What is an average day like?
Most Acute Medicine doctors will spend the
majority of their working day in or around the AMU. Activities of
an “average” day will therefore be highly dependent on the way in
which the local AMU is run. There is also variability in daily
structure because of the unselected nature of medical
AMU consultants will spend at least part of
their day reviewing newly admitted patients, ensuring that
assessment, investigation, diagnosis and treatment is progressing
in a timely way. This is a hands-on job – urgent intervention may
be required if a patient is critically ill.
Another key role is liaising with other
specialties to determine whether a patient needs to be admitted to
a downstream specialty ward, or whether early supported discharge
might be feasible. Meetings with the multidisciplinary team to
discuss these decisions are an important part of daily work.
Some AMUs will run an ambulatory care facility
or rapid access outpatient clinics, which will also need input from
the AMU consultant.
Other activities will depend on the specific
interests of the individual doctor. Roles in teaching and training,
management and clinical leadership are just a few examples of those
undertaken by medical staff in Acute Medicine.
What are the hours like?
In keeping with the other emergency
specialties, Acute Medicine operates 24 hours a day and 365 days a
year. AMU does not shut at night, at the weekend or during
holidays! Medical staff are increasingly working in shifts in order
to allow adequate coverage for the out-of-hours period. At the
moment, most consultants still work to an on-call system where they
are available from home, but this may change in the future.
Where is the work based?
As described above, the majority of the work
takes place in the AMU. AMU doctors may also be expected to review
patients in the Emergency Department and on other inpatient wards,
but they are based in AMU.
What people work in the same team?
The multidisciplinary AMU team has input from
many allied healthcare professionals, including pharmacists,
nursing staff, physiotherapists, occupational therapists and social
workers. Many AMUs now incorporate a GP service as well, to deal
with ambulatory medical patients requiring access to rapid
As the “gateway” to medical admissions, Acute
Medicine doctors must also build relationships with doctors working
in the Emergency Department, the other medical specialties, and
also the surgical teams, whose skill and expertise may be needed
for management of some patient problems.
Types of patients
A broad spectrum of patient problems will
present to the AMU and this variety is often considered one of the
main attractions of Acute Medicine. Some patients will be
critically ill, and some will be ambulatory. Most will have medical
problems of some kind, but others may have surgical or psychiatric
diagnoses which have been attributed to a medical cause.
Number of patients seen in a day?
This depends on the size of the hospital and
other local factors, but the numbers are usually high. This is a
busy specialty. However most units are well supported by junior
medical staff, nurse specialists and allied healthcare
professionals. The need for timely assessment of patients on the
AMU by senior clinicians has been recognised by many hospital
Trusts as a key requirement in maintaining the flow through the
Emergency Department. This has led to considerable expansion in the
speciality over recent years.
What is most enjoyable?
The clinical variety in Acute Medicine is one
of the things that makes it so enjoyable. The intellectual
challenge of diagnostic decision-making and the practical hands-on
approach to treatment are also plus points. There is a tremendous
amount of satisfaction to be gained from working as part of a
multidisciplinary team, whose primary aim is to improve the health
and wellbeing of patients.
What is most challenging?
The fast pace and high intensity of the
specialty is not for everyone. High turnover of patients means that
continuity of care can suffer.
Opportunities for flexible working
A significant proportion of UK Acute Medicine
trainees are undergoing flexible training; arrangements are made
between the trainee and their deanery.
Opportunities for research and teaching
AMU is an ideal environment for teaching and
training at both undergraduate and postgraduate levels. Many
doctors in Acute Medicine will choose to study for a postgraduate
qualification in medical education, allowing them to take on formal
roles in education and training alongside their clinical
Research opportunities in Acute Medicine are
many and varied as the evidence base underlying much of what is
done in Acute Medicine is fairly poor. There is however no doubt
that the development of acute physicians has been associated with
better outcome for patients. With the development of Acute Medicine
there are active research groups in a few hotspots around the
country. There is immense scope for development here, and
academically oriented trainees should welcome the chance to get
involved in AMU-based research design and implementation.