Emergency Medicine Training
“Welcome to the real world” – 2015 UOW gradua?ng class
Dr Bishan Rajapakse -‐ MBChB, PhD Honorary Clinical Lecturer – GSM, UOW
Emergency Medicine Advanced Trainee -‐ ACEM
27th November 2015
Overview
• What is EM? – Start with a simulaKon
• My EM training journey • ACEM training • Work life balance, compassionate health educaKon & following your DREAMS!
to be the “Calm within the storm”
To create some“Structure from the Chaos”
find the “Signal within the noise”
to take action given limited resources�
“a field of practice based on the knowledge and skills required for the prevention, diagnosis, and management of acute and urgent aspects of illness and injury affecting patients of all age groups with a full spectrum of episodic undifferentiated physical and behavioural disorders; it further encompasses an understanding of the development of pre-hospital and in-hospital medical systems and the skills necessary for this development”
IFEM definiKon of EM
“a field of practice based on the knowledge and skills required for the prevention, diagnosis, and management of acute and urgent aspects of illness and injury affecting patients of all age groups with a full spectrum of episodic undifferentiated physical and behavioural disorders; it further encompasses an understanding of the development of pre-hospital and in-hospital medical systems and the skills necessary for this development”
IFEM definiKon of EM
Acute and Urgent aspects of illness
Full spectrum of undifferen?ated physical and behavioral disorders
Development of in-‐hospital and pre hospital systems
all age groups
My educaKonal Journey – “the scenic route”
1997-‐2000 Exploring the way (undecided) 2001-‐04 Romance with surgery 2005-‐06 Changing to EM 2006-‐10 Beyond the endpoints 2010 – 2016 Finishing specializaKon
PhD -‐ “Improving the emergency management of OP poisoning through medical educa?on & research” (2006-‐2012)
• Advanced Trainee EM (ACEM)
• PhD in “Knowledge transla?on” – Use of biomarkers in OP poisoning (RBC-‐AChE)
– Rural doctor resuscita?on
ACEM: Official Training Pathway
Pre voca?onal training (24 Months)
24 Months Gen Reg NZ/ Aus
Provisional Training (12 Months)
12 Months 6/12 ED 6/12 ED or Non ED
Advanced Training -‐ 30 Months ED -‐ 6 Months Non-‐ED
-‐ 6 Months Discre?onary
48 Months -‐ 6/12 Major Referral -‐ 6/12 Rural Regional
-‐ 6/12 CriKcal care -‐ PAED logbook or
6/12 paeds ED -‐ Special skills -‐ Overseas opKon
Interrupted Training -‐ During advanced training
Upto 2 years -‐ Rest/recuperate -‐ Do what ever!
Pre voca?onal training (24 Months)
Provisional Training (12 Months)
Advanced Training -‐ 30 Months ED -‐ 6 Months Non-‐ED
-‐ 6 Months Discre?onary
Interrupted Training -‐ During advanced training
Years PT
PYG 2
-‐
PGY 3
-‐
PGY 7
11
PGY 9
13
But how long will it take?
“Life is not a race.. But unfortunately we live on a race course”
The journey of a thousand miles begins with one step. Lao Tzu
Assessment in ACEM
• Primary Exam – Anatomy – Physiology – Pathology – Biochemistry
• Fellowship Exam – Wrihen/SAQ – Clinical
• Work Based Assessments
Version 2: February 2015
Perks of EM -‐ Flexibility
• Training anywhere – 5 countries – MulKple hospitals
• OpKon of non-‐training Kme – (upto 2 years)
• Interna?onal EM – Making a difference globally
Downsides of ED
Light at the end of the Tunnel!.. Perhaps? • Teaching Training • Conferences / InternaKonal work • MAKING A Difference in the world!
Downsides Remedy (for some)
Shij work Can surf during the week?!
HARD/Stressful Off-‐Kme is your own!
Lack of respect Humility is a virtue
Limited specialist pathways Established & Evolving fields: -‐ Paediatric EM -‐ Toxicology
Special interest gropus -‐ InternaKonal EM -‐ Geriatric EM -‐ Public Health EM
My educaKon Journey!
Born in Sri Lanka –Paradise!!
Research in Sri Lanka “Learning outside the box”
2006 2010 1997 1975 (13yo)
MBChB Otago, NZ (22 yo)
Sri Lanka U K
New Zealand
Saudi Oz
UK
USA
(16yo)
NZ
Oz
1st Year Uni Psychology World Religions Anthropology
Tsunami
PGY 14!!
Fun
Surgery
Emergency Medicine
Research
FUN, Adventure & Learning!
NZ
Part Kme ED
My educaKon Journey! (cont..)
Emergency Medicine
EducaKon & Research
InnovaKon
2016 2017 2015 2010 2011
PhD gradua?on
“knowledge transla?on”
Fellowship exam
Sydney POW
Sweden
2013
Research: Part Kme Research
2012 2014
Full Kme ED
Part Kme ED
Wollongong -‐ TWH
Res:Full Kme
Sydney -‐ Locuming in Aus
2014: ED 6/12, Anes/ICU 6/12
2015: PhD 3/12 ED 6/12, Med 3/12
Why I chose EM? • Inspired by
– “Many Mentors” – ImprovisaKon/CriKcal thinking (under pressure) – CreaKvity & spontaneity – EM is the “King of Simula?on”
• Type of work – Diverse range of clinical contact – Team dynamics – Procedures / resuscitaKon/ minor surgery/ – Public Health & psychological health – Systems/Research
Why do we chose a career path?
• InspiraKon – Many mentors
• Type of work • Dreams “Know thyself”
It’s good to know your plan from the start, But someKmes….
“Life is what happens whilst you are making other plans”
“Life / Work” -‐ balance • Looking ajer ones mental(emoKonal) / physical and social health
• Compassionate Health EducaKon
My Secret
• Follow your passions • Be “kind” to others (paKents, staff, seniors, juniors) – And YOURSELF ; daily
• Know Thyself • Many Mentors
– People (in and out of medicine) – Books – Social groups /media / conferences
Compassionate Health EducaKon
• Psychological Health? • Depression? • Burn out?
Be part of a new evolving culture of ‘heart-centred’ clinicians,
“Be part of the change!!”
Why not..
hhps://compassionatehealtheducaKon.wordpress.com
Summary • EM is interes?ng/dynamic/inspiring! • Find many mentors • Know thyself
– What inspires you – Who inspires you
• EM is approx 8-‐10 years of study and training – Its not a race, but do finish!
• Oh, one more thing…. – How about regularly sparing a thought for “our planet”… and the peaceful revolu,on?
Thank you for invi.ng me J
Extra Slides
Links to click on!
hhps://bishansworld.wordpress.com/tag/emergencymedicine/
hhp://lifeinthefastlane.com/alternaKve-‐emergency-‐medicine-‐training/
hhps://rxcreaKves.wordpress.com/2014/10/01/fry-‐day-‐drama-‐club-‐meeKng-‐2/
hhps://vimeo.com/50003925
hhps://www.researchgate.net/profile/Bishan_Rajapakse
hhp://journals.plos.org/plosone/arKcle?id=10.1371/journal.pone.0079491
hhps://bishansworld.wordpress.com/tag/phd/
hhps://soundcloud.com/acousKc-‐funkster
A story from a recent arKcle published in “the Rounds” (Our local hospital newsleher – TWH). Thanks to Ivana Goluza from Research Central for conducKng this interview!
Research Central ar?cle
Selected Poems submihed to the ACEM 2012 conference (Hobart)
HEADING
page1
T H E A R T A N D S C I E N C E O F E M E R G E N C Y M E D I C I N E
AC EM
AUSTRALA
SAIN
COL
LEGE FOR EMERGEN
CY
MEDICINE
www.cdesign.com.au/acem2012
A U S T R A L A S I A N C O L L E G E
F O R E M E R G E N C Y M E D I C I N E
ANNUAL SCIENTIFIC MEETING The Hotel Grand Chancellor, Hobart
Monday 19 – Thursday 22 November 2012
INVITATION TO SUBMIT
It is with much pleasure that I invite delegates to submit abstracts for presentation at the 29th Annual Scientific Meeting of the College. Inspired by MONA (www.mona.net.au) the theme of the meeting is “The Art and Science of Emergency Medicine”, and authors are asked to consider not just the science of their topics but how the art and the uncertainty that pervades our specialty influences their thinking and their practice. Our keynote speakers will explore how this uncertainty influences their practice, and we’d like to hear the same from you.
Trainees are encouraged to submit abstracts. As they are the future of the College, the Committee is engaging as many trainees as possible and will be making the conference as affordable as practicable.
A/Prof Geoff CouserACEM 2012 Committee Convenor
PROGRAM TOPICS
There have been a number of key developments in health policy in Australasia in recent years, that affect the practice of emergency medicine. Delegates are invited to submit abstracts which deal with these changes and how they will impact upon us as a specialty in coming years, both at a clinical and at an administrative level.
• The interface between the art and science of emergency practice
• Critical care
• Health policy and its impact upon practice – for instance, the four hour rule, medical graduate numbers and health economics
• Paediatrics
• Research
• Rural and regional practice
• Special skills/special location of practice
• Technology and its impact
• Toxicology
• Trauma/surgery
• Undergraduate and postgraduate emergency medicine education
• Futile care and palliative care in the emergency department
Use the QR Reader on your mobile device to visit the conference website.
Invitation CALL FOR ABSTRACTS
Bishan Rajapakse
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