Alright bab, it’s great to be back in Birmingham and even better to be here for the 2026 RCEM Annual Conference, a huge undertaking with the merger of the annual CPD and scientific conferences, and we’ve been looking forward to attending for months.
We (Simon and Chris) are here to take you through the lessons we have learnt from the conference each day, and deliver you some much needed #FOMO, maybe from some of the streams that you missed, or maybe you’re one of the lovely folk staying behind on the shop floor to allow others to attend the conference either in person or online – thank you, here’s what we found out.
Keynote Sessions
Kicking off with the opening session, after an introduction from the organising committee featuring a Brummie welcome video (which could have used subtitles!), RCEM president Dr Ian ‘Higgi’ Higginson, recalled the state of medicine when he started as a doctor and tried to predict how things might look in 2070.
Recent advances have taken emergency medicine outside of the ED with development of EEMAC (extended emergency medicine ambulatory care), and there is increasing dual and subspecialisation. Geriatric emergency medicine has been a topic at conferences for years, will this become a reality? Will there be a split between “core” EM consultants and “specialist” EM consultants? Higgi was keen to stress that there are so many things we should not be, we can’t just be the fallback for other specialties, but it’s inevitable that we are the safety net for patients purely by virtue of being a 24/7 service. He’s done a great job of advancing emergency medicine in the minds of government committees and wider and continues to be a huge advocate.
“Emergency medicine is absolutely bloody amazing, and we should be loud and proud about that”
– Dr Ian Higginson
One great thing that we can lead on is fostering a positive culture, not just for the benefit of those who work within EM, but for the relationships we have with those around us.
Next, a talk from a former hostage negotiator Sam Louden, describing how some of the skills she used in her job could be used in the emergency department where we also deal with people whose day has taken a sudden and unexpected turn, situations that can be highly emotional. She discussed how emotional intensity can limit communication, and how important it is to take steps to reduce this emotional intensity to allow effective communication to take place. By looking at the five core emotional concerns – appreciation, affiliation, autonomy, status, and role – all things we need as humans to feel content – we can bring patients and their families along with us and ensure they feel heard in difficult situations.
Finally before coffee, Dr Caroline Leech came in with an incredible presentation on a typical day in the emergency department, interspersed with frequent interruptions, patients lost and wandering across the stage, the fire service arriving with breathing apparatus and axes to investigate a smoke alarm activation, ECGs and blood gases to sign, tannoys and alarms blaring, bringing us all away from the conference and feeling like we were back at work.
After coffee, Chris was in the rapid fire diagnostics stream, whilst Simon was giving a talk on educating future generations.
Rapid Fire Diagnostics
We started with a great talk from Dr Hesham Ibrahim on small findings in ECGs that can make a difference for patients if you spot them. Subtle changes around the ST and T segments can give clues for impending ischaemia and can trigger you to repeat an ECG and keep a closer eye on these patients in the meantime. One of the key learning points was to ensure you know some of the rules for ECGs, for example “T waves must be inverted in aVR, should be inverted in V1, and can be inverted in III”. If you’re clear on what all the rules of normal ECGs are then you can quickly spot those ones that just aren’t quite right and interrogate them further.
A masterclass in paediatric rashes next from Dr Helen Goodyear. Top tips involved immersing yourself in paediatric rashes – there are multiple excellent online resources such as DermNet, and Helen emphasised that common conditions are easily recognisable, and so really just like with ECGs, if you have a greater understanding and memory bank of the “normal” appearance of these skin conditions, you can spot when things aren’t quite right, prompting a more detailed review and consideration of other issues. Helen promoted this video from Birmingham Children’s Hospital which gives top tips on eczema management and can be signposted to patients and their parents and families to ensure that they get the right care when they go home.
Dr Nigel Chan spoke of his POCUS journey and how he has used POCUS in the paediatric emergency department to direct further imaging or negate the need entirely. It was interesting to see how ultrasound could be used for minor injuries either alongside or instead of x-ray to improve injury detection and ensure patients receive the correct management. It’s hard to imagine that we’ll be able to replace x-ray completely and convincing other specialties such as radiology and orthopaedics to go along with an ultrasound done by a non-expert would be tricky. Nigel is much more qualified in ultrasound than the majority of EM clinicians and spoke of difficulties even he faces in his own department but is confident that changing a few minds each time may help to move things forward slowly.
Educating the Next Generation
Three talks in this session. I (Simon) spoke on Educating Generation AI. That’s a talk I will separately blog about, but in essence I love the title, but it’s actually wrong in some ways, or at least incomplete. We do need to help our new generation of learners use AI well, but they will do a lot of that anyway. The tricky group is the trainers who need a lot more work!
We also heard from Umer Hakeem who brought us up to date with the National EM Journal Club that he designed and now runs. It’s a fantastic project that will no doubt improve skills across our specialty. If you have not yet subscribed then you absolutely should. Here is the link https://rcem.ac.uk/virtual-events/em-journal-club-webinar/ What was really interesting was to see how he has automated a lot of the tasks using AI, and how the team has used data to develop the project. It’s so much more than a webinar, it’s a real passion project that embraces #FOAMed principles (we love this).
Omar Hafeez-Bore brought us his YouTube video projects that embrace entertainment and learning. Here at St Emlyn’s we would call this Medutainment and we love it. We originally met Short Sharp Scratch productions years ago and I must admit that I thought he was heading to ENT (follow the link and you might know why), so I was delighted to see that he has chosen EM. I won’t say more here, just follow this link, sit back, laugh and learn. It really is top stuff. https://www.youtube.com/channel/UCCzTLsbAPpLJmQZkHmNdkyQ
Lunch next and off the back of the next generation stream, it was fascinating to see an increase in work related to artificial intelligence in the emergency department, from investigation interpretation to notes writing. Certainly a tool that is coming (if not already here!) and it will be interesting to see the advances that will be made and introduced in the next few years and how they might change the way we work.
Off to the afternoon streams…
Core EM: Recent updates and diagnostic challenges
With 1.6 million adults in the UK being prescribed weight-loss injections, there will be more and more patients coming to the emergency department who are taking them, and so an increased awareness of the drugs and the side effects that they can cause is key. 50-70% of patients will experience gastrointestinal issues, often these can be solved with dietary changes. More severe issues such as pancreatitis can exist, but are rare. Make sure you ask specifically about weight-loss injections in patients presenting with abdominal symptoms or signs, as some patients may not offer this information initially.
Manchester representation with Dr Ijeoma Chibuzo and Dr Rebecca McKnight on everyone’s favourite topic – ketamine! But it’s not all great, and as a urologist and a psychiatrist, Ijeoma and Rebecca took us down the negative and long term effects of ketamine use. They have been working hard to ensure education and training around particularly the negative effects of ketamine on bladder function, for patients but also for clinicians, so that we have the knowledge to identify such cases and reduce our unknown unknowns.
The big takeaway message was that In young adults with lower urinary tract symptoms and a negative urine dip, ask about ketamine use. There are also some excellent online resources from the British Association for Urological Surgeons.
Finally in this session, our very own Prof Dan Horner on the PEITHO series of trials for PE. We won’t steal his thunder, you can read all about his talk on his blogposthttps://www.stemlynsblog.org/high-five-for-high-peitho-intermediate-high-risk-pe-st-emlyns/!
Global Health
RCEM makes available grants of up to £5000 for research projects in Lower-Middle Income Countries (LMICs). As part of the grant, investigators may be invited to present the findings of their work at the RCEM conference. We very much enjoy this stream, it’s so interesting to see what is going on around the world and how college funds have helped to enhance research in other countries. Most of all, it is always an inspirational stream with inspirational speakers. You can read more about the LMIC research grants here.
Palliative care and end of life care discussions in the ED are inevitable and challenging. Through training and support this can be better and fostering links with local palliative care services to inreach into the emergency department is key. It was great to hear from Dr Anita Eseenam Agbeko some qualititative research around clinician’s experiences with communication at the end of life in an ED in Ghana, with challenges that didn’t appear too disimilar to those we experience in the UK.
Dr Finot Debebe presented on the WHO Basic Emergency Care (BEC) Training programme in Ethiopia, her qualitiative study found that confidence of clinicians improved, and they felt more comfortable to initiate management early. This was not a study that could demonstrate numerical outcomes but the feeling from those taking part was that lives had been saved as a result. We heard about the challenges faced to deliver the programme particularly around candidate selection and other systemic issues, but also about how they had overcome additional challenges around language and adapting the trainng to be relevant to Ethiopia.
Planning the last 10 years of your career.
For some reason we sent Simon to this one (can’t think why). It was really interesting, but actually I think you should start planning for your lifetime of work and retirement right from your foundation jobs. I did that, and I have no regrets for doing so. That was also something the panel agreed on, but if not defo 10 years out as a minimum.
Jocelyn Britliff gave a really interesting talk that focused on how our changing bodies with age can influence how we work effectively. That does not mean that we will gradually get worse, rather it means that we need to adapt, and perhaps our work, working patterns and environments need to adapt around us too. Sure, it was sad to see how I’m falling apart with age, but also really positive that this is something we can adapt well enough to continue to contribute to EM. Headline issues included…..
- Sensory change, especially vision and hearing. Especially hearing in the crazy noisy and complex environments we work in.
- Chairs – get a good chair and computer set up, you’ll last longer
- Menopause – increasingly recognised (but not adjusted for) as an issue for female clinicians. Lots of things that can be done, but it needs thought and planning.
- Shift work – you will die earlier, more likely get dementia, and take longer to recover if you do night shifts.
- Consultants often get a better deal as they age as compared to their SAS/LED colleagues. This is something we should all be mindful of. Don’t inadvertently discriminate just because you are in charge!
Tony Goldstone talked on pensions, which is so unbelievably complex it makes my head hurt. There are so many traps and pitfalls in our pension program that it’s impossible to do without specialist support IMHO. You should start thinking about this as soon as possible, and especially if you approach some trigger points at 100k and 200k annual salaries. Tony has a calculator here that we should all look at.
And there is a medics money episode on it here.
Do it today. I also learned that there is a 100% indication to at least partially retire at 60 as going beyond that just means wasting money. Not long for me then!
Finally we had Lois Brand from Oxford who talked really honestly about ageing as an EM consultant and how it can affect our sense of worth and value unless we think about it and tackle it head on. There are clearly ways that we can continue well into our 60s as valued and really important members of our teams, but that will probably look different to how we worked in our 30s. One thing that really struck me was the idea of a three part lifetime that used to exist. The three blocks are. 1. A block of education. 2 A block of work. 3. A block of retirement. In the past that block of education lasted all through work as work was shorter (earlier retirement) and things did not change as quickly. These days neither is true and it’s the case that our education block will become too long ago and we will lose touch. Defo a role for more structured CPD, and perhaps a more formalised retraining program. Lois also runs what looks like an amazing careers retreat which you can access here. https://careerpitstop.co.uk/ I might even go myself to this as looks really interesting and could make a weekend of it in a lovely place too.
So loads of great stuff today. It’s also worth mentioning that this really feels like a great conference at scale. We will have to wait for the feedback but my initial feeling is that moving to a once a year model with a real focus on highlighting what’s great about our specialty is a good move.
vb
Simon and Chris
