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Specialty spotlight: Rural generalist medicine

30 November 2022

Specialty spotlight: Rural generalist medicine

For Dr Helen Fraser, rural generalism has not only offered diverse and challenging medicine, it’s also been an opportunity to champion health equity for rural hospitals and take a clinical leadership role for the region. Senior Medical Officer (SMO) at Ayr Hospital for the past six years, Dr Fraser chairs the Townsville Hospital and Health Service Clinical Council, which gives clinical staff a voice in the management of the region’s health service. Dr Fraser grew up on a farm between Hamilton and Warrnambool in southwest Victoria. “Some of my friends’ parents were the doctors in town and they practised rural generalism before it was known as rural generalism. They were the people who I really looked up to at that time.” After graduating from James Cook University in 2012, she stayed in Townsville for her intern and Registered Medical Officer (RMO) years and completed advanced skills in emergency medicine and anaesthetics before taking up an SMO role in Ayr, 88km to the city’s south. “As a rural generalist in Ayr with advanced skills, we're using all of those emergency medicine skills and then we're using internal medicine skills because we look after everyone on the ward,” Dr Fraser says. “I use my anaesthetic advanced skill for emergency presentations with imminent airway risk, but also with our obstetric deliveries and providing epidurals after hours. We do a lot of gastroenterology procedures, and going forward, we're hoping that more surgery will be performed in Ayr.” Life as a rural generalist The National Rural Health Commissioner, Adjunct Professor Ruth Stewart, and trainee rural generalist Dr Preston Cardelli, a JCU graduate, talk about the rewards and rich experiences of rural generalism.

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Tackling health at population level

28 November 2022

Tackling health at population level

JCU GP registrar Dr Jay Short has been part of North Queensland’s public health response to everything from COVID-19 to monkeypox, bat bites, melioidosis, meningococcal disease, diphtheria, Hendra virus and Japanese encephalitis in 2022. In December, Dr Short becomes the first Australian College of Rural and Remote Medicine (ACRRM) registrar to complete Advanced Specialised Training in population health in Townsville. Dr Short worked as a remote area nurse across Australia for 13 years before completing his medical degree at James Cook University in 2018. His deep knowledge of the region’s remote Aboriginal and Torres Strait Islander communities has proved invaluable for the Townsville Public Health Unit, which manages multiple disease outbreaks concurrently across a vast area. Dr Short’s JCU supervisor, public health physician Dr Nishila Moodley, draws an analogy between public health specialists and the sci-fi secret agents of the Men in Black films. While the COVID-19 pandemic has elevated the specialty’s profile, much of their work still goes under the radar. “If we do our job correctly, no one knows we're there. That's why people don't know who we are. I always tell them, we're like the Men in Black,” says Dr Moodley. “In Townsville, we've never really had an alpha or beta COVID-19 outbreak because we had responded clinically to those individual cases so rapidly that infection didn't get a chance to establish itself here.”

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An intern’s top 3 tips for medical students

22 November 2022

An intern’s top 3 tips for medical students

Internship at Townsville University Hospital has been a first-rate training ground for aspiring rural generalist Dr Harjyot Gill. Dr Gill looks back on her first year as a doctor, her med school experience at James Cook University (JCU) and gives her top three tips for med students: “Internship is very exciting. Finally, you've made it, you're a doctor and you get to go to work and make a real difference to people’s lives each day.” “My first term was in ED, which was a great experience because you work up a patient from the very beginning. I found the emergency department offers a great opportunity to round out your knowledge and skills whilst rapidly assessing and treating undifferentiated patients in a time-critical manner. “My second term was in Charters Towers, as I'm currently on the prevocational pathway for rural generalism. My time in Charters Towers was probably the best so far. I was rounding on patients myself, discussing management plans with my supervisors and with their feedback I would enact the plan. “The type of experience or exposure I had in Charters Towers is unheard of in a tertiary setting. In rural communities you're doing a lot more, which allows you to develop your clinical decision-making skills. I felt like my knowledge and skills were growing exponentially as I was making my own decisions but in a very supportive clinical environment where the senior doctors were always there to guide me. “My third term was my surgical term, in gynaecology. My clinical elective in sixth year was also in gynaecology at Townsville University Hospital. The only difference was now as an intern I was getting paid to do all the things I loved as a medical student. I was assisting in theatre, seeing patients in clinics and on some occasions witnessing the magic of childbirth. It felt like I just picked up from where I had left off as a medical student in sixth year. “I’m currently on paediatrics. This is just a short elective for five weeks, and every second week I'm rostered on to baby checks. So just this morning, I was examining babies and squeezing in a couple of cuddles here and there, which always warms my heart. “Essentially, at this stage, I'm trying to complete all the prerequisites for the rural generalist pathway. Next year, I'll be rotating through obstetrics, anaesthetics, emergency medicine as well as another rural term and a relieving term. Beyond that, I'll be planning to apply to one of the GP colleges, whether it's ACRRM or RACGP, and deciding on an advanced skill I would like to specialise in. “Ultimately I see myself in a rural community with women’s health as a part of my practice. I would love to be a part of a community, and I feel like in smaller hospitals, you're able to know everyone in the team. In Charters Towers, by my third week I knew everyone in the hospital; I knew who was on the wards, I knew who was in admin, and who was in the kitchen.”

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Reaching for balance with a passion outside medicine

10 October 2022

Reaching for balance with a passion outside medicine

Obstetrician and gynaecologist Dr Tiarna Ernst has a high-flying perspective on finding life balance, having trained in tandem as both a professional athlete and doctor. The 2011 James Cook University graduate, who grew up in Cape York, was drafted into the inaugural AFLW competition in 2016, winning a premiership with the Western Bulldogs in 2018 and continuing to play elite sport throughout her medical specialty training. “I knew for me, running out on to the football field was almost therapeutic and that I could switch off from the pressures associated with being a junior doctor,” Dr Ernst says. “I could just be a player and it didn't matter what I did outside of playing footy. I think that can be transferred into any area of interest; it doesn't need to be sport.” Dr Ernst will deliver the keynote closing address at the AMA Queensland Junior Doctor Conference, which is supported by NQRTH.  She will talk about how to find purpose and passion outside of medicine. “My message for junior doctors to find something, whatever it is, outside of medicine that gives you balance in your life,” Dr Ernst says. “I think you need to find a passion. It doesn't need to be sport. It doesn't need to be physical. It could be analytical, it could be academic, but it needs to be something different outside of medicine. It needs to be something where you can switch off, you can forget that you're a doctor or a medical student, and just pour your energy into that thing. “I've got some colleagues who are very interested in music, others are interested in volunteering groups, climate change, things like that.”

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Leading leaps in genetic research from northern Australia

5 October 2022

Leading leaps in genetic research from northern Australia

Townsville nephrologist Professor Andrew Mallett is internationally recognised for his work in identifying new approaches, understanding and treatments for genetic kidney disease. The Bowen-raised James Cook University graduate returned to North Queensland in late 2020 as director of clinical research at Townsville Hospital and Health Service, becoming the first JCU Medicine graduate to be appointed professor of medicine. Prof Mallett leads the KidGen Collaborative, a national clinical and research consortium championing novel diagnostic and research pathways for patients and families affected by inherited kidney disorders. His multidisciplinary renal genetics clinic model operates in 18 locations across Australia. “Kidney health is a national quandary,” Prof Mallett says. “It's a massive need. At a national level today, there are something like 1.7 million Australians affected by kidney disease, and about a million of them don't even know it. Kidney disease disproportionately affects those in Northern Australia and in rural and remote areas. Wherever you practise, you're contributing to the greater good, but to do it here where there's clearly such need, I think is really important.” Prof Mallett is one of a handful of nephrologists in the country who specialise in genetic forms of kidney disease. “When I was doing my renal advanced training in 2011 to 2013, there was no one in Australia in that subspecialty area,” he says. After completing a Churchill Fellowship in the United Kingdom, France and North America, he focused his career on heritable forms of kidney disease. “It's an area in which there's a great clinical and research connection,” he says. “By understanding how changes in our genes may cause or relate to the development of kidney disease, we've got a really good chance of understanding how these diseases individually work, and that may lead to better treatments in the future. “At the same time, there's a great personal connection to patients, because many are seeking a diagnosis. What is the cause of their kidney disease? What is the type of their kidney disease? Both when I was a renal advanced trainee and before that as a more junior physician trainee and medical student, most of the time we didn't have good answers. Everyone seemed so comfortable with that, and I really wasn't. “A lot of my research is focused on the development and application of new genomic technologies to help patients in a clinical context to get those answers.  We now understand that at scale, and it's available in clinics right around the county.” A key achievement has been the Medicare listing of genomic testing of patients with heritable forms of kidney disease as of July 1 this year. “It’s something that was aspirational and unthinkable five years ago,” he says. “It's been great to contribute in a research way to realising things like that at the same time as doing the research that underpins driving major clinical and policy change.” Now a teacher of JCU medical students, Prof Mallett started at JCU in 2001 as a 17-year-old fresh from boarding school in Brisbane and a holiday job as an assistant nurse at Bowen Hospital. “I worked as an AIN (Assistant in Nursing) at Bowen Hospital practically every weekend from before I got into medical school and then for the first five years I was at medical school,” Prof Mallett says.

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Emergency Medicine Spotlight: Queensland’s first Indigenous FACEM’s mission in medicine

20 September 2022

Emergency Medicine Spotlight: Queensland’s first Indigenous FACEM’s mission in medicine

North Queensland born-and-raised JCU alumnus, Dr Tatum Bond, has become Queensland’s first Indigenous Fellow of the Australasian College for Emergency Medicine (FACEM). The achievement is the culmination of six years of specialist training in Rockhampton and Cairns, combined with a life-long passion to help Close the Gap in Indigenous health outcomes and increase the representation of Aboriginal and Torres Strait Islander doctors in medical specialities.. Part of the Ngajanji people from the southern Atherton Tablelands, Dr Bond grew up in the Central Queensland town of Gladstone. Even as a child, she looked destined to be the first in her family to pursue a medical career. “I've always been fascinated by how the human body works. I was a big fan of those biology children's books and models,” Dr Bond says. “My mother tells a story of when I was about four or five, I was meant to be asleep but I was watching the TV from around the side of the wall. It was a 60 Minutes program about a baby who was born with their intestines on the outside of the body, and apparently, it was from then on that I’d say ‘I want to do medicine’.” Dr Bond says it was important for her to be close to family, so choosing to study medicine at JCU in Townsville was the logical choice. It was a decision that would hone her medical interests and her path into specialisation. “I'd never travelled outside of Queensland. So having something ‘close-ish’ to home was important to me. I really enjoyed JCU and thought it was a very well-run medical school. “The rural placements were where I had the most fun and learned the most. I went to Cooktown in my second year and absolutely loved it. I went to Thursday Island in my sixth year and was just really accepted as part of the team. These experiences led me down the rural generalist pathway after graduating, before ‘jumping ship’ to ED in 2014,” Dr Bond says. Now, as an ACEM Fellow, Dr Bond has returned to Cairns and works as an Emergency Consultant, dividing her week between Cairns Hospital and the Royal Flying Doctor Service.

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NQRTH is an initiative of the Australian Government's Integrated Rural Training Pipeline (IRTP) and is facilitated by James Cook University in partnership with public and private hospitals, Queensland Aboriginal and Islander Health Council (QAIHC), health services, Aboriginal Community Controlled Health Organisations (ACCHOs) and GP clinics.

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