Exams – what to do, what not to do – and when to do?!

Having recently passed the FRCEM (Primary) – I have yet to decide what my next step is going to be. I start my second year of training in 4 weeks. I had initially planned on a practical approach to training requirements, such as trying to get atleast 1 exam (check!) and 1 course (ALS/ATLS/APLS) per year of training, and though I have not yet done another course (I did my ALS in 2015!) this year and ideally would like to do another course this year – I am getting more and more inclined towards taking the next part of the FRCEM, known as the intermediate part. I am wondering whether that would be a good idea. Everyone I encounter seems to think that is a good way to go. One of my consultants even feels the intermediate might be an easier exam to take than the primary, since it is clinical oriented and has to do with what you deal with on a day to day basis rather than the facts and figures of physiologyanatomymicrobiology and the other basic sciences. So it tends to be easier for someone who is working in an environment that gives them good amount of clinical exposure to day to day EM cases. Thoughts, anyone?

The whole examination schedule is a bit of a confusion at the moment – well, let’s face it, examinations are very confusing anyways, atleast for someone like me. So let me break it down for you, if you were as confused as i was – if you weren’t, good on you and you can move on!

WHAT IT USED TO BE
It used to be a membership exam, which entailed 3 parts and got you a ‘Membership by examination’ of the Royal College of Emergency Medicine, UK (which used to be just the College of Emergency Medicine until about 2014 when it was given the status of a Royal college, in essence converting the MCEM into the MRCEM) – the first part was the written, true or false patterned exam. It dealt with all the basic sciences (physiologyanatomymicrobiology), and the format was 50 questions with 4 parts each (so in essence 200 questions) each with a true/false answer. This was followed by a 2nd part, the MCEM B which was a clinical knowledge exam, also written. And then came the MCEM C, the practical or “multiple stations of interaction, examination, history taking, counselling etc” exam. Pass all three and you gained the membership of the RCEM. This was the prerequisite for someone training, or interested in training, in emergency medicine needed to pass before being considered for a higher training post (the ST4 onwards stint in a ST1-6 training program). After entering ST4, and before the end of ST6 you were required to sit for the FRCEM (used to by the FCEM) exams which were the Fellowship of the RCEM exams – pass the 5 parts of that (yes FIVE! hideous, I know!) and you can move on to a consultant post – a specialist in the field of emergency medicine.

WHAT IT IS NOW:
They are now in somewhat of a transition period. They are starting to phase out the MCEM/MRCEM exams as a requirement for trainees in the UK at least – after 2018 I believe it won’t be a requirement at all. They have now coalesced the MRCEM and the FRCEM exams into one single entity, called the FRCEM exams, which entails three parts. The first part is the basic sciences bit, the equivalent of the MRCEM A, and is called the FRCEM (primary) – *please click here to get to the post about my experience with this exam*   followed by the FRCEM (intermediate), which as I understand consists currently of 1 part, the written clinical oriented short answer questions exam but as of a few months later (autumn 2017) there will be a ‘part 2 of the part 2’ a second component of the Intermediate exam. This bit, called the Situational Judgement Paper or the SJP for short (and for convenience!) is more of a management type exam that is once again a written exam like the SAQ. But I have no idea what else it entails; more on that in a later post! But as it stands right now, the FRCEM intermediate is just the clinical written exam.

I am yet to figure out what is the counterpart of the MRCEM C, the practical bit of the previous set of exams, in this new-fangled exam scenario. I have been told however that you can take the part C exam of the MRCEM and if you are able to do that before August 2018, then you have 2 pluses: you are exempt the SJP (which means its the counterpart of the MRCEM C?) and you get an official membership degree, the MRCEM, in addition to the FRCEM degree when you complete it.

The third and final part of the FRCEM exams is the FRCEM (final) which is basically what the original FCEM exam used to be – with a slightly different format/ and 1 or 2 parts either exchanged to something else or dropped completely from the list.

As I understand, you need the FRCEM  primary and intermediate before you can be considered eligible to progress from ST3 to ST4 as an EM trainee. The rest you can complete thereafter. You have 6 attempts at each part, previous attempts at their counterparts do not count – so if you have attempted and failed the MCEM A, those failed attempts won’t count when you attempt the FRCEM primary, it will be a clean slate that you start off with. If you fail a 6th time, and can explain away the reason for failing as a genuine distraction/trigger for failing – the college does consider and may allow you to take the exam a 7th time but that is to their discretion and is dealt with on a case by case basis. You are also allowed an extension of 6 months of your rotation, from ST3 – to allow you to pass the exam and move to the 4th year of training.

Non-trainees or doctors not working in the UK can still choose to obtain the MRCEM by examination, and take parts A, B and C of the MRCEM; it carries weightage in India, Pakistan, Sri lanka (not sure) and UAE/Dubai/Middle East. If you are in a UK based training program in emergency medicine you automatically become a member of the RCEM by association – so the MRCEM is now technically obsolete. It is still a good exam to have on board, a great feather in the cap.

I am just beginning my journey in the EM training field so my experience with the rest of these exams is minimal. I will update this post as and when I prepare/take the other exams, and/or find out more knowledge/updates about the various parts/schedules/content. Or it may be in a later post, the link of which I would put up here. Till then, I sincerely hope I have not confused you further!

FRCEM (Primary) – Done and dusted!

So I am happy to report that the results of the recent FRCEM (primary) exam were announced this evening – and I am proud (read ecstatic!) to share that I passed it! *takes a bow* (if you are interested in questions from the exam, read about that in a separate post here)

This is why I have been slightly out of the blogging scene for the past few weeks – prepping for the exam, juggling the ARCP for my first year of training and what has been very likely the hardest and longest and hottest summer stretch I have ever endured (and I am from Pakistan!) But I am back with the proverbial bang!

And I bring with it the novelty of experience.

It’s not a difficult exam per se – but it is an exam that requires commitment, and time and energy. Be ready to make that commitment. It’s a new exam, only started in Autumn 2016 I believe.

Back in the good old days when I was a (very) junior doctor back home in Pakistan, I had the luxury of having ‘many’ weeks off in lieu of exam prep – the job itself was intense but i had no other commitments; i.e training, portfolio, assessments, ARCP, etc. For this exam, I was working in your regular, run-of-the-mill A&E department in the UK, as a 1st year trainee. I decided to take the exam, decision was taken in January, I booked an online question database then, and I booked the exam in mid February, but I didn’t really get a good momentum going initially, and was still in 2 minds. Why? Because of the ARCP which is an assessment of all your competencies for a required year of training that you have managed to accumulate over the period of the past year, and a panel of judges basically sits and decides whether your performance (based on these signed competencies) is good enough to warrant your progression to the next stage/year of training. So this year was to be my first ever ARCP and coincidentally the exam fell on the exact same date as the ARCP, so in addition to the preparation of the exam, I had to focus on my assessments/requirements for ARCP – all to be juggled along side a full time job in the A&E as one of the juniors. It is doable folks.

So in bits and bobs I started my prep. I had that textbook of emergency medicine, but I must admit I never got beyond the first 5-7 pages of it! Doing the questions from the question bank is what helped me pass along with (as I said) youtube videos. I took a 4 month subscription for the FRCEM exam prep website – previously known as MCEM exam prep website. (‘tom-aye-to, tom-aah-to’). They have a good database of questions fortunately of the SBAQ type as well as the older true/false format. I have ready in many places that you could use any of the other websites/question banks as well.

On my days off, I aimed to do 50-100 question (see, I made you laugh there!) Who am I kidding, I barely got 30 done on a good day – these questions came with explanations, why this option is right, and why the others are wrong, along with a short description of the topic that the question deals with. I inevitably began making a habit of taking pictures of the explanations in my cellphone, and I went back to them again and again, for example before going to bed, or while waiting for my wife/son to wake up in the morning on my rare days off. I found this habit helpful, as you may not retain some of the information that you read, but if you go back and go through it again, or atleast if not all of it, then maybe just the major salient points, it is bound to stick to you.

On my days where I was working, I tried doing a few questions while at work, on my phone, between patient. That was a bad idea. Not only did I not have enough time to do even a single question justice – I also did not retain too much due to the lack of concentration in a busy A&E department. Ditched that idea fast. I did however vow not to waste any of the days I was working though, so after a busy shift, I used to come back, rest, recuperate or sleep (mostly slept) thanks to my wife who really upped her support game and banished me to a separate room in the house at all hours of day or night, waking or asleep – no diaper duty, no bath time no sleep time with the baby – just the books, fooding and my laptop. Where was I? Yes – days I was working, depending on what shift I had done, I still tried to get a good solid 3 plus hours of ‘mcqsing’ as I called it. On days that I was on morning shifts, I came home by 5 pm, straight to bed, slept for an hour and a half or 2 – woke up – tea/food/family time for an hour or 2 and then hitting the books (or laptop in this case) from 10 pm onwards up until 2-3 am – then 5+ hours of sleep and a repeat of this. Or on the afternoon shifts (2pm/4pm to 10 pm or midnight) similarly I used to come back home, freshen up, spend a minuscule amount of time with the family before they dropped off to sleep and then ‘mcqsed’ till the wee hours of morning, going to bed at 5 am or thereabouts, to wake up just in time for lunch and off to work. Night shifts were a bit more difficult, and I sort of gave up on trying to cram anything in my head during the 4-5 night stretch we have – the hangover like state I was in during the night shift stint was not really amenable for any further insult to the brain by forcing it to swallow any other bits of information/mcqs.

I also youtubed a lot of videos – specially anatomy ones, and one or two for physiology and microbiology. There are a lot of good ones out there. I focussed on upper and lower limb anatomy the most, along with the plexuses. You can just search for them under ‘anatomy, mcem or mrcem’.

My strategy towards the middle/end of my prep was to focus mostly on the maximum yield subjects – broadly anatomy and physiology which carried the most weightage in the actual exam, with 60 questions from each subject (out of a total of 180 questions!) Followed by significant input from microbiology/pharmacology/pathology. I used to do 3 sets of 20 questions in a row – the first set being anatomy, second physiology and the 3rd annoys the others, but I kept the first two sets the same, due to its weightage. Anatomy threw me, as it was basically learning a new something I had learnt almost 13-14 years back in the early medical school years! I think it was safe to say I had forgotten most of it, despite having a refresher course during my stint at the USMLE exams. But I digress. I found the following topics high yield, and got an inkling from my various forays into the question banks that these were important enough to be tested and warranted more attention (or repetitive attention) from my end.

ANATOMY

– Upper limb (muscles -attachments and function, nerves, bones, blood vessels) -Lower limb (Same as above) – brachial plexus – abdominal wall layers – blood supply of the heart – borders of the heart – contents of spermatic cord/inguinal canal – Sacral plexus – Optic nerve lesions – cranial nerve basics – triangles of the neck – foramina of the skull and their contents – diaphragmatic openings – Facial nerve – spinal cord lesions based on presentation – stuff going on at T4 level – brain blood supply

PHYSIOLOGY

Lung volumes – cardiac cycle – hormones (renin, angiotensin, mineralocorticoid, cortisol, adrenal medulla, pancreas, PTH, calcitonin, Vit D and its metabolytes) – renal physiology – 

MISCELANEOUS 

Vaccination program – Drugs that induce/inhibit cytochrome p450 – broad microbiology – allergic/hypersensitivity reaction types – types/examples of vaccines – immunoglobulin types – 

I also attended a course arranged very kindly by our deanery for candidates interested in the FRCEM primary. It was purported to be a tough exam, as the previous attempt had had a passing percentage of 43 percent. Yes, only 43 % of the candidates who appeared for the previous attempt passed. We gulped down our fears, and while the course gave us a broad idea of what wee needed to be doing (which was a lot!) it served no greater purpose than to tell us that we were not alone in being scared and that everyone seemed to be equally stumped by their performance in the questions – slightly reassured by the fact that during practise mcq sessions, when the consultants tried to solve the questions they were mostly unable to. Slightly reassuring, and mostly horrifying, as how were we supposed to pass the exam?! Yikes. What threw most people was that the exam format had been changed – from the previous true or false format, to the  Single Best Answer Question or SBAQ format. All options in a given question may be correct in different ways, but select the answer which is most appropriate according to the stem. Which basically translates to “guess what the examiner was thinking when he/she made this question” – so no pressure!

By the last few weeks, I was about to pull my hair out – the amount of mcps I was doing wasn’t too much, and I didn’t seem to be ding all that well if you calculated the number of questions I was getting right – overall a 52-55 percent of correct answers. Abysmal. I did not let that disappoint me, however, knowing full well that practicing questions was the way to go in such an exam format.

I used up all of my 2 weeks of annual leave and 3 out of 5 days of study leave for this exam, which brought me to just about 20 days of uninterrupted preparation (coupled with MANY visits to the department for ARCP related issues). That I feel was the single best thing in way of preparation – the time off was focussed, and I wasn’t tired from running around – preparation is mentally exhausting as it is, coupled with the physical exhaustion of day-to-day ED life – it takes a toll. All I did was sleep, eat and study. Lather, rinse, repeat.

But I will reiterate here what I have said before as well – you can never do enough questions as practise – just keep doing as much as you can, every waking minute make sure you are doing questions. Whether its 5 or 50 questions, make sure you stay consistent and do not get laid-back and forget to do questions – keep doing them, whether right or wrong, as long as you are also focusing on the explanations of those questions, its a learning experience.

Advice about the exam itself: Time management – 180 questions, 3 hours. The way I did it was divided it into 3 parts, so I needed to have completed 60 questions in 1 hour, and preferably even faster than that, since I needed to allow some time at the end to go back and tackle the more difficult or confusing questions. Keep track of time as well – if you seem to initially be on track, keep checking the clock every 10-15 minutes and make sure you are on track. If you feel you need to think more than 20 seconds for an answer and are still unable to do so, then mark the question and move on, return to it later. Do not waste minutes on a single question, causing a delay and jeapardising multiple other questions. Read the stem carefully – often we do not read the ‘except’ ‘all’ which’ ‘most appropriate’ next step’ gold standard’ ‘not included’ bits of the stem and inadvertently end up selecting the wrong option. In case of long stems, read the last bit/question and the skim over the rest of the stem, to gauge what they are looking for. If you don’t know the answer, go through the options by the process of elimination. Eliminate the blatantly wrong options. Think about the rest, if possible eliminate another 1 or 2 till you are left with one. If you read the stem and know the answer, look for that in the options, if you see it, select that. Always attempt all questions, no use leaving a question blank and lose an opportunity of a lucky guess. Feel free to draw, make flowcharts, write things down in the margins of the question paper if it helps you remember, calculate, reach a conclusion (I remember I drew the whole optic nerve/tract/radiation diagram to help me diagnose where a lesion was based on the hemianopia referred to in the question paper!) The questions may be easier than your practise question bank – don’t worry!

And I had the support of good friends. I don’t know, there is something about prepping for an exam (or anything in life for that matter!) and knowing that there is someone else going through the exact same thing as I am – it creates an interestingly unique bond. I had 2 such colleagues and friends, and I am pleased (and incredibly proud) that they have passed as well. We used to work together in the same ED department back home in Pakistan, and are now in different parts of the UK pursuing careers in emergency medicine. Onwards and upwards!

The world is indeed your oyster – always work to improve!

Always set goals for yourself, it is never too late to improve yourself, or hone a skill. Add to your already accumulated skill set, or improve pre-existing ones. There is always room for improvement. Always another star you can aim for.

If you find yourself saturated (or the environment around you saturated, and you can’t get a foothold) move to greener pastures – if you are the best at something in one place, chances are there will be something new to learn in a different place, even if you do the same thing.

Get another degree (something which I am trying to do), study a new culture, learn a new language (something I am currently working on!) get a new hobby (like photography? cooking? Blogging!) Move to another town, another city, another country – see how another part of the world does it’s business. Read a new book – finish it and pick up another one, go through a personal list, then go through someone else’s list – make new friends, meet new people. Make a mistake. Learn from it, move on. Do not be afraid to make a mistake. Share your knowledge (yes, you have it!) Pick someone up from where they have fallen. Help them if you can. Surprise yourself with how good it feels, and how easy it is to make someone happy (or just less sad).

Be the best you can be, and then strive for even better than that.

Always improve. Always be open to change. Always be open to suggestion to make yourself better. Always be humble enough to know that there is always room for that little bit of change, however hard you try to fight it – you will end up being a new ‘you’, very likely for the better. You are your own best investment. Do right by yourself.

EM interview – my experience

So a lot of you have asked about my interview experience – I had it last year and it was my first major interview experience in the UK. I applied for the ACCS-EM post, run through training. My interview was last year, and the details are a bit sketchy, but I am putting them up here in case someone is curious about what it actually entails.

It was done in two batches on the day of interview, there was a morning batch and an afternoon batch, and I believe this was;t the only day of interviews. Mine was part of the morning batch.

(I will upload a separate post about portfolio requirements, here I am just sharing my interview experience.)

It had four stations. Presentation – Ethical scenario/clinical scenario – portfolio station – General Management etc

Each station had 2 emergency medicine consultants giving feedback, so in all 8 consultants to give you a score.

My first station – and possibly my worst one! – was the presentation station. This is where they give you a topic for presentation, the topic can be anything, it has to remotely be related to the medical field, it doesn’t have to be something clinical. You get the topic when you reach the station, after which they give you a few minutes to prepare (3 or 5 minutes, I don’t remember the exact amount of time) They take you into a separate room, you are provided with different coloured markers/pens, sheets of paper on a stand and the topic at hand. My topic was ‘Should the UK adopt a policy of implied consent for organ donation after death?’ I thought about what it meant, because it doesn’t really come to you straightaway does it, the meaning of the statement? I assumed (probably rightly) that it meant should the UK adopt a policy of implied consent where the wishes of the deceased had not been known, in cases of sudden or unexpected death, and utilise their organs without actually having their prior consent. I decided I stood against this notion, and I went ahead to try and make a presentation around it. Now here is where I hit a snag – I can say if the answer is yes or no, but to make a 5 or 7 minute presentation around it? What do I do? So I started by outlining what I wanted to speak about, first minute of introduction to what organ donation actually was, which organs could be transplanted and used by other individuals, etc. Then I tackled the actual controversial topic: yes or no. I said no, and then I gave my reasons: Patients ultimately should have a right of deciding what happens to them or their bodies, and in cases where they can not or have not expressed their wishes then their next of kin or legal guardian or court appointed person has to make the decision for them. But someone has to MAKE the decision for this to happen, it shouldn’t automatically happen, you have to take into account the deceased person’s wishes, their family’s wishes, their religious or cultural factors influencing their decisions. I think I babbled on for a while, and ultimately petered to a stop. The two consultants present in the room smiled at me. I thought that was it. But no. They had questions! The first one was pleasant, smiling – and asked me a question I do not remember even. I don’t think I knew the answer to that question but I bravely said I could look up the information if you like and come back to you with that information, but that I honestly did not know. She backed down. The second consultant, boy was he getting into a state! I realised now they were playing good cop bad cop. He questioned my opinion, asked me three times (yes, three times!) how I felt it was appropriate to let organs go to waste when the dead people couldn’t utilise them and why would I not want these to be put to good use. I kept calm and reiterated my initial stance, he even banged his hand on the table to express his displeasure at my answer. I stood my ground (what could I do, I did not want to portray one opinion from the beginning of the presentation and then back down and go for the complete opposite opinion!) He then finally smiled at me and said your time is up, you may proceed to the next station. I was shaking in my suit but I felt it could have gone worse. Atleast I got to say what I felt and wanted to say, eh?

Second station was the ethical/clinical scenario station – 2 consultants, one scenario each, but they were sat at the same table so both could give an assessment of both answers. First case was the ethical case: You are asked to see a 50 year old male in rests who comes in clutching his chest in apparent chest pain – he speaks no english and you do not speak his language. He is accompanied by his 11 year old (or 14 year old, I don’t remember the actual age) daughter who speaks both languages fluently. How do you proceed? Now having worked in the ED in the UK, I knew that it was frowned upon to use relatives/friends as interpreters, and it was preferred to use professional interpreters that the hospital may provide, or a service called ‘language line’ which you ring up and ask for whichever language professional interpreter to be put through, and you basically use him/her as the middleman as you take the history and examine the patient, all the while communicating by phone. Not the most practical solution, but one that appeases examiners, as it did this time. They were quite happy with my answer, I told them ideally I would like to use a professional interpreter, language line etc. But since this is potentially an emergency and I am aware of the time it may take to arrange an interpreter, I would atleast like to ask for patient’s known history and whether he was allergic to anything, and atleast begin the process of giving painkillers and start my assessment with his consent via his daughter. I also used the phrase ‘will ask seniors to advise me on this situation as well’ which always sits well with examiners, especially for the more junior posts. They do not want you to be a hero, they want you to be safe and utilise appropriate senior help whenever you feel the situation entails. The interviewer then asked me if there was any other avenue I could utilise for this purpose, and I remembered once having had to use one of our staff members, a registered nurse, as an interpreter. I mentioned that, which was seemingly the right answer, as they moved on to the next question: what do you think would be the problems that you may face if you do end up using the daughter as an interpreter? I mentioned she is not a professional, I won’t have any guarantee that what she is relayed to the patient an what the patient is relaying to her is not literally lost in translation. I also mentioned there would be aspects of the history that she may not be aware of, such as his medications or some malignancy that he has kept from her. She may also be very frightened and seeing her father in pain or unwell may cause her to be very distressed, and would make her even more distressed if I used her in this situation. The buzzer went off at this point and so I was asked to move on to the next examiner (sitting in the same room). The second scenario was a clinical case, the interviewer showed me an ECG – asked me to identify it (it was an SVT – atleast, I thought it was!) which I did, and then she went on to ask me how I would go about managing the patient, I kept giving her options but I felt she was probing further, and then it clicked: ask for senior help or specialist advice, which I mentioned and she let me off the hook. I stepped into a 3rd encounter:

Third station – portfolio station: Once again, two interviewers, who already had access to my portfolio (they asked us to submit our physical portfolios at the start of the interview outside the portfolio station, and before our turn came for the actual portfolio station they had already gone through the broader aspects of each portfolio). Now here I must add there were candidates who had come in with huge binders of information, one candidate had three such folders and about 7 rolls of what seemed like very large maps but were very likely poster presentations of various researches and audits he had undertaken – these served to really really unnerve candidates like me who had the thinnest portfolio! Anyway, I went in, they asked expected questions, that sounded more like mere confirmation of information I had already provided (twice- first time when I wrote it all down in my application, and second time when I handed them the portfolio with all the hard copy evidence) – still they had questions like: So you have done an ALS course, no others, correct? Yes. And you have no other degrees other than your primary medical qualification? Yes. And I see you have some feedback from medical students that you have taught. Yes. Is there any other evidence of teaching? No (because if I had, wouldn’t I have submitted it before already?!) and this went on. We discussed some bits about my CV. Some bits about my prior experience (Tell me about this 6 month volunteer post you did back in the USA, or So I see you have some experience in Oncology? Tell me more.) So just basically a general chat to gain an idea about who I am and what I have done and how I have turned into this person sitting in front of them, applying for a training post in emergency medicine, how did I get here, what roads have I travelled.

Lastly – the Fourth station – I don’t know what this station is called but they asked sort of direct and indirect abstract questions vaguely related to the practise of emergency medicine. They asked me if I knew what the term exit block meant. I didn’t, so they explained that an exit block means that patients are coming in to the emergency department, but they are not coming out of it, probably due to a shortage of beds for the admitted patients, so that the system isn’t moving forwards, and there is a jam, or a  literal block. They then asked me how I would deal with this phenomenon.  I thought about it and replied to the tune of ‘make sure it’s still a safe department, make sure everyone has adequate pain relief, comfort measures, next antibiotic doses and regular medications prescribed, if they have been waiting a while, maybe get them a more comfortable bed instead of the trolley, try to offer them something to eat if it is clinically warranted, and a cup of tea or coffee would go a long way, along with a sincere apology about the wait and an explanation that all efforts are being made to make sure things progress. There was another question which I forget, but it was once again more abstract not directly clinical medicine but more management, I think it was along the lines of if you see a colleague is drunk or intoxicated, how would you proceed (I am not sure, I may be remembering some other time this question was asked of me) but anyway, you get the gist of it.

That was it.
I went home. Or rather I went to the train station, and took 3 connecting trains back home, slept for 3 hours and went to work on a night shift. I thought I hadn’t done too well, and anyway, it was my first interview for a training post.

It was also my last. At least for the next 6 years!

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!”

 

(WATCH THIS SPACE FOR MORE POINTERS, I WILL COME BACK AND EDIT THIS AND ADD SOME MORE THINGS.  THIS IS AS MUCH AS I COULD TYPE FOR NOW, DADDY DUTY CALLS. MY SON IS TRYING TO TYPE onNTHELaptopsh and canhtwriteakh anyFURTHer862mx..