MEDICAL ALUMNI MAGAZINE

Bachelor of MedicineJoint Medical PrograM

2012

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Five years into the partnership of the Joint Medical Program (JMP), our first students will graduate from the program. the Une cohort has spent three of those years in a rural city, experiencing medicine of a different kind to that of their metropolitan colleagues in Newcastle. Time will tell if students who study in the bush return to the bush to work, but there are some, in our first JMP cohort, who are destined for rural practice.

This year the JMP has reflected on where it stands on the platform of medical education and is revitalising its curriculum and introducing new technologies to fit with the evolution of teaching practice in this digital era.

UNE has led the way, introducing iPads as a learning tool for its Year 1 students and ultrasound training for undergraduates. Students use the iPad to access online learning materials and elective subjects delivered by video conference. Ultrasound provides an exciting addition to learning about surface anatomy as well as learning some ‘bedside’ techniques to exploit the increasing availability of hand held devices. Newcastle has also piloted iPad and ultrasound projects to assess the possibilities of a wider incorporation of their use in the program. Year 1 students at Une will again receive iPads in 2013.

Technology is also taking over our clinical schools with upgrades to those based in the Central Coast and Hunter regions. Simulation is now a large part of clinical teaching across the program. Technology in the clinical schools allows students to participate in simulation via video conference from any of the clinical schools in the JMP and beyond if needed.

Construction has begun on a new clinical training facility at Armidale. The facility will deliver GP and allied health services along with training facilities for local medical students. It will also include a GP training practice, a simulation centre, as well as teaching and training areas.

Many of you will have trained at the University Department of Rural Health and Rural Clinical School (UDRH/RCS) in Tamworth under the directorship of associate Professor Steven doherty. Steve has moved on from his role at the UDRH/RCS leaving large shoes to fill for the next Director who will be appointed in 2013.

The JMP continues to hold a reputation for its support of Aboriginal and Torres Strait Islander students. Our annual intake has grown to around 12 students per year. As part of the application process for next year, potential students were invited to attend a one week Pre Med program designed to enhance the current support programs already in place for indigenous JMP students.

Researchers previously based at Newcastle’s David Maddison Building have moved into the new $90 million HMRI Building at the John Hunter Hospital campus. The 16,000sq metre, state-of-the-art medical facility will initially house around 340 staff working in a diverse range of fields. The building was designed to promote the translation of laboratory-based findings into improved clinical care. The modern, open-plan layout will encourage researchers to develop collaborations, both internally and globally, and fuel the continued growth of the institute.

Newcastle’s innovative medical program has led the way of change in medical education over the last 30 years. The JMP partners are now taking another step into the unknown with a five year MD program being discussed as part of a curriculum review. The feasibility of this proposal is currently being assessed by Academic Boards at each University. Students and alumni have made valuable contributions to the review process and will continue to be involved.

Over the next few years, I anticipate our facility upgrades will help increase students’ confidence and capabilities in the clinical setting and improve work readiness. I look forward to the impact eLearning and curriculum renewal have on teaching quality to not only improve program delivery but to maintain the reputation of the Joint Medical Program into the future.

Highlights of 2012professor Ian symonds Dean – Joint Medical Program (JMP)

Alumni– JMP 3

A dream environment for sport and exercise medicine physicianBeing surrounded by people who are extremely fit and healthy is a bit of a dream environment for someone who prescribes exercise, in preference of medication, for his patients.

Newcastle medical graduate, Dr David Hughes (BMed 1988) experienced one of the highlights of his career as team doctor for the australian opals at the london olympics.

He has been working with the Opals as team doctor since 2009 and has supported them through many world championships, but this was his first Olympics.

Working with elite athletes is usually a small part of Dr Hughes’ work which turned into a big opportunity in 2012 to travel with the Olympic team to London. He said life in the Olympic village is very different to the real world.

“Many of my usual patients need a lot of encouragement to comply with a prescription of exercise. My biggest challenge at the games was managing the determination of the individuals in the team to compete despite the pain,” said Dr Hughes.

“I had to make a call about one player who sustained an injury just before the games. I had to decide if she was going to be fit enough to achieve her dream of playing in the Olympics or be sent home. I didn’t get much sleep that night!

“We declared her fit, she stayed, she played every game and has gone home with her bronze medal.

“As with any medical decisions, you just have to remain objective, ignore the hype and base your decision on the evidence in front of you,” explained Dr Hughes.

Dr Hughes studied a diploma in sports medicine in London in the early 1990’s and considers London his second home. At the games he discovered many of the people he trained and worked with in London were now supporting the British team or working in the olympic village.

“The competitiveness between these British colleagues and me over the medal tally was pretty intense, but thankfully, the atmosphere at the games put that all in perspective!

“Life in the Olympic village was a wonderful mix of cultures. With competitiveness kept for the field, the village was a place to bond, meet people and share stories while queuing for dinner.”

living in a place that exists for the elite athlete meant the exercise and medical facilities were first class.

“It was so easy to get out and go for a run and you never knew who you’d meet on the way!

“It was very luxurious to have excellent medical support including a full suite of radiology services, a well stocked pharmacy, lots of high tech rehabilitation facilities and a purpose-built recovery centre. This was all available via the Olympic polyclinic. Normally on tour, I have to rely on the contents of my medical bag.”

Dr Hughes believes inactivity is a key underlying factor for the major health challenges in western society. Diseases such as obesity, diabetes, cardiovascular disease, osteoporosis and some cancers are all impacted by people’s ability to be physically active.

Many people have difficulty being active due to injury, illness or age. Others develop injuries or musculoskeletal pain because of poor lifestyle choices such as spending too long sitting at a desk, television or steering wheel.

Offering lifestyle advice or a modified exercise plan is a way of allowing people to overcome these barriers to exercise and overcome or prevent injury.

“Removing barriers for people to become physically active is a big part of my job,” said Dr Hughes.

“Its satisfying when you can improve someone’s health without prescribing medication but by increasing their participation in physical activity.”

“Not everyone can be as fit as an Olympic athlete, but taking a small step towards physical activity is a prescription that can cure not only a current complaint but also impact on the future health of a patient and the health system as well.”

Dr Hughes has recently accepted the position of Chief Medical Officer at the Australian Institute of Sport in Canberra where he will play a clinical and administrative role with a range of elite athletes at the Institute as well as work with national and state based sporting bodies. Congratulations David.

Dr David Hughes tends the wounded courtside.

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Year 5 JMP student, Anisha Saxena has been invited to attend a conference and present a teaching workshop in South Africa next year as a result of her experience in a Special Study Option (SSO) in Social Determinants of Health, a new rotation for JMP medical students.

The SSO entailed observing people from different socio-economic groups to determine how their health is affected by their lifestyle. anisha attended many community placements in organisations specifically designed to help the homeless and those living a less affluent lifestyle to learn more about the different types of issues prevalent in this part of the community.

Anisha said the study has helped her develop a broader understanding of the way healthcare is viewed based on social context.

One of her favourite experiences was the Soul Cafe in Newcastle which provides meals and services for the homeless and disadvantaged.

“At the Soul Cafe I worked under Dr Sales’ supervision to conduct patient interviews as part of the Cafe’s GP service. I enjoyed being able to privately discuss my diagnosis with Dr Sales and then join him in advising the patient of their condition and treatment. We saw a variety of cases, including some very interesting mental health conditions.

“A vast majority of what we saw were skin conditions, which I believe reflects the unfortunate circumstances in which a lot of the patients live.

“It appears that therapeutic listening in this population is just as important, if not slightly more pertinent, than in the general community due to the neglect homeless people often experience,” said anisha.

Time spent with the Lifeline Financial Counsellor explored the links between health and unemployment.

“long term unemployment often leads to a lack of effective budgeting with people being seen to lash out at their situation and splurge simply because they feel they deserve some luxury.

“Dietary change takes place with healthy home cooked meals being replaced with fast food.

“Services offered by Lifeline improve overall health by decreasing stress, helping with unemployment, offering financial education and guidance and providing a support network during a time of need.

“Addressing these issues has been shown to help decrease the burden of ill health within communities,” explained Anisha.

At Rendez-Vous 2012 in Thunder Bay, Canada, Anisha shared the success of this new study option and demonstrated why it is necessary to integrate environmental context into our delivery of healthcare.

“I found it valuable to understand the importance of providing healthcare within a specific patient context, taking into account the individual concerns and difficulties of each patient,” explained anisha.

Her presentation at the conference prompted an invitation from Professor Marietjie Nel, from the University of the Free State, to attend a teaching workshop and conference in South Africa and to run a workshop teaching medical students more about the way in which health can be affected by social, cultural and environmental context.

“This amazing opportunity would not have been possible without the supportive staff of Newcastle University and the elective units which medical students undertake over the five years of the program.

“I believe that this SSO will benefit the healthcare systems of the future by helping to shape the minds of the student doctors of today by allowing us to broaden our horizons regarding ways to deliver quality healthcare to a population,“ Anisha said.

New rotation broadens horizons for Year 5 student

Year 5 student Anisha Saxena presented a poster at Rendez-Vous 2012

Alumni– JMP 5

The shoes are off – the battle to control the running shoe narrativedr CraIG rICHards (BMed 2002) – Hunter Gait

We are all aware of the potential influence that pharmaceutical companies can exert on drug prescribing. But do we consider the influence of shoe manufacturers on running shoe prescription?

While running shoes are widely prescribed as injury treatment and prevention devices, the major running shoe manufacturers make no therapeutic claims about their products. As such they are not sold as medical devices and all running shoes are effectively being prescribed “off label”. As producers of consumer goods rather than medical devices, the running shoe industry is unregulated by the Therapeutic Goods administration and manufacturers are under no obligation to establish the safety and efficacy of their product. Manufacturers universally respond by not publishing any safety or performance data for their shoes.

This scenario should pose no barrier to quality health care. it simply means that running shoe prescribers (primarily sports doctors, physiotherapists, podiatrists and chiropractors) need to adhere to evidence based practice. Interestingly, at no point in the 30 year life of the modern running shoe industry has this been even remotely possible.

When Parker Magin, Robin Callister and I published a systematic review of running shoe prescription in 2008, we found there wasn’t a single published attempt to test modern running shoes in a controlled clinical trial. Strangely, the fact there had never been any evidence as to the therapeutic qualities of these shoes seemingly came as a bolt from the blue to the sports medicine community.

three large pseudorandomised military trials have subsequently demonstrated that the time honoured practice of prescribing different shoe types based on arch type makes no difference to injury rates. A small randomised controlled trial

in recreational runners showed that wearing the “correct” shoe based on your foot type actually results in more running related pain, not less.

While there has been an influx of “barefoot” and “minimalist” shoe manufacturers into the marketplace in recent years, in my experience there has not been a significant change in their attitude to research. Fledgling companies are eager to have their product tested in clinical trials until they start to make money and then their fear of destroying a successful product overrides their belief in the effectiveness of their product. While this approach of substituting endorsements for evidence and marketing for science has served shoe manufacturers well to this point, I predict that it will soon become their greatest weakness.

The game-changer I am alluding to is our establishment of a Running Shoe Safety and Performance testing Program at the University of Newcastle. This testing program will provide runners and health professionals alike with the objective injury and performance data they require to choose between the wide variety of running shoe types currently available. In the first year of the program we will be evaluating fourteen different running shoes ranging from barefoot to maximalist approaches to running shoe intervention.

running shoe manufacturers may still choose to block us from testing their shoes by refusing to sell their product to us. However, the end result will be that their products are left behind in a marketplace where for the first time in history evidence will take control of the narrative.

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Off the beaten trackIt is not every day that you meet someone who will encourage a prospective doctor to postpone both their study and career to pursue other interests.

Lakshmi Nayana Vootakuru is not your everyday person.

With an approach to medicine that displays wisdom beyond her years Nayana is a young woman looking to change the world and is well on her way to achieving her goals.

Graduating with a Bachelor of Medicine from the University of Newcastle in 2006, Nayana moved to Sydney to complete her internship and residency training.

Currently studying to be an anaesthetic registrar, Nayana is moved every few months for her training, the nature of which will provide her with a breadth of experience in her medical career.

Such a breadth of experience is something that Nayana has always focused on, having worked in remote and Indigenous communities in different capacities.

She has spent time in northern Western Australia with the Royal Flying Doctor Service and in the Northern Territory with the Aboriginal medical services. The time spent in these remote parts of Australia has allowed her to gain different perspectives on various policies.

“When you are off the beaten track, so to speak, you are forced to break the patterns that develop in medicine,” Nayana explains.

“There are no x-rays, no access to various pieces of equipment. it is completely different, as they (the patients) do not come to a clinic; we (the medical team) drive and visit them for vaccinations.”

In 2008 Nayana worked as a policy and diplomatic officer for the department of Foreign affairs and trade.

In an environment where most people come from a business economic or political background, Nayana brought an entirely new perspective with her medical science background.

Nayana credits this time working for the Department of Foreign affairs and trade as life changing, and uses it as an example as to why medical students should chase their other interests, and not be solely focused on their medical careers.

“It was an entirely different experience to clinical medicine, and some of the most salient years of my life,” she explains.

“I learnt more about humanitarianism, Australia’s unique place in the world and the context of Australia amongst its neighbours in Asia and the Pacific. It was instrumental in expanding my experience.”

Working for the Department of Foreign Affairs and Trade in no way detracted from Nayana’s medical career, as her love for policy and humanitarianism fuelled her passion for the work.

In the future she aspires to work in health policy, refugee and migrant issues and contribute to the greater discussion that is Australia’s role and what it should be in relation to these various issues that are at the forefront of the world stage.

More recently, nayana has returned from a year of studying her Master in Medicine at the Harvard School of Public Health in Boston, USA. This unique opportunity came about after she was awarded the 2010 Menzies Scholarship

Nayana is very humble when discussing this outstanding accomplishment, crediting the University of Newcastle as she was one of three chosen from the University to receive this scholarship.

“It is an honour that Newcastle, as a smaller university, produces quality students who receive such recognition.”

Nayana comments that her experience in Boston was both eye-opening and rewarding, considering how medicine in the USA >>

Alumni– JMP 7

All for one and one for all

GeorGIa Carroll UNEMSA President 2012

This year has been a landmark year for the JMP and the University of New England Medical Students association (UneMSa). For the first time, five year groups of Une medical students are present and accounted for. it is for this reason in particular that I have felt so privileged to be the UNEMSA President in 2012.

UNEMSA’s calendar was packed with all the usual events plus a few new ones, but the most memorable for me were our Practice OSCE Day and Medicine Charity Ball. It was a pleasure to see our fourth and fifth years coming from Gosford, Newcastle, Tamworth, Taree and Armidale to bestow their knowledge and experience upon the third years at Practice OSCEs, before five years worth of students came together for UNEMSA’s biggest Med Ball ever. That weekend proved to me (and hopefully to everyone else) that the bonds we form here in ‘Farmidale’ will not be broken by the passing of time or distance.

Med Ball highlighted something else that i think is really special – the nomenclature that separates us in our preclinical years really is superfluous in the grand scheme of things. Seeing so many faces of our Newcastle-bred JMP friends in the crowd as I looked out over 300 attendees just proves that we are one cohort, one set of exceptional medical students and one big, amazing group of friends.

As I reflect on the year that was for UNEMSA and myself personally as President, the things that jump out at me aren’t the countless hours of meetings, the frustrating barriers encountered or the moments of indecision. Instead, I remember how JMP students who started out in different places have come together as one on many memorable occasions from O’Camp in Year 1 to Celebration Week in Year 5.

As I drive out of Armidale for the last time to embark on my clinical years, I leave behind the comfort of familiarity and my duties as President. Nostalgia is in full force when I look back at the last three years, but you, the first ever cohort of students graduating with their Bachelor of Medicine from UNE (who I first met when they were third years) have shown me that there is much, much more to look forward to in my final two years as a JMP student.

So my last words in my capacity of UNEMSA President are to the class of 2012: Thank you for the legacy that you have left for us that follow you. I can’t wait to see what the future brings for you.

is approached with a sense of possibility where one has access to people with experience, stories and opportunities to broaden their approach to medicine.

Nayana’s experience isn’t the most expected, she is pleased though to have prolonged her studies and pursued other interests.

“Don’t be afraid to stray off the beaten path. Embrace those parts of the puzzle that you are interested in, as interconnecting these with medicine will give you a more innovative and creative approach. Avoid the tunnel vision; you are never just a doctor,” is her advice.

Nayana’s respect for the field of medicine is inspirational, as she acknowledges that it is not a career, but a lifestyle choice that requires incredible stamina with the hours, training, and approach one must take to succeed.

Nayana recalls her time at the University of Newcastle fondly, finding the interconnectedness and ability to reconnect with the Newcastle network comforting.

Nayana is a doctor whose approach to modern medicine is refreshing and innovative.

Her drive to contribute to the issues on the world stage is inspirational, and in her case, absolutely achievable.

There is no doubt that she is not just a doctor, she is a young woman ready to change the world.This article was written by Jessica McAneney for Yak Magazine and is used with permission.

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Alumni– JMP 9

BMed to MD – the discussion behind the planIn the last decade there has been a comprehensive review of health care delivery in Australia. The results of this review have revealed that a major reform of health care services is required for Australia to continue to deliver high quality health care in a cost effective manner. A system that has a greater focus on prevention and early intervention, integrates health care over the course of an individual’s life and is designed to manage chronic illness and complex health problems is required for the 21st century.

in response to these changes, it is also necessary to review the ability of the current medical degree to produce graduates who will thrive and contribute to the new paradigms in health care delivery.

So what should a 21st centrury medical graduate possess?

The medical graduate of the 21st century needs to draw on global knowledge and networks to practise effectively in a local context. in addition to possessing the skills and knowledge of their profession, a 21st century graduate must have an understanding of local, national and international health systems and delivery, and be a leader of or advocate for enlightened change in those systems. they should have the capacity to add new medical knowledge and critically evaluate new information as it becomes available. They should also possess the core competencies to operate in effective multi-disciplinary teams to provide patient-centred care in health systems. there is also a need to know how to use communication technologies effectively for continued learning and analysis on a global scale.

Key features of the proposed curriculum

a comprehensive consultation process was undertaken in the second half of 2011. As stakeholder feedback revealed a strong preference for the retention of an undergraduate program with a duration of five years, but acknowledged the desirability of enabling all students to graduate with an MD, a curriculum model was developed which allows all students to graduate with an MD after five years of study. The model consists of a two year intensive undergraduate component followed by a three year Master component.

other key features of the revised curriculum include the introduction of longitudinal themes and student-selected pathways, greater emphasis on patient centred learning, interprofessional learning,

leadership, teaching and communication skills, longer clinical rotations, full year courses with greater opportunities for feedback and remediation, and a more effective use of e-learning and communication technologies. the curriculum will also include an increased research component culminating in a substantial project or capstone experience, meeting the requirements for AQF Level 9E.

Features of the current program which have contributed to its national and international reputation will be retained and strengthened. these include its focus on rural, regional and indigenous medical education, its connection to the local community, integrated curriculum delivery and problem-based learning methodology.

The case for a Doctor of Medicine

there are compelling educational reasons for moving to the award of MD. As well as those outlined above, the following points need to be considered:

• Of the 20 medical programs offered in Australia, only five are five year undergraduate programs. the rest are six year undergraduate or four year graduate entry programs. it is apparent that most schools have moved to or are considering moving to the MD award.

• A major benefit of the MD is the opportunity for students to have a substantial research experience, which develops critical analysis skills and facilitates further professional development. the JMP, having the resources of two established universities available to it, is the only medical program in australia outside the metropolitan areas which would have the capacity to offer students a high quality research experience.

• The JMP has a stated mission to provide medical training for regional, rural and indigenous students. it also has a historical and continuing commitment to community-based medical education which is inclusive of students with low socio-economic backgrounds. With the strong indication that a substantial number of medical schools are moving towards an MD, it would be unthinkable if the program which caters specifically for ‘disadvantaged’ groups were denied the opportunity to compete with other institutions offering an Md.

We agree, the proposed curriculum framework is unorthodox, but you are encouraged to consider these final two advantages:

• Students graduate with an MD in the shortest possible time, reducing the financial and time impost on students (and on government in relation to the provision of Youth Allowance and Austudy) compared with a standard six year program.

• The five year MD will enable students to gain the higher qualification with no disruption to intern placements/workforce planning.

While we can’t compare these ideas to the innovation introduced by David Maddison at the inception of the Newcastle medical program in 1978, we wish to draw on the inspiration and success of his work to propel these ideas forward. Relying on the input of our stakeholders, the wisdom of the collective minds involved in this process and the hard evidence of research, we plan to deliver a successful new curriculum from 2015.

professor braIn jolly Professor of Medical Educationjudy Wood Curriculum Renewal Project Officer

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Giving a voice to people with rare disease

Dr Tracey Dudding (BMed 1990) is a Clinical Geneticist in the Hunter Genetics Team who see approximately 1000 new families each year. Many of these individuals and families have a rare disease with a low prevalence, generally affecting less than one person per 2000 in the population.

Low prevalence does not equal low burden of illness. Rare diseases often begin in childhood, are disabling or life threatening and can be difficult to diagnose.

Dr Dudding has a professional and personal connection with rare disease. She explains that for many people with these conditions, there is no effective treatment.

“Families and carers of children with a rare disease often experience significant psychological distress due to complex medical problems, delayed diagnosis, social isolation, lack of information and difficulty accessing coordinated health care,” said dr dudding.

“Rare conditions are referred to as ‘health orphans’ because they are neglected with respect to research.”

It is estimated that there are between 5000-8000 distinct rare diseases which collectively affect 6-8 percent of the community in the course of their lives. the paradox is that although each condition is individually rare, it is not uncommon to have or know an individual with a rare disease.

So unity became the foundation stone for Rare Voices Australia, a national alliance established in February 2012 which represents the interests and concerns of all Australians living with a rare disease.

As an umbrella group, Rare Voices Australia can pursue national agendas and provide thorough representation for patients with a rare disease living locally and nationally.

The inaugural newsletter was published recently to coincide with the establishment of the website www.rarevoices.org. Future plans include the establishment of a one stop web-based information portal for patients with a rare disease and their clinicians.

“Hunter Genetics and Rare Voices Australia are united in their goal to improve health care for people with a rare disease through better access to diagnostic tests and specialised services.”

“I hope that Hunter New England Health employees can share the knowledge of Hunter Genetics and Rare Voices Australia with patients, colleagues, family or friends living with a rare disease, and that together we can present a unified voice.”

This article is used with permission from Hunter New England Health Communications Team.

Alumni– JMP 11

Experiencing health inequality first hand in South Africa peter ryan Year 3 Student

Apartheid ended with the election of Nelson Mandela in 1994 but there remains an obvious distinction between whites and blacks in most economic, social and health domains. While the population is 80 percent black and 10 percent white, the population at restaurants, pubs, festivals, private hospitals and attractions seems the inverse.

Cardiac Surgeon, Christian Barnard, who performed the world’s first heart transplant, returned to South Africa from the United States with a donated heart-lung machine and continued his research into heart transplantation – on dogs for many years. Once the team was ready, the first opportunity to perform a heart transplant was thwarted as it was considered grossly inappropriate to transplant a black donor heart into a white recipient.

In South Africa, 70 percent of the country’s doctors work only in the private health system, serving the less than 20 percent of the population who can afford it. Staggeringly, 55-60 percent of the national expenditure on health care (private and public) is on that same 20 percent. New Somerset Public Hospital sits in the wealthy, tourist-filled Victoria and Alfred Waterfront, a stark contrast in itself. Underfunding and understaffing mean that medical students are often useful and as such, there is ample opportunity to assist. Being a teaching hospital of the University of Cape Town, the placement was well organised and integrated with the teaching timetables of fourth and sixth year students (tutorials, lectures, etc.). Much of my time was spent wandering in and out of my comfort zone, being asked to take blood, place drips, clerk patients in ED and assist in theatre. There isn’t enough space here to talk about HIV and TB but in 90 percent of the TB/HIV presentations, the intern or Registrar would turn to me and say “I bet you wouldn’t see this in an Australian ED.” True.

Many of the surgical department’s patients travel long distances for treatment, many from other sub-Saharan African countries like Zimbabwe where even basic services are non-existent. The cost of transport is prohibitive for many and by the time patients attend, breast cancers are advanced, feet gangrenous and hernias strangulated.

As many would expect, penetrating trauma is a common ED presentation although Somerset Hospital receives only simple stabbings and uncomplicated gunshots. Most weeks saw the male wards empty on a Friday and fill again on a Monday after the weekend’s stabbings. One chair, one intercostal drain, a few paracetamol and a few days before discharge for most. Students were expected to assist with evening on-calls – really the best time to be there.

despite the lack of funding, the interns, registrars and consultants seemed exceptional and, in a system so disadvantaged, it was pleasing to see that patients were treated by well-trained doctors.

12Dr Julia Brotherton with her girls, Eleanor and Charlotte

Alumni– JMP 13

HPV and all that: reflections on a journey into public healthdr julIa brotHerton (bmed 1996) Public Health Physician, Epidemiologist, Medical Director of the National HPV

Vaccination Program Register, VCS, Melbourne

I was fortunate enough recently to have an opportunity to return to the university to speak to current students at the invitation of the Alumni Association. I come back to Newcastle not infrequently, with family and friends still in town, but I have not had a reason to come to the uni for many years. It was great to remember my uni days on the beautiful campus and less great to shudder at the thought that it is 17 years since graduation!

The best thing about my visit to the uni was encountering the enthusiasm and excitement of the current students. I remember really having no idea in which direction my medical career would take me but also having that zest for life and all the amazing possibilities stretching before me. I still feel that way to some extent and I believe that there is probably a perfect job for everyone in Health and Medicine – if only you take the time to find it.

I assumed when I graduated that I would become a physician of some kind (having zero natural dexterity or patience for the intricacies of surgical practice). But i found internship and residency quite exhausting and demoralising – I didn’t find the intellectual spark and enthusiasm I felt was required to do a job for a lifetime. i did love the patients though, and the care aspect, and toyed for a while with oncology as a career. But I couldn’t get excited about the 20 differential diagnoses of anything and greatly feared developing the savage sense of humour all the oncologists seem to have – presumably in defence of their own emotional sanity.

I met a fellow resident who was studying public health and, remembering that I had been one of the few students who had seemed to love dissecting and critiquing papers at uni, I decided to enrol part time in a Master of Public Health. It only took a few weeks for me to realise that it had been a perfect decision. I felt as though my brain was switched back on. For the first time in a long time, i felt intellectually excited and interested and enthusiastic, thriving on the big picture perspective of public health. I went on to complete my MPH with Honours and then undertake advanced training in public health medicine.

In my final year of studying for my Fellowship in Public Health Medicine, I was employed at the National Centre for Immunisation Research and Surveillance (NCIRS) at the same time that the first study demonstrating the remarkable efficacy of prophylactic human papillomavirus vaccines (HPV) was published (Koutsky L et al. NEJM, 2002). I was tasked with considering what epidemiological data would be required to assess the possible role for these type specific vaccines in Australia. We instigated collaborative studies to look at HPV prevalence in Australia through a study of types present at the cervix in women presenting for Pap smears (Garland et al 2011, BMC Medicine) and a national serosurvey (Newall et al 2008, Clin Infect Dis). I became the technical writer for the HPV working party of the Australian Technical Advisory Group on Immunisation, which provided advice to the government and the Pharmaceutical Benefits Advisory Committee regarding the vaccine. Between 2007 and 2009, Australia provided all women

aged 12 to 26 years with the opportunity to be vaccinated against HPV: this program remains the world’s most widely targeted funded HPV vaccination program. As of next year, boys will also be offered vaccine in the first year of high school, alongside girls.

I have spent the last few years evaluating various aspects of the HPV vaccine program. In 2008, I moved to Melbourne and became the epidemiologist for the National HPV Vaccination Program Register and Victorian Cervical Cytology Registry. My work has been diverse and interesting– across vaccine coverage, safety, and vaccine effectiveness studies. Last year we published an observation in The Lancet of a significant decline in high grade cervical lesions in young women in Victoria following the vaccination program (Brotherton et al, The Lancet 2011). We are currently working on an analysis of a linked dataset of information from both vaccine and Pap test registers which will describe the incidence of cervical disease in vaccinated compared to unvaccinated women.

I really do love my work. Why? Because I can plan my workload and my days, I undertake interesting research that will make a contribution to scientific understanding and policy, I help prevent disease in the first place, I have had the flexibility to work part time while raising children, I get to travel nationally and internationally to share information with colleagues and world leaders in my field, and I am constantly inspired by the dedication of the public health professionals around me. Public health is certainly not for everyone (my husband, Jon Dowling (BMed 1996) is an emergency physician and he wouldn’t want to do my job – nor I his!) but it suits me, and the way I view and interact with the world, perfectly. My hope for all of you is that you have found, or can find, an occupation that is equally suited to you.

Dr Julia Brotherton with her girls, Eleanor and Charlotte

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Newcastle MedSoc steven HurWItz President 2011

Keeping students engaged and entertained since 1978

I remember two lectures from my very first day of medical school in 2008. One was by the ever enthusiastic Prof Geoff Cutfield, who revved up all my classmates and I to get excited about our first PBL. The other lecture was by a student at the time, Andrew Williams, the President of the University of Newcastle Medical Society (MedSoc). He showed a slide with a heard of buffalo crossing a river, with a single zebra in the middle. The message was that we’re all in this together, and even if you’re not a buffalo, the herd can help you across the crocodile infested med school exams. It was this herd that gave MedSoc such strength.

Like many students who went through the University of Newcastle I felt my first real introduction to MedSoc was through its opening event of the year, First incision. early in the night i found myself surrounded by a group of seven final year students, keen to pass some wisdom down to me. Reflecting back on this, I think it’s when I first realised the potential strength of MedSoc to connect students from such varying backgrounds together, be they zebra or buffalo!

As time went on, I found MedSoc to be a diverse organisation. I was lucky to be the First Year Representative, which gave me an early insight into the role the society had in helping to improve our medical program. But there was so much more. MedSoc was part of discussions on a national scale through the australian Medical Students’ Association (AMSA). AMSA also provided MedSoc the opportunity to help connect Newcastle med students, not just with

each other but also with students all across the country through its national convention.

Personally, my favourite parts of MedSoc are its community initiatives like The Teddy Bear Hospital, which aims to alleviate anxieties Newcastle children might have when visiting the doctor, and the charity fundraising which supports Hunter charities. Events like Med Revue (this year it was a play called Peter Pansystolic) consistently remind me how talented my peers are and our Annual Rugby Derby with the law students has always showed off the best of our boys.

In 2013 when I complete my final year of medical school I’m sure I won’t become the first alumnus to look back on my time in medical school and have such great memories that were shaped by MedSoc. Of course some were from the excellent events like First Incision and The Great Debate, but MedSoc also represented the very best of the Medical School in Newcastle- the students! It encompassed motivated and enthusiastic students who embodied what the BMed has represented since 1978. I may believe MedSoc is great, but I know the best part of medical school is creating strong relationships with other medical students!

Alumni– JMP 15

All in a day’s workDr Pat Oakley (BMed 1990), Staff Specialist in General Medicine, Division of Medicine, John Hunter HospitalAS well AS beIng A StAff SpeCIAlISt, yOu wOrk In OutreACH tO AbOrIgInAl COMMunItIeS. tell uS AbOut tHIS rOle.

My involvement in Aboriginal health began in 2008 through the Integrated Chronic Care for Aboriginal Patients program. I visit the Aboriginal Medical services at Inverell (Armajun), Tamworth (TAMS), Taree (Biripi) and in Newcastle (Awabakal) six times per year, and also cessnock community centre. the royal Flying doctors Service has been fantastic in providing flights to and from Tamworth and Inverell. In four years we have only missed two clinics – dust storm and mechanical failure. HOw lOng HAVe yOu been DOIng tHe OutreACH SerVICeS, AnD HAVe tHere been Any CHAngeS OVer tHIS tIMe?

The first clinic we attended was at Armajun and following this we were invited by Tamworth, Taree and Awabakal to visit. From the outset the focus of the clinics was chronic disease: diabetes, cardiovascular, renal disease etc, but always with an open door to consult on anything medical - usually complex. HOw DO yOu MAnAge yOur buSy SCHeDule AS well AS tHe trIpS tO DIfferent AbOrIgInAl HeAltH ClInICS?

Fortunately a number of my colleagues are keen to do some clinics, and a couple of our original trainees have completed training.

wHAt MAkeS yOu wAnt tO be perSOnAlly InVOlVeD, AnD HOw DOeS It Help yOur prOfeSSIOnAl DeVelOpMent?

There is a perception that this field - dealing with chronic disease in Aboriginal people - is just too hard, even hopeless. For me the most satisfying thing is the revelation that this presumption is absolute garbage. The Aboriginal people I see are keen to engage with health professionals and to take control of their health. It gives me immense satisfaction to see that good medical practice works really well in an area considered “too hard” by so many in health.wHAt DO yOu DO In yOur SpAre tIMe, If yOu HAVe Any?

I surf often, and badly. Otherwise, I try to spend as much time as possible pursuing outdoors activities with the kids. wHAt’S yOur fAVOurIte pArt Of yOur JOb?

No contest. The best (working) day involves a fully booked clinic in Armajun, 20 minutes for lunch and a cup of strong coffee from the local barista (not a bad cuppa), followed by a flight home at sunset. When the patients who were previously “too hard” are now getting better, and the new referrals are just as interesting, it even compensates for missing the morning surf.

This article is used with permission of Hunter New England Health Communications Team.

16

Alumni– JMP 17

Let’s talk about UNEalexander WHItfIeld Class of 2012

I can hardly do justice to our time together in Armidale. Anecdotes may give a pencilled outline of some of our experiences but I doubt if they really capture our journey.

Many people were anxious about leaving their homes for some far away mountain town, “Where is Armidale?!” was a refrain heard across the country when the university results came out. Soon though, this apprehension disappeared as we formed our own community built on shared circumstance, medicine and the town around us.

After Daniel Hobbs’ mysterious disappearance we got down to business. Drinks were had, dinner parties hosted and hikes hiked. Inevitably drama bloomed. Some of us began to wonder if this was all a big social experiment or Truman Show like arrangement; 60 people thrown together in this med school and observed. How else to explain this particular combination of personalities held together in this chilly environment?

In a way it was a great experiment. An experiment in running a joint program across two campuses, an experiment in running a rural medical program. Because we were the first to do this, things were worked out as we went along. We had no one to look up to, so we found our way together.

There was more than a little relief when we reached second year and a new cohort entered the program. Cabin fever sets in when the same small group of people are confined together for long periods, but of course we set only good examples for the years below.

In our third year we travelled away on our various GP placements. This was our first real taste of clinical practice and of online PBL. Never had we worked harder at updating Facebook than in those PBls.

This was also the time for the Health Equity Selective. HES was a wonderful learning experience and, for many of us who went overseas, a source of diarrhea stories to last a lifetime.

There were sad times too. Natalie Edwards, a much loved student and friend sadly passed away in second year. A tragedy that affected us all deeply. Natalie was a kind and open friend, always putting others before herself. It is very sad that she is unable to live out her passion to become a paediatrician and a terrible shame she is no longer with us today. We miss her still.

And we left Armidale. Some were glad, for many it was time to move on. But for everyone there was a little sadness I think. This was the end of a chapter in our lives and we were leaving a place that had helped shape us, where we had shared a great common experience.

It has been five years since we began this journey together. We have come a long way from being those nervous first years and a lot of things have changed. In our time together we have grown into the prepared professionals we need to be and we will grow even more in the years and decades to come. In many ways this is just the beginning but no matter where we go we will not forget where we came from. I know that when we look back on those formative years it will be with nostalgia and a smile.

thank you, all.

18

A pathway for better patient careThe importance of community health and the ability to problem solve are two important legacies of the University of Newcastle medical course for Dr Tracey Tay (BMed 1985), John Hunter Hospital anaesthetist, and one of the Clinical Leads for the Innovation Support Unit in the Hunter New England Local Health District.

Together with an ever-growing group of clinicians and managers, including a number of Newcastle medical alumni, Dr Tay is part of a novel approach to integrating care around patients, one that is beginning to show real results.

With the increasing demand for hospital outpatient services and frustration expressed by GPs and their patients with long waits for appointments, it was clear that only a collaborative effort between the primary and acute care worlds could make a significant improvement.

Making this connection for patients across the primary, community and acute sectors is the overarching goal of a new program called HealthPathways. It is based on the program of the same name developed in the Canterbury region of New Zealand.

Driven by a formal partnership between the Hunter Medicare Local and Hunter New England Health, HealthPathways is an online portal where GPs can access up to date, evidence based information on health conditions and access relevant, local referral information.

The website allows GPs to enter a condition, see the red flags to watch out for and access management and referral information for their patient. The recommended ways to manage patients are called ‘pathways’.

Dr Tay says the HealthPathways team is pleased with the progress so far.

“Over 85 GPs, 80 specialists and many nurses and allied health staff have been involved so far in our Pathways development teams,” she said.

“Since March this year, the website has been available for all GPs and referrers to access pathway information.”

“With 67 localised pathways, 70 in progress and over 350 from New Zealand, we’re on the way to improving communication and connecting care for patients.

The pathways help GPs to more confidently provide care in the community and then refer the patient to specialist care at the appropriate time. From the patient’s perspective, this means less delay in initiating care and better access to specialist care in a timely fashion.

The system also hopes to improve communication and networking among GPs and specialists, filling a void that has long needed attention. Dr Tay is excited by the response she’s been getting from both sides of the health spectrum.

“I’ve never been involved in anything quite like this where I’m getting phone calls from previously very disenfranchised specialists asking to be part of the movement.

“There’s a central integrity to the idea. People get it because they can see that by having a place to talk with other colleagues providing care to patients, we can start to cut through things that are stopping us in our provision of care to patients. It’s a very, very exciting process,” dr tay said.

Based on their observation of the success of the Hunter program, a number of other NSW and interstate regions are also investing in the HealthPathways model of primary and acute sector collaboration and clinician-led reform.

Both HNE Health and Hunter Medicare Local are committed to ensuring that the HealthPathways program continues to grow, delivering the right care for patients, at the right time and in the right place.

Thank you to HNE Health Communication team for their contribution to this story.

Dr Jo Mesure (bMed 1993) Medical Coordinator at the Hunter Clinic of family planning nSw says “Health pathways is a great initiative. I am involved in the development of a ‘Contraception’ pathway at the moment, and am already finding the website incredibly useful when referring patients to outpatient clinics in general.”

Alumni– JMP 19

Medal and Prize winners 2012 Alumni Medal winners

The Alumni Medal was instituted in 1987, and is awarded to a graduate with an outstanding record of professional excellence in leadership, knowledge and/or professional practice.

professor David CurrowChief Executive Officer Cancer Institute NSW New South Wales Chief Cancer Officer Bachelor of Medicine (1988)

Newcastle-born medical specialist Professor David Currow is the CEO of the Cancer Institute of NSW and Chief Cancer Officer in NSW. He is a Professor of Palliative and Supportive Services at Flinders University (SA) and an Honorary Professor of Sydney University and the University of technology, Sydney.

David’s career has been an exercise in commitment to improving the quality of care for people at the end of their lives. His impact is evident in policy and service development, research and teaching throughout Australia and the world.

With more than 240 publications to his name, David was recently rated one of the top 10 most published palliative care researchers in the world. He and four other editors are currently working on the next edition of the Oxford Textbook of Palliative Medicine, the highest-selling textbook in the field.

David is the principal investigator on the Australian government-funded Palliative Care Clinical Studies Collaborative, the world’s largest clinical trials group in palliative care.

In recognition of his contribution to palliative care, David was invited to present the 2011 Dame Cicely Saunders Oration at the Kings College, London.

Associate professor Mark parsonsSenior Staff Specialist in Neurology, John Hunter Hospital, Newcastle Associate Professor in Medicine, Faculty of Health, University of Newcastle Director, HMRI Stroke Research ProgramBachelor of Medicine (1992) Faculty of Health

clinical neurologist Mark Parsons, senior staff specialist at John Hunter Hospital, is a rare breed – not only a highly regarded researcher, but also a clinically experienced neurologist with specialist training in cutting-edge brain imaging technologies.

Mark is Director of the Hunter Medical Research Institute‘s Stroke Research Program and founder of the John Hunter’s Stroke Imaging Research Laboratory.

His internationally recognised work in thrombolysis (clot-dissolving) treatment aims to reduce irreversible damage to brain tissue in the 48 hours following a stroke. His pioneering research into the application of advanced brain imaging to identify salvageable brain tissue adds new and exciting management options for stroke patients.

Mark’s award-winning work developing an ambulance protocol in the Hunter region for rapid identification, prehospital notification and transport of patients to a specialist stroke centre has resulted in 21 percent of patients receiving thrombolytic therapy.

Mark was admitted as a Fellow of the Royal Australasian College of Physicians in 1999 and was awarded his Doctor of Philosophy in 2003.

BMed Prizes

AMA (nSw) prizePhoebe Moore (2011)

Mother & Son prize in paediatricsZoheb Williams (2011)

the John Hamilton prize for Indigenous Medical StudentsBart Scanlon (2011)

HpMI prizeamanda White and daniel oliver (2011)

Andrew lojszczyk prizeJennifer Young

John Mcphee Memorial prizenicholas Ferguson and James Lawler (2011)

Steele Douglas prize in pathologydakshika gunaratne

rAnSCOg women’s Health AwardJennifer Young (2011)

Australian Council on Healthcare Standards (ACHS) prizeAminuddin Hasnol Aidi, Ettiene Musumeci, Subhash Nayar and Umi Qamruddin

faculty of pain Medicine prizeliam Back

Andrew lawson Memorial prizeLawrence Kasherman & Jodie Parker

Valley to Coast prize in primary Health Care SelectiveJennifer Young

JMp prize for primary Health Care SelectiveJessica nathan

rAnSCp prize for psychiatryJennifer Young & Alexandra legge

Joint recipients of the 2012 Alumni Medal – associate Professor Mark Parsons and Professor David Currow. Photo by Murray McKean.

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Cover photo: Dr David Hughes savouring the moment with Australian Opal Samantha Richards