Information for Bendigo ED Registrars & JMOs regarding medical students

Medical students in their foundation clinical year (FCY, 3^rd year undergrad) and final year (5^th year undergraduate) rotate within the emergency departments from Monash and Melbourne University. These students are here to embed themselves within the team, and make the most of learning opportunities. We encourage you to engage with them and help them learn, within the guidelines below. We also have Medical Assistance Officers (MAO), who are senior medical students employed to assist our consultant on evening shifts in Ambulatory Care. We hope this is valuable learning for them, but this is not an educational role, and the consultant will use this assistance in the best way they are able to improve efficiency and flow.

The 3^rd year students are within the emergency department for 2 weeks at a time and will be accompanied by a Clinical Nurse Educator (CNE). They are supervised by the CNE to take histories, examinations and procedures. Please assist if asked by the CNEs, or recommend patients to them if you have someone appropriate.

The final year medical students may be asked to accompany you as a registrar. They are not to present histories and examinations in the intern like model, because of the increased clinical risk this presents. You may supervise them for basic procedures or tasks such as IV cannulation, epistaxis management, or simple wound closure, which you are highly proficient in. As a resident or intern, you should not be working with the medical students, but rather focusing on your own learning.

Senior registrars, in the transition to being a consultant, may be asked by consultants to supervise medical students, and may be permitted to work in an intern like model. This recognises that the transition phase requires you to develop supervision skills, and that you understand the heightened clinical risk that this presents. You must review all patients, remember to keep an open mind, and be cognisant that this is a challenging task. You are still welcome of course to choose to work in a model whereby the student accompanies you to see patients, rather than seeing them initially and presenting to you.

Medical Students

This is a public page with information for medical students who rotate through Bendigo Emergency Department from Monash and Melbourne Universities.

As part of a teaching hospital, the Emergency Department enjoys giving students an opportunity to be exposed to acute medicine.  We love the energy that you bring to our workplace and we would like to warmly welcome you to our department.  Regardless of year level we encourage you to get involved as much as you are able to.

In your time in the emergency department there are some simple rules that apply to you regardless of seniority:

• Dress appropriately and maintain a professional demeanour at all times.
• Identify yourself as a medical student when engaging staff and patients
• Ensure that anything you do related to patients has the consent of patients and staff.

Foundation Clinical Year / 3rd Years

This is generally the first year of significant clinical exposure and we encourage you to spend as much time talking to and examining patients, understanding their symptoms and signs, and then correlating your thoughts with what the staff are thinking in way of differential diagnoses and pathology.  This will make your formal learning around conditions more meaningful.  Using your logbook as a guide, try to see as many of the different 'cardinal presentations' and practise as many clinical skills as you can during this rotation. We also strongly recommend that you understand what the investigation and management issues are even though this may not be your core focus.

During your 2 weeks with us you will be directly supported by a CSSC Clinical Educator who act as your concierge in the ED on Monday to Thursday (0900 to 11.30am). You can meet them directly at the critical lifts in the emergency department.

On Wednesday afternoons there is an ED teaching session for Interns and HMOs in the ED education room at 1630, which you are welcome to attend if you are available.

The medical student supervisor is Dr Phil Naidoo pnaidoo@bendigohealth.org.au and you are welcome to introduce yourself or email if you have questions, but during third year you will be supported by the Monash CSSC educators during your ED time.

Final Year / 5th Years

Orientation & Commencement

Dr Phil Naidoo pnaidoo@bendigohealth.org.au will be your consultant supervisor and will orientate you on your first day. You will get an email in the week or two prior to your rotation with details of your orientation, and how to access your roster for shift allocations.

For a rostered day shift, come to the main central area of ED before 0800 and ask for assistance to go to the allied health room or handover room, which is back towards the central patient lifts from the ED main central area. This is where the morning handover occurs. Students rarely come for an evening shift, but if you are rostered, these start at 1400 and occur on the ED side of the critical lifts, toward the ED administration area from Resus.

Always introduce yourself to the duty consultant on arrival.  We have a roster of who we are expecting and we do keep track of your attendance.

You will be sent a generic log in to the ED central website in the email a week before you start with us. We expect you to read the medical orientation information prior to your first day with us. www.edcentral.co/orientation-layout/

Please stick to the times you are rostered to come to ED.  You may be able to attend on the weekend but this needs to be negotiated with your ED supervisor and also have the approval of the duty consultant for the shift.

When you come to the ED you can put your bags in any available lockers located in staff change rooms (in the administration area of the ED).  You can set a temporary 4 digit pin for the day.  Please remove all your belongings at the end of the day.

Teaching

The formal part of the Emergency Medicine teaching program is held every Thursday morning at 8am in the ED education room.  All 5th years are expected to attend.  If there are teaching related issues, then the Co-Directors of Emergency medicine Training Dr Kiran Veera, Dr Yvette Bassin, and Dr Ian Staples will be happy to assist you.

On Thursday afternoons there is a teaching session for ED interns and HMOs.  This is on most weeks, starts at 1630h and goes for one hour in the ED education room

Working in ED

5th years have been present for many years in the ED and undergo an intern like model of work supervised by the duty consultant.   You cannot work in this model with registrars: if the consultant is busy and you are asked to attach yourself to a registrar, you should help where possible but you cannot take a denovo history, report back to the registrar and write notes for them. Occasionally the consultant in your area may delegate supervision to a senior registrar, and discuss with you and them about working in an intern like model, however this MUST ONLY be with a senior registrar at the consultants request.

How do you learn in ED?

1) Working in an-intern like model supervised by the consultant (main area or ambulatory care).  You will see patients and learn to have some responsibility.  See the patient and take a history, and examine them. Report back to the consultant within 30 min, and present with a differential diagnosis and consider the management plan. The consultant should then order any imaging and pathology required. You should write the notes, and the consultant must sign all documentation written by you, and the discharge summary should be done if the patient is to be discharged. The consultant MUST see the patient themselves.

 If you are unable to follow through a patient to the end due to time constraints of having to be elsewhere then let the consultant know.  Do not leave the department without letting the consultant know you are leaving.

2) Teaching sessions: Thursday registrar teaching 0800-1200.  Wednesday HMO teaching 1630-1730h.  You should attend both sessions.

3) Modules – these are now self-directed, and are ideally completed during your rotation. They will help you to learn about emergency presentations and help you make the most of your rotation. The Medical Student Supervisor (Caitlin Young) is happy to go through them with you if you have completed them.

4) Logbook - please get going on this early.  Your 6 week rotation will go past quickly and you cannot count on the consultants to be constantly available to review your presentations and sign off logbooks when the department is busy, as it invariably will be.  Utilise the periods when the ED is less busy (e.g. mid-morning) to try to check off your logbook tasks.  Please notify the duty consultant at the start of your shift if there is any procedure or type of patient you need to cover and we will endeavour to find you a good case. The physiotherapists and plaster technician Jason are able to sign off your plastering and bandaging.

In preparing for your time in ED you might like to watch some of these short video lectures from Flipped EM Classroom. They are 5-10 minutes each and are created specifically for senior medical students on rotation in ED. Watch the ones on Chest Pain and Abdominal Pain before you start as these are two of the most common ED complaints.  These complement the video lectures in your modules.

Another excellent online resource is Life in the Fast Lane - blog, discussion board, ECG archive, textbook. It is a bit all of these things and a great resource when preparing a talk.

5th year RULES

1) You may ONLY work in the intern-like model seeing patients with the CONSULTANT, or occasionally with a senior registrar if this responsibility is delegated by the consultant.

2) You may not write notes for or consult patients in our intern-like model with the registrars or other junior doctors - they must see patients first and do all documentation and referrals.  If the consultant is busy you should see patients and tag along with registrars in a more passive role but they will still be able to help you with procedures and lots of other teaching.

Further Questions

For questions related to your rostered shifts please contact your university coordinator.  For other issues related to training or the ED these can generally be directed to Dr Phil Naidoo pnaidoo@bendigohealth.org.au