How to Maximise Your Portfolio for Application
Experience and commitment! ACCS, EM has become extremely competitive and as a result these two things are proving increasingly important to give you the best possible chance of getting into training.
Emergency Medicine is not a choice you make for a straightforward lifestyle!
Before committing, you need to not only prove to yourself but also to those interviewing you that you absolutely know it is the speciality for you.
More recently, successful applicants are those who have taken years out post foundation, prior to applying, to gain experience both in a clinical setting but also in general life. Being a good EM clinician requires you to cope with pressure, constantly make decisions, communicate well with, and lead multiple team members, whilst remaining positive and approachable.
Showing that you have a life outside of medicine is almost just as important as clinical experience when it comes to applying to EM. You not only gain skills to use in a clinical setting, but you also prove that you are human and recognise the importance of family, friends and hobbies as a vital crutch to your future career in EM.
For myself, I can’t sit still, which turns out to be a common trait for EM applicants! This is not a bad trait at all, and I found it easy to link some of the questions to non-clinical scenarios, which received good feedback post interview. The increase staff burn out rate in EM and ways to deal with this are important to acknowledge. Proving that you have the ability to relax in whatever way this may be, (often not how most people “relax”!), is just as important, and I was able to draw on this in my interview to good effect.
If you are fortunate to have had a reasonable amount of experience working in ED, coupled with a life outside of work, then your enthusiasm for it will naturally shine through, and it will make for an enjoyable interview.
The other part of the application is the MSRA. As irrelevant as lots of the questions may feel for an EM job, you see more and more primary care cases presenting to ED now, so refreshing your knowledge by doing this exam is quite helpful. I purely used PassMed, working through all the question bank, including the SJT questions. There are courses and books available, but I found the questions and reading relevant guidelines ample to obtain a good mark.
During your foundation years, you will have to complete a QI project. Most likely, it wasn’t related to emergency medicine.
Most Emergency Departments will have a QI/ audit lead consultant. If you can contact them and try to assist with a relevant project that may also be able to be produced and presented as a poster locally or nationally, there are multiple opportunities.
In terms of teaching contact the consultant lead for medical students. Offering to have students shadow is something most will say in an interview. If you are able to provide formal teaching or join the OSCE examination committee, this is easy to do and a beneficial learning experience for you also.
Making the Most of Emergency Medicine Placements
You will find, due to the availability of locum shifts, that a lot of people work in ED, so trying to stand out from others is important in this competitive world.
If your only experience working in ED is a 4-month rotation in F2, then try to maximise this as best as possible. Asking to be the Resus doctor for the day early on in the job will allow you to gain exposure to unwell patients whilst being well supported. Over the 4-month period, you should have become more independent with managing certain resus patients and can offer to lead, with consultant supervision, to get a chance to manage a team, giving you lots to draw upon in your interview. Seeking out any QI/audits whilst you are working in ED and being actively involved in any simulation and teaching opportunities will stand you in good stead.
Since COVID, minor injuries are streamed to separate urgent treatment centres or minor injury units. Seeking out opportunities to go and do a shift there, on a day off or study day, will allow you to develop skills that are needed in a night shift when these patients come to ED. This will also prove to those interviewing you that you understand the dynamics of ED and how important it is to develop and maintain your skillset.
If there is an opportunity to undertake an ED fellow, then take it! Fellow roles are often 80% clinical time in ED and the other 20% having extended opportunities such as ultrasound, simulation, trauma and teaching. These show not only that you are committed to ED but also recognise the importance of developing the other skills and experiences required to aid your ED training.
During my fellow year, I got a non-trainee RCEM portfolio and was able to start to get certain procedures and cases signed off. This proves that you are genuinely committed, as it is an expense to do this. It will also give you a good understanding of the trainee requirements and the curriculum firsthand if this comes up in your interview.
As well as this, you can start to attack some of the exams, which will give you a real advantage once it comes to starting ACCS. The MRCEM primary exam runs twice a year, and you need to have completed this exam, the MRCEM SBA and OSCE by the end of ST 3 for ACCS ED.
Over the last few years, ED has become increasingly overcrowded, and in terms of your application and interview, it is important to recognise this. There are some important documents to be aware of and have read, namely RCEM’s “Tackling Emergency Department Crowding”. This will allow you to add evidence-based facts and figures to your own views on how you see EM in the future.
Top 3 Tips for Getting Into ACCS Emergency Medicine
- Commitment.
Working beyond a 4-month foundation post, potentially in a fellow role, a mix of tertiary and secondary hospitals or even abroad, will only add to your application. Have other strings to your bow related to EM, such as additional life support courses. Relevant QI/audits, posters, teaching programme involvement or even your MRCEM primary.
- Enthusiasm.
If you genuinely want to do EM, it will naturally shine through. EM is a fantastic speciality and attracts some of the most amazing clinicians, and getting to be part of one big team is a unique aspect. Don’t be afraid to curb your enthusiasm- they want to hear how amazing their job is! Show how much you have got stuck in and why you want to do this.
- Work-life balance.
Recognise the changing dynamics of an ED department over the last years and the toll this can have on staff, evidencing an increased burn-out rate. Prove how you have a life outside of work and the ways in which you unwind and the positive effect this has on your ability to focus at work.
