The role of the ECI registrar

Dr Michelle Spelman Registrar/Advanced Trainee Emergency Medicine Emergency Care Institute

Who am I? • I originate from Ireland where I did my internship at The

Royal Victoria Hospital Belfast. • I then dipped my toe in Australian waters for a year and

did a resident year in Gosford Hospital, Central Coast NSW.

• Unsure of my direction I returned home and undertook a Masters in Sports Medicine, Trinity College Dublin.

• However I realised the error of my ways • and found myself back in Sydney • I am now in my 4th year of Advance Training Emergency Medicine

Royal North Shore

Gosford

Alice Springs ED and Flying

Doctors

ECI Registrar • 6 months employment of which 0.5 is FTE with the ECI and

0.5 is FTE in RNS ED • It is a special skills term and fulfils the requirement of non

emergency medicine • Special skills of management and administration • I am the first registrar in the position which commenced

January 2013 • Today I am going to talk about what I’ve been up to over

the past 4 months

‘Running an ED involves far more than leadership training applied to a particular context, or expert clinical skills or

running a clinical team. It involves operational management, systems knowledge and manipulation, diverse communication and diplomacy skills, ability to

source information quickly, multitasking and being able to deal with interruptions, all within a dynamic and high-stakes

environment’

Celenza, Antonio, April ‘13 EMA

Can we learn this working in ED?

• Certainly we deal with interruptions and multi-tasking on a daily basis working on the floor.

• Team leading is learnt in an ad hoc way, generally when we do nights as the Registrar in Charge.

• Operational management, systems knowledge and manipulation, diverse communication and diplomacy are not skills I have had either informal or formal training in.

• Prior to this term I had very little idea about what goes on down that corridor, away from the ED, leading to the Director and consultant offices.

• And the Garling inquiry? Or ACI?? Or ECI???

The world outside ED

How have I stepped out into the world? • Simply working in the ACI office has exposed me to the

existence of many different clinical networks. • The ECI takes part in various committees and I have

attended meetings for the Incident Advisory Committee, The Research Committee and The Clinical Advisory Committee

• I have been on 2 rural and regional ED trips • As part of my job I have had the opportunity to attend

courses, conferences and showcases.

Rural and Regional Visits • Trip 1 to Southern NSW which included Moruya, Batemans Bay,

Milton/Ulladulla, Shoalhaven, Shellharbour and Wollongong. • Trip 2, Western NSW, which included Cowra, Forbes and Parkes

and an education day in Orange. • It’s enlightening to experience ED’s when released from the fish

bowel and the tunnel vision of surviving until your next 10 hour shift.

• I found it a privilege to hear the issues, struggles, hopes and achievements of the different hospital’s Nurse Managers and Directors

• In just 2 trips I’ve seen very different emergency departments and also how staffing numbers, personalities, relationships, location and even equipment can hinder and help the running of an organisation

ECI webpage, projects and courses • In conjunction with Dr Mackenzie, we work to produce up-

to-date, concise and to the point clinical tools regarding topical and relevant emergency conditions or procedures

• Specific personal projects I’ve worked on include :

Sedation Package

End of Life webpage

• To date I have interacted with ACI clinical networks, staff for LHDs, ED directors and a Ministry representative

• I have completed an AIM course (accelerating implementation methodology)

• I have attended a Showcase for Ambulance Service of NSW

• I have even completed some Management Moodles

Personal take home thoughts • A beneficial 6 months in the lead up to the Fellowship

exam- • On the job I’m being constantly kept up to date with journals and researching

clinical conditions • On the non-ED days you have greater scope to divide study time, attend tutorials

and most importantly manage fatigue.

• Recognition that policy making, guidelines and committees need representation from nursing and medical staff who regularly work the shop floor.

• More of us need to be aware that we can assist in decision making but more significantly we are an important part of the process.

Any Questions?