Honest reflection on finishing my first FY1 placement (long)
Background – I’m an FY1 doctor who’s just finished his 1st placement on general medicine. I’m making this post just to gauge how my experience differed from other peoples and to give some insight into what to expect to any student lurking. My advice is more general than medical, on the account of this being a reflection. Also this turned out quite a lot longer than I thought it would.
I’ll try target a few different topics, including how it felt starting on the wards, on-calls, pay and how things progressed over time.
Induction
First thing’s first, after the long summer we had a week long induction period. This mostly included being talked at in a lecture theatre as well as being thrown on the wards. The talks were okay, but I felt like they could have prioritised showing us the most important basic things, like specifically how order bloods, a chest x-ray, CT and any kind of form relating to insulin prescribing.
Wards
The first time going onto the wards is pretty scary, but during your induction the main priorities is to introduce yourself to the team and get all your IT logins sorted. Honestly the logins took me about an hour and I had to get 3 different programmes authorised. After I got that sorted I remember going onto the ward. For a ward induction I feel like I got thrown into the deep end, and I just started getting handed over jobs to do; mainly bloods, cannulas and a collateral history. It’s also quite important to see how a TTO is written too. Don’t worry about asking for help for any of those because like many people I forgot how to medicine after summer. I think my success rate for bloods/cannulation in my first week was about 20%, don’t sweat it – it just be like that.
Another thing I’d like to highlight is that stating stuff and actually doing it is different. It’s easy with your mates saying I’d do an A-E but when a nurse came up to me and said ‘Doctor can you see a patient who’s MEWSing’, I was like where’s the doctor? Now I look back and I can say I’d have a look at the obs, what they’re like normally, what the patient’s on, recent investigations and then try find the cause of the MEWS. If it’s infective and no recent bloods, go take some, if they’re septic go for sepsis 6, new CAP/HAP order a chest x-ray. Generally I had good senior support, and if you’re worried then talk to them after you’ve ordered it and get advice on management and how to proceed. Also don’t be worried about talking to other specialties, if someone’s come in with a back fracture, haemorrhage etc. I know it can be daunting to call a speciality like neurosurgery, even my reg got berated by micro once!. If it comes to it and you can’t persuade a speciality to review your patient or give you advise, just ask someone more senior than you to go for it.
For ward rounds, in the morning I came in at 8.30 every day to prep the new patients notes for the ward round. I was quite lucky because my consultant is very laissez faire, because sometimes if there were a lot of patient I wouldn’t prep the notes, I’d just prep details on my handover sheet to tell the team. Just make sure you know what you’re treating the patient for and what treatment they’re on, and some brownie points with physio if you know their living situation/mobility. I left around 4.30-5pm daily after I got used to the swing of things and because my team were really efficient, I had large periods of breaks during the day too, though I know this isn’t usually the case in gen med. I know some consultants had 3-5 hour ward rounds, with daily cannulas and bloods for each patient.
Coming up to the weekend just make sure cardexes are rewritten for the weekend, and bloods for phlebs are ordered.
On-calls
In terms of quantity I had 2 sets of nights, 3 or 4 days long each, 1 in 3 weekends, and maybe 4 days of acute medical on calls every 5-6 weeks.
On admissions acute medical on-calls, we had a team comprising of a senior registrar, IMT, SHO and myself. These are really good opportunities to get see a lot of different cases. Whilst I was here I treated my first NSTEMI, DVT, LRTI and sepsis. Seniors are often around to help support you and whilst I often did clerking, I organised for scans, and started treatment in some cases where needed. In the case where I saw the NSTEMI, it was very atypical, but the troponins were very raised so immediately went to a senior to get advice, and partly because I’d forgotten dosing of ACS meds. At some points consultants will grab you to effectively scribe for them and do the jobs. I remember my first weekend where I got sent to an area I didn’t know and I couldn’t find the notes, or find what category the patients obs were under, or even how they wanted notes prepping. Don’t take it personally, just crack on even if they call you slow. It’s a learning process.
The worst time I’ve had was a weekend on call. It wasn’t my usual ward, it was more a service provision thing. On the Sunday the SHO called in sick and the hospital weren’t able to provide anyone to cover him, so effectively I was with 40 patients. Obviously just make sure you clarify exactly what your consultant wants and datex! The main jobs were just referrals and bloods, though I did get harassed by hospital managers for TTOs. Whilst I didn’t have any SHO support, I had to call the med reg once for advice, but when I did this I was very specific about what I wanted. One thing I felt really uncomfortable about was that there was no cover to take over from me from 5pm til the night team started, and when 5pm came I started being handed over new jobs from new patients arriving, but I had to stand my ground, I ended up handing over to the med reg and leaving. Just make sure it’s safe, but you can’t have people take advantage of you, because they will.
Pay has been around 2.1k a month after deductions. In a way I’ve struggled with this as I live alone and wasn’t in the best place financially after being a med student, but I plan to locum on my old ward to boost finances a bit.
How I’ve felt
All in all I've really enjoyed my normal week ward, as I really enjoy the banter between me and my team, and my reg is really friendly. On calls, especially nights/weekends can be difficult mentally, with the fatigue and it being hard to switch off. There’s been times where I’ve woken up after remembering I did something wrong, or had difficulty sleeping as I feel like I made the wrong decision. This is normal, and just something you have to learn to cope with. It's not always like that though, and at least for the first few months I looked forward to going into work.
Outside of medicine
I can’t say I’ve done too much. I tried taking up the gym but after I got the flu 3 months ago I stopped going. I try keep up with guitar as a hobby but manage around 10-20 minutes a night. Socially I don’t have any friends here, and only go out to see my girlfriend or friends back home. In terms of my uni friends, I only really speak to one regularly, I stopped reaching out to others when I felt like the effort was one sided. At times I’ve felt really alone and isolated, I can get really down and I can totally see how people can find it overwhelming, but I feel like it’s quite normal considering the change in lifestyle and placement. It’ll take me a bit of time to find my feet, but I’ll keep looking forwards.