POSITIONDESCRIPTION

PositionTitle SeniorResidentMedicalOfficerCriticalCareRotations
HealthDistrict NepeanBlueMountainsLocalHealthDistrict
Network N/A
Facility NepeanHospital
Division CriticalCare&Imaging
Geographical NepeanHospital,PenrithNSW2750
Location
ReportsTo Clinically:IntensiveCareSpecialist(AnaestheticorEDSpecialist)onduty
Administratively:ProfessorTonyMcLeanDepartmentHead,ClinicalDirectorICUat
Nepean
Specialty IntensiveCareMedicine
SubSpecialty CriticalCare
SubSubSpecialty N/A
Unit IntensiveCareUnit
Award ResidentMedicalOfficer
Classification1
Award N/A
Classification2
AwardName PublicHospitalsMedicalOfficers(State)Award
Hoursperweek 38
Parttime No
Jobshare Yes
Rotation/Network TheCriticalCareSRMOrotatesthroughAnaesthetics,EmergencyMedicineandthe
IntensiveCareUnitsatNepeanHospitalandIntensiveCareUnitatOrangeBase
Hospital.ThepositionmayincludearotationtoBathurstHospital.
SelectionCriteria 1. MBBSorequivalent.Currentlyregisteredoreligibleforregistrationwiththe
MedicalBoardofAustralia.

2. Demonstratedclinicalpracticeasaregisteredmedicalpractitionerinthelast2
yearsinasettingappropriatetotheneedsoftheposition.

3. MinimumtwoyearspostgraduateexperienceplussuitablecoursessuchasBASIC,
ALS.

4. AninterestinIntensiveCare/CriticalCare.

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 5. Abilitytoworkaspartofateam

6. Highlevelofcommunicationandinterpersonalskills

7. Demonstratedcommitmenttoqualityimprovement,patientsafetyandrisk
management

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PURPOSEOFPOSITION

TheCriticalCareSRMOrotatesthroughAnaesthetics,EmergencyMedicineandtheIntensiveCareUnitsat
NepeanHospitalandIntensiveCareUnitatOrangeBaseHospital.Thepositionmayincludearotationto
Bathurst Hospital. The Critical Care Rotation allows the Senior Resident to develop a good practical
knowledgeofcommoncriticalillnesses,experienceinthemanagementofcriticallyillpatientswithsenior
supervision,andtheappropriateproceduralskills.He/shewilllearntorecognizelifethreateningillnessor
acutephysiologicalchange,andhowtorespondappropriatelyintermsofearlymanagementofairway,
breathingandcirculation.

AMedicalProviderNumberisrequiredtorequesttestsandmakereferrals.

1.Qualifications
1. MBBSorequivalent.CurrentlyregisteredoreligibleforregistrationwiththeMedicalBoardof
Australia.
2. Demonstratedclinicalpracticeasaregisteredmedicalpractitionerinthelast2yearsinasetting
appropriatetotheneedsoftheposition.
3. MinimumtwoyearspostgraduateexperienceplussuitablecoursessuchasBASIC,ALS.
4. AninterestinIntensiveCare/CriticalCare.
5. Abilitytoworkaspartofateam
6. Highlevelofcommunicationandinterpersonalskills
7. Demonstratedcommitmenttoqualityimprovement,patientsafetyandriskmanagement

2.Clinicalduties

IntensiveCareUnitNepeanandOrangeBaseHospitals
TheCriticalCareSRMOassiststheICUTraineeinthedaytodaymanagementofallpatientsintheICU,
andhelpsprovide24hourmedicalcoverbyworking12.5hourshifts.Dailydutiesinclude:
Wardrounds
Prescriptionofdrugs,fluidsandventilatorsettings
Documentation of patients history and examination, problem list, management plan, investigations
andactiontakenintheelectronicmedicalrecordsystem
Attendanceandcontributiontoweeklyclinicalmeetings
ReviewofICUandwardpatientsasrequired
Patientmanagementaccordingtothelevelofexperience
Arranginganddocumentingpatientinvestigationsandconsultations
Regular communication with all members of the ICU multidisciplinary team, other medical and
surgicalteamsabouttheirpatients,andpatientsandfamilies
Provisionofacentrallineservicetothegeneralwards
Collectionofdataasrequired
MedicalEmergencyTeamcalloutsattherequestofseniorstaff
Medicalhandoverofpatientsattheendofashift
Ensuringthatallarrangementsforautopsy,deathandcremationcertificatesaremadeexpeditiously
andappropriatesupporttootherstaffandfamilyisgiven.

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 Ensuring effective, timely and accurate discharge planning occur for the patient, family and other
caregiversandanadequateandtimelydischargesummaryisprovidedtothoseinvolvedinaftercare
includingtheGeneralPractitionerandtheAttendingMedicalOfficer.Includingliaisingwiththebed
managementandpatientflowteams/units.
TheclinicaldutiesaresimilarfortheICUatOrangeBaseHospital,withtheexceptionthattheSRMO
worksdirectlywiththeSpecialistonduty.

EmergencyDepartment:
Assess, investigate and manage patients presenting to the Emergency Department, requesting senior
helpwhenappropriateaccordingtolevelofexperience.
Provide adequate documentation (including information required for the completion of the
EmergencyDepartmentInformationSystem(EDIS)dataset,andthedocumentationofthedetailsof
anyhistory,examination,investigationsandtheirresults,treatmentanddispositionofpatientsseen).
EnsuringadequatenotificationofapatientsConsultantorTraineeintheeventofadmission.
EnsuringadequatenotificationofapatientsLocalMedicalOfficerintheeventofdischargefromthe
Emergency Department, including the writing of discharge letters detailing the patients stay in the
ED.
Communicate clearly to patients, and their relatives where appropriate, the findings of assessment
andtheplanofmanagement.
Complywithotheradministrativepoliciesasrequested
Handovercareofpatientsattheendofeachshift

Anaesthetics:
AssistVMO/StaffSpecialistAnaesthetistsduringroutinehourswithelectiveandemergencycasesas
requiredintheOperatingTheatre,andinremotelocationssuchasMedicalImagingandEndoscopy
Suites.
Perform pre and post operative evaluation of patients as required, with attendance at Pre
AnaestheticClinicandAcutePainRounds.
AssistinteachingmedicalstudentsassignedtoDepartment.
TakepartinthepostgraduateeducationprogramwithinDepartmentandwithinthehospital.
Contributetotheafterhoursrosteruntil9pm

3.ResearchandTeaching
The SRMO is expected to participate in quality assurance, peer review and research programs in each
Department during the respective terms. Attendance and contribution to any weekly teaching sessions
arerequired.Experienceinteachingjuniormedicalstaffandmedicalstudentsisdesirable:willingnessto
teachisessential.

ContinuingEducation
AttendingHospitalGrandRoundsandrelevantweeklymeetings
ObtainingandmaintainingBasicandAdvancedCardiacLifeSupportaccreditation
ParticipationinPrimaryexamcoursesassuitable

TheSRMOwillreceivetraininginthefollowingproceduresastheopportunityarises:
Airwaymanagementandendotrachealintubation

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 Insertionofarteriallines,centralvenouscathetersandPICClines
Chestdraininsertion
Ascitictap
Ventilatormanagement
BalloonPumpManagement
AdvancedLifeSupport
Diagnosticultrasoundforcriticalillnessandechocardiography

4.Orientation
TheDoctorwillberequiredtoundertakethecoremandatoryorientationto:
Gainanunderstandingoftheorganisationalvalues,goalsandethics.
Gainknowledgeanddevelopskillstoworkinamannerwhichpromotestheirownhealth,safetyand
securityatwork.Includinginformationrelatingtoinfectioncontrolandneedlestickinjury.
Gain an understanding of child protection legislation policies and responsibilities associated with
notifyingandreportingissuesaboutchildprotection.
Given guidance on ways to perform their job in an efficient and effective manner; and the code of
conductandethics,includingthebehavioursandstandardsexpectedofNBMLHDEmployees.
Understandtheprinciplesofwastemanagementandthelocalprocessesinplace,whicharedesigned
toreducewaste.
Gainanunderstandingoftheadministrativeproceduresrelatingtotheperformanceoftheirwork.
Developanunderstandingofthelegislativeandindustrialcontextinwhichtheywork.
GaininformationonNBMLHDEmployeeAssistanceProgram(EAP).
Gain education and training in the minimisation and management of aggression, Work Health and
Safety,FireSafetyandqualityimprovementprocesses.

5.Supervision
TheSRMOmaybeaskedtocontributetothesupervisionofjuniorResidentsandmedicalstudents.

6.Otherresponsibilities
In addition to the core competency standards, the doctor is expected to comply with legislative,
policy/protocolrequirementsastheyrelateto:
ThesupervisionrequirementsassetoutbytheMedicalBoardofAustralia;
TheLocalHealthDistrictsPerformanceManagementPolicy;
Work,healthandsafetyrequirementsasanemployee;
TheNSWHealthCodeofConduct.

7.Medicalleadership
5momentsofHandHygiene
Clinicalhandover
DETECTtraining
ParticipateinRCA,QA,M&M,incidentreview,complaintmanagementasrequested
Activelyparticipateinrevenueandcostsavinginitiatives
Demonstratetheabilitytoeffectivelymanagestaffandhospitalresourcesincluding:
a) Showingleadership
b) Communicatingeffectively

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 c) Prioritisingtasks
d) Usingtimemanagementskillsappropriately
e) Assigningtasksanddelegating
f) Ensuringtasksareprogressingasplanned
g) Coachingandmentoringasappropriate

Inadditiontothecorecompetencystandards,theMedicalOfficerisexpectedtocomplywithlegislative,
policy/protocolrequirementsastheyrelateto:
1. Compliancewithallapplicablepublichealthorganisationandhospitalpoliciesandprotocols,andwith
applicablePolicyDirectivesandGuidelinesissuedbytheNSWMinistryofHealth,asamendedandas
inforcefromtimetotime,includingtheNSWHealthCodeofConduct
2. Ensuring that all services provided to patients are consistent with any instructions issued by your
supervisororDepartmentDirectororanyconditionsimposedbytheMedicalBoardofAustralia;
3. Maintenance of adequate hospital clinical records, including completion, within a reasonable time
periodfollowingthepatientsdischarge,ofpatientdischargeletters;
4. Observance of general conditions of clinical practice applicable at the Public Health Organisation
whereyouwillbeworkingfromtimetotime;
5. Demonstratingatalltimescourteousandprofessionalbehaviourtowardspatients,theirrelativesand
otherstaff.

LOCALBACKGROUNDANDENVIRONMENT

NepeanHospitalisareferralandteachinghospitaloftheUniversityofSydney.Itservesthelocalareasof
Penrith,HawkesburyandtheBlueMountains(comprisingapopulation>300,000)andacceptspatients
fromasfarwestasLithgowandBathurst.NepeanHospitalhasapproximately560beds,with24/7cover
for ICU, anaesthetics, neurosurgery, thoracic surgery, orthopaedics, plastic and faciomaxillary surgery,
and most medical specialties. There are interventional cardiology and inpatient dialysis services.
Pathologyandradiography/CTservicesareavailable24/7.MedicalImagingDepartmentincludesgeneral
imaging,ultrasound,MRI,CTscan,angiographyandNuclearMedicine.Reportingservicesareavailableon
site during office hours, and an informal report after hours for CT scans. There is also a highrisk
pregnancy unit, Neonatal Intensive Care Unit, and a paediatric department. There is an after hours
referralarrangementwithWestmeadHospitalforophthalmologyandENT.

The Emergency Department at Nepean Hospital sees approximately 65,000 patients per year, of which
about33%areadmittedtothehospital.About20%ofthesepatientsareunder14yearsofage.Nepean
Hospital is designated a Regional Trauma Centre by the Institute of Trauma and is accredited by The
AustralasianCollegeforEmergencyMedicinefor2yearsofadvancedtraininginEmergencyMedicine.

The Anaesthetic Department has 60 specialists and 16 full time trainees. There is an accredited
multidisciplinary Pain Service within the department, and the Department is accredited for 4 years of
FANZCAGeneralProfessionalTraining.

TheNepeanIntensiveCareUnitprovidesIntensiveCare/CriticalCareservices,andaMedicalEmergency
Team response for Nepean Hospital. The Department has 22 Intensive Care Beds (Capacity for 16
ventilatedand5nonventilatedpatients)staffedby8StaffSpecialists,1ClinicalSuperintendent,1Echo

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ProvisionalFellow,3ProvisionalFellows,10Trainees,4SeniorMedicalResidentOfficersand4Residents.
TheUnitisaccreditedbasicandcoretrainingfortheCollegeofIntensiveCareMedicine.

Orange Base Hospital is a rural referral hospital with approximately 120 beds, and is part of the Rural
Clinical School of the University of Sydney. Orange Base Hospital provides Emergency, general medical
(except for acute haemoncology) and surgical services (except for major acute neurosurgical and
cardiothoracic conditions), paediatrics and obstetric services. Facilities at Orange include Pathology
between07002400(oncallafterthat),Radiology06002100forradiography,ultrasound,CT(oncallafter
that),offsiteMRIfacilities.Thereislimitedinterventionalradiologyduringweekdays.Reportingservices
areavailableonsiteduringofficehours,andaninformalreportafterhoursforCTscans.

OrangeBaseIntensiveCareUnitprovidesIntensiveCare/CriticalCareservices,andaMedicalEmergency
TeamresponseforOrangeBaseHospital.Italsoprovidesremotevideoconferencesupporttoemergency
departments of GWAHS district hospitals via critical care advisory service. The Department has 5 ICU
beds,4HDUbedsand5CoronaryCarebeds.

KEYINTERNALANDEXTERNALRELATIONSHIPS
The Critical Care SRMO is ultimately responsible to the Directors of the Intensive Care Units, the
Emergency Department and the Department of Anaesthetics in the respective terms. On a daytoday
basis,theSRMOreportstoallseniormedicalstaffonduty.He/sheworkswithamultidisciplinaryteam
thatoftenwillincludenursingstaff,alliedhealthpersonnelandclericalstaff.

TheSRMOhasconstantcontactwithallwardsandserviceswithinthehospitalonalllevelsinregardto
management and investigation of patients. The SRMO may also be required to communicate with the
NSW Retrieval Service as well as Bed Managers and Specialists from other hospitals to arrange inter
hospitalpatienttransfers.

Communication with patients and their families is required on a regular basis, and for Police and
Ambulancepersonnelonanoccasionalbasis.

SUPERVISIONARRANGEMENTS

Supervisionduringnormalhours:
Immediate supervision of the SRMO is provided by the on duty Trainee, Provisional Fellow and Staff
Specialist or VMO. Mixes of senior staff for each term are always on site and readily available during
normal hours. The SRMO does not function independently during the Anaesthetics term, and
independentactionduringothertermswillbeaccordingtotheSRMOlevelofexperience.

Supervisionafterhours:
DuringtheAfterHoursperiodinNepeanICUtheSRMOissupervisedbytheTraineewhoisthemost
seniordoctoronsitewithintheIntensiveCareUnit
DuringAfterHoursatOrangeBaseICUtheSRMOwillworkintheICU/HDU/CCU,andthereisatleast
anequivalentSRMOormoreseniorEDstaffmemberavailableonsiteatanytime.Medical,Surgical
andAnaestheticsTraineesareavailableonsitewithin5minutes.

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 TheOnCallICUspecialistforNepeanorOrangeBaseisalwayscontactedbytelephoneandmustbeat
thehospitalwithin20minutesifhelpisrequired.
DuringAfterHoursinED,theTraineeondutyprovidesimmediatesupervision.Medical,Surgicaland
ICUTraineesareavailableonsite24/7.TheEDSpecialistondutyisavailableonsiteuntilmidnight,
andtheniscontactablebyphone.

YES NO NA
1. At all times during normal working hours, the applicant will have a X
more senior doctor on site available to help. ie. Inhours, the
applicantisneverthemostseniordoctoronsite.
2. Iftheapplicantwillbeworkingafterhours,oncallorovernight,there X
willalwaysbeamoreseniordoctoronsiteavailabletohelp.ie.After
hours,theapplicantisneverthemostseniordoctoronsite.
3. Theapplicantisexpectedtosupervisejuniormedicalstaff. X
4. Theapplicantwillbeexpectedtodoretrievalwork. X

CHALLENGES/PROBLEMSOLVING
ChallengesoftheSRMOroleinclude:
Havingcomposureduringemergencysituationsandbeingabletocomeupwithtimelymanagement
plansforeffectiveairwaymanagementandresuscitation
Interactionwithpatientsandtheirfamiliesinregardtosevereacuteillnessandendoflifedecision
making.
Timemanagementandprioritisationskillstohandletheworkloadataconstantfastpace
Providingeffectivehandoversofpatientcare.
Workingcollaborativelywithotherstaffinamultidisciplinaryteam.
MaximisingtheefficientutilisationofthephysicalresourcesoftheLocalHealthDistrict.
BeingflexiblewiththeworkrequiredinarangeofLocalHealthDistrictandlocations.
Responsibilityforsupervisionandteachingofjuniormedicalofficersattachedtothemedicalteam.

COMMUNICATION
TheSRMOisakeypersonwhoworkscloselywithallmembersofstaffandmust:
Workaspartof,andcontributetoamultidisciplinaryteam,maintainingclearcommunication
Dealwithmattersofanurgentorsensitivenature.
Havetheabilitytoexercisediscretion,sensitivityandmaintainconfidentiality.

DECISIONMAKING
TheDoctorwillberequiredtoexerciseindependentjudgement,initiativeandproblemsolvingskills,but
thisshouldbeexercisedinconsultationwithsupervisingmedicalstaff.

Decisions that are made in consultation with an ICU/ED/Anaesthetic Specialist or other senior staff
include:
Managementofimmediateproblemsofthepatientsairway,breathingandcirculation
Holisticproblembaseddiagnosisandmanagementofacuteillness
Managementofendoflifeissues
Medicationandfluidprescription

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 Insertionofarteriallines,centralvenouslinesanddrainagetubes
Ventilationsettingsandmode

TheMedicalOfficerwillberequired:
Toexerciseindependentjudgment,initiativeandproblemsolvingskills,butthisshouldbeexercised
inconsultationwithsupervisingmedicalstaffincludingpatientescortsandtransfers.
CloseandeffectiveliaisonwithconsultantstoallowtheMedicalOfficertodemonstratetheirlevelof
abilityandunderstandingofpatientcareandenableanexpansionresponsibility.
All patients managed within the hospitals of the Health District are under the direct care of a
specialistmedicalpractitioner.Alldecisionsregardingtheircarearetobeclearlycommunicatedwith
the specialist responsible for that care to ensure appropriate input from key decision makers and
achieveconsensuswhenpossible.

PERFORMANCEMONITORING
TheCriticalCareSRMOisresponsiblefor:
ParticipatinginongoingperformancereviewandtrainingatdepartmentalmeetingssuchasMorbidity
andMortalityMeetings,JournalClubsandpeertutorials.
Participatingincontinuingmedicaleducationandprofessionaldevelopment
Maintaininghis/herprofessionalcompetence.

Each term will supply a nominated supervisor for the SRMO, who is responsible for documentation
regardingSRMOperformanceandfeedbacktotheSRMO.

ORGANISATIONALCHART

DIRECTOR

STAFF
SPECIALISTS

Echo Fellow Advanced Trainee

Clinical Superintendent
Provisional Fellow
Post Graduate Fellow

TRAINEES

SRMO/RMO

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VERIFICATION

Thepositionholderagreestoworkinaccordancewiththerequirementsofthepositionandacceptsto
complywithpoliciesandproceduresofNepeanBlueMountainsLocalHealthDistrict.

POSITIONHOLDER

Name:

Signature:

Date:

SUPERVISOR

Name:

Signature:

Date:

CONTACTDETAILSFORAPPLICANTENQUIRIESABOUTTHEPOSITION

Name: DrLouiseCole
Phone: 0247342490
Email: l.cole@sydney.edu.au

CONTACTDETAILSFORAHPRA/COLLEGEENQUIRIESABOUTTHEPOSITION

Name: JuniorMedicalWorkforceUnit
Phone: 0247342281
Email: NBMLHDJMORecruitment@health.nsw.gov.au

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