Tips for Locuming in a New Specialty – Emergency Medicine

You may have chosen to do an F3 year for lifestyle reasons, to try out different specialties you didn’t get during your Foundation rotations, or to gain more experience in a specialty you’re particularly interested in. Of course, if you’re a current F2 or F3, you might've missed out on rotating on to different specialties because of the coronavirus pandemic.

Whatever the reason, at some point you may find yourself working in Emergency Medicine for the first time having no previous experience in it, which can be a daunting prospect!

So, to help you with that challenge, this article explains what your daily workload will be like, talk through common clinical scenarios you’ll face, and share some tips to ensure you’re prepared for starting the job!

Where Will I Cover?

Most hospitals have a similar spread of clinical areas you’ll be asked to work in as an Emergency Medicine SHO, and in different units you may cover both a paediatric ED area as well as adult ED.

Minors – This may cover minor injuries, and there may be a separate Minor Injuries Unit in the area or attached to the hospital

Majors – This will be for medical or surgical patients with a variety of problems who are reviewed by A&E or specialty doctors.

Triage – In some hospitals there are also junior doctors who work on triaging patients coming through ED to help stream them more efficiently to the right services. This can be referring them to specialties in the hospital, streaming them through the main A&E department, or sometimes streaming them to a GP out-of-hours (OOH) service attached to A&E.

Paediatric ED – Some district hospitals may have this included in their main ED, but in large Trusts with separate children’s hospitals they tend to have their own ED.

Resus – This tends to be where very unwell or unstable patients are taken via ambulance or are streamed from the front door in severe cases.

What’s the Day-to-Day Like?

Patients can be referred by themselves on a walk-in basis, through 999, through 111, through their GP, or through a walk-in centre or GP OOH.

You’ll usually be asked to clerk patients and make a management plan, for example requesting investigations and initial treatments.

You’ll see a wide variety of clinical presentations, so one day is never the same. There are some common presentations that you’ll see a lot of, for example chest pain, abdominal pain, shortness of breath, and a variety of injuries in Minors.

Work in ED depends a lot on your ability to work in a team, as it’s definitely a team effort and you’ll get to know your colleagues very quickly.

Most clinical skills are performed by support workers or phlebotomists in ED, but you’ll still sometimes need to do cannulas, bloods, and blood gases. You may also be asked to do some suturing on minor wounds from time to time.

Depending on your previous experience, you might be confident enough to discharge and refer patients to inpatient specialties independently, but it will be expected early on that you’ll need to present most patients to a senior colleague and check your management plans with them.

Referring patients to specialties or asking advice from specialty colleagues is something you’ll become familiar with very quickly as well.

If you decide a patient can go home, you’ll usually write a quick ED discharge note to the patient’s GP so they’re aware of the patient’s attendance.

You could also be called to help in emergencies if a patient is in arrest or peri-arrest. Usually your role in these situations will be to assist with life support measures, sometimes to cannulate, take bloods, or do blood gases. Alternatively, you might just need to help in general, such as scribing, gathering equipment, or checking observations.

Our Top Tips

    1. Try to get some taster experience first to try it out beforehand. Some units will want you to have some experience of working in ED before you start there as a locum.

    2. Practise presenting cases, as you’ll be doing this every time you ask a senior for advice and refer to an inpatient specialty.

    3. Read up on any common conditions you might manage in ED, for example chest pain. There are plenty of resources out there to help you, such as the TeachMe Series or the Oxford Handbook of Emergency Medicine.

    4. Use the Trust guidelines to help you, including antibiotic guidelines.

    5. Be sure to take your breaks. It’s a fast-paced, hectic area, and you’ll need to make the most of the opportunity to rest and recharge.

    6. Don’t see any new patients in the last thirty minutes of your shift. You won’t have enough time to do everything for them. It’s usually better for you to use your last half-hour to help your colleagues finish off any jobs for their patients than to end up handing over a patient who you haven’t been able to fully manage.

    7. Don’t be afraid to ask for help, and make the most of the whole multidisciplinary team!

Working in ED is very different than other specialties you may have experience in, and you’re likely to need a lot of support and advice at the beginning, but this is completely normal and expected. Your seniors will be very approachable and helpful, and the team you have around you will help to develop your decision making skills.

If you follow the above advice, the process of working in Emergency Medicine for the first time will be easier and less daunting. By taking our tips on board, you’ll be able to hit the ground running when you start.

Best of luck!

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Specialty-Specific Guides

We're also working hard to provide you with a guide for each of the main specialties, giving you tips on how to settle into those departments. These will be especially useful if you haven’t rotated through that specialty in your Foundation Training rotations before.

Tips for Locuming in a New Specialty – Paediatrics

Tips for Locuming in a New Specialty – General Medicine

Tips for Locuming in a New Specialty – General Surgery

Tips for Locuming in a New Specialty – Obstetrics & Gynaecology

Tips for Locuming in a New Specialty - Trauma & Orthopaedics (Coming soon)

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This article is part of a wider series, supporting doctors like yourself with a comprehensive set of guides to ensure your F3 year is a success. These guides cover everything from initial planning, options for moving abroad, help with finding work, and tips for making the most of the experience. Click here to visit our F3 Resource Hub to explore the full list of guides and articles.

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