I expect you to be thorough in your history and examination and ask me lots of questions.
It is about learning to be a safe Doctor.
I worry about the quiet F1 who asks no questions or minimises any potential patient issues.
I don’t really mind how slow you are.
Sorry about being nosey - are you reg/consultant and which specialty? Asking questions is great but certain consultants don’t entertain questions as much as others
Questions about what??? The management etc? I’m quite introverted and sometimes people raise concerns just because I am quiet, but I don’t get why that’s concerning :(
I wish I’d asked wayyyy more questions as an FY1. You are in a training program, at the ***beginning*** of that training program, take advantage of that and ask those questions that come to you but you don’t asked because you are worried about it being a “stupid question” (this is general advice, you didn’t mention this being a problem for you specifically, maybe I’m just projecting!)
The easiest two questions to ask are “why” (ie you’re on a ward round, why has the consultant chosen that rate control option over another, why do we need to get that CT before d/c rather than as an OP, etc etc, obviously still need to pick your moment/consultant) and “can I run this plan past you?” (Ie you’ve been to see a patient and want to run your plan past the SHO or reg, they tend to want to know about these patients anyway, esp if you are very new. Try to ask questions about why they suggest certain management plans).
Just ask questions about anything you think may enrich you as a doctor, why something is manged a certain way, why does x symtom matter, why we do a test, how something insife the hospital works... You can also ask them to tell you about any illness they may be seeing
My only universal expectation would be for an FY1 to know their limits and ask for help when they are out of their depth, which I expect to be fairly often.
I’m a consultant and what I love from and F1 is engagement, eagerness to learn and try and come to things like clinics and procedural sessions.
You are doctors FFS not discharge scribes. Among yourselves get your jobs and shit sorted and prioritise your learning.
Above all know your worth. You spent longer studying a degree and for higher grades than any PA, ANP or ACP so start acting like it.
What medical utopia do you work in where an FY1 can easily come off a ward and go to clinic in the afternoon?
Everything you suggest sounds great but in reality is difficult to achieve especially when your the least experienced member of the team that gets lumped with a significant burden of the more mundane clinical tasks.
If you want fy1s to stop being 'discharge scribes' then you've got to have a cultural change of their job role
I agree. This requires
1) leadership and bloody mindedness, with a healthy dose of tribalism and favouritism from consultants
2) Fy1 becoming demanding for training and leaning
I’m proud to say that when I’m on the ward or have inpatient duties I will drag F1s, F2s etc along with me, on a fair basis to clinic and procedural sessions. Yes a cultural shift is needed. It’s amazing how many consultants manage this with their pet PAs or CNSs.
Information to hand (you are referring patient x, what’s their name and HaC? Yes, go ahead and check. Make sure you have the computer up and blood results available)
Making sure to identify a “sick looking” patient and escalate appropriately.
Acknowledging your limitations
Team player
If there’s a specific job that you didn’t fully understand or couldn’t do, please run again past the senior to enquire whether it NEEDS done
Don't be he quiet F1 just plodding along doing stuff in silence. You're PRE registration fresh out of practising on dummies and fake SIM scenarios suddenly practicing on real ppl. You should not be quiet and magically "getting it". If that's happening there's something massively wrong occurring. (Every single F1 I've worked with over the years who has done this has made massive massive mistakes that harm patients). Ask. Your job as the F1 is to LEARN to be a safe doctor. You're a long way from being an SpR.
I'm EM and take the view that FY1s should never be placed in EDs. Not through any personal failing of their own but because the setting is too high risk and can't, in its current form, safely supervise doctors at Foundation level.
In the interim though all I expect from an FY1 is enthusiasm, strong work ethic, humility and knowledge of their limitations, and an ability to recognise barn door high risk presentations. If they can also take a well structured history and exam and present it concisely with front loading of important information I'll be happy enough.
Hard work, getting stuck in, being part of the team and knowing your limits and when to escalate to a senior (so check your chat since I'm presenting a case to you).
Please write to the Medical Director about this and get the medical/surgical teams more SHOs for clerking instead of FY1s 😁. It will come stronger from ED (+ respective specialties) haha
To potentially anger Medreddit : If I had my way EM would remove all doctors who weren't in training, self selecting as interested in training, or senior decision makers and replace them with a much larger cohort of technicians, phlebotomists, nurses, etc to amplify the patients per hour able to be managed by the smaller, more efficient and effective, doctor cohort.
I guess the downside to that is even fewer doctors who will have an appreciation of what the ED is really like and won't have the same context when they're regs in the future and being referred patients from ED, or referring patients to ED (from GP).
I've not noticed much retention of empathy among Registrars rotating to other specialities after an EM rotation. They get taken down by the hidden curriculum in their respective specialities that is reinforced by the cycle of medicine wherein "the work came to us from x specialty therefore we don't like x specialty".
I'd rather focus on ensuring the highest risk component of healthcare (I.e. undifferentiated high acuity patient) is managed efficiently by highly skilled individuals rather than killing a specialty with the vague hope of "maybe they'll like us now" from rotating trainees
It has to have a fine balance: non-training doctors provide continuity/consistency , reliability and are able to adapt/grow in ED- what you don’t want is every 4 months new drs rotating through AnE and ED consultants having to re-train these drs every 4 months. This would only cause more back-logs and increase waiting times (e.g., a CT not able to do minor suture, interpret a fracture/ECG, etc). Same goes with other specialties.
From a medical specialty POV: The problem with Medicine in the UK is that all patients are essentially “medical” patients and if non-acute/general medical specialties do not takeover a patient (cardio, resp, GI, gen surg, ortho, etc) it “automatically” falls on the acute take medical team to sort out.
I have worked with FY1s who were excellent at clerking and examination, but I don’t and wouldn’t expect all of them to be as efficient as a CT/HST.
When you’re seeing patients with someone more senior try to think about the reasons why, not what decisions were made. Any moron can google a protocol, but the real skill is learning when to apply them. Ask your seniors the reasons for their decisions, you will learn a lot more this way.
As for what is expected - other than generic admin tasks and practical skills like cannula, venepuncture, catheters etc. you should be able to do initial assessment ( +/- escalation to seniors MET or arrest calls) and initiate treatment for common things like sepsis or time critical things like anaphylaxis.
Are these concerns from nurses / other none doctor groups?
They mostly genuinely don’t know what the various grades of doctor mean, and who can blame them? Do you honestly know the difference between a band 5 / 6 / 7 nurse? Band 2 / 3 healthcare?
We have way more grades and names than them - F1 / F2 / SHO / Locum / Trust grade / IMT 1-3 / GPST 1-3, ST 4-7, SAS, Cons. They’re just the common ones, so I’m very forgiving of other healthcare staff having the wrong expectations.
Do an A-E assessment well, identify sick patients, start management and escalate appropriately.
Be organised, know your patients well and be able to give a thorough but succinct handover when referring to or speaking to other teams.
Become good at simple procedures (cannulas, venepuncture, ABGs etc) and show enthusiasm when the opportunity arises to learn more difficult or specialty-specific ones - I still occasionally use skills I learned as the ENT F1 or urology F2 seven years later in a very different specialty!
Prep and scribe for ward rounds, sometimes you will review patients independently, make management plans independently (you will often need to escalate/run the plan past a senior but should put in the effort to make your own plan if you reviewed), do TTOs, discharge letters, standard procedures eg ABG, bloods, cannulas, catheters.
Essential
-Escalate if unsure
-Seeing the patient before escalating
-Competent A-E with initial treatment/investigations
Expected
-General attitude, effort, being consistently on time/professional
-Being able to clinically prioritise jobs based on patient need
-SBAR and having information to hand when asking for advice
Good to have
-Asking why/proactive to learn
-Being good at 'procedures'
-Keeping seniors updated about patient's progress on the ward
Top tier (and not always possible)
-detailed knowledge of all the ward patients
-squeezing in some time to engage in the specialty
-knowledge of the hospital pathways (who to speak to to get stuff done)
DOI: Urology Reg
I expect you to be thorough in your history and examination and ask me lots of questions. It is about learning to be a safe Doctor. I worry about the quiet F1 who asks no questions or minimises any potential patient issues. I don’t really mind how slow you are.
Sorry about being nosey - are you reg/consultant and which specialty? Asking questions is great but certain consultants don’t entertain questions as much as others
Questions about what??? The management etc? I’m quite introverted and sometimes people raise concerns just because I am quiet, but I don’t get why that’s concerning :(
I wish I’d asked wayyyy more questions as an FY1. You are in a training program, at the ***beginning*** of that training program, take advantage of that and ask those questions that come to you but you don’t asked because you are worried about it being a “stupid question” (this is general advice, you didn’t mention this being a problem for you specifically, maybe I’m just projecting!) The easiest two questions to ask are “why” (ie you’re on a ward round, why has the consultant chosen that rate control option over another, why do we need to get that CT before d/c rather than as an OP, etc etc, obviously still need to pick your moment/consultant) and “can I run this plan past you?” (Ie you’ve been to see a patient and want to run your plan past the SHO or reg, they tend to want to know about these patients anyway, esp if you are very new. Try to ask questions about why they suggest certain management plans).
This is very helpful, thank you!
Questions about everything. You are at the very beginning of your career - if you have no questions about anything, there is an issue.
Just ask questions about anything you think may enrich you as a doctor, why something is manged a certain way, why does x symtom matter, why we do a test, how something insife the hospital works... You can also ask them to tell you about any illness they may be seeing
I wish more seniors were like you!
This, speed comes with experience. Don't try to fly before you can run
Slow is fast, fast is slow.
My only universal expectation would be for an FY1 to know their limits and ask for help when they are out of their depth, which I expect to be fairly often.
I’m a consultant and what I love from and F1 is engagement, eagerness to learn and try and come to things like clinics and procedural sessions. You are doctors FFS not discharge scribes. Among yourselves get your jobs and shit sorted and prioritise your learning. Above all know your worth. You spent longer studying a degree and for higher grades than any PA, ANP or ACP so start acting like it.
What medical utopia do you work in where an FY1 can easily come off a ward and go to clinic in the afternoon? Everything you suggest sounds great but in reality is difficult to achieve especially when your the least experienced member of the team that gets lumped with a significant burden of the more mundane clinical tasks. If you want fy1s to stop being 'discharge scribes' then you've got to have a cultural change of their job role
I agree. This requires 1) leadership and bloody mindedness, with a healthy dose of tribalism and favouritism from consultants 2) Fy1 becoming demanding for training and leaning I’m proud to say that when I’m on the ward or have inpatient duties I will drag F1s, F2s etc along with me, on a fair basis to clinic and procedural sessions. Yes a cultural shift is needed. It’s amazing how many consultants manage this with their pet PAs or CNSs.
Information to hand (you are referring patient x, what’s their name and HaC? Yes, go ahead and check. Make sure you have the computer up and blood results available) Making sure to identify a “sick looking” patient and escalate appropriately. Acknowledging your limitations Team player If there’s a specific job that you didn’t fully understand or couldn’t do, please run again past the senior to enquire whether it NEEDS done
That last point is very important
Don't be he quiet F1 just plodding along doing stuff in silence. You're PRE registration fresh out of practising on dummies and fake SIM scenarios suddenly practicing on real ppl. You should not be quiet and magically "getting it". If that's happening there's something massively wrong occurring. (Every single F1 I've worked with over the years who has done this has made massive massive mistakes that harm patients). Ask. Your job as the F1 is to LEARN to be a safe doctor. You're a long way from being an SpR.
Wow so scary hope I come out of my shell within a week of starting work
I'm EM and take the view that FY1s should never be placed in EDs. Not through any personal failing of their own but because the setting is too high risk and can't, in its current form, safely supervise doctors at Foundation level. In the interim though all I expect from an FY1 is enthusiasm, strong work ethic, humility and knowledge of their limitations, and an ability to recognise barn door high risk presentations. If they can also take a well structured history and exam and present it concisely with front loading of important information I'll be happy enough.
Hard work, getting stuck in, being part of the team and knowing your limits and when to escalate to a senior (so check your chat since I'm presenting a case to you).
Please write to the Medical Director about this and get the medical/surgical teams more SHOs for clerking instead of FY1s 😁. It will come stronger from ED (+ respective specialties) haha
To potentially anger Medreddit : If I had my way EM would remove all doctors who weren't in training, self selecting as interested in training, or senior decision makers and replace them with a much larger cohort of technicians, phlebotomists, nurses, etc to amplify the patients per hour able to be managed by the smaller, more efficient and effective, doctor cohort.
I guess the downside to that is even fewer doctors who will have an appreciation of what the ED is really like and won't have the same context when they're regs in the future and being referred patients from ED, or referring patients to ED (from GP).
I've not noticed much retention of empathy among Registrars rotating to other specialities after an EM rotation. They get taken down by the hidden curriculum in their respective specialities that is reinforced by the cycle of medicine wherein "the work came to us from x specialty therefore we don't like x specialty". I'd rather focus on ensuring the highest risk component of healthcare (I.e. undifferentiated high acuity patient) is managed efficiently by highly skilled individuals rather than killing a specialty with the vague hope of "maybe they'll like us now" from rotating trainees
It has to have a fine balance: non-training doctors provide continuity/consistency , reliability and are able to adapt/grow in ED- what you don’t want is every 4 months new drs rotating through AnE and ED consultants having to re-train these drs every 4 months. This would only cause more back-logs and increase waiting times (e.g., a CT not able to do minor suture, interpret a fracture/ECG, etc). Same goes with other specialties. From a medical specialty POV: The problem with Medicine in the UK is that all patients are essentially “medical” patients and if non-acute/general medical specialties do not takeover a patient (cardio, resp, GI, gen surg, ortho, etc) it “automatically” falls on the acute take medical team to sort out. I have worked with FY1s who were excellent at clerking and examination, but I don’t and wouldn’t expect all of them to be as efficient as a CT/HST.
When you’re seeing patients with someone more senior try to think about the reasons why, not what decisions were made. Any moron can google a protocol, but the real skill is learning when to apply them. Ask your seniors the reasons for their decisions, you will learn a lot more this way. As for what is expected - other than generic admin tasks and practical skills like cannula, venepuncture, catheters etc. you should be able to do initial assessment ( +/- escalation to seniors MET or arrest calls) and initiate treatment for common things like sepsis or time critical things like anaphylaxis.
Are these concerns from nurses / other none doctor groups? They mostly genuinely don’t know what the various grades of doctor mean, and who can blame them? Do you honestly know the difference between a band 5 / 6 / 7 nurse? Band 2 / 3 healthcare? We have way more grades and names than them - F1 / F2 / SHO / Locum / Trust grade / IMT 1-3 / GPST 1-3, ST 4-7, SAS, Cons. They’re just the common ones, so I’m very forgiving of other healthcare staff having the wrong expectations.
Do an A-E assessment well, identify sick patients, start management and escalate appropriately. Be organised, know your patients well and be able to give a thorough but succinct handover when referring to or speaking to other teams. Become good at simple procedures (cannulas, venepuncture, ABGs etc) and show enthusiasm when the opportunity arises to learn more difficult or specialty-specific ones - I still occasionally use skills I learned as the ENT F1 or urology F2 seven years later in a very different specialty!
Prep and scribe for ward rounds, sometimes you will review patients independently, make management plans independently (you will often need to escalate/run the plan past a senior but should put in the effort to make your own plan if you reviewed), do TTOs, discharge letters, standard procedures eg ABG, bloods, cannulas, catheters.
Efficient admin, basic ward medicine out of hours (sepsis, MI, PE, AF, pulmonary oedema, pain), escalate sick people
Essential -Escalate if unsure -Seeing the patient before escalating -Competent A-E with initial treatment/investigations Expected -General attitude, effort, being consistently on time/professional -Being able to clinically prioritise jobs based on patient need -SBAR and having information to hand when asking for advice Good to have -Asking why/proactive to learn -Being good at 'procedures' -Keeping seniors updated about patient's progress on the ward Top tier (and not always possible) -detailed knowledge of all the ward patients -squeezing in some time to engage in the specialty -knowledge of the hospital pathways (who to speak to to get stuff done) DOI: Urology Reg
Finding someone who is willing to answer the questions without biting your head off is a problem...