Just before Christmas, I spent a weekend down in Bristol at Take AIM, a conference aimed at junior trainees who have an interest in acute medicine.
The second year of core medical training is notable for a sharp uptick in the number of times per week a person is asked if they’ve had any thoughts as to the specialty training they might consider. I tell them that I’m applying to ST3 in Acute Medicine, and they’re startled — either by my questionable life choices or my level of decisiveness, I’m never quite sure.
“Oh, and — really?” asked my most recent clinical supervisor. “Do you think I could get you to change your mind?”
I should be clear, my choice of medical speciality is hardly the first time I’ve had a questioning eyebrow raised at my life choices. My life choices have, after all, led to me sitting on the M74 on my day off looking for exit signs to Lesmahagow with my only provisions being a boot full of wedding paraphernalia, and being in the back of a Jeep reversing backwards around the corner of the shelf of the Ngorogoro Crater while the part of my brain not occupied with screaming asked if this was really how it was all going to end, and nearly getting arrested in the middle of Tianenmen Square. And those things all turned out brilliantly. So.
The raised eyebrows can be flattering, in their way, if their purpose is to persuade me out of my specialty and into theirs, which is sometimes.
But — unspeakably frustrating in another way.
At this point in CT2, some people haven’t made up their minds, which is fine: that’s why staff grade posts and taking time off from training are good things to do. I have, though. I had my time off from training, remember, and I needed an Archimedean epiphany fuelled by sleep deprivation and adrenaline, but I’m done. I’m sure. I’m not a foundation trainee who ought to be prudently murmuring about keeping her options open. I’m in, and with my eyes wide open. If my mind wasn’t changed by perpetual backshifts in a hospital that was literally closing down around me and where we occasionally had to see patients in the cupboard for lack of bed space, it is unlikely to be changed by the prospect of thirty years as an oncologist.
I know when I was ten that I thought that a doctor was a doctor and it was all basically the same thing, but it’s not like that’s actually true.
Yes, isn’t it nice that we don’t have to all be the same thing?, I want sometimes to say.
I’ll be honest, mind: I understand in my brain why my particular thing isn’t for everyone. In my heart, I don’t really understand why anyone would ever do anything else.
The frustration of being a core medical trainee is that it feels — and is — a terribly peripatetic existence. I don’t yet have my tribe, or whatever the collective noun for my specialty colleagues would be. An insanity of acute physicians, perhaps. I still don’t have that, five years in. My experience is that nor do most CMTs. You sort of have to go looking for it, and therefore my weekend in Bristol was precisely what I needed.
Take AIM was the initiative of registrars training in acute medicine and has the stated intent of promoting what is a still relatively new and rapidly expanding speciality to juniors. It gets funding from Health Education England and support from the Society of Acute Medicine, and it has consultant input, but it’s still principally led and run by senior trainees — which, as someone who isn’t yet but hopes soon to be in specialty training, is a helpful thing for me, to hear from people who are in a position to tell me what the next five years of my life are likely to look like and who are willing to do it in a warts and all kind of a way. My first real contact with them was in October 2015, when I joined in an hour-long discussion on a Sunday evening on Twitter and came away from it feeling that thing you feel when you have found your people and they get you.
Bristol was like that, too, but better.
It had a bit of careers advice in it, and a bit of debunking of the more commonly held myths of acute medicine. Personally, I’m considering getting the sentence No, I’m Not Just Going To Be The Med Reg Forever tattooed across my forehead. It was also very well populated with very lovely trainees who were keen to chat about training and careers between the main sessions.
A lot of the day was education on acute medical topics. The philosophy went something like: “We are going to expect you to engage in acute neurology teaching first thing on a Saturday morning, but we are going to make sure that you are very well caffeinated for it.” That’s basically what I mean when I call them my people.
I would not dare to speak for everyone on this, as training experiences vary across the UK and everyone’s experience of their own training is different anyway, but the topics covered are ones that in my experience are covered badly, not enough, or not at all. To take an example from one of the earlier national conferences, in 2015, a session on “The Pregnant Patient on AMU”. It is not a thing that I’ve ever been taught and yet is a patient demographic that I happen upon all the time. It is incredibly exciting to me to spend a day being taught useful things by people who understand what happens at the front door of the hospital and want to help make it happen better, and that was what that day felt like. The presentations from the Bristol conference are all available online for those of an acute medical inclination, and a Storify, which includes video of a hundred people doing the dermatome dance, still first thing on a Saturday morning, has been put together of the day as told via social media.
It didn’t convince me that I want to be an acute physician; I knew that already. I think it reinforced for me that I’ve made the right decision.
I apply for a job in a month. For those of you who have been on this particualr merry-go-round with me for the last five years: Yes. Again. It’s a bit scary, this time. I remember when I was an FY1 that I definitely thought the registrars were the Proper Grown Ups. If you need me, I’ll be taking deep breaths with my head between my knees.