Dr Katharine Ganly, Senior Clinical Fellow in Pre-Hospital Emergency Medicine, Ysbyty Gwynedd, Bangor, Wales
The Emergency Department of Ysbyty Gwynedd, Bangor, provides the opportunity for middle grade doctors to further develop their Emergency Medicine skills in a rural ED that sees everything from trauma to snake bites. Their fellowship also provides protected time to undertake Pre-Hospital Emergency Medicine work across several services. Dr Katharine Ganly shares her experience of this unique role.
Clinical fellowship title, specialty and grade
Senior Clinical Fellow in Emergency Medicine (EM) and Pre-Hospital Emergency Medicine (PHEM)
Structure of the role
The PHEM clinical fellow jobs are offered as 12 months fixed-term contracts. 80% of your time is spent in the Emergency Department (ED) at Bangor Hospital and 20% of your time is spent in pre-hospital activities, split between HEMS (Helicopter Emergency Medical Service) shifts with the Welsh Air Ambulance, EMRTS Cymru (Emergency Medical Retrieval and Transfer Service, Wales) and the Welsh Ambulance Service. There is the option for less-than-full-time working.
Prerequisites for application
Prerequisites are that applicants should have completed UK ACCS training (or be able to demonstrate equivalent competencies in Emergency Medicine, Acute Medicine, Intensive Care Medicine and Anaesthetics).
The majority of PHEM clinical fellows are EM trainees, however Anaesthetic or Acute Medicine Trainees would also be eligible to apply provided they have at least 6 months of EM experience. For interested applicants who don’t quite meet the level of experience required, there are options for 6-month SHO-tier EM posts in order to become eligible, on discussion with the department.
Whilst the positions are generally offered as 12-month posts, MRCEM/FRCEM Intermediate holders with 12 months EM experience can apply for posts of 6-month duration.
As a post ACCS (Anaesthetics) doctor, albeit with some additional EM experience, I started the job with a degree of trepidation regarding being the EM senior on-site overnight. However, the consultant body and senior nursing staff are extremely friendly and are available for support and advice through your solo shifts. You learn the ropes quickly, and I would not let being from a non-EM base specialty put anyone off the role.
Location of fellowship
Fellows are based in the ED in Ysbyty Gwynedd, Bangor. The PHEM portion of the role is primarily based out of the EMRTS base at Caernarfon airport. There is scope to have shifts out of the sister EMRTS site at Welshpool. The remaining PHEM time can be spent with the Welsh Ambulance Services Trust (WAST) on RRVs (Rapid Response Vehicles), ambulances, or in the Ambulance Control Centre. There are also a range of observer shifts available with the North West and North Wales Paediatric Transport Service.
Academic accreditation
The fellowship does not provide academic training or accreditation.
Brief description of the job role
On EM shifts, the role is of an EM middle tier doctor on the registrar rota. Ysbyty Gwynedd is a rural emergency department that sees a wide range of presentations. There is a fair amount of trauma. Given the unit’s proximity to the mountains, fallen walkers and climbers are not infrequently brought in, especially during the summer months. Farm, water, and motorbike-related trauma are equally not uncommon. The rural location means snakebites are also seen, a rare presentation in an urban ED. Overnight you are the senior clinician in the ED, with easy access to Consultant support by telephone if needed. During daylight hours there is a Consultant on the shop floor who holds the supervisory role.
The PHEM portion of the role (which equates to approximately four days per month) comprises two monthly EMRTS air-ambulance shifts and two slots for other PHEM activities. The EMRTS shifts are as a third person on the Clinical Air Ambulance team. Depending on the day, the fellow will either be joined by a Consultant and Critical Care Paramedic (CCP) duo or a double-CCP team. The variation in team makeup allows you to see a different range of presentations. You are a functional member of the clinical team, not a passive ‘observer’, and are able to fully participate in the initial assessment, management and transfer of patients as your skill set allows.
There is flexibility with the remaining two PHEM sessions, and they can be used with WAST, in Ambulance Control, or on PHEM-related courses and activities.
You are expected to participate in Clinical Governance in both your EM and PHEM roles, for example in the form of M&M meeting attendance, chairing, or minute-taking.
Overall impression
The workplace environment in both the ED and the Air Ambulance is exceptionally welcoming and supportive, and I was unsurprised when Ysbyty Gwynedd (Bangor) ED came out top in the UK for EM training in the GMC 2023 survey. For those used to large urban hospitals, it will be a change, as a lot of staff know each other socially as well and professionally, and most know at least some of the patients in the department as well. The working atmosphere is friendly across the MDT, despite the pressures on emergency departments in 2024. The ED promotes a good work-life balance, and less-than-full-time working is quite normal for fellows in this role.
There is good senior support, and as a PHEM fellow you get a named Educational Supervisor who is a PHEM consultant and can help identify PHEM-specific areas for development and progression. The exposure to pre-hospital medicine during this post will help those who are considering applying for PHEM subspecialty training, or those who just want to know what it is all about.
Highlights of the job are a fully-funded place on the National PHEM course, which is excellent high-fidelity training held annually in August. The opportunity to fly over the hills of North Wales and make a real difference to outcomes through immediate management of trauma and illness is an additional high point, and immensely rewarding.
It would be remiss not to mention the location as a benefit. North Wales is a wonderful place to live for those that love the outdoors, with access to sea and mountains in equal proximity, and plenty of friendly outdoors folk to enjoy them with.
Outcomes of the fellowship
The opportunity to start building a PHEM portfolio will put fellows in good standing if they decide to pursue formal PHEM training pathways. The posts equip fellows with many of both the ‘essential’’ and ‘desirable’ attributes required by the PHEM sub-specialty person specification, and you get a good overview of both HEMS and the wider Ambulance service.
There are opportunities to present at M&M’s, Trauma Meetings and Clinical Governance Meetings, all of which are CV-building. You are enrolled in the national PHEM course in August as part of your clinical fellow post, which is an excellent immersion into PHEM. Other PHEM-related courses can be attended during PHEM-allocated time, and there is a study budget available. There is access to the Mountain Medicine database for those interested, and this can be used for research projects and publications. There is an excellent network of wilderness-minded medics for those wanting to make contacts and pursue activities in the fields of outdoor and wilderness medicine.
Costs and potential funding
There are no extra costs associated with this post. There is an NHS relocation budget accessible to post holders. PPE and training is provided.
The geographical location of this post is favourable financially. North Wales has a relatively low cost of living compared to elsewhere in the UK.
The study budget for these posts is a very generous £5000. A portion of this goes towards funding the IBTPHEM course which is run in August. This comprises approximately half of the budget, and the remainder can be used to fund other PHEM and CPD courses.
Anything you wish you’d known beforehand?
Accommodation in North Wales can be tricky to find from afar, but you can be put in touch with people locally if you ask to be plugged into the local WhatsApp group upon appointment. Once you are here it is a lot easier and places to live can be found easily.
The flexible annualised rota means you can plan for an adventure or time off and work your shifts around it. If you have something in mind, start thinking about it before you get here. I arranged a few weeks off in early springtime in order to undertake a winter Arctic expedition and it was not difficult to plan my shifts around this. Offering to work the Christmas shifts gave me a bit of goodwill ‘in the bank’ with my fellow mid-tier colleagues, and meant I could organise a decent block of time away from work later in the year. You don’t necessarily need to bargain by offering to do the unpopular shifts, the rota is set in 6-month blocks and if you can alert colleagues early to the dates you would like off, the team can usually support everyone’s requests.
It is worth learning a little Welsh before you get here. The DuoLingo course is not bad, and being able to say ‘hello’ and ‘thank you’ goes a long way. There are Welsh courses available locally with substantial discounts for NHS staff, and I would highly recommend attending one of these when you arrive if you are able to. The language is wonderful.
Links
The best place to check for jobs is the YGED website at: https://www.mountainmedicineyg.co.uk/jobs
Here you can see job specifications and current vacancies. If you are interested in working at YGED you can also contact the Consultants through the details available on the above page.
In addition to the PHEM Clinical Fellow posts, posts are also offered with Medical Education, Quality Improvement and Global EM as alternative options to the PHEM interest. There is the option to work less than full-time if desired.
