AUTUMN Newsletter – April 2012
For all Division enquiries and further information visit our website, email or phone: 04 550
2829
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From the Council Chair Dr Nina Stupples
The divRHM is set to become a chapter of RHM within the new College rules. This is unlikely to affect the day
– to day functioning of the division but will mean that our potential for representation on advisory boards within
the college is enhanced.
We are currently operating within budget and all funded places on the training programme have been filled.
The division has amended its rules to allow a registrar representative to be on both the board of studies and
the council. Mark Smith is now filling the role having taken over from Anu Shinnamon who was the pioneering
first registrar representative on the board of studies.
We have three other new representatives of the division i.e. Dr Steve Main from Rawene and Dr Abby Rayner
from Grey Hospital, who are both on the board of studies and the council, and Dr Vaughan Laurenson from
ANZCA who is on the board of studies.
It is important to keep new ideas and perspectives coming through the division and the help of these new
members are appreciated greatly. The divRHM council and Board of studies currently meet 3 times a year
face-to face and I would encourage you all to raise any issues you have regarding the direction of the division
and the training programme with council and BOS members so we can address difficulties as they arise.
Registrars in the 4th intake of the training programme have now commenced their training runs. This brings
our compliment of registrars up to 27 (some are part time/ on parental leave). We had hoped to have 40
registrars enrolled in the training programme by now but since we have never been funded for 10 registrars
per year and also not had 10 registrars applying for the training programme in any one year it seems we are
utilitising the capacity we have available to the best of our ability.
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We are likely to be able to award Fellowship to at least 2 registrars this year which will mark an important
milestone in the provision of healthcare in rural NZ as well as a milestone for the Division RHM. (Since Nina
wrote this letter, we have in fact awarded fellowship to the very first fellow of the training programme, Dr
Jeremy Webber. More about this later in the newsletter).
This year is the final year of the grand parenting process and one of our projects over the next year is to make
decisions about what will follow this. It is likely we will need an experiential pathway to fellowship for those
experienced practitioners who would not benefit hugely from joining the training programme.
With the proposed changes in GPEP we may well see more GP registrars working in Rural hospitals for their 6
month attachment in hospital based practice (or practice in a different scope), this can only be a good thing for
the division, a greater exposure of GP registrars to Rural Hospital work may encourage them to seek further
training with the division or to have the confidence to work in Rural general practice.
The Division also this year will continue to work on the development of a NZ version of
StAMPs.
Through the clinical leaders we are starting to see more rural and provincial hospitals apply for accreditation
as training posts thus providing more options for the incoming registrars. Anaesthetics jobs are still at a
premium but through some innovation and a few motivated DHB’s there are likely to be some dedicated jobs
out there for our RHM registrars. We have had indications from Taranaki, Northland and Westcoast /
Canterbury DHB’s that they are working on creating some vacancies in this speciality.
A closer relationship between Australian College of Rural and Remote Medicine (ACRRM) and divRHM
regarding mutual recognition of qualifications is also nearly finalised, still outstanding is the endorsement via
the Australian Medical Council which is now in progress. Theoretically this may mean we have some ACRRM
registrars seeking training in our Rural Hospitals. Likewise jobs in Australia that are accredited for ACRRM
training are able to be credited by our registrars and runs in their remote rural hospitals may be a good training
option for some of our registrars particularly those who already have some procedural skills eg anaesthetics/
retrieval in order to fulfil their requirements for rural hospital runs in a location where they can practice their
procedural skills.
A variety of political developments in the last few months are hoped to make advocacy for rural health issues
more powerful. The Rural Health Alliance and the formation of the Rural Hospitals group have emerged from
the Rural Health symposium and the Rural GP Network conference 2011. Peter Rodwell (a fellow of div RHM)
organised a rural hospital education day in conjunction with the rural GP network (it was held on Thursday 8 th
March 2012) and also has been instrumental in creating the rural hospital group. Their aim is to be an
advocacy group for issues involving rural hospitals and although we as a division are not directly represented
on the group they are keeping us in the loop regarding their activities by sending through minutes of their
meetings etc. If there are council or BOS members that would like to represent the division in this group I am
sure Peter would appreciate our direct input.
Last year at one of the face to face meetings we decided that we need to try and stick to our core business of
delivering training and setting the standards of care in rural Hospitals and that political activity would be best
conducted by groups such as the RGPN and the Rural Hospital group. However there may well be issues that
we need to be directly involved in and thus if we have members eg James Reid in the RGPN it makes it easier
for us to communicate our position.
Recently Jenny Dawson and I met with Health Workforce NZ (HWNZ), Medical Council of New Zealand
(MCNZ) and RNZCGP/ACEM/AMPA in Wellington for a discussion on commonalities in our training
programmes. The idea is to look at how these could be adapted in the future to recognize the shared
competencies of the Generalist working either in the community or in hospitals. The divRHM training
programme already is very flexible in recognizing prior learning and in accepting other training programmes as
equivalent to certain requirements of the training curriculum so we are in a good position to enter these
discussions without looking at any radical changes to our programme. Its not certain where the end point of
these discussions will go but was useful to bring all parties together and may in fact benefit our programme in
highlighting difficulties for our registrars in regards to funding and training placements with relevant bodies esp
HWNZ. There have also been indications that the current model of funding for our programme is likely to
change in the near future - what to and when remains to be seen.
It may also be timely this year to start discussions with the MCNZ regarding the Rural Hospital List. For
training purposes if a provincial hospital is not designated a Rural hospital but a certain job within it eg ED
work seems to be within the scope of Rural Hospital Medicine we are able to accredit that run appropriately.
The clinicians in that hospital must still have a collegial relationship if they are Fellows of DivRHM. The ED job
in Grey base Hospital is an example of this. If we were to recommend that hospitals such as Grey Base,
Blenheim and Whakatane are in fact more like level 3 rural hospitals those clinicians who are Fellows of
DivRHM would no longer need a collegial relationship to practice in that hospital within their scope eg working
in ED in Greymouth.
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If we are to go down this line we need to be fairly careful to apply some consistent criteria to the process and
until now this has been a bit hard as there is a spectrum of rurality and drawing a line in the sand will always
be somewhat arbitrary. Any suggestions as to how we could proceed fairly and openly would be much
appreciated. There are potential implications for the other staff at such hospitals eg if a hospital is designated
‘rural’ is there then less obligation on the part of the DHB to find appropriate specialist staff and will the
specialist positions become even harder to fill? Should this be a concern of ours in the divRHM or should we
look at it purely from the point of view of scopes of practice within the hospital and training runs for our
registrars?
I am interested to hear your thoughts on this matter.
Nina Stupples, Chair of Council. (
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Congratulations to our new Fellow of the Division of Rural
Hospital Medicine via the Experiential Pathway
Since last newsletter, we have awarded Fellowship of the Division of Rural Hospital Medicine (FDRHMNZ) to:
Dr Marc Gutenstein – Queenstown
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Rural GP Network Conference in Queenstown
8 – 11 March 2012.
This years Rural GP Network Conference included several special events for us:
Registrar / Education facilitator workshop
Again this year, we ran a DRHM workshop for registrars and education facilitators involved in the RHM training
programme. There was really good attendance from both registrars and education facilitators. Programme and
all power points from the day can be accessed on the DRHM page on OWL.
(if you do not yet have access to OWL (online web learning) – please contact Helene.Keating@rnzcgp.org.nz)
Sponsorship from Emergency Care Co-ordination Teams
The division of Rural Hospital Medicine had received a generous grant from ECCT to help sponsor speakers
and resource people for the registrar day.
We were pleased to be able to support the Rural Airway Management Course with $3000.
The remaining funds will be kept for speakers in 2013.
On behalf of the entire DRHM – we sincerely thank ECCT for this support.
Behind the scenes – Roadside to Bedside
Trauma? Medical and surgical emergency? Complicated Birth?
www.ecctcanterburywestcoast.org.nz
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The Emergency Ambulance Communication Centre (111) is contacted about a major car accident in a remote
area. The centre dispatches Police, Fire, Ambulance, or Helicopter. A St John Ambulance Paramedic,
Primary Response in Medical Emergency (PRIME) Nurse, Doctor, Policeman, and Fireman attend the scene.
The trauma patient is transported by Ambulance or Helicopter to either a Hospital or a General Practitioners
practice. The patient is attended to by the Trauma team in the Emergency Department.
Imagine the logistics with personnel, environment, equipment, systems and facilities! Does the emergency
ambulance communication centre send a Helicopter or an Ambulance? Who’s on the scene first? What
Hospital does the patient need to go to? Does the road need to be closed? Who makes the decisions?
When you are dealing with a life or death situation it’s important that all key-players work together.
The Emergency Care Co-ordination Team (ECCT) is a clinical network group that works across all pre-hospital
and in-hospital emergency services to help resolve these challenges. ECCT aims to ensure the patient
receives the right care, at the right time, in the right place and from the right person. The focus is to share
knowledge and build relationships to provide a coordinated response for the patient. An example is
addressing issues relating to inter-hospital transfer of patients by air ambulance. The team works together to
provide a patient-focused, seamless service which will enable all New Zealanders to gain timely and
appropriate access to emergency services required to manage:

trauma

medical and surgical emergencies

complicated births
Canterbury West Coast ECCT committee was re-established in 2010 and meets four times a year. The
committee includes representatives from Ministry of Health (MoH), ACC, Canterbury DHB, West Coast DHB,
South Canterbury DHB, Nelson Marlborough DHB, National Ambulance Sector Office (NASO), Emergency
Ambulance Communications Centres, St John Ambulance, Primary Response in Medical Emergency (PRIME)
Nurses, General Practitioners, Garden City Helicopters, Maori Health, Maternity Health Providers, Public
Health Providers and Primary Health Organisations. The committee aims to help emergency services deliver
the best possible care to patients, seeking to provide solutions to problems that have been identified.
For more information contact the Canterbury / West Coast ECCT Regional Coordinator, Gillian Thomson by
email: Gillian.Thomson@cdhb.govt.nz or cell phone 027 689 0277
Delivering the right care in the right place at the right time, delivered by the right person
Annual DRHM AGM
The annual AGM followed the workshop. Minutes can be viewed here.
Congratulations Fellowship award to Dr Jeremy Webber
At the Rural Network Conference we all celebrated with Jeremy when he – as the very first registrar –
achieved fellowship of the Division of Rural Hospital Medicine via the registrar training programme.
Jeremy’s fellowship certificate was presented to him during the key note session at the Conference, by
Associate Minister of Health Jo Goodhew along with Drs Garry Nixon, James Reid and Jenny Dawson:
“The Rural Hospital Medicine Training Pathway provides vocational education for rural hospital doctors which
prepares them for a role in the community where they are able to improve the health of New Zealanders
through high-quality rural hospital care.
During the training rural doctors acquire a core body of generalist knowledge and the specific skills and
attitudes needed to practice competently in a rural environment and in a rural hospital.
Jeremy Webber is the first doctor to graduate from the programme.
Five other doctors were also part of the first intake with Jeremy, but as a significant part of his previous work
experience was recognised by the Division of Rural Hospital Medicine he only needed to complete two years
of the programme.
Jeremy was born in Fielding, and raised in Whangarei.
He graduated from medical school in 2003 and has worked in Australia and New Zealand, much of the time in
rural settings. In his ‘spare’ time he is an international level triathlete.
We asked Jeremy about his involvement with the programme and this is what he told us:
Why he entered the rural hospital medicine pathway:
To me rural medicine epitomises 'real clinical medicine' and the components of the training programme are
sufficiently broad and thorough for a graduate to feel comfortable with a diagnostic process for any medical
challenge in any environment
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Highlights of the training programme:
The opportunity to meet and share experience with like minded professionals
What he plans to do next and why having a program like this is important:
I intend to become increasingly involved in the development of the training programme and its registrars and
increase the awareness of our training across New Zealand and Australia.
Having recognition from the NZ Medical Council as doctors with a unique skill set and responsibility enables us
to further develop New Zealand rural hospitals as sound clinical environments for delivering high quality
healthcare to our local communities and to anticipate the growing demand on health services.
Picture from Jeremy’s Fellowship assessment visit. From left: Dr Kati Blattner, Dr Harpal Singh-Sandhu, Dr
Jeremy Webber, Rhett Emery, Dr Jenny Dawson
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DRHM Registrar Training Programme 2013
We are now accepting applications for the Registrar Training Programme which commences December 2012.
Application deadline is Saturday 30th June 2012.
Application information and forms can be found on the College website
http://www.rnzcgp.org.nz/training-and-recertification/
Please feel free to contact us for further information:
Administrator Helene: helene.keating@rnzcgp.org.nz
Clinical Leader Pragati Gautama: pragspall@world-net.co.nz
Clinical Leader Patrick McHugh: mchugh@tdh.org.nz
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DRHMNZ / Cook Islands Initiative 2012 - UPDATE:
Main objective: to set up a rural hospital medicine training post at Rarotonga Hospital, Cook Islands
Set up phase: from mid March and throughout the year we have Fellows or ‘nearly fellows’ (on experiential
pathway ) RHMNZ successively spending 4-6 weeks in the Cooks the idea being to build the program (as
well as the relationship) up for the trainees over the next year or two.
We have had a wonderful response from RHM doctors. As there were still two gaps to fill this year, after
discussion with the Cooks we asked for interest from RNZCGP fellows and GPEP2 registrars via epluse and
now have 2 GPEP2 registrars to join for 2012. (Their focus will be more on community and outer island clinic
work but again with the same overall aim of building the program and the relationship.)
This work is not salaried so these doctors are going on a voluntary basis taking either annual or sabbatical
leave. The Cooks have agreed to provide funding for: return flights, accommodation, and car rental whilst in
the Cooks and a daily allowance for 2012.
Kati Blattner has started this phase off and is currently working in the Cooks from March for 4 weeks. The plan
would be to start gathering information in the form of a log book or a brief report to pass on to all those who
are following: if everyone does this then we would have a great resource by the end of the year.
Kati Blattner.
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University of Otago Diploma of Rural and Provincial Hospital
Medicine
Reflections from participants of the recent residentials held in Hokianga for papers
724 and 725. Attended by a group of doctors with common rural focus.
By Jenny Maybin , GP and grandparenting RHD , Central Otago
No idea what to expect, rumours you have to sing a song.
What does one wear? Where do we sleep? Are there showers? I am not singing a song. Who else will be
there? 3 days 3 nights that's quite a few hours. I am not singing a song.
Treaty of Waitangi and Maori health views we try to comprehend.
Communication, palliative care, death and dying, what happens in the end?
The acutely distressed patient and disparities in health, what can we possibly do?
Self care - who’s looking after who?
I am still not singing a song.
So what did we learn: rural medicine? – you’re wrong, something much more important, much more valuable in the form of a song?
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By Rachel Lynskey, Registrar on the RHM Training Programme
Spending three days on a marae with eleven strangers is not your average university paper residential, but it
turns out this is the perfect environment to learn about communication.
By the time we departed we knew much more about ourselves and intimate details of others culture, lives and
where to sleep to avoid the snorers.
The locals spoilt us with fantastic food and taught us valuable lessons from their varied experiences of life,
death and the health system.
Thank you to the participants and organisers for making the residential into an experiential lesson.
By Nigel Cane , Rural GP , Kerikeri
As an experienced ( i.e. grey haired ) rural GP from Northland I approached the residentials for both the
Context and Communication papers for the Diploma with a mixture of emotions , relief that I didn't have to
travel to Dunedin and instead could travel an hour westward to a very beautiful and somewhat mystical part of
New Zealand, excitement to have a week off work and examine my navel and spend some time with younger
enthusiastic students and wise locals and some trepidation with respect to the formal powhiri processes both
at Rawene and Te Kai Whara at Waiwhatawhata in the Hokianga ( its all about the public waiata thing )
The relief and excitement were justified, as the Hokianga really is a very special part of New Zealand and a
great place to be in late summer and also an appropriate place to talk about rural health issues and how we,
as doctors, fit in to the mix, how we keep ourselves well, healthy, safe and how we can be more effective in
our clinical interactions with patients. The navel gazing is important sometimes and the challenges offered by
the visiting Health and Disabilities Commissioner and various Specialists and Generalists, were interesting in
that they mirrored the challenges offered by local Kaumatua and the solutions both to personal and
professional issues were remarkably similar.. stop,listen, think, revisit, be kind, courteous, loyal and say sorry,
and that the concept of whanaungatanga is a useful tool equally as useful in Oamaru or in Kaitaia, in the end it
reinforced that we as Generalists do have a role and that our services are valued, the now traditional debate at
the end of the context residential ended with an overwhelming win for the affirming team "That this house
believes that you get better treatment if you are sick or injured in a rural hospital " , although a vote on an
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appropriate T shirt slogan for the next residential was not " Rural Docs do it better " but that " Rural Docs do it
the next day " !
The trepidation was not actually justified, the formalities of the process were explained by Marara Rogers from
Hokianga Health , and she proved to be an excellent Waiata coach , the Marae at Waiwhatawhata is a
fantastic place to spend a few days,and the powhiri process is an actual transformational one from manuhiri to
tangatawhenua, communal living does however have its challenges, some of the snoring was louder than the
extreme winds the carved Whare Nui is exceptional, and the kai legendary, probably the most important part of
the few days for me was the time, hospitality, kindness and patience offered by the kaumatua, the cooks and
kuia, these people feel that our presence and our learning is so important to them and their families that the
give up several days of their busy lives to us to offer their experiences and wisdom, yes some of the process is
uncomfortable and personal and even awkward , but as was pointed out to us it is useful for us to experience
the awkwardness, how uncomfortable do we think it is for some of our patients to visit a large tertiary hospital
and spend days with strangers dressed in nothing but their pyjamas !
All in all a satisfying few days and one that I would recommend to Registrars or Grand parenting Docs, and I
hope the tradition will continue for the next residential, it's all about the kai...
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FROM THE MOPS/CME DESK
International conferences
In the 2011 – 2013 MOPS triennium there is no automatic credit for non-endorsed CME activities. This
includes attendance at non-endorsed international conferences.
To gain credit from non-endorsed CME, including international conferences, it is necessary to apply your new
knowledge or skills. If as a result of attending a conference you instigated some form of practice improvement,
credit can be claimed under the CME section 'Practice Improvement Activities'. Alternately, if the content of
the conference is specifically related to a goal listed in your professional development plan, conference
attendance can be claimed as ‘CME reflected in PDPlan’. [Note that this does not include any events
organised by pharmaceutical companies]. Details of the event and the purpose of your attendance can be
recorded in the 'Notes' section of your MOPS online, or using the Learning Reflection Form available on the
website under MOPS Information and Resources.
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CME / Conferences, Courses & Seminars
Rural Hospital Medicine CME Workshop held at Rarotonga Hospital, Cooks Island
(Click for Brochure)
Thursday 12 – Saturday 14 July 2012
For graduates of the DipPRHM, Fellows of RHM or those on the experiential pathway to Fellowship or any
doctor with an interest in rural hospital medicine.
Approximate cost $1,900 to cover tuition lunches and dinners.
Updated topics from the Diploma of Rural & Provincial & Hospital Practice
with a focus on rural hospital medicine.
This will run parallel with the local Cook Islands Health Conference
so there is the great opportunity to also attend sessions at this conference.
Limited to first 25 participants.
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Please indicate expressions of interest ASAP to:
Raelene Abernethy
Rural Postgraduate Administrator
Department of General Practice and Rural Health
University of Otago
PO Box 913
Dunedin
Email: raelene.abernethy@otago.ac.nz
Ph 021 263 2635
Confirmation will depend on sufficient numbers.
Travel and accommodation are not included in the fee.
You will need to organize your own accommodation.
CME points 1 per hour (ie. 18 hours)
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POLAR MEDICINE COURSE JULY 2012: PISA RANGE near WANAKA
The Polar Medicine course has been developed for medical professionals, expedition and wilderness medics
working in cold and/or high altitude environments. The winter days will be used to experience and develop
winter survival skills, emergency shelters, navigation, fire & stove lighting, digging snow holes and avalanche
awareness, as well as mastering the different techniques required for travel in a polar environment: dogsledding, skiing, snowmobiling and snow shoeing. The evening sessions will cover the academic side,
illustrated with real case examples, to complement the days activities. Participants will gain a thorough
understanding of the depth and breadth of capabilities needed to be an effective polar medic.
If you have ever considered working in a polar or high altitiude environment, a ski patrol or simply having the
experience of a lifetime, then this is the course for you!
CME accreditated by the Wilderness Medical Society.
Full details at www.polar-medicine.com
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Advanced Paediatric Life Support – Courses 2012
- Christchurch - 15-17 March (Course already fully subscribed - waiting list possible)
- Dunedin 29-31 March
- Auckland - 8-10 May (Course already fully subscribed - waiting list possible)
- Wellington - 24-26 May
- Wellington - 23-25 August
- Waikato (Hamilton) - 24-26 October
There will be two courses in Auckland in November, but Jo has yet to confirm the availability of the venue.
To sign up for a course please contact:
Jo Jones
NZ Executive Officer
APLS NZ
Phone: 07 312 9574
E-mail: jo@apls.org.nz
Web: http://www.apls.org.nz/
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Advanced Life Support in Obstetrics (ALSO)
ALSO has been running in NZ over 10 years and is based on the international ALSO teaching. It covers
emergency care aspects of obstetrics from first trimester to medical and birth emergencies to neonatal
resuscitation. The course is available twice per year. It has been endorsed by the RNZCGP for 16 hours of
CME/MOPS for GP.
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For more information please contact Nicky van der Hulst on
www.also.co.nz
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Academic Papers
Postgraduate Certificate/Diploma in Rural and Provincial Hospital Practice
(PGCert/DipRPHP)
The following papers will be offered in 2012. The structure of the diploma changed in 2010. If you completed
papers in 2009 or earlier you should talk to the course administrator about exclusions.
GENX 724 Context in Rural Hospital Medicine 15 points Semester One
Examines the context of clinical care in rural hospitals in relation to the person and profession of the doctor,
the hospital and the community.
Restriction: GENX 723
Residential workshop: Mon 27 - Wed 29 February 2012, Hokianga
GENX 725 Communication in Rural Hospital Medicine 15 points Semester One
Clinical skills, knowledge and values required in the rural hospital setting for psychiatry, palliative care and
communication with patients in New Zealand's bicultural and multicultural society.
Restriction: GENX 723
Residential workshop: Thur 1 - Sat 3 March 2012, Hokianga
GENX 726 Obstetrics & Paediatrics in Rural Hospital Medicine 15 points Semester Two
The management of paediatrics, neonatal care, and obstetrics and gynaecological emergencies in a rural
hospital setting.
Restriction: GENX 721 and 722
Residential Workshop: Mon 23 - Fri 27 July, Wellington
GENX 727 Surgical Specialties in Rural Hospitals 15 points Semester Two
The management of common surgical problems appropriate to be managed in a rural hospital setting.
Restriction: GENX 722
Residential Workshop: Mon 19 - Fri 23 November, Dunedin
Postgraduate Certificate in Clinician-Performed Ultrasound (PGCertCPU)
Designed for rural doctors who wish to pick up ultrasound and ECHO skills.
GENX 717 Generalist Medical Echocardiography 30 points (full year)
This paper is co-requisitely studied with GENX 718 Generalist Medical Ultrasound for generalist medical
practitioners who wish to gain basic skills in procedural and diagnostic echocardiography and ultrasound.
Taught from Dunedin. Limited to nine participants in each stream.
GENX 718 Generalist Medical Ultrasound 30 points (full year)
This paper is co-requisitely studied with GENX 717 Generalist Medical Echocardiography for generalist
medical practitioners who wish to gain basic skills in procedural and diagnostic
ultrasound and echocardiography. Taught from Dunedin. Limited to nine participants in each stream.
Both residential workshops for GENX 717/718 of 3 x 3 days are taught together. Dates to be confirmed.
For more information on PGCert/DipRPHP or PGCertCPU please contact:
Raelene Abernethy
Rural Postgraduate Administrator
Otago University (Wed, Thurs and Fridays)
Department of General Practice and Rural Health
PO Box 913
Dunedin
Phone: 03 479 9186 or Mobile: 021 263 2635
Email: raelene.abernethy@otago.ac.nz
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General
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FELLOWSHIP/MO position available at Clutha Health First, Balclutha:
Position available in our rural community hospital from May onwards.
Happy to support doctor interested in Rural Fellowship Pathway. Friendly staff plus ex roster.
Email ray.anton@chf.co.nz for further details.
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