MY FIRST day on the ward as an FY1 followed a summer of mostly unbridled celebration – the roller coaster of final year worries having given way to the euphoria of qualification. Only toward the end of July did my confidence start to wane and self-doubt rear its ugly head. Thoughts of capability were replaced by culpability. Would I be good enough? What really was expected of me? I hoped all my patients would have good veins! Such ruminations persisted despite the completion of the obligatory ‘shadowing week’. Nothing could have prepared me for what lay ahead, not even watching endless reruns of Scrubs.
Clutching my ‘cheese and onion’, clenching my teeth, shielded in legitimacy by my stethoscope, I arrived on the ward for my first placement.
“Maggie, welcome!” Boomed out an unfamiliar voice. “Just in time! Grab some venflons and come over here”.
Venflons! Oh no! Beam me up Scotty. I’d rather have met the Klingons!
But as I grew familiar with the new surroundings and got to know the rest of the team I became more at ease. Certainly a warm welcome is helpful and in this I was lucky in my first placement. Only when you are comfortable with your environment can you contribute and work effectively with others.
Not to say that it was easy for me in those first few weeks. I started out feeling certain that I must be the ‘worst junior doctor ever’. But such feelings were soon negated by more senior colleagues teasing out my knowledge in a kind and helpful manner. This allowed me to dismiss any feelings that I would be a hindrance rather than a valued member of the ward team.
So what advice could I offer in surviving those first few weeks of foundation year one? If, as they say, “every day is a school day”, then working in a structured environment requires self-organisation. Here are a few tips in no particular order.
Proper time management allows a balanced lifestyle and provides welcome breaks and more time for the inevitable chasing of blood results. Nothing can prepare anyone for this. The key principle to success is timely intervention. There is no point in starting result chasing five minutes before a scheduled departure from the ward. All this does is enrage your SHO when you page them for help; it does nothing for your confidence or reputation.
Another hurdle to cross is the consultant-led ward round, as these take on a whole new dimension in terms of your participation. Being recently qualified assures your position of one rung up the ladder from the final year students. It’s amazing how the stammering student reply affords you enough thinking time to answer those awkward questions. Furthermore, the ward round is the time for you to impress your more senior colleagues. Again, preparation is the key to success. Know the results! Nothing more infuriates the consultant than a junior doctor unaware of a patient’s condition or progress. Knowing how the consultant likes their tea or coffee will forgive the occasional time when you haven’t done what was asked of you.
Another of the duties expected of you is dealing with blood forms left by the phlebotomist, especially those bearing the most heartbreaking statement a junior doctor could face – ‘could not obtain’. Even the simplest of procedures such as venepuncture and cannulations are daunting in the first few weeks of work, especially when you are under pressure. The secret is practice. I wish I had spent more time as a medical student on hospital placements using patients as the proverbial pincushion. I know it’s easier to go for a coffee at the WRVS instead of attempting that venflon the SHO asked you to do. However, getting lots of 'hands-on' experience at medical school does ensure an easier rite of passage as a new doctor.
Working in a multidisciplinary team
Teamwork is essential for survival in medicine. Therefore, having a ‘doctor knows best’ mentality is one sure way of exponentially increasing your workload. Such a frame of mind upsets nurses and other members of staff. My advice is to play the game. Consideration to others, the appropriate use of listening skills and sharing your own knowledge are de rigueur. Most importantly, I found all of the former is a good way of finding out those individuals that cannulate/take blood, therefore, making your working life a lot easier.
The transition from medical student to junior doctor is a massive and daunting challenge. Nothing can adequately prepare anyone for this. It requires a lifestyle change, a juggling of work and personal commitments. It’s an art form which must be mastered. Stress and depression are very real issues amongst junior doctors. Being able to leave work and forget about your patients is hard to do. It will become easier and I would advocate to any doctor no matter their grade or seniority to seek help if they are struggling to cope with the demands placed on them at work.
The successful transition onto FY2 is dependent upon a necessary level of competence at work in addition to completion of your e-portfolio and the mastering of those dreaded DOTS (Doctors Online Training System). Leaving such matters to the last minute is both foolhardy and dangerous. Starting early with a continuous input is more productive and satisfying.
Having now finished my first foundation year I feel that, whilst it was a steep learning curve and at times unnerving, it was an experience I will cherish. The insight into others’ lives is a privilege, and though as an FY1 you may consider your influence to be minimal, in the grander scheme it is nevertheless much appreciated and worthwhile. FY1 is a fast and short dance on the medical stage so prepare well, learn your lines but most importantly, enjoy!
Dr Maggie Cairns is starting her foundation year two programme at Stobhill Hospital, Glasgow
Tips for surviving FY1
• A clipboard with a copious quantity of A4 sheets is far better for notes than the back of an X-ray card.
• Consolidate all the jobs that you have to accomplish in one ‘To-Do’ list.
• Ensure on ward rounds that you can at least outline every patient’s story and there is ready access to notes and test results.
• Ensure that your medical notes are legible and avoid abbreviations - especially those with dual meaning.
• Get organised before picking up the phone to refer and ensure you know the patient’s history well.
• Set aside adequate time (and a quiet place) for handovers.
• Work-life balance – try to exercise, sleep and eat well; keep in touch with family, loved ones, friends and, importantly, non-medics.
• Treat all of your colleagues and patients as you would wish to be treated.