Jennifer Jamieson

Compassion fatigue in emergency medicine: The cost of caring.

Compassion is often considered a prerequisite for entering the medical profession; indeed, it is a fundamental principle in the Hippocratic Oath. However, the privileges and challenges of caring on the frontline can affect us personally. Emergency medicine exposes us to trauma and distress on a daily basis and compassion fatigue can occur when repeated exposure takes its toll. This edition of Emergency Medicine Australasia examines the ‘cost of caring’ in emergency medicine.

Bullying and harassment of trainees: an unspoken emergency?

Earlier this year, vascular surgeon Gabrielle McMullin issued some startling advice to female surgical trainees: acquiesce to the sexual advances of your male colleagues, or risk compromising your career. The comments might have been controversial, but they were successful in exposing a silent epidemic of bullying and harassment in medicine. McMullin’s thinly veiled entreaty for action has resulted in unprecedented media attention, including an investigation by Four Corners and articles in major newspapers. In response, the Royal Australasian College of Surgeons (RACS) has commissioned an Expert Advisory Group to report on discrimination, bullying and sexual harassment, the Australian Medical Association (AMA) has convened a high-level roundtable and the New Zealand Resident Doctors’ Association has instituted meetings with the Ministry of Health, union representatives and health professionals. But will any of these interventions secure lasting reform? This article explores the susceptibility of emergency medicine (EM) trainees to bullying and harassment, and distils stakeholder opinions on a destructive phenomenon plaguing medical culture.

The role of short courses in Australasian emergency medicine training

For the purposes of this article, short courses are defined as courseworkbased training opportunities, of less than 2 week’s duration, delivered independently of hospital-based clinical teaching programmes. A growing number are available to emergency medicine (EM) clinicians and cover a variety of areas including trauma, resuscitation, ultrasound, paediatric emergencies and research methods. A sample of popular courses is provided in Box 1. The next edition of the Trainee Focus section will consider the role and value of longer, universitybased degree programmes focussed on EM. As scientific knowledge and trainee numbers in EM expand, demand for short courses is likely to grow. Other potential drivers of attendance include future increases in professional development (PD) allowances, and more rigourous safety and quality standards in relation to life support skills and training. The trend towards subspecialisation in EM might also precipitate new and expanded courses in areas such as toxicology, pre-hospital and retrieval medicine and international EM.

The role of universities in Australasian emergency medicine training

Emergency medicine (EM) is an increasingly challenging discipline in which to work and train. Community expectations of EM services are rising, and emergency clinicians face a growing burden of complex and chronic disease. As a reflection of ongoing advances in scientific and educational knowledge, EM training curricula have expanded in both breadth and depth. There are also more medical graduates than ever before, and competition for specialty training places is increasing. It is timely, therefore, to consider whether current models for the delivery of postgraduate medical education (PGME) are fit for purpose. In a demanding training and service environment are colleges – acting through clinicians, hospitals and health services – best placed to deliver specialty education? Is there a role for universities? These issues are considered in the accompanying articles by Roberts and McCarthy, and this article provides further background to the debate.

Training in global health and international emergency medicine: Where to next?

The Trainee Focus section in this edition of Emergency Medicine Australasia explores training in global health (GH) and international emergency medicine (IEM). In the article by Thurtle et al., several emergency medicine (EM) registrars describe the benefits and challenges of working in resource-limited settings, and Phillips provides insights based on her experience as a mentor and remote supervisor. This introductory piece outlines recent developments in GH training, and reflects on the IEM learning opportunities currently available to Australasian EM trainees.

Gender equality in emergency medicine: Ignorance isn't bliss

The concepts of discrimination and inequity based on gender, age, race and sexuality are issues that unfortunately remain prominent in Australia, New Zealand and across the globe. Gender equality is a broad topic spanning societal, political and industrial domains and is associated with a diverse range of behaviours and attitudes requiring attention. The United Nations HeForShe campaign is a powerful global initiative to promote the achievement of gender equality. Two of its core strategic pillars are ‘acceleration of women’s economic empowerment’ and ‘advancing women’s political participation and leadership’. Emergency medicine (EM) is a young specialty that prides itself on being progressive; however, these two pillars continue to require improvement within academic and clinical EM in Australasia. Although much of the dialogue is specific to female trainees and FACEMs, this editorial and the associated articles in this series will also explore the less publicised issues affecting our male EM workforce.

Insights into the development of a trauma short course for Australasian emergency medicine clinicians

Emergency Department, Royal Darwin Hospital, Darwin, Northern Territory, Australia, Emergency and Trauma Centre, The Alfred Hospital, Melbourne, Victoria, Australia, Department of Emergency Medicine, Royal Adelaide Hospital, Adelaide, South Australia, Australia, Department of Emergency Medicine, Austin Health, Melbourne, Victoria, Australia, and Department of Emergency Medicine, Royal Brisbane and Women’s Hospital, Brisbane, Queensland, Australia

Perspectives on working and training in global health and international emergency medicine

Emergency Department and Department of Clinical Toxicology, St Thomas’ Hospital, London, UK, Emergency Department, St Vincent’s Hospital, Melbourne, Victoria, Australia, The University of Melbourne, Melbourne, Victoria, Australia, Emergency Department, Royal Darwin Hospital, Darwin, Northern Territory, Australia, Department of Intensive Care, Western Hospital, Melbourne, Victoria, Australia, Emergency Department, Modilon General Hospital, Madang, Papua New Guinea, and Emergency and Trauma Centre, The Alfred Hospital, Melbourne, Victoria, Australia

Idiopathic systemic capillary leak syndrome presenting as septic shock: A case report

Background: Idiopathic capillary leak syndrome (Clarksons Disease) is a rare angiopathy with a heterogenous phenotype that may present as distributive shock refractory to resuscitative management. Objective: We report a case of idiopathic systemic capillary leak syndrome presenting as septic shock. Methods: Structured case report and review of the literature. Results: A 27‐year old man admitted to our institution with coryzal symptoms rapidly deteriorated with presumed sepsis, leading to intensive care unit admission. Following further deterioration, Idiopathic systemic capillary leak syndrome was considered and intravenous immunoglobulin administered, resulting in rapid improvement in the patients clinical status. Conclusions: Idiopathic systemic capillary leak syndrome is a rare and potentially life‐threatening angiopathy that may present as, and should be considered in, refractory distributive shock. Administration of intravenous immunglobulin resulted in rapid recovery in this patient, and has been associated with positive outcomes in previous cases.

Compassion fatigue in emergency providers: Experiences from Sub‐Saharan Africa

Emergencies happen every day across the globe, and health systems shoulder the responsibility for the care of emergencies, regardless of their capability to do so adequately. Nowhere is this more apparent than in Sub-Saharan Africa (SSA) where there is a disproportionate burden of disease and injury. Emergency medicine (EM) in SSA is a developing field. However, EM is complex, and implementing highquality, affordable emergency care is difficult. EM systems in SSA remain poorly developed despite evidence that emergency care is an efficient and costeffective method of preventing further complications. Existing EM resources in SSA are overstretched and overburdened. Frontline EMproviders can experience physical and psychological effects from witnessing significant morbidity and mortality every day. In this article, we will discuss factors contributing to compassion fatigue in emergency providers working in low-income countries using experiences from SSA.