Emergency Medicine

Section 1: Information about the writer

Dr. Muhalab Tajeldin,

Emergency Medicine ST6- UK

Section 2: What is Emergency Medicine

Emergency Medicine is a field of practice based on the knowledge and the skills required
for the prevention, diagnosis and management of acute and urgent aspects of illness and
injury affecting patients of all age groups with a full spectrum of episodic undifferentiated
physical and behavioural disorders at any hour of the day or night.-1
Emergency medicine requires decisiveness, teamwork, resilience and excellent
interpersonal skills as well as a breadth of knowledge across all facets of medicine.
It is not for the recumbent or the weak-hearted.
Emergency doctors are trained to acquire specialist skills in resuscitation and diagnosis in
the acute phase of illness, sometimes working with limited information and in an uncertain
situation. They use their clinical and interpersonal skills to recognise the seriously ill patient
and identify clinical priorities, to lead the team in the initial assessment and resuscitation,
to Construct hard and difficult decisions in a time-pressured environment where the stakes
and emotions could be high, and to deal with uncertainty whilst best caring for patients and
relieving their symptoms, or helping them to maintain their dignity and humanity in their last
moments of life.
These are what form the challenges and the thrills of Emergency Medicine practice

Emergency Medicine is a rapidly evolving speciality.

Section 3: Is Emergency Medicine for me?

• Do you enjoy variety and excitement?
• Do you enjoy dealing with acute presentations from various specialities?
• Do you hate dull days and become bored by a repeated routine?
• Do you like clinical challenge, quick thinking, action and team working?
• Do you like practical, hands-on clinical practice?
• Do you prefer a shift-based pattern of work?
• Do you like getting involved in a life or death decision making?

If you answered yes, Then Emergency Medicine is for You!

Section 4: Why Emergency medicine is fantastic?

• The Emergency Department is where the public go when they need
  help. They value the service. In return you have the privilege of
  helping people when they are most in need.
• You manage a wide spectrum of illness and injury, in patients of all
  age groups, from all section of the community.
• You see the ‘best bits’ of all the specialties, as well those aspects of
  their practice which cannot be described as such. Then you pass it
  on!
• There are no long ward rounds, having to deal with the same
  patients, or sitting for long periods of times doing the same thing
• The Emergency Department is the forefront of hospital practice.
• You work with a variety of different people with whom you share
  team spirit and camaraderie.
• Emergency Medicine attracts a wide variety of inspiring characters
  and dynamic personalities.
• There is a huge scope to develop a special interest in almost
  anything you can think of; trauma, toxicology, medical education,
  point of care ultrasound, medical education, hospital management,
  etc

Section 5: A day in your life as EM registrar

Section 6: A day in your life as EM Consultant

Section 7: Your ED team

Example of your Emergency Department (ED)Team:
o Consultant

o Registrar ST4-6,

o Middle grade, Associate specialist

o ST1-3

o Staff nurse

o Sister (female) / charge nurse (Male)

o Nurse practitioner They have a great scope of practice and a wealth of clinical experience.

§ ENPs (Emergency nurse practitioner) see certain categories of minor’s patients.
§ ANP (advanced Nurse practitioner) ANPs see minors and majors.

o EDA (Emergency Department assistant)

o Physician Assistant

Section 8: Recruitment and Training

Recruitment to the emergency medicine is on the high! UK has directly recruited many EM doctors from India who completed MRCEM. There are different ways to become a consultant in emergency medicine in the UK (please check the table below for comparison):
You may be applying to one of the following posts:
• Run-through training – Core Training – ACCS
• DRE-EM ST3 entry
• Higher Specialty Training
• fixed term (LAT, FTSTA)
• Academic Emergency Medicine

GMC Approved Training

1. Run-through ACCS
The straightforward entry point is the GMC approved runthrough 6 years training programme which constituted of 3 years of Acute Care
Common Stem (ACCS) with:
a. 18 months of Emergency Medicine and
b. 6 months of Anaesthetics,
c. 6 months Intensive Care Medicine and
d. 6 months Acute Medicine each followed by
e. 3 years of Emergency Medicine as Higher Specialty Trainee (HST).
It was not an option between 2013-2015 due to lack of positions in round 2 but started to appear again in 2016 and 2017. This will lead to a Certificate of Completion of Training (CCT) by the GMC.
National recruitment is an online application via Oriel website.
National Training website for ACCS
Two recruitment rounds:
1. Round one normally open August to November, interviews in January, job start in August.
2. Round Two normally open February, interviews March to April, job start in August

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Section 9: Medical Training Initiative

The MTI is a government authorised exchange under Tier 5 of the Points Based System
allowing overseas doctors to obtain training in the UK for up to two years.
The Royal College of Emergency Medicine’s International Sponsorship Scheme offers
Emergency Medicine training opportunities within the MTI. Successful applicants can
obtain full GMC registration without taking the Professional and Linguistic Assessment
Board (PLAB) test.
Further information on theRCEM MTI pages

Section 10: Sub specialities in EMergency Medicine:

Many trainees choose to train in other specialties:
o Paediatric Emergency Medicine, For more information click here
o Pre-hospital Emergency Medicine, For more information click here
o Intensive Care Medicine For more information click here
Some choose to develop special interest in different field for examples:
o you can develop interest in Sports and Exercise Medicine
o Academic Emergency Medicine tings.

Section 11: Interview and CV

• The Interview
  Once selected you will be contacted with details of stations of the interview and a list of documents you will need to prepare and bring with you to the interview. Common stations used in previous interviews for example:
  1- Portfolio station (either you hand in your portfolio and it will be marked based on
  the evidence you have or face to face discussion)
  2- Prioritisation scenario
  3- Clinical case discussion
• Writing your CV:
  Generally, if you are applying through the online system you will need to fill in certain sections (up to 20 pages) but an overall minimum CV should contain:
  1- Name, address, contact details email and phone
  2- Education
  3- Academic awards and achievements
  4- Employments history
  5- Course
  6- Audit and clinical governance activities
  7- Research and publication
  8- Special interests
  9- References

Section 12: Courses and Postgraduate Exams

First: Courses:
Emergency medicine is a dynamic speciality which demands highly skilful, knowledgeable, updated and motivated doctor. There is certain life support, resuscitation and ultrasound courses which are considered to be the cornerstones for the capacity building.

1- Advanced Life Support (ALS) which is adopted by the Resuscitation Council-UK

• This course should be taken in the first year of working in the Emergency Department.
• The provider certificate is valid for 4 years from the date of your course.
• For the doctors who are working in Ireland, it is recommended to take the American version of ALS which is known as ACLS -Advanced Cardiac Life Support.
• The course fee is about £485 but may vary slightly depending on the centre.
• Further information click here

2- European Advanced Paediatric Life Support –EPALS

• The European Paediatric Advanced Life Support (EPALS) course is a collaboration between the European Resuscitation Council and the Resuscitation Council (UK).
• The provider certificate is valid for 4 years from the date of your course.
• It is recommended that this course should be taken for all doctors who are working in Paediatric emergency departments.
• The course fee is about £485 but may vary slightly depending on centre
• Further information click here

3- Advanced Trauma Life Support -ATLS (American College of Surgeons)

• ATLS® program can teach you a systematic, concise approach to the care of a trauma patient. The course teaches you how to assess a patient’s condition, resuscitate and stabilize him or her, and determine if his or her needs exceed a facility’s capacity.
• It is conducted in the UK by the Royal College of Surgeons
• The Fee is £600 British pounds but may vary slightly depending on the centre.
• Further info click here

4- Training in point-of-care ultrasound (PoCUS)

• Now a days Ultrasound is an elementary skill for the emergency physician. For example, Shock and Pneumothorax are diagnosed and treated by the ultrasound.
  Thus, the Royal College of Emergency Physician included the Ultrasound in the training curriculum.
• From 2010, the higher specialty curriculum for emergency medicine incorporated
  PoCUS as a mandatory element. This means that from 2013 trainees need to be signed off at CORE level prior to CCT being awarded.
• For further information click here
• One of the approved courses by the college is Bromley Core Ultrasound Course, Bristol Emergency Medicine Ultrasound (BEMUS) Fee £375 Pounds.

Second: Examinations

From August 2016, the College is introducing a new suite of examinations, mapped to the Emergency Medicine 2015 Curriculum. Success in all components leads to the award of Fellowship by Examination (FRCEM).
The changes to the examination structure will be phased in during a two-year period to permit trainees and other candidates the opportunity to complete the existing suite of examinations.
From August 2016, the Fellowship examination will consist of the following components:

• FRCEM Primary Examination, replacing MRCEM part A
• FRCEM Intermediate Certificate, replacing Part B and Part C

And consists of:

• 1-Short Answer Question Paper (FRCEM Intermediate SAQ)
• 2-Situational Judgement Paper (introduced from Autumn 2017)

FRCEM Final Examination from AUG 2018

• Critical Appraisal (Short Answer Question Paper)
• Quality Improvement Project (QIP)
• Clinical Short Answer Question Paper
• Objective Structured Clinical Examination (OSCE)

The College continues to offer Membership (MRCEM) for candidates who have passed all the following examinations:

• FRCEM Primary (or MRCEM Part A between 1 August 2012 and 1 August 2016 or granted exemption)
• FRCEM Intermediate SAQ (or MRCEM Part B between 1 August 2012 and 1 August 2016)
• MRCEM OSCE (previously called Part C. Passed after 1 August 2012)

For more information, check the RCEM examination section

Section 13: Visa and Living information

• The regulation change very frequent. Better always to check the website on regular basis see link below
• The overall idea is non-UK or non-EEA nationals with limited leave to remain in the UK, whose employment will require a Tier 2 visa, are subject to the Resident Labour Market Test and would only be considered for appointment if there were no suitable UK or EEA national (settled status) candidates for the post.
• You will need to apply under skilled worker category also called Tier 2 General (up to 3 years)  https://www.gov.uk/tier-2-general/overview
• The fee you would expect to pay is:
  

Up to date information is available here:
https://www.gov.uk/government/organisations/uk-visas-and-immigration

Pay scale UK:

• Speciality Registrar from ST1 onward: (30,302 – 47,647 plus 50% on top banding)
• Non-training registrar jobs can either follow the above pay scale or sometimes be
  offered under SAS pay scale (37,547 - 50,391) which has no banding and based
  on the number of programmed activity (PA) each equal to half day (4 hours) which
  can be negotiated (https://www.bma.org.uk/advice/employment/pay/sas-payengland).

Living cost (UK):

• Generally living in the south west of England is cheaper than the north and south-east.
• Moreover, Scotland and Wales have better support from a social welfare point of view.
• Big cities are more cosmopolitan and provide options for food, schools, transport and entertainments. London, Manchester and Birmingham airports are the main hubs for airlines with flights to Khartoum.

Due to the nature of the emergency medicine, working in an ED mandate either you live close to the hospital with a walking distance that is safe at 4 o’clock in the morning or you buy a car. Getting an agreement with a taxi company with a discounted fare can be an option for some time but significantly costly in the long run.

Tax System (UK)
Very complicated system be careful you are paying the right tax amount and check your
payslip regularly. Detailed information here:
https://www.bma.org.uk/advice/employment/tax/tax-guidance

Child care (UK):
You will have several options for childcare:

• Nursery
• Childminder
• Aupair
• Nanny
• Further information on please click the following link
  https://www.bma.org.uk/connecting-doctors/my_working_life/b/weblog/posts/a-working-parent-stips-for-childcare

Rent a Flat:
These estimate based on 2-bedroom flat

• London area and big cities: £750 and above Per calendar month
• Outside London and big cities £500 and above

Section 14: The Wall of Thanks

It is my great honour to work with this group of dedicated and enthusiastic Sudanese
Emergency Medicine doctors. Without them, this document would not have been possible.
I would like to offer my sincere gratitude to everyone who has contributed to the content
of this document:
1. Dr Zafir Ahmed
Consultant in Emergency Medicine- UK
2. Dr Ahmed Abdalla Zeinelabden Elmagzoub
Registrar of Emergency Medicine, Mercy University Hospital-Cork, Ireland
3. Dr Dr.Mutaz Eltayeb
Emergency Medicine Registrar - Mercy university hospital- Ireland
4. Dr Ahmed Eltahir O Ali
Emergency Medicine ST4- North West deanery- UK