Louise Tossell / SHO in Acute & Rehabilitation Medicine, UK
Desperate to explore but worried about the long-term consequences of stepping off the training ladder? We’ve all been there. So far though, we’ve always found these fears to be happily unfounded. For the Adventure Medic team, our time out of training has been personally enriching, as well as helping us get on professionally.
However, we’ve all been asked to justify our decisions at one point or another, to ourselves or to to others. Louise Tossell is due to start GP training in August, has worked on several expeditions in Central America and has been involved in remote jungle medicine between her training posts. In this article, Louise pulls out some buzzwords to make your expedition shine on your job application or annual review. Specialty Training Gold!
In these uncertain times, many doctors are looking for alternatives to the traditional training pathways and are considering a break from full-time work in the NHS. Expedition medicine is an attractive proposition, providing opportunities for travel and adventure around the globe. But how can working on expedition help you progress? The General Medical Council’s Good Medical Practice requires a doctor to demonstrate many professional qualities and to continue to develop them throughout their career, and gaining some experience in this out-of-the-ordinary speciality can do just that.
In August 2013, when I had completed my second year of Foundation Training, I decided to step off the training ladder and try something different. After attending an Expedition Medicine course, I applied for a post with Raleigh International and in 2014 I set off to Costa Rica as a medic on their summer expedition. As a multidisciplinary team of eight UK medics, we provided training, support and medical care for approximately one hundred and forty staff and volunteers across two countries. We treated a wide range of conditions requiring knowledge of occupational health, acute medicine, trauma care and ENT, to name but a few.
What exactly is an expedition medic?
The role of an expedition medic is exciting and varied, and may involve: pre-expedition planning; the provision of training and medical support at the in-country headquarters; being the on-site medic at static projects; or acting as the mobile medic on trek. The reality of the job, however, is that you will often not do much medicine at all… Medics will usually be expected to fulfil additional roles on a trip, stepping sideways into the clinical role as and when required. For example, on a Raleigh expedition the medics are as much project managers as the non-medical volunteer leaders; you are required to organise and lead a sustainable development project or to head up a trek, alongside a team of young volunteers whose personal development you need to guide and nurture along the way.
The definition of ‘medicine’ itself is different from that which you might expect. I recently returned from a trip with the British Exploring Society, as one of three medics on the expedition in the Peruvian Amazon. During my time there I was involved in CASEVAC planning and reconnoitring the local hospitals and clinics before the main party arrived. One memorable day involved rising before dawn to travel upriver and visit the nearest town, where a group was scheduled to take part in a community project. My job as part of the recce team was to visit the medical centre, view the facilities, and speak to the staff about the extent of treatment they could provide to ensure that it was appropriate for use by the expedition. We also needed to identify a safe campsite with adequate access to water and a clear evacuation route in case of medical emergency, and to visit and risk-assess the intended worksite. Not a typical set of tasks for the average NHS doctor.
On our return to camp, I was greeted by the request “stitch me up, Doc”. One of the leaders had sustained a head injury while clearing an area of ground with a mattock. Suturing a scalp laceration in the dark and the rain, by the light of a head torch, in the middle of the Amazon? Only on expedition.
So how do you tick that CPD box?
The worry for anyone taking time out, not infrequently bolstered by the scare stories of those who have not, is that it might be difficult to justify the decision at interview, on application forms, or at any medical review panel. Here are just a few of the many reasons that this argument holds no water. After all, everyone loves a CPD buzzword:
The demands and scope of expeditions provide ample opportunities to apply both practical and managerial skills; from dressing wounds and splinting, to record-keeping and accounting. Arguably though, the most important skill for an expedition medic is that of effective communication. Working internationally brings with it a wide demographic and a variety of languages and cultures, and – in addition to interacting with the people on expedition – you may come into contact with local communities and medical services, or have to liaise with medics and relatives at home. Telephone triage is a big challenge, especially with a language barrier, and requires a cool head and logical thinking to decide whether to treat in the field or evacuate the patient to a secondary medical facility. It is tricky, too, to advise a non-medic over the phone to perform an examination and then to gain a clear description of their findings, in order to form a management plan. All these situations require clear, concise communication. I distinctly recall a series of conversations with the non-medic leader of a group isolated on a mountain, for whom English was their second language, using a poor phone line which often cut out – trying to explain how to assess a participant’s neurological symptoms before darkness cut off their evacuation route was more than a little challenging.
I have been fortunate during expeditions and events to work alongside paramedics, nurses and first-aiders, as well as doctors from various specialties. The opportunity to work with such a team on expedition is invaluable, as the sharing of knowledge and experience helps everyone to pick up amazing tips, and enables you all to provide great all-round care for participants. It also fosters a true appreciation of each healthcare professional’s role, both within the event team and in the UK health service. You may be required to deliver first-aid training to expedition participants; a useful exercise in itself, but doubly valuable from an educational perspective when delivered by a multidisciplinary team. Doctors in training are expected to provide evidence of teaching experience, and the opportunity to teach groups of non-medics is an interesting and rewarding one: harder to find, perhaps, in a hospital environment.
Expedition medicine often calls for strong leadership skills, especially during casualty evacuations. A group may instinctively look to the medic in an acute incident; not just to deal with the casualty, but for general and logistical guidance. In such circumstances, you will have to communicate with headquarters, delegate roles to other group members and facilitate the evacuation procedure, as well as treating the patient. These are excellent learning opportunities from both a clinical and personal point of view, particularly when married up with good reflective practice – and you will definitely have plenty of fodder for that. At the expedition headquarters in-country, the medic may be involved in the planning of a MEDEVAC (non-urgent medical evacuation of a casualty) or CASEVAC (urgent evacuation for treatment), alongside non-medical staff members. This can be a fascinating insight into the crisis management procedures of an organisation, and provides rare experience of the organisation and logistics required to successfully carry out such an operation. Teamwork, communication, time management and task prioritisation all come into play, while at the same time you need to provide medical advice to those in the field with the casualty. There is much to be learned from being part of a practised and efficient multidisciplinary team working behind the scenes in an emergency, and these skills are just as important and applicable when participating in an A&E trauma call as they are on expedition.
Another of the appeals of this speciality is to develop the ability to work with limited kit and resources, in environments far from the cleanliness and order of an NHS hospital. Washing an eye out with an IV giving set in the middle of the jungle, for example, will later make you truly grateful for the comparative luxury of an A&E Minors department! Problem-solving, lateral thinking and the ability to make-do and improvise promote self-sufficiency and a diagnostic mind, essential for every clinician. In our current world of cut-backs and budget restrictions, a medic who has learned to appreciate the resources available and to use only what is needed, without waste, is a very useful one indeed.
Tempted to give it a go?
There are several UK-based organisations which recruit medics at various levels of training to provide support on expeditions. If you have some A&E experience, are at least post-FY2 level and have an Expedition Medicine course under your belt, you’re often eligible to apply.
Communication, teamwork, organisation and resourcefulness are just a few of the characteristics thought by the GMC to be vital for every doctor. I am not advocating that a life practising medicine in the wild is the only way to gain these skills; rather that seeking some experience in expedition and wilderness medicine, alongside a career in the NHS, can provide novel and exciting opportunities for continued professional development.
Editor’s Note
Adventure Medic Director Matt Wilkes is a seasoned time-outer and has always been able to sneak back into training. He has the following advice for anyone concerned about the UK application implications of taking time out:
Applications shouldn’t be the first thing on your mind when you step out of training. Instead, your thoughts should be about how your decision will enrich your life: what you’ll learn as a person and a doctor and the incredible opportunities and experiences now open to you. Many of your future colleagues and employers will be sympathetic and see that as ‘justification’ enough. When talking to those who are still sceptical: own your choices, be enthusiastic about the path you have taken and what you have learnt as a result. They may not agree with your decisions, but they will respect them.
However, I do know that the decision not to apply to the next stage can be daunting. In UK training, there is always another rung on the ladder in easy reach and the pressure from colleagues to grab it immediately can be quite intense. So, please remember you lose no points on UK specialty training applications for taking time out. Yes, there are time limits for how much extra specialty experience you can gain, but expeditions and other adventures do not count there. There is also a section on most forms asking you to list any breaks in employment but this is for occupational health reasons – they want to know if you were in bed with back pain or locked up in jail – not to punish you for going on safari.
In fact, you can only gain application points (and experience) from going away: use a small fraction of your time to do an audit, a presentation, an interesting course, write a letter or an article and you’ll be swimming in points that you would have missed out on if you had applied straight away. Look at person specs for the job you want and fill in some of your blanks in between travels. Each job and specialty is unique and frequently updated, but see the NHS Speciality Training 2015 Person Specifications for guidance. You’ll be at the top of the pile in no time.
Finally, think about who is giving you advice. We all like to feel we have made good decisions in life, so a doctor who has taken no time out of training might be more likely to recommend that you don’t either, as that helps validates their own decisions. The same applies equally to us, we want you to take time out to explore because we have too. So, take advice widely from all camps – it is sometimes good for people to tell you what you don’t want to hear – but take it all with a pinch of salt. You only have one life, think about what you actually want to do with it and then get on and enjoy it. Then, write in and tell us all about what you got up to.
Further Reading
For more information on CPD and what’s important according to the UK’s General Medical Council (GMC), see their Good Medical Practice and Tomorrow’s Doctors guidance.
Looking for some bed-time reading before a trip away? Try Expedition Medicine by the Royal Geographical Society. Warrell, DA and Anderson, SR. Expedition Medicine. London: Profile Books Ltd, 2002. Print.
Visit the British Exploring Society, Raleigh International and our own Resources pages for up to date information on expedition links both in the UK and elsewhere.
Click here for our article on Breaking into Expedition Medicine and consider reading our piece on the Top Ten Skills To Master for the Expedition Medic by Harvey Pynn, Medical Director of Wilderness Medical Training.
Photos: Louise Tossell
