My advice to foundation year one doctors

Congrats! You are now a doctor. Do not ever forget what a great feat you have achieved no matter what anyone else says!

What to expect in your first few days

INDUCTION DAY

You will be asked to attend induction. Now you would expect to be taught about how to request investigations, refer patients but instead you will be rather disappointed when you are taught about handling fires and clinical governance. This is equally important though.
You will also receive your ID badges, get your logins and passwords and will be given a brief demo on the e -prescribing software ( if that exists in your trust), etc. You will be given your bleeps with a demo on how to bleep.
Some trusts offer basic life support training during induction ( BLS )
You will also be given a tour of the hospital. Of course, none of us remembers where the doctors mess and cafeteria is so it is a good idea to take a picture of the hospital map or download it on your phone by visiting the hospitals website.

Things to ask during induction:
Please feel free to ask any questions from the IT department at this stage in particular
- Whom should I contact during working hours and out of hours in case I have forgot my password/ locked myself out of my computer by entering the incorrect password a few times.
- Whom should I contact if the computer in my ward is not working.
Also
- Find out what the timings of the hospital cafeteria are and if there is a snacks store in the hospital.
- How to book your ALS/ ATLS course by asking during the BLS training session.



The induction will last the whole day. It will be a mixture of useful stuff and boring stuff. Get to know your colleagues at this time - hopefully you will find one or 2 college mates.

After induction:
The induction day may last till 4 or 5 PM. Try to visit the ward where you will start working at just so that you have a general idea of where it is and meet the ward clerk/ nurse in charge. Ask where to put your jacket/bags/etc. Also ask where the toilet is and what the code for that is.
If possible, meet the junior doctors on the ward and ask where they meet for the ward handover ( if there is any). Getting their phone numbers can be useful in case you are running late the following day or are lost in the hospital.
This will put you at ease when you start the following day as you will be familiar with the place. 


Specialty induction:In most trusts you will have a specialty induction in which you will be informed about other specialties and what services they offer. 

Departmental induction:
You will also have departmental induction in which the consultants of the department you will work in will go through how things work in their department and how to get the most out of your training. 

The specialty and departmental induction may happen a few days after you have started. 


YOUR FIRST DAY:

The bad news: It may be horrible. Good news: We all went through the same.
Try to come to the ward 10-20 minutes early. The ward clerk will give you a handover list/ kindly inform you that you have access to the handover and will explain to you how to print it.
Hopefully the SHOs/ registrars will turn up before 9 AM and all you have to do is follow them.
This is how a medical ward works:
http://omarsguidelines.blogspot.com/2017/05/guideline-for-junior-doctors-working-in.html

MY TIPS FOR FOUNDATION DOCTORS:
On the wards:
1. Never ever forget that you have achieved so much already. Do not let yourself/ anyone else demoralize you.
2. No one is perfect when it comes to cannulas. Ask for help! If you have a SHO, ask him/her, otherwise the registrar. If there is no one around, your consultant can help. The ward matrons can also cannulate if you cannot find anyone.
3. The phlebotomists take bloods at around 9 AM. Make sure all the blood forms are out for the necessary patients before then.
4. Sometimes phlebotomists cannot bleed patients because they are having a wash/ being seen on a ward round. Usually they come back to do them. If they do not, they leave the request card at the nursing station. Make sure that you know if a patient has not been bled ( by checking if there are any outstanding request cards when the ward round is finished).
5. Make a list of jobs after the ward round and do the urgent ones ( like a CT head request for a patient who has had a suspected bleed) immediately.
6. Have your lunch! Unless a patient is very sick ( in that case the SHO, registrar and consultant will be around), eat! The best time to eat is when the patients have their lunch. Luckily, for us in most trusts we cannot disturb patients when they are having their lunches.So there is no point hanging around in the ward during that time.
7. Eat your lunch in the doctors mess! Socialize with your colleagues. This is the time to relax! So do not worry about anything.
8. Do TTOs in advance. This will avoid jobs piling up on a busy day.
9. Follow up investigations - if they are not back by the time you are about to leave, hand it over. It is justified to handover stuff. Do not be shy.
10. Leave on time! If there is a sick patient, ask your SHO/reg/consultant to review him/her. Go through the EWS charts/ ask the nurses in charge of the bays if they are worried about anyone at around 3 PM so that you have enough time to escalate and make a management plan.
11. If you do not leave on time and this keeps on happening, exception report it!
12. If you have time and you see a good vein which needs to be bled, do it yourself. This will increase your confidence.
13. Volunteer to do ABGs, pass NG tubes, catheterize patients ( if you have time). Remember, in one year you will be on the SHO / TIER 2 rota so this is the best time to perfect yourself in the basic stuff.

14. Document everything! Every conversation you have had with the family, another specialty for advice (even if they have not got back to you. eg, bleeped orthopedics regitsrar at 1500, 14/7/18. No response.) , etc.  

HORUS Portfolio/Supervisors 
1. Your ES is not only your supervisor but also your mentor/friend/guide. Inform him/her about anything you are worried about - be it an upcoming exam, a difficult colleague or something you wish to change in the ward ( do it as a quality improvement project -
http://omarsguidelines.blogspot.com/2018/02/all-about-quality-improvement-projects.html)
2. Start filling out your portfolio from day one. I have made a guideline for core medical trainees (http://omarsguidelines.blogspot.com/2017/03/maintaining-your-e-portfolio.html) which may be slightly different than Horus but the basic principle is more or less the same. Tick off all the boxes on time, get assessments whenever possible.

Give yourself a break.
1. Book your annual leaves early and go on a nice holiday every few months. You deserve to unwind and relax.
2. Do not burn yourself out. You do not have to give all parts of your MRCP exam in your foundation year- so relax. Study, but take it is easy.
3. Come slightly early but leave on time unless there is a sick patient.
4. Eat! Know what the timings of the cafeteria are, where the snacks shop is and eat with your colleagues in the doctors mess. This is your time to relax.
5. Leave your worries in the hospital! When you walk out of those doors at 5 PM, you should be thinking about how to relax when you get hope rather than " Oh my God, did I miss a pnuemothorax on that patients X ray?"
6. Handover outstanding investigations - there is no point waiting for a patients blood tests till 6 PM. This is what doctors on ward cover are for!

Learn and teach!
1. Learn to interpret scans. Look at the images, make your own interpretation and then read the report.
2. Even discharge summaries teach you a lot. Going through a patients notes to make a discharge summary will teach you how that patient was managed.
3. Ask if you have any queries. Make a list of questions if the ward round is exceptionally busy to ask in the end.
4. By the end of your rotation you will be a pro at everything! So it is time to teach and guide what you have learnt to the next batch of foundation doctors.
5. Read about interesting cases you have seen on the ward round. Discuss what you have learnt / any questions you have during the next ward round.
6. Attend grand rounds and other "non-mandatory" teaching sessions. Foundation teaching is mandatory but there are a lot of other sessions as well which are equally beneficial like your ward MDT meetings, specialty MDT meetings, radiology meetings, etc.

On calls.
Go through this:
http://omarsguidelines.blogspot.co.uk/2017/05/guideline-for-on-calls.html
Just remember these points:
1. Rest well
2. Eat well
3. Escalate
4. Do not over do it.
5. Handover outstanding jobs. 

6. Document everything with your name, GMC number and bleep number in the patients notes.

MOBILE APPLICATIONS AND USEFUL WEBSITES 
Trust based - Kindly confirm if your trust follows the guidelines in these apps

Microguide
http://www.microguide.eu/

This has a list of all the antibiotics used in most trusts according to the latest guidelines by the microbiology department. Some trusts may not be in the list of this app and your trust may use some other guideline.
PLEASE DO NOT USE THIS IF YOUR TRUST IS NOT MENTIONED IN THIS.
This app is the basic starter pack for all junior doctors. 
It has all the details of how to bleep, request bloods and the directory for most trusts.

Induction app
https://induction-app.com/ 
Bleep and phone directory for most trusts 

Bleeppod
Directory for doctors working at Guy’s and St Thomas’ NHS trust

Forward app
Kindly confirm from your trusts information governance and IT team if you are allowed to use this as a communication tool in your trust. 

https://bnf.nice.org.uk/drug/
BNF is a must have while working in the NHS.
Most wards will have a paperback BNF  but at times you may not have access to it.

http://rx-guidelines.com/ 
This allows you full access to uptodate:

Case Records of the Massachusetts General Hospital
http://www.nejm.org/medical-articles/clinical-cases?category=clinicalcases&articletype=caserecordsofthemassachusettsgeneralhospital

https://www.toxbase.org 
This is to access the national protocols for drug overdose. 
Your trust will have a login for this.

Radiology images:
https://radiopaedia.org/ 

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