Dr Mike Mears: "Eight years on, the Rural Clinical School has achieved a great deal. Progress is being made to increase the number of rural doctors"

‘Doctor’, I vaguely remember, comes from the Latin verb ‘docere’, meaning ‘to teach’. The teaching role of the doctor was inculcated early in my professional life in London but the registrars were bitter and struggling up an impossible career ladder and the consultants were distant, austere and taught by anecdote. Clinical reasoning and evidence based medicine were largely unknown. Simple humanity was lacking. I left my medical school with a cynical mind and no role models, on a nomadic career path towards general practice that eventually found me in rural Western Australia. Whereas in England I felt my clinical skills atrophy under a load of administration, in rural WA doors kept opening and the opportunity presented itself, to open a Rural Clinical School site in Esperance and teach medical students.

If I could stay one step ahead of the students, this was a great opportunity to learn all the medicine I hadn’t been taught in London! And maybe I could be their role model, in contrast to my experience as a student – my professional career was now varied and fulfilling, home life great, and the recreational opportunities exceptional.

Eight years on, the Rural Clinical School has achieved a great deal. Progress is being made to increase the number of rural doctors although the lead times are long. We have had a number of graduates in the Prevocational General Practice Placements Program (PGPPP) working in Esperance and next year we welcome back one of our previous students as a GP registrar.

But the relationship is dynamic and many of the benefits of moving undergraduate teaching to the country have been subtle but no less welcome. Less often do I feel that yawning cultural divide as I phone a specialist registrar in the city to be told ‘just send them to the clinic tomorrow’; often now I’m speaking to one of my ex-students who understands perfectly my patient’s situation, and mine. An understanding of the geography of WA is essential to the practice of medicine here. I know that better than most having spent my first three years in WA as a ‘Flying Doctor’.

Specialists have become colleagues, with much greater mutual respect after my years of examining students in both the city and country. This will only increase as more specialists have country experience.

The students have wrought unexpected benefits; my rurally educated children have had role models in the students and are now moving into their own university careers. GP colleagues who were becoming tired and burnt out have developed new career opportunities.

The Rural Clinical School has shifted the focus of medical training not only to the country but also into primary care. It never made sense to me that medicine was learnt on the rarest and most unusual teaching hospital cases and the bulk of human suffering was never seen as it never reached such hallowed environments. Surely it makes more sense to learn medicine from the ground up rather than top down? Build the foundations first and then add the wings, turrets, gazebos, the follies and hahas later!

As my wife remarked after she delivered specimens to our ED and noted three students busy there, one with the ophthalmologist, one examining a patient, and another stitching up his preceptor who had cut himself with an angle grinder, plus the ex-Rural Clinical School doctor setting a fracture; ‘These students have breathed life back into this place - it feels like a real teaching hospital’.

The good news is, all our country hospitals are now ‘real teaching hospitals’ and this is because of the students, the teachers and those with the vision to make it happen. Why was it ever otherwise?