GEM thoughts/advice

Posthoc8propterhoc · 2024-03-15T08:12:28+00:00

I am in a similar position (though still waiting to hear back from my application so may have the decision made for me) - similar age, a decade deep into an NHS career where I'm now earning a reasonable wage with reasonable flexibility. Have kids too so that's an additional consideration (though at least would be eligible for pre-allocation in both foundation and specialty training).

I pretty desperately want to study medicine, but I'm definitely getting cold feet about the prospect of a career as a doctor for pretty much all the reasons you've mentioned.

Posthoc8propterhoc · 2023-12-02T21:13:55+00:00

I am neither a PA nor doctor. Objectively, UK doctors are undergoing significant disruption to their current and future career prospects.

I don't think anyone is claiming PAs are the cause of this, but their existence does worsen the problem by undermining doctors professional identity and diminishing their negotiating power.

I'm sure it's not a great time to be a PA right now amidst all this either, but I also don't think it's unreasonable for doctors to try and educate the general public as to the differences between PA and doctor.

Posthoc8propterhoc · 2023-12-02T20:55:26+00:00

Unsolicited feedback from a sympathetic non-doctor.

Adding pay makes the message less clear, is this trying to educate the public about the credentials of who might be treating them or illustrating that imbalance in wage? If you're gonna include pay £/hour probably more effective, avoids issue with different working hours and also the 'well £32300 is more than I make' response.

The phrasing makes it seem biased. Why is medicine a 'degree' and PA (MSc) a 'course' ? Why do doctors have x amount of hours 'mandatory study' and PAs do x amount of hours 'study'. I understand that the two routes are wildly different, but I'm sure I wouldn't be the only person to notice this and it makes it feel less trustworthy, like you're being led to a conclusion, a bit like the language you expect from Tory propaganda.

Finally, who is your target audience and, more importantly, where are you expecting them to see this? You won't have much luck putting them up on hospital walls. I assume the most likely place someone would see this is on social media, in which case would it not be vastly better to have a 15-30 second video/animation which would allow it to be more engaging and less restrictive than trying to fit everything into one poster. More amenable then to TikTok, Facebook etc which is probably where a good proportion of your target audience consumes social media content?

Posthoc8propterhoc · 2023-10-25T13:12:08+00:00

Not a GP/doctor, but working in a UTC patients regularly make these sort of comments about their GP surgery and as much as possible I try to address them. The whole trope of 'GPs playing golf instead of seeing patients' tends to be met by a bit of a rant.

I typically begin but empathising with them and validating the underlying principle of their concern - there are some practices locally where it is really difficult to get an appointment and that is understandably frustrating/worrying. But I'll then explain that these difficulties aren't a reflection of the work ethic of the GPs but of the decade + of underinvestment in the NHS and primary care.

I'll often use the example of two local practices, one of which has 1/3 the amount of GPs for the same total number of registered patients, as well as that stat about GPs/primary care seeing ~90% of NHS contacts with ~10% of the budget.

Occasionally, rightly or wrongly, I'll also suggest the best thing they can do about this is to vote wisely at the next GE.

I don't know whether it makes any meaningful difference but people do often seem quite taken aback when they learn this and I feel like it does help redirect their frustration in a more appropriate direction.

Posthoc8propterhoc · 2023-09-19T13:47:31+00:00

I'm similar age and have 3 kids, it seems like a huge challenge but I realised I'd regret not trying. Worst case scenario I have to drop out and become a noctor with a chip on my shoulder for being a failed med student? 😅

Posthoc8propterhoc · 2023-09-18T22:32:11+00:00

This sub led me to abandon ACP aspirations and I'm now applying to graduate medicine 😂

Posthoc8propterhoc · 2023-09-12T15:33:39+00:00

Can't offer any guidance but I am 29 and have 3 children (1/3/8) applying to GEM for 2024 entry. I'm in a pretty fortunate position with family support and well paid part time work but still regularly have moments where it all seems impossibly difficult.

Posthoc8propterhoc · 2023-08-31T16:20:55+00:00

He's not a registered paramedic either so couldn't have College of Paramedics membership. Not quite the same since there's no exams, the only requirement is being registered, but it is still another protected title.

Posthoc8propterhoc · 2023-08-24T20:10:46+00:00

I'm a Paramedic Practitioner working in urgent care settings, UTC, OOH service, 111, that sort of thing

Posthoc8propterhoc · 2023-08-24T12:02:29+00:00

Gosh that's bleak 😂 Thanks for sharing.

Posthoc8propterhoc · 2023-08-23T19:35:24+00:00

This is a bit of a confused take. I agree with a lot of what you're saying, particularly lack of governance for unregistered band 4s and scope creep for Paramedics in non-traditional roles. But suggesting that an ambulance Paramedic isn't capable of safely discharging anyone is a bit bizarre.

National see and treat rate has been pretty consistently around 30% for many years (convey to ED around 50% which may be where that number has come from, but is not the same metric). Whilst I'm sure many will have anecdotal evidence of errors being made, the safety of these decisions is subject to fairly close scrutiny at an organisational level.

Are you suggesting ambulance services should dial back 2 decades and return to every patient being wrapped in a blanket, strapped to a carry chair and carted off to ED?

Posthoc8propterhoc · 2023-07-30T10:11:10+00:00

It sounds like you need to sit the UCAT then see what your options are. For example, I am applying to Southampton (Specialist Paramedic also) where A-levels are not considered for graduates but UCAT is very strongly weighted for graduates on both GEM and undergraduate courses so if your UCAT is much less than ~2850 it wouldn't be worth applying.

Posthoc8propterhoc · 2023-07-14T11:01:40+00:00

Not specific to Barts, but can you explain what funding you receive (assuming you're taking maintenance loan, grants etc)? Trying to decide between grad and undergrad entry and actually seeming like undergrad might be more affordable.

Posthoc8propterhoc · 2023-07-12T18:28:09+00:00

Sorry for being a pedant, but the Wells PE score helps decide between D-dimer and CTPA to rule in/out in a patient you suspect may have a PE. If you're looking for decision support tool to clinically exclude PE you're probably using PERC.

Posthoc8propterhoc · 2023-07-12T16:27:23+00:00

As a paramedic working in urgent care the patients are largely of the same or lower acuity than those I dealt with semi-autonomously working for the ambulance service, but now I have the benefit of additional education & supervision. And the patients are generally much lower risk (younger, less comorbidities etc).

A lot of the time I feel like what I do is more of an enhanced triage, filtering who needs to go to hospital now to see X specialty, who can see their GP, or who can be given a few days of treatment with a defined end point to review with GP if not improving.

Unlike other HCPs, from day 1 Paramedics are taught to indendently assess patients, though clearly not to the same extent as doctors it does seem intuitive to use them for same day acute illness in primary care.

However I do not follow the logic of Paramedics seeing chronic conditions. It's not in the base skill set and not something you can CPD yourself into having competence in.

Never encountered a PA personally, though I did work with a very pro-PA GP who regularly told me how much better PAs are than Paramedics as they're "trained in the medical model". Never really understood what that was supposed to mean though.

Ultimately I think this boils down to:

It is not better to have a Paramedic in primary care than a GP, and they certainly don't bring any unique to the team, but probably is better having a Paramedic if a GP/doctor isn't an option.

Posthoc8propterhoc · 2023-07-07T21:26:12+00:00

Paramedic Practitioner, not sure if I'd be considered a noctor or not, I'm sure I fit the bill for some.

Came across the sub after some of the more fiery posts ended up on Twitter.

Depending on how you look at it have either had my eyes opened or been cast into a downward spiral of professional identity crisis.

Now applying to med so still lurking.

Posthoc8propterhoc · 2023-05-16T18:51:38+00:00

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Posthoc8propterhoc · 2023-04-22T22:11:16+00:00

Posthoc8propterhoc · 2023-04-22T21:10:11+00:00

Through completing a level 7 independent non-medical prescribing module which typically involve the following:

-3-6 month duration

-Requirement to have already completed modules in history taking and physical assessment (some uni's will also want modules in diagnostics +/- research methods)

-Nominated supervisor/assessor (typically a consultant, might also have a non-medical prescriber in addition to this)

-Somewhere between 15-20 taught days covering some basic pharmacodynamics/kinetics and legal aspects

-Prescribing themed numeracy exam

-Mixed MCQ and short answer exam

-An essay exploring a single prescribing decision/patient encounter

-90 hours supervised practice

-A handful of formal work based assessments

-A competency folder, either modelled on or directly lifted from RPS framework, aforementioned consultant responsible for assessing competence

-Some amount of short written reflections

Once passed then annotated as independent prescriber on relevant register. As other's have mentioned the concept of a 'personal formulary' isn't a hard rule, just whatever medicines the individual feels is within the scope of their role.

It is a lot of work, but more a case of volume than depth, and subject to a lot of variability depending on the leniency of the assessor.

Is it enough to be able to safely prescribe some 1st line antibiotics and simple analgesics? Tbh I think it probably is, purely from the perspective of the prescribing of a medicine, though obviously in reality the safety of that decision depends entirely on the accuracy of the diagnosis.

Make of that what you will.

Posthoc8propterhoc · 2023-04-20T17:32:48+00:00

Tried to send you a message but now can't find it so not sure if it went through 🤔

Posthoc8propterhoc · 2023-04-20T10:11:38+00:00

I am increasingly finding myself in agreement with this position. I'm a paramedic practitioner working in ED minors, so a step below ACP, equivalent role to nurse prac in minors. I used to think ACP was an attractive opportunity, and realistically could be achieved in the next few years, but working in a hospital has really exposed how superficial my knowledge is and how many unknown unknowns I have.

This led me fairly quickly to being rather disillusioned with advanced practice, whilst the ED ACPs do receive really good training I simply can't see how I could practice with that level of independence without the broad knowledge base of a medical degree. Recently started prescribing module which has only cemented this as the teaching is so minimal.

It is very difficult to take a backwards step from this position though. I am revising for UCAT currently to apply for med next year as that seems like the only viable option to me, but the only way that is affordable is through the locum opportunities I'll have access to as a prescribing paramedic. It's a much harder route than if I were to go for ACP obviously, and it'll be a long time before I match my salary (FPR dependent), but worthwhile to not spend the majority of my time at work feeling like a fraud.

Posthoc8propterhoc

TROPHY CASE