UK Emergency Medicine – A Student's Perspective
A question commonly posed to medical students – and which I’m increasingly being asked – is what specialties they are considering pursuing in their future career. In some countries the structure of medical training creates the need for students to decide on their specialty prior to qualification. Thankfully, in the UK, where I’m progressing through school, there is an increased level of flexibility which gives students more time to contemplate which specialty is right for them.
I am in the minority of students in the UK, as I have always known I wanted to pursue a career in emergency medicine. I am also incredibly lucky to be at a very supportive medical school, where the flexible curriculum has allowed me to explore various extra-curricular opportunities relating to emergency medicine – most recently helping lead the student team at the Social Media and Critical Care (SMACC) Conference in Sydney. In particular, this year I have had the unique opportunity of completely immersing myself in the specialty I aspire to join. After having completed four years of medical school, I am currently taking a year out from the standard medical school pathway and undertaking a separate degree in emergency medicine, which is based mostly in the clinical ED setting. This year, alongside my involvement as the UK representative for ISAEM, has allowed me to contemplate my goals and further explore the specialty, including aspects of it which previously made me apprehensive. It has also given me more time to learn the thoughts (both optimistic and apprehensive) of many other medical students who are also seriously considering a career in EM. This piece is based on many of these conversations.
It is well-known that the rotas as a UK EM trainee make maintaining healthy relationships and a life outside of medicine more challenging. I have personally spoken to multiple doctors who have withdrawn from formal EM training for this very reason.
Regardless of future career aims, time spent in the emergency department is beneficial for all students and trainees. It offers an unparalleled opportunity to improve critical thinking skills, knowledge of functional anatomy and gain an appreciation of human factors in medicine, whilst actively prioritising interdisciplinary teamwork and communication in a way I have not seen outside of other acute specialties. In the UK, however, a multitude of factors have led to emergency departments being understaffed. Support for medical students interested in EM is plentiful at both local and national levels; however, in order for the specialty to continue growing, it is imperative that the issues hindering retention within the specialty continue to be explored.
Whilst emergency medicine remains an attractive option for many students, anecdotally due to its fast pace and broad spectrum of presentations, for some the perceived threat of not having a work-life balance in EM means that other specialties are rated more highly. It is well-known that the rotas as a UK EM trainee make maintaining healthy relationships and a life outside of medicine more challenging. I have personally spoken to multiple doctors who have withdrawn from formal EM training for this very reason. This issue is being addressed through increased provision of flexible rotas and less than full time posts (seemingly more so than in many other specialties), however progress needs to continue to ensure retention of more trainees.
The concept of ‘burnout’ is also being discussed more frequently, with many also researching the topic and trying to find solutions to the seemingly increasing number of clinicians within the field of emergency medicine suffering from it. Whether this is purely due to evolving working conditions, or whether the fact that doctors have become more comfortable discussing the topic in recent years has also contributed, is something that remains to be seen.
Encouragingly, these topics are frequently discussed in the department I am placed in and I feel lucky to be supported both academically and emotionally. Students considering a career in EM will undoubtedly be considering these worries, especially as they gain prominence in medical conversations and increasingly also in the media, therefore an open dialogue between seniors and juniors about the problems and how to tackle them is encouraging. Having seniors be honest about their experiences and open to hearing my concerns, as well the many aspects I am excited about, is reassuring me that I am on the right career path, and also teaching me how to act with colleagues and eventually juniors in the future.
Undoubtedly, there will be moments in my career where I will question my choice to pursue EM, but I honestly believe that it will remain the area of medicine where, both clinically and academically, I feel most fulfilled.
Undoubtedly, there will be moments in my career where I will question my choice to pursue EM, but I honestly believe that it will remain the area of medicine where, both clinically and academically, I feel most fulfilled. Emergency medicine as a specialty seems to excel at openly considering its flaws, and ways in which it can improve and further support juniors – something that is particularly important to me, and other students I have spoken to. It will be a privilege to have a career in emergency medicine if it can provide this, alongside the fast pace, variety, countless opportunities and challenges which make the specialty so enticing to students.