St Emlyn’s Lesson Plans
Your first day in Emergency Medicine
Find out how to get help, hand over unfinished work and make discharge decisions on your first ED shifts.
New to Emergency Medicine / Induction / Early-career Emergency Medicine · 45-minute session
For learners
Before: Allow about 8 minutes in total. With the reading alternative: about 8 minutes.
When we meet: We will discuss a patient with a pending result and another who has become unwell while waiting.
For facilitators
Send: the learner preparation link before teaching.
Bring: A local contact card, blank handover record and whiteboard; no slides required.
Before the session
If you are attending this session, complete the core preparation below before you come. Allow about 8 minutes in total. With the reading alternative: about 8 minutes.
Core preparation
Core listening · 4 min 59 sec
St Emlyn’s Podcast: Ep 96 - Everybody's free - Top Tips for the Class of 2017
Practical prompts for asking for help, keeping colleagues informed and looking after the team.
Search for this episode by title in MedPod Learn if you want to record your listening there.
Prefer to read? Use GMC: colleagues, culture and safety instead of listening. Allow about 5 minutes.
Read paragraphs 48–50 and 65–67 on teamwork, sharing information and seeking help, then answer the question below.
https://www.gmc-uk.org/professional-standards/the-professional-standards/good-medical-practice/domain-3-colleagues-culture-and-safety
This 2017 reflection considers asking for help and keeping colleagues informed. After listening or reading, use the question below to identify whom you could contact on your first night shift.
https://www.stemlynspodcast.org/e/everybodys-free-top-tips-for-the-class-of-2017/
Think about (allow 3 minutes): Who would you contact on your first night shift if you were worried about a patient but unsure of the diagnosis?
Picture the scene
You are starting your first Emergency Department placement. You know how to take a history; you are less sure who can help you discharge a patient safely.
By the end of the session
- Find and use the department’s supervision and escalation routes.
- Explain what must be agreed before handing over or discharging a patient.
- Turn an uncertainty into a clear request for help.
After the session
- On your first shift, test one escalation contact before you need it.
- After a discharge, ask your supervisor to review how you explained uncertainty.
Facilitator guide
Send learners the preparation link several days before teaching. Allow about 8 minutes in total. With the reading alternative: about 8 minutes.
Before learners arrive
- Bring the current handover, result-review and discharge-supervision policies.
- Confirm who is available on evenings and nights, and how to call emergency assistance.
- Identify break cover, wellbeing support and how to report a safety concern.
Equipment: A local contact card, blank handover record and whiteboard; no slides required.
Setup: Work in groups of three: the clinician explains the concern, a colleague receives it and an observer checks what has been agreed. Use the two cases over three short rounds, repeating either case so everyone can practise explaining a concern.
If the preparation has not been completed
Replace the opening worries and contact-finding activities (13 minutes). Use the local contact card for eight minutes in pairs: find supervision, the emergency call and the result-review route. Spend five minutes comparing answers and naming unanswered questions. Then move to the cases. For the 30-minute version, use the first eight minutes for this contact-card activity instead of the worries and local-routes opening.
Suggested session plan
- 0–5 min — Start with uncertainties. Ask each person to name one first-shift worry; group them without judging.
- 5–13 min — Find the local contacts. Pairs locate supervision, emergency-call and result-review routes on the contact card.
- 13–33 min — Rehearse the two cases. Use three rounds across the two cases, repeating one. Rotate roles each round; the observer checks that each request has an owner.
- 33–40 min — Build a shift checklist. Agree three actions before discharge or handover.
- 40–45 min — Choose a follow-up action. Each learner names the first person they will approach if unsure on shift.
Start the discussion
Read the opening scenario together. Give everyone a moment to think, then ask what concerns them and what they need to know next.
Cases and discussion
Use these cases, or invite an anonymised case from the group that addresses the same questions.
The results are not all back
Your shift ends in ten minutes. A patient with abdominal pain feels better and wants to leave; one requested investigation is still pending.
Add this information as the discussion develops:
- A colleague offers to “keep an eye on it”, but has not heard the history.
- The patient has caring responsibilities and cannot easily return.
Ask the group:
- What do you need to decide before anyone leaves?
- What exactly must the accepting clinician agree to do?
- How would you explain the uncertainty to the patient?
Discussion notes
Points to draw out:
- Review the clinical risk with the supervising clinician; feeling better alone does not establish that discharge is safe.
- Name the clinician taking over, the outstanding task, the trigger for action and the time for review. Use the local handover record.
- Ask about practical barriers and agree understandable return advice and follow-up responsibility.
Common misconceptions:
- Assuming a test order guarantees somebody will review it.
- Discharging because the shift is ending.
For a more experienced group: Ask the group to design a handover for an abnormal result arriving after discharge.
I am worried but cannot name the diagnosis
A patient waiting for assessment has become quiet and clammy. The first observations were reassuring.
Add this information as the discussion develops:
- The nurse is also concerned; the senior is occupied in another bay.
Ask the group:
- What would you do now?
- How will you make your concern heard?
- Who else can help?
Discussion notes
Points to draw out:
- Repeat an ABCDE assessment and observations, summon appropriate help and use the departmental emergency escalation process if needed.
- A specific observation plus a direct request is more useful than apologising for being inexperienced.
- Nursing concern and changed appearance are valuable information, even before a score changes.
Common misconceptions:
- Waiting for diagnostic certainty before escalating.
For a more experienced group: Rehearse the next escalation if the initial call is not answered.
Important clinical points
- Work within competence and seek timely supervision; do not wait for a diagnostic label to escalate deterioration.
- Oxygen, fluids, antibiotics and analgesia are treatments with indications and risks, not an automatic package for every patient.
Closing the session
Use these questions to check what the group will take away. Go back over any clinical points that remain unclear.
- How will you hand over a pending result so that action is reliable?
- What makes discharge advice usable for this particular patient?
- How will you raise a concern when the team is busy?
Key teaching points:
- Ask for help when concern arises, even if you cannot yet explain the diagnosis.
- Agree who will act on each outstanding task and when it needs review.
- Know how to arrange breaks, obtain support and raise concerns during a busy shift.
Before leaving, ask each person to choose one action from After the session and say when they will try it. They complete that follow-up in practice, with supervision where needed.
Adapting the discussion
Uncertainty and local practice
Discharge supervision and escalation arrangements differ between departments; show learners the local process and contacts.
If the discussion drifts
Who owns the next decision, and when will it happen?
For a more experienced group
Ask experienced participants to find a gap between the written policy and the night-shift reality and propose a small improvement.
A 30-minute version
30 minutes: worries 3; local routes 5; first case 12; deteriorating-patient rehearsal 5; consolidation and reflection 5. Omit the longer checklist exercise.
Evidence and guidance
- GMC: Good medical practice 2024 — Professional responsibilities, safe care and a supportive working environment.https://www.gmc-uk.org/professional-standards/good-medical-practice-2024
- GMC: Delegation and referral — Effective January 2024; updated December 2024. Responsibilities and transfer of care.https://www.gmc-uk.org/professional-standards/the-professional-standards/delegation-and-referral/delegation-and-referral
Suggested curriculum links
RCEM 2021 curriculum (2025 update): SLO1 Care for physiologically stable adults with acute presentations
Safe assessment, differential diagnosis and disposition.
RCEM 2021 curriculum (2025 update): SLO7 Manage complex situations in the workplace
Communication, escalation and continuity of care.
Check these links against the learner’s stage and programme. Attendance at a teaching session does not establish competence.
Clinical review: awaiting clinician sign-off
The references have been checked during editing. A named clinician has not yet signed off the revised lesson collection. Use current local guidance when preparing to teach; editorial updates do not constitute clinical approval.
First published 2020-06-16 · Iain Beardsell.