WHY TRAIN IN EMERGENCY MEDICINE?
Emergency Medicine (EM) is one of the most exciting, challenging and rewarding areas of medicine. As with all medical specialties, no two patients are the same, however this is more apparent in EM as there is exposure to the acute aspects of all medical and surgical specialties. This requires very broad knowledge and attention to detail, as Emergency Doctors are often the first to diagnose and treat these problems.
EM is a very hands-on speciality requiring quick decision making and often immediate investigation and treatment. The skills-set required takes from many other specialities such as Anaesthetics, Intensive Care, Cardiology, Surgery and many more.
There is also a large amount of multi-disciplinary and multi-professional teamwork, as Emergency Doctors must liaise with their own teams including allied health professionals, other specialty doctors and with the Emergency Services.
CHALLENGES OF EMERGENCY MEDICINE
Although EM is often exciting and very rewarding, it can be quite challenging and stressful. The responsibility of managing acutely unwell patients, together with the large influx of patients to A&E makes this a demanding, high pressure career. Emergency Doctors are also increasingly being put under tougher time-constrains which can add to the stress.
As mentioned before, the patients come with a wide variety of Medical and Surgical problems, requiring a large skill-set from the Doctors and a lot of studying, training and examinations. In addition, the patients themselves can provide their own challenges due to communication barriers, the emotional stress of being acute unwell and sometimes hostility towards the hospital staff.
Furthermore, the Emergency Department (ED) needs to be staffed 24/7 365 days a year. This requires all staff to work in a shift rota pattern. This can sometimes make it difficult to maintain a good work-life balance and healthy social life.
TRAINING PATHWAY FOR EMERGENCY MEDICINE
Following medical school and foundation training, entry into the specialty training programme for Emergency Medicine requires completion of the Acute Care Common Stem (ACCS) programme. This is a core training programme incorporating Emergency Medicine, Acute Medicine, Intensive Care and Anaesthetics training.
The first two years of the programme include a 6 month placement in Accident and Emergency, 6 months in Acute Medicine and 1 year of Anaesthetics and Intensive Care. The third year is specific to the trainee's preferred specialty and includes 6 months of Paediatrics.
Following this trainees must apply to a nationwide selection process for specialty training year 4. Specialty training years 4-6 involve placements of 12 months in various A&E departments. Furthermore, trainees can apply for additional training to sub-specialise or dual accredit in an area such as paediatric emergency medicine, intensive care medicine, acute medicine or pre-hospital care.
The progression through training and completion of assessment and objectives is recorded in an E-portfolio system, requiring trainees to keep a track of their Continuing Professional Development (CPD).
The Royal College of Emergency Medicine (RCEM) was established in 2008. EM trainees must complete two examinations to gain their certificate of completion of training in order to become a consultant.
The first of these is the Membership of the Royal College of Emergency Medicine exam (MRCEM). This exam is in three parts: Part A - multiple choice questions, Part B - short answer questions, and Part C which is an Objective Structured Clinical Examination (OSCE).
Following this, senior EM registrars must complete the Fellowship of the Royal College of Emergency Medicine exam (FCEM). The FCEM has five parts: a clinical short answer question; a clinical OSCE; a management viva; a critical appraisal short answer question; and a clinical topic review viva.
These exams cover topics which assess the candidates knowledge and experience in all major areas of Emergency Medicine. Candidates often reflect that the exams are very characteristic of real clinical practice.