Bond University Medical Program Emergency Medicine Rotation Clinician Guide YEAR 5 2018
Introduction Students in the final year of the Bond University Medical Program have 6 rotations to train in a broad array of medical, surgical, and other specialities. These Rotations are made up from one of each of: Anaesthetics, Critical Care, and orthopaedics (2 weeks of each) Elective or Capstone Emergency Medicine, Flexible General Practice, Selective Rotation Block 1 Block 2 Block 3 Block 4 Block 5 Block 6 Flexible Rotation Dates 15 Jan 2 Mar 5 Mar 20 Apr 23 Apr 8 Jun 25 Jun 10 Aug 13 Aug 28 Sep 22 Oct 16 Nov The capstone, elective, flexible and selective rotations provide students a choice of interest area, or speciality placement, to gain additional clinical experience on top of specified clinical curriculum placements. The learning priorities for all clinical specialities are to gain insight and understanding of the most common presentations and conditions encountered. It is anticipated that all students will have opportunities to enhance their skills in history taking and clinical examination. Students should also be encouraged to translate the information from patient interactions into commonly used formats by interns, such as ISBAR (Introduction, Situation, Background, Assessment, Recommendation) Additional specific procedural skills development is welcomed Year 5 Learning Outcomes Apply current medical and scientific knowledge to individual patients, populations and health systems. (S1) Demonstrate cognitive, technical and interpretive skills in undertaking an accurate, detailed system focussed history from a range of patients within a variety of clinical settings. (P1) Perform an accurate and complete physical examination in any body system including mental state examination. (P2) Use knowledge of common and important conditions, the patient history and physical examination findings, and clinical data, to undertake clinical reasoning and formulate probable and differential diagnoses. (P3) Recognise and assess deteriorating and critically unwell patients who require immediate care. Perform common emergency and life support procedures. (P4) Safely perform a range of common procedures including safe, effective and economic prescribing. (P5) Select and justify common investigations, with regard to the pathological basis of disease, utility, safety and cost effectiveness, and interpret their results. (P6) Formulate an initial management plan in consultation with patients, family and carers across a variety of clinical settings considering psychosocial and cultural aspects that may influence management. (P7) Bond University Medical Program Page 2 of 9
Integrate prevention, early detection, health maintenance and chronic disease management into clinical practice. (H1) Discuss and critically reflect on population health issues applicable to the relevant clinical and community setting. (H2) Demonstrate knowledge and a critical understanding of medico-legal and ethical issues that impact on patient management. (H3) Demonstrate an ability to clerk a case across a range of patients and from a variety of clinical settings. (H4) Comply with organisational policies regarding timely and accurate documentation. (H5) Discuss the complex interactions between healthcare environment, doctor and patient, promoting risk awareness and reporting risks in the workplace. (H6) Demonstrate an ability to work as an effective team member, understanding and respecting the variety of roles within the clinical setting whilst acknowledging the professional responsibilities relevant to their position. (H7) Communicate effectively in wider roles including health advocacy, teaching and assessing and appraising. (H8) Integrate the practice of evidence based medicine in the care of patients. (S2) Uphold the standards and values of the medical profession and perform clinical activities in accordance with Good Medical Practice for Doctors in Australia. (H9) Plan and execute a substantial research- based project, OR capstone experience and/or professionally focused project and write up (S3) Self-evaluate their own professional practice, and know when and how to refer patients (H10) Demonstrate life-long learning behaviours (H11) S= Scientist and Scholar, P=Practitioner, H= Health advocate and professional Emergency Medicine (ED) Overview Unlike all other Rotations, the Emergency Medicine Rotation combines facets of all subspecialties while focusing on: acute and critical care management; improving differential diagnosis insight and skills; co-ordinating inpatient and outpatient healthcare with primary care and other providers. For this rotation, students will be placed at either the Gold Coast Emergency Department (Southport or Robina) or the Tweed Hospital. You will have shifts on a roster basis that will cover morning, afternoon, evening, night and weekend work. Bond University Medical Program Page 3 of 9
Emergency Department Rotation Specific Learning Outcomes Students should be able to: Demonstrate knowledge, skills and attitudes required to assess and manage common adult and paediatric emergencies; Explain the role of Emergency Departments and Emergency Medicine as a speciality; Demonstrate, where possible, the practice of key emergency procedural skills such as cannulation, wound care, suturing and splinting as well as basic life support skills. Demonstrate the development of professional skills such as clinical reasoning, critical analysis, teamwork and dealing with uncertainty when managing patients; Demonstrate the development of attitudes, knowledge and skills for competent care of injured and /or infirmed individuals of all ages, socioeconomic, ethnic backgrounds for disease prevention, recognition of disease presentation and promotion of optimal health habits. Symptom Based Approach Acute Rashes and swelling Acute visual loss Bleeding problem Breathing problem Burns Examples Angioedema Urticaria Epistaxis Haematemesis Haemoptysis Dyspnoea Wheezing Coma, alteration in conscious level Disorientation, confusion Fever Headache Hypothermia The Ill Child Injury Child with fever Fitting child Limping Non accidental injury Respiratory emergency Abdomen Chest Head Long bones Maxillofacial Bond University Medical Program Page 4 of 9
Major trauma Pelvis Spine Soft tissue Near drowning Pain/Discomfort Painful Eye Backache Constipation Joint Swollen/painful leg Urinary retention Seizure Shock and Hypotension Syncope, collapse Undifferentiated Medical Conditions Child Health Emergencies ENT Medical Emergencies Mental Health Emergencies Ophthalmology Orthopaedics Surgical Emergencies Abdominal pain Chest pain The Ill child (see above in symptom based approach table) Dysphasia Ear pain Foreign bodies Loss of hearing Acute coronary syndromes Allergic reaction Cardiac arrhythmias Diabetic ketosis Exacerbation of OCAD, asthma Heart failure Pancreatitis Pulmonary embolus Subarachnoid haemorrhage Stroke Psychotic patient Blunt trauma to the eye Foreign bodies Dislocated joint Fractured bones Nerve /tendon /muscle injury Septic arthritis Differential diagnosis of the acute abdomen Ischemic limb Bond University Medical Program Page 5 of 9
Toxicology and Environmental Emergencies Trauma Women s Health Emergencies Common drug withdrawal states Overdose of drugs Benzodiazepines Opiates Paracetamol Salicylates Serotonin Tricyclics (TCA) Use of specific antidotes (Flumazenil, Naloxone, & N-acetylcysteine ) Environmental Electrical injuries Envenemation (snake and spider bites ) Hypothermia and hyperthermia Near drowning Poisoning- carbon monoxide Single injury Multiple injuries Abdominal organs Chest Facial Head Limbs Spine Bleeding in early and late pregnancy Ectopic pregnancy Eclampsia Pelvic inflammatory disease Procedure Cardiopulmonary 12 lead ECG ACLS and BLS Arterial blood gas sampling Peak flow measurement Spirometry Pleural effusion/pneumothorax To observe or perform Perform and interpret normal and common conditions on a 12 lead ECG Observe and describe Observe and describe indications for taking an arterial blood gas sampling Perform and interpret a peak flow measurement Perform and interpret a spirometry reading Observe and describe indications for aspiration or drainage Bond University Medical Program Page 6 of 9
Diagnostic Blood culture Blood sugar Wound swab General Administration of analgesia and sedation Apply a cervical collar Assess and Interpret disorders of coagulation Catheterisations (Vascular or urinary ) Describe X-ray findings of chest, abdomen and limbs Give an IMI (ADT booster) Identify and interpret acidbase disorders Identify and interpret glucose, sodium, potassium and calcium disorders Observe insertion of chest drain Perform a Glasgow Coma Scale Perform a ring block Use suction Visual acuity- measure Wound description and management Measurement ECG Injection Intravenous venepuncture IV cannula IV infusion IV drug administration Take blood for culture Estimate the blood sugar using a glucometer Take a swab from a wound Observe and describe the indications and principles for inserting a chest drain Clean, dress, apply steristrips, glue or sling/tubigrip Perform and interpret an ECG Perform injections IV, IM, SC Perform venepuncture Insertion of an IV cannula Set up an IV drip Describe the safe administration of an IV drug Bond University Medical Program Page 7 of 9
IV fluid and electrolyte therapy Spirometry Urinalysis Respiratory Nebuliser/inhaler Oxygen therapy Explain fluid and electrolyte balance, how to calculate and the correction of imbalance Perform and interpret basic spirometry Perform dipstick urinalysis testing Instruct a patient on using a nebuliser/inhaler Demonstrate the use of oxygen by mask and nasal prongs Timetable and Contacts Students are expected to be present for shifts as allocated, during their rotation, and this includes signing in and out, so that the university can monitor attendance. If students are unable to attend for any reason, they are required to advise the clinician, hospital co-ordinator (where available) and the Placements Team at Bond University, please refer to student guide for clarification on attendance requirements. Student involvement in the day-to-day care and management of patients provides the best opportunity for learning. Students will be able to learn the most through interviewing and examining patients and being involved in clinical decision making at the bed side. As well as clinical knowledge, students must display other professional skills such as working well within the multidisciplinary team, considering the psychological and social impact of the illness on the patient and the family, being honest, empathetic, and respectful with regard to the patient's choices and decisions. It is also important for students to recognise their own limitations, competencies, and scope of practice associated with their stage of training. Bond University Medical Program Page 8 of 9
Clinical Supervision and Assessment Formal educational sessions should be conducted every week throughout the clinical rotation to reinforce and enhance their learning. These sessions may vary throughout the placement. During the clinical placement, students will be supervised by a number of clinicians such as those in specialist training pathways in the medical team. Weekly student case presentations and mini CEXs can be assessed by these team members. Students need to submit written case reports to BOND. One case presentation, and/or one mini CEX, should be assessed by the Supervising Consultant (unless there are extenuating circumstances). The END of Rotation summative assessment: Should use the In Training Assessment (ITA) form and reflect: The student s clinical history taking and examination skills. 1. The student s performance and professional conduct during the rotation 2. A formal case presentation and/or mini CEX assessed by the Consultant 3. The Consultant's signature and assessment opinion with input from the team. Students need to submit one written case report, two mini CEXes, and ITAs to BOND Assessment is completed on Bond University s Osler App/website. The student requests the supervisor to review their assessment via Osler. The supervisor can be a user of Osler (require login details) or be requested as a Guest Assessor (email link to assessment). It is recommended to be set up as a user if completing numerous assessments. Paper assessment documents are available on request from student. Please contact osler@bond.edu.au for further information or to be set up as a user on Osler. If you have any concerns regarding any aspect of student behaviour and/or performance Please contact the Year 5 Lead (07 5595 4499) or Medical Program Placement Team (0420 928 125 or MED-Placements@bond.edu.au) ASAP. Bond University Medical Program Page 9 of 9