ISSUE 19 FREE
January – April 2016
Following your
bliss
Dr Jenni Parsons enriching career enriched life
Also inside about general practice | profiles | clinical cases | agpt program
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In this issue...
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3 Welcome
Feature Published by General Practice Registrars Australia Ltd Level 1, 517 Flinders Lane Melbourne VIC 3001
4 General practice – the specialty of choice Choosing general practice as your specialty gives you the freedom to design a career that’s just right for you.
Profiles 8 Dr Jenni Parsons
P 03 9629 8878 E enquiries@gpra.org.au W gpra.org.au
Dr Jenni Parsons has had a most diverse general practice career. She shares with us the secret to having it all.
ABN 60 108 076 704 ISSN 2203-2657
The promise of being on the medical front line has steered Dr Jamie Mackay towards a general practice career.
16 Dr Jamie Mackay
Editorial team Registrar Advisor Dr Mary Wyatt
18 Dr Mary Wyatt
Editor Denese Warmington denese.warmington@gpra.org.au
20 Professor David Atkinson
Writers Laura McGeoch Jan Walker Denese Warmington Graphic Designer Jason Farrugia GPRA staff CEO Sally Kincaid General Manager – Marketing and Communications Wayne Bruton wayne.bruton@gpra.org.au Advertising sales Lisa Mugg lisa.mugg@gpra.org.au
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Our very own Registrar Advisor, Dr Mary Wyatt, shares with us her own journey to general practice. Professor David Atkinson talks to us about his varied career spanning more than 30 years.
Clinical
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23 GPRA clinical cases 24 Clinical case review
Reviews 26 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.
12 General practice training Interested in applying to the Australian General Practice Training program? We give you the facts.
32 First wave Q&A Fiona Li answers our questions about her John Murtagh First Wave Scholarship placement. Produced with funding support from © 2016 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. This publication is intended for medical students, doctors and health professionals and, as such, may contain material of a medical or graphic nature. GPRA does not accept liability for the use of information within this publication.
Welcome Welcome to Issue 19 of GP Journey, proudly brought to you by General Practice Registrars Australia (GPRA). GP Journey is a magazine that prides itself on showcasing the interesting and exciting aspects of general practice and the stories of GPs, general practice registrars and medical students in general practice placements. Our feature story in this issue is about the journey to general practice as the specialty of choice. The diverse opportunities that are available in training and beyond fellowship, and the unique relationships we form with our patients and communities. Once again, we have had the opportunity to interview some very interesting doctors about their journey to, and through, general practice. Dr Jenni Parsons is a Victorian GP with a diverse career in general practice spreading across several countries and clinical contexts. Her story is a true reflection of the varied opportunities available to GPs. Professor David Atkinson from the Kimberly region highlights the rich rural experience from working in remote communities and the unique sense of belonging and community that being a rural GP encompasses, and Dr Jamie Mackay, a prevocational doctor from South Australia, talks about his journey to general practice and that defining moment when he knew general practice was his career of choice. The final profile in this issue is about my own personal journey to general practice, and the opportunities and wonderful support that GPRA has given me on that journey.
provide support on the journey to general practice: from medical student to recently Fellowed GP. GPRA is free to join for medical students, prevocational doctors and general practice registrars and I would encourage you all to join this wonderful organisation and be part of the conversation to make general practice the best it can be. As part of your membership you will get access to resources to help you study for exams, and regular access to clinical articles.
The John Murtagh First Wave Scholarship is a wellestablished and competitive scholarship for first and second year medical students. The scholarship allows selected students to experience general practice early in their medical training. In this issue, we talk to Fiona Li, a third year student from UNSW about her placement in an inner Western Sydney practice. It’s amazing what talking about McDonalds with children can achieve! If you are interested in applying for the next round of scholarships, make sure you read Fiona’s story.
I hope you enjoy reading this issue of GP Journey, and consider your own journey into the specialty of general practice.
General practice is both a demanding and rewarding career. The most enjoyable aspect of this job is that there is never a dull moment; there are always issues to be explored with your patients and opportunities to help them improve their health or quality of life. If you are interested in a career in general practice I would encourage you to talk to your local GPSN Club Chair or GPN Ambassador and become a member of GPRA today.
Dr Mary Wyatt General practice registrar – Ranford Medical, Canning Vale, Western Australia and Registrar Advisor, GP Journey
In this issue there are also some interesting apps and book reviews that may help you in your clinical practice, as well as key information about the Australian General Practice Training program, the general practice colleges and pathways to becoming a GP. GPRA is a not for profit organisation whose primary goals are to advocate for the future generation of GPs and to
With you on your journey 3
F E AT U R E
General practice The specialty of choice
General practice was recognised as a medical specialty in 2010 by the Medical Board of Australia. That means general practitioners are considered ‘general specialists’. What is general practice? General practice has been described as a medical specialty that provides ‘person-centred, comprehensive and coordinated whole-person health care to individuals and families in their communities’. A general practitioner is a doctor who treats acute and chronic diseases, which are often in their early stages of development and undifferentiated.
How do I get into general practice training? You can apply to the Australian General Practice Training (AGPT) program as early as your intern year (PGY1) and
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undertake your second year (PGY2) as part of general practice training. Applicants in later stages of training may be eligible to apply for recognition of prior learning for their hospital-based general practice training component.
Who manages the training program? The AGPT program is managed by the Australian Government Department of Health, and delivers the postgraduate vocational training programs of The Royal Australian College of General Practitioners (RACGP) and the Australian College of Rural and Remote Medicine (ACRRM). The AGPT program is delivered by a national network of training organisations dedicated to supporting general practice registrars as they embark on a career in general practice.
How long is the training program? The training program involves either a three or four-year full time commitment. Most registrars pursuing the RACGP Fellowship (FRACGP) are able to do so in three years. For those registrars interested in either ACRRM Fellowship (FACRRM) or the Fellowship in Advanced Rural General Practice (FARGP), this is generally acquired over four years. General practice training is quite varied, and registrars acquire experience in different training locations. These locations may include teaching hospitals, rural and urban practices and specialist medical centres. Registrars also undertake an extended skills term and can pursue areas of special interest, such as procedural and academic general practice. There are 1500 funded training places in the program and at least 50 percent of applicants must select the rural pathway for their training.
What are the endpoints? Fellowship of ACRRM and/or the RACGP or FARGP are approved pathways to specialist registration as a general practitioner. Fellowship demonstrates that a doctor has met the required level of competence to deliver unsupervised general practice services in any general practice setting in Australia, whether it be urban, regional, rural or remote. It also confers the ability to access specialist medical registration and consequently A1 rebate rates under Medicare legislation.
“General practice is ever evolving: we have of necessity become the expert generalist doctors of the 21st century and we remain front and central in the delivery of health care. We know that 89 percent of the Australian population visit their general practitioner at least once per year, and people with chronic ongoing medical conditions approximately five times per year. The clinical activity we see is unique with a massive variability. The skills required are complex, but include the ability to assess and manage multiple undifferentiated presentations and consequent clinical uncertainty, having the knowledge base for therapeutic options (not just pharmacotherapy) and the ability to provide quality continuity of care. No other medical or allied health specialties have these necessary skills within the community.” Associate Professor Frank R Jones President The Royal Australian College of General Practitioners
“General practitioners work across a dynamic and changing primary and secondary care interface, typically developing extended competencies in one or more discrete fields of medicine, thereby ensuring community access to the range of needed services in a supportive network of colleagues and health care providers. As the medical expert with the broadest understanding of a patient’s health in their cultural, social and family context, the general practitioner has a key role in coordinating the care pathway in partnership with the patient, including making decisions on the involvement of other health personnel.” ACRRM: The definition of general practice
For more information about general practice training, see pages 11–14 in this issue of GP Journey and visit agpt.com.au For more information about ACRRM or the RACGP, visit the college websites.
With you on your journey 5
GPRA...
with you on your journey GPRA is run by members for members. From GPSN university clubs, to hospital-based GP Ambassadors and a national general practice registrar support team, GPRA is with you on your journey from medical student to general practitioner.
Member benefits
• Member-priced products and publications • Free Medical Observer e-subscription
• Bank of Queensland products
Students 6-1-9 visit 2453 gp99 sn. org.au 8-0ISBN 97 Prev
• Access to peer-to-peer networking events • Global Medical Education – 10 percent discount.
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Inside
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• Free registration to Medicine Today’s clinical archive
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GP
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With y ou on e e Th yp ctic rau r eral o n e g joeuxarmnbeook y
First 20 16 The essentia l guide for
e ral practic The gene
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:
general practice pathway clinical pl s acemen t tips internsh ip facts what yo u can ea rn surviving it all
tional doc gpaustr tors alia.org. visit au
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With you on your journey 7
GP PROFILE
Follow your
bliss
Dr Jenni Parsons has made general practice work for her – on a professional and personal front – at all stages of her career.
and enjoys photography. And she’s recently proved handy with a hammer and saw.
Is it possible to have more than one calling? A few minutes into an interview with Dr Jenni Parsons makes me think that perhaps it is.
Her kitchen is set among five acres of bush land in Victoria’s Macedon Ranges. On any given day she is likely to spot an echidna wandering across her driveway or, if she’s lucky, a koala up a tree.
On the professional front, Jenni has notched up 25 years as a GP, while also taking on supervisory and teaching roles. She’s edited a medical journal and done locum work on Hamilton Island (“the only time you get to wear shorts and tee shirts to work!”) treating holiday markers with coral cuts and injured construction workers. A stint in London doing corporate health work rounds out a pretty diverse career. A snapshot of her personal life appears just as full. She’s a mum of three, now all in their twenties. She loves the great outdoors, and has done a six-week camping trip through north-western Australia and walked the Larapinta Trail in the Northern Territory to raise money for Amnesty International. She’s “a bit arty”, likes to paint
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“I made a table the other day. That was exciting!” she laughs. “I made it out of floor boards from our old kitchen.”
Sound good? A general practice career has helped her to set up this life. And while she’s never “seriously considered” a career outside medicine, being able to combine general practice with family commitments and personal interests has likely kept her in the job for longer. “I think I’d burn out really quickly if I did 10 sessions a week,” Jenni tells GP Journey. Right now, she combines consulting and supervising three days a week with teaching, which she says “keeps me on my toes”. This mix of work, and the sanctuary of her bush land property, provides a welcome outlet. “In general practice, you do spend
all day in someone else’s head space,” she says. “The natural environment is a really nice way to be mindful and float off.” Keeping her head space healthy is important when working with mental health patients, which she sees her fair share of since developing an interest in the area. Mental health can be tricky; there’s rarely a quick fix. But Jenni says GPs need to address it as best they can. “There’s a point in lots of consultations where you kind of think: ‘If I ask the next question, then I am going to end up in a long consultation’ because you know there are mental health concerns underlying the presentation. And if you realise that, you have to ask that question,” she says.
I’ve been able to make it “ work for my life and there’s a lot of scope for doing lots of things.
”
“It [mental illness] can be so destabilising and so unrecognised. For a lot of people it’s the worst thing that ever happens to them,” she says. What should GPs look out for? Jenni says patients often present feeling tired and ask for blood tests and other investigations. “You go through that process and your differential diagnosis… but 70 percent of the time, probably at least, there’s some underlying anxiety, depression or lifestyle distress of some sort that’s behind it all.” Pinpointing the problem and finding the right treatment is difficult. And doing your best doesn’t always lead to the best outcomes. Some years back, Jenni experienced a “traumatic” period when three of her patients, all with mental health issues, were involved in separate tragic situations. It was an “overwhelming” time, both professionally and personally. “Now, looking back, I don’t think that there was anything that I probably could have or should have done differently,” she says. “The older me realises that I did the best I could. The reality is that sometimes you can’t stop bad things happening.” Unlike in the hospital, where there is usually a “clear pathway” for patients, Jenni says GPs often work with the unknown. “I think I probably didn’t realise how much you have to deal with uncertainty and not knowing the answer,” Jenni admits. “Sometimes the answer is: ‘There’s nothing life-threatening, there’s nothing serious, let’s just wait and see.’ Which is kind of hard because people want you to be authoritative, but you can’t always be like that.” Despite the uncertainty that comes with working with people from all walks of life, the human interaction remains one of the most enjoyable parts of her job. “I like the people stuff,” she says. “I like people’s stories. You kind of get a big spectrum of that and their lives.” As a child, Jenni was interested in personal stories. But she wanted to tell them as a journalist or writer. It wasn’t until she moved from regional Victoria to boarding school in Melbourne that she discovered science. She liked it and was good at it. “It’s funny because I didn’t know anyone who had even done a science subject in secondary school!” It sparked the idea that she could study medicine, and perhaps be a doctor. That way she could still work with people.
had enrolled in a writing course. She was doing an editing subject when she saw a “tiny one paragraph ad” for an assistant editor of Australian Family Physician. She sent off an application and ended up working on the journal for 10 years in various capacities, including as medical editor. “It was a great way to keep up with everything,” she says. “I learned a bit more about the research community and a bit more about evidence-based medicine and how to research.” Working on the journal also gave her flexibility to look after her children. She even managed to do it while working and travelling in the UK and Europe. Looking towards the next couple of years and “heading into semiretirement” Jenni plans to work while answering a call to travel again. She is considering doing locum relief work for doctors in rural towns in Western Australia, a part of the country that she feels connected to. “I just like… the remoteness of it and the red earth. It sort of seems like it would be desert and nothing there, but the plant life is amazing,” she says. “There’s something about that feeling of being really close to the natural environment.” Once again, Jenni is harnessing the flexibility of general practice to add a new dimension to the next stage of her career and life. “I’ve been able to make it work for my life and there’s a lot of scope for doing lots of things,” she says. “It’s definitely a very portable job, which is great.”
She wouldn’t have known it at the time, but being a doctor would also help her reach her writing dream. She’d maintained an interest in literature and languages after studying medicine, and
With you on your journey 9
GP TRAINING
What’s your
practice?
General practice gives you the freedom to follow your passion, subspecialise and design the career that’s right for you. Here are just some of the directions you may like to explore.
Aboriginal health Aboriginal health forms part of the AGPT program for all general practice registrars. Training posts in Aboriginal primary health care offer unique and challenging opportunities and allow prevocational doctors to play a hands-on role in improving access and preventing and managing chronic disease in Aboriginal communities.
Academic posts/research Teaching and research can expand your career path in general practice. Research enables you to develop valuable skills to take into your clinical work and could act as a steppingstone towards an academic career. There is widespread agreement that research in general practice is essential for the improvement of patient health care outcomes.
Military medicine Training as a registrar in the Australian Defence Force offers opportunities and challenges. There is a focus on emergency medicine and similar skills to rural general practice, including self-sufficiency in remote locations.
Overseas posts If you enjoy travelling and are keen to gain clinical experience in another country, both ACRRM and the RACGP offer exciting opportunities to complete part of your general practice training overseas. International terms can be taken in countries such as the United Kingdom, Ireland, USA, China, Malaysia and the Middle East. Discuss your interest in overseas training with your training provider early on in your training.
Part-time options The part-time training options and parental leave available to general practice registrars make general practice training
flexible and family-friendly. The flexibility of general practice when it comes to working hours is one of the reasons many people choose it as their career path. Flexible working hours are ideal for those with children, and can also give registrars the freedom to take up opportunities such as becoming a Registrar Liaison Officer, or taking on an academic post.
Rural general practice Doctors undertaking general practice training usually spend some time working in a rural area. Many find the challenging variety of work as a rural GP to be particularly inspiring. As a rural registrar, there is a diverse range of presentations to challenge you and opportunities to broaden your clinical skills.
Sports medicine If you want to get out of the practice and on to the field, and have a particular interest in musculoskeletal injuries and exercise medicine, sports medicine could be for you. You could be providing care to elite athletes through to weekend warriors or the non-exercising person just wanting to improve their exercise level or deal with an injury.
With you on your journey 11
GP TRAINING
Are you ready to start The Australian General Practice Training 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 and The Royal Australian College of General Practitioners. 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.
Key dates for 2017 AGPT selection 10:00 am AEST 11 April
Applications open
10:00 am AEST 9 May
Applications close
13 June – 4 July
National Assessment Centres – SJT online
24 June – 17 July
National Assessment Centres – MMIs
1 August
Applicants are notified of scores and given the opportunity to change preferences (Preference Distribution Matrix posted)
10:00 am AEST 8 August
Applicant preference changes due to the Department of Health
10 August
Applicants notified of RTO shortlisting
12 August – 2 September
RTO placement assessments
10:00 pm AEST 12 September
Outcomes due
your
journey?
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.
Program delivery The AGPT program is delivered by a national network of training organisations. See the map below for the training boundaries.
General practice training boundaries
To find out more about the AGPT program, including a breakdown of the new training boundaries, visit agpt.com.au
With you on your journey 13
GP TRAINING
The AGPT program Endpoint qualifications and fellowships General practice registrars enrolled in the AGPT program can elect to train for Fellowship of ACRRM and/or the RACGP. Fellowship qualifies you for specialist registration and approval to work in unrestricted general practice anywhere in Australia.
Year one
The ACRRM training program comprises three stages of learning: • core clinical training (12 months)
Possible equivalence*
Hospital training time 12 months
++ Year two
Primary rural and remote training 2 x 6 months
Joint training opportunities are available†
GP terms GPT1 – 6 months GPT2 – 6 months
++ Year three
Primary rural and remote training 2 x 6 months
Joint training opportunities are available†
+ Year four Note: Fourth year is for FACRRM and FARGP candidates
• ACRRM accredited-facility training (24 months) • advanced specialised training in one of the 11 disciplines specified by ACRRM (12 months). ACRRM training must include a minimum of six months in a community primary care setting, a minimum of six months in hospital and emergency care, and a minimum of 12 months living and practising in a rural or remote setting.
Training towards FRACGP Candidates wishing to achieve FRACGP must complete the following components of vocational training: • hospital training (12 months) • general practice placement (18 months and including a compulsory minimum term of six months in an outer metropolitan or rural or remote area) • extended skills training (six months). Registrars may also choose to undertake a fourth-year of additional training in advanced skills to obtain the RACGP Fellowship in Advanced Rural General Practice (FARGP). 14
Core clinical training time 12 months
Training towards FACRRM Candidates wishing to achieve FACRRM can apply for one of three training pathways: the Vocational Preparation Pathway, the Remote Vocational Training Scheme or the Independent Pathway.
FRACGP qualifications (RACGP)
FACRRM qualifications (ACRRM)
Advanced specialised training 12 months
GPT3 – 6 months Extended skills – 6 months
FRACGP (VR) Possible equivalence*
Advanced rural skills training for FARGP (12 months)
FACRRM (VR)
* Credit given for AGPT training already undertaken towards one fellowship, prior to undertaking a second or third fellowship † Can be achieved in dual-accredited practices or posts Note: Although this table is presented in a linear format, both colleges have flexible training options to enable registrars to plan their training around their own needs and interests. See the college websites for more information. Registrars can undertake dual fellowships with both ACRRM and the RACGP and the training must be concurrent. However, requirements for placement, duration, completion of training and assessment are different between FACRRM and FRACGP. Registrars seeking both fellowships will need to talk to their training organisation about a program that complies with both colleges.
For more information and full details, visit ACRRM – acrrm.org.au RACGP – racgp.org.au
With you on your journey 15
P R E V O C AT I O N A L D O C T O R P R O F I L E
Journey
front
to the
The promise of varied work and being on the medical front line has steered Dr Jamie Mackay towards a general practice career. Part way through a biomedical science/science double degree at Monash University, Dr Jamie Mackay reached a crossroad. He liked science. It made his brain tick, especially the biomedical science subjects of embryology and genetics. But as he studied, he found himself increasingly drawn to the “clinical side of things”. And he wasn’t sold on every aspect of science. Because he liked working with people, he wondered if working in a lab, often solo, for eight hours a day would satisfy him socially. He decided to get some advice from one of the university’s scientists. “They described science and medicine as a ‘war zone’,” Jamie tells GP Journey. “The scientists develop everything for the ‘front soldiers’ to use. I think at that time I realised I wanted to be the one at the front.” Jamie made the switch and moved from Melbourne to Adelaide to study medicine at Flinders University. It wasn’t long until he found himself at the front; the first rotation of his internship at Flinders Medical Centre was ‘medical nights’. It was a good fit and Jamie enjoyed the step up. “You actually get to do ‘real doctor’ things rather than just paperwork,” Jamie says. Was there a moment when he suddenly felt like he was a ‘real doctor’?
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“When I first signed for a medication or decided that someone could have treatment – and I think it was probably like Panadol or something! – but I still got to make that decision,” Jamie recalls. “Nobody told me to write it. Nobody asked me and then agreed with me… I just wrote it and it happened. “It was a bit scary,” he admits. “A bit daunting in that you have that power and responsibility and no one was there to check on you anymore.” Jamie says that although as a prevocational doctor he was “left alone” to a large extent, he knew there was backup if he needed it. “There is always someone you can call for help. I wasn’t afraid to call!” he laughs. “I probably called more often than I needed to.”
I liked everything a little “ bit. In general practice you get to see everything.” During a quiet moment on the hospital ward, he sat down with a surgical RMO and talked his options over. “She asked me what I wanted to do, and I listed all the things I liked about medicine. And then she said: ‘There is only one solution for you. You need to be a GP’.” It was what he needed to hear.
While he enjoyed the work and patients he saw on nights, the rotation made him realise that he wanted a working life outside the hospital. “Although the work was fun, it was also socially isolating,” he says. “You just simply work and sleep and repeat.
“It helped that someone else agreed that I was making the right choice!” Jamie laughs. “I liked everything a little bit. In general practice you get to see everything.”
“But I liked that I saw the patients every night, or consecutive nights, during the week. I liked that continuity.”
It’s somewhat of a full circle for Jamie. He is working at Box Hill Hospital, the hospital where he was born. It’s also where his father, a GP obstetrician, worked earlier in his career.
As Jamie moved through his rotations, he found that he enjoyed something about every part of the medical spectrum. “All of my rotations were amazing,” he says. This includes his introduction to general practice. Having already developed an interest in obstetrics and gynaecology, time in a general practice clinic showed him the full breadth of work that GPs can practise. “I had a really good GP supervisor who used to do surgery for one day a week and I got to assist, which would be really fun,” he says. He lists some of the “mostly dermatological skin procedures” that he assisted with as abscesses, mole incisions and skin biopsies. Jamie’s time at university and in the hospital had made three things clear to him: he wanted to work with people; he wanted continuity with patients; and he wanted to do diverse work. General practice was emerging as the one specialty that would tick these boxes. But he wanted a second opinion. Just as he did at university before making the switch to medicine, he sought insight from someone who had been there and done that.
This year, Jamie is returning to Melbourne to work as a HMO as part of his training through Eastern Victoria GP Training.
While his dad, who is now a partner in a suburban Melbourne clinic, didn’t push him into general practice, Jamie says that seeing the enjoyment his father got from the specialty influenced his decision. “I feel like he had a good work-life balance and was really positive about his work,” Jamie says. “He was never stressed or overworked and seems to still really like what he does.” So, looking ahead, what does he want from a general practice career? “I guess just to see a wide variety of patients and presentations,” Jamie says. “I also want to do some obstetrics and paediatrics, and also some minor surgical work... lumps and bumps. “I just want a good continuity of patients and to be able to follow them through and help them coordinate their clinical care.” Seems like Jamie is taking the right steps to be at the front.
With you on your journey 17
GP REGISTRAR PROFILE
A
friend on the
From her first year at medical school to her fellowship exams, GP Journey’s Registrar Advisor Dr Mary Wyatt and GPRA have been constant companions. Like a loyal friend by her side, GPRA has always been there for final-year GP registrar, Dr Mary Wyatt – and Mary has always been there for GPRA. She credits GPRA with enriching and enabling her path to becoming a GP, from the suturing workshops she organised for the General Practice Students Network (GPSN) to her later involvement at Board level. “Those pig’s trotters really did stink!” she says with a giggle as she revisits memories of the suturing skills workshops.
It all goes to make Mary something of an expert on the benefits that membership of GPRA, and it’s networks, can offer to medical students, prevocational doctors and registrars. For registrars, Mary says it’s not just advocating for GP registrars as a professional group that’s valuable. The support can also be personal. “On an individual level, if you’re having trouble with your training organisation or placement and you’re not really quite sure where to go, you can always go to GPRA for help,” she says. “I would also encourage any GP registrar to become involved in any or all the standing committees which cover assessment and standards, closing the gap, IMGs, registrar wellbeing, rural issues, and terms and conditions.
“In my first year of medicine at the University of Wollongong, GPSN started and there was a call-out around Australia for medical students at all the universities to become GP Student Ambassadors. So I was the first ambassador at Wollongong Uni – that was my introduction to GPRA.”
“It really is as simple as contacting your RLO or GPRA directly to become involved in the conversations in this area via an email list.”
The string of firsts continued. Later, Mary was asked to become the first Student Director on the GPRA Board. She went on to serve for four years as Student Director and Prevocational Director.
“There are webinars for exam preparation which provide an opportunity to learn from other registrars. There’s also an exam book and a clinical cases book with lots of scenarios. It’s worth going to the GPRA website to see the webinars and other resources.”
In addition, Mary became a GP Ambassador with the Going Places Network when she moved to Perth for her prevocational training at Royal Perth Hospital and supported her colleagues through the general practice application process. Since becoming a GP registrar, she has been a Registrar Liaison Officer with her training organisation, served on the GPRA Advisory Council and attended countless GPRA conferences. And of course, Mary has taken on the role of Registrar Advisor on GP Journey magazine. Over the past two years, she has also chaired the National Terms and Conditions Committee and has been involved in negotiating better terms for registrars in their later training years.
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Mary says another strength of GPRA is that there is an ever-expanding range of resources.
Mary began studying medicine as a second career in her early 30s. Previously a high school maths teacher, she had always been drawn to medicine as part of a medical family. “I have two brothers who are GPs, my father was an orthopaedic surgeon and my mother was a GP.” However, on leaving school she was reluctant to leave her home city of Wollongong to study in Sydney so she studied biomedical science and became a teacher instead. When she took a break to start her family of four children with her husband, Antony, she paused to reconsider her future. At the same time, a new postgraduate medical course started at the University of Wollongong – and everything fell into place.
journey “I remember being in a mothers’ group and we were all talking about what we were going to do when our kids got older. I had taught the kids at school that they should go for what they really want in life – don’t settle, keep trying – and I decided at this mothers’ meeting that really I wanted to do medicine.” After completing her medical degree in Wollongong, Mary’s project manager husband got a fly-in, fly-out
mining job in Western Australia. Consequently, Mary completed her postgraduate and registrar training in Perth. When we spoke to Mary, she was enjoying work at a large outer suburban general practice in Perth. “I love everything about general practice and I’ve enjoyed the journey,” she reflects. And GPRA has been along for the ride all the way.
I love everything “ about general practice and I’ve enjoyed the journey.
”
With you on your journey 19
GP PROFILE
Giving it Taking up unexpected opportunities has helped Professor David Atkinson to discover a passion for Aboriginal health and add new dimensions to a career spanning more than 30 years.
couple would take a “whole bunch of people” in David’s Toyota “troopie” out bush or to nearby fishing holes.
Sometimes you just need to say “yes”.
Like housing, David says observations in Aboriginal health need to be made over longer than one or two years, because “nothing appears to change” during this time. Now living in Broome and still working around the Kimberley as Head of the Rural Clinical School of WA, he has the benefit of a 30-year perspective. He says while it’s not all encouraging when it comes to Aboriginal health, there are some positives.
It’s what Professor David Atkinson said when offered a solo GP job in Fitzroy Crossing. It was 1984 and it would be a big step for the 29-year-old, born and bred in Perth. He had two young sons and his wife, Sue, was pregnant with their third. The couple talked it over. “We decided: ‘Well… yep. Let’s go!’” David wasn’t going there totally raw. His first GP role was in Darwin and had taken him to Jabiru – full of uranium miners – for six months. In Jabiru, he looked after the miners and their families and got an “introduction” to remote Aboriginal health while visiting the surrounding communities. Memories of those first visits, particularly seeing Aboriginal people living with the consequences of Hansen’s disease (leprosy), are vivid. He was impressed with their resilience. He tells GP Journey about one young mother with two small children. “She just coped. She had significant disability of her hands and arms, but it didn’t really interfere with what she was doing and how she was looking after her kids.” Although he enjoyed working in the territory, David says there wasn’t a clear pathway at the time for prevocational doctors working remotely. Needing more training and experience, he returned to Perth and worked in a general practice and in Aboriginal health. But the city wasn’t for him. Within two years, his family moved 2500 km to Fitzroy Crossing. “I found it incredibly rewarding work,” he says. “The community really did value what we were trying do for them.” The community embraced his family. The women looked after their youngest son while Sue worked part time for the Department for Community Development. In their free time, the
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While the area was rich in natural beauty, living conditions for the local Indigenous people were “relatively rough”, especially compared to the new builds in Jabiru. However, David says housing did improve during his three years there.
“Kids were really sick back then. And yet in the 80s, they were a lot less sick than they were in the 60s and early 70s… and the number of kids in hospital now is a tiny fraction of what it used to be,” he says. When his eldest son was nearing high school, the family left Fitzroy Crossing for Perth again. David achieved a Masters in Public Health, knowing it would complement his remote work when he returned – always the plan – to the Kimberley. The couple moved to Broome in 2002 when their youngest son went to university. David planned to combine teaching at the rural school with consulting work. But another opportunity came up. The Kimberley Aboriginal Medical Services Council (KAMSC) and Western Australian General Practice Education and Training (WAGPET) developed a program training GPs in Aboriginal health across the Kimberley. They needed someone to run it. David said “yes” and hasn’t looked back. “It’s been one the great experiences of my career.” Together with KAMSC, he got registrars to say “yes” to working in Aboriginal health. Four registrars started in the program in 2003 and now more than 100 have been trained. In 2015 and after he took on his current role, David passed responsibility for the program on to the GPs trained in the program.
a go
Fitzroy Crossing
WA
NT SA
Registrars are taught to trust their judgement and hone their basic clinical skills. David says they shouldn’t be daunted by not having access to “machines that go ‘ping’” and operating theatres. “It’s not all that often that dramatic interventions make a difference, even in emergencies. Rather, it’s about standard life support – giving fluids, making sure patients can breathe and looking after them until they can get somewhere with more facilities” he says. If things do go wrong, David says there is support from surrounding medical services and that people in small communities “jump in and help”. While at Fitzroy Crossing, a Hilux carrying 18 people rolled and five passengers died. The town rallied. If someone could help, they did. The evacuation service worked efficiently and ferried patients to Derby through the night. And while registrars working in remote Aboriginal health will see complex and serious illnesses, they will also “see people with more settled lives and less complex problems”. He believes they get a much broader perspective than their urban counterparts. He recalls a “delightful” couple in Fitzroy Crossing. The wife complained her husband couldn’t hear. David saw that the man “didn’t have much left in the way of eardrums” due to childhood infections. He made the arrangements for them to be repaired and remembers the couple’s happiness with the result. “There wasn’t anything terribly technical about it,” David notes. “But nobody had ever done anything about it.” There’s still a chance to make an impact, he says. “You can’t always make a difference to all patients… but you can make a big difference to some individuals’ lives. “Give it a go,” he says. “Go out remote and really experience something different!”
You can’t always “ make a difference to all patients… but you can make a big difference to some individuals’ lives.
”
With you on your journey 21
A DV E R TO R I A L
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GENERAL PRACTICE CASES
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The following cases have been taken from the GPRA publication, The general practice exam book.
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Kath O’C onnor Robin Pa rk Fabian Sc hwarz Tammra Warby Yashar Al iabadi Za deh
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Case 1
Case 2
Doris, a 68-year-old woman presents with a lesion on her right inner arm (see figure below). She noticed it rapidly growing over the previous two months. It is firm and has a solid keratin core. The most likely diagnosis is:
Alicia, a 16-year-old female, presents to your clinic requesting advice regarding her acne. She has had difficulty with mild comedomic acne for the past 12 months (see figure below). You give Alicia the following advice:
A. Bowen’s disease
A. She should avoid chocolate and fatty foods
B. Keratoacanthoma
B. Using cosmetics will make her acne worse
C. Basal cell carcinoma
C. She should use appropriate sun protection
D. Solar keratosis
D. She should wash her face daily with soap
E. Amelanotic melanoma.
E. Gently lancing white-head lesions with a sterile needle and then wiping them with an alcohol swab can be helpful.
Image reproduced with permission. New Zealand Dermatological Society Inc. Published online at dermnetnz.org
Answer to Case 1 This question raises the importance of history in dermatological disease. The rapidity of onset and typical appearance and history are most consistent with a keratoacanthoma. Bowen’s disease does not enlarge in the same way. A squamous cell cancer (SCC) or a basel cell carcinoma (BCC) is possible, but the duration makes this less likely. A solar keratosis is also possible but this does not fit with the appearance of the lesion. An amelanotic melanoma does not fit the timeline or the presentation.
Answer to Case 2 This question requires a knowledge of the evidence base behind advice that is commonly given regarding the management of acne. There is no evidence that diet or the use of cosmetics contribute to the worsening of acne. Soap products should be avoided in all patients with acne. Whiteheads should not be lanced as this can lead to scarring. Transient sun exposure can improve acne but this should not be suggested as a treatment due to the sun’s damaging effects on skin.
With you on your journey 23
CLINICAL CASE REVIEW
Summer seasonal affective disorder A less common variant By Philip Boyce
What is summer seasonal affective disorder and how should it be managed?
Case scenario Meredith, aged 50 years, complains of what she claims is ‘seasonal affective disorder’ (SAD). She describes a classic depression that starts suddenly, not in winter, but in November each year and then abruptly ceases in March. On questioning, she admits that the Christmas period is never a happy time for her due to longstanding family conflict. She has never been referred to a psychiatrist or psychologist and never been treated with any form of antidepressant. She has read about melatonin and wonders if it might help. Can SAD occur in summer? What would be the appropriate management for this patient, and is melatonin likely to be of any use?
Commentary A pattern of depressive episodes recurring each year, in a specific season, has been observed since antiquity; however, it was not until the 1980s that the symptom pattern and a specific treatment were described for recurring episodes of winter depression, labelled as ‘seasonal affective disorder’. The initial descriptions of SAD focused on recurring episodes of depression, arising in autumn/winter and spontaneously remitting in spring/ summer. The condition was linked to the short day length (photoperiod) of wintertime, with a disturbance to circadian rhythms that could be corrected by suppressing melatonin secretion by using bright artificial light.1
What is summer SAD? Although initial interest in seasonal mood disorders focused on recurring episodes of winter depression, a less common summer variant has also been identified.2,3 This form of SAD
This article originally appeared in Medicine Today 2014;15(7):48–49 and is reprinted here with permission.
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presents with the ‘classic’ (or melancholic) symptoms of depression, rather than the atypical symptoms (characterised by hypersomnia, increased appetite, rejection sensitivity and ‘heaviness’ in the limbs) found in winter SAD. The exact mechanism for this form of depression is not known, but it is most likely the result of a change to the normal regulation of circadian rhythms, with a ‘phase advance’ of rhythms arising as a result of the longer photoperiod. A phase advance means that the normal circadian rhythms are shifted to earlier in the day. For example, the usual nadir of the temperature and cortisol rhythms are at around 3 am; with a phase advance the nadir would be ‘advanced’ to around 1 am (a possible reason for the early morning awakening with depression). Recurring episodes of depression at the same time each year do not necessarily imply SAD; the depression could arise as the result of stressful life events that regularly occur at the same time each year, such as times of particular work or family stresses, or the anniversary of a tragic event. Meredith describes Christmas as ‘never being a happy time’ as a consequence of family conflict. Although this could be a reason for her depression developing in the summertime, it is unlikely to be the cause because the onset of her depression, in November, is a considerable time prior to the stressful Christmas period. In addition, her depression remits around the onset of autumn, suggesting a seasonal pattern. In Meredith’s case, an important consideration is the impact of her depression and ability to cope with family conflict. It is possible that while depressed she becomes more sensitive to the family conflict and that this exacerbates her depression and makes it more difficult to deal with the conflict. It is also possible that her being depressed (and possibly withdrawn) leads to family conflict.
Managing summer SAD The management approach to summer SAD should follow the usual guidelines for the management of depression.4
Bright light therapy, although effective for winter SAD,5 has not been used to treat the summer form because the depression is not the result of delayed melatonin secretion. If the depression is mild to moderate, focused psychological treatments, especially cognitive behavioural therapy (CBT), may be sufficient to treat Meredith’s depression.6 This would also be of considerable benefit for her in developing skills to be able to deal with the family conflict. Antidepressant medication is indicated for moderate to severe depression, with the selective serotonin reuptake inhibitors (SSRIs) and serotonin noradrenaline reuptake inhibitors (SNRIs) having demonstrated efficacy for SAD.7 If Meredith was able to identify the early warning signs, she could start taking the antidepressant with the first emergence of symptoms in November and then discontinue treatment in late March when her depression would normally remit. Psychological treatments, especially psychoeducation and CBT, should also be offered along with the medication. The new antidepressant agomelatine, which has a direct effect on synchronising circadian rhythms by its action on the melatonergic receptors in the suprachiasmatic nucleus, has been shown to have benefit in SAD.8 The role of melatonin in treating SAD is unclear, particularly for summer SAD. One study has shown that melatonin has a moderate effect in subsyndromal SAD,9 but it has not been evaluated thoroughly in the treatment of the summer variant of SAD. Melatonin (2 mg nocte) would only be indicated if there were significant associated sleep disturbance during the summer that may be exacerbating Meredith’s depressive symptoms.
Conclusion A summer variant of SAD has been identified that presents with the melancholic symptoms of depression rather than the atypical symptoms in winter SAD. This form of depression is not thought to be due to the result of delayed melatonin secretion. Its management approach is the same as that for depression in general. Meredith’s family stress at Christmas time may be a consequence of her depression and her having difficulties coping with interpersonal problems.
Author Philip Boyce MBBS, MD, FRANZCP is Professor of Psychiatry in the Discipline of Psychiatry, Westmead Clinical School, Sydney Medical School, The University of Sydney, Sydney, New South Wales. Competing interests: Professor Boyce has acted as a consultant and received unrestricted research grants and honoraria for speaking from Servier Laboratories.
References 1. Boyce P, Hopwood M. Manipulating melatonin in managing mood. Acta Psychiatr Scand Suppl 2013;(444):16–23. 2. Boyce P, Parker G. Seasonal affective disorder in the southern hemisphere. American Journal of Psychiatry 1988;145:96–99. 3. Tonetti L, Sahu S, Natale V. Cross-national survey of winter and summer patterns of mood seasonality: a comparison between Italy and India. Compr Psychiatry 2012;53:837–842. 4. Malhi GS, Adams D, Porter R, et al. Clinical practice recommendations for depression. Acta Psychiatr Scand Suppl 2009;(439):8–26. 5. Golden RN, Gaynes BN, Ekstrom RD, et al. The efficacy of light therapy in the treatment of mood disorders: a review and metaanalysis of the evidence. Am J Psychiatry 2005;162:656–662. 6. Rohan KJ, Roecklein KA, Tierney Lindsey K, et al. A randomized controlled trial of cognitive-behavioral therapy, light therapy, and their combination for seasonal affective disorder. J Consult Clin Psychol 2007;75:489–500. 7. Westrin A, Lam RW. Seasonal affective disorder: a clinical update. Ann Clin Psychiatry 2007;19:239–246. 8. Pjrek E, Winkler D, Konstantinidis A, Willeit M, Praschak-Rieder N, Kasper S. Agomelatine in the treatment of seasonal affective disorder. Psychopharmacology (Berl) 2007;190:575–579. 9. Leppämäki S, Partonen T, Vakkuri O, Lönnqvist J, Partinen M, Laudon M. Effect of controlled-release melatonin on sleep quality, mood, and quality of life in subjects with seasonal or weather-associated changes in mood and behaviour. Eur Neuropsychopharmacol 2003;13:137–145.
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. 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 25
Reviews Books
Fitzpatrick’s color atlas and synopsis of clinical dermatology, seventh edition Klaus Wolff, Richard Allen Johnson, Arturo Saavedra This book lives up to its name. With outstanding quality pictures of common (and many uncommon) dermatological issues captured alongside skin manifestation descriptors – that we all learn as medical students but struggle to picture – this book is a dermatological staple.
pictures, it’s easy to find information in a hurry. An excellent reference book that could easily become my one and only dermatological go-to book. The only downside is its price; but if you’re going to buy one book on dermatology, this should be it. Publisher: McGraw-Hill Education, 2013 Cost: $149.00 Rating: 4/5 Reviewed by Dr Emma Thompson Intern, Wollongong Hospital NSW
With a basic introduction on how to use common skin terms, this book covers ground from medical student to dermatological registrar. Organised logically and with an easy to use index, again with
First do no harm: being a resilient doctor in the 21st century Leanne Rowe, Michael Kidd Leanne Rowe and Michael Kidd are wellrespected doctors who boast extremely well rounded careers, including past chair of The Royal Australian College of General Practitioners and current President of the World Organization of Family Doctors respectively. They team together to write this extremely well rounded book about how to be a resilient doctor in the 21st century. Despite mental health being recognised as a major issue in society, it still plagues doctors and medical students. First do no harm looks at the ways in which our relationships with ourselves, family and friends, colleagues and patients affect our lives, including the conflicts and problems that arise and how we can go about solving
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them. This book is filled with practical advice, anecdotes, check-lists and inspiring quotes to help doctors and medical students play an active role in improving their approach to their own lives. I highly recommend First do no harm to every doctor and medical student; it is easy to fit reading it into your busy lifestyle, and I am certain you will find much use for it. Publisher: McGraw-Hill, 2009 Cost: $39.95 Rating: 4.5/5 Reviewed by Esther Zhou Final year medical student, University of New South Wales
General practice psychiatry Grant Blashki, Fiona Judd, Leon Piterman A great book for revisiting common psychiatric presentations in general practice, particularly for registrars preparing for final exams. Chapters dedicated to GP self-care, cross-cultural issues, Indigenous issues and tools for assessment of mental health conditions are welcome trimmings alongside the usual compilation of chapters on common axis one disorders. The strength of this book is that it is well written. It is concise, intelligible and covers many essential topics thoroughly. However, there are two significant limitations to this book. First, this 2006 publication refers to
the DSM-IV and not the current psychiatric gold standard DSM-V. In saying that, the latest criteria is easily found on the internet and is rarely the content that is required when looking to a reference textbook. Second, there is no mention of axis two disorders, including personality disorders and intellectual disorders, so these will need to be studied elsewhere. Overall, an interesting, easy read with many essential areas covered. I would recommend it. Publisher: McGraw-Hill, 2006 Cost: $89.00 Rating: 4/5 Reviewed by Dr Alyssa Jayne Kelly GP registrar, Adelaide SA
Apps
Yoga Nidra – deep relaxation practice
Pros:
Elizabeth Papadakis
• can choose between guided meditation or background sounds for your own practice
Yoga Nidra is pitched as an app designed to help with stress management but I found it to be so much more. Not only was it quick and easy to install but navigation of the app was also easy. Initially I started with the shorter 10-minute guided meditations once or twice throughout the day, but as I became comfortable with my practice I found myself wanting to use the longer meditations (30 minutes) more and more. 20 minutes of the nature sounds was especially useful just before bed – I slept a treat!
• super easy to use interface
• different lengths of practice make app easy to access – great for a short ‘regroup’ between patients or for a more extended end of day ‘wind down’ • suitable for any fitness level • well priced. Cons: • only offers three time lengths: 10, 20 or 30 minutes. Compatibility: designed for both iPhone and iPad Cost: $5.99 Reviewed by Kat Moritz Freelance writer, Vic
With you on your journey 27
GOING PLACES NETWORK
Your
prevocational community
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.
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 or find your hospital-based GP Ambassador from the list on page 29.
Being an Ambassador “ means I can keep doctors up to date about what’s happening in general practice and how to achieve their goals. It’s all about staying informed.
”
Royal Children’s Hospital, Vic
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
28
Dr Billy Stoupas
GP Ambassadors Want to get involved? Going Places Network GP Ambassadors are prevocational doctors who have a real passion for general practice. Ambassadors can help answer all your questions on becoming a GP.
NSW and ACT
Find the contact details for your GP Ambassador from the list below. To find out more about becoming a GP Ambassador, email goingplaces@gpra.org.au
VIC
Hospital
Contact
Hospital
Contact
Bankstown Hospital
bankstowngp@gpra.org.au
Albury Wodonga Health
wodongagp@gpra.org.au
Gosford Hospital
gosfordgp@gpra.org.au
Austin Hospital
austingp@gpra.org.au
Hornsby Hospital Network
hornsbygp@gpra.org.au
Ballarat Hospital
ballaratgp@gpra.org.au
John Hunter Hospital
johnhuntergp@gpra.org.au
Eastern Health
boxhillgp@gpra.org.au
Maitland Hospital
maitlandgp@gpra.org.au
Geelong Hospital
geelonggp@gpra.org.au
Royal North Shore Hospital
royalnorthshoregp@gpra.org.au
Northern Health
northernhealth@gpra.org.au
Royal Prince Alfred Hospital
royalprincealfredgp@gpra.org.au
Shepparton Hospital
sheppartongp@gpra.org.au
St George Hospital
stgeorgegp@gpra.org.au
Southern Health
southernhealthgp@gpra.org.au
Tamworth Hospital
tamworthgp@gpra.org.au
St Vincent’s Hospital
stvincentsgp@gpra.org.au
The Canberra Hospital
canberragp@gpra.org.au
Western Health
westerngp@gpra.org.au
Westmead Hospital
westmeadgp@gpra.org.au
Wollongong Hospital
wollongonggp@gpra.org.au
QLD Cairns Base Hospital
cairnsgp@gpra.org.au
Gold Coast Hospital
goldcoastgp@gpra.org.au
Logan Hospital
logangp@gpra.org.au
Mackay Base Hospital
mackaygp@gpra.org.au
Nambour Hospital
nambourgp@gpra.org.au
Princess Alexandra Hospital
princessalexandragp@gpra.org.au
Redcliffe Hospital
redcliffegp@gpra.org.au
Rockhampton Hospital
rockhamptongp@gpra.org.au
Toowoomba Hospital
toowoombagp@gpra.org.au
Townsville Hospital
townsvillegp@gpra.org.au
TAS Launceston Hospital
launcestongp@gpra.org.au
Royal Hobart Hospital
royalhobartgp@gpra.org.au
WA Fremantle Hospital
fremantlegp@gpra.org.au
Joondalup Health Campus
joondalupgp@gpra.org.au
Royal Perth Hospital
royalperthgp@gpra.org.au
Sir Charles Gairdner Hospital
charlesgairdnergp@gpra.org.au
SA and NT Flinders Medical Centre
flindersgp@gpra.org.au
Lyell McEwin Hospital
lyellmcewingp@gpra.org.au
Modbury Hospital
modburygp@gpra.org.au
Royal Adelaide Hospital
royaladelaidegp@gpra.org.au
Royal Darwin Hospital
darwingp@gpra.org.au
The Queen Elizabeth Hospital
queenelizabethgp@gpra.org.au
With you on your journey 29
GENERAL PRACTICE STUDENTS NETWORK
Your student community The General Practice Students Network 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 University Club contacts University
Contact
ACT Australian National University
anu@gpsn.org.au
NSW
GPSN clubs host a range of educational and career-focused events across Australia and provide professional resources to medical students. GPSN is funded by the Department of Health and overseen by GPRA.
University of Newcastle
newcastle@gpsn.org.au
University of New England
newengland@gpsn.org.au
University of New South Wales
unsw@gpsn.org.au
University of Notre Dame Sydney
usyd@gpsn.org.au
Being part of GPSN is being part of a community of more than 21,000 medical students, prevocational doctors and general practice registrars.
University of Sydney
usyd@gpsn.org.au
University of Western Sydney
uws@gpsn.org.au
University of Wollongong
wollongong@gpsn.org.au
Connect with us
Northern Territory Medical Program (NMTP Flinders University)
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.
NT
QLD Bond University
bond@gpsn.org.au
James Cook University
jcu@gpsn.org.au
University of Queensland
uq@gpsn.org.au
Griffith University
griffith@gpsn.org.au
At a national level, members can become involved with GPSN working groups, attend the GPSN national conference or become part of the GPSN National Executive team.
SA
Why join?
University of Tasmania
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. 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 National Council comprises the local university club chairs and the national executive. The national executive meets frequently throughout the year to discuss, debate and share ideas, and to further develop the network.
30
flindersntmp@gpsn.org.au
Flinders University
flinders@gpsn.org.au
University of Adelaide
adelaide@gpsn.org.au
TAS utas@gpsn.org.au
VIC Deakin University
deakin@gpsn.org.au
Monash University
monash@gpsn.org.au
University of Melbourne
umelb@gpsn.org.au
WA University of Notre Dame Fremantle
notredame@gpsn.org.au
University of Western Australia
uwa@gpsn.org.au
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 is working on, please contact one of the team members.
2016 GPSN National Executive Meet the team
National Chair
National Vice Chair
National Secretary
Claire Chandler Flinders Northern Territory Medical Program chair@gpsn.org.au
Jayden Murphy University of Wollongong vc@gpsn.org.au
Rebecca Calder Griffith University ns@gpsn.org.au
National Events and Projects Officer
Local Events Officer
Promotions and Publications Officer
Larry Lam University of Sydney Western neo@gpsn.org.au
Lawrence Ling James Cook University leo@gpsn.org.au
National Working Group Officer Kerry Chen University of New South Wales wgo@gpsn.org.au
Renata Pajtak Australian National University publications@gpsn.org.au
With you on your journey 31
F I R S T WAV E Q & A
The John Murtagh First Wave Scholarship provides early exposure to general practice in a range of settings. University of New South Wales third-year medical student and scholarship recipient, Fiona Li, answers our questions about her recent placement.
Where was your placement? My placement was at Astley Medical Centre, a busy practice in St Marys in western Sydney.
What did you observe while on your placement? On my placement I was offered insight into the weird and wonderful moments that constitute ‘GP land’. I interacted with patients from all walks of life, who each presented with a unique concern and context. It was very interesting to observe a differing approach to management of each patient, and exciting to experience patientcentred care, as opposed to a more illness-centred approach on clinical placements through the university curriculum.
What was your supervisor like? My supervisor was absolutely wonderful, going out of her way to create a supportive, comfortable and safe environment for me to achieve the optimal learning experience. She was very knowledgeable and accommodating, and offered me an honest and real perspective into her experiences training for, and as a GP.
What was the highlight of your placement? A junior primary school boy presented to my supervisor after he had collided into the edge of a door just before morning recess. Despite the terrifyingly deep cut in his forehead for which he needed several stitches, this boy was surprisingly chirpy and charismatic.
As he lay down on the bed, he was completely unfazed by the medical staff bustling around him preparing for the procedure. However, immediately with the sight of the anaesthetic needle, he broke into hysterics, crying and screaming uncontrollably. Quickly I tried to distract him by asking him about school and friends, favourite colour (and all the other things you’re taught to say), to no avail. I moved on to the topic of favourite meals, his favourite order at McDonald’s and favourite cookie flavours, and he instantly calmed and didn’t even flinch at the injection! This was one of my favourite experiences of my placement because firstly, that was one deep cut; secondly, it goes to show how universally wonderful food is; and lastly, it made me realise that as a medical student you can stand in the corner, or you can engage, try and be useful and make a difference. Needless to say, this boy was chirpy post-procedure and almost restored to his original (cheeky) condition at follow-up!
What did you learn about general practice? General practice is far from flus and colds, lumps and bumps. If anything, I came to see general practice with everything beyond and in between. With every new patient who walked through the door, I was on the edge of my seat to find out what problem they would bring to the table – presentations ranged from chronic disease management and counselling, to emergent chest pain and trauma cases. Ultimately, it was most inspiring to see primary care in action, and to see what a difference a compassionate and conscientious practitioner can make to a patient’s experience and medical care.
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 in May 2016 and close early July 2016.
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
AUSTRALIAN GENERAL PRACTICE TRAINING
2017 Applications for 2017 open 11 April 2016
www.agpt.com.au @AGPT_GPTraining
Murtagh Library designed specifically to ng and development.
Independent learning program for GPs
Independent learning program for GPs
Unit 497 August 2013
The #fgp16 conference program will see more than Neurology 60 speakers educating delegates on the many fields of general practice, challenging views of patient care and discussing how general practice will evolve in the future. Speakers include: Prof Michael Kidd
Dr Jomini Cheong
A/Prof Frank R Jones
Dr Margaret Kay
Brisbane
Dr Wendell Prof Paula Barrett DynaMed, an Explore theRosevear popular Access 1–3 April 2016 Dr Bruce Willett Dr Gerry Considine check* Program evidence based point Dr Genevieve Yates showcasing case of care tool or the John For registration details and speaker studies written Murtagh Library’s online updates visit by expert clinicians. databases for research fgp.org.au projects/assignment preparations. www.racgp.org.au/check
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23/08/13 12:05 PM
Independent learning program for GPs
Independent learning program for GPs
al training and learning cgp.
With thanks to our conference partner