¬ By Abeera Khan
A&E is the front door of the hospital. A lot of IMGs think about picking up A&E as their first job as ED is on shortage occupation list and there are lot of vacancies in different trusts. It is commonly heard that ED job is very hectic at SHO level, and some people might tell you not to join ED as a first job. However, I can assure you that many IMGs have started it as their first job and they settled well with time. No matter where you start from, it would be difficult at first as this would be your first NHS experience.
I had many job rotations offers but I opted for A&E and AMU rotation for a year (06 months each). I worked in one of the busiest A&E departments in the North region which covers a very large population. We had an 8 bedded Resus, 15 bedded Majors with 4 Rapid Assessment Rooms, 6 in Minors/urgent care and a separate Paediatric area, fracture/plasters room and GP consultation room.
Yes, it is very overwhelming especially during winter months, but you need to understand that if its busy in ED, its busy in the medical and surgical departments too.
Watch this video to see how winter pressures affect NHS. BBC was given free access to the A&E of Royal Blackburn Hospital while I was working there last winters (2016-2017).
The best thing I like about working in A&E is a good mix of cases you see ranging from trauma (if the ED department is a trauma centre), acute medical and surgical conditions, orthopaedic emergencies (fractures), managing paediatric conditions, gynae cases to assess and then refer and common illness seen in minor area.
As a starter, it is the best place to practise ABCDE protocol. From the moment you start taking your history, you try to rule out differentials. If you have been out of practise, you will get hands on doing cannulations, blood sampling, ABGs, urinary catheters, suturing. As ED is constantly busy with rapid influx of patients, you can’t just sit and wait for the Nurses to come over and do everything for you.
There is a lot of senior support on the floor and they would always listen to you and guide you.
In urgent care/minor area, you can see, manage and discharge patients on your own if you are confident. If you are not, always consult with the Registrar.
Be very clear in your documentation. If you are not sure about reading X-rays (especially for fractures), don’t make your assumptive diagnosis. Always ask your seniors.
You can easily get your foundation competencies signed off if you are working well.
Yes, the job is hectic because it is constant brain storming. You see one patient, plan and then move on to the next. We could have a 20-minute break after 4 hours in an 8-hour shift. And two 20-minute breaks in 10-12 hours every 04 hours.
You develop good communication and referral skills when you deal with other specialties. Remember you are the one who has seen the patient and you know if patient is stable to be discharged or not. Treat the patient, not the Numbers.
Just to quote an example, I have had 5-year-old with extradural hematoma and midline shift (prompt History, examination, knowing NICE guidelines for CT scan, speaking to radiology Registrar and referring to Manchester Royal Infirmary all done in an hour) and then followed up with that patient post-surgery, reflected upon it on my portfolio.
The only thing I found hard was my Rota as there is a constantly changing pattern of shifts. You would do Standard days, long days, then twilight shifts (18:00 to 02:00, 18:00 to 04:00, 16:00 to 04:00, 12:00 to 00:00), night shifts. Be prepared for this as the ED rotas may be a bit maniac.
You can even follow up your patients in AMU/Surgical assessment Unit/Paediatrics later, as in ED you would manage the acute condition and stabilise the patient.
Another thing IMGs worry about is the portfolio. I would say that,
- There is a lot of experience you can reflect upon in your portfolio while working in A&E.
- You can get MSF from colleagues working at different grades.
- You can get your CBDs and mini-CEXs signed off.
- You can do audits while working in A&E.
- You can get your foundation competencies signed off (I did after 04 months)
All the above things I have mentioned, I have got them all in 06 months rotation.
Only drawback I found was there is less of teaching as due to rotas, you tend to miss the teaching sessions. But then you can ask for a teaching presentation to deliver. You can always email the undergrad/postgrad department in your trust and they are always very helpful.
IMGs worry if working in A&E would help them in future or not especially when applying for training. The UK foundation trainees do get to rotate in A&E in their training as it is very essential. I applied for my CMT and GP training while in A&E and got offer for both.
I believe every work you do helps you and gives you experience and knowledge. I have a variety of background experience of working in general medicine, neurology, radiology, A&E, acute medicine, undergrad teaching and I have never regretted anything I have done so far as I feel I have learnt a lot from everywhere I have worked.