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.
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

quick-tip-e1366327676423Emergency 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
  • 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,

quick-tip-e1366327676423Emergency physicians thrive on challenge and change.

Section 5: A day in your life as EM registrar

6:00 PM

6 PM You are starting a late shift. You arrive to find the department full. You were asked to start in the “Paediatric Area”, you see a mix of unwell children and minor injuries. You notice that many of the cases you see were driven by
parental anxiety and were due to the hyperactive nature of children.

8:00 PM

8 PM you were asked by your consultant to receive a priority call from the
ambulance service. a 6 months old child been fitting continuously for about 30
minutes. You provisionally diagnose a status epilepticus. A paediatric emergency
call was triggered. You received the child in the “Resuscitation Room” (resus) and
the paediatric team and the anaesthetic team joined you in treating the child. The
paediatric registrar managed to quickly secure and IV access, as you were going
through the ABCDE of standard APLS. You administered IV lorazepam and aborted
the seizure. The anaesthetist intubated the child. You made a referral to the ICU
doctor on call. The child was eventually transferred to PICU.

10:00 PM

10 PM You moved to help clearing the large number of patients in the “Minors Area” of the department. These are usually a mix of minor injuries and simple complaints cases. You can go through them quickly. You can help guide the team of Clinical Nurse Practitioners who normally see these patients in your department. You were a bit frustrated by what seems a regular response to a common clinical question: “Did you take any painkillers for your injury? “Oh no doctor, I did not like taking painkillers” or “I did not like painkillers”. You saw one patient who had badly cut themselves while drunk. You enjoyed practicing suture skills you recently acquired in the recent Regional Nerve Blocks Course you had attended.


Midnight. An ambulance alert arrived in resus. A man with chest pain, whose ECG showed an ST segment elevation myocardial infarction. You see the patient, confirm the paramedics diagnosis, and quickly activate STEMI call. The patient was transferred urgently to the Catheterization Laboratory ‘’cath lab’’ for Percutaneous Coronary Intervention (PCI). Thanks to the clinically able paramedics and your rapid response.

12:30 AM

12:30 AMYou moved to the “Majors Area” of the department for the remainder of your shift. The patients are piling up in the department, and there was a shortage of hospital beds that night. Your patients were a woman with bleeding in early pregnancy, an elderly woman from a nursing home with urinary sepsis, a man with neck pain after a road traffic collision and a confused elderly lady who was found lying in the floor for 36 hours.

2:00 AM

2 AM. It was the end of the shift. You handed over some clinical tasks to one of your colleagues who was working the night shift and you leave the department. There was no need to set the alarm clock, as you were again on a late again
tomorrow, so you can enjoy a lie in.

Section 6: A day in your life as EM Consultant

5:00 PM

5 PM. You were starting an on-call shift. The department was full of patients as you arrived. There were “breaches” (patients who had been in the department for more than four hours), owing to a lack of hospital beds. You checked to make sure all appropriate investigations had been ordered for the patients waiting to be seen. This will help making clinical decision quicker when these patients are being seen. You walked around the department with the Shift Leading Senior Nurse, and reviewed some of the seriously ill cases in resus.

6:00 PM

6 PM. You supervised a registrar giving procedural sedation to reduce a dislocated shoulder. The registrar then asked you to fill out an online Direct Observation of Procedural Skills Assessment (DOPS) for them.

7:00 PM

7 PM. You noticed the wait was building up in “Minors” as you looked in the computer screen at the Patient Flow Management software. You identify many cases that can be seen quickly. You assign a registrar and one of the nurses to help him with treatments to go through these cases.

8:00 PM

8 PM. The emergency Red Phone rang to announce an alert. A 53-year-old man with bradycardia and hypotension and no response to atropine is coming in an ambulance. His ECG shows an unusual broad complex tachycardia. When the patient arrived to resus room his VBG revealed hyperkalaemia. You started standard treatment for that and asked the medical registrar to see the patient in Resus.

9:00 PM

9 PM. You were asked by one of your junior doctors for advice about a oneyear-old child with bizarre burn marks in their buttocks. You were concerned about non-accidental injury and asked your junior doctor to call the on call paediatric doctor to admit the child to the paediatric ward and tell their consultant. You asked one of the senior nurses to look into the electronic system for any social services records.

10:00 PM

10 PM. You were called to the Clinical Decision Unit (CDU), an observation ward in the department, to see a depressed patient wanting to discharge herself against medical advice. You manage to persuade her to stay voluntarily and ask the emergency department junior to request an urgent mental health assessment.

11:00 PM

11 PM. The department was under control. Most the waiting patients has either been seen and sent home or transferred into the hospital. You let the registrar and senior nurse know that were leaving. They know you were on-call and they could call you for advice or ask you to come back to help with a serious clinical problem. Fortunately, there were no phone calls during the night

quick-tip-e1366327676423Emergency physicians work with patients of all ages & all presentations.

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


2. FTSTA / LAT: locum appointment for training and fixed Speciality Training Appointment. These are approved training post for up to one year. You will need to be appointed to core training post after this year. Uptodate information will be at the RCEM website and Health Education England
Apply to ST4 posts
Hybrid 1. Apply to ST4 posts: These are becoming less in numbers after the run-through option was introduced 3 years ago. It requires evidence of competencies in Anaesthetics, ICU and Acute Medicine, the first two can be hard to get and no guarantee to be accepted when you apply to complete the training. National recruitment is run by Yorkshire and the Humber deanery see National EM ST4 recruitment page. This page will give you up to date information about:

  • – Person specification
  • – ST4 Portfolio guide
  • – ST4 Applicant handbook
  • – Interview information
  • – Portfolio levels of evidence form

The application normally open in February, interview in March for jobs to start in August

Hybrid -DRE-EM
2. DRE-EM (Defined Route of Entry – Emergency Medicine): Allow you to start
training as ST3. You then spend another 12-18 months to finish missing ACCS
competencies (which can vary between trainees) before starting ST4. From ST4 on
the trainee continues as any other run-through trainees. It started in 2014 as a 3
year pilot and there is suggestion it might now continue in 2018. See
. Some deaneries do offer ST3 posts individually and essentially it follows the
same track of the national ST3 DRE-EM.
These options will lead to CESR-CP (Certificate of Entry to Specialist Register –
Combined Programme)
( It sounds like
CESR but actually the process is closer to CCT with a specific awarding day.

Non-Training posts
Non-Training posts
1. Trust-based schemes: several trusts (Hospitals/Health boards) started to have their local schemes with rotations in all necessary specialities to complete the competencies. Examples are Manchester Royal Infirmary and Derby Hospital.
Trust grade jobs: most trusts (Hospitals) now are willing to arrange for their non-training registrars to have secondments in other necessary specialities so they can complete their competencies. It is on an ad-hoc basis and usually after the registrar works with the trust for a considerable time.
These option will lead to application of CESR (Certificate of Entry to Specialist Register). CESR application can be between 1500-2000 pages and usually takes more than 6 months to complete.


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 the
RCEM 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)
  • The fee you would expect to pay is:
Who you’re
applying for
Apply (outside
The UK)
Extend or switch
in the UK
Extend or switch
in person in the
UK (premium
You £575 £664 £1,164
All dependents £575 each person £664 each person £1,164 each person

Up to date information is available here:

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 (

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:

Child care (UK):
You will have several options 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

Although the information contained in this guide should be fairly accurate, and every effort has been made to check Its details. However, it is possible that some errors have been missed or that some information may have been revised. The information provided by this website is believed to be true and accurate at the date of publication.