The transition from final year medical student to foundation doctor is one that is notoriously challenging, but also exciting and rewarding. You’ll meet colleagues who will become friends for life, see conditions and manage them for the first time together, and collectively muddle through the highs and lows of hospital life.
While some land their top choice job in their top choice hospital, others are allocated an unexpected location and doing rotations they didn’t choose. Whatever your situation, you’ll be working with colleagues in exactly the same boat as you and it’s not uncommon to be pleasantly surprised completing a rotation initially expected not to be enjoyed.
All FY1’s start with a few days shadowing outgoing first year foundation doctors and during this time you will be bombarded with paperwork and e-Learning as well as inductions and tours. It can be quite overwhelming at the start with the information overload, but take this time seriously and aim to get the administrative tasks done as soon as possible. Use the time to acclimatise to the new environment and map the hospital geography, get all of your computer logins and try to become au fait with the IT programs. Practice printing a blood test form, learn how to request a scan and ask to be shown how to bleep the med reg/a colleague/put out a crash call.
On The Wards
The day-to-day job of the foundation doctor will be assisting consultants and registrars on ward rounds, ordering and reviewing blood tests and scans, liaising with other specialities for advice, phoning and updating patient relatives, and writing prescriptions and discharge letters.
Organisation and time keeping is the key to success here and many doctors find it useful to keep a list and use a ‘box checklist’ format to work with during the day. Write the job that needs to be carried out and draw a small box at the end of the sentence. Half fill it in from corner to corner when the task has been ordered/requested, and then fill the other half in when the results have been reviewed/checked/actioned.
There is usually more than enough to keep you busy, so it is essential to stay hydrated, have lunch (find out canteen opening/closing times) and go to the loo! It’s easy to keep pressing on with jobs but there is almost always five minutes to spare to have a cup of tea.
On Calls and Night Shifts
The character of on-calls and night shifts differs as you will tend to more urgent jobs, reviewing unwell in-patients and admitting new patients. Everyone is anxious to hold a bleep for the first time and nervous to be the first to arrive at a crash call at 4am in the morning.
Know how to do an A-E assessment, know the SEPSIS-Six and escalate appropriately to a senior using the SBAR communication tool. If you can do these three things on your first day, the rest will fall into place with time, practice and experience!
You’ll sometimes be asked to do multiple jobs at once, so it is important to write them down and complete them in order of priority, something that you will naturally get better at. It’s also good to know how to politely inform a colleague that you are unable to carry out their request immediately, I use something like “I’m currently busy with another task at the moment, but I will do it as soon as I can”.
Apps and Technology
No one is expecting you to know everything when you start, and truthfully you never will! However, you will be expected to know how to find something out and so it’s good to have some resources at hand to know where to look. There are some really helpful apps, some of which I use on a daily basis and I encourage installing the following before you start:
- Microguide – for your local Trust’s antimicrobial guidelines
- Induction – for useful hospital extension numbers
- BNF – the medicines app
- MDCalc – for quick calculation of medical scoring systems
- iResus – Resus Council Guidelines
It is also worth ensuring you know how to access your local trust’s guidelines, and these are usually found on your hospital’s intranet. Almost all trusts will have internal guidelines, protocols and treatment algorithms which you can follow for common scenarios, for example managing hyperkalaemia or delirium.
Keep your hobbies up and do not lose your passions! F1 can be really tiring at times especially when on acute rotas with lots of on calls. It’s important to switch off from medicine and although sometimes easier said than done to ‘leave work at work’, take the time and effort to try and do a non-medical related activity when you get home to achieve this. For me this meant doing online Zoom tap classes and getting down to the beach come rain or shine!
Some days will be really great, with every procedure a success, patients managed well and discharged home after a successful course of treatment. Echoing the great days however are the occasional bad days, bad weeks, and rarely even bad rotations. At times the job will be very stressful, so it is important to remember that you are never alone, and there are many sources of support you can access. Arrange to meet your educational and clinical supervisors as soon as you can into the placement, make a group WhatsApp with your new colleagues, speak to the Nurse in Charge or Matron if you have a problem, discuss issues with friends and family you trust. Get involved with your hospital’s Mess events, socialise with fellow F1’s and offer your support and ears to others.
Every foundation doctor must complete an online portfolio to present at the Annual Review of Competence Progression at the end of the academic year. ‘Little and often’ was the best advice I was given by my predecessors – it’s much easier to input all the teaching hours gained and cases or procedures you’ve done as you go rather than leaving everything until the end of the year. I would also become familiar with the curriculum and the required number of competencies at the beginning of the job in order to forward plan their completion and to make it feel less burdensome.
Reflection is also required for the portfolio and is extremely important practice to aid self-assessment and development. It’s easy to view mandatory reflection exercises as a tick box task but they can be an excellent tool to evaluate hospital experiences, both the good and the bad. A poor interaction or experience with a colleague or patient more often than not is secondary to a stressful situation rather than you as a person/doctor and reflecting on such a situation will enable identification of rectifiable differences as well as more serious problems.
There is no such thing as the ‘perfect’ doctor, but practice makes proficiency. Above all, be safe and work within your competencies, but also strive to improve and be open to new challenges. Ask your senior to observe or talk you through new procedures, welcome feedback with open arms, and ask what can be done differently next time.
Good luck, enjoy, and embrace!