"If you’re going to be a bear, be a grizzly": Life in the 'Top End' on the ACRRM GP training pathway

Dr Tarun Patel,
ACRRM GP Registrar, Katherine, Northern Territory

Australian GP training applications closing soon

For Dr Tarun Patel, Australia's 'Top End' is a long way from Auckland, New Zealand -where he spent much of his childhood at his parents' grocery store in the bustling suburb of Mt Eden.

Yet training as a GP in the Northern Territory has brought him much closer to realising his own inner strength.

It has driven him to try things out of his comfort zone - including recent GP training placements in remote Australia.

Last year, Tarun was working as a GP Registrar at Nhulunbuy in the NT's remote Arnhem Land. Now he is based at Katherine with the Wurli Wurlinjang Aboriginal Health Service.

He is undertaking GP training through the Australian College of Rural and Remote Medicine (ACRRM), which will lead to Fellowship of ACRRM (a 'FACRRM') - one of only two specialist General Practice qualifications in Australia.

Prior to going north, he undertook clinical training placements in metropolitan and coastal NSW, completing rotations in everything from Intensive Care to Psychiatry.

"I have really enjoyed my rural medical training" he says.

"There is a wonderful sense of community in the bush, and I have been given hands-on training opportunities I would not otherwise have had.

"You're not just a cog in a machine, you know all the hospital and practice staff, and people tend to look out for you a bit more.

"All in all, I've been a lot happier in my rural placements compared with my time training in the city hospitals."

Tarun chose to undertake GP training in the Northern Territory not only because it seemed to be "the most adventurous option", but also for the scope of training it could provide.

"I wanted to be a doctor who was multi-skilled and resourceful in challenging environments" he says.

"I felt it would be good to stretch myself and see whether I could cope in a place that was difficult."

While the first six months at Nhulunbuy were a steep learning curve, Tarun found he had more resilience than he'd expected.

"I had been anxious about working in such a different environment, and feared I would be working relatively unsupported - but I actually had a fantastic group of colleagues who were really competent doctors and inspiring mentors.

"You quickly learn what you should attempt yourself, and when to call for help - and the nice thing about training in a rural setting is that your colleagues are always generous with their time and support."

A critical situation at the local hospital one Saturday morning demonstrated to Tarun that he could rise to the challenges of remote medical work.

"A staff member - one of the ward nurses and a friend - suffered a spontaneous collapsed lung, and I was the only doctor working in the Emergency Department at the time. Going through the initial management of that was very challenging, but it ended up being a good educational experience for me."

He adds that his work this year in Katherine is "brilliant".

"Wurli Wurlinjang runs a very popular medical service - my colleagues and I might see 50 or more patients on a busy day.

"In the second half of my year in Katherine, I'll also be working part-time at the hospital. After that, I'm hoping to do additional training in Paediatrics and perhaps also Internal Medicine."

The three hour drive to Darwin and its international airport also meant that, over Easter, Tarun could get back to New Zealand to see his family.

Another recent patient presentation at Wurli Wurlinjang gave Tarun increased confidence in his ability.

"A mother came in with her daughter, who seemed unusually restless and couldn't sit still. As I sat there chatting to mum, it clicked with me as to what might be wrong.

"There's a condition called 'chorea' which I'd heard about at medical school but had never actually seen. It's a feature of rheumatic fever where the body attacks the heart and part of the brain.

"The only reason I picked up on it was because I'd seen this little girl before, without those symptoms. In any other situation I would probably have just thought she was full of beans! I was very glad we referred her to hospital, because rheumatic fever can have life-long complications."

In selecting the College to provide his GP training, Tarun fell back on an expression he'd once heard that seemed apt for his situation.

"I thought 'If you are going to be a bear, be a grizzly'. I knew I was going rural and remote, and I wanted to be able to practise Medicine more widely, including in developing countries - so I figured 'Why not do the most relevant training?'

"I got the sense that ACRRM was a bit more focused on acute and critical care, and that it would equip me with a broader set of skills.

"Its stipulation of doing hospital-time during training, as well as the advanced skills training in Emergency Medicine afforded by the ACRRM pathway, is appropriate and important, because those skills are applicable across all medical fields. You need to be familiar with the more critical stuff because it often comes to you first at a rural general practice or an Aboriginal Medical Service.

"The assessments conducted by ACRRM are also tailored to making medical decisions in resource-limited environments.

"Our oral assessment takes place in an imaginary town called Stampsville, which has a finite number of services that are only available at limited times - this reflects the workforce and resource challenges that often accompany rural and remote medical work."

Outside Medicine, Tarun's time in Nhulunbuy saw him making the most of a passing interest in theatre... albeit to his surprise.

"I acted in a local pantomime there - it was called Men in Tights and I really did it as a favour to a colleague. She came into my room one day, plonked a script on my desk and just looked at me, almost expectantly, without saying anything.

"I reluctantly agreed... but it ended up being great fun!

"The play was held at a shed in town. I was amazed when I walked in that it had a proper lighting set-up and even tiered seating! It was a proper theatre - but you'd have no idea that it was from the outside.

"I was only in the last scene so I would often just rock up after intermission. It was only five minutes away from where I lived so that was handy. Everything in Nhulunbuy is just five minutes away!"

In Katherine, Tarun is a regular attendee at the town's gym and pool, and he and other local health staff occasionally go for a Sunday morning run to the iconic Katherine Gorge.

"That's a nice thing about living and working here - you end up spending social time with more senior colleagues, specialists and those from other health disciplines" he says.

"It doesn't seem to happen so much in the city, but you all become really good friends in these smaller places."

The application period for Australian General Practice Training (2019 intake) closes on 30 April 2018. To find out more about undertaking GP training via the ACRRM training pathway visit acrrm.org.au/agpt.

Dr Tarun Patel is undertaking his ACRRM GP training as part of the Australian General Practice Training (AGPT) program.

His training is being delivered by Northern Territory General Practice Education, the NT's only Australian General Practice Training (AGPT) regional training organisation.

Becoming a GP in Australia

In Australia, junior doctors undertake a period of additional hospital-based intern training once they have graduated with a Medical degree from university. Thereafter, they can undertake further training to be able to specialise in a particular field of Medicine. To be accredited to work as a General Practitioner (GP) in Australia, doctors must first undertake a significant period of training as a GP Registrar.

This includes working in General Practice under the supervision of a GP Supervisor, while also undertaking formal training via one of two colleges - the Australian College of Rural and Remote Medicine (ACRRM) or Royal Australian College of General Practitioners (RACGP) - whose qualifications for General Practice are accredited by the Australian Medical Council. Training towards the qualification of Fellowship of ACRRM (FACRRM) also entails additional hospital-based training.