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The People’s Hospital Tales from the surgeon's table

Chapter Four

University turf wars

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Surgeons and nurses operating in theatre in 1977.

Western Health archives

The first group of medical students at Footscray Hospital arrived in 1964, brought there by Vernon Marshall, one of the hospital’s small team of honorary general surgeons.

Professor Marshall combined his duties at Footscray with surgical work at two of Melbourne’s big teaching hospitals - the Royal Melbourne and Prince Henry’s.

At the Royal Melbourne he was a Melbourne University appointee, employed by the university to teach its medical students and conduct surgery at the hospital’s Department of Surgery.

Professor Marshall’s appointment as an honorary surgeon at Footscray in 1963 enabled the university to extend its undergraduate medical training program beyond the big city hospitals.

That year President Roy Parsons and the Footscray Hospital board met with Professor (Sir) Sydney Sunderland, Dean of Melbourne University’s Faculty of Medicine, to discuss the idea of Footscray helping to train some students from the university’s clinical school at the Royal Melbourne.

The following year Footscray Hospital’s honorary medical staff began conducting Saturday morning seminars at the hospital for final year medical students from the Royal Melbourne.

Professor Marshall said the first batch of students to arrive at Footscray had an invigorating effect on the hospital. “The ethos of a hospital is vastly improved by having a young, ragamuffin body of students asking questions.”

The teaching program gradually expanded. Medical students were attached to a single ward for up to three months, shadowing the doctors and immersing themselves in the daily routine of patients and staff.

“Good teaching is about stimulation rather than recitation. It was patient based teaching rather than lecture-based,” Professor Marshall said. “You’re immediately confronting real patients and you follow that patient through the evolution of that illness through to surgery through to the cure of the disease and recovery. That’s a very striking illustration of the natural history of an illness - a great contribution that surgery can make to the evolution of disease.”

Over the next eight years the hospital continued to receive a limited number of medical students from Melbourne University for experience in its casualty and outpatients departments as well as medical students from Monash University for tuition in obstetrics.

It established strong inter-hospital relationships with three big teaching hospitals - the Royal Melbourne, St Vincent’s and Prince Henry’s Hospitals. Each provided medical staff at registrar and junior resident level on a rotation basis to Footscray. “Without their assistance it would have been most difficult to have adequately staffed the hospital in certain areas,” President Parsons said in the 1972 annual report.

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Hatching an ambitious plan

President Parsons and the board had great ambitions for their hospital.

“A formal affiliation of a university to Footscray and the eventual aim to become a Teaching Hospital is of the highest importance to Footscray’s future development and reputation,” President Parsons said. “Tentative negotiations have taken place between this hospital and a university.”

Behind the scenes both Melbourne and Monash University clinical schools – the only medical schools in Victoria at the time - were vying to expand their influence, research and training capabilities.

By 1977 Footscray Hospital reached agreement with Melbourne University to teach and train medical students in the disciplines of Medicine, Surgery and Obstetrics. But the arrangement fell short of Footscray’s goal to become a fully-fledged teaching hospital with its own clinical school and research departments.

Then, in 1980 the breakthrough came. Footscray’s executive director Allan Wallace announced that the hospital had become an affiliated teaching hospital with Monash University and a clinical school of the faculty of medicine would be established. The building previously known as the “Staff Home” was upgraded to provide office accommodation and student facilities for the university and it was renamed “Western General Hospital-Monash University Clinical School”.

Over the next six years Footscray Hospital medical staff and Monash University teaching staff, including those from Monash’s other clinical school at Prince Henry’s, were appointed to the clinical school.

Medical students from Monash spent six-week periods in residence at the hospital attached to various clinical units.

The hospital began to develop a reputation as a good place for surgical training. “Most of the students have been sent for surgical training, as this is difficult to obtain at the central teaching hospitals,’’ Dr John Mathew, the Dean of the clinical school, wrote in Footscray’s 1983 annual report.

The following year, his successor, Mr Barry King, a vascular surgeon, reported the number of final year students training on site had increased and the hospital was keen to cater for more undergraduates. About half of the final year students studied at the hospital for an eight-week period, making it the only period of surgical training in their final year.

The other half came for a shorter period, in addition to their surgical training either at Footscray or Prince Henry’s Hospital. Mr King reported that extra clinical tutorials in medicine and surgery had been organised as part of the relationship between Monash University’s clinical schools at Prince Henry’s and Footscray.

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An unhappy engagement

However many senior medical staff at Footscray were dissatisfied with Monash’s relationship with the hospital, believing that the university hadn’t paid enough attention or provided enough resources to the partnership.

Unhappiness about the arrangement festered for several years, with some senior staff arguing that the hospital should dump its formal affiliation with Monash and create a new affiliation with Melbourne University.

The issue came to a head in 1986 when the Cain state government announced its plan to close Prince Henry’s and relocate some its services in the west, as part of a massive expansion of hospital and health services in the western suburbs.

Under the government’s blueprint, Footscray Hospital would be upgraded to become a two-campus major teaching hospital, with one campus at its Eleanor Street site and the other campus at a new 285-bed $66 million hospital to be built at Furlong Street in Sunshine.

The government announced that a new teaching hospital arrangement would be established as part of the service expansion. The news triggered a heated debate among the medical staff at Footscray, who argued over the merits of continuing with the Monash affiliation. Eventually a meeting of the entire medical staff was held and the staff was asked to vote for their preferred university affiliation.

Dr Mary Stannard, the medical director at the time, remembers the meeting. She said dismay about Monash’s slow progress in establishing a clinical school at the hospital and Monash’s distant location in Melbourne’s outer east were crucial factors that influenced the vote’s outcome.

“I’d read the original memorandum of understanding that Monash had with the hospital so I got up at the meeting and quoted from it” she said. “Monash had promised that the Western (Footscray) would be the jewel in the crown of its teaching efforts. They’d promised the earth but hadn’t delivered - there was virtually no academic work going on in the place, some of our staff had university titles but we had no university department, or any staff or research.

“My recollection was that the vote was very tight, with Melbourne University winning by one vote. It may have been a casting vote. That vote was terribly important. The government may well have been going to decide in Melbourne University’s favour anyway but the vote would have influenced its decision.”

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Divided loyalties

The medical profession has a long tradition of people remaining loyal to the hospital that trained them.

As debate continued in the hospital and at government level about which university should be fully affiliated to the upgraded hospital, divided loyalites were evident among some of the surgeons. Those who had trained at Prince Henry’s or had appointments there tended to favour Monash, while others who had past or current links with the Royal Melbourne tended to prefer Melbourne University.

The Deans of Medicine at both universities were also influential in the debate, outlining to the government and hospital administrators what their respective universities could offer.

Joseph Epstein spent a lot of time talking to his colleagues about switching allegiances from Monash to Melbourne in the year leading up to the staff vote. The Division of Surgery held meetings to discuss the issue.

“The senior staff spent more than a year debating what we should do,” Mr Epstein said. “People were vexed about it. We were doing an enormous amount of teaching of the Monash students and we felt it wasn’t being recognised properly.

I remember making the argument that we were weak - a minnow in all of this university politics. So why not go with the strength, why not go with the traditional university?

We felt that Melbourne University had a much more traditional approach to university education and because we were starting from scratch and we were out in the sticks, we were more likely to gain stature by associating ourselves with a more traditional, established university.

The decision to go with Melbourne meant that the staff felt that at last someone was actually noticing what they were teaching. As surgeons we felt we were more likely to be acknowledged, supported and recognised if we switched.

“One of the reasons why I was enthusiastic about Melbourne University was that they were really interested in emergency medicine.”

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Melbourne University eventually won the turf war. David White, the Cain government’s health minister, said the hospital’s expansion and its new formal teaching affiliation with Melbourne University would enable it to become one of Australia’s leading teaching hospitals.

In 1987 the hospital board severed its ties with Monash University’s faculty of medicine and the clinical school of Prince Henry’s Hospital.

Under the partnership with Melbourne University, funding was provided for a Professor of Medicine at Footscray, and for university-equipped research laboratories. Clinical teaching facilities were also funded for the new Sunshine Hospital.

In 1988 Professor Neville Yeomans, of Melbourne University’s Department of Medicine, was appointed as Footscray Hospital’s first Professor of Medicine.

The following year marked a watershed in the hospital’s development. It became a fully- fledged teaching hospital of Melbourne University with a clinical school and research laboratories.

Professor Neville Yeomans, the hospital’s first professor of medicine.

Professor Neville Yeomans, the hospital’s first professor of medicine.

Western Health archives

Large numbers of undergraduate medical students started their training and students in their fourth, fifth and sixth years were taught internal medicine, surgery, obstetrics, gynaecology and paediatrics.

Writing in the hospital’s 1989 annual report, Professor Yeomans said his staff in the newly created university department of medicine would begin their clinical and basic research by focusing on: the therapeutics of peptic ulcer disease and reflux oesophagitis; the prevention of alcohol-related diseases via community education; as well as clinical immunology.

Major grants from the National Health and Medical Research Council, the Potter Foundation, The Brockhoff Foundation and the Australian Associated Brewers, helped buy equipment for the new research labs and pay for the scientists’ salaries in the new department.

By 1991 the research team of scientists had grown to 12, with the team expanding its research efforts to include the clinical immunology of asthma.

Professor Yeomans reported that post-graduate specialty education was steadily developing. The hospital had achieved accreditation as a parent training hospital, for two of the three years of basic training in internal medicine (for the Fellowship of the Royal Australasian College of Physicians).

It had also started training postgraduates in surgery and several other specialties, as well as continuing its traditional role of training graduates for practice in Family Medicine. It was on its way towards fulfilling the state health minister’s prediction.

Professor Yeomans in 1993 with fellow research staff from the hospital’s first Department of Medicine.

Professor Yeomans in 1993 with fellow research staff from the hospital’s first Department of Medicine.

Western Health archives

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