I was not always interested in Emergency Medicine. Unsurprisingly, I used to be interested in surgery. I completed my medical school education in Pakistan, and did an elective placement in surgery at a Harvard hospital whilst still a medical student. It doesn’t get any more committed than that.
Fast forward a few (read quite a few years!) and I found Emergency Medicine (or it found me, but that’s a story for another post). I did 3-4 years of Emergency Medicine as a non-training doctor back home in Pakistan, passed the PLAB test, which gave me a license to practice in the UK, and moved there to really try and get into a training post. I got into a non-training trust grade post as an ED SHO, and I have to admit, (credit where credit is due) my experiences in both the ED back home in Pakistan, and the ED where I started and got my bearings in the UK, both played a significant part in finally landing me this current training post I am in.
My advice to my peers and readers of this blog who are considering, or might be considering a future in Emergency Medicine to be their thing, is as follows:
- Start early. Prepare yourself. Arm yourself with as much information as possible about the program or specialty, about its general requirement and then its finer, more intricate details. Look at the RCEM website, speak to college tutors and colleagues who are within the department. Gather information from them about the various different pathways available, about what you need to do to get started, and also, of the many pathways available, find out which one is best suited for your unique experiences and skill set.
- Pick a pathway that meets your requirements (or vice versa, you meeting its requirements, it’s all one happy marriage!) and set to work fulfilling the criteria for application. There are usually two sets of criteria for application to these posts: the mandatory and preferable criteria. The mandatory criteria are those that are absolutely necessary requirements, where if you apply with even one criterion missing from this list your application will go directly into a large waste bin the size of Suffolk that has accumulated many a CV since the olden days. The preferable criteria are lesser known, and hence considered less important. These, however, can be the difference between being offered an interview and going into the reject pile. If you have one or more of these, your application becomes a lot more likely to be considered over someone who say, has all the mandatory requirements but none of the additional preferred ones. Where can you find this information you ask? Ask around, read a blog (!), or do a Google search for ‘Person specifications for application to EM training‘ followed by the year in which you will be applying, as they tweak the requirements every year. Look at the criteria now, and make a list of the things you have, and a list of things you still need to work on.
- Then decide on a timeline: is an application achievable by the application deadline this year? Ask yourself the question, is it really worth applying this time round with minimal criteria? Or could you perhaps look better (at least on paper!) next year and improve your chances by waiting until then to apply? At any rate, if you have all of the mandatory criteria, it cannot hurt to apply. If nothing else comes of it, then you can at least consider it a learning experience, filling out the application and making yourself aware of the timescale and what needs to be done etc.
- Get a few things out of the way, as soon as possible. If you do not already have one, get a National Insurance number. Make sure you have at least one major course out of the way. ALS always helps, wherever you are applying, even if it is for a non-training post. ALS will also make you feel good about yourself and give you the confidence to handle most critical emergencies. ALS is definitely a plus to have on board, but do also consider doing at least one other course, ATLS or APLS, or even the European versions of them, obviously depending on availability, calendar of events for the rest of the year, study leave, and your budget. Never underestimate budget restrictions and always have that in the back of your mind. You can’t book an exam or a course or…do anything essentially, if you can’t afford it. You should also make sure that you are a member of a medicolegal indemnity/insurance organization, such as the MDS or MDU.
- Look at exam dates. If there is an exam requirement for the post you are applying for, then make sure the exam requirement is met. At the very least you should make an effort towards it (an honest effort, not just applying for an exam just so you can let someone know that yes I will be appearing for this exam, but I intend to party my free time away). Factor in exam prep and study leave for the exam, as well as travel and stay expenses if the exam is out of city, which it usually is. Also factor this in with your plans to participate in a course like ALS, ATLS etc, so that these don’t clash.
- Check which specifications are necessary for your application. When looking at the list of person specifications, you will notice that every requirement has an indication of when it is required by. So it will say, for example, that A is required by the time of application, and B is required by the time of interview, and C is required before the start of the program. So you can factor those elements in, and change the timeline of your requirements as needed.
- Audit. Audit. Re-audit. The importance of audit cannot be understated, not just as a requirement for your application, but also for your GMC appraisal, and for your own personal growth as a physician. Get involved in anything from a minor audit to actual active research, anything that may serve to improve patient care from any aspect in the future. The topic of the audit can be relevant to your specialty, or a general one, but what people tend to ignore is the fact that an audit is not just a ‘tick-off-from-a-checklist-and-forget-about-it-now-that-I-am-done’ thing. Instead you should create a timeline where you spread the findings from your audit to everyone concerned, for example to the staff in your department, and let them know how to improve things. Keep reiterating how to improve things, and keep reminding them until you achieve a situation where things have improved a little. THEN YOU RE-AUDIT THE WHOLE THING AGAIN to see if there is actually any real improvement. You could re-audit it again, and again. Interviewers and the people considering your application want to see commitment to a goal, and what better way to show commitment than to keep trying to address an issue that you think is a problem and can be improved. Speak to your supervisor or any consultants, they will be glad to receive some help with an ongoing audit, or you could provide an idea for an audit of your own.
- Get started on an e-portfolio. This is absolutely essential! Also start getting any and all competencies signed off as early as possible. What you do matters, and make every bit count. If you have intubated 500 patients, but cannot provide any documented proof of it, then you will be second to the person who can show signed competences of having done only 25 intubations.
While this is by no means an exhaustive list, it is a work in progress and I still have much to learn, I do feel that it forms the basis for entering into any training post, and not just emergency medicine. You could embellish your CV in any way to make it better suited to a certain specialty, but these particular little things form the crux of any training application.
In the end, I would like to add a forgotten little adage: “Anything worth doing, is worth doing right.”
So make sure you do it right. Good luck!
Medical Exam Prep would like to thank Dr. Usama Basit for contributing this post.
Dr. Basit is an Emergency Medicine trainee in the UK. He writes about his own personal experiences as a blog series, which can be followed here: www.themaddocblogs.com