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Introduction
Emergency medicine (EM) is the term used in the UK for the hospital-based clinical specialty that encompasses knowledge, skills and competencies required for the prevention, assessment and management of acute and urgent aspects of illness and injury. 1 Over the past three decades in the UK, EM, previously known as the specialty of accident and emergency, has gone through several stages of development, which have resulted in increasingly well-defined training pathways. Notable landmarks were the establishment of the Intercollegiate Board on Accident and Emergency Medicine in 1991 and the inauguration of the Intercollegiate Faculty of Accident and Emergency Medicine in 1993. 2
The specialty continues to develop. The College of Emergency Medicine (CEM) has published recommendations for expansion of the EM consultant workforce. 3 Its case, based on a review by the Academy of Medical Royal Colleges, 4 is that expansion is essential for providing the best possible specialist emergency care for patients. The CEM recommends that every emergency department should have a minimum of 10 whole time equivalent EM consultants, more in larger departments, to provide up to 16 h of immediate on-site cover 7 days a week. The current average number of EM consultants per UK emergency department is 4.4. 3 The expansion of the consultant workforce would require a substantial increase in the number of training posts.
With this as background, we have analysed data in a large multi-cohort, multi-purpose study of doctors' career choices and progression covering eight UK cohorts of doctors who graduated between 1993 and 2009. In this paper, we report on early career choices for EM, whether early choices for EM are predictive of eventually working in the specialty, and doctors' reasons for selecting and rejecting EM as a career.
Method
Our study included the medical graduates of 1993, 1996, 1999, 2000, 2002, 2005, 2008 and 2009 from all medical schools in the UK. Our methods have been described in detail elsewhere 5 6 and in the online supplementary methodological appendix. In brief, towards the end of the first, third and fifth years after qualification, and at longer time intervals after that, postal (and, more recently, web-based) questionnaires are sent to all doctors in each cohort. We ask structured questions about the doctors' preferences for future specialty...