How competitive is A&E?

[469er]

I think I may want to specialise in A&E after my foundation training. Does anyone know how competitive ST posts are likely to be? Ideally I'd like to do it in the south east or London - not that I'd be completely unwilling to relocate, but I have a family to factor in, so that would be my ideal. Would the medical school I train at make much difference career-wise (I know the party line, but what I'm asking is if anyone knows different), and are there any specific forms of experience I should be getting along the way which would maximise my chances of getting the sort of post I want?

Not to be snotty, but I really don't want to be told that it's way too early to be planning what specialty I want to go into - I appreciate I may change my mind along the way, but meantime would really appreciate some info from someone who knows more than me.

Cheers

[Caroline M]

Can't offer any views here, but there are competitive stats available on the MMC site. Try this link, if it doesn't work pm me and I'll instruct you on the navigation

Competition Ratios

Half way down the page there is a table headed Competition Ratio Tables. You can then drill down by both location and specialty.

[469er]

Thank you kindly, Ms M, very interesting link.

I would love to hear from anyone who has personal experience of progressing through the ACCS to EM, how it's all organised, whether that's working, whether you have to reapply each year or if your pathway is guaranteed from the outset, what sort of experience(s) during med school/foundation training are useful - anything really. Scuse my ignorance.

Also, I'd especially like to hear from anyone in A&E in the KSS deanery. I noticed recently that the East Sussex NHS Trust was advertising mid-year for a whole load of SHOs for A&E this spring - what's that all about??

[Touche]

I was offered the London ACCS EM rotation but turned it down as I also wanted to do something else and luckily was offered that too.

I did an F2 job finishing with 6 months of A&E in a big London hospital. I got some middlegrade experience in the same department right afterwards. I did some research, a few audits, some teaching, all the obvious courses. One of my A&E bosses was on my interview panel too *cough*. I put down very little to support my application from my med school days, I actually stuggled to cram some of the stuff I'd done as an F1 onto my application.

Its about as competitive as you might expect and they're reasonably picky. I know this year London EM havent filled all their posts despite calling just under 3x the number of people to interview (there are reasons for this other than being picky though).

ACCS in general seems pretty well organised. You have a 3 year rotation with 6 month blocks of EM/ITU/Anaes/AM. As a core rotation it seems to be better planned than most of the other specialities. After that you can apply to Anaesthetics, EM or AM. You are not guaranteed anything after your 3 year ACCS rotation, you have to apply for a higher rotation at that point.

They might be advertising for SHOs because all ACCS posts weren't filled... or they might not have got as many ACCS doctors as they'd have liked and want some extras to prop up the rota.

Nothing wrong with thinking about things early as long as you're aware that you'll likely change your mind several times over the next few years... so don't go overboard on the speciality specific stuff (eg. my CV is ortho focused but not to the extent that I couldn't make it all fit into an EM application). Make sure you get a decent A&E stint as an F2 as its different to what many imagine. I only seriously considered it as a career after I'd had a good amount of exposure.

[469er]

Hey, thanks Touche, this is really useful info. Can I ask you a couple of other things? (Or anyone else who knows the answers, for that matter.)

I did some research, a few audits, some teaching, all the obvious courses.

Again, excuse my ignorance, but what kind of research would tend to be particularly appropriate to A&E? And what would be the 'obvious' courses? Also (and I'm blushing slightly here), what is an audit? I see the term bandied about here, but have never really known - might as well get all my stupidities into the open at once!

Make sure you get a decent A&E stint as an F2 as its different to what many imagine. I only seriously considered it as a career after I'd had a good amount of exposure.

Agreed. I've done a bit of work experience in A&E, and loved it, but someone else I know who did almost exactly the same thing in the same hospital thought it was dismal. It seems a shame, to me, that A&E occupies such a tiny amount of the curriculum in most medical schools.

One other question: Could I ask where you trained? No need to be specific. Just that I'm contemplating training outside London, but might like to work in one of the big London A&Es in the future - wondering if I'd be able to hack it if my undergrad training has been less than high-octane. From your experience, sounds like you might have a feel for the answer to this - ?

Thanks

[Touche]

Again, excuse my ignorance, but what kind of research would tend to be particularly appropriate to A&E?

Research is not all that easy to get into unless you show a ridiculous keeness at med school or do a BSc with a research component. I did some stuff on sports injuries and got a few publications out of it as part of an MSc I did after med school.

And what would be the 'obvious' courses?

The obvious courses are the life support lot: ALS/ATLS/APLS/(PHTLS). Then there is stuff like the A&E Radiology Survival Course. You can generally only do them once qualified but some have insane waiting lists (eg. 18 months for ATLS in many places). I would not worry about any of that for now.

Also (and I'm blushing slightly here), what is an audit? I see the term bandied about here, but have never really known - might as well get all my stupidities into the open at once!

Audit is about looking at what you're actually doing and comparing it to what you should be doing according to national/local guidelines. So you identify guidelines on a topic, set some objective measures based on these, collect all the relevant data from your department, compare your data to what the guidelines say you should be achieving. You will identify defecits in the care you're giving, so you then have an intervention (could be specific education for all the doctors for example), attempting to make your care better. Wait a while and then start a new audit cycle and see if your intervention has improved things. It's an ongoing process aimed at keeping standards of care high. If you're very keen you could get involved in this sort of thing as a med student (as everyone pretty much hates doing it :P).

One other question: Could I ask where you trained? No need to be specific. Just that I'm contemplating training outside London, but might like to work in one of the big London A&Es in the future - wondering if I'd be able to hack it if my undergrad training has been less than high-octane. From your experience, sounds like you might have a feel for the answer to this - ?

I trained in London. It doesn't matter where you trained though to be honest. When you start A&E you will invariably be clueless and have to develop quickly. Everyone's in the same boat no matter where they trained. There are also loads of great departments spread around the country.

[469er]

Touche, many thanks. This is all really useful information. Thank you for taking the time.

[lloyddr]

useful post by touche... thanks for it...

[CmatteRN]

There's an 18 month wait list for ALS/ATLS, etc?!?!

I know this is an older thread, but I can't help but comment. I'm applying from the states, currently a nurse here. I have taken all of these courses (the US equivalent anyways--PALS, ACLS, Trauma Life Support, etc) and was an instructor briefly for BLS. I'm kind of shocked that there would be a wait list that long. Are these courses different for doctors, or is it just that there are fewer of them?