My First Week

It's hard to believe I've only been here slightly more than a week. My humble living quarters & the ins & outs of my daily life here are beginning to feel like home. I've settled in quite well here.

While here, I'll be dividing my time between infectious diseases (ID) & pediatrics. To ease the transition to working in the Australian health system, my sponsors thought it would be best that I start on the ID team. The ID department at RDH is one of the largest & well respected departments at the hospital & there's a long-time connection with Duke because several of the RDH ID "consultants" (attendings) completed their ID fellowships at Duke. The ID service consists of the adult ID inpatient team & a very large & active consult service. The inpatient team is composed of patients whose primary admitting issue is infectious & they are primarily managed by us, rather than being admitted to general medicine with ID consulting. Our ID team census has been in the low teens but added to that is a large group of active consults ranging anywhere from 20-30 patients. We also cover pediatric ID consults. There's a dedicated peds ID ward, for which the pediatricians are the primary caretakers with ID consulting.

Here's a rough outline of my weekly schedule:

Daily 8am medicine handover of new overnight admissions & daily 11am-noon microbiology plate rounds.

Monday
8:30-9:30: ID case presentation conference
11:00-12:00: plate rounds & ICU micro rounds
Afternoon: ID clinic

Tuesday:
Morning: blood-borne infections clinic (HIV & hepatitis)

Wednesday:
7am-8am: general medicine teaching conference
Morning: TB clinic
12:00-1:00: medicine grand rounds

Thursday:
11:00-12:00: micro plate rounds & ICU rounds
12:00-1:00: ID journal club

Friday:
8:30-9:30: ID teaching
10:00-11:00: pediatric ID rounds
12:00-1:00: radiology conference or pediatric grand rounds

In the midst of all these formal learning opportunities, we spend our time rounding on & caring for the inpatient ID team, seeing old & new consults, completing new admissions from the emergency department, & rounding formally with the ID consultant, so the days are quite full. The earliest start is Wednesday with the formal general medicine teaching session. Otherwise, the workday always starts at 8am & ends by early evening, generally around 5-6pm.

The ID team is composed of two ID senior "registrars" (US equivalent of a senior ID fellow), an "RMO" or "registered medical officer" (US equivalent of a 2nd year resident), & two medical students. One ID registrar generally acts as the inpatient registrar leading the inpatient team & seeing most of the inpatient consults while the other ID registrar oversees the three weekly ID clinics & "Health in the Home" or the home-health team that manages home IV antibiotic infusions. There's a third ID registrar who is on the medical outreach teams & flies to remote villages for one- or two-day clinics.

I'm the equivalent of a senior medical registrar here but I'm essentially functioning as an ID registrar in something of a hybrid role: I've been seeing & following new consults, helping with emergency department admissions, seeing patients in clinic, & rounding on the inpatient team & generally helping out where I can. I may also get to visit some remote villages with the outreach registrar.