My third job in the NHS - Core Medical Trainee Year 2 : York Hospital
I will be sharing my experience on my Core Medical Training Year 2 in York Hospital in this blog post which started on the 1st of August, 2018.
Here is my experience:
https://omarsguidelines.blogspot.com/2019/06/my-experience-of-working-in-neurology.html
My rotations are:
4 months in renal medicine
4 months in gastroenterology
4 months in neurology
MY ROTA:
The renal department in York Hospital is quite extensive for a district hospital. There is a dialysis center, renal biopsies are done here and there is an on call renal consultant 24/7.
My neurology rotation was very helpful as I have been able to see 'PACES cases' which come to the outpatient clinic and day unit for their IV infusions. This helped me pass my PACES exam. 4 months in renal medicine
4 months in gastroenterology
4 months in neurology
TIMELINE:
1. I was sent a copy of my offer letter and contract and was asked to submit a scanned copy of my passport, BRP, payslip etc on the 14th of May.
2. I received my work schedule and rota on the 4th of June.
3. I was emailed the induction program on the 20th of June.
4. I was emailed my annual and study leave policies on the 9th of July.
5. I applied for all my annual leaves for the whole year in mid July.
6. I had induction day on the 1st of August - I was emailed what documents to bring a few days before.
7. I had specialty induction on the 2nd of August from noon to 2 PM.
8. My first full working day was the 3rd of August.
7. I had specialty induction on the 2nd of August from noon to 2 PM.
8. My first full working day was the 3rd of August.
I did not have to go for an ID check as York Hospital would do it on the day of my induction.
INDUCTION DAY:
We were asked to report to the education center at an inhumane time of 645 AM.
Surprisingly, the HR department was all ready and waiting for us at that time.
Even more surprisingly, there were refreshments.!
We were called one by one and asked to show our original documents which included BRP, passports, GMC license to practice, MBBS certificate, drivers license, DBS , most recent payslip and bank details.
We were called one by one and asked to show our original documents which included BRP, passports, GMC license to practice, MBBS certificate, drivers license, DBS , most recent payslip and bank details.
Our pictures were taken and then the lectures started.
The medical director, guardian, rota coordinators, deputy director of medical education and a consultant anesthetist went through the basics and local protocols - all very relevant and new to us ( as the local policies vary from trust to trust).
The medical handovers were explained and we got a brief summary of how the acute take works.
The medical handovers were explained and we got a brief summary of how the acute take works.
There was the usual fire safety lecture too.
We were then given free lunch which was quite fancy.
Then we were taken to the IT training room where we were given a demo on the IT system of the hospital.
The IT system here is completely different than what I was used to in my previous 2 trusts and this training session helped me get used to it.
We finished at around 4 PM so most of us went to our respective wards to introduce ourselves and just to get to know the teams.
The following day, we started working in our respective wards and were then asked to attend specialty induction at noon. This involved all the specialty consultants and a few registrars explaining how their departments work and what services they provide.
It was short and relevant. Unfortunately we did not get any free lunch with this.
We then went back to our respective wards and worked till 5 PM.
MY ROTA:
This is what my rota looks like.
The non highlighted days are my regular days on the ward from 9 AM to 5 PM
The orange highlighted days are my days off
The green highlighted days are night shifts (from 8 PM to 9 AM)
The pink highlighted days 2 PM to 12 AM shifts
The pink highlighted days 2 PM to 12 AM shifts
The yellow highlighted days vary from 8 AM to 530 PM to 830 PM shifts
SHOs ( ie FY2, CT1, CT2s, trust grade SHOs) only do clerking in this hospital.
FY1s do both clerking and ward cover.
However the SHOs are expected to help the FY1s if they get busy on the wards and help manage sick patients.
MY FIRST ROTATION- RENAL MEDICINE
The renal department in York Hospital is quite extensive for a district hospital. There is a dialysis center, renal biopsies are done here and there is an on call renal consultant 24/7.
Although these are early days, but this department is great to work in especially if you are considering renal medicine as a specialty.
GETTING USED TO THE NEW SYSTEM:
When I started work in the NHS in Jan, 2016, it took me a few months to get settled and understand how everything works. When I started my second job as a CMT1 in Harrogate, it took me a week or 2 to understand everything. When I started this job, it took a day or 2 to get used to the complicated IT system, etc.
I feel that as I progress in my career ( and get used to changing trusts), the time taken to get used to the system reduces significantly. I know that some IMG non trainee doctors are hesitant to change their jobs for this very reason and I can assure you that it is not very difficult.
When I started work in the NHS in Jan, 2016, it took me a few months to get settled and understand how everything works. When I started my second job as a CMT1 in Harrogate, it took me a week or 2 to understand everything. When I started this job, it took a day or 2 to get used to the complicated IT system, etc.
I feel that as I progress in my career ( and get used to changing trusts), the time taken to get used to the system reduces significantly. I know that some IMG non trainee doctors are hesitant to change their jobs for this very reason and I can assure you that it is not very difficult.
This is my third job in the NHS and personally, I feel that changing trusts helps a lot. These are the advantages:
1. You learn about new systems
2. You can implement the good things you saw in your previous trusts ( as a QIP)
3. You get to start afresh with a new team and can work on the mistakes you made in your previous trusts - like being more friendly, asking for help more often, not being shy, etc
4. This moving about does not make you stagnant. As a SHO, you will reach a point when you will think that you have learnt enough and it is time to move on - This moving from one trust to another prevents that.
ON CALLS:
The best thing about the on calls in York District Hospital is the management - our rota team. They have a SHO WhatsApp group which all the FY2s, CTs, trust grade SHOs and acute consultants are members of. If there is any vacancy due to sickness ,etc they message on that group. There is also a group of bank SHOs who are have been working in this hospital for a few years and they are excellent ( most of them are better than registrars ) as they know the hospital well - the rota team contacts them and usually a vacancy is filled within a few minutes of the rota team informing us. Which is why all the wards are adequately staffed , we have a full team on our on calls and all the members of the team understand the local guidelines well as the trust doesn't need to advertise this to an external agency. This is such a simple system - all you need is good organizing skills and you've a well staffed hospital 24/7.
Given that the hospital is a very supportive place to work at and the city is nice, we have a good number of locum SHOs who are always available to cover gaps.
I have managed to get 8 ACATs in my first 4 months. This is because the acute medical consultants are always willing to assess junior doctors and give feedback.
SHOs are encouraged to do procedures and see sick patients ( with supervision). However no one is forced to do anything which outside his/her comfort zone.
Escalation plans of acute patients are made early in the admission and the on call clinical outreach team is excellent - they can do ABGs, cannulas, take bloods, ECGs and escalate it to the seniors if required.
The on calls can be busy at times but we are well supported by the consultants - some consultants even clerk patients themselves and do the discharge summaries.
As a result, core medical trainees are able to learn and gain experience rather than do service provision.
By the end of 3 months, I could confidently do lumbar punctures, ascitic drains ( I had done most of these in my core medical training year 1 in Harrogate but I got more chances to do them in York Hospital - given that it is almost double the size of Harrogate Hospital).
RENAL ROTATION:
The best thing about renal consultants is that they're available 24/7. We have a ward WhatsApp group (we don't share any patients details on it ) where the team members inform each other where they are and what they're doing. This way everyone stays up to date.
The consultants are approachable on their mobiles and we have their contact details so rather than waiting for them to come to the ward we just call them directly.
They know their patients really well (as they follow them up as outpatients and prepare them for dialysis / renal transplants ,etc) and I'm sure they know more about their patients than they know about themselves.
Monday's are always difficult in the NHS as new patients are admitted over the weekend therefore all of the renal consultants (all 5 of them) come and help see the patients and referrals. We have seen all patients by 11 am some of them even do discharge summaries for the patients they have reviewed. Then there is a consultant on for the whole week who comes in on weekends as well. There is another consultant who is available out of hours throughout the week.
We have a handover everyday at 9 am, then we have lunch together and go through the patients list ,then have another handover at 230 pm and then again at 4 pm. The nurses , dieticians, dialysis team are all aware of what's going with these patients. Each patient has an escalation plan before the weekend ( the consultants have already had a discussion with the patients and their relatives ).
This is an amazing system of ensuring safe management of patients. We have the same amount of funds as any other hospital in the UK but with good leadership and teamwork , we are all extremely happy and our patients always give positive reviews.
The consultants encourage juniors to do QIPs ( Managed to start 3 QIPs in my renal rotation), present cases, get assessed all the time , observe procedures like Vas Cath and Tesio line insertions.
We had an excellent team:
1. One ACP who was amazing at doing bloods, cannulas, doing discharge summaries and documenting the consultants ward round.
2. 2 foundation year 1 doctors
3. 1 foundation year 2 doctor
4. One CT1
5. One CT2
6. Two registrars
7. Seven consultants - all of whom used to come every Monday to help with the post weekend review of patients and help with renal referrals.
8. One consultant who used to teach, did clinics and was a clinical supervisor for registrars.
At the end of my rotation, I feel like I can manage renal patients confidently. I managed to attend 10 clinics at the end of my rotation and met a lot of items related to this in my curriculum. Overall, it was a great experience.
Also read my experience in detail here:
https://omarsguidelines.blogspot.com/2018/10/dealing-with-renal-patients.html
GASTRO ROTATION :
The gastroenterology wards in other hospitals are notorious for being understaffed and the juniors feel unsupported. It is the exact opposite in York. We have a similar WhatsApp group and have daily consultant ward rounds and they make sure every patient has escalation plans. Even if they are scoping, they are available via phone.
Like the renal consultants, they are extremely supportive and are always approachable.
We have an amazing team of:
1. 2 Foundation year 1 doctors
2. One trust grade SHO/ SpR
3. One CT2
4. Three registrars
5. Six consultants
6. One ACP who can do everything from prescribing to passing ascitic drains.
We have a consultant to consultant handover every monday and we go through all of the patients on the ward and outliers. They are handed over to the next consultant who manages everything ( ie ward patients, outlier patients and referrals) for the next week ( Just like renal). All of the consultants attend this handover session and this way, a smooth handover of patient care is transferred to the next consultant.
It has been an amazing experience. I have managed to attend clinics, observe endoscopies, passed ascitic drains and have learnt how to manage GI emergencies.
Here is my experience:
https://omarsguidelines.blogspot.com/2019/03/my-experience-of-working-in.html#!/2019/03/my-experience-of-working-in.html
NEUROLOGY ROTATION:
1. You learn about new systems
2. You can implement the good things you saw in your previous trusts ( as a QIP)
3. You get to start afresh with a new team and can work on the mistakes you made in your previous trusts - like being more friendly, asking for help more often, not being shy, etc
4. This moving about does not make you stagnant. As a SHO, you will reach a point when you will think that you have learnt enough and it is time to move on - This moving from one trust to another prevents that.
ON CALLS:
The best thing about the on calls in York District Hospital is the management - our rota team. They have a SHO WhatsApp group which all the FY2s, CTs, trust grade SHOs and acute consultants are members of. If there is any vacancy due to sickness ,etc they message on that group. There is also a group of bank SHOs who are have been working in this hospital for a few years and they are excellent ( most of them are better than registrars ) as they know the hospital well - the rota team contacts them and usually a vacancy is filled within a few minutes of the rota team informing us. Which is why all the wards are adequately staffed , we have a full team on our on calls and all the members of the team understand the local guidelines well as the trust doesn't need to advertise this to an external agency. This is such a simple system - all you need is good organizing skills and you've a well staffed hospital 24/7.
Given that the hospital is a very supportive place to work at and the city is nice, we have a good number of locum SHOs who are always available to cover gaps.
I have managed to get 8 ACATs in my first 4 months. This is because the acute medical consultants are always willing to assess junior doctors and give feedback.
SHOs are encouraged to do procedures and see sick patients ( with supervision). However no one is forced to do anything which outside his/her comfort zone.
Escalation plans of acute patients are made early in the admission and the on call clinical outreach team is excellent - they can do ABGs, cannulas, take bloods, ECGs and escalate it to the seniors if required.
The on calls can be busy at times but we are well supported by the consultants - some consultants even clerk patients themselves and do the discharge summaries.
As a result, core medical trainees are able to learn and gain experience rather than do service provision.
By the end of 3 months, I could confidently do lumbar punctures, ascitic drains ( I had done most of these in my core medical training year 1 in Harrogate but I got more chances to do them in York Hospital - given that it is almost double the size of Harrogate Hospital).
RENAL ROTATION:
The best thing about renal consultants is that they're available 24/7. We have a ward WhatsApp group (we don't share any patients details on it ) where the team members inform each other where they are and what they're doing. This way everyone stays up to date.
The consultants are approachable on their mobiles and we have their contact details so rather than waiting for them to come to the ward we just call them directly.
They know their patients really well (as they follow them up as outpatients and prepare them for dialysis / renal transplants ,etc) and I'm sure they know more about their patients than they know about themselves.
Monday's are always difficult in the NHS as new patients are admitted over the weekend therefore all of the renal consultants (all 5 of them) come and help see the patients and referrals. We have seen all patients by 11 am some of them even do discharge summaries for the patients they have reviewed. Then there is a consultant on for the whole week who comes in on weekends as well. There is another consultant who is available out of hours throughout the week.
We have a handover everyday at 9 am, then we have lunch together and go through the patients list ,then have another handover at 230 pm and then again at 4 pm. The nurses , dieticians, dialysis team are all aware of what's going with these patients. Each patient has an escalation plan before the weekend ( the consultants have already had a discussion with the patients and their relatives ).
This is an amazing system of ensuring safe management of patients. We have the same amount of funds as any other hospital in the UK but with good leadership and teamwork , we are all extremely happy and our patients always give positive reviews.
The consultants encourage juniors to do QIPs ( Managed to start 3 QIPs in my renal rotation), present cases, get assessed all the time , observe procedures like Vas Cath and Tesio line insertions.
We had an excellent team:
1. One ACP who was amazing at doing bloods, cannulas, doing discharge summaries and documenting the consultants ward round.
2. 2 foundation year 1 doctors
3. 1 foundation year 2 doctor
4. One CT1
5. One CT2
6. Two registrars
7. Seven consultants - all of whom used to come every Monday to help with the post weekend review of patients and help with renal referrals.
8. One consultant who used to teach, did clinics and was a clinical supervisor for registrars.
At the end of my rotation, I feel like I can manage renal patients confidently. I managed to attend 10 clinics at the end of my rotation and met a lot of items related to this in my curriculum. Overall, it was a great experience.
Also read my experience in detail here:
https://omarsguidelines.blogspot.com/2018/10/dealing-with-renal-patients.html
GASTRO ROTATION :
The gastroenterology wards in other hospitals are notorious for being understaffed and the juniors feel unsupported. It is the exact opposite in York. We have a similar WhatsApp group and have daily consultant ward rounds and they make sure every patient has escalation plans. Even if they are scoping, they are available via phone.
Like the renal consultants, they are extremely supportive and are always approachable.
We have an amazing team of:
1. 2 Foundation year 1 doctors
2. One trust grade SHO/ SpR
3. One CT2
4. Three registrars
5. Six consultants
6. One ACP who can do everything from prescribing to passing ascitic drains.
We have a consultant to consultant handover every monday and we go through all of the patients on the ward and outliers. They are handed over to the next consultant who manages everything ( ie ward patients, outlier patients and referrals) for the next week ( Just like renal). All of the consultants attend this handover session and this way, a smooth handover of patient care is transferred to the next consultant.
It has been an amazing experience. I have managed to attend clinics, observe endoscopies, passed ascitic drains and have learnt how to manage GI emergencies.
Here is my experience:
https://omarsguidelines.blogspot.com/2019/03/my-experience-of-working-in.html#!/2019/03/my-experience-of-working-in.html
Most neurology patient care is in the outpatient setting. Hence we have very few inpatients. However the ones we have as an inpatient are acutely unwell and need a lot of attention.
This is what our team comprises of:
1. One consultant of the week ( we have a total of 7 consultants)
2. Neuro-rehab consultant who comes once or twice a week to assess any in-patients who can be transferred to a neuro-rehab facility.
3. Neurology registrar
4. One physician associate who can even do lumbar punctures independently.
5. Neuro OT/PT
6. Nuero dieticians.
7. Neuro-psychologists
8. Neurosciences team - consultant and technicians who do EMGs, NCS, EEG.
Here is my experience:
https://omarsguidelines.blogspot.com/2019/06/my-experience-of-working-in-neurology.html
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