Category: Careers

A typical shift in A&E: What is it like to be an EM trainee?

12:06pm 

I arrive at work a few minutes late due to a cancelled train, but fortunately everyone is too busy to notice. The consultant asks if I can go straight to resus to perform a primary survey on a trauma patient.  The trauma team has arrived consisting of a variety of anaesthetic and surgical colleagues. I am a bit nervous examining the patient in front of so many colleagues, but it is nice to know that they are there if needed. The trauma patient is a teenage girl who has been trampled on by a horse. She is cold, wet and terrified, I try my best to reassure her, but I don’t think I am as convincing as I want to be. A CT scan reveals she has a large liver laceration and so is transferred for surgery. 

13:35pm 

With the trauma patient now in the hands of the surgeons I get settled into seeing patients in majors. It is the usual collection of chest pains, abdominal pains and ‘collapse query causes’. I meet the most incredible elderly gentleman, despite his denial I suspect he has no recollection as to how he came to be on the floor, however, he can remember every detail of the the second world war! He flew Lancaster bombers, just like my grandfather, and still has the ‘RAF’ mustache to prove it! 

19:40pm 

I am shocked when I look at the time, I had been so wrapped up in seeing patients I didn’t even realise I was hungry! I take myself off to the break room for some well-earned dinner. At this time it is filled with nurses having a last cup of caffeine before starting their night shift. We exchange banter that would be considered offensive by most, but instead is the highest form of respect in A&E! The best thing about working in A&E is that you get another family – a really big, occasionally cranky, often hilarious, but always reliable family! 

20:05pm 

I’m entitled to a 40min break, but once the nurses leave me on my own in the break room I quickly get lonely and bored (a side effect of working in such a busy place). On heading back to work I pass an ambulance crew rushing into resus with a very sick looking man. I follow out of curiosity and then find myself getting stuck in doing my best to help. I perform an ABG that shows he is in very severe metabolic acidosis. He will need urgent dialysis, but first we need to stabilse him. Simultaneously we are putting in a central line, an arterial line and urinary catheter; starting infusions of noradrenaline and bicarbonate and performing a bedside cardiac echo. We eventually get control of his blood pressure and he is transferred to intensive care. It later transpired that he had taken an overdose of amitriptyline. 

21:20 

I feel exhausted after the last patient so I take myself over to minors to treat some less life-threatening problems. I meet a girl who fell off her high heels the night before whilst drunk and has a swollen ankle. It has taken her nearly 24hrs to come to A&E because she was too embarrassed. This makes a refreshing change! I cannot see any fractures on her X-ray so I discharge her with ankle sprain advice. The next patient has put his hand through a glass window sustaining a laceration to his forearm. With no glass visible on his X-ray and all of his nerves and tendons functioning, I get to work on stitching him up. I accidently cover him in water whilst cleaning his wound. I am totally mortified, but fortunately he laughs it off, it amazes me how resilient some patients can be!  

22:10pm 

I leave feeling I have done some good and tomorrow I get to do it all again!

All your Q&As answered here! Study EM dishes the dirt on life as an ED doctor and making it:

What can I do as a student to get started in Emergency Medicine? 

1) Spend as much time as possible in A&E, even if you end up specialising in another area, the skills you learn in A&E will be invaluable as a Foundation Doctor. 

2) Do an elective in A&E – either at home or abroad 

3) Volunteer for life support courses eg. ATLS 

4) Attend a RCEM careers day 

5) Choose specialist study modules (SSC/SSM) in areas allied to emergency medicine, such as pre-hospital medicine and toxicology. 

 

What can I do as a Foundation Doctor to get involved in Emergency Medicine? 

1) Apply for a rotation that includes Emergency Medicine 

2) Select a taster week in A&E, CED or Pre-hospital medicine 

3) Chose an audit relevant to Emergency Medicine 

4) Try to get involved in some research or write a BestBET (http://www.bestbets.org) 

5) Ensure you attend at least an ALS course and maybe even an ATLS course 

6) Complete relevant elearning modules 

7) If you have some pennies left over then you could join the Royal College of Emergency Medicine. This gives you access to the Journal of Emergency Medicine and discounts on some courses and events.  

All your Q&As answered here! Study EM dishes the dirt on life as an ED doctor and making it:

So how do I become an Emergency Consultant? 

 You will be asked to apply for specialty training in the December of your F2 year with interviews being held from late January to late spring. Try to have evidence of your interest in emergency medicine before this point. It is worthwhile looking up the selection criteria 🙁http://specialtytraining.hee.nhs.uk/portals/1/Content/Person%20Specifications/Emergency%20Medicine/Emergency%20Medicine%20ACCS%20CT1.pdf) for the previous year and filling in any CV blanks sooner rather than later. If you do not feel you are ready to start specialty training then there is always the option of taking what is affectionately being referred to as an ‘F3’ year. Taking a year out gives you time to experience other areas of medicine either at home or abroad. You might even get the opportunity to try something different and exciting, which might not be an option later in life when children limit your options. It is no longer frowned upon to take time out as long as you can prove that you spent that year bettering yourself as a doctor (FYI, more experience = better doctor)  

Currently emergency medicine training consists of a 6 year run-through programme; 3 years of core training (Acute Care Common Stem [ACCS]) and 3 years of Higher Specialty Training (HST).  

CT1 – 6 months emergency medicine and 6 months acute medicine 

CT2 – 6/9 months anaesthetics and 3/6 months intensive care 

You are required to pass you FRCEM Primary exam (previously known as the MCEM Part A) before you can progress to CT3. 

CT3 – A&E with a focus on paediatrics and trauma – ideally this year will be split between a Children Emergency Department (CED) and an Emergency Department in a Major Trauma Centre/Trauma Unit. However, not all regions are able to provide this. As such you might spend some time in paediatrics and/or orthopaedics.  

You are required to pass your FRCEM Intermediate exam (previously known as the MCEM Parts B &C) prior to progressing to ST4.  

ST4-6 – More A&E and paediatric emergency medicine. You also need to become proficient in emergency ultrasound and get to grips with management and other qualities required to run an Emergency Department. It is during this time that you can take time out to dual qualify in specialties such as intensive care and paediatric emergency medicine. 

Before you are awarded the illustrious Certificate of Completion of Training (CCT) you need to pass the FRCEM Final exam. Once you have served your time, passed the required exams and convince someone to give you consultant job then you have finally done it and then the real hard work starts! 

All your Q&As answered here! Study EM dishes the dirt on life as an ED doctor.

What is it like to work in an Emergency Department? 

Emergency Departments are the ‘front door’ of the hospital. It is always open and usually busy! Emergency doctors diagnose patients presenting with a variety of problems, often with limited information. We rely heavily on our clinical skills, a wide range of investigations and of course the experience of our seniors. Emergency physicians work closely with a number of specialty doctors, nurses, physiotherapists, social workers and of course patients from every walk of life…if you do not like people, then A&E is unlikely to be the career for you!  

But isn’t A&E really hard work? It can be, but on the flip side, your day never drags and you never get bored.  

As you progress you can develop other interests such as education, research, paediatric emergency medicine, sports medicine and pre-hospital medicine including trauma, refugee, wilderness and disaster medicine. Other interests help break up the pressure of working in A&E and keep us mentally healthy. 

But isn’t working so many antisocial hours difficult on your home life? It can be, but again there are many positives: 

1) You are off when other people are at work, so no queuing up with everyone else at the weekend.  

2) Most A&E rotas try to clump your time off so you can go on holiday without using up your annual leave.  

3) The late starts are great if, like me, you are not a morning person 

4) If you do have kids, then working when your partner is at home saves a fortune on childcare, plus part time work is more accessible in A&E due to its flexible nature.  

5) Antisocial hours come with a higher pay banding and since we don’t actually earn as much as the Daily Mail makes out, then every penny helps.