Name: Kathleen Bonnici
Speciality: Acute Internal Medicine and General Internal Medicine
Role: ST6 AIM and GIM
Deanery: North West London Deanery
Are you pleased you chose Acute Internal Medicine?
Definitely. Acute Medicine is unparalleled as a specialty in the wide range of cases that one gets to manage. The Acute Medical Unit (AMU) is a dynamic and exciting work environment – every day that you come into work you know that you’ll be facing a whole new set of different medical problems to treat. Looking forward to the future, it’s a rapidly expanding specialty so job prospects are good and there are plenty of opportunities to be involved in setting up new services and helping develop a department.
What can you choose as a special skill?
There’s a lot of flexibility in what you can choose. I have chosen a less common special skill, Toxicology, and have completed a diploma in the subject through Cardiff University before spending time Out Of Programme at St Thomas’ hospital to have some clinical experience. Most people chose echocardiography or ultrasound as more ‘practical’ skills or develop skills such as Management or Education. The most important thing is to choose something that you can see yourself continuing to use in the years to come.
Isn’t being on-call a lot miserable?
Being on-call is one of the parts of the job that I enjoy the most. Yes, sometimes being the medical registrar can be stressful but these times are the most rewarding and recently I have found the level of support to be high in most hospitals.
Acute medics are generally on-call no more than any other specialty in the way that most medical rotas are currently organized.
Why AIM and not another acute specialty?
Because choosing any other specialty would narrow the range of cases that I get to see. I liked most specialties in my training and thus acute medicine seemed the natural choice as there are few other specialties that allow you to be a ‘generalist’ these days.
Isn’t it just all old ladies with UTIs and DVTs?
No, although the case-load of any AMU will be determined by the population surrounding the hospital, there is vast range in patients’ ages at any time on the AMU from the young to old. With ambulatory care there is the opportunity to provide a good service to local GPs to help investigate diagnostic conundrums. It’s really satisfying to be able to provide patients with the rapid turnaround service that we’d all want if we were on the other end of the stethoscope.
Can you work flexibly?
The shift pattern of most acute medical units suits flexible working very well. As a mother of three young children I see this as another strong positive of Acute Medicine. As patients on an AMU should be discharged within 48 hours or so, you get to see the majority of cases through to their conclusion even if you are only working part-time. Most deaneries are very supportive of flexible trainees and the whole process has become more established in the last few years.
What advice would you give those thinking about AIM?
To spend some time with some acute medical teams and ideally visit as many different hospitals as possible as they all use different strategies to manage acute medical patients. There is great variation in what an ‘AMU’ is in different hospitals and hence so is people’s opinion of what ‘acute medicine’ is. I would also recommend attending one of the Society of Acute Medicine’s Conferences that are usually very enjoyable and give you the opportunity to meet a lot of other people with interest in the specialty.
I think a level of interest in management and education is fairly essential as many AMUs are still evolving projects. This can also be used to trainees’ advantage as there is generally a lot of opportunity to get involved in service development and projects allied to this.
Do other specialties regard you as “good” as them?
I feel that attitudes towards acute medics have changed over the last few years. Acute medicine is a fairly new specialty, and the training had some teething problems in some areas in its infancy. As the specialty has became established, the trainees coming through are of an increasingly high standard with understanding and along with this, respect for the specialty has improved.
Who/what makes a great acute physician?
I think first and foremost you need to be a good communicator and enjoy being around people as you are dealing with patients, relatives, doctors from a lot of other specialties and many members of the multi-disciplinary team on a daily basis.
You need to be a good all round clinician who can make decisions regarding patient’s needs quickly and know what to do or who to call to sort them out!
Leadership skills are essential given that many acute medical teams are evolving fast and enthusiasm is key to help motivate those around you.
Kathleen Bonnici