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.
Arriving in the ED
Report for your rostered shift to the main central enclosed area of the ED which we call the fishbowl. Always introduce yourself to the duty consultant on arrival on your first shift. We have a roster of who we are expecting and we do keep track of your attendance.
When you are onsite you will have full access to ED Central and we would encourage you to review the site during your first half hour in the department - go to www.edcentral.com.au. Having a quick look at the medical orientation manual http://www.edcentral.com.au/doctors/orientation and at the clinical resources we use in the ED will help give you a grounding about what is happening around you.
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.
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.
The formal part of the Emergency Medicine teaching program is held every Thursday morning at 8am in the ED education room. All 3rd and 5th years are expected to attend. If there are teaching related issues or you need other advice, then the Co-Directors of Emergency medicine Training Dr Ben McKenzie and Dr Kiran Veera will be happy to assist you.
On Wednesday afternoons there is a teaching session aimed more at ED intern and HMO level. This is on most weeks, starts at 1630h and goes for one hour in the ED education room
Different year levels have different focuses during their time with us:
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 diffent '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, Tuesday and Wednesdays (0800 to 11.30am). You can link up with them at the ED handover meeting at 0800h. After 1130 we generally ask you to shadow one of the registrars and see patients with them. They will provide you with plenty of opportunities for learning. You may also be able to assist with some procedures if time and work load permits - get involved and do as much as you are able. Please do not take any significant responsibility for any of the registrars or residents - sometimes you may get confused with 5th year students (who work with the consultants and have increased responsibility).
On Thursdays mornings you are scheduled to attend ED teaching in the ED education room (administration area) from 0800h until late morning when the sessions break up for exam preparation. Occasionally the teaching will be located elsewhere e.g. Monash sim lab or offsite - please check the calendar on ED central (link from main page). The teaching is generally pitched at registrar level so don't worry if you find some of it over your head. In 2017 we introduced intern and HMO level teaching on Wednesday afternoons (1630h) which you may find more useful.
During the first week of your ED rotation, please introduce yourselves to one of the medical student supervisors Dr Richard Smith or Dr Mazdak Mansoury, either in person (depending on the roster) or via email email@example.com, firstname.lastname@example.org
Please make sure you understand that you are welcome in the department and that we want you to see as much as you can - if we are busy or look distracted, this is not about you but at times of peak demand you will need to make use of your own initiative to see patients. This means checking with a nurse or doctor if its appropriate to approach a patient and then introducing yourself to take a history and carry out an examination.
You are present in the Emergency Department for 2 shifts during your Children's Health rotation. Although your time with us is short we hope that you have positive experience and have an opporunity to have some good clinical encounters. Your shifts in ED are designed to increase your exposure to acute paediatric presentations. The ED is a fantastic place to see undifferentiated patients, often in contrast to ward patients who have been sorted and stabilised.
We ask you that at the beginning of each shift you introduce yourself to the duty consultant on and then identify any paediatric patients in the department.
Paediatric patients attend in fits and starts and more often in the evening - if there are no paediatric patients then we suggest that you introduce yourself to the triage nurse and linger in the triage area (there is usually one computer available there to peruse the RCH guidelines while you wait). It also gives you an opporunity to ask and understand how triage works. When a paediatric patient presents you will then be able to follow them on their journey through the department.
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 and write notes for the registrar.
You will be forwarded a login to ED Central and we expect you to read the medical orientation manual prior to your first day with us. http://www.edcentral.com.au/doctors/orientation
There will be a consultant to orientate you on your first day (usually around 12:30pm on the first Monday). This will usually be one of the ED supervisors for medical students: Dr Richard Smith email@example.com, Dr Mazdak Mansoury firstname.lastname@example.org
How do you learn in ED?
1) Working in an-intern like model supervised by the consultant (main area or fast track/short stay area as rostered). You will see patients and learn to have some responsibility. The patient is under the consultants name and the consultant MUST sign all imaging + pathology requests, ED documentation written by the student, and ED discharge summary. The consultant MUST see the patient themselves. You are expected to see the patient fresh, discuss the patient with the consultant within 30 minutes of being allocated to that patient. You must order and follwup investigations, come up with a differential and management plan as well as document care in the notes and write a discharge summary. 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 - some of these are done while seeing patients on the floor and others require a written response. Please ask the duty consultant to help you identify an apppropriate patient for the relevant clinical scenarios in your modules. Not all ED supervisors have access to Moodle, so please create a word document with your written module responses on it and forward it to your ED supervisor by the last Tuesday of your rotation. We need both to make sure you have done it and that we have enough time to read it so we can go over it with you in your feedback session (typically on the last Thursday of the rotation).
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. Registrars are not able to sign off your logbooks.
5) Departmental audit - this allows you to put a quality and safety project on your cv and understand how hospitals work beyond clinical medicine. We believe this is vital to making sure you start work and understand the complexities of public health care at the outset.
In preparing for your time in ED you might like to watch some of these short video lectures from FlippedEMClassroom. They are 5-10 minutes each and are created specifically for senior medical students on rotation in ED. I strongly recommend watching the ones on Chest Pain and Abdominal Pain before you start as these are two of the most common ED complaints. These complement the compulsory 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.
2) You may not write notes for or consult patients in our intern-like model with the 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.
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 Richard Smith email@example.com, Dr Mazdak Mansoury firstname.lastname@example.org.