Clinical Fellow Satisfaction with the posts

(and what we do to try to keep our doctors happy)


Deciding where to do your OOPE is an important decision, especially if it involves upping sticks and moving to the far end of Wales for a year!

No job can please everyone, but we are very

pleased with our current 94% satisfaction rate

with our Bangor ED middle-grade posts.

The data in the pie chart is as of March 2018:

  1. 54 Clinical Fellows or HSTs since the Fellow scheme began

  2. 14 loved the posts so much they extended their stay (or asked to, but we didn’t have space)

  3. 38 = number of Fellows who came for the length of time they originally intended, but told us they us at their exit interviews they were happy in their posts (many of these Fellows told us they would have extended their stay had they not come to the end of their OOPE time) plus Fellows who are currently with us and tell us they are enjoying their jobs.. 

  4. Three really really didn’t like it. Two of them left after 6 months instead of the intended 12, one stuck out the 12 months despite not enjoying the ED component. 

  1. The n=3 “unhappy” does not included the individual who was dragged to Bangor by his other half (a mountain bunny who loved it) but who felt there should be 50% “playtime” (a sentiment we concur with, but cannot persuade the hospital to pay for!) and didn’t like the weather!

Our last major survey of our Clinical Fellows was 18 months ago. At that time, 95% of respondents said they would recommend the posts (and 71% had already done so).

Obviously, we would love to have 100% satisfaction rates with our posts, but we also know that isn’t realistic... especially when for some of our Clinical Fellows, our posts are “Last Chance Saloon” before giving up EM, or even giving up medicine. Truly regretting becoming a doctor is too fundamental a problem for a decent rota and some playtime to fix. On the other hand, we have a wonderful success rate at persuading wavering post-ACCS anaesthetists into EM, and sending some very burned-out and broken post-ACCS EM Fellows back to their deaneries refreshed, rehabilitated and reinvigorated after a year with us.

Where we are seeing a theme emerging is quite marked culture shock for trainees coming from some major cities (for which, read “London”) where ST3 doctors seem not to be given as much opportunity to rehearse the middle grade role compared with provincial deaneries; where tertiary specialities are only minutes away; and there’s always a consultant present in the department. The culture shock on moving to a rural unit, where the ED middle grade is the most senior doctor present overnight, and tertiary help two hours away, is considerable... so considerable that we have added a section in the #NotTheOfficialJobDescription specifically about this. Now we have cottoned on to this, we will be offering more tailored support and coaching to future trainees coming from London or other units where they have never really experienced DGH Emergency Medicine (let alone a DGH at the end of the road, as we are).  

With seven years of experience and more than 50 Clinical Fellows under our belts now, we recognise that most people come to our posts because they are running towards what we have to offer - typically, the chance to do PHEM, a try at rural EM, or to exploit the annualised rota features. There’s more on this at the end of the section here.

But others are running away from something - be that crappy rotas, a decision about whether to continue into HST, or burnout. And of course, our Clinical Fellows are no different from their peers: exactly as we can expect from the statistics, some will be wrestling with mental health problems and may require extra support at times - which we can easily put in place, if we know about it (remember, occupational health won’t tell us, if a newly arrived doctor tells them a mental health problem “is all under control” or if they ask occ health not to).

It must also be remembered that these posts - despite the playtime/SPA of nearly 25% - are predominantly EM middle-grade posts. If you struggle with the very essence of Emergency Medicine (i.e. decision making under pressure, clinical uncertainty, managing risk, multi-tasking) you’re still going to find them very stressful, and winter in Welsh EDs is no less plagued by serious crowding issues than it is in England. If this is you, think hard before applying; get in touch with Scheme Director Linda for a chat, or Helen our RCEM Clinical Tutor, and don’t even think of trying to do it on the traditional, 1A-equivalent 13-session job plan. If you know your resilience is less robust than average, take the opportunity to work fewer sessions, make the job side of life less arduous, and increase the time available to you to look after your wellbeing. Please visit this section of our website that talks about resilience/stress/burnout to find links to resources.    

Finally, we monitor the quality of our posts closely; seek feedback from post-holders constantly; strive action their suggestions whenever it’s feasible to do so; and we aim to do something to upgrade the posts every year, be it in choice (e.g. addition of Global EM and Mountain Medicine programme) T&Cs (e.g. introduction of annualised rota; the new emphasis on “pick your own job plan”) or quality (e.g. upgrading the Helimed side of the PHEM posts to full-service HEMS via EMRTS shifts). New for 2019/20 is upgrading the Study Leave Budget to a maximum of £5000 for all the Fellows - our MedEd fellows have always enjoyed this as we paid for their PGCertClinEd, but now any of our Fellows can undertake a PG Cert if they wish.     

We know we aren’t perfect - no job is - but we are truly committed to producing posts that doctors can be happy in. It doesn’t do you - or us - any good for a Fellow to be unhappy, which is why we always encourage potential applicants to come and visit and have a really in-depth chat with the Clinical Fellow Scheme Director Linda Dykes.

We’ll be straight with you what we can and can’t reasonably achieve, and if we are aware of another option that would suit you better we will happily send you towards it. We aren’t about recruiting at all costs - we want the right doctors, because what is right for us is also right for you.