From Small Rural Primary School to Dean of Australia’s Top Medical School.
A trailblazer. Professor Jane Gunn AO was the first person to be awarded a PhD in general practice at the University of Melbourne, was inaugural Chair of Primary Care Research where she is also Dean of the Faculty of Medicine, Dentistry and Health Sciences.
Professor Jane Gunn AO is a distinguished academic general practitioner and inaugural Chair of Primary Care Research at The University of Melbourne where she is also Dean of the Faculty of Medicine, Dentistry and Health Sciences. Jane grew up and went to school in rural Victoria, Australia. As the daughter of two teachers, she observed the transformative power of education – of both the mind and the body.
Jane’s trailblazing research into the complex interplay between mental and physical health, and the key role of general practice in maximising wellbeing, led to her appointment in 2009 as Inaugural Visiting Professor to the Scottish School of Primary Care to join an international team to investigate multiple long-term physical health problems (multimorbidity). Jane continues to champion the value of ‘Generalism’ and the Generalist approach, particularly regarding mental health care.
“… I was very interested in pursuing an understanding of the concept of generalism, how can we support and strengthen generalism in a health care system where it was really starting to fade away… generalism, multimorbidity, and mental health have all been things that have formed my research interests over the last 25 to 30 years.”
Watch the video, listen to the podcast, read the transcript below
What a remarkable journey, tell me about your current role and your academic journey…
Jane Gunn: My current role is that I’m Dean of the Faculty of Medicine, Dentistry and Health Sciences at the University of Melbourne. It’s a very large Faculty. We are made up of six different schools; Medical School, Psychological Sciences, Health Sciences, which includes all the Allied Health disciplines, and a Dental School, and a School of Biomedical Sciences, and the School of Population and Global Health. That makes us a very large academic community of almost 3000 staff, and very many students and professional staff. It’s a very large part of the University of Melbourne and we are very lucky to be right in the middle of a very vibrant and strong biomedical research precinct right here in Parkville, surrounded by medical research institutes such as WEHI and Peter MacCallum Cancer Centre, etc., as well as many well-established hospitals that are globally recognized tertiary training hospitals. We are right in the thick of it.
Link here to the Faculty’s BioMed Precinct Interactive Map
DMacA: There aren’t many primary care doctors who rise to the heights of the Dean of a Faculty.Tell us about your career in general practice…
JG: I did my medical degree at the University of Melbourne. So, I haven’t moved far over the years in that I’m still here. I did enter into the general practice training program a couple of years after leaving my intern year and did the residency program. We called it the Family Medicine Program back in those days. I did the Family Medicine Program and a Diploma of Obstetrics and Gynaecology and then entered into an academic training program which was run by the Victorian State Government. It doesn’t exist anymore. There’s a national program now. It focused on special skills posts so it included academic general practice, forensic medicine, family planning, cancer rotations, all the kinds of things that weren’t really core to the early resident years. And I took part in that program.
And then I think what happened… I was really on the course to be a rural GP. In my mind I was going to be a GP- Obstetrician, practise in the country, and live out my life as a rural GP. But doing the academic training, I caught the bug for academic pursuits. I loved the interaction with medical students and I really enjoyed the quest for knowledge in the research side of things. I got hooked.
And then there was an opportunity while I was doing my fellowship training for general practice. That opportunity was to apply for a PhD scholarship and I, under the advice of Professor Doris Young, a bit of a livewire and head of the Department of General Practice at the time. Doris said “Here’s the perfect opportunity, Jane.” Pop in this application for a Ph.D. due in two weeks, what could go wrong?
I put that application in, and was successful, and then did my Ph.D. as well as finishing GP training. So, it was a pretty busy few years back then. But, it was all doing things that I really enjoyed and that set me up, I think, for an academic career, which I then went on to pursue.
DMacA: Tell me about your research. You had great interest in particular aspects of primary care research.
JG: There’s probably three main themes and they’re all interlinked. One was around looking after the mental health needs of people in primary care, and it began with a focus on the health of mothers after childbirth. And that’s what I did my PhD on. And then I moved more broadly into mental health in general. And, in looking at health after childbirth that was a really good introduction to the concept to multimorbidity, not that we called it that at the time. It was really just talking about health following childbirth, but I became very interested in the way that physical and mental health are interlinked. As a GP, of course, we all know that. But the thing that struck me was how that was not recognized and not appreciated and not valued beyond what I was hearing and seeing in general practice. So, I became very interested in pursuing that and building a body of knowledge around the whole way that physical and mental health were interlinked. And that concept of multimorbidity emerged over that time.
I was very engaged with understanding the way that multiple conditions affected mental health and vice versa. And at the same time, one of the things that underpinned a good approach is that of the generalist, and I was very interested in pursuing an understanding of the concept of generalism, how can we support and strengthen generalism in a health care system where it was really starting to fade away, and I became interested in the generalist topic back in, probably, the early 2000s. There was very little written about it and it was just dying away.
So, generalism, multimorbidity, and mental health have all been things that have formed my research interests over the last 25 to30 years.
“I remember David Mant saying to me…. “Look, you really want to think about a real program of research. Think about the next ten years. Don’t think about the next two.” At the time, I left his office thinking, God, now I have to think about the next ten years- that’s a bit much.”
DMacA: And, of course, there was a lot of international involvement as well because you had an interest in Oxford, and you got to meet Ian McWhinney and Barbara Starfield- some of the greats. Tell me about their influence.
JG: Oxford. Yes. I spent 2001 in Oxford and that was a really great time. I went there for a sabbatical, which was a fantastic opportunity. I had my family with me, which was great. It was one of those really bright times to reflect and meet all sorts of people. David Mant was the Head of the Department of General Practice at the time, Primary Care as it was then called, and I went there for two reasons. One, with my primary care interest, but also because of my PhD supervisor, Professor Judith Lumley. Judith is dead now, but she was a very famous perinatal epidemiologist with a great respect for general practice and for midwifery. The National Perinatal Epidemiology Unit was at Oxford, and Judith had been the head of that for some time. Not when I went there, but there were always connections.
I had a wonderful time in Oxford, and it coincided with the retirement of Sir Richard Doll. So that was pretty impressive thing to be to be there for and I even managed to have a trip up to Edinburgh that coincided with his big retirement gathering in Edinburgh. It’ll live very long in my memory. The opportunities to be there and meet people like that, and also to be exposed to some of the thinking. And I remember one conversation during that time in Oxford about what I might do in research. I remember David Mant saying to me,” Look, Jane, this I don’t give much advice….” I’m sure he gave plenty of advice, but his advice was good in that he said, “Look, you really want to think about a real program of research. Think about the next ten years. Don’t think about the next two.” At the time, I left his office thinking, God, now I have to think about the next ten years- that’s a bit much.
But, that was a really great prompt to me to think about setting up research and thinking about it over a longer term. And that was fabulous. And the other opportunities that I had around meeting people, like Barbara Starfield and Ian McWhinney, and just how generous they were with their time.
Those sort of interactions happened as part of the NAPCRG (North American Primary Care Research Group) meetings. I started going to those meetings after I’d been over in 2001. I went to the Society of Academic Primary Care, (SAPC) meeting in 2001. That was in Leeds, Yorkshire, and it was a fantastic meeting, and it was the first really big international meeting where I met other general practitioners who were really passionate about research and realized that there was an academic community out there that I really felt a part of. And it was great, fantastic. I think those NAPCRG meetings and the SAPC meetings were really key to developing all the networks that so foster and keep you energized as part of an academic career. They were just wonderful opportunities to just think about the big issues and, of course, generalism. And Barbara Starfield, and thinking about the place of primary care and that fundamental work that she did, which, of course, is still pertinent today. I still talk to young doctors, the Ph.D. group and ask them, have you read Barbara Starfield? And they look at you quizzically and then they go and have a look. But yet it’s really important stuff. And there have been great, really great mentors throughout my career.
“I think those NAPCRG meetings and the SAPC meetings were really key to developing all the networks that so foster and keep you energized as part of an academic career. They were just wonderful opportunities to just think about the big issues and, of course, generalism. “
DMacA: So you’ve become the ultimate clinician scientist, and it must be pretty difficult to combine clinical work as a high powered academic in the current academic climate. Tell us how that works?
JG: At the moment I have actually stepped aside from my clinical work and I did that post pandemic, because it was just too difficult to keep that going in a way that was going to be sustainable. I was pinned to my computer for 12-14 hours a day trying to search out information, joining to webinars all over the world, trying to find out what was going on, and what we could how we could prepare. And that was an amazing experience, even though it was very, very challenging. Following that I thought, okay, they got along fine without me while I was doing the university work, and I stepped aside. I didn’t step back into the general practice. At the moment I’m not doing any clinical work and just hanging on to that general practice time through bits and pieces of the things that I do around the university.
DMacA: Talking about the university, and focusing on your work as a dean, I see that you’ve been voted, or you’ve been acclaimed, the number one medical school in Australia, 20th in the world. That must be one heck of a challenge. Tell us about that work.
JG: The medical school has a very long tradition. It’s one of the oldest medical schools in Australia. It has really deep connections within healthcare and the hospitals around us, and a very strong focus on training clinician academics, really fostering that opportunity. We have a four year medical degree now, it’s a postgraduate degree and all the students come from various backgrounds. There are no prerequisites. There used to be, but now they can come from any discipline and we’re exposing them to a really contemporary curriculum- that is actually being redesigned as we speak- focused a lot more on supporting the student to learn in their own time, removing grading as hurdles, and with requirements rather than grading people at the end of each year. That’s rolling out through the years. And we have a wonderful group in medical education, a Department of Medical Education within the medical school, really committed medical educators. One of the things that I’m thinking at the moment is how our training, whilst we have a revised curriculum etc., that with the changes that we’ve seen in the last few years with the introduction of AI, more digitization, the fact through the pandemic we really switched to telehealth and virtual care across this country and globally, that one of the things we’re contemplating is, what does the medical trainee need to look like in the future? And, are we really training our medical students with the right skills they are going to need in five, ten, 20 years, time? The answer probably is no. We probably aren’t and we need to think about how the medical training might change. When we consider that we have all been trained in a model of clinical placement, observation, the apprenticeship kind of model, is that actually going to be the way that we train in another ten years?
“…we’re exposing them to a really contemporary curriculum – being redesigned as we speak- focused a lot more on supporting the student to learn in their own time, removing grading as hurdles, and with requirements rather than grading people at the end of each year.”
DMacA: That’s a fascinating radical vision of the future of education and it fits in very well with something else I want to ask you about, and that’s student wellbeing. Because, we see almost a crisis in medical students around the world, where people are finding it very high pressure, very dissatisfied, people leaving…
JG: We have seen that. We have seen students here and globally. Talking with my peers in other countries we’re seeing that. Once we had the medical student come into the medical school and they would get out the other end pretty successfully. Obviously, there would be some stumbles and things along the way for some. But most made it through quite successfully and then continued their careers for 30, 40 years. But we’re seeing now that students are taking more time out. They’re looking at exploring different opportunities, and they are experiencing large degrees of mental health concerns, particularly things like anxiety, depression, those are common mental health problems. And we see that they want something different. They are not expressing it that way. They just say the training is what it is. But you can see that they are probably finding it a little bit more difficult to engage, and particularly with the students that have had a couple of years where there wasn’t that clinical interaction. It was much more difficult in the clinical setting for them, to get embedded. But, on the other hand we had students that were doing things that were very purposeful and really helping with the pandemic. So, we could see this dichotomy of experience for students. And I think it made us reflect on what we could do differently to support students? One of the things that we’re really considering is looking at how we can support students to work and learn the skills of working in a team, and that’s why we’ve set up a Centre for Collaborative Practice.
That is a multidisciplinary approach that has deep engagement within the Medical School and Allied Health and Dental Schools to bring the students together from the first year and give them exposure to team based practice and teach them the skills to be part of a good team. Because, we know, and I think it’s recognized by many, that health care is going to be more about how high performing teams deliver highly effective health care. It’s better for the practitioners and there is also evidence that it’s better for the health outcomes of patients as well. So, marrying that sort of team based practice but also, trying to do that in a way where we keep the focus on person centred care- those principles of the good generalist approach to care. And, how we embody some of these traditional elements of general practice into the way that teams might work across the health care system is something that we’ve got a whole group who have picked this up and are running with it. They are coming out with some great programs that are teaching things in a very in-depth way around, for example, how do we notice, that clinical skill of noticing. Professor Liz Molloy , and her team in the faculty have done some great programs on attending to noticing and that clinical skill.
So, we’re trying to bring alive those human skills of being a doctor while, at the same time, recognizing that the contemporary doctor is going to have to really embrace digital tools. They’re going to have to be very savvy around how AI, etc. is used. And this is, I think, a really interesting time in training doctors as to how we embrace technology but don’t lose, what I feel very passionate about, that essence of what makes a good doctor, which I think will stay the same no matter how many machines help us with the tasks.
“… with the introduction of AI, more digitization, the fact through the pandemic we really switched to telehealth and virtual care across this country and globally… what does the medical trainee need to look like in the future? And, are we really training our medical students with the right skills they are going to need in five, ten, 20 years, time?”
DMacA: That’s a lovely note to end on, and thank you very much for chatting to us today. It’s easy to see now, having listened to you, how you went from a small rural primary school to be head of the biggest university medical school in Australia, gathering the Order of Australia, and many other honours along the way. It’s always fantastic to chat to you. Thank you very much indeed.
