• training
• education, methods
• emergency department management
• management, emergency department management
• teaching

Dear Editor,

Emergency medicine (EM) is prevalent in the media at the moment, with a variety of problems being highlighted including increasing attendance figures and staffing problems. One of the factors that has caught my interest is recruitment and retention of trainees to EM, which has a knock-on effect on the number of potential consultants at the end of the process.

Having recently made this transition to middle grade level, I can offer a current perspective into this difficult period in training. The more obvious factors are commonly quoted, for example, antisocial working hours. However, little has been mentioned so far about the challenge of making the transition from working at more junior grades (foundation year (FY)2, core training (CT)1/ special training (ST1), general practice vocational training scheme (GPVTS) to becoming a middle grade (CT3/ST3 and above).

I first joined the middle grade rota as a CT3 acute care common stem (ACCS) trainee, very much looking forward to getting back to EM after 16 months of acute medicine, anaesthetics and intensive care.

I was equal parts excited and anxious about …