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

2. 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

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

4. Why should you get the job ?

5. 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

6. 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 !

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

8. MENTOR
PROGRAM

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

10. Workplace-Based Assessments WBAs

11. 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

12. 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.

13. 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.

14. EM-WBAs MINIMUM REQUIREMENTS

15. 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.

17. 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.

18. 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.

19. 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)*

20. 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.

21. 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.

22. 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).

23. 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.

24. 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.

25. 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).

26. 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.

27. 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

28. 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.

29. WBAs at FMC

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

33. 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

34. 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 !!

35. 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
Tweenie
Trainee
Last Wednesday of month
M and M meeting multidisciplinary @ 1:30pm
Trainee/DEMT Meeting
Integrated 3:30pm

36. Training Schedule First Wednesday 1300-1745
ED Radiology (L2 seminar room) List
Streams
Trainee teaching
Second (+) Wednesday
Streams
Trainee Teaching
Last Wednesday
M and M
DEMT/Trainee Meeting (Fiona)
Integrated Streams

37. Evolving Teaching Program
Primary
Fellowship
Written
OSCE
Tweenie

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

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

40. 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

41. 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?

42. Maybe you could help answer those questions ?

43. Social Events
Monthly Drinks
Sim day
Trainee Rep
Departmental Events

44. Questions??

45. 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

46. SKILLS STATIONS
Station 1
Sim 1 5 4 3 2
Station 2
Procedure
Station 3
L# nurse office
Station 4
VR/Resus
Station 5
AMU seminar

47. Questions??

48. Edinburgh Hotel Mitcham