Emergency medicine

Emergency medicine (EM) is the new name for accident and emergency (A&E) medicine, reflecting a dynamic, rapidly evolving specialty. An average emergency department sees between 50,000 and 70,000 new patients per year and 15–30 per cent need hospital admission. There are 600 consultants working in the specialty and the numbers are set to double over the next five years. Departments are led by a team of consultants and they will often specialise in specific areas such as paediatric emergencies, medical emergencies or sports injuries.

Training pathway

Postgraduate medical training is currently undergoing change. The diagram below outlines the training programme recommended by the College of Emergency Medicine. After two years of foundation training you will seek a specialist training post, which will be part of a two-year training package and involve jobs in EM, acute medicine, intensive care and anaesthetics. The membership exams (MFAEM Parts A and B) are taken during this time (see the UK Emergency Medicine website for more details). There is a further year with experience in paediatric EM and orthopaedics/sports medicine, which leads to higher training. Full membership is needed to progress to the final three years of training. These are spent mostly in the emergency department with increasing responsibility not only for the clinical cases but also in training junior staff. In the final year you take the fellowship exam (FFAEM). There is currently an option to undertake further training in paediatric EM and in the future further qualifications in acute medicine, ITU or sports medicine may be available.

Key skills and aptitudes

The emergency department depends on the teamwork of many individuals, making teamworking and communication skills essential. You have to be adaptable; 95 per cent of the work is routine, but you never know what the next ambulance will bring. Confident humility is an unusual combination of character traits – confidence is essential to make split-second life and death decisions, but you’ll need the humility to realise how difficult diagnosis and treatment might be in challenging circumstances. Stamina and flexibility are necessary to cope with the physical demands of shifts.

Training posts and competition

There has been a rapid expansion of trainee numbers over the past few years. At present about 100 trainees per year are recruited – this may increase. Demand for training places is high; over 240 trainees applied to sit the next Faculty membership exam.

Best and worst

The highlights are the teamwork, the buzz of a resuscitation and being able to make an instant difference to a patient in pain. However, EM is a 24/7 specialty and many people find shifts difficult. The job can be very stressful, often having to deal with three or four conflicting priorities at once. Dealing with unexpected death, especially in children, can leave you emotionally drained.

Key information resources

Senior specialist registrars or consultants are a mine of information, but try not to ask questions in the middle of a busy shift!

• College of Emergency Medicine
• The Emergency Medicine Journal

Jim Wardrope MBChB, FRCS (Edin), FRCS (Eng), FFAEM is president elect of the College of Emergency Medicine and emergency medicine consultant at Northern General Hospital, Sheffield.