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                                                                                                                 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



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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.



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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




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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




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