Letters
Health services administration
Volume 189 - Issue 9

An observational study of emergency department intern activities

Authors:  Belinda Doherty and Mark A Brown

Med J Aust 2008; 189 (9): 529. || doi: 10.5694/j.1326-5377.2008.tb02160.x
Published online: 3 November 2008
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To the Editor: The study of intern activities in Melbourne emergency departments (EDs) highlighted gaps in the ED training of interns.1 In particular, it was shown that interns undertake a low number of procedural tasks. Most did not perform urinary catheterisation, nasogastric tube insertion or reductions of fractures and dislocations, just some of the skills highlighted as important in the Australian Curriculum Framework for Junior Doctors (ACFJD).2 Time pressure on supervisors was cited as a reason for this.

New South Wales will experience a doubling in the number of medical graduates in the next few years. Increased capacity in emergency terms will be needed. The reported capacity (available supervision, clinical workload and funding) in NSW EDs indicates that a shortage of terms could develop from 2011.

The NSW Institute of Medical Education and Training (IMET) recently explored the educational validity of retaining the emergency term as a mandatory requirement for general registration3 in view of the reported limited capacity.

IMET-accredited emergency term descriptions were reviewed and mapped against the “Common presenting problems and conditions” listed in the ACFJD. The study found that an ED term would likely provide exposure to most of the common conditions, many of which were unlikely to be encountered in other medical or surgical hospital rotations. The acute phase of key conditions, that all medical practitioners are expected to be able to recognise and treat appropriately, were often unique to the ED term. Further, most of the “Skills and procedures” for junior doctors were likely to be learned in the ED, and around 50% were not commonly experienced elsewhere. Many of the broader competencies of the curriculum such as “Doctor and society” are also covered in an ED term.

The ED provides a unique context for learning, bridging community and hospital situations. The approach to acutely ill patients, with as yet undifferentiated problems, for whom JMOs learn to initiate treatment and appropriate investigations concurrently, cannot be reliably replicated elsewhere.

Emergency departments bear the brunt of the growing demand for acute care from an ageing population with multiple comorbidities, and also of the growing demand for excellent and accountable postgraduate medical training. In NSW, about 30% of directors of prevocational training are ED physicians, reflecting their commitment to education. They typically supervise numerous trainees at a time. The educator role of ED physicians and other senior doctors in EDs is essential. Resources should be directed to supporting this role and enhancing the capacity of EDs to train medical graduates.

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