In 1994, Wyatt published a similar breakdown of the work of a single A&E registrar over a one-year period, noting that only 4% of its total hours included teaching, research, or administration.8 This paper recommended tailoring training and experience to the consultant`s expected work model. It is obvious that the documentation for a year may not cover the full range of activities that a specialized registrar can expect during the training period. However, if the results of this consultant study are representative of most A&E consultants, the training needs to be adjusted to have more time for training and supervised experience in areas other than clinical patient management. This limited study serves to show the wide variety of professional interests of emergency physicians and documents the flexibility of the specialty. There is a significant but predictable gap between the commitment to administration and the meetings of a one-handed clinical director compared to a consultant working in a multi-consultation department of a teaching hospital. The ability to develop a personal interest can be illustrated by the variety of time spent, such as teaching or the type of meetings he attended. Interestingly, all the consultants spent time in research, auditing and medical training (FMC), with the maximum time spent by the lecturer, who recorded 32% of his research hours. Other consultants spent a lot of time on auditing (5%) or HSF (18%). BaEM has distributed guidance on work schedules that set a maximum number of fixed sessions to accommodate the unpredictable workload.1 This document also provides a recommended overview of the distribution of hours, in which it is recommended to devote 47% of the 40-hour week to „work in the department” and 21% to management. Committees and administration. This is different from the documented activities of the majority of consultants in this small study. Previous work has shown that there are five areas in a consultant`s work: administration, diagnosis, resuscitation, teaching, and connecting with other services and the community.2 This study identified additional activities such as staffing, research, reporting, audits, etc. These are particularly relevant in the context of current developments such as clinical governance with the need for professional development and evidence-based medicine.
This study also specifically included the daily management of all types of patients in the diagnostic category, as well as the assessment of critically ill and injured patients. The work of an accident and emergency (A&E) consultant is not clearly defined. It is difficult to create an employment plan due to the unpredictable workload. This study shows the daily activities of nine A&E consultants over a one-month period. The results suggest that A&E consultants vary greatly in the content of their workday, although in any case, a large portion of the hours are spent on administrative tasks. Predictable variations occur between a one-handed clinical director who spends 60% of his time in management and the consultant in a multi-consultant department who devotes 74% of his time to clinical care and teaching. None of the consultants studied spent more than 48% of their time in clinical contact. A&E remains a specialty without coherence between the activities of consultants and where there are opportunities to pursue special interests. Training should ensure that appropriate attention is given to management and that methods are found to support new consultants in their leadership role.
There are some individual anomalies, such as the difference in the recording of time spent reading magazines. The study was informal, the consultants were specifically asked to record the activities while they worked, and it may be that other people simply did not record this article. It is unlikely that there was no other consultant reading a magazine. For this reason, a detailed analysis is not possible and we cannot draw concrete conclusions. A repeated or larger study would benefit from specifically including this category. The results of this small informal study show that there are big differences in how participating A&E consultants spend their time. The consultants who participated are all relatively young and have completed a comprehensive training program. It is to be expected that their activities will be representative of the activities expected of future consultants. The relatively small proportion of time spent on direct patient care confirms the perception that administrative and other non-clinical activities occupy a significant portion of the A&E consultant`s time.
However, it is interesting to see the diversity of work practices and confirm that A&E is a specialty where consultants can create their own employment plans and pursue their own interests tailored to the needs of a single community and department. The high proportion of time spent in management reinforces the need for training on management issues and support in the early days of a new consultant appointment. In terms of personal well-being, it was interesting to note that only one counselor recorded lunch as a standalone activity.