Intensive Care Unit/ Trauma/ ED, Royal Melbourne Hospital

I chose to go home to Melbourne for my elective placement at the Royal Melbourne Hospital.

Intensive Care Unit

The ICU provides sophisticated, indefinite multi-system life support for patients following surgery, major trauma, complex respiratory management, sepsis, oncology, renal failure, infectious diseases and multiple organ dysfunction.

I spent the first two weeks of my elective in ICU supervised by the incredible A/Prof Jeffrey Presneill and a team of fantastic, eager-to-teach Registrars, Residents and nursing staff. It was required by the Department to attend morning and afternoon ward rounds which were an excellent opportunity to observe handovers and the multidisciplinary approach to critical care.

After wards rounds, I would sit with the Residents and Consultant to interpret all imaging relevant to the patients in our pod.

In my first week, I was able to present patients during handover which was nerve-wracking but a very helpful learning opportunity. In addition, I assisted the junior medical staff with note-taking and simple medical procedures such as venepuncture, inserting intravenous cannulas, nasogastric tubes and indwelling urinary catheters.

There were only two medical students on elective in ICU, including myself and we were invited to attend regular Resident and Registrar teaching.

In a more acute setting, I was able to accompany the Registrar on MET and Code Blue calls which was a unique experience to observe cohesive team work and the thought process behind managing a deteriorating patient.

Whilst I found many of the cases of motor vehicle accidents, assaults and drug-related accidents confronting distressed, I feel this elective has helped me become more emotionally resilient.

I felt quite humbled to be invited to sit in on family meetings and observe the techniques used by various Consultants in delivering bad news. It was also interesting to observe interactions between the medical and homicide teams and legal proceedings in one particular case which will stick with me for a long time.

Trauma/ ED 

The Trauma Service is one of two adult major trauma services in Victoria and is served by a roof-top helipad with an average of more than one helicopter arrival per day.

The department is responsible for for trauma patients with multi-system and torso injuries and coordinates their care with Emergency, Neurosurgical, Orthopaedic, Plastic, Surgical, Intensive Care, Anaesthetic, Urological, Ophthalmological, Maxillofacial, ENT and Allied Health services.

I spent two weeks as the only medical student on the Trauma service which was again, confronting but a great learning experience thanks to the Registrars who were very keen to involve me.

The days started with a ward round which could last hours but were usually interrupted by trauma calls. Here, I observed clinical handover from paramedics and learnt the components of primary and secondary surveys and emergency procedures.

In some cases, I was able to assist maintaining airways and suture minor lacerations which was fantastic.

In the Emergency Department setting, I was able to practice my interpretation of radiology and observe verbal de-escalation of agitated and aggressive patients when working with the Trauma Coordinator nurse.

Socially, I played evening soccer with the junior doctors and attended various comedy shows which was fun.