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Teaching tomorrow’s GPs today
For JCU Medical Educator, Dr Steve Salleras, the golden rule as a GP is to always keep the patient at the centre of what you do. And it’s a message he emphasises to the registrars he teaches.
“Medicine is about the patient and our role is to be the tool for the patient to optimise their sense of well-being and happiness,” Dr Salleras said.
“Frequently in the medical system, the tail wags the dog. It becomes about the system and not the patient. It’s almost as if the patient is doing us a favour by coming to see us, but it should never be that way.
“We need to be respectful and consistently compassionate because nothing else works. In many ways, we need to share the journey with them. We shouldn’t be the ‘adult’ lecturing the ‘child’, because people hate that.”
It’s an approach Dr Salleras has taken throughout the decades of his career as a rural generalist GP. It’s one he’s found works especially well in the rural communities he has served.
Dr Salleras’ commitment to rural medicine stems from his background growing up on a cane farm in far north Queensland. There he saw ﬁrsthand how difﬁcult it was for people to access quality medical services close to home.
As a medical student, it became clear to him the rural generalist pathway was both the most interesting, and the one in which he could be of genuine use to rural communities.
Completing his training with skills in emergency medicine, critical care, obstetrics, anaesthetics and psychiatry, Dr Salleras Fellowed as GP in the mid-1990s. Now more than 25 years on, and after supervising countless registrars in general practice, he has taken on the role of lead medical educator for the JCU GP training Cairns region, covering Cairns and its rural surrounds.
The move into medical education has been something of a natural progression.
“I have found working as a rural generalist throughout my life has been consistently challenging, frequently taxing and exhausting, and always constructive. In pretty much every consultation there are things you can do that have a useful effect on the patients’ wellbeing,” Dr Salleras said.
“I believe in the positive role that we can play, and I’ve always enjoyed teaching in general practice, even though we are always very busy clinically. I was always interested in getting into training and having dealt with JCU as a supervisor, it was clear that it was going to be a good organisation to work with.”
A year into his new role, Dr Salleras can’t speak highly enough of the program and its focus.
“It is a remarkable organisation. The fact that it is so focused on the goal of producing rural GPs for Australia is great. It’s producing doctors who are very well trained and who are likely to stay and be happy to work and live in rural areas,” Dr Salleras said.
“The energy and resources tend to be very well directed to ensure registrars get what they need to become great doctors for their jobs, while also helping them develop the wisdom and understanding they need to ensure they don’t destroy themselves during their big careers.”
Dr Salleras sees his role as very much that of mentor and facilitator to ensure registrars have the information they need to make informed choices about their careers.
“With the water under my bridge I can say well this is my personal viewpoint and take it or leave it, but this was my personal experience with this choice or with that choice. In many ways it’s sharing that vulnerability of saying I did this, it didn’t really work for me, but it may work for you. Or, I tried this, and it was great.”
He’s also committed to ensuring registrars don’t cut off their options and box themselves in too early in their career. He’s keen for them to have the opportunity to explore all their options before making big decisions.
“The range of options to do interesting stuff is extraordinary, especially for rural generalists, they don’t want to limit themselves. Especially when people are younger and earlier in their careers, they have the opportunity to do things that they may not later in life.”
Having experienced ﬁrsthand the shortage of doctors across rural communities in the north he is keen to open registrars’ eyes to the experience of ‘going rural’, both for sake of their career development and to support communities in need.
“Over the past 20 years there has been a doubling of medical students and medical schools, yet we are still stuck for doctors in non-urban areas. I ﬁnd it quite distressing to witness. If I was a doctor living in an urban area, I don’t think I would do general practice. I don’t think it would push my buttons. The scope of practice in rural areas is far more rewarding.”
“I do encourage those in the Cairns training area to consider heading rural. People can get a fantastic experience in these places along with the chance to live in a different style of community. I have a lot of registrars that if they spend time in places like Tully and Innisfail a decent proportion of those will stick. So getting registrars into those areas is pretty crucial.”
Another focus for his role is working to ensure the excellent collaboration between the program and the practices and hospitals where registrars train. Having been a supervisor for many years he saw how helpful the program was to work with. And he has the utmost respect for the job supervisors do juggling their training role and clinical work.
“We have an excellent relationship with those practices and hospitals that do the heavy lifting in the training. We aim to provide everything they need by way of support and nothing they don’t. We understand that supervisors are bloody busy, we also know they need them to be able to turn up and consistently provide high-quality teaching for high-quality doctors,” Dr Salleras said.
“It’s about being helpful, maintaining mutual respect, and ensuring we are always on the same page.”