student115
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Hey guys,

I understand that you can dual qualify in certain specialties e.g emergency medicine & intensive care and that the programme is slightly extended so that competencies can be met.

However, is it possible to dual specialise in areas which don't have an official programme - e.g emergency medicine & anaesthetics? Or would you have to complete the required number of years of the other specialty once one is completed?

Thanks very much for any replies
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Spencer Wells
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(Original post by student115)
Hey guys,

I understand that you can dual qualify in certain specialties e.g emergency medicine & intensive care and that the programme is slightly extended so that competencies can be met.

However, is it possible to dual specialise in areas which don't have an official programme - e.g emergency medicine & anaesthetics? Or would you have to complete the required number of years of the other specialty once one is completed?

Thanks very much for any replies
You would not normally be able to complete dual training programmes in unrelated fields simultaneously. There are only a few recognised programmes that allow dual CCTs (acute med + specialty, ICM + anaesthetics/ED/acute med) and these programmes have been GMC approved.

You would therefore have to do the two programmes one after the other, and then convince an employer to employ you as a consultant in both, which would be difficult. I do not know of anyone who has ever done this.
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MonteCristo
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This isn't done very often and lots of people will tell you that it's impossible for various reasons. They are probably wrong.

You could formally train in one specialty (e.g. anaesthetics) and then put together a portfolio to demonstrate that you have achieved the competencies for the second. This would mean a Certificate of Completion of Training (CCT) in Specialty 1 and a Certificate of Eligibility for Specialist Registration (CESR) in Specialty 2. You would then be on both specialist registers.

You could, for example, take two years out of an anaesthetics training programme to pick up the extra skills that you would need to join the emergency medicine specialist register. You'd already have your anaesthetic and intensive care competencies. If you did ACCS, you might even be able to demonstrate some of the necessary acute medicine competencies. You'd then just have to complete the emergency medicine + paediatric emergency medicine competencies. 2-3 years might be enough for this.

For what it's worth, you wouldn't actually need to be on the specialist register of Specialty 2. NHS trusts can only appoint candidates that are on a specialist register as substantive consultants. You do not have to be on the specialist register of the specialty to which you are being appointed as a consultant. This is how anaesthetists (and occasionally physicians) are appointed as ITU consultants despite not being on the intensive care medicine register. It is how some paediatricians and acute physicians are working (sometimes at exorbitant locum rates) around the country as EM consultants.

If you could satisfy an NHS organisation that you were capable of working in two specialties, they could therefore appoint you as a consultant in both. Spencer Wells is right that it might be difficult to convince a trust that you could work safely in both jobs and that this fulfils their service needs. The reality is that you would probably end up having a restricted practice in one or both specialties, e.g. just resus/majors in the ED.

As it currently stands, most trusts would probably snap you up as a competent person to plug the ED consultant rota. They may well find a way to let you keep up an anaesthetic interest as the price of buying your soul as an EM consultant. This is all up for negotiation and would depend on your skill set, how much the two departments wanted you, and the various egos/personalities involved. It might be that a trust genuinely wants a 50% anaesthetist and are delighted to find a candidate who's willing to offer the other 50% of their time to battle the queue in the ED.

Incidentally, if you are just looking for an adrenaline fix, both EM docs and anaesthetists can train in pre-hospital medicine and fly around in red helicopters if that's their interest...!

Just my tuppence.
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student115
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(Original post by Spencer Wells)
You would not normally be able to complete dual training programmes in unrelated fields simultaneously. There are only a few recognised programmes that allow dual CCTs (acute med + specialty, ICM + anaesthetics/ED/acute med) and these programmes have been GMC approved.

You would therefore have to do the two programmes one after the other, and then convince an employer to employ you as a consultant in both, which would be difficult. I do not know of anyone who has ever done this.
(Original post by MonteCristo)
This isn't done very often and lots of people will tell you that it's impossible for various reasons. They are probably wrong.

You could formally train in one specialty (e.g. anaesthetics) and then put together a portfolio to demonstrate that you have achieved the competencies for the second. This would mean a Certificate of Completion of Training (CCT) in Specialty 1 and a Certificate of Eligibility for Specialist Registration (CESR) in Specialty 2. You would then be on both specialist registers.

You could, for example, take two years out of an anaesthetics training programme to pick up the extra skills that you would need to join the emergency medicine specialist register. You'd already have your anaesthetic and intensive care competencies. If you did ACCS, you might even be able to demonstrate some of the necessary acute medicine competencies. You'd then just have to complete the emergency medicine + paediatric emergency medicine competencies. 2-3 years might be enough for this.

For what it's worth, you wouldn't actually need to be on the specialist register of Specialty 2. NHS trusts can only appoint candidates that are on a specialist register as substantive consultants. You do not have to be on the specialist register of the specialty to which you are being appointed as a consultant. This is how anaesthetists (and occasionally physicians) are appointed as ITU consultants despite not being on the intensive care medicine register. It is how some paediatricians and acute physicians are working (sometimes at exorbitant locum rates) around the country as EM consultants.

If you could satisfy an NHS organisation that you were capable of working in two specialties, they could therefore appoint you as a consultant in both. Spencer Wells is right that it might be difficult to convince a trust that you could work safely in both jobs and that this fulfils their service needs. The reality is that you would probably end up having a restricted practice in one or both specialties, e.g. just resus/majors in the ED.

As it currently stands, most trusts would probably snap you up as a competent person to plug the ED consultant rota. They may well find a way to let you keep up an anaesthetic interest as the price of buying your soul as an EM consultant. This is all up for negotiation and would depend on your skill set, how much the two departments wanted you, and the various egos/personalities involved. It might be that a trust genuinely wants a 50% anaesthetist and are delighted to find a candidate who's willing to offer the other 50% of their time to battle the queue in the ED.

Incidentally, if you are just looking for an adrenaline fix, both EM docs and anaesthetists can train in pre-hospital medicine and fly around in red helicopters if that's their interest...!

Just my tuppence.
Thank you very much for the info!
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belis
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Why would you want to? You can't simultaneously be a consultant in ED and Aesthetics. Unless you are some sort of Schrödinger's cat.
If you can't decide at this stage you could do Acute Common Stem post Foundation to give yourself more time before needing to settle.
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lyra1987
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(Original post by belis)
Why would you want to? You can't simultaneously be a consultant in ED and Aesthetics. Unless you are some sort of Schrödinger's cat.
If you can't decide at this stage you could do Acute Common Stem post Foundation to give yourself more time before needing to settle.
Forgive me if this is a stupid question. And I may not be wording it very clearly.

If you were to do ACCS (anaesthetics) and then decided that you really wanted to do ED. Would you have to start again/reapply on the ACCS (EM) track or CT (EM)? Or would you be able to gain competencies needed for EM by extending your current training or applying for an LAT post?
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belis
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(Original post by lyra1987)
Forgive me if this is a stupid question. And I may not be wording it very clearly.

If you were to do ACCS (anaesthetics) and then decided that you really wanted to do ED. Would you have to start again/reapply on the ACCS (EM) track or CT (EM)? Or would you be able to gain competencies needed for EM by extending your current training or applying for an LAT post?
No such thing as a stupid question. The FAQ explains better about changing the 'parent speciality'. It is difficult at the moment but they are looking into making it easier.

In the grand scale of things, a couple of years extra in training doesn't make a big difference and many people do change specialities and start from scratch. In child and adolescent psychiatry we have a few ex-paediatricians and ex-GPs. Additional experiences make them well-rounded consultants.
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MonteCristo
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(Original post by lyra1987)
If you were to do ACCS (anaesthetics) and then decided that you really wanted to do ED. Would you have to start again/reapply on the ACCS (EM) track or CT (EM)? Or would you be able to gain competencies needed for EM by extending your current training or applying for an LAT post?
It's mad that you can't change parent specialty, particularly to go from anaesthetics to EM, which is the opposite direction to most ACCS trainees!

If you did complete ACCS anaesthetics and wanted to jump ship into EM, you could just take some time afterwards to meet any missing competencies and then apply directly into ST4. Your main obstacle would be the exams as you need the full MRCEM for ST4 entry.

It wouldn't be the end of the world to do this for a while post-ACCS, though, as you can make a small fortune as an ED locum in the meantime.
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