Overview

Trainee Job at NSW Health Service Blue Mountains NSW

Job Description

Position Title Trainee

Position Number 21609

Employment Status Full Time – Exempt

Applications Close 25/10/2019

Maximum length of training contract 31/01/2021

Local Health District Nepean Blue Mountains Local Health District

Facility Nepean Hospital

Specialty Intensive Care Medicine

Sub Specialty None

Award Public Hospital Medical Officers (State) Award

Classification Resident Medical Officer

Registrar

Salary Band $81,639.00 to $127,539.00

Main Purpose of Position To provide effective medical services to patients under supervision, while developing expertise in medical practice, in a complex clinical environment in inpatients and outpatient areas in the public health organisation. Responsibilities include:



How Nepean ICU can help an ICU Trainee

  • Depending on individual requirements and satisfactory performance, we will arrange guaranteed placements for CICM-accredited trainees to complete the mandatory training requirements in medicine, anaesthesia, paediatrics and rural medicine.
  • Weekly formal teaching for Primary and Fellowship exams.
  • Nepean ICU has 3 Fellowship CICM examiners and 1 primary examiner, offering high-level support and excellent insight into the Primary and Fellowship exam processes;
  • Trainee mentorship program run by Fellows – trainees can approach Fellows for advice, support, feedback and assistance;
  • Excellent supportive environment for ultrasound training and skill-upgradation;
  • Highly productive research unit.

Clinical responsibilities

  • Under supervision, coordination and documentation of the of clinical management of patients referred to / admitted to the ICU including, but not limited to, admission, discharge, and provision of clinical care;
  • Effective supervision of residents;
  • Safe transport of the critically ill patient within the hospital;
  • Effective communication with nursing and senior medical staff, other medical and surgical specialties and families.
  • Participation in the afterhours and relief roster.

Academic / research responsibilities

  • All CICM-accredited trainees will undergo an initial interview with the Supervisor of Training (SOT) to make a formal training program;
  • Every trainee must actively participate in and contribute to ICU teaching sessions, as an attendee and as a presenter, including the Clinical Rounds, Journal Club and Intensive Care Tutorials.
  • Trainees intending to sit the Primary or Fellowship exams within 12 months of taking up the position are expected to regularly participate in the formal exam-teaching program.
  • Trainees not intending to sit the CICM exams within 12 months will be expected to complete their mandatory academic requirements such as the formal project, cardiac ultrasound training etc, as determined during the initial interview with the Supervisor of Training.
  • Trainees will be exposed to many concurrent local and multicentre research studies. Trainees who are not sitting exams within 12-24 months must contribute/participate in Research/Quality Assurance activities/audits (especially Trainees requiring to complete the CICM formal project).
  • All trainees are expected to assist in enrolling patients for research projects, including notifying the appropriate staff, assisting with obtaining consent, discussion with patients and relatives, and when necessary assist in the collection and collation of data.

Position Requirements 1.Qualifications

  • MBBS or equivalent.
  • Currently registered with the Medical Board of Australia.
  • Demonstrated clinical practice as a registered medical practitioner in the last 2 years in a setting appropriate to the needs of the position.
  • Demonstrated commitment to relevant training program and related medical experience in relevant specialties. Working towards completion of relevant College examinations.

2.Proven expertise/experience in the following clinical skills:

  • Management of commonly encountered critically ill medical and postoperative surgical patients under supervision;
  • Effective leadership to manage emergency medical situations, including competence in leading the Medical Emergency Team service;
  • Basic airway management and vascular access – preference will be given to candidates with advanced expertise in endotracheal intubation including difficult airway management and arterial catheter insertion, central venous access and insertion of intercostal catheters (chest tubes)
  • Mechanical ventilation;
  • Advanced Cardiac Life Support;
  • Management of postoperative patients after major surgery, including cardiothoracic intensive care;
  • Trauma intensive care.

The following is a full list of responsibilities of the ICU Trainee:

  • Clinical management of ICU patients under supervision, including the resuscitation and management of unstable patients within the ICU and hospital;
  • Assessment of patients referred for Intensive Care Admission as per the ICU Admission Policy and discussion with the Intensive Care Specialist before accepting or refusing patients;
  • Appropriate communication to other staff members and family;
  • Comprehensive documentation of all significant clinical events;
  • Ensure that all transports for procedures outside the ICU are conducted according to the CICM standards for the transport of the critically ill. The ICU Trainee is generally responsible for transports to CT. Transport arrangements for MRI, interventional radiology and other prolonged investigations will be coordinated by the ICU Specialist on Duty.
  • Discharge planning after discussion with ICU specialist, including communication with ward team Specialist or Trainee;
  • Safe and timely performance of ICU procedures;
  • Safe transport of the critically ill patient;
  • Supervision of ICU RMO’s, including appropriate delegation of duties and training them in performing procedures such as arterial and venous cannulation and insertion of intercostal catheters.
  • Team Leader of Medical Emergency Team and team member of the hospital Trauma Team;
  • Ensure that the ward team Specialist is aware of the outcome of MET calls on their patients;
  • Participation in educational and research programmes as listed above.

DAILY CLINICAL DUTIES SHARED BETWEEN TRAINEE & RESIDENT:

  • Ensure that there is a Medical Officer present within the Intensive Care Unit at all times.
  • Notify NUM 1 and other ICU Resident/Trainee if leaving the Unit, even if only for a short period of time. Any prolonged (more than 15 minutes) absences from the Unit during the day must be approved by the ICU Provisional Fellow or ICU Specialist.
  • Communicate frequently with other members of the ICU medical team.

General ICU management is a team effort and involves “network” communication (please see the section on “How We Work”). All significant changes in a patient’s condition must be discussed with the Provisional Fellow or Specialist. In crisis situations, communicate directly with the Specialist.

For allocated patients:

  • Present patients at daily ward rounds and the patient care meeting each Thursday morning.
  • Review patients (at least once per shift) and document patient status in the computerised medical record
  • Review and edit the ”clinical issues list” each shift on Intensys (Electronic Medical Record)
  • Review patients with acute changes in condition and manage as appropriate, after senior consultation.
  • Document all ventilation settings, drugs administered by infusion, and fluids on the ICU computerised medical record.
  • Ensure nursing staff are aware of patient management plans and that the plans are carried out.
  • Ensure that every documented problem has an action plan and help formulate this plan.
  • Arrange investigations and consultations.
  • Document and review results of investigations and consultations. Ensure recommendations made by consulting teams are acted upon and implemented after discussion with senior ICU staff.
  • Notify appropriate staff of the results of investigations and consultations, and help formulate management plans consequent on these results.
  • Ensure appropriate ICU Admission and ICU Discharge Summaries are written in every patient’s medical record.
  • Ensure adequate documentation of all deaths in the ICU, including date, time and criteria used. Ensure ward team Specialist (after hours) or ward Trainee (within hours) is notified of the death of the patient.
  • Be trained, perform and document necessary procedures on patients, according to level of experience.
  • Document all recognised incidents that actually or potentially lead to patient morbidity in the Incident Information Management System (IIMS), including complications of procedures.
  • Be involved in the Intensive Care teaching sessions, both as an attendee and as a presenter. This includes the Journal Club and the Intensive Care Tutorials.
  • Attendance at non-ICU hospital clinical meetings is encouraged, provided that this does not interfere with the performance of normal duties.
  • Be familiar with enrolment criteria for research projects and inform senior ICU staff when potential patients are identified.
  • Assist with aspects of research where necessary (eg obtaining consent, discussion with patients and relatives).
  • Aid in collection and collation of data as required.
  • Participate as required in Quality Assurance activities.

3. Research and Teaching

The Nepean Hospital Department of Intensive Care Medicine is highly involved in both local and multi centre trials. The ICU Trainee is involved in recruitment and patient management in regards to research trials.

4. Orientation

The Trainee will participate in an orientation program at the commencement of employment.

The Doctor will be required to undertake the core mandatory orientation to:

  • Gain an understanding of the organisational values, goals and ethics.
  • Gain knowledge and develop skills to work in a manner which promotes their own health, safety and security at work. Including information relating to infection control and needlestick injury.
  • Gain an understanding of child protection legislation policies and responsibilities associated with notifying and reporting issues about child protection.
  • Given guidance on ways to perform their job in an efficient and effective manner; and the code of conduct and ethics, including the behaviours and standards expected of NBMLHD Employees.
  • Understand the principles of waste management and the local processes in place, which are designed to reduce waste.
  • Gain an understanding of the administrative procedures relating to the performance of their work.
  • Develop an understanding of the legislative and industrial context in which they work.
  • Gain information on NBMLHD Employee Assistance Program (EAP).
  • Gain education and training in the minimisation and management of aggression, Work Health and Safety, Fire Safety and quality improvement processes.

5. Supervision

The ICU Trainee is supervised clinically by the Intensive Care Specialist and Provisional Fellow. Professional training is supervised by the Supervisor of Training, College of Intensive Care Medicine of Australia and New Zealand.

The ICU Trainee is responsible for the supervision of the ICU RMO’s. They are to be involved in the training of the ICU RMO’s in performing procedures such as arterial and venous cannulation and insertion of intercostal catheters. The ICU Trainee is the Team Leader of Medical Emergency Team providing clinical support to patients who meet the MET criteria in the designated areas outside of the ICU.

6. Other responsibilities

In addition to the core competency standards, the doctor is expected to comply with legislative, policy/protocol requirements as they relate to:

  • The supervision requirements as set out by the Medical Board of Australia;
  • The Local Health District’s Performance Management Policy;
  • Work, health and safety requirements as an employee;
  • The NSW Health Code of Conduct.

7. Medical leadership

  • Participate in RCA, QA, M&M, incident review, complaint management.
  • Contribute to hospital wide patient flow and meeting ETP targets through timely review of consults in ED and the wards, early identification of discharges including pre 09am discharges, completion of discharge paperwork and participating in Whole of Hospital strategies to ensure the appropriate and timely care of patients.
  • Demonstrates the ability to effectively manage staff and hospital resources including:

a)communicating effectively

b)prioritising tasks

c)using time management skills appropriately

d)assigning tasks and delegating

e)prioritising and re-prioritising clinical tasks in the ‘on-take’ day and during medical disasters

f)ensuring tasks are progressing as planned

  • Communicate with and co-ordinate specialty teams to achieve an optimal environment for patient care.
  • Effectively use resources to balance patient care and systemic demands.

In addition to the core competency standards, the Medical Officer is expected to comply with legislative, policy/protocol requirements as they relate to:

1.Compliance with all applicable public health organisation and hospital policies and protocols, and with applicable Policy Directives and Guidelines issued by the NSW Ministry of Health, as amended and as in force from time to time, including the NSW Health Code of Conduct

2.Ensuring that all services provided to patients are consistent with any instructions issued by your supervisor or Department Director or any conditions imposed by the Medical Board of Australia;

3.Maintenance of adequate hospital clinical records, including completion, within a reasonable time period following the patient’s discharge, of patient discharge letters;

4.Observance of general conditions of clinical practice applicable at the Public Health Organisation where you will be working from time to time;

5.Demonstrating at all times courteous and professional behaviour towards patients, their relatives and other staff.

Local Background & Environment Nepean Hospital is an important referral and teaching hospital of the University of Sydney. It serves the local areas of Penrith, Hawkesbury and the Blue Mountains (comprising a population of 300,000 and growing) and accepts patients from as far as Lithgow and Bathurst flown in by helicopter retrieval services. Nepean Hospital is the Regional Trauma Centre for these areas. The ICU Trainee positions are accredited with the CICM (ANZ), RACP, ANZCA, and ACEM for Intensive Care Training. Trainees are encouraged to prepare for appropriate exams.

The role of the Intensive Care Unit is to provide Intensive Care services to the community as well as providing emergency response to all wards within the hospital. The unit consists of 21 beds, 16 of which are equipped for mechanical ventilation. The department has 8 Staff Specialists, 1 Clinical Superintendent, 1 Echo Provisional Fellow, 3 Provisional Fellows, 10 Trainees, 4 Senior Medical Resident Officers and 4 Residents.

The facilities at the Nepean Hospital include:

  • Trauma including neurotrauma
  • All surgical specialties except cardiac surgery and solid organ transplantation
  • All medical specialties including a comprehensive Cancer Care Centre and bone marrow transplantation
  • High risk obstetrics and a neonatal intensive care unit
  • Interventional cardiology
  • Radiology including general imaging, ultrasound, nuclear medicine, CT and MRI.
  • Pathology

Trainees within the Intensive Care Unit work 12 hours day and night shifts. During the day shift hours of 0800-2030 the Trainee is supervised by both Provisional Fellows and the ICU Specialist. On day shift there is also an SRMO and Resident on shift. The Trainee is responsible for providing supervision and assist in training of junior residents. During the night shift hours of 2000-0830 the Trainee works with an SRMO and Resident. The Provisional Fellow and ICU Specialist are always on call during this period to provide any support that may be required. A Medical Provider Number may be required to request tests and make referrals.

Key Internal and External Relationships The Intensive Care Trainee is responsible to the Director of the Intensive Care Unit as well as all senior medical staff. The Trainee has constant contact with all wards within the hospital on all levels in regard to management of patients that may require intensive care consultation. The Trainee is also required to communicate with the NSW Aero medical Retrieval Unit (AMRU) and the NSW Medical Retrieval Services as well as Bed Managers and Specialists from other hospital who require a patient to be transferred to Nepean Hospital for Intensive Care Treatment.

Arrangements are in place to second ICU Trainees to medical and anaesthetic terms within Nepean Hospital as required in order to complete their CICM requirements. Supervision is available from the Specialist team attached to each medical term.

Supervision Arrangements Supervision during normal hours:

  • Immediate supervision of the Trainee is provided by the Provisional Fellow and Intensive Care Specialist. Senior staff are always at hand during normal hours
  • Other Specialists that are not rostered on clinically are on site during the day and are mostly contactable at any time if assistance is required
  • Senior staff responsible for supervision are always contactable by phone
  • Trainee assists in supervision and training of Junior Residents

Supervision after hours

  • The Trainee is responsible for supervision of junior residents after hours. The Trainee is also responsible for maintaining contact with the on call Provisional Fellow and ICU Specialist.
  • During the After Hours period the Trainee is the most senior doctor within the Intensive Care Unit
  • Support can be provided from the Emergency Department or Anaesthetic Department if required
  • The Provisional Fellow and on call Intensive Care Specialist are always contacted by telephone and must be at the hospital within 20 minutes if help is required.

The supervision of staff within the Nepean Hospital Intensive Care Unit is shared amongst the Intensive Care Specialists. Generally the Specialist rostered on clinically is responsible for junior medical staff working that shift.

Challenges/Problem Solving Challenges of the Trainee role include:

  • Having composure during emergency situations and being able to come up with appropriate management plans in a short time frame to effectively manage emergency situations
  • Communication patients and their families with regard to end of life decision making.
  • Managing the constant fast pace of work in the Intensive Care Unit, which requires excellent time management skills to manage the workload and delegate to junior staff.
  • Working collaboratively with other staff in a multi-disciplinary team.
  • Maximising the efficient utilisation of the physical resources of the Local Health District.
  • Being flexible with the work required in a range of Local Health District and locations.
  • Responsibility for supervision and teaching of junior medical officers attached to the medical team.

Decision Making Decisions that can be made by the Trainee without consultation include:

  • Insertion of Arterial Line
  • Insertion of Central Line
  • Medication prescription
  • Ventilation in Emergency situation

Decisions that must be made in consultation with the ICU Specialist include:

  • Accepting admissions
  • Withdrawal of treatment
  • Commencement of Ventilation
  • Refusal of an admission request

The Medical Officer will be required:

  • To exercise independent judgment, initiative and problem solving skills, but this should be exercised in consultation with supervising medical staff including patient escorts and transfers.
  • Close and effective liaison with consultants to allow the Medical Officer to demonstrate their level of ability and understanding of patient care and enable an expansion responsibility.
  • All patients managed within the hospitals of the Health District are under the direct care of a specialist medical practitioner. All decisions regarding their care are to be clearly communicated with the specialist responsible for that care to ensure appropriate input from key decision makers and achieve consensus when possible.

Communication The Trainee is responsible for:

  • Participating in ongoing review and training at departmental meetings such as Morbidity and Mortality Meetings, Journal Clubs and giving peer tutorials.
  • The Nepean Hospital Intensive Care Unit provides policies and procedures that are easily accessed and should be followed by all Trainees
  • Participating in continuing medical education and professional development
  • Maintaining his/her professional competence.

Performance Monitoring The ICU Trainee is responsible for:

  • Participating in ongoing review and training at departmental meetings such as Morbidity and Mortality Meetings, Journal Clubs and giving peer tutorials.
  • Following the policies and procedures of the Department of Intensive Care Medicine
  • Participating in continuing medical education and professional development
  • Maintaining his/her professional competence.

Dr Stuart Lane (Staff Specialist, Supervisor of Training CICM(ANZ) is responsible for providing reports on ICU Trainees as well as feedback to the College of Intensive Care Medicine.

Additional Information

Additional Documents no addditional documents have been provided

College College of Intensive Care Medicine of Australia and New Zealand

Organisation Chart 2020 ICU Trainee – adhoc.pdf

Job Demands Checklist Click Here to View

Selection Criteria 1: MBBS or equivalent, currently registered with the Medical Board of Australia.

2: Demonstrated clinical practice as a registered medical practitioner in the last 2 years in a setting appropriate to the needs of the position

3: Ability to work independently within a supervised complex clinical environment utilising excellent clinical skills, communication skills (verbal and written) and computer skills

4: Demonstrated good organisational, time management skills and commitment to quality improvement, patient safety and risk management.

5: Prior postgraduate experience and/or qualifications in intensive care medicine

6: Proven expertise/experience in management of commonly encountered critically ill medical and postoperative surgical patients including cardiothoracic intensive care and trauma patients under supervision

7: Prior experience in leading a Medical Emergency Team service

8: Proven expertise in basic and advanced airway management and vascular access, mechanical ventilation, advanced cardiac life support

About Company

Company: NSW Health Service

Company Location:  Blue Mountains NSW

Job Category:

About NSW Health Service