Good on you Paul!!!
Often very therapeutic too!
As a recently gradulated FACEM, I am biased, but proud of my training.
Learning plenty from an admin prospective working over here, which is a
necessity for being a "grown up consultant".
I am assuming you are stationed at RCH in Melb???
Beth
>From: Paul Middleton <[log in to unmask]>
>Reply-To: Accident and Emergency Academic List <[log in to unmask]>
>To: [log in to unmask]
>Subject: Re: [Re: ACEM position on merit badges]
>Date: Thu, 29 Nov 2001 05:19:59 GMT
>
>Cliff Reid <[log in to unmask]> wrote:
>As a UK trained EP I agree with Craig's comments about the unequal
>distribution of resuscitation skills amongst existing consultants....
>Dear All
>
>As a certified list lurker, I almost always read the submissions without
>feeling the need to add anything. This thread, however, makes me feel the
>need. I am in a similar position to some others on the list, having trained
>in
>the UK, FFAEM in May, awaiting the CCST in Dec, and now in Australia.
>
>Along the way I accumulated ATLS, ALS, APLS and even MIMMS and PHTLS
>certification. I now instruct in ALS, ATLS, and APLS. Why? It was not for
>the
>"badging" status of the provider or instructor courses, although in
>competitive interview situations every little helps. The reason was that
>the
>clinical, "on the job" teaching which theoretically should pass on these
>and
>other skills was largely absent from the SpR training as I experienced it.
>I
>did them because I knew I had to be competent in my management of the
>seriously ill, and it wasn't coming from anywhere else.
>
>I began SpR training after a 6 month locum reg post (minimal teaching
>anyway,
>as it was a purely service post), prior to which I completed a surgical
>training (I had never come across an A&E Reg who had MRCP before I moved to
>London). In the area I did my SHO rotation, nobody had any constructive
>advice
>on what I should do before reg jobs, certainly no suggestions like I make
>to
>SHO's when asked now, such as do some paeds, some anaesthetics, and a lot
>of
>medicine, and then think about SpR interviews!
>
>I did my SpR training over several large teaching hospitals, and several
>busy
>DGH's. In few of these was there more than notional clinical teaching. Some
>hospitals (regions) had immensely better training days etc, but not on the
>shop floor. I managed to accumulate many of the skills and much of the
>knowledge to manage patients in resus and elsewhere from constant reading
>(probably a good thing) but also from doing and teaching the courses. I am
>now
>in Australia largely to attempt to bring my skills and knowledge up to what
>I
>believe I need to function as a consultant level EP, in an environment that
>has consistent senior presence from people that not only like to teach
>clinically, but are very proactive about it!
>
>Lists like this seem to attract comment largely from a knowledgeable, keen
>and
>articulate audience. Maybe the juniors in your departments are receiving
>constant clinical teaching that makes the ALS courses etc redundant, but if
>so
>it will be a marked change from that which I saw over a quite a range of
>big
>and small hospitals (with greater and smaller levels of self-importance!)
>
>Two more points:
>
>Recently, a very senior (UK) consultant took exception to my comment that
>the
>FFAEM goes nowhere near enough testing the clinical acumen and performance
>of
>trainees (whatever you think, the FACEM is a lot closer), with the
>rejoinder
>that we had all completed a logbook, and therefore we must be clinically
>competent, and therefore that aspect did not need to be tested. Am I
>cynical,
>or does everyone out there really pop in to the consultant's office at the
>end
>of every day and say "could you just sign
>me up for that cardiac arrest / chest drain / DKA we saw TOGETHER
>earlier?" I
>accept that we are a young speciality in the UK, and that many talented and
>committed people are striving to drag our competence and our credibility up
>by
>the bootstraps, but complacency about training in this way certainly ain't
>the
>way forward.
>
>Secondly, it all very well for the list members to consider the guidelines
>/
>protocols in the ALS / ATLS etc to be superseded by their clinical acumen,
>and
>I would certainly hope this to be true. But please let's not forget that
>the
>care that most patients receive in most hospitals in the UK is still from
>junior doctors, some of which may be very junior, and some of which may be
>just out of housejobs. Hands up those of you who run departments with 24
>hour
>registrar cover on-site, let alone in the department. Before these courses,
>the patients that we see were in a whole lot worse situation than they are
>now. They are designed for junior doctors and nurses, and they explicitly
>say
>so.
>
>
>Anyway, that's that off my chest.
>
>Back to the sun.
>
>Paul Middleton
>Visiting Reg in Paeds EM
>Melbourne
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