Zayn’s Rural Medicine Placement
My 4 weeks in Maclean were hands down the best clinical training I have had across my degree.
My Rural Medicine placement allowed me to spend 3 days a week in emergency with a rural generalist (a gifted educator) and the last 2 days of the week on the acute ward. Maclean is a very small 50 bed hospital with a 5-bed emergency department which manages to see over 15,000 patients per year. There is X-ray everyday and ultrasound some days of the week, but no CT and no after-hours imaging or pathology. This means your clinical skills, focussing on attentive listening, close questioning, and comprehensive understanding of physical signs is essential. These are essential to detect serious pathology in need of transfer or urgent retrieval and to be sure of less serious diagnoses to allow patients to be treated in their community without being transferred elsewhere for unnecessary tests. I was entrusted with complete autonomy to see patients alone and then present their case to the doctors. The 1-to-1 education I received was unprecedented for me. Working rurally, the nursing staff in emergency and on the wards are incredibly good at their jobs and do not hesitate to share their vast expertise with you. The small size of the hospital and close-knit nature of the staff allowed me to learn more from the nursing staff than I have ever been able to in busier hospitals.
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Spending the end of the week on the acute ward means you can follow the journey many patients you saw earlier in the week who were admitted from ED. On the ward, there is no JMO or RMO, just you and the consultant meaning you are rapidly promoted up through the ranks and able to document, examine patients on rounds, review their investigations, and propose management plants to the consultant. The consultant frequently bounces their ideas off you and I found myself rapidly applying things I had been taught in lectures to form differentials, suggest changes to management, and question the rationale of investigations and treatments. This ward is run by a locum consultant who changes every week, meaning you are the only stable figure for many of the longer stay patients. You become a comforting presence for them and a key resource for the consultant to inform them what has been happening earlier in the patient’s admission.
Maclean itself is a wonderful town with a wonderful community and possible the best IGA in NSW. The spectacular region of Yamba, Iluka, Brooms Head and surrounds are right on the doorstep and offer some magnificent coastal walks. Afternoons and weekends in this region were always enjoyable.
The community depends on this hospital, which seems to be continually under threat of closure. Much of the hospital’s renovations and infrastructure has been founded by the community and generous bequests. The ED makes emergency care accessible for locals and takes a huge amount of strain off the considerably.
overburdened local GPs who often don’t have appointments for 3 weeks. Crucially, the ward care enables locals to be treated and recover near their loved ones. Spending time here has crystallised my passion for rural healthcare and desire to live and practice rurally long-term. This placement was unique and unbelievably beneficial, and I would encourage all students to fight for a placement here.
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