Registrar Orientation Welcome to Flinders Medical Centre Emergency Training 2017 ! Registrar Orientation

What we do matters First point of contact Set a path Mistakes cost time and may cost lives Demands expert level : Knowledge Clinical skills Clinical integration Common sense Communication skills

State of Play Fellows: (33%) 2101 Trainees: (39%) 2321 AT (44%) 1572 PT (51%) 749 SA Fellows 119 Accredited ED 138

Why should you get the job ?

What Can We Do? Supportive Training Environment Protected Teaching Time Regular Assessment, Feedback and Guidance Tools to own and manage your training Varied Case mix – truly mixed ED. Multidisciplinary Team exposure

What can you do ? Define your training goals Set yourself up You lead, we resource and enable Set yourself up Plan to be different Research , enthusiasm, professionalism. What’s your niche ? Respond to feedback Give US feedback !! We are exceptionally enthusiastic and keen to provide an educational program that is adaptive and responsive !

Orientation information Mentoring Simulation WBA LNA ITA Exam leave Mandatory training Work email Term dates Leave requests Time checks Research Survey Website Evolving Teaching Structure

MENTOR PROGRAM

SIMULATION 1. Departmental Multi-Disciplinary Thursday 07:30 2. Paediatric - Tuesday morning after handover 3. Streams training - integrated in teaching throughout year. 4. Mid Year Sim and Skills Day

Workplace-Based Assessments WBAs

Emergency Medicine-WBAs EM-WBAs involve short periods of observation and/or discussion with a trainee in clinical practice, followed by structured feedback to the trainee and a rating of the trainee’s performance during the specified period. 1:1 teaching opportunity

Direct Observation of Procedural Skills (DOPs) The trainee is directly observed whilst performing a specific clinical procedure, to assess and provide feedback on trainee performance of the procedure. Mini-Clinical Evaluation Exercise (Mini-CEX) The trainee is directly observed whilst performing a focussed clinical task during a specific patient encounter, to assess and provide feedback on trainee performance in the patient encounter.

Case-based Discussion (CbD) The assessor engages the trainee in discussion of a selected case, which the trainee managed, to assess and provide feedback on trainee's clinical reasoning and decision making. Shift Report The trainee is observed for the duration of a clinical shift, to assess and provide feedback on trainee performance during a discrete time period of clinical work.

EM-WBAs MINIMUM REQUIREMENTS

Please note that the minimum rate of completion of WBAs is a set rate, irrespective of your FTE. Trainees who have met the minimum time requirement for ED time in Advanced Training, and continue working in ED placements, will be required to continue completing EM-WBAs as per 'Late Phase' minimum rate of completion and complexity requirements. This is required until the trainee is elected to Fellowship.

DOPS No more than one DOPS can be completed on a single procedure to fulfil the minimum requirements. Trainees are encouraged to complete repeated DOPS on the same procedure to facilitate and demonstrate learning in a particular procedure, however subsequent completions of the same procedure cannot be counted towards the minimum number of DOPS required.

Core DOPS Procedure Requirement  For the Core DOPS Procedure Requirement to be met, A trainee must complete at least five (5) DOPS assessments on procedures selected from the Core DOPS Procedure List. Procedures in the list marked with an asterisk include an option, so to complete these procedures the trainee need only undertake one of the options presented. Completion of more than one option within the same procedure on the Core DOPS List can only be counted as one procedure towards the Core DOPS Procedure requirement.

Core DOPS Procedure List 1. Advanced Airway (including both: 1. direct laryngoscopy, insertion of oral ETT, use of RSI technique [including drugs, stylet, bougie] and 2. setting up a transport ventilator) 2. Use of non-invasive ventilation device (either: adult or paediatric)* 3. Tube thoracostomy 4. DC Cardioversion 5. Emergent fracture/ dislocation reduction 6. Lumbar Puncture 7. Administration of procedural sedation 8. Central venous access (either: ultrasound guided central vascular access or insertion of a central venous line)* 9. Arterial line insertion 10. Performance of Focused Assessment Sonography in Trauma (FAST) (either: FAST or e-FAST)*

Compliance Compliance refers rate of completion requirements, and any other requirements as specified by the Council of Education (or delegated entity). The three main elements for EM-WBA compliance are: Rate of completion for phase Minimum complexity for phase Minimum instrument numbers for phase.

WBA Panel WBA Panel Review points Trainees are reviewed by the Regional WBA Panels when they reach a progression point/milestone. Any trainee who has reached a progression milestone within the training program will be reviewed at the next Regional WBA Panel meeting after their time is approved. Trainees can be remediated at a progression review for non-compliance or for not meeting the required standard for their stage of training as outlined in the ACEM Curriculum Framework.

Progression milestones Provisional Training time (+/- Structured References) Early Phase ED time in Advanced Training Late Phase ED time in Advanced Training Critical Care time in Advanced Training Non-ED time in Advanced Training Discretionary time in Advanced Training Advanced Training Completed end of any remediation period (as relevant) end of any conditional progression period (as relevant) end of each 6 months FTE period in Maintenance Pathway, for each stage of training (as relevant).

The progression milestone date is unique to each trainee The progression milestone date is unique to each trainee. The progression milestone can be calculated using the 'Monitoring My Progress' page on the trainee’s Member Portal. The date is unique to each trainee because time accrual is not necessarily aligned to term dates. Training time is accrued individually for each trainee due to the flexibility of the FACEM Training Program.

The progression milestone date for each trainee, for each phase, will differ for each trainee according to their FTE status, site accreditation limits, leave from training, when they have completed Non-ED placements, etc. Trainees who have not completed the correct minimum amount of instruments, complexity or rate of completion may be placed into remediation at this point for non-compliance.

What information does the Regional WBA Panel review? All Regional WBA Panels view de-identified data, which includes: In-Training Assessments (ITAs) completed on the trainee for the stage of training EM-WBAs completed by the trainee (ED reviews only) Learning Needs Analysis (LNAs) completed by the trainee and DEMT/Supervisor Structured References (Provisional reviews only). WBA Panel Report with remediation or progress with conditions outcome (as relevant).

What are the outcomes of Regional WBA Panel review? The outcomes of a progression review by the WBA Panel include the following: progress to next stage of training (or to Maintenance Pathway) progress to next stage of training, with conditions remediation period, with remediation requirements to complete.

Remediation Trainees subject to remediation requirements may have increased minimum training time requirements, in any discipline, as specified by the WBA Panel. All trainees placed into a remediation period will be required to complete a Learning Needs Analysis (LNA). This applies to all training types for which the trainee is placed into remediation, including ED, Non-ED, Critical Care, or Discretionary. Trainees placed into remediation for ED will be required to complete EM-WBAs as specified in their individualised remediation plan

The minimum remediation time for non-compliance is 3 months FTE The minimum remediation time for non-compliance is 3 months FTE. The minimum remediation time for not meeting the required standard is 6 months FTE. The minimum remediation time for non-compliance and not meeting the required standard is 6 months FTE. WBA Panel may, however, alter the remediation timeframe according to the specific needs of the trainee.

WBAs at FMC

Training Administration Email/ Mandatory Training Exam /Study /Annual Leave/Sick Leave Time checks/Term Dates Orientation Book Noticeboards Website/Social Media

LNAs Own your training Set goals each term development and growth Reviewed beginning/ mid/ end term Self assessment Align to curriculum domains and relevant to your level of training Compulsory at FMC

ITAs Every 3/12 learning outcomes mapped against the ACEM Curriculum framework Feedback obtained from consultant group and nursing staff Midterm feedback provided DEMT complete ITAs and feedback to trainees The ITA is considered one of your WBAs Correct entry of term dates is essential !!

Trainee Teaching Wednesday Afternoon Protected, timely return to floor Paid if off duty 75% attendance (attendance recorded; ITA implications) ED Radiology First Wednesday every month (ED seminar room) 1300 Every Wednesday except last Wednesday of month Primary Fellowship 1415-1600 Tweenie Trainee 1600-1745 Last Wednesday of month M and M meeting multidisciplinary @ 1:30pm Trainee/DEMT Meeting Integrated teaching @ 3:30pm

Training Schedule First Wednesday 1300-1745 ED Radiology (L2 seminar room) List 1300-1400 Streams 1400-1600 Trainee teaching 1600-1745 Second (+) Wednesday 1415-1745 Streams 1415-1600 Trainee Teaching 1600-1745 Last Wednesday 1330-1730 M and M 1330-1500 DEMT/Trainee Meeting 1500-1530 (Fiona) Integrated Streams 1530-1730

Evolving Teaching Program Primary Fellowship Written OSCE Tweenie

Integrated Streams Continues in 2017 – with some minor changes More emphasis on take home messages Exam question examples at both Primary & Fellowship level

New Directions Ultrasound Non Clinical portfolios Protocol roll out Special Skills Post Skills training Non Clinical portfolios Senior registrar role Audit and policy development

Clinical Matters A. EECU B. Discharge Summaries 4hr Plan Admission criteria EECU Handover (morning/night) Met Calls (ED vs EECU) B. Discharge Summaries C. Consultant Call Back Whenever you want to ! D. Trauma Team Activation Level 1 Level 2 F. Orthopaedic Handover

Research @ FMC ED Have you ever wondered why we do some of the things we do ? Have you ever thought there might be a better way? Do ALL those people really need to be admitted?

Maybe you could help answer those questions ?

Social Events Monthly Drinks Sim day Trainee Rep Departmental Events

Questions??

Skills Stations Station Location Skill Facilitator 1 Sim Room BLS Uli & Melissa 2 Plaster Room Nitrous I-care tonometer Jo 3 L3 Nurses Office Ventilator Ina 4 Relatives/Resus Room Defib/ Pacing Doley 5 L3 AMU Room Pelvic Binder CT 6 spint Derek/Deb

SKILLS STATIONS 1500-1525 1530-1555 1600-1625 1630-1655 1700-1725 Station 1 Sim 1 5 4 3 2 Station 2 Procedure Station 3 L# nurse office Station 4 VR/Resus Station 5 AMU seminar

Questions??

Edinburgh Hotel Mitcham