> > Also does A&E appear on any SHO training rotation? How can anyone choose
to come into A&E as an SPR if there is no exposure on a rotation? > A&E may
be in a critical care component of SHO training I think.
Indeed, A&E was conspicuously absent from Sir Liam's original proposals! Of
the 8 basic specialist training programmes, none seemed to include a clear
pathway for training towards emergency medicine (i.e A&E as we currently
know it). The original 8 were surgery, medicine, obs, paeds, anaesthesia,
GP, psyche and path, all proposed as two-year SHO programmes. The needs of
our specialty was subsequently acknowledged in the responses received
following last year's consultation, with particular mention of the need for
a programme in Emergency Care [sic].
I suspect that this additional programme, "Emergency Care", has been
deliberately left a little vague. This may, indeed, represent a rather
generic programme, to include elements of critical care medicine together
with accident & emergency medicine. One can see the attraction of a
programme including, for example, posts in emergency medicine (i.e. A&E),
acute medicine, intensive care medicine and anaesthesia. Such a programme
would prepare trainees for entry into higher specialist training towards a
career as an emergency physician (i.e. A&E), an acute general physician
(notwithstanding the presence of a dedicated medical programme), an
intensivist or an anaesthetist (notwithstanding the presence of a dedicated
anaesthesia programme), but such a programme would clearly enrich the
trainee's approach to any of these subsequent subspecialties.
This type of programme would, however, further encourage the
"medicalisation" of our specialty, which seems rather inevitable these days,
but I for one feel that we must continue to encourage our more surgical
trainees into our specialty. We could, of course, aim for a more focused
accident & emergency medicine programme, to include the critial specialties
mentioned above, but also to include a surgical specialty or two.
Alternatively we need to ensure mechanisms will exist whereby we can take
trainees off the end of a surgical programme, for example, and further
prepare them to divert into higher specialist training in accident &
emergency medicine, or simply accept direct recruitment to HST in A&E
(although I suspect that these trainees would be disadvantaged in open
competition). The same should hold true for trainees who initially follow
the pure medicine pathway or the pure paediatrics pathway, as we will need
to attract such trainees also (and it is unlikely that these "pure"
programmes will include an A&E component in the future as this will form
part of the foundation programme). As some correspondents rightly pointed
out - and I paraphrase - the demands of becoming a generalist can far
outweigh the demands of becoming a specialist...
Adrian Fogarty
A&E Consultant
Royal Free Hospital
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