What is expected from IMT 3 trainees stepping up as a registrar in their placement on AMU
Some IMT 3 colleagues have contacted me to ask what they should expect in acute medicine as a 0800 to 1600 regular job as part of their 3 or 4 month placement as a registrar.
Se DGHs are not used to having a registrar on AMU and consultants have no idea.
I am working as a ST5 registrar in acute internal medicine and had two 4 month placements in acute medicine and this was my rota
Day one
0800 to 1600 on AMU
My job description
1. Attend handover at 0800 am
2. The consultants then ask me to see patients who have already been post taked from the past few days and I do senior reviews
3. I do any procedures like LPs, drains , etc
4. I help other colleagues with difficult cannulas , ABGs, etc
5. I am usually done by noon.
6. I am free for most of the afternoon and help with
- discharges
- clerking
And I always leave on time at 1600. Sometimes the consultants ask me to leave early( by 1500 if there is nothing much)
Day 2
Ambulatory care unit
0900 to 1700
I see patients on ACU
The consultant is there who does senior reviews of patients seen by ACPs, FY1s, SHOs. My job is only to see patients on my own.
I leave at 1700 after handing over to the registrar/ consultant who is taking over at 1700.
Day 3
Medical short stay unit
0800 to 1600 /0900 to 1700
This is where patients who have been post taked are transferred and stay for a few days.
I usually come at 0800 and see the unwell patients/patients who can go home and do their discharge summaries.
Then I start seeing one half of the ward
The consultant comes at 0900. By then I have seen the unwell patients and discharged the medically fit patients.
Then I see half of the ward.
I am usually done by 11 am and then we have an afternoon huddle in which patients who can go home , what is keeping them in hospital and if the discharge coordinators can help in expediting anything.
I am then free for most of the day and help out with ward jobs.
Day 4
Either AMU , ACU , medical short stay
Or medical stay in the morning and ACU in the afternoon
Day 5
Off as personal development.
WHAT TO DO IF YOU ARE STRUGGLING:
Talk to your supervisor/TPD
Se DGHs are not used to having a registrar on AMU and consultants have no idea.
I am working as a ST5 registrar in acute internal medicine and had two 4 month placements in acute medicine and this was my rota
MY ROTA ( TEACHING HOSPITAL)
Every weekDay one
0800 to 1600 on AMU
My job description
1. Attend handover at 0800 am
2. The consultants then ask me to see patients who have already been post taked from the past few days and I do senior reviews
3. I do any procedures like LPs, drains , etc
4. I help other colleagues with difficult cannulas , ABGs, etc
5. I am usually done by noon.
6. I am free for most of the afternoon and help with
- discharges
- clerking
And I always leave on time at 1600. Sometimes the consultants ask me to leave early( by 1500 if there is nothing much)
Day 2
Ambulatory care unit
0900 to 1700
I see patients on ACU
The consultant is there who does senior reviews of patients seen by ACPs, FY1s, SHOs. My job is only to see patients on my own.
I leave at 1700 after handing over to the registrar/ consultant who is taking over at 1700.
Day 3
Medical short stay unit
0800 to 1600 /0900 to 1700
This is where patients who have been post taked are transferred and stay for a few days.
I usually come at 0800 and see the unwell patients/patients who can go home and do their discharge summaries.
Then I start seeing one half of the ward
The consultant comes at 0900. By then I have seen the unwell patients and discharged the medically fit patients.
Then I see half of the ward.
I am usually done by 11 am and then we have an afternoon huddle in which patients who can go home , what is keeping them in hospital and if the discharge coordinators can help in expediting anything.
I am then free for most of the day and help out with ward jobs.
Day 4
Either AMU , ACU , medical short stay
Or medical stay in the morning and ACU in the afternoon
Day 5
Off as personal development.
WHAT A ROTA IN A DGH SHOULD BE LIKE
Some trusts , like DGH hospitals only have a AMU and no medical short stay ward. The ACU is run by a separate team and they are usually well staffed.In which case their job plan should be something of this sort :
AMU for 4 days
0800 to 1600
1. Attend handover at 0800 am
2. The consultants will ask them to see patients who have already been post taked from the past few days and to do senior reviews
3. Do any procedures like LPs, drains , etc
4. Help other colleagues with difficult cannulas , ABGs, etc
5. Help with unwell patients, etc and leave by 1600.
Personal development day on day 5.
You're now a registrar. Dont anyone abuse you or use you for things like
Clerking from 0800 to 1600 everyday in ED - this is NOT what your AMU placement is about.
Asking you to cover understaffed wards everyday.
Ensure you have at least one day off for personal development. This day should be used to work on your MRCP exams ( or attending clinics for your speciality you're interested in if you have already passed MRCP ).
You might feel you're done by 1200 and have nothing to do after that which is absolutely fine. Use that time to work on your portfolio, CV , speciality of interest, MRCP exams, etc.
Make a PDP ( personal development plan ) and job schedule with your supervisor and tell them this is what it should be like.
Please let me know if you have any questions. I am happy to email you my job plan and work schedule as an acute medical trainee if your consultant/ supervisors don't agree.
AMU for 4 days
0800 to 1600
1. Attend handover at 0800 am
2. The consultants will ask them to see patients who have already been post taked from the past few days and to do senior reviews
3. Do any procedures like LPs, drains , etc
4. Help other colleagues with difficult cannulas , ABGs, etc
5. Help with unwell patients, etc and leave by 1600.
Personal development day on day 5.
You're now a registrar. Dont anyone abuse you or use you for things like
Clerking from 0800 to 1600 everyday in ED - this is NOT what your AMU placement is about.
Asking you to cover understaffed wards everyday.
Ensure you have at least one day off for personal development. This day should be used to work on your MRCP exams ( or attending clinics for your speciality you're interested in if you have already passed MRCP ).
You might feel you're done by 1200 and have nothing to do after that which is absolutely fine. Use that time to work on your portfolio, CV , speciality of interest, MRCP exams, etc.
Make a PDP ( personal development plan ) and job schedule with your supervisor and tell them this is what it should be like.
Please let me know if you have any questions. I am happy to email you my job plan and work schedule as an acute medical trainee if your consultant/ supervisors don't agree.
IF YOU ARE STRUGGLING AND FEEL UNSUPPORTED
Remember to escalate early if you feel unsupported and are strugglingMost IMT trainees got a good outcome in their IMT 2 ARCP and were deemed fit to step up as registrars from August. However a lot of them have expressed concerns and I completely understand.
I went through the CMT route from 2017 to 2019. It was a 2 year training programme and it was essential ( for my ARCP at the end of the CMT 2) that I pass my MRCP PACES and I was also informed I will not be able to work as a trainee registrar unless I have full MRCP.
I went through the CMT route from 2017 to 2019. It was a 2 year training programme and it was essential ( for my ARCP at the end of the CMT 2) that I pass my MRCP PACES and I was also informed I will not be able to work as a trainee registrar unless I have full MRCP.
I knew from day 1 of starting my core training that I :
1. Have to pass MRCP PACES before August 2019
2. I will be working as a registrar from August 2019.
I've mentioned how I managed this here : https://omarsguidelines.blogspot.com/2021/03/progressing-from-sho-to-registrar-in.html
Unfortunately things have changed a lot with the new IMT curriculum and training registrar requirements as well.
This is what was different for IMT trainees
1. PANDEMIC
This played an important role. They were unable to attend simulation sessions , sit their MRCP exams ( cancellations , delays) , do clinics, rotate in specialties.
Instead they were asked to cover COVID-19 wards and missed out on a lot of essential training.
2. IMT 3 DOUBTS
During induction, they were informed that they will have some say in whether they will be working as a registrar as IMT 3 and there will be a mutual agreement with their supervisors regardless of the MRCP exams.
Thus a lot of IMT 2 trainees didn't really step up under supervision like I did as a core medical trainee year 2. And comes end of July- they are added to the registrar rota. Some didn't even have a proper meeting with their supervisors.
3. MRCP exams
Now this might sound strange - but MRCP exams do help in
- problem solving
- thinking outside the box
- clinical work under pressure
- communication skills not only with patients, but consultants at 4 am at night.
I personally believe this is what would have helped:
1. IMT 3 trainees are supernumerary registrars in ED resus , see all unwell patients with the actual registrar present as well for the first 3 months
2. IMT 3 trainees who passed their PACES should have been allowed to step up.
3. It should have been a 2 way conversation regarding working as a registrar rather than being forced on a rota.
I do hope IMT 3 trainees who are struggling and are left all alone without any support are able to escalate this concerns early. You should not work at a level you don't feel comfortable at. It's a difficult conversation to have but please express any concerns early.
1. Have to pass MRCP PACES before August 2019
2. I will be working as a registrar from August 2019.
I've mentioned how I managed this here : https://omarsguidelines.blogspot.com/2021/03/progressing-from-sho-to-registrar-in.html
Unfortunately things have changed a lot with the new IMT curriculum and training registrar requirements as well.
This is what was different for IMT trainees
1. PANDEMIC
This played an important role. They were unable to attend simulation sessions , sit their MRCP exams ( cancellations , delays) , do clinics, rotate in specialties.
Instead they were asked to cover COVID-19 wards and missed out on a lot of essential training.
2. IMT 3 DOUBTS
During induction, they were informed that they will have some say in whether they will be working as a registrar as IMT 3 and there will be a mutual agreement with their supervisors regardless of the MRCP exams.
Thus a lot of IMT 2 trainees didn't really step up under supervision like I did as a core medical trainee year 2. And comes end of July- they are added to the registrar rota. Some didn't even have a proper meeting with their supervisors.
3. MRCP exams
Now this might sound strange - but MRCP exams do help in
- problem solving
- thinking outside the box
- clinical work under pressure
- communication skills not only with patients, but consultants at 4 am at night.
I personally believe this is what would have helped:
1. IMT 3 trainees are supernumerary registrars in ED resus , see all unwell patients with the actual registrar present as well for the first 3 months
2. IMT 3 trainees who passed their PACES should have been allowed to step up.
3. It should have been a 2 way conversation regarding working as a registrar rather than being forced on a rota.
I do hope IMT 3 trainees who are struggling and are left all alone without any support are able to escalate this concerns early. You should not work at a level you don't feel comfortable at. It's a difficult conversation to have but please express any concerns early.
WHAT TO DO IF YOU ARE STRUGGLING:
Talk to your supervisor/TPD
Make a job plan like:
1. Work as an AMU/ACU/medical short stay registrar from 0800 to 1600/0900 to 1700 ( or if out of hours, only when there is a consultant around- in some trusts there is consultant cover on ACU from 1700 to 2200 and on AMU from 1700 to 2100)
This will help in the following ways:
- You will feel more confident in managing patients as you know there is senior support around
- You will learn what to do when you are fed back on what you could have done differently and you can do that ( like managing a patient differently, etc)
2. No out of hours on calls as a registrar when there is no consultant cover for the first few months. Till then, work as a SHO.
After working as a registrar under supervision, you will become more confident and will gain the 'logistical knowledge' to work as a safe registrar out of hours when the consultants have gone home.
When you feel comfortable and confident enough, you can revisit this again ( this can vary from 3 to 6 months but there should not be any deadline)
1. Work as an AMU/ACU/medical short stay registrar from 0800 to 1600/0900 to 1700 ( or if out of hours, only when there is a consultant around- in some trusts there is consultant cover on ACU from 1700 to 2200 and on AMU from 1700 to 2100)
This will help in the following ways:
- You will feel more confident in managing patients as you know there is senior support around
- You will learn what to do when you are fed back on what you could have done differently and you can do that ( like managing a patient differently, etc)
2. No out of hours on calls as a registrar when there is no consultant cover for the first few months. Till then, work as a SHO.
After working as a registrar under supervision, you will become more confident and will gain the 'logistical knowledge' to work as a safe registrar out of hours when the consultants have gone home.
When you feel comfortable and confident enough, you can revisit this again ( this can vary from 3 to 6 months but there should not be any deadline)
3. While working as a SHO out of hours :
- When you have finished clerking, provide senior support to your colleagues - do difficult cannulations, lead CRASH calls, see unwell patients. Also go to ED resus and see unwell patients with the on call registrar. Develop quick ( yet safe) clerking skills so that you can see more patients ( in a safe manner) and provide support as a registrar level.
This way, you will gain some excellent leadership skills
If you feel bullied/ are not being listened to/ feel that you are being forced to work at a level you are not comfortable at, please escalate it:
https://omarsguidelines.blogspot.com/2020/01/bullying-and-stress-in-nhs.html
- When you have finished clerking, provide senior support to your colleagues - do difficult cannulations, lead CRASH calls, see unwell patients. Also go to ED resus and see unwell patients with the on call registrar. Develop quick ( yet safe) clerking skills so that you can see more patients ( in a safe manner) and provide support as a registrar level.
This way, you will gain some excellent leadership skills
If you feel bullied/ are not being listened to/ feel that you are being forced to work at a level you are not comfortable at, please escalate it:
https://omarsguidelines.blogspot.com/2020/01/bullying-and-stress-in-nhs.html
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