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The transition from medical school to a foundation year one doctor (FY1) can be one of the most daunting and arguably largest steps in your medical career. However, it is also an exciting opportunity filled with new experiences and increased responsibility. Here are some top tips and general advice to set you on the right track (that I wish I could have told my former self!).
Ten top tips
1. Know your patients
This is my absolute number one top tip. As a foundation doctor, seniors won’t expect you to know the ins and outs of their specialty, in fact, they will generally be keen to provide you teaching on this. However, the good Foundation doctor knows the patients on the ward, including their clinical condition, current treatment, investigations, social history etc, etc. This makes you look much smarter than the person who can list twenty rare causes of hyponatraemia.
2. Good documentation is essential
Learn to document properly, and if documenting more complex discussions (breaking bad news, complaints) ask a senior how they would like it to documented, particularly if you are documenting for them.
3. Understand what is required
When being asked by seniors to complete a job, always be sure you understand exactly what they expect from you and that you know how to do it (or where to find out).
4. Don’t panic
There are times you will be dealing with acutely unwell patients or be in other similarly stressful situations. Never panic, it won’t help the situation at all. Communicate with your seniors if you feel out of your depth, they will be expecting you to do this, so don’t hesitate. If you continue to try and deal with a situation outside of your competency level, your seniors will not appreciate it when they find out later.
5. Never stop learning
Learning doesn’t stop at the end of medical school, in fact, it only just begins! Take an interest in each rotation, and use the opportunity to learn as much about the specialty as possible (even if you are not interested in pursuing it in the future, lessons learned may be useful for future rotations).
6. Admit to your mistakes
We all make mistakes, it’s inevitable. Be honest and own up to any mistakes, NEVER try and cover anything up.
7. If in doubt ask
It is much better to take a few seconds to clarify things before you start a task than to waste time doing it incorrectly. Everyone was new once. Nurses are a great source of clinical information and ward clerks are the fountain of all knowledge when it comes to anything administrative.
8. Smile and be polite
Simple, but this gets you a surprisingly long way, especially when asking people for favours!
9. Wear comfortable shoes
Being a junior doctor can involve being on your feet a lot of the time. Having good comfortable shoes really pays off.
10. Enjoy it
Medicine is an exciting and rewarding career; you’ve worked hard to get here so enjoy everything the job has to offer.
Good advice for few common encounters
When asked to request a scan, make sure you know which scan is required and what they are looking for. If you are unsure, stop and ask, no matter how rushed the ward round is, this is time well spent, as radiologists will want to know this information.
When filling out the request be sure to include all the relevant information about the patient (presenting complaint /reason for admission, relevant investigations, past medical history, previous scans). You also need to let the radiologist know what question you are hoping to answer with the scan (e.g. “Is there evidence of colonic malignancy?”).
What you document on the request will determine how the radiologists interpret the scan and their report. Request scans early on in the day to avoid delay in it being performed.
Phone calls to other specialties are potentially the most feared and daunting job of a foundation doctor. They are a chance to ask advice from senior doctors from other specialties on the management of patients under the care of your team.
First, make sure to read through the patient’s notes beforehand so that you are familiar with their history. It’s also worth checking if the patient has been seen by the specialty in question before (and if so are they known to a particular consultant).
Be sure you understand what it is you are phoning about and what question your seniors would like answered (if not, clarify this with your team before making the call).
Make sure you have the patients opened up on the computer system and have all the paperwork you need in front of you (notes, obs sheet, drug card etc.) as the specialist will undoubtedly ask you for a piece of information you hadn’t anticipated.
You will develop your own structure for conveying the necessary information with time (e.g. SBAR), just be sure to include all the salient points. You should start the call by introducing yourself and briefly explaining the reason for your call (e.g. “Hi, I’m Dr Smith, one of the FY1 doctors. My team has asked me to seek your opinion on…. Is now a good time?”). You can then go on to give more details about the patient. At the end of the phone call always ask the name of the person you are speaking to and document this. They will get easier with practice (honestly).
These are something that you may have little experience of as a medical student. Night shifts are a marathon, not a 100m sprint, they are often long shifts that are going to feel tough and arduous at times. Everyone develops a different sleeping pattern when it comes to night shifts, so find one that works for you- just make sure you are getting a decent amount of sleep at some point.
Keeping up to date with your e-portfolio pays off and can prevent considerable stress around ARCP time. The key is to know what the requirements are in terms of skills and assessments that you need to get signed off; being aware of this means you can be opportunistic in getting everything signed off as the situation arises, rather than rushing around at the end of your rotation. Communicate with your supervisors early to arrange meetings, as they can often be busy people who are difficult to track down.
Plan ahead and book your annual leave early. There will be a restriction on which shifts you can and can’t take off (nights, on calls etc.), as well as the need to ensure a minimum number of junior doctors on the ward. Rotas can be difficult to organise, so book early to enable shifts to be organised and to prevent you from missing out on any precious relaxation time. Many jobs require six weeks’ notice for any annual leave.
These essentially sum up everything that has happened to the patient during admission. When thinking about the level of detail to include, think about what another doctor would want to know about what happened during admission if the patient were to be readmitted tomorrow. Be sure to include any follow up the patient requires including any jobs for the GP. Remember that they are given to the patient, so anything you put can be read by them. Get them done early, especially if the patient will need any drugs from pharmacy before they are discharged. Discharge letters can be started at any point during admission and edited as you go along, to prevent delaying the patient’s discharge; just make sure you don’t sign it until it is complete.