Central Australia specialities and rotations

General Medicine in Alice Springs is an exciting area in which to work – true, acute General Medicine with few sub-specialty admission units, it is an ‘all comers’ unit.

Almost 84 per cent of patients admitted are Aboriginal, many from very remote parts of Central Australia. Patients often have limited English and differing health beliefs, so working in such a cross-cultural context is both rewarding and challenging.

Alice Springs Hospital is also a referral hospital for the smaller Tennant Creek Hospital, 500 kilometres to the north.

Patients referred from remote Aboriginal communities when their care needs exceed those of the primary and public health care centre also are admitted following retrieval by The Royal Flying Doctor Service. The hospital has strong links to hospitals in Sydney, Melbourne, Adelaide and Darwin.

The General Medical workforce includes Consultant Physicians, many with dual training and a sub-specialty interest. The registrar workforce is a combination of locally employed registrars (a mix of BPTs and ATs) and rotating Basic Physician Trainees from Royal Adelaide Hospital, Flinders Medical Centre and Lyell McEwan, Royal Prince Alfred Hospital (Sydney) and Barwon Health (Victoria).

There is an extensive education program incorporated into the Department of Medicine, including whole-of-department sessions, and sessions directed at junior staff. Registrars are involved in all aspects of teaching and there is also a strong focus on research, with trainees encouraged to partake in research – either smaller scale projects, or by becoming involved in one of the larger ongoing projects.

The hospital has research affiliations with Baker Heart and Diabetes Institute, which has an onsite facility, and the Menzies School of Health Research. Flinders University has a campus situated in the hospital site as part of their Northern Territory Medical Program.

Alice Springs Hospital (ASH) and our networked hospitals have a strong basic physician training program, covering a range of general and specialty rotations as well as preparation for the RACP exams.

Our Basic Physician Training (BPT) program is best suited to applicants in their PGY3 or above and can include entry at Registrar level.

PGY2 applicants should apply to the Resident Medical Officer (RMO) Medical BPT Stream where we have 2 x 2 year positions allocated to ‘pre-BPT’ rotations to prepare trainees for physician training in their PGY3 year.

About the program

Alice Springs Hospital is a level 2 teaching hospital with 183 beds, servicing a total population of around 40,000 people in Central Australia, including approximately 25,000 in Alice Springs and the rest living remotely, up to 1,000km away.

Despite the population being fairly ‘small’, there is a unique diversity of country, language and culture making this place rich and fascinating.

Trainees are part of service delivery across a large geographical area, engaging with remote Aboriginal communities and Aboriginal led health organisations.

The pathology encountered with direct patient care is unique and requires clinicians to employ the biopsychosocial model of care on a daily basis as well as develop their skills around cultural understanding, cultural care and cultural safety.

Aboriginal people make up 30% of the NT population, but reflect 75% of patients in the Central Australian healthcare system.

Our diversity presents both opportunities and challenges. Working and training in Central Australia allows trainees to be part of delivering innovative, integrated patient-centred care in a rural and remote setting.

Participating in clinical care which is culturally safe and responsive in a linguistically diverse population challenges clinicians to place all patients at the centre of their care as well as deepen their understanding of the strong links many patients have to country and culture.

NT Health is known for its infectious diseases service and many trainees come from around the country and overseas to gain experience in this area in a remote setting close to South East Asia.

Alice Springs Hospital shares its campus with Flinders NT Medical School and the Remote Centre for Health, offering the opportunity for staff to engage in research and teaching.

Rotations and Requirements

Basic physicians will be given a balance of core and non-core training terms over the 12 to 24 months of training. The maximum amount of BPT time that can be completed at ASH is 24 months.

During your acute general medicine rotations you'll be required to partake in nights and admitting shifts in a week on/ week off roster. The rest of the rotation you are allocated to 1 of 4 general medical teams. The admitting shifts are a great opportunity to see a wide range of presentations and work alongside our outstanding emergency department to manage acute presentations such as stroke and acute coronary syndromes.

Specialties and Education

The following specialties are covered in the basic physician training program:

• General Medicine
• Renal
• Medical Oncology/ haematology /gastroenterology
• Alcohol and Other Drugs.

Formal teaching opportunities include:

• weekly Hospital Wide Grand Rounds
• weekly Department of Medicine Teaching
• weekly Basic Physician Trainee Registrar Bedside Teaching
• weekly Division of Medicine Journal Club
• weekly specialty meetings; cardiology, echocardiography, renal, endocrinology, infectious diseases, lupus/ vasculitis, rheumatology.

RACP Exam preparation

In preparation for the exams, there is weekly teaching including bedside teaching, written exam preparation and a formal mock clinical exam provided to all candidates.

Alice Springs Hospital is a clinical exam site for the RACP clinical exam.

We have access to other written and clinical training programs through our secondment hospitals; Royal Prince Alfred (Sydney), Royal Adelaide Hospital and Flinders Medical Centre (Adelaide).

2 weeks of study leave is approved for study courses.

How to apply

You can apply to join the basic physician training program between May and August each year, but we also welcome applications at any time outside of that period.

If you're a junior overseas doctor and interested in working with us, we encourage you to reach out to discuss opportunities.

To apply for basic physician training, you'll need to provide a:

• resume
• cover letter outlining your training goals, aspirations and whether you wish to enter training at the RMO or registrar level
• names of 2 physician referees who can assess your potential for the program.

Contact

Tina Foster, Medical administration, tina.foster@nt.gov.au

Dr Kirsten Neal, Registrar Recruitment, Kirsten.neal@nt.gov.au

Dr Sajan Thomas, Director of Physician Education, sajan.thomas@nt.gov.au

The Hospital has a strong generalist focus. Medical patients all come under one of our 4 medical teams. Sub-specialties do not have bed-cards but consult, the General Medicine department has about 50 to 80 inpatients admitted under our service at any given time.

GACM Advanced Trainees have exceptional access to high quality rotations in acute general medicine, core and non-core rotations. They can also apply for our sub-speciality training programs (see sub-speciality page).

Training Structure

Alice Springs Hospital (ASH) supports up to 4 GACM Advanced trainees.

General medicine terms:

1. acute and core general medicine – allocated to general medicine team, includes rotating through admitting and night shift, and 2 outpatient clinics weekly
2. outpatients and outreach – attached to general medicine and multiple sub-specialty local and visiting clinics including gastroenterology, rheumatology, endocrinology, allergy, immunology, neurology, respiratory, infectious diseases. Attend remote clinics with general medicine and sub-specialty teams
3. Tennant Creek - General combined general medicine and renal, mix of inpatient consults for their 20 bed hospital, general medicine outpatients and support for the renal dialysis unit
4. Renal (core and non-core) - apply through gen med OR subspecialty renal pathway

Sub-specialty terms:

5. Renal (core and non-core) – suitable for general medicine OR renal trainee. Apply through general medicine OR subspecialty renal pathway
6. Palliative care – apply through subspecialty palliative care pathway. Community, inpatient, outpatient and home visit service. 2 palliative care physicians for support and an on-site state of the art palliative care hospice
7. Alcohol and Other Drugs (AOD) - apply through subspecialty AOD pathway. Community, inpatient and outpatient service. 2 AOD consultants for support
8. Endocrinology – suitable for general medicine trainee or endocrine trainee. 2 on site endocrinologists and 4 diabetes educator positions
9. Cardiology – recruited as secondment from RAH. Onsite cardiologist
10. infectious diseases – recruited as secondment from Barwon Health. 3 on site infectious diseases physicians.

All trainees are expected to take on a departmental portfolio and be involved in hospital committees, including but not limited to: BPT exam preparation, teaching lead, newsletter/ communication, procedure support, Quality Use of Medicines Committee and morbidity and mortality.

ASH has strong links with the Royal Darwin Hospital (RDH) and are included in their weekly general medicine teaching program. Sub-specialties offer their won teaching programs (see sub-specialty programs).

Structure of the General Medical service

General medicine comprises 4 inpatient teams, staffed by a consultant, registrar, and usually 2 Junior Medical Officers (JMOs), with each team having an average of 10 to 20 inpatients per day.

The teams follow a ‘take day’ model however patients are divided evenly between teams unless a patient is already known to a particular team.

The average number of patients admitted to the service each on-take day is 7 to 15.

The rapid response team of the hospital is the responsibility of the admitting registrar and the ‘on-take’ teams JMO, in conjunction with ICU support.

Additionally, each medical team has a geographic region for which it provides an outreach service.

Each medical team also has its own outpatient clinic, which is attended by the team registrar with the support of the team consultant. General medicine advanced trainees do an extra general medicine clinic weekly, or can negotiate a subspecialty clinic.

Medical team registrars are expected to help one afternoon each week in exercise stress testing.

Specialty Terms

Specialty terms are governed by their respective units.

Cardiology, Renal, Endocrinology, Gastroenterology, Infectious Diseases and Rheumatology are predominantly outpatient-based services, providing a consult service to inpatients. Alcohol and other Drugs and Palliative care have bed-cards, but also offer inpatient consults and out-patients services both onsite and offsite.

How to Apply

Applications for training positions are made from June to September each year, but applications and queries are welcome outside this window. You will need to supply:

• resume
• cover letter outlining your training goals, aspirations and whether you wish to enter training at the RMO or registrar level
• names of 2 physician referees who can assess your potential for the program.

Contact

Clinical Administration Support Team Medicalrecruitmentash.ths@nt.gov.au

Dr Kirsten Neal, Registrar Recruitment, kirsten.neal@nt.gov.au

Dr Sajan Thomas, Director of Physician Education, sajan.thomas@nt.gov.au

The hospital currently has a Cardiology Registrar position that is accredited for General Medicine and is in the process of being accredited for Cardiology advanced training.  This is a popular and sought-after term, and General Medicine trainees should apply early.

Cardiology is a growing department with a strong focus on non-interventional cardiology. The high burden of cardiovascular disease and rheumatic heart disease remains an attraction for those interested in making a difference in the Territory, and obtaining significant exposure to echocardiography and valvular heart disease.

There are two resident Cardiologists at the hospital, with additional visiting specialists from Adelaide and Melbourne. There is a strong working relationship with Cardiology services at Royal Adelaide Hospital and Flinders Medical Centre (South Australia) who provide Alice Springs Hospital with angiogram and revascularisation services, specialist visits (including specialist electrophysiology) and Cardiac Surgery.

Cardiology services include a fulltime Transthoracic Echocardiographic Service and Transoesophageal echocardiography. Functional testing in the form of Exercise Stress ECG, Stress/Pharmacologic Echocardiogram and CT Coronary Angiography and Cardiac MRI are available. The Cardiology Registrar is actively involved in the provision of all services as well as Cardiology Outpatient clinics.

With the high prevalence of Rheumatic Heart Disease in Central Australia this is an excellent opportunity to gain extensive echocardiogram experience, and Cardiology Registrars are strongly encouraged to partake in echocardiogram training and service provision.

There is also an outreach service, which consists of a cardiologist, a registrar, an echocardiogram technician, and a cardiac nurse educator. This service regularly visits remote Aboriginal communities to provide clinical and echocardiography services, allowing trainees to partake in a unique experience.

There are opportunities to be involved in research conducted through the hospital, and trainees are encouraged to initiate smaller projects or become involved in larger ongoing projects already running.

You can contact Clinical Administration Support team by emailing Medicalrecruitmentash.ths@nt.gov.au.

Looking for somewhere challenging, confronting, and rewarding... somewhere fundamentally different?

Alice Springs Hospital (ASH) is seeking a motivated advanced trainee to work as endocrinology registrar in the Department of Medicine. This is accredited as general medicine non-core/ sub-specialty.

The expanding Endocrinology and Diabetes team at ASH consists of two local endocrinologists and is complemented by four Diabetes Nurse Educators. The high prevalence of diabetes in the local population (up to 40 % of aboriginal adults) provides opportunity to improve your knowledge and management of diabetes. Hospital work involves outpatient clinics (both Diabetes and general Endocrinology), ward consults of often complex patients, and opportunity for outreach clinics.

The medicine here is entirely unique. Around 75% of patients are Indigenous - many from remote communities. Co-morbidities and social conditions can be complex and effective communication is essential. Alice Springs Hospital is a 183 bed teaching hospital affiliated with the Flinders University South Australia and Charles Darwin University, Royal Darwin Hospital, Royal Adelaide Hospital, Royal Prince Alfred Hospital and Flinders Medical Centre, with many visiting specialists. The catchment area is over a million square kilometres with a strong focus on Indigenous and remote health.

The Department of Medicine staff consists of a mix of General Physicians and other Specialists, many with dual training. We have local cardiology, rheumatology, infectious diseases, palliative care, alcohol and other drugs, a large renal unit, gastroenterology and many regular visiting specialists. There is on site general surgery, orthopaedics, obstetrics, gynaecology, psychiatry, paediatrics, day procedures unit and an 11 bed ICU. There are four General Medical teams, a busy Outpatient Department and we provide outreach clinics to some of the most remote parts of Australia.

Alice Springs is the regional hub of Central Australia with an urban population of approximately 30,000 people. It is multicultural with well-established schools and amenities, high quality local cafes and restaurants, an active entertainment scene and multiple local sporting clubs with something for everyone. Alice is bicycle-friendly - rarely taking more than 10 minutes to get anywhere. Out of town are places to camp under the stars, swim through gorges, explore rocky mountain ranges and hit world-class mountain bike trails. The sky is sunny 95% of the time, making it perfect for outdoor activities.

For more information on working and living in Alice Springs see the RACP video series here.

Essential Qualifications

Applicants must be AHPRA-registered and eligible for Advanced Training. The position is accredited for General and Acute Care Medicine and can count towards Endocrine "elective" year. Subspecialty advanced trainees wanting experience in rural general medicine or indigenous health are strongly encouraged to apply.

Contact

Dr Kirsten Neal, Endocrinologist and General Medicine, Department of Medicine, Alice Springs Hospital

Email: kirsten.neal@nt.gov.au

Ph: 08 8951 7777

Practising General Medicine in the Northern Territory is an exciting and challenging opportunity due to the young age of patients and the complexity of their co-morbidities, as well as the linguistic, psychosocial, and cultural circumstances.

Trainees have access to a variety of presentations in General Medicine as well as rotations through subspecialty areas not readily available to non-subspecialty trainees in larger centres, including senior trainee positions in Nephrology, Cardiology, Endocrinology, Infectious Diseases, Intensive Care and Palliative Care.

You can contact Dr Anna Holwell, Director of Medicine by emailing anna.holwell@nt.gov.au or Medicalrecruitmentash.ths@nt.gov.au.

The hospital has two accredited Advanced Trainee positions, and one non-accredited position (available to other RACP subspecialty trainees and trainees of other colleges, i.e. CICM) in Renal Medicine.

Renal medicine is one of the most fascinating areas of medical practice in the Territory. In addition to ward-based care the renal team provides a clinical service to a large geographical region across Central Australia. Registrars travel to Tennant Creek, Yuendumu and smaller communities to conduct clinics.

As well as an eight-bed dialysis unit within the hospital there are patients on home dialysis and two community satellite dialysis units in Alice Springs, and one in Tennant Creek, which a registrar and consultant visit regularly. There are also remote dialysis services.

Registrar clinics include a weekly chronic kidney disease clinic and transplant clinic, while trainees become skilled in vascular access techniques, renal biopsies, management of peritoneal dialysis catheters and fistulas. They are also involved in the weekly interventional nephrology session where the unit provides angiogram, angioplasty and fistuloplasty services. There is a strong education program both within the renal department and as part of the Department of Medicine teaching.

You can contact Dr David Fernandes Head of Renal Unit by emailing Medicalrecruitmentash.ths@nt.gov.au.

The hospital has one non-accredited Palliative Care Registrar position, generally filled by Advanced Trainees in General and Acute Care Medicine, but open to trainees from other specialties and colleges (e.g. GP/ACRRM, ICU etc.).  Approval for Accredited Advanced Training positions in Palliative Care is pending.

Once again, this is a sought-after term and trainees should enquire early.

Palliative Care in Central Australia is a distinctive training opportunity for palliative medicine, and the team has a passionate commitment to providing excellent palliative care to the widespread community. The majority of patients are Aboriginal, and many are traditional people from remote communities. The Palliative Care registrar is supported to provide culturally safe care and to understand the powerful social determinants of health in Central Australia.

There is a new 10-bed inpatient palliative care facility, as well as a strong and well integrated consultation service that supports timely referrals from inpatient teams. In addition to medical oncology, the team works with the general medical teams, renal services, Emergency Department and Intensive Care Unit, and the retrievals team.

Alice Springs Hospital is linked with Tennant Creek Hospital and Royal Darwin Hospital, and has strong connections to Royal Adelaide Hospital and Flinders Medical Centre as tertiary referral centres and hosts visiting specialists from these hospitals.

The registrar positon involves community visits locally and to remote communities.  A rotation in Alice Springs is an unforgettable experience that will teach applicants clinical and communication skills that will stand them in good stead for the rest of their career.

You can contact Dr Christine Sanderson, Palliative Care Physician by emailing Medicalrecruitmentash.ths@nt.gov.au.