The Faculty of Pre-Hospital Care

Answers

Can anyone undertake PHEM sub-specialty training?

Essentially, no. When Pre-Hospital Emergency Medicine (PHEM) was first approved it was initially only open to individuals with a parent specialty of Anaesthesia or Emergency Medicine (EM). Since then Intensive Care Medicine (ICM) and Acute Medicine (AM) have been added to the list of approved parent specialties. The list of approved parent specialties continues to grow all the time. The best advice is to look on the Intercollegiate Board for Training in Pre-Hospital Emergency Medicine (IBTPHEM) website (www.ibtphem.org.uk) for the most up to date list of approved sub-specialities at the time of your application.

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What are the entry criteria?

Again we would suggest looking at the IBTPHEM website for the most up to date person specification. Please note that at the time of writing, applicants from parent specialties of Anaesthesia and EM must have a ‘minimum of 6 months training in an approved training post at CT1 level of equivalent in EM or Anaesthesia. This is likely to be extended to include 6 months AM and 6 months ICM (in addition to the Anaesthesia/EM) to reflect the Acute Care Common Stem (ACCS) programme in the near future. If you are applying from an AM or ICM background you currently need to demonstrate having ‘a minimum of 6 months experience at CT1 level or equivalent’ in all 4 specialties (Anaesthesia/EM/ICM/AM).

So if you are a Foundation Programme doctor interested in doing PHEM in the long term, we strongly suggest you consider applying for ACCS as this should meet all future requirements. If you are looking at doing PHEM from a later stage of training and have not got this experience you would need to get it prior to applying for PHEM training. This may involve taking time out of training.

At the time of writing it is not possible to apply for, and be appointed to, a PHEM post ‘pending meeting the entry requirement’. You simply can’t apply as you do not meet the entry requirements. PHEMTA is however continuing to engage with IBTPHEM on possibly working towards this style of system as we are aware that taking up to 2 years out of programme to gain eligibility for a post you might not get is a risk and may put off good candidates. However, the Committee does support the IBTPHEM view that this ‘ACCS Equivalent’ level of training is essential and should be the entry criteria.

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When can I do PHEM training?

That depends to an extent on your base specialty and LETB. What will be consistent is it should be undertaken as a ‘Senior Trainee’, which in most specialties will be during the last 1-2 years of training. It may also be completed after your specialist-training programme (post–CCT). We therefore advise that if you are interested in applying for PHEM training you speak to your local training programme director, educational supervisor, college tutor early to highlight your intentions. This is even more important if you need to take time out of programme to gain eligibility as discussed above.

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How does PHEM fit in with my base specialty?

There are different types of training scheme; A, B, and C. A is a 2-year programme which is ‘blended’ with your base specialty. So for example you might do 50% Whole Time Equivalent (WTE) in each area of practice over 2 years, or perhaps do an 80% PHEM : 20% Base split in year one then 20% PHEM : 80% Base in year 2. The exact arrangements are likely to depend on the Local Education Training Board (LETB) offering the PHEM training. Scheme B essentially involves 2, full time 6 month rotations in PHEM being spread across 2 years. Scheme C is a 1 year, full-time PHEM programme. More information can be found on the IBTPHEM website regarding this. 
To give an indication of different schemes, in 2016 the breakdown 73% of trainees were on scheme A, 10% were scheme B and 17% were Scheme C.

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Does PHEM involve any exams or assessments?

Yes, lots! As a recognised training post it has, like other training programmes, work place based assessments, supervisors meetings, an end of the WTE year ‘Training Assessment Panel’ (similar to an ARCP) and 2 College Examinations. The first is the Diploma in Immediate Medical Care (DIMC) held at the end of Phase 1 (6 months WTE) and then the Fellowship in Immediate Medical Care (FIMC) at the end of Phase 2 (12 months WTE). Both examinations are administered by the Royal College of Surgeons of Edinburgh and passing them is a requirement to successfully complete the PHEM training programme. The good news is that if you hold the DIMC prior to starting PHEM training, you don’t have to do it again!

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What can I be doing now to help increase my chances of successful application?

Here comes the slightly tricky bit, and might depend where you are in the country. Naturally some experience or evidence of interest in the sub-specialty should make getting selected more likely, but how can you get it? Well, generally it is easier than you think. You won’t need to do all of them and it is probably better to have a range of experiences done over several years (as this demonstrates ongoing commitment) rather than a few things all at the last minute! Some suggestions are listed below:

  • Request an observer shift with your local ambulance service
  • Request an observer shift with your local PHEM/BASICS/HEMS service
  • Request an observer shift with the medical services providing mass gathering/event/sporting event cover
  • Attend a local PHEM/BASICS/HEMS clinical governance day (or travel further afield if needed)
  • Ask a friendly PHEM trainee, pre-hospital clinician or service lead if there are any audit/research projects you could help with. If you manage to do this try to get a poster/oral presentation at a meeting/conference using this work.
  • Do an audit/research in your own place of work that has a PHEM aspect to it (eg. something around trauma calls to resuscitation area etc)
  • Attend a PHEM style course (eg. BASICS courses, ATACC, PHTLS)
  • Attend a PHEM conference (eg. Trauma Care, BASICS/FPHC, Retrieval, London Trauma Conference)
  • Volunteering to help with the fundraising/charity side of PHEM organisations will help them raise vital funds and may give you the opportunity to speak to the right people to help open up opportunities mentioned above.
  • You could start practicing some basic level PHEM yourself (eg. community first responder schemes, St John’s Ambulance, responding for BASICS organisations etc). However, please be cautious about doing so as this needs to undertaken in a professional way! Further, limited advice below….

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Do I need to be practicing PHEM (ie. treating patients) already?

No. You can enter PHEM training having never done any pre-hospital practice at all. Naturally you are more likely to be shortlisted and selected if you have shown interest and tried to gain some experience of PHEM work within your scope of practice. However, for many this will be limited to observer shifts, governance day attendance etc.

Some individuals may already be practicing PHEM in one way or another (eg events cover, St John Ambulance work or responding for BASICS or CFR schemes), or may choose to do so before they apply for a sub-specialty training post. If you are in a position to do that we would highlight a few ‘rules’ and suggest you seek further advice locally from your training programme directors and/or supervisors. Firstly you will need to ensure you have adequate medico-legal protection for this work as the majority of providers would not cover any practice under ‘good Samaritan’ acts if you are sitting in a first aid tent or responding to emergency calls. In addition, any activity undertaken as a doctor should be subject to annual appraisal. So, for example if you are undertaking voluntary work with local BASICS/HEMS organisation and you receive a complaint or are subject to investigation, this needs to be declared at your annual appraisal, even if that is being conducted by a non-PHEM panel. As this all gets rather complicated and the Faculty Pre-Hospital Care, BASICS and the Association of Ambulance Chief Executives have produced a joint statement on this.

Why is this important? Well if you are able to practice elements of PHEM work in a well-governed and supportive environment prior to undertaking a PHEM training programme that is great! It may help you perform better at selection. However, the reverse may also be true. If you attend selection already practicing PHEM, how do you think it will look if the panel find out you do not understand any of the rules pertinent to this area practice and that you have not been following them? So just be careful and chat to your supervisors in advance.

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Upcoming System Maintenance & Network Disruption

Due to essential systems maintenance and upgrades there will be intermittent interruptions to some on-line services on Saturday 27th of February. There will be further interruption to some core services on Wednesday 2nd and Thursday 3rd of March.

We apologise for any inconvenience caused.

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