Work as an emergency fellow in Ireland

I posted on this last year but the department I work in as a few upcoming vacancies in July so I thought I would update things for those who might want to come work.

MMUH resus

Are you an emigrated Irish doc in training in Oz or NZ and fancy coming home for 6 months as part of your training? Are you a kiwi or Aussie and fancy some time in Europe as part of your training?* Do you simply want to come and work in a different system and advance your practice. Then these might be the jobs for you. Are you an Irish trainee between basic and advanced training? If you’re working in Ireland and fancy a career development opportunity in one of the big Dublin hospitals then read on. 

[* the Mater is accredited for training in Ireland through the (recently Royal) college of emergency medicine which is the specialist college for emergency medicine in the UK and Ireland. From communication with the Australasian College in Emergency Medicine (ACEM) we have been told that any trainee wishing to undertake training overseas and have that time accredited toward their ACEM training can apply to ACEM prior to beginning the post and obtain prior approval to have the training added toward their ACEM training. So as far as we know we are eligible for training by ACEM too]

The Mater Misericordiae University Hospital (The Mater) in north Dublin is one of the main tertiary centres in the country. It has the national spinal injuries centre and all major specialities apart from neurosurgery and as far as I’m aware it’s the only place doing ECMO in the country. The hospital recently (2013) moved to brand new facilities including a new Emergency Dept, theatres and ICU.

The ED encompasses a large ‘acute floor’ model with acute medicine working out of the same department.  There is a 5 bed resus with CT scanning within the resus bay. There are 2 dedicated ED ultrasound machines.

The hospital serves one of the more deprived areas of Dublin with the obvious result that it sees a fascinating range of pathology from stab wounds, pedestrian trauma to complications of alcohol and  intravenous drug use and all the interesting infectious disease complications that come with it. One of the emergency medicine trainees is a lead for an international HIV screening project in the department.

The ED has created several posts at registrar level to attract new staff and facilitate career development. All posts have protected non clinical time to pursue the appropriate sub specialty. Clinical work will be on the registrar rota in the ED.

Link to official job advert [search for mater misericordiae]

Video ad from Dr Tomas Breslin, Consultant in EM, Mater Hospital

Feel free to contact myself [emergencymedicineireland [at] gmail.com] or Tomas Breslin [tbreslin [at] mater.ie] if interested.

Fellow in imaging

  • 20% protected non clinical time
  • 2 machines in ED
  • Weekly USS teaching (led by fellows)
  • Liaison with emergency radiology (fellowship trained)
  • Echo Module
    • 6 months
    • 2 hrs/wk in ICU with echo tech supervised scanning
    • 1hr/wk with ED/CCU patients with echo tech supervised scanning
    • Formal lectures
    • Examination
  • Early Pregnancy Module
    • based in local maternity hospital
    • this years fellows just starting
  • Suitable for (but not limited to)
    • post basic EM training, able to work clinically as registrar/advanced trainee in ED
    • prior to entry to formal higher training scheme, allows clinical development and level 1 USS skills with space to develop CV prior to application to higher training OR
    • post training as a fellowship to acquire higher level ultrasound skills
    • particularly well suited to UK/Australasian/South African trainees as registration recognised

Education fellow

  • University hospital with huge opportunities for educational development
  • Already happening in ED
    • weekly Registrar/consultant teaching (focused on FCEM exams)
    • weekly SHO teaching (focused on basic approaches to EM)
    • monthly radiology/EM/Acute medicine meeting
    • weekly ultrasound teaching
    • monthly joint EM/ICU meeting
    • Regular student placements as elective students throughout year or 4th year students for weekly placement jan-march
    • Online education induction package for SHOs and student placement
  • 30% protected time for non clinical activities to coordinate and develop education in emergency medicine
  • Suitable for (but not limited to)
    •  post basic training in EM,
    • able to work clinically as registrar/advanced trainee in ED

Conflict of interest statement

  • I work in the ED and really quite enjoy it there but no favours, cash or back rubs were exchanged for this post. I am happy to promote (on the same “no favours, cash or back rubs” terms) other interesting/innovative Irish emergency medicine jobs if people see the need.
  • My opinions are of course my own and do not necessarily represent that of the hospital.

Anatomy for Emergency Medicine 030: CFN Eye Anatomy Part 1

This is the first of a series of podcasts I’m doing on basic eye anatomy for the CEM FOAMed Network. This is a developing resource which aims to provide a fully mapped college curriculum with FOAMed resources. Be sure and check it out and get the podcast. This podcast went out a while ago on the CFN and I’m just providing it for everyone else who hasn’t got it already.

The single most important resource you need is Ophthobook.com

[Direct Download] [8omb]

AFEM Podcast

Medical Complications of Pregnancy

This is a talk I gave recently for our registrar teaching morning. Not the sexiest presentation (forgive the bullets) but hopefully will give you the basic, textbook level info a al foamcast style

 

Direct Download [60mb]

References:

 

 

SMACC Gold Neuroanatomy Talk

Back in March 2014 I had the pleasure of speaking at SMACC Gold in Australia. The whole thing was great fun and I’m sure you’re all aware it’s going to Chicago in May 2015 so be sure to be there. Indeed Registration opens tonight (in the UK at least) so check it out!!!

Every talk from the conference is coming out via the SMACC podcast so make sure you subscribe.

As my talk is so predominantly visual, it really needs the slides for it to make sense so I’ve included the slideset here and put the audio over the slides so you can get the feel of the talk.

Direct Download [SD 41mb]

For people interested in learning some more detailed neuroanatomy I’d strongly recommend headneckbrainspine.com

They’ve done what I’ve always wanted to do and have created scrolling, labelled radiology images that wonderfully demonstrate the anatomy in 3 dimensions. Really invaluable stuff.

Here’s a list of previous neuro related podcasts I’ve done:

And if you’re interested in working where I work as an ultrasound or education fellow then get in touch.

tPA for stroke debate at IAEM 2014

The 2014 meeting of IAEM was a great experience. For a country of 4.5 million with just over 70 emergency physicians we put on a pretty good show I think. I like to use “we” even though I had no part to play in organising the damn thing. Credit to David Menzies for leading the work.

There was almost a mini SMACC reunion with Rick Body, Mark Wilson, Weingart and John Hinds all in attendance and speaking. Through the premiere of Code Black I also managed to have dinner with Billy Mallon which was everything you would expect it to be.

I also got the chance to do my first stroke thrombolysis debate. I got into all this about 3 or 4 years ago when I first started listening to the abstracts and heard Jerry Hoffman on it. It was the first real topic to get me really excited about critical appraisal and reading the medical literature. If it turns out us skeptics are all wrong on tPA then at least I’ve gained a few skills along the way.

Below is my half of the debate. The pro side was delivered by a local stroke physician and I have to confess that I lost the debate. I must be doing something wrong if the emergency doc can lose a debate on stroke thrombolysis to a room of other emergency docs…

As with most short debates like this, it isn’t a deep and considered view of all the evidence, it’s as much about making the argument as anything else. Any feedback is of course welcomed. I’ve tried to include a reasonably comprehensive list of references at the bottom.

It’s probably worth noting that I work in a hospital that has a very enthusiastic stroke thrombolysis team (which as part of my job I have a small role in activating) and to give credit where it’s due they provide a great service with the quickest and best assessment in the ED you can imagine. It’s very rare in Ireland to get a consultant to the patient’s bedside within minutes of arrival but our stroke team does this well. We would do well to provide close to such a service for our trauma patients but that’s another story altogether…

 

References:

The BMJ Pro Con Debate

The Ioannidis Paper

  • Ioannidis JPA. Why Most Published Research Findings Are False. PLoS Med. Public Library of Science; 2005;2(8):e124. [full text]

A decade of reversal

  • Prasad V, Vandross A, Toomey C, Cheung M, Rho J, Quinn S, et al. A Decade of Reversal: An Analysis of 146 Contradicted Medical Practices. Mayo Clinic Proceedings. Elsevier; 2013 Aug;88(8):790–8. [Full Text]

The Lenzer paper on the problems with guidelines

Roger Shinton’s letter to the Lancet

Simon Thompson’s paper on heterogeneity in meta-analysis [H/T Dave Newman for this one]

  • Thompson SG. Why sources of heterogeneity in meta-analysis should be investigated. BMJ (Clinical research ed). 1994 Nov 19;309(6965):1351–5. [Full Text]

The systematic review mentioned

  • Wardlaw JM, Murray V, Berge E, del Zoppo G, Sandercock P, Lindley RL, et al. Recombinant tissue plasminogen activator for acute ischaemic stroke: an updated systematic review and meta-analysis. Lancet. 2012 Jun 23;379(9834):2364–72. [Full Text]

Jeff Mann’s break down of the NINDS patients revealing the baseline imbalance

  • Mann J. Efficacy of Tissue Plasminogen Activator (Tpa) for Stroke: Truths about the NINDS study: setting the record straight. Western Journal of Medicine. 2002;176(3):192. [Full Text]

The RCTs

  • Intravenous desmoteplase in patients with acute ischaemic stroke selected by MRI perfusion-diffusion weighted imaging or perfusion CT (DIAS-2): a prospective, randomised, double-blind, placebo-controlled study. Lancet Neurology 2009 Feb.;8(2):141–150. PMCID 2730486
  • Effects of alteplase beyond 3 h after stroke in the Echoplanar Imaging Thrombolytic Evaluation Trial (EPITHET): a placebo-controlled randomised trial. Lancet Neurology 2008 Apr.;7(4):299–309.PMID 18296121
  • Randomised controlled trial of streptokinase, aspirin, and combination of both in treatment of acute ischaemic stroke. Multicentre Acute Stroke Trial–Italy (MAST-I) Group. The Lancet 1995 Dec.;346(8989):1509 -1514. PMID: 7491044 
  • Thrombolytic therapy with streptokinase in acute ischemic stroke. The Multicenter Acute Stroke Trial–Europe Study Group (MAST-E). N Engl J Med 1996 Jul.;335(3):145–150. PMID: 8657211
  • Streptokinase for acute ischemic stroke with relationship to time of administration: Australian Streptokinase (ASK) Trial Study Group. JAMA 1996 Sep.;276(12):961–966. PMID: 8805730
  • Recombinant tissue-type plasminogen activator (Alteplase) for ischemic stroke 3 to 5 hours after symptom onset. The ATLANTIS (B) Study: a randomized controlled trial. Alteplase Thrombolysis for Acute Noninterventional Therapy in Ischemic Stroke. JAMA 1999 Dec.;282(21):2019–2026. PMID: 10591384 
  • The rtPA (alteplase) 0- to 6-hour acute stroke trial, part A (A0276g) : results of a double-blind, placebo-controlled, multicenter study. Thromblytic therapy in acute ischemic stroke study investigators.(ATLANTIS A) Stroke 2000 Apr.;31(4):811–816.  PMID 10753980
  • Tissue plasminogen activator for acute ischemic stroke. The National Institute of Neurological Disorders and Stroke rt-PA Stroke Study Group (NINDS). N Engl J Med 1995 Dec.;333(24):1581–1587. PMID: 7477192
  • Intravenous thrombolysis with recombinant tissue plasminogen activator for acute hemispheric stroke. The European Cooperative Acute Stroke Study (ECASS). JAMA 1995 Oct.;274(13):1017–1025.1. PMID: 7563451 
  • Randomised double-blind placebo-controlled trial of thrombolytic therapy with intravenous alteplase in acute ischaemic stroke (ECASS II). Second European-Australasian Acute Stroke Study Investigators. The Lancet 1998 Oct.;352(9136):1245–1251. PMID: 9788453 
  • Thrombolysis with alteplase 3 to 4.5 hours after acute ischemic stroke (ECASS III). N Engl J Med 2008 Sep.;359(13):1317–1329. PMID: 18815396 
  • The IST-3 collaborative group. The benefits and harms of intravenous thrombolysis with recombinant tissue plasminogen activator within 6 h of acute ischaemic stroke (the third international stroke trial [IST-3]): a randomised controlled trial. Lancet. 2012 May 23.PMID: 22632908

 

A few #FOAMed resources