Clinical Experience

 

All EM clinicians must ensure they get experience in all areas of the ED. This is especially important for trainees. All of us have a tendency to stick to our clinical comfort zones but this will not help you develop. It is your responsibility to make sure you get a spread of experience; majors, resus, minors and paeds. It is our responsibility to enable that to happen. Ask at handover or when you come on shift if you need experience in a particular area and we will do our best to facilitate it. 

 

Education and Supervision

 

All doctors will be allocated an educational supervisor. Please arrange to see your educational supervisor within 2 weeks of starting in post – contact their secretary or e-mail them directly. Your education in ED will take place in a variety of ways:

Scheduled EM teaching days for which you will be freed up from clinical duties and your attendance will be mandatory.

Specialty / foundation teaching for which you will also be freed up from clinical duties.

 

Shop floor teaching – This will form a major part of your EM education. Each time you ask for advice about a patient is a personalised learning episode which will develop your knowledge or decision-making skills. Make sure you use these interactions to clarify uncertainties or fill gaps in your clinical knowledge. Not all your learning will be from doctors – be open to learning from other members of the ED team too.

 

Self-directed learning – you will be faced with a wide variety of clinical cases in ED and it’s unlikely you will already be knowledgeable about all of them. Try to get into the habit of reading up on at least one patient / condition based on your experience each day. This should be a career-long habit for successful doctors.

 

Handover – we aim to include an educational element in handover – it may be a nugget about a particular patient being discussed, an ED Pearl (brief learning notes commonly about EM pitfalls) or a quality and safety topic.

Risky Business – our governance newsletter which is packed with lessons from incidents, complaints, good and bad cases and lessons from our departments. The articles are written by you and your colleagues to help us all learn from mistakes and errors without having to make them ourselves.

 

Pitfalls documents: In your induction pack you should have received copies of Generic Practice Pitfalls and Specific Clinical Pitfalls. These are based on cases from our own department and well recognised areas of risk in ED. It’s essential that you read these to help keep you and your patients safe. They are worth re-reading a few weeks in too – your first month will be a steep learning curve.

 

 

WPBAs

 

When you start make a list of the WPBAs you need to complete. Make sure you have made a start on them in month 2. It will never be quiet to do these but our juniors all manage to complete them. DOPS and Mini-CEX must be observed in real time but CBDs can be done away from the shop floor and you can book time with Consultants to do these. Remember as trainees it’s your responsibility to drive the requirements for your portfolio. As supervisors it’s our responsibility to provide the necessary support and assessments when asked.

 

Sickness

 

If you have planned sickness e.g. an operation or investigation please give the rota team as much notice about this as possible. E-mail: a&Erotateam@heartofengland.nhs.uk or phone ext 43445.

 

For unexpected sickness you must phone the duty ED Consultant as soon as possible once you have identified you are unfit for work. If this is between 10pm and 8am please speak to the night Middle Grade (bleep 2523 via switchboard). Do not leave messages with any other members of staff. You will still need to speak to the Consultant the following morning so that we can gauge what rota amendments need to be made and provide any advice or support if necessary. You must comply with the HEFT sickness policy which is available on the intranet.

 

Stress

 

For some people the ED is a very stressful environment to work in. If you are having difficulties and are aware that stress may be a problem we would like to help you sooner rather than later. You can speak to your own educational supervisor or another consultant if you prefer or you can speak to one of the clinical tutors. There are confidential counselling services available through Occupational Health. Don’t bottle things up; talk to your colleagues and seek help early.

 

 

Raising Concerns

 

If you have concerns about an aspect of work in the ED, patient safety issues or about a colleague please share them with one of the consultants, your educational supervisor or a clinical tutor. The Trust incident reporting system (Datix) is accessible on the intranet home page. (Red triangle icon at the top right, or under I in the alphabetical search).

 

Police Statements

 

• You may be asked to provide a statement for the police in relation to a patient you have seen – commonly this will be an assaulted patient and commonly it will be some weeks or months after you saw the patient. 

• Consent will usually already have been obtained from the patient. 

• You will be relying on the quality of your original notes to write the statement.

• You will be providing a statement of fact not giving an expert opinion.

• Statements should all be written in layman’s language avoiding medical terminology. You are advised to seek advice or get your statement reviewed by your educational supervisor. 

 

 

Final Top Tips

 

Try to treat your patients as you would wish your family or yourself to be treated.

 

Patient safety is our top priority and trumps other targets.

 

If in doubt about patients, ask for senior advice.

 

We’re all in this together – look after your colleagues in the whole team and they will look after you.

 

Thoughts from a current junior doctor:

 

Quickly coming up with management plans is obviously very important in A+E. For many doctors coming from medical rotations especially, it may seem normal to wait for bloods and other investigations to come back before making up your mind about diagnosis. I would say that if you are not sure after seeing any patient (taking history and examination) 1. What the likely diagnosis is and 2. if they need to be admitted or not, then check with a senior (cons/reg) ASAP in order to later prevent charge nurses and other staff rushing you to refer/discharge etc. This may obviously result in inappropriate referral or discharge otherwise! 

 

In minors and paediatrics, you are very likely to come across pathology you have previously never seen before (in f1/f2 etc). Have a generally low threshold for coming around to majors and asking a senior. Also, don’t hesitate to ask the paediatric nurses for general advice - don’t have too much of an ego that you think you cannot ask them or that you’ll appear incompetent! ED is very different to the ward jobs that most of us are generally used to. They know very well which child is sick and needs referral and which one doesn’t. Obviously for unwell children, involve an ED senior and paediatric SpR early. 

 

Finally - never let the area of ED you find yourself in determine how thorough you are with patients. Just because you are in minors, it certainly does not mean that the patient is generally well and will be discharged. Likewise, in majors not everybody needs bloods, X-rays etc and you may discharge them without any investigations. It all varies and depends, so treat each patient irrespective of the area of ED they are in.