ARTICLES

Diploma of immediate medical care (DiplMC RCSEd)

Authors: Caroline Lee 

Publication date:  11 Dec 2004


Who's it for?

It is aimed at doctors, nurses, or paramedics who are concerned with prehospital care. Doctors must have had full registration for at least two years, must have documented evidence of clinical experience in prehospital emergency care for one year, and must have at least three months' training in hospital posts approved by the college which entail the management of seriously ill or injured patients.

When did you do it?

I took the exam in June 2003. At that stage I was a senior house officer training for a career in emergency medicine, with four years' experience in prehospital medicine.

I would strongly recommend this diploma to all doctors who wish to practise prehospital medicine

Why did you do it?

I was concerned with prehospital care as a doctor with my local BASICS scheme, and this diploma is recognised as a standard level of knowledge.

How much effort did it entail?

I revised for the exam using prehospital textbooks as well as advanced life support (ALS), advanced paediatric life support (APLS), and advanced trauma life support (ATLS) manuals. There is no substitute for prehospital experience for this exam, so I made sure I had plenty of shifts with the rapid response vehicle. I asked paramedic colleagues for help with revising for the practical aspects of the exam (for instance, taking apart or changing medical equipment).

Is there an exam?

The exam is held over one day at the Royal College of Surgeons in Edinburgh and costs £425. The morning comprises: projected material questions for 30 minutes (electrocardiograms, road traffic crash scenes, pictures of equipment); twenty multiple choice questions for 20 minutes; six short answer questions over 30 minutes; and a written incident scenario exercise, including major incident management and triage. The afternoon is a practical exam in two parts for 30 minutes each. The first is a core skills assessment including a viva on all aspects of resuscitation. The second is a clinical incident scenario concerning a medical or trauma incident on an adult or paediatric patient followed by viva questions on any topic within immediate medical care. The candidate is given the result of the exam at the end of the day. The percentage of candidates who pass is 40% for each examination sitting.

Did you go on a course?

There are currently no specific revision courses for this exam, but there are plans for an unofficial revision course to be started later this year. Candidates would benefit from the BASICS immediate care course ( [Link] ) or the prehospital trauma life support course, and they need to be up to date with ALS, APLS, and ATLS.

Top tips:

Think prehospital. The candidates who failed were not experienced in prehospital care and were treating patients as if they were in the accident and emergency department. Practise your ALS, APLS, and ATLS skills. Make sure you are familiar with all prehospital medical equipment (so you can change an oxygen cylinder, operate an automated external defibrillator, or describe all the features of a bag valve mask). Ask people who have already taken the exam for tips on possible questions as the syllabus is very generalised.

Was it worth it?

The exam was a fair and relevant test of prehospital emergency practice. The day was well organised and at a great venue at the Royal College of Surgeons. Preparing for the diploma updated and consolidated my knowledge and practical skills, which has increased my confidence working out of hospital as a doctor with no immediate medical back up. I would strongly recommend this diploma to all doctors who wish to practise prehospital medicine as a basic standard. The fellowship of immediate medical care is also available for more experienced practitioners with longer prehospital service.

Further information:

Royal College of Surgeons of Edinburgh, Adamson Centre, 3 Hill Place, Edinburgh EH8 9DS. Tel 0131 668 9222. [Link]

Caroline Lee senior clinical fellow in emergency medicine Manchester Royal Infirmary

Cite this as BMJ Careers ; doi: