Guidance article for HospitalDr.
1. Don’t try to be all things to all men
A wise old proverb that couldn’t be more truthful for first year medical students…you simply can’t be all things to all people and you can’t do all things all at once. We can sometimes behave this way to help us cope with the many demands as doctors, as we try our very best to meet and exceed expectations and standards.
You’re just setting out on your journey, you’re a first year medic with your own thoughts, beliefs and behaviours, and though you’ll want to prove yourself early on, keep grounded, focused and concentrate on being a good doctor.
2. Be efficient and organised
Throughout medical school you’ve been disciplined, prioritising and organising your workload. It’s stating the obvious but the same principles apply in your first year of medicine, and throughout your entire career. The only difference is there are other competing demands.
As your working day will be a continuum of activity, with no two days the same, you’ll have to prioritise patient care and delivery based on individual circumstances. In organising your workload, set realistic objectives.
3. Soak up every minute as a valuable learning opportunity
You’ve been to medical school; you’ve worked hard for this opportunity. The learning never stops. Make the most of every minute of every day to learn even more from those around you. Your working experiences are invaluable; you’ll learn things you never even touched upon at medical school. These are your ‘real-life’, eye-opener experiences, your memories, your lessons learnt.
4. Organise leave among your peers early
Every NHS employee is entitled to take annual leave. Foundation year 1 doctors are entitled to five weeks annual leave and junior doctors’ input into rota design is encouraged to ensure better working relationships. There will however potentially be resistance to changing set annual leave dates so be sure to organise yours as early as possible. Explore the possibility of organising annual leave with your colleagues as hospitals’ leave terms vary. The ideal situation would be to come up with a rota that enables you to take your leave entitlement in a more flexible manner.
5. Have a meeting at the start of every shift with colleagues
Consistent and quick communication in your ward or department with colleagues is vital. Though this won’t always be possible due to demands, set yourself up for the day ahead by meeting with your peers to ensure you know what is required of you and what the priorities are. You’re busy and your patients need your care so try to summarise as best you can.
6. Document, document and document
I cannot stress this point enough and it is part of your duties in delivering patient care to write everything down. Although you’re sometimes encouraged in medical school not to write when seeing a patient, it’s probably a skill worth honing.
Accuracy and timeliness are absolutely imperative to documentation for effective communication between you and your patient, from your clinical notes, lab results, to consent forms – the list goes on. Also by documenting, your colleagues can effectively and confidently pick up where you left off.
And remember, your notes could be used in a court of law. If you don’t write it down, it didn’t happen. Poor documentation is a major factor in litigation cases. Patient notes will be examined and negligence may be considered as the cause of patient morbidity and or mortality.
7. If you are unsure – ask
Don’t put too much pressure on yourself early on. There is no such thing as a silly question and asking for help is probably one of the most important things you can do as a junior doctor. If in doubt, approach senior colleagues, they were once in your shoes and will be expecting your queries.
You’re not going to pick up absolutely everything in the first few months, and put every piece of theory into practice. I’m sure you’ll agree, asking that question is certainly more favourable over making a glaring error, especially in such a crucial stage of your career. It’s better to be safe than sorry.
8. There is no such thing as a ‘doctor’s job’ or a ‘nurse’s job’ if it’s something your patient needs – make it happen
This is where the term ‘teamwork’ comes into play. You won’t be able to provide top quality care alone. You’re working in multi-discipline teams so you’ll need to build rapport quickly and together, need to understand what the best plan of action is for the patient.
‘I didn’t know it was my responsibility to carry that out’, won’t go down well, but calling on other colleagues and working together for best patient outcomes, will.
The experience you gain from those around you, whether they’re a fellow FY1, FY2, nurse or other staff member is invaluable in managing situations, and knowing who to call on.
9. Deliver a comprehensive handover
As a result of increasing workloads and changing work patterns, delivering a comprehensive handover has never been so important, especially handovers for the next batch of junior doctors. Ensure details included within the handover are of the key vital pieces of information your colleague will need to know about. It must remain relevant.
Handovers that miss vitally relevant details could impact quality of care and have a negative effect on staff in terms of stress and tension. It is advised that medical students attend handovers to learn the necessary skills. I will often cover handovers within my lectures and clinical skills workshops.
10. Make appropriate people aware of things at appropriate times
During pressured periods (which we know is pretty relentless in the NHS working environment), emotional intelligence will direct how, when and to whom you will deliver specific information or highlight particular issues. Though there is no right or wrong time to make your colleagues aware, you can assess the situation, assess your environment and make a justified decision.
About Dr Kishan Rees
Dr Kishan Rees has been working as a locum doctor with ID Medical since 2011. His educational enterprise, WatMed educational, is a community for junior members of the medical profession and aspiring doctors (A-Level students). Visit WatMed educational’s YouTube channel and pose your questions to Dr Rees on Twitter @Prepare4FY1.