[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.