~ Clinical Sub-Dean, Rural at Griffith Health, Prof. Scott Kitchener
Welcome to the Griffith Rural Health Stream. This program is actually several streams depending on what you are interested in and what you want to make of it. It is more than just the Longlook program or Selective/Elective placements.
Rural Health Seminars are provided in each of the first three years of the Griffith MD program. They are provided at G40 but also at piped to other sites and they are examinable. Seminars build from the nature of rural Australia and rural Australians, their population health, and the determinants of that health, in first year. In second year, we discuss the common health issues causing the increased burden of disease in rural Australia, conditions which you will be learning about in your MD Program. Problem-based learning will include rural examples and rural alternative clinical scenarios for all students to begin to become familiar with rural health. The second year seminar will precede the selection process for third year zones to give students the chance to ask questions about the rural zone and placements available. Additional information evenings will also be available or students may contact the Rural Stream staff directly at the Darling Downs Clinical Training Centre (T: 46387999). Third year seminar content is much more focused on specific rural health issues including a seminar on tropical medicine, a seminar on agricultural health, injuries, zoonotic disease and career pathways such as the Rural Generalist program and rural pathways of specialist Colleges.
There are several ways in which Griffith medical students can experience rural medicine beyond the rural health seminars in each of the first three years of the program.
Skills weekends are commonly run. Joining Hope4Health is the easiest way to get access to these great weekends. Many of these are run using the Griffith rural campuses.
The Rural Health Stream is not just one placement at one hospital to work through the same old terms. There are many combinations of experiences depending on your interests. Rural experiences can be as short as one term or as long as two years.
The slides below build to go through the various Rural Health Stream options and how they could fit into a MD program. There are slides about longer and shorter experiences in rural available through the Rural Health Stream.
The Rural Medical Longlook began with 4th year students working and learning in rural hospitals. In the current model of 4th year rotations at GSOM, Longlook students all complete their Elective in Block 7 immediately following their summer holiday. Orientation to 4th year and to Longlook occur together at the beginning of Block 8. We will be in contact with you during Block 7 to ensure you are progressing with your DLEEP final assessment which is due in Block 8.
One of the distinctive features of 4th year Longlook is the integration of medicine rather than the term-based approach. Unfortunately, patients don’t read the textbook prior to presenting or have specifically medical, surgical, obstetric or mental health issues for doctors to manage, so the integrated approach more approaches the reality of practice. This also does mean that Longlook students are mentored, supervised and administered by the same people throughout the year. We are told by students that they like having a 4th year home base, particularly for exam preparation.
During 4th year Longlook you are based in an Emergency Department and a General Practice (blended). Selective attachments also occur weekly throughout the year and Critical Care occurs in association with the two main placements. Much Orthopaedics occurs in GP and in EM, but students also visit Ortho services. Rural placements used include Anaesthetic services. Critical Care itself is part of a continuum, so in addition to seeing an ICU/CCU, students are able to follow patients from GP/EM up to ICU and back to see how Crit Care fits into medical services.
Third year Longlook was the natural progression after our first year. Further to the point above that patients don’t read the textbook before presenting, rural generalist hospitals in which Longlook is based perfectly match this model of care. Rural Generalist supervisors and their hospitals in which the Longlook program are the backbone to the program. Students are able to readily move through the curriculum of 3rd year usually addressing multiple learning objectives across several terms (as metro students would be doing it) in the one patient. The great advantage of this for your learning in medicine is not only to see and learn from patients as they actually present, but also to see that medical conditions, which we artificially silo into specialties, actually present as co-morbidities; that drugs for different conditions interact, that families and communities are part of individual health, that doctors are only one part of a health team, and, with the longitudinal nature of Longlook, you also get to see how health conditions evolve for better and for worse and how the health care system joins up (or not) in response.
In 2017, Griffith takes responsibility for medical student training on the Sunshine Coast. Sunshine Coast Hospital and Health Service and the Sunshine Coast Local Medical Association and Primary Healthcare Network all include rural sites along the Hinterland and on the Cooloola Coast. The Rural Health Stream is the first opportunity for Griffith students to place on the Sunshine Coast.
Third year Longlook at Gympie is a wonderful opportunity to expand the medical training at this large rural generalist hospital. The hospital readily supports the clinical experiences for all of third year. QRME have purchased the Popes Rd. student residence a short walk from the hospital.
Fourth year Hinterland Longlook is based around the Emergency Departments of Nambour, Maleny and Gympie Hospitals with General Practice placements throughout the year either in the north of the region at Cooroy, or in the south, around Maleny and Landsborough. Selectives are available at Nambour, Maleny and Gympie Hospitals and potentially also at the Sunshine Coast University Hospital.
An Amalgamative 4th year Longlook is new in 2017. It begins with an Elective of your choice in Block 7 during which we will be in contact to ensure you are progressing with your DLEEP final assessment that will be due early in Block 8, after you begin Longlook. Orientation for Longlook and the entire 4th year is still at the beginning of Block 8. Block 8 & 9 are then integrated as are Blocks 10 & 11. Students will have an integrated dual (2 blocks) placement for EM & Critical Care at one of our larger hospitals; and an integrated dual placement for GP and Selective at Goondiwindi. The amalgamated year then covers the (post-Elective) terms integrated in 2 large blocks. Selectives available in a rural town like Goondiwindi are many, ranging from Indigenous Health, to rural EM, rural GP and rural sub-specialties. You can experience more medical imaging. There are visiting and local surgeons and anaesthetists. Goondiwindi is also a procedural maternity service.
Rural General Practice placements were piloted in 2016 with great success and are being expanded to be available throughout the year from 2017 onwards. The nature of the GP curriculum is such that teaching is centred around weekly tutorials therefore Rural GP term placements are centred around the Darling Downs Clinical Training Centre in Toowoomba.
Choice of GP placements occurs in around the third quarter of Year 3 after zone placements and rotation patterns are provided to students. Knowing which block in 4th year you are allocated to do GP placement, a preferencing process is opened in which Rural GP is available as an option. Rural GP placements are in the practices around the rural margins of Toowoomba, commutable from the Jellicoe House, the DDCTC and the GyG. Rural GP terms differ somewhat, we are told, from metro placements. They are more procedural. You will see actual rural people.
Rural Indigenous Health (Selective) placement are available as Selective terms throughout the (4th) year. Indigenous Australians make up a greater proportion of the population of rural communities than in cities therefore, Indigenous Health is a major part of rural medicine, but should be a major part of all medical learning and practice. We are fortunate to have several different Indigenous Health Selective placement options available:
- Palm Island Community Clinic partnered with QRME, Griffith and Hope4Health in 2016 to develop a Selective placement for 2 students per term to live and work on the Island. Travel up to the island is supported by H4H and QRME.
- Yulli Burra Ba on Stradbroke Is. is a different clinic again, that is also a little closer to home. The clinic also takes a community controlled primary care and preventive health approach to improving indigenous health.
- Goolburri Health Service is in Toowoomba providing not only primary care but dental and child safety services to indigenous Australians on the eastern Downs and for many further west.
PNG placements will continue as Selective or Elective terms throughout the (4th) year. Rural health occurs not only in Australia, but is the predominant model of health care internationally as more than half of the global population lives in rural areas. As for Australia, rural health is lesser world-wide with lifestyles that lead to lesser health for which there is lesser health care services available and accessible. Health care in rural developing nations is an even more focused way to remember why you become a doctor and what real health care is about. For several years Hope4Health and QRME have supported elective and selective placements of Griffith final year medical students to work in Kiunga in the poorest province of our nearest neighbour.
The privilege of living in Australia comes with the responsibility to work with developing nations. Our closest developing neighbour is PNG. Western Province has mining interests but limited investment in other areas. We have chosen Kiunga as a hospital and community that isn’t first in line for that investment, but is safe for male and female student placements and has very good hospital management, accommodation and links with other organizations. The opportunities for this placement are better told by the students who have had the privilege of working in Kiunga.
Mixed short looks are feasible such as to do both a rural GP term and a PNG Selective or (if available) a PNG Elective and Palm Is. rural Indigenous Health Selective, for example. Longlook students may also do PNG placements either following 3rd year (shown above) or prior to 4th year in Block 7.
Be aware that as Longlook students who have through their placement committed to helping rural areas, will be given priority for PNG placements.
Queensland Rural Medical Education
The model of a rural clinical school around Australia is as a business unit within the medical school or health faculty. Griffith has chosen to partner with a local not-for-profit rural health education group that has arisen and is based in rural Queensland, Queensland Rural Medical Education or QRME. QRME started out as an education group raised to support rural medical education by rural doctors, for rural doctors in rural communities. The relationship with Griffith Health has been fruitful and close, leading to successful rural health programs and funding from the Commonwealth. QRME is now the body working specifically to Griffith Health delivering the Commonwealth Rural Health Multidisciplinary Training program which funds all rural clinical schools around Australia. QRME remains locally based, locally led and locally governed to retain a unique rural focus for the Griffith Rural Streams.
As a result of this program, we trust you will have the chance to meet real rural doctors in various stages of training to ask them about their path in medicine, and also to participate in rural medical education for junior doctors and registrars and in continuous professional development activities for vocationally registered specialist rural doctors.
Student Experience Video from Kingaroy Hospital
Queensland Rural Medical Longlook Program
The Longlook Program that you’ve joined is well regarded locally on the Darling Downs and around Australia. Longlook students are sought-after in hospitals and health facilities of the Darling Downs, South Burnett and the Granite Belt.
Longlook is somewhat unique in Australia in being a longitudinal rural community based program for the final and penultimate years in a postgraduate Doctor of Medicine program. It arose by a combination of (Griffith) student activism, seeking positive rural experiences in their medical program, and rural clinical supervisor requests for motivated students to come to rural hospitals and practices for long enough periods of time to become part of the rural health team. The initial Longlook trial in 2010 at Warwick and Stanthorpe was without external funding but with great local support. The Commonwealth Government also liked the program and offered a series of grants to continue and to build the facilities we now have in Kingaroy, Toowoomba, Warwick, Stanthorpe and are developing in Dalby along with the other smaller refurbishment and improvement grants to smaller communities around the Downs. The Queensland Rural Medical Longlook program is now very fortunate to have been accepted onto the Commonwealth Rural Health Multidisciplinary Training program that funds all rural clinical schools around Australia.
Another unique aspect of the Longlook program is the close relationship with rural registrars. As you’ve probably gathered in the tertiary hospital environment, there is much to learn from registrars. Rural hospitals are no different, except the registrars are in a different College training program. They are still close enough to the student experience to remember what you want and need to learn, but far enough through their medical training to have much to teach. They also welcome assistance from motivated students.
Ultimately, the Longlook program is about Rural Medicine. The content and complexity of Rural Medicine meets the curriculum requirements of the Griffith Doctor of Medicine program. The context of Longlook placements brings an additional dimension to develop professional practice and understanding of the community and some of rural Australia.