Junior doctors - Resident Medical Officers

First Year House Surgeons Second Years and SHOs Registrars Resident Medical Officer (RMO) Services Unit The RMO Services Unit was established by Waikato DHB to develop, implement and support strategies to ensure the effective recruitment, rostering and retention of RMOs at Waikato Hospital. We provide support, guidance and clarity on a variet of issues, some of which are listed below:

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• Coordinate Year 1 House Officer selection as well as other HO and SHO recruitment
  
  
• House Officer Orientation
  
  
• Rosters (Surgical House Officer, all General Medicine and O&G SHO rosters)
  
  
• Checking Annual Practising Certificates and in conjunction with the MCNZ, registration status
  
  
• House Officer 'run' allocations
  
  
• Managing Surgical and Medical Relief Pools
  
  
• Maintain a central repository of all RMO run descriptions
  
  
• Administrative duties - distribute meal 'chits', monthly RMO newsletter, leave forms, etc

First year house officers

You're a brand new doctor and you've just started as a House Officer.  And it's really scary! Can you remember how to do that lumbar puncture or insert an intercostal drain?  How do they want things done at Waikato Hospital?

To ensure all first year house officers are well prepared to carry out a variety of procedures at Waikato Hospital, our house officers must attend a free three-day orientation course before starting work at the hospital.  This course is run by the RMO Services Unit with facilitators coming from a variety of specialty areas.

Clinical Learning Stations include:

• IV Line Insertion
• Venepuncture
• Pain Management
• Infection Control
• Radiology
• Laboratory
• Medication/Prescription Issues
• Clinical Coding

First year house officer teaching programme

All first year house officers have 2 hours of ‘protected time’ each week to attend teaching sessions.

Every Tuesday afternoon, there is a variety of clinical topics presented by senior doctors who are all experts in their field. These sessions are informal and usually case based.

Topics are wide-ranging with an emphasis on a practical approach to caring for patients.

Following is an example of the topics presented to our house surgeons:

• Post operative pain management
• Cancer pain management
• Post operative complications
• Gastro-intestinal bleeding
• Bowel obstruction
• NSAIDs & G.I. Bleeds
• Renal colic
• Chronic liver disease
• Viral hepatitis
• U.T.I.

House officer runs

• Surgical (including General Surgery, Urology, Orthopaedics, Plastics & Paediatric Surgery)
• Medical (including General Medicine, Cardiology, Haematology, Respiratory and Rehabilitation)
• Psychiatry

Allocation of first year runs

There are currently 20 x 4 3-month runs accredited by the Medical Council of New Zealand for use for first year training.  Some of these are A runs that have to be equally shared amongst the candidates.  This leaves about 50% available for allocation.  We are open to suggestion as to how to do this in the interest of the whole group but cannot be pressured by individuals if this is detrimental to opportunities of others.

The following are the priority ratings for allocation:

All runs are allocated randomly if applicants make no specific requests

• Priority 1:  Medical Council requirements have to be fulfilled.
• Priority 2:  Matching spread of popular and unpopular runs.
• Priority 3:  Fulfilment of request.
• Priority 4:  Swapping of runs between individuals with mutual consent.
• Priority 5:  Matching spread high and low workloads runs.

This process we feel is fair to all and accept individuals will get some runs they do not like.  We hope, at worst, to limit your exposure to an unfavourable run to one run only.  There is no privilege offered to current trainee interns above others or vice versa.

Second years and SHOs

No matter how experienced you may be as doctor, starting work in a new environment can be stressful – how do they want things done at Waikato Hospital?

To ensure all new doctors are well prepared to carry out a variety of procedures at the hospital, all doctors are inducted through a functional orientation programme on their first day. Time is spent with recruitment personnel, the RMO unit, the new service manager, communications plus other related departments as necessary.

A formal Waikato District Health Board Orientation Programme (half a day) is run monthly and other formal training such as Fire Training and CPR courses are scheduled throughout the runs.

The RMO Services Unit can provide an Orientation Booklet, which contains details on such things as:

• IV Line Insertion
• Venepuncture
• Pain Management
• Infection Control
• Radiology
• Laboratory
• Medication/Prescription Issues
• Clinical Coding

Second year and SHO teaching sessions

As with registrars, there is a wide range of training and teaching sessions available for second year house officers and SHOs.  Senior doctors who are experts in their field present a variety of clinical topics at these sessions.  Topics are wide-ranging with an emphasis on practical approach to caring for patients, as wells as professional development topics.

Following is an example of the topics presented:

• Post operative pain management
• Cancer pain management
• Post operative complications
• Gastro-intestinal bleeding
• Bowel obstruction
• NSAIDs & G.I. Bleeds
• Renal colic
• Chronic liver disease
• Viral hepatitis
• U.T.I.
• Dealing with stress
• Financial management
• Medical insurance

Second year house officers and senior house officer runs

Surgical

• General Surgery
• Surgical Reliever
• Urology
• Orthopaedics
• Plastics
• Cardiothoracic
• Vascular
• Ophthamology
• ENT

Medical

• General Medicine
• Neurology
• Gastroenterology
  
• Cardiology
• Haematology
• Oncology / Palliative Care
• Medical Reliever
• Renal
• Rehabilitation
  

Anaesthetics

Psychiatry

Obstetrics and Gynaecology

Paediatrics (including Paediatric Reliever and Paediatric Surgery)

Registrars

There is a wide spectrum of approaches to the training and supervision of registrars.  Some departments have developed rigorous workbooks for trainees, others assist in planning medium-term run placements to optimise training, while others offer a complete "in-house" training programme.

The range of training across specialities includes:

• Part 1 and part 2 training courses
• Journal Club
• Morbidity/mortality meetings
• (Combined) ward round
• Case review meetings
• Formal teaching sessions
• Audit sessions
• Supervised clinics
• Registrar presentations
• Radiology/Pathology meetings
• Advanced trainee sessions at Auckland Hospitals
• Approved conferences and courses
• Grand Round
• Waikato Postgraduate Medicine weekly and monthly meetings.

Ward based experience

The mainstay of clinical practice and learning for RMOs at Waikato District Health Board is the ward work. Waikato District Health Board has a wide range of both common and extremely rare and specialised patient groups. house officers are well supported by specialist registrars and their consultants who are usually freely available and approachable.

The support for RMOs on the ward also includes a highly experienced and motivated nursing staff, including out of hours support from clinical nurse advisers who will advise nursing staff on particular clinical issues. In all wards there are protocols and guidelines on patient management and procedures to assist in decision making.

The educational content of the ward work is based on the "apprenticeship model" in which students learn from the house surgeons and senior house officers who in turn lerarn from the registrars who learn primarily from their consultants. This apprenticeship model is deeply ingrained in the culture of the organisation in the hope of broadening the clinical experience of our junior doctors, maximising their clinical confidence and competence and allowing a safe practising environment for both the patients and doctors.