- Be Organised
- Be Reliable
- Value Your Colleagues
- Take Breaks And Drink Water
- Sort Your Annual Leave ASAP
- Ask For Help
- Be Practical & Come Equipped
- Keep On Top Of Your E-Portfolio
- Download The Necessary Apps/Resources
As we have seen above in the time-table, ward round usually starts at 8:00/9:00am in the morning. This means that, as the most junior person in the team, it is your responsibility to guide your consultant/registrar through the ward round. It is better if you know your patients and usually F1s are expected to prepare the patient notes beforehand. This is so that:
You know the patient and their details/history
Your seniors get reminded of who they are seeing (amongst the other 30-40 patients they are caring for),
You don’t have to search up investigation/observation results during the ward round – this can delay the ward round and so, may prevent you from leaving work on time.
You know what questions to ask your senior regarding patient management (if there are any, for example, decision to start/withhold anticoagulants etc?)
2. Be Organised
Even though this may sound obvious, it is super important! As the FY1 doctor on the ward, it’s your job to know the patients. When you are going through the ward round, make sure to write the jobs on a separate lists/handover sheet as well, so that you do not have to go back and look through the notes – this can also prevent you from leaving work on time.
You normally have a handover sheet listing the patients, their details & their pending jobs. You can add new jobs to that list. This also helps with prioritisation which we will discuss next.
Using the universal-coloured box technique seems to work well:
- an empty box would indicate a task still needs to be done
- a line through the box would convey it has been requested
- a coloured in box means the job has been completed!
Not only does this ensure jobs are done, it is highly satisfying when you can colour in all the boxes by the end of the shift!
3. Be Reliable
It is self-explanatory. None of your seniors expect you to know everything but if they find you reliable, they know they can trust you with their patients.
If you are working with other junior doctors, DO NOT ASSUME jobs have been done. Ensure you finish your jobs and thereafter, come together with the rest of the team or go through the list to ensure all jobs are done and to ensure your colleagues are not swamped with jobs.
The art of prioritisation goes hand in hand with being organised.
Unwell patients are always the top priority.
As mentioned above, once you get organised and you are sat there in the office with the list of jobs, scan through it and see what was highlighted to be urgent by your senior or what you think is of utmost importance.
As a FY1 doctor, you will be asked to refer or discuss a patient with a different specialty. Certain discussions may well be a matter of seeking their expert opinion only rather than having to actually come review the patient on your ward. However, there are other discussions which require the respective speciality to review the patient and these are the discussions that need to be prioritised, call them early so they can plan & prioritise their day too. For e.g., discussion with Orthopaedic team regarding ?septic arthritis.
Prioritisation also plays a key role in discharging patients. You will constantly be asked to do discharge summaries and it often feels like they are never ending! Discharge summaries should be one of your top priorities. If beds are being blocked because one hasn’t been discharged in a timely manner then other people’s care will be compromised. Also, think about the patients –if we were a patient ourselves, we would be itching to get out of hospital.
Just like any other field, communication is of utmost importance and we cannot emphasise this enough. During & after ward rounds, it is important to communicate your plans with the rest of the team members. Their involvement in patient care is absolutely essential.
Communicating with relatives is also imperative. Especially during the Pandemic, with the inability of relatives to visit their loved ones in hospital due to restrictions means that their only reliance on any updates would be on the healthcare professionals looking after their loved ones. If you place yourself in the position of a relative, imagine not being able to see your mother or father or your sibling and not being able to speak to them directly either. You would want somebody to take the time to call you to update you.
6. Value Your Colleagues
Ensure you are wearing comfortable clothes, you have enough pens (you may find them scattered on the wards too), and you have your stethoscope. If you know you require topping up of sugar throughout the day, make sure you have your snacks.
7. Take Breaks And Drink Water
The great thing about being a doctor in the 21st century is that there is a plethora of resources available to you in the form of apps. Ensure you download them and have them ready. Useful apps to download
MICROGUIDE – depending on trust – this is where you can find the trust’s clinical guidelines on antibiotic therapy for various conditions, on how to manage diabetes etc
INDUCTION – consists of all the numbers (extensions and bleeps) used in your hospital
BNF – to look at medications, their doses, side effects, etc
MDCalc – to calculate certain scores – WELLS score (PE) CREATININE CLEARANCE (for Gentamicin dosing), CHADSVASC (AF), etc.
iResus – all the guidelines from the Resus Council
iArrest – a useful breakdown of what to do in a Cardiac Arrest
8. Sort Your Annual Leave ASAP
I think it is fair to say that we are all humans and we have made this choice to join this highly rewarding field which can only mean that we value human life and so valuing your colleagues should come innately. You may think we are stupid for mentioning this but, KNOW THE NAMES of your colleagues, KNOW YOUR NURSES, PHYSIOTHERAPY TEAM, DISCHARGE OFFICERS, WARD CLERK, PORTERS, HEALTH CARE ASSISTANTS, etc. Team work is an essential part of working in the NHS and a symbiotic professional relationship between everyone, will help facilitate good patient care.
9. Ask For Help
You may be thinking to yourself – “Now what? What on earth is an e-portfolio?”
We will explain to you what an e-portfolio is in detail later on but to quickly summarise, it is an online database where you can document what you have done as an FY1 and FY2. Upon fulfilling the requirements set by Health Education England, you are able to proceed through to further training (IMT, CST, GP etc)
You upload evidence of all the wonderful things you have done throughout the year and there is nothing worse than trying to upload them at the last minute! If there is no proof of you completing something on the portfolio then essentially you have not done it!
The portfolio is the crucial factor that decides if you pass through FY1 or not. If you feel you have any issues then you can always discuss this with your educational or clinical supervisor.
10. Be Practical & Come Equipped
In our battle to conquer all jobs and ensure all patients are stable, we forget to take care of ourselves. HYDRATION is key – drink as much water as possible. Especially now during the pandemic, we are wearing masks and this can often be a hindrance to drinking water but set yourself a reminder to drink water and take breaks if you have to!
FY1 is a demanding role and there will inevitably be times where you will feel stressed and frustrated, you will have your highs as well as your lows, there will be times when you will feel defeated but just remember that, if you are having a bad day, then that bad day too shall pass and good days will come by. Ensure you have family & friends you can speak to. If you need to speak to somebody in the trust, there should be a wellbeing officer who can signpost you to the relevant team.
You are not alone!
11. Keep On Top Of Your E-Portfolio
No question is a silly question! If you are unsure on why you are requesting a certain scan – always ask during the ward round. Not only will this ensure your request does not get rejected but you will also learn this way. It is so important to know why you are doing something as this makes it easier for others to understand why you have requested a particular scan or put in a particular referral to another specialty. If you’re ever unsure about anything, ask for help.
12. Download The Necessary Apps/Resources
You will usually need to provide at least 6 weeks’ notice to ensure your leave can be guaranteed. The earlier you apply for your annual leave, the more likely you are to get it. You are entitled to 9 days of annual leave per four months rotation. If you work on a bank holiday you receive a day back in lieu – this means that you are owed one more day off because you worked on a bank holiday. – Keep track of those because nobody else will be doing it for you.