A Course..a Course! My Kingdom for a Course!

[adapted from King Richard III, Shakespeare, W 1594]

Well, this week I am up in Darwin teaching on an EMST course. The Early Management of Severe Trauma course is the Australasian version of the worldwide Advanced Trauma Life Support course from the American College of Surgeons. The history behind it is interesting, but the bottom line is that this course teaches a uniform, practical and structured approach to the management of trauma…identifying and treating immediately life-threatening injuries (hence early management of severe trauma).

I’ve been teaching on this for a few years now and I enjoy the interaction with other Faculty. Although badged under the College of Surgeons, Faculty are a hotch-potch of surgeons, anaesthetists, intensivists, retrievalists, emergency physicians and the odd rural doctor. I think they put me on the Faculty for comedy value.

But I always learn something from fellow doctors who teach…and hopefully the 16 Candidates on each course benefit from our combined experience. It’s something I am pretty passionate about…and later this year I will be taking up the mantle of Course Director which will be interesting.

EMST is just one of the many courses ‘out there’. For rural doctors like me, who need to be able to manage pretty much whatever comes through the door (at least initially until the cavalry arrive), there are many entry-level courses such as:
Advanced Paediatric Life Support (APLS)
Emergency Life Support (ELS)
Rural Emergency Skills Training (REST)
Advanced Life Support Obstetrics (ALSO)
Major Obstetric Emergencies & Trauma (MOET)
…plus a few courses run by State agencies such as rural doctor workforce groups and trauma/retrieval services. Minh le Cong’s RFDS STAR programme looks interesting and I’ve done some components of the James Cook University ‘Aeromedical Skills course’ along with colleagues at MedSTAR. But they are aimed at the prehospital/retrieval audience.

When I am teaching on EMST I often feel constrained by the limitations of the course. Don’t get me wrong, it’s a great programme, and aimed squarely at junior doctors who are developing their skills and involvement in trauma management. But there is just so much more out there…and a lot of ‘current’ thinking is not taught on these courses as it takes time to translate through course manuals, materials and instructors.

I’ve just been reading about finger thoracostomy over on the Scancrit.com blog. It’s a technique I always try to explain & demonstrate in the animal lab and on thoracic trauma skills stations, but it’s not (yet) in the standard EMST teaching.  So I reckon there’s scope for a ‘masterclass’ course, constantly evolving and reflecting some of the topics and discussions that one comes across on the net or that are used day-to-day by experienced practitioners.

After all, medicine evolves and our learning should be lifelong. Why then just have a series of entry-level courses for the rural docs – especially when access to hands-on learning for them is often difficult. Rather than repeat the course, better to advance to a new level.

Such a course would be a great addition to the entry-level courses…the knowledge of which is assumed. It’d be aimed squarely at the experienced rural doctor and could be delivered by our College, ACRRM. Of course they also deliver the REST course – so an advanced course would frighteningly be called something like ‘advanced rural & remote skills training’ or ARREST!

Regardless of the name (and I think something along the lines of ‘rural masterclass’ or ‘current topics in…’ etc work better), one can imagine a two day course covering things like:
  • ECG phenomena such as Brugada etc
  • use of ultrasound inc FAST/RUSH
  • difficult airway gadgets and protocols
  • what’s new in paeds/O&G
Content would be delivered by experienced rural or specialty docs, with content shaped by participant’s needs and reflecting current thinking. Getting along a few of the reps such as KingVision, Ambu, Laederal, iSimulate and SonoSite would seem sensible and allow hands on of equipment that your cash-strapped, time-poor rural health service would not otherwise have had access to.

Now THAT would be worth the $2K a day procedural upskilling grant that is available.

5 thoughts on “A Course..a Course! My Kingdom for a Course!”

  1. Hey Tim, great idea on the ARREST front. I was at a SAPMEA (or whatever the hokey acronym was) event in Whyalla based on retrieval and multitrauma medicine recently. Wasnt really worth the $300 than us rural registrars had to pay (let alone 800 for fellows!) for 8 contact hours. It wasn't structured well and lacked the hands on, lets look a different airways/ECGs/whatever crazy stuff you might see in the country. They did talk about finger chest decompression though which was great. Anyway long time listener first time caller. Spent some time with Ben in Jtown and now in Wudinna for the year. Feel free to check out the blog Ive just started. Hoping to add some more med stuff as it starts to interest me again!Cheers

  2. Bloody hell – do ALL the Wudinna docs fly? Scott and Karen were over at the weekend and I was mighty impressed with their 'family plane'…now it turns out there's more of you.Do give me a bell or email off list re: courses and training stuff – I'm getting really fired up about improving rural GP and registrar training with hands-on sessionsKeep up the good work

  3. Tim, I hear you. I am an EMST instructor as well and yes there are things that could improve. You hit the nail on the head when you wrote, "rather than repeat the course, isnt it better to advance to a new level?" The answer is of course, yes. Your problem, is that there is no current advanced course, well at least not what you are looking for. Teaching the cutting edge, controversial stuff…all courses in Oz teach conventional, peer accepted material. at the point you are at, you need to slay a few critical care dragons and deal with bloody sick or injured patients until you are ready for the next level. I would not spend more time in anaesthesia. I would spend time in a busy ED that sees everything from all age groups. Thats where I do my CME nowadays. I was recently doing three weeks at Cairns Base hospital ED and I develop my critical care and ED USS skills there each time I go. sit in with the sonographers and learn routine USS. during my three weeks, I used bedside USS to pickup a pericardial tAmponade, haemoperitoneum and appendicitis. I tubed two critical kids, one a sixth month old . dealt with two serious traumas in the one shift.even better ask Dan Ellis if you can spend time as the retrieval Fellow at Medstar. They do take rural GPs and roster them as registrars under consultant supervision. tHats the next level for you, being on the other side of the retrieval game. Alternatively, ask Cliff Reid if you can spend time with their unit. Their induction training is probably some of the best prehospital critical care training in the country.I agree ite a great idea to have rurally focussed critical care training for the rural doctor. a Skills and drills short course light on the lectures and heavy on the problem based skills and procedural content. I will talk to my brother and see what we can try in Adelaide!

  4. Hey TimGreat post.A master class would be perfect. I wonder how we could get some rustling in the ACRRM faculty? I am actively looking this year at how I am going to spend my time upskilling and what courses I would like to attend.For Anaesthetics (Newly fellowed as yourself) I was thinking-> EMAC-> Airway skills or Advanced Airway Management Refresher-> I week back where I trained in late Jan 2013-> ARACUS -> regional ultrasound course run here in WAFor Emergency I was actually going to do as Minh suggested and rock up to my old ED in Fremantle or do some Paediatrics at Princes Margaret Hospital in Perth for a few weeks.But we should be using our time to update and advance ourselves to the current evidenced based way or be presented with the controversies and work it our for ourselves!JR

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