Constantly learning from peers and patients
For Clinical Associate Professor Nicola Cunningham, the joy of medicine comes from the conversations she has with people, and the connections these interactions bring.
As a FACEM, Nicola splits her time between working on the hospital floor and navigating the policies and legislations of government bodies. In the emergency department (ED), her favourite days are when she has the time to stop and have a “proper chat” with her patients and their families.
“It's an honour to get that little glimpse into their lives when they're experiencing something that might be quite traumatic because they're in an emergency department,” Nicola says.
“I never take that for granted.”
““It’s an honour to get that little glimpse into their lives when they’re experiencing something that might be quite traumatic because they’re in an emergency department.””
Listening to different perspectives
When she's analysing healthcare systems, interpreting policy, or creating educational packages, her on-the-job happiness comes from hearing the perspectives of her colleagues – people whose experience and expertise comes from many different parts of the healthcare world.
“I love hearing what goes on in their brains and, honestly, feel like I'm constantly learning from my peers.”
Nicola began working in emergency medicine in regional Newcastle. After a move to Melbourne during her advanced training phase, a six-month special skills rotation led to a love affair with forensic medicine. Since then, she has worked as both an emergency consultant and a forensic physician – and spent 17 years as the coordinator of a leading Forensic Medicine Registrar Training Program. She also works as an Academy Member for Safer Care Victoria, as a Practitioner Member on the Victorian Medical Board of Australia, and as the Patient Safety Education Lead for Monash Medical School.
A lifelong commitment to learning
For Nicola, education is a lifelong pursuit – a belief that means she is currently balancing her busy schedule to complete a Master of Patient Safety and Clinical Human Factors.
“My husband thinks I'm mad because it's my third masters!”
Working both clinically and in regulatory roles are two very different ways to apply medical knowledge. But for Nicola, they are both crucial in providing a sense of perspective to her work. It also sees her utilising her unique combination of experiences to deliver compelling education to others at all levels of the healthcare system, from diagnostic excellence talks for medical students to clinical governance workshops for CEOs and board directors.
Her work as a clinician with a forensic and legal background has been invaluable for her ED practice. It has also helped her support her colleagues at St Vincent’s Hospital in Melbourne when they’re confronted with police officers or patients who may be involved with other legal issues while in the ED, and for follow-up court attendances.
“[These situations] can be very confronting, and a little bit terrifying, so I've found that, in some instances, I've been able to be that [medico-legal] point of contact for a lot of my colleagues,” she says.
Understanding the hospital system
On the other side, when working with policy writers and government bodies, knowing what it’s like working within the hospital system can help inform some of the solutions suggested, to help them work better in practice.
The Future Leaders Communiqué is led by Nicola’s colleague, Dr Brendan Morrisey
“It's very easy to sit outside of the system and imagine how you think things should have happened and then unwittingly apply a little bit of your cognitive bias to it,” Nicola says.
“I think that working within the system as well keeps you grounded and helps you to remember and appreciate that it is incredibly complex, and that a lot of thought needs to go into all the contributing factors around why we do what we do, and why some of the outcomes are as they are.”
These two aspects of her work – the ‘big picture’ and the practical application – have culminated in Nicola’s involvement with The Communiqués.
These educational not-for-profit quality and safety publications and podcasts are a project Nicola co-founded with geriatrician Professor Joseph Ibrahim in the early 2000s.
Translating complex findings into engaging learnings
The Communiqués is a collation of coroners’ findings, which are summarised and analysed by experts from the specific areas of medicine each case relates to. It’s an approach that helps ensure the learnings from these cases can be effectively communicated and applied.
Nicola says that writing for The Communiqués is possibly the “most useful thing I have done in my career”.
Coroner’s findings can often be between 50 and 100 pages long and are written in dense legal prose. The re-worded case summaries in The Communiqués distil that information into a palatable, more engaging format, so that readers can learn from the information more efficiently.
“Writing for The Communiqués is possibly the most useful thing I have done in my career.”
“We've got this massive bank of coroners’ findings and really important messages… and they're just sitting there,” Nicola says.
“So much of them we don't hear about and don't learn from.”
Nicola believes that the work of The Communiqués plays a part in bridging communication between the legal and healthcare systems, so that the findings of coronial inquests can be practically applied – informing healthcare workers of knowledge gaps or systems failures they may not otherwise know exist.
Currently, there are three products from The Communiqués that are released quarterly: Nicola leads the flagship Clinical Communiqué, Joe leads the Residential Aged Care Communiqué, which focuses on aged care, and their long-standing colleague Dr Brendan Morrissey leads the Future Leaders Communiqué for recent graduates.
Expert writers volunteer their time to summarise and write commentary on a particular case. Nicola cold-calls most of these writers and finds that, 99.9 per cent of the time, they’re happy to contribute.
“It gives me hope because … there are so many people out there who just want to help make things better, and who see the value in sharing their knowledge without asking for anything in return,” she says.
Change-makers showcasing difficult issues
““I reached out to a few people that I knew and people that they knew, and we ended up with this amazing team.””
While the output created by The Communiqués can only exist through the unpaid and dedicated labour of its editors and specialist writers, there are some benefits to the publication’s grass-roots nature. One of these benefits is the fact that the editors have almost complete control of what they can write about, which allows them to discuss difficult issues and endeavour to bring about change – without having to go through the political and bureaucratic hoops that come with receiving funding from public or private sponsors.
For example, the Clinical Communiqué was able to publish an edition centring on suicides in health practitioners.
“If this was a government publication, there is no way I would have been allowed to publish it because there's a lot of fear about how things are done,” Nicola says.
A subsequent publication centred on cultural safety – another area that Nicola believes government bodies may have felt uncomfortable engaging with constructively.
“A lot of people said to me ‘that's a hornet's nest’,” she says.
“But I think it's about recognising how you go about something carefully and safely. For that edition, I was very clear that it needed to be led by Indigenous contributors… so, I reached out to a few people that I knew and people that they knew, and we ended up with this amazing team.”
Connecting through stories
One of the central tenets The Communiqués has adopted is the belief that what’s happened in the cases they explore could happen to anyone – from both the practitioners’ and patients’ points-of-view.
Nicola leads the flagship Clinical Communiqué
Its guiding editorial principle seems to be to go out of its way to decentralise the salacious details and judgement that can be felt when reading these horror stories – situating the reader as an empathetic observer of the facts.
“[When we write] we're standing there alongside the people that are experiencing this stuff,” Nicola says.
“We're not standing up on a ledge looking down at what they're doing and saying, ‘Oh dear, isn’t that terrible’.”
Nicola believes this approach has led to truly positive outcomes, both in helping doctors navigate the healthcare system, and helping them speak out or feel less alone when faced with difficult situations.
She says being part of The Communiqués has helped her recognise how powerful and important storytelling is in healthcare – “whether you’re face-to-face talking to patients and their loved ones, helping inform the direction the healthcare system is going in, or sharing cases with students or colleagues for educational purposes”.
And at the heart of it all, she believes that storytelling is what helps form meaningful and sustainable connections between people.
“And if you make a connection, then you can have a lasting impression – and that's where people learn.”
