Full Time - Exempt
Training Network/Training Rotation
Emergency Medicine Network 5 - Westmead Nepean Blacktown Mt Druitt Tweed
Public Hospital Medical Officers (State) Award
Resident Medical Officer
Current Rotations/Networks (which may change from time to time)
The trainee may rotate to other training hospitals within the network as required.
- Auburn Hospital
- Blacktown Hospital
- Mt Druitt Hospital
- Nepean Hospital
- Orange Base Hospital
- Tweed Heads Hospital
- Westmead Hospital
- Westmead Children's Hospital
Main Purpose of Position
This position serves as an introduction to Emergency Medicine training. Its main purpose is to give the SRMO a broad experience in Emergency Medicine and Critical Care and may include terms in Paediatrics, Intensive Care and anaesthetics, depending on availability. It serves to support completion of the Certificate and Diploma of Emergency Medicine through the ACEM. It also serves to accredit training in other training programs, such as for the College for GPs or the College for Rural and Remote Medicine, and terms appropriate to this training can be sought. The position is also recognised by the RACGP for prior learning, including paediatrics.
Rostering for trainees is arranged by the ED administration in consultation with the Director of Emergency Medicine Training and includes a rotating roster of days, evenings, nights and weekends. Current staffing allows for the allocation of 4hours per week clinical support time separate to clinical shifts as part of the trainee’s normal hours. This is for the purpose of teaching, education and various other quality assurance activities carried out within the department. Shift length is 10 hours and shifts run from 0800 – 1830, 1330 – 2330 and 2200 - 0900.
Trainees are responsible for the assessment, investigation and initial management of patients presenting to the Emergency Department. This is under the supervision of the Emergency Physicians, Advanced Trainees and more senior CMOs.
The trainee is primarily responsible to the Emergency Physician, with secondary responsibility to the patient’s consultant. Where there is any conflict, the trainee should seek advice from the Emergency Physician on duty as soon as practical. Trainees may be expected to assist in the supervision and teaching of Junior Medical Officers (JMOs) when able.
1. MBBS or equivalent, currently registered or eligible for registration with the Medical Board of Australia
2. Completion of at least two postgraduate years, including demonstrated clinical practice as a registered medical practitioner in the last 2 years in a setting appropriate to the needs of the position.
3. Significant experience in an Australian Emergency Department or equivalent in the last 2 years.
4. Demonstrated ability to work independently in a supervised environment and work effectively as part of a multidisciplinary team.
5. Effective oral and written communication skills and demonstrated good organisational and time management skills
6. Evidence of continued professional development and commitment to self-education
7. Ability and willingness to work at the facilities within the Network to deliver patient care and preparedness and ability to participate in a 24 hour shift work roster
8. Demonstrated commitment to quality improvement, patient safety and risk management
The successful applicant will be working as a Trainee within the Emergency Department of Nepean Hospital. This will involve working all areas of the Emergency Department. They will be expected to manage patients in a semi-autonomous manner with some supervision from senior emergency trainees and staff specialists.
The year will be divided into 3 month terms, with at least 1 term in non-ED rotations and the remainder of the year in the ED. Available non-ED rotations include paediatrics, ICU and anaesthetics. Other non-ED terms are available by negotiation and include Obstetrics/gynaecology, psychiatry, drug and alcohol and neonatal intensive care.
1. Be available to provide management of patients presenting to the Department of Emergency Medicine.
2. Provide adequate documentation as per Nepean Blue Mountains Local Health District policy. This includes clearly documenting information required for the completion of the Emergency Department Information System (EDIS) dataset, and the documentation of the details of any history, examination, investigations and their results, treatment and disposition of patients seen.
3. Ensuring adequate notification of a patient’s Consultant or Trainee in the event of admission.
4. Ensuring adequate notification of a patient’s Local Medical Officer in the event of discharge from the Emergency Department, including the writing of discharge letters detailing the patient’s stay in the ED.
5. Communicate clearly to patients, and their relatives where appropriate, the findings of assessment and the plan of management.
6. Participation in the Emergency Department Teaching Program, including attendance at lecture and tutorial sessions and participation in exam preparation when appropriate. This includes supervision and teaching of JMOs.
7. Discuss with the Director of Emergency Medicine Training, or the Director of the Emergency Department, any problems encountered while working within the Emergency Department.
8. Fulfil administrative duties of the Emergency Department as per the clinical support time policy.
At the commencement of the shift, the trainee will report to the Staff Specialist on duty. They will then either be allocated specific tasks or be directed to see the next patient waiting. Any questions arising regarding ongoing care should be directed as soon as possible to the Emergency Physician on duty. All trainees on duty are expected to handover care of their patients at the end of their shift.
In general teaching sessions will be held on Wednesdays. Trainees will be required to attend when possible. When rostered on for clinical support time for the day, attendance at any education sessions held on that day is compulsory.
During the Emergency Term, the trainee should develop a sound knowledge of Emergency Medicine, the aim being that the trainee should be able to operate fairly independently and be able manage both common and complex ED presentations with little input or advice from more senior colleagues. The development of sound procedural skills is essential. Specific objectives are as per The Australasian College for Emergency Medicine Training HandbookCompetency is expected in the following as a minimum:
2. Venous and arterial cannulation
3. CPR, BLS and ALS
4. Suturing skills / Removal of foreign bodies
5. Urinary catheterisation
6. Plastering techniques
7. Lumbar Puncture
8. Slit lamp examination
9. Reading of X-rays and ECGs
10. Interpretation of basic blood results
3. Research and Teaching
The trainee may begin to fulfil the requirements of Emergency Medicine training. This may involve studying for the ACEM part 1 exam. The Network, through its involvement with HETI, runs dedicated primary exam tutorials and trial viva exams for candidates sitting the exam. Should the trainee be undertaking another training program, it is expected that they will fulfil the training requirements for this.
A research project can also be undertaken. The department has an active research program and there are a number of projects that are suitable. There is also scope for the trainee to be supported through the alternate pathway for satisfying the research component of advanced training.
The Emergency Department has an active simulation training program based in the ED. This forms a part of trainee education and training.
There will be formal orientation to the Emergency Department on the first day the successful applicant commences work. This will involve orientation to the Emergency Department as well as an introduction to the Emergency Department information system.
The Trainee will also be required to undertake the core mandatory orientation to:
- Gain an understanding of the organisational values, goals and ethics
- Gain knowledge and develop skills to work in a manner which promotes their own health, safety and security at work, including information relating to infection control and needle-stick injury
- Gain an understanding of child protection legislation policies and responsibilities associated with notifying and reporting issues about child protection.
- Given guidance on ways to perform their job in an efficient and effective manner; and the code of conduct and ethics, including the behaviours and standards expected of Health Service Employees.
- Understand the principles of waste management and the local processes in place which are designed to reduce waste.
- Gain an understanding of the administrative procedures relating to the performance of their work.
- Develop an understanding of the legislative and industrial context in which they work
- Gain information on the Health Service Employee Assistance Program (EAP)
- Gain education and training in the minimisation and management of aggression, Occupational Health and Safety, Fire Safety and quality improvement processes.
The Trainee will be directly supervised by the staff specialists, accredited trainees and senior CMOs on duty. It is not expected the doctor will have any supervisory roles within the emergency department. However, from time to time they may help out junior staff when required and help out with medical student education in such roles as on the floor teaching.
6. Other responsibilities
As indicated above, the trainee may begin their training with the ACEM. The trainee will be allocated clinical support time to facilitate their education requirements. There will be formal education and training activities. The trainee will also participate in various quality assurance activities performed within the Department as a normal part of operations.
Indicate that, in addition to the core competency standards, the Trainee is expected to comply with legislative, policy/protocol requirements as they relate to:
- The supervision requirements as set out by the Medical Board of Australia;
- The Public health organisation Health Service's Performance Management Policy;
- Occupational, health and safety requirements as an employee;
- The NSW Health Code of Conduct.
7. Medical leadership
- Contribute to meeting NEAT targets using the current model of care in the ED
- Actively maintain appropriate infection control including the 5 moments of Hand Hygiene
- Attendance at formal clinical handover when required at the start and end of each clinical shift
- Participation in mandatory detect and OH&S training
- Participation departmental M&M meetings as well as RCAs, QA reviews, incident reviews and complaint management when appropriate
- Early identification of appropriate patients/clients for Connecting Care Program to avoid hospital admissions.
- Actively participate in revenue and cost saving initiatives
- Demonstrates the ability to effectively manage staff and hospital resources including:
a) showing leadership
b) communicating effectively
c) prioritising tasks
d) using time management skills appropriately
e) assigning tasks and delegating
f) prioritising and re-prioritising clinical tasks when there is a critical patient load in the department, including during medical disasters
g) ensuring tasks are progressing as planned
h) managing and leading clinical teams
i) coaching and mentoring as appropriate
- Communicate with and co-ordinate specialty teams to achieve an optimal environment for patient care
- Effectively use resources to balance patient care and systemic demands
- Serve in administration and leadership roles, as appropriate
In addition to the core competency standards, the Trainee is expected to comply with legislative, policy/protocol requirements as they relate to:
1. Compliance with all applicable public health organisation and hospital policies and protocols, and with applicable Policy Directives and Guidelines issued by the Department of Health, as amended and as in force from time to time, including the NSW Health Code of Conduct
2. Ensuring that all services provided to patients are consistent with any instructions issued by your supervisor or Department Director or any conditions imposed by the Medical Board of Australia;
3. Maintenance of adequate hospital clinical records, including completion, within a reasonable time period following the patient’s discharge, of patient discharge letters;
4. Observance of general conditions of clinical practice applicable at the Public Health Organisation where you will be working from time to time;
5. Demonstrating at all times courteous and professional behaviour towards patients, their relatives and other staff.
Local Background & Environment
Nepean Blue Mountains Local Health District consists of both urban and semi-rural areas, covering almost 9,179 square kilometres. The LHD is responsible for providing primary and secondary health care for people living in the Blue Mountains, Hawkesbury, Lithgow and Penrith local government areas and tertiary care to residents of the Greater Western Region.
The Nepean Clinical School, based at Nepean Hospital, is one of the eight Clinical Schools of the University of Sydney. Since becoming a teaching hospital of the University of Sydney In 1990, Nepean Hospital has experienced continued growth in its teaching and research.
The Department of Emergency Medicine, at Nepean Hospital, sees approximately 65000 patients per year, of which about 40% are admitted to the hospital and 20% are under 14 years of age. Nepean Hospital is designated a Regional Trauma Centre by the Institute of Trauma and Injury Management and is the primary referral hospital for patients meeting the T1 protocol requiring transfer to a major trauma centre. The Department is accredited by The Australasian College for Emergency Medicine for 2 years of advanced training in Emergency Medicine as well as the paediatric log book. The Department is also accredited for Advanced Specialty Training by the Australian College for Rural and Remote Medicine.
Nepean Hospital is the tertiary referral unit for Katoomba and Lithgow Hospitals as well as the Central West of NSW. Nepean Hospital is covered 24/7 by ICU, neurosurgery, thoracic surgery, orthopaedics, plastic surgery, ENT and faciomaxillary surgery. Interventional cardiology and radiology is available 24/7, as is thrombolysis for stroke, and there is an inpatient dialysis service. There is also an excellent high-risk pregnancy unit, neonatal intensive care unit and paediatric department. There is an after-hours referral arrangement with Westmead Hospital for emergency ophthalmology services.The area is divided into 4 clinical areas:
the Resuscitation Rooms; Acute Care; Waiting Room Acute Care for complex ambulatory patients; and Fast Track for low complexity patients. The Department is staffed by Emergency Physicians providing up to 3 consultants covering the department from 0700 to 2400 hours, seven days a week. There is Advanced Trainee/senior CMO cover 24 hours per day. There is also nursing assistance in all areas of the Department.
The department is on the cutting edge of patient flow. Research into the novel Waiting Room Acute Care has been published showing remarkable improvements in patient flow, access block and NEAT targets. Nepean ED also uses a teams model of care where the ED medical staff are divided into 3 medical teams allocated to individual parts of the department, namely acute care and resusc, fast track and WRAC, and the short stay ward. This has further improved access block and NEAT targets as well as improving staff working conditions with regard to supervision and support.
Rostering for trainees is arranged by the ED administration in consultation with the Director of Emergency Medicine and Directors of Emergency Medicine Training, and includes a rotating roster of days, evenings, nights and weekends by negotiation. Shift length is 10 hours and run from 0800 – 1830, 1330 – 2330 and 2200 - 0900. Trainees are allocated 1 clinical support shift per month that acts as quarantined time for education and training. This is part of normal hours and does not constitute overtime.
Trainees are responsible for the assessment, investigation and initial management of patients presenting to the Emergency Department. This is under the supervision of the Emergency Physicians when required. However it is expected that trainees should be fairly autonomous and independent and require little input for the majority of patients presenting to the ED. The ED is committed to the 4 hour national Emergency Access Target and it is expected the trainees will support procedures designed to facility this.
The trainee is primarily responsible to the Emergency Physician, with secondary responsibility to the patient’s Consultant. Where there is any conflict, the trainee should seek advice from the Emergency Physician on duty as soon as practical. Trainees may be expected to assist in the supervision and teaching of Junior Medical Officers when able.
Key Internal and External Relationships
Key Internal Relationships
- Clinical streams
- Multidisciplinary teams
- Other Clinical Divisions
- JMO Management
- The doctor will be expected to work with other doctors, nurses, allied health and clerical staff as part of their role.
- Quality assurance, peer review, education would be via medical team meetings.
- Multidisciplinary meetings are held and the incumbent would work with a multidisciplinary team with acute care work.
Key External Relationships
- Police, Ambulance
The Trainee will be directly supervised by the staff specialists, accredited trainees and senior CMOs on duty. It is not expected the doctor will have any supervisory roles within the emergency department. However, from time to time they may help out junior staff when required and help out with medical student education in such roles as on the floor teaching.Supervision of the Trainee in normal hours of work:
Supervision of the Trainee after hours:
- The Trainee will receive direct supervision and support from the Consultant, accredited trainee or senior CMO within the department they are rotating through. As such daily supervision is available at any time.
- The Trainee will have access to a senior supervisor at all times.
- The Trainee will receive direct supervision and support from the Consultant, accredited trainee or senior CMO within the department they are rotating through.
- The Trainee will have access to a senior supervisor at all times.
- Working in a complex environment where there are competing priorities and strict deadlines.
- Developing strong working relationships with a multidisciplinary workforce.
- Understands and is committed to organisational mission and goals.
- Demonstrating initiative to resolve issues.
- Sharing information and learning experiences with colleagues.
- Developing and exhibiting good communication skills.
- Demonstrating a commitment to personal development as a professional.
- Demonstrating a commitment to the National Emergency Access Target.
- Completing a patient history from the patient and from other relevant sources (eg medical record, family, nursing home, general practitioner, ambulance transfers sheet etc).
- Documenting the history and physical examination within progress notes.
- Formulating a management plan for every patient in consultation with more senior medical staff.
- Ensuring that appropriate investigations are ordered and followed up and that the management plan is altered necessarily.
- Demonstrating a commitment to the effective handover of patients.
- Designing then communicating a discharge plan containing an accurate history of their admission and a clearly identified and attainable management plan.
- Appropriate liaison for advice/help with supervising medical staff.
- The completion of death certificates, cremation certificates, medical certificates and discharge scripts.
Decision MakingThe Doctor will be required:
- To exercise independent judgement, initiative and problem solving skills, but this should be exercised in consultation with supervising medical staff.
- To ensure appropriate input from key decision makers and achieve consensus when possible.
- To appropriately allocate teaching time according to evidence of learning need.
- To deal with matters in a confidential manner.
- To respect the professional values of staff
The Trainee is a key person who works closely with all members of staff and must:
- Work as part of, and contribute to a multi-disciplinary team.
- Deal with matters of an urgent or sensitive nature.
- Must have the ability to exercise discretion, sensitivity and maintain confidentiality.
- Works co-operatively within a team environment and actively contributes to team activities including pro-actively participates in team meetings and decision making processes.
Performance MonitoringThe Trainee is responsible for:
- Participating in ongoing review of their clinical practice as per conditional registration guidelines;
- Participating in continuing medical education and professional development as covered by the supervision arrangements stipulated by the Medical Board; and
- Maintaining his/her professional competence.
The Trainee is required to maintain a continuing level of satisfactory performance and successful compliance with the requirements of the relevant training program, including progression through the program at the expected rate.
- Satisfactory progress with college examinations
- Attendance at Departmental training sessions
- Maintenance of Advanced Cardiac Life Support Accreditation
- Annual Performance Evaluation & Development Review. (e.g. in-training assessments)
Performance reports and training supervision will be provided by the Director(s) of Emergency Medicine Training.
This position is available for the period 5th February 2018 to 3rd February 2019.
no addditional documents have been provided
2018 Emergency Unaccredited Trainee.pdf
Job Demands Checklist
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1: MBBS or equivalent, currently registered or eligible for registration with the Medical Board of Australia
2: Completion of at least two postgraduate years, including demonstrated clinical practice as a registered medical practitioner in the last 2 years in a setting appropriate to the needs of the position.
3: Significant experience in an Australian Emergency Department or equivalent in the last 2 years.
4: Demonstrated ability to work independently in a supervised environment and work effectively as part of a multidisciplinary team.
5: Effective oral and written communication skills and demonstrated good organisational and time management skills.
6: Evidence of continued professional development and commitment to self-education.
7: Ability and willingness to work at the facilities within the Network to deliver patient care and preparedness and ability to participate in a 24 hour shift work roster.
8: Demonstrated commitment to quality improvement, patient safety and risk management. -