University Hospitals Dorset provides a unique opportunity for junior doctors to combine an emergency medicine post with a fully funded qualification in the world’s first postgraduate course in Extreme Medicine. Dr Johnston and Dr Pearson have melded a passion for adventure with academia and clinical experience. They discuss the realities of the role and the exciting places it has led them.
Structure of the Role
The post is an 80:20 split of clinical emergency medicine to non-clinical time development time. From a clinical perspective, a fellow will work a normal SHO or middle grade rota in the Poole Emergency Department. The remaining part of the year involves the completion of course modules culminating in a Postgraduate Certificate (PGCert), Diploma (PGDip) or Masters (MSc) in Extreme Medicine from the University of Exeter.
The job is for twelve months with an optional extension of up to three years for the completion of the MSc. If a fellow’s academic requirements are completed early, the remaining non-clinical time can be used to work as a doctor on an expedition or event. Such positions are arranged by the individual, not by the department.
Prerequisites for application
For the SHO role, a candidate must have completed foundation training or the equivalent if applying from overseas and should have at least six months experience in Emergency Medicine.
For the Specialty Registrar role at least three months experience in anaesthetics and/or ICU is required. If a candidate has prior experience working in remote environments or evidence of an interest in expedition or humanitarian medicine this will be looked upon favourably, but is not a requirement.
Location of the fellowship
Fellows are primarily based in Poole Hospital, with the option of a secondment to Royal Bournemouth Hospital for more varied clinical exposure. The rest of the post involves course modules which are based in the UK and abroad. Examples of the MSc course locations include: Oman (Desert Medicine), Norway (Polar Medicine), Costa Rica (Jungle Medicine), Nepal (Mountain Medicine), Florida (Dive Medicine) and Slovenia (Alpine Medicine).
The trust provides a funded place on the MSc in Extreme Medicine from the University of Exeter. A MSc will be obtained, assuming academic satisfaction, after 3 years working for the trust. For those in the fellowship for a shorter duration, such as one or two years, there is the option of completing a PGCert or PGDip in Extreme Medicine respectively.
Our Overall Impression
The opportunity to learn to provide medical care at a high level in extreme environments is what distinguishes this job from other emergency medicine fellowships. For each module, the multi-disciplinary student cohort is different and therefore peer-to-peer learning and networking is exceptionally varied.
The modules generally consist of a residential component, with opportunities to learn both expedition skills and the medical considerations relating to a specific environment. The academic component required after each course is linked to the theme of the module. For example, a fellow may be asked to write a critical appraisal of the evidence surrounding the prevention and treatment of heat-related illness following the desert medicine module.
The Poole Emergency Department is a friendly and supportive workplace. The clinical work is diverse, team-based and enjoyable. As the fellowship is a full-time post in the same department, the rota will often be made available up to six months in advance. The town of Poole is a fantastic place to live. There is easy access to the Jurassic coast and the harbour is great for water sports, including kitesurfing.
Outcomes of the fellowship
An Extreme Medicine qualification does not automatically lead to pre-hospital work, however partaking in the modules provide ample opportunity for networking with expedition clinicians and inspirational colleagues. The MSc modules cover the logistics, practicalities and the medico-legal considerations of working in an expedition environment, which prepare fellows to work outside of the hospital environment.
In terms of career progression, fellows are encouraged to undertake quality improvement projects within the emergency department and maintenance of a clinical portfolio is facilitated by the senior team.
The cost of the PGCert/PGDip/MSc is funded by the trust, however personal kit, transport (including flights) and certain course supplements need to be self-funded. While attending a course module a fellow will continue to receive their usual daily wage.
There is an additional study budget provided by the department for related courses and conferences. Study leave will be incorporated into the time required to complete the relevant Extreme Medicine modules.
It is worth bearing in mind that although this is a largely clinical role, when there is personal development time, it is taken in blocks throughout the year. A fellow will be expected to work a full-time rota for the remainder of the post. This inevitably leads to a greater proportion of lates, nights and weekend shifts.
Currently, the Poole and Bournemouth Emergency Departments are split-site resulting in a lack of exposure to certain clinical presentations. Bournemouth is the acute stroke and cardiology centre, so fellows placed in Poole will see fever stroke and acute cardiology presentations. On the other hand, Poole is the local trauma unit, so a fellow will see more trauma presentations. A new acute service is being built and the departments will be merged into a single-site in 2025.
This job is ideal for an adventurous medic who wants to combine clinical experience with expedition academia. It is a unique role, which allows for development as a clinician and exploration of opportunities outside the typical hospital environment.
For those considering this post, recruitment for August 2024 will begin in October and will be advertised on NHS Jobs and World Extreme Medicine’s social media platforms.
Information about the MSc in Extreme Medicine can be found on the University of Exeter webpage: Extreme Medicine MSc (Distance) | Postgraduate taught | University of Exeter.