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The Division of Medicine is a rapidly growing and dynamic area which is committed to providing holistic and safe medical care to our patients. There is a wide range of on-site and visiting specialist services currently provided through the Division. Current onsite services include General Medicine, Infectious Diseases, Endocrinology, Neurology, Cardiology, Nephrology, Haematology, Oncology, Palliative care, Rheumatology, Immunology and Rehabilitation services. Current visiting services include Gastroenterology and Hepatology, Thoracic and Sleep Medicine and Dermatology. Provision of outreach services to the indigenous communities is an exciting part of the clinical work in the Division of Medicine.
Specialist clinicians, medical registrars, resident medical officers and interns make up the medical division work force.
There is a strong link with NT clinical school of Flinders University and most specialists hold academic positions. The division also works closely with the Menzies School of Health Research and number of our specialists are actively involved in research.
Division of Medicine at RDH also works closely with other hospitals in the territory (Alice Spring Hospital, Gove District Hospital, Katherine District Hospital) and there are plenty of opportunities to provide visiting services to these hospitals.
Basic Physician Training
RDH is a level 3 teaching hospital accredited for 33 of 36 months of basic physician training.
Streamed and non-streamed positions are available to basic physician trainees at PGY2 and PGY3 levels. These positions afford exposure to general medicine, cardiology, renal, haematology, oncology, infectious diseases, rapid assessment and planning unit, intensive care and rural rotations(non-core). Some trainees wish to obtain a broader exposure to the medicine available in the Northern Territory by doing remote general practice rotations and rotations to smaller outlying hospitals such as Katherine District Hospital, this is encouraged and supported.
At BPT registrar level trainees have access to similar terms assuming more responsibility and learning to supervise resident staff within their team. Palliative care, subacute care, neurology and respiratory medicine are also available in addition to the rotations outlined above. The are a growing number of advanced training positions. Core training in cardiology (through Flinders Medical Centre), general medicine, infectious diseases, endocrine, nephrology, oncology and haematology are all available as well as term 4 and 6 in palliative care. Popular positions for advanced trainees include the general medicine outreach to remote communities and the medical registrar position attached to the centre for disease control in which trainees gain broad exposure to public health practice.
Please contact Dr Emma Spencer DPE by emailing hospitaldoctors.THS@nt.gov.au
There are strong ties between Royal Darwin Hospital and Alice Springs Hospital and trainees wishing to combine rotations in both centres will be supported. For specific information about rotations at Alice Springs Hospital please contact Dr Steve Brady, Director of medicine by emailing hospitaldoctors.THS@nt.gov.au
The Royal Darwin Hospital is an exam centre and when the clinical examinations are held at RDH (eg 2010) basic physician trainees will be able to act as "bulldogs".
Advanced Physician Training
Within the department of medicine there are advanced training positions in General Medicine, Nephrology, Cardiology (secondment from Flinders Medical Centre), Infectious Diseases, Palliative care, Haematology, Endocrinology and Intensive Care.
Practising general medicine in the Northern Territory is attractive due to the complexity of the medical illnesses as well as the challenging psychosocial circumstances. Advanced trainees in general medicine are encouraged to construct a two-year training programme at Royal Darwin hospital. Trainees have access to pure, true acute general medicine as well as rotations through subspecialty areas not readily available to non-subspecialty trainees in larger centres. General medical registrars have worked in haematology, oncology, nephrology, cardiology and intensive care at senior trainee level. The general medicine position attached to the infectious diseases team is also a popular and valued experience. The CDC and outreach registrar positions are ideal for a general medical trainee in their final year.
The rich clinical experience at RDH has resulted in a strong link between the Division of Medicine and clinicians from Oxford, UK. There are regular visiting specialists from UK who come for the unique tropical clinical experience. There is the possibility of our clinicians going to the UK also. We aim to develop close links with other Australian general medical units and neighbouring Asian countries (Singapore, Malaysia, Indonesia) for the potential to share trainees and specialists in a mutually beneficial manner.
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 the top end. Registrars travel to Gove, Katherine and the Tiwi Islands to conduct clinics.
As well as a 10 bed dialysis unit within the hospital there are patients on home dialysis and satellite dialysis units in Nightcliff and Palmerston which the registrar and consultants visit regularly.
A collaborative project with the palliative care services exists to provide sensitive end of life care when required. The registrar participates in this service using teleconferencing as a tool to facilitate communication with patients in remote communities.
Registrar clinics include a weekly chronic kidney disease clinic, a transplant clinic and an immunosuppression clinic. The trainee will become skilled in vascular access techniques, renal biopsies, management of peritoneal dialysis catheters and fistulas. There is also a weekly vascular access round with the surgical team. There is a traditional weekly teaching ward round held on Wednesdays.
Cardiology at Royal Darwin Hospital is a strong and growing department. The high burden of cardiovascular disease and rheumatic heart disease remains an attraction for those interested in making a difference in the Territory. On site cardiologists provide services throughout the territory including Central Australia. There is a strong working relationship with Cardiology services at Flinders Medical Centre, SA. They provide RDH with revascularisation services, visiting services, back filling, weekly cardiac conference as well as advanced trainee cardiology registrars.
At RDH we have a 9 bed coronary care unit with CPAP, BiPAP and invasive monitoring facilities.
Other services we provide in conjunction with Darwin Private Hospital are echocardiograms (transthoracic and transoesophageal) which frequently reveal the high burden of valvular heart disease, diagnostic coronary angiogram (more than 700 per year) with approximately 50% of patients requiring revascularisation, pacing services (permanent pacemakers and defibrillators are implanted at RDH).
There is also an outreach service which consists of a cardiologist, a registrar, an echocardiogram technician, and a nurse educator. This service regularly visits indigenous communities to provide clinical and echocardiography services. Visiting cardiology services are also provided to other regional hospitals in the territory.
The haematology position at RDH is unique. It is a combined clinical and laboratory training experience affording excellent exposure to a wide range of malignant and non-malignant haematological diseases. Additionally there is an active Territory wide transfusion service.
The Royal Darwin Hospital is a major trauma centre and the haematology department provides high-level transfusion medicine input into this integrated service.
Imported malaria is of major public health interest in the Top End due to our geographical location. Trainees have the opportunity to improve their malaria microscopy skills.
The trainee participates in consultant lead outreach haematology clinics to Alice Springs.
The Cancer service at Royal Darwin Hospital has expanded in recent years, the team consists of an Oncologist, Haematologist, Cancer Support Nurse, Chemotherapy nurses, Clinical Trials nurse, Dietitian, Social worker and administrative officer. Soon to join the team is a McGrath Foundation Breast Care nurse. In early 2010 Royal Darwin Hospital will be able to offer patients radiotherapy treatment, currently patients need to travel interstate for this service.
Multi-disciplinary Meeting (MDM)
Each week the Surgical Oncology MDM is held and many of the new cancer cases in the Top End are discussed to form a comprehensive treatment plan for each patient. The MDT in Darwin includes: oncologist, haematologist, general surgeons, palliative care, nursing, dietetics, social work and the visiting radiotherapist when he is in Darwin.
Cancer patients receive most of their chemotherapy as outpatients enabling them to have as little disruption to everyday life whilst undergoing treatment. Symptom management is improving continually and chemotherapy is better tolerated. The Cancer Support Nurse and the Chemo Suite nurses support patients throughout their chemotherapy treatment. Currently chemotherapy is only administered in Darwin but as part of the CanNET project the team is working toward the safe delivery of chemotherapy for patients closer to home and community. The Chemo suite is located at Darwin Private Hospital on the first floor but is a public hospital service.
Patients travel interstate for radiotherapy treatment, as currently there is no service available in the Northern Territory. The Cancer support nurse offers advice and assistance in arranging travel interstate. Patients and their carers are supported for travel and accommodation by PATS.
Currently there are four clinical trials being offered at Royal Darwin Hospital, two are available to Oncology patients and two for Haematology patients.
This position is a full-time position accredited as 1 year core training by endocrine SAC.
This is an exciting opportunity for advanced training in endocrinology in Darwin.
Our endocrinology & diabetes team at RDH consists of 3 consultants, a diabetes educator and an Aboriginal health worker. We also have strong links to the Menzies School of Health Research.
To provide consultation service to inpatients at RDH as a member of the multi-disciplinary diabetes team (Includes patients under care of medical, surgical, orthopaedic & obstetric teams. Approximately 60% of diabetic inpatients at RDH are Aboriginal people hence a large amount of work in the area of Indigenous Health).
To manage inpatients admitted under endocrine team, especially patients with DKA or hyperosmolar states.
- Diabetes Clinic- weekly
- High-risk foot clinic- weekly
- Endocrine Clinic- weekly
- High-risk medical antenatal clinic- weekly
- Urban Outreach- monthly diabetes clinic with Louise Maple-Brown at Danila Dilba Aboriginal Medical Service
- Remote Outreach- opportunities for general medical & diabetes outreach to regional hospitals & larger Aboriginal communities are available
- Liaison with primary care - telephone advice to urban & remote GPs & other health professionals on endo/diabetes management
Likely clinical cases:
- Plenty of diabetes, metabolic syndrome, PCOS- forms majority of inpatient work & 50% of outpatient work
- Large amount of thyroid- approximately 30% of outpatient work
- Other endo (pituitary, osteoporosis, reproductive) forms remaining 20% of outpatient
This job includes the potential for flexibility within the above structure depending on particular interests of the registrar (eg. Obstetric medicine, paediatric endocrinology, general medicine)
Training & education:
- Weekly endo clinical meeting/journal club
- Weekly general medicine clinical meeting
- Weekly general medicine journal club
- General medical registrar overtime shift once every 4 weeks (weekend day shift)
- Teaching of basic trainees, JMOs & medical students
For further information please contact:
Dr Louise Maple-Brown by emailing hospitaldoctors.THS@nt.gov.au
Outreach Registrar and Disease Control Medical Registrar
Positions have been created to accommodate the need of young physicians to train in the specific practice of rural and remote medicine. Trainees in this area require consistent exposure to the ambulatory care setting and practical experience in the practice of public health medicine.
Both positions involve 6 months based at Royal Darwin Hospital within the general medicine units during which trainees gain experience in the unique nature of clinical medicine in the Northern Territory and build the networks they will need to be effective in their roles outside hospital based work.
It is hoped that trainees will choose to do a 2-year program covering both of these positions as well as a year of ward based general medicine and subspecialty experience.
Disease Control General Medical Registrar
During the 6 months of Public Health experience the trainee will be attached to the Darwin Centre for Disease Control (CDC). The CDC in the Northern Territory provides a range of services to monitor, control and prevent communicable and non-communicable diseases that affect the population of the NT and also our international neighbours in the region.
The position has been created to address the public health training needs of future general physicians who will work in remote and resource limited settings, including internationally. The CDC placement will afford exposure to clinical management of cases of TB, leprosy, non-tuberculous mycobacterial disease, HIV and other STIs, hepatitis B and C as well as programmatic control via public health responses for over 60 different notifiable conditions.
This will include community involvement, health promotion, healthcare colleague support and education around conditions such as measles, mumps, meningococcal disease, malaria, arbo-viral diseases, rheumatic fever and rheumatic heart disease, acute post streptococcal glomerulonephritis and trachoma. The experience will provide an invaluable public health perspective aimed at enhancing a physician's day to day clinical practice.
In addition to the clinical service related to TB diagnosis and treatment there will be involvement in protocol based screening of illegal fisherpersons apprehended in Northern waters. It will also involve clinics in the regional centres of Katherine, Gove and Maningrida. There will be an educational component to this position with trainees expected to teach medical students, physician trainees, nurses and aboriginal health workers.
The trainee will also gain experience in writing ministerial and press briefings, as well as fact sheets. Project work will also be undertaken with an expectation of publication in the "NT Disease Control Bulletin".
Outreach and Remote area General Medical Registrar
The outreach registrar position has already proved extremely popular. The position is ideal for a senior advanced trainee in general medicine or a subspecialty trainee who wishes to broaden their exposure to general medicine in the remote ambulatory setting.
The practice of medicine in remote areas can be challenging and frustrating. Interacting with patients in the environment in which they live however is extraordinarily rewarding and many adult and child physicians at the Royal Darwin hospital have dedicated large parts of their professional lives providing excellent clinical services in the most remote parts of the Northern Territory.
The trainee will gain a unique and privileged perspective into the practical aspects of managing complex and multiple disease processes in a context other than the acute care setting and can begin to understand the real issues affecting access to and delivery of a first world medical service within what is often referred to as a third world context.
General medicine will be seen in it's broadest sense with exposure to cardiovascular disease, acute rheumatic fever and it's chronic sequelae, obstetric medicine, diabetes, COPD and bronchiectasis, mycobacterium tuberculosis, melioidosis, chronic liver disease, scabies, chronic renal disease and systemic lupus erythematosis.
During the six month remote outreach attachment the trainee will be based out of Royal Darwin Hospital and will fly or drive to remote areas including the Tiwi Islands, East Arnhem Land and the regional centres of Gove and Katherine to conduct general medicine outreach clinics. The trainee will also have an opportunity to travel with the cardiology team who already provide a well organised outreach service managing cardiovascular disease and Chronic Rhematic valvular disease throughout the Territory. The trainee also travels with the renal physicians to Katherine and Gove hospitals.
There will be up to 2 days a week when no clinics will be scheduled and the trainee will have an opportunity to check letters generated by their visits, arrange tests, follow up investigations, attend Grand Rounds, journal clubs and various other meetings which occur in the hospital.
There is also an educational and mentoring role attached to the outreach position.
Infectious Diseases Registrar
The ID registrar position is highly sought after due to the unique opportunity of gaining exposure to rare tropical and infectious disease within Australia. The unit is staffed by clinician researchers who also conduct research out of the Menzies School of Health Research (www.menzies.edu.au). Within Menzies the research is separated into two divisions: Tropical and Emerging Infectious Diseases Division; and the International Health Division. Through working with this team of clinicians you will gain exposure to diseases such as melioidosis, rheumatic fever, pneumonia, scabies, HIV, hepatitis, malaria, dengue and much more.
General Practice Trainees
The department of medicine at Royal Darwin Hospital is committed to providing training opportunities to general practice trainees and has a special mission to provide appropriate hospital experience to practitioners who wish to work remotely. We are happy to work with other areas of the hospital to facilitate a broad training program which may be required for people who will work in an environment where a skills set across medicine, surgery, obstetrics and paediatrics are required.
Enquiries regarding all the above medical registrar positions should be made to Dr Emma Spencer DPE RDH by emailing hospitaldoctors.THS@nt.gov.au
The Rehabilitation Service at the RDH provides a wide range of services with a variety of casemix. These include: stroke, amputees, brain injury, orthopaedic injury, multitrauma, spinal cord injury & other neurological conditions. Some of the unique cases include CNS melioidosis, Hansen's disease & embolic stroke due to rheumatic heart disease. There is a high burden of illness among the Indigenous population who represent over half of the inpatients.
There are fulltime specialists (AFRM fellows) who supervise the accredited registrar position.
There is a multidisciplinary therapy team with its own therapy centre & access to hydrotherapy.
The registrar is primarily responsible for the inpatients including consults. Outpatient clinics are held involving chronic pain, amputees, spasticity & rehabilitation. Other services provided include botulinum injections for adults & paediatrics & Baclofen pump refills. Outreach clinics are held regularly to Katherine & Nhulunbuy (Gove).
Medical students from James Cook University spend time with the unit. There is a strong liaison with the Division of Medicine, Orthopaedic, High Risk Foot Service & Prosthetic/Orthotic Service.
Regular weekly education sessions are conducted & there is ample opportunity to access other education opportunities.
The registrar is required to work Monday to Friday with no after hours responsibilities.
Palliative Care Medicine
Territory Palliative Care (TPC) Top End consists of a multidisciplinary team based at Royal Darwin Hospital and provides palliative services to the Darwin, Katherine, Arnhem, Daly River and Port Keats regions.
TPC offers inpatient and outpatient consultations to patients in RDH, together with community palliative care support, in both urban and remote settings. Patients are accepted on to the program with both malignant and non-malignant conditions when they are unlikely to live longer than twelve months. We provide specialist palliative input to manage significant symptomatic problems or complex care issues.
TPC Top End comprises of a dynamic and diverse team of professionals with Palliative Care Consultants, medical registrar & resident, a Clinical Nurse Manager, Clinical Nurse Consultants, Social Workers, an Aboriginal Health Worker, Bereavement, Pastoral Care and Volunteer Coordinators, occupational therapist, physiotherapist and dietician, a Palliative Care Network and Quality Coordinator, together with a fully staffed in-patient hospice unit. The case-mix and diversity of patients is unique in Australia with more than 40% of referrals being Aboriginal and 40% of referrals coming from rural/ remote communities.
The clinical work is challenging and exciting requiring the full range of palliative care knowledge and skills, with a 65: 35 malignant to non-malignant ratio of patients. TPC works closely with haematology, oncology, medicine, surgery, anaesthetic pain services and the chronic disease networks. TPC encourages continuing General Practitioner involvement with all patients throughout the end-stage care period.
You can contact the TPC Medical Director by calling +618 8922 7981or email HospitalDoctors.THS@nt.gov.au.