POWH ED Registrar Orientation

Prince of Wales is a busy, tertiary Emergency Department and in 2019 we saw approximately 63,000 patients. Our patient mix is of high acuity and complexity, with an admission rate of approximately 40%. We see adults from age 16 within a varied local population from Waverley to Botany Bay, as well as those seeking or referred to us from around the state.

We have some special roles: we are the ED serving the Correctional Complex at Long Bay, the ED for one of 2 spinal units in the state, and we are the receiving hospital for Lord Howe and Norfolk Islands. Our patent mix is also influenced by our proximity to beaches, the University of NSW, and the airport.

POWH is classified as a Local Hospital within the NSW Trauma Services Plan, and so our ED does not routinely receive major trauma, but we do receive moderate volumes of minor trauma and secondary referrals from throughout NSW for spinal/ neurosurgical care. We have a 24/7 Interventional Neuroradiology service. We also have large psychiatric, cardiology, renal (including transplant), haematology and cancer care services, all of which serve patients from a wide catchment.

Our function is to provide an acute medical service to the community. The ED is an important access-point to the hospital, and acts as a bridge between primary care, other community care and inpatient services. Our particular role is in stabilising and managing the sickest and least differentiated patients and guiding them safely to appropriate inpatient care. Equally important is the role we play in treating acute illness and injury in those who do not currently need inpatient care, but for whom timely and effective treatment can prevent deterioration or disability, and allow return to work and safe return home.

Our catchment population, roughly the Randwick, Botany and Waverley Local Government areas, is over 200,000 people and growing, with widely varying socio-economic profiles.

Over 20% of our patients are aged 75 or over, and this proportion is projected to grow significantly in coming years. Roughly one in five of us will need to visit an ED in any 12-month period, so a well-functioning ED is important for all of us.

As a tertiary emergency department we provide 2 years of advanced emergency training, all required secondments and all provisional training. We have doctors working with us at all levels of training from medical students to fellows.

Our goal is to see you complete your training as a qualified and excellent emergency physician. To achieve this, we ensure you have access to an excellent variety of rotations to fulfil your training requirements.  We are committed to ensuring your individual needs at all stages of training are met;

The goals of the term are in line with the ACEM curriculum framework. We aim to develop your knowledge, skills and attributes relevant  to the level of training in the following domains

• Medical Expertise
• Communication
• Health Advocacy
• Leadership and Management
• Prioritisation and Decision Making
• Professionalism
• Scholarship and Teaching
• Teamwork and Collaboration

Secondments offered from POWH include;

• Intensive Care at Prince of Wales
• Anaesthetics at Campbelltown Hospital
• Paediatrics; Sydney and Westmead Children’s Hospital Emergency Department
• Liverpool Hospital- mixed tertiary ED with trauma
• Campbelltown hospital- mixed ED regional placement
• Coffs Harbour- mixed ED regional placement
• Toxicology- special skills during advanced training at POWH
• Ultrasound- special skills during advanced training at POWH
• Psychiatry- Special skills
• There are also opportunities on a case by case basis for medical terms such as palliative care etc
• Support in advanced care training leave without pay for opportunities such as Retrieval medicine.

You are expected to supervise junior staff in the emergency department and you will be well supported by the consultant team in doing so.

This is as an important part of your training and an invaluable skill. From 8 am until midnight emergency physicians are on site to assist.

Overnight from midnight until 8 am the emergency department is staffed by a minimum of 2 registrars and 3-4  junior doctors . An emergency consultant is always available via phone if help is required.

For more details on the FACEM Training program please refer to the FACEM Training Handbook available via the ACEM website.  https://acem.org.au/getmedia/5651dae4-bbf4-4a80-b68d-cd402912577b/FACEM_Training_Handbook_1-12-2

Administratively the ED forms part of the Program for Emergency, Specialist and Continuing Medicine.

Acting Director: David Murphy

Directors of Emergency Medicine Training (DEMT): Kate Sellors and Therese Becker 

Whilst working in the emergency department you will be allocated one of the DEMTs as your primary supervisor. Please note both are available to you at any time. You will need to enter your allocated supervisor on your ACEM training portal.  

Your supervisor will meet with you both mid-term and at the end of term to undertake your In-Training Assessment (ITA).

We would like you to do your learning needs assessment prior and show you have been keeping your procedural skills log book updates.

Staff Specialist Team (and other roles):                 

Therese Becker                     (Toxicologist, Co-Director of Emergency Medicine Training)

Laura Brown                           (PGY2 supervisor)

Betty Chan                               (Director of Toxicology, Clinical researcher, ILP supervision)                    

Angela Chiew                         (Toxicologist, Clinical researcher, HREC member, Hospital opioid drug committee, ILP supervision)

Matt Davis                               (Quality/ incident review)

Michael Golding                    (Medical Director, Emergency Care Institute NSW)      

Sarah Gollance                       (PGY1 supervisor)

Susan Hertzberg                    (Incident review/ medicolegal)

Andrew Hugman                   (Clinical Lead, My Health Record in Emergency     Departments)

Farzad Jazayeri                      (Fellowship Training Program Course)

Ezila Kapilan                            (Complex Management Plans)

Daniel Khamoudes               (Simulation clinical co-lead)

Marian Lee                              (Fellowship Training Program Course, EDSSU clinical lead, Education Committee Chair  )

Claire Leonard                        (Mental health, Drug and Alcohol liaison)

Jeremy Lawrence                  (Incident review)

Ellen Meyns                            (PGY1 Supervisor)

John Mackenzie                    (Medical Project Officer, Emergency Care Institute NSW)

Alvaro Manovel                     (Ultrasound clinical supervision)

Sally McCarthy                       (President-elect, International Federation for Emergency Medicine)

David Murphy                        (Acting Director of EM, Director of JMO Training in ED)

Prianca Prabhakar                (Registrar Roster, Work Based assessment coordinator, Simulation clinical co-lead )

Zoe Rodgers                            (Simulation clinical lead)

Irene Rotenko                        (Ultrasound Special Skills Lead)

Kate Sellors                              (Co-Director of Emergency Medicine Training)

Joanna Short                           (SRMO supervision, gynaecology liaison, medical student coordinator)

Bruce Way                               (POWH Co-Director Prevocational Education and Training, Ultrasound Clinical Supervision)

Several sessional Visiting Medical Officers/ Locum Staff Specialists also complement our Specialist staff.

There are 4 hours of protected teaching time each week. In 2020 teaching will be held Wednesday afternoons 1.30-5.30 pm. Unless advised otherwise these sessions are held in the medical records conference room. All registrars rostered on a day and evening shift are expected to attend. SRMOs on a day shift attend the same teaching session for 3 hours from 2.30-5.30 pm. If the SRMO is on an evening shift they should attend from 1.30 pm rather than go on the floor for 30 minutes. Registrars not rostered are encouraged to attend if they wish to do so.

Teaching sessions are aligned closely with the ACEM Emergency Training Curriculum. These will involve;

• Core sessions by various emergency physicians
• Monthly simulation sessions
• Paediatric sessions
• Invited speakers on specialist topics
• Core Procedures Course – once a term
• Ultrasound sessions
• Morbidity and Mortality sessions
• Monthly journal club
• Registrar presentations

This year we will be having regular registrar sessions to give all trainees the opportunity to teach. There will be fortnightly registrar sessions for 30 minutes. When allocated you will be asked to present an interesting or challenging case you have seen in the recent weeks. These sessions should present the case, outcomes and some background so we can learn from each other.

If you have a special interest in teaching and would like to do more please let your DEMTs know. You are encouraged to get involved if you have a special interest in a topic or teaching itself.

The 2020 the exam dates are;

Primary Written

• Friday 7 February 2020
  Friday 7 August 2020

Primary Viva

• 7 – 8 May 2020
  5 – 6 November 2020

Fellowship Written

• Friday 15 May 2020
• Friday 13 November 2020

Fellowship OSCE

• 10-13 March and 16-17 March 2020
• 8-11 September and 14-15 September 2020

For more details see the ACEM website at https://acem.org.au/Content-Sources/Training/How-the-FACEM-Training-Program-works/Examinations

Primary Examination Preparation Course

POWH ED has a well-established and successful primary examination preparation course. This involves a 6 month timetable in the lead up to the written. Once the written is passed  there is scheduled weekly OSCE practice with Dr Kate Sellors. These are scheduled on Monday afternoons.

Fellowship Examination Preparation Course

This year we are excited to be starting a more formalised fellowship preparation course. We advise you start this course 18-12 months prior to sitting the fellowship written exam.

This course is a 30 week program that will involve weekly sessions commencing 19th February on Wednesdays prior to registrar teaching. The course will run from 12- 1.30 pm. There is a timetable and you will be expected to have revised the topic. The candidates will then meet with a consultant and be asked questions to ensure the material has been covered. They are not didactic teaching sessions. They provide a framework and accountability to keep you on track, demonstrate the depth of knowledge required and identify knowledge gaps.

In collaboration with this course we have a large bank of exam papers and a team of emergency physicians to mark these. This will help master your exam technique. You are encouraged 8-12 months prior to the exam, to sit a paper weekly under exam conditions. This will be marked and you will receive direct feedback. 

Your DEMTs will discuss exams when relevant. Circumstances are different for every candidate and we are here to help you with this.

If contemplating the Primary or Fellowship exam please talk to us early. Planning is the key;

• Primary Exam; Dr Kate Sellors Kate. Sellors@health.nsw.gov.au
• Fellowship Exam; Dr Therese Becker Therese.Becker@health.nsw.gov.au

Fellowship OSCE Preparation

There are multiple courses and opportunities to prepare for the fellowship OSCE run through the NSW Fellowship Preparation Course (see below) and other providers. In addition to these courses when at this phase of training we will schedule regular OSCE practice with a variety of consultants.

NSW Fellowship Preparation Course

Whilst preparing for the written fellowship we advise you do undertake the NSW Fellowship Preparation Course. This course is run by various NSW hospitals and involves weekly sessions run by different teaching hospitals. At each session you will do questions on various topics to develop your examination skills and test knowledge. You will then review the answers and technique with the presenting team. This course is free of charge.  

For 2020 timetable and contacts https://docs.google.com/spreadsheets/d/19PSAEsMxQccr8Y00FDS9F0H4cTV-Ghn9m9I-M1pUAYI/edit#gid=2083086363

A fundamental component of emergency training is Work Based Assessments.

Depending on your phase of training once an advanced trainee you are required to do work based assessments (WBAs) of varying complexity. You can familiarise yourself with these via the ACEM website and FACEM training Handbook.

There are 4 types

1. Direct Observation of Procedural skills (DOPs)
2. Case Based Discussions (CBDs)
3. Mini- clinical Evaluation Exercise (Mini CEX)
4. Shift Reports

We encourage you do as many WBAs as you can with a variety of different consultants. This increases learning opportunities and allows valuable individualised time to learn different approaches to multiple problems.

As a trainee it is your responsibility to be aware of your anniversary date (when you transitioned to an advanced trainee with ACEM) and know your minimum requirements.

Shift reports and DOPs can be done during clinical time as opportunities arise. There are core DOPs that need to be observed, so always ask when doing a procedure to have it observed and recorded. All consultants are keen to be involved in this process so please do not hesitate.  

Whilst in POWH emergency for the term you will also be scheduled with 2 different consultants to do either a Mini CEX or CBD. Two appointments will be made for you on clinical day shifts during the term. This allows you to complete the minimum requirement. For term 1 you will be contacted in mid-March regarding these appointments by Yuen Au who is our education coordinator to arrange this.

If you have any issues or questions our Prince of Wales Emergency WBA coordinator is Dr Prianca Prabhaker (Email: Prianca.Prabhakar@health.nsw.gov.au)

An important learning and development strategy in emergency training is to have a dedicated mentor.

The benefits of having a mentor  to the  emergency trainee include;

• Personal and professional development
• Being able to discuss career options and plans in an open and nonthreatening environment
• Networking opportunities
• Opportunity to be challenged constructively
• Having a role model
• Developing professional behaviour and identity and better understanding of organisation
• Improving problem solving skills
• Increasing confidence and leadership skills

Mentoring often occurs informally on the floor in emergency departments. This year we are formalising these relationships to provide trainees with greater support and further develop our culture of emergency training excellence. The mentor relationship is one of guidance and support and not of performance management or assessment.  It is a relationship that is driven by the trainee to address and challenge their own learning goals and needs.

In a few weeks all trainees will be asked to nominate 3 emergency physicians. We recognise that if you haven’t worked here before you don’t know everyone. To address this we will send out a list of potential mentors with a bit about each of them. We will then aim to match you with one of your chosen mentors.

The Prince of Wales Emergency Registrar Roster is written by Dr Prianca Prabhaker and Judith Lissing

Please email all requests or concerns to them;

• Priance Prabhaker:
• Judith Lissing :

Sick Leave

When sick you must contact the emergency consultant on duty on the floor via phone on (02) 9382 8400 and email Adrianne Love : Adrianne.Love @health.nsw.gov.au and Judith Lissing; Judith.Lissing@health.nsw.gov.au

If you require more that 2 consecutive days off you will need to provide a doctors certificate. Planned sick leave should be discussed as soon as known (eg elective surgery etc)

Annual Leave

When on secondment the various terms are obliged to  provide only one week of leave during a 3 month term. Any more is up to their discretion and back filling from the emergency department is not always possible.

Any annual leave longer than one week needs approval before you book flights/ holidays etc as we must be able to cover the emergency department during ANY placement, including Prince of Wales. We do our best to be flexible and meet everyone’s needs. Exams and major life or family events take priority for leave to be fair to all. In general we allow either Christmas or New Year off but not both.

Study Leave

You are entitled to one week paid study leave a year. This needs to be requested and can be to study for exams or to do courses. Medical workforce generally do not approve leave for conferences. Unfortunately we have no study budget for courses at this time, but costs incurred can be claimed in your tax return.

Shift Swaps

We are happy for shift swaps but to be valid they must be updated on the roster. The only time we may refuse a shift swap is on night shifts- the roster is carefully done at night to ensure the right skill mix and we cannot have two junior registrars on at night alone.

Therefore please email all shift swaps to Adrianne Love and Judith Lissing for approval. If it is NOT updated on the roster it is NOT approved.

At South Eastern Sydney Local Health District (SESLHD) workplace bullying and harassment is unacceptable.

SESLHD is committed to providing and promoting a safe, positive, respectful and equitable workplace for all workers. SESLHD seeks to eliminate bullying and harassment from all SESLHD workplaces. More details are available at the following links 
http://seslhnweb/jmo-central-hub/administration.html

If an issue or grievance arises during your time working at Prince of Wales Hospital we encourage you to address this as soon as possible. The following pathways in the emergency department  are available to you;

1. Initially we suggest you try to resolve the problem with the person/s involved.
2. If this is not possible for any reason or the issue has not been resolved your first contact should your term supervisor/DEMT.
3. If you feel this is not appropriate we have a box where you can place your grievance and it will be reviewed and addressed by a separate dedicated emergency physician. This is the “Permission To Speak Box.”   It is located in the emergency department administration office.
4. You can also approach the Emergency Department Acting Director Dr David Murphy
5. If you still feel your concerns have not been addressed you can contact the human resources department of Prince of Wales Hospital.

Acting Nurse Manager: Amy Fenton

• Carmel Hagness/ Deborah Tracy /Hayley McGregor Nurse Practitioners
• Wayne Varndell/ Allison Jeffers Clinical Nurse Consultant/ ED
• Eloise Berry, Kiri Hargreaves Nurse Educators
• Ann Kelly, Dasha Riley: ASET team.

The ED has a very large and highly skilled team of nurses in a variety of roles, including nurse specialist and advanced practice roles.

On the floor, in addition to nurses assigned to each treatment area, you will come into contact with the following roles:

• Coordinator: responsible, in liaison with duty consultant, for immediate bed management and placement of new patients;
• Navigator: assists coordinator in placing admitted patients, needs to know about all new admissions or any requests to move patients.
• Triage nurse: will complete triage, place patients in an appropriate area and alert staff of any urgent or important issues.
• Waiting Room Liaison/ Clinical Initiatives Nurses: will monitor waiting patients, observe for any safety issues or deterioration, and undertake under protocol guidance procedures (e.g. x-ray, analgesia) that would be expected to improve or expedite care.
• Extended Practice Nursing (EPN): Several of our nursing staff have undergone extra training to pick up their own patients, and manage them under protocol guidance and senior medical supervision. Deborah Tracy and Carmel Hagness are our Nurse Practitioners and will see patients independently with support as needed from senior medical staff. They have a range of skills including wound closure and splinting, and will be happy to help you for specific procedures.

Physiotherapy Practitioners

The ED is served by a physiotherapy team, led by Jimmy Roumanous, 7 days a week (Mon-Fri 0800 to 1630, Sat-Sun 1000 to 1800), based in Fast-track. Physiotherapists will pick up patients independently within scope of practice, are available for advice or support for other patients (e.g plastering, musculoskeletal advice), and will seek medical support (or transfer of care) when required.

Senior Clerical./ Administrative Staff

Adrianne Love/ Judith Lissing      Medical Workforce Coordinators

Danielle Shephard                           Clerical Manager

Anne MacLauchlan                          Assistant to the Acting Director

Sally Jularic                                         Clerical Supervisor

Chris Yap                                             IT/ Data Manager

Grant Bernes                                     Clinical Support Officer/ documentation support

Other important staff members include our Communications clerks, EMR staff, front desk Clerical Staff, Health and Security Assistant(s), ED porters, ED radiology porters, and Patient Services Assistants.