I graduated from the University of Liverpool Medical School in 2007. During foundation years, I developed great interest in managing complex cases, in particular the medical mysteries. During my ED rotation, I spent most of my time in the Resuscitation Room and enjoyed looking after acutely unwell patients across a wide range of different specialties. I embrace the idea of being a ‘Jack of all trades’ doctor who is able to provide comprehensive care to variety of patients. After completing foundation year training, I enrolled into the ACCS Emergency Medicine training with a primary goal to be an Emergency Physician.
During my ACCS rotation, I have had the privilege to work in one of the busiest ICU in the Mersey Region. Through this I discovered that ICU in many ways resembles ED where both departments look after a cohort of undifferentiated patients. ICU also accommodates a huge proportion of interesting medical patients who require high level of care. Through my observation, Specialty clinicians from both fields are able to attain quick diagnostics, confirm diagnoses and commence treatment rapidly based on quick turn-around of information. This has therefore inspired me to consider ICM as a lifelong career.
After having discussions with several Intensive Care consultants, I come to realise that there is a possibility of combining training from both specialties. With my completion of 3 years ACCS training and MCEM, I was eligible to apply for this very first ICM training scheme. In 2013, I successfully obtained EM higher training post in the same deanery which enabled me to become one of the first Dual CCT trainees.
According to the recruitment data for 2013 published in Critical Eye Issue 4, there were only 4% of trainees who intend to dual accredit with EM. After analysing at the national data, this is not a popular combination. However I find both specialties complement each other very well. My ICM training has definitely been invaluable during my emergency work and vice versa.
In ED, critically ill patients constitute a significant proportion of the resuscitation room where majority of the patients require complex medical treatment and critical care input including ICU or HDU. Due to the shortage of higher level care beds, it is not uncommon to witness advance medical treatment being initiated in ED department i.e. central vascular access for cardiovascular support, NIV support etc. Being trained in both specialties has given me valuable skills to manage such complex medical patients. With further airways and anaesthetics skills which I have acquired from intensive care training, I became more comfortable in dealing with airway emergencies and performing both interhospital and intrahospital transfer of sick patients. Undoubtedly my communication with family members has also improved significantly when breaking bad news in the ED.
In ICU, I have had to use a good amount of urgent care skills. I manage to integrate my EM skills to improve patient’s care with my resuscitation skills and broad clinical experiences. In addition, I can also utilise my procedural skills in ICU setting for instance, inserting surgical chest drain, closing ICP bolt wound with sutures, reviewing facial x-ray in patients with maxillofacial trauma, examining patient’s eyes for abrasion or removing foreign body etc. I was even once asked to perform a head injury assessment on a patient who fell off from his bed on the unit!
I enjoy teaching and sharing experiences with my juniors, and I was recommended to be an Instructor for various courses e.g. ALS, APLS and MOET. I have also obtained Post-Graduate Certificate in Medical Education during my ST3 year in order to improve my teaching methodology. Locally, I help co-ordinate the Regional ICM teaching. On the other hand, I represent EM higher trainees in the STEC meeting to improve the local training programme.
In future I believe the job prospect is promising as both of these specialties are relatively young and rapidly expanding. The presence of an emergency/intensive care physician in the department is likely to benefit not only the patients but also the department itself. Committing to both specialties also ensure that my clinical skills and knowledge are kept up to date. I am also confident that this new ‘hybrid’ of dual specialty physician will be in high demand, especially in the major teaching hospitals and trauma centres. I strongly encourage Emergency Medicine trainees to consider this attractive Dual CCT role in order to enrich their clinical experience
ST6 Emergency and Intensive Care Medicine