Advice that I wish I had when applying or even thinking about applying for EM training

Pre-alert! Boring post with an avalanche of information up ahead, kindly move on if not interested in EM as a future.

I was not always interested in EM. No, unsurprisingly, I used to be interested in surgery. I completed my medical school education in Pakistan, and actually did an elective placement in surgery at a Harvard hospital. WHILE in medical school. 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 blog post – can’t put ALL my ideas in the same post now, can I? otherwise I am not going to have too much of a blog, right?). I did 3-4 years of emergency medicine as a non-training doctor back home in Pakistan, passed my PLAB exams which gave me a license to practise in the UK, and moved here 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 department of ED back home in Pakistan, and here where I started and got my bearings in this ED world, have quite a significant part to play 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 consider a future in EM to be their thing, is going to be severely bullet-pointed, for emphasis:

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, glean from them information about the various different pathways available, and what you need to do to get started, and also, of the many pathways available 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. Now there are usually two sets of criteria for application to these posts: the mandatory, or absolutely necessary requirements, where if you apply with even one criteria 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; and the lesser known and hence considered less important (but can be the difference between being offered an interview and going into the reject pile) preferable criteria, which aren’t mandatory, but 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. Most important question? Where do you get this information. Ask around, read a blog (!) or google search ‘Person specifications for application to EM training‘ followed by the year when 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 it achievable by application deadline this year? Ask yourself, is it really worth applying this time round with minimal criteria? Or can you look a bit better (atleast on paper!) next year and have a better chance? At any rate, if you have all of the mandatory criteria, it can not hurt to apply. If nothing else comes of it, then you can atleast 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. Get a National Insurance number, make sure you have at least 1 major course out of the way, ALS always helps, wherever you are applying, even if it is a non training course and I mean, come on, it should technically make you feel good about yourself and give you the confidence to handle a critical emergency, should it suddenly arise while you are let’s say standing in line at the Costa in the hospital and the woman in front of you collapses. Yes, ALS is definitely a plus to have on board, but do consider doing at least one other course – ATLS or APLS, or even the European versions of them – depending on availability, and your calendar of events for the rest of the year, your 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. Also, make sure you are a member of medicolegal indemnity/insurance organisations like MDS or MDU.

Look at exam dates, if there is an exam requirement, make sure the exam requirement is met, atleast 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 an exam and 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.

– Looking at the list of person specifications, you will notice that every requirement has an indication of when it is infact 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. Audit. Re-audit. It is so important, not just as a requirement for your application, but also for your GMC appraisal etc, and for your own growth as a physician, to participate in some form of quality improvement projects, 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, or just any specialty actually, 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, but you should create a timeline where you spread the findings from your audit like the joy it will bring (it will not) to everyone concerned, for example your department staff, and let them know how to improve things. Keep reiterating the how-to-improve-things and keep reminding them till you achieve a little things-have-improved situation. THEN YOU RE-AUDIT THE WHOLE THING AGAIN, after a certain time period to allow for improvement, see if there is any 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 in some ongoing audit or you could give an idea for an audit of your own.

Get started on an e-portfolio, and started 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 can not provide any documentary proof of it, then you will be second to the person who can show signed competences of having done even 25 intubations. MAKE EVERYTHING COUNT. Read more about this here.

While this is in no way an exhaustive list – it is still a work in progress and I have still got so much to learn – but I do feel that this list forms the basis for entering into any training post, 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!”