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    Hi, I'm a final year medical student,

    I was recently told that I should "get an A&E rotation in fy1/fy2" as you need that to locum in the future,

    I have a few ignorant questions:
    1) how true is this?
    2) when in my career would I need to locum? Would I locum if I wanted to take a break from formal training, but needed extra money? Do people also locum to make extra money on top of their regular jobs?

    Apologies, completely new to all this
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    [1] Not true. *What might have been meant, is that if you want to locum in an A&E department, it is particularly helpful to have done an A&E job before. *But an A&E job is not a prerequisite to doing all locums.

    [2] People do locums for lots of reasons. *Yes, sometimes to earn extra money on top of their regular job. *This is usually because there are rota gaps in their current hospital, and people agree / get coerced into covering the shifts at set hospital locum rates. *I recently did some locums at the hospital I worked in a year ago, because they were very short, and I did this through the hospital's locum bank because they already knew me, rather than through an agency. *Otherwise yes, people might do locums if they're not in a training job. *This can either be on a shift by shift basis at different hospitals and specialties, organised through a locum agency, or sometimes on a fixed term basis such as 6 months covering maternity leave. *In these sorts of situations, where you're doing it through an agency, the agency will send your CV to the hospital showing what jobs / experience you've done, and the hospital will decide based on that whether they want you to fill the shift needed. *This is where for example it makes a lot more sense to have someone covering an A&E shift who's already done an A&E job and knows the ropes. *A paeds department would be highly unlikely to take on someone for a locum shift who'd never done paeds before, etc.*

    My anecdotal experience is that generally, some medics do a few extra shifts in their own department / a department they worked in previously, in a hospital that they already know, organised through that hospital's locum bank. *I know very few people who've signed up for a locum agency.*
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    Funnily enough this is exactly my plan. I am potentially interested in EM as a long term career, and either way I think it's a very useful rotation to have as you're bound to learn a lot, but part of my plan is also to supplement an F3 year out with A&E locums.

    As an aside, most places do not do A&E for FY1 because you don't have the experience to practice independently. Similar to why GP is never an F1 job. Even if you could get it at F1 (there are some hospitals that do it) everyone I've spoken to has strongly advised against it
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    The salient points are covered above, but in my experiences with regards to A&E locums, policy varies by trust.

    I know trusts that are desperate for anything that moves to fill vacant posts and will pay relatively well for it. They don't care what you have worked in before. There are other trusts that will want you to have had some form of acute medical experience, be it in A&E or MAU etc... There is also a trust I know of which will let external locums fill posts/shifts regardless of their experience but will not let internal locums (i.e. hospital junior doctors) fill them unless they have had previous rotations there.
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    (Original post by Ghotay)
    As an aside, most places do not do A&E for FY1 because you don't have the experience to practice independently. Similar to why GP is never an F1 job. Even if you could get it at F1 (there are some hospitals that do it) everyone I've spoken to has strongly advised against it
    I did A&E FY1. I much preferred it to having to do it in FY2. I was lucky in that it was my last FY1 rotation but there is no difference between an FY1 at that stage and an early FY2. Therefore, it is not correct to say that A&E (and GP) jobs are not offered because of lack of experience.

    It would be more correct to identify that FY1s cannot make the decision to admit or the decision to discharge a patient. They also cannot prescribe out-of-hospital medications. The lack of these is somewhat obstructive to the core function of an A&E junior doctor who will be making these decisions for every patient. Having to run each and every patient by a senior doctor, and the feasibility of this within a unit, is the reason some trusts do/don't offer FY1 A&E placements. It also explains why FY1s cannot be GPs.
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    (Original post by Kyalimers)
    It would be more correct to identify that FY1s cannot make the decision to admit or the decision to discharge a patient. They also cannot prescribe out-of-hospital medications. The lack of these is somewhat obstructive to the core function of an A&E junior doctor who will be making these decisions for every patient. Having to run each and every patient by a senior doctor, and the feasibility of this within a unit, is the reason some trusts do/don't offer FY1 A&E placements. It also explains why FY1s cannot be GPs.
    That makes a lot of sense actually, thanks for explaining!
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    A&E is an excellent rotation to arrange in FY1/FY2. You see a wide range of pathology, learn to make decisions (usually in a supportive environment with senior colleagues immediately to hand), and develop your own approach to different presentations (chest pain, abdominal pain, rash, etc). You can then use these throughout the rest of your career.*In short, seeing lots of undifferentiated patients in a four month period will make you a much better doctor than any other rotation.

    If you have done A&E before, you can find A&E locum shifts to work at in almost every hospital on almost every day. My current hospital needs between 3 and 6 locums in A&E every day of the year. This means that you will never go short or work and/or hungry !! *There are locum shifts available in most specialties but there is less of a desperate need than in A&E.*For this reason, A&E locums are often better paid than those in other specialties and, fortunately, A&E locums are more interesting than shifts in other specialties as well.
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    Just for the sake of pointing it out - there are GP FY1 jobs. And A&E F1 jobs. They're just few and far between for reasons mentioned, that the amount of supervision for a provisionally registered Dr renders them somewhat redundant. IMO you get more out of these things when you are able to be a full decision maker. That's the same for all jobs really, however both of those jobs generally rely on a single person taking the main decisions :P

    I picked to do an A&E job for F2 as an experience thing. I think it will always have merit in the same way I think a GP job will always have merit - between the two they are the gateways into specialist medicine and to know and understand them is a good thing. And it's true about A&E locum shifts generally wanting people who have already worked in A&E. But the whole NHS is desperate for locums. It may be most acute in A&E but if you've not got that background then don't worry.

    Having said all that, I personally would trade in my A&E job for almost anything haha. I've come to realise how important work/life balance is, something you don't realise IMO until you actually have work to interrupt your life balance and people telling you when your meagre days of holiday are. I've no interest in A&E or indeed in being an A&E locum, and I need my free time to keep sane. I forsee a period of great mental depression in my future. @[email protected]
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    I've got an A&E placement in F2 and I'm dreading those unsocial hours already.

    (Original post by seaholme)
    Having said all that, I personally would trade in my A&E job for almost anything haha. I've come to realise how important work/life balance is, something you don't realise IMO until you actually have work to interrupt your life balance and people telling you when your meagre days of holiday are.
    But I did strategically look for a placement that had A&E in the hopes that it would make me better AND so I could locum in the future.
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    I know one of my local trusts - Northumbria - have F1s on A&E. From what I've heard from the juniors working there, they either seem to love it or hate it. I'm not sure I would feel confident enough as a newly-qualified in A&E, just from what I've seen at work . But I don't doubt that experience would be invaluable!
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    (Original post by thtgreeneyedgirl)
    I'm not sure I would feel confident enough as a newly-qualified in A&E, just from what I've seen at work . But I don't doubt that experience would be invaluable!
    It will depend very much on the amount of support available in each department. At its most basic, an A&E job can mean just seeing a patient, presenting their case to a senior, then implementing the plan with as much help as you require. As common things are common, you quickly become good at some presentations (simple wounds, minor head injuries, abdominal pain, etc) and can start to manage these independently. This will provide you with an approach to various problems that you will encounter as a FY1/FY2 on the wards out of hours when such support might not be readily available.

    The worst case scenario is (of course) working as a FY1 in an A&E where the only senior support is from SHOs +/- unenthusiastic middle grade doctors.*

    I worked as an FY2 in a very professional ED where every case (however simple) had to be shared with an SpR/consultant. This meant the senior doctor had to click on the patient with you and agree with your plan before you could proceed. The result was that I learned something about every single patient, even sometimes about those I thought I could manage independently. It made be a much better doctor going forward.
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    Majority of hospitals like to see a doctor with an A&E rotation so approx 6 months experience when looking to work locum in A&E. Any questions regarding locum just ask
 
 
 
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