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JCU JCU Medicine: The Unofficial JCU Med Bible (Vol. 2)

JL538

Monash University - BMedSc/MD I
Hi guys, just to confirm - JCU has major exams at the end of year 5 and year 6 is just preparation for placements right? Also, is such a structure the norm for 6 year med courses? Since Adelaide is the same.
 

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Crow

MD3 | Staff
Moderator
Hi guys, just to confirm - JCU has major exams at the end of year 5 and year 6 is just preparation for placements right? Also, is such a structure the norm for 6 year med courses? Since Adelaide is the same.
The current structure is that the major final exams are completed in 5th year, yes. UNSW has a different program structure to JCU so it’s not identical between 6 year programs (there aren’t any others aside from JCU/Adel/UNSW).
 

Stapedius

JCU MBBS III
Valued Member
Hi guys, just to confirm - JCU has major exams at the end of year 5 and year 6 is just preparation for placements right? Also, is such a structure the norm for 6 year med courses? Since Adelaide is the same.
Yes, as Crow has said you basically sit your final exams at the end of 5th year. 6th year is completely pass/fail and has no real written examination component as you spend your entire time in hospitals on various rotations and get assessed on competency/professionalism. For this reason, many students do consider it a mini-internship and particularly in rural areas I've spoken to some doctors who say the 6th years get treated like interns. Some may call it unpaid volunteering... others might call it great experience haha. I only know of one person who has failed 6th year, and that was because they simply wouldn't show up to their rotations on time pretty regularly and thus didn't meet course requirements.
 
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Stapedius

JCU MBBS III
Valued Member
2nd Year 1 Month Rural Placement Review
Introduction
So having had some time to relax after my 2nd year one month placement and to gather my thoughts, here’s my more comprehensive review of the whole experience. For anyone that is yet to do a rural placement at any medical school, I hope this provides some insight into why you should not be scared about it, nor should you go into it with the wrong mindset. I remember when I was allocated to my rural clinical site, I was very hesitant to go and felt initially annoyed that I was no-where near a big city as some students want so they can “return to Brisbane on the weekends” (unfortunately this is the thinking of some people). My rural site in QLD was further away from Brisbane than Brisbane is from Melbourne, with a population just shy of 4000. The closest “city” is Cairns which is still close to 15 hours away (by car) from my placement site. But I wanted to keep an open mind, because ultimately I was going to be here for a month, and wanted to make the most of the experience while I had it.

Arrival
Rocking up, we got in touch with our placement coordinator, who is employed by JCU to basically coordinate our daily schedules and weekend activities and to make sure we have a point of contact for any questions/concerns. Our placement coordinator was not a doctor, but a member of the community who integrated us into the culture of the town we went to. He gave us the keys to our accommodation, which is subsidised by JCU for about $100/week. For this, the person I went with and I got a whole 4 bedroom house to ourselves, fully furnished. The first few days we all just got settled into the location.

Starting at the hospital
When we started our placement at the hospital, my placement partner and I alternated between doing ED and Ward/Outpatients so we could get to see a variety of Medicine in the hospital we were primarily situated in. But this is not your typical hospital; as you’ll find in rural areas the hospital had RAC, outpatient GP rooms, a dental clinic, ED, surgery and a dialysis unit, all under the one roof. I started in ED and on my first day, the nurses got me to do a IM dorsogluteal bicillin injection and take bloods, even though I’ve never done this before. Of course this was supervised and we were taught through the process, but it was pretty crazy considering I was only just a measly second year. Next minute, I was observing a implanon removal in one of the outpatient GP surgery rooms.

One of the greatest benefits of going out to a true remote location is that you actually do get to see a lot more Medicine, because the reality is, unlike those regional centres which lie only a few hours out from major tertiary hospitals, the ability to transfer patients with more complex conditions to the bigger hospitals is something that is not easy. RFDS and QAS did run various flights for patients that required certain specialist interventions (like a tooth knuckle injury which required orthopaedic assessment), but the nearest base hospital is in Cairns and it takes time to get everything arranged and patients can only be transferred if they are stable. This means that sometimes the doctors at the place I went to would be forced into making life-or-death decisions to treat patients who may ultimately need specialist care but should they risk putting them on a flight to Cairns or Townsville, they may not survive the flight. Hence, while I didn’t see anything of the sort while I was there, one of the SMOs I was working with told us a story of how she has performed a fasciotomy in my rural location for a patient that had compartment syndrome; a time critical and serious syndrome that is really hard to identify, but delays in intervention can be disastrous.

Placement Experiences
Other things we got to see were cardioversion, tooth extractions, fishhook removals, cyst drainages, atrial fibrillation. I also intubated (LMA) a patient under sedation, even though that’s a 4th year clinical skill. I’m surprised I didn’t end up sticking the tube down the oesophagus rather than the larynx... I then ended up manually inflating the lungs of the sedated patient using this balloon thing (that’s the technical term, yes) and tried to remember all the Respiratory Medicine content I had learnt in Semester 1, and why the anaesthetist wasn’t concerned when he asked me to stop the manual inflation of the lungs. Because of course, when you stop breathing, eventually the CO2 level rises enough and your hypercapnic drive triggers your respiratory drive. Eventually, this did happen after much anguish. It’s still disconcerting to hear the apnea beeping noise, and see the O2sats% drop, especially when you’ve been told to induce this by an anaethetist. But I guess it’s all basic biochemistry. The fact that I got to do all of this is likely because ultimately there is less bureaucratic red tape for remote hospitals and less hierarchy because there are only 5/6 doctors for the entire hospital. Everyone works together and tries to share their skills, because ultimately it’s just not possible to have subspecialist doctors be there all the time. Hence the role of rural generalism. As I’ve seen on placement in a big hospital, everything is very much regulated and honestly in my 2 week elective at the end of 1st year which I did do in a major tertiary hospital, the most I did was lift up the bed.

Being part of the team
As a result, one of the great things about doing placement in such a remote location is you start to feel like a part of the team. I got to know all my doctors well, and you hear that they are very much humans too, with families. We got invited to go to parties with them on the weekend, boating trips, road trips and during the day at work got to help them out with procedures and do some of our own procedures. I ended up in ED by the end of the placement as a mini PHO (a PGY2 was deemed a ‘PHO’ in the rural hospital I was at because they don’t take interns or JHOs due to how small the hospital is, and as a result the PGY2s are thought to do the same tasks and have the same responsibilities as PHOs); was conducting histories, coming up with differentials, writing ED summaries and then assisting with treatment plans and discharge summaries. On ward rounds, I did a TTS, practiced my system exams and I honestly have learnt an incredible amount from this experience of actually being able to do rather than merely passively observe. Especially with cannulation – this was honestly one of those things which I started out fearing, especially when I missed 3 cannulations in a row one day and this destroyed my self esteem. But you can only learn from failure and by the end of the placement I was starting to get more successful cannulations than failures, which I see as an improvement! Having the Medical Superintendent sit down and explain the physics and special techniques behind cannulation for 30 minutes out of his own time is just something you do not see often.

Indigenous health
The other thing which was great to see is actually observing some of the Indigenous healthcare issues. I can not understate enough that the stuff you learn in Medical school about Indigenous health is not only true, but it arguably doesn't even go far enough. The place I went to had a large Indigenous population, and not a single day went by where we didn’t see ARF and RHD. About every second day, 2 Indigenous patients were on dialysis for CKD. Because the cycle of disadvantage and systemic socioeconomic inequalities have not yet been solved. I saw young Indigenous kids aged 5 lose half their teeth due to cavities, some of those newly budded adult teeth. It’s disheartening stuff. And you cannot resort to victim blaming – you speak to these people and you realise the physical, sexual and verbal trauma that many of them have suffered through and the damage that alcohol has brought to communities, and you realise that there is not an easy fix. It’s difficult when there are limited jobs in the region, and when you have to actually see the application of kinship and how transferring a critically ill Indigenous patient to Cairns may actually not be viable, as they have cultural ties to the community. Simply not turning up to appointments was commonplace, and it’s so easy for people who have not been to these communities to just say “they need to get their act together” (I have people say this to me so it's not a rare sentiment), but you do not really know how important the cultural ties are until you’ve spoken to these people. A residual fear from the Protectionism era of hospitals as a “place to die” rather than a “place to heal” is something I heard time and time again from Indigenous elders, and is another factor in the huge issue that is closing the gap. Because the gap is real, and it still needs to be closed. But in saying that, things have gotten better than the team I was working with were really dedicated to trying to resolve some systemic issues through active prevention programs. We got to see some of the outreach programs run by one of the Rural Generalists who had subspeciality qualifications in renal care, who was basically doing the same work as a nephrologist without a nephrologist being present physically. By travelling out to communities to provide primary care for patients who would otherwise not present to hospital or GPs. By latching onto the issues early and improving health literacy about some of their conditions so patients can become empowered to make healthy changes, a study commissioned by the state gov found their program had reduced later kidney-related hospital admissions by those patients due to CKD by about 30%, due to the early intervention.

Collaboration with other healthcare workers
We were the only medical students on placement there at the time (which probably was great for us because it meant we probably got to do more), but there were a few OT students on placement from another university who we hung out with in our spare time. We also attended multidisciplinary meetings which saw the integration of doctors, nurses, RAC staff, OTs, allied health, etc. to discuss complex management of patients which need coordinated care. It was great to see that there was no superiority complex which you often hear from the doctors, thinking that they are the ‘top dogs’ in healthcare. Actually, everyone contributed their own specialist advice to management in a mutually beneficial and collaborative way. I honestly probably hung out with the nurses more than the doctors on some days - sometimes they were just more chill and were fun to talk to!

Summary
Overall, I have learnt a lot. I had a great time, made a lot of friends and felt so encouraged to return. Student support was fantastic, something I was scared about from the start. Being isolated in an isolated location is something I think we all fear. But everyone feels part of a big team, and I can definitely see myself returning at some point, even if it’s a 1 month locum down the track. I would highly recommend if you get the opportunity to do a rural placement, to go really rural so you get to see a whole lot and do a whole lot. I'm not saying you have to be rural generalist to enjoy a rural placement, nor do the doctors there expect everyone to want to do rural generalism (they were open with us about this) but if they can make your experience enjoyable enough that you will return even for a 2 week, 1 month of 6 month locum as any type of doctor (even a FIFO specialist) then to them, that is a success story for helping deal with the difficulties or rural and remote health.
 

avocado5

Lurker
Stapedius thank you for sharing this information. How did you get yourself to the placement location? How did you arrange transport? Some areas can be hard to get to and I do not feel comfortable driving by myself for long distances.
 

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Stapedius

JCU MBBS III
Valued Member
Stapedius thank you for sharing this information. How did you get yourself to the placement location? How did you arrange transport? Some areas can be hard to get to and I do not feel comfortable driving by myself for long distances.
Hi there! Obviously how you get to your placement location depends on where it is and how far away it is. Some locations (such as Bowen or Innisfail) are only an hour or so drive away from Townsville and thus you can drive there pretty easily. Most placement sites are not solo, and thus generally people allocated to that site end up going together and splitting the fuel cost (which you can reimbursed by JCU). For longer distances, such as Weipa, Mt. Isa or Thursday Island, you might instead opt to fly there, and can get some of that cost subsidised by JCU as far as I'm aware (although I've only ever drive so I haven't gone down this route). While my placement site was indeed a very long (~20hrs) drive from Townsville, the person I was going with had a 4WD car and knew the region well enough so we turned it into a bit of a road trip sleeping halfway at a rural town and got something like $500 from JCU for fuel money (which worked out to be a little more than we spent on fuel). JCU helps you arrange transport if needed, and makes students submit a form prior to the placement so they're aware of your transport and how long it will take you, so they can keep track of you and make sure you're okay. Hope that helps :)
 
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hey just wondering if you have a copy of the msa med handbook cus I don't think the link works, or is there anywhere else I can see a structure of all the subjects because im super confused !! also wondering if I need to brush up on any chemistry/maths before I go as I'm hearing mixed opinions on how many calculations etc are involved in the course
 

Stapedius

JCU MBBS III
Valued Member
hey just wondering if you have a copy of the msa med handbook cus I don't think the link works, or is there anywhere else I can see a structure of all the subjects because im super confused !! also wondering if I need to brush up on any chemistry/maths before I go as I'm hearing mixed opinions on how many calculations etc are involved in the course
Hi, being the tech wizard that I am, I have fixed the website problem for you. You should be able to see the 2020 guide now - I'll add a PDF download link when I have some time later this week. As for your 2nd question, if you passed year 8/9 maths, you will be absolutely fine with the maths in the course. You do a 'Basic Numeracy Quiz' at the end of Year 1 which honestly had a question like "convert 15g into mg". You'll be glad to know the days of trig and integration are well over. There is some pretty heavy chemistry for the first couple weeks in the MTC course, but it's glossed over so fast and doesn't ever actually get assessed in the final exams, so I wouldn't worry about it too much. If you really really want, looking over a bit of Year 11/12 organic chem and enantiomers etc. may help you slightly, but for most people you'll be fine if you passed Chem.
 
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