Onwards and upwards

FYi editor Maggie Cairns recalls her welcome, though occasionally unnerving, transition to foundation year two

MY FINAL ward round as an FY1 was full of goodbyes: a poignant and emotional journey towards the exit or perhaps more appropriately the entrance to FY2. This was not just saying goodbye to a job description but to colleagues and a health team, all of whom had become firm friends.

It was also farewell to a comfort zone and hello to a new stage in my medical metamorphosis.

My educational supervisor had confirmed full competence by delivering a ‘stamp of approval’ to the certificate of completion of year one. This was akin to receiving a ‘Willy Wonka Golden Ticket’ to the next level in foundation training. My confidence level was certainly higher than on that first day as a newly qualified doctor. Progress indeed!

‘The Chocolate Factory’ to which I was dispatched was of the older variety than what I had left behind. The hospital entrance was adorned with the slogan, ‘21st century medicine in a 19th century building’ – clue to the building decay but also to the high level of care delivered.

Ward round

My first day was an introduction with the proverbial bang. New responsibilities were expected of me as a fully certified FY2. The sister in charge, with dignified authority, suggested that the ward round would ‘require your presence’. Instinctively I looked over my shoulder for my registrar. ‘She must be talking to someone else,’ I thought. This was sadly not the case. A solo effort was required.

The fear that I had initially felt on that first day as a junior doctor again raised its ugly head. Trolley in tow, I commenced the lone journey helped by sympathetic smiles from colleagues I didn’t yet know. Nearing lunchtime and feeling physically exhausted, I saw my last patient. I sought some acknowledgment from sister of the completed task. Her reply was to give me a cup of sweet tea and an assurance that it hadn’t been the longest ward round she had ever experienced. My initial euphoria was quickly dashed when it was pointed out that I was expected at an outpatient clinic in the afternoon. ‘Outpatient’, I recoiled, Glasgow’s answer to Nemesis, the Goddess of Retribution.

Outpatient clinics

In truth, my first exposure to the responsibilities required of attendance at clinics was never the terror expected. Rather, I found myself shadowing the registrar who was doing his best to impress whilst honing his sapiential authority. In essence, he taught very well and I was a willing learner.

On a more serious note, outpatient clinics are a great opportunity to increase your medical knowledge and sharpen your decisionmaking skills within a protected environment. Your outpatient work is not finished simply when the clinic doors are shut. Dictation! Herein lies a lesson that needs to be learned quickly and which comes with a warning to current and future foundation doctors – take a crash course in dictation! Performing this task efficiently will not only ensure your desk remains clear but will also enable you to avoid the wrath of the unit secretaries – a skill I have yet to master!

Acquisition of new skills

The first few days of FY2 introduced me to more challenging procedures than I had previously been exposed to. Lumbar punctures and ascitic drains became second nature. Such complicated procedures were all carried out under the auspices and guidance of senior colleagues. Gone were the days of the dreaded venflon… there was now a new FY1 to do that!

FY2 is a continuation and widening of the skill base initiated at FY1 level. The rule of thumb remains the same: ‘see one, do one, teach one’. The success of this depends on one’s willingness to join in, to be hands-on and above all to be receptive to the acquisition of new skills. Being involved at this greater level increases your confidence and self esteem. It enhances your reputation as a member of the team and whets your appetite for further education. This education can be broadly split into two camps: the first being medical education and the second a more broader education in aspects of legal status and audits. It helps at this stage of your foundation career to become more than familiar with subjects such as governance and patient safety, and to acknowledge your role in attaining best results in both.

E-portfolio

The new rite of passage of current foundation doctors entails a dedicated recording of one’s clinical development within an e-portfolio. Resist the temptation of leaving achievements unrecorded. Don’t rely solely on memory. A written record is worth its weight in gold when it comes to interviews for specialty training programmes. FY2 offers the best opportunity to promote talents whilst enhancing your chance of obtaining a training post in a chosen specialty. Application deadlines come fast and furious so prepare well in advance. Update the CV weekly and never be afraid to recognise any supposed weakness in your knowledge and skill base. Seek more senior help in rectifying such gaps.

Audits

Another way of ensuring a potential successful application is by participation in clinical audit. An invitation by your consultant to participate in an audit should be viewed as a worthwhile opportunity and should receive an immediate and positive reply. Audits, properly conducted, yield valuable information and can form the basis of future best practice in clinical management. It’s also another valuable thing to add to your CV.

Taster weeks

Built within foundation training is the concept of taster weeks. This new approach gives current year two trainees the opportunity to experience a clinical specialty before committing themselves. In reality it may be difficult to convince more senior colleagues of the purpose and advantage of such a scheme and eliciting their support in obtaining time off for such matters. Current FY2s should promote this as being worthwhile in relation to their professional career development, and work with colleagues to attain this.

Personal life

As ever, a career in medicine could simply be filled with medicine. I can’t emphasise more the importance of extracurricular activities to offset the sometimes-overwhelming workload. Doctors, like other professionals, should adopt a more holistic approach to life, thus ensuring maximum efficiency at work and preventing undue stress and burnout potential.

Nearing the end of my foundation programme, I now have the opportunity to reflect upon my experiences of being a new doctor. Overall, I believe I have made a positive contribution and have grown in knowledge and confidence through my own endeavours and the support of my colleagues. With this in mind I am reminded of the battle cry ‘Onwards and upwards’. Here’s to the future.

Dr Maggie Cairns is in her foundation year two programme at Stobhill Hospital, Glasgow