SUPPLEMENT
January 2005
FAEM and BAEM, on our higher train- departments for training specialist regis-
The Joint Committee on ing committee. Over the years this has trars. There are separate forms for
Higher Training in A&E proved invaluable and we have retained
an element of this representation on our
recognition of training in general and
in paediatric A&E medicine; all docu-
Medicine ‘‘new look’’ committee where chairmen mentation and advice sheets can be
or nominated representatives of regional downloaded from the JCHT section of
training committees predominate. The the Faculty website.
The chairman, Jane Fothergill answers a new structure links Regional Specialist The programme of regional visits
few questions. Training Committees in England, continues, with increasing use of assess-
Scotland, Wales, Northern Ireland, and ment by interview for selected depart-
Eire directly into the JCHTA&E. This has ments in place of site visits. The
What does the JCHTA&E actually already proved beneficial as we are specialist registrars’ views on their
do? capitalising fully on the practical experi- training are always paramount and we
The JCHTA&E is one of the three ence of those who administer training
committees of the Faculty. The others locally.
The EMJ supplement
are the Education and Examinations Being a member of the JCHTA&E is
(E&E) Committee and the Research hard work and I thank all who have
contributed their time and energies over From this issue, the EMJ will appear
Committee; there is some overlap monthly. The supplement is also chan-
between the three. The JCHTA&E has the past few years. I took over the chair
from Jonathan Marrow in June 2004; ging and will now appear quarterly as
as its core responsibilities the regular a double sized, eight page supple-
inspection and approval of all depart- he contributed eight years of his time
ment. We hope this change will
ments and rotations for higher specialist and never seemed short of energy.
increase the scope of topics we can
training in the UK and the regulations Stella Galea, our excellent JCHTA&E
cover.
for training in A&E and its subspecial- Administrator, will be known to many
This is the last issue which has been
ties. The chairman, honorary secretary, readers, at least by name, and as a
put together by Sue Heels, our techni-
and administrator calculate each train- helpful voice on the ’phone. Stella is
cal editor at BMA House. Since the
ee’s CCST date and confirm the content invaluable and with Wayne Hamer, the
supplement started in September 1999
of their specialist training, as well as equally efficient newly elected honorary
Sue has had to deal with a constant
recommending them for the award of a secretary, I think we make a good team.
stream of articles many of which are
CCST at the end of training. A JCHTA&E There are now just under 500 specialist
too short, too long, too late, or simply
panel assesses all overseas-trained spe- registrars in A&E medicine—a 60%
incomprehensible. She has tackled
cialists who apply to enter to the increase over the year, which is good
these problems with unfailing patience
specialist register. From next year the news for the specialty. The increase in
and good humour. Any polish and
STA, which is the body that regulates all training numbers has, however, largely
coherence the supplement may have is
specialist training, will be replaced by been confined to England so A&E largely due to her high professional
the Postgraduate Medical Education staffing in Scotland, Wales, and standards. She has our best wishes for
and Training Board on which the Northern Ireland is falling behind. her retirement.
Faculty will have direct representation Claire Folkes will take over from Sue
as a truly independent specialty. for future issues. We look forward to
What else is new? working with her and wish her well
We have revised our visit documenta- with the challenges ahead.
Who is on the committee? tion so that it combines the application
We are a Faculty of several parent form and JCHTA&E visitors’ inspection Mike Beckett and Diana Hulbert
colleges and chose to have representa- report. We hope this increases trans- Editors
tion from them all, as well as from parency in the process of recognising
www.emjonline.com
2 EMJ supplement
intensive care medicine is achieved by Committee. Peter Driscoll, the incoming
a brave minority of trainees who may Dean, and I hope to harness the
then programme some of their consul- expertise from both to continue improv-
tant activities in ICM. The RCP has ing specialist training. The new curricu-
drawn up the curriculum for training in lum should allow us to be clearer about
acute medicine as a CCST specialty and the particular knowledge, skills, and
there are ‘‘medical’’ specialist registrars attitudes that a specialist registrar
in post in five deaneries. As regards should have gained at the end of each
acute medicine as a subspecialty of A&E year of training. This will be useful to
or intensive care medicine, the details both trainers and trainees and, together
are still under discussion and acute with improved appraisal and workplace
medicine is not yet a recognised CCST assessment of performance, should bet-
Stella Galea, Jane Fothergill, and Wayne subspecialty. As soon as there is agree- ter inform the RITA process. We need to
Hamer. ment we will post the details on our ensure all trainees are optimally pre-
website. pared for the FAEM examination. It
continue to be most impressed with the may be that in time the examination
enthusiasm and professionalism of our moves to a modular format where some
trainees, as well as with the quality of aspects are assessed earlier in the train-
What changes will there be to
training available in the vast majority of ing and fewer left to the end; the E&E
specialist training and
departments. Committee is constantly refining what is
Our regulations for educational recog- accreditation over the next year
or two? already accepted as a fair assessment
nition of training posts and rotations that is fit for its purpose. Trainees do,
have been updated in the light of One of the main changes that the
PMETB is obliged by law to set up is however, still find the transition from
changes to service configurations in specialist registrar to consultant a diffi-
many hospitals throughout the UK. In assessment of experience as well as of
training and qualifications, as a route to cult one. That tells us there are still
some, a high quality service for patients improvements to make. These changes
and excellent training for specialist specialist registration. PMETB will over-
see the framework for assessments to training, appraisal, and assessment
registrars has been maintained despite will need to accommodate the needs
a reduction in on-site specialty backup. across all specialties and general prac-
tice but the Faculty will of course tailor of SAS doctors and some of those
The challenge is to provide a good, from overseas who wish to enter the
balanced training rotation for each the process for A&E. The exact format of
the assessment is not yet clear, and specialist register. The Faculty will
registrar and our updated regulations soon be appointing an educator whose
reflect this. different processes may be applied to
overseas applicants from those used to role will be pivotal in guiding these
assess SAS doctors in the UK. The developments.
challenge will be to produce an evalua- The delay in activation of PMETB
What progress has there been has also precluded decisions being
tion that is robust and easily repeatable
with subspecialty training taken on the structure of run through
and which clearly and reliably demon-
programmes? training. The faculty hopes that a
strates if a doctor is or is not able to
Our foremost subspecialty at present is common stem training in post-
work as a consultant in A&E medicine.
paediatric A&E medicine. Demand for graduate years 3 and 4 will include
It must be scrupulously fair and free
consultants with this training substan- A&E, anaesthetics, intensive care
from discrimination—for example,
tially outstrips supply but several train- medicine, and acute medicine; year 5
against doctors from different basic
ees with CCSTs in A&E medicine and might include paediatric A&E and
training backgrounds. The JCHTA&E
paediatric A&E medicine emerge each orthopaedics and the last three years
will be responsible for processing all
year. We welcome moves in many be completed in emergency medicine.
applications under the new legislation.
regions to identify posts offering specia- The JCHTA&E will clearly be closely
Once the details of the evaluation
list registrar level rotations geared to involved in these changes as general
process become clearer the details will
paediatric A&E medicine. The rather and specialist training merge. We will
be posted on the FAEM/BAEM website.
meagre allocation of 10 additional also be involved in the accreditation
national training numbers for A&E of training posts at all levels in our
medicine in England for this year has specialty.
been allocated to paediatric A&E depart- What other ambitions do you
ments so that specialist registrars can have for specialist training?
gain subspecialty training in paediatric There are areas of overlap between the
A&E medicine. Dual accreditation in work of the JCHTA&E and the E&E JANE FOTHERGILL
www.emjonline.com
EMJ supplement 3
The new consultant N Clinical audit regular programmed work in emergency
N Job planning medicine.
contract—one year on N Appraisal Problems with implementation of the
new contract have arisen as a result of
In October 2003, a majority of consul- N Research disputes between the hours a consultant
tants and SpRs in England voted in
favour of the new contact proposals,
N Clinical management considers he/she perceives he/she works
negotiated between BMA negotiators N Local clinical governance activities and the management view of hours
worked. This can be resolved by all
and a negotiating team from the Supporting professional activities do consultants keeping a detailed work
Department of Health. not normally include additional NHS diary, covering the minimum of one full
What was voted for was a contract responsibilities—for example: rota cycle. However, the more informa-
that, for the first time since the NHS
tion available, the better the evidence in
was inaugurated in 1948, limited the N Medical or clinical director favour of the consultant in the event of
number of hours consultants were
required to work and offered, for the N Lead clinician an appeal.
significant majority, an improved rate of N Caldicott guardian
pay. N Clinical audit lead New and replacement posts
All consultants appointed since the N Undergraduate or postgraduate dean All consultant posts now advertised
beginning of 2004 will have been
appointed to the new contract. Existing
N Clinical tutor should be for the basic 10 programmed
activities with any extra programmed
consultants had the option of accepting N Postgraduate advisor activities by agreement only. Consul-
the new contract or remaining on the nor external duties undertaken as part of tants in post must ensure that new
existing contract. Consultants who colleagues are not paid less for doing the
the job plan by agreement between the
opted to remain on the existing contract same job—that is, all consultants on the
consultant and the employers—for
can switch at any time but they will not same rota, undertaking the same duties
example:
receive any back pay. should receive the same number of
Job content
N Trade union (BMA) duties programmed activities.
The basic contract is for 40 hours work
N Inspection work for NHS organisa-
tions—for example, NCCA On-call work
per week, consisting of 10 programmed
activities of four hours each. Normally, N Work for FAEM or BAEM Time spent on ‘‘unpredictable emer-
gency work’’, when on-call, should by
this will be divided into 7.5 programmed N Work for government departments
based on the weekly average of all the
activities of direct clinical care and 2.5
programmed activities for supporting
N Acting as external member of an
advisory appointment committee
consultants, during a full rota cycle.
Calculations should be based on the
professional activities. time spent on phone calls plus recalls to
Direct clinical care represents work the department. When called back in to
‘‘directly relating to the prevention, Extra programmed activities the department, time is measured from
diagnosis and treatment of illness or Any time worked over 40 hours should answering the phone to the time to
injury’’. be paid in the form of extra programmed returning home.
This includes: activities, calculated in whole pro- When calculating average out-of-
N ‘‘Shop floor’’ work grammed activities or 0.5 programmed
activities only.
hours workload, prospective cover for
colleagues should be built in. Remember
N Emergency work during and arising
from on-call
Some strategic health authorities that by covering for six weeks’ annual
have attempted to place a ceiling of 12 leave, two weeks study leave, and
N Ward rounds programmed activities on consultants, statutory days you are likely to be
N Clinic activities citing the European working time direc- covering nearly 10 weeks of each col-
N Multidisciplinary meeting relating to
direct patient care
tive limit of 48 hours per week. This is
based on a false premise. Consultants
leagues duties—that is, you do 52 weeks
of on-call work in 42 weeks at the
N All administrative work relating to all
the above
can work in excess of an average of 48
hour per week by signing an opt-out to
hospital.
Until March 2005 ‘‘unpredictable
this effect. In addition, if there is emergency work’’ is limited to one
agreement for programmed activities to programmed activity per week and
‘‘Shop floor’’ work be worked in premium time (where a thereafter, the limit is two programmed
BAEM has recommended that consul- programmed activity is three hours activities but you can still get recognised
tants schedule 5.5 programmed activ- long), 12 programmed activities would for this work by pay or time off in lieu. If
ities per week as ‘‘shop floor’’. This will thereby represent fewer than 48 hours the work is sufficiently regular, it should
include not only the primary assessment worked. be programmed as ‘‘predictable work’’—
of patients but also the direct super- In emergency medicine, there is that is, by direct clinical care pro-
vision and teaching given on the shop greater scope for working in ‘‘premium grammed activities.
floor to junior medical and nursing time’’—that is, outwith the new con-
colleagues. tract’s definition of the ‘‘standard work- On-call category
Supporting professional activities ing week’’ of Monday to Friday 7am to Category A is paid where the consultant
underpin direct clinical care and include 7pm. Consultants signing up to the new is typically required to return immedi-
participation in: contract, including all new appointees, ately to site when called or has to
have no obligation to work any of their undertake interventions with a similar
N Training
programmed activities in premium time. level of complexity to those that would
N Medical education Any non-emergency work in premium normally be carried out on site, such as
N CPD time is by agreement only. ‘‘Non-emer- telemedicine or complex telephone con-
N Formal teaching gency work’’ specifically includes any sultations.
www.emjonline.com
4 EMJ supplement
Category B applies where the consul- activities will normally be undertaken at mediation process with their medical
tant can typically respond by giving the place of work, supporting profes- director. If agreement still cannot be
telephone advice and/or by returning to sional activities may be worked flexibly reached, a formal appeal takes place.
work later. by agreement. Consultants can appear in person
Disputes have arisen where trusts Any regular fee paying work—for before the appeal panel and take a
have argued as to the definition of the example, category 2 medicolegal work, representative with them.
word ‘‘typically’’. There is still disagree- should be included in the job plan. The appeal panel consists of:
ment between the Department of Health Where this causes ‘‘minimal disruption
Consultant Contract Implementation to NHS work’’ or work can be time- N A chair, nominated by the employer
Team (CCIT) and the profession as to
how this should be interpreted. The
shifted, fees should be retained by the
consultant.
N A representative nominated by the
consultant
CCIT has argued that ‘‘typically’’ means
more than 50% of the time. Objectives
N A third member chosen from a list,
approved by the strategic health
The view held by the BMA is that For pay progression to be achieved, a authority and the BMA
where a consultant is expected to be in a consultant must make every reasonable
position to return to site immediately effort to meet the agreed, set objectives The panel makes its recommendation
when called, irrespective of the number included in the previous year’s job plan. to the trust board.
of times contacted, they should be in A consultant has no obligation to sign In summary, the key considerations
category A—that is, all emergency med- up to objectives that they consider to be to be given to the new contract are built
icine consultants. unreasonable. into the job planning process which will
be undertaken annually. An earlier job
Availability supplement plan review can be requested should
This is paid to recognise the inconve- Resources
circumstances change before the pro-
nience of being on-call and is dependent The job plan review also gives consul-
posed review date—for example:
on the number of consultants on the tants the opportunity to identify
rota and on-call category. resources required to do their job and
achieve their objectives—for example,
N Fewer consultants on rota
Job planning secretarial support, additional medical N Increase in training obligations—for
example, MMC
All consultants signing up to the new staff, office space, or IT.
contract should have agreed, in writing, If set objectives are not achieved due N Service reconfigurations
their job plan with their clinical man- to lack of identified resources, pre-
viously agreed or any other factors Further information and all the rele-
ager. A number of consultants admit vant documentation on the contract can
that they have agreed a specific number outwith the control of the consultant,
then pay progression cannot be with- be found on the BMA website www.
of programmed activities but have not bma.org.uk including an FAQ section.
agreed a written job plan, detailing how held.
Any further queries can be addressed
programmed activities are to be worked. to me via Julie Bloomfield at the
Location, time, and number of pro- Mediation and appeals BAEM office (julie.bloomfield@
grammed activities should be agreed Many consultants have been unable to emergencymedicine.uk.net).
and documented. It is expected that agree their job plan with their clinical
while direct clinical care programmed manager and have proceeded to the DON MACKECHNIE
* * * * *
the GP’s out of hours contract and hard work and also to all those of you
From the President… also the implementation of Modernising who helped.
We should now all be getting the feel of Medical Careers. I still remain unsure who May I take this opportunity to wish
the impact of the new GP’s out-of-hours is going to do the service part of our job. you all a Happy New Year. I am sure this
contract. We will be sending a ques- I am certain we will have to spend much year will present us with similar chal-
tionnaire regarding attendances in more time inducting and educating the lenges to previous years but, as specia-
December and I would be very pleased F1, F2, and third year trainees. Please let lists in emergency medicine, we will do
to hear from you. Please fill this in and me know through your regional repre- our best to deal with them!
return it to the BAEM office as soon as sentatives of any difficulties you are One last piece of news—we may have
possible. having. the opportunity to move into new
I would also like to hear how you are As you are probably aware, the Way premises. Alastair is leading this project
coping with your 98% four hour target. Ahead document is now available on the and he gives some details on p7. Alastair
Despite what the Department of Health web and we will be using this as the and I will be in close contact about this
says, I think this target will be extremely basis for staffing in emergency depart- and we’ll keep you informed.
difficult to hit and will be even more ments from now on. Thanks to John M J SHALLEY
difficult to sustain especially in view of Heyworth and Jim Wardrope for their President, BAEM
www.emjonline.com
EMJ supplement 5
Round up of forum N Membership secretary (ex officio) N The comments received from ques-
N Website officer (ex officio) tionnaire respondees eloquently sum-
news from FASSGEM 5. The lead organiser for the annual
marise the main problem areas—
namely the urgent need for a new
The FASSGEM Conference 2004, held at
FASSGEM conference may also be co- contract, the need for staff grade
the Kensington Close Hotel in London,
opted onto the FASSGEM committee for practitioners to be given opportu-
was a very great success from an
a period of one year before the con- nities for career progression, the
academic point of view. Attended by
ference, to include attendance at the overwhelming need for staff grade
more than 80 delegates, the three day
FASSGEM committee meeting during practitioners to be offered reasonable
conference saw a more wide ranging
that conference. The role of treasurer for and appropriate rates of remunera-
and busy programme than any of our
the conference account will be taken tion, and above all the need to make
previous annual events. Thanks go to Dr
over by the organisation committee for staff grade posts in emergency med-
Meng Aw Yong for organising it.
that year’s conference. icine an attractive proposition in
As predicted, the Annual General
6. Regional representatives should be comparison to other posts that are
Meeting and the medicopolitical lec-
elected in the current manner for each available within the NHS at the
tures were very lively, with many of
and every region (elected every four current time (especially those in
the contentious issues surrounding non-
years). However, to facilitate and out-of-hours primary care work).
consultant career grade posts being
discussed at length. Full minutes of the streamline committee meetings, the
country will be divided into seven
N The data on levels of staff grade
satisfaction suggest that greater
AGM are available on the FASSGEM
website (www.fassgem.org.uk). sectors: London, southern England, degrees of staff grade satisfaction
Of major significance, a motion to Midlands, northern England, Scotland, are achieved in smaller departments
bring about constitutional change to the Wales, Northern Ireland, with only one where there are fewer consultants
constitution of FASSGEM was passed at representative from each sector attend- in post, presumably reflecting the
the AGM and the key points of this ing committee meetings. fact that in such departments staff
constitutional change are as follows: 7. FASSGEM committee meetings will grade practitioners are given greater
1. That the Chair of FASSGEM be continue to be held at least twice a year degrees of responsibility and accord-
elected for a period of office of four at the FASSGEM Spring Conference ingly feel more valued for the work
years as a single term. and during the FASSGEM Annual that they do—an important message
2. The elections for Chair of Conference, however with a smaller for all departments to heed, regard-
FASSGEM should take place two years committee regular group email contact less of size or consultant staffing
into the term of office of the existing will be maintained to improve the level.
dissemination of information through-
Chair; such that there is a duly elected
‘‘Chair Elect’’. This would allow the out the organisation. N It is of significance that fewer than
40% of departments have an associ-
Chair Elect to become familiar with the A recent survey of all emergency
ate specialist in post at the current
current political situation and to act as departments in this country has high-
time. Given the current BMA recom-
an assistant to the Chair, supporting lighted the true breadth and depth of
mendations on the upgrading of all
attendance at meetings to ensure that a problems around staff grade recruit-
eligible staff grades to associate spe-
FASSGEM voice is always present. ment and retention at the current time.
cialist status, this would suggest that
3. On completion of a term of office, A full copy of the survey report can be
a significant percentage of trusts
the ‘‘immediate past Chair’’ should found on the FASSGEM website, how-
have either not heeded the advice
become the FASSGEM representative ever the executive summary of this
from the BMA (or that trusts have
on the Faculty Committee for a period report reads as follows:
chosen to block internal regrading of
of four years, as this will ensure
continuity and familiarity with the N In summary, this survey has shown
the very great extent to which emer-
eligible staff grades to associate spe-
cialist status for whatever reason).
current issues of relevance. The immedi-
ate past Chair will also then be in a good gency departments in this country
The FASSGEM Spring Meeting will
position to advice the Chair as and are experiencing problems with staff
take place in Southampton on 20 May
where appropriate. grade recruitment and retention.
2005. A conference flyer for the event
4. In addition to the posts for current N Nearly 70% of departments currently
have staff grade vacancies. Over 60%
can be found at the FASSGEM website,
Chair, ‘‘Chair Elect’’ and ‘‘immediate or alternatively further information
past Chair’’ (Faculty representative), the of departments have reported the loss can be obtained by contacting either
following officers’ appointments would of a staff grade practitioner to a Dr Adel Aziz (amabdelaziz@yahoo.com)
also be elected on a four yearly basis. primary care post (within the last or Dr Andrew Newton (apnewton@
year) and, moreover, half of all fairviewshipham.fsnet.co.uk).
N British Medical Association represen-
tation
departments report that the last time
they tried to recruit a staff grade ANDREW NEWTON
N Minutes and correspondence secretary practitioner they were unsuccessful. Chair of FASSGEM
www.emjonline.com
6 EMJ supplement
Faculty is also exploring the possibility myself or the new Education and
News from BAETA of moving out of the Royal College of Examinations Committee representative
Emergency medicine should be a great Surgeons and joining the Royal College who should be appointed this month
specialty in which to train and work. of Anaesthetists when they move into (January 2005).
Unfortunately though, we live in a Churchill House, their planned new
healthcare system with the four hour building in central London. There Training
targets, European working time direc- appears to be major educational and Based on my own experience and after
tive, inadequate staffing, Modernising financial benefits in doing this, but it extensive discussion with colleagues
Medical Careers, and so on. These issues should be made clear, this would not across the country, I believe that the
combine to adversely affect both the involve becoming a Faculty of the quality of UK emergency medicine
quality of training we receive and the College of Anaesthetists. training is poor in too many depart-
quality of care we deliver. ments, certainly when compared to the
So what can we trainees do about it? Faculty textbook quality of training seen in Australia and
Well, there are currently around 500 This will be based on the core curricu- the United States. On the other hand,
SpR trainees in emergency medicine in lum, and should be the definitive text- the view of the JCHTA&E is that ‘‘We
the UK; 10 years ago the entire member- book for those working for the continue to be most impressed with…
ship of the Faculty was less than 500. We Membership and Fellowship examina- the quality of training available in the
have a tremendous opportunity to get tions in emergency medicine. This pro- vast majority of departments’’*. I could
involved and help change emergency ject will only happen if both trainees be wrong (hardly unusual)…but if not, I
medicine in the UK…as well as a and consultants commit to support the suspect the reason for the disparity lies
responsibility to ourselves, our patients, project by: in the feedback we give regarding
and future trainees to make it happen. training departments, and the nature
If, like me, you’re unhappy with the N Signing up to contribute to a chapter of its collection. The current system of
quality of UK emergency medicine
training, or the skills that we’re
N Agreeing to purchase the first two
volumes in advance (at the dis-
giving feedback on a training post at the
RITA has an inherent conflict of inter-
‘‘allowed’’ to use, or our relationship counted price of £100 v £140 full est: ‘‘So, you feel that the training
with other specialties, then you need to price for two volumes) you’ve received over the last year has
get involved and do something about it. been very poor…Don’t worry, we can
There are a number of exciting develop- The publishers require commitments
arrange for you to do an extra year as an
ments currently taking place which I’d (that is, £100 ‘‘up-front’’, to be held by
SpR to help make up the deficit, thanks
like to discuss, but if we trainees don’t the Faculty) from at least 150 people in
for the feedback…’’.
play our part, we may not like the order to go ahead with the project: with
I believe that as a matter of urgency,
result…and we’ll deserve what we get. 500 SpRs currently in training, I believe
the trainees’ association needs to work
that the trainees alone should be able to
closely with the JCHT to implement a
Core curriculum achieve this number. I urge you all to
more robust system to allow honest
The draft version should have been get involved: to quote the outgoing Dean
feedback on training departments and
published by the time of this EMJ issue, David Skinner, ‘‘The Faculty is nothing
individual trainers without fear of repri-
so if you haven’t read it yet, go and do it without the full support of its mem-
sal. To have, as has happened recently,
now! This is an extremely important bers’’. Regarding payment of book
trainees failing the Faculty exam due to
document; the contents of the final deposits, please contact the Faculty
inability to demonstrate basic clinical
version will define both the examina- offices (faem@emergencymedicine.uk.
skills is clearly unacceptable, and begs
tions and what we do clinically for net); to express an interest in a book
the question, ‘‘Who has been responsi-
much of our consultant careers. If you chapter, contact Peter Driscoll, the new
ble for their training for the past four
think skills in rapid sequence intubation Dean (faem@emergencymedicine.uk.
years?’’
should (or shouldn’t) be a requirement net).
This is my first time writing the
for every ED consultant, or that ED trainees’ column of the EMJ supple-
consultants should (or shouldn’t) man- FFAEM examination ment, so please let me know if you have
age patients for the first 24 hours of Major efforts are ongoing to try and strong views on either the style or
their care (as in Australia), make sure improve guidance for candidates and content. I will be in touch via email to
you have your say during the consulta- trainers following the problems with the all those on the EMTEL list; see the
tion process. The chance may not come FFAEM exam over the last few years. BAETA website for details of how to
again for a very long time. Peter Driscoll, Ruth Brown, and others sign up. Many thanks to the current and
from the Education and Examinations outgoing BAETA committee members
College of Emergency Medicine Committee have been rewriting the for helping me get my bearings over the
The Faculty is currently in discussion main information booklet, making the past few months, and for your efforts
with the various Royal Colleges about areas and depth of knowledge required during the past few years.
the establishment of a College of much more explicit, and including past/
Emergency Medicine, which would example questions wherever possible. GHUFRAN SYED
replace the Faculty and (probably) The aim is to get the document onto the President of BAETA; ghufran.syed@
BAEM. Initial soundings have been Faculty website during January 2005, ntlworld.com
extremely positive, and although noth- aiding candidates going for the April *Written report from the Chairman of the
ing has been finalised, it could happen 2005 diet of the exam. Please feedback JCHTA&E to the Faculty AGM, 19 November
as soon as late 2005/early 2006! The on this or any related issue to either 2004.
www.emjonline.com
EMJ supplement 7
Regional faculty written for these posts, which are
expected to be closely aligned with the
N Provide an annual report to the Chair
of the Research Committee.
academic leads educational system and the STC. The
key responsibilities of the RFAL will This will entail a significant commit-
For a number of years the Faculty has be: ment from an individual. We would
developed a network of regional suggest that about 0.5PA would be
research advisors to assist both trainees
and consultants in emergency medicine
N Organise an annual regional research
day.
required to undertake these tasks.
Nominations for the post would be
undertake research and other academic
work such as critical appraisal. The
N Ensure that critical appraisal training
is available within the region.
made by the STC, and the appointment
made by the Research Committee. These
influence of these posts has been some-
what patchy—with some regions having N Keep a list of projects in progress
within their region.
posts are important to the Faculty and
should be recognised as such in assess-
excellent academic training and support ment of performance awards.
provision, while other regions have little N Keep a list of academic outputs from
the region.
We hope that these posts will provide
activity in this area. Many regions have a reinvigorated system of academic
regional academic days, an active critical N To provide local peer review. advice and training at a regional level,
appraisal training programme, and
easily accessible advice for researchers.
N To provide assistance with the local
ethics application process.
and give a uniform national pattern, so
that every trainee and emergency med-
However there are also many regions
that have few or none of these elements
N To know local sources of expertise. icine practitioner in the UK will have a
of academic support. N To attend the annual meeting of
faculty research leads.
local source of help and advice. We will
publish the new list of RFALs in 2005 on
The Research Committee would like
to strengthen the provision of academic N Receive the unapproved minutes of
the Research Committee.
the Faculty website. In the interim
please contact the Faculty Office if you
support to emergency clinicians and are unsure of the identity of your
trainees. The regional system is being N Give a report to each meeting of the
STC.
current RFAL.
reorganised, with the post now being
called ‘‘regional faculty academic lead’’
(RFAL). A job description has been
N Nominate members of the Research
Committee.
FIONA LECKY
TIM COATS
* * * * *
Churchill House theatre in the basement, a conference,
To contact the editors:
The Royal College of Anaesthetists (RCA) educational and examination facility on
has recently purchased Churchill House, the next two floors, and to build a new
Mike Beckett and Diana Hulbert, Acci-
a 45 000 square foot freehold office block council chamber as a top storey. As
dent and Emergency, West Middlesex
in Red Lion Square, London WC1. investment partners we would have
University Hospital, Twickenham Road,
A recent meeting of trustees of the rent-free use of these facilities as well
Isleworth, Middlesex TW7 6AF (tel 020
RCA determined that an offer should be as at least three times our existing office
8565 5486; fax 020 8321 2516;
made to FAEM and to BAEM to become space.
email craybould@bmjgroup.com).
involved in the project. The Intensive While the building is structurally
Care Society and the Pain Society have sound, there needs to be a considerable
already done so. investment to make it fit for purpose.
with a view to our becoming partners in
We have the opportunity to either Nonetheless, preparatory work could be
this venture. We would wish to do so in
lease office space or invest in the completed as early as September 2005. partnership with BAEM who have
building and become partners. The AGM of FAEM on 19 November agreed to the principle of joining us.
There are well developed and detailed 2004 authorised the Board to pursue the
plans to create a 168 seat raked lecture most favourable possible arrangements ALASTAIR MCGOWAN
www.emjonline.com
8 EMJ supplement
Notice
We are up-dating the careers advice document the specialty produces and need your help:
N If you are interested in making promotional material including videos and interactive websites let us know—we need your
skills
N If you have a photograph which defines the specialty in any one of its myriad guises we need it
N There will be a prize for the best image
Please contact us and send your images to:
ruth.brown@st-marys.nhs.uk or diana.hulbert@suht.swest.nhs.uk
Consultant appointments September to November 2004. The information for the consultant appointments is provided by the
Faculty and any errors should be notified to them and not the journal
Name Hospital Previous post
Adrian Boyle Addenbrooke’s Hospital SpR, Addenbrooke’s Hospital
John Criddle Guy’s and St Thomas’ Hospital Locum consultant, North Thames
Ulf H Demnitz Royal Liverpool University Hospital SpR, Merseyside
Nigel P F X Harrison University Hospital, Lewisham Consultant, Queen Mary’s Hospital
Rachel C Hoey Watford General Hospital SpR, Watford General Hospital
Michelle F Jacobs Watford General Hospital SpR, Northwick Park Hospital
Lewis Jones Royal Devon and Exeter Hospital (Wonford) SpR, Derriford Hospital
Darren A Kilroy Stepping Hill Hospital SpR, North Western
Duncan J McAuley Addenbrooke’s Hospital SpR, Norfolk and Norwich Hospital
Nicola McDonald Guy’s and St Thomas’ Hospital SpR, South Thames
Audrey McKelvey Lagan Valley Hospital SpR, Royal Belfast Hospital for Sick Children
Jennifer M Medcalf Royal Shrewsbury Hospital SpR, New Cross Hospital
Asim Shafqat Arrowe Park Hospital Locum consultant
Robert A Simpson Milton Keynes General Hospital Unknown
Sarah E Spencer Princess of Wales Hospital SpR, Oxford
Christopher D Stevenson Aintree Hospital SpR, Royal Liverpool University Hospital
Aravinthan Suppiah Royal Liverpool University Hospital SpR, Merseyside
Beverley L Watts Queen Alexandra Hospital, Portsmouth Consultant, North Hampshire Hospital
The telephone
It is said that the very first message to be passed between the first pair of working telephones was a request for urgent medical help.
Alexander Graham Bell used his prototype telephone to call for his assistant’s help because he had spilled battery acid on his
clothes. His assistant was able both to confirm the successful function of the new instrument and to administer first aid. This was in
1876.
In 1879 the Lancet carried an anonymous report from the USA about a doctor who was woken in the night by a mother who
thought her child had croup. Mother was instructed to ‘‘lift the child to the telephone’’ so that the physician could hear it cough.
‘‘That’s not the croup’’ was the verdict and apparently mother and child, as well as doctor, went to sleep content.
In 1880, the Lancet carried a brief notice that telephones had been installed at the Women’s Hospital in Birmingham to connect
the indoor and outdoor departments with the doctors’ residences. Dr Jacob from Dublin is quoted as urging the use of telephones
for better communication between resident staff and ‘‘honorary officers’’ (we would say consultants now). The editor wonders if this
might not be a ‘‘needless aggravation’’.
In 1883 the editor was still uneasy. He feared that ‘‘to have a dozen telephone consultations in one day, or conversations that
might be thought to supersede a consultation, would be a doubtful addition to one’s advantage or repose’’.
Despite these worries, use of the gadget spread. In the usual flurry of suspicion about new things, a disease of ‘‘telephone ear’’
was soon described. In 1889, a French expert recommended sparing use of the instrument in the case of those whose ears are
sound, and ‘‘absolute abstention for those whose organs are already impaired’’. The features of the syndrome were nervous
excitement, vertigo, and ringing in the ears. Today, ringing in the ears is commonly caused by someone else’s mobile phone.
Acknowledgement—The clinical information in this short article is taken from the pages of the Lancet, but I was directed to look in
its pages by an article by Professor Sidney Aronson in Medical History (1977;21:69–87). I am most grateful to Professor Aronson.
Jonathan Marrow
www.emjonline.com