Doctor, Greenwich Hospital (Connecticut, USA)
It may be a cliché, but I like to help people and feel like a productive part of society. I was never 100% sure I wanted to do medicine until I actually got into medical school. I wanted to live in a country other than the USA and experience a different health system. I researched all the medical schools in Australia and Flinders University was internationally recognised for excellence. In addition, it has an amazing rural program that I thought would help broaden my experiences.
My time at Flinders was both challenging and satisfying. The biggest challenge in coming to Australia was building a new support system in my adopted country.
You need a lot of focus to study medicine and oftentimes it can be overwhelming. Over time, I made good friends in med school and was able to turn to them for strength and encouragement.
The strong clinical program at Flinders gave me the skills that I use every day to diagnose my patients. Studying medicine involves maintaining focus on your ultimate goal but I’ve learned to treasure those which are dear to me, including family, friends and staying healthy.
Plastic Surgeon (Sydney)
Flinders had a huge impact on me. I had wanted to be a doctor all my life but my memories of Flinders are more than just the training and the medical lessons. They taught me to be a caring doctor aware of the whole community. It’s important for your patient to know that you stand up for them.
Medicine at Flinders was very well run. There was a lot of emphasis on self-directed learning – which is great – but you also get a very good grasp of being a better doctor. You never lose focus on the importance of the doctor-patient relationship. That’s what makes Flinders different to other unis – you get a lot more views than simply the medicine.
I did an elective on plastic surgery in my third year and ended up on exchange in Columbia University in the USA. I went to New York and I studied plastic surgery over there. Apart from the opportunity, it was a lot of fun and quite a memorable time.
One of the best times in my life was doing my medical course, meeting my friends, doing stuff on campus and going to the Uni bar after lectures to catch up with people. We were told in the very first lecture that you’ll never forget those people you go through your medical studies with… and that was absolutely right.
I came to Medicine through the Indigenous Entry Stream. I hadn’t really thought of medicine before as it’s such a difficult course to get into but the Flinders staff encouraged me to go for it. At every stage, they kept me going and I was successful in getting in.
I’m studying at home and that’s critical for me – I can do Medicine while I’m in Darwin. It’s different doing video conferencing for lectures and having to study online but I’m enjoying it. The course is set up so even though we’re still in first year we also get to the hospital and interview patients. We’ve got our own anatomy laboratory so we can still learn via hands-on lessons.
There are Flinders staff up here who keep an eye on us as well. They are very helpful if you need someone to talk to about issues to do with your study.
My interest is in Indigenous health as an Aboriginal man. I want to get out to communities and try to improve Aboriginal health in remote areas as well as in Darwin and the bigger centres. I’ve heard stories from colleagues who have finished their medical studies and gone to work in a remote health centre. They’ve seen the elders break down in tears because they never thought they’d live to see the day where they would be treated by an Aboriginal doctor. That’s a pretty significant driver for me – just to be able to one day get out there and help.
I’ve just finished my first two years, which is the clinical science component and now I’m starting the postgraduate medical science part of my studies. With this pathway into Flinders I was able to get into medicine as an undergraduate which meant I could just get going straight from school, just as I wanted.
The first two years were great – it’s basically medical science or health science and you also do a few other subjects that help round out your understanding of medicine. University is a different world compared to school. I don’t think I expected university to be as free as it is.
It’s a bit of a shock to the system at first but two years in you really appreciate the freedom and choice they give you. It’s a different experience but once I’d gotten used to it I wouldn’t change it for anything. You’ve got to do a lot of work yourself. That’s great – it really throws you in the deep end and opens up a new world of challenges.
At this stage, I’m looking to specialise in paediatrics but that could change in the next four years. Your specialty is a decision to come to yourself but you are exposed to many areas of medical practice and you get the chance to find an area you’re interested in. I may find another area of medicine that I really enjoy, and I’m looking forward to finding out.
Dr Lara Andrachuk
A Canadian Experience
Inevitably, the first question I am asked on any new rotation is “where did you go to medical school?” It always surprises me how many physicians in Toronto have not only heard of Flinders University, but are also aware of its reputation for quality education and research.
I began my five-year Dermatology residency at the University of Toronto in July 2009 after graduating from Flinders GEMP in December 2008. As an international student at Flinders, I had always intended to return home to Canada for residency training, but was unsure of my chances of securing a training position. In preparation, I wrote both the Canadian and American medical licensing exams and maximized my elective rotations in North America (Toronto, New York City, Vancouver Island). On these rotations, I found that my knowledge and clinical skills were up to par with the local students, albeit with a few gaps in North American specific knowledge such as the management of Rocky Mountain spotted fever and coccidioidomycosis!
Despite these positive elective experiences, I still felt quite anxious about my ability to perform in the Canadian system at the beginning of residency. There were many daunting aspects; the advanced specialty knowledge expected of first year residents as a result of direct entry into specialty programs from medical school, the “on-call” system where residents work ~30 consecutive hours every fourth day, and the plethora of distinct medical lingo and pronunciations.
Now three quarters of the way through my first year, I have learned to pronounce cephalosporins and encephalitis with a soft “c”, and order a “TEE” (Transesophageal echocardiography) (not a “TOE”). I have trained my brain to function for more than 30 consecutive hours, return pages politely at 4 am, and I have finally learned how to take daytime naps. I have also picked up some fancy dermatology knowledge along the way, and can manage getting “pimped” (a.k.a. grilled/tested/questioned in front of your colleagues) at dermatology rounds every week. The Flinders “self-directed learning” model has certainly served me well!
I have spent most of my year at St. Michael’s Hospital, one of UofT’s eleven teaching hospitals, in downtown Toronto. The typical inner city, multi-ethnic patient population provides for a challenging but highly rewarding work environment. On my infectious disease rotation, I managed patients with disseminated sporotrichosis, leprosy and AIDS. While on emergency medicine, I managed everything from superficial abrasions to multi-trauma patients. My one-month dermatology rotation this year introduced me to the varying presentations of cutaneous disease in skin of colour, the multitude of bullous diseases and cutaneous neoplasms. As my program narrows to pure dermatology in the last three years, I expect that my general experience in the first two years will strengthen my clinical acumen.
As one of North America’s major medical centres, Toronto is great place to consider undertaking electives or fellowships. Visit the Postgraduate Medical Education office at http://www.pgme.utoronto.ca/home.htm, or the UofT undergraduate medical program at http://www.md.utoronto.ca/students/visiting.htm for more information.
Dr Lara Andrachuk
Dr James Doube
Remote medicine – a graduate’s experience in Australia’s Antarctic Program
Dr James Doube graduated from our medical course in 2002. He is currently the Expedition Medical Officer on Macquarie Island, a beautiful and remote island in the Antarctic. James will spend a year being the only doctor is this very isolated location. Here he describes the environment in which he is working and some of the unexpected extra responsibilities he has as the station doctor. James says the Flinders graduate entry medical program has equipped him well for this role.
I am stationed on Macquarie Island – a small island in the middle of the Southern Ocean, about 1500 km south east of Tasmania, and 1300 km north of the Antarctic Continent. Macquarie Island, or “Macca” as it is generally referred to, is 34 kilometres long and up to 5 km wide. It is a World Heritage Area due to its unique geology (it is a piece of oceanic crust which has been relatively recently forced up to the surface due to movement of tectonic plates), but on arrival the abundance of wildlife is the most amazing feature. As the only piece of land for nearly 1000 km in any direction (and the only piece of land in these latitudes for much further), anything which wants to come ashore to breed, or dry its feet, tends to end up here. In addition, the island has no native terrestrial mammals, and the only predators are birds, so much of the wildlife lacks the normal fear of humans (despite massive exploitation of seals, whales and penguins in the 19th and early 20th centuries). Penguins (particularly the larger King Penguins) will approach a person if they sit quietly, even gently nibbling at them.
The island itself is generally very steep sided, but has an undulating plateau over most of the top (200-350 m above sea level). All but the immediate vicinity of the station is impassable to any form of vehicle. There are no trees, and the vegetation is dominated by grasses and some large herbs. Unfortunately as these plants have evolved without herbivores, they tend to be palatable, and have been severely impacted by rabbits (which were introduced as a food source by the sealers).
The climate is very different to the Australian mainland – apart from significant changes in day length, there is very little seasonal change. It is cold, wet and windy all the time (it rains about 310 days a year). Due to this rainfall, most flat areas are inclined to become very boggy, and in many cases formed of a floating layer of vegetation (featherbed). Due to its position on the junction of the Indo-Australian and Pacific plates, the island is subjected to regular earthquakes, and this, combined with the high rainfall, and lack of large vegetation (made much worse by the rabbit problem) means that landslips are common. Fortunately the island is still being forced up, so is unlikely to disappear in the foreseeable future!
The station is at the northern end of the island, and is home to up to 20 people during the winter, and up to 40 during the summer. These personnel include Tasmanian Parks and Wildlife Service rangers, scientists, tradesmen, Bureau of Meteorology Staff, communications staff, the chef, the station leader, and a doctor.
As can be imagined by the small number of personnel on the island, (who have all had extensive pre-departure medical screening), the day-to-day medical workload is not huge, but one of the major differences with remote areas on the mainland is that there is no option of transferring a patient out. The doctor must be able to function as solo surgeon/anaesthetist, but also be the pathologist (good basic haematology, biochemistry and microbiology resources are available), radiologist (although, like most remote areas, films can be sent out electronically for a second opinion), public health physician (maintaining water quality is critical, especially in a site with so may animals defecating and dying in the supplies), and, probably the most daunting for many, the dentist! Fortunately, to date, I have had relatively few dental cases, and have only had to perform two fillings.
Two expeditioners (in my case the chef and the electrician) receive a fortnights training as anaesthetic assistants, and another two (communications technician and a member of meteorology staff) are trained as theatre assistants/nurses, but there are no other paramedical/allied health staff. Therefore the doctor is also the physiotherapist (a significant part of the work on Macca is musculoskeletal injuries), occupational therapist, orthotics/podiatrist and counsellor.
The medical facilities are probably amongst the best per capita anywhere in Australia – There is a well equipped operating theatre, a small ward, consulting room with extensive pharmacy and a smaller darkroom/ dental room. It initially seems almost excessive, but one rapidly realises that it is a necessary contingency, and the systems have evolved over many years of experience.
Prior to departure extensive training is provided in the additional “medical” skills, but also in other expeditioner roles. This is a very interesting and enjoyable time with week plus courses in inflatable boat handling (including surf training as there is no sheltered landing or jetty/wharf on the island) and fire-fighting. There are also trips to the highlands for field training and a weekend of search and rescue. Additionally, it is expected that the doctor will obtain a forklift licence, and ideally a front end loader ticket as well - these courses are all provided on site, and provide an interesting change on the station. Finally, a number of other short courses such as hairdressing and hydroponics are provided.
The trip south is by ship (typically RSV Aurora Australis, an ice breaker) and inclined to be very rough. In my case, it was via Antarctica, but unfortunately, as Macca is only resupplied in autumn (to minimise disturbance to breeding wildlife), the ice was too thick to reach the Antarctic shore (necessary transfers are made by helicopter).
One arrives on the island into the busiest period of the year – resupplying a whole community with everything it needs for a year, as well as various projects by “round-tripping” (staying with the ship) scientists. However, when everyone leaves within a week the isolation suddenly becomes apparent – it is quiet, the mess seems virtually empty (especially when compared to the busy ship), and the only people around are those with whom you will spend the next year.
Most personnel take on other tasks around the station (which has to function as an entire community). These roles vary from statutory ones like postmaster and electoral/census officers (the station leader is typically a JP and has police powers – in the unlikely situation that they be needed), to store keeping and boat maintaining, to forming the primary fire teams. Also important are running the hydroponics and brewery! In my own case I am the search and rescue team leader (fortunately, to date, this has only involved SAR training and organising the equipment), one of the Coxswains (inflatable boat drivers), the station environmental officer and a helper in hydroponics. The doctor is also a quarantine officer, but this role is really only required on the rare occasions that a ship unexpectedly visits (there are tourist vessels during summer which require briefings, but this is usually simple).
The doctor is expected to be within 24 hours of the station (given reasonable weather) but fortunately, a fit person can travel the length of the island in a day (if really necessary), so travelling around the island is permitted (and required to check field medical supples and SAR equipment). There are five field huts around the island, providing basic, but comfortable accommodation. All have comprehensive first aid kits and two have additional medical and SAR supplies, sufficient to manage most foreseeable incidents. The terrain makes retrieval of a stretcher patient exceedingly difficult (except in the very rare cases when the sea is calm enough for boating), and therefore some incidents may have be managed in a hut for an extended time.
There is the opportunity to be involved in a variety of medical research projects – many looking at adaptation to working in such an extreme environment (both physiologically and psychologically), and changes in immune function. In addition there are established links with NASA, who see the stations as an accessible analogue for extended space missions.
For those who may be interested in this work, the selection process involves a detailed application form (a broad range of medical skills are required – typical ED or rural GP, plus some surgical training – you need to be able to preform a appendicectomy or similar unsupervised) and a medical assessment (must be fit and healthy, and cannot rely on any medication), followed by psychological screening, and then interviews. Doctors are typically employed for 15-18 months - some standard training and some specific to needs and experience, followed by 13 months or so south. There are also some shorter postings, usually on ships. One of the more unusual specifications is that doctors cannot take their appendix south (understandable due to the extreme isolation and lack of medical back up) – so appendicectomy is often required (a hint – be more organised than me - a few days before Christmas is not the ideal time for an elective operation). The Australian Antarctic Division website (http://www.aad.gov.au), provides a lot of general information, and the Polar Medicine Unit can be contacted directly on 03 6232 3302.
Published May 2006