1. Hit the ground running
Familiarise yourself with the ACCS Curriculum and start attaining sign-offs/SLEs from day 1. Time flies and there’s a lot for you to achieve.
2. Set a strategy
When you are familiar with the ACCS Curriculum it’s time to plan how you will meet its requirements. There are some curriculum requirements that you will only be able to achieve in a specific specialty. For example, ‘reduction of a fracture/dislocation’ can only realistically be achieved during your Emergency Medicine rotation; and ‘abdominal paracentesis’ only during your Acute Medicine rotation. There are other examples; you will only know them by knowing the curriculum.
3. Push yourself forward
The NHS is under pressure and you will be taking a step up from Foundation Training, so no one will spoon feed you. Own your training by deciding what you need and asking for it. If the rota allocation has consistently denied you ambulatory care experience or time in A&E resus, tell the consultant in charge this is what you need. Likewise with procedures, or situational experiences such as team leading under supervision in cardiac arrests or major trauma.
4. If you are unhappy/experiencing problems with your training escalate this early
Don’t be shy about raising concerns about your training experience. Whether it's problems getting sign-offs, SLEs, procedures, attending teaching, or anything else; escalating early will give the opportunity for problems to be rectified before you rotate. I would advise you first escalate issues to your departmental consultants and clinical/educational supervisors. If you have no success, the next step would be to speak to your Trainee Rep +/- college tutor. The next step after this would involve your Trainee Rep escalating issues to the Local Faculty Group and then the Local Academic Board on your behalf.
5. Try to resolve issues locally
As indicated above, try to resolve any issues within your department before escalating to your Trainee Rep. Your reps are trainees too. Beware of burdening them with problems before you have attempted to resolve them yourself. Diplomacy is a skill we all need to develop to be good registrars/consultants in the future.
Opportunities on offer
The Trust offers a range of free or reasonably priced courses to internal trainees. Included are Focussed Intensive Care Echocardiography (FICE), Trauma Team Member course (TTM), Managing Organ Donation in Simulation (MODIS), and more. Places on these courses are limited and in high demand, so the only way you will gain a place is by keeping a beady eye on your NHS email account and rapidly registering your interest.
Opportunities for procedural experience and sign off are plentiful, but you need to know the right places to look. During your AIM rotation, Ambulatory Care offers plenty of opportunities to perform chest and abdominal drain insertions, lumbar punctures, and some basic bedside ultrasound scanning.
You will be allocated a clinic week during which you can book into clinics that are relevant to your training – the cardioversion clinic offers ample opportunity to increase your competence in cardioverting patients, whereas eye casualty offers opportunities to attain portfolio sign-off in ‘red eye’ (not the easiest competency to sign off elsewhere!).
There are excellent opportunities to develop skills in point of care ultrasound (including FAST scanning, venous access ultrasound, and lung and aortic ultrasound) during your Emergency Medicine rotation. A number of consultants are certified to train and offer supervision and logbook sign-off for ultrasound. If you are interested, ensure you put yourself thorough a Core (Level 1) Emergency Ultrasound course; then you will get the most out of this opportunity.
Things I wish I’d known
I wish I’d been more aware of the wide variation between different hospitals' AMU inpatient services. East Kent Hospitals' AMUs are currently short stay/referral wards, there are plans to offer more Level 1 care in the future, but during my rotation the AMU was not a Level 1 Acute Ward. This is a big contrast to what the NHS Health Careers website says about AMUs and the specialty of Acute Internal Medicine. This incongruity meant I arrived at the Trust with unrealistic expectations.
Dr David Jones
ACCS ST1 Trainee and Rep 2018-2019