New Cook Island GPs

Thursday, January 14th, 2021 | Rory | No Comments

Congratulations to Dr Teariki Puni and Dr Koko Lwin who recently graduated with the Cook Islands General Practice Fellowship.

A ceremony was held in Rarotonga on December 18, 2020 where both doctors were awarded  their Fellowship by former Secretary of Health Dr Josephine Aumea Herman.

The Cook Islands General Practice training programme was established in 2016 by the Cook Islands Ministry of Health under former Secretary of Health Elizabeth Iro, in partnership with University of Otago and the RNZCGP. The aim of the programme is to build local capacity and leadership in primary and frontline care. The academic component of the programme is made up of four distance taught papers from the Rural Postgraduate programme. The clinical component involves 12-24 months in NZ based clinical practice (rural and urban general practice and emergency medicine). The establishment by Otago of a Pacific Islands Nation liaison role (currently held by rural doctor Kati Blattner) provides support and navigation for the doctors studying on the programme. 

Many NZ based doctors know Teariki and Koko having completed postgraduate papers with them, crossed paths during their NZ clinical attachments or spent time working alongside them in the Cook Islands.

Teariki Puni and Koko Lwin follow in the footsteps of Nini Wynn and Mareta Jacobs who completed their fellowship in 2019 and 2017 respectively.


Words provided by Dr. Katharina Blattner

National study of the impact of rural immersion programs on intended location of medical practice in New Zealand.

Monday, December 7th, 2020 | Rory | No Comments

Abid Y, Connell CJW, Sijnja B, Verstappen AC, Poole P. National study of the impact of rural immersion programs on intended location of medical practice in New Zealand. Rural Remote Health [Internet]. 2020 Nov 1 [cited 2020 Dec 3];20(4):5785. Available from: 

Open access paper

This recent piece of observational research combined data from the Medical Students Outcome Database (MSOD) for New Zealand graduates of both Medical Schools with University rural experience data. They looked at graduate’s future intentions to work in Rural, Regional or Urban location, comparing those who participated in long rural immersion programmes (RMIP and Pūkawakawa), short interprofessional programmes (RHIP and TIPE) and those who didn’t participate in any specific rural programme.  

Why is this important? 

Essentially this is proof in the value of long rural immersion programmes in Aotearoa! This study has shown that those who participated in long rural immersion programmes were over 6 times more likely to show an intention to work rurally and over 4 times more likely to show an intention to work regionally! This is consistent with overseas research but one of the first pieces to show this in New Zealand.

This study also supports ongoing importance of rural background on career choice while also demonstrating that through long rural immersion programmes we can still convert plenty of city kids.

What’s next? 

This paper only looked at workforce intentions. Next we need to look to see if this finding persists further into postgraduate years and actual changes in workforce outcomes.


Introduction:New Zealand (NZ) faces an ongoing shortage of rural medical professionals. In an effort to increase interest in rural practice, both of the medical schools in NZ offer rural immersion programs as well as rural entry pathways. The aim of this study was to compare the effect of long (>33-week) rural immersion with a short (5-week interprofessional) rural immersion or no rural immersion on the career location intentions of NZ medical students.
Methods:  This observational study used linked data from the Commencing Medical Students Questionnaire (CMSQ) and Exit Questionnaire (EQ), collected between 2011 and 2017 as part of the Medical Schools Outcomes Database project, along with information on whether or not a student undertook a rural immersion program. The main outcome measure was EQ career location intention (Rural (population <25 000), Regional (25 000–100 000) or Urban (>100 000)). The explanatory variables were rural immersion (long, short, none), age, ethnicity, background, CMSQ career location intention, gender, specialisation preferences and interest in rural medicine. In addition to univariate analysis, data were used to build a multinomial model to determine relative associations of these variables with the outcome.
Results:  Full data were available for 1367 NZ medical students (47% of all students during the time period). Of these, 17.4% had undertaken a long or short rural immersion program. In univariate analysis, age was the only variable that did not significantly predict EQ rural intention outcome. In the multivariate model, rural immersion was a significant independent predictor of EQ career location intention. Students taking a long rural immersion were 6.4 and 4.4 times more likely to select a Rural or Regional intention, respectively, than those with no rural immersion. This strong effect on rural intentions was seen regardless of background. CMSQ career location intention, background, ethnicity, rural club membership and preference for general practice were also significant predictors. While short rural immersion did not have an independent effect, this finding should be interpreted with caution given the smaller number of students and the response rate.
Conclusions:Long rural immersion is highly beneficial for increasing interest in rural work, increasing the likelihood that medical students will intend to work outside an urban setting. Students who signal an early rural intention are strong candidates for such programs later in their course, regardless of their background. A three-category classification for geographic background and career location intention permitted a more detailed understanding of the interplay among demographic variables and rural immersion in influencing career intentions. Following cohorts into their postgraduate years is needed to ascertain if these career location intentions persist.

Thank you to Katelyn Costello for the review of this paper.

DRHMNZ training programme: the first 10 years part 1

Friday, December 4th, 2020 | Rory | No Comments

Blattner, K,  Lawrence‐Lodge, R,  Miller, R,  Nixon, G,  McHugh, P,  Pirini, J.  New Zealand’s Rural Hospital Medicine training program at 10 years: Locality and career choice of the first graduate cohort. Aust J Rural Health.  2020; 00: 1– 3.

Pre-publication, open access article available here:

This short report describes the locality and career choice of graduates from the first 10 years of NZ’s Rural Hospital Medicine training programme.

There were 29 graduates, with 26 currently practicing. Of these 24 (92%) are practicing in a rural location, most in a rural hospital. Half were also working in an additional scope. This compares favourably with international literature.

“This study provides the first real evidence on actual postgraduate practice location, as compared to ‘intent to practice’ for rural career choice for NZ medical practitioners.”

A paper further describing this cohort, including active trainees and those that have withdrawn will be published later.

CME courses

Tuesday, November 17th, 2020 | Rory | No Comments

ResBaz 2020 : Pick n Mix, 23-27 November 2020. 

This Pick n Mix edition of Research Bazaar is free, open and online – a series of digital research skills workshops, each individually bookable. Some sessions are up now – Bookable links and more sessions will be added during the week. 

ResBaz Pick n Mix sessions are open to NZ researchers, postgraduate students and those supporting research. 

Please take a look and share with your communities. 

#resbazNZ2020 #resbazpicknmix

If anyone is looking for a online conference early next year the ED/ortho conference “CASTED” has decided to offer an online course for Australia and New Zealand participants.

Go to the Jan 21-22 course for New Zealand and Australia. And click on register. And then another click to get to the registration form.

Thanks Hannah Lawn for the tip.

Note the Rural Hospital Medicine CME planned in October – Queenstown – will almost certainly have sessions on fracture management. Watch this space.

Wellington Public Health Summer School is running again next year:

The 2021 Public Health Summer School will offer 24 short courses (1–2 days long) presented by an outstanding faculty of public health academics and practitioners. There are 12 new courses as well as 12 of our most popular core courses. Courses vary from small group computer lab classes to interactive workshops and multi-speaker symposiums.

You are invited to register in a single course or create a programme based on your interests. Read more about each course below

Research, epidemiology, big data and statistical methods

Qualitative methods

Evidence, economics and healthcare systems

Māori and Pacific health and cultural competencies

Population mental health

Healthy public policy and law

Infectious diseases, environmental health and sustainability

Kotahitanga 6

Thursday, November 12th, 2020 | Rory | No Comments

Thanks to Robin from Island Docs for hosting Kotahitanga and providing the brief comment found on her blog. There is plenty of great stuff to be found there:


“Another great read from Kotahitanga. Recurrent cellulitis is common cause of repeat admissions to our ward, especially in our fluid overloaded heart failure patients. Thanks S.Beck for the article!

Compression therapy reduced incidence of cellulitis recurrence in patients with chronic oedema compared to conservative. 40% recurrence in control group vs 15% recurrence in compression group. Also showed reduction in hospital admissions (14% vs 7%) but insufficient data.

Compression is particularly useful to those with chronic leg oedema, recurrent episodes of cellulitis or BMI >33, for which antibiotic prophylaxis is unlikely to benefit. Reduced medium leg volume by -241mls after 15months. Compression is also the primary treatment for lipodermatosclerosis (often misdiagnosed as cellulitis + antibiotics ineffective).”


Does it matter where you have your STEMI?

Tuesday, November 3rd, 2020 | Rory | No Comments

Lee S, Miller R, Lee M, White H, Kerr A. Outcomes after ST-elevation myocardial infarction presentation to hospitals with or without a routine primary percutaneous coronary intervention service (ANZACS-QI 46). The New Zealand Medical Journal. 2020 Oct 30;133(1524):64-81.

Link – NZMJ articles become open access after 6 months.


Commentary from Associate Professor Garry Nixon

Why no difference? There should be a difference!

As expected STEMI patients who present to rural and provincial hospitals are older,  more likely to be Māori and have on average lower socioeconomic status (because our patient populations are). They also get fibrinolytics – a second rate substitute for primary PCI. You’d expect, even with the best will in the world, that there would a measurable difference in outcomes, with patients presenting to urban PCI centres doing better . That this study failed to demonstrate this is, to say the least, surprising.

The authors attribute this to the adoption of the pharmaco-invasive strategy and the implementation of current strategies including the out-of-hospital STEMI pathway (which includes the ‘appropriate bypass of non-intervention hospitals’). But the study period (2011-2016) predates the NZ out-of-hospital STEMI pathway and we were practicing a Rescue PCI strategy targeted at patients who failed to reperfuse back then. This is evidenced by the small percentage of rural patients getting angiography within 24 hours (about 25%; a pharmacoinvasive strategy = PCI within 24hrs of fibrinolysis). And these results are not the result of hospital bypass, the basis of the study groups was hospital of initial contact. The results are however a lot better than studies done in the 1990s that demonstrated much poorer outcomes for provincial AMI patients.  My guess is the key here is good communication between peripheral centres and base hospital cardiology units, and that was becoming well established by 2011 in NZ; and all parties should aim to keep building these networks.

I have to thank the whole ANZACS QI team. Its great to see a major NZ research unit looking seriously at rural outcomes. In large part that’s due to the work of the 2nd author. Well done to him.


AIM: Primary percutaneous coronary intervention (PCI) is the optimal reperfusion strategy to manage ST-elevation myocardial infarction (STEMI). Where timely primary PCI cannot be achieved, an initial pharmacological reperfusion strategy is recommended with subsequent transfer to a PCI-capable hospital. The study aim was to assess STEMI outcomes according to the interventional capability of the New Zealand hospital to which patients initially present.

METHODS: Nine thousand four hundred and eighty-eight New Zealand patients, aged 20–79 years, admitted with STEMI to a public hospital were identified. Patients were categorised into three groups— metropolitan hospitals with all-hours access to primary PCI (routine primary PCI cohort), metropolitan hospitals without routine access to PCI, and rural hospitals. The primary outcome was all-cause mortality. Secondary outcomes were major adverse cardiac events (MACE) and major bleeding.

RESULTS: Invasive coronary angiography was more frequent in the routine primary PCI cohort compared to metropolitan hospitals without routine access to PCI and rural hospitals (90.6 vs 83.0 vs 85.0% respectively; p<0.001) and occurred more commonly on the day of admission (78.9 vs 28.7 vs 25.7% respectively; p<0.001). There were no differences in multivariable adjusted all-cause mortality, MACE or major bleeding between patients admitted to any of the hospital groupings.

CONCLUSION: Outcomes after STEMI in New Zealand are similar regardless of the interventional capability of the hospital where they first present.


Any views or opinion represented in this site belong solely to the authors and do not necessarily represent those of the University of Otago. Any view or opinion represented in the comments are personal and are those of the respective commentator/contributor to this site.


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