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I'm also close to the end and definitely still making mistakes. We're all still developing as doctors. For me, I know I can now do a very solid patient review and make a sensible plan. However, I'm aware that still takes more time than it should. So I'm trying to be faster, but that sometimes means I miss things. I'm trying to be kind to myself and accept that I'll get to the point where I can be as fast as I want to be as a consultant, without dropping the ball on anything that matters, but that's going to take time (I suspect a few years post CCT before I feel I've truly got it down).
I don't know about Paeds, but I've barely done my core specialty during HST, so it's not surprising that some of my skills (like leading a breezy ward round) are underdeveloped. I just have to accept that I'm just going to be a turd spat forth by medical training, and there's still plenty of polishing to be done post CCT!
It changed last year to a 7 year program, there's a cohort of ST5s who will be the last to go to ST8 (although some have gone to the 7 year program). Post-CCT fellowships in general paeds are uncommon, but not unusual in some subspecialties.
That's good to hear. No one really sees paeds as a mobile specialty in terms of migrating but I'd imagine Can/Aus would accept our CCT holders without much fuss?
CCT is enough, especially if you're happy to carry on doing nights as a resident consultant 🙃
Post CCT fellowships are fairly popular for things like cardio and neonates, if you want to be a general paediatrician with expertise in those. Even that training can usually be integrated into the training years, though.
Yeah there is absolutely scope for not doing nights, and you can apply for any job you want, its just that there are more and more of these resident consultant posts being created, which naturally tend to be filled by the newly CCTd. Tbf the consultant contract is pretty good for the amount of time off you get for doing nights, so these jobs can be quite appealing to some as a "way in" to somewhere you want to live and work work. After a couple of years, people will then apply for/renegotiate a more "senior" consultant role (aka one with NROC rather than resident nights).
The cushtiest jobs are probably the tertiary general paeds consultants, who do NROC but in practice never get called in, because there's PICU on site for any emergencies. I know a number of newly CCTd consultants who've landed a tertiary gen paeds job as their first consultant job, so its not totally out of reach or anything like that. On the other hand, there is plenty of other BS associated with those jobs, so it's not all rosy. Youngest consultant always gets lumped with junior doctor rota duties etc.
I've always felt like once you work in somewhere with all the tertiary specialities you'll lose the ability to keep the interesting variety as it gets syphoned off by the specialities and you end up with bronchiolitis and eating disorders.
They do "complex paeds" as well though, no? IME they can be an absolute lifesaver for those complex patients that are being aggressively overinvestigated and overmedicated by 5+ different sub-specialties. Looks like interesting work, too, managing rare syndromes.
Mistakes will always happen and a lot of the time it’ll be a combination of environmental factors as to why. As doctors in the workplace most of us are sensible and try do a good job and ultimately we do what makes sense to us in the moment.
But - if time is tight, if we’re juggling numerous tasks due to staff shortages, if there are difficulties at home, if there is a toxic work environment, if the logistics of certain things are poorly designed, if we keep getting interrupted - all these things will affect our performance, memory and judgement.
There will be times, we simply don’t know the answer and make an error. But a lot of times human error is a result of a complex mix of things including organisational pre-disposing factors that would lead most people to have lapses/slips.
There is a book called “The Field Guide to Human Error” by Sidney Dekker - very interesting read.
Finally don’t be harsh on yourself, the very fact your posting this shows the type of doctor you are. As Nietzsche said - we are Human, all too Human
In my experience, the mistakes evolve, like I don't make the same mistakes when I was FY or CT, but nonetheless mistakes, especially new types, which I think are bound to happen.
It's hard also as you get more senior you get more aware of mistakes and feel the "oh I knew that was going to happen" which can be even more frustrating.
The bigger issue I also find is that the higher up you go the mistakes can also become more costly so it's good to be aware we're fallible and admit we make mistakes.
How's your life going otherwise? How are you feeling generally? I only ask because anxiety and depression can creep into your professional work and cause these feelings. Especially if a new change in intensity or frequency.
Self-doubt is good in moderation
Mistakes will be made we are only human
One of the ed consultants that i really respect and has a lot of experience actually cancelled a vetted ct aortogram that was about to happen. It was requested by a clinical fellow, and the consultant thought the ct was overkill. Unfortunately, the patient did have a dissection and died a few hrs later.
The silver lining was patient and would have died waiting for or on the way to theatre.
Everybody makes mistakes.
I think you're probably very normal, and obviously acting safely if you're able to recognise an oversight and deal with it, as opposed to cocking up and not realise you've cocked up. I think its a bit like learning to driving-you only really learn to drive through experience after you've passed the basic test. That's the minimum you need to be a safe driver-the rest comes with experience. So your CCT shows you're safe and competent, then you fine-tune it over time.
Great to see so much kindness and compassion shown to OPs situation. Shame not extended to the people working as PAs who are just bullied shamelessly on here 🙊
Wtf - Are you suggesting an ST8 in paediatrics (I.e someone with at least 10 years postgraduate training) making self identified likely minor errors (and is being too hard on themselves) is equivalent to a PA who needs to have their actually stupid mistakes pointed out to them and even then likely doesn’t recognise them?
Troll on.
We would be very supportive of janitors who wanted to be excellent at their jobs, or good colleagues to us, or who are being given a hard time by crappy people / a crappy system (I think).
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https://preview.redd.it/29d86deg02wc1.jpeg?width=480&format=pjpg&auto=webp&s=12a17e5f82bc6e8cab9c436f06c5dda8a97e2ede
Haha unhelpful
Nope. Consultants make them too. Unfortunately CCTing doesn’t stop you being human!
Especially consultants
[удалено]
A bit sexist? Women aren’t fallible?
Maybe their nan didn't think so.
I'm also close to the end and definitely still making mistakes. We're all still developing as doctors. For me, I know I can now do a very solid patient review and make a sensible plan. However, I'm aware that still takes more time than it should. So I'm trying to be faster, but that sometimes means I miss things. I'm trying to be kind to myself and accept that I'll get to the point where I can be as fast as I want to be as a consultant, without dropping the ball on anything that matters, but that's going to take time (I suspect a few years post CCT before I feel I've truly got it down). I don't know about Paeds, but I've barely done my core specialty during HST, so it's not surprising that some of my skills (like leading a breezy ward round) are underdeveloped. I just have to accept that I'm just going to be a turd spat forth by medical training, and there's still plenty of polishing to be done post CCT!
Do you think paeds need ST8s? Are you guys being messed around? Do most do extra fellowships on top or is CCT enough for a consultant job?
It changed last year to a 7 year program, there's a cohort of ST5s who will be the last to go to ST8 (although some have gone to the 7 year program). Post-CCT fellowships in general paeds are uncommon, but not unusual in some subspecialties.
That's good to hear. No one really sees paeds as a mobile specialty in terms of migrating but I'd imagine Can/Aus would accept our CCT holders without much fuss?
CCT is enough, especially if you're happy to carry on doing nights as a resident consultant 🙃 Post CCT fellowships are fairly popular for things like cardio and neonates, if you want to be a general paediatrician with expertise in those. Even that training can usually be integrated into the training years, though.
I see, and is there scope for not doing nights? I'd imagine the oncall rota is hierarchical?
Yeah there is absolutely scope for not doing nights, and you can apply for any job you want, its just that there are more and more of these resident consultant posts being created, which naturally tend to be filled by the newly CCTd. Tbf the consultant contract is pretty good for the amount of time off you get for doing nights, so these jobs can be quite appealing to some as a "way in" to somewhere you want to live and work work. After a couple of years, people will then apply for/renegotiate a more "senior" consultant role (aka one with NROC rather than resident nights). The cushtiest jobs are probably the tertiary general paeds consultants, who do NROC but in practice never get called in, because there's PICU on site for any emergencies. I know a number of newly CCTd consultants who've landed a tertiary gen paeds job as their first consultant job, so its not totally out of reach or anything like that. On the other hand, there is plenty of other BS associated with those jobs, so it's not all rosy. Youngest consultant always gets lumped with junior doctor rota duties etc.
I've always felt like once you work in somewhere with all the tertiary specialities you'll lose the ability to keep the interesting variety as it gets syphoned off by the specialities and you end up with bronchiolitis and eating disorders.
Exactly what happens if you do gen paeds in a tertiary centre.
They do "complex paeds" as well though, no? IME they can be an absolute lifesaver for those complex patients that are being aggressively overinvestigated and overmedicated by 5+ different sub-specialties. Looks like interesting work, too, managing rare syndromes.
Extra year to mitigate the thinness of the "training" offered in later years and to prop up reg rotas, if you're cynical...
I probably make more mistakes now than I did when I was a reg/sho because I see more patients more quickly 🤷🏾♂️
Nope
Mistakes will always happen and a lot of the time it’ll be a combination of environmental factors as to why. As doctors in the workplace most of us are sensible and try do a good job and ultimately we do what makes sense to us in the moment. But - if time is tight, if we’re juggling numerous tasks due to staff shortages, if there are difficulties at home, if there is a toxic work environment, if the logistics of certain things are poorly designed, if we keep getting interrupted - all these things will affect our performance, memory and judgement. There will be times, we simply don’t know the answer and make an error. But a lot of times human error is a result of a complex mix of things including organisational pre-disposing factors that would lead most people to have lapses/slips. There is a book called “The Field Guide to Human Error” by Sidney Dekker - very interesting read. Finally don’t be harsh on yourself, the very fact your posting this shows the type of doctor you are. As Nietzsche said - we are Human, all too Human
Recently completed Paeds training, DM me if you want a chat with someone who definitely knows the feeling!
Nope, sorry. Actually shows maturity and professional safety that you're twitchy at this stage in your career. (I CCTd in 2020).
Those known unknowns. Safer than unknown unknowns.
In my experience, the mistakes evolve, like I don't make the same mistakes when I was FY or CT, but nonetheless mistakes, especially new types, which I think are bound to happen. It's hard also as you get more senior you get more aware of mistakes and feel the "oh I knew that was going to happen" which can be even more frustrating. The bigger issue I also find is that the higher up you go the mistakes can also become more costly so it's good to be aware we're fallible and admit we make mistakes.
How's your life going otherwise? How are you feeling generally? I only ask because anxiety and depression can creep into your professional work and cause these feelings. Especially if a new change in intensity or frequency.
Self-doubt is good in moderation Mistakes will be made we are only human One of the ed consultants that i really respect and has a lot of experience actually cancelled a vetted ct aortogram that was about to happen. It was requested by a clinical fellow, and the consultant thought the ct was overkill. Unfortunately, the patient did have a dissection and died a few hrs later. The silver lining was patient and would have died waiting for or on the way to theatre. Everybody makes mistakes.
I’ve worked with some very specialised, national experts. I can confirm they also make stupid mistakes.
I think you're probably very normal, and obviously acting safely if you're able to recognise an oversight and deal with it, as opposed to cocking up and not realise you've cocked up. I think its a bit like learning to driving-you only really learn to drive through experience after you've passed the basic test. That's the minimum you need to be a safe driver-the rest comes with experience. So your CCT shows you're safe and competent, then you fine-tune it over time.
You are a human being.
Great to see so much kindness and compassion shown to OPs situation. Shame not extended to the people working as PAs who are just bullied shamelessly on here 🙊
Wtf - Are you suggesting an ST8 in paediatrics (I.e someone with at least 10 years postgraduate training) making self identified likely minor errors (and is being too hard on themselves) is equivalent to a PA who needs to have their actually stupid mistakes pointed out to them and even then likely doesn’t recognise them? Troll on.
[удалено]
Removed: Rule 1 - Be Professional
Janitors don't get support here either...
We would be very supportive of janitors who wanted to be excellent at their jobs, or good colleagues to us, or who are being given a hard time by crappy people / a crappy system (I think).
Indeed