BEN SMYTH — COMMUNITY ENGAGEMENT PROJECT OFFICER
HENRY SUNDRAM — COMMUNITY ENGAGEMENT PROJECT OFFICER
Centre for cOMMUNITY cHILD hEALTH (CCCH) — THE ROYAL CHILDREN’S HOSPITAL
At the Centre for Community Child Health, we’re striving for equitable health and developmental outcomes for all children. The Centre has been committed to improving the lives of children and families for the past 25 years and we will continue to lead efforts to achieve equitable outcomes until this vision becomes reality.
The Centre provides leadership on the health and wellbeing of children aged 0–8 years. It aims to:
- improve development outcomes for Australian children;
- advance equitable health for disadvantaged children;
- and promote positive early life conditions for children.
Ben Harkin is a Fellow in Community Child Health, undertaking The Victorian Training Program in Community Child Health at CCCH.
This program provides clinical and theoretical training in developmental-behavioural paediatrics. Fellows develop individual learning goals for the year, and are paired with mentors who have expertise in clinical practice, population child health research, public health and policy development, and program development and evaluation. Moreover, an emphasis is placed on clinical training that occurs within community and specialist outpatient clinic settings.
What was your educational and career path like, and how did you eventually transition into medicine and paediatrics?
I had a very unusual path into medicine. I came to medicine much later in life as a mature-age student (early to mid-30s). Before that, I did a Masters of Public Health—which I embarked upon because I needed to do more tertiary education closer to applying for medical school and it seemed to be a logical thing to do.
But prior to my Masters, I hadn’t done any science or anything in that field since I left school. I went to Melbourne University and did an arts degree, then as I had an interest in the performing arts, I auditioned for different drama schools in Australia and attended the Western Australian Academy of Performing Arts. Following which, I worked for about 10 years as an actor, director and producer.
Then when I was in my early 30s, I was thinking about my future and what I would be doing in 10 years time, and I thought, ‘the thing I’m doing now, I’m done.’ And then I thought: ‘what am I going to do with the rest of my life?’ I rang some mates who were doctors and said, ‘I’m in my mid-30s, how do I become a doctor? Is it possible?’ They said, ‘sure, you have to sit the GAMSAT and can apply as a mature age student.’’ So that’s what I did. Remember that it’s never too late to shift to something else and that skills you have in one career can also be transferred to other careers.
Being a doctor isn’t just having a knowledge base—it involves patient relationships, working in management teams and hospitals.
I attended medicine at the University of Western Australia and they had a version of the course where we crammed in all the basic science stuff as a cohort of 60 mature-age students in seven months and then joined the undergrads in the clinical years. What was interesting about that cohort is that about a third of them were from non-science, non-medical backgrounds.
For me and others who don’t come from a medical background, the first seven months were just crazy—it felt like my brain was exploding every day, getting around concepts like the Krebs cycle and biochemistry. But once we hit the wards and began clinical work, those of us who had non-medical backgrounds started to feel a bit better and do quite well because our patient interactions were influenced by our life experience.
The moral of the story is that if you would like to change your pathway, be aware that you bring a lot of different things to your practice as a doctor. Being a doctor isn’t just having a knowledge base—it involves patient relationships, working in management teams and hospitals.
What advice would you give to medical students who are unsure about which fields they would like to pursue? More generally, what advice would you give to those who are unsure about which career path to follow?
The experience of a med student is that you never know anything because you’re always being asked by someone who knows more than you. I remember saying to one of these senior people, ‘I’m so sick of just feeling stupid all the time’ and he said, ‘Don’t worry, that’s your entire life in medicine; there’s always going to be someone in the room who knows more than you.’
What’s interesting about medicine though is that there’s a niche for every personality type and interest; it’s so broad. Because of that breadth, it’s impossible to know everything about everything. People have different approaches to this: some people prefer a more generalist approach where they get to do a lot of different stuff and have a certain level of knowledge across a broad base, such as general pediatricians and general practitioners, and then other people like to drill down and know everything about a particular field and subspecialise.
A useful thing to ask is: how does your brain work? Do you like to know a lot about a specific thing or do you prefer a more general approach? Then what type of medicine do you like to do: the kind of procedural-based, practical stuff; or more patient interaction?
The other important thing is to look at other people in the career that you’re wanting to pursue. This applies to everything in life, but with medicine, certain personality types are drawn to certain specialties. But also those specialties create a world that encourages that personality type. You can look at the physicians or surgeons that are in the area of medicine you want to go into and think, ‘Are these my people?’
Find something that you’re interested in and talk to people who are in the field. What’s their daily experience? What are the good things and what are the crappy things about the job? Because there will always be good things and bad things. For me, before working in developmental paediatrics, I couldn’t quite find my niche in medicine. When I started working more specifically in developmental paediatrics, I kind of thought, okay, here are my people. This is where I fit.
This applies to everything in life, but just to talk about medicine: certain personality types are drawn to certain specialties. But also those specialties create a world that encourages that personality type. You can look at the physicians or surgeons that are in the area of medicine you want to go into and think, ‘Are these my people?’
What is your typical day like? Does it vary or do you have a particular structure that you follow?
I’ll talk very briefly about a day in the hospital, which is not what I’m in now but what I’ve done for many years. As a junior doctor, you’re the one that often gets all the jobs done, you’re the engine that makes the team work. There are more senior doctors who are making management decisions and discussing with colleagues and deciding what investigations or other tasks might need to be organised by the junior doctors. They also coordinate the team and make sure everyone works well together. So that’s your basic nine-to-five day. There is also an after hours component in big hospitals, where you will be covering the care of patients from a number of teams that you may not necessarily be involved in on a day to day basis.
The work I’m doing now is more outpatient-based and so I see kids and families from a range of cultural backgrounds with very complex social backgrounds, lower socioeconomic status and trauma. These kids may have developmental/behavioral difficulties such as delayed speaking, autism spectrum disorder, behavioral dysregulation, ADHD, a whole lot of things. Basically, if someone identifies a kid who’s at risk of not developing, they come to me for an assessment and I try to work out what’s going on. I have a couple of days in a community clinic, one day involved in cases where children have a background of Child Protection involvement and another day working with mental health services.
So my current work is not about sick kids in the hospital. It’s not just getting them in, making them well and sending them home, it’s a much longer process. This is stuff where I see kids over months to years and try to slowly make improvements. Since every kid’s different, each child is a bit of a detective case to suss out and a large part of that is working with the families to understand their experience, and the child’s experience within the context of the family, school, larger society.
What was your journey like through training and how have these experiences influenced your practice?
For those readers who might be medical students, your exams are ongoing and you always continue to study and learn. Certainly, there are people in medicine who have incredibly bright minds and think in incredible ways, but there are also people who have different strengths. I don’t think you have to be a genius to be a doctor but you must be smart enough to know how to study and particularly be able to apply yourself consistently. One thing you need to get through medicine is to be able to persist because it’s a long slog.
In order to work well in this area of medicine, you have to recognise the toll it takes, and be able to offload and accept that. This is an important part of your training. It’s very enjoyable, but it’s also very intense.
In terms of training once you have graduated from medical school, most of our basic pediatric training is geared towards acute medicine (although interestingly enough, many general pediatricians working in the community will not see these acute presentations). The first part of training is fascinating but also very challenging. There are certainly some difficult times along the way in terms of really hard exams you need to pass, challenging patients and family interactions, and really sick kids.
Therefore it is important that you have people who support you and ways you can balance your working life. Certainly many of us have found ourselves at points where we feel burnt out. It used to be a problem that people didn’t want to address but now we are becoming more aware that, in order to work well in this area of medicine, you have to recognise the toll it takes, and be able to offload and accept that. This is an important part of your training. It’s very enjoyable, but it’s also very intense. Therefore, make sure you take care of your own mental health so that you can work and take care of others.
Advanced training is where you become more specialised and where you try to become the type of doctor you want to be now that you have a solid foundation of knowledge. This is where you can work out what areas of medicine you want to work in. I’m currently a part of the Victorian Training Program for Community Child Health, which focuses on development and community pediatrics, which basically means I just get to play with kids all the time whilst assessing their development!
You mentioned that this year is giving you a chance to hone in on the areas you’re interested in. I was reading up on the training program and it said that the trainees set personal training goals, and they work with a mentor to realise them. So my question is how did you go about setting those goals and the mental challenges that were associated?
One aspect is, you need to meet the training requirements. There are certain things you’ve got to tick off so some of those goals are about, ‘Okay, I need to do X, Y, and Z to make sure that I’ve done these specific things for these six months so that I’m accredited.’
Typically, minimum training time is probably about six years but most people spend more than that because you can’t really string everything together nicely. Often there are times within the training where you need to work in a particular area of pediatrics to progress but you might not be able to pick up the specific job to fulfil that requirement. So although you’re working as a doctor, it doesn’t necessarily progress your training. So you need to be setting goals and having your mentor keeping you on track to fulfil the training requirements.
Then the other consideration is more about what sort of things do you want to get out of your time? This is where you and your mentor get to have a bit of a philosophical discussion about life in medicine, what is your area of interest and how are you managing the work/life balance, because it becomes pretty all-consuming. That’s one of the biggest challenges that you’re going to talk to your mentor about. If you can, try in your current studies to find a really good way of working effectively and efficiently. It’s a great skill to have—the more efficient you are, the more downtime you’ll have in the future.
It’s always important to remember that you’ve got a rotating roster of doctors in the hospital and part of that reason is so that people finish on time and can hand it over to the incoming team. So don’t feel that everything has to be perfect before you leave. Remember the perfect can definitely be the enemy of the good!
From your meetings with those more senior physicians and supervisors/mentors, were there any gems that you’ve incorporated into your practice?
That’s a great question. I think one of the things to remember about medicine is that you can’t know everything and what is important to know and the way in which you work varies depending on the area of medicine you work in. So for working in an ICU or an ED, there is an immediacy to this area of medicine. There are emergencies that happen and you need to be able to react, and think quickly and efficiently. In lots of other types of medicine, particularly physician’s training, you generally have time to consider the options, research, and plan your approach.
So a great bit of advice I got was recognising that you don’t have to have all the answers immediately. Often in medicine, you recognise that you’ve got some time to consider the issue and knowing how to get the information that you don’t have is the more important skill.
Also knowing that you don’t necessarily need to be the one with all the answers. It’s important to remember that it takes a team to effectively manage a patient, whether that’s an acute medical team or in an outpatient setting, the best way to practise medicine is always in a team.
If the lighting guy is asleep then the stage is dark and it doesn’t matter what you do as an actor, no one’s going to see you.
Forgive the comparison, but this parallels with a performance of a play. It takes a team. If the lighting guy is asleep then the stage is dark and it doesn’t matter what you do as an actor, no one’s going to see you. You’ll find that this applies to most aspects of life.
Although one aspect of medicine is about acquiring knowledge and applying it to patients, the other aspect is effectively communicating to both your team and the patient as well. So another gem is that as a junior doctor, the best residents are the ones who know how to communicate well and get stuff done.
When it comes to medicine or any other career pathway, always try to find ways to venture outside your comfort zone and expand your thinking. I spent the last two years working in remote Western Australia in the Kimberley Region traveling to small Aboriginal communities. I had to adjust and reset my mind to working in clinics there. Adapting to these different environments definitely informed my practice and made me a better doctor. It was a great experience and I would encourage you to always find that opportunity to venture to greater depths because we grow by pushing ourselves to our limits. ●