Monday, March 10, 2014

Rural & Emergency Medicine (RETROSPECTIVE POST)



Rural (3 Weeks)
Me and a Friend were allocated a Rural Town in Victoria for our Rural Rotation. The first week involved Lectures in Shepparton for a few days on Rural and Aboriginal Health before we headed off to our respective Towns which involved a tour of the different Hospital Departments. To be honest we didn’t actually do much Clinical work coz we had a 20 Minute Powerpoint Presentation to work on and present at the end of THIS Rotation, which was actually very stressful given the seeming lack of Direction in the Assignment and difficulty collecting relevant Data in the allocated Time. 

We got to stay in a House that was shared with 2 Nursing Students who provided interesting Social Company at the Time. One of the Nursing Students was a Mature-Aged Student who had 3 Nephews with Asperger Syndrome which amused me greatly. I found it interesting to hear more in depth what studying and working in Nursing was like, and she also provided a bit of Advice on how to deal with Patients.

The Rural Rotation was also an Opportunity to practice Domestic Tasks like Cooking and doing the Laundry, which I’m usually too lazy to do at Home… : )

ED (3 Weeks)
3 Weeks for ED was surprisingly short given that it’s actually a Core Rotation (10 weeks) in Internship. It also didn’t help that it was our final Rotation for Semester 11 and I was frantically preparing for Exams. The other Students were preparing for Exams and Internship Applications, which made them even more stressed out. I’m aware that in the new MD Course, it’s now 8 weeks but also fuses Elements from the other Adult Medicine Specialties from our MBBS Course (eg Endocrine for Diabetic Ketoacidosis). We had a few Tutes which IMHO were overly detailed, and I learned and retained the most by actually going to the ED and speaking to Patients.

I loved the Practicality of ED. Triage was very useful for OSCE practice coz I had to take a targeted History for a Presenting Complaint and rule out the Differentials in a rapid Manner, along with presenting the Info to an ED Registrar / Consultant. I think when you are under Pressure to perform, you tend to acquire the necessary Skills a lot quicker out of Necessity. In my case, it was only a matter of Days in which I could memorize the Questions to ask for an AMI (Heart Attack) / Angina, and know what Tests to order, followed by initial Management. It’s not expected to CURE a Patient at the ED, but one can always try to make a quick positive difference which was what I liked.

It also provided Opportunities for IV Cannulation and Venepuncture, of which I got a few Cases signed off. Similarly, Clerking was easier, coz the Patients were relatively “new” to the hospital and haven’t been “interrogated” by all the Healthcare Staff, so were more receptive to answering medical Questions and being physically examined (providing they were conscious!). I also appreciated that as a Student, it was considered acceptable to come to the ED at Night-time or early Morning for extra experience, as other staff would assume you were rostered onto a late Shift!!!

During this Rotation, I was so enamored by ED’s Practicality that I was interested in ED Training as a serious Alternative to Pathology. Interestingly, both Specialties have a preliminary Exam that tested on Pathology (from the “Robbins & Cotran - Pathologic Basis of Disease” Textbook). However, an ED Registrar suggested I don’t, and instead pursue the latter, as there was currently an oversupply of ED Registrars, for which there’ll be a insufficient ED Consultant (and ongoing ED Registrar) Posts in about 3 years’ time. She also said that the Shift Work would eventually take a toll on your Physical and Mental Wellbeing to the Point where you won’t be able to enjoy the Work as much as you’d like. Although one of my Medications (Modafinil) is officially indicated for Shift Work, I was inclined to agree with her given my previous Experiences. What a shame…

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