Working in Acute Medicine in the NHS UK

Acute medicine may have a different name depending on your hospital or Trust. Sometimes it you may hear it being referred to as AMU (Acute Medical Unit) or CDU (Clinical Decisions Unit). Regardless of the name used, you may find that your first medical rotation/job in the UK is in acute medicine, so let’s discuss what you can expect.

Why Acute Medicine?

Acute medicine is a great place to start out if you want to see a variety of patients. While the influx is not as fast paced as that of A&E, you still have the opportunity to deal with a selection of patients that can help you later prepare for exams such as PACES.

The patients you will see will have already been initially managed and dealt with in A&E, where they were then deemed to be unfit to send home, and sent to acute medicine for further management, investigations, and potential referral to another, more appropriate, department.

The doctors on call will have seen, clerked, and followed up on the patients A&E referred, so depending on when new patients arrive, you may have to then post-take these patients with a consultant on the ward.

The posttake ward round is a critical time for reviewing the initial history, examination and results, and the stage at which further treatment and investigations will be determined.

When you do the post-take, there is a good chance you’ve not seen this patient before. You’ll need to quickly skim through the clerking done by your colleagues and take short notes as needed for yourself to present to the consultant when they come to see the patient. That should be one of the first tasks for you to do when you come on in the morning so that you’re ready to start after handover is done. This will also allow you to present the patient as per the following:


Responsibilities of FY1/2 On-Call

  • Attending handover
  • Clerking new patients and ensuring the new patients are reviewed by the on-call registrar (if needed) and the on-call consultant
  • Discuss management plans with on-call CT/registrar if need be
  • Attend cardiac arrest calls
  • Ensure proper documentation of the clerked patients
  • Ensure blood forms are completed if needed for another day
  • Act on blood/radiology results of patients on the ward

Responsibilities of CMT/ACCS trainee On-Call

  • Attending handover
  • Discuss management plans of acutely unwell patients with high NEWS scores with registrar on-call and consultant if needed
  • Attend cardiac arrest calls
  • Clerk and initiate management of referrals to the ward
  • Present cases to on-call consultant and ensure post-take review on all patients
  • Prompt review of sick patients on the ward as needed
  • Ensure clear documentation including relevant results with proper action on the results
  • Ensure blood forms are completed if needed for another day

Responsibilities of Registrar On-Call

  • Attend handover
  • Take referrals of unwell patients from A&E/GP/surgical specialties/etc
  • Supervise on-call junior staff, ensuring proper clerking and management
  • Attend and lead cardiac arrest calls
  • Review patients on the ward as needed

Note that these are just generalized roles and may vary from hospital to hospital. If you are still confused about what you’ll be asked to do, check out the role of a junior doctor.

Learning opportunities in Acute Medicine

Acute medicine is a watered down version of A&E, but you get more time with the patient and often get to see them fully recover. The approach you require is very important for you to grasp and work on in order to continue on in your training. More often than not you will need to do follow up investigations for patients who are now due for another round of repeat blood tests, etc. You may also need to update the prescription chart after medicine reconciliation has been done by pharmacy, and of course continue the patient’s care after the initial clerking with ward round notes. Discharge summaries, out patient and in patient referrals, and ongoing care and management of your patients is paramount in your time in acute medicine.

Your time management skills will also be pressed in this department. You may have a good number of patients to balance and tasks to complete, so a smart tip may be to keep a spare sheet of paper whereon you can write up anything pending you have that needs to be done. I personally like making a little checklist and then ticking off whatever work I’ve done. Use the best of your time in acute medicine to get your FY2 competencies signed off and any directly observed procedures (DOPs), case-based discussions (CBDs), or mini-examinations (Mini-CEX) that you may need.

A really great resource for acute medicine is the Oxford Handbook of Clinical Medicine .and the Oxford Handbook of Acute Medicine.

How to get into Acute Medicine training?

Acute medicine affords you the chance to apply via two routes. You can either apply by going through Internal Medicine Training (IMT) or by completing ACCS-AM training. Typically trainees pursue training by ACCS as it is more acute medicine centered versus IMT, but IMT has now made acute medicine a mandatory rotation, so it is up to you to choose which pathway you think would be more suitable.

If you decide to follow IMT, you’d need to complete the full three years of IMT and then apply for specialty training in acute medicine. As mentioned before, acute medicine is now a mandatory rotation, so you would be able to get a good insight into how acute medicine works and how it is an important part of referring to specific specialties.

ACCS-AM is also a three year training post, where you would in the first two years rotate between acute medicine, emergency medicine, ICU (critical care medicine), and anesthetics. Your third year would be in medical ward based specialties.

Alternatively, if you have already completed MRCP and wish to apply directly into specialty training, you may do so as long as your core competencies are signed off.

So what can I expect?

You can get a pretty great idea of the acute medicine setting and feel from our interview with an acute medicine consultant:

To Summarize

Acute medicine affords you the chance to jump right into the UK healthcare system by seeing patients who require immediate management, care, referral, and treatment. While not necessarily an overall hectic ward, it can often be cumbersome to manage the amount of tasks you need to complete for your patients. All in all, it is a great place to start working if you really want to get a feel of the system before rotating into another, more specific, speciality. If you have any other concerns about starting your new job, don’t hesitate to check out Your First Day on the Job.