Resuscitation,4,2 17-218

Editorial

Development of a specialty Everyone must be aware that in the United Kingdom a new specialty is emerging from the remains of the old-style casualty departments. The evolution from a casualty room staffed by hospital residents to a department under the control of a non-resident doctor to the present independent accident and emergency department is well known. There are now more than one hundred casualty consultants in Britain. Some, however, have doubts about the success of these new appointments (Editorial, Injury, vol. 51no.4). In certain centres conflict has undoubtedly arisen. The fault here must lie sometimes with the appointment committees who have made appointments because of the candidate’s formal qualifications without considering whether he has the experience, training or wish to run an efficient service department. This desire for efficiency does not take away the right of this consultant to embark on long-term treatment of a particular patient if he has a special skill to do so. It is clear that most of the appointments have been successful, some almost revolutionary. It must be realised that it is impossible to produce uniformity overnight. The present casualty consultants come from a most varied background, e.g. general surgery, orthopaedics, general medicine, anaesthetics, general practice. Only a small handful of young doctors have become consultant casualty surgeons as their first and only choice. How therefore is the specialty to be developed? A recognised training programme must be established rapidly. Much of the planning has already been done but the implementation appears to be seriously delayed in its prolonged committee stages. A proper career ladder must be created linked to the training programme. Many young interested doctors are leaving the specialty because they can be given no clear guidance as to how to develop their training. This forces them into other specialties to obtain higher degrees and if they do ever return to accident and emergency it will presumably be as frustrated specialists in other subjects. Some diversification is necessary but it must be remembered that casualty (like any other specialty) is best learned by spending much time in that specialty being tutored by good clinical teachers. The specialty must gain independent recognition. The Casualty Surgeons Association has contributed greatly both in the administrative and clinical efforts to promote the service but still remains without executive powers. Many feel that a Faculty of Emergency Care should be established under the wing of one of the Royal Colleges. This would allow organ&d expert supervision and guidance during the development of the specialty. In Great Britain there is little doubt that the advice at present emanates from bodies largely unfamiliar with the problems except possibly as they affect the organisation of their own particular specialty. Every doctor however junior or senior still considers himself an expert on accident and emergency, despite the poor results obtained before the appointment of casualty consultants. The third development necessary is the merging of the medical services on an area or 217

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regional basis with the other emergency services, i.e. police, fire, ambulance etc. An ‘overlord’/minister of government should be made responsible for the emergency services; this post should not be a political appointment. It is to be hoped that the young doctors now entering the specialty of accident and emergency will not be too rapidly embittered by the struggle for independence and will continue to press for development of the emergency service. K. Little (Editor for the Casualty Surgeons Association)

Editorial: Development of a specialty.

Resuscitation,4,2 17-218 Editorial Development of a specialty Everyone must be aware that in the United Kingdom a new specialty is emerging from the...
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