Emergency medicine journal : EMJ
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Where is the present flurry of activity in medical education leading and what sort of future is envisaged? This paper looks at trends in postgraduate medical education. Four themes and two trends for each theme have been identified. ⋯ Any limitations in implementing change will likely result from a lack of imagination in those planning postgraduate medical education and their ability to bring about the necessary changes. To avoid a growing gap developing between what is possible educationally and what is delivered, it is clear that we need a new paradigm for postgraduate medical education.
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Bedside clinical teaching in emergency departments is usually opportunist or ad hoc. A structured bedside clinical teaching programme was implemented, where a consultant and registrar were formally allocated to teaching and learning roles separated from the usual departmental management or clinical roles. Themes emphasised included clinical reasoning, practical clinical knowledge, communication, physical examination, procedural and professional skills. ⋯ Formal bedside teaching is effective if organised with adequate staffing to quarantine the teacher and learner from routine clinical duties, and concentrating on themes best taught in the patient setting. Clinical reasoning and clinical knowledge were perceived to be most important, with positive effects on patient care through more thorough assessment and faster decision making.
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Sternal fractures cause considerable pain, and a proportion of patients require admission for analgesia. Local anaesthetic techniques have been used to reduce the pain from chest wall injuries and may reduce complications from these injuries. ⋯ This technique was recently offered to patients in the emergency department at the Royal Devon and Exeter Hospital, Exeter, UK, and the experiences of patients and doctors are reported. Findings from this first case series suggest that the technique seems to be effective, well tolerated and acceptable to patients.
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To describe the triage of patients operated for non-ruptured and ruptured abdominal aortic aneurysms (AAAs) before the endovascular era. ⋯ A multidisciplinary unified strategy resulted in a rapid throughput of patients with acute AAA. Rapid transport, diagnosis and surgery resulted in favourable hospital mortality. Despite the fact that nearly all the patients were operated upon, survival was favourable compared with published data.