Why Emergency Medicine? – A student’s perspective. St. Emlyn’s

On Phil Keating’s rescue course.

Claire Bromley (that’s me third from the right in the photo)

I am currently a fourth year medical student studying at St. Emlyn’s, and was inspired to write this after reading multiple pieces from emergency medicine clinicians across the UK, in celebration of the Royal College of Emergency Medicine’s 50th birthday. I hope that a view of the specialty from a student’s perspective will prove interesting and useful.

As a senior medical student, I am being asked more and more frequently by clinical supervisors about what specialties I am interested in pursuing in the future. I’m sad to say that more often than not, my enthusiastic reply of “Emergency Medicine” is met with negative responses.

 “I don’t envy you!”

“But what about when you have children?”

“Don’t you want a quality of life?”

Even after I explain my reasoning, my interests and my personal idea of a quality of life (that it will be influenced by my level of interest in the work I’m doing as well as my time away from it!), too often I just hear a tut and a “you’ll change your mind in the end”.

I am aware that there are many specialties I have yet to experience, and that there’s no way of knowing whether my priorities and interests will change in the future. Of course there’s the possibility that I might change my mind. Right now, however, there is no other specialty which, despite its challenges, will make me feel quite as fulfilled as I think a career in emergency medicine will.

For me, the specialty encompasses everything that made me want to become a doctor in the first place.

I have known since before I started medical school that I will become a generalist. I am fascinated by people. All people – old, young, male, female, happy, worried, intoxicated or sober! I love hearing their stories and am not intimidated at the thought of hearing their fears. I am equally interested in both medicine and trauma, and want to see the entire spectrum of severity – from minor injuries and illnesses, to those who are severely unwell. I know I will need to be in a speciality that constantly keeps me thinking and on my toes. Emergency medicine ticks all of those boxes.

Through my experiences of emergency medicine, I have met and learned from countless inspiring, thoughtful, thought-provoking clinicians and educators who want to teach as much as I want to learn. They have pushed me to test the boundaries of my knowledge and encouraged me to combine the knowledge I have gained from other placements, which often seem so compartmentalised and detached. I have been invited into multidisciplinary teams and immediately felt welcome and useful. I genuinely feel like I am already a part of the global EM community, and see myself there in the future.

I am fascinated by the immediacy of the critical thinking required, and how quickly a patient’s condition can be improved by effective diagnostics and treatment – even when often, more will be required in the future. I have had the privilege to see and learn from patients of all ages, in some of the most challenging and distressing moments in their lives. Ultimately, although there are difficult days, emergency physicians are really ‘making a difference’ in the way I have always wanted to.

Through emergency medicine, I have heard about and consequently been able to seize so many learning opportunities – volunteering at dasSMACC and with the ATACC faculty, making links with other healthcare professionals and providers (such as the local ambulance service), and attending various CPD days (such as Phil Keating’s (@keatingteam1) ‘Medical Rescue at Height’ course). My knowledge of functional anatomy and intricate physiology has enormously improved through these and time in the emergency department, which has benefited me endlessly throughout all the different placements I am experiencing.

On the ATACC course.

There are so many exciting things happening in the world of Emergency Medicine at the moment, and wonderfully it seems that lots of it is on our doorstep – it is especially exciting, for example, that this year’s EUSEM conference will be held in Glasgow, together with the RCEM. I feel extremely lucky to studying in a country where there is so much support for students interested in Emergency Medicine, and during such an exciting period in the specialty. I cannot wait to see what progress is made before I even qualify and get properly involved myself!

The 50th anniversary of the RCEM has prompted many people to think about how far Emergency Medicine has come, despite it still being considered a relatively new specialty in the UK. There are many places worldwide, however, where the specialty is even younger – or not even recognised at all.

As Stevan Bruijns (@codingbrown) said, however, ‘perhaps the next 50 should focus on bringing that same standard of EM to the rest of the world’.

Whilst volunteering at dasSMACC, I was lucky enough to be able to meet the BadEM team from South Africa – people of multiple healthcare professions who provide free access to educational material surrounding emergency medicine in Africa, where the specialty is still rarely recognised (it has only been a registered speciality in South Africa since 2003), and highlight the unique challenges faced by clinicians working there.

Next year, I will be spending my six week student elective with them in Cape Town, in the Emergency Department of Mitchells Plain Hospital, in one of South Africa’s largest townships. I will also gain some pre-hospital experience, which I hope will give me a wider understanding of the communities patients live in, and consequently a more holistic view of the factors impacting their health. I hope that this will help me in turn enable me to better understand the people I will help treat once they present to hospital.

I have always been fascinated by emergency medicine and global health, and in the future aim to be an emergency and pre-hospital medicine clinician in various countries where I will gain different experiences from different challenges. I cannot wait to be surrounded by clinicians who are pioneers of the specialty on their continent, and who are constantly pushing for a greater understanding of African emergency medicine issues.

It is a perfect example of how exciting and rapidly-changing certain Emergency Medicine is worldwide, and I hope that through spending time with these exciting, energetic clinicians who are passionate about improving the conditions of their communities, I will be a more globally-conscious and conscientious student and clinician in the future, and more aware of healthcare challenges not frequently seen in the UK.

http://badem.co.za/blog/

There seems to be a negatively biased view of emergency medicine that is probably being affected somewhat by the current press. I am sure there will be challenges and times where I will question my decision to pursue EM, but honestly believe that it will remain the specialty in which I feel most at home. I want to be in a specialty that actively encourages interdisciplinary teamwork, communication and an understanding of human factors, and openly talks about ways in which it can improve. I want to be involved in something that is fast-paced and varied, where I am pushed and challenged, and where there will be so many opportunities in the future.

Happy birthday, RCEM – I can’t wait to join you and be a part of the next 50 years!

Claire Bromley

Gareth, Chris, Jenny Beck-Esmay (from FeminEM), Nicola and Claire at SMACC in Berlin

2 Comments

  1. Robyn

    Claire thanks for writing this. I’ve found that this applies to nearly any specialty which is not a “lifestyle” specialty –
    whatever a lifestyle specialty is somehow meant to be. It seems that people feel GP and Anaesthetics fall into this category in my experience although I’m never quite sure why as Anaesthetics requires a huge amount of out of hours work and my GP friends work very hard!

    I’m never sure how much is due to being female but I found I was constantly being told “oh but you won’t want to be doing that when you have a family”, “you’ll change your mind when you have kids”, “that’s a tough career when you’re trying to raise a family”. Like you though, when doing Emergency Medicine I often had conversations with people where I felt this sudden sense of “heyyy…they’re just like me! I’ve found my tribe!”. I’m still in the process (6.5yrs postgrad) of figuring out exactly what my “specialty” will look like but would add that taking the scenic route to consultant-land has so far been great fun and I wouldn’t trade the experience of working in other specialties and the opportunity to work in other countries (so far: Ireland, New Zealand, Australia, South Africa, Scotland) for finishing my training a few years faster.

    I think this is an incredibly exciting time for prehospital and emergency medicine, as you’ve said. I can’t wait to see how we grow this global community over our careers!

    ps – are you going to be at Bad EM Fest? I’m looking forward to meeting some of the St. Emlyn’s crew.

    Reply
  2. MIchael Lauria

    Awesome. Fantastic and well-written post, Claire. Great to hear from other students and why they are passionate about going into EM.

    Cheers!

    Reply

Thanks so much for following. Viva la #FOAMed

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