The year of Rural Clinical School in Broome – that is, literally, the 12 months – helped determine Andrew Lim’s approach to his career as a physician, specialising in rheumatology.
“Definitely,” he says.
“Monitoring people over a 12-month period influenced what I do now which is managing patients’ chronic conditions; in particular, conditions like rheumatoid arthritis which is a chronic lifelong disease. RCS certainly did influence that aspect in terms of my career development.
“I had a couple of cases which I had to follow from the start of the year to the end of the year, particularly in the paediatric setting, and you could really observe the child’s health condition develop during that time – whether it was a positive outcome or to their detriment, as a result of the condition itself.
“Observing their progress for the full 12 months – which is, in essence, what we do in reality in terms of the management of patients in the longer term and not just for the ‘there and then.’
“Also, over the course of the year you not only established a relationship with the patient, but also with their family, the clinicians and allied health staff looking after that patient.”
And that leads to another aspect of RCS – a benefit Andrew sees from the close-quarter environment of the learning, and also from living in a country town.
“It really improved the way I interact with patients and colleagues in terms of confidence and building interpersonal skills, and the way I developed my own style of learning and gaining new knowledge as well.
“Because there were fewer doctors in town we were able to establish open lines of communication with our supervisors and the ability to take on feedback, or criticism, was much easier having become closer friends with the people you work with. I think that assisted greatly.
“Also, being part of the rural lifestyle, people around town knew who you were, you knew who other people were … this led to involvement in local activities including social sports – which I ended up continuing back in Perth – which has continued to this day. “
In Andrew’s year, 2005, the Rural Clinical School was still a relatively new concept, but its attractiveness was spreading as an alternative to the style of city-based, hospital ward rounds-type learning. Andrew, along with some friends, was looking for a break and a bit of adventure.
But he says there was more.
“The doctors supervising us there took ownership of our small group and that probably provided a better learning experience compared to the city where you were one in the crowd”.
“The city learning in the year prior to me living in Broome was somewhat sterile. You would go on ward rounds and there would be more of you on the round and you did not have that direct one to one contact with the senior clinician, and then at the end of the ward round it would just be finished.
“With Rural Clinical School it was very small group orientated, like one or two of you, with direct contact. You would receive feedback on whatever activity you were undertaking, whether it was a clinical examination or a procedure – you learned a lot more in that sense.”
After graduation and his internship at Fremantle Hospital, Andrew’s following years as a resident and registrar saw him return, at times, to Broome as an RMO and a locum managing patients on the ward at the hospital.
“The overall experience stimulated my interest in chronic disease management and, eventually, the physician pathway, and following this, I developed an interest for rheumatology which is all things bones, joints, autoimmune diseases.
“I now spend the large part of the day in the clinical setting, both in private consulting rooms and in tertiary hospitals.
“I work at Fiona Stanley and Royal Perth consulting; then I supervise some of the registrars in training for rheumatology – educating them, but also undertaking ward rounds in the inpatient setting at these hospitals. So, it is managing patients on the ward, but largely clinical management of outpatients as well.”
Even for doctors who may not be disposed to the rural career and lifestyle, Andrew believes a year of RCS brings the benefits of a broader perspective of medicine.
“While not undertaking rural work at this time, even though I do have desire this in the near future, I think the experience does open your eyes to a different side of medicine … and a side of medicine that many of us in the city haven’t experienced.
“So I think it does expose us to a different side of medicine, and that’s important to whatever we end up doing and wherever our career takes us – having an understanding of what goes on in our own country is really important.”