VI  Year  Student  Attachment  2014  Modbury  Hospital  Emergency  Department    

Term  Supervisors:    Dr  Tim  Burrough,  Dr  Jason  Bament,  Dr  Peter  Stuart    

Welcome  to  the  Emergency  Department.  On  your  first  day  you  will  receive  an  orientation  to  the  ED  and  meet  with  the  Term  Supervisors.  During  your  attachment  you  will  be  rostered  to  work  a  variety   of   early   and   late   clinical   shifts   operating   in   one   of   the   two  major   ED   areas   :   Area   A   /  Resuscitation      and    Area  B  /  Rapid  Assessment  /  Paediatrics.    

During  your  attachment  you  will  have  the  opportunity  to  learn  many  new  skills  and  deal  with  a  wide  range  of  medical  conditions  that  commonly  present  to  the  Emergency  Department.  Below  is  some  suggested  learning  objectives  for  your  attachment.  You  will  probably  wish  to  modify  them  according  to  your  need.    At  the  completion  of  your  attachment  you  should:      

1.  Have  knowledge  of  the  role  and  function  of  the  Emergency  department.    2.  Be  able  to  diagnose  and  manage  the  following  common  presenting  complaints  including    

• Chest  pain    • Dyspnoea    • Abdominal  pain    • Febrile  child    • Simple  wounds    • Common  ENT  and  eye  conditions    • Common  orthopaedic  injuries    • Basic  psychiatric  presentations    

3.  Be  confident  in  resuscitation  and  management  of  the  following  emergencies:    • Asthma  /  exacerbation  of  COAD    • PV  bleeding  in  first  trimester  pregnancy    • Myocardial  ischaemia  (AMI  /  unstable  angina)    • Anaphylaxis      • Acute  poisoning    

4.  Be  able  to  independently  perform  the  following  procedures:    • Basic  CPR    • Slit  lamp  examination  /  Removal  of  corneal  foreign  body    /  Pack  a  nose    • Apply  a  POP  to  upper  and  lower  limbs    • Suture  simple  wounds    

5.  Be  confident  in  interpreting  the  ECG,  Basic  radiological  investigations,  ABG’s,  Biochemistry,  Liver,  Renal  Function  tests  and  CBE    

Clinical  Shifts    Clinical  Attachment  :  3  shifts  /  week  on  a  7  day  roster  (days  and  evenings)  

During   the   6  weeks   you  will   rostered   to  work   3   clinical   shifts   /  week   over   a   7   day   roster.     In  general  you  will  rostered  in  pairs  with  one  student  assigned  to  each  of  the  two  main  clinical  areas  of  the  ED  :  Area  A/Resuscitation  and  Area  B/RAT/Paeds.    

Log  Book    You  will  be  given  a   log  book  to  complete  during  your  attachment.  The  log  book  lists  10  specific  types   of   ED   cases   you   should   see   and   treat   see   during   your   attachment.   The   logbook   is   easily  completed   and   aims   to   ensure   you   receive   exposure   to   core   ED   cases   such   as   chest   pain,  abdominal  pain,  paediatrics  and  trauma.    Mini  CEX    As   a   part   of   your   learning   you   will   undertake   a   Mini   CEX   assessment.   The  Mini   CEX   involves  undertaking   a  patient   history   and   examination  under   the  observation  of   a   consultant.   You  will  then  be  asked  to  present  the  case  and  provide  a  differential  diagnosis  and  management  plan.  The  Mini   CEX   is   intended   as   a   learning   experience   and   you   will   be   provided   feedback   on   your  assessment.  The  Mini  CEX  will  generally  be  completed   in   the   last   two  weeks  of   the  attachment  and  the  procedure  discussed  during  at  the  weekly  Student  tutorial.    Clinical  Shifts  To  enable  you   to  participate   in   the   teaching  program  offered  by   the  University  you  will  not  be  rostered  on  clinical  shifts  on  either  a  Wednesday  or  a  Friday.    

Times  of  the  shifts  are  shown  below    

• Morning  shift  :  8  am  –  4  pm  (includes  a  30  minute  lunch  break)    

• Afternoon  shift  :  2  pm  -­‐  10  pm  (includes  a  30  minute  tea  break)    

When   you   are   rostered   on   a   clinical   shift   you   are   expected   to   function   as   one   of   the   ED   team.  Punctuality   is   important.  Apart   from  meal  breaks,  you  are  expected  to  remain  in  the  ED  for  the  duration  of  your  shift.  If  you  need  to  leave  for  any  reason  please  ensure  you  discuss  this  with  the  ED  Consultant.    

Your  name  will  appear  on  the  daily  list  of  medical  staff  on  the  shift.  Please  sign  your  name  when  you  attend  the  shift  –  this  is  required  for  us  to  validate  your  work  in  the  ED  as  part  of  the  term  evaluation.    If  you  are  unable  to  attend  a  shift  (eg  due  to  sickness)  you  must  phone  the  ED    (8161  2315   or   8161   2350)   and   speak   to   the   duty   ED   Consultant   (or   ED   Medical   team   Leader   if   a  consultant  is  not  available)  

 

 

Student  Tutorial  Program    A  2  hour  tutorial  is  scheduled  each  week  to  discuss  clinical  cases,  explore  questions  and  topics  of  interest  and  provide  support  with  the  student  project  (outlined  on  the  next  page).  

Each   student   should   select   a   recent   clinical   case   they   have   seen   in   the   ED   and   be   prepared   to  present  this  at  the  tutorial  for  discussion.    

Time  :  Tuesdays  2  –  4  pm  (Emergency  Department  Tutorial  room)  

Tutorial  Objectives  :  The  student  tutorials  provide  the  opportunity  for  students  to    

1. Present  and  reflect  on  their  clinical  cases    

2. Receive  direction  on  their  learning  project  and  report  progress  

3. Focus  their  learning  on  specific  clinical  topics        

Program  of  Clinical  topics  and  Pre-­‐learning  activities            

Week  1       Introduction  to  the  Student  Project    :  Project  Topic  /  Goals  /  Allocation  of  roles                                                             /  Timelines  /  Expectations  /  Resources  /  Support  

Week  2     Student  project  :  Completion  of  outline  /  plan  /  Case  Discussions  

Week  3     Student  project  :  Progress  report  /  Case  Discussions  

Week  4     Student  project  :  Progress  report  /  Case  Discussions    

Week  5     Student  project  :  Completion  of  report  /  Presentation  to  student  group       Student  Presentation  :  Discussion  of  the  format  and  material  /  timings  

Week  6     Mini  CEX  /  Review  of  Log  Book  /  Completion  of  Evaluation  form  

 Modbury  E-­‐learning  -­‐  EDGE  Program            edge.learnem.net.au    Modbury  Hospital  has  developed  an  e-­‐learning  program  to  assist  medical  students  during  their  time  in  the  Emergency  Department.  The  program  is  termed  Emergency  Medicine  on  the  Edge.  

The  e-­‐learning  provides  the  opportunity  for  students  to  :  

1. Understand  the  approach  to  a  range  of  common  presenting  complaints    

2. Develop  a  working  knowledge  of  the  assessment  of  the  acutely  ill  or  injured  patient  

3. Learn  and  consolidate  a  range  of  common  practical  skills  required  for  the  acute  care    

The   program   is   accessed   via   the   Modbury   ED   website   or   directly   via   the   EDGE   webpage  edge.learnem.net.au   and   requires   a   username   and   password   (available   from   the   ED   Secretary  when  you  begin  your  attachment.    

ED  Student  Project  During   your   attachment   you   will   undertake   a   learning   project   focusing   on   an   aspect   of  emergency   care.     The   topic   of   the   project   will   be   discussed   during   your   orientation   and  supervision  and  support  will  be  provided  at  the  weekly  student  tutorials.    

At  the  completion  of  the  project  students  are  required  to  prepare  a  2  page  summary  and  provide  this  in  electronic  form  (for  placement  of  the  student  page  at  Modbury  on-­‐line).  The  project  will  be  presented  to  ED  staff  in  the  last  week  of  the  attachment  at  the  Tuesday  (2  pm)  teaching  tutorial.    

 Structure  of  the  Project  Each  student  will   focus  on   the   topic   from  a  different  perspective.  These  are:  Literature   review,  Evidence  Based  Practice,  Medical  education  /E-­‐learning,  Case  audit.      1.  Medical  Education  /  E-­‐learning    This  project  involves  identifying  a  “typical”  clinical  case  that  illustrates  the  clinical  problem  and  adapting  this  for  the  delivery  of  medical  education  in  the  following  contexts;  

1. Student  presentation  in  the  last  week  of  the  attachment    2. Resources   for   student   e-­‐learning  using   the   clinical   case   as   the   basis   for   an   interactive  

case  discussion  incorporating  findings  of  the  literature  review,  EBM  and  clinical  audit.  The  student  will  have  the  opportunity  to  become  familiar  with  the  development  of  an  interactive  case  based  teaching  tool  and  receive  feedback  and  support  during  this  process.    2.  Clinical  Guidelines  /  Evidence  Based  practice  This   aspect   focuses   on   current   practice   and   considers   the   question   –   is   current   practice  evidenced  based  and  if  so  what  level  of  evidence  supports  our  practice.  The  aim  of  this  approach  is  to  enable  the  student  to  explore  how  to  apply  the  very  useful  evidence  based  methodology  to  clinical  practice.    A   possible   starting   point   for   this   topic   will   be   to   determine   if   there   are   standard   clinical  guidelines  for  the  condition  and  then  consider  how  these  were  developed.  Was  an  evidence  based  approach   utilised   and   if   so   was   the   level   of   evidence   considered?   Are   the   guidelines  predominantly  based  on  expert  consensus  and  to  what  extent  are  they  practical  and  applicable  to  clinical  practice  in  an  ED  (such  as  Modbury  hospital).    3.  Literature  Review  The  research  approach   is   focused  on  examining  recent   (i.e.  <  5  years)  published  papers  on   the  clinical  topic.  The  aim  is  to  explore  what  current  research  has  to  say  about  the  clinical  problem.    Some  of  the  questions  to  consider  include  better  understanding  of  how  a  patient  presents  to  the  ED,   common  clinical   errors,  new  or  potential  methods   for   improving  diagnosis,  new  diagnostic  tests  and  their  role,  new  approaches  to  treatment,  complications  etc.  

4.  Audit  A  small  audit  is  undertaken  of  patients  presenting  to  the  ED  with  the  clinical  problem.  The  aim  of  the   audit   is   to   enable   the   student   to   consider   the   clinical   issues   related   to   the   condition   (e.g.  nature   of   presenting   symptoms,   type   of   testing   required,   potential   complications   and   drug  treatment  etc)  and  design  a  short  audit   tool   for  gathering  this   information  from  the  case  notes.  The  student  will  then  undertake  a  case  review  of  a  small  selection  of  ED  cases  (usually  about  25  –  30  cases).    

 Student  Feedback  /  Evaluation  

You  will  work  closely  with  the  consultants  with  the  opportunity  to  receive  continuous  feedback  during  your  attachment.  (If  there  are  specific   issues  on  of  the  Term  Supervisors  will  schedule  a  time  with   you   to   discuss   the   issue).   You   are   free   to   approach   any   of   the   Term   Supervisors   to  arrange  a  time  to  discuss  an  issue.    

In   the   final  week   the  Term  Supervisors  will   schedule  a   time   to  meet  and  provide   feedback  and  complete   your   evaluation.   In   general   this   will   take   place   on   the   Thursday   (however   on   some  occasions  this  may  be  undertaken  on  the  Tuesday).    

Please  bring  your  log  book  with  you  to  the  meeting  with  your  term  supervisor.  

ED  feedback:  You  assess  us!    

We  are  keen  to  receive  your  thoughts  on  how  the  attachment  worked  for  you  and  suggestions  on  future  improvement.  Please  ensure  you  complete  the  ED  feedback/evaluation  for  the  attachment  and  leave  the  completed  forms  with  the  ED  secretary  in  the  last  week  of  your  attachment.    

The  Final  Word  

If   you   have   any   issues   during   the   attachment   please   feel   free   to   approach   an   ED   consultant   and  arrange  a   time   to  meet.  We  are  here   to  assist   this   you   in  making   this  attachment  one  where  you  learn   new   skills   and   become   more   comfortable   with   approaching   and   treatment   acutely   ill   or  injured  adults  and  children.