Where did the acute medical trainees go? A review of the career pathways of acute care common stem acute medical trainees in London

Abstract

Acute care common stem acute medicine (ACCS AM) training was designed to develop competent multi-skilled acute physicians to manage patients with multimorbidity from 'door to discharge' in an era of increasing acute hospital admissions. Recent surveys by the Royal College of Physicians have suggested that acute medical specialties are proving less attractive to trainees. However, data on the career pathways taken by trainees completing core acute medical training has been lacking. Using London as a region with a 100% fill rate for its ACCS AM training programme, this study showed only 14% of trainees go on to higher specialty training in acute internal medicine and a further 10% to pursue higher medical specialty training with dual accreditation with internal medicine. 16% of trainees switched from ACCS AM to emergency medicine or anaesthetics during core ACCS training, and intensive care medicine proved to be the most popular career choice for ACCS AM trainees (21%). The ACCS AM training programme therefore does not appear to be providing what it was set out to do and this paper discusses the potential causes and effects.

A Springboard for physicians returning to practice

“…Non-technical skills, such as leadership and decision making, have been shown to account for the majority of the responsibilities of a medical registrar; a role for which trainee physicians perceive as one of the most stressful in the hospital and experience apprehension to take on, even without a career break. 10 It is recognised that more effort should be devoted to training leadership skills in physicians 10 practice. 11 Furthermore, based on the principle of motivation theory, learners'self-efficacy ratings (e.g.…”

The millennial doctor – A blue collar worker?

“…This is exemplified by acute care common stem acute medicine (ACCS AM) training, which aims to develop competent multi-skilled acute physicians to manage patients with multimorbidity from 'door to discharge'. 11 However, are such schemes fit for purpose when only a minority of trainees actually progress into higher training in acute and internal medicine? 11 Fixed training with the hours restriction imposed by EWTD has resulted in some junior doctors' struggling to obtain the competencies that they require.…”

“…11 However, are such schemes fit for purpose when only a minority of trainees actually progress into higher training in acute and internal medicine? 11 Fixed training with the hours restriction imposed by EWTD has resulted in some junior doctors' struggling to obtain the competencies that they require. MMC has seen the rise of the all-consuming e-portfolio and the box ticking exercise that it demands to demonstrate competency from training.…”

Where did the acute medical trainees go?

“…1 The authors only briefly discuss this critical issue in their analysis -that trainees in acute care common stem acute medicine (ACCS AM) training posts 'may never have intended' to pursue a career in acute medicine. Foundation and physician trainees recognise that ACCS AM provides a quality, and less variable, path of training for acute medicine, but also a path to high-acuity specialties such as intensive care medicine, respiratory medicine and cardiology.…”