Report to AAAGP of the inaugural Travelling Fellowship

By Marie Pirotta

Thank-you

Firstly, I would like to thank AAAGP for the wonderful opportunity presented to me in being granted the first AAAGP Travelling Fellowship. I also thank sincerely the groups of people at both universities who arranged and assisted throughout my stay. I learned a great deal and thoroughly enjoyed myself.

Program

I spent two weeks in January with the Flinders University Graduate Entry Medical Program (GEMP). The first week I spent in the Riverland during the orientation period for the Parallel Rural Community Curriculum (PRCC) students and the second week was based at Flinders Medical Centre for the intensive week of teaching in general practice for the third year students.

After overseeing the beginning of my fifth years at the University of Melbourne, I then spent a fortnight at the University of Queensland’s Graduate Medical Course (GMC), based in the Centre for General Practice in the Department of Social and Preventive Medicine.

GEMP - PRCC

Flinders’ four year GEMP has run for several years and in 2000 the first group completed their intern year. Year three is considered the tough year, with a large knowledge component. In this year when the students are learning about women’s and children’s health, general practice, medicine, surgery and anaesthesia, they may apply to spend the entire year in either the Northern Territory or in the Riverland district of north-east South Australia. The bulk of the students remain based at the Flinders Medical Centre. I chose the timing of my stay to coincide with the orientation of the new group of seven students (approximately 10% of the year) in the Riverland PRCC. I knew little beforehand of the wonderful program that Paul Worley has established there. The time I spent in the Riverland was very exciting in terms of curriculum development ideas for University of Melbourne’s new course.

From my observations, the PRCC is based on the presumption that the students can learn all they require in third year in the rural setting, with some formal tutorials and lectures supplied. The students must apply for these positions and clearly personal skills of independence, resourcefulness, self-motivation and maturity are necessary. Coming from a largely undergraduate course, (my experience has only been with undergraduate students at this stage), I was very impressed by the calibre of these seven students. I think three of them already had PhDs and the average age was around 30. Two male students had their families with them. They had to be prepared to be away from the comfortable and high-powered surrounds of the tertiary teaching hospital and largely to direct and motivate their own learning for the year. All had a strong interest in rural practice as a career. Paul Worley evaluates their progress with their GPs on a regular basis. I am sure this program would challenge a lot of students.

Flinders has clearly invested a great deal in the PRCC to assist these able students. There are 1.3 administrative staff (based at Flinders and Renmark) to oversee the intensive planning of the year. Each student is supplied with a Mac laptop computer with appropriate software, a mobile phone and for their room in the GP clinic a

One of the Riverland local hospitals where students are based for the year.

 

 

Video-conference supervision for the first PBL tutorial. Note laptop computers.

 

 

 

 

One student’s orientation visit to her general practice – already working!


Hospital orientation by the Director of Nursing

Posing for the local media – several stories were generated

The Commencement Dinner in Renmark, attended by the Dean of Medicine and many faculty members, the Mayor of Renmark, senior members of the local hospital authorities and boards and old students.

separate phone line, TV/video, internet access and a small medical library which includes videos of past third years lectures. Local health authorities and councils help with rent and petrol subsidies and the university pays for five trips by bus back to Adelaide per year. The university has also set-up video-conferencing facilities at rooms provided by each of the five local hospitals where the students meet for teaching.

The students are based in local general practices in one of the five towns in the region servicing a local hospital. The students are usually in pairs and are about 30 minutes drive from each other. They come together once each week formally for a "tutor-less" PBL tutorial and video-conferenced lectures at rotating hospitals. Students are rostered on to theatre sessions with local and visiting surgeons and each month spend a day with a visiting medical specialist. The local Division of General Practice involves the students in CME activities.

The local community has been mobilised to support this program and are vital to its success. Clearly they hope for benefits in the future with these students returning long-term as doctors for the community. Although early days, there are signs that this is happening. The GPs I spoke to, said that although it was time consuming having the students at the beginning of the year, by the end they were doing a lot in the practice and were a great help. They are keen teachers and most arranged for extra tutorials within the practice, which all students were welcome to attend. Students were expected to be on-call for at least two days and one night each week.

 

GEMP – Flinders

It was interesting to enter another department and observe so many differences to my own in Melbourne. The Flinders Department of General Practice is based in the Flinders Medical Centre. This is a huge hospital and the Department of General Practice sits alongside laboratories and other specialised units. The advantages of this location may include better collaboration and relationships in teaching with specialists collocated with you and access to hospital patients for teaching purposes.

In the Flinders-based program, the GP teaching is largely compressed into a one week intensive, which precedes the semester in Women’s and Children’s Health. In contrast to the vast amount of exposure the PRCC students have to patients, the Flinders students have only a two-week block in a rural practice and nine half day placements in a metropolitan practice spread over the semester. This is repeated in the second semester.

The teaching intensive concentrates on consulting skills and other process issues, rather than clinical content. It was a very full week, even more so than usual as there was a public holiday on the Friday. Due to some tutor and actor shortages, I was able to actively participate in several sessions, including taking my first PBL group. The group was very gentle with me.

The sessions the students really enjoyed were two devoted to consulting skills and two to special GP skills. The consulting skills teaching was done in small groups with actors playing patients with a shopping list, needing a procedure to be explained, the angry and drug-seeking patients and cases requiring motivational interviewing etc. The clinical skills were about giving vaccinations, ENT examinations, sensitive breast examinations utilising trained women as tutors, writing prescriptions and sick notes and a difficult consultation with a simulated actor playing the patient from the PBL case.

During the semester, students are expected to do at least one web-based PBL (there are many other resources provided that they may access) and a continuity of care assignment.

GMC – Queensland University

The Department of Social and Preventative Medicine at Queensland University reminded me more of my own, with it’s multidisciplinary staff and a sense of being a separate unit within the university whole. They are blessed with fabulous views of tall eucalyptus trees in the surrounding park with many native birds – I am sure this must improve productivity, if compared to our view of the City Ford Service centre staff playing footy at lunchtime in their driveway. The department adjacent to the medical faculty building and a short walk from a campus of three teaching hospitals for adults, children and women.

The staff were extremely friendly and approachable. Despite being quite disparate in locations (eg two senior lecturers are based at the RACGP), clearly an effort is made to keep staff in touch with each other.

My time at Queensland was well organised and I was able to have more of a focus on the research side of my interests. My interests were e-mailed around the department prior to my arrival, so that on my first morning I was given a timetable of possible activities, complete with phone numbers of all the possible people I might like to meet with during my stay. This was invaluable.

As in Flinders, the students here are postgraduate, although did not seem as old overall. Once again I was very impressed by the calibre of the students. I was able to attend both second and third year PBL groups. It was of interest to me that the third year group met out in the suburbs at the RACGP building. Although still called PBL, at this level the students are encouraged to bring in cases from their clinical placements to discuss various aspects of general practice, for example diabetes in my week.

I spent time with staff members discussing the teaching of clinical skills and the rural components of the course. The proximity to the teaching hospitals gave the general practice staff an opportunity to introduce GPs as tutors within the hospitals, teaching with patients recommended by the registrars. GPs have taken a large role in the teaching of the GMC.

I was invited to attend an assessment meeting – the first of the year to plan for final year exams. A large group representing many branches of medicine met and seemed remarkably organised to me. I learnt later on while meeting with the woman who oversees assessment and evaluation why this is so. Not only is she a very impressive and dedicated woman, but she seems better resourced with staff than my university and has taken on the role of all assessment at all year levels centrally, while keeping the different departments vitally involved at all stages. The examiners even come into her offices at a set time to do all the corrections!

I was able to attend a few "work in progress" research meetings and observe strong collaboration across the centres. I was fortunate to share a research interest (complementary therapies) with a few members of staff and was invited to discuss research proposals in that area with a few people. The Acting Director of the Centre for Evaluation of Complementary Health Practices spent several hours discussing research ideas with me. I also learnt more about the innovative N of 1 trials program.

The nervous highlight of my visit was a meeting over dinner that Chris Del Mar hosted at home, which was attended by about 12 members of staff. The focus was my presentation of my research proposal and I received excellent feedback and many suggestions for improvements.

OUTCOMES:

  • Personal

I did more useful networking during my fellowship than I had done in the six previous years during attendances at many academic GP conferences. This reflects on my somewhat shy in a crowd personality, but also the focus in most conferences for networking is your area of research and this is difficult when you are just beginning. The opportunity to compare teaching and curriculum development experiences was wonderful. I have forged some wonderful friendships and linkages at each university, and even discovered that Anna Vnuk, who has a similar role to mine at Flinders University, and I are third cousins.

The visits revitalised my commitment to academic general practice and helped me to understand that there are many different ways to approach both curriculum and assessment development and research cocooning processes within institutions.

  • My department

Melbourne University is deep into its planning for the remainder of the new curriculum and the place of both clinical skills teaching and of the new semester 12 rotation in general practice are still evolving. My experiences and observations at both Flinders and Queensland should be useful to stimulate ideas and discussions in this planning phase.

While on the travelling scholarship, I made the most of every opportunity to inform other academics of what we do in our department, gave names to researchers for possible collaborations and encouraged people to consider a visit to our department in the future.

  • Wider AAAGP community

I hope that my visit to each department was informative to them of how things run at Melbourne University, both in curriculum and research. The linkages made will run in both directions and opportunities for further exchanges may have been laid.

 

Advice to further applicants for this Travelling Fellowship

  1. Do it. It is well worth the experience.
  2. Plan where to visit according to your major interests – this may require some research beforehand. Visit the departments’ websites.
  3. Once you have chosen your preferred universities, liase closely with them regarding the timing of your visit. There is definitely a trade-off between arriving at a busy teaching time to get a lot of exposure but finding that staff may be too busy to spend much other time with you.
  4. To get the most from the visit, ask the university to identify an academic to oversee your visit and help you to locate the people you will benefit most from meeting.
  5. Think twice about visiting the South Australia in summer – it was 47oC the day I arrived in Berri and was never under 35o for the next two weeks!