S01E5: What is regional medical school and pathology practice like?

Hosted by RCPA Vice President, A/Prof Trishe Leong, Micro Waves is a Pathologist Cut spin-off exploring the fascinating careers in pathology.

In the fifth episode, we chat with Dr Kim Cheah, and Dr Phillip Steele. Dr Cheah is an anatomical pathologist working in a regional area. Dr Phillip Steele is a GP and is director at The Border Regional Training Hub, located in the Border region of Albury-Wodonga, and affiliated with the Rural Clinical School of UNSW. 

Transcript

00:00:00:03 - 00:00:07:01

[Dr Phillip Steele]

As a GP, I see pathology as a branch of medicine, which takes a deeper look into the body.

00:00:07:07 - 00:00:13:00

[Dr Kim Cheah]

I think pathology is a real hidden gem of a of a career path.

00:00:14:12 - 00:00:22:08

[A/Prof Trishe Leong]

I'm Associate Professor Trishe Leong, anatomical pathologist and vice president of the Royal College of Pathologists of Australasia.

00:00:25:09 - 00:00:32:04

[Voiceover]

Find your path to pathology with the RCPA Micro Waves podcast.

00:00:34:03 - 00:01:00:03

[A/Prof Trishe Leong]

Hi everyone and welcome to another RCPA Micro Waves podcast. I'm Associate Professor Trish Long and anatomical pathologist and Vice President of the Royal College of Pathologists. And today I'm delighted to have two guests on the podcast, Dr. Phillip Steele and Dr. Kim Cheah. Phillip Steele is director at the Border Regional Training Hub for Uni, New South Wales Rural Clinical School at the Albury-Wodonga campus.

00:01:00:12 - 00:01:23:06

[A/Prof Trishe Leong]

He completed his GP training early in his career and has special interests in obstetrics and paediatrics, having completed training positions in the UK prior to commencement in Wodonga, Phillip is an advocate for medicine as a career and is particularly passionate about training in regional areas. He loves spending time in the great outdoors. He's a keen trail runner, a cyclist and kayaker and living in a regional area.

00:01:23:06 - 00:01:52:10

[A/Prof Trishe Leong]

It means that all of these activities are available close to home. Bonus. Dr. Kim Cheah is an anatomical pathologist who completed his medical studies in Perth and now resides in regional Victoria. As pathologists in charge at Dorvich Pathology, Albury, Kim freely shares his pathology knowledge with students and junior doctors and often has them on lectures. Kim's a member of the Victorian State Committee and examiner and enjoys the challenges and opportunities of regional pathology practice and outside of work.

00:01:52:10 - 00:02:05:05

[A/Prof Trishe Leong]

He enjoys spending time with his young family, amateur photography and thinking about such things as how new technology could influence the future of anatomical pathology. Kim That's way too heavy. Welcome, Phillip and Kim.

00:02:05:14 - 00:02:07:02

[Dr Kim Cheah]

Thanks.

00:02:07:02 - 00:02:13:13

[A/Prof Trishe Leong]

Just kicking off and we asked this to everyone. Kim, what is pathology to you?

00:02:15:00 - 00:03:05:03

[Dr Kim Cheah]

Oh, that's a pretty broad and open question. I think. But I guess for me, on multiple levels that are philosophically, I think pathology is seeing the world as it is and sort of going down into sort of higher power, scientifically, things that deviate, normal processes, biological processes deviate and then medically from a work perspective, you know, the identification of abnormality with sort of scientific rigor and responsibility of making a diagnosis and clear communication of that to our clinicians from a medical student and junior doctor point of view, it's a fundamental part of medicine that's not really appreciated until later on in the career.

00:03:05:03 - 00:03:07:11

[Dr Kim Cheah]

So I think that's why podcasts like this are really important.

00:03:08:01 - 00:03:15:11

[A/Prof Trishe Leong]

That's awesome Kim.  It's great, it's good to have a non-pathologist perspective on the podcast for change. What's pathology to you as a as a clinician?

00:03:16:03 - 00:03:51:00

[Dr Phillip Steele]

Yeah, well essentially and I was thinking about this before and you know, again, like Kim says, I mean, to me as a, as a GP, I see pathology as a branch of medicine which, you know, takes a deeper look into the body and in, you know, both, both histological terms and chemical in terms of viewpoints and really assist me in my work as a GP and in looking after my patients and, you know, pathology.

00:03:51:04 - 00:04:39:11

[Dr Phillip Steele]

But the pathologists and the scientists who work with pathologists and are very much part of the team of people that provide information to clinicians in order to assist them to look after their patients. Well, the relationship that clinicians in rural and regional areas have with their fellow clinicians in those regions and pathology is no different here because I know on multiple occasions over the years, if I've had concerns about a, you know, a blood test result or his type of I just bring up the local pathologist who I know and have a discussion about it.

00:04:39:11 - 00:04:55:10

[Dr Phillip Steele]

And it's, you know, it's that sort of close relationship that can happen. And that's a GP level. And clearly at, you know, surgical level or oncology level is their relationship is much closer and it's a really strong personal relationship and it and it really works and enhances patient care.

00:04:56:04 - 00:05:21:02

[A/Prof Trishe Leong]

Finally got a non-pathologist point of view. Yeah so, I've got a terrible confession to make to two people who work in rural practice. When I did my training, I remember choosing where to go to based on providing, it was within 20 minutes of where I lived at home. So open my eyes, open my eyes and open the listeners eyes.

00:05:21:05 - 00:05:38:06

[A/Prof Trishe Leong]

We want to know about what it's like to, to, to work in a regional area and what's, what's fantastic about it, what attracts you to it. So Kim, maybe you can kick off with telling us about as a pathologist working a regional area, how did how did that come about after all, you know regional Victoria from Perth.

00:05:39:05 - 00:05:41:15

[A/Prof Trishe Leong]

Yeah. Heads I'll start for you. And what do you like about it.

00:05:42:06 - 00:06:20:07

[Dr Kim Cheah]

Yeah. So I was born and raised in country Western Australia, in Kalgoorlie. So the idea of just being regional wasn't a new thing. And so the way I ended up skipping across from Perth was just because there was a pathologist in charge position available in Albury-Wodonga. So that's how I landed here and I ended up sharing an office with the previous head of department here who recommended as a role in terms of seeing if I like the idea of being there.

00:06:20:11 - 00:06:36:02

[A/Prof Trishe Leong]

So you've worked in both you would have done your training I guess in in Perth, maybe done some train training regionally, worked regionally. Now what's the difference? What do you find the differences between working in metro versus regional?

00:06:36:02 - 00:07:02:09

[Dr Kim Cheah]

Well, as much as possible from just a sort of from the work perspective, from the day-to-day work perspective, we try to aim for as many as minimal difference as possible. We try to seek sort of regional and metropolitan equivalents. So anything that every metropolitan patient would receive in terms of their pathology, we try to do exactly the same thing.

00:07:02:09 - 00:07:34:12

[Dr Kim Cheah]

So we try to take sort of location out of the equation from a patient perspective. But from the pathologist’s perspective, I'm pretty much all of the benefits of living regionally, which include being in this beautiful environment, having really short commutes, being able to spend time with your family, all of those all of those things are also available living regionally.

00:07:36:00 - 00:07:42:06

[A/Prof Trishe Leong]

Haven't you, Philip? Can you tell us a bit about your role in regional medical training and how that works?

00:07:42:09 - 00:08:20:10

[Dr Phillip Steele]

Well, that's it's a bit of a long story, Trish, but it's something, you know, I but I actually I grew up in Melbourne, I went to Melbourne Uni but I always wanted to be a rural GP and, and, and so that at the first opportunity which was intern year, I came to Albury and, and spent a fantastic year there immersed in medicine in Albury and then as you say before went to the UK and did my obstetrics and paeds and emergency medicine training for a few years over there and then came back.

00:08:20:10 - 00:08:47:09

[Dr Phillip Steele]

And so I've been a GP ongoing for the last 40 years or so and, and you know, doing a lot of GP obstetrics and looking after young families and that that's in the last few years I've been backing out of that and, and I was tasked by one of our local surgeons if I would become involved with you in this town to use regional training hub when it was first set up about five years ago.

00:08:47:09 - 00:09:21:13

[Dr Phillip Steele]

So that was a bit of a, you know, a transition period for me. So I was able to spend less time in in GP land and more at the university. And over the years I've seen the fantastic training opportunities that are available in regional areas and particularly here. So under-utilised over the years. You know I think can people just have appreciated the quality of the training that's available in regional areas and nor have they seen the, you know, the numbers of training posts that are really that that are here.

00:09:22:00 - 00:09:42:14

[Dr Phillip Steele]

I don't know if you know the history of regional training hubs, but they were, you know, established about five years ago by the Commonwealth Department of Health, has about 26 of them in Australia and we're all attached to them. Rural clinical schools. The job of regional training hubs, among other things, is to promote these training opportunities and develop further training opportunities in rural and regional areas.

00:09:43:02 - 00:10:21:02

[Dr Phillip Steele]

So, you know, it's I've always been involved in GP training for many, many years and medical student training and this is just another, you know, extension of that. And looking at other specialty areas such as pathology and anaesthetics, physician training, surgical training, all sorts of, you know, training pathways which are here available virtually go if we can just change that mindset around that, you know that the quality of the training to know that the quality of training is actually can be better in regional and rural areas than it is in metro.

00:10:21:02 - 00:10:42:13

[A/Prof Trishe Leong]

Mm. Yeah. Do you want to elaborate a little bit more on that. I mean I agree. I think people who work in the rural areas, there's a wealth of knowledge there that genuinely, I think to work in the rural area, they're usually genuinely passionate about, about the region and doing the best for the region. How does how does regional study differ from studying in the metro regions?

00:10:43:07 - 00:11:25:02

[Dr Phillip Steele]

Yeah, well, I think well number one, the smaller groups student cohort might be, you know, 40 or 50 students in all the years. So, you know, tutorial groups are smaller teachers generally, you know, very experienced consultants who are, you know, dedicated to teaching the hands on practical stuff is so much created, like the opportunities for students and junior doctors to be involved in in, you know, significant procedural skills, much better in regional and rural areas because, you know, you don't have the number of more senior people getting in the way of the junior doctors.

00:11:25:02 - 00:11:52:06

[Dr Phillip Steele]

Do you know, I've been there as a as a as an internship intubating patients in my first anaesthetic term on day two of my term. You know, it was it was that. And it's that sort of that sort of level of involvement with the consultants, particularly that and the GP is when they're people are working in general practice, you know, that sort of level of connection with the specialists is fantastic.

00:11:52:06 - 00:11:53:09

[Dr Phillip Steele]

And from the learning point of view.

00:11:53:12 - 00:12:14:14

[A/Prof Trishe Leong]

I've got to remember who's paying the wage. So we've got to get back to pathology. I'll put you on hold. Philip, back to Kim. You mentioned Kim, you know, you when you first came to  regional Victoria, you know, you were trying on the role of director of the department to so you see if you like to say, well, see what you found made of it, obviously you must have liked it because you stuck around.

00:12:15:04 - 00:12:24:03

[A/Prof Trishe Leong]

So can you tell can you tell us a bit about what the pathologist in charge does in a in a practice like yours on a sort of everyday, everyday basis?

00:12:24:10 - 00:12:52:00

[Dr Kim Cheah]

So this big picture point of view for my role is just to ensure stability of the service needed to be addressed when I first started. So that includes making sure that we're appropriately resourced for the amount of work that was coming through and to also make sure that pathologists were only getting as much as they could comfortably and safely handle in terms of workload.

00:12:52:02 - 00:13:14:04

[Dr Kim Cheah]

The registrar to make sure that the registrars as part of their training were adequately supervised as and were working hard but not getting overworked as part of their service work. So a lot of managerial, administrative type things as well, which takes up a lot of time. But as well as on top of that, just a normal pathologist reporting.

00:13:15:10 - 00:13:19:08

[A/Prof Trishe Leong]

And what I mean, what do you enjoy about it? What drew you to it?

00:13:19:15 - 00:13:22:08

[Dr Kim Cheah]

Yeah, that's a great question. I actually don't know. Like, it's just.

00:13:23:04 - 00:13:24:15

[A/Prof Trishe Leong]

Some days you hate it? Sometimes. Yeah.

00:13:25:01 - 00:13:44:07

[Dr Kim Cheah]

Yeah, it's really, it's really just something that I feel compelled to do in terms of just my sphere of responsibility, where I feel like if I can make a difference, then being able to push that sort of across as broad an area as possible, then, then that's what I'll one I'll do.

00:13:44:10 - 00:14:06:05

[A/Prof Trishe Leong]

Yeah, I think, I think that's absolutely right. You know, even though some, some days might be ghastly, you know, you're making is you're making a difference in what you do. So maybe I'll, I'll swing it back round to Phillip then. You know, you're also in charge of the border regional training hub, as you said. Oh, how did how does that pan out?

00:14:06:05 - 00:14:09:08

[A/Prof Trishe Leong]

Over a usual day. What do you what do you have to deal with?

00:14:09:15 - 00:14:37:10

[Dr Phillip Steele]

I will tell you that. But just one thing that Kim just said and reminded me a bit of a comment at that regional training hub, most recent meeting where, you know, I have a number of clinical aides who are part of our team and we were talking about, in fact, this podcast and that I was going to be involved in this and promoting pathology as a and helping to promote pathology as a as a career for our students and junior docs.

00:14:38:02 - 00:15:07:04

[Dr Phillip Steele]

One of these clinical aides who is an oncologist but quite eloquently about the importance of pathologists in his work, you know, cancer management nowadays, you know, probably never was able to be done without the involvement of the pathology team. And particularly, you know, as the advanced techniques in pathology have been developed in recent years. He was just saying to us that it just has made such a difference to his life.

00:15:07:08 - 00:15:42:05

[Dr Phillip Steele]

And so the you know, that their close involvement with the pathology team was vital to his ability to do his job. So, you know, and, you know, I guess you would probably find and find those same sorts of comments from any oncologist around the traps now, you know. Yeah, you need it and the and the multidisciplinary team meetings where, you know, you guys are part of that with the surgeons and the physicians and the, you know, the radiologists, etc. and the GP's for that matter are really good meetings where you can all share ideas about how to look after that patient as well as possible.

00:15:43:12 - 00:15:46:04

[A/Prof Trishe Leong]

Oh that's great to hear, Philip. Thank you. Your cheque’s in the mail.

00:15:48:06 - 00:16:09:02

[Dr Phillip Steele]

And my job as a as a reasonable training director was really just one of those ones where you know, it's a part time role but gets jammed into bits and pieces around every day. But a lot a lot of that working with other training hubs to encourage governments and specialist colleges to really make the most of this training opportunity.

00:16:09:02 - 00:16:35:14

[Dr Phillip Steele]

Yeah. Again, as I said before, there's been a bit of a, you know, metro centric approach to medical training in general. And we're trying to really make the point that if we're going to do to try and solve this, you know, rural and regional workforce shortage and, you know, pathology is no different from this. And we need to be getting new doctoral students and junior doctors to be doing as much of their training as possible in regional centres.

00:16:35:14 - 00:16:58:07

[Dr Phillip Steele]

And then hopefully rotating to Metro rather than the other way around. That clearly that's not going to happen for all postgraduate training. But the more of it that happens, the better, the better will be lots of meetings and conferences, etc., and phone, phone calls and meeting with junior doctors and students to try and find out what they want to look in.

00:16:58:07 - 00:17:09:10

[A/Prof Trishe Leong]

Back to you Kim. As an anatomical pathologist working in the regions, what traits do you think? Does someone need if they're going to be in this sort of role?

00:17:10:02 - 00:17:50:10

[Dr Kim Cheah]

So I guess for AP in particular, I think something that's really important for regional pathologists is to be able to articulate their level of certainty or uncertainty with regards to certain diagnoses. If something is just landing on suspicious or if it's an outright diagnosis, I think that's really important to be able to convey both on paper through your report, as well as when you're speaking with the clinicians on the phone, because it's much better to be able to convey if something's not a clear picture of and if something needs to be for a biopsy it rather than making an incorrect call.

00:17:51:10 - 00:18:08:03

[A/Prof Trishe Leong]

Phillips busy getting the medical students into the regions. And then we want to get the medical students in the regions into pathology. So I know, Kim, we mentioned you take junior docs and students on lab tours. How else can the student, can they find out more about pathology?

00:18:08:08 - 00:18:27:12

[Dr Kim Cheah]

Yeah, I think visiting a lab is really important to where we are. Unfortunately, the histo lab isn't on site in the hospital, it's off site. So we don't have that sort of direct presence like a lot of the larger sort of metropolitan centres would do where a lot of surgical teams would just swing by the pathology lab.

00:18:27:12 - 00:18:39:01

[Dr Kim Cheah]

So we haven't got as much visibility. So if anyone's interested then to contact your closest lab through the US paper website is probably the easiest way.

00:18:39:11 - 00:19:02:01

[A/Prof Trishe Leong]

I think the college always likes us to put in a plug as well for the student scholarships. If you if you're keen the scholarships are available through the college. The it always seems odd to recommend that students do an exam, but the basic pathological sciences exam, though, is a great basis for any med student going into any specialty really.

00:19:02:01 - 00:19:21:07

[A/Prof Trishe Leong]

It's good to know more about basic path and you'll get your credits for a number of the of the of the different specialties. And if you can't make it to a lab, there's always the option of virtual pathology electives. If you go if you Google virtual pathology elective, you'll feel that you'll find some options online for people who are interested.

00:19:22:09 - 00:19:37:10

[A/Prof Trishe Leong]

So I'm going to I guess we're going to monitor now the number of applicants we get for the pathology in Albury. So, Kim, any final words for a medical student considering a pathology career?

00:19:37:10 - 00:20:06:06

[Dr Kim Cheah]

Well, I'd say with all medical students, you can use your consultants as time machines to see into the future because pathology or medicine in general is such an encompassing sort of career that it invariably sort of shapes your life. So if you if you swing by a laboratory and say what the pathologists are like, then you will be able to tell for yourself as to whether or not it's something for you.

00:20:06:09 - 00:20:14:01

[Dr Kim Cheah]

And I think pathology is a real hidden gem of a of a career path. So it's definitely worth checking out.

00:20:14:13 - 00:20:30:12

[Dr Phillip Steele]

And that little message that I give to medical students and particularly junior doctors and registrars that are training with me, is that when you're filling a pathology form, remember that the person who is reading it is a doctor.

00:20:30:15 - 00:20:34:12

[A/Prof Trishe Leong]

Oh Phillip, you're a legend and I love it.

00:20:34:12 - 00:20:46:02

[Dr Phillip Steele]

And so I give them a clue. Think and think if your colleague at the other end of the of the request form and if you give them some information, then they'll get better information back to you.

00:20:46:09 - 00:20:51:13

[A/Prof Trishe Leong]

That is a great message to get out there. We didn't even prime you, it’s fantastic.

00:20:51:13 - 00:20:54:02

[Dr Phillip Steele]

Yes, no, its one of my things.

00:20:54:02 - 00:21:06:14

[A/Prof Trishe Leong]

Think there's a there's a reason Phil's in charge. I feel more positively inclined towards the regions for sure, after talking to both of you. Thank you, Kim. Thank you, Phillip, for a great discussion and.

00:21:07:05 - 00:21:08:10

[Dr Phillip Steele]

Kim.

[Dr Kim Cheah]

Thanks.

00:21:12:04 - 00:21:20:08

[Voiceover]

To find out more about a career in pathology, go to rcpa.edu.au.