Improving access to Pre-Hospital Emergency Medicine

Great Western Air Ambulance Charity’s (GWAAC) primary purpose is to be there for people experiencing a life-changing illness or injury and to give them the best care as soon as possible. We want to make sure that everyone can benefit equitably from our expertise and that’s why we strive to provide clinical and operational excellence with a specialist and diverse team.

To encourage a diversity of practitioners, members of GWAAC’s clinical team have been working hard to improve access and support for those thinking about, or in the process of applying for, a career in Pre-Hospital Emergency Medicine (PHEM).

About GWAAC’s Access to PHEM programme

GWAAC’s Access to PHEM programme was initiated by Medical Director Andy Lockyer in 2023 and is currently being led by Critical Care Doctor Nicky Moore and the newest PHEM Trainees at GWAAC—Dr Mark Winstanley and Dr Celestine Weegenaar.

The programme runs four sessions a year for doctors in training in the Severn Deanery (a postgraduate medical education region in southwest England). There is a focus on education, mentorship and interview preparation to address barriers in transitioning from hospital practice to pre-hospital care, especially for underrepresented groups such as female doctors.

Dr Nicky said, “Most of the work is about removing the barriers that people from various groups face when starting out in pre-hospital practice from in-hospital practice. The most significant group is female doctors who make up half of the in-hospital workforce but only a small proportion of the pre-hospital workforce. We’ve been looking at why this discrepancy exists and what we can do to change things.”

Dr Celestine says, “As the first female PHEM Trainee at GWAAC and now national Chair of the PHEM Trainees Association, I’m committed to paving the way for others, ensuring that opportunities in pre-hospital emergency medicine are accessible to all.”

For Dr Mark it’s also about passing forward the help that he received in his early days on his PHEM pathway: “I was very fortunate to have some similar help from friends and colleagues and almost didn’t apply as I felt it may be too much with two young children. It feels great to be able to help colleagues now in a similar way and make sure we are giving equal opportunities across the Deanery. Although there is still work to be done with underrepresented groups in PHEM, GWAAC’s Access to PHEM and Fem in PHEM programmes are helping to improve these and that is great to be a part of!”

What you can expect from the programme

Dr Mark sums up what people can expect: “I think the overall aim of the sessions is to widen access to any clinician who is able to apply to PHEM should they want to. We try to break down perceived barriers and provide ways for people to boost their portfolios and CV by getting involved with local projects or opportunities. This helps them build an area of their practice where they haven't had much exposure and use their time most effectively with a view to then applying and being a strong candidate. Often people are concerned about the effect of trying to build up a CV or undertake the job with a busy life or family commitments. We try to break down the myths and barriers to show people that it is an exciting and very obtainable job despite those commitments.”

Session one: an introduction to PHEM and the roles of GWAAC clinicians

Some common questions answered — What is PHEM application and training like? How does PHEM work across different career streams? What are the ups and challenges of this career? How can you structure your career towards PHEM? You’ll have a tour of the airbase and will talk to GWAAC’s Doctors and Paramedics to get a feel for the job and what it all entails. You’ll also be offered informal mentorship from a group of local doctors, including those who have recently been through PHEM training at GWAAC.

Session two: for those hoping to apply for a PHEM Trainee role in the next year or two

Advice on how to structure your application and how you can build on your experience from opportunities across the region. You’ll learn about the reasons why people want to work in PHEM to help you frame your thoughts and word applications effectively.

Session three: support with applications

Aimed at those who have submitted their applications. We’ll help you with presenting your CV and considering how your unique experiences demonstrate that you would be a good candidate for the job.

Session four: for successful applicants preparing for PHEM Trainee interviews

An opportunity to take part in a practice interview and receive feedback from different GWAAC clinicians on how to approach portfolio presentation, interview techniques and practical station techniques. You will then be offered ongoing support from members of our Clinical Team.

Early success from the programme

Dr Celestine and Dr Mark coordinated and delivered PHEM Application workshops with 11 participants attending in August and September 2024. Dr Mark said, “We appreciated the help of Dr Olivia Cheetham who is a PHEM Trainee at Dorset and Somerset Air Ambulance. Dr Olivia helped widen access to the programme. She is of anaesthetic background so helped to speak to all specialities as myself, Dr Nicky and Dr Celestine are all emergency medicine.” The participants then submitted their applications and five of them, including four women, were shortlisted. They went on to attend a mock interview workshop and successfully secured competitive PHEM positions in air ambulance services across the county including GWAAC.

Dr Celestine said, “It's been incredibly rewarding to see five local Trainees, secure competitive PHEM positions this year. This success underscores the impact of targeted mentorship and support in breaking down barriers to pre-hospital careers.”

Dr Mark says, “I have had very positive feedback about the programme so far. We’re thrilled that everyone who got to interview this year who had taken part in the programme were successful in getting job offers in PHEM training. We have also had both female and male clinicians express their thanks for demonstrating that applying for and undertaking PHEM training is very achievable despite busy family or life commitments as they had always felt this to be a barrier.”

Dr Nicky Moore said, “I am absolutely delighted with this. The number and diversity of PHEM-trained clinicians is growing in the region and I think GWAAC is at the centre of it.”

If you’re a doctor considering a career in PHEM, read our blog post: From in-hospital to Pre-Hospital Emergency Medicine: Q&As with Dr Nicky

Did the successful participants do anything else to expand their understanding of PHEM?

All five successful candidates attended GWAAC open Clinical Governance sessions and training events and all five successful candidates had observer shifts with GWAAC. Two of the candidates spent time on GWAAC’s airbase last summer preparing for their Diploma of Immediate Care exams which they passed and most of the candidates have been involved with providing CPR training to schools and community groups as part of our Great Western Hearts programme. Last but not least, all candidates attended the Severn Emergency Medicine High Risk Procedures Day which is run predominantly by GWAAC clinicians.

Dr Celestine says, “GWAAC is not just delivering critical care; it's cultivating a diverse and inclusive environment where all clinicians feel they belong and can thrive in pre-hospital medicine.”

Alongside the Access to PHEM programme, we offer other opportunities for clinical professionals, including paramedics, to learn from the knowledge and skills of our specialist team:

• Some of our Clinical Governance days are open to both physicians and paramedics so they can learn more about GWAAC and PHEM through talks, simulations and Q&A opportunities
• We host Fem in PHEM events for female doctors, paramedics and nurses from diverse backgrounds. The events support women in healthcare by providing guidance on entering the competitive field of PHEM and addressing the barriers that contribute to female underrepresentation. Dr Celestine says, “Through initiatives like Access to PHEM and Fem in PHEM, we're actively working to encourage more females into PHEM.” Hear more from Dr Celestine and our other female clinicians about their experiences in PHEM and life at GWAAC: Pre-Hospital Emergency Medicine: A female view
• Our Clinical Engagement work is designed to provide education for frontline ambulance staff around critically unwell patients. The programme aims to give ongoing continual professional development to ambulance staff to enhance and build on their background knowledge of pathophysiology, pharmacology, and treatment options as well as a chance to practice and simulate clinical skills and scenarios
• We periodically run masterclasses and Symposiums for clinical professionals; details of which can be obtained by joining our Clinical Mailing List
• We've also supported Dr Sethina Watson to publish data to the Royal College of Anaesthetists around perceived barriers to accessing PHEM careers for minority groups

Final thoughts from the 2025 Access to PHEM Programme team

Dr Nicky says, “Our work to improve accessibility to PHEM is very much a long-term project. We hope to be creative with the education and support we can offer as we further address the pain points of clinicians wanting to transition into the pre-hospital setting. And at the heart of it all is making sure that everyone from all genders and backgrounds is welcomed into GWAAC and supported on their journey into PHEM.”

Dr Celestine agrees: “Representation matters. By providing mentorship and sharing our experiences, we aim to inspire and equip the next generation of diverse clinicians to pursue careers in PHEM.”

Dr Mark adds, “As clinicians we bring in-hospital experience to supplement GWAAC’s incredibly talented Advanced Clinical Practitioners and Specialist Paramedics in Critical Care, and the road paramedics we work with at the scene. By having diverse experience and backgrounds we can bring these skills and understanding to the patient and the team, making it stronger.”

GWAAC’s Medical Director is proud of what the team has achieved. He says, “It's important that our team aspires to reflect the community we serve, and it's crucial that GWAAC looks to identify and address barriers to seeking careers in PHEM.”

If you’re a clinical practitioner and want to keep up to date with GWAAC’s training and engagement opportunities, join our Clinical Engagement Mailing List or email inquiries to: clinical.engagement@gwaac.com