The Sweet Spot – Meredith Borland, part 2

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The Paediatric Emergency Department is a relatively unique area in medicine as the registrar workforce usually comes from one of two backgrounds: Emergency or Paediatrics. Consequently, we strive to have the optimal combination of both specialties – The Sweet Spot.

The two groups come with a very different skillset and approach to medical care. In some cases, the Emergency trainee may not have cared for children previously, or the Paediatric trainee not have worked in the ED since their intern year.

In this edition of the Sweet Spot, we’re hearing from Dr Meredith Borland, Director of Emergency Medicine at Princess Margaret Hospital for Children in Perth, Australia. She has previously featured on the empem series of podcasts. In her own words;

“I came to Paediatric emergency medicine after working as a GP for 8 years and realising my passion was paediatrics and emergency medicine. It seemed logical to return to training through the ACEM. This was when the JTC PEM was still being negotiated and I was lucky to complete training in WA and Vic and commence full time as a PEM consultant position in 2004. Since then I have enjoyed developing the field of PEM for both paediatric and emergency trainees.”

Part 2 : For Emergency doctors new to the Paediatric setting:

What are some common stumbling blocks & how can these be avoided/fixed?

Assuming that children don’t have serious illness like adults and failing to recognize subtle signs.

How does their mindset need to change/evolve?

Realise that the only way to recognise subtle serious illness signs is to see lots and lots of children with common childhood illnesses.

Recognise the child is part of the family unit and just because the child looks well doesn’t mean you have reassured the parents if you don’t address the parent’s concerns directly.

What are some knowledge deficits that can be ameliorated...

– quickly and easily? How to relocate a pulled elbow

– with concerted study and experience? Common neonatal problems – from sepsis to feeding difficulties and how to reassure the parents

The skill/attribute that differentiates an average Registrar from an exceptional one is…?

Recognise the subtle signs of serious illness – hard to teach gut instinct but you can develop a sharper instinct with time and experience.

Capacity to recognise the need put the foot down – to churn through the workload while still keeping the quality of the assessments.

Uses current evidence to question practice and challenge dogma and learning how to incorporate this into practice.

What is the most under-used feature in the History/Examination/Investigation?

History – the social history

Examination – the heart rate

Investigation – rationale use of investigations

How is the communication different...

– with parents? Should be inclusive – work as a team for the child, respectful instructive and knowledgeable

– with medical & nursing colleagues? Supportive, knowledgeable – encourage to think rather than follow protocols without rationale

– with senior staff? Respectful, ask questions to help inform practice

A strength that this group might be surprised they have is…?

Know how to work hard and prioritise workload.

My top five tips for this group:

1. Don’t be scared of neonates and babies

2. Your input is valuable but don’t try to impose adult approaches

3. Read up on common paediatric presentations

4. Take up any simulation or airway sessions offered

5. Always look at the observations and repeat them if they’re not within normal range for age

The most important piece of advice for an Emergency Reg new to Paeds ED

PED staff love emergency registrars with their confidence, resuscitation and trauma skills. Don’t try to impose ways you have seen things done differently – question and read up on why and as the staff in the PED and you get to know each other you can learn from them and they can learn from you.

Thanks for the wise words Dr Borland! Be sure to read part 1 of her interview ; For Paediatric registrars new to Emergency, here.

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About 

A Paediatric Trainee based in Queensland, Australia, Henry is passionate about Adolescent Medicine & General Paediatrics, with a strong interest in Medical Education & Clinical Teaching. An admitted nerd & ironman with a penchant for Rubik's Cubes & 'Dad jokes'.

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