Reflecting on the last 12 months, I would never have guessed that my first year as a junior doctor would be so gratifying, terrifying, surprising, boring, funny, sad, exciting, puzzling, stressful, enriching… This year has HAD. IT. ALL. The 2.5 days of shadowing during induction left me feeling somewhat unprepared on my first day. Thankfully, I had a wonderfully supportive team and friendly colleagues to guide me as I bumbled through my first few weeks on the ward.
F1 has inundated me with new experiences and the learning curve has been steep. I reviewed a patient with “abdo pain” only to diagnose them with a pulmonary embolism after convincing the on-call radiologist that a CTPA was absolutely necessary. After all, “I don’t take referrals from F1s for CTPAs”. I advocated for patients. I held their hands. I relieved an elderly gentleman of his painful paraphimosis preventing a urological emergency in a hospital which has no out of hours urology service. I told frightened family members their loved one might not make it through the night. I spent a whole morning liaising with radiology, gastroenterology, dietitians and a worried wife to organise a PEG (percutaneous endoscopic gastrotomy) extension for my patient, only for it not to go ahead. I was shouted at by frustrated patients and anxious relatives. I’ve clapped and cheered as Covid patients were safely discharged home. I watched as others didn’t make it. I cannulated. I catheterised. I laughed. I cried.
Some of you may already have some stories to tell as coronavirus forced you out of medical school and onto the wards as doctors earlier than expected. Others may have volunteered for the NHS or worked as HCAs. Or maybe you focused on enjoying your “final months of freedom”. Whatever your circumstances and prior experience, starting F1 can be daunting. It would be impossible for me to try to teach you everything you need to know about being a doctor and *surviving* F1 so I will simply highlight a few points to remember.
You are not alone
Sometimes you may hear horror stories about F1s left on their own to manage a ward of 30 patients on their first day or dealing with a deteriorating patient with no senior support. Remember these are just horror stories! The overwhelming majority of foundation trainees do not share these experiences. In reality, you are never alone as an F1. There should always be an SHO, registrar or consultant responsible on your ward who you can call on (even if they are busy in clinic, surgery or seeing a referral elsewhere). You are not expected to know everything - especially in the first few weeks - so please ask even if it’s just for reassurance!
Recognise what is your job and what isn’t. Sometimes you may have jobs and paperwork pushed your way that isn’t really your responsibility. There are ward clerks who book appointments and arrange transport, discharge co-ordinators who liaise with social workers about social care, nursing staff who change dressings and administer medications. Whilst it is not unreasonable to help your colleagues when you have the capacity, it is generally quicker, safer and better for your patients when the correct person completes the job they have been trained to do!
What can I do for you?
Learn how to delegate when necessary. If you are on call covering the wards and you are asked to review a sick patient, always ask the nurses to obtain any useful investigations (e.g. ECG, blood sugar, neuro obs) and check if they can take bloods, cannulate or run blood gases. They won’t necessarily volunteer to do these things if you don’t ask. They can help you get a head start in managing the patient before you have even stepped onto the ward.
HELP! It’s an emergency!
MET (medical emergency team) calls and cardiac arrests
Many new doctors’ ask, “When is it appropriate for me to put out a MET call?”
If you’re worried about airway compromise, put out a MET call.
If you need more hands, put out a MET call.