Introduction & Background
1. Can you tell us a little about yourself and why did you choose Emergency Medicine as a career?
I grew up in Boyle, County Roscommon and graduated from TCD in 2019. Following my intern year, I worked in Fiona Stanley Hospital in Perth, Western Australia for 18 months. It was here that I got my first taste for the buzz of EM and realised that this was the career for me. I always had an inclination to try out EM in Ireland and, as such, I came back home to do a standalone year in SJH ED. I had a fantastic time and applied to CSTEM that year. I was fortunate enough to secure a spot on the SJH scheme and haven’t looked back since!
Funnily enough, my mother was Fergal Hickey’s secretary in Sligo back in the 90s. I’m told that I was brought into the office for a visit when I was about 3 months old. Therefore, I like to think that I’ve demonstrated a keen interest in EM from a very young age!
Training & Experience
2. What has been the most challenging aspect of your EM training?
I’d say that the most challenging – and in a way, most rewarding – part of EM training has been learning how to support and lead a team during busy shifts. While seeing your own patients is a core skill for an EM doctor, it’s very much a team sport. Ensuring that your colleagues are well-supported is the best way to keep an ED moving forward, which ultimately optimises outcomes for our patients and ourselves.
3. Can you describe a typical day as a CSTEM ST3 trainee?
As I’m currently doing my Anaesthesia rotation in RVEEH, my typical day is quite atypical by EM standards. We start at 07:30 by prepping the drugs and machines before carrying out the pre-op assessments. I spend much of the rest of the day managing GA patients in the pre, intra and post-operative periods. I’m getting excellent airway experience with plenty of intubations and SADs, which I’ve no doubt will really stand to me when I return to EM in July.
4. What has been the most rewarding time over the past 3 years?
The most rewarding time over the past 3 years has been the craic and camaraderie which I’ve shared with my colleagues. There seems to be a certain type of person who chooses to work in an Irish ED and as a result we all tend to get along quite well. You could be in the middle of a week of nights with 60 to-be-seen and a full resus, but you’ll find there’s always a box of Offbeat donuts in the tearoom or a bit of craic to be had with a co-worker to brighten your day (or night).
Skills & Growth
5. What are the key skills that you think every CSTEM trainee needs to develop?
By the end of CSTEM, I think that a trainee needs to be able to manage a sick patient and be able to manage and support their junior colleagues in order to run the floor. These are both challenges and, in my view, best tackled at separate times. As such, I’d strongly recommend that first and second-year trainees try to see as many resus patients as possible with Consultant/SpR supervision, so that they’re comfortable with this ahead of stepping up to Reg in third year, when they’ll be expected to discuss patients with SHOs and interns.
6. How has your confidence as an Emergency Medicine doctor evolved since you started training?
I think that my confidence has grown hugely during CSTEM, in no small part due to the training and mentorship I’ve received over the years. That said, as time goes on, you also start to “know what you don’t know” so it’s always important to never be afraid to phone a friend or ask for help when you need it.
7. Can you share a case or experience that had a significant impact on you?
I was on nights with another Reg a couple of years ago and we had a patient in her early twenties come in with ROSC following an OOHCA due to a then-unknown underlying heart condition. While it was a scary pre-alert to receive, the team managed the case well and the patient was discharged a week later, fully neurologically-intact. It was around this moment that I felt that I was getting the hang of EM and that the years of training and study were starting to come together.
Mentorship & Support
8. Have you had a mentor who influenced your career? How did they shape your journey?
I’ve been lucky enough to have had many mentor figures in EM. All of the Consultants at SJH ED have been hugely supportive to me over the past 4 years. I’ve also had the opportunity to work with some brilliant SpRs who have guided me with sage advice and wisdom over the years – Nallasegarampillai Muthalvan (Dr Mak), Orla Kelly, Mo Hamza, Ahmed Al-Rasheed and Vijay Narayanan to name a few.
9. What advice would you give to medical students considering EM training?
Go for it! It’s a great specialty. I’d try to get an EM rotation or elective, not only because the ED is a great place to work but also because there’s nowhere else in the hospital where you’ll get such a variety of patient histories, signs and symptoms so in a way it’s a goldmine for exam prep.
10. How do you support your fellow trainees in difficult times?
From experience, it’s all too easy to bottle up all of your worries and concerns after a difficult situation, which isn’t a good thing to do. Having a chat with a colleague over a coffee or a pint is often the perfect remedy for this, and something which I always try to encourage when it’s needed. Alongside this, I think it’s important to be flexible. If a colleague needs a swap or needs a shift covered, I’d always try to help them where possible.
Work-Life Balance & Wellbeing
11. What strategies do you use to maintain your well-being and mental health?
I know it sounds clichéd, but trying to eat well, sleep well and do a bit of exercise is a great start. It can take years to build the habits that support this, and is by no means something which I’ve mastered (as evidenced by my slowly-weaning Deliveroo dependency).
12. How do you balance your personal life with the demands of EM training?
I think that you have to be strict with your time, and more specifically have to strictly protect your free time. While there’s definitely a degree of ‘extracurricular’ work that you need to do alongside EM training, you do need to be careful not to over-commit and to maintain a healthy and active life outside of work.
One piece of advice I got from an SpR a few years ago was to always have something to look forward to. Be it a holiday, a night out or even a coffee with a friend; it’s good to always have something positive on the horizon to keep you going.
13. What do you do to relax and unwind outside of work?
Running and hiking are the big ones nowadays. Nothing quite clears the head like a weekend trip home to Boyle and a Saturday morning run around the woods at Lough Key Forest Park!
Future Plans
14. What changes or advancements in Emergency Medicine excite you the most?
James Foley gave an excellent talk at the recent IEMTA ASM about the role which AI will play in EM going forward – assisting with note-writing, discharge letters and even triage. I’m excited to see how this tool will become a bigger part of our day-to-day practice (although hopefully not replacing us entirely).
15. If you could change one thing about Emergency Medicine training, what would it be?
It’s already happening, but I’d definitely continue to increase the trainee numbers. It’s great to see such huge numbers going for CSTEM year-on-year – this really reflects how EM has become a dynamic, attractive career option. We need to bring as many of these people into the CSTEM/ASTEM pipeline as possible across a variety of training sites so we can ensure a strong EM workforce for years to come. Ultimately, this will improve access to emergency care for patients nationwide.
Final Thoughts
16. What’s one piece of advice you wish you had received before starting training?
Learn to say no! There are only 24 hours in a day and you need to protect your time outside of work. So unfortunately you do have to say no to some of the requests that come your way so you can focus on the stuff that really matters, both in work and outside of it.
17. If you could give one message to first year trainees, what would it be?
Get your leave requests in early! The likes of IAEM, EUSEM and the IEMTA ASM are not only great learning opportunities, but also great craic. One of the best parts of EM is the community built around it, and you’ll find that the friendships and support networks you develop during training are just as important as the medicine.
18. What’s next for you?
I’ll be starting ASTEM as a first year SpR in Galway ED. Really looking forward to the challenge and getting back over West for the year.
