Editorial

Whether acute medicine registrars should have the opportunity to acquire a procedural skill during their training has been the subject of considerable debate over recent years. The issue often dominates discussion amongst trainees and trainers alike at national meetings; exchanges are frequently heated and prolonged, highlighting the strength of feeling on all sides regarding the challenges which this creates. So the inclusion of three articles relating to this subject within this edition of Acute Medicine is not in any way disproportionate. In the past, much of the debate has centred on the concept of the ‘Sanity Session’ – the idea being that specialist acute physicians might need some clinical activity outside the acute arena to help prevent ‘burnout’. The three articles in this edition focus more specifi – cally on the issue of bedside investigation in the clinical setting. Many of us will recognise the scenario of the acutely unwell, hypotensive patient, for whom an urgent echocardiogram or ultrasound would enable great strides towards a diagnosis. Extracting a radiologist or cardiologist from their respective departments often requires a talent for negotiation of which a member of the Diplomatic Corps would be proud. Access to the equipment and possession of the necessary skills to undertake such procedures at the bedside would be a great asset for any Acute Medical Unit. While some units are undoubtedly already making great strides in this direction, this often results from the enthusiasm of individuals, many of whom have been trained in other specialities before moving to Acute Medicine. The statement from the British Society of Echocardiography on p95 should be viewed as an important step in identifying a level of training in which is feasible for trainees in acute medicine. The Royal College of Radiologists has also recently produced recommendations for training in ultrasound, which is described in detail by John Lorains; Mark Mallet also highlights some of the practical challenges which may arise in establishing an acute medical ultrasound service. Readers of this journal may note a slight change in the format, with fewer ‘commissioned’ review articles than in previous editions. The editorial team has been pleased to receive an increased number of unsolicited articles over recent months, which has facilitated this change. As the speciality continues to develop, a larger number of research-orientated papers are also beginning to fi lter through, which will be included over future editions. This increased number of submissions requires that a more rigorous review process is introduced. This will require an expanded team of editorial referees in the future. If any reader is interested in volunteering to help in this way, I would be grateful if you could email me at the address on this page, indicating your areas of interest and expertise. In addition any feedback from readers regarding the future format of the journal would be most welcome. I am also keen to establish a ‘correspondence’ section for future editions, so if any of the articles in this edition have raised your heckles, or reminded you of similar experiences which you wish to share, I would be delighted to receive these.