RMO General Medicine Rotation 3

TERM DESCRIPTION

RMO General Medicine Rotation 3

DOCUMENT VERSION: 9 July 2018

FACILITY: Calvary Public Hospital Bruce (CPHB)

TERM NAME: PGY2 Medical Rotation 3 TERM SUPERVISOR: Dr PK Tan

CLINICAL TEAM: Include contact details of all relevant team members

The Clinical team consists of clinical team members attached to each medical unit highlighted in the table below.

Gen Med

5 MAPU Palliative

Care Night shift Evening

shift Off days

RMO General Medicine Rotation 3

3 weeks 4 weeks 3 weeks 1 week 1 week 1 week

General Medicine Team 5

Dr PK Tan (Gastroenterology)

Dr Mary-Ann Kulh (Geriatrics)

Dr Tony Kwan (Nephrology)

Dr Sharon Ong (Nephrology)

MAPU

All consultants

Palliative Care

Dr Suharsha Kanathigoda

Dr Susanne Rainsford

Ward 4E, 5W, CCU and other clinical staff

All Consultants can be contacted through the Calvary switchboard on 62016111.

ACCREDITED TERM FOR:

Number Core/Elective Duration PGY2 1

Medicine 13 Weeks

OVERVIEW OF UNIT OR

SERVICE

In Calvary Public Hospital, there are five separate teams in General Medicine and three subspecialty medical units (Cardiology, Neurology and Palliative Care). 85% of all acute medical admissions to Calvary Public Hospital Bruce come through Emergency and are cared for by the Medical Consultant on call. Occasionally, a patient may be referred to a different Consultant but only with the consent of the Consultant on call. The remaining patients are admitted by a consultant under their care as elective admissions for investigation or management. Patient casemix is very general covering a range of common conditions. Neurological and cardiology admissions tend to be directly admitted under the respective subspecialty teams. As admissions through Emergency can result in significant variations in workload, all the JMOs are encouraged to work collaboratively and assist each other as needed. The Clare Holland House (CHH) is a 19 bed, stand alone, hospice unit located in Menindee Drive, Barton. Admissions to the hospice are under care of either Dr Kanathigoda or Dr Rainsford with the team consisting of the PGY2 JMO, a Palliative Care Advanced Trainee as well as nursing, Social Work, Counsellor, Pastoral Care, Physiotherapy, Occupational Therapy staff and Volunteers. Admissions to the unit are arranged following review by the Palliative Care Specialist involved on a planned or semi-urgent basis. Hospice admissions may be arranged for acute symptom management, medical assessment, respite care or end-of-life care. The normal working day is from 0830-1700. The PGY2 JMO will also participate in night and evening duties; and the after- hours roster at the Calvary Public Hospital, Bruce campus. The RMO General Medical Rotation 3 is designed to enhance clinical exposure in Medicine and to provide broad exposure in subspecialty areas in Renal Medicine, Geriatric Medicine, Palliative Care and Gastroenterology.

REQUIREMENTS FOR

COMMENCING THE

TERM:

There are no prerequisites for commencing this term.

ORIENTATION:

There will be a formal orientation session on the morning of the first day of term, delivered by Medical Administration and Directors of Prevocational Education and Training. The orientation session will include information relevant to the Calvary Hospital campus in Bruce and Clare Holland House in Barton. Informal orientation on the wards will be conducted by clinical team members. JMOs who are attached to the Palliative Care team will also receive a tour and an internal orientation at Clare Holland House.

Formal orientation on the first day also includes an overview of MAPU covering admission criteria and general ward operations (from Director of MAPU).

Informal orientation on ward with MAPU, CNC and Advance Trainee including work flow, Patient Journey Board, individual responsibilities of MAPU Team members, and Structured Interdisciplinary Bedside Rounds (SIBR). This usually occurs on day 2 of the term.

JMOs CLINICAL RESPONSIBILITIES AND

TASKS:

• To ensure continuity of patient care by handing over relevant clinical details to the after hours JMO on the next shift and receiving handover information from the after hours JMO from the previous shift.

• To admit patients not arriving through the Emergency Department. • To provide continuing care of all patients on the team under the supervision of the

registrar. • To ensure appropriate documentation is up to date including a daily review of the

patient’s condition, a review of current management and outlining future plan. These must be legible.

• Electronic Discharge Referrals should be up to date and preferably a copy provided to the patient upon discharge to take to their GP, in other cases they must be completed within 3 days of discharge. The referral must include a complete list of medications on discharge.

• To attend ward rounds. This includes medical patients, consults, ICU and Stroke Unit patients and patients on outlying wards.

• To attend patient conferences & to assist in careful discharge planning. • To ensure that all fluid and medication charts are up to date. • To arrange investigations and chase up results, and ensure the registrar is aware of

abnormal results, as soon as practically possible. • To attend and participate in Grand Rounds and weekly Medicine department meetings

with case presentations as requested. • Endoscopies are a useful learning situation. The JMO should attend at least one session

during their term. • To participate in the Friday cardioversion session in CCU with the Director of Cardiology. • To participate in the after-hours ward roster. • The JMO attends the morning handover meeting at 0800. • The JMO is responsible for the effective handover at the end of the term to the incoming

JMO on rotation. Additional responsibilities in MAPU

1) To ensure continuity of patient care by handing over relevant clinical details to the JMO on the next shift and receiving handover information from the JMO on the previous shift.

2) To admit patients arriving through Emergency Department in consultation with the MAPU Advanced Trainee and Basic Physician Trainee.

SUPERVISION:

IN HOURS: JMOs are supervised by their registrar & consultants during the day and the Medical Registrar after-hours. An on-call medical registrar is available 24 hours a day and can be paged via switchboard. Consultants are happy to be called if there is a problem and can be contacted via switchboard. After hours, other senior medical staff are always available in the Emergency Department, Intensive Care and Anaesthesia for acute problems. The hospital also operates a Medical Emergency Team. After hours Ward JMO shifts are as per the roster distributed by Medical Administration.

AFTER HOURS: This term includes participation in the ward after-hours roster.The medical JMO is usually rostered on as the after hours medical JMO , but may sometimes be rostered on as the surgical JMO. Both medical and surgical registrars are available at all times for supervision. They are the immediate supervisor. The Director of Medical Services or delegate is available at all times as needed via switchboard on 6201 6111.

STANDARD TERM

OBJECTIVES:

CLINICAL MANAGEMENT:

• Understand the management of common general medicine conditions which may include: COPD, pneumonia, thromboembolism, hypertension, congestive cardiac failure, atrial fibrillation, acute kidney injury, electrolyte disorders, acute pancreatitis, febrile neutropaenia, GI bleeding, chronic liver disease, falls in the elderly, dementia and delirium, diabetes, musculoskeletal back pain & cellulitis.

• To become proficient in history taking, ensuring all relevant information is obtained, including relevant radiological films.

• To perform a thorough physical examination and be able to elicit physical signs. • To develop a provisional plan of investigation and management based on a provisional

diagnosis and differential diagnosis. • To use laboratory and radiological investigations for clearly specified purposes keeping

the cost in mind. • To develop organisational skills and effective time management. • To gain experience and proficiency working in a multidisciplinary team.

COMMUNICATION:

• To be able to communicate with patients and their relatives about the patient’s illness and future plans for managing that disease and the patient.

• To be able to communicate with external medical and paramedical staff, including the GP, about the patient and to ensure good follow up care on discharge.

• To communicate effectively with hospital staff involved with the patient including the consultant & the registrar.

• To be able to communicate effectively via the written medical record with appropriate documentation of clinical findings, test results and the clinical plan.

• Be able to communicate with nursing staff regarding the clinical plans for each patient.

PROFESSIONALISM: • To show enthusiasm and initiative for learning. • To be willing to teach and assist other staff including medical students. • To demonstrate a desire for self-directed learning. • To be punctual, reliable and honest and behave in an ethical manner to patients and

staff, with respect for confidentiality. • To be prompt and efficient in the management of work and show good prioritisation of

tasks • To be committed to good patient care and good relations with other staff.

TIMETABLE (the timetables are not intended to be a roster but rather a guide to the activities that the JMO should participate in during the week)

MAPU

Monday Tuesday Wednesday Thursday Friday Saturday Sunday

AM

0800 Handover 0745 hanover 0800 Handover 0800 Handover 08k00 Handover 0800 Handover 0800 Handover

0930 Ward SIBR Round

0800 Division of Medicine

Clinical Meeting




PM

1330-1530 Education Program at

Calvary

1200 Grand Rounds

1500 -1600

Gen Med Journal Club

General Medicine Team 5


AM

0800 Handover

Post Take

Ward Round Following Handover

0730 Handover

Post Take


0800 Handover

Post Take


0800 Handover

Post Take


0800 Handover

Post Take


0800 Handover

Post Take


0800 Handover

Post Take


0900 Ward Round

Dr Kwan

0800-0900 Division of Medicine

0900 Ward Round

Dr Kwan

0900 Ward Round

Dr Tan

0800-0900 Neurology education

Clinical Meeting

0900 Ward Round

Dr Ong

1030 Ward Round

Dr Ong

0900 Ward Round

Dr Kwan

1200

Neurology Journal Club

PM

1600 Ward Round

Dr Kulh

1330-1530 PGY 1&2

Education

1200-1245

Grand Rounds

1400

Ward Round Dr Tan

1300 Ward round

Dr Kulh

1300 Ward round

Dr Ong

1500-1600 Medical

Journal Club

1600

Handover 1600

Handover 1600

Handover 1600

Handover 1600

Handover 2200

Handover 2200

Handover Palliative Care


AM

0900 Ward Handover Meeting


0830 Journal Club


0830 Education Session

0930 Ward Round

0930 Ward Round

0930 Ward Round

0930 Ward Round


PM

1130am Ward Interdisciplinary

Meeting.

1330 Education

Session

1000 Ward Round

PATIENT LOAD: General Medicine: 10-20 patients/day

MAPU: 8 patients but high turnover (every 48-72 hours). Unit load is 24 inpatients. Complexity high number with multiple chronic co-morbidities.

Palliative Care: 19 patients shared with Palliative Care Advanced Trainee.

OVERTIME Average hours per week ROSTERED: 3.73 hours.

UNROSTERED: Average of 4 hours per fortnight which can change due to seasonal changes or activity.

EDUCATION: PGYs are encouraged to attend as many educational events as possible.

• Tuesday morning Physician meetings: the PGY will be expected to present at these.

• Tuesday afternoon teaching at Calvary. This is protected teaching time. • Wednesday lunchtime Grand rounds at Calvary – registrars are expected to present

as arranged. • Neurology education: these alternate between neuroradiology meetings and

clinical case presentations every Friday 0800-0900. • Medical Journal Club. Friday 1500-1600. This is protected teaching time for

registrars. • In-Service sessions at Clare Holland House as workload allows.

Palliative Care Education Resources

The CHH library holds a small range of Palliative Care texts and Journals. Internet access to a range of databases including Medline, CINAHL, Cochrane Library, HIAP and AustHealth is available as required. Therapeutics guidelines, Martindale and Medicines Handbook are all available on the Hospital Intranet, as are a range of clinical policies and procedures.

The Term Supervisor will provide formal assessment and feedback using the one 45 system assessment forms at mid-term and at the end of term. In completing the Assessment Form, the Term Supervisor will consult with other members of the team (AMOs, registrars, nurses and other professional staff). It is the JMO’s responsibility to ensure that the term supervisor completes a mid-term and end of term assessment.

ADDITIONAL INFORMATION: Scope of Practice:

http://connect.calvarycare.org.au/committees/CHCBrucePolicyCommittee

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Term Supervisor Signature: Date: .......................................................................................... ......../......../........

17 07 2018