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F1 survival guide
Education
F1 survival guide
you have been scribbling a word in the notes which you think you heard when in fact it was something totally different! When you ask for investigations, you might not understand the logic behind it. Ask the consultant, or whoever has asked for the test, why they want it. Speaking to a radiologist about something you don’t have a clue about often ends in a miserable grilling session where you are bound to lose. This again ties in with hint one – be friendly. Knowing the people who do the investigations and having a rapport with them helps get things done faster. People are more likely to trust you if you are able to communicate well with them.
Mareeni Raymond
From the beginning of medical school we had been waiting to become house officers. We looked up to them. We wanted to be a good house officer, whatever that was. We talked to other house officers with awe. Well, most of the time. When, at the end of medical school, we were the guinea pigs, thrown into a new ‘Foundation’ system, we were undoubtedly wary. Did this mean we had to unlearn all the good things we had learnt about being a house officer? What did that mean for our future? What should we put on our name badges – a Foundation Year One? But, that sounds rubbish! With troubled minds and trepidation, we commenced the Foundation Years. Being an FY1 is much the same as being a house officer, but with more paperwork and, in some cases, more structure. We had an educational supervisor, someone to make a personal development plan with, and a set of goals. And of course CaseBased Discussions (CBD), Direct Observed Procedures (DOPS) and Mini Clinical Exercises (Mini-CEX) to complete. As with previous generations of house officers, medical knowledge takes a back seat to organizational skills, time management and paperwork. The smug feeling of having just passed finals is replaced by absolute confusion about what exactly your role is. The Foundation Years pack guides what you should be doing in FY1, but it does not really prepare you for the nitty gritty, the shop-floor, the – shock horror – patients. Below is a list for FY1 ‘foundlings’ of what I found most important in that year.
Ask what your role is Every job is specialized, and you may or may not have a senior house officer/FY2 to guide you. This means that your role will be broader, or completely different, depending on the post. So ask at the earliest stage what you are supposed to do. My first weekend on call was a weekend of ward cover in medicine. I commenced a ward round of the 90 patients on the care of the elderly ward, thinking that was what I had to do, all day. Thank goodness a nurse asked me what on earth I was doing – and would I mind rewriting a drug chart please? And on my first week I was told off by my seniors for writing down word for word what was said on a ward round (hey, I like writing, what can I say!). I soon learnt the medical shorthand version. The list The list is an FY1’s bible, but also sometimes a curse. It is a list of all the patients, their medical problems, their management so far and jobs pending. Some doctors swear by them, and I personally find them very useful. Updating a list every day helps you to write good discharge summaries, and to keep up to date with what needs to be done. However, don’t get obsessive about the list – I knew doctors who would be at work for ages updating their list each evening. Simple is best; life stories, not necessary. Look it up If you don’t understand something, ask a senior or, better yet, look it up. Don’t throw away your ‘cheese and onion’ (the Oxford Handbook of Clinical Medicine). You will need it for the first year. And in particular, when prescribing drugs you aren’t sure about, check them in the British National Formulary. The worst thing is to make a prescribing error – no one will be impressed when you say you ‘thought that was the right dose’.
Make friends and influence people The FY1 is essentially a skivvy, being asked to do jobs and having to do them as quickly and efficiently as possible. These jobs are made easier by communicating well with absolutely everyone in the hospital, from the cleaners to the consultants. It makes a big difference to your working environment if you are friends with the staff. The nurses will be invaluable. They know the ward, the patients, the regular attendees, where everything is, and if they have a good relationship with you they will be able to help you get things done properly. Ask if you don’ t understand There will be lots of things you don’t understand in the first few months. Ask immediately if you don’t know, as it looks bad if
Audits and stuff In your PDP, make sure you include an audit and presentation, and grab opportunities to do them. They will be useful for when you apply for jobs in future, and your consultants will love your enthusiasm.
Mareeni Raymond is a foundation year (F2) doctor in Welwyn Garden City, Hertfordshire, UK.
Recap I recommend that at the end of a ward round, and then at the end of the day, you make sure you know what jobs have to be done, and have been done, by meeting with your team members to
THE FOUNDATION YEARS 3:4
139
© 2007 Elsevier Ltd. All rights reserved.
Education
discuss. It will make your team much better run and encourage communication between the members.
Portfolio Collect every little compliment or achievement, and present it as evidence in the all-important portfolio, as this will be reviewed when you apply for jobs.
Time management Remember to leave at the same time as the rest of your team, on time. You don’t get paid for working overtime and when you get your time audit, your consultant will not be impressed if the trust owes you money for unnecessary overworking. Do your assessments on time! Throughout the year do the CBDs, DOPs and Mini-CEXs as they come up – don’t be shy to ask people to assess you; it is their job to do so.
Use your educational supervisor He or she is there to help you. If you are having problems, be they academic or personal, your supervisor is there to help iron out these issues in a practical way. Socialize! The best part of the FY1 year is the social life. Get to know all your colleagues and encourage everyone to go out and relax at the end of the day – it is what keeps you sane!
Document everything This includes documenting every conversation with family and patients. If it isn’t written down, it never happened, and all your hard work will have gone to waste.
THE FOUNDATION YEARS 3:4
Good luck!
140
◆
© 2007 Elsevier Ltd. All rights reserved.
F1 survival guide
you have been scribbling a word in the notes which you think you heard when in fact it was something totally different! When you ask for investigations, you might not understand the logic behind it. Ask the consultant, or whoever has asked for the test, why they want it. Speaking to a radiologist about something you don’t have a clue about often ends in a miserable grilling session where you are bound to lose. This again ties in with hint one – be friendly. Knowing the people who do the investigations and having a rapport with them helps get things done faster. People are more likely to trust you if you are able to communicate well with them.
Mareeni Raymond
From the beginning of medical school we had been waiting to become house officers. We looked up to them. We wanted to be a good house officer, whatever that was. We talked to other house officers with awe. Well, most of the time. When, at the end of medical school, we were the guinea pigs, thrown into a new ‘Foundation’ system, we were undoubtedly wary. Did this mean we had to unlearn all the good things we had learnt about being a house officer? What did that mean for our future? What should we put on our name badges – a Foundation Year One? But, that sounds rubbish! With troubled minds and trepidation, we commenced the Foundation Years. Being an FY1 is much the same as being a house officer, but with more paperwork and, in some cases, more structure. We had an educational supervisor, someone to make a personal development plan with, and a set of goals. And of course CaseBased Discussions (CBD), Direct Observed Procedures (DOPS) and Mini Clinical Exercises (Mini-CEX) to complete. As with previous generations of house officers, medical knowledge takes a back seat to organizational skills, time management and paperwork. The smug feeling of having just passed finals is replaced by absolute confusion about what exactly your role is. The Foundation Years pack guides what you should be doing in FY1, but it does not really prepare you for the nitty gritty, the shop-floor, the – shock horror – patients. Below is a list for FY1 ‘foundlings’ of what I found most important in that year.
Ask what your role is Every job is specialized, and you may or may not have a senior house officer/FY2 to guide you. This means that your role will be broader, or completely different, depending on the post. So ask at the earliest stage what you are supposed to do. My first weekend on call was a weekend of ward cover in medicine. I commenced a ward round of the 90 patients on the care of the elderly ward, thinking that was what I had to do, all day. Thank goodness a nurse asked me what on earth I was doing – and would I mind rewriting a drug chart please? And on my first week I was told off by my seniors for writing down word for word what was said on a ward round (hey, I like writing, what can I say!). I soon learnt the medical shorthand version. The list The list is an FY1’s bible, but also sometimes a curse. It is a list of all the patients, their medical problems, their management so far and jobs pending. Some doctors swear by them, and I personally find them very useful. Updating a list every day helps you to write good discharge summaries, and to keep up to date with what needs to be done. However, don’t get obsessive about the list – I knew doctors who would be at work for ages updating their list each evening. Simple is best; life stories, not necessary. Look it up If you don’t understand something, ask a senior or, better yet, look it up. Don’t throw away your ‘cheese and onion’ (the Oxford Handbook of Clinical Medicine). You will need it for the first year. And in particular, when prescribing drugs you aren’t sure about, check them in the British National Formulary. The worst thing is to make a prescribing error – no one will be impressed when you say you ‘thought that was the right dose’.
Make friends and influence people The FY1 is essentially a skivvy, being asked to do jobs and having to do them as quickly and efficiently as possible. These jobs are made easier by communicating well with absolutely everyone in the hospital, from the cleaners to the consultants. It makes a big difference to your working environment if you are friends with the staff. The nurses will be invaluable. They know the ward, the patients, the regular attendees, where everything is, and if they have a good relationship with you they will be able to help you get things done properly. Ask if you don’ t understand There will be lots of things you don’t understand in the first few months. Ask immediately if you don’t know, as it looks bad if
Audits and stuff In your PDP, make sure you include an audit and presentation, and grab opportunities to do them. They will be useful for when you apply for jobs in future, and your consultants will love your enthusiasm.
Mareeni Raymond is a foundation year (F2) doctor in Welwyn Garden City, Hertfordshire, UK.
Recap I recommend that at the end of a ward round, and then at the end of the day, you make sure you know what jobs have to be done, and have been done, by meeting with your team members to
THE FOUNDATION YEARS 3:4
139
© 2007 Elsevier Ltd. All rights reserved.
Education
discuss. It will make your team much better run and encourage communication between the members.
Portfolio Collect every little compliment or achievement, and present it as evidence in the all-important portfolio, as this will be reviewed when you apply for jobs.
Time management Remember to leave at the same time as the rest of your team, on time. You don’t get paid for working overtime and when you get your time audit, your consultant will not be impressed if the trust owes you money for unnecessary overworking. Do your assessments on time! Throughout the year do the CBDs, DOPs and Mini-CEXs as they come up – don’t be shy to ask people to assess you; it is their job to do so.
Use your educational supervisor He or she is there to help you. If you are having problems, be they academic or personal, your supervisor is there to help iron out these issues in a practical way. Socialize! The best part of the FY1 year is the social life. Get to know all your colleagues and encourage everyone to go out and relax at the end of the day – it is what keeps you sane!
Document everything This includes documenting every conversation with family and patients. If it isn’t written down, it never happened, and all your hard work will have gone to waste.
THE FOUNDATION YEARS 3:4
Good luck!
140
◆
© 2007 Elsevier Ltd. All rights reserved.