Subspecialties

Current Lead: Dr Suresh Kumar Gopala Pillai is a Senior Lecturer In Emergency Medicine (Enhanced Research), Swansea University and is the Director of Welsh Centre for Emergency Medicine Research (WCEMR), Morriston Hospital.

Current EM/ICM Leads:

ICM TPD – John Glen (Glan Clwyd)
ICM Deputy TPD – Nia Williams
Regional Advisor – Teresa Evans (Grange)
Deputy RA – Bethan Gibson (Royal Glamorgan)
ICM/EM dual training lead – Ranga Mothukuri (Morriston)

Admission Criteria:

Admission criteria can be found on the FICM website.
Person Specification
For EM trainees by the time of appointment you will need to have completed ST3 of EM training. 
FRCEM Intermediate exams are required for application. 

Application Process:

Appointment is through national recruitment via Oriel.
If you plan to dual CCT you can only apply to the deanery in which you currently hold a national training number.   
Shortlisted for interview based on the score from your application form. 
The interview involves several different stations – Portfolio assessment, clinical scenario, task prioritisation scenario, Presentation of a topic given to you on the day, and a 30 minute reflective writing station.  

An account of the interview process

Additional Training Time:

This is an example dual training programme from FICM website.
As there are competences which are common to both EM and ICM the additional training time compared to single CCT EM is 18 months. 

Trainee Perspective – Katy Talbot

Dual training in EM and ICM has allowed me to hone the skills that I love using to manage critically unwell patients in resus. It brings with it advanced communication and decision making skills, and allows us as Emergency Physicians to maintain some continuity of care for our sickest cohort of patients. The two specialities really complement one another, and I feel that as more clinicians are dual trained the working relationship between ED and ICU will only continue to improve, for the benefit of patients and staff alike.  

In Wales both Schools have been overwhelmingly supportive of this training pathway, and made the process as straightforward as possible. If you are considering dual training with EM and ICM I would be very happy to answer any queries to the best of my ability – katy.talbot2@wales.nhs.uk

Current PEM Lead: Zoe Roberts, University Hospital of Wales, Cardiff

CT3/ST3:

You will encounter Paediatric Emergency Medicine throughout your Core and Higher training in Emergency Medicine, but there is a specific focus on PEM for 6 months during CT3 (ST3). In Wales, trainees will be placed in one of seven Emergency Departments that have Consultants with a specific interest in PEM. These departments are based in Bangor, Bridgend, Cardiff, Merthyr, Newport, Swansea and Wrexham. The curriculum for this period covers a broad range of paediatric topics which can then be expanded upon further in higher training.

PEM Subspecialty:

EM trainees with a particular interest in PEM may choose to dual accredit, earning CCT in Emergency Medicine and Paediatric Emergency Medicine at the end of training. The PEM subspecialty training consists of an extra year, taken at any point during higher training. It comprises 6 months in a Paediatric ED, 3 months in Paediatric Critical Care and 3 months in General Paediatrics. Entry is competitive. Although the post does not require previous paediatric experience, demonstration of interest and commitment to PEM is advantageous.

The centre accredited for PEM sub-speciality training in Wales is the University Hospital of Wales (UHW), Cardiff. UHW sees over 34,000 children a year and there are currently ten PEM Consultants and five dual accredited EM/PEM Consultants to help support education and supervision. The Paediatric Emergency Department operates 24 hours a day, seven days a week and is situated adjacent to the adult ED with a well-established paediatric nursing workforce, including ENPs, ANPs and a Play Specialist. Within the on-site Children’s Hospital for Wales, there are many learning opportunities, including an acute assessment unit for GP expected patients, a large general paediatric service, a wide array of tertiary specialist paediatric services and a Paediatric Critical Care Unit.

The General Paediatrics placement involves the acute assessment and management of patients in the assessment unit, outpatient clinics, and hospital wards. The Paediatric Critical Care service based at the University Hospital of Wales is a regional service for South Wales. It is a 15 bedded paediatric critical care unit (PICU and HDU combined) with a combined throughput of over 700 patients per year. Trainees will keep in touch with their EM supervisor throughout their time outside the ED. 

Each department provides a comprehensive teaching program that includes simulation, lectures, journal club discussions, and pratical skill-based training. There are also opportunities for management experience though Q&S meetings, joint PICU/ED feedback sessions, M&M reviews, Radiology teaching and weekly multidisciplinary safeguarding meetings. There is an expectation for trainees to be involved in quality improvement with dedicated educational development time. All trainees are expected to work towards presenting work at one of the annual national meetings and are fully supported in this. Cardiff is a PERUKI centre and participation in local and national research is actively undertaken within the department. 

Successful trainees will be involved in the teaching and supervision of medical students, junior colleagues and nursing staff. There are many opportunities for teaching, both undergraduate and postgraduate, both locally and regionally. There are close links to Cardiff University and as such trainees are actively encouraged to assist with the running of the paediatric module on the Emergency Medicine BSc. Management experience includes the handling of critical incidents and complaints, rota responsibility, case reviews for the Paediatric M&M and project management.

Paediatricians can also get dual accreditation (in Paediatrics and in Paediatric Emergency Medicine) by completing a 2 year training programme which also includes surgical specialties and critical care. Posts for this Grid training post are also available in UHW, Cardiff. The co-location of both Paediatric and Emergency Medicine trainees allows for the sharing of skills and knowledge across the two backgrounds.
PEM sub-speciality training is a fantastic opportunity for those interested in the management of Children and Young people in our Emergency Departments to develop their skills and further their passion.

Current PHEM Lead: Laura Owen – Grange University Hospital, Aneurin Bevin

Pre-Hospital Emergency Medicine has been an accredited sub-specialty training option since 2013, and can be accessed from training in EM, ICM, Anaesthesia or Acute Medicine. There is a national recruitment process annually for posts starting the following year.

PHEM posts in Wales provide an opportunity for senior training grade doctors (ST 5-7) in Emergency Medicine, Anaesthesia, Intensive Care Medicine or Acute Internal Medicine to undertake sub-specialty training in Pre-Hospital Emergency Medicine within appropriately supported and governed clinical services. It is aimed at those individuals whose long-term career aspirations involve a significant component of Pre-Hospital Emergency Care work. Successful completion of the training programme will allow for sub-specialty accreditation in Pre-hospital Emergency Medicine.

Information on PHEM training is available from the Intercollegiate Board for Training in Pre-hospital Emergency Medicine (IBTPHEM).

Posts are available for Scheme A (blended) or C (full-time). Scheme C is delivered as a full-time 12 month training period outside core specialty. Scheme A is delivered over 2 years with 3 weekly rotation between EM and PHEM. Less than full-time (LTFT) trainees can also be accommodated.

The training scheme is split into 3 phases. 

Phase 1a is an induction phase where you will receive comprehensive and immersive training required to work safely and effectively in the pre-hospital environment. This is predominantly delivered in the EMRTS Dafen base but includes induction days with the Physician Response Unit (PRU) in Newport and Conflict Resolution/Manual Handling training with WAST. You will also spend 10 days on the national PHEM induction course.

In phases 1b and 2, you will be supervised by experienced consultants in Pre-Hospital Emergency Medicine. You will also have a HEIW supervisor allocated to you to guide you safely through the curriculum. You will always work under the supervision or mentorship of an experienced provider in the pre-hospital environment.

80% of the Wales PHEM training is completed as an attachment to EMRTS Cymru. This service runs in conjunction with Wales Air Ambulance from its bases in Llanelli, Welshpool and Caernarfon therefore most shifts will be based around these sites. The remaining 20% of training is undertaken with the PRU based out of Newport. EMRTS have a new airbase that opened in 2016 near Llanelli, with dedicated training rooms and conferencing facilities. There are also IT and study facilities there.

Some aspects of the PHEM curriculum cannot be covered by Critical Care alone and therefore PHEM trainees in Wales will also spend some time on the PRU – a joint venture between the Welsh Ambulance Service and Aneurin Bevan University Health Board in SE Wales. These shifts will enable you to manage mainly lower acuity patients and find new ways to apply your pre-hospital skills. More specialist training will be delivered by study days at a regional level in conjunction with the HEE South West (Severn) PHEM training scheme. 

Supervision is provided on several levels. Once Phase 1a is completed, the trainee will be working directly with doctors and paramedics who have been trained in the use of the IBTPHEM Workplace Assessment tools. A Consultant Clinical Supervisor will also directly supervise the trainee during the entirety of Phase 1, and your Educational Supervisor will meet with you regularly to assess your progress. During phase 2 more independent practice is encouraged and you will undertake more “solo” shifts whilst supervision is maintained at a more distant level.

Wales offers an excellent opportunity to train in PHEM, providing the full range of pre-hospital care and retrieval medicine in both the Urban and Rural environment. Another great reason for training in Wales is the amazing people you will meet and places you will see – what other reasons can you need for training here?

Lucy Blackbourn is a Welsh dual trainee in EM & PHEM. Here is her account on what it’s like.

PHEM Application Quick Hits provided by Lucy. 

The Applicants Guide for PHEM 2025-26