How the Clinical Fellow posts work (PHEM Option)

THE ORIGINAL DESCRIPTION from the archives

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Most of this time will be spent on attachment with Welsh Ambulance (“third manning” on an ambulance, going out with an RRV, or flying with EMRTS on Helimed), but there will also be opportunities for other PHEM-related activities.... in previous years of our Clinical Fellow scheme, our post-holders have undertaken (or are scheduled to undertake) the following activities:


  1. RNLI live casualty exercise

  2. Participating in an inland rescue course (immersion suit on, chucked into river....)

  3. Night search exercise

  4. Extrication training

  5. Multiple casualty triage exercise

  6. Medic for charity boxing match

  7. Bronze Incident Commanders course

  8. Plane crash exercise (and the real thing!)

  9. Flying with the Welsh Air Ambulance

  10. Assisted with training MRT & SAR personnel

  11. Teaching on pre-hospital related courses

  12. Medical cover at Royal Welsh and Anglesey Shows

  13. Forensic Awareness at scene training

  14. Supporting medical training of SAR rear crew

  15. Medic at motor racing events

  16. Major incident exercises - including organising & participating



We will also facilitate opportunities for you to undertake other PHEM-related activities in your own time:


  1. The Chairman of our local BASICS scheme has offered to call our Clinical Fellows to meet him at scene of any incidents he is called to (and once the PHEC Advanced course has been completed, you could join the local BASICS scheme yourself).


  1. We are often asked to supply “casualties” for various SAR training exercises in the area which is a superb opportunity to see how SAR medicine actually works! 


  1. We are often asked if we can supply doctors for sporting events (paid extra, own time)


Please note that if you don’t want to do the helicopter stuff, or the more full-on Search & Rescue activities, you don’t have to!


It is vital that any potential applicants appreciate these are NOT exclusively HEMS jobs. There are some air ambulance shifts (max 50% of your PHEM time) - which may reduce as the number of Fellows increases - but these are not meant to be the only focus of the PHEM side of the posts, which is intended to provide a rounded first-hand experience of UK PHEM in a rural/suburban environment, learning primarily from experienced paramedics (not doctors) and this is deliberate.


If you continue your pre-hospital career, you will have plenty of opportunity to experience a high percentage of high-acuity jobs by helicopter. But most schemes utilising doctors in the pre-hospital arena in the UK don’t have the luxury of being able to expose them to the full range of challenges faced by paramedics - the PE who has collapsed in the bathroom at home, the belligerent drunk, the panicking parent of a small child who has done something that we know is trivial, but the parents do not.


I don’t have any pre-hospital experience, can I still apply?


Yes! These posts are designed to be suitable for complete beginners in PHEM. You will start off primarily as an observer with Welsh ambulance crews, and as you become more comfortable in the pre-hospital environment you’ll find yourself becoming more and more an active part of the crew.  You’ll then join the EMRTS crew  (supernumerary at all times) and learn/work alongside their CCPs and consultants. 


In addition, in conjunction with our BASICS, WAST and Fire Service colleagues, our Fellows can access
activities such as extrication training sessions, and pre-hospital simulation sessions.


I do have some PHEM experience already, can I still apply?


    Yes! If you are already comfortable working in the pre-hospital environment (or in some specialised pre-hospital environments, such as mountain rescue) that’s great.


We are currently exploring with Welsh Ambulance various ideas for how our clinical fellows can help support the provision of excellence in PHEM in our area, and once doctors have a good grasp of the realities of working pre-hospital in rural North West Wales (t is different from working in cities!) then we are hoping to provide some active support for the development of projects such as a Clinical Desk at ambulance control.   


I’m not currently undertaking RSI in my ED work. Can I still apply?


Yes! We are NOT aiming to produce HEMS doctors or to replace sub-specialty training in PHEM. Our aim is to produce doctors who are completely comfortable working using their existing skills in the pre-hospital environment, and who have a solid appreciation of how the various elements of emergency care fit together in a rural environment. This foundation of knowledge and skills should serve you well in any future PHEM ambitions, or indeed, in any future role in integrated unscheduled care planning. Think of it as “Prep school for PHEM”. 


Only PHEM consultants (or signed-off PHEM trainees) undertake pre-hospital RSI in Wales... you’ll see (and assist) on EMRTS Helimed shifts, but otherwise our Fellows do not undertake RSI outside of hospital. Quite rightly, the governance is tight and competency of performing RSI in hospital is not assumed to be directly transferable to  the pre-hospital environment. 


I am currently undertaking RSI in my ED work. Will I be able to use this skill on my PHEM placements?


Only if you are flying with a PHEM consultant on an EMRTS Helimed shift, when you will be part of the team delivering pre-hospital anaesthesia should a patient require it. 


You will not be undertaking RSI when working in other PHEM roles, e.g. with Welsh Ambulance rapid-response vehicles or emergency ambulances.


Therefore, any applicants for Clinical Fellow posts must be able to get their head around the fact that their scope of practice whilst working with WAST assets will be significantly less than their hospital practice.  If this would cause you too much personal/professional inner turmoil, then these posts are probably not for you.


That said - in 7 years we’ve probably only had about 8 patients brought in by Clinical Fellows who’d clearly have benefitted from on-scene RSI had it been available.  It is by no means an everyday scenario with the population base and epidemiology of North Wales - we’re not inside the M25!


Are these posts educationally-approved for higher specialist training in EM?


No: we have not applied for these Clinical Fellow posts to be educationally-approved towards UK HST in EM or PHEM.


And to be honest, we don’t think we want to…. we are hearing time and time again from trainees interested in these posts that they specifically want to step off the training treadmill for a year: they feel that ACCS + ST4-6 is simply too hurried, and they want to take the opportunity to spend an additional year developing their skills in a nice, friendly, well-supported environment.


Please do not ask us to host you as an Clinical Fellow with partial OOPT approval. If you want to come to Bangor on OOPT, it has to be on a “100% OOPT” basis as a normal ST4-6 (no playtime).


However:


  1. Many Clinical Fellows have come to us on OOPE from EM ST4 or ST5 - you can ask your deanery if you’d be allowed to come on OOPE into a Fellow post or “100%” OOPT as a normal ST4-6 (no PHEM or other playtime with this option, sadly)  - we have educational approval for two higher specialty trainees in EM but only one allocated from the Welsh Deanery, so we can sometimes take an extra funded by BCUHB.


  1. The Australasian College of Emergency Medicine have previously approved the posts on an individual basis for their trainees. 


Our ED does host EM trainees (both ACCS, ST3 and ST4-6) from the Welsh Deanery, and we have also hosted a military ST4 for a year.... we have an FRCEM/MRCEM examiner on the consultant body.


What about Study Leave?


The Clinical Fellow post attracts 10 days of study leave per year, and our management have been very supportive about funding reasonable study leave fees and costs for all ED non-training grade doctors. Given the perilous state of NHS finances, we can’t guarantee this will continue, but we can only keep our fingers crossed... but many of our Clinical Fellows have had £3-4k+ in study leave funding in their year with us, and that isn’t including any PGCertMedEd or PHEC courses! In the event of the study leave pot running dry, it’d be a case of the time off for study leave is in paid work time but finding your own course fees and expenses.


We offer to put all our 12-month PHEM Clinical fellows (assuming they want to!) through the BASICS PHEC and PHEC Advanced course, ATACC, or PHTLS (following poor feedback about the PHEC courses, we recommend the latter) - we included this cost in the Business Case for the creation of the posts (the time would come from the allocation of PHEM days).


Similarly, we offer our 12-month MedEd posts a funded PGCertMedEd course i addition to study leave funding, usually in either Bangor (some contact days which come from MedEd days) or distance learning from Cardiff. This is, however, dependent upon a 12-month commitment to the ED 9and it isn’t compulsory - it is a lot of work!).


Please note we will not be putting the Clinical Fellows through the Helicopter Crew Course - sorry!


BACK TO THE CLINICAL FELLOW INFORMATION CENTRE






 

The basis of the Clinical Fellow post is that the post-holder works as a middle-grade in the ED 80% of the post, but will be released from the ED one day/2 sessions a week (totalling 44 days per year on a 13-session contract… one for each week, less annual leave 6 weeks and study leave 2 weeks) to undertake activities. Including the SPA session each week, that means 23% of the standard 13-session job plan is spent away from the ED shop-floor grindstone.

This page is all about the PHEM Clinical Fellow Posts - but we also can offer posts with 20% MedEd & Management/QI posts - or you can mix & match.