Kathryn Dickson, Medical Student, 2018

Third year ANU medical students spend 6 weeks undertaking a rural placement to learn about the benefits and challenges of working away from tertiary centres.  I was lucky enough to spend my rural rotation at Main Street Medical Centre, a GP practice located in sunny Merimbula on the southern NSW coast.  This medical practice has a strong focus on teaching junior doctors and students and I was given many opportunities to get hands-on experience.

A typical day would involve observing my clinical supervisor, Dr Nick Theris, treat patients for a broad range of conditions, from simple colds to mental health presentations to complex chronic conditions.  These observations gave me a deep appreciation of the types of patients who present to their GP, as well as insight into management strategies.  I was also able to observe consults at the weekly skin cancer clinic, improving my ability to recognise various skin lesions.  Whenever possible I was given the opportunity to parallel consult and see patients on my own before presenting their case to Dr Theris.  This experience was incredibly valuable and my history taking, physical examination, clinical reasoning and basic management skills vastly improved.  I was also given the opportunity to learn and practice basic practical skills under supervision, such as immunisations, simple excisions and suturing.

Multiple teaching sessions for the GP registrars were run weekly, involving discussions on interesting cases, teaching on various topics and practicing consultation skills.  I was able to attend and participate in these sessions, which were a great learning opportunity.

Overall, I had a fantastic time as a student at Main Street Medical Centre.  The staff were incredibly welcoming, and Dr Theris and the rest of the team went out of their way to facilitate a beneficial learning experience for me, with my clinical knowledge and skills improving dramatically as a result.  Merimbula itself was a beautiful town to spend time in and I look forward to returning in the future.

Kathryn Dickson,
Yr 3 Medical Student ANU
2018

Jonathon Gardner, Medical Student, 2017

To Dr Theris and the Merimbula Main Street Medical Centre,

Firstly, thank you for your hospitality and mentorship while I have been on my 6-week rural medical placement in Merimbula. I’ve thoroughly enjoyed my time over the last few weeks and have found it a useful and valuable experience in my training pathway. As someone who is genuinely considering a career in general practice, this experience has re-energized me and given me much to think about going forward.
I found my time at the practice beneficial for a number of reasons. I was given responsibilities that I was ready to take on as a phase 2 medical student, and I felt like I was incorporated into part of the team as a necessary and valued member of the team. I was given patients of my own to assess and manage, and felt that this independence made my experience valuable and well-spent. I was grateful for the trust given to me by the practice manager and the doctors at the practice, and felt like my learning could be accelerated for this reason. I understand that the doctors and staff at the practice made a special effort to accommodate me, and for that I am grateful.

The practice has a sound teaching philosophy – letting students learn by getting them take a proactive approach and take on responsibility within the practice. Through a careful and well-supervised approach, I was able to consult my own patients and develop my skills within a real working general practice. There was always support available when I felt out of depth, and I was grateful that I was free to work within a safe and supported environment.

Thank you again, for the time and effort you have put in over the last 6-weeks to help me achieve my goals and develop my skills in general practice. I will remember my time here in Merimbula with great fondness.

Kind regards,
Jonathon Gardner
Year 3 Medical Student U5742034
The Australian National University
2017

Dr Sanjay Zanak, Registrar, 2017

I started work in Merimbula in February 2017 with excitement in this picturesque coastal town of NSW. Soon I began to explore the walk ways along the cliff and the lake with a few beaches.I arrived when the town was bustling with summer tourists. The atmosphere was relaxed, friendly and their seemed to be a sense of calmness. I learnt about travel medicine and the aspects of care involved with one off consultations and communication of test results and follow up with the primary carer.

I work with a group of General practitioners with varied interests who made me feel comfortable through their warmth and appreciation of my experience and skills. I am delighted to be mentored by Dr Nick Theris my Supervisor who is professional, approachable, kind and considerate of the skills I need to improve and implement in my dealing with patients.

On Fridays we have an hour dedicated to difficult and undifferentiated cases. I find this session, enhancing my clinical acumen the most where we discuss baffling cases. With many minds working together, I am equipped with the ability to channelize appropriate care without being stressed of not having explored different options. I am fortunate to observe Dr Theris conduct skin check clinics and perform complex cancer excisions and aesthetic flap reconstructions with excellent results. The challenges of limited Specialist services in close proximity, has helped me to step out of my comfort zone, accept challenges and provide adequate care in the interim.

I have two Registrar colleagues and we have formed a study group to help us prepare for the FRACGP exams with Dr Theris facilitating us. Support staff have been very friendly, helpful and accommodating. I am thoroughly enjoying this term and look forward to ongoing learning.

Dr Sanjay Zanak
2017

Dr Kal Bhide, Registrar

GPT registrar from Feb. 2016
Currently working at Main street medical Centre, Merimbula
Supervisor – Dr Nick Theris

I have worked both GPT1 and GPT2 terms at this practice. It was my first experience of general practice and I was apprehensive at the beginning.
Fortunately this practice has been really excellent in changing my perspective towards general practice.
The level of teaching and supervision, support and mentoring has been excellent as I navigated my way through this new area of medicine. It helped me to be more effective as a GP and more confident in managing patients.
It gave me a very sound understanding about basics in general practice and perspectives about prevention of illnesses.
The team at this practice also have been fantastic.
The atmosphere is friendly and supportive with great teamwork.
The town of Merimbula and surrounds offers a fantastic lifestyle.
I would wholeheartedly recommend this practice for any aspiring GPT registrar.

2016

Tze Hao Wong, Medical Student,  July 2016

Feedback for Main Street Medical Centre

Feedback will be divided into two aspects: Academic and Social
Academic
⦁ Variety of cases
⦁ 7 different doctors to observe, that gives a bigger variety of cases to see. And not to mention that every doctor’s consultation has a different style to it. We as students are able to pick out things we like and learn them.
⦁ Sitting in with Kal, we went back to basics during our discussions about a case, I was able to follow her train of thoughts as well so it was a big plus to sit in her consultation.

⦁ Established Practice
⦁ It’s a really busy practice, you don’t go by a day without at least seeing 10 or more patients.
⦁ The fact that it’s an established practice, patients are more keen on students seeing them given that they are familiar with the treating doctor.
⦁ Practical skills
⦁ Loved that I got to do a lot of immunisations and INR with Cass, there are lots of soft skills and little tricks that I got to learn from her. Like rubbing  the baby’s chin when giving oral immunisation to encourage swallowing.
⦁ Pap smears are a plus even though we are not really expected to learn them this term, but it’s still worthwhile doing them.
⦁ Skin cancer excisions are great for practicing suturing and handling the scalpel. We don’t get many opportunities to practice this at any other places.
⦁ Physical Findings
⦁ It was great when I had the chance to verify my physical findings with any doctors around. Thing is when we’re out in the hospital we have no one to correct us or even confirm what we’re doing is right.
⦁ Differentiating between creps and transmitted noise from nose is also difficult so it’s very reassuring that someone always ask me: “So what did you find on auscultation? “

⦁ On the go teaching
⦁ Love that we can have a discussion while the consultation is still ongoing or even after that, sure beats having a 1 hour lecture about physiology etc.
⦁ It is confronting when being put on the spot while the patient is still there, but I think I’ve gained a lot from that because I would be motivated to make sure I can answer those questions.
⦁ Eg: 67 year old female traveller with no significant medical history who was in a long car ride presented with Chest pain.
“What do you want to know Hao?”   Loved this because it makes me think on the spot.

Social
⦁ One big family
⦁ Main Street feels like one big family to me. There’s always someone watching your back. There’s so much laughter and warmth going around the whole practice. It doesn’t take one to be working in the practice to notice this, I’m sure the patients would even agree.
⦁ All staff members were extremely hands on when being asked for help.
⦁ Drinks/Outing on weekend
⦁ I don’t think any other practice does this. Everyone was surprised to know that we went out drinking after work. I myself was surprised (very pleasant) when we went on the first week of my posting, because not only do I get to know you all on a professional level, I also get to know you guys personally. Which is a huge plus!

Tze Hao Wong
Medical Student ANU Year 3
July 2016

Alix Vivant, Medical Student, 2014

Clinical Placement at the Main street Practice, Merimbula

The postgraduate medical curriculum at ANU offers an exposure to general practice in its third year. This essentially consists in a six-week placement in an urban practice and a six-week placement in rural practice in regional New South Wales. I was given the opportunity to do my six-week placement in Merimbula at the Main street practice under the supervision of Dr Theris.

This proved to be my most enjoyable and beneficial learning clinical experience. In the absence of clear learning objectives to guide this clinical placement, Dr Theris and myself established a list of learning outcomes to achieve and clinical skills to practice throughout my six week placement. My clinical experiences included a variety of tasks. I attended some of Dr Theris’s consultations with patients, whereby he would explain interesting cases in details. I was also given the opportunity to initiate consultations with patients independently, taking a history, performing an examination and formulating a management plan, which I would then discuss with Dr Theris. Other general practitioners working at the practice would also kindly show me interesting cases to assist my learning.

I was lucky enough be able to perform numerous procedures including punch biopsies and excision biopsies, under Dr Theris’s supervision which was really helpful in terms of learning basic suturing skills. I was also able to practice venepunctures on a daily basis.
Dr Theris kindly arranged that I attend some of the visiting specialists’ clinics held at the practice which was a great learning opportunity. I also was invited to join Dr Theris and his team to a local three-day symposium on current medical issues including an accreditation course in advanced cardiac life support.

Overall, this general practice experience in the rural setting was by far my best and most rewarding clinical experience as my needs as a student were carefully taken into consideration and every staff member at the practice made sure that these were met. I gained a lot of clinical skills throughout these weeks and I met some great people who made me feel like I was part of a team.. I also learnt about the real challenges that general practice is faced with in a rural setting and was taught how to look at the delivery of clinical medicine from a different angle under such circumstances.
None of my other clinical experiences have lived up to the high expectations that I have set since my placement at Dr Theris’s practice in Merimbula, which made for a very positive, encouraging and supportive learning environment.
I am very grateful for this enriching placement and I believe this type of clinical learning experience is the gold standard for clinical placements for medical students.

Alix Vivant
2014

Dr Nathan Dawe (MBBS,FACRRM,DCH ), Registrar, 2013

Working at Main Street Medical Centre. Merimbula.

I initially commenced work at Main Street Medical Centre in early 2012 as a vocationally registered GP under the rural local relief program, 2 years ago I enrolled into the ACRRM independent pathway for fellowship and achieved my fellowship this year.
I have worked part time throughout the last 4 ½ years, working 2 days a week at the GP clinic, and 3 days a week at Bega hospital.

During my time at Main Street Medical Centre there has been a lot of changes and growth, initially being only 3 doctors, with only the practice principal Dr Nick Theris having his fellowship, with now a team of 7 doctors, 4 of which have full fellowship, (2 RACGP, 2 ACRRM)
I have gained a great deal of knowledge and experience, mostly thanks to the practice principal Dr Nick Theris, with over 25 years experience in rural medicine, both general practice and extensive work at the hospital, Dr Theris has been an excellent source of wisdom, and has always been available and approachable for advice, either “on the run” or during dedicated teaching times. He has not only provided excellent clinical advice and supervising and also been happy to share his wealth of knowledge about the running of the practice, both the day to day business work, and the strategic planning. Even when I was quite junior, I always felt my opinion was welcome and valued, and this only increased with my own experience gained through my work at the practice. Regular meetings provided all members of the team to share ideas, both clinical and organisational, which was a very rewarding process to be a part of.

The patients at Main Street Medical Centre are a lovely blend of ages and demographics. Most of them are very keenly interested in their health, and quite happy to take advice, and proactively engage in their care. This serves to give a great deal of job satisfaction, and it is very easy to develop a genuine connection to patients, who you often run into down the street. The real feeling of holistic, ongoing family care and ownership of patients is strongly encourage at Main Street Medical Centre, giving a truly rewarding sense of true rural family general practice.
The practice itself is situated in the middle of town, with on site access to radiology and pathology. This very close relationship, both geographically, and professionally, aids in providing care to patients, allowing cases to be easily discussed directly with appropriate services.
The Main Street Medical Centre staff are an excellent group of professional people, who work very hard to provide professional service to the doctors they look after. We have a great working relationship with the staff, being able to rely on them to assist us, and also ensure we are not overburdened. Owing to our large population of regular patients, the staff know many of these patients, and so they feel very welcomed, which serves greatly to enrich patients experience at the practice.

In summary, I have thoroughly enjoyed my training at Main Street Medical Centre, and plan to remain there for the foreseeable future, as it has a real family practice feel about it, not just the patients and their families, but also amongst the staff and the doctors.

Dr Nathan Dawe
2013

Dr Dilini Pelpola, Registrar, 2012

Hi Nick,

As you know I am currently doing my Gp training through GP synergy , one of the RTP’s in Sydney. I wanted to thank you for the experience , support and guidance I received during my time at Main Street Medical Center from 2008-2012. Its given me a strong foundation for my formal GP training.

Now that I’ve worked at a few accredited training practices , I can confidently say that Main Street compares very favourably and sometimes surpasses some of these. Your practice is run very efficiently and the staff from practice nurse , practice manager to reception staff are very supportive and were always willing to help me and teach me.

You were always available for advice and never hesitated in coming in to review patients or sit in with me and teach , even during busy days. I remember the after work teaching sessions and the days you took the time to go over interesting cases that you had seen as well. You have such a great patient mix too. A good case mix from paediatric to geriatric, minor surgical to antenatal and mental health.

I remember having no general practice experience when I started there and you gave me a chance. Its with your support that I have become confident with assessing and managing patients and more importantly building a rapor with patients. Working at Main Street helped me to understand what kind of a doctor I want to be.

I am hoping to sit the FRACGP exams next year . I have to say that the majority of experience and knowledge I’ve gained about general practice , from the management aspects of critical and chronic illness , to communicating effectively , to the legal and administration side of general practice and being an effective advocate for my patients , I learnt working with you and your wonderful team.  I hope one day you will consider training other registrars and potential registrars , like me as I am sure that anyone who experienced what I did , working there would benefit greatly and come out as highly effective and confident future GP’s.

Kind regards and warm wishes to you and all the wonderful staff at Main Street Medical Centre

Dr Dilini Pelpola
2012