Why don't subspecialties teach us :(

tallaght01

Bit of a rant, and I'm sure it's not representative of all subspecialties.

I'm working in A+E at the minute. We get a few hours of teaching every wednesday. We have a locum consultant who comes into cover the floor and all the registrars and consultants go to a session where a subspecialist gives us a talk on a topic. It can be really useful, as obviously all kinds of stuff comes through the door in A+E.

Last week, the diabetes consultant was supposed to give us a talk. But instead he sent his diabetes nurse. It was fine. She knows a lot about diabetes. But wasn't able to answer a lot of the molecular stuff she was being asked about. She also wasn't experienced in acute management.

Today the orthopods were supposed to be giving us a chat on the evidence base relating to who we should be imaging and who we shouldn't. Instead, they sent their 2 physios. They put up a powerpoint presentation with a list of signs and symptoms of various fractures. the lists were nearly identical. They are very good physios. But they never ever see patients acutely, yet they were lecturing to our consultants about fractures.

I was asking about the ottawa criteria, and at what ages the different components were usueful. They hadn't a clue. My boss answered the question instead.

The joke afterwards by the clinical director was "and next week the dental hygienist will be giving a talk on max-fax emergencies".

This is something that had started to happen all the time in the UK. It used to really bug us. These people are all very good at their jobs, but I certainly find that sit down teaching by consultants is becoming much rarer.

A lot of jobs that I've done have scheduled teaching. But often this means that the juniors have to give the talk!!! There's some nonsesne spouted about how if we gather the info ourselves, we'll learn it better. The reality.....you do a quick cut and paste the night before after a week on-call, and the first time you REALLY read the stuff is as you're giving the talk. You're colleagues are bored senseless at another cut and pasted unimaginative talk.

The Tallaght01 campaign for proper teaching is officially underway :P

DrIndy

i completely agree - i work in A&E now and feel the same.

Emergency medicine is the cutting edge of medicine where you don't need to know only the breadth of all medicine, but also its depth. There is a real need for other specialities to get involved in educating us, for their own sake as well as us. (you can't complain about an inappropriate referral or an incorrectly worked up referral if nobody taught us what is needed to be done!)

I have done a lot of medicine so i have done presentations on medicine topics in good detail and in fairness the stroke reg and the cardiologists do spend their time with us - but this should be across the board and we should have a different specialist coming every week.

tallaght01

Yea I thought it was a bit ironic today when the ortho reg had a go at me for not describing an xay to him to his satisfaction over the phone.

He was giving out about my grading of a supracondylar fracture.

I told him the physio never mentioned anything about it. It went over his head, though :P

sam34

do psychiatrists get asked to do these talks? am not having a go, its just that ive never heard of anyone being asked

Traumadoc

Actually Psych is someting we should get talks on as to who is or is not safe to go home. Also organic causes for acute mental illness.


Tell the Ortho reg the next time to give you a quick rundown of the AO classification of Supracondyler fractures, better stlii give him the description in AO and express your suprise when he asks you to describe it.

http://membrane.com/aona/longbone/13.html

Amnesiac_ie

I've never worked in A&E myself but a lot of my friends have and they all complain that there is little to no formal teaching in the departments they have worked in, and certainly not from "in-house" specialists.

Would it be helpful for A&E staff to attend Medical/Surgical/Paediatric Grand Rounds? In most Irish hospitals, the "grand round" is the cornerstone of any formal postgraduate education programme. I don't recall ever seeing A&E consultants or NCHDs at these meetings; perhaps it would be a good place to start?

tallaght01

problem is grand rounds can be quite useless to A+E docs. Recent paediatric talks I've been to have been about stuff like neurosurgical advances in cerebral palsy, atypical epilepsies, and some molecular biology of cancer jazz.

The teaching given to A+E docs should be relevant. Like the oncologists talking about mangement of oncological emergencies and neutropenic kids. Or ENT talking about post tonsillectomy bleeds etc.

These things don't tend to get covered regularly at grand rounds.

Fionnanc

Supracondylar fracture in a child? If so should have put the phone down and come in the next available opportunity.
I have worked in casualty and some of the surgical specialties aswell and unfortunately quite frequently the information given over the phone could not be trusted. I have had acute traunatuc knee effusions sent to me as septic arthritis, out of control alcoholics with ?back fracture ?PUD, get exact AO classifications that I can't remember to be presented with something that could have been casted and sent to the clinic a week later.
May way around this was just to see everything, sometimes between cases and before bedtime make a sweep of the casualty saying hello to everybody. Saved work in the long-run.

The grand round though interesting is not a teaching tool, hearing about the one patient with a mitochondrial gene defect is not educational hour.
An hour spent in small groups applying Colles casts on eachothers' arms, or a rundown of DKA treatment, something useful.

Any of ye guys get to use the IO drill yet?

The senior registrars on clinical fellowship would be a good option for teaching.

Traumadoc

Yea used the IO good few times. works a treat. but you have to aspirate before you infuse.

Fionnanc

No more femoral/saphenous vein cannulation then

Traumadoc

Well the surviving sepsis campaign recommends central venous access - I prefer femoral approach ( less risk of pneumothorax:o) So I will still use it as well as IO.

tallaght01

It's cannula in, first time every time for my arrests, losers :P