Advanced Trainee


Position Title Advanced Trainee
Position Number 23980
Employment Status Full Time - Exempt
Applications Close 12/10/2020
Maximum length of training contract 4 years
Training Network/Training Rotation Emergency Medicine Network 5 - Westmead Nepean Blacktown Mt Druitt Tweed
Facility Nepean Hospital
Specialty Emergency 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
Current Rotations/Networks (which may change from time to time) Emergency Medicine Network 5 (Sydney West) – Auburn Hospital, Blacktown Hospital, Mt Druitt Hospital, Nepean Hospital, Orange Base Hospital, Tweed Heads Hospital, Westmead Hospital, Westmead Children's Hospital. Rotations outside Nepean are not mandatory and are negotiated on an as needs basis.
Main Purpose of Position Due to COVID-19 and the changes to college requirements during the pandemic, NSW Health may make changes to the recruitment process. Formal interviews may be conducted electronically rather than face to face however, candidates will be notified as soon as practical of any changes.

This position serves to continue and complete training in Emergency Medicine. Its main purpose is to fulfil requirements for advanced training and to facilitate the achievement of Fellowship of the Australasian College for Emergency Medicine.

Advanced Trainees are responsible for the assessment, investigation and initial management of patients presenting to the Emergency Department. This is under the supervision of the Emergency Physicians as required. It is expected that Advanced Trainees should be semi-autonomous and require less Emergency Physician input for the majority of patients presenting to the ED. Advanced Trainees should also take an active role in the resuscitation room and aim to run complex resuscitations, with supervision from the Emergency Physician, as part of their training. Advanced Trainees are also expected to assist in the supervision and teaching of Junior Medical Officers.

Rostering for Advanced Trainees is arranged by the ED administration in consultation with the Director of Emergency Medicine Training and includes a rotating roster of days, evenings, nights and weekends. Shift length is 10 hours with shift times from 0800 – 1830, 1330 – 2330 and 2230 - 0900. Advanced Trainees are allocated 10 hours per fortnight rostered clinical support time separate to clinical shifts. This is for the purpose of teaching, education and various other quality assurance activities carried out within the department.

To facilitate completion of advanced training Non-Emergency term rotations are available in Paediatrics, Ultrasound, Medical Education, Intensive Care, Anaesthetics and other rural and urban Emergency Departments

Position Requirements 1. Qualifications
1. MBBS or equivalent, currently registered or eligible for registration 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. Minimum 3 years full time equivalent post graduate years and significant experience in an Australian or New Zealand Emergency Department.
4. Has qualified as an Advanced Trainee as per the requirements by ACEM or expects to have met the criteria by commencement of employment February 2021.
5. Demonstrated commitment to and satisfactory progress in the ACEM Training program.

2. Clinical
The successful applicant will be working as an Advanced Trainee within the Emergency Department of Nepean Hospital. This will involve working in all areas of the Emergency Department. They will be expected to manage patients in a semi-autonomous manner with some supervision from senior advanced trainees and staff specialists as required. They will also be expected to rotate through various non-Emergency Medicine training positions as part of their training in Emergency Medicine.
Specific Duties
1. Be available to provide management decisions for patients presenting to the Department of Emergency Medicine.
2. Provide adequate documentation as per Nepean Blue Mountains Local Health District policy. This includes clearly documenting information required for the completion of the Emergency Department information system dataset, and the documentation of the details of any history, examination, investigations and their results, treatment and disposition of patients seen.
3. Ensuring adequate notification to a patient’s inpatient consultant or trainee in the event of admission.
4. Ensuring adequate notification to a patient’s Local Medical Officer in the event of discharge from the Emergency Department, including the writing of discharge letters detailing the patient’s stay in the ED.
5. Communicate clearly to patients and their relatives where appropriate, the findings of assessment and the plan of management.
6. Participation in the Emergency Department teaching program, including attendance at workshop and tutorial sessions and participation in exam preparation programs when appropriate. Advanced Trainees are expected to provide some supervision and teaching to JMOs.
7. Discuss with the Director of Emergency Medicine Training, or the Director of the Emergency Department, any problems encountered while working within the Emergency Department.
8. Fulfil administrative duties for the Emergency Department as per the clinical support time policy.
Daily Routine
At the commencement of the day shift Advance Trainees will attend the morning briefing in the Emergency Department. At the commencement of other shifts the trainee will report to the Staff Specialist on duty leading the specific team the trainee has been allocated to within the Emergency Department. They will then be either allocated specific tasks or be directed to see the next patient waiting. Any questions arising regarding ongoing care should be directed as soon as possible to the Emergency Physician on duty. All trainees on duty are expected to handover care of their patients at the end of their shift.
Teaching Sessions
In general teaching sessions will be held on alternate Wednesdays. Advanced Trainees will be required to attend when possible. When rostered for clinical support time for these days, attendance at education sessions is compulsory. Nepean ED runs dedicated fellowship exam tutorials in collaboration with other network 5 hospitals.
The Emergency Department has an active combined medical and nursing simulation training program based in the ED. This forms part of the trainee / SRMO education and training. Nepean ED also provides an ED point of care ultrasound training program and any progress towards an ultrasound qualification, such as the CCPU, can be supported.

The trainee should develop a sound knowledge of Emergency Medicine, the aim being that the trainee should be able to operate independently and manage both common and complex ED presentations with minimal input or advice from more senior colleagues. The development of sound procedural skills is essential. Specific objectives are as per the Australasian College for Emergency Medicine Training Handbook.

Competency is expected in the following as a minimum:
1. Venepuncture
2. Venous and arterial cannulation
3. CPR, BLS and ALS
4. Suturing skills / Removal of foreign bodies
5. Urinary catheterisation
6. Plastering techniques
7. Lumbar Puncture
8. Slit lamp examination
9. Reading of X-rays and ECGs
10. Interpretation of basic blood results

3. Research and Teaching
As an Advanced Trainee in Emergency Medicine, it is expected that the trainee will aim to fulfil requirements for advanced training and to facilitate the achievement of Fellowship of the Australasian College for Emergency Medicine. This will involve completing a research project or university course as required for completion of advanced training in Emergency Medicine. The department has an active research program and there are a number of projects that could fulfil this requirement. There is also scope for the trainee to be supported through the alternate pathway for satisfying the research component of advanced training.

As an advanced trainee in Emergency Medicine, it is expected that the trainee will be supervising junior medical staff and medical students and be involved in their education and training with respect to their daily duties.

4. Orientation
There will be formal orientation to the Emergency Department on the first day the successful applicant commences work. This will involve orientation to the Emergency Department as well as an introduction to the Emergency Department information system.
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
During the hours of 0700-2400, the clinical staff specialist on duty will supervise the Advanced Trainee during their shift as required. Overnight between 2400 and 0700, they will often be one of the senior doctors on in the Department and will be expected to be partly responsible for running the department. There is on-call staff specialist coverage during these hours. It is expected the Advanced Trainee will supervise junior staff within the emergency department and have some responsibility for their patients.
6. Other responsibilities
The Trainee will be aiming to complete their training with the ACEM. They will be allocated clinical support time to facilitate their education requirements and to take part in formal education and training activities. The trainee will also participate in various quality assurance activities performed within the Department as a normal part of operations. The trainee is also expected to be involved with tutorials given to the junior staff in the Emergency Department.
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
 Contribute to meeting ETP targets using the current models of care in the ED
 Actively maintain appropriate infection control including the 5 moments of Hand Hygiene
 Attendance at formal clinical handover at the start and end of each clinical shift
 Participation in mandatory detect and OH&S training
 Participation in departmental M&M meetings as well as RCAs, QA reviews, incident reviews and complaint management when appropriate
 Actively participate in revenue and cost saving initiatives
 Demonstrates the ability to effectively manage staff and hospital resources including:
a) showing leadership
b) communicating effectively
c) prioritising tasks
d) using time management skills appropriately
e) assigning tasks and delegating
f) prioritising and re-prioritising clinical tasks when there is a critical patient load in the department, including during medical disasters
g) ensuring tasks are progressing as planned
h) managing and leading clinical teams
i) coaching and mentoring as appropriate
 Communicate with and co-ordinate specialty teams to achieve an optimal outcome for patient care
 Effectively use resources to balance patient care and systemic demands
 Serve in administration and leadership roles, as appropriate

In addition to the core competency standards, the Advanced Trainee 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 Blue Mountains Local Health District (NBMLHD) consists of both urban and semi-rural areas. Nepean Hospital is a tertiary referral centre and 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. Nepean Hospital is the Regional Trauma Centre for these areas, covering almost 9,179 square kilometres. The Nepean Clinical School, based at Nepean Hospital, is one of the eight Clinical Schools of the University of Sydney. Since becoming a teaching hospital of the University of Sydney in 1990, Nepean Hospital has experienced continued growth in its teaching and research.

The Department of Emergency Medicine, at Nepean Hospital, sees approximately 75,000 patients per year, of which about 36% are admitted to the hospital. Approximately 20% of these patients are under 14 years of age. The Department is accredited by The Australasian College for Emergency Medicine for 2 years of advanced training in Emergency Medicine as well as the paediatric log book.

Nepean Hospital is the tertiary referral unit for Blue Mountains and Lithgow Hospitals as well as the Central West of NSW. Nepean Hospital is covered 24/7 by ICU, neurosurgery, thoracic surgery, orthopaedics, plastic surgery, ENT and faciomaxillary surgery. Interventional cardiology and radiology are available 24/7, as is thrombolysis for stroke, and there is an inpatient dialysis service. There is also an excellent high-risk pregnancy unit, neonatal intensive care unit and paediatric department. There is an after-hours on call service for emergency ophthalmology.

The Emergency Department is divided into 3 clinical areas: the Resuscitation Rooms; Acute Care; and Sub-acute Care area covering both complex ambulatory and fast track type patients. The Department is staffed by 30 Emergency Physicians providing up to 4 consultants per shift covering the department from 0700 to 2400 hours, seven days a week with Advanced Trainee/senior CMO cover overnight. There is also a 14 bed emergency medicine short stay unit covered by an emergency physician 16 hours per day.

The Department has undergone recent renovations with an enlarged subacute care area and an expanded dedicated paediatric acute care area, increasing the emergency department bed base by 20%, to a total of 40 beds. This has improved the quality of care delivered and performance with respect to standard ED KPIs, including Emergency Treatment Performance (ETP). It has also created an open and pleasant environment for both staff and patients. The Emergency Department will move into a brand new 60 bed facility in late 2021 which is currently under construction.

Rostering for trainees is arranged by the ED administration in consultation with the Director of Emergency Medicine and Directors of Emergency Medicine Training, and includes a rotating roster of days, evenings, nights and weekends by negotiation. Shift length is 10 hours and run from 0800 – 1830, 1330 – 2330 and 2230 - 0900.

The trainee is primarily responsible to the Emergency Physician, with secondary responsibility to the patient’s inpatient consultant. Where there is any conflict, the trainee should seek advice from the Emergency Physician on duty as soon as practical. Trainees may be expected to assist in the supervision and teaching of Junior Trainees when able.
Key Internal and External Relationships Key Internal Relationships

  • Clinical streams

  • Multidisciplinary teams

  • Consumers/Carers

  • Other Clinical Divisions

  • JMO Management Unit

  • The doctor will be expected to work with other doctors, nurses, allied health and clerical staff as part of their role.

  • Quality assurance, peer review, education would be via medical team meetings.

  • Multidisciplinary meetings are held and the incumbent would work with a multidisciplinary team with acute care work.


  • Key External Relationships
  • Consumers/Carers

  • GPs

  • Community

  • Police, Ambulance

  • Supervision Arrangements During the hours of 0700-2400, the staff specialist on duty will supervise the Advanced Trainee during their shift as required. Overnight between 2400 and 0700, they will be one of the senior doctors on in the Department and may be expected to be responsible for overseeing the department. There is on-call staff specialist coverage during these hours if required. It is expected the Advanced Trainee will supervise junior staff within the emergency department and have some responsibility for their patients.
    Supervision of the Trainee in normal hours of work:
  • The Advanced Trainee will have access to a Clinical Emergency Physician at all times.


  • Supervision of the Trainee after hours:
  • The Trainee will be able to call the Emergency Physician on call for support and supervision after hours.

  • Challenges/Problem Solving
  • Working in a complex environment where there are competing priorities and strict deadlines.

  • Developing strong working relationships with a multidisciplinary workforce.

  • Understands and is committed to organisational mission and goals.

  • Demonstrating initiative to resolve issues.

  • Sharing information and learning experiences with colleagues.

  • Developing and exhibiting good communication skills.

  • Demonstrating a commitment to personal development as a professional.

  • Demonstrating a commitment to the Emergency Treatment Performance (ETP) targets.

  • Completing a patient history from the patient and from other relevant sources (eg medical record, family, nursing home, general practitioner, ambulance transfers sheet etc).

  • Documenting the history and physical examination within progress notes.

  • Formulating a management plan for every patient in consultation with more senior medical staff.

  • Ensuring that appropriate investigations are ordered and followed up and that the management plan is altered necessarily.

  • Demonstrating a commitment to the effective handover of patients.

  • Designing then communicating a discharge plan containing an accurate history of their admission and a clearly identified and attainable management plan.

  • Appropriate liaison for advice/help with supervising medical staff.

  • The completion of death certificates, cremation certificates, medical certificates and discharge scripts.

  • 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 The Doctor 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.

  • To appropriately allocate teaching time according to evidence of learning need.

  • To deal with matters in a confidential manner.

  • To respect the professional values of staff

  • Communication The Trainee is a key person who works closely with all members of staff and must:
  • Work as part of and contribute to a multi-disciplinary team.

  • Deal with matters of an urgent or sensitive nature.

  • Must have the ability to exercise discretion, sensitivity and maintain confidentiality.

  • Works co-operatively within a team environment and actively contributes to team activities including pro-actively participates in team meetings and decision making processes.


  • Performance Monitoring The Trainee is responsible for:
  • Participating in ongoing review of their clinical practice as per conditional registration guidelines;

  • Participating in continuing medical education and professional development as covered by the supervision arrangements stipulated by the Medical Board; and

  • Maintaining his/her professional competence.


  • The Trainee is required to maintain a continuing level of satisfactory performance and successful compliance with the requirements of the relevant training program, including progression through the program at the expected rate.
  • Satisfactory progress with college examinations

  • Attendance at Departmental training sessions

  • Maintenance of Advanced Cardiac Life Support Accreditation

  • Performance Evaluation & Development Review. (e.g. in-training assessments)


  • Performance reports and training supervision will be provided by the Directors of Emergency Medicine Training or their delegates.

    Additional Information
    Additional Documents no addditional documents have been provided

    College Australasian College for Emergency Medicine
    Organisation Chart 2021 Emergency Advanced Trainee Standard AMR23980.pdf
    Job Demands Checklist Click Here to View
    Selection Criteria 1: MBBS or equivalent, currently registered or eligible for registration 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: Minimum 3 years full time equivalent post graduate years and significant experience in an Australian or New Zealand Emergency Department.

    4: Has qualified as an Advanced Trainee as per the requirements by ACEM or expects to have met the criteria by commencement of employment February 2021.

    5: Demonstrated commitment to and satisfactory progress in the ACEM Training program.

    6: Demonstrated effective communication skills, clinical skills, judgment and expertise, teamwork, time management and problem solving skills in the clinical setting.

    7: Demonstrated commitment to quality improvement, patient safety and risk management.

    8: Evidence of continued professional development and commitment to self-education, experience and willingness to teach junior medical staff.