Trainee Journeys

Accepting that I’m never going to be a formula one driver, an astronaut, or a professional surfer, I can genuinely say I have my dream job. I did medicine as a second degree, having first studied neuroscience, and throughout medical school everybody told me I was going to be an anaesthetist. They were almost right, but actually, ICM always appealed as the best mixture of nerdy physiology, cool equipment, and varied pathologies and patients. However, I still felt the call of neuroscience and the urge to do some basic science. 

With this in mind, I found an academic foundation program job that had an ICM placement and neuroscience research in Bristol, which I loved. After a year in South Africa, I then did ACCS AM in London followed by an ACF in ICM at UCL. This was a great job in a great team, but I wanted to get back into autonomic neurophysiology and so began to work up ideas for a PhD fellowship back in Bristol. I was lucky to get a Wellcome-funded fellowship in Bristol, followed by an NIHR-funded clinical lecturer post. I study hibernation as a model protective autonomic response and investigate whether synthetic hibernation-like states might be possible in species that do not naturally display it. 

So, now I am in my final year of training in ICM and spend 50% of my time in the lab, 50% in the hospital. It’s a great mix, and I never (rarely) get Sunday evening blues. Combining basic science research with ICM provides great variety in terms of ways of thinking, the challenges that I deal with, and the timescales of my tasks. Plus, the flexibility that academic time gives me has allowed me to get more involved with clinical research projects in the region.

I am a Single Speciality ICM Trainee in the North West of England, and after taking a few detours on my career path, I am now settled in ICM. I am currently in the midst of Stage 2 of my training, rotating through Cardiothoracic ICM, and preparing to sit the FICM MCQ.

One of the things I love about ICM is the diversity of trainees it attracts, thanks to its multiple routes of entry. This has made for a rich and enjoyable experience for me.

I first got involved in ICM during my FY2 year, but I was eager to take a break from training and see more of the world. So, I decided to pursue my Diploma in Tropical Medicine and Hygiene in Liverpool, just as the Ebola epidemic was breaking out. It was an incredible experience that taught me not only about tropical medicine, but also introduced me to a network of friends and colleagues who have opened doors for me in my career. Without them, my career path would likely have been narrower and less exciting.

After completing my diploma, I had the opportunity to work abroad in Belize and the Himalayas on various expeditions, where I gained invaluable experience in challenging environments. When I returned to the UK, I started ACCS Acute Medicine in the hopes of broadening my skill set. However, I was learning that I really enjoyed caring for sick patients, and less the post take ward round. I decided to continue in AIM for another two years one of which was in Edinburgh before eventually coming back to ICM, which I now believe is the right decision for me.

ICM training in the North West offers a wealth of opportunities, and as a single CCT, I feel like I have the space and focus to do it justice. There are so many skills to learn and the day-to-day work is varied and interesting. Of course, there are downsides, such as the on-call and night shift-heavy rotas, but they have improved over time and it is now easier to find the time to work on the extra skills that are vital for progression.

Looking ahead, I am hoping to complete my exams and enter my SSY phase of Stage 2, which will hopefully allow me to focus on a specific skill. I believe that ICM is the right career path for me, and the additional experiences and exposures I have gained along the way have only added to my overall ICM experience. With a bit of luck with rotas, I may even be able to fit in some more expedition medicine next year!

I had an unorthodox route into medicine with 3 rounds of applications, 12 rejections and one last minute offer to the postgraduate programme at the University of Birmingham, having completed an undergraduate degree there, in Medical Sciences with Pharmacology. At medical school, I was initially interested in going on to do Emergency Medicine but undertook a self-selected 4^th year module in anaesthesia and ICM in Worcester which changed my career focus. This had been intended to broaden my experience of practical procedures but ended up being the kick-starter for my interest in anaesthesia and critical care. I went on to complete my foundation training in the West Midlands and like many trainees, had intended to travel to Australia to work for a year. I had, by then, lived in Birmingham for nearly 10 years and decided I fancied a change of scene, despite my sadness at having to leave the University Ice Hockey Team.  I figured I’d apply for ACCS Anaesthetic training in Bristol as a “practice”. The Severn deanery was very competitive at the time and I believed I probably wouldn’t get the job and would go to Australia as planned. However, by some miracle, I was offered a place there and have remained in the Bristol region ever since. Having grown up in Devon, for me Bristol was slightly closer to home but not so close that my parents might turn up on my doorstep unannounced. During my ACCS training I completed my Primary FRCA examination and obtained full MRCP as I has always enjoyed the Medical aspects of training and felt this would be useful for a career in critical care later on.

Following my ACCS training I had a character building period of time out of training whilst I repeatedly attempted to obtain registrar training numbers in Anaesthesia and ICM in the Severn Deanery. During this time, I did an ST3 level clinical fellow post with 6 months ICM and 6 months Anaesthesia. Having had a combined total of 6 interviews for each of the specialties, I often joke to other trainees having difficulties that I can help with interview practices as “I must have heard all the questions”. Having persevered, I am so pleased to say it has been totally worth it. The combination of the two specialties has allowed me to experience treating some of the sickest patients in the hospital right through the patient journey. A pathway that starts at the “front door” in the emergency department, transitions through the critical care unit and continues onto the wards, with a potential theatre trip or 2 thrown in for good measure. It has also allowed me to work with some amazing and hugely diverse colleagues from a range of specialties and the multi-disciplinary team. For me, the enormously social and team work orientated aspects of a career in critical care has been a major driving force behind my love of the specialty.

My name is Dan, and I am currently working at the University Hospital for Wales. This is a large tertiary unit with a Neurosurgical unit and recently has become a Major Trauma Centre. I first wrote about my career for the college whilst I was on a Critical Care rotation as a foundation doctor, now I am four years on!

I knew early on that I wanted to specialise in Critical Care. Following a lot of advice, I came into Intensive Care via the ACCS Anaesthetics route. For those who want a career in Critical Care this is also the route I would advise too! There have been a lot of advantages. Firstly, coming onto the registrar rota I feel the most prepared at my level with airway skills. Secondly, the experience that I have gained in Medicine and Emergency Medicine, which all count towards your time in training in Critical Care. Finally, even though the exam was incredibly tough via this route it has prepared me well in terms of confidence as a registrar.

Currently, I am very happy to say, I hold a training post offer to start in August with FICM. This year I took a year out to undertake a Research Fellow Post in my department. This has been an amazing opportunity. I have had the chance to set up a medical device trial and complete the Associate Primary Investigator Role. Alongside this I have stepped up to the registrar rota clinically. Taking this time out has massively enhanced my career without the pressures of being in training and clinically I feel more than prepared to start as a FICM trainee.

COVID hit during my time as a core trainee. I was already on my Critical Care rotation and oddly being part of Critical Care during the pandemic reinforced my career aims. It was tough, but I learnt a lot and will take all this experience with me. Overall, I was working in Critical Care for each of the peaks in the pandemic. They became more tough as they went along. The initial challenges of the first pandemic were around not knowing clinically what was best. However, the later peaks became more tough with dwindling support, resources and public backing. I think it is important to point out though, that even though it was tough on the medical side, I think the Critical Care nurses had the hardest job!

The hardest part I find being in Critical Care is the rota and workload. This varies on jobs though. Most of my shifts currently are long days with frequent nights. However, this does mean less overall less days in work. This changes on my next job. Even when I do find it tough, I do remind myself that every registrar workload and rota is tough in its own way in all specialties. The challenges are the post COVID workload and the amount of hours we work, wherever you work clinically! It works for me, but I just make the most of my time off when I get it.

Overall, Critical Care Medicine is for me. The speciality covers all over specialties and from my point of view the interesting parts of them. I have even had interesting Dermatology emergencies this year! I like that we treat each organ system, and we aren’t focused on just one system. The main thing I like, and I know it’s not for everyone, is that one moment you are slowly debating a small decision on ward round, then seconds later you’re called to run a major haemorrhage. It is a speciality that will always keep you interested and on your toes!

My first exposure to intensive care medicine was as a foundation doctor in F2. Truth be told I sort of fell into the speciality. I actually had a keen interest in orthopaedic surgery and thought this would be my career path. This all changed when I realised in my surgical job that I preferred being at the head of the bed! I also found the anaesthetic procedures exciting and interesting and often found myself entering theatre early to see patients anaesthetised prior to scrubbing in to assist surgically. This changed my career pathway to that of anaesthetics. I still had very little understanding of Intensive Care and very little exposure to the speciality, but I always knew an area of medicine that I enjoyed was managing and treating critically ill patients.

I then started my F2 ICM job in December 2019, unaware of what was to come in early 2020 with the Covid pandemic and the challenges that would be faced by the team. I was based in Antrim Area Hospital which is a busy District General Hospital. What was initially supposed to be a 4 month rotation turned into 8 months when changeover was postponed in 2020. This presented me with great challenges but also huge opportunities that I had not anticipated I would be given at this stage in my career. Immediately being part of the team and being in the environment of Intensive care I realised that this is where I belonged. With the new expectations, responsibilities and pressures that came with working in ICU during the pandemic I found that I thrived in the high pressured environment. I found I wanted to learn more about intensive care and whilst not yet in a training scheme I realised that this is the specialty that I needed to apply for.

A post for an ICM Clinical Fellow in my hospital opened up and I jumped at the opportunity to apply for it after completing F2. Whilst working in ICU, I was given a lot of advice on the best route into ICM. It was clear that the best trainee pathway for me at this stage was through ACCS Anaesthetics. My job as a clinical fellow gave me a fantastic experience and helped me develop many skills that will be extremely useful going forward and prepared me well for successfully applying to the ACCS anaesthetics training scheme which I am now a CT1 trainee in.

My year as a clinical fellow in ICM presented challenges in both my professional and personal life. Working within ICU during the pandemic forced me to change my working pattern - moving from a sheltered rota with few on call shifts to essentially working on call every other shift. It was necessary to make sacrifices in my personal life to accommodate this, particularly with my sport. I realised that my main priority was my career and I threw myself into my job and fully availed of any opportunity that presented itself. I became certified in FUSIC Echo - an incredibly useful skill in ICU often reached at a later stage in training. I also had the chance to enhance and expand my understanding on the importance of QI and governance, presenting at international conferences on a safety improvement project I conducted on central venous catheters whilst in ICU.

Despite all the opportunities and positive experiences I gained, I have to be honest and admit on occasion I felt drained emotionally and physically. It was important to try and maintain a work life balance and at times the demands of the job made this more and more difficult. Despite these challenges I went to work every day in the knowledge that I was making a difference (even if it was a small difference) and doing my part for a fantastic team during a worldwide crisis. This further strengthened my belief that this was what I wanted to do for the rest of my career.

Going forward into the future my goal is to complete the ACCS training scheme and apply for dual Anaesthesia and ICM training. I am hopeful that my experience to date will stand me in good stead for this application process. I feel very lucky to have had the experience and exposure to ICM that I have had so far in my career. I can't imagine experiencing the same feeling of job satisfaction in any other specialty that I achieved when working in intensive care, and I know whilst the journey ahead is long and full of challenges the end goal will be worth the hard work and sacrifice.