that provides varied clinical work, continuity of patient care, the opportunity to subspecialise, dynamic team-based medicine and flexible working hours.
“I would recommend being a GP to others, due to the variety of conditions you see, the freedom to develop your own special interests and the flexible working hours.” Dr Liz Bond, Melbourne, Vic The AGPT program delivers the vocational training programs of the Australian College of Rural and Remote Medicine (ACRRM) and The Royal Australian College of General Practitioners (RACGP). It takes 3–4 years to be ready to attempt fellowship of the college(s). General practice training provides valuable practical experience in different training locations, including teaching hospitals, rural and urban practices and specialised medical centres.
Extended skills and advanced specialised training During training a number of extended skill and advanced specialised training posts are available to develop skills relating to your special interests. For example, you can choose to undertake an Aboriginal health training post where you will be immersed in a unique cultural environment and gain experience in Aboriginal health, seeing significant common and uncommon conditions.
“I’ve had the chance to work with the RFDS providing health care to Aboriginal communities in outback South Australia. I was the only female doctor in the group of RFDS doctors, which was a gap in the service I was able to help with. I was known as the ‘kunga’ (a Pitjantjatjara word for girl/female). It used to make me laugh. I’d hear the AHWs or clinic nurses asking patients if they wanted to see Dr so-and-so, or the ‘kunga’.” Dr Crystal Pidgeon, Beaudesert, Qld
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Academic posts are also available during training where you can undertake a project in partnership with a university to develop skills in research, teaching, project work and critical evaluation of research, relevant to the discipline of general practice. Other examples of extended skills training include but are not limited to, anaesthetics, palliative care, mental health and dermatology.
“I realised that general practice training would provide a solid and broad base to work from, so I joined the [AGPT] program. From there, my interests developed along the way.” Dr Michael Christmass, AGPT registrar, WA
How to apply to the AGPT program The application process consists of three stages:
1. Application and eligibility check To apply to the program you will need to register online at agpt.com.au and complete the online application form. Your eligibility will be assessed during this first stage. Overseas trained doctors and Australian Defence Force doctors can also apply to the AGPT program.
2. National assessment If eligible, you will be invited to stage two, where you will complete both a Situational Judgement Test (SJT) at a national testing centre, and a Multiple Mini Interview (MMI) at a national assessment centre within Australia. The SJT is an online test comprising 58 multiple-choice questions, which takes 116 minutes to complete. MMIs involve rotations between interview stations. Both of these tests require applicants to draw on their own experiences and assess the applicant’s suitability to general practice.
3. Training provider selection and placement offers On completion of the SJT and MMI, applicants are notified of scores and given the opportunity to change preferences and undertake placement assessments with their training provider if successfully placed into the program.
your
journey?
Further information The AGPT program is managed by the Department of Health and delivered by a national network of training providers dedicated to supporting GP registrars as they embark on a career in general practice.
To find out more about the AGPT program visit agpt.com.au
Changes to general practice training boundaries On 9 April 2015, the Minister for Health, Sussan Ley, announced the new geographic training regions and establishment of an advisory committee that will provide advice about the delivery of the Australian General Practice Training program. This means that for those who are considering starting their general practice specialist training in 2016, you will be able to train with one of 11 providers in these new training regions. The Australian Government will soon conduct a tender for new training organisations to deliver the AGPT program from 2016 onwards. If your application is successful and you are offered a place, it is expected that the training organisations in each region will be known before you are asked to make any preference changes. The new training organisations are expected to be in place ready for you to start your training in early 2016.
For further information, including a breakdown of the new training boundaries, visit the AGPT website at agpt.com.au To review the Minister’s announcement, visit health.gov.au
With you on your journey 11
A DV E R TO R I A L Ten years ago, McMasters’ Solicitors, Accountants and Financial Planners, looked to Vietnam as an answer to offshore accounting, but what started as a business venture has blossomed into so much more.
The two orphanages care for children of all ages and are in constant need of support to provide meals, accommodation, health care, tuition fees and clothing to the 175 children in their care.
According to Terry McMaster, Director of McMasters, the staff in Vietnam were incredibly hard-working, but it was their kind-heartedness and generosity which impressed him most.
McMasters’ annual cheques have been an enormous help to the centres, said Ms Nyugen.
“Many of the employees in Vietnam volunteered at various orphanages and protection centres on the weekend,” he said. One employee, Dung Nyugen started volunteering as an English teacher at the Thao Dan Protection Centre when she was in university and continues to do so each Sunday. “I think free education is extremely necessary, especially for disadvantaged children, to allow them to grow and learn in a protected environment,” she said. Upon learning of his staff’s philanthropic effects, Mr McMaster began financially supporting three local centres of their choosing: the Thao Dan Protection Centre, the Linh Son Pagoda orphanage and the Truyen Tin orphanage. Sue Torwick, McMasters’ practice manager, visited the Vietnam office in January, and witnessed staff members’ generosity first hand. “Dung sent an email asking for donations for our visit to Thao Dan. We took six large bags of clothes, books and food donated by the staff that day… it was very impressive,” she said. The Thao Dan Protection Centre caters for children who are orphans, or whose parents cannot afford to send them to school, as well as street kids and children with disabilities. The centre provides children with a nutritious meal, free health care, a place to study and take English classes.
“We liaised with the centres to determine what they needed immediately, and with McMasters’ donation we were able to provide 500 kg of rice, 150 litres of oil, 60 kg of sugar, 30 parcels of noodles, 400 textbooks and lots of stationery, which was shared among the three centres. “Thanks to the donations, the kids have a better chance of staying in school, and better studying materials. The donations also provide them with a daily meal which takes a huge burden from families,” she said. McMasters also runs a scholarship program to enable disadvantaged Vietnamese students to undertake studies in economics. Without these scholarships, they simply could not afford to study. In January 2015, 54 scholarships worth about $55,000 were donated to successful applicants. Recipients of these scholarships will have much brighter futures, and may even become the next McMasters’ employees. Mr McMaster hopes to continue his support to the Vietnamese people. “Our Vietnam staff make the biggest contribution with their time, as well as toys and clothing. In addition to annual donations, we are currently developing web-based business ventures from which 100% of income will go to the orphanages,” he said.
www.mcmasters.com.au/about-us/social-responsibility
C l inica l q ui z
What are these blisters? By Dr Sangeetha Bobba and Dr Wendy Sehu
Case study
Answer 2
A 55-year-old woman presented to her GP with a three-day history of blisters on her right eyelid.
A viral PCR swab of the vesicles should be sent – this later confirmed type 1 HSV. HSV affecting the eye or the ophthalmic region can lead to HSV keratitis, which can ultimately lead to blindness.
There was an associated stinging sensation, but no pain (see Figure 1). The eyelid was not itchy. She denied any change in her vision. The patient had a history of atopy, but otherwise reported no significant medical conditions.
Figure 1. Patient’s eye at initial presentation
How would you manage this condition?
On examination, she had mild erythema and ptosis of the right eyelid, with multiple 1 mm vesicles on the eyelid. Her left eye was unaffected.
Answer 3 An urgent ophthalmic assessment should be obtained.
She also had follicular conjunctivitis of the right eye. Visual acuity was found to be 6/6 uncorrected bilaterally. Fundoscopy and fluorescein staining were normal, revealing no evidence of corneal involvement.
Question 3
In addition, oral acyclovir or valaciclovir should be commenced. Figure 2. Patient’s eye at review
Question 1 What is the diagnosis? A. Herpes simplex B. Impetigo C. Basal cell carcinoma D. Insect bites.
Answer 1 Based on the clinical presentation, a provisional diagnosis of herpes simplex virus (HSV) blepharo-conjunctivitis was made.
Question 2
There is sufficient drug availability in tears from systemic treatment to treat an ocular infection, although any ocular involvement may require extending treatment time with regular reviews to ensure the eye is not compromised. Treatment may include regular lubricants to relieve associated discomfort. On review, the patient’s vesicles had ruptured leaving residual healing ulceration (see Figure 2), which resolved completely without causing ophthalmic complications.
Authors Dr Bobba is a GP with a special interest in dermatology practising in Sydney, NSW. Dr Sehu is a staff specialist at the Sydney Eye Hospital and St George Hospital, a lecturer at the University of Sydney and works in private practice in Sydney, NSW. Photos courtesy Dr Sangeetha Bobba
How would you confirm the diagnosis?
This article was first published in Australian Doctor, 12 December 2014 and is reprinted here with permission. australiandoctor.com.au
With you on your journey 13
D E R M AT O L O G Y
An annular eruption on the trunk By Dr Gayle Fischer
Case presentation A 10-year-old girl presents with a four-month history of a scaly annular eruption that has been gradually evolving on her trunk (see Figure 1). It is mildly itchy, but not severely enough to wake her at night. Tinea was initially suspected, but skin scrapings for fungal infection have returned negative results. The patient has not had any recent contact with pets or other animals, and treatment with antifungal creams has been ineffective. What is the cause of these scaly annular lesions?
Differential diagnosis There are many causes of annular eruptions. The diagnoses to consider in a child of this age include the following.
Figure 1. The scaly annular eruption, four months after onset
Tinea
Pityriasis rosea
Tinea is a common fungal infection and usually the first suspect for a scaly annular lesion. Tinea that produces the classic ‘ringworm’ appearance has often been acquired from a pet rodent such as a guinea pig or mouse; cats and dogs are less common vectors. The edge of the lesion is scaly and erythematous, and itch is a feature. A diagnosis of tinea is easily made by taking a scraping of the scaly edge of the lesion – direct microscopy is available within 24 hours but culture commonly requires three to four weeks. Unless the lesion has recently been treated with an antifungal agent, a negative test result will usually rule out a diagnosis of tinea.
Pityriasis rosea is presumed to be a reaction pattern to a viral infection, although the viral cause has not been isolated. It can produce multiple scaly lesions, annular to ovoid in shape with a band of scale on the inner aspect of the annular edge (see Figure 2). Lesions are usually located on the trunk. The condition is usually asymptomatic and always self-limiting, disappearing spontaneously after about six weeks.
Granuloma annulare Granuloma annulare is a very common idiopathic condition. Lesions are slowly progressive. It is characteristically asymptomatic and not scaly and does not usually produce more than a few lesions at any one time. Typical sites are the dorsum of the hands and feet, the elbows and knees.
This article originally appeared in Medicine Today 2014;15(12):55–56 and is reprinted here with permission.
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Cutaneous lupus erythematosus Cutaneous lupus erythematosus can produce annular lesions, which may be scaly and often have an atrophic centre. They are most commonly found on sun-exposed skin surfaces. Lupus erythematosus is seen in children, but it is very rare.
Erythema annulare centrifugum Erythema annulare centrifugum presents with a relatively small number of polycyclic (rather than annular) lesions with
an erythematous edge and with scale on the concave side (‘trailing scale’, see Figure 3). It is asymptomatic and may persist for years. The lesions slowly migrate and are not responsive to topical corticosteroid treatment. Erythema annulare centrifugum is a very rare condition of unknown cause and can occur in children.
Psoriasis Psoriasis is the correct diagnosis in this case. It is unusual for the lesions of psoriasis to be so strikingly annular; clues to the diagnosis include the presence of other, more typical lesions on the rest of the skin (such as the dorsal surfaces of the elbows and knees), nail pitting and a flaky scalp. Although parents commonly deny a history of psoriasis when asked, it is interesting how many of them have a mild degree of it when examined. Children with psoriasis often have a history of cradle cap and nappy rash as babies. Other common inflammatory dermatoses in children, such as eczema, are not annular and are usually very itchy, waking the child at night.
Management
Figure 2. Pityriasis rosea
Although psoriasis has a characteristic histological appearance, biopsy is rarely necessary. The condition responds to treatment with moderate to potent topical corticosteroids and, as it is chronic condition, maintenance therapy is often required. In children, ointments and creams containing tars such as liquor picis carbonis are good preventive measures and should be applied daily after a remission is induced with topical corticosteroids. Natural sunlight is helpful for psoriasis, and more severe cases can be treated successfully with ultraviolet phototherapy.
Author Gayle Fischer MBBS, MD, FACD is Associate Professor of Dermatology at Sydney Medical School – Northern, University of Sydney, Royal North Shore Hospital, Sydney, NSW. Competing interests: None.
Medicine Today provides GP Journey with selected articles from its archive of peer reviewed clinical content. To view the full archive, first register to use the website at http:// medicinetoday.com.au/user/register and then browse the content online or download Medicine Today for iPad, available from the App Store at https://itunes.apple.com/app/ id666623264.
Figure 3. Erythema annulare centrifugum
Registration and online access to Medicine Today’s rich knowledge bank of clinical content is free to all members of GPRA, GPSN and GPN.
With you on your journey 15
Become a member of GPSN or GPN and receive FREE clinical cases. GPRA and Medicine Today – working together to deliver clinical case studies straight to your inbox
Students visit
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INDIGENOUS GENERAL PRACTICE REGISTRARS NETWORK Supported by GPRA
Murtagh’s tales
Test yourself with clinical cases from the master of general practice, Professor John Murtagh.
Case 1 Acute respiratory distress three days after trauma A 30-year-old man sustained a fractured pelvis after he fell three metres from a ladder. He was admitted to hospital for intravenous fluids and pain management. He also had soft tissue injuries but these were not a concern. He was usually healthy, but with a history of asthma. Three days later he developed unexplained sudden deterioration of his health with confusion, agitation and shortness of breath. On examination he had a petechial rash on the anterior chest, neck, axilla, conjunctiva and inside his mouth on the mucous membranes. Vital signs: pulse 120/min, respiration 20/min, temperature 38°C, blood pressure 100/65, PaO2 = 55. Auscultation of the lungs reveals some diffuse crackles and wheezes.
Questions 1. What is your provisional diagnosis? 2. What investigations would be appropriate at first?
Answers 1. T he man with major trauma to his pelvis has a fat embolism whereby fat droplets from an open fracture enter the systemic venous circulation and embolise to the lungs. Fat embolism is more commonly encountered in fractures to long bones especially the femur. This pulmonary syndrome is similar to acute respiratory syndrome. 2. F irst line investigations should be a chest X-ray and examination of the sputum and urine for fat droplets. Treatment is oxygen by mask.
Case 2 Unexplained stroke in a healthy adolescent A 15-year-old schoolgirl, who had been in perfect health, was found in the early hours of the morning, collapsed on the floor of her bedroom. Her parents were woken by a loud noise (presumably due to her falling) and found her lying on the floor unable to speak or move.
Questions
On examination during a home visit she was lying stuporous on the floor, unable to speak or understand the spoken word. She had a dense right hemiparesis involving the arm, leg and face and swallowing was impaired. There was no neck stiffness. Cardiac examination was normal. There was no evidence of bruits in the neck, and ocular fundi were normal.
1. T his adolescent girl has a paradoxical embolus, also called cryptogenic stroke. It can occur with a patent foramen ovale, atrial septal defect or ventricular septal defect.
The patient was transferred to hospital by ambulance where she underwent investigation. There was no evidence of emboli or blood in the urine. Routine haematology and urine tests, ECG and chest X-ray were all normal.
1. What could be an explanation of this unusual presentation? 2. What further investigations are appropriate in this girl?
Answers
2. F urther investigations included a CT scan of the brain, angiography and tests for thrombophilia including lupus anticoagulation screen. These tests revealed cerebral infarction but no haematological disturbances, however a transoesophageal echocardiograph using a contrast demonstrated right to left shunting through a large patent foramen ovale. The defect can be closed with a percutaneous image guided ‘umbrella’ device.
With you on your journey 17
GP PROFILE
Dr Hip Dr Hip Hop is in the house! Brisbane-based GP, Dr Tu Pham, leads a second life as a hip hop artist with a global fan base. By day he’s Dr Tu Pham, a recently fellowed Brisbane GP. But after hours, Tu’s alter ego emerges – he’s hip hop artist Tu P. Tu’s beats and lyrics explore themes such as identity and racism among young Australians from refugee and socially disadvantaged backgrounds. As the son of Vietnamese refugees growing up in the multicultural south-west of Brisbane, Tu writes and performs what he knows. Enabled by the global power of social media, Tu’s debut album, Made of Jade, has received airplay in the United States and South America. In 2014, he reached number one on the ReverbNation hip hop charts in Brisbane. Music critic Jason Randall Smith states: “Tu P keeps it truly real by being himself.” Yet to some, hip hop music and medicine would seem to be an odd pairing. So how does Tu reconcile his dual roles as doctor and rapper? “I’ve been doing hip hop longer than I’ve been doing medicine. I started when I was 14 years old,” Tu reflects. “Back then, it was mainly about personal issues or issues about my background as a Vietnamese Australian. “As I did more study, I became exposed to more issues that were affecting my local community and so I became interested in health care advocacy.”
Tu’s GP training rap Tu has these tips for prevocational doctors and medical students thinking about doing the Australian General Practice Training program. 1. Keep all your resident assessments. Recognition of prior learning (RPL) from work done during your residency may be possible in the AGPT program. But you’ll need meticulous records, so remember to file all your paperwork.
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Hop
In my second album, which I’m “ working on now, I want to use my music as a platform to discuss the issues I see in medical practice.
Today a stethoscope is Tu’s preferred bling. In the future, he hopes to merge his medical and musical interests by creating hip hop tracks about health issues for the youth market. When GP Journey spoke to Tu, he had just wound up a GP term at the Aboriginal and Torres Strait Islander Community Health Service in Brisbane and had started a new job at the UQ Health Care Ipswich Clinic. Tu successfully completed his RACGP Fellowship exams last year, so this year he is enjoying more work-life balance and time for his second career. “In my first album, I wanted to bring awareness to different cultures and reduce racism. “In my second album, which I’m working on now, I want to use my music as a platform to discuss the issues I see in medical practice. “I like hip hop because it has the capacity to send out a message. You can have a lot of words in a hip hop verse. As a genre, hip hop has a history of communicating about social issues. “I would love to be able to work with organisations like beyondblue or the Black Dog Institute. I’m planning to make songs and videos about mental health themes and then pitch these ideas to the organisations to see whether I can work with them.” Tu believes another area where hip hop could work well to get across a health message is in the management of chronic disease in adolescent populations. 2. Apply for resident terms with GP relevance. For the RACGP Fellowship, there are four mandatory hospital terms for general practice: general medicine, general surgery, emergency medicine and paediatrics. For ACRRM, add obstetrics and gynaecology, and anaesthetics. Demand for certain terms can be quite competitive, so apply early. 3. Be proactive in your GP terms. When you’re working as a registrar in a general practice, it’s your job to take charge of your learning. In patient consultations, make a note of anything you need to follow up with your supervisor – and always follow up.
”
“I’ve seen quite a few adolescent patients with epilepsy and type 1 diabetes who have poor control because of the numerous medical tasks they need to manage at a time when they are developing their identity,” he observes, citing image concerns and peer pressure as barriers to chronic disease management. “I’d like to make music videos that visually and sonically describe situations which are relatable for patients, and demonstrate that good chronic disease control is possible.” Tu says he conveys the same messages to his patients as a GP. “But it’s just one at a time. Using a platform like hip hop, you can convey your message to several people at once.” Tu’s background gives him street cred with multicultural youth. A proud Aussie, he was born in Brisbane but he understands what it’s like to grow up as a child of migrants caught between two cultures. His parents were refugees who came to Australia with a group of other Vietnamese after the Vietnam War around the late 1970s. “From all the stories I hear it was quite difficult. A lot of people died at sea. “Even though my parents arrived with few possessions, my sister and I went to good schools and were encouraged to study hard. For Vietnamese people, education is very important.” Tu began his tertiary studies at the University of Queensland by concurrently doing science and law, but after finishing his science degree he switched to medicine. Driven by a social conscience from an early age, Tu says he always wanted a career where he could make a difference. After graduating, Tu finished his medical training in locations from Brisbane to Roma, Tara and Charleville. In his downtime, aside from his music, Tu enjoys catch-ups with friends, playing volleyball and travelling overseas. He also does volunteer work with underprivileged youth, often establishing a rapport through a shared love of hip hop. Experience Tu P’s music and videos at youtube.com/mctupham
Written by Jan Walker
With you on your journey 19
G P profi l e
Remotely
interested
Alice Springs academic GP and public health physician, Dr Carole Reeve, is a fierce advocate for fair care in rural and remote regions. Carole admits that public speaking is not her favourite pastime. But lately this Alice Springs academic GP and public health physician has been speaking out. Health equity – or fair care – in rural and remote populations is her pet topic. Carole recently gave the keynote address at a Rural Medicine Australia conference and highlighted a telling statistic. According to a National Health Performance Authority Report (2013), your average life expectancy if you live in Sydney is 84.6 years. If you live in certain remote areas in Australia, it’s down to about 76 years. The statistics cover both Indigenous and non-Indigenous populations. “That’s a huge difference in life expectancy,” Carole says. “I think it’s because of a combination of things starting with the underlying social determinants of health such as increased levels of poverty and social disadvantage. “In addition to that, there’s decreased access to services. It’s partly geographic – you’ve got large areas of very sparse population.” It’s the inverse care law in action, Carole says. The inverse care law is a principle of population health first proposed by British GP Dr Julian Tudor Hart in the early 1970s. “The inverse care law says those who need care the most are the least likely to have access to it,” Carole states. “This often applies to people in rural and remote areas. A lot of people feel that funding should be based on numbers or on equality, which is different from fair care. Fair care says that people who have a higher level of need therefore require a greater investment.”
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Carole has worked across northern Australia for the past 10 years, in positions that have tapped into her abiding interests of rural and remote health, public health, research and medical education. She is currently based in Alice Springs with her husband and their two children. Here she enjoys a varied workload as an academic GP and part-time clinician. She is a senior lecturer at the Centre for Remote Health, a joint initiative of Flinders University and Charles Darwin University. “In my day-to-day job I do a mixture of teaching, research and clinical work,” she says. When GP Journey spoke to Carole, she was preparing to do some clinics with the Royal Flying Doctor Service at Lake Nash. Carole’s interest in how to deliver health care to the least advantaged started early. As a young child growing up in Bolivia she had witnessed the effects of limited health care on people in South America. Later, Carole returned with her parents to New Zealand, where she completed her medical degree and hospital training. As idealistic young health workers, Carole and her husband were drawn to travelling and working internationally. Together they managed the maternal and child health service and laboratory service in a hospital in Tanzania, without mains power and 10 times as many patients as beds during the malaria season. “In the rainy malaria season we would have up to 200 children in 20-bed wards. We had them lying on the floor, under the beds, four to a bed. “We had quite high levels of most infectious diseases, including meningitis. We had limited resources and a very high workload.” Carole characterises many of the diseases she saw in Tanzania as “diseases of poverty”. It made her realise that big picture thinking about the prevention of
In my day-to-day job I “ do a mixture of teaching,
”
research and clinical work.
disease and the best allocation of health funding is vital. “During this time I developed an interest in public health because a lot of these diseases could have been prevented. To me, this really reinforces the need to have good primary health care.” Carole eventually returned to New Zealand and started a family, but her interest in public health and tropical medicine had been ignited. “While my children were small it seemed like a good time to further my studies in the area,” she reflects. There were no suitable postgraduate programs on offer in New Zealand – at least not in tropical medicine – so Carole and her family moved to Townsville where she completed a Master of Public Health and Tropical Health at James Cook University. At the same time Carole undertook general practice training in Townsville and later at the Mount Isa Centre for Rural and Remote Health, including a year at the local Aboriginal Medical Service and an academic term in Indigenous health. She completed fellowships with both the RACGP and ACRRM. “I’m embarrassed to admit that one of my hobbies is studying,” she says. A move to Broome in Western Australia’s Kimberley region saw Carole take on a major public health job for the first time as a regional public health physician with the Western Australian Department of Health. “In this job, I was shifting away from seeing patients individually to looking at public health programs. And I also had the opportunity to spend time with the RMOs, training the health workforce,” she says. Carole and her family are now happily settled in Alice Springs, and plan to stay there while the children finish school. Meanwhile, in addition to her normal workload, Carole is working on a PhD based on her public health research over the past 10 years. And she has another keynote address to prepare.
Written by Jan Walker
With you on your journey 21
FE C onference AT U R E re v iew
#fgp15 GPRA’s 9th annual conference, which included the inaugural student, prevocational doctor and registrar three-day conference, attracted more than 250 delegates from around Australia. Held at the Melbourne Convention and Exhibition Centre between 22 and 24 April, the conference program showcased the varied and exciting career of general practice.
Day one highlights General Practice Students Network National Chair, Nicola Campbell, opened the medical student stream alongside GPSN National Events Officer, Jaislie Anderson, and welcomed Dr Brad McKay from the television series Embarrassing Bodies Down Under. During his informative and often hilarious presentation, Dr McKay dispelled the myths around being “just a GP” while advising delegates to be accurate and measured when talking to the media. He also discussed how to inform the public with science-based medicine in an industry often tarnished by sensationalism.
From left: Dr Jomini Cheong with medical students and members of the GPSN National Executive team
Throughout day one, students also heard from Bionics Institute Deputy Director, Professor Hugh McDermott and dermatology expert Dr Alvin Chong. Dr Jeff Ayton spoke about working in Antarctica in the area of expedition medicine and Dr Gerry Considine of ruralflyingdoc.com incorporated practical information on how to manage burnout and the challenges facing rural doctors into his presentation. The highlight of the day for many students was the opportunity to snap a selfie with Professor John Murtagh, who unsurprisingly drew a huge crowd! The renowned GP and author shared his experiences and provided tips on how to be a great GP in the form of a clinical reasoning skills session. From left: GPSN National Chair, Nicola Campbell; The Hon Catherine King; GPRA CEO, Sally Kincaid; GPRA Patron, Professor Michael Kidd; GPRA Chair, Dr Jomini Cheong
Day two highlights
Day three highlights
GPRA Chair, Dr Jomini Cheong and GPSN National Chair, Nicola Campbell, delivered an inspirational welcome address before handing over to GPRA Patron, Professor Michael Kidd. Professor Kidd shared his experiences in general practice – from working with patients living with HIV to being an advisor to governments as well as a national and global leader and health advocate. He also showcased primary care models in Cuba and Brazil, demonstrating his passion for general practice around the world. In closing, he said that being a GP was a great privilege and urged delegates to “be a loud voice and stand up for what is right”.
The final day of the conference opened with a mindfulness seminar presented by psychologist Dr Richard Chambers, which was followed by a presentation on the transformation of Tennant Creek Hospital by Dr Samuel Goodwin.
Following Professor Kidd, the Shadow Minister for Health, The Hon Catherine King, took to the stage to discuss the need to strengthen general practice and improve the experience for patients. She said that every Australian should have access to the best quality health care “regardless of where they live and regardless of their capacity to pay”. Throughout day two, delegates also heard from speakers including the Department of Health’s Penny Shakespeare about the future of general practice training and Professor Ray Wills, who discussed innovation and new technology in the health sector, Dr David Hawkes on the controversial topic of anti-vaccination and how to deal with anti-vaxxers in the general practice setting, and Dr Andy Morgan on how to diagnose and differentiate common conditions seen in general practice. Dr Bruce Greaves led a suturing workshop and Drs Carolyn O’Shea and Justin Coleman provided prevocational doctors and registrars with medical writing and editing tips.
Delegates heard from prevocational doctors Joseph Monteith and Carolina Radwan about the highs and lows of life in the hospital system, Terry McMaster on financial planning for GP registrars, and Dr Edmund Poliness on his inspirational work with Melbourne’s homeless population. Margaret Villella ran an ECG interpretation workshop, while Professor Kelsey Hegarty educated delegates on domestic violence and how to respond to women and children exposed to abuse. Prominent GP, Dr Mukesh Haikerwal, addressed the audience on mental health in the medical industry, while Dr Sally Cockburn presented on the role of the media when identifying and tackling important medical issues. Renowned medical author, Dr Ranjana Srivastava, closed the 2015 conference with an uplifting talk about what makes a good doctor. She left delegates with some thought provoking advice that it, “doesn’t matter whether you’re a nurse, physio or doctor, it is our collective responsibility to care for our patients”.
That evening, delegates let their hair down at a social function at River’s Edge Events along Melbourne’s iconic Yarra River.
From far left: Dr Ranjana Srivastava, Dr Brad McKay, Professor John Murtagh, #fgp15 delegates Photos courtesy Raimond Aide
With you on your journey 23
Reviews Apps
Oxford handbook of obstetrics and gynaecology, 3rd edn As a terrified resident commencing a terrifying rotation with a busy O&G unit, I jumped at the chance to review the Oxford Handbook of Obstetrics and Gynaecology app. I remembered reading the hard copy back in medical school, and like many prevocational doctors have a comfortable, trusting relationship with the Oxford series. As a day-to-day reference this app shines. Following the (long and tedious) installation process, it gives rapid access to a comprehensive range of O&G topics. When working on call or in various clinics, this app works as a great aide-memoir for less common presentations and clarifying management plans. I found myself quickly reading through relevant chapters in the elevator on my way down to ED following a referral, and brushing up on more complex presentations prior to seeing patients in clinic. The app is simple and concise, and the quick index search function makes up for the somewhat clunky navigation system. Additionally, this app works
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really well as a study aid, with references and external links to supplementary information.
Pros:
• Comprehensive, up to date information at your fingertips • Fast access, great for on-call situations and clinics • Useful for study, particularly for students and prevocational doctors.
Cons: • Can be clunky to navigate • Requires significant set-up, including downloading MedHand Mobile Library App • Expensive; you are paying for portability. Compatibility: iPhone, iPad, Android Cost: $39.99 Rating: 4/5 Reviewed by Josh Saunders Prevocational doctor, Ballarat Base Hospital, Vic
Essential anatomy 4
Pros:
Essential Anatomy 4 is a 3D model that maximises the capacity of an iPad by being able to rotate, pan and zoom around the virtual body. It has 11 complete body systems, including muscular, nervous and digestive systems. The structures can be isolated or viewed together for comparison. Detailed descriptions and pronunciations are provided for each anatomical structure. Other features include the search, note, bookmark, quiz and pin functions. My favourite function is being able to rotate the systems 360 degrees, which allows for the full appreciation of the anatomical location and surrounding structures. The app gets updated frequently and there is also an option to buy add-ons for the muscle and skeletons, which provides useful information about the structures, including the parts, surfaces and videos to show the movement (for the muscles). One drawback is that some of the systems (particularly the arteries, veins, lymph and nervous system) can be quite convoluted and hard to navigate, although this is how the body’s anatomy works and the search function easily solves this issue.
• Extremely detailed, visually stunning and accurate anatomical structures • Overall ease of use with various functions • Detailed quiz function • Continual updates to improve the experience.
Cons: • Missing female body system • Some systems are too complex. Compatibility: iPad and iPhone Cost: $31.99 Add-ons: M uscle System Plus: $9.99 Skeleton System Plus: $9.99 Rating: 5/5 Reviewed by Esther Zhou Fifth year medical student, University of NSW
G
12-lead ECG challenge The 12-Lead ECG Challenge is designed to test ECG interpretation of a wide range of cardiac and non-cardiac conditions. It focuses on common and serious presentations including STEMI and electrolyte imbalances. Each question provides a short clinical history and a 12-lead ECG reading to interpret. Answers are available immediately and are detailed in their explanation.
Pros:
GP RA1 _ 2 P a g e a d
-
1
• Focuses on common and serious conditions • Uses actual patient ECG readings, therefore includes typical and atypical readings as well as those with artefact • Detailed answers are provided with annotated ECG readings • The clinical history provides a background to aid interpretation • Features include ability to exclude previously answered questions, choose 5/10/20
questions per session and zoom in on ECG trace • User-friendly design.
Cons: • Clinical histories are very brief, eg. ‘60 year old male with weakness’ • Not for those with advanced ECG interpretation skills • Cheaper ECG interpretation apps are available (but often with less detailed explanations). Compatibility: iOS 5.0 devices (iPhone, iPad and iPod touch) via iTunes and Android via Google play or Amazon Cost: $7.49 Rating: 4/5 Reviewed by Natalia Ngu Fifth year medical student, Monash University, Vic
2 0 1 5 - 0 3 - 0 3 T1 2 : 0 9 : 3 8 + 1 1 : 0 0
GPCE
AUSTRALIA’S LEADING PRIMARY CARE EVENT
• Extensive choice of topics delivering the latest evidence, guidelines & best practice • Cutting edge medical products, services and technologies
• Hands-on group learning to enhance your practical skills • Exclusive forum to interact with peers, share ideas and experiences
• Learn from leading local specialists and gain impartial, expert advice. • CPR Training Sessions
50% Discount for GP Registers
REGISTER AT GPCE.COM.AU
22 – 24 May 2015
Sydney Showground, Sydney Olympic Park
Reviews Books
Essentials of internal medicine 3rd edn by Talley Frankum and Currow Essentials of Internal Medicine is a concise and trustworthy textbook best suited for final year medical students or trainees in internal medicine. Essentials of Internal Medicine reads like the summarised notes of an expert in the field. There is no waffle and everything is immediately relevant in a clinical context. However, the succinctness means the book isn’t sympathetic to pre-clinical medical students, and the level to which pathophysiology is explored is inconsistent. The text incorporates the latest information in the field with high quality pictures and medical imaging to provide a good resource for the practice of internal medicine. It is organised by body systems with some useful introductory chapters (evidence based practice, ethics, pharmacology and imaging).
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The self-assessment questions at the end of each chapter are carefully considered with detailed answers, and the ‘clinical pearls’ which appear throughout the text usually live up to their name. One excellent feature of the book is that it is written by Australian authors and editors with Australian medical practice front and centre. If you’re comfortable in that ‘just right’ zone between clinical and academic you will value this book. Cost: $105.00 Rating: 4/5 Publisher: Churchill Livingstone, 2014 Reviewed by Amer Mitchelle Third year medical student, University of Notre Dame Fremantle
“Filled with practical advice, the GP Companion will add to the richness of your experiences during your clinical roations in general practice.” Professor Michael Kidd – GPRA Patron
Are you a GPRA member? Get your copy of GP Companion for the special member price of
$19.95 RRP $34.95
Students visit
gpsn.org.au Prevocational doctors visit
gpaustralia.org.au
INDIGENOUS GENERAL PRACTICE REGISTRARS NETWORK Supported by GPRA
GOING PLACES NETWORK
Your
prevocational What is the Going Places Network? The Going Places Network (GPN) is for prevocational doctors interested in the most challenging and versatile medical career of all – general practice. Joining GPN gives you access to national general practice focused events, publications, online resources and more.
What is a GP Ambassador? GP Ambassadors play a pivotal role in the Going Places Network. As the champions of general practice in their hospital, they have a strong dedication to developing and promoting GPN while being the primary point of contact for other prevocational doctors wanting to find out more about general practice. GP Ambassadors also help us run our GPN events, from hospital-based coffee mornings and educational workshops to larger networking events, such as winery tours and barefoot bowls.
How can a GP Ambassador help me? GP Ambassadors are always willing to give honest and useful advice. Whether you have a question about a career in general practice and the training program, or just simply want to chat, your local GP Ambassador will make time for you and offer you the support you need.
Being a GP Ambassador “ means being an easily recognisable and friendly face in the hospital who people feel comfortable approaching for any advice they might need in regards to a future career in general practice.
”
Dr Lauren Mann, Logan Hospital, Qld
How can I contact my GP Ambassador? Visit gpaustralia.org.au/gp-toolkit/ambassador-directory/ for a state-by-state listing of our GP Ambassadors.
Does this sound like you? We currently have a vacancy for a GP Ambassador at Sir Charles Gairdner Hospital in Western Australia. If you are interested in becoming part of the GP Ambassador team, please email goingplaces@gpra.org.au
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What are you waiting for? Explore the specialty of general practice while you complete your hospital training and embark on the journey of a lifetime. Join the Going Places Network at
gpaustralia.org.au
community Have you seen us at these events? Check out some of the recent events GPN has hosted around Australia.
SA and NT • Intern orientation sessions at all five major hospitals • Workshop focusing on dermatology with presenters, Drs Paul Dilena and Lawrie McArthur • How to apply for general practice training session.
Being a GP Ambassador is “ a privilege. I am honoured that I am given the opportunity to advocate for primary health care in my hospital and to unite passionate colleagues in achieving our respective goals together.
”
Dr Chloe Hang, Greenslopes Private Hospital, Qld
Vic and Tas • Intern orientation sessions at Monash, Royal Melbourne, Western, Geelong, St Vincent’s and Ballarat hospitals • Meet your GP morning tea • AGPT program information session.
NSW and ACT • Intern orientation sessions at Tamworth, Canberra, Royal Prince Alfred and Wollongong hospitals • GP Ambassadors workshop and Q&A with Kate Froggert.
QLD • Intern orientation sessions across the state • Skills Up GP Ambassador workshop • Dermatology workshop and dinner focusing on identifying and treating lesions, with Dr Peter Smith.
WA
Upcoming events Don’t want to miss out? Discover what’s happening in your state. Visit gpaustralia.org.au for a list of upcoming events.
• Intern orientation sessions at hospitals across the state from Albany to Broome • AGPT program information session and talk from current registrars’ personal experience on the program • ‘Sundowner’ event focusing on the selection process and how to prepare for general practice training.
With you on your journey 29
General practice students network
Your
student community The General Practice Students Network (GPSN) is a national network of university clubs based at every medical school in Australia, supported by a national executive committee. Club chairs promote GPSN at their university and are a point-of-contact for medical students with general practice career questions. GPSN clubs host a variety of educational and career-focused events across Australia and provide professional resources to medical students. GPSN is funded by the Department of Health and run by GPRA. Being part of GPSN is being part of a community of more than 21,000 medical students, prevocational doctors and general practice registrars.
Connect with us There are many ways to get involved in GPSN. At the university level, members have access to events run just for them by their university GPSN club, or become part of the club executive, where they can continue their passion for general practice through advocacy and events. At a national level, members can become involved with national GPSN working groups, attend the GPSN national conference or become part of the GPSN national executive team. Email your university club chair or gpsn@gpra.org.au with any suggestions or feedback.
Why join? As a GPSN member, there are many benefits available to you, including access to free events, discounts and free resources as well as national representation on external committees. We are constantly working on new benefits, based on member feedback. Visit gpsn.org.au to learn more.
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Photo courtesy Eclectic Photography
As a GPSN member, you also become an Associate Member of GPRA. Both GPSN and the Going Places Network, which is for prevocational doctors, are represented on the GPRA Board and on various external organisations. The GPSN National Executive and Council work to ensure you have the right support to assist you on your journey through medical school, your transition in to the hospital system and on to general practice.
National Council The GPSN Council comprises the local clubs chairs and the national executive. The national executive meet frequently throughout the year to discuss, debate and share ideas, and to further develop the network. At the recent council meeting in Sydney, 30 members, including the national executive and club chairs, met to reflect and plan the rest of the year. The national council passed a number of policies including a review of the rules and regulations, and clubs were given the chance to collaborate for events and brainstorm ideas for national projects.
GPSN National Executive University
Name
Position
Contact
Griffith University
Nicola Campbell
National Chair
chair@gpsn.org.au
University of Western Sydney
Rajdeep Ubeja
National Vice Chair
vc@gpsn.org.au
University of Notre Dame Sydney
Emma Thompson
National Secretary
ns@gpsn.org.au
Flinders University – Northern Territory Medical Program
Claire Chandler
Working Group Officer
wgo@gpsn.org.au
University of Western Sydney
Jaislie Anderson
National Events Officer
neo@gpsn.org.au
Griffith University
Rebecca Calder
Local Events Officer
leo@gpsn.org.au
University of New South Wales
Esther Zhou
Promotions and Publications Officer
publications@gpsn.org.au
University of Western Sydney
Jarrod Bradley
Communications and Online Media Officer
como@gpsn.org.au
GPSN University Club Chairs University
Name
Contact
Cindy Guo
anu@gpsn.org.au
University of Newcastle
Pariza Khale
newcastle@gpsn.org.au
University of New England
Audrey Guo
newengland@gpsn.org.au
University of New South Wales
Deborah Song
unsw@gpsn.org.au
University of Notre Dame Sydney
Melissa Godwin
usyd@gpsn.org.au
University of Sydney
Sureka Vyravipillai
usyd@gpsn.org.au
University of Western Sydney
Larry Lam
uws@gpsn.org.au
University of Wollongong
Jayden Murphey
wollongong@gpsn.org.au
Lauren Thomas
flindersntmp@gpsn.org.au
Bond University
Georgia Cox
bond@gpsn.org.au
James Cook University
Radhika Patwardhan
jcu@gpsn.org.au
University of Queensland
Lulu Zhang
uq@gpsn.org.au
Griffith University
Lucy Holden
griffith@gpsn.org.au
Flinders University
Madeleine Cox
flinders@gpsn.org.au
University of Adelaide
Matthew Chu
adelaide@gpsn.org.au
Zoe Hernstadt
utas@gpsn.org.au
Deakin University
Ellie O’Connor
deakin@gpsn.org.au
Monash University
Natalie Ngu
monash@gpsn.org.au
University of Melbourne
Laura Machan
umelb@gpsn.org.au
University of Notre Dame Fremantle
Jessica Raubenheimer
notredame@gpsn.org.au
University of Western Australia
Michelle Tan
uwa@gpsn.org.au
ACT Australian National University NSW
NT Northern Territory Medical Program (NMTP Flinders University) QLD
SA
TAS University of Tasmania VIC
WA
Get in touch If you have any questions about a career in general practice or would like to attend a local GPSN educational event, please contact your local university club chair.
To find out about projects the National Executive team are working on, please contact one of the team members.
With you on your journey 31
first wav e Q & A
The John Murtagh First Wave Scholarship provides early exposure to general practice in a range of settings. University of New England third year medical student and scholarship recipient, Jessica Jose, answers our questions about her placement.
Where was your placement? Grant Street Clinic at Ballina (near Byron Bay in New South Wales).
What did you observe while on your placement? First Wave was my first real chance to see how things work in a general practice surgery. I saw a lot of things first hand that I found super interesting. Tears and smears were a given, but I also got to see punch biopsies, the use of fluorescein, cryotherapy, ante- and post-natal appointments, and a whole range of all the weird and wonderful things you can and do see in general practice.
What was your supervisor like? She was friendly and knowledgeable, and always happy to involve me in her consultations.
What was the highlight of your placement? It was really cool to be invited to sit in and help my supervisor GP registrar practise for her final RACGP exams. I got to be a ‘mock patient’ and it made me feel like all those pesky OSCEs we do throughout medical school actually do help us to become really great doctors.
From left to right: University of New England First Wave scholars: Sujay Salagame, Jaimie Ho, Audrey Guo, and Jessica Jose
Did you do anything interesting outside your placement? Apart from spending time in the practice, we also attended one of the training days that keeps doctors in the loop and refreshes their minds (and ours) on musculoskeletal physical examinations, and common presentations and treatments. We spoke to local physios, did some shoulder and knee exams, and learnt about arthritis.
What did you learn about general practice? General practice is anything but boring! For example, in between patients I’d get a handy quick, who’s-this-patient rundown, and my supervisor usually had an idea of what they wanted to come in for. It was eye opening to see her very ‘usual’ patient come in for a very unusual and unexpected reason that none of us saw coming. Just when you think general practice might be all boring and mundane, something happens to keep you on your toes!
The John Murtagh First Wave Scholarship Program What is it? Honouring former GPRA Patron, Professor John Murtagh, the GPSN scholarship program provides positive, early and structured exposure to general practice in a range of settings including urban, outer metropolitan, rural and Aboriginal Medical Services.
How does it work? Candidates apply via a formal online process. Successful scholars are then matched with a GP who mentors them during their scholarship period.
What does it involve? The scholarship involves completing a series of supervised sessions in a clinical practice. Clinical sessions are generally scheduled during university summer holidays. 32
Participants are also required to attend a fully-funded two-day orientation workshop.
Who can apply? First and second year Australian medical students studying at an Australian medical university.
When can I apply? Applications open 29 May 2015 and close 3 July 2015.
How do I apply? The John Murtagh First Wave Scholarship program is advertised online and at participating university campuses through their local GPSN club. For more information, visit gpsn. org.au or email firstwave@gpra.org.au
With you on your journey GPRA – proudly supporting medical students and prevocational doctors on their journey to general practice.
Students visit
gpsn.org.au Prevocational doctors visit
gpaustralia.org.au
INDIGENOUS GENERAL PRACTICE REGISTRARS NETWORK Supported by GPRA