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

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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