My experience of core medical training - York and Humber: 2018-9
I worked as a core medical trainee in Harrogate ( CT1) and York (CT2) as part of my training in York and Humber Deanery.
WHY I CHOSE THESE PLACEMENTS:
I wanted to rotate in all major specialities. The rotations in my CT1 were : respiratory, stroke and elderly and in CT2, I rotated in renal, gastro and neurology.
I had already done a 6 months placement in cardiology in my non training post as my first job in the NHS.
I liked Harrogate and York. Harrogate was a small town town and was recently voted the happiest city in the UK.
My wife was expecting and Harrogate offered the best maternity services.
I had selected other cities, like Leeds as my top preference however I got my fifth preference ( ie Harrogate and York). After researching these hospitals and cities, my wife and I decided to select these without the option of upgrading.
MY EXPERIENCE OF CT1
Harrogate was a lovely small district hospital. Everyone knew each other. The respiratory team was amazing and the 2 consultants ( one of them was my educational supervisor and the other one was the college tutor for CMT) were very proactive. Hence, I got to do chest drains for pneumothorax, pleural taps and pleural drain insertions and was signed off for them. I got adequate time off for my personal development and was able to work on my portfolio in hospital ( rather than at home).
My second placement was excellent as well as the stroke consultant single handily managed the ward and knew about all the sick patients. I got the opportunity to see acute strokes, manage them and got loads of opportunities to discuss escalation plans, DNARs.
My third placement in elderly medicine was very nice as well as the consultants were very proactive in training. I was frequently supervised and got mini-CEX, CBDs signed off.
The on calls were pretty relaxed in Harrogate. The ward cover shift was always busy but it was manageable. The clerking shift was very relaxed as it is a small district hospital and the ED team is amazing. They used to discuss all cases with the medical team and were very proactive in referring patients to ambulatory care.
The post take consultants used to come at 7 AM and we were able to go through all our patients on their post take ward rounds hence got our ACATs, CBDs signed off.
Here is a blog on my experience:
http://omarsguidelines.blogspot.com/2017/06/my-second-job-in-uk-core-medical.html
MY EXPERIENCE OF CT2
My first placement in renal medicine was amazing. The consultants were extremely proactive. We have a consultant of the week whereby one consultant sees all the admitted patients and referrals. On Monday, we have a handover in which all the consultants come in and take a hand over. Then they divide patients among themselves and manage to see all of them by 11 AM. Hence, the well known 'manic monday' was never ever manic for us as all of our patients had plans before lunch time and us juniors would just do jobs.
I got plenty of opportunities to learn. I also attended a CVC line insertion course and passed a Tessio Dialysis line under supervision of my consultant.
Given that the renal ward was so busy, I never felt overwhelmed thanks to the amazing consultants who would stay late with us and ensure that we left before them if there was a sick patient on the ward. We had a very active WhatsApp group on which no patient details were discussed but everyone knew where the other team members were and the consultants were approachable via their mobiles at all times.
I have also made a blog based on my experience in renal medicine here:https://omarsguidelines.blogspot.com/2018/10/dealing-with-renal-patients.html
My second placement in gastroenterology was very useful as I got to see plenty of sick patients and learnt management of acute GI emergencies. Like the renal team, we had a very active WhatsApp group and hence sick patients were always dealt with on time and hence the juniors did not have to stay till late.
This is my blog on my experience in gastro:https://omarsguidelines.blogspot.com/2019/03/my-experience-of-working-in.html
My third placement in neurology as very relaxed but I learnt a lot. I passed my PACES halfway through my placement as I got to see typical exam cases like CIDP, MS, myasthenia gravis, etc in the outpatient clinics and when they came for their IV infusions to the medical day unit.
The consultants were always approachable on their mobiles.
I also got very good at doing lumbar punctures as we have a twice a week LP clinic as an outpatient which is SHO led.
This is my experience in neurology:https://omarsguidelines.blogspot.com/2019/06/my-experience-of-working-in-neurology.html
The on calls in my CT2 were only clerking based. Hence I got to see a lot of sick patients and also frequently stepped up as a registrar and made decisions about ceiling of care ( of course, under supervision where appropriate).
The best thing about York hospital was the amazing rota team who had a very active WhatsApp group on which all the SHOs ( and a lead AMU consultant) were part of. Any locum shifts were put there ASAP and as a result, I have never worked on an call which has been understaffed.
This is my blog of my experience:
http://omarsguidelines.blogspot.com/2018/08/my-third-post-in-nhs-core-medical.html
ARCP
I managed to get an outcome 1 in CT1 and outcome 6 in CT2 just because of my supportive consultants.
I got plenty of opportunities to do all sorts of procedures and get signed off. I attended the required clinics thanks to the reasonable work load and also saw patients independently ( rather than sitting in with a consultant).
I had 3 ARCP sessions in both CT1 and CT2: One was a remote interim review, then I got my ARCP outcome ( provisional) and was then allowed some time to work on my deficiencies. This way, the deanery ensured that trainees got the best outcome possible by allowing them time to work on whatever they were missing.
Also read this:
http://omarsguidelines.blogspot.com/2018/06/arcp-in-core-medical-training.html
TEACHING
Honestly, there were very few good sessions when it came to mandatory teaching days. I had to commute to different cities and had to attend a total of 9 mandatory training days in each of my CT1 and CT2 training.
I found them boring, tiring and a waste of time. I also fed this back to the deanery. The most useful sessions were the ASCME course - which is a deanery based course similar to ALERT: an observed simulation course on management of medical emergencies. I also found the supervised procedural courses useful.
The weekly hospital based teaching was good as the consultant teaching us knew us well and we not only discussed academic topics but also our training concerns.
TRAINING
Overall, the core medical training curriculum has definitely helped me become a more competent SHO. Of course, I still have plenty to learn but the e-portfolio is not just a tick box mechanism. Reflecting upon cases, CBDs, mini-CEX, doing the necessary number of clinics not only become a better doctor but also helped me pass my PACES exam.
LEADERSHIP
I got plenty of opportunities to teach medical students, colleagues and did a few teaching sessions in both my CT1 and CT2. I got plenty of time (at work) to prepare for them.
I also got the opportunity to lead CRASH calls, see sick patients, manage transfers of unwell patients ( once I had to talk to the medical director of another hospital to prevent transfer of an unwell patient) and lead handovers.
SERVICE PROVISION
When I was about to start my training, I heard this term a lot - that all I would be doing as a SHO would be discharge summaries, cannulas and talking to relatives. However this training post was definitely more than that. Yes, sometimes I had to do discharge summaries and cannulate loads of patients but this improved my communication skills and cannulation skills.
THE PROGRAM DIRECTORS:
The TPDs here are very willing to improve training and hence are open to feedback. One of them always used to come to the mandatory teaching day and ask about our concerns and would not only listen to us but follow up on this as well. My colleagues who had issues with their visas were personally supported. I had the mobile number and email address of my TPD and he always used to respond to them appropriately. This made me feel very supported.
MY FUTURE PLANS FOR TRAINING
I have loved this deanery so much, that I opted for this for my specialty training in acute internal medicine.
MY ADVICE TO NEW TRAINEES - IMT trainees.
Make the most of your placements. Do not think that your portfolio is just a tick box exercise. Fill it out on a regular basis and get assessments wherever possible. Everyone is happy to fill them out- even consultants! Sometimes you may have to chase people but if you start early, you will not worry about not meeting your ARCP requirements.
You will not regret working in York and Humber. However all deaneries are equally good. At the end of the day it comes down to the trainee on how much effort and positivity (s)he puts into his/her clinical practice.
Also read this:
https://omarsguidelines.blogspot.com/2019/06/my-advice-to-imgs-who-are-starting-in.html#!/2019/06/my-advice-to-imgs-who-are-starting-in.html
WHY I CHOSE THESE PLACEMENTS:
I wanted to rotate in all major specialities. The rotations in my CT1 were : respiratory, stroke and elderly and in CT2, I rotated in renal, gastro and neurology.
I had already done a 6 months placement in cardiology in my non training post as my first job in the NHS.
I liked Harrogate and York. Harrogate was a small town town and was recently voted the happiest city in the UK.
My wife was expecting and Harrogate offered the best maternity services.
I had selected other cities, like Leeds as my top preference however I got my fifth preference ( ie Harrogate and York). After researching these hospitals and cities, my wife and I decided to select these without the option of upgrading.
MY EXPERIENCE OF CT1
Harrogate was a lovely small district hospital. Everyone knew each other. The respiratory team was amazing and the 2 consultants ( one of them was my educational supervisor and the other one was the college tutor for CMT) were very proactive. Hence, I got to do chest drains for pneumothorax, pleural taps and pleural drain insertions and was signed off for them. I got adequate time off for my personal development and was able to work on my portfolio in hospital ( rather than at home).
My second placement was excellent as well as the stroke consultant single handily managed the ward and knew about all the sick patients. I got the opportunity to see acute strokes, manage them and got loads of opportunities to discuss escalation plans, DNARs.
My third placement in elderly medicine was very nice as well as the consultants were very proactive in training. I was frequently supervised and got mini-CEX, CBDs signed off.
The on calls were pretty relaxed in Harrogate. The ward cover shift was always busy but it was manageable. The clerking shift was very relaxed as it is a small district hospital and the ED team is amazing. They used to discuss all cases with the medical team and were very proactive in referring patients to ambulatory care.
The post take consultants used to come at 7 AM and we were able to go through all our patients on their post take ward rounds hence got our ACATs, CBDs signed off.
Here is a blog on my experience:
http://omarsguidelines.blogspot.com/2017/06/my-second-job-in-uk-core-medical.html
MY EXPERIENCE OF CT2
My first placement in renal medicine was amazing. The consultants were extremely proactive. We have a consultant of the week whereby one consultant sees all the admitted patients and referrals. On Monday, we have a handover in which all the consultants come in and take a hand over. Then they divide patients among themselves and manage to see all of them by 11 AM. Hence, the well known 'manic monday' was never ever manic for us as all of our patients had plans before lunch time and us juniors would just do jobs.
I got plenty of opportunities to learn. I also attended a CVC line insertion course and passed a Tessio Dialysis line under supervision of my consultant.
Given that the renal ward was so busy, I never felt overwhelmed thanks to the amazing consultants who would stay late with us and ensure that we left before them if there was a sick patient on the ward. We had a very active WhatsApp group on which no patient details were discussed but everyone knew where the other team members were and the consultants were approachable via their mobiles at all times.
I have also made a blog based on my experience in renal medicine here:https://omarsguidelines.blogspot.com/2018/10/dealing-with-renal-patients.html
My second placement in gastroenterology was very useful as I got to see plenty of sick patients and learnt management of acute GI emergencies. Like the renal team, we had a very active WhatsApp group and hence sick patients were always dealt with on time and hence the juniors did not have to stay till late.
This is my blog on my experience in gastro:https://omarsguidelines.blogspot.com/2019/03/my-experience-of-working-in.html
My third placement in neurology as very relaxed but I learnt a lot. I passed my PACES halfway through my placement as I got to see typical exam cases like CIDP, MS, myasthenia gravis, etc in the outpatient clinics and when they came for their IV infusions to the medical day unit.
The consultants were always approachable on their mobiles.
I also got very good at doing lumbar punctures as we have a twice a week LP clinic as an outpatient which is SHO led.
This is my experience in neurology:https://omarsguidelines.blogspot.com/2019/06/my-experience-of-working-in-neurology.html
The on calls in my CT2 were only clerking based. Hence I got to see a lot of sick patients and also frequently stepped up as a registrar and made decisions about ceiling of care ( of course, under supervision where appropriate).
The best thing about York hospital was the amazing rota team who had a very active WhatsApp group on which all the SHOs ( and a lead AMU consultant) were part of. Any locum shifts were put there ASAP and as a result, I have never worked on an call which has been understaffed.
This is my blog of my experience:
http://omarsguidelines.blogspot.com/2018/08/my-third-post-in-nhs-core-medical.html
ARCP
I managed to get an outcome 1 in CT1 and outcome 6 in CT2 just because of my supportive consultants.
I got plenty of opportunities to do all sorts of procedures and get signed off. I attended the required clinics thanks to the reasonable work load and also saw patients independently ( rather than sitting in with a consultant).
I had 3 ARCP sessions in both CT1 and CT2: One was a remote interim review, then I got my ARCP outcome ( provisional) and was then allowed some time to work on my deficiencies. This way, the deanery ensured that trainees got the best outcome possible by allowing them time to work on whatever they were missing.
Also read this:
http://omarsguidelines.blogspot.com/2018/06/arcp-in-core-medical-training.html
TEACHING
Honestly, there were very few good sessions when it came to mandatory teaching days. I had to commute to different cities and had to attend a total of 9 mandatory training days in each of my CT1 and CT2 training.
I found them boring, tiring and a waste of time. I also fed this back to the deanery. The most useful sessions were the ASCME course - which is a deanery based course similar to ALERT: an observed simulation course on management of medical emergencies. I also found the supervised procedural courses useful.
The weekly hospital based teaching was good as the consultant teaching us knew us well and we not only discussed academic topics but also our training concerns.
TRAINING
Overall, the core medical training curriculum has definitely helped me become a more competent SHO. Of course, I still have plenty to learn but the e-portfolio is not just a tick box mechanism. Reflecting upon cases, CBDs, mini-CEX, doing the necessary number of clinics not only become a better doctor but also helped me pass my PACES exam.
LEADERSHIP
I got plenty of opportunities to teach medical students, colleagues and did a few teaching sessions in both my CT1 and CT2. I got plenty of time (at work) to prepare for them.
I also got the opportunity to lead CRASH calls, see sick patients, manage transfers of unwell patients ( once I had to talk to the medical director of another hospital to prevent transfer of an unwell patient) and lead handovers.
SERVICE PROVISION
When I was about to start my training, I heard this term a lot - that all I would be doing as a SHO would be discharge summaries, cannulas and talking to relatives. However this training post was definitely more than that. Yes, sometimes I had to do discharge summaries and cannulate loads of patients but this improved my communication skills and cannulation skills.
THE PROGRAM DIRECTORS:
The TPDs here are very willing to improve training and hence are open to feedback. One of them always used to come to the mandatory teaching day and ask about our concerns and would not only listen to us but follow up on this as well. My colleagues who had issues with their visas were personally supported. I had the mobile number and email address of my TPD and he always used to respond to them appropriately. This made me feel very supported.
MY FUTURE PLANS FOR TRAINING
I have loved this deanery so much, that I opted for this for my specialty training in acute internal medicine.
MY ADVICE TO NEW TRAINEES - IMT trainees.
Make the most of your placements. Do not think that your portfolio is just a tick box exercise. Fill it out on a regular basis and get assessments wherever possible. Everyone is happy to fill them out- even consultants! Sometimes you may have to chase people but if you start early, you will not worry about not meeting your ARCP requirements.
You will not regret working in York and Humber. However all deaneries are equally good. At the end of the day it comes down to the trainee on how much effort and positivity (s)he puts into his/her clinical practice.
Also read this:
https://omarsguidelines.blogspot.com/2019/06/my-advice-to-imgs-who-are-starting-in.html#!/2019/06/my-advice-to-imgs-who-are-starting-in.html
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