My ST3 post in Acute medicine - Scarborough ( August 2019 - August 2020)
This was my timeline:
I applied for my ST3 post in February, 2019.
I gave my interview in March.
I was offered a post in the deanery of my choice (York and Humber) in April.
I accepted the offer in May.
I received my offer letter on the 28th of May, 2019 that I will be working in care of elderly for the first 6 months.
This is my rota:
The non highlighted days are my regular 9 AM to 5 PM ward timings.
The orange highlighted days are my days off.
The yellow highlighted days are my long days - 0800 to 2000
The green highlighted days are my nights- from 2000 to 0800.
The pink highlighted days are my study days
The circled days are my urgent annual leaves I booked before I received my rota to ensure I am not not on call during that time and do not have to worry about swapping shifts
Here are a few projects I am involved in:
1. SAFER handover - This is trust based "huddle" we do to ensure patients are discharged earlier by making decisions by involving senior clinicians ( and where required, other specialties )
2. Paired learning programme - Some doctors have been paired with managers so that they can both understand each other roles and improve patient safety and workforce satisfaction by feeding back to their respective teams on what they have learnt.
3. Associate college tutor. My role is explained here:
https://www.rcplondon.ac.uk/rcp-college-and-associate-college-tutors
4. Quality improvement projects:
Management of hyophosphataemia
Management of electrolytes imbalance in patients who are admitted to CCU with VT/VF
Whether DNAR forms are countersigned by consultants if they are signed by junior doctors.
5. Improving patient flow by suggesting different ways medical registrars can improve patient transfers from ED, discharges.
6. Active involvement in development of our new ambulatory care unit.
I have also become the trainee representative for acute internal medicine trainees in East Yorkshire.
The good things about Scarborough Hospital
Parking:
This is amazing! If you arrive by 0845 AM, you can easily find a paring spot in the staff car park.
Bleep filtering system at night
The bed managers filter all bleeps to the junior doctors during the night ( ie from 2200 to 0600 AM). The nurses have to bleep the bed manager on call who takes the request for review, assesses urgency and then bleeps the appropriate doctor.
The bed managers are extremely active and rather than pushing the medical staff to do discharges, they actually help boost the morale of staff by ensuring they are overwhelmed by bleeps.
On calls:
Thanks to the bleep filtering system, the shifts for junior doctors is very peaceful.
Usually, there are 3 junior doctors ( FY1/FY2/IMT/GPST1 trainees/ non trainee SHOs/locum SHOs) - the registrar and one junior doctor clerks and 2 juniors are on the wards.
The bed managers are very active- especially at night and if there is any concern, they sometimes bleep the registrar directly depending on how ciritical the patients review is via bleep filtering.
They keep a log of all bleeps as well making it easier to audit whether it is working or not.
The ED team:
We have an amazing cohort of consultants who make everyone love ED medicine. They are involved in management ( some of them are clinical directors as well) and want to make sure we get it right at the front door.
All patients admitted to the trust come through ED - they have their basic investigations and management. This way, you do not find any patients on random wards admitted via O/P clinics who have not been seen/managed as they all come through the same ED department.
Acute medical unit:
We have a small AMU whcih is run by passionate consultants who are actively involved in improving patient care. It is an excellent place to work in and get your assessments done.
Critical care outreach service
We have a very good team of cirtical care outreach nurses. There is one nurse on call and she is bleeped for any patient the healthcare staff is worried about. They assess the patient immediately and also escalate to the medical registrar/ITU team where appropriate.
Online forum for staff feedback:
The new management has started a secure online forum which can also be accessed from home. They can post issues they face and also give solutions on how the management can improve things. The administration of the hospital are very fast in responding to such suggestions and implement them ASAP.
Clinical support:
There is a clinical support nurse available 24/7 in the hospital who can do bloods, cannulas, catheters and ECG.
Most wards have 1 or 2 nurses who can do bloods and cannulas as well.
Teaching sessions :
We have a very good clinical governance session every Wednesday in which one of the consultants presents "catastrophic cases" and the important learning points - this has been the best teaching I have ever attended!
AMU teaching every Thursday - in which a doctor presents a case.
Grand Round on Friday - In which a consultant presents an interesting case.
All three of these sessions have free food ( Which is very important in a junior doctors life).
Rota team:
The rota team is very proactive and I have not had a single on call which has been understaffed. If there is any understaffing on the ward, I am always able to get extra help.
The exception reporting system of my trust is very good - we were able to get an extra registrar because the FY1 trainees were staying late ( and exception reporting) when I was not on the ward ( due to on calls/leaves).
We have a very active WhatsApp group and if there is any help needed, other doctors come in.
The bed managers ensure any doctors who come for locum are paid - hence everyone's hard work is paid for.
Appreciation :
We have an amazing way to appreciate the hard work of our colleagues:
https://www.yorkhospitals.nhs.uk/contact-us/star-award/
Junior doctors forum:
We have a very active forum where junior doctors ( FY1s to registrars) are all welcome to attend and give their suggestions.
The team then ensures these are implemented and discusses further issues every few months.
This way, any doctor can escalate concerns to the management in safe, anonymous way.
Teaching:
We have the following teaching sessions:
Monday - Care of elderly journal club
Wednesday - Learning from mistakes: Excellent presentations given by a medical consultant on errors, avoidable mistakes, interesting cases.
Thursday - AMU teaching
Friday - Grand round
Other than this, we have IMT teaching and foundation trainees teaching on Tuesdays.
The Wednesday, Thursday and Friday also have lunch sponsored by pharmaceutical companies.
Junior doctors frequently present during these sessions as well.
QIPs:
We have a very active clinical effectiveness team and consultants who are willing to supervise projects.
PS: I have around 8 QIPs which will need to be followed up and I am happy to be contacted ( https://www.facebook.com/omar.ay.37 ) and I can let you know whom to contact if you are interested in those projects.
Previous history:
Before 2019, the hospital was understaffed and did not get a good CQC rating either. Doctors who worked here before August, 2019 may not have a good impression of this trust. However the management has changed this place around and hence, please contact people who have worked here after August, 2019 to get a better idea of what it is like.
This shows how things change annually as mentioned here:
https://omarsguidelines.blogspot.com/2018/11/guidance-on-getting-reviews-of-hospitals.html
However, given the current management, their plans and how willing they are to improve things, it is very unlikely that things will deteriorate.
Nurses:
The nurses here are amazing - from respiratory specialist nurses who personally teach doctors how to manage NIV to cardiology nurses who help even registrars when we are on call.
The nurses in charge are always willing to improve patient flow and hence are open to ideas. They support junior doctors and work closely with consultants to improve their experience.
Mandatory training days:
Scarborough District Hospital is a small trust, most training days are based in Hull, York, Harrogate, Leeds and in Scarborough.
However there is a good train service from Scarborough to all these cities and the drive is not too busy either.
Post graduate center :
The post grad center has a very good team who approves leave expenses easily provided these are mandatory for your training - this includes course expenses, accommodation, fuel expenses and train tickets.
The resuscitation officers are always keen to teach.
Medical students:
Scarborough Hospital is closely linked with HYMS ( https://www.hyms.ac.uk/ ) and trainees get plenty of opportunities to teach medical students - The administration team frequently sends emails to all junior doctors to get involved in teaching and this is an excellent way to get involved in teaching.
Support:Some doctors may struggle and need assistance. This is no way bad. They just need a helping hand. Thankfully, we have a very good post graduate center who supports trainees in difficulty and the deanery ( York and Humber) is actively involved in this as well.
The occupational health team is excellent and provides support wherever needed.
Living in Scarborough:
This blog might help:
https://omarsguidelines.blogspot.com/2019/12/my-experience-of-working-and-living-in.html
I applied for my ST3 post in February, 2019.
I gave my interview in March.
I was offered a post in the deanery of my choice (York and Humber) in April.
I accepted the offer in May.
I received my offer letter on the 28th of May, 2019 that I will be working in care of elderly for the first 6 months.
I received my certificate of sponsorship on the 3rd of June, 2019 during my core medical training year 2
I applied for my standard visa extension on the same day and applied for my bio-metrics on the 10th of June, 2019.
I received my rota on the 26th of June, 2019.
I applied for my standard visa extension on the same day and applied for my bio-metrics on the 10th of June, 2019.
I received my rota on the 26th of June, 2019.
This is my rota:
The non highlighted days are my regular 9 AM to 5 PM ward timings.
The orange highlighted days are my days off.
The yellow highlighted days are my long days - 0800 to 2000
The green highlighted days are my nights- from 2000 to 0800.
The pink highlighted days are my study days
The circled days are my urgent annual leaves I booked before I received my rota to ensure I am not not on call during that time and do not have to worry about swapping shifts
I started in respiratory medicine and it has been going smoothly. I tend to help my junior colleagues wherever possible.Here are a few projects I am involved in:
1. SAFER handover - This is trust based "huddle" we do to ensure patients are discharged earlier by making decisions by involving senior clinicians ( and where required, other specialties )
2. Paired learning programme - Some doctors have been paired with managers so that they can both understand each other roles and improve patient safety and workforce satisfaction by feeding back to their respective teams on what they have learnt.
3. Associate college tutor. My role is explained here:
https://www.rcplondon.ac.uk/rcp-college-and-associate-college-tutors
4. Quality improvement projects:
Management of hyophosphataemia
Management of electrolytes imbalance in patients who are admitted to CCU with VT/VF
Whether DNAR forms are countersigned by consultants if they are signed by junior doctors.
5. Improving patient flow by suggesting different ways medical registrars can improve patient transfers from ED, discharges.
6. Active involvement in development of our new ambulatory care unit.
I have also become the trainee representative for acute internal medicine trainees in East Yorkshire.
The good things about Scarborough Hospital
Parking:
This is amazing! If you arrive by 0845 AM, you can easily find a paring spot in the staff car park.
Bleep filtering system at night
The bed managers filter all bleeps to the junior doctors during the night ( ie from 2200 to 0600 AM). The nurses have to bleep the bed manager on call who takes the request for review, assesses urgency and then bleeps the appropriate doctor.
The bed managers are extremely active and rather than pushing the medical staff to do discharges, they actually help boost the morale of staff by ensuring they are overwhelmed by bleeps.
On calls:
Thanks to the bleep filtering system, the shifts for junior doctors is very peaceful.
Usually, there are 3 junior doctors ( FY1/FY2/IMT/GPST1 trainees/ non trainee SHOs/locum SHOs) - the registrar and one junior doctor clerks and 2 juniors are on the wards.
The bed managers are very active- especially at night and if there is any concern, they sometimes bleep the registrar directly depending on how ciritical the patients review is via bleep filtering.
They keep a log of all bleeps as well making it easier to audit whether it is working or not.
The ED team:
We have an amazing cohort of consultants who make everyone love ED medicine. They are involved in management ( some of them are clinical directors as well) and want to make sure we get it right at the front door.
All patients admitted to the trust come through ED - they have their basic investigations and management. This way, you do not find any patients on random wards admitted via O/P clinics who have not been seen/managed as they all come through the same ED department.
Acute medical unit:
We have a small AMU whcih is run by passionate consultants who are actively involved in improving patient care. It is an excellent place to work in and get your assessments done.
Critical care outreach service
We have a very good team of cirtical care outreach nurses. There is one nurse on call and she is bleeped for any patient the healthcare staff is worried about. They assess the patient immediately and also escalate to the medical registrar/ITU team where appropriate.
Online forum for staff feedback:
The new management has started a secure online forum which can also be accessed from home. They can post issues they face and also give solutions on how the management can improve things. The administration of the hospital are very fast in responding to such suggestions and implement them ASAP.
Clinical support:
There is a clinical support nurse available 24/7 in the hospital who can do bloods, cannulas, catheters and ECG.
Most wards have 1 or 2 nurses who can do bloods and cannulas as well.
Teaching sessions :
We have a very good clinical governance session every Wednesday in which one of the consultants presents "catastrophic cases" and the important learning points - this has been the best teaching I have ever attended!
AMU teaching every Thursday - in which a doctor presents a case.
Grand Round on Friday - In which a consultant presents an interesting case.
All three of these sessions have free food ( Which is very important in a junior doctors life).
Rota team:
The rota team is very proactive and I have not had a single on call which has been understaffed. If there is any understaffing on the ward, I am always able to get extra help.
The exception reporting system of my trust is very good - we were able to get an extra registrar because the FY1 trainees were staying late ( and exception reporting) when I was not on the ward ( due to on calls/leaves).
We have a very active WhatsApp group and if there is any help needed, other doctors come in.
The bed managers ensure any doctors who come for locum are paid - hence everyone's hard work is paid for.
Appreciation :
We have an amazing way to appreciate the hard work of our colleagues:
https://www.yorkhospitals.nhs.uk/contact-us/star-award/
Junior doctors forum:
We have a very active forum where junior doctors ( FY1s to registrars) are all welcome to attend and give their suggestions.
The team then ensures these are implemented and discusses further issues every few months.
This way, any doctor can escalate concerns to the management in safe, anonymous way.
Teaching:
We have the following teaching sessions:
Monday - Care of elderly journal club
Wednesday - Learning from mistakes: Excellent presentations given by a medical consultant on errors, avoidable mistakes, interesting cases.
Thursday - AMU teaching
Friday - Grand round
Other than this, we have IMT teaching and foundation trainees teaching on Tuesdays.
The Wednesday, Thursday and Friday also have lunch sponsored by pharmaceutical companies.
Junior doctors frequently present during these sessions as well.
QIPs:
We have a very active clinical effectiveness team and consultants who are willing to supervise projects.
PS: I have around 8 QIPs which will need to be followed up and I am happy to be contacted ( https://www.facebook.com/omar.ay.37 ) and I can let you know whom to contact if you are interested in those projects.
Previous history:
Before 2019, the hospital was understaffed and did not get a good CQC rating either. Doctors who worked here before August, 2019 may not have a good impression of this trust. However the management has changed this place around and hence, please contact people who have worked here after August, 2019 to get a better idea of what it is like.
This shows how things change annually as mentioned here:
https://omarsguidelines.blogspot.com/2018/11/guidance-on-getting-reviews-of-hospitals.html
However, given the current management, their plans and how willing they are to improve things, it is very unlikely that things will deteriorate.
Nurses:
The nurses here are amazing - from respiratory specialist nurses who personally teach doctors how to manage NIV to cardiology nurses who help even registrars when we are on call.
The nurses in charge are always willing to improve patient flow and hence are open to ideas. They support junior doctors and work closely with consultants to improve their experience.
Mandatory training days:
Scarborough District Hospital is a small trust, most training days are based in Hull, York, Harrogate, Leeds and in Scarborough.
However there is a good train service from Scarborough to all these cities and the drive is not too busy either.
Post graduate center :
The post grad center has a very good team who approves leave expenses easily provided these are mandatory for your training - this includes course expenses, accommodation, fuel expenses and train tickets.
The resuscitation officers are always keen to teach.
Medical students:
Scarborough Hospital is closely linked with HYMS ( https://www.hyms.ac.uk/ ) and trainees get plenty of opportunities to teach medical students - The administration team frequently sends emails to all junior doctors to get involved in teaching and this is an excellent way to get involved in teaching.
Support:Some doctors may struggle and need assistance. This is no way bad. They just need a helping hand. Thankfully, we have a very good post graduate center who supports trainees in difficulty and the deanery ( York and Humber) is actively involved in this as well.
The occupational health team is excellent and provides support wherever needed.
Living in Scarborough:
This blog might help:
https://omarsguidelines.blogspot.com/2019/12/my-experience-of-working-and-living-in.html
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