Tell us about your journey into rural generalism and why you chose ACRRM. 

My early childhood was spent growing up in the country which I always yearned to return to. My journey to rural medicine began through elective and compulsory rotations through medical school. I had my first taste through a placement in Gunnedah, NSW, which had me wondering about a future in rural medicine. However, it wasn’t until a 10-week secondment during my residency that my interest was solidified into a future career as a Rural Generalist.  

I was in the process of applying to AGPT at the time of my rural placement and knew that as someone who was not yet connected with the Rural Generalist pathway that I would need as much help as I could get to navigate training to fellowship. I knew ACRRM would be the college to best help me as a result. 

What does it take to be a Rural Generalist and do the work you do?  

Being a Rural Generalist is a rewarding yet challenging job. Working full time can be exhausting with on-call and recalls resulting in long hours, which can be sporadic any time of day or night. The love and support of my husband has been absolutely essential for me to do my job. Thankfully, he loves the rural lifestyle and the close-knit community feel that has come with it and does not begrudge the sacrifices he has made to support my career. Equally, the support of friends in the different rural areas we have lived has been crucial - both for emotional support in the unique challenges we face as Rural Generalists, as well as providing backup for us when unexpected work/life challenges come along.

Aside from the challenges of distance, being a Rural Generalist is quite similar to many other careers in medicine and requires fundamental skills of clinical reasoning, professionalism and engagement in a multi-disciplinary team, procedural skills (especially depending on your area of advanced training), leadership and an interest in helping others/ facilitating change for better. Rural Generalists also need to be passionate for their community and health advocates in their own right. They need to be adaptable, learn how to rationalise resources and, in my experience of the doctors I look up to, display humility, a sense of humour and a willingness to engage in the community outside of work. 

Describe your journey to Fellowship with ACRRM. 

I commenced as a registrar with ACRRM in 2016, in which I completed my DRANZCOG Adv at Nambour Hospital. I then completed my training in a mixture of GP and Rural Generalist provisional SMO roles between Ayr Hospital, Roma Hospital and two private GP practices, culminating in Fellowship at the end of 2020. This was punctuated with two stints of maternity leave and part-time training between children, which was well supported by ACRRM and my RTO. I felt very fortunate to have ACRRM to support me through the challenges of return to work after maternity leave and navigating the assessment process. I found ACRRM was always easy to contact to ask questions on how to achieve a certain pre-requisite or clarify questions relating to assessments. In particular, they helped me to obtain my anaesthetic term as an integrated supervised term through my rural hospital. 

With rural generalism being such an incredibly vast knowledge basis to study, I found structured study quite difficult to achieve between life and work, so I tried to maximise my efficiency by using ACRRM resources as much as possible. I found the StAMPS tutorial groups great for becoming familiar with the StAMPS-based examination and expectations, and was able to use that understanding to practice with other ACRRM trainees over skype. I also enjoyed the ACRRM Online modules and the sense of achievement that came with completion of a module, rather than the never-ending reading from studying topic after topic. My final assessment was my CBD which I ended up sitting when my second baby was just two weeks old! I knew I would be better prepared having the cases fresh in my mind and not being out of the workforce long. Despite enjoying ACRRM’s support and feeling well prepared for the assessments performed, it was a definitely a big relief for it to be over.  

What does a typical day at work entail? What challenges do you face working in a rural area?  

A typical day at work starts with a multi-disciplinary handover at 8am, discussing current inpatients, new admissions from the ED overnight and any expects that will be returning that day. It is also a chance to catch up about any potential staffing issues and fatigue concerns. From there, I go to my area of work allocated for the day. Often this is either the ward where we supervise an intern and medical student as part of our team, or the ED. One day a week we have antenatal clinic where we see out obstetric patients choosing to have care locally and perform mirena insertions for post-natal women in our community. Occasionally I might be running an exercise stress test day, delivering advanced neonatal resus lectures, or supporting the visiting consultant cardiologist in the outpatients’ clinic. Of course, having an bbstetric AST, there is always the possibility I will be called from wherever I am in the hospital to an antenate requiring assessment, or a woman in labour needing intervention.  

It certainly can be challenging to balance all roles one has as a Rural Generalist with obstetrics. Clinical care of patients is always a priority, but sometimes that means it can be hard to focus on other important areas of my job such as education of junior doctors and medical students, keeping up with mandatory training requirements, and furthering our rural centre through reflective practice and audits. It’s often just when you think you will have time to catch up on administrative duties when you end up called in all night and end up on fatigue instead! Currently there are only two obstetric advanced skills at my hospital, so the on-call burden has been higher for us than the rest of the team. Luckily, it is one of the most rewarding parts of this gig.  

What is your Advanced Specialised Training (AST) and how do you think this skill helps your community?  

My AST is in obstetrics and gynaecology which is a vital part of rural community care as women, and, in particular, first nations people, do not want to be displaced from their families and community during one of the most significant times of their life. I thoroughly enjoy accompanying women on their journey through antenatal, perinatal and postnatal care, and have even been lucky enough to be involved in helping women with infertility work and ovulation induction with the permission of our flying obstetric service.  

Being a small team means I get to know the majority of the women choosing to birth locally on a personal level, so that I am not a new face when I am there for the delivery. For some women having a challenging experience, seeing a friendly face they can trust can be instrumental in how the birth proceeds. Most uncomplicated vaginal births are managed solely by the midwives, with us on site during delivery just in case of an unanticipated complication, whereas my role is mainly in management of deliveries requiring assistance, such as a vacuum assisted birth or caesarean section. There are a range of other services we offer women such as management options for miscarriage and mirena/implanon insertions. In our community, we also have the benefit of the flying O&G for more complex issues such as ectopic pregnancies in order to provide as much holistic care locally as possible (if safe to do so).  

After women have been discharged from our service, I love seeing them out in the community flourishing as mothers. And now that I have been in the area for almost three years, I’ve had the fortune of repeat customers.  

How do you manage your professional development?  

Professional Development is definitely something I have struggled with since Fellowship. This is mainly due to fellowing in the middle of a pandemic where many educational activities were cancelled or moved to online platforms. I certainly miss going away for different courses and conferences to maintain my CPD but have come to accept the new world in which we live and adjust my expectations of how I will need to achieve my CPD moving forward.  

I use ACRRMs Professional Development Program as it is the most streamlined system to upload courses and certificates and see how I am tracking towards achieving my requirements each triennium.  

What advice would you give to medical students and junior doctors who are thinking about training as a Rural Generalist?  

If you are looking for a challenging and rewarding career with the benefits of a small team and community to make some long-life friends, then rural generalism is for you. Making the commitment to living and working in a rural community can be daunting if you haven’t done it before (especially if you are considering uprooting your family to do so), so make sure you give it a try first. A good way to get a taste of rural generalism is to connect with your University's Rural Health Club and talk to your university placement team about getting some short- or long-term placements in areas you might consider working in the future. This can be a great way to make contacts and mentors for your future. I also recommend getting involved in the ACRRM and Rural Doctors Association’s annual conference Rural Medicine Australia (RMA). It is a great social event and even has a junior doctors’ stream with educational sessions and activities.  

If you decide that rural generalism is for you then ACRRM and your state-based Rural Generalist training team will definitely be able to put you in good stead to making your career aspirations come to fruition. Good luck!