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 excited to interview Dr Sean M. Fox; the energy, brains and action behind Pediatric EM Morsels, as well as working as an Associate Professor in Paediatric Emergency Medicine at the Carolinas Medical Center in Charlotte, North Carolina, USA. Why “Morsels?” He likes dessert more than jewelry (also known as pearls).
Sean was a resident in training for 5 years as both a Pediatric trainee and an EM trainee. So, he actually knows what it is like to be a Pediatric doctor covering the random pediatric hospital floor emergencies in the middle of the night with limited resources as well as what is like to be a junior EM resident trying to not look completely overmatched in a trauma code.
Part 1 : For Paediatric doctors new to the ED setting:
What are some common stumbling blocks & how can these be avoided/fixed? How does your mindset need to change?
One of the biggest stumbling blocks for a Pediatric trainee to start working in the ED and feel like she or he is an “outsider.” This can lead to a feeling of detachment. One of the most powerful and rewarding aspects of working the ED is the collegial atmosphere and team-based approach to patient care. I would be useless without my nursing and tech staff. I would not be nearly as proficient without my amazing residents. It is truly a team in the ED, and if a trainee doesn’t attempt to belong to this team, it is detrimental to everyone and can negatively affect the educational value.
Additionally, considering oneself as being an “outsider,” dissociates that person from some of the pressing workflow issues. Teammates don’t just “pick up the next patient,” they appreciate the triage process and nuance, they listen for when the next critical patient is due to arrive via EMS and anticipate the fact that multiple tasks are being done concurrently and not linearly. I have found that once Pediatric trainees become invested in the team concept then the enjoyment and educational opportunities increase exponentially.
In addition, thinking of the ED as merely an aspect of Pediatrics that is either “for you” or “not for you.” Yes, Emergency Medicine is a branch of medical practice that can be “home” or some and “hectic” for others; however, the time spent in the ED offers so much opportunity to refine one’s clinical practice and can give insight to the medical system as a whole that will be valuable regardless of what branch of pediatrics a trainee is most drawn towards. A common sentiment that I hear is that if a trainee is going into, say, primary care, then she/he doesn’t really need to focus on a lot of what happens in the ED. Let’s be real, A LOT of what happens in the Ped ED is primary care. Additionally, if the pace seems to be too much, let’s just ask some of our seasoned primary care providers. If a trainee hopes to have a leisurely clinical practice, then I gently ask if she or he has a secret financial reserve, because otherwise there will be a rude awakening. There are very few leisurely aspects about the care and management of people, of any age. So, it can be wise to look at working in the ED as an opportunity to refine skills to assist with expeditious histories and physical exams. These skills will help trainees to be successful regardless of which field of practice they intend on going.
What are some knowledge deficits that can be ameliorated a. quickly and easily, and b. with concerted study and experience?
Obviously, the primary care topics they will be more comfortable with, but still should not overlook them. That being said, the evaluation of minor and major trauma is always a good idea to concentrate on during the ED rotation. Along with this, intimate knowledge of medical resuscitations and resuscitation procedures is vital. Other commonly encountered issues that cause children to be potentially critically ill like Diabetic Ketoacidosis or Ingestions/Intoxications is valuable.
Exceptional learners exude a passion for caring for patients and an equal passion for appreciating the TEAM dynamics and striving to be an active member of that team! Essentially, showing a willingness and eagerness to help the team in an effort optimize patient care. When one does this, then she/he will actually augment her/his own learning opportunities.
Become comfortable with being uncomfortable. Strive to glean as much from every rotation you are able to and no rotation will give you a better opportunity to learn as much as the Emergency Department.
Pursue patients with complaints that you are not as familiar or comfortable with. While you may end up working in a Primary Clinic and never see severe trauma again, learning some basic concepts about their management will help you understand the medical system and know when certain patients need to seek care in the ED.
Thanks Dr Fox!
Check back soon for the rest of Sean’s interview, Part 2 : For Emergency registrars new to Paediatrics.