Thoughts for the struggling trainee

(and anyone else whose relationship with EM is “complicated”)


Things to consider if you are considering these posts because you’re struggling at ST3

With a humane rota, friendly ED, supportive seniors, and inspiring place to live, we think we really do provide great posts, and we successfully turn around almost all of our Fellows who arrive struggling with burnout. You can see our current Clinical Fellow feedback data here

But at the end of the day - these are still just jobs. And, sadly, the NHS in Austerity Britain - in Wales as well as the rest of the UK - is tough. Sometimes, really REALLY tough. Especially in winter - we are as riddled with crowding problems as everywhere else (if not worse).

The “playtime” in our Clinical Fellow posts, diluting the intensity of the weekly workload and giving decompression time away from the hot-zone, helps enormously. And of course we bust a gut to look after the wellbeing of our doctors to the very best of our ability, but you must remember that the bottom line is these are still primarily middle-grade EM jobs (and, for most of our Fellows, their first experience of the always-big step up to middle grade). Like all jobs, we take away your time and energy and remunerate you with money (and also, because it’s Bangor, with all the added perks).

For doctors who are struggling, then unless the underlying problem is rota-related (and it is surprising how often that is the case) then we won’t necessarily magically have a solution. Try as we might, we can’t fix relationships on their last legs, regretting becoming a doctor, hating the very essence of EM (i.e. responsibility and handing of risk), and untreated or unrecognised mental health problems.

If we pick up on these then naturally, we do our best to support and help, but - much though we wish it were so - “I had a brilliant time in Bangor” cannot possibly equate to “a job in Bangor cures all that ails EM trainees”.

If you’re reading the above and you know in your heart of hearts it describes you, please get in touch for a chat. Programme Director Linda is pretty good at careers counselling, and equally good at suggesting non-Bangor alternatives if our posts aren’t what you need to be looking for.

If our posts are what you are looking for, but you are fighting vulnerabilities, then it really helps if we know... then we can have sensible discussions about which programme to choose.  The Global EM Year One, for example, is seriously tough with the highly demanding DipTM&H course in the middle and is absolutely not suitable for anyone who is struggling with their resilience even a little, and should not be attempted on on anything more than 10/11 sessions.

We encourage you to seek proper, effective help if you are wrestling with anxiety or depression: just taking a couple of weeks off periodically (+/- medication) seems to be far too common, and does nothing to help you develop essential coping strategies for the long-term.  

Should you join our team, then picking the right job plan (10, 11, 12 or 13 in general) is really important. In general, we encourage all our Fellows to work as few sessions as they can afford. Year after year, it is evident that in general (not always!) our happiest doctors are those on 10 or 11 sessions. In fact, we only offer 13-session job plans (equivalent to an old 1A rota) because some people do need (or want) to maximise their income, and because that provides a reference point for all the job plan options with fewer sessions.   

Working 10 sessions (about the same as a 70% LTFT trainee, but with no impact on your pension), 11 sessions (recommended for most Fellows) or 12 sessions, you obviously earn less money than on 13 sessions. Luckily, housing costs are much lower here than in cities, and many Fellows who are renting out their city properties use the difference to fund reducing their sessions.

But if you want to really find out whether what you are struggling with is fatigue/burnout (which is fixable), or the interface between you and EM (which may or may not be) then please, please don’t try to do it on 13 sessions. And let us help you - we are very happy for you to use some of your Study Leave for sessions with a career and wellbeing coach, for example. It doesn’t have to be all for conferences or courses. 

Give us a fair crack of the whip, and we can make the Bangor Clinical Fellow scheme magic wand work for nearly everyone.

RESOURCES & LINKS - with thanks to Melanie Jones @medicsupport for suggestions

  1. BMA’s Support For Doctors page - links to lots of resources

  2. Facebook’s Tea & Empathy group - you join using your GMC number, some of the posts are heartbreaking (and they’re also relatively public) but great peer support.

  3. The tools and resources inside the Physician Burnout Proof app (starts at $9.99) has also been highly recommended to us, and (who does the app) has a selection of youtube videos (suitable for use just on audio when you’re doing something else) for free. 

  4. Some of our consultants report Mindfulness techniques are helpful (admittedly, others are more sceptical!) and if you haven’t tried them, do give them a try, here are some easy techniques.  


Psychological distress, burnout, and mental health problems are much too common in our deanery trainees in the UK, and becoming more so... in fact, the problems are starting even before doctors qualify, with nearly one third of senior medical students in some UK medical schools struggling with stress, anxiety and depression. 

To make matters worse, there’s no hiding the fact that Emergency Medicine is tough, especially in this era of NHS austerity, and we know that many trainees are feeling pretty broken by the end of ST3. Posts like ours - a “year out” from training - can sometimes be a great help, but only if you are able to recognise what’s happening, accept help, and work in partnership with us to ensure that your job is not pushing you beyond your tolerance whilst you heal, or at least, work on your coping strategies.

This section goes through a bit of a reality check, makes some suggestions about how our flexible job planning options might be used to your advantage, and ends with some resources for doctors who are struggling.