My life as an Emergency Medicine SHO

Where are you in your training?

I am currently a Clinical Teaching Fellow at Leicester University. I have finished my FY1 and FY2 and this is currently my “F3” before applying for ACCS (Emergency Medicine) next year.

Where are you working?

Leicester – in the LNR deanery.

What stage did you decide on your speciality & what other specialities were you considering?

I firmly decided on A&E during my second rotation in FY2. I had enjoyed most of my previous foundation posts, particularly vascular and O&G. I very seriously considered continuing with O&G as I particularly enjoyed the practical skills. When I started A&E, I realised the bits I enjoyed most were the acute presentations in these jobs, which I still got to experience in EM.

What brought you to your decision?

I was fortunate to have a job in an excellent department with super friendly people, who helped me feel very comfortable there. I’ve always liked the unpredictability of A&E. It was exciting, interesting, and fitted with my adrenaline-seeking nature – and maybe my slightly dark sense of humour!

I love the variety and not being sure who might come through the door next. A consultant at a careers workshop I attended as a medical student told me, ‘You’ll find your specialty when you find your tribe.’ I only really understood when I started Emergency Medicine.

In terms of the job itself, I don’t mind doing nights and weekends as my partner is also a medic, and I found EM more flexible in terms of getting annual leave and time off together. Obviously, this is quite area-dependent. I also like the procedural skills involved.

The deciding factor for me was discovering the flexibility that EM offered. Most of my senior colleagues had various other commitments, from teaching and pastoral care at the university or with trainees, to being involved with the GMC, to being involved with St John’s Ambulance and other large events, to management!

How have you found the exams so far? How did you revise for them?

I have yet to sit the FRCEM primary, but I’m currently revising using a combination of core textbooks (Grey’s, Moore’s, Kumar and Clark etc.), YouTube videos and an online question bank. Hopefully, it’ll do the trick!

What aspects of being an EM SHO have you enjoyed the most? What has been hard?

My favourite area in A&E is definitely the Emergency Room (resuscitation), as I like the focus that an acutely unwell patient provides. You also tend to get immediate (or at least relatively quick) feedback on whether your management is working.

One of the best aspects of being EM SHO is the camaraderie in the department, particularly with other MDT members. I found there to be much less of a hierarchal structure compared to other specialties, but equally a clear team leader when support was needed.

The hardest part for me is seeing the re-attenders frequently. Those that attend regularly due to issues with homelessness, social care or lack thereof (particularly in the elderly), drug or alcohol abuse and other mental health issues can be incredibly frustrating. Often the resources needed to break the cycle don’t exist. It can be heartbreaking to be unable to offer useful solutions, particularly when the deficit is due to finances or the recent withdrawal of services. Often people refuse the help that is available, which can be difficult to understand and empathise with!

What’s the best thing about being an EM SHO?

The variety, for sure!

What’s the worst thing about being an EM SHO?

The relentlessness, particularly in winter. The pressure when the department is busy tends to be constant and can feel never-ending! Having to apologise for long waits and deal with (understandably) irate patients and families can grind you down.

Many junior doctors in EM worry about getting a life changing decision wrong because of the pressure you’re under. How would you reassure junior doctors thinking of going into in EM about this?

Trust your colleagues and trust your gut! It is a worry, but you realise that there are many ways to safety net, and that we are all only human.

I tend to be quick to ask for advice from senior colleagues from A&E and other specialties (even if it’s just to glance at my patient from the end of the bed) and I also try to be totally honest with my patients and explain my thought process as much as possible. For example, ‘I don’t think you require admission at the moment as X, Y and Z are within normal limits. However, I am not 100% sure of the source of your symptoms, so if things change or deteriorate, please seek medical advice ASAP.’ Also, if I feel something is ‘off’ but can’t put my finger on it, often it’s down to my inexperience and someone more senior will be able to identify the problem.

I tend to ask myself ‘is the patient safe to…?’ rather than ‘what is the diagnosis?’

How do you deal with the increased demand on the Emergency department?

Take your breaks, look after your colleagues (nursing, healthcare and admin staff included – it’s amazing what baked goods can do for morale!), and always try to recognise when you are learning, even if that is learning how to hone non-medical skills! Also, if it’s going to take longer to ask someone else to do the job than doing it yourself, you should probably just get on with it.

How can we protect training as the pressures continue to increase?

I think the best training I have had personally has been from consultants in pressurised situations – a good teacher who knows how to make you feel confident and enthusiastic is worth their weight in gold. LRI employs clinical staff as teaching fellows and has consultants who are on the floor in teaching roles, and therefore are extra to the staff on normal shifts. I always found this to be effective without compromising too much service provision, as you could fit case discussions and supervised procedures between patients. I also think study leave for training programme teaching days needs to be protected.

Some specialties criticise EM doctors for the lack of continuity of care beyond triage that patients may get in the ED. What are your thoughts on this?

I think this unfortunately can happen but I don’t see continuity of care as being hugely relevant in ED. By being seen by a number of professionals in ED separately, it allows multiple points at which patients can be kept safe and comfortable and have multiple medical opinions.

What do you think are the most critical personality traits that a doctor should possess for a career in EM?

Ultimately, I think you need to be calm in a crisis, you need to be confident in your own knowledge (and equally, recognise you own limits!) and it helps to be naturally curious and assertive.

You also need to be thick-skinned as, like GPs, you will always have other specialties with different priorities tutting at your management.

On the whole, pragmatism and resilience are important but will be traits that you continue to develop throughout your career and will be nurtured by your experience.

A concern of many trainees applying for EM training is the work-life balance; how do you manage to maintain a work-life balance?

It is definitely a challenge and I’m not convinced I’ve got it right just yet!

I tend to be able to switch off fairly easily after a shift, because I found the handover process more robust than in other departments I had worked, and therefore didn’t tend to worry in the same way when I got home. In general I try to ensure that I am meeting with friends, family or spending proper time with my boyfriend at least twice a week, and I meet friends for breakfast as often as we go for dinner.

I also try to take my annual leave to have blocks of time off and I find physical distance really helps and so I save throughout the year to spend on holidays!

What’s your number one piece of advice to junior doctors who are considering applying for emergency medical training?

Get as much experience as possible! EM is all about being hands-on.