ISSUE 20 FREE
A place in the country Dr Joshua Saunders rural heart rural practice
Also inside agpt | wonca | medico-legal | clinical | profiles
May – August 2016
18
In this issue...
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3 Welcome
Feature 4 All about WONCA Published by General Practice Registrars Australia Ltd Level 1, 517 Flinders Lane Melbourne VIC 3001
You’re training to give special treatment, now you can expect to receive it Not everyone is eligible to be a client of BOQ Specialist. But you are. As a medical student or prevocational doctor, you’re eligible to join the numerous medical professionals who have chosen to trust us with their finances. You’ll discover that, like you, we are specialists. We’ve worked closely with the medical industry for over twenty years. And because we’ve taken the time to know more about you, we can do more for you.
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Profiles 14 Dr Natasha Pavlin
P 03 9629 8878 E enquiries@gpra.org.au W gpra.org.au
Dr Natasha Pavlin chats to us about her general practice career and the endless pursuit of exciting opportunities.
ABN 60 108 076 704 ISSN 2203-2657
Dr Ethan Salleh shares his journey from veterinarian to registrar with a special interest in transgender medicine.
Editorial team Registrar Advisor Dr Mary Wyatt Editor Denese Warmington denese.warmington@gpra.org.au Writers Laura McGeoch Denese Warmington Graphic Designer Jason Farrugia
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16 Dr Ethan Salleh
18 Dr Joshua Saunders Dr Joshua Saunders wants to return to his roots. He chats to us about his search for the perfect country practice.
General practice training 9 Subspecialise with general practice 10 AGPT program
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11 AGPT national assessment 12 AGPT endpoint qualifications and fellowships
Medico-legal 20 Medical records – the essentials
GPRA staff CEO Sally Kincaid General Manager – Marketing and Communications Wayne Bruton wayne.bruton@gpra.org.au Advertising sales Rosa Gentile rosa.gentile@gpra.org.au
Clinical 23 GPRA clinical cases 24 Dermatology clinic
Your networks
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28 Going Places Network 30 General Practice Students Network
Also inside 7 Membership of GPRA 27 Reviews 32 John Murtagh Scholarship
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© 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.
Avant Doctor in Training Research Scholarship Program 2016
Welcome Welcome to Issue 20 of GP Journey, which is – as always – proudly brought to you by General Practice Registrars Australia (GPRA). GPRA is the national body representing and supporting almost 27 000 members through its various networks: the General Practice Students Network (GPSN) for medical students, the Going Places Network (GPN) for prevocational doctors, the General Practice Registrars Network (GPRA), which includes immediate past registrar members – the new fellows, and the Indigenous General Practice Registrars Network (IGPRN). We are a strong and united group of networks, working hard to secure the future of general practice as the specialty of choice for the doctors of the future.
Avant scholarship recipients
We do more than protect your future, our scholarship program will help you build it. At Avant, we understand the pressures you face as a doctor in training. Making a contribution to medicine through research is personally rewarding. It can also be one of the best ways to advance your career. That’s why we’ve enhanced the Avant Doctor in Training Research Scholarship Program. So you have more opportunities than ever before to pursue research as part of your training. Not all doctors are the same. The same goes for MDOs. Avant. Your advantage.
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Over the years we have enjoyed strong support from a range of organisations including the Federal Government. This support has seen the numbers applying into general practice training grow significantly, and we are now in the position where only quality applicants are accepted into the Australian General Practice Training program. It is incredibly important that we keep the momentum up for this supply pipeline to continue to remain healthy into the future. Sadly, the Federal Government has made the decision that they don’t believe support for medical students and prevocational doctors is necessary, and consequently funding support for GPSN and GPN was not renewed from 1 January this year. Unfortunately we were only given around six working days notice of this development just prior to Christmas. Some GPRA staff were told that they would not have a job in 10 days time, and many of the activities that were planned for ‘O’ weeks had to be curtailed.
Also in this issue, we have the usual mix of clinical articles and reviews, and the most up-to-date contact list for medical students and prevocational doctors to get in touch with their local GPSN club chair or hospitalbased GP Ambassador for all things general practice. We also feature the first in our new series on medicolegal matters, share tips on how to prepare for the AGPT national assessment, and provide an introduction to WONCA with our feature story. I hope you enjoy reading this issue of GP Journey and consider your own journey into the specialty of general practice. Dr Mary Wyatt General practitioner, Canning Vale, Western Australia Registrar Advisor, GP Journey
However, despite this significant withdrawal of government funding, GPRA is committed to continuing its support of members and in that vein we bring you this – the 20th issue of GP Journey! In this milestone issue we look at the breadth of practice that you can conduct as a GP – from rural, small community to palliative medicine, sexual health, academic research and transgender medicine. Our cover profile story looks at the drivers that bring rural medical graduates back to work in a rural environment as GPs in their communities.
With you on your journey 3
F E AT U R E
The Rajakumar Movement The Rajakumar Movement was established in 2009 and named after Dr MK Rajakumar, a socialist leader and medical practitioner, often regarded as a founding father of the discipline of family medicine. Its current chair, Dr Shin Yoshida, a prevocational doctor from Japan, says that part of his mission is to “share our generalism, learn from our differences and build true friendship in the WONCA Asia Pacific region”.
Let us form collaborative “ bilateral links for a pooling of
All you didn’t know What is ‘WONCA’? WONCA is the acronym of the World Organization of National Colleges, Academies and Academic Associations of General Practitioners/Family Physicians. WONCA is also known as the ‘World Organization of Family Doctors’. WONCA was founded in 1972 by member organisations in 18 countries around the world with the aim of improving the quality of life of all peoples. It now has 118 member organisations in 131 countries and territories with a membership of about half a million family doctors. Over 800 individual general practitioners/family physicians have chosen to join WONCA in their own right.1
There are seven regions, each with their own council, that make up WONCA:
WONCA in the Asia Pacific region
• Europe
Member organisations from Australia, China (mainland), Fiji, Hong Kong, Indonesia, Japan, Republic of Korea, Macau, Malaysia, Mongolia, Myanmar, New Zealand, Philippines, Singapore, Taiwan, Thailand and Vietnam form this region. WONCA Asia Pacific work in many areas, including:
• Iberoamericana-CIMF
• mental health
• North America
• research
• South Asia.
• rural practice
WONCA’s current President is none other than GPRA’s Patron, Professor Michael Kidd. (You can meet Michael at GPRA’s #fgp16 conference in Brisbane, 1–3 April.)
• women and family medicine
• Africa • Asia Pacific • East Mediterranean
They also have many special interest groups, including in the areas of: • cancer and palliative care
“
Current WONCA Executive (Back row from L to R) Pratap Nayaran Prasad (Nepal); Inez Padula (Brazil); Matie Obazee (Nigeria); Ruth Wilson (Canada); Job Metsemakers (The Netherlands); Mohammed Tarawneh (Hashemite Kingdom of Jordan); Jungkwon Lee (South Korea); Raman Kumar (India) (Front row from L to R): Luisa Pettigrew (UK); Donald KT Li (Hong Kong, China); Amanda Howe (President Elect, UK); Michael Kidd (President, Australia); Garth Manning (CEO); Karen Flegg (Australia)
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WONCA aims to improve the quality of life of the peoples of the world through defining and promoting its values, including respect for universal human rights and including gender equity, and by fostering high standards of care in general practice/family medicine.
”
WONCA mission statement
• conflict and catastrophe medicine • migrant care, international health and travel medicine.1
experience and expertise that will have a beneficial multiplier effect on both partners. Experience in vastly different cultures and environments will make us better doctors and better human beings.
”
Dr MK Rajakumar
For more information on The Rajakumar Movement, visit globalfamilydoctor.com/groups/ YoungDoctorsMovements.aspx or email the Chair, Shin Yoshida, at rajakumar@wonca.net
WONCA Young Doctors’ Movement WONCA has movements designed especially for young and future family doctors: the Vasco da Gama Movement in Europe; the Spice Route in South Asia; the Waynakay Movement in the Iberoamericana-CMIF region; and the Rajakumar Movement in the Asia Pacific region.1
WONCA journal and forums Did you know that WONCA has its own journal with many Australian doctors and professors on its Boards, including GPRA past Patron, Professor John Murtagh? Asia Pacific Family Medicine is an open access journal that ‘provides a forum for the dissemination of high quality regional research, and aims to enhance the standards of family medicine by focusing on best practice’. To sign up for article alerts, visit apfmj.biomedcentral.com
Family doctors/general practitioners around the world can also participate in the WONCA online discussion ‘WONCA Forum’, which provides access to a general discussion area and the ‘Ask a colleague’ section. Membership to WONCA is not necessary to access these forums.
To find out more about WONCA, membership and how you can get involved, visit globalfamilydoctor.com Reference 1. W ONCA: Global Family Doctor. Available at globalfamilydoctor.com [Accessed 8 February 2016].
With you on your journey 5
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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 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: • Member-priced products and publications • Free registration to Medicine Today’s clinical
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With you on your journey 7
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. You can even train part-time. Does this sound like you? 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/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 stepping-stone towards an academic career.
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.
Other extended skills posts Other exciting extended skills posts you can experience as part of your general practice training include: • Custodial medicine • Drug and alcohol medicine
Rural general practice
• Emergency medicine
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.
• Forensic medicine
Sports medicine
• Sexual health and HIV medicine.
If you 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.
Part-time options
• Mental health • Obstetrics and gynaecology • Paediatrics • Palliative care
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.
With you on your journey 9
GP TRAINING
The AGPT program
The national assessment
The Australian General Practice Training (AGPT) program is a postgraduate vocational education and training program for prevocational doctors wanting to become a general practitioner.
So you’ve passed stage 1 of the AGPT program, your application and eligibility check. Are you prepared for stage two: the national assessment? Follow our tips for success.
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. 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.
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. 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.
Applying to the program The application process consists of three stages: • Application and eligibility check • National assessment
The assessment The national assessment consists of two parts, each with an individual weighting of 50% of the total AGPT program selection score. The assessment, which is held at designated national testing centres throughout Australia, consists of: • the Situational Judgement Test (SJT) – an online test comprising 58 multiple-choice questions, which takes approximately 2 hours • Multiple Mini Interviews (MMIs), which involve rotations between interview stations and takes 1–2 hours.
Extended skills and advanced specialised training
• Training provider selection and placement offers.
Both of these tests assess the applicant’s suitability for general practice.
Program delivery
Tips for success
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
The AGPT program is delivered by a national network of training organisations. See the map below for the training boundaries.
Tip 1. Book your tests early
General practice training boundaries Training organisations
You must book into both the SJT and the MMIs. Applicants must attend two separate assessments, to be held on two separate days. The 2016 sittings (for entry into the 2017 program) will be held on: • SJT – 13 June - 4 July
Tip 4. Make the most of patient encounters Both the SJT and MMIs require applicants to draw on their own experiences, so use every patient encounter as a learning experience. Take notes of good patient encounters and review them before sitting the assessment. Remember the tests assess your suitability for general practice. Tip 5. Check out example questions Example questions for both the SJT and MMIs are available on the AGPT website. You can also watch a demonstration video that goes through the assessment process. A practice version of the SJT will be emailed to you prior to the SJT dates… USE IT! Tip 6. Tap into GPRA resources GPRA’s The general practice exam book and The general practice clinical studies contain 100 practice case studies. Perfect for preparing for the national assessment. Available at gpra.org.au
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
• MMIs – 24 June - 17 July. Tip 2. Don’t forget your ID For both the SJT and MMIs you must take the following: • Your current photo identification (passport, drivers licence) • Your Applicant ID (you should already have this) • Your booking confirmation email (either printout or displayed on smart phone/tablet, etc.). Tip 3. Don’t be late! Sounds obvious. But applicants who arrive late may not be able to sit the assessments:
To find out more about the AGPT program, including a breakdown of the new training boundaries, visit agpt.com.au
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• Allow yourself plenty of time to get to the assessment centre • Check out parking and public transport options BEFORE the day.
For more information about the AGPT national assessment call 1800
372478 email agptselection@health.gov.au visit agpt.com.au With you on your journey 11
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
Core clinical training time 12 months
Year two
Primary rural and remote training 2 x 6 months
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.
Hospital training time 12 months
Joint training opportunities are available†
GP terms GPT1 6 months GPT2 6 months
++ Year three
The ACRRM training program comprises three stages of learning:
Primary rural and remote training 2 x 6 months
Joint training opportunities are available†
+
• core clinical training (12 months)
Year four Note: Fourth year is for FACRRM and FARGP candidates only
• ACRRM accredited-facility training (24 months) • advanced specialised training in one of the 11 disciplines specified by ACRRM (12 months).
Training towards FRACGP
Possible equivalence*
++
Training towards FACRRM
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.
FRACGP qualifications (RACGP)
FACRRM qualifications (ACRRM)
Advanced specialised training 12 months
GPT3 6 months Extended skills 6 months FRACGP
Possible equivalence*
FACRRM
Advanced rural skills training for FARGP (12 months) FRACGP and FARGP
*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.
Candidates wishing to achieve FRACGP must complete the following components of vocational training:
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.
• hospital training (12 months)
For more information and full details, visit
• general practice placement (18 months and including a compulsory minimum term of six months in an outer metropolitan or rural or remote area)
acrrm.org.au racgp.org.au
• 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).
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With you on your journey 13
GP PROFILE
Open to opportunities Taking on rural roles – and accepting the associated challenges – has enriched Dr Natasha Pavlin’s general practice career. “Eclectic, flexible and interesting.” That’s how Dr Natasha Pavlin describes her general practice career. And it seems spot on. Right now she’s working as a GP for Defence personnel at a Royal Australian Air Force base near Katherine. There are three registrars in her team and she’s enjoying the combination of mentoring and “on the ground” clinical work. The regular hours allow her to continue teaching and medical education work with the RACGP and Northern Territory General Practice Education. “And I get to live in another new and interesting non-urban part of Australia,” Natasha adds. In terms of new and interesting places, a stint on Magnetic Island deserves a mention. PGY2 at the time, Natasha was effectively a solo GP on the island. Although she had some “really experienced nurses” on hand and an ambulance driver for emergency back-up, it was a steep learning curve. “Looking back,” she tells GP Journey, “I found doing that kind of work when I was very junior and everything seemed overwhelming, difficult and scary, was strangely easier than doing it when you are more experienced and expect to work in your comfort zone and know your own scope of practice.” On Magnetic Island she first experienced how GPs see a “bigger picture” of their community. She recalls a holidaymaker who suffered horrific injuries in a car accident. The driver deemed at fault was a young local woman. Not only were there devastating consequences for the holidaymaker, Natasha witnessed the stress it caused the woman, her family and community. But being “useful” to a community is what Natasha enjoys about rural work, and each role comes with rewards and challenges.
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I like to be open to “ opportunities. There’s just too many good things to do.
”
Natasha, who grew up in Brisbane, took opportunities to venture into smaller Queensland and New South Wales communities during her final years studying at the University of Queensland. They were her first exposures to remote Aboriginal health. She found it “overwhelming” at times and doubted her ability to work in the area. Later on she was placed as a registrar in a small community-controlled Aboriginal health service in country Victoria. She imagined that working with less traditional people who were not “remote” might be easier, but it only re-affirmed that the social and health complexities that impact Aboriginal communities are far-reaching. Natasha says she needed to accept that, as an individual, she couldn’t make an impact on such a large social and historical problem. “Once you feel comfortable knowing that, you don’t have so much pressure on yourself to be the individual making a difference. “It’s the personal individual connection I might have with someone, who develops a relationship with me and trusts me and is able to let me be involved in their care and share their information with me… is what ultimately may make a difference to helping that person.” Perhaps the idea of helping people was why she first declared at primary school that she wanted to be a doctor. The thought was forgotten until towards the end of high school when her father became seriously ill. Originally from Slovenia, he had survived the Dachau concentration camp but developed type 2 diabetes early in life. He endured the associated complications before dying of heart failure when Natasha was in year 12. “I spent lots of time at his hospital bedside in his last couple of years of his life,” she says. While part of her was “terrified” by death and illness, she also “wanted to become more comfortable with it”.
Years later, Natasha would use her medical experience to care for another loved one. This time her mother, who was diagnosed with lung cancer. Natasha moved to Darwin to care for her. Over the next two years being with her mother before she passed away in 2011, Natasha experienced some “confronting” insights into Australia’s health system. “If you have a potential to support someone you love when they need to interact with the health system a lot, it’s incredibly valuable to have a knowledgeable advocate,” she says. She believes patients can “get lost” in the system and left out of the information loop when different health professionals and services from across multiple locations become involved in the treatment. One of the positive outcomes of moving to Darwin was taking on a public health role, which gave her “an amazing chance” to learn more about the area’s broader health picture. Through learning more about health systems, public health and advocacy she was able to contribute to more
substantial improvements in Aboriginal health than would have been possible for her as an individual clinical doctor. Natasha, who is a former GPRA board member, likes that general practice allows GPs to work in non-clinical roles. She recalls another “great experience” as a registrar when she did an academic post at the University of Melbourne. The research findings outlined in the paper, Take the sex out of STI screening! Views of young women on implementing chlamydia screening in general practice, were highly accessed and referenced in other studies. She doesn’t rule out an academic career, but for now is enjoying her Defence role and taking time to explore the Top End with her partner, Dave. She says she doesn’t like being limited by long-term planning. “I like to be open to opportunities,” she says. “There’s just too many good things to do.”
With you on your journey 15
GP REGISTRAR PROFILE
A unique mix Palliative medicine, sexual health, HIV and transgender medicine is a unique mix, but it’s just the right combination for Dr Ethan Salleh. Dr Ethan Salleh divides his time between two roles that both support people through major transitions in their lives. He spends half the week at Brisbane’s Wesley Hospital as a palliative medicine registrar where he supports the terminally ill and their families through some of life’s most physically, emotionally and spiritually confronting moments. The rest of the time he works at Gladstone Road Medical Centre as a general practice registrar, where he has a special interest in supporting transgender people through the next stages of their lives. He also has an interest in HIV medicine where he cares for people living with the virus. Both roles give him a “sense of fulfillment”, he says. “I believe I’ve hit the sweet spot, if you like,” he tells GP Journey. “As a GP registrar working in a clinic, I see a variety of patients, from women and children to the young and elderly, and yet follow my special interest in HIV and transgender medicine. At the same time, I can continue to work at a hospital and train in palliative medicine, which I absolutely love.” Where did his general practice journey begin? Ethan says it actually started during his first foray into medicine and science – as a veterinarian. While working as a vet, he became drawn to the concept of ‘continuity of care’. “I looked after animals from cradle to grave and I’ve always enjoyed that aspect of medicine,” Ethan explains. And it seems he has maintained a love for animals – during his interview with GP Journey he was feeding a family of possums in his backyard! But at 41 and after nearly 20 years of working with animals, he decided to follow his dream of studying medicine. It was
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General practice is one of the few medical “ specialties where you can have many sub-interests and yet maintain a very generalist knowledge. ” an intense personal experience that put him on the path towards general practice and palliative medicine. While in the second year of medical school, his mother received the devastating diagnosis of brain cancer. Ethan, together with his whole family and supported by the “amazing community palliative care team” cared for his mother at home, where she died. “I got talking to one of the palliative care nurses about what palliative medicine was and my interest was sparked.” He is quick to dismiss the perception that palliative care is all about “death and dying” or hopelessness. “It’s not about saying: ‘There’s nothing else medicine can do for you’,” he says. “There’s always something we can do.” “What palliative care doctors do is control any distressing symptoms, reverse any reversible causes (such as an infection) and offer psycho-spiritual support to the patient and their families,” he explains. Ethan became interested in general practice – one of the avenues into palliative medicine training run by the Royal Australian College of Physicians – after a clinical rotation at his friend’s general practice. He was amazed at the scope of medical presentations and impressed by how his friend managed patients through different psycho-social issues. “I saw the care that GPs gave their patients, from a woman’s distress at losing a child, to a man with a new cancer or HIV diagnosis, a child with ADHD, or an older person going through dementia,” Ethan explains. Ethan says that as well as psycho-social issues, GPs working in transgender medicine must also help their patients navigate the legal aspects when transitioning. This includes birth certificate name changes and facilitating their gender marker change on Medicare to access PBS-subsidised medications (such as oestrogen
or testosterone). Ethan says the final legal phase of transitioning is changing their gender on their birth certificate for those who choose to proceed with sex reassignment surgery. Sexual health, HIV and transgender medicine wasn’t on Ethan’s “radar” when he started work as a first-year general practice registrar at Limestone Medical Centre at Ipswich. His journey into sexual health began when he was encouraged by a colleague to attend a sexual health course run by the University of Queensland. This led to him attaining his s100 prescriber status in the highly specialised drugs for HIV. “I was fortunate to find a registrar position at the Gladstone Road Medical Centre, a practice that has a special interest in managing patients with HIV. This allowed me to maintain my credentials for the s100 program.” Once there, he met Dr Gale Bearman, who he describes as a “pioneer” in transgender medicine. “She talked about the issues that transgender people faced and that there wasn’t enough doctors working in the area,” he says. “General practice is one of the few medical specialties where you can have many sub-interests and yet maintain a very generalist knowledge,” Ethan says. His work in palliative medicine allows him to “osmotically absorb knowledge” by just being on the wards among his specialist colleagues. This knowledge complements his general practice work, he adds. So, in the clinic or at the hospital, what’s a good day for Ethan? “A good day is when my patient and I are able to come together to facilitate a solution to ease their distress. Then I can come home, relax and feed my possums.”
With you on your journey 17
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
A place in the country After first seeing community medicine in action as a chemist delivery boy, Dr Joshua Saunders wants to return to his rural roots. Dr Joshua Saunders is looking for a place in the country. He wants to find just the right town, possibly somewhere on Victoria’s Great Ocean Road, for he and his wife Jacinda to settle down. Somewhere with fresh air and good views for a morning run. A place where he can get to know the local people. A practice where he can care for families across the generations. It’s a “traditional and idyllic” picture, Josh admits, but it’s what gets him excited. “I’m drawn to the idea of a GP who finds a community and stays there. Who has a bunch of kids and does everything in the town,” Josh tells GP Journey. “It’s about having the skills behind you to be an asset to a place and providing a service that improves the health of the people living there.” The setting would be a familiar one for Josh. He grew up in Camperdown, a town of about 3500 in southwest Victoria. It was here that, as a 12-year-old chemist delivery boy, he first saw rural medical services working together. In particular, the local GPs made an impression. “They could do anything! They delivered babies, they did anesthetics, they ran the clinics and they managed the emergency department.”
Further rotations in Melbourne-based clinics confirmed that, even in a city setting, general practice would keep him interested and passionate. “Out of all the areas of medicine that I’ve worked in, general practice is the one that has given me more energy than it’s taken away,” Josh says. While he’s excited about a rural setting, Josh is aware of some of the challenges of rural work. This includes having limited nearby medical support or facilities and managing health issues, such as chronic diseases, that impact some smaller towns. He’s structured his training with this in mind. He’s done a Diploma in Obstetrics and is now doing his advanced skills year as an emergency registrar at Ballarat Base Hospital, where he is also a GP Ambassador. He says the “limitless support” from hospital consultants and seeing some of the 120 to 200 people who come through
Out of all the areas of “ medicine that I’ve worked in, general practice is the one that has given me more energy than it’s taken away.
”
the ED each day is preparing him for the next step. “I want to go from being a really terrified GP registrar to being a terrified GP registrar with at least a bit of experience under my belt!” he jokes. Josh says life as a doctor is about being able to “work to the best of your abilities” at all stages of training. This rang true soon after he finished medical school. He was returning from a family wedding in Adelaide when he came across a car accident. There were no fatalities, but two people were injured. “Here I was, technically a doctor but having spent zero hours inside a hospital. When the police arrived, everybody sort of looked at me to make decisions and to give a good clinical assessment.” While he expands his clinical knowledge, he’s also enjoying connecting with patients. He shares the experience of his first “really nice therapeutic relationship” with an admirably stoic patient who was battling cancer. “Even though I was expected to be the one with all the answers, she knew that I was very junior and that this was a heavy thing for me to go through,” he says. “She probably took as much care of me as I took care of her.” Then there’s the toddler – terrified of doctors – brought into the ED with croup. Josh put the boy at ease, made him laugh and treated him. And when his mother returned with another child, she told Josh that the boy’s eyes had “lit up” at the thought of his sibling seeing Josh. It seems fitting that his student cohort named him the ‘Doctor you’d most likely send your mum to’ at his Monash University graduation dinner. Josh also won the Neil Carson prize for Community Medicine, but says the informal nod gives him most pleasure. “It was an amazing acknowledgement from my peers that they felt that I was the person they would trust to look after their family.”
Years later, the delivery boy returned to Camperdown as a final year medical student. Josh says it was a “defining moment” in his medical journey. “Just being able to work with the same doctors who looked after me when I was growing up and starting to do some of the same things alongside them was amazing.”
As a GP Ambassador, Josh tries to get aspiring GPs to understand and articulate what motivates and excites them about general practice. What did he say when asked this for his general practice training program interview? “I just talked for eight minutes straight with a big grin on my face!”
How did he feel about seeing people he knew growing up as patients? “It was something I was really tentative about at first,” he says. “But everybody was very open and honest.” Photos: Suzie Haslam, Lovely Day Films
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With you on your journey 19
M E D I C O - L E G A L M AT T E R S
Medical records: the essentials Detailed medical records are essential to ensure that the ongoing care of patients is efficient and safe. Be aware that there is a range of statutory and ethical considerations that govern the creation, maintenance, retention and use of medical records.
What are medical records? ‘Medical record’ is a general term for many types of health data and includes a patient’s progress notes (handwritten or computer-generated), appointment books, accounts, consultant reports, hospital discharge summaries, pathology reports and medical imaging reports, X-rays, videos, photographs and medico-legal reports. Medical records may be used as evidence, for example in legal proceedings (criminal, civil or disciplinary) and inquiries. Conversations and correspondence between a doctor, their medical indemnity provider and lawyers are NOT part of the patient’s record. These documents should be kept separate from the patient’s clinical file. Correspondence regarding patient complaints should also be kept separate from the clinical file.
What should medical records include? Good records are not only essential for patient care, they also assist in the defence of any claim or complaint. Records should include the following: • sufficient information to identify the patient and allow another medical practitioner to continue management of the patient • any information known to the doctor who provides the medical treatment or other medical services to the patient that is relevant to their diagnosis or treatment, such as: – information concerning the patient’s medical history – the results of any physical examination of the patient – information obtained concerning the patient’s mental state – the results of any tests performed on the patient – information concerning allergies or other factors that may require special consideration – particulars of any clinical opinion reached by the medical practitioner
20
– any plan of treatment for the patient – particulars of any medication prescribed for the patient – notes about information or advice given to the patient in relation to any medical treatment proposed by the treating practitioner. The records should also contain the following particulars of any medical treatment (including any medical or surgical procedure): • the date of the treatment • the nature of the treatment • the name(s) of the person(s) who gave or performed the treatment
It’s hard to make a case against the expertise of Avant
agreement. It is useful to clarify these matters when you start work in your practice.
– a treatment summary, or
How long must records be kept?
There is no obligation to provide original records. The patient should bear the reasonable cost of providing this information,
It is recommended that medical records be kept for as long as possible. This is especially true where there has been dissatisfaction expressed regarding treatment, where there has been an adverse outcome, or there has been threatened legal action. Some states and territories have legislation mandating that records be kept for minimum periods. Such periods vary between jurisdictions.
• the tissues (if any) sent to pathology
At a minimum, it is recommended that records in relation to health information are kept, in the case of a child, until they are 25 years old, and for adults, for at least seven years after the last consultation.
• the results or findings made in relation to the treatment
Patient access to medical records
• any written consent given by a patient to any medical treatment (including any medical or surgical procedure) proposed by the treating practitioner.
Introduction of Commonwealth and state/territory privacy legislation now generally provides patients (with limited exceptions) with a statutory right of access to their records, including:
• the type of anaesthetic given to the patient (if any)
Storage of records The main issues relating to storage of records are: • preserving the confidentiality of the medical record • preventing damage, loss, or theft of the records • keeping records in a reasonably accessible manner to ensure continuity of medical treatment • securely storing records: in broad terms, you must take all reasonable and prudent steps to protect the security of your medical records. It is unlikely you would be held liable for the theft of records from properly secured surgery premises. However, you might be held liable for a theft from the seat of an unlocked car in a shopping centre car park.
Who owns the records? In solo practice, the medical file belongs to the doctor who prepares them, not the patient. An exception here might be X-rays or investigations paid for by the patient. The question of ownership where doctors practise together or in shared premises can become complicated without an express
• having a copy of the records • inspecting their records • having a copy provided to a third party authorised by the patient, eg. a solicitor.
– preferably, a copy of the medical records.
but failure to pay should not be used as a reason to prevent relevant information being provided to the new practitioner. Patients must sign an authority to transfer their care and records to another practitioner. The authority should: • request that a copy of the records be transferred to the new practitioner • contain the name and date of birth of the patient whose records are to be transferred • be signed by the patient (or parent/guardian where applicable) • be dated. If records are transferred to a new practitioner, and in particular when a practitioner is leaving a practice and a number of patients wish to follow them to their Dr significant Amanda Brownlow new Avant GPpractice, memberthe practice should keep a register or record of: • the patients • the date the authority is received • the date of transfer of records • whether the original record has been transferred and a copy made
lawyers, medical advisors, claims managers and This year, manyGiven doctors like you will face a medical medico-legal this access, it is advisable that records shouldincluding be • the location of the records and the name of the new, or
than just notesto to defend assist youryou, memory. should notlocal be state experts, it’s hard to make a case against the claim. Without more a strong team anyThey action relocating practitioner. written in personal shorthand or obscure abbreviations. In this
expertise of Avant. could have a massive on your career. form, theyimpact can be misinterpreted unless translated by the author.
Take-home messages
Disposal of medical records
• Good medical records are essential for good patient care.
As Australia’s Ifleading MDO, Avantto has the depth,at a A claim• against you canarehappen any defence time. Good medical records essential forat a proper a patient wishes to transfer another practitioner in the event it’s of a claim complaint you. different practice, new practitioner is entitledand to information strength of resources and the experience to advise Don’t wait until tooorlate, callagainst us today. required for the proper ongoing care of the patient, by way of:
protect you. With 70 in-house medico-legal specialists,
• If in doubt, retain medical records.
This publication is not comprehensive and does not constitute legal or medical advice. You should seek legal or other professional advice before relying on any content, and practice proper clinical decision making with regard to the individual circumstances. Persons implementing any recommendations contained in this publication must exercise their own independent skill or judgment or seek appropriate professional advice relevant to their own particular practice. Compliance with any recommendations will not in any way guarantee discharge of the duty of care owed to patients and others coming into contact with the health professional or practice. Avant is not responsible to you or anyone else for any loss suffered in connection with the use of this information. Information is only current at the date initially published. © Avant Mutual Group Limited 2015. 3539 09/15 (0389)
Avant. Your Advantage
With you on your journey 21
*IMPORTANT: Professional indemnity insurance products are issued by Avant Insurance Limited, ABN 82 003 707 471, AFSL 238 765. The information provided here is general advice only. You should consider the appropriateness of the advice having regard to your own objectives, financial situation and needs before deciding to purchase or continuing to hold a policy with us. For full details
GENERAL PRACTICE CASES
Test your knowledge with our general practice cases, taken from the GPRA publication, The general practice exam book.
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Case 1
Case 2
Greg, a 36-year-old man, presents two days after twisting his right knee during a basketball game. He landed from a jump shot and pivoted inwards on the flexed knee. He felt pain instantly and swelling occurred almost immediately (see figure below). He was unable to weight-bear due to the pain.
John is a 62-year-old man who presents to your rural emergency department with belching, diaphoresis and right arm pain. An electrocardiogram (ECG) is performed and a segment of this is shown below. The ECG demonstrates:
戀爀椀攀昀 挀愀猀攀Ⰰ 愀渀搀 戀甀氀欀礀 洀攀搀椀挀愀氀 攀焀甀椀瀀洀攀渀琀 愀渀搀 爀甀渀 愀 氀漀最 戀漀漀欀 昀漀爀 ㈀ 眀攀攀欀猀 猀栀漀眀椀渀最 栀漀洀攀 琀漀 眀漀爀欀 琀爀愀瘀攀氀 愀猀 搀攀搀甀挀琀椀戀氀攀 戀甀猀椀渀攀猀猀 琀爀愀瘀攀氀⸀
On examination there is obvious knee swelling with medial joint line tenderness and a positive Apley’s grind test. There is no pain on stressing the knee in a varus or valgus direction. Anterior/posterior draw tests are normal.
B. Anterolateral STEMI
䄀刀刀䄀一䜀䔀 䤀一䌀伀䴀䔀 䌀伀一吀䤀一唀䄀一䌀䔀 䌀伀嘀䔀刀 ⠀愀琀 氀攀愀猀琀 ␀㘀 欀 愀 礀攀愀爀⤀
From this information, which knee structure is MOST likely to have been damaged?
E. Posterior STEMI.
䈀唀夀 䄀 䠀伀唀匀䔀 䤀一 䄀 䌀䄀倀䤀吀䄀䰀 䌀䤀吀夀 愀渀搀 爀攀渀琀 椀琀 漀甀琀
愀猀 愀 渀攀最愀琀椀瘀攀 最攀愀爀椀渀最 猀琀爀愀琀攀最礀⸀ 吀栀椀猀 眀椀氀氀 栀攀搀最攀 礀漀甀 愀最愀椀渀猀琀 昀甀琀甀爀攀 栀漀甀猀攀 瀀爀椀挀攀猀Ⰰ 洀愀欀椀渀最 椀琀 攀愀猀椀攀爀 琀漀 戀甀礀 愀 栀漀洀攀 搀漀眀渀 琀栀攀 琀爀愀挀欀⸀
䈀唀夀 䄀 䌀䄀刀 愀渀搀 挀愀爀爀礀 礀漀甀爀 氀愀瀀琀漀瀀Ⰰ 瀀愀琀椀攀渀琀 渀漀琀攀猀Ⰰ 搀漀挀琀漀爀ᤠ猀 戀愀最猀Ⰰ
琀漀 愀最攀 㘀㔀 眀椀琀栀 愀 㤀 搀愀礀 眀愀椀琀椀渀最 瀀攀爀椀漀搀Ⰰ 甀猀椀渀最 琀栀攀 䴀挀䴀愀猀琀攀爀猀 䤀渀猀甀爀愀渀挀攀ᤠ猀 挀漀洀洀椀猀猀椀漀渀 爀攀戀愀琀攀 猀攀爀瘀椀挀攀⸀ 䴀漀爀攀 椀渀昀漀 愀琀 眀眀眀⸀洀挀洀愀猀琀攀爀猀椀渀猀甀爀愀渀挀攀⸀挀漀洀⸀愀甀
䤀昀 礀漀甀 栀愀瘀攀 搀攀瀀攀渀搀愀渀琀猀Ⰰ 愀爀爀愀渀最攀 甀瀀 琀漀 ␀Ⰰ Ⰰ 漀昀 挀栀攀愀瀀Ⰰ 琀愀砀
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Visit gpra.org.au
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The g e n e ra l prac tice e xam b ook
A DV E R TO R I A L
攀û攀挀琀椀瘀攀 愀渀搀 䌀伀䴀䴀䤀匀匀䤀伀一 䘀刀䔀䔀 䰀䤀䘀䔀 䤀一匀唀刀䄀一䌀䔀 戀礀 戀甀礀椀渀最 攀砀琀爀愀 氀椀昀攀 椀渀猀甀爀愀渀挀攀 椀渀 礀漀甀爀 椀渀搀甀猀琀爀礀 猀甀瀀攀爀愀渀渀甀愀琀椀漀渀 昀甀渀搀⸀
䔀一䨀伀夀 䄀 吀䄀堀뫶䐀䔀䐀唀䌀吀䤀䈀䰀䔀 伀嘀䔀刀匀䔀䄀匀 匀吀唀䐀夀 吀伀唀刀
瘀椀猀椀琀椀渀最 洀攀搀椀挀愀氀 椀渀猀琀椀琀甀琀椀漀渀猀 愀渀搀 氀攀愀爀渀椀渀最 洀漀爀攀 愀戀漀甀琀 琀栀攀 眀漀爀氀搀 漀昀 洀攀搀椀挀椀渀攀 ☀ 最攀琀 愀猀 洀甀挀栀 搀椀瘀攀爀猀椀琀礀 椀渀 眀漀爀欀 攀砀瀀攀爀椀攀渀挀攀 愀猀 礀漀甀 挀愀渀⸀
A. Non-ST elevation myocardial infarction (NSTEMI) C. Complete left bundle branch block D. Interior STEMI
A. Medial collateral ligament B. Lateral collateral ligament C. Anterior cruciate ligament D. Medial meniscus E. Patella tendon.
Answer to Case 2 Answer to Case 1
⨀吀栀椀猀 椀猀 最攀渀攀爀愀氀 愀搀瘀椀挀攀 漀渀氀礀 愀渀搀 椀猀 渀漀琀 瀀攀爀猀漀渀愀氀 愀搀瘀椀挀攀⸀ 倀攀爀猀漀渀愀氀 愀搀瘀椀挀攀 椀猀 渀攀攀搀攀搀 戀攀昀漀爀攀 洀愀欀椀渀最 愀渀礀 搀攀挀椀猀椀漀渀 挀漀渀挀攀爀渀椀渀最 渀愀渀挀椀愀氀 瀀爀漀搀甀挀琀猀 漀爀 礀漀甀爀 渀愀渀挀椀愀氀 昀甀琀甀爀攀⸀
This case requires a knowledge of which knee structures can be damaged when the knee is injured, and correlate this knowledge with history and examination findings. The injury in this case study occurred while weightbearing; this is the most common way to injure the medial meniscus. The immediate pain, swelling and difficulty weight-bearing also correlates with this type of injury. The Apley grind test is designed to detect meniscal injury. With medial and lateral collateral ligament injuries there would generally be laxity on varus and valgus stress. Anterior cruciate ligament injury would be noted on draw testing. Patella tendon injuries do not correlate with the history or examination findings.
This question requires the ability to read an ECG. The ECG of this patient demonstrates significant ST elevation through V1–V6, 1 and aVL. The anterior leads V1–5 suggest an anterior infarct and the V5–6 and I and aVL demonstrate a lateral component. This correlates with significant ST depression in leads I I, III and aVF. The correct answer is therefore B. This ECG was from a patient with 100% occlusion of the left anterior descending artery. A NSTEMI would not have ST elevation. There is no evidence of left bundle branch block with QRS widening. An inferior STEMI would show ST elevation in 2, 3 and aVF. A posterior STEMI would show reciprocal ST depression through the anterior leads V2–6.
With you on your journey 23
D E R M AT O L O G Y C L I N I C
An enlarging lesion on the neck By Gayle Fischer
Test your diagnostic skills in our dermatology quiz. What is the diagnosis of this enlarging lesion occurring on a 13-year-old boy’s neck?
Case history A 13-year-old boy presented with a raised, hyperkeratotic, warty lesion on his neck (Figure 1). His parents said it had been there since his first year of life but had recently enlarged and become more prominent. The patient’s voice broke recently. The lesion is not symptomatic but it often gets caught on his collar.
Diagnosis
The lesions are harmless and have no potential for malignant transformation and, particularly when localised, are rarely associated with any other abnormalities.
The correct diagnosis in this case is a verrucous epidermal naevus, a birthmark that occurs mainly on the trunk and limbs. These lesions may be congenital but in over half of cases the onset is in the first year after birth. They may spread beyond their original size with age, usually over a few months but sometimes several years. It is not unusual for them to become more raised and ‘warty’ at puberty.
They can easily be differentiated from a viral wart on histopathology, but they may be confused with a seborrhoeic keratosis unless the pathologist is aware of the age of the patient.
Treatment Treatment is often requested for verrucous epidermal naevi for cosmetic or functional reasons. Although there are superficial ablative procedures such as laser ablation that are effective, these lesions will often recur afterwards. Naevi that have any protruding areas or are interfering with function need complete excision to avoid recurrence.
The colour of verrucous epidermal naevi ranges from flesh-coloured to brown and black. They may occur as single or multiple grouped lesions and can have a linear or whorled distribution. On the chest there is often a dramatic cut-off at the midline.
Differential diagnosis Although verrucous epidermal naevi resemble common viral warts (hence the name verrucous) and seborrhoeic keratoses, they have little in common with these lesions.
Author Figure 2. True viral warts
Competing interests: None.
Viral warts are very unlikely to have their onset in a patient’s first year of life or to persist unchanged for more than two or three years. It is also unusual for many viral warts to be grouped on the shoulder or neck (as in this patient’s case), although this presentation is not uncommon on the hands (Figure 2) and feet. Seborrhoeic keratoses generally occur from middle age and they present as discrete lesions (Figure 3).
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.
The back is a typical location, but they can be found on any part of the skin.
Cause Figure 1. The lesion occurring on the patient’s neck, which has recently enlarged and become more prominent
The cause of verrucous epidermal naevi is unknown, but they are believed to arise from a post-zygotic mutation resulting in epidermal mosaicism.
Gayle Fischer MBBS, MD, FACD, is Associate Professor of Dermatology at Sydney Medical School – Northern, University of Sydney, Royal North Shore Hospital, Sydney, NSW.
Figure 3. A typical seborrhoeic keratosis in a woman aged in her 60s
Registration and online access to Medicine Today’s rich knowledge bank of clinical content is free to all members of GPRA, GPSN and GPN.
This article originally appeared in Medicine Today 2013;14(8):58–59 and is reproduced here with permission.
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With you on your journey 25
“Filled with practical advice, the GP Companion will add to the richness of your experiences during your clinical rotations in general practice.”
Reviews Books
Professor Michael Kidd – GPRA Patron
The Australian medico-legal handbook
This book is a core medicolegal text and the handbook with PDA software version makes it an easy read.
Cameron Stewart, Malcolm Parker, Ian Kerridge
Publisher: Elsevier Australia, 2007
A concise, handy and quick access text that clearly outlines the key areas of medical law as relevant to anyone in the field of medicine (from medical student to practising doctor).
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I particularly liked the use of dot points (which is good revision for exam preparation) and the use of case examples to highlight relevant legal topics.
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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.
Q&A
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 locate your hospital-based GP Ambassador from the Australiawide list on page 29.
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
gpaustralia.org.au
28
”
GP Ambassador, Western Health, Vic
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.
How can a GP Ambassador help me?
an interest in general practice – to encourage them to see it as a career they can excel in and achieve great things with.
Dr Tristan Barnes
What is a GP Ambassador?
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.
an Ambassador means engaging bright “ Being young doctors from all walks of life to take
Dr Bridget Fernando GP Ambassador, St Vincent’s Hospital, Vic
Find your GP Ambassador What are you looking forward to as a GP?
Check out the list below for contact details of your GP Ambassador.
Building strong relationships with my patients and becoming part of a community.
To find out more about becoming a GP Ambassador, email goingplaces@gpra.org.au
Why did you choose general practice?
NSW and ACT
SA and NT
Hospital
Contact
Hospital
Contact
Bankstown Hospital
bankstowngp@gpra.org.au
Flinders Medical Centre
flindersgp@gpra.org.au
Gosford Hospital
gosfordgp@gpra.org.au
Lyell McEwin Hospital
lyellmcewingp@gpra.org.au
Hornsby Hospital Network
hornsbygp@gpra.org.au
Modbury Hospital
modburygp@gpra.org.au
John Hunter Hospital
johnhuntergp@gpra.org.au
Royal Adelaide Hospital
royaladelaidegp@gpra.org.au
maitlandgp@gpra.org.au
Royal Darwin Hospital
darwingp@gpra.org.au
Royal North Shore Hospital
royalnorthshoregp@gpra.org.au
The Queen Elizabeth Hospital
queenelizabethgp@gpra.org.au
Royal Prince Alfred Hospital
royalprincealfredgp@gpra.org.au
St George Hospital
stgeorgegp@gpra.org.au
• I like the variety that general practice offers
Tamworth Hospital
tamworthgp@gpra.org.au
• I have a young family, so it is important to me to have some flexibility in terms of where I work and what hours.
The Canberra Hospital
canberragp@gpra.org.au
Westmead Hospital
westmeadgp@gpra.org.au
Wollongong Hospital
wollongonggp@gpra.org.au
There are three reasons that specialising as a GP appeals to me: • I feel GPs have the opportunity to make the most meaningful contribution to the health of their patients; they are in a position to diagnose disease early enough that management can limit the impact on the patient’s life, and can inspire healthy living before chronic diseases develop
Who or what inspires you?
Maitland Hospital
VIC
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
An emergency consultant at a hospital where I was on a student placement. He always went out of his way to be friendly and inclusive to patients, their families and the doctors, students and other health staff working with him.
Albury Wodonga Health
wodongagp@gpra.org.au
Austin Hospital
austingp@gpra.org.au
Ballarat Hospital
ballaratgp@gpra.org.au
Eastern Health
boxhillgp@gpra.org.au
Launceston Hospital
launcestongp@gpra.org.au
What three words describe you?
Geelong Hospital
geelonggp@gpra.org.au
Royal Hobart Hospital
royalhobartgp@gpra.org.au
Never sits still!
Northern Health
northernhealth@gpra.org.au
What three things would you take to a deserted island?
Shepparton Hospital
sheppartongp@gpra.org.au
Fremantle Hospital
fremantlegp@gpra.org.au
Southern Health
southernhealthgp@gpra.org.au
Joondalup Health Campus
joondalupgp@gpra.org.au
St Vincent’s Hospital
stvincentsgp@gpra.org.au
Royal Perth Hospital
royalperthgp@gpra.org.au
Western Health
westerngp@gpra.org.au
Sir Charles Gairdner Hospital
charlesgairdnergp@gpra.org.au
My family, my bike and my coffee machine!
TAS
WA
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 clubs host a range of educational and career-focused events across Australia and provide professional resources to medical students. GPSN is supported and funded by GPRA. Being part of GPSN is being part of a community of more than 27,000 medical students, prevocational doctors, general practice registrars and new fellows.
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 GPSN working groups, attend the GPSN national conference or become part of the GPSN National Executive team.
Why join?
GPSN University Club contacts University
Contact
ACT Australian National University
University of New England
newengland@gpsn.org.au
University of New South Wales
unsw@gpsn.org.au
University of Notre Dame Sydney
undsyd@gpsn.org.au
University of Sydney
usyd@gpsn.org.au
University of Western Sydney
uws@gpsn.org.au
University of Wollongong
wollongong@gpsn.org.au
National Secretary
flindersntmp@gpsn.org.au
Rebecca Calder Griffith University ns@gpsn.org.au
NT Northern Territory Medical Program (NTMP Flinders University)
Rebecca Calder National Secretary
Jayden Murphy University of Wollongong vc@gpsn.org.au
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
SA Flinders University
flinders@gpsn.org.au
University of Adelaide
adelaide@gpsn.org.au
National Working Group Officer Kerry Chen University of New South Wales wgo@gpsn.org.au
TAS University of Tasmania
Q&A
National Vice Chair
newcastle@gpsn.org.au
utas@gpsn.org.au
University of Notre Dame Fremantle
notredame@gpsn.org.au
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.
University of Western Australia
uwa@gpsn.org.au
30
Claire Chandler Flinders Northern Territory Medical Program chair@gpsn.org.au
University of Newcastle
VIC
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.
National Chair
anu@gpsn.org.au
NSW
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.
National council
2016 GPSN National Executive
Deakin University
deakin@gpsn.org.au
Monash University
monash@gpsn.org.au
University of Melbourne
umelb@gpsn.org.au
National Events and Projects Officer Larry Lam University of Western Sydney neo@gpsn.org.au
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 is working on, please contact one of the team members.
Local Events Officer Lawrence Ling James Cook University leo@gpsn.org.au
Promotions and Publications Officer Renata Pajtak Australian National University publications@gpsn.org.au
When and why did you became involved in GPSN? I became involved in my local GPSN club during my first year of medical school. I was always interested in general practice and thought this would be a fun way to get more involved in extracurriculars and pursue a passion. During my third year of medical school I was also on the national executive as the local events officer. The more involved I became in GPSN the more I wanted to be a part of their great network!
What do you want to do when you graduate? When I finish medical school I plan on travelling and enjoying my two month holiday before internship, whether that’s around Australia, abroad or both! My goal at the moment is to train in rural generalism in Queensland, with a subspecialty in obstetrics or anaesthetics. I have loved the time I have spent working rurally, with a highlight of my training so far being stationed out at Kingaroy in Queensland for third year.
How do you unwind when you’re not studying? I love to eat out and explore new restaurants and places. I also love to catch up with friends I sometimes go months without seeing, particularly over cheese and wine. For longer breaks I love getting outside and camping and travelling the world. I also play the acoustic guitar and find playing that can be very relaxing.
With you on your journey 31
F I R S T WAV E
Healthy Profession. Healthy Australia.
The GIVE YOUR COMMUNITY AN ADVANTAGE
What is it?
Who can apply?
The First Wave Scholarship program was established in 2008 to provide medical students with positive, early and structured exposure to general practice in a range of settings including urban, outer metropolitan, rural and Aboriginal medical services. It was renamed in 2015 as the John Murtagh First Wave Scholarship Program, in honour of our Emeritus Patron, Professor John Murtagh.
First and second year Australian medical students studying at an Australian medical university. Those interested in working in an Aboriginal medical service should be second year students.
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. It is anticipated that this prestigious scholarship will be awarded to the best candidate in each state. There may be further bursaries awarded to other suitable candidates, based on funding availability.
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. Participants are also required to attend a fully funded two-day orientation workshop. There will also be appropriate cultural training provided to those undertaking placements in Aboriginal medical services.
When can I apply? Applications open Monday 31 May and close Friday 24 June 2016.
How do I apply? The John Murtagh First Wave Scholarship program will be 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
Enrol in the dual FRACGP/FARGP pathway Gain additional skills by completing a 12 months Advanced Rural Skills Training (ARST) Complete a 12 month procedural or non-procedural ARST and gain additional rural skills, such as Anaesthetics, Emergency Medicine, Obstetrics, Mental Health and Aboriginal Health. It’s more flexible and achievable to complete an ARST discipline with the support and guidance of your RTP.
Flexibility of training Get the most out of your GP training by completing the FRACGP and FARGP dual pathway. The FARGP offers the greatest benefits to you and your community when you enrol early and go rural. Commencing early allows you to complete more of the FARGP requirements prior to starting your FRACGP exams.
Identify the needs of your community
Gain two GP fellowships over one
Identify the needs of your rural community and develop a project to address these needs by completing a 6-month ‘working in rural general practice’ communityfocused project.
Why complete one qualification when you can streamline your training and for only a further 12 months you can graduate with two RACGP fellowships. Start your GP career with an advantage and be recognised for your rural skills and commitment.
Easy access
Contact us and enrol
The RACGP offers opportunities for online learning through it’s gplearning website. This includes the FARGP Online Learning Platform which offers streamlined and interactive, engaging and rural relevant activities.
For more information and to enrol contact the RACGP on 1800 636 764 or email education@racgp.org.au
Visit www.racgp.org.au/eduction to enrol now. 32
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