Acute Medicine – South West Peninsula Trainee Case Study

South West Peninsula Deanery
Career Planning Service
Acute Medicine – South West Peninsula Trainee Case Study
Dr Juline Smit – Acute Medicine SpR – September 2008
Your background prior to studying medicine
I went to medical school straight from school.
The reason for choosing Acute Medicine
Whilst at medical school I had various ideas of what I might want to go into, however it was
only after finishing medical school and started working that I decided. I had always felt
inclined to do medicine over surgery, and it was my experience working in many different
areas of medicine which confirmed my choice of eventual acute medicine.
I decided to do acute medicine as it is the only specialty involved in true general medicine.
All other specialties have become extremely specialised whereas acute medicine covers a
bit of everything. Some people like going into great detail into certain areas, however general
physicians deal with such a huge variety and cover all sort of topics. As it is a relatively new
specialty – it is only in the last two years it has become recognised - it is an exciting and
developing area to work in. Hopefully as it develops further we will become even better at
treating and managing the acutely ill patients.
The training involved in becoming a consultant is hard and long, therefore it is important to
find your niche and find something that you really enjoy and are motivated to do.
The reality of working in Acute Medicine as a trainee doctor
The environment of acute medicine is quite stressful. There is rarely a point where it is not
busy as it is admitting 24 hours a day. On other wards things often calm down after the ward
round, however this is not the case on a medical assessment unit. You do need to be careful
as it could be easy to burn out.
As it is a new specialty and constantly developing you need to be able to cope well with
change and instability.
In my opinion the best part of this specialty is the excitement and the challenge of the work.
On other wards, the patient would have already been seen and would have quite a stable
diagnosis and you would largely be sorting out the minor details. In acute medicine you are
involved at the very early stage and this is exciting. The first 48 hours of admission are often
the most crucial for patients. You are given the job of initially managing the patient, working
out the correct diagnosis and to a certain extent you are a ‘detective’ in their condition. Even
as a junior doctor you are drawn into the heart of things as they are happening.
The job is incredibly varied which I love and I love the atmosphere of constantly learning and
keeping up to date with new developments. The broad spectrum of the work means that it is
easy (and encouraged) to specialise in another area of interest to you. You are not set in
stone like other areas and instead can tailor your subspecialty to your own diverse interests
e.g. ICU, chest medicine etc.
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Daily activities and responsibilities
We usually start the day with a ward round to see all the patients admitted overnight. We do
an initial assessment of prioritising patients who are particularly unwell, and then we see the
others. We all work closely in the team to ensure that investigations and tests are followed
up and the treatment plans are followed through. I supervise the junior doctors and other
staff within the department. I also work one day on call overseeing all the medical
admissions and taking GP referrals for admission.
Suggestions for personal development and managing change
I think that it is important that if you are considering a career in acute medicine that you work
at least 4-6 months on a medical ward before deciding on the specialty, as your perception
can be markedly different to the reality and it is vital that you are sure of your choice.
It is important that you have good communication skills. The team work closely together and
therefore if you prefer to work individually this would not be a suitable career choice. In this
job you need to be able to think on your feet and function well under pressure. Excellent time
management skills and prioritising tasks are vital.
Ways to achieve a successful work-life balance
I think that it is important to develop other interests outside of your day to day work. I have
developed a sub-specialty interest and started doing more teaching which gives me a short
break from the ward work. To relax I enjoy yoga and the arts.
Snapshot of your career path to date
My training has been slightly different, in that I did my medical training in South Africa which
is six years. I worked in South Africa for three years after qualifying before coming to the UK.
I came to the UK and did a medical rotation in Plymouth for three years. I then worked in
Plymouth before starting as a trainee registrar in Acute Medicine. My training has been
longer than the normal training route, however I don’t regret this. Even now as a registrar I
still feel like a junior and I think that my additional years of experience in the different areas
of medicine gives me greater confidence in what is a very difficult and testing job.
Career goals for the future
In addition to my ST training, I am also training in cardiac ECHOs and will be sitting the BSE
(British Society of Echocardiography) examination, in order to train to the standard of a
cardiac technician. I hope eventually I will be able to run an outpatient cardiac ECHO list
once a week.
I really enjoy teaching and like the environment of working with the medical student and
junior doctors. I hope to continue to love clinical medicine and do more teaching.
I will qualify as a consultant in acute medicine in 2011. At present it is daunting to be head of
a unit, as the consultant effectively manages the entire unit, hopefully as the specialty gets
more recognised these duties will be more structured.
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