The Ten Commandments of the Foundation Programme: A Survival Guide!

Dear FY1s/Final Year Medical Students,


Firstly congratulations on your graduation from medical school! Or if you're a final year preparing for graduation - hopefully these tips will help you out during your first days as a Foundation Doctor! As a result of the pandemic, 2020 has been a tough year to be a final year medical student. Despite the difficulties, you have survived and achieved what you set out to, all those years ago when you applied. Now that you are finally foundation doctors, here are some rules to help you along the way.


Part 1: Clinical Commandments


Commandment 1: I Will Be Organised


This may sound like a basic one but I cannot stress enough the importance of being organised as a foundation doctor. An organised FY1 really does help make the ward run more smoothly and makes life easier for seniors. For the ward round, update the patient list and have enough copies for everyone. For each patient, look at the drug chart and see if it needs to be rewritten - there is nothing worse for the on call team than being bleeped to rewrite a drug chart! In a similar vein, make sure you prescribe all of your patients’ warfarin doses before you go home. Throughout the ward round, compile a list of jobs that need doing. Having a good, structured jobs list leads us to the second commandment:


Commandment 2: I Will Prioritise

When looking through your jobs list it is important to prioritise tasks. For example, it is a good idea to get scans requested and discussed as early as possible, as well as any urgent referrals to other specialties. As an FY1, you will frequently be asked about discharge summaries. Ensure that you prioritise the most time sensitive ones such as those for patients going home with dosette boxes - these often need to be in pharmacy before lunchtime for patients going home that day. Normally one of the lowest priority jobs is putting blood forms out for the next day as this is usually the last task done before going home.


Prioritisation is equally important during on call shifts. You may get one bleep about a patient with cardiac-sounding chest pain, and another about prescribing a sleeping tablet. It is clear here which job takes priority, but what about when you receive two simultaneous bleeps about chest pain? Enter the third commandment:


Commandment 3: I Will Always Ask For Help


Remember that in medicine you are part of a team and help is always available. If you are swamped on your on call, ask your fellow FY1 or SHO for help. There are also other incredible sources of support such as nurse practitioners and the critical care outreach team.


As an FY1 you are not expected to know it all. Always work within your own competence and escalate to your seniors as necessary. In appropriate cases (i.e. not when someone is about to arrest - put that 2222 call out immediately), make sure that you have done an initial assessment and management plan before escalating to your seniors. When it comes to assessing the acutely unwell patient, it is always a good idea to have a strong structure...


Commandment 4: I Will Not Forget My A to E

Throughout medical school we are constantly reminded of the A to E method of assessing patients, so we won’t list the details here. Just remember that this structure is useful because it ensures that you cover all bases and don’t miss anything out. Once you’ve completed your A to E, use the SBAR structure to handover or escalate.


Commandment 5: I Will Make Technology My Friend

Sometimes you will forget some of your A to E. Sometimes you will forget the protocol for the investigation and management of PEs. Sometimes you will forget which drugs need to be stopped in AKI. It happens, and it’s okay. There are many apps that have been created to help us out. From Pocket Dr to MDCalc, make use of tech available. Your trust may even have its own app or have its guideline available on the microguide app. For those of you that prefer books, The Oxford Handbook for the Foundation Programme is a good one to carry around.


Part 2: The Self Care Commandments


Commandment 6: I Will Eat Lunch

This commandment refers to the need to take breaks. When you are FY1 the workload can seem overwhelming and the joblist endless. For this reason you may find yourself doing one more task before eating, then another, and another, until before you know it is 4pm and you haven’t eaten anything since breakfast, nor had any water or looked away from your computer screen! This non-stop attitude is not sustainable and can lead to burnout. Additionally, let’s not forget that old adage, tired doctors make mistakes.


Commandment 7: I Will Leave Work on Time...

...Or as close to on time as is possible. This commandment follows on from taking breaks. Obviously there will be occasions when leaving promptly will not be possible. This usually occurs when starting a new rotation and getting to grips with the job, or if there is an emergency, or if it is just one of those crazily busy days. However, do not make a habit of leaving work late. Of course it is important to get all your jobs done but make sure you handover what needs to be handed over and go home. Just as not taking a break will cause burnout, so will staying late for two hours everyday.


Commandment 8: I Will Not Take Work Home With Me

Once you do get home, try not to think about work. Maintaining a good work-life balance is incredibly important for your wellbeing and longevity as a doctor. Medicine can sometimes seem all encompassing but remember that you are a well-rounded individual with multiple interests and hobbies. Do not forget about them. From yoga to choir, all of these activities help make you a resilient and happy doctor.


Commandment 9: I Will Keep My Portfolio Up to Date

There is a lot of admin to do as an FY1 and letting it all pile up can make it an extremely stressful experience. From mini-CEXs to CBDs, there is a lot that you are required to get signed off. You can take the stress of portfolio demands away by regularly working on it. All it takes is 30 minutes every fortnight to have a stress-free end to the year. This advice also goes for any portfolios needed for subsequent applications. Collect evidence for your achievements as you go along because trying to get proof of something that you did two years ago can be a nightmare!


Commandment 10: I Will Check My Pay and Rota

The system is not perfect and sometimes mistakes are made regarding pay and your rota. Make sure you look at your payslip each month to check that you are receiving the right amount. The BMA can offer support for this as well as a free contract checking service for members. It is important to make sure that your rota is compliant and finally, to make sure that you are getting all of your annual leave!


To conclude, these are the commandments of being an FY1. It is a tough, but enjoyable year and what you have been waiting for since applying to medical school. Don’t forget the advice given to you and that support is always available if you need it. You’ve got this!



Written By Katy Chisenga, Clinical Fellow in Geriatrics



References

Cover Image ref: Shuttershock 2020. Black Man Doctor. [Accessed 12/12/2020] https://www.shutterstock.com/search/black+man+doctor

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