Wednesday, May 29, 2013

Your guide to being an FY1

With my ARCP coming up, I have been grasping at straws for ways to fill up my portfolio with useful things. A big box on the portfolio is for teaching. Now this box is currently empty, yet I am always teaching students and foundation doctors. Mostly this is informal hints and tidbits of information, usually when they ask for help. Helpfully, whilst chatting to a medical student bemoaning her lack of preparedness for being an actual doctor in 2 months, I came up with an idea. I thought I should give a lecture on the practicalities of being a junior doctor, which the students seemed eager to absorb.

Then I thought, what advice do I actually have about being an FY1? I did a post 3 years ago about what I did as an FY1 but felt it wasn't helpful for students as it was just a list of boring tasks. There are lots of medical facts you learn at medical school but never really need to use. If you are present and reasonably attentive you should absorb by osmosis most of the things you need to know about hospital medicine to get by and compulsory courses should furnish you with information about how to use the defib and stuff like that. Practical skills will be picked up easily as you have to perform them ad nauseum, so don't worry about cannulas, bloods, arterial gases, catheters etc as you'll get plenty of opportunities to do them!

I have little advice about applications or what to do to get a training post as I am unable to get one myself! The people that already know the specialty they want as a 5th year medical student will already know what they need to do to get on and the bottoms to kiss (if any).

As it turns out I only have 5 pieces of advice.

- The List must be well maintained: I cannot overstate the importance of a good patient list. Spend 20 mins at the start and 20 minutes at the end of the day updating it and your life will be immeasurably easier. If everyone is accounted for in the right place, in the right order your ward round speeds up by 25% (citation missing). You don't have to spend ages revising about your patients, risking looking stupid on rounds because your list will have all recent scans and bloods as well as outstanding clinical problems. It will have all their demographics and past medical history so you don't need to rifle through the notes all the time. It also provides a place to collect all the jobs you need to do for that day. This is especially important on a post take ward round in a hospital where patients could be in one of 50 places. Ring A&E/MAU to find out where all newly admitted patients were dispersed to and update the list accordingly. Your seniors will think you are well organised and be nicer to you if the list looks good. It also helps if all patients can fit on one piece of A4 as it provides a psychological drain to the morning round if you see 3 pieces of paper. In addition to the list, your morning ward round should also contain spare history sheets, radiology request sheets etc so you are not forever running back and forth from the office.

- Ask for help: In your first job every problem you will be presented with will be new. You can muddle your way through the first 15 minutes of most urgent ward calls with a combination of Oxygen, fluids, pain relief, and doing bloods. You then have 3 layers of doctors above you to ask for help. If you don't know the answer to a question and it can't be easily gleaned from the BNF or trust guidelines, ask for help from a colleague, they were all house officers once. Having a patient come to harm because you were hesitant to ask a senior or did the wrong thing is worse than appearing needy or having a grumpy registrar. I honestly like being asked what to do by a junior. It makes me feel like I've learned something in the last 4 years. This advice also applies to your career or life in general. If you want to be a neurosurgeon and don't know how to go about it, ask one, most people will be flattered you want to do their chosen career and will dispense advice accordingly. If life is getting difficult with housing, relationships, children, bullying, asking for help will be a lot better than keeping problems to yourself.

- Do what you are told: I mean this in the nicest possible way and only if it's legal. If a patient doesn't want to be stabbed any more, leave them alone.  If on the ward round your boss says do daily bloods, this is probably a good idea. If the anaesthetist wants an echo before an operation, again, this is probably for a reason. Sometimes life isn't that glamorous and just getting on with the pile of discharge summaries, scan requests and paperwork is the only way forward. If you can present a fully completed job list at the end of the day even if you have had to speak to 6 different people for one thing it will be worth it for you, your patients and your references! If you think another member of the MDT is a jobsworth and is making stupid, picky demands just smile and perform their request. Don't forget, you have been there 2 weeks, they may have been there 20 years and they probably talk to your boss more than you do. This goes for trust/deanery/contractual instructions. If they want rota monitoring yearly, do it. If you need 6 case based discussions a rotation, then that is what you need. If you need a week of mandatory training, so be it. Moaning about it and then doing them is better than not doing them. However, this doesn't mean you shouldn't point out bad practise or seek to change things you feel are unsafe or inefficient, you should just aim to keep as many people on side as possible as you'll need them to change things! This brings me onto point 4.

- Be nice: To everyone you meet at work. Patient's are the most important people in the hospital, even if you sometimes want to scream at them. This is followed by nursing staff. Hospital's are very incestuous places and if you are spiky or arrogant to even one porter, radiographer or pathologist in a distant wing of the hospital, you can guarantee that they are related to staff you work with regularly. News spreads fast, so if you act like an idiot to one nurse all the other nurses find out quickly and treat you accordingly. It may be difficult if you have been bleeped 5 times about a sick note when you are at an arrest, but be polite, thank them and apologise profusely that you haven't had time. Making tea for people is nice as well. Asking people how they are and smiling is also useful. Being nice to all the ward staff has many benefits for you. They are more likely to do what you ask when a patient is crashing.

-Turn up on time: Most important in my opinion. Clinics run late, theatres run late, emergencies make you run late, but for your morning duties, there really is no excuse.You could be the best doctor in the world, but you are as useful as a chocolate teapot if you aren't there on time.  People will notice if you are not on time and will comment. Get out of bed earlier. Punctuality ties in with the first rule as the list can't be maintained if you are late. It ties in with the third rule as you are not following your contractual obligations if tardy. It ties in with the fourth rule as lateness is akin to rudeness and not enjoyed by your seniors especially if you don't let them know you are being late. When you give a time to do something to the nurses, try and stick to it, as it will only get you bleeped when you are not there. Timekeeping is even more important when you are a medical student. You don't bring much use to the team so the only thing you can do is to be on time and appear interested.You can forgive a degree of incompetence if you are at least punctual. Also, always give realistic estimates of how long you will be when talking to nurses, theatre staff etc about outstanding jobs. Nothing worse than hearing "30 minutes tops" from the surgeon and then the operation finishes 2 hours later. You also look really good if you do a task before you said you would. I have been late to work once in my life and it was my own fault and I could still kick myself for it. I cycled to work but forgot to pack a pair of trousers so had to cycle back into town to get to a Primark to buy some so I had something to wear that day other than pants. It was only 10 minutes but I still had my boss tapping his watch when I got back.

So there you go, nothing really clever, mostly common sense things that people should do in everyday life, not just in medicine. I have to say I've probably fell foul of all the rules at some point or another, but hopefully not often enough to cause any lasting damage.

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