A day in the life of....an ACCS trainee

In the second of our Day in the Life series of blogs Dr Lyle Moncur shares a glimpse of ACCS training in SE Scotland with us.

I am currently a CT2 Emergency Medicine trainee, mid-way through the ACCS programme within the South-East Scotland Deanery.

The three year ACCS programme involves rotating through emergency medicine, acute medicine, intensive care medicine and anaesthetics. As an Emergency Medicine run-through trainee I will spend my 3rd year of ACCS rotating through paediatric emergency medicine then a further six months of emergency medicine before beginning work as an Emergency Medicine registrar. It is a requirement for the MCEM exam to be completed prior to beginning work as a registrar.

Why did I choose Emergency Medicine?

Emergency Medicine is exciting, varied and fast paced, offering exposure to all specialities. No two days are ever the same. The work can be hard, with high volume and time constraints to deal with, but also extremely rewarding. I enjoy being part of a large team, communicating with patients and colleagues, and performing practical procedures. It has its challenges, and at times an unforgiving rota, but if you are willing to work hard, then it is an immensely fun and satisfying speciality to be a part of.

A typical day in the life of an ACCS trainee in the Emergency Department:

I arrive fifteen minutes early to catch up with my fellow colleagues, following a busy shift the prior evening. We work within a team throughout the 6 month rotation, developing a feeling of camaraderie. This team support is vital to getting through the highs and lows of a day in the Emergency Department. After a bit of banter we allocate working areas for the shift ahead. The department is split into resus, high dependency (HD), immediate care (IC) and exam. The workload in each area varies throughout day and night, and so we are often re-deployed throughout shifts to match needs.

Each shift change begins with a formal handover away from the clinical area. Every patient in the department is briefly presented by their care provider so that the entire team is aware of the clinical picture and management plan. This doubles up as an excellent teaching opportunity, with interesting ECG's/imaging flagged up for impromptu learning. We also discuss any important departmental updates/issues before hitting the floor.

I begin my shift in exam. The case load here is extremely varied, covering orthopaedic injuries, ENT, ophthalmology and mental health to name a few. The turnaround time in exam is fast, requiring quick decision making. It can feel intimidating at first, due to the undifferentiated range of presentations, but support and advice is never far. We work alongside nurse practitioners, physiotherapists, OT's, radiographers, nurses and senior doctors, who have a wealth of knowledge and experience to share. There are plenty of opportunities to learn and develop practical skills. These include fracture manipulation, reducing dislocations, suturing wounds and removing eye foreign bodies.

Whilst working in exam, I also respond to any patients triaged to the resuscitation area. Critically unwell patients are brought to the resus rooms, with presentations including cardiac arrest, myocardial infarctions, major trauma, sepsis, reduced conscious level, stroke and difficulty in breathing. The ambulance crew pre-alert the hospital prior to arrival with seriously unwell patients so that we can assemble a team and prepare. Each team member is allocated a role prior to the patient arriving to ensure that the team works efficiently and effectively.

My role is to assist the senior doctor in making a focused assessment of the patient. This may range from examining the patient, to performing procedures or ordering investigations. When clinically appropriate, I get the opportunity to lead the resuscitation room and make decisions about the initial management of the patient. This is an excellent chance to put into practice my current knowledge and abilities, whilst developing new technical and non-technical skills.

I spend the rest of my shift working between IC and HD, which is where the bulk of majors patients are seen. Clinical presentations include (but are certainly not limited to) chest pain, abdominal pain, collapse, seizures and breathlessness. Patients have been triaged prior to arrival, with initial investigations ordered and completed by the one-patient pathway team. My job is to take a focused history and examination, order and review appropriate investigations, and then formulate a management plan. I am given autonomy to learn and make decisions within a supportive environment. Senior doctors are always near-by to assist with clinical decision making.

The shift finishes with handover. I hand over my patients, safe in the knowledge that each of them has been allocated a new care provider, ensuring they receive uninterrupted care. A team member takes the opportunity to share a pearl of wisdom with the team, a short but valuable lesson they have learnt from the shift before. Impromptu learning like this is important when the workload is constant.

Each day at work brings new challenges, but with that comes new learning experiences. I can honestly say that I make a positive difference to somebody's life every shift I work, whether that be easing pain, alleviating anxiety or just listening to their concerns. It can be stressful, it can be sad, but it is an overwhelmingly fantastic speciality to be a part of.