PHEM training in London: Harriet’s Journey.

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5th December 2016…post-nights brunch. An e-mail appears in my inbox from oriel.nhs.uk. Palpitations, dread, nervousness ensue… do I open it now? Do I leave it…? Post-nights lack of straight thinking hits and I press open almost without realizing it, without realizing the ramifications of what I will read next…

“Thank you for attending the recent interview for Pre-hospital Emergency Medicine Level Sub-Specialty….We are pleased to offer you the following programme….”

And I am over the moon. This is what I have been working towards since I was a medical student, throughout foundation and emergency medicine training. I have directed most of my time and energy in medicine towards this, and finally it had happened. Disbelief, relief, excitement, apprehension, a complete gamut of emotions hit me – I was definitely not sleeping post finishing nights that morning!

I had applied via the formal PHEM training scheme, for which you are eligible post successful completion of ST4 ARCP in emergency medicine. There are pro’s and cons to PHEM vs. standalone posts, but one of the reasons I had applied via PHEM was that it gives an objective, transferable set of competencies and assessments and is GMC recognized, and hopefully leads to a consultant post in PHEM as part of your job plan, which is transferable around the country. As with any formal training post, there are work-place based assessments which must be carried out, and the summative exams are the DipIMC and the FIMC, which must also be passed to complete the training post.

The application process itself is fairly straightforward and the IBTPHEM website clearly sets out the timeline. The recruitment is at present done via Oriel, the online NHS recruitment portal, which is distinct to the standalone jobs which are mainly still advertised and run on the NHS jobs website.

The process is co-ordinated centrally by the East of England deanery, and is excellently run throughout. Their team readily and quickly answer any questions you have, clarify any concerns, and are brilliant during the interview day.

The online application consists of the standard questions regarding medical student training, previous employment, disabilities, criminal offences, equal opportunities references etc. (in fact pretty much identical to the ST4 application form on Oriel) which is simple if time-consuming to complete. The PHEM-specific questions are: achievements outside the field of medicine, presentations and publications (local, regional and national); teaching, audit and research; suitability for specialty; commitment to specialty – achievements and activities. These are harder to complete as they have strict word limits, and it is prudent to write these with the person specification to hand (to be found on the website referenced below) to ensure a) you include everything you want to and b) you do not duplicate points and therefore ‘waste’ valuable words! You are also asked to document supporting evidence, such as additional undergraduate degrees and qualifications, postgraduate degrees and qualifications, additional achievements (prizes, awards, distinctions) and relevant training courses attended. In contrast with the stand-alone PHEM jobs, you are not asked to list the numbers of relevant procedures you have done (e.g. RSI).

You are also expected to complete a fitness test prior to interview, based on the Welsh Ambulance Service Fitness test, which you download and complete with a registered fitness professional (I did mine with one of the Personal Trainers at Nuffield Health), and then either upload to Oriel or bring with you on the day of the interview. It is not essential to have completed it by the time the online applications close, as long as you bring it with you to interview. This is not onerous, and should not be seen as in impediment to applying! You also need to have pre-approval from your head of school to apply (at least for EM trainees) and this form needs to be submitted at interview – so make sure you request this early to ensure you have it for interview.

There was a two week period whilst the online applications were open (again, time-lines are clearly stated on the IBTPHEM and HEEE website). Following closure of this window (the end of October) it was about three weeks until invitations to interview were e-mailed. Again, all the timelines were clearly stated on the website, as was the interview date itself. From receiving an invitation to interview to the interview date was approximately ten days. I used this time to prepare my portfolio to ensure that appropriate evidence and documentation was clearly and readily available, arrange some interview practice, ensure I had appropriate evidence and copies of everything I had referenced in my application, read key papers (focusing on areas I was interested in and could talk knowledgably on, rather than trying to learn everything) and ensure I was up to date with current research/guidelines/topics. I am sure there are myriad ways to prepare for the interviews, but I found this worked for me, as well as keeping me calm and giving me some structure to my preparation. Of note, at present you do not need to bring references to the interview – these are collected by HEE afterwards and are therefore one less thing to worry about.

The interview itself took place near Cambridge. The slots were booked via Oriel, and these got booked up fairly quickly. It is an easy drive from Cambridge station and there is also plenty of parking available on site. Travel expenses were reimbursed. Again, the HEE team was hugely helpful with any logistical queries/last-minute worries. There was no need to arrive earlier than the allocated start time of the interview slot as this included all document checking. From memory, there were slots every from 0900, every 90 minutes to two hours with 4-6 candidates per slot (again, this may vary from year to year and from slot to slot)

On arrival essential documents were checked (GMC/life-support/degree certificates, address proof etc). There are two twenty minute station and candidates are randomly allocated to one followed by the other. One station is a scenario, for which you are given the context outside the room and have two-three minutes to mentally prepare, followed by a few questions related to themes and issues raised by the scenario. The second station is a more formal ‘interview’ style station, with 3-4 interviewers and a lay representative. It begins with a presentation, and all candidates are given the topic just prior to the station with two-three minutes to prepare (again, in contrast with some of the stand-alone interviews). Onward questions range from review and reflection of your experiences in pre-hospital care, motivations, thoughts and discussion of current and future topics, research, audit and governance, teaching, your activities and interests outside of medicine, and many other areas. The questions and scenarios differ from year to year. The panels were made up of PHEM leads from the regions offering PHEM training, with approximately 3-4 in each interview, but again this may vary from year to year. I was not interviewed by anyone I had worked with or knew, but I am unsure whether this was by accident or design.

Again, everyone at the selection centre was supportive, reassuring and helpful, and a great part of the day was meeting other candidates, finding out more about their backgrounds, what it was like working in their regions, and their hopes and aspirations for the future. Apart from the fact that it was an interview, it was actually a very enjoyable and thought-provoking and stimulating day, offering you the opportunity to meet with other like-minded people, discuss interesting and relevant topics, and stimulated further reading and training.

After the interview we then were asked to rank our preferences amongst the different training schemes and regions, and this had to be submitted by the end of the day (For further information regarding the variations in training schemes and the training in different regions please see the websites below). I emailed several of the PHEM leads to ask further questions regarding training in their region, and they all replied quickly and were very helpful and informative. Of note, one of the possible ‘negatives’ of the PHEM scheme is that you can, in theory, be allocated to any post in the country, rather than applying directly for a specific post, and you are ‘competing’ with trainees from other specialties as well as your own. However, it is important to read the different schemes available for trainees, and reflect on the pros/cons and what would work for you. One reassuring fact from chatting to other candidates at interviews was that everyone had very different rationales for applying for posts – and indeed we were all ranking things differently – so I think the point I took from that was apply for, and rank, what you want to apply for, rather than second guessing everyone else’s motivations or trying to play the numbers game. Again, everyone will have different advice on this, but it seems that working out what works for your and your personal and professional life is really important, as PHEM is a really tough year and you need to be 100% happy with where you are going to work and the pressures it will place on you both professionally and personally.

Offers were emailed out 4 days following interview, and required acceptance within 48 hours. As pre-approval had been given by the head of school for the OOP time, there was no need to delay in applying. You could accept, accept with upgrades or decline. I accepted my first choice, KSS, so that was one less thing to agonize over.

Of course, the decision to apply and subsequently be lucky enough to be offered a PHEM job was not a decision made overnight. Wanting to do PHEM has been a constant throughout my years in medicine (a picture of the LAA helicopter got me through finals as motivation!) and my ‘extra-curricular activities’, as it were, have been focused on this. However, it is not just the ‘doing’ of these things but also the reflection on them is important; people can ‘do’ everything on offer, spend thousands on different courses but the important thing is to be focused on what your are doing, to reflect on your experience and take back to your own practice, which is definitely picked up on in interviews. Having said that, it felt like one of the things which was important was long-term commitment to the specialty, a real interest and enthusiasm, a knowledge of how it had evolved and was evolving, and your personal involvement over time rather than overnight. I remember speaking to Dr Anne Weaver as an FY2, and feeling really nervous about saying in front of her that I wanted to do HEMS, but she gave me such great advice and ideas for the future. The frustrating thing is waiting until you are senior enough to apply, but you can use this time to enhance your skill sets, competencies and experience.

From a purely personal perspective, and I am sure whoever you speak with will have different advice, perspective and routes, I found that attending governance days was hugely beneficial as it gave great insight into the mindset of those involved in pre-hospital care, into the situational awareness and decision making processes required, into the types of patients you may be caring for, and into the complex logistics and environmental considerations involved. I was lucky enough to go on observer shifts, which gave similar insights, and speaking with those already working in pre-hospital care was invaluable. I attended training courses offered by KSS AA, and also gave medical support to expeditions and sports events such as the London Marathon and Wimbledon.
As an EM trainee, I felt that I needed more airway experience so arranged additional adult and paediatric anaesthetic experience. I also completed courses such as MIMMS, PHTLS and ATACC, and attended relevant courses and conferences, and these were incredibly useful – but again pointless without reflection on your own practice and what you have gained and learned from them. My audits and research were geared towards pre-hospital care, and I undertook a trauma sciences MSc based at the Royal London and QMUL, which further developed my academic and research side. I also took two years out of emergency medicine training to do a retrieval and transfer medicine post, which also involved training in aviation medicine, which gave me invaluable experience and hopefully added depth to my application. Having said that, I can only comment from my own experience and my own pathway to a PHEM job – there are many other perspectives, and many routes, but it seems that the key things are persistence, enthusiasm, and commitment over a long-time period, which hopefully I have illustrated with my pathway to PHEM, but which is but one of many.

It seems also important to remember that having a PHEM job is not the be all and end-all; it is by its design a training post designed to equip trainees to become consultants in PHEM and their parent specialty rather than being an end-point in itself. It can act as a spring board to many other professional and personal opportunities within PHEM, and is the start of another exciting and challenging part of your medical career; as with most things, you don’t know who you are going to meet on the way, and what opportunities are going to present themselves, but PHEM training is an amazing and invaluable opportunity to realize a career long-goal, and give you the building blocks to open up and progress towards many others. I am hugely excited, but also hugely daunted, by the thought of the year ahead – the dream has become a reality, and it is a very challenging reality! It will be a really tough year – but one I am hugely looking forward to and ready to embark on, and which will guide and enhance my future career.

By Harriet Tucker, ST5 EM Trainee.

 

Useful references/websites:

https://heeoe.hee.nhs.uk/recruitment_phem
http://www.ibtphem.org.uk

These both offer comprehensive guidance to PHEM training, the application process, the person specification, the most up-to-date numbers on training posts, which regions are now offering PHEM training (the numbers are expanding!), the numbers in each region, the differing regions and schemes of training and good contacts for further information.

Pre-hospital and Retrieval Medicine by Dr D Ellis and Dr M Hooper – great case-based text with excellent learning points drawn out from each case.

www.associationofairambulances.co.uk – a useful guide into how air ambulance charities are structured, run, supported, governed and funded.

www.trauma.org

Podcasts (I’m sure you all know these! I spent a lot of time listening and reflecting whilst running and cycling)

PHEMCAST
Pre-hospital and retrieval medicine
SMACC
St. Emlyn’s
EMCritFOAMcast

Please feel free to contact me on harrietftucker@gmail.com for any further questions regarding the interview process/preparation/relevant papers

 

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