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    Hi all,

    just wondering if anyone on here is currently doing EM training or thinking about it...what would you recommend as the best resources for FRCEM in terms of books and websites...
    Also when is the best time to sit FRCEM primary?

    Any general advice/tips/opinions re EM training would also be welcome!

    I'm currently an F1.
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    (Original post by Anna1988)
    Hi all,

    just wondering if anyone on here is currently doing EM training or thinking about it...what would you recommend as the best resources for FRCEM in terms of books and websites...
    Also when is the best time to sit FRCEM primary?

    Any general advice/tips/opinions re EM training would also be welcome!

    I'm currently an F1.
    Thought about it. Then did it. Then realised I value my social life.

    I would get a feel for the rota first. There's a reason why retention is such a big issue for EM. Why rush with exams... ACCS gives you plenty of time to do it, especially during the anaesthetics chill...
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    (Original post by Anna1988)
    what would you recommend as the best resources for FRCEM in terms of books and websites... Also when is the best time to sit FRCEM primary?
    I am using this site which has a large bank of questions in both the old (MRCEM Part A) and new (FRCEM Primary) formats.

    A lot of people will tell you to delay sitting exams until you have some clinical experience on which to base your studying. My view on exams is very different and that they are best sat early because:

    (1) The first parts (whether MRCP Part 1, MRCS Part A, or FRCEM Primary) tend to cover a lot of basic knowledge (anatomy, physiology, biochemistry) that will be fresh from medical school but fading once you've inserted your 500th cannula...

    (2) Getting them done early means they are out of the way so that you can relax (or focus on other things) earlier. It also avoids the risk of not passing them "in time" (can't progress to ST4 without FRCEM Primary and Intermediate or complete CMT/CST without MRCP/MRCS). This is particularly an issue for people that find themselves having to sit some parts multiple times.

    (3) They are a vehicle for studying while you work. I found I got much more out of my jobs (and more made sense earlier) because I was working towards postgraduate exams at the same time. The FRCEM is necessarily so general that it will be useful for all of your jobs.
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    Hey, thanks for the advice, that is very helpful. What's your opinion on when to apply for ACCS? would you say apply straight from F2 or have a year or two of clinical fellow jobs in EM then apply?
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    (Original post by Toiletpaper8)
    Thought about it. Then did it. Then realised I value my social life.

    I would get a feel for the rota first. There's a reason why retention is such a big issue for EM. Why rush with exams... ACCS gives you plenty of time to do it, especially during the anaesthetics chill...

    So what have you chosen to do instead of Emergency Med?
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    (Original post by Toiletpaper8)
    Thought about it. Then did it. Then realised I value my social life.

    I would get a feel for the rota first. There's a reason why retention is such a big issue for EM. Why rush with exams... ACCS gives you plenty of time to do it, especially during the anaesthetics chill...
    Agreed on trying it and its lack of life first, I'm doing A&E right now and I think I've written my resignation letter about 50 different times in my head each day I drag myself back into work. It's only the knowledge that it will be finite that stops me writing it for real. Not being melodramatic but I never could have imagined just how much I would hate this job!

    Anyway, IMO the earlier you do exams the better. Why not, they'll be out the way and you'll be more knowledgeable. Doing FRCEM is good but equally MRCP part 1 isn't too hard and would count on applications too.
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    (Original post by seaholme)
    Agreed on trying it and its lack of life first, I'm doing A&E right now and I think I've written my resignation letter about 50 different times in my head each day I drag myself back into work. It's only the knowledge that it will be finite that stops me writing it for real. Not being melodramatic but I never could have imagined just how much I would hate this job!

    Anyway, IMO the earlier you do exams the better. Why not, they'll be out the way and you'll be more knowledgeable. Doing FRCEM is good but equally MRCP part 1 isn't too hard and would count on applications too.
    What are you thinking of doing long term if not ED?
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    @Anna1988 You'll hear this a lot from people who've rotated through A&E and most will think you are mad for choosing it as a career. My advice is to visit your own A&E (+/- email whichever consultant is responsible for education/training) and find a couple of trainees or consultants to meet "off the shop floor" to discuss things. There is a huge retention problem in EM but most of the trainees I know love it and wouldn't have been satisfied in any other specialty. I haven't yet resolved this paradox but can only think that EM trainees are a self-selected group - if you get through ACCS without switching to anaesthetics (which seems to be the default bail out option) then you're probably the right person for the job.

    I personally think there is a lot to be said for the variety ("the most interesting 20 minutes of every specialty", shift working (you actually go home on time...), opportunities for specialisation and/or dual accreditation (paediatric EM, pre-hospital, ICU), developing a hugely saleable skill set (wanted almost everywhere in the world), teaching opportunities (keen medical students and wide-eyed FY2s seeing/managing things for the first time), a flat hierarchy (team working is the rule in most EDs and doctors/nurses tend to be a little more "high octane" than in other places) and the other elements of running a busy ED (management, hospital politics, human factors, quality/process improvement, interface with ethics/law, medicolegal work, etc). Newly qualified EM consultants can more or less choose any hospital in the UK (?? world) to work at because few (even household names) are fully staffed.

    Anti-social hours working is (of course) a huge issue to consider. That said, this is going to become even more of a feature of other specialties (medicine, surgery, etc) in the future as the direction of travel is towards senior doctors being available on site regardless of time and day.

    As it stands, many EM consultants are paid 2 hours per PA instead of the usual 4, which effectively means that one night shift is the same as working two days. A lot depends on how each department is run but this can mean a lot of "time off" as compensation for working anti-social hours. The general rule is that 4 PAs in a 10 PA job (i.e. 40% of an EM consultant's time) should be away from the shop floor (e.g. admin, teaching, etc). Things are not as rosy for trainees (but the training is shorter than many other specialties) and we'll have to see what is left when the new Consultant Contract comes into being.

    DOI: T&O SpR who spends most of his spare time working in various EDs and is very tempted to put down roots in one of them...
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    (Original post by Anna1988)
    What's your opinion on when to apply for ACCS? would you say apply straight from F2 or have a year or two of clinical fellow jobs in EM then apply?
    ACCS EM should snap you up after FY2. I can't see any advantage to prolonging your time as an SHO unless a very special opportunity came up, e.g. something very lucrative in a sunny location.

    If you really wanted to take time out in the UK, you'd be better off doing so after ACCS when you could locum as an ED SpR (£70+/hr without negotiating very hard, i.e. 3 days per week for £100,000/year) and so fund some time off. Or you could take time out later on to dual accredit in ITU or anaesthetics, spend a year as a helimed doctor, etc.

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    (Original post by MonteCristo)
    @Anna1988 You'll hear this a lot from people who've rotated through A&E and most will think you are mad for choosing it as a career. My advice is to visit your own A&E (+/- email whichever consultant is responsible for education/training) and find a couple of trainees or consultants to meet "off the shop floor" to discuss things. There is a huge retention problem in EM but most of the trainees I know love it and wouldn't have been satisfied in any other specialty. I haven't yet resolved this paradox but can only think that EM trainees are a self-selected group - if you get through ACCS without switching to anaesthetics (which seems to be the default bail out option) then you're probably the right person for the job.

    I personally think there is a lot to be said for the variety ("the most interesting 20 minutes of every specialty", shift working (you actually go home on time...), opportunities for specialisation and/or dual accreditation (paediatric EM, pre-hospital, ICU), developing a hugely saleable skill set (wanted almost everywhere in the world), teaching opportunities (keen medical students and wide-eyed FY2s seeing/managing things for the first time), a flat hierarchy (team working is the rule in most EDs and doctors/nurses tend to be a little more "high octane" than in other places) and the other elements of running a busy ED (management, hospital politics, human factors, quality/process improvement, interface with ethics/law, medicolegal work, etc). Newly qualified EM consultants can more or less choose any hospital in the UK (?? world) to work at because few (even household names) are fully staffed.

    Anti-social hours working is (of course) a huge issue to consider. That said, this is going to become even more of a feature of other specialties (medicine, surgery, etc) in the future as the direction of travel is towards senior doctors being available on site regardless of time and day.

    As it stands, many EM consultants are paid 2 hours per PA instead of this usual 4, which effectively means that one night shift is the same as working two days. A lot depends on how each department is run but this can mean a lot of "time off" as compensation for working anti-social hours. The general rule is that 4 PAs in a 10 PA job (i.e. 40% of an EM consultant's time) should be away from the shop floor (e.g. admin, teaching, etc). Things are not as rosy for trainees (but the training is shorter than many other specialties) and we'll have to see what is left when the new Consultant Contract comes into being.

    DOI: T&O SpR who spends most of his spare time working in various EDs and is very tempted to put down roots in one of them...
    Reading this made me very excited, I really want to work in EM in the future. Although it's apparently quite common for med school hopefuls to feel this way and turn to something else not long after experiencing EM. However, I currently work on a ward with close ties to the ED and feel like I have a better idea than most of what to expect.

    Sorry for hijacking the thread, but EM is incredibly interesting to me.
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    The ED I work in currently (as a medic) has a really good team spirit and really good nurses and it does make it tempting.

    But every SHO there says the same thing - the rota is just a killer. You're doing 2 early shifts then 2 nights then back to earlies then a couple lates, random days off during which you can't do anything but catch up with sleep, 1 in 2 weekends... and not a single one I've met wants to continue. In fact its the most dreaded rotation, despite the lovely team.

    Why the UK can't do what other countries do - put you on a month or two of nights, then a break followed by 1 or 2 months of lates etc, so that your sleep isn't totally ****ed... I'll never know.
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    (Original post by Marathi)
    Reading this made me very excited, I really want to work in EM in the future. Although it's apparently quite common for med school hopefuls to feel this way and turn to something else not long after experiencing EM. However, I currently work on a ward with close ties to the ED and feel like I have a better idea than most of what to expect.

    Sorry for hijacking the thread, but EM is incredibly interesting to me.
    I think a lot of people enjoy EM to an extent, and I don't disagree with anything in that poster MonteCristo posted, but there are some significant negatives which it doesn't mention, and which are enough to put off a lot of people, myself included.

    The rota is the biggest killer. The nature of EM means it will always be a 24/7 specialty, and we are moving more and more towards 24/7 consultant shop floor presence, so it's not even like you can slog through a crappy few years and look forward to it getting easier. There are lots of different variations on how you can arrange shifts, and some are definitely more manageable than others, but there's no getting away from the fact that you will be working more evenings, nights and weekends than anyone else. It's ok for 6 months as an FY2, but even now (early 30s, middling level of registrar) that kind of pattern would be too much for me. Add in childcare/other commitments and it rapidly becomes unworkable.

    For me, I would happily work all day in resus/proper majors, seeing sickies and sorting them. I know that's the bit that some people are scared of, but I love it. I also actually enjoy some bits of minors - suturing, pulling joints etc - but there's a lot of crap in between that grinds you down, especially when it comes with a side order of shouty patients/relatives.

    The other thing that bothered me was that as an EM consultant, you spend a lot of your time people-managing and fire-fighting, especially to chase that wretched 4 hour target. You might lead the odd trauma/arrest call (though you might equally likely be supervising a junior doing it) but you don't actually see many patients solo.

    Having said all that, we're crying out for enthusiastic EM doctors, so if you are keen, don't let me put you off!

    (Original post by nexttime)
    Why the UK can't do what other countries do - put you on a month or two of nights, then a break followed by a 1/2 months of lates etc, so that your sleep isn't totally ****ed... I'll never know.
    They actually did this for the MAU SHOs in one hospital where I worked - they hated it and complained to the GMC.
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    I'm just finishing 6 months in ED.
    Loved the team of people I worked with - really fantastic, amazing teamwork and support. They've been like my second family given the amount of time I've spent at work. I think the team makes or breaks an ED job, and I've been very lucky.
    I learnt a LOT of medicine. Lots of confidence in managing emergency situations.
    Often got frustrated at the number of people who came to ED who should have been seen by their GP.
    Loved the variety of things and being the first person to see / assess.
    Bit frustrating sometimes having to relinquish / refer patients on within 4 hours and wondering what happened next - but there are usually ways of finding out.
    The rota was a KILLER. I have spent most of the last 6 months either working or sleeping. I'm in my mid thirties and found it hard To be fair, it was the middle of winter, but it was exhausting.
    My perspective as a single person who lives on my own is that ED rotas can be very lonely - you rarely see anyone except your work colleagues. All my shifts were 10 hours, most of them twilights. Finish work at 2am, go home, eat, spend a bit of time de-stressing from the day = go to bed around 4-5am. Get up at midday again, more or less time to get ready to go back to work again, my friends are already at work, no-one around to see for that 1-2 hours in the middle of the day.
    Overall, I'd say that I chose this job mainly for the experience it would give me, but the reality is that I have actually enjoyed it a LOT more than i thought I would. I'm not sure that I could have done that rota and that intensity for much more than 6 months, but it's been good and I will miss it.
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    (Original post by Helenia)
    They actually did this for the MAU SHOs in one hospital where I worked - they hated it and complained to the GMC.
    Yeah I don't get the impression it would be popular here, even though it makes so much more sense imo. No more having to switch sleep back and forth, no more finishing Sunday night then working again 8am Tuesday morning...

    I didn't even consider the option until talking to a Canadian (or maybe Australian?) doctor. They'd normally do 2 months of nights then no more night the whole year. - they were horrified to a hilarious degree when i said I worked 3 or 4 nights every 3 weeks with days shifts in between. They couldn't understand, or even believe to be honest, how we dealt with such jetlag on such a regular basis, kept talking about health implications etc. I kind of wish I'd had the ED rota, which was way worse, to hand :p:
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    (Original post by junior.doctor)
    My perspective as a single person who lives on my own is that ED rotas can be very lonely - you rarely see anyone except your work colleagues. All my shifts were 10 hours, most of them twilights. Finish work at 2am, go home, eat, spend a bit of time de-stressing from the day = go to bed around 4-5am. Get up at midday again, more or less time to get ready to go back to work again, my friends are already at work, no-one around to see for that 1-2 hours in the middle of the day.
    Tbf, even when in a relationship, working in ED is still quite lonely. I was living with Mr Helenia (who is a non-medic with a fairly normal hours job) and there would be weeks where we barely saw each other. I did at least manage to have a holiday with him as our rota had fixed leave built in - and that's when we got engaged - but during normal working periods we were ships that passed in the night.
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    (Original post by Anna1988)
    Hey, thanks for the advice, that is very helpful. What's your opinion on when to apply for ACCS? would you say apply straight from F2 or have a year or two of clinical fellow jobs in EM then apply?
    clinical fellow jobs would surely be AFTER ACCS ? as after foundation programme you'd be looking at LAS F2 or 'standalone 'SHO'

    Clinical fellows proper up the middle grade rotas
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    (Original post by zippyRN)
    clinical fellow jobs would surely be AFTER ACCS ? as after foundation programme you'd be looking at LAS F2 or 'standalone 'SHO'

    Clinical fellows proper up the middle grade rotas
    Some places have "junior clinical fellow" posts which are essentially non-training SHO jobs. I did one straight out of FY2, though in ICU rather than EM.

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    (Original post by Helenia)
    Tbf, even when in a relationship, working in ED is still quite lonely. I was living with Mr Helenia (who is a non-medic with a fairly normal hours job) and there would be weeks where we barely saw each other. I did at least manage to have a holiday with him as our rota had fixed leave built in - and that's when we got engaged - but during normal working periods we were ships that passed in the night.
    How do you feel the ED rota compares to the medical rota especially at Reg level? Cause some of the medical rotas look pretty hideous too with lots of nights plus one or two med regs having to deal with the entire hospital overnight
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    (Original post by MonteCristo)
    @Anna1988 You'll hear this a lot from people who've rotated through A&E and most will think you are mad for choosing it as a career. My advice is to visit your own A&E (+/- email whichever consultant is responsible for education/training) and find a couple of trainees or consultants to meet "off the shop floor" to discuss things. There is a huge retention problem in EM but most of the trainees I know love it and wouldn't have been satisfied in any other specialty. I haven't yet resolved this paradox but can only think that EM trainees are a self-selected group - if you get through ACCS without switching to anaesthetics (which seems to be the default bail out option) then you're probably the right person for the job.

    I personally think there is a lot to be said for the variety ("the most interesting 20 minutes of every specialty", shift working (you actually go home on time...), opportunities for specialisation and/or dual accreditation (paediatric EM, pre-hospital, ICU), developing a hugely saleable skill set (wanted almost everywhere in the world), teaching opportunities (keen medical students and wide-eyed FY2s seeing/managing things for the first time), a flat hierarchy (team working is the rule in most EDs and doctors/nurses tend to be a little more "high octane" than in other places) and the other elements of running a busy ED (management, hospital politics, human factors, quality/process improvement, interface with ethics/law, medicolegal work, etc). Newly qualified EM consultants can more or less choose any hospital in the UK (?? world) to work at because few (even household names) are fully staffed.

    Anti-social hours working is (of course) a huge issue to consider. That said, this is going to become even more of a feature of other specialties (medicine, surgery, etc) in the future as the direction of travel is towards senior doctors being available on site regardless of time and day.

    As it stands, many EM consultants are paid 2 hours per PA instead of the usual 4, which effectively means that one night shift is the same as working two days. A lot depends on how each department is run but this can mean a lot of "time off" as compensation for working anti-social hours. The general rule is that 4 PAs in a 10 PA job (i.e. 40% of an EM consultant's time) should be away from the shop floor (e.g. admin, teaching, etc). Things are not as rosy for trainees (but the training is shorter than many other specialties) and we'll have to see what is left when the new Consultant Contract comes into being.

    DOI: T&O SpR who spends most of his spare time working in various EDs and is very tempted to put down roots in one of them...
    How are you finding life as a T&O SpR? both in terms of what you do and the hours and rotas.
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    (Original post by Anna1988)
    How do you feel the ED rota compares to the medical rota especially at Reg level? Cause some of the medical rotas look pretty hideous too with lots of nights plus one or two med regs having to deal with the entire hospital overnight
    Oh, being a med reg is a hellish job, no doubt about it. But that's more from the intensity and insanity of the on-calls rather than the rota itself. No doubt some are worse than others, but while they will have to do some lates/nights/weekends, it won't be as many as an ED doc does, and their "normal" day will be 8/9-5ish. There often isn't really a "normal day" shift in ED - on my SHO rota there was 1 week of 8-5 in 16 weeks!.
 
 
 
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