What you should know before starting the foundation programme
Junior doctors share their advice on how to make the most of the foundation programme
- By: Thomas Cassidy
Read up on local guidelines
Elizabeth Emsley, F2 doctor, Royal Sussex County Hospital, Brighton, UK
Before you start at your new hospital, become familiar with your hospital trust’s guidelines—for example, managing clinical emergencies, warfarin doses, and venous thromboembolism prophylaxis. This will make on-calls and life on the wards much less daunting. It will also save you time when it is 2 am and a patient’s potassium is high. You do not need to memorise pages and pages of guidelines, but it is important to know where to look.
As a foundation year 1 doctor (F1), your team are keeping a close eye on you to make sure you make safe decisions. You will be well supported. The step up from being an F1 doctor to F2, however, should not be underestimated. Suddenly you are a senior house officer and you have more independence and responsibility. Do not be too hard on yourself if you find aspects of this challenging, especially early on. It is a learning curve.
Take regular breaks. This was the advice given to me when I started. You will work hard and at times feel exhausted. Taking five minutes to hide away in a corner and gather your thoughts is important. Finally, keep up hobbies, interests, and friendships as you start work. Life outside medicine helps you to maintain perspective and build resilience.
Make the most of being the most junior doctor in the hospital
Alice Hughes, academic F1 doctor, Royal Devon and Exeter Hospital, Exeter, UK
Being the new F1 on the ward can be daunting and scary, but it is a great opportunity to learn while still being relatively well protected. As you are the most junior, don’t hesitate to ask the advice of your seniors at any level. Even if I was almost completely sure, I often got senior house officers to double check things like chest radiographs for correct nasogastric tube placement. It is always best to ask.
See every patient as a learning experience. If you haven't come across something before, do your best to make a note and read up about it afterwards. This is hard when you are spending long hours in the hospital, but even a quick glance in a textbook or online is a good way to reinforce your knowledge and commit things to memory.
Try to make friends with fellow F1s. You are all in it together and chatting with each other can make the difficult days much easier. Also, make use of more senior doctors you trust. I found talking to a supportive consultant after the death of a patient I had got to know quite well helpful.
Remember that your skills and confidence will grow as the months go on. Even though I was a keen medical student when I started, I was still shocked at just how much more I needed to learn. It gets much easier as the months go by, and before you know it the bleep asking you to review a sick patient isn’t half as scary as it first was.
Tell your seniors if you make a mistake
Isabel McLuskie, F2 doctor, Imperial College Healthcare Trust, London, UK
If you have induction days before you start your first job, make sure you go to them to become familiar with the practical aspects of the job, such as how to order blood tests, how to bleep, how to discharge patients, and who to speak to to organise outpatient clinics and theatre slots. Arrive early on your first day, introduce yourself to the nursing staff, and put the jobs you need to do in order of priority. Bring a box clipboard for keeping request forms, spare paper, and snacks (you never know when you’ll eat). Also, bring a stethoscope, black pen, and notebook to note down access codes and bleep numbers.
If you make a mistake, don’t panic. Everyone makes them. The most important thing is to keep the patient safe. Tell your senior immediately as they will know the best way to rectify it. Be honest and transparent with the patient and get senior advice on how to handle this. Making mistakes can be stressful and upsetting, but they are important learning opportunities.
Practical procedures often cause a lot of stress for new F1s. It is not uncommon to start having never taken an arterial blood gas before. When faced with new procedures only do what is within your competency and ask for help if you are out of your depth. If you are struggling to bleed or cannulate a patient, call for help from other junior doctors who have more experience.
Nurses are your best friends, and keep your ePortfolio up to date
Trevor Kileen, F1 doctor, James Paget University Hospital, Norfolk, UK
Make friends with the nurses as they will bail you out more often than anyone else. When you’re standing on a ward and you don’t know who to call or what to prescribe, ask your nursing colleagues—nine times out of 10 they will be able to help you. It doesn’t matter if you’ve completed medical school and been published in Nature, being a good team player is far more important. This is particularly important at weekends, when the nurses will be invaluable to you. Bringing in homemade cakes can also go a long way to keeping them on side.
You may have managed as a medical student not getting enough sleep, but it’s not the same when you’re in the hospital working as a doctor. It’s not just physical tiredness, it’s emotional exhaustion that you need to factor in. Make sure you get enough sleep and rest when you can.
It may seem like an administrative task, but remember to keep your ePortfolio up to date. Aim to tick off one or two tasks from your ePortfolio each day. I kept up to date with my ePortfolio on my first rotation but slacked off on my second rotation, and this left me with lots of extra sign-offs to get near the end of my placements.
Also, don’t take on too much to begin with. You may be enthusiastic about doing things that will help your career, but focus on becoming a good doctor first. You need to be a good team player, and if you take on too much you can’t help out colleagues.
There are some great apps that can make your life easier. If your hospital subscribes to Induction make sure you download it as it includes all the extension and pager numbers your hospital uses. The MicroGuide app is also worth checking out as it will give you hospital-specific advice on antibiotic prescribing.
But, the most useful app I use is WhatsApp. I set up a WhatsApp group for all the doctors on my firm and other F1s working in the hospital. It’s a great way to quickly get an answer to a question about the hospital if you get stuck.
Question why decisions are made
Mehdi Masood, trainee radiologist, Leicester Royal Infirmary, Leicester, UK
Being the most junior member of the team can be daunting, but don’t be overawed by your seniors or take everything you are told at face value. For example, if your senior house officer asks you to take an arterial blood gas from a patient, ask yourself why you are doing it—the patient may have had one that morning. If you can’t find an answer yourself, ask the person who told you to do it why it is needed. Questioning your own and other people’s decisions will make you a better doctor and a team player, and your seniors will respect you.Thomas Cassidy, final year medical student
University of Bristol, UK
Competing interests: None declared.
Provenance and peer review: Commissioned; not externally peer reviewed.
- Published: 01 August 2016
- DOI: 10.1136/sbmj.i2218