Name: Ash Sadighi
Speciality: Acute Internal Medicine and General Internal Medicine
Role: ST6/7 AIM and GIM
Deanery: North West London Deanery
What made you decide to do AIM?
I originally chose to do the Emergency Medicine training programme in 2005. The reasons I chose to do Emergency Medicine were that I didn’t enjoy long ward rounds, I enjoyed managing acutely sick patients, doing procedures and I enjoyed variety in my workload. Add to this the low number of long clinic sessions and this seemed the perfect mix. I soon realised that Emergency Medicine wasn’t for me. I enjoyed looking after acutely unwell medical patients, but also wanted to provide ongoing care for these patients beyond 4 hours. Acute Medicine wasn’t really a major specialty when I applied for Registrar posts in 2005 but was an expanding specialty after I had quit Emergency Medicine in 2008 and returned from working abroad in 2010. Acute Medicine also allowed me to continue my special interest of ultrasound, which I had taken up abroad.
What were your first impressions of Acute Internal Medicine?
So in 2010 I started Acute Medicine at the Bristol Royal Infirmary. I thoroughly enjoyed it. I would alternate every 2 months between the Admissions and the Short Stay Unit. This gave me the chance to look after acutely sick patients and also work on a ward with patients that were expected to be discharged within a week. The Acute Medical Consultants I worked with on the Unit were all young and dynamic and keen to teach and train. I was part of the on call Medical Registrar rota but this was still about 1 in 12 and although busy and hard work – manageable. I knew that I had chosen the right specialty for me.
What training do you need to have to get into AIM ST3?
After foundation training, trainees enter AIM through either Acute Care Common Stem (ACCS) or Core Medical Training (CMT). Trainees must complete the MRCP (UK) before entering AIM training at ST3 level.
What are your Specialty Training Years like?
My specialty training has been extremely enjoyable and variable. There are a certain number of areas that you need to cover to obtain your CCT (Certificate of Completion of Training). These are:
4 months of Cardiology
4 months of Intensive Care Medicine
4 months of Respiratory Medicine
4 months of Medicine for the Elderly Medicine
These areas shown above have to be covered in your 4-5 years as a Registrar. These are not hard and fast and you could for example get your Respiratory training as part of a spell on the High Dependency Unit. The Cardiology and Medicine for the Elderly training can be done on a sessional basis – in other words via CCU ward rounds and Clinics (Heart Failure Clinic, General Cardiology Clinic, TIA Clinics etc) The ITU stint is part of all training programs in my experience.
In other words you are given time to go to clinics and work in other specialties to aid your training. This is not something I had experienced before. It means you have a diverse and interesting training programme and plenty of time away from your base specialty. No time to get bored! Add to this a special interest which is also a requirement of the AIM Training Programme and it is a really varied 5 years. The special interest can be anything from a procedural skill (eg ultrasound, endoscopy, bronchoscopy, echo….) or non-procedural (eg management/teaching/leadership…).
So not all the 5 years is doing “acute takes” and being on call. In fact I have found that I do probably less on calls than Registrars in other medical specialties for the reasons above. I certainly would not let the fear of being the Medical Registrar on call dissuade you form doing AIM. During the training programme you will become a confident and competent Medical Registrar and the on call commitment is not crippling and there is a good work life balance depending on your placement for that year.
If you are to become a Consultant in AIM I would also suggest doing General Internal Medicine, which would add an extra year to training. Most countries do not accept AIM alone and also it will give you another string to your bow when you are applying for posts as a Consultant. An AIM Consultant looks after patients for around 72 hours, but a GIM Consultant there is no restriction.
I am in my last year now – and I have really enjoyed my training. Also, I am in the lucky position that as AIM is an expanding specialty I will probably be going to the Trust I wish to work at as a Consultant at the end of the year. I can help expand the service. This is not the case with a lot of specialties.
What are the opportunities with AIM?
AIM is a rapidly expanding specialty. There are opportunities arising at Trusts all over the country. So it is likely you can work in a Trust and a location you wish to. There is a huge growth in Ambulatory Care that is likely to continue with the increasing numbers of people attending hospital for emergency treatment. I am currently helping plan and set up the Emergency Ambulatory Care for a West London Trust. There are opportunities abroad to consider also. There is a demand for ”Internists” in the Gulf. The Acute Internal Medicine model is being looked into and actively followed in Singapore. These countries pay lucratively if that is your motivation as obviously there isn’t a great deal of private work in AIM.
Can you do research?
This is an area that hasn’t particularly interested me in the past. However, at my current trust it is positively encouraged. Acute Medicine is still establishing its academic base but there are great research opportunities to be had. An area of increasing interest and value is research into the processes of acute care, frailty syndromes and acute admission avoidance. The data being generated by AMUs is gaining a lot of interest from trust boards and local commissioners.
Do you have job satisfaction?
Yes. I have a varied role. I manage patients for one day to a week or so. I get involvement with High Dependency Units and work closely with all the Medical Specialties. This ensures I keep up to date with current practices amongst the specialties and maintain skills and links with colleagues. I don’t spend my day looking after one system and do not sit through all day clinics. All of which are a bonus I think most people would agree. It used to be said that the Emergency Department was the face of the hospital. This is still true to some extent but the Acute Medical Units are now the face and nerve centres of hospitals. Acute Medical Units far more thoroughly assess, treat and ambulate patients than Emergency Departments can do with the 4 hour rule and its restrictions. The Acute Medical Units integrate care across many specialties and will successfully treat most patients and discharge them. Up to 70% will be under your care up to the point of discharge. There is real ownership in Acute Medicine. The more complex patients that need inpatient specialty care can be highlighted and transferred appropriately. Essentially, the AMU has become the hub of the hospital and in my opinion is the most exciting and interesting place to work. As such I think it attracts very good nurses, physios, occupational therapists and a great team spirit.
What skill sets are required to be a AIM Registrar?
Despite many misconceptions being a Medical Registrar is not as horrible as some people would like you to believe. The on call commitment is by no means that arduous. On calls are busy, there is no escaping that. But throughout your training you will become the expert in looking after acutely sick patients and managing busy on call takes. Experience results in a calm and confident approach and genuinely leads to better patient care not only for medical patients but for patients from other specialties that ask for a medical opinion. Also, night shifts are now a feature of most specialties and Medical Consultants are still free from resident on calls and are rarely called in at night on call. Remember, you are a Medical Registrar for a limited time only.
The skill sets required to be an AIM Registrar are mainly generic and transferable in my opinion:
To be hard working
To be flexible and be able to multi task
Keen to learn and to improve by reflection, training and experience
Keen to teach
Work well in a team
Good communication skills
Good leadership and delegation skills
Good time management
What would I say to someone considering a career in AIM?
I would strongly recommend a career in AIM if you have any of the traits I have outlined above. It is a fast paced, varied and rapidly expanding specialty. There is the benefit of having a special interest which opens up a world of procedural and non-procedural opportunities. You can move into research, teaching and even move abroad. You have to remember that you are a Medical Registrar for just 5 years or so and that you will be a Consultant for decades so you need a specialty that will ensure you do not get bored and can thrive. AIM can offer that.