Throughout my time as a junior doctor, I thoroughly enjoyed engaging in the intellectual challenge and interpersonal skills required within the medical teams. I often looked to the consultants on medical rounds with awe and disbelief that someone could recall and apply that much knowledge. I would think I could never be like the medical registrars who were often doing 12 hour shifts, looking after junior members of the team, coordinating family meetings and carrying the emergency pager as well. Then, to even my surprise, I decided to complete my AST in adult internal medicine.
To say that the first few months were a challenge would be an understatement. Unlike most of the other medical registrars who had spent their last 12-24 months doing solely medical rotations I had spent the last 12 months doing anaesthetics, obstetrics and mental health. Let’s just say, my medical skills and knowledge were not quite at the level of my colleagues. But in true Rural Generalist style, I rose to the challenge and went on to not only survive but thrive as a medical registrar.
It was in fact during those last few months of my training that I truly started to find my feet within the busy world of internal medicine. Here is some advice I have for those currently completing their AST and how to get the most out of the precious time you have left in a tertiary hospital.
Check your AST requirement list and plan ahead
I will admit that I am not the best planner and did unfortunately leave some of my AST requirements to the last few weeks of my training. Though I did manage to get everything signed off, I would not recommend this tactic. As most registrars in all training spheres have requirements to be signed off, the last few weeks of the registrar term can be competitive with most registrars competing for the attention of their consultants to sign off required assessments. Most advanced skills require log books, mini-Clinical Evaluation Exercises (CEXs), supervisor reports and examinations. I would recommend downloading the list of training requirements from your college website now and ticking off anything you can prior to the Christmas period. Before you know it, Christmas will be upon you and this is when most of the senior staff disappear for holidays. This then only leaves a 4-week window after New Year to get your requirements done.
Challenge yourself within the protection of your tertiary centre
Now is the time to push yourself within your current tertiary location. I know from personal experience that I often wasn’t confident in my decision making and would enlist the help of a senior early, rather than trusting in my own knowledge and skills. In my last few months my seniors encouraged me to trust myself and empowered me to make my own management plans and see them through. Though the first few times it was terrifying, I knew challenging myself in this way would make me a better practitioner within my current community. Obviously, I don’t mean practising inappropriately in areas where you are uncomfortable or lack the skills. Challenge yourself in an environment where senior staff are still around to lend a hand. Have a go at the difficult intubation or assisted delivery knowing your consultant is still around to bail you out if you run into trouble. For those like me who are doing a non-procedural skill, formulate your own clinical impression, develop a management plan and either enact your plan or present your whole assessment to your consultant.
Beef up your knowledge
Obviously, our practise in a tertiary hospital is going to vary to that in a rural or remote location. Over the next few months, I challenge you to plan how you would manage cases if you were in a rural location. You will often be managing patients who have come from a rural location, so be curious, review their chart, think through how you may have managed their presentation if you were the Senior Medical Officer (SMO) at the referring hospital. This is both a great technique for self-learning but also you might pick up some tips from your fellow rural GPs in the process.
One of the things I found challenging was the lack of context my colleagues and occasional senior staff had regarding rural patients. This is a prime learning moment! Ask your consultants how management could be translated to a rural location, if and how a patient may have been safely managed without transfer and if transfer was required, what they would like to see performed prior. This will help you going into your exams and into rural practise next year. Plus, it will give your care an edge while impressing your colleagues in the referral hospitals.
Lock down your job
Most of you would have started the process of finding a position for next year. If you haven’t started or still are undecided, have a look at the Rural Generalist vocational employment vacancy list which is released in approximately July. It allows you to see what jobs are out there where you can utilise your new skills. You can also get a jump on what you’ll need to provide for credentialing by checking the HHS credentialing guide and gathering your evidence. However, if there is a community you may be interested in, contact them directly and express interest. Some communities don’t have vacancies at the time of the vacancy list being distributed or may not currently have a specific position for your AST but would consider making one if you expressed interest. Either way, no harm could come from letting them know you are interested. I personally utilised this method as I knew what rural locations I wanted to work in, so I contacted the decision-makers directly and secured my current position in Longreach.
If you have a partner or family, do your research into what the prospective community offers such as schools, employment opportunities, housing and hobbies. We know that people are more likely to remain in rural and remote communities if their family are happy. It’s worth asking questions and discussing potential opportunities for your family when in talks with your future employers.
Although my time as a medical registrar was intense, the skills I gained have made me a better doctor for my community. So, finish strong and spend those last few months soaking up all the knowledge and experience you can get your hands on, as those skills are what are going to help you be an excellent Rural Generalist.
Dr Tiffany Cover | Internal Medicine AST, Longreach