The way forward has to be a unified training grade. In time I am sure we
will see this 'looking forward to the day' as David Williams said last week
for our 'Royal College'. There will then be a common part 1 entrance and a
final exit exam the FFAEM. This is the way things have gone in Australia and
essentially in the US and Canada. Until then people who show a clear
committment to A&E as a career, by taking FRCS A&E must do one year of
medicine, one year of surgical related jobs and 1 year of A&E before they
can take part 2 FRCS A&E. This as preparation for a future career and a SpR
job inb A&E has to be of more value than spending 2 years in a rotation that
includes neurology, gastroenterology, nephrology and maybe 6 months A&E. As
it stands a doctor could then apply and successfully be appointed to a SpR
job in A&E without having treated children or without a decent understanding
of trauma or indeed have any surgical skills whatsoever.
Our recommendation to juniors planning a career in A&E is now to apply for
our 2 year rotation at SHO level designed for doctors wishing to persue a
career in A&E. After house jobs they do 6 months A&E, 6 months general
medicine, another 6 months A&E and 6 months orthopaedics. They take MRCP
part 1 and FRCSEd A&E part 2. During the 2 years they undertake all the
appropriate advance life support courses and are involved in audit and
research related to A&E being encouraged to present at national meetings and
submit papers to JAEM. At the end of this time if they have been successful
in their exams they can apply for a SpR post. If they have had a blip and
missed the exams they pass into phase 2 which includes 6 months
Anaesthetics/ITU, 6 months paediatrics, 6 months overseas in Australia and 6
months A&E locally again. If they still have not got the exam or a sPR job
then they are counselled about persuing a career as a staff grade.
Frankly the idea of persuing MRCP only as a route to an A&E career shows a
lack of understanding for the needs of the specialty and the way in which
emergency medicine is progressing worldwide. Trainees applying for SPR job
with FRCS A&E clearly are demonstrating a committment to A&E as a specialty
and have a better understanding of the strengths and weaknesses of the
specialty.
Dr John M Ryan
Consultant & Senior Lecturer in A&E medicine
Royal Sussex County Hospital
Eastern Rd.
Brighton
BN2 5BE
UK
Ph; 00 44 1273 696955
Fax: 00 44 1273 680627
http://www.pavilion.co.uk/users/ryanj/
http://www.rsch.org.uk/rsch/rschae.htm
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