Co-authored with Dan Darbyshire (@dsdarbyshire)
Training and practicing in emergency medicine has been hard the last 18 months. The 2020 EMTA survey tells us where things are not working and where things could be better for emergency medicine trainees (EMTA website). In this blog, Dan and Thomas, the chair and research representative of EMTA share the good, the bad and the ugly of the findings of the survey.
What is EMTA?
Readers outside the UK will probably not be familiar with EMTA. Hopefully you have a national equivalent where you are. We are also sure some UK-based trainees won’t have heard of us. That’s on us for not trying hard enough to reach you. EMTA is an acronym for the Emergency Medicine Trainees’ Association. It does what it says on the tin. We aim to represent EM trainees in the UK. EMTA sits within the UK based Royal College of Emergency Medicine (RCEM). We are made up of trainee reps appointed to (pretty much) every committee. These trainee reps aim to make the trainee voice heard in all RCEM business. We advocate for trainees when decisions are being made that may affect them. To support this advocacy role reps need weapons and one of our best is data.
The EMTA Survey
The current survey is the fifth iteration with all previous versions available on the EMTA website. 369 EM trainees gave us their thoughts on a diverse range of topics related to their training. The survey was available to complete from March 8th to April 13th 2020. This was early on in the COVID pandemic. We don’t think we fully appreciate the impacts the pandemic has had (and is continuing to have) and will continue to have, on trainees and the wider workforce. But I’m sure you can draw your own conclusions on how it impacted the information collected.
Less-than-full-time working (LTFT)
There seems to be a feeling that nearly all EM trainees are LTFT. However, in the EMTA survey 77.9% of trainees were full time. This probably reflects that the pilot to allow EM trainees to work LTFT for any reason was restricted to trainees from year 4 onwards based in England who are actually a minority of trainees. More broadly 32.4% of trainees anticipate going LTFT for health or caring reasons and 28.9% out of choice. Only 28.1% of trainees anticipate working full time as a consultant, with 45.2% actively planning to work LTFT and the remaining 26.7% undecided. Many departments are already recognising this change towards LTFT and portfolio working for emergency physicians. However, it may have a big impact on the number of people we need to train to meet future staffing requirements.
Time away from the grind
Clinical EM can sometimes feel like a bit of a grind and we are not all lucky enough to work somewhere like Virchester (the home of St Emlyns) where every patient encounter is a learning outcome. Training also comes with admin like the e-portfolio and gaining experience and confidence in skills such as writing a coroners report or managing a complaint really needs to be done away from the shop floor. RCEM recognised this some time ago and made recommendations that trainees should have time, which they termed SPA (supporting professional activities) time. This is now termed Educational Development Time (EDT) (RCEM EDT).
|Training stage||Time allotted for EDT|
|ACCS||3 hours per week or 60 hours during their 6-month EM block|
|ST3||4 hours per week or 160 hours per annum|
|HST||8 hours per week or 320 hours per annum, (pro-rata for LTFT)|
For EMTA, we see this time as more than a practical necessity (though it definitely is this), it is a marker for how much departments value their trainees. Unfortunately 1 in 3 trainees in the EMTA survey said that they had no access to SPA time. This rose to 63% for those in the first three years of training.
A car crash of a shift
We have all had shifts which either through catastrophe or calamity are best described as a bit of a car crash. If you are lucky you might have fallen asleep on the bus after such a night shift, if you were unlucky this might be while driving. Nearly 1 in 5 respondents in the EMTA survey felt unsafe to drive home after a shift. 87.2% feeling fatigued after night shifts and nearly two-thirds reporting that fatigue negatively affected their family or personal life. Through the excellent work of the Trainee Emergency Research Network (TERN) we know a lot about the need for recovery for emergency physicians (TIRED).
We need to keep talking about fatigue and the impact night shifts have on our physiology and psychology. A previous St Emlyns blog is a good place to start.
Work is hard enough without having to put up with bullying
The British Orthopaedic Trainees Association (BOTA) did a similar survey to ours in 2016, they found that 7% of trainees reported being bullied and 70% had witnessed undermining. This led to a coordinated campaign, entitled ‘hammer it out’ to try and tackle bullying in that specialty.
The 2017 EMTA survey, which was the first to look at this, found that 19.9% had felt bullied at work, 53.5% felt undermined and 20.8% had witnessed a colleague being harassed. In the 2020 survey 10.1% had felt bullied at work, 27% felt undermined and 8.2% had witnessed a colleague being harassed. This looks like an improvement, but it is still probably worse than the 2016 figures from orthopaedics. These figures relate to ‘the last 4 weeks’. We dread to think what they would be if we asked about the past year. There are also free-text responses to this section and it doesn’t make for comfortable reading. Bullying is ‘endemic’ in emergency medicine according to the EMTA survey with supervisors and colleagues as the perpetrators.
It’s not all bad
The headline findings from the EMTA survey were always likely to be the hardest to read. But it is important to note training in EM in the UK is ahead of the game in many ways. Flexible training is becoming a cultural norm. Ring-fenced time for training is an integral part of the 2021 curriculum. Trainees are also having a more and more varied experience. There are excellent opportunities for research, leadership and teaching to name just a few, increasing in both quality and quantity.
One final finding from the survey — most trainees felt that their educational supervisor was effective and added value to their training — the importance of this relationship can not be underestimated, particularly when things get tough, which, clearly, they are.
What’s next for the EMTA survey
The next EMTA survey will be launched at the EMTA annual conference on 25th November 2021. The EMTA survey aims to add value to the GMC National Training Survey (see some initial analysis above by Dale Kirkwood, EMTA survey lead). It will try and understand trainee confidence in emergency medicine specific skills, procedures, supervision and working environment. As well as areas of concern such as minor injury exposure and paediatrics.
Dan Darbyshire is chair of EMTA, emergency medicine trainee (ST5) working clinically at Salford Royal and NIHR Doctoral Research Fellow.
Editors note (@EMManchester): As trainers and as education leads we get a lot of surveys and a lot of data about training. Some of it good, some of it not so helpful. The EMTA survey is one of the better ones and we should pay head to it. As an educational lead involved in quality for the GMC and HEE my questions to any department are usually 2-fold. Firstly: What did you think of the results of your GMC/EMTA/other surveys. Secondly: What have you done about it? The first answer tells me whether people care. The second tells me whether they care enough.