Dr Emily Watts / Specialty Doctor in Emergency Medicine with Special Interest (PHEM) / North Cumbria
Dr Emily Watts is working as a registrar in Emergency Medicine with special interest in Pre-Hospital Emergency Medicine based in Cumbria. She is developing her expedition and wilderness portfolio with a post graduate diploma, and has been involved with medical cover for ultramarathons in the UK and Europe. Outside of work, she can be found up a fell, on or in the water, or cycling the gravel tracks that make living in the Lake District so fantastic for any outdoorsman.
Clinical fellowship title, specialty and grade
Title: Clinical Fellow in Emergency Medicine with Specialist Interest
During my fellowship, the role was advertised for those with a special interest in Pre-Hospital Emergency Medicine. This has now been broadened to include special interests in Pre-Hospital Medicine, Mountain Medicine, Simulation Medicine, Academic Medicine, Paediatrics, and Intensive Care Medicine.
Base Specialty: Emergency Medicine
Grade: Post-FY2 – commonly as stand-alone FY3 or as an ‘out of programme experience’ for EM trainees.
Structure of the role
This role is a fixed-term contract for 12 months. My time was split as 70% Emergency Medicine and 30% special interest, which has changed to an 80% / 20% split since. My PHEM special interest time included experience with North West Ambulance Service and Mountain Rescue Teams. The opportunity to work with Great North Air Ambulance Service was unfortunately limited by the onset of the Covid-19 pandemic. This has since been re-established for more recent fellows.
The trust supports less than full-time working – ask on application if interested.
Prerequisites for application
This fellowship prerequisites are straightforward:
- 4 months experience in Emergency Medicine
- Completion of the foundation training programme
- Advanced Life Support (ALS) provider
This post is targeted at the post-FY2 / pre-specialty application doctor, and represents the majority of the applicants, but they are open to applications with higher levels of experience.
Location of fellowship
Clinical Fellows are based in Cumbria, in the North-West of England. The hospitals are in Carlisle (North East Cumbria) and Whitehaven (North West Cumbria), with the fellowship base hospital usually set as Carlisle. This is discussed on an individual basis and decided based on special interest preferences. As my interests included mountain medicine, my base was set as Whitehaven for my fellowship year.
Pre-hospital experience will be largely dependent on where you are based owing to the geography of the Lake District and Cumbria in general. I joined ambulance crews from bases local to the Whitehaven area and worked alongside the Wasdale mountain rescue team. The Great North Air Ambulance Service has bases in Langwathby and Eaglescliffe.
Brief description of the job role.
Emergency Medicine:
You will join the SHO rota, working alongside the clinical team and wider MDT to provide emergency care to the local and visitor populations. This roster includes working a range of shifts, including late and night shifts, as well as weekend working – this is unlikely to be surprising to applicants, given the prerequisite for ED experience. Both hospitals have mixed Emergency Departments, meaning there is an opportunity to work with the paediatric and adult patients. Owing to the rural location and nature of a district general hospital, there are limited specialty services on-site, especially at Whitehaven. Consequently, there is a greater emphasis on procedures and skills being taught and performed within the Emergency Department. The tertiary centre for many specialties will be in Newcastle, approximately 2 hours away by road from Whitehaven.
Special Interest:
The fellowship was a new role when I joined, without any set format or criteria. This meant that there was a lot of work on my part initially to set up opportunities by email and phone calls. This is now a well-established role so there is more structure to facilitate the ease of taking up local opportunities. For applicants considering this role, I suggest you reach out to the recruiting team to see if they can cater to your area of interest and particular opportunities you would like to experience (I expect the answer will be yes!).
Within the rota, I was allocated a week at a time (roughly every 3 weeks) as my pre-hospital time. However, as long as I ensured I could account for my hours at the end of the year, the senior leadership team was happy for me to self-manage this time. I relished that I was given the freedom to do so, and it meant I got far more done. For example, attending a weekly training session with the mountain rescue team. Some weeks I ended up mixing clinical and pre-hospital elements, whilst others were almost rest weeks to compensate. The senior leadership team was incredibly supportive – making suggestions and options for ways to use my time, they were also able to help nudge opportunities along if I wasn’t getting responses.
Unfortunately, by the time I had arranged observer shifts with GNAAS, the COVID-19 pandemic had hit, so these and my observer shifts with the ambulance crews were put on hold. However, my pre-hospital time was protected despite the circumstances, and I was able to develop other areas of my portfolio: teaching, quality improvement projects, etc.
Academic accreditation
I did not receive accreditation for training for my fellowship year. I used this time to complete an appraisal, maintain my portfolio and prepare for specialty application. Contact the department for further discussion and information.
Overall impression
I was excited by this ‘sideways’ career move, as it offered a chance to develop on my career interests throughout my working week rather than cramming it into my rest days. After the usual challenges of relocation and settling into a new trust and department, it quickly became apparent that it was the best decision I could have made.
In my pre-hospital weeks, I had the chance to go on courses (yes, there was a study budget too!) and be an observer with the local ambulance crew. I also linked in with one of the local mountain rescue teams – helping with medical training, but also being accepted as a probationary member for callouts. I covered an ultramarathon in Belgium, with further events lined up for later in the year, and I liaised with the Great North Air Ambulance Service, to arrange exposure to the world of Helimed.
When COVID-19 hit, it threw a spanner in the works and life as we all knew it ended, which included many of my pre-hospital opportunities. Due to lockdown, the lakes were quieter resulting in less footfall and, therefore, fewer injuries and accidents.
Outcomes of the fellowship
As well as confirming that the ED is where I want to be long-term, it demonstrated how beneficial it is to have allocated time to pursue courses and self-development opportunities is. It reignited my passion for medicine and allowed me to focus on optimising my application for specialty training, without sacrificing rest and recovery.
Ultimately, taking this job helped me to realise that I don’t want to rush through training and that I am happy to take a path less travelled. Whilst I returned to training the following year, this was largely due to the uncertainty around the Covid-19 pandemic. I had initially planned an ‘FY4’ to travel and pursue expedition and remote medicine opportunities. With world travel and a return to normality appearing uncertain, I decided that re-entering training instead would allow me to enhance my skill-set in preparation for future out-of-training options. As a result, I uncoupled training – making a natural break between core and higher training. With the completion of my core years now imminent, this is a decision that I am so glad I took. It allows me further time out to pursue a wide breadth of opportunities, without prohibiting return to higher training in due course.
Costs and potential funding
Travel: Cumbria is rural, with limited public transport options. Whilst it is possible to get around without a car, in my opinion, driving is fundamental to maximise the opportunities this fellowship offers.
Accommodation: Hospital accommodation is available. The human resources team and ED secretaries also have a list of local landlords with available properties for a variety of timespans and needs.
Courses: Applicants are encouraged to pursue areas of interest that can benefit their career. I completed APLS and would have also done ATLS (COVID-19 meant this was postponed to the following year). There is a study budget, but it is not unlimited. If an applicant has a particular course or degree in mind, I suggest discussing this before or during the application process.
Anything else you wish you’d known beforehand?
Bear in mind that Cumbria is rural. For many (myself included) this is a perk. However, this does mean that it’s not got everything at its fingertips. Deliveroo does not exist and there is no large shopping centre! Public transport can be unreliable, and is not as frequent as in cities.
Job application:
Advertised via NHS Jobs. Jobs can open as early as March, for an August recruitment. This last year (2024), applications opened in June.
Application found by searching here: https://www.jobs.nhs.uk/candidate
