Paediatric Registrar Orientation

Consultants

There are 6FTE: 4 fulltime and 4 part-time consultants. The on-call consultant looks after all the inpatients on the wards, although overall care of chronic patients will be by their usual consultant. There is a consultant or senior registrar ward round every day.

Senior Registrar

Weekly Roster

Monday / Tuesday / Wednesday / Thursday / Friday
Clinic / 08:15 Xray conference

Post acute ward round

/ 08:00 SSH paediatric update via telepaeds

Clinic

/ 08:15 am SHO teaching
Clinic / 1100: Team meeting and joint ward round
1:30pm clinic letters, journal club, audit / 1pm SSH grand round via telepaeds
On acute take 1300- 0800 / Clinic / Clinic

Senior Registrar Clinics

  • You will do outpatient clinic with consultant back up. You can either discuss each case with the consultant as you see them, or if you are relatively confident with your management then you can discuss them all at the end of clinic. You will need to dictate a letter on each patient you see in outpatients.
  • You may be rostered to go to an outreach clinic in one of the smaller centres in Northland with a consultant.

Registrar on call

Currently the senior registrar is first on-call (with nominated consultant back up) on Monday and 1 in 5 weekends. When on call you will function in a junior consultant capacity, being on call from 1300 to 0800 on Monday and 48 hours on a weekend. On weekends you will do the ward round and then be available on call.

Currently the registrar is also doing one week in 5 as the ward consultant (with nominated consultant back up). The ward consultant is the on-call consultant Monday-Friday 0800- 1600, doing the daily ward round in Ward 2 and SCBU and providing supervision to the junior staff. During this week, there are no outpatient clinics.

Calls re acute admission usually go to the admitting SHO. You will take the GP/ED calls for advice or re seriously unwell children. The SHOs will ring you to discuss patients as they admit them or as they have questions. We are available for any difficult decisions or difficult clinical cases but encourage you to deal with cases which you are experienced and confident with. We would expect to be told about all admissions to ICU (not necessarily HDU). We would initially supervise your post acute ward rounds but again would let you work alone when you are confident.

All patients are admitted under the on-call consultant of the day. Long term patients are however best discussed with their usual Paediatrician.

Other Registrar Responsibilities

  • Teaching. You will be asked to provide teaching to the paediatric SHOs and lead the Thursday morning paediatric teaching session. You may also be asked to present at the grand round, provide nursing, midwifery or GP teaching as needed.
  • Project: you will be expected to complete a college project; there will be a number of audit possibilities available.

Specific Registrar Objectives

At the beginning of the year we will jointly set out your specific goals – including college projects, research projects, child psychiatry and community paediatrics.

Meetings / Teaching

  • Tuesday morning 8:15am xray meeting for interesting inpatient films or any outpatient films that need review.
  • Monday 1:30pm consultant peer review of clinic letters, presentation of interesting journal articles, case discussions and audit
  • Friday morning ward round and audit involves all consultants and includes a review of the weeks discharge letters, AAU letters and ward 2 inpatient files, including drug charts. The RMOs are expected to read out a brief summary of each child’s admission.
  • First Friday of the month: M&M
  • Wednesday morning Starship Paediatric Update in the Child Health Centre via telepaediatrics
  • Thursday morning there is teaching from 8:15 (after a quick handover) to 9am in ward 2 “back office”. The SHO on SCBU for the week prepares a topic and presents it. You, together with the on-call consultant, provide comment and answer any questions. A list of appropriate topics (based on the diploma curriculum) is on ward 2, or the teaching can be based on interesting cases from the ward.
  • Thursday lunchtime PGY1 house surgeon teaching 12:30 level 2 conference room. You will be expected to participate in this teaching (prob 1-2 times over the year).
  • Friday lunchtime grand round meeting – choice of local grand round or SSH Paediatric Grand Round. You will be expected to participate in this teaching.
  • Neonatal Resuscitation: We run a formal one day neonatal resuscitation teaching course (NLS) at the beginning of each quarter. You may be asked to be part of the teaching team for this

SHOs

There is an SHO orientation document that you should read. Many of the SHOs are with the service for 6 months and do a diploma with either Auckland or OtagoUniversity. Often there is a basic trainee doing the SHO job for a year.

There are 5 different jobs on the SHO roster with a degree of cross-cover.

  • Ward 2. Primary area of responsibility is paediatric inpatients on ward 2 and ICU, and patients referred to the AAU. This SHO who takes the GP calls, ED referrals and does the acute paediatric admissions for the day.
  • SCBU. Primary area of responsibility is the SCBU (special care baby unit), neonatal problems on ward 11 (post natal ward) and attending deliveries as requested by the obstetric service. Unwell babies routinely have daily review as part of the ward round. “Well” babies are not always seen on the ward round but need a thorough review by the SHO at least once per week with update of problem list, review of medication and examination of the baby.
  • Clinics. SHOs see mainly new referrals. They are usually supervised by a consultant; occasionally you may be asked to supervise. On Thursdays there is no clinic: the SHO is expected to help with booked events on ward 2/AAU – eg sedated echo’s; stim testing; food challenges.
  • PM shift. Continuation of Ward 2 and SCBU roles
  • Night shift. Continuation of Ward 2 and SCBU roles. There is also an expectation that the night SHO check that problem lists are up to date, chase results for the morning ward round and complete any unfinished discharge summaries.

Mail

The senior registrar will have a mail slot in the child health centre. They will also have a nhl email address.

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