Mountain Medicine Conference – Chch 17/4/20

Wednesday, February 5th, 2020 | Rory | No Comments

See the below programme for the International Commission for Alpine Rescue medical commission and Land SAR mountain medicine conference to be held at The Commodore Hotel 449 Memorial Ave Christchurch on Friday 17th April

To register see the ICAR-MED website


1 0830 Welcome: NZ & Antarctica Dick Price & John Apps NZ
2 0845 Volcanic Eruption on Japanese Mountain Kaz Oshiro Japan
3 0925 White Island Eruption Craig Ellis NZ
4 0945 Penthrox: the NZ experience Craig Ellis  
5 1000 Analgesia in the field Panel International
6 1030 Morning Tea    
7 1100 Hypothermia & HOPE score M athieu Pasqqier Switzerland
8 1140 ECMO & Mechanical CPR NZ Sara Gordon NZ
9 1200 CPAP type device Geoff Shaw NZ
10 1230 LUNCH    
11 1330 Equipment in the Cold Steve Roy Canada
12 1410 Determination of Death Corrina Schon Switzerland
13 1500 Afternoon Tea    
14 1530 Emotional Rescue Alison Sheets USA
15 1610 Crush Injuries TBA  
16 1630 6 trips by sea to Antarctica Jenny Visser NZ
17 1715 Social function: meet & greet    

Rural Simulation Faculty Development Plan

Monday, January 20th, 2020 | Rory | No Comments

The simulation team that put on the rural inter professional simulation course have developed a Rural Simulation Faculty Development Plan.

This useful document provides a pathway that those that are interested can follow to up-skill in simulation and debriefing.

Look forward to more simulation resources being made available – and perhaps a repository of NZ rural cases and scenarios that we can contribute to and access.

Check out the Rural Health Academic Centre, Ashburton (RHACA)  (permanent link in the side bar) and I know Marc and Sampsa will welcome any correspondence. Drop them a line!

click here to access the document in full (PDF)



The Rural Simulation Faculty vision is of a pool of inter-professional faculty with expertise around simulation-based education (SBE) and debriefing who can all contribute to all rural simulation courses as needed. The group of rural courses should be strategically planned each year by the whole group to maximise value and demand. Each course will have designated course directors or leaders but can expect assistance from all faculty group members as available.




  • Establish a broad interprofessional rural group of SBE faculty across NZ.
  • Describe a common pathway for rural faculty to be credentialled as course providers through a shared understanding and experience of SBE
  • Maintenance and development of simulation expertise through feedback, mentoring and sharing of learning resources
  • Develop opportunities for learning, developing and collaborating using simulation-based education.
  • Design interprofessional educational courses for rural health care workers.
  • Research and evaluation of rural SBE



Rural simulation faculty development stream:


  1. Open for all doctors, GP’s, nurses, paramedics, allied health and midwives involved in rural health care at all levels of training.
  2. Faculty development stream comprises 7 components within three tiers, with stepwise progression through.
  3. Participation is purely voluntary and is expected to be self directed

Interested in medical workforce/education research?

Thursday, December 19th, 2019 | Rory | No Comments

Interested in medical workforce/education research?


A team of supervisors from Auckland and Otago Universities is currently looking for Masters and/or PhD students to work with the MSOD project.


About half of doctors make career decisions in the early postgraduate years, rather than during medical school. But we are aware from the international literature and our own research on Otago and UoA MBChB graduates that there are multiple factors that influence decision making starting with who is selected to become a medical student. Currently there is a mismatch between what doctors might decide as a career and the health workforce needs of Aotearoa New Zealand.

The Medical Schools Outcomes Database (MSOD) is a national longitudinal project collecting information on intended career choices and locations.  Medical students are surveyed at entry to and exit from medical school and graduates are surveyed 1, 3, 5 and 8 years after graduation.  Included in the surveys, are 24 questions that ask about influences on career choices – respondents are asked to rate these in importance.


To better understand what factors influence the career decisions recently graduated doctors make. (using the database).

If you might be interested I can provide further information and contacts.

Guidelines kete: LOFP

Wednesday, December 4th, 2019 | Rory | 1 Comment

Kia ora kotou,

We now have a guidelines/protocols section of LOFP. You can find this on the menu to the left of the screen.

Over here

Many thanks to Jono Wills (Dunstan Hospital) who provided the first contribution.

People may find these useful to adapt to their own working environments in an effort to stop reinventing wheels from scratch. Initially these

are local guidelines but as we find time we will add links to relevant international and national guidelines that maybe useful for rural practice.

You can send your guidelines/protocols you want considered to go up to

Apologies for the previous post misadventures



Leaning on Fence Posts: 2019 Taranaki CME workshop a success. Join in Rarotonga 2020!

Tuesday, December 3rd, 2019 | Rory | No Comments

The 2019 Rural Generalist CME Workshop was held in New Plymouth in early November, with the support of Taranaki DHB, Te Rau Ora and Matua Raki.  Local and distant resource experts, including rural doctors, shared their knowledge and experience over the three day workshop.  It was an excellent opportunity for rural doctors (from general practice and rural hospitals) to spend valuable time together, and we were very pleased to have several rural hospital registrars join us this year.  The weather was beautiful, giving us a chance to enjoy the stunning Taranaki scenery.

Next year’s CME Workshop will be held in Rarotonga, September 9-11 2020.  Please contact Matilda Hamilton if you are interested in attending. More details to follow soon.

photo credit: Katherine Orme, RHM registrar


last try. the stoats have been humanly dealt with. Sorry for the spam

Congratulations Sarah – Clinical Research Training Fellowship

Wednesday, November 6th, 2019 | Rory | No Comments

Congratulations to Central Otago physiotherapist Sarah Walker who has received a Clinical Research Training Fellowship from the Health Research Council to undertake a PhD. Sarah is interested in defining the broader skill set practiced by rural allied health professionals and how best to support it. Sarah will be jointly supervised by the School of Physiotherapy and the Section of Rural Health and will join the growing community of rural higher degree students.

Well done Sarah.

Link to the Otago University Bulletin

Sarah on a hill

Wilderness Medicine in the Wairarapa

Monday, June 24th, 2019 | Rory | No Comments


Over the weekend of 25thMay sixteen students of the Wellington School of Medicine spent the Friday night Saturday and Sunday morning at Holdsworth Lodge  in the Tararua Forest Park near Masterton. They were joined by John Apps, Jan Arnold, Richard Price, Jo Scott-Jones, Jenny Visser, Petra Watson and myself (Branko Sijnja).  The students enjoyed morning runs, a few braved the chill of the river and some climbed nearby hills to Rocky Lookout.  They learned of mass casualty triage, altitude medicine, hypothermia, how to improvise to carry patients over rough terrain, some suturing skills, expedition medicine and the development of rural health services in Clutha.  On the Saturday they were joined by Rural Medical Immersion Programme students from the Wairarapa regional teaching centre who presented the programme.


Branko Sijnja

Director Rural Medical Immersion Programme


Rural Medical Immersion Programme (RMIP) takes Matagouri Club to Balclutha

Saturday, May 25th, 2019 | Rory | No Comments

On a pleasant autumn evening on the first of May (May Day) fifty five members of the Matagouri Club motored their way to Balclutha to visit Clutha Health First, have an evening meal and view the Mobile Surgical Services bus.  Amongst the fifty five were forty medical and fifteen dental students. This is an annual event sponsored by RMIP.  Matagouri Club is the rural undergraduate club of the Health Sciences students of University of Otago.  They were presented with the Clutha Health First story by Branko Sijnja who described the community’s efforts to firstly try to save their 120 bed rural hospital and when that proved unsuccessful design a new sustainable community owned model that is now the successful facility occupied by general practices, an inpatient ward, diagnostic services and community services for the people of the Clutha District.

They enjoyed fifty five take away meals lovingly prepared by the Raj Indian Restaurant of Balclutha (no doubt the best Indian Restaurant in New Zealand). Great food, great taste, great portions and great variety.

The RMIP students based in Balclutha escorted the students around the facility and then they visited the Mobile Surgical Services bus which was preparing for an operating list the next day.  A very successful day.

Dr Branko Sijnja | MBChB, FRNZCGP, FNZMA, PGDipObst, PGDipRPHP, PGDipGP | Director Rural Medical Immersion Programme

Tracking the students

Friday, May 24th, 2019 | Rory | No Comments

Poole P, Wilkinson TJ, Bagg W, Freegard J, Hyland F, Jo E, et al. Developing New Zealand’s medical workforce: realising the potential of longitudinal career tracking. New Zealand Medical Journal. 2019;132(1495):9.

“Some of the key findings to date are:

  • Most New Zealand graduates wish to work in New Zealand.
  • Rural background is very important in rural career intention, justifying the rural preferential entry pathways to New Zealand medical schools.
  • Over time, fewer New Zealand students have an urban career intention, while rural and remote medicine is emerging as a career path.
  • Student perception places the major influence on career intention as ‘atmosphere/work culture typical of the discipline’. The importance of a range of positive undergraduate and early postgraduate experiences cannot be overstated, especially since most students are undecided at graduation. Specialties finding it difficult to attract sufficient numbers of trainees need to address factors that affect student choices“.

Note that rural is defined as ‘rural-regional’ (from location <100 000 population)


For over a decade, the Medical Schools Outcomes Database and Longitudinal Tracking Project (MSOD) has collected survey information from medical students and junior doctors in Australia and New Zealand to look at social, demographic and training effects on career intentions. In New Zealand, over 4,000 students have voluntarily provided information at various time points, and the project is at a stage where some firm conclusions are starting to be drawn. This paper presents the background to the project along with some early results, and future directions.


For over a decade, the Medical Schools Outcomes Database and Longitudinal Tracking Project (MSOD) has collected data from medical students in Australia and New Zealand. This project aims to explore how individual student background or attributes might interact with curriculum or early postgraduate training to affect eventual career choice and location. In New Zealand, over 4,000 students have voluntarily provided information at various time points, and the project is at a stage where some firm conclusions are starting to be drawn. This paper presents the background to the project along with some early results and future directions.

Masters theses conferred to rural docs

Tuesday, May 21st, 2019 | Rory | No Comments

Congratulations to two rural docs who were conferred their Masters degrees very recently from the University of Otago. Both theses are available free and open access from the University of Otago

Histories of Chest Pain from a Master of GP (credit) – Trevor Lloyd

Lloyd, T. (2018). Histories of Chest Pain: history of the presenting complaint as recorded by different health care providers of patients presenting to a rural hospital with suspected acute myocardial infarction (Thesis, Master of General Practice). University of Otago. Retrieved from Permanent link to OUR Archive version:

“Although there are many parallels between literature and clinical records, they are not the same thing. Clinical records are produced in a different way – typically by a team. They have different intended audiences. They have different associated ethical issues. Most importantly, they have different purposes.Clinical records are not designed to entertain, or to tell a story merely to find out “what happens next”. It is important to understand, for its purpose of facilitating clinical care, that the record is not merely a description of events. Each piece of information recorded by each health care provider is part of a carefully constructed document, that can be used for multiple purposes.The most important of these is to co-operate in describing, interpreting, and determining the best course of action, in the unique way that clinicians refer to as history and examination, diagnosis, and treatment.“


This thesis investigates how different health professionals record the history of the presenting complaint of patients with suspected acute myocardial infarction admitted to a rural hospital. Different health professionals, each with their own ways of working and communicating, co-operate in diverse teams that ideally have more to offer the patient than individual professionals working alone. This includes the taking and recording of the patient’s history. This account should not be regarded as merely a way of copying a component of a clinical encounter, but as part of a sophisticated tool to guide and organise patient care. This is a case study conducted by a participant observer. A range of qualitative research analysis methods for document analysis are used to analyse what is written in patients’ clinical records by general practitioners, ambulance officers, hospital nurses, and rural hospital doctors, about their presenting complaint. Of 347 patients admitted to the hospital in 2011 who had a Troponin I blood test ordered, the clinical characteristics recorded of 50 are compared, and 10 of these are selected for more in-depth analysis. The 10 records are analysed in terms of style, vocabulary, abbreviations, what gets recorded, what gets repeated, what gets added, what gets deleted, and what gets modified. Three of the 10 records are analysed to explore how the individual records are constructed. The clinical record emerges an incremental, multi-authored, multi-layered, intertextual account, being co-produced by a range of health providers, using information from a variety of sources. The different health providers, at different stages, and using their different voices, interact to record the history of the presenting complaint. In addition, the clinical record can be seen as a way of telling the patient’s story, like a novel where the central narrative is explored from the perspectives of different characters or commentators. The record is a carefully constructed document, whose chief purpose is to develop a shared understanding of the patient’s progress and the care that needs to be provided. Good documentation is equated with good care. It is important for practising clinicians to understand how the clinical record is constructed, as an organised interdisciplinary process, and how it is used in care. Furthermore, with a move to electronic health records, it is essential that those responsible for their introduction have a similar understanding of the nature of clinical records.

Impact of RHM vocational scope in the Hokianga from A Master of Health Sciences (distinction) – Kati Blattner

Blattner, K. (2019). The impact of the rural hospital medicine vocational scope on the Hokianga Health service (Thesis, Master of Health Sciences). University of Otago. Retrieved from

The study found that RHM with its associated targeted rural training and professional development programs has enabled the strengthening of both clinical practice and wider quality systems and standards at Hokianga hospital, thus meeting the intentions of the new scope at this site. Challenges arising from the new RHM scope were also identified at both the individual practitioner and the health service level. It is acknowledged that, ten years from the introduction of the RHM scope, it is still too early for the full impact of the RHM scope to be assessed. Though focused on one rural health service with a unique, long-established model of care, findings from the study are applicable to other rural health services in NZ and internationally.


Rural Hospital Medicine was recognised in New Zealand as a vocational scope of medical practice in 2008. The intention was to provide recognised standards of training and professional development for doctors working in rural hospitals and to encourage quality systems to become established in rural hospitals. Hokianga Health is an integrated community owned health service including a hospital in the far north of New Zealand, serving a rural Māori community. The aim of this thesis was to explore the impact of the Rural Hospital Medicine scope at Hokianga Health.

Methods A case study design using qualitative methods comprising a document analysis and interviews was chosen. A thematic analysis of key documents tracking change and development at Hokianga Health was undertaken. Twenty-six documents (ten internal and sixteen external to Hokianga Health) were included. Eleven individual semi-structured interviews were undertaken with past and present employees of Hokianga: eight were medical practitioners, three were senior non-medical staff. The interview explored the participant’s view of the Rural Hospital Medicine scope of practice. Interviews were recorded and transcribed. Thematic analysis of the interviews was undertaken. The two data sources were analysed separately followed by a process of convergence and corroboration of findings.

Results Before 2008 there was a mismatch between the scope of medicine practiced at Hokianga and available medical training and professional development programmes: the hospital aspect of practice fell outside the General Practice scope. This created a vulnerability for individual practitioners and the hospital service. The Rural Hospital Medicine scope brought a specific focus to hospital practice and thus validation of this aspect of the medical practitioners’ work. The Rural Hospital Medicine and General Practice scopes together provided the right fit for medical practice at Hokianga. The strengthening of clinical practice and improved scope of services resulting from the alignment with Rural Hospital Medicine and the associated rural hospital regulatory policy, systems and processes, strengthened clinical safety and thus the viability of the hospital service. The Rural Hospital Medicine movement also strengthened Hokianga Health’s external strategic alliances helping to create a sense of belonging, and facilitating alignment with the changing external regulatory environment including nomenclature. Challenges resulting from the Rural Hospital Medicine scope at the individual practitioner level mirrored those at the health service level: rural practitioners and the rural hospital service attempting to deliver to regulatory systems and processes that had not been set up with their scope of practice and model of care in mind.

Conclusions The new vocational scope of Rural Hospital Medicine enabled the strengthening of both clinical practice and wider quality systems and standards at Hokianga Hospital, thus meeting the intentions of the new scope. In highlighting wider challenges to rural health the study supports the notion that New Zealand implements a process of rural health impact assessment. Though focused on one rural health service, findings are applicable to other rural health services in New Zealand and internationally.