Specialty secondments for accident and emergency registrars.

Did you know that accident and emergency (A&E) registrars have as many as five three month secondments to other specialties during their training? These secondments involve the specialist registrar (SpR) joining a specialty related to A&E in a supernumerary capacity. The aim of the secondments is for the trainee to learn how related specialties manage their acute problems. This article outlines the background of why A&E SpRs have secondments and some ideas on how they can be used to full advantage. A&E has a five year registrar training programme. The minimum entry requirements are to have passed MRCP, FRCS (there is an A&E version of the fellowship), or final anaesthetic examinations and have at least six months' A&E experience. Currently A&E registrars are equally drawn from medicine and surgery. Towards the end of the programme trainees are required to sit an exit examination. A&E is a broad specialty and its doctors need a wide variety of skills. A&E deals with a whole spectrum of acute medical, surgical, obstetric and gynaecological, psychiatric, paediatric, anaesthetic, and social problems. Trainees should be skilled in treating minor injuries and have an understanding of pre-hospital care. In order to help train doctors in this broad discipline, the Joint Committee of Higher Training in A&E have stipulated that all registrars must have experience in the following specialties: x Acute medicine (including cardiology) x Acute surgery (including, if possible, general surgery, plastics, neurosurgery, and cardiothoracic surgery) x Orthopaedics x Anaesthetics (with at least one month in intensive care) x Paediatrics SpRs who have not had at least six months' experience in any of these areas as a senior house oYcer are sent on a three month secondment to observe and work in that specialty. During a secondment the registrar is still funded by, but does not work for, the A&E department. The trainee is expected to work their normal hours, including on-call time, in the specialty to which they are attached. The possible exception to this is that if on-call time in a particular specialty is of little training value, the registrar may be asked to work " on-calls " in the A&E department. This point is open for local negotiation. So how can we make best use of these secondments? The following points should be considered when planning a secondment: (1) Where will the trainee gain the best experience? This need not be in the hospital …