ACH - Career Opportunity in Emergency Medicine . . . Waiting Room Medicine Fellowship

Humour and Humanity

CJEM 2007;9(1):71

Classified Advertising

The Department of Emergency Medicine at Any Canadian Hospital (ACH) is actively seeking qualified applicants for a 6-month fellowship position in the emerging Emergency Medicine (EM) subspecialty of Waiting Room (WR) Medicine. This unique opportunity is being offered through the busy waiting room of the Emergency Department (ED) at ANY CANADIAN HOSPITAL, a premiere teaching institution with the University of Said Province.

The Setting

The ED sees in excess of 65,000 patients per year (mostly in the waiting room!), and is the trauma receiving hospital for the region. Located in or near a great Canadian city, there are many recreational opportunities for interested applicants (which is important because, truth be told, the work is not so rewarding).

The Crowding Problem

Access to inpatient beds for acutely ill patients in Canada has been consistently decreasing over the last decade. Many EDs have been paralyzed by the admitted patients in their stretchers warehoused in their hallways. Emergency Physicians (EPs) have little formal training in providing medical care outside of the usual confines of an actual bed with a nurse available to provide care. Clearly, this training deficit leaves most EPs behind the times. Much of the care provided in contemporary EDs is done in chairs, on ambulance gurneys, behind temporary curtains, or in broom closets, bathrooms, offices, and of course, in the waiting room. With the ever increasing demand for Waiting Room Medicine, we see a fabulous opportunity to foster the unique skill-set of WR medicine in EM learners and EPs seeking higher levels of training.

Rotations include

• Unmonitored Cardiology — Make decisions about which of the 6 patients with crushing chest pain should get the next available bed when it opens up in the morning.
• WR Surgery — You'd be surprised how many things you can sew, lance, drain and wrap in a simple WR chair.
• Communication Skills — Key objectives for the communication skills module include learning how to ask embarrassing questions in front of a crowd, learning to say "I'm sorry for the care you're receiving" in a manner that doesn't lead to your being assaulted by angry family members, and learning to say "these curtains are soundproof" with a straight face.
• EMS — Deal with ambulance diversion, critical care bypass; provide catering and nutritional requirements for waiting ambulance crews. Gain valuable skills in diverting ambulances with seriously ill patients from your ED to another equally overcrowded ED.
• Lab & Radiology — Learn to make judicious use of investigations based on a triage note and/or EMS report; no need to bother yourself with talking to or examining the patient until all the labs are back.
• Triage in the Real World — Practise reverse triage, where CTAS IVs and Vs are seen expeditiously, because they are "quick and easy," and CTAS IIs and IIIs are left to languish for hours.
• WR Ethics — Triage the conflicting values of good patient care and maintaining the flow.
• WR Admin Interactions — Dealing with disappointment; how to carry on after seeking help from the administrators on call.
• WR Patients as Monitors — Learning to use other WR patients for the reassessment of critically ill patients (with a focus on teaching lay people about the recognition of seizures, initial management of cardiac arrest, and guidelines for involving the triage nurse in WR care).

Advanced Electives

• Parking Lot Medicine
• WR Intensive Care — Pocket Pressors are our friends

Learning Materials

• Standard EM texts, PLUS
• All seasons of MASH on DVD

Application Instructions

Qualified applicants will have at least one year of EM experience, or be entering the final year of their EM residency training. All applicants must provide evidence of current CMPA coverage (you're gonna need it). Forward a copy of your CV and a letter of interest to waiting@rchemerg.ca. In your letter of interest, please indicate why you would like to become an expert in WR Medicine. Excerpts from letters may be reproduced on our WR Fellowship Web site (www.rchemerg.ca/waiting).

Special Opportunity for ED Chiefs

If you have any resources, experiences, or examples that you think would be of assistance to our Waiting Room Fellows, please contact us at waiting@rchemerg.ca. We would be pleased to permit our WR Fellows to rotate through other waiting rooms with unique learning opportunities.