Gippsland Regional Clinical School has hosted the first of a five-day series of workshops as part of an interprofessional program on managing delirious patients.

The workshops include medical students and nursing students and are designed to teach people from different health professions to work together to improve the care of patients.

In this case, the workshops focus on patients with delirium, using case studies and opportunities to practice on a patient actor who is simulating a delirious episode. Managing patients when they are in a state of delirium – which can often include agitated, confused and even aggressive behaviour – can be very difficult.

In years gone by such patients may have been strapped down or sedated but these often caused further issues.

The new program promotes methods such as helping patients to orient themselves by explaining where they are, offering them a phone or a clock, and attempting to de-escalate the agitation. It’s an area of health care in which professionals working together as a team have much better outcomes for the patient.

In the GRCS program, workshops run for about three hours, half in tutorial and half in simulation.

It is the first time GRCS has been involved in the workshops, which also run at Berwick and in Melbourne. The program is based on the PhD studies of Lecturer Debra Kielgaldie and developed by the Head of the School of Nursing and Midwifery Professor Wendy Cross and Director of Geriatric Medicine at Eastern Health Professor Peteris Darzins.

Bernadette Hayes is pictured with local students, playing a very convincing role as a confused and demanding elderly patient with delirium.

Students at the Gippsland Medical School had an opportunity to hear an address by Dr Tim Ross, the AMA Victoria Board Representative.

The Medical School hosted the AMA’s visit recently while the AMA provided lunch for the attendees, something always appreciated by the students.

Dr Ross has worked in general practice for 15 years including outer-urban, urban, rural, and international settings. His clinical work has been supplemented by work at University of Melbourne, AMA and RACGP representation and teaching as a GP supervisor.

Dr Ross has a keen interest in the emerging trends of work-life balance which tied in nicely with the recent Year A theme, seminars on Health Enhancement.

Dr Tim Ross addresses the audience at Gippsland Medical School.

Former student and soon-to-be sessional staff member at Warragul, Cara Malzinskas, has settled back in the area and was married recently.

Now Dr Baillie, Cara completed Year 3 with the Gippsland Regional Clinical School in 2006 and came back to West Gippsland Healthcare last year to undertake a paediatric rotation.

It has been a busy year already for Cara, who is currently based at Royal Children’s Hospital.

As well as marrying Chris Baillie, she is studying for her Paediatric clinical exam after passing the written in February this year.

The year is about to get busier still, with Cara to join the Clinical School in Warragul as a sessional staff member in Semester 2.

Cara and Chris have settled in Lang Lang, a small town between West Gippsland and Westernport Bay.

Cara and Chris Baillie on their wedding day.

The opportunities that come about through spending time at one of the School of Rural Health clinical schools are as diverse as they are interesting.  Just ask Dr Joe O’Brien, a former Year 4C and Year 5D student who has returned to Bendigo after a 12 month research stint at Oxford University in the UK.

He is back in Bendigo working as an intern at Bendigo Health.  The following is Joe’s story.

In the middle of my fourth year of medical school in 2010, I made an eleventh hour decision to do a BMedSc but narrowly missed out on securing a research position at one of the overseas institutions I had been corresponding with.

With the permission of the university to do a BMedSc post-5th year, and a very understanding Monash supervisor on board – the affable and ever so efficient Associate Professor Pamela Snow – I now had a whole year to nail down a project anywhere I like, in any field of my choosing. This is how I ended up completing a lab-based project at the University of Oxford’s Centre for Diabetes, Endocrine and Metabolism.

Under the supervision of Professor Fredrik Karpe, an expert in the field of lipid and diabetes metabolism, I spent roughly nine months investigating the role of novel nucleic acids known as micro-RNA in the metabolic inflammation of obesity.

Roughly put, the risk of thromboembolic events in the obese is mostly driven by the rupture of atherosclerotic (fatty) plaques in the arteries. Inflammation is a big factor in what makes parts of these plaques flick off, and bigger-than-normal fat cells put out a lot of inflammatory chemicals into the bloodstream.

My project was essentially trying to make it ‘safer’ to be fat by playing about with these microRNAs, turning off the inflammatory part of their cellular pathways.

After several months of labwork, I completed my thesis. Unfortunately the result was negative, but the concept of manipulating inflammatory cellular signals with microRNA is still in its infancy and remains a promising field for future work.

My 12 months in the UK were amazing, and I was exposed to a world class centre of research. I would never have been able to complete my project without the help of the team at OCDEM and Bendigo’s own Pam Snow. I would encourage any students contemplating a BMedSc year to ensure they have a supervisor as helpful as Pam, because you never know what challenges the year will throw in your direction.

I have followed up a successful 2012 by officially starting my medical career here at Bendigo Base Hospital. The time I spent in Bendigo as a student has been invaluable towards ensuring a smooth transition from student to doctor.

This year I have the opportunity to rotate through Surgery, Medicine, Emergency and Cardiology. I look forward to completing the rest of my time here and am always happy to answer any questions students may have about career opportunities in rural medicine.

By Dr Joe O’Brien

Two Gippslanders have featured in the Faculty of Medicine, Nursing and Health Sciences Prize list for 2012, which were presented in May.

Dr Denise Bullen, who studied at the Gippsland Regional Clinical School, won the South East Palliative Care Dr Ruth Redpath prize for years 1A to 5D, awarded to a student enrolled in the Central or Gippsland programs of the Monash MBBS who writes the best essay about an aspect of palliative care.

One of the two Year 3B Faculty Prizes was awarded to Lukas Sahhar, who is studying in the metro area but is originally from Warragul where his father Dr Cleo Sahhar runs a medical clinic.

There are some 50 prizes open each year to Monash MBBS students. The prizes reward students who excel in particular units, across their year level or in prize-specific exams or essays.

The award ceremony was held The Edge at Federation Square in Melbourne.

Year 2 students on placements in Mildura had the opportunity to see first-hand rare examples of Aboriginal history when they toured the Mungo National Park during May.

Mildura-based MUDRIH lecturer Rose Gilby together with Desley Reid-Orr took 14 students Mungo, to join in a discovery tour. The guide was Ricky, a softly-spoken Indigenous Parks Ranger with so much knowledge it was hard to take it all in.

Ricky first showed the group the initial work on the new ‘Footprint Exhibit’, which is a very accurate transposition of a collection of footprints found in a geological layer within the national park and only recently exposed by wind action.

The footprints are thousands of years old, and allow interpreters to tell a story of a one-legged man chasing a kangaroo; a group of women gathering food; and child who wandered away from the family group who was subsequently shooed back into the group by an adult.

The group was privileged to walk into the lunette – which is not publicly accessible – where Ricky led them through the stark lunar-like landscape, showing recently wind-exposed fireplace thousands of years old. The remnants of the fireplace show that it was used to cook fish and yams.

A tiny ear bone from a fish was sufficient proof of this claim and it also proved that hawk eyes are needed for this job!

Another fireplace showed evidence of being used by women and children, a conclusion drawn from the fact that it had been used to cook emu eggs. Ricky described the technique for cooking your emu egg evenly – standing it up in the sand in the edge of the fire and spinning it until it is done. Further along was the remains of a kangaroo intermingled with a raccoon which was a little bit of a mystery as these animals would not have co-existed amicably.

The group was honoured with much more detailed information than would normally occur.  All were most appreciative of this fact and respected both the environment and the value of the experience and information imparted.

Mungo is famous for its eerie pinnacle formations, held within the eroding lunette. It was necessary to walk carefully throughout the landscape, but when the group arrived at the top of the dunes, the students were set free to frolic in the sand.

They also had a unique opportunity to view the cataloguing of artefacts on site by indigenous archaeologists and parks personnel. Many of the artefacts are tens of thousands of years old.  The students’ hushed and respectful tones were testament to the value that each one placed on this experience.

Rose and Desley provided a barbecue lunch of hamburgers with students constructing their own with rolls, salad and sauces supplied.  Back on the bus it was amazing to note just how many of the students fell almost immediately asleep for the return journey!

Students admire the sand dunes at Mungo, albeit hundreds of kilometres from the coast.

The intricacies of wool growing and sheep meat production – and even a lesson in sheep tossing – proved an eye opener for Year 2 students in Mildura.

Local veterinarian Dr Bill Sutherland facilitated a fascinating visit to a working farm which combines traditional sheep wool and meat flocks, together with a more modern and lucrative genetics industry involving the production and sale of frozen embryos.

Farm owner Brendan talked for a while about his business outlets. He has recently sold off the bulk of his Merino flock and is now concentrating on Dorper meat-producing sheep.

Bill impressed on the students the inevitability for station owners to put health problems on hold because they need to work to continue to earn and support their family.  Brendan described a close neighbour who has serious mental health problems and depression because he finds it difficult to cope with drought, poor production etc.  Hopefully the students took in the messages here.

It was fascinating to hear Brendan describe his farm as being in “the suburbs” only about two hours of a town and shops!

Next it was off to the shearing shed to discover how Dorper rams are thrown onto their backs for veterinary inspection.  These beasts weigh 100kg and although they are docile and compliant once on their backs, they are not so keen to be grabbed and thrown in the first instance.

There were also three merino ewes in the shed for a shearing experience. One poor old girl bore the brunt of the students’ fumbling attempts and came away looking quite motley and moth-eaten!

Brendan’s wife Maureen put on her usual excellent spread for ‘smoko’ and Gerald was so impressed he took several photos.

The trip home was drama-packed.  The very new work car developed a problem, resulting in an unbearably loud, constant metallic squealing noise.  We drove back to Glen-Esk where Bill and Brendan between them agreed that the problem was most likely one involving brake callipers – not potentially disastrous – so Bill bravely drove the Mondeo back to Mildura where he was greeted by Fiona, Ros, and Kate.

The following day a mechanic removed a large limestone pebble from the brakes – worn glassily smooth on one face.

In the shearing shed, where one poor old ewe submitted to the shearing ‘skills’ of the students.

Sale and Bairnsdale hosted students on their Year 2 rural placements recently and a myriad of activities were well received by all students.

Bush Tucker Day at the Bairnsdale campus proved to be a real highlight, held to promote Aboriginal culture and heritage. Students were treated to a display of traditional items including a decorated gathering dish and other handmade utility items and were also involved in hands-on activities including making echidna-quill necklaces.

The day was led by Cassie Harrap, a local Aboriginal woman soon to become an elder in the area.

Following the activities at Lakes Entrance, students were treated to a Lake Tyers foreshore walk where Cassie enlightened them about edible plants, such as Warrigal Greens and pig face. Warrigal Greens is a leafy ground cover which can be used as a substitute for spinach and any recipe, in particular a quiche. More information on Warrigal Greens can be found at the following link: http://www.thebackyardfarmer.com.au/byf7/green.html

Cassie’s passion for her heritage, the lore and the art of her people, has been passed on from her father and she now works closely with secondary schools and other businesses to pass on her knowledge.

A highlight for Deborah Hewetson, the Year 2 coordinator, was an invitation extended to staff and Year 4C students by the Year 2 cohort, to a last night barbecue held at Paynesville on the lovely Gippsland Lakes.

Sessions in the skills lab were also held for the students, under the instruction and supervision of Deborah and Laurea Atkinson, the SLE project officer at Bairnsdale campus.  The students were able to experience the simulation equipment, the majority for the first time, and had half day sessions with ALS, SimMan, and SimMom, a particular highlight being the delivery of a baby.

Feedback from the students was excellent, albeit with humorous undertones!

In Sale, Year 2 students Sale spent an early and rather foggy morning visiting a dairy farm at Denison, half an hour’s drive from the Clinical School.

Dairy farmer Matt Coleman had already been up for some hours milking his herd of 250 cows, keeping just a few back ready for the arrival of the students at 7am.  Matt and tutor Jason McAinch, also a dairy farmer in the district, took students through the procedure associated with milking, cleaning the lines and storage of milk.

Matt emphasised that the dairy farm is a ‘food production facility’ and so requires exemplary hygiene standards. Students were given the opportunity to sample “real milk” and there was some promotion of milk by Jason as a healthy diary product versus soy drink. As Jason said “soy is not a milk…it is made from a bean!”

Students were shown the array of equipment used on a daily basis by farmers including tractors, hay forks and 4-wheelers. Jason emphasised the risks involved in the use of such machinery, issues of complacency which can lead to accidents and the need, as potentially rural doctors, to be aware of the risks often taken on farms.

Students were intrigued by the echidna quill necklaces, demonstrated by Cassie Harrap

A ‘Thanks a Million’ afternoon tea party was held for volunteers at Latrobe Community Health Service (LCHS) in mid-May during Volunteers’ Week.

According to Jane Taylor, the MUDRIH lecturer who supervises a student-centred clinic at LCHS, the volunteers are “our secret weapon in providing a powerful role in student learning.”

“The volunteers are first trained as simulated clients, and they are on call to be interviewed by Interprofessional pairs of students. We were delighted to honour two of our faithful volunteer simulated clients, who have attended regularly since the student clinic started in 2010, amongst the finalists in the ‘Volunteer of the Year’. Some of our volunteers who are our simulated clients attended for the party along with many other LCHS volunteers.”

The ‘Thanks a Million’ volunteer afternoon tea had a 1960’s Rock and Roll theme.

Kerry Bell, administrative officer at MUDRIH for the GRIPS project and who also works at LCHS, collaborated with the LCHS volunteer coordinator Joanne Creighton to create a sixties ambiance. Kerry provided some of the music and posters and also led a troupe of enthusiastic and nimble footed rock ‘n roll dancers.

“Our MoU with LCHS is often serious, but sharing in a celebratory event such as the afternoon tea is just as important as the more academic side of our collaborations within the community health service,” Jane added.

Kerry Bell enjoyed the ‘Thanks a Million’ volunteer afternoon tea, especially the opportunity to break out the dancing shoes with Greg Cake.

The East Gippsland Regional Clinical School’s Cultural Safety plan is now complete with an acrylic plaque having been mounted on the wall adjacent to the reception desk of the Sale campus.

Designed in consultation with the Koori Liaison Officer at the Central Gippsland Health Service, Sandra Neilson, the plaque acknowledges the five Koori groups of the Gippsland area and acknowledges that the East Gippsland Regional Clinical School is situated on the traditional land of the Gurnai Kurnai people.

It is hoped that an official unveiling will take place as part of local NAIDOC week celebrations in July.

The plaque, recognising Gippsland’s five Koori groups, at East Gippsland Regional Clinical School’s Sale Campus.