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PRINCESS ALEXANDRA HOSPITAL
DEPARTMENT OF EMERGENCY MEDICINE
Trainee Manual
2013 / 2014
1
PRINCESS ALEXANDRA HOSPITAL EMERGENCY DEPARTMENT
Our mission is to partner trainees in attaining the aims of the PAH Emergency Medicine
Training Program:
Our aim is to develop:
• Trainees with the ability to be:
o Higher order thinkers
o Effective communicators
•
Trainees with the self-belief to be:
o Independent
o Decision makers
o Resilient
•
Trainees with the capacity to:
o Show empathy
o Link actions to outcomes
o Be discerning and ethical decision makers
•
Trainees with the courage and commitment to:
o Aspire to excellence
o Be tolerant and inclusive
o Be patient advocates
Contents of this manual


PAH Emergency Medicine Training Program
o
Overview
o
Advanced Trainees - Registrars
o
Provisional Trainees – Training SHOs
o
Rostering
o
Trainee Education Programs
o
Research
o
Mentoring
o
Operations and Orientation
Trainee Manifesto
Trainees are required to also read:

PAH ED – General Information

PAH ED – Clinical Practice Manual
PAH EMERGENCY MEDICINE TRAINING PROGRAM
OVERVIEW
The PAH ED offers a high quality, comprehensive training program for emergency medicine
trainees. It includes specific programs to suit the needs of trainees at all stages of their
training.
An overview of the training requirements for fellowship with the college, and how these
requirements can be met within the PAH ED training program, is as follows:
o
Basic Training – 2 years – usually, the intern and second postgraduate years.
o
2
Basic training can
2 post graduate
undertake some
cardiology, ENT,
surgery.
be undertaken anywhere; if you are at PAH for the first
years, we would advise that in PGY 2 you seek to
rotations from the following selection: anaesthetics,
orthopaedics, renal medicine, ophthalmology, plastic
o
Provisional Training – 12 months (minimum):
o
6 months training in a single approved ED
o
6 months other approved training (this may be ED or non-ED)
•
o
Completion of the Primary Exam (this may be completed at any time
during basic or provisional training)
•
o
PAH ED provides a Primary Exam Preparation Program prior to
each exam. It is expected that provisional trainees undertaking
the Training SHO role will complete all their provisional training
requirements, including the primary exam, within this year.
Extended training time requirements (if required) – whilst completing
primary exam requirements beyond the initial 12 months of provisional
training.
•
o
PAH ED, through the Training SHO positions, provides an ideal 12month program for provisional training suited to PGY 3 or 4
trainees.
Additional provisional training time, beyond the Training SHO
year, will generally be facilitated by the DEMTs to occur in one of
the nearby accredited EDs.
Advanced Training – 48 months:
o
30 months training in approved ED posts (minimum of 6 months in a
major referral hospital's ED and 6 months in a non-major referral
hospital's ED)
•
PAH ED is accredited for 24 months of advanced emergency
medicine training and is considered to be an ED within a major
referral hospital (MRH).
•
o
18 months training in approved non-ED posts.
•
o
o
3
Non-MRH ED time requirements (minimum 6 months) are
generally provided by rotations to nearby Mater Adults, Logan,
Redlands, Greenslopes, QEII or Ipswich ED (however PAH ED has
links to all accredited EDs in QLD and a non-MRH rotation can
generally be arranged to wherever the trainee wishes). As PAH ED
does not receive paediatric or obstetric presentations these
rotations offer the opportunity to see these patient populations.
Non-ED rotations currently available to trainees at PAH include:
PAH ICU (either at a junior or senior registrar level); PAH
Psychiatry; PAH Internal Medicine; Anaesthetics (QEII) and
Retrieval Medicine with Careflight Medical Services. Many other
rotations are available via the DEMT on negotiation with the unit
in question.
Minimum paediatric requirement – accredited via a logbook system or
completion of 6 months in an accredited Paediatric ED.
•
Most trainees will satisfy the minimum paediatric requirement via
a 6 month rotation from PAH ED to the Mater Children’s ED.
•
Otherwise Paediatric Logbook requirements can generally be
completed during non-MRH rotations to mixed EDs.
Research requirement – to be eligible to sit the Fellowship Exam trainees must
have completed their Trainee Research Project (TRP):
o
We strongly recommend that trainees within our program satisfy
their research requirement by undertaking the necessary TRC
approved university subjects.
o
The UQ - PAH ED Research Unit will help instigate, oversee and
support trainees that wish to undertake a research project –
preferably after they have completed their university subjects.
o
Fellowship Exam – may be undertaken after completing 36 months of advanced
training and completion of the Trainee Research Project:
o
A highly regarded Fellowship Exam Preparation Program is run from PAH
ED prior to each exam. This program is often accessed by trainees from
all over SEQ.
PAH ED Trainees
The PAH ED currently has positions for:
•
18.5 FTE Registrars. The registrar positions within the ED are reserved for
advanced training registrars.
•
12.0 FTE Training SHOs. These positions are generally reserved for those
commencing their training (i.e. provisional trainees). The expectation is that
trainees are only in this position for 12 months.
Directors of Emergency Medicine Training
Darren Powrie and Jonathon Isoardi are the Co-DEMTs. They are responsible for ensuring
the provision of a training program commensurate with the accreditation status of the ED.
The DEMTs take responsibility for all training issues within the ED and coordinate the
delivery of trainee education programs and in-training assessment.
James Collier manages the employment of the registrars; whilst Andrew Staib and James
Collier manage the employment of the Training SHOs.
Other general training issues concerning QLD based trainees can be taken up with either:
•
QLD Censor / Deputy Censor
•
ACEM Trainee Representative, QLD
•
Or the relevant contact at the college (see ACEM Website – Contact Us)
Trainee Assessment
The DEMTs coordinate the assessment process for all trainees. All consultants provide
individual feedback on trainees (via a Survey Monkey process) with emphasis on strengths
and weaknesses. Start of term meetings, Mid-term and end-of-term assessments are
conducted by the DEMTs with the trainee and where possible their mentor. Aims and
objectives for the coming training period are set and action plans implemented where
necessary.
With respect to the In-Training Assessment (ITA) process it is expected all trainees
familiarise themselves with the relevant rules and procedures. With respect to entering a
DEMT within the system when undertaking an ED term at PAH, trainees should select
either ‘Darren Powrie’ or ‘Jonathon Isoardi’.
Communication
All communication concerning the training program, including the education programs, will
occur via www.emergpa.net calendar and via email.
Consultant ACEM Roles
Various consultants hold ACEM appointments and as such may be a useful resource for
trainees:
James Collier – Regional Censor, QLD; Board of Education; Accreditation Committee; Court
of Examiners; CRP Steering Group; Trainee Research Committee – Senior Adjudicator
Sean Lawrence – Court of Examiners; FEC subcommittee – SCE Committee; CPD – Chair,
ACME Monitoring Subcommittee; Local WBA Coordinator
Hector Fuentes – PEC – Pathology Subcommittee; FEC – SAQ Committee
Michael Sinnott – Trainee Research Committee - Adjudicator
Colin Page – Trainee Research Committee – Adjudicator
Phil Kay – Private Practice Committee
Iain McNeill - Local WBA Coordinator
Marianne Cannon – Public Health Committee
4
ADVANCED TRAINEES - REGISTRARS
The program for advanced trainees at the PAH ED can be thought of as one that covers the
duration of their 48 months of advanced training with the college.
The DEMT(s) will liaise with you to map out an individually tailored program that covers
your training needs and rotations over the 48 months. This will be reviewed regularly with
you to ensure its currency in light of any training or personal changes. The DEMT will take
responsibility for facilitating your rotations outside of PAH ED.
Advanced training registrars can be expected to spend 18-24 months in the PAH ED during
the course of their training. We generally recommend that a continuous 12 months be
undertaken in the PAH ED leading into and including the time of the Fellowship Exam, in
order to readily access the exam preparation program and other resources we have to
offer.
As a result the first 2 years of advanced training will generally involve proportionally more
non-ED time and include your non-MRH ED time. The last 2 years will include more PAH ED
time as you prepare and sit your Fellowship Exam.
Registrar Clinical Role
The clinical duties of registrars within the ED primarily involve patient care and supervision
of junior staff. The balance can be difficult at times, but guidance from consultants is
always close at hand.
The role on the floor at PAH ED is weighted towards the ED registrars taking on a more
supervisory role of their resident team. The registrars will have less of their own patients
to manage independently, but will be intimately involved with the patients the residents
within their team are seeing, with particular emphasis on the ATS Category 2 patients.
With respect to ATS Category 1 and 2 patients within the ED Resuscitation Rooms, the
consultants and registrars take primary responsibility whilst utilising the assistance of the
junior staff.
The senior medical staff, in conjunction with the senior nursing staff, should also take
responsibility for the flow of patients through the department. This entails:
•
knowledge of all patients in the department
•
guidance of the resident staff in efficient work practices
•
timely clinical
disposition
decisions
regarding
patient
assessment,
management
and
Within PAH ED there is a high level of consultant supervision of the registrars. This is not
intended to be intimidating but offers an opportunity to have frequent clinical discussions
and receive ‘teaching on the run’.
Resident Supervision
Medical staff work within clinical teams consisting of a consultant, a registrar and 2-3
residents (this will often include a Training SHO); the teams are responsible for geographic
areas of the department. The registrar, in liaison with their consultant, is expected to
manage their team and coordinate the delivery of patient care by their team. It is the
registrar’s responsibility to know what their residents are doing. The residents are told to
seek their registrar out early in their deliberations with patients. Early guidance in their
management of patients can save appreciable time later.
Short Stay Unit
A consultant and resident are assigned each day to the SSU. The 'Ambulatory Care'
registrar will assist them each day from 08:00 - 10:00 to ensure trainee exposure to
observational medicine.
Please see the ‘Clinical Practice Manual’ and the Trainee Manifesto section of this manual
for more specific details on the role of a registrar within the department.
Procedural logbook
It is suggested / expected that all trainees keep a logbook of their patient and procedural
experiences to facilitate reflective learning. This logbook may be reviewed at mid and end
5
of term assessments. There are many free apps available to assist you in logging your
patient and procedural experiences.
Intern, Resident Teaching
The majority of intern and resident teaching occurs 'at the coal face'. The ED offers a
unique opportunity for resident staff to easily access consultant / registrar teaching whilst
discussing cases throughout their shift.
Interns have their own educational program – More Learning for Interns in ED (MoLIE) that is delivered every Tuesday and Wednesday by the consultant group. This program is
resourced such that interns are provided with 8 hours of teaching per week.
There is also a program for resident teaching each morning. A 30-40 minute session for
residents in the ED occurs Mon-Fri at 08:00 (except Thursday). This is run by a consultant.
There are weekly educational themes with topics covering common ED presentations or
practical skills. The use of simulation training and multidisciplinary teaching is emphasised
within this program.
Registrars are involved in both of these educational programs.
Resident Assessment
Registrars are required to provide feedback on the performance of the interns and
residents working within the ED. Interns and residents receive a mid and end of term
assessment interview with a consultant. Access to Survey Monkey is sent to all consultants
and registrars at these times to provide feedback prior to these interviews. Registrars’
compliance with this is taken into consideration within the ITA for the term.
Problems on the floor
Occasionally you will confront problems whilst undertaking your clinical duties. The
consultants have a presence on the floor from 08:00 – 24:00 every day and would
encourage you to bring any query, concern or problem to them.
Consultant Supervision
The consultants provide clinical coverage from 08:00 – 24:00 every day. They expect to be
notified at all times about critically ill or injured patients and anything 'political' in the ED.
Overnight they are on-call and will readily return to the ED if requested by the registrar.
Major trauma overnight is an automatic call in for the consultants.
Clinical issues, problems with inpatient teams etc should be escalated to the consultants at
all times.
The consultants will conduct hand-over rounds at 08:00, 13:00 / 14:00, 17:00 and 22:00.
Between these times they will often undertake frequent rounding of the ED with the senior
nursing staff and the registrar and their clinical team. Rounding with the on-call physician
and MAPU consultant also occurs each week-day at 14:00.
Registrar Education
The programs and resources available for registrars are described in detail in the ‘Trainee
Education Programs’ section of this manual.
Another important aspect of education is that which occurs on the floor. The consultant
group will always attempt to take advantage of ‘learning opportunities’ on the floor; either
in hand-over rounds or simply in discussing a case one-on-one.
6
PROVISIONAL TRAINEES – TRAINING SHOs
The 12-month Training SHO position involves either:
•
9 months in PAH ED and 3 months in PAH ICU (working as the ICU Junior
Registrar), OR
•
6 months in PAH ED and 6 months in a nearby accredited ED, OR
•
12 months in PAH ED.
The objectives of the 12-month program are:
•
To further develop a trainee’s interest in emergency medicine.
•
To develop a trainee’s emergency medicine and critical care knowledge and skills
beyond those of other senior residents.
•
To provide an environment conducive to successfully completing the ACEM Primary
Exam.
•
To produce at the end of 12 months a trainee who has completed all requirements
for provisional training and has the knowledge and skills to undertake a registrar
role as an advanced trainee.
Details of the 12 month Program
3 months ICU
The 3 month rotation to ICU as a junior registrar is ideal for immersion in critically ill
patients. PAH ICU is a high volume unit with a patient acuity and complexity reflective of
the tertiary status of the hospital. The ICU junior registrar position is a supported one, with
more senior staff supervising and in attendance for high level decision making and
procedures.
Trainees will gain experience in many aspects of caring for the critically ill, but in particular
management of the ventilated patient, patient transfer and vascular access.
9 or 12 months ED
The Training SHOs’ primary goal when working in the ED is to ‘see patients’, in order to
achieve the clinical exposure we believe the trainee needs at this stage of their training.
The main difference from the registrars working in the ED is that Training SHOs do not
have formal responsibilities for supervising the resident staff in the ED. The main
differences from the resident staff working in the ED is that the Training SHOs are
supervised (mainly by consultants, but also by the registrars) and educated on the floor
within the context of their emergency medicine training (i.e. they are prompted and
questioned from the point of view of what they need to learn to function as a registrar one
day); they are more closely involved with the management of patients in the resuscitation
rooms; and they have access to the resources and education programs available to the
registrars.
Training SHO Duties
The ED Training SHOs work a 24/7 roster, separate from the registrar and resident rosters.
The shifts are designed to cover times of need for the department as well as provide
maximal clinical exposure to the trainee.
There are several patient groups, and thus areas within the ED, for the Training SHOs to
gain as much experience as possible:

Urgent, acute care and resuscitation-type patients

Non-urgent, complex patients (e.g. ATS Category 3 medical patients)

Non-urgent, ambulatory patients
7
Each is as important as the other and it is vital to spread your exposure across all these
areas. We expect you to eventually achieve a junior registrar level of skill (with respect to
knowledge, practical skills and decision making abilities) in dealing with all these types of
patients.
You will usually be working within a team with a supervising consultant and registrar, and
whilst the consultants are closely involved with supervising your work you will need to
keep the registrars informed of your patients as well.
It is expected all trainees keep a logbook of their procedural experiences. This logbook
may be reviewed at mid and end of term assessments. There are many free apps available
to assist you in logging your patient and procedural experiences.
Training SHO Education
The programs and resources available for Training SHOS are described in detail in the
‘Trainee Education Programs’ section of this manual.
Another important aspect of education is that which occurs on the floor. The consultant
group will always attempt to take advantage of ‘learning opportunities’ on the floor; either
in hand-over rounds or simply in discussing a case one-on-one.
ROSTERING
Registrars
Colin Page coordinates the registrar roster.
It is a rolling roster with requests added in as required. If you want any time off on a
particular day / weekend / morning / evening etc you can request this when requests are
sought for the compilation of the following roster period. When the roster is written, every
effort will be made to accommodate your requests. However, there can never be a 100%
guarantee of fulfilling all requests.
Usual shift times –
•
DAY shift: 08:00 – 18:30
•
EVENING shift: 14:00 – 00:30
•
NIGHT shift: 22:00 – 08:00
Punctuality for the commencement of shifts is expected.
Principles of the roster
There are 3 day (0800-1830), 3 evening (1400-0030) and 2 night registrars (2200-0830)
each day. This may change if staffing is stretched due to leave and exams etc. With
respect to the Training SHOs there is at least one SHO per shift, seven days per week.
Trainees work 4-5 out of 8-10 weekends on average.
One of the DAY registrars is on-call for the evening / night shift if there is sick leave or
high acuity overload within the department. However, the call-back rate is extremely low.
There will always be a 10 hour break between rostered shifts.
The roster is based on 8 X 10 hours per fortnight. The standard week therefore is 40
hours. Occasionally, to balance leave requirements in particular, rosters may be 30 hours
one week and 50 hours the next.
Nights are broken into 2 periods and follow each other. Mon – Thur one week; and Fri-Sun
the following week.
Process of writing the roster
Each roster will be written for approximately 3 months i.e. Jan-Apr, April-July, July-Oct,
and Oct-Jan.
All requests must be in writing, usually by email. Verbal requests do not count.
8
If you want any time off on a particular day/weekend/evening/morning you can request it
when requests are called for the next roster period. There can never be a 100% guarantee
that you will get all your requests; however every effort is made to accommodate
everyone’s requests. Please note that after the roster is written, late requests will almost
never be met.
A notice for roster requests will be distributed approximately 5 weeks before the end of the
last published roster. You will have 1-2 weeks to submit your requests. You will be emailed
to confirm that your requests have been received. It is also advisable that you also put
down any holidays to be taken in that period in addition to entering them on the leave
roster. Requests are taken only for the dates the roster is being written. Please do not
send requests for dates outside of the roster. Requests must be received by the due date.
Late requests will normally not be accepted.
A final roster will be published approximately 1 week after all requests are received. It will
be labelled ‘final roster’. Thereafter, any changes to the roster are made amongst
yourselves (i.e. you can swap with your colleagues providing that the department coverage
remains unaltered and follows the rules below).
For those sitting exams, if possible you will not be rostered for nights in the 3 weeks
before the exam.
Principles of swaps on the roster
A swap with your colleagues once the final roster is completed is allowed. Colin does not
require notification of your swaps; however notification of all swaps must go to Jillian
Vernon (ED Office Manager) who will change the master copy.
Though the swap must still comply with the following:
o
Coverage of the department should remain the same as the original roster
o
Minimum of 3 days off after 4 nights and 2 days off after 3 nights
o
No evening shift after finishing a night that morning
o
No more than 6 days worked straight
o
For pay office reasons swaps must be in the same pay fortnight and the total hours
rostered after the swap cannot be less then 80 hours in that fortnight
o
Any problems regarding swaps, then please see Colin Page or Jillian Vernon
Holidays and exam time
Holiday requests are made in writing via email to Jillian Vernon who enters them on the
leave roster.
A central official registrar holiday register is kept. It is located on the “G” drive of the
hospital computer system (G drive – Emerg – Share – Rosters – Consultant and Registrar
Leave) for reference. If it isn’t on the leave roster then the request doesn’t exist. Request
early and if time off is to be taken in the next roster request period ensure the holidays are
recorded before the final date for roster requests elapses.
First in gets the holidays, except in the month before exam times when people sitting
exams are given priority - unless extenuating circumstance prevail (e.g. getting married,
having a baby etc).
Generally only two people off at any one time (obviously exam leave for attendance at the
exam is the exception).
If more than two people want time off to study for an exam, a ‘job share arrangement’ can
be undertaken whereby 2 people each work 20 hours/week. The details can be worked out
with Colin Page.
If you want the weekend off before the holiday, then let Colin Page know at roster request
time. In general this will be factored in on the roster anyway but it cannot always be
guaranteed.
Unless there are extreme circumstances you can only take your annual entitlement (6
weeks annual leave, plus 1 week professional development leave) of leave each calendar
year. This rule is so everyone can freely take their entitlement. Carrying forward leave
9
from other hospitals etc impacts on your colleague’s ability to take their leave. For those of
you who are with us for only 6 months then you are only entitled to half of the above.
Unexpected emergency leave e.g. sick leave/compassionate leave, maternity/paternity
leave
Please discuss this with Phil Kay, James Collier, Andrew Staib or the DEMTs. All reasonable
requests will be accommodated even at very short notice.
If you need to take sick leave, as much notice as possible would be appreciated on the day
e.g. 8 am call before an evening shift, night shift etc. This will enable changes to be made
to cover your shift. You need to notify the consultant who is on at the time that you ring
(If ringing at night, then notify the night registrar).
Any problems
Contact Colin Page. Email: [email protected] Mobile: 0404 044 732. If all else fails –
contact Jillian Vernon by phone (3176 7513) and leave a message or contact by email
[email protected]
Tasks for you
It is strongly advised that you notify Colin and Jillian of your personal email address if you
want rosters etc via this route. Colin will be doing the roster notifications by email.
Training SHOs
Andrew Staib coordinates and writes the Training SHO roster. It is a rolling roster which
covers 24/7.
Usual shift times –
•
DAY shift: 08:00 – 18:30
•
EVENING shift: 14:00 – 00:30
•
NIGHT shift: 22:00 – 08:00
Punctuality for the commencement of shifts is expected.
The general rule is one away at any one time, except for special circumstances such as
exams. Unlike the resident leave roster at PAH you do not have to take all your leave at
once.
Generally you should aim to spread your allocated annual leave across the 12 months.
Jillian Vernon, Office Manager, administers a spreadsheet that records your annual leave.
When you know what leave you want, notify Jillian in writing via email. If it is not on the
spreadsheet it doesn’t count. If there is already someone away on the dates you want, the
rule is first in, first served, unless negotiated otherwise. The roster is written three months
in advance and we will try to accommodate all reasonable requests.
10
TRAINEE EDUCATION PROGRAMS
PAH ED provides a comprehensive education program to guide trainees through their
emergency training.
There are many opportunities to be involved in teaching in numerous environments. A
great deal of effort is made by all the consultants to ensure you receive high quality
education. Your attendance is expected.
Ultimately, you are responsible for your own learning. If you would like more sessions, or
missed out on something you feel to be important, please approach Jon Isoardi, Darren
Powrie or James Collier. Alternative arrangements can always be made.
Please note that all education sessions are programmed and rostered, you will need to
keep abreast of the program, and your involvement within it, via the calendar on
www.emergpa.net.
OVERVIEW
Departmental CME:
Thursday
0800 – 1200
Simulation training:
Airway simulation
Weekly team simulation
Trauma simulations
Tuesday
1400 - 1500
Thursday
0800 - 0900
x3-4 per year (whole hospital)
Fellowship Exam Teaching
Tuesday
0900 – 1200
Primary Study Group
Thursday
Tuesday
1600 – 1800
1600 (before viva)
Online Education Modules
www.emergpa.net
DMEDED (DAY - MEDICAL EDUCATION)
Your day to deliver medical education to
the junior doctors under consultant
supervision
DANAES (Airway Management Program)
Selected trainees undertake an 8-week
airway management program involving one
day a week in theatre
Airway Management Module
Training SHOs and selected advanced
trainees to participate in airway
management module
Continuing Medical Education (CME) - Weekly ED Education Sessions
The weekly training sessions for the consultant and registrar group are held on Thursday
mornings from 0800 - 1200.
Within the CME program exists small and large group teaching sessions.
Session 1 – 08:00 to 09:00
Format: Small Group Teaching, 2 – 3 streams
Activities:
Stream A - Simulation Training – multidisciplinary, team focused scenarios. Trainees are
rostered to this stream and will receive email invites. Watch the emergpa calendar. Meet in
the ED Simulation Room.
11
Stream B - Clinical Examination Teaching - a consultant will facilitate clinical examination
practice. Meet in the ED medical write-up area.
Stream C - when programmed - Education Modules – Airway, Trauma, DKA, ABG,
Epistaxis, Clinical Procedures, USS, SCEs etc. Watch the emergpa calendar. Meet in the
Trainee Room.
Learning Outcomes:
Stream A activities:




Understand, initiate and complete a systematic and simultaneous assessment and
resuscitation of critically ill or injured patients
Understand and employ effective communication strategies
Understand and employ effective teamwork principles
Demonstrate an appropriate level of mastery with respect to clinical procedures
Stream B activities:


Demonstrate history and examination skills in order to collect accurate clinical
information
Demonstrate the ability to synthesise clinical information and generate a
differential diagnosis with diagnostic reasoning.
Stream C activities:







Understand and demonstrate skills with respect to the assessment and
management of the airway and ventilation
Understand and demonstrate safe procedural sedation
Understanding of the spectrum of clinical presentations to the emergency
department
Understand the basic sciences with respect to clinical presentations
Understanding of the modifiers that determine patient acuity and complexity
Understand and apply clinical reasoning, timely decision-making, risk:benefit, risk
stratification and risk management
Understand and demonstrate an ability to reflect good clinical practice in a
structured, logical verbal format
Session 2 – 09:15 to 10:45
Format: Large Group Teaching
Activities:
This session will involve either radiology teaching with Dr Nivene Saad (Consultant
Radiologist), or clinical cases and data interpretation sessions.
Learning Outcomes:



12
Understand rational investigation selection
Demonstrate an appropriate level of mastery with respect to the description and
interpretation of investigation results (imaging and laboratory)
With respect to case discussions:
o Generate problem lists, differential diagnosis, investigation and
management plans
o Understand and apply clinical reasoning, timely decision-making, risk:
benefit, risk stratification and risk management
o Understand and demonstrate an ability to reflect good clinical practice in a
structured, logical verbal format
Session 3 – 11:00 to 12:00
Format: Large Group Teaching
Activities:
This session will involve disease / condition focused topics, frequently with invited
speakers, or registrar presentations.
Learning Outcomes:





Understanding of the spectrum of clinical presentations to the emergency
department
Understand the basic sciences with respect to clinical presentations
Understanding of the modifiers that determine patient acuity and complexity
Understand and apply clinical reasoning, timely decision-making, risk: benefit, risk
stratification and risk management
Understand and demonstrate an ability to reflect good clinical practice in a
structured, logical verbal format
Rosters for the CME sessions are provided well in advance to allow you sufficient
preparation time. Please note that a consultant is generally assigned to facilitate each
session and they will assist trainees in the preparation of their presentations.
Whilst the ED does not provide for paid attendance to all these sessions, we do attempt to
provide non-clinical days for trainees throughout the term. These DE (Day Education) are
generally rostered to occur on Thursdays. There is an expectation that trainees will attend
75% of the Thursday sessions throughout a term (an attendance record is kept). Night
shifts and annual leave etc is not taken into consideration as there is no expectation that
you will attend. You will manage most of this with day shifts and DE days, but it does
mean there will be days you attend when you are on evening shifts or a day off. It is
hoped the morning’s program is of enough interest and benefit to make this an easy chore
anyway.
Simulation Training
Simulation training accounts for a considerable proportion of the CME program and the
training program as a whole. It allows for multidisciplinary teaching, communication and
team work training and is well regarded by all levels of staff.
Weekly team simulation sessions involving trainees, junior medical staff and nursing staff
occurs weekly on Thursdays 08:00 – 09:00.
Small group multi-disciplinary simulation training also occurs on a weekly basis on Tuesday
afternoons, with a focus on airway management simulation. A selection of Registrars and
Training SHOs on a DE day or from an EVENING shift will be rostered to attend.
Sean Lawrence and Jonathon Isoardi are the coordinators of simulation training within the
ED.
ACEM Primary Exam Preparation
This is coordinated by the DEMTs with the assistance of other consultants. Sessions occur
on Thursdays 1600 – 1800 and the department ensures resources and advice are readily
available to guide and assist you in your preparation. Please see www.emergpa.net for the
Primary Exam Preparation Manuals and other resources. The ED also has all the textbooks
and anatomical models that are utilised in the exam to assist you in your preparation.
The sessions held are study group sessions with trainees meeting in the Trainee Room for
protected study time and discussion of topics / issues etc.
The focus of the program is one of support rather than ‘teaching content’. A consultant will
be made available to facilitate the session if required, but this needs to be requested via
the DEMTs.
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Following the MCQ exam, twice weekly viva practice sessions facilitated by the consultants
are held on Tuesdays and Thursdays (from 16:00) until the viva exam.
Please see the DEMTs with respect to commencing your preparation.
ACEM Fellowship Exam Preparation
This is coordinated by Darren Powrie with the assistance of other consultants. A formal 910 month program is conducted prior to each exam sitting for candidates.
The program involves sessions at PAH ED every Tuesday 09:00 - 12:00. The program is
highly regarded, with trainees outside of PAH frequently accessing it, and is associated
with a high degree of success at the exam.
The emergpa website, www.emergpa.net contains resources including the Fellowship Exam
Preparation Manual.
Please see the DEMTs with respect to commencing your preparation.
Online Education Modules
Various consultants have collated resources and provided specific education modules on
important emergency medicine topics. These modules, located on the emergpa website,
www.emergpa.net combine latest evidence with PAH specific clinical practice guidelines to
provide a comprehensive overview of topics with local applicability.
We would recommend all trainees work through theses modules during the course of their
term in the ED.
DAY – Medical Education (DMEDED)
A large part of your future role as an Emergency Physician will be in the education of
emergency medicine trainees and junior medical staff. As a result we aim to provide
education on “how to teach” via rostering registrars to ‘Medical Education Days’ (appearing
as DMEDED on the roster). These days consist of:
1.
Involvement in morning resident tutorials (08:00 – 08:30)
Each weekday morning, except Thursday, at 0800 the A3 consultant delivers a tutorial for
the residents. There is a theme for each week. The DMEDED registrar will be expected to
deliver some of this tutorial, with a consultant mentor (A3 consultant). You will need to
liaise with the A3 consultant rostered for that day to work out your preparation. The
session outline can be found on the USB stick on the noticeboard in the EM office area.
2.
Involvement in MoLIE teaching (13:00 - 17:00)
The intern cohort from both PA and QE2 hospitals are rostered for one non-clinical day per
week. This day is for MoLIE teaching (MOre Learning for Interns in Emergency). The day
consists of two modules: 0830 – 1230 and 1300-1700. Registrars will be helping to
facilitate the afternoon session. Each module has a theme and is structured around cases.
There is a variable amount of practical teaching depending on the module. Most of the
teaching takes the form of group discussion.
Each registrar will be expected to facilitate some of these modules, under the mentoring of
a consultant. You can expect to be given feedback on your teaching skills.
Please liaise with the allocated consultant prior to the session. The “MoLIE B” consultant
will be the person to approach. You will need some time to become familiar with the
module prior to its delivery; do not turn up unprepared. The actual modules can be
accessed from the USB stick on the noticeboard on the EM office area.
Airway Management Program - DANAES
In order to address the difficulties in acquiring and maintaining airway management skills
we have developed a specific airway management module in conjunction with the
Department of Anaesthetics. It is an 8-week program undertaken by one trainee at a time.
The program involves one day per week being assigned to theatre to acquire and develop
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skills in airway management. They will also be expected to complete certain reading
requirements (airway management manual), attend the airway simulation sessions on
Tuesdays (as the roster enables) and complete the Airway Education Module (on-line and
within the small group training sessions on Thursday mornings). More specific details will
be provided to those trainees selected to undertake the program.
Airway Management Module
This is an online module but also delivered over the course of 10 weeks within Session 1
Stream C on Thursday mornings. It is run twice a year and is for the Training SHOs and
selected registrars who are undertaking the airway management program.
RESEARCH
The consultant staff actively encourages research initiatives within the ED. The UQ - PAH
ED Research Unit overseas all research within the department.
Dr Michael Sinnott is the current Head of Research. Rob Eley is the Academic Manager of
the Research Unit. Drs Ellen Burkett, Iain McNeill, Colin Page and Andrew Staib are the
other consultants with significant research expertise.
The DEMTs strongly advise trainees to complete their trainee research requirement via
undertaking Trainee Research Committee approved university subjects. All trainees should
have completed their trainee research requirement requirements prior to commencing
their preparation for the fellowship exam. Thus, these subjects should ideally be completed
during advanced training years 1 and 2.
If a trainee has an interest in research, then they are actively encouraged to undertake
research through the department’s research unit after having first satisfied their training
research requirement via the university subjects.
If a trainee wants to utilise a Trainee Research Project (TRP) to satisfy the research
requirement, then they MUST gain prior ‘approval’ from the DEMTs, before commencing
their project with a TRP supervisor.
MENTORING
The department has a mentoring program available to trainees who wish to have a
mentor.
The DEMTs and Directors are not involved in the mentoring program. However, all other
consultants are available. Please see the DEMTs for further details.
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PAH ED OPERATIONS AND ORIENTATION
All trainees must read the PAH ED – General Information Manual and the PAH ED – Clinical
Practice Manual (CPM). These detail important information about the department and the
way in which it conducts its business. In particular, the ED CPM is a practical manual for all
medical staff working in the ED and can be found on the ED intranet website and on the
emergpa website.
Trainees must familiarise themselves with the emergpa website (www.emergpa.net) and
the PAH Intranet site, including the ED intranet site.
Trainees should also ensure they have watched the orientation videos on the emergpa site
prior to commencing work in the department. There are videos on “Practical Points’,
Orientation Tour’, ‘Nursing’, ‘Administration’, ‘Imaging’, ‘Physiotherapy’ and ‘EDIS’.
Importantly, PAH ED runs a comprehensive orientation program for its trainees at the start
of each term. It is here that we attempt to explain not only ‘what to do’ but ‘why we do it’
in order that you gain an understanding of the model of care we aim to deliver.
Other important points:
ED Scrubs
Consultants and trainees have the option of purchasing PAH ED scrubs to wear on duty.
Please see Jillian Vernon, Office Manager, for details and ordering.
Scrubs can be ordered and purchased from Hunter Scrubs:
www.scrubs.com.au
Order NAVY. Landau unisex tops and pants are favoured by most – though there are also
many other styles. Embroidery – the PAH ED logo should be purchased and placed on the
left pocket of the scrubs top.
Communication, Resources and Information Distribution in the ED
The primary method of communication in the ED (other than face-to-face in meetings etc)
is via email and the emergpa calendar. Ensure you set up your GroupWise email
accounts upon arrival (see Jillian Vernon, Office Manager, for details). Please also provide
Jillian with your home email.
The emergpa website, www.emergpa.net is the location for all resources associated with
training at PAH ED. The site is managed by Iain McNeill.
The PAH ED intranet website also contains clinical resources, in particular guidelines and
policies.
The hospital’s intranet website contains useful information as to what is occurring within
the hospital and provides access to the Clinicians Knowledge Network and Up to Date. It
also contains information from various clinical units regarding their own guidelines and
protocols.
Information will also appear in your pigeonholes (in the trainee room).
Trainees are also provided with laminated cards to be carried on their person; these
contain information on: important phone numbers, the PAH Trauma System and principles
of critical care patient management.
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TRAINEE MANIFESTO
Trainee Clinical Practice Expectations – the specifics:
Enjoy yourself

You are training in your chosen specialty, being exposed to new experiences each
day and gaining knowledge and skills that will shape the rest of your professional
career – what is not to enjoy!
Clinical expectations

Expectations for the standard of clinical care in this department are high; as a
result you can expect to be closely supervised; and with this comes support for the
challenges you will face and many ‘teachable moments’. We would hope this
provides an overall rewarding experience.

Be responsible for the delivery of patient care in your clinical area:
• The registrars largely dictate the quality of care in the department. Your
role in “quality control” cannot be understated. If anyone, including a
consultant, makes a decision that you think undermines good quality care,
please bring this to light at the time. In this situation, it is likely that you
have more accurate, detailed or timely information. Raise your concern
such that a discussion can take place; apart from being good medical
practice, it is a good opportunity for teaching!
• Discuss any concerns with your consultant, at any time; these concerns
may relate to direct patient care, supervision of junior doctors, or relevant
personal concerns.
• Always discuss the care of critically unwell patients with the consultant.
• Clinical guidelines and protocols do exist for some conditions – be aware of
them. However this is a highly consultant supervised department affording
you the ability to learn from multiple consultants. Use these opportunities
to learn and formulate your own safe approach.
• Ensure your residents are delivering high quality patient care.
• Do not refuse the transfer of critically unwell or trauma patients to our ED.
• Always write good clinical notes (or ensure good notes are written by your
residents) – once the patient leaves the ED, your notes are the only thing
that reflects your quality of care. Good notes are accurate, thorough yet
focused, include results of all investigations ordered, contain a diagnosis /
differential diagnosis list / or a problem list, and a management plan. Be
sure that your clinical notes are always printed out and placed in the
patient’s chart.
•
Always use the ‘Trauma Form’ for all trauma patients seen in the
resuscitation area. All areas of the form need to be completed accurately
and thoroughly. Use additional ‘Progress notes’ if necessary.
•
You should always aim to ‘finish’ your patients to an ‘admission level’. That
is, to a level where they can go to the ward without seeing an inpatient
team. This includes clinical notes with management plans, medication
charts, fluid orders and nursing orders.
Professional expectations

Do not leave your clinical area with excessive work for your colleague on the
following shift

Be punctual

Be courteous to all patients, visitors and work colleagues

Strive to effectively communicate with all clinical staff and especially your patients
and their families – when patients are in our ED it is not just another day at work
for them; communication and compassion goes a long way.
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


Complete your administrative paperwork, including medico-legal documents, in a
timely fashion
Check your emails frequently
Check the emergpa calendar regularly
Education and Training expectations

Be responsible for your involvement in the PAH EM Training Program and in your
own self-directed learning program. We aim to ensure that teaching opportunities
are numerous, however you will not be ‘dragged’ in to becoming involved in your
own education.

Rostering is undertaken to ensure as much as possible your availability to attend
the various education sessions is in ‘clinical support time’ (i.e. DE or education
days). When this is not possible strategies are in place to ensure you can be
‘relieved’ of your clinical duties to attend. This is guaranteed on Thursday mornings
(CME program) and depending on workload and staffing generally possible on
Tuesday mornings (Fellowship Exam Program) and Thursday afternoons (Primary
Program).

The 3 registrars and Training SHO rostered for a ‘DAY’ shift on a Thursday need to
present first to the floor at 08:00 and aim to take a quick hand-over of SSU
patients. They should then collectively sort these patients out prior to presenting
to teaching at 08:30. Most patients can be seen and a plan made in this time.

Ensure that you remain ‘on-site’ within the hospital for your DE days.

Rostering and other allowances are given to those sitting the Fellowship Exam; it is
expected that the wider trainee group also supports them at this time and will see
that these allowances will one day be theirs when they sit.
Specifics of the clinical shifts

Ideally, you will be the first point of call for residents in your area. If you are
struggling with your patient load, let the consultant know (this does happen and
will happen to everyone). Remember to redirect residents to discuss their cases
with a consultant if you are busy – this is not a sign of ‘failure’.

The model of care for registrars is balanced more to the supervision of residents
and early focused input into patients within the ‘acute’ area and more direct patient
care with respect to patients in the resuscitation area.

Aim to discuss patients with residents at the bedside so you can clarify history and
exam findings.

Whilst patient flow is the concern of the consultants and quality of care is the
concern of trainees; do be aware of potential patient movements that may aid the
running of the department.

You and your team must aim to ‘finish’ your patients as soon as time allows; ‘finish’
means completed notes, fluid charts, medication charts, and orders to an
admission level. For many patients this allows for their movement to the ward
prior to being seen by the accepting inpatient team.

Notify the consultant of any procedure you are going to undertake.

All patients being discharged should have been discussed and usually seen by a
registrar or consultant.

The overlapping of shifts in the afternoon coincides with the department’s peak


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activity. Ensuring new patients are seen and ‘finishing’ off patients from the
morning is vital. Working as a team with your evening registrar counterpart on
your side is crucial to this.
The evening shift teams should ensure they do not leave excessive work for the
night shift.
If you are in ambulatory care:

You and your team will be attending to patients triaged to that area, the
waiting room and the procedure room. Some of these patients will be
‘acute’ and some will be ‘complex’ – however they should all be able to sit
and generally will be ambulatory (except for some fractures / dislocations
etc).







If you

See patients by time of arrival rather than triage category – however be
aware to scan the screen and liaise with nursing staff to ensure the priority
of who will be seen next is appropriate.
Look to identify patients who will be uncomplicated and quick and ensure
at least one resident continues to work their way through these. The other
resident(s) can then continue to work their way through the complicated
patients who may take some time to sort out.
Ensure you still discuss patients you are unsure about with the consultant
and alert them to any issues.
All patients being discharged should have been discussed with or seen by a
registrar or consultant.
You (or your team) will often be the first point of call for performing
procedures on patients (including many on patients from the acute area) in
the procedure room, reviewing paediatric presentations at triage, seeing
patients in the Security Unit or undertaking medical reviews of psychiatric
patients in ED Mental Health.
Do not leave excessive numbers of patients in the waiting room left unseen
at the end of the evening shift.
are on the night shift:
This is recognised as a difficult shift – it is expected that sometimes the
department may be ‘unsorted’ in the morning.
Aim to at least have a plan for each patient rather than just ‘touch base’
with every patient and have no decisions made or plan enacted.

If you are concerned or worried about any patient ring the consultant.

If you have a critically unwell patient ring the consultant.

You will have to manage general patient flow to some extent on this shift –
however, if you have a problem with the overall running of the department
ring the consultant – the nursing shift coordinator has been given the same
instructions, so do not feel aggrieved if they ring the consultant.

Look to nominate one resident to continue to see patients in the waiting
room through the night shift.

You will be the point of contact for incoming medical calls - do not refuse
the transfer of critically unwell or injured patients to our ED
On every shift:

Ensure you and your team communicate to the nursing staff

Ensure you and your team communicate with your patients

Manage yourself and your residents - such that everyone gets their breaks

Aim for you and your team to leave on time and enjoy your shift


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