[carcinoma]

(Original post by Mushi_master)
Ours takes into accounts year 3/4 only along with SSC, so you may be lucky!

Really?

That's so cheeky of Kings, also didn't they change the examinations they include for the new EPM. As I don't think they were listed, as one keeping the same system.

(ill check - nope Kings along with 22 of the uk medical schools said they would use their current system, with minor adaptation.)

[Mushi_master]

(Original post by carcinoma)
Really?

That's so cheeky of Kings, also didn't they change the examinations they include for the new EPM. As I don't think they were listed, as one keeping the same system.

(ill check - nope Kings along with 22 of the uk medical schools said they would use their current system, with minor adaptation.)

Very cheeky indeed, especially as I did well first 2 years! I think they changed the weightings a little, but not a lot.

[fizz123]

Guys

Im starting my F1 shadowing tomorrow- and I'm really stressed / apprehensive about it. I did my med degree from a non UK school ( another EU country). Therefore, I just dont feel like Im to speed with basic clinical skills and the general know-how of how to adapt to UK wards.

I assume the UK grads will be more experienced in terms of clinical skills etc. I haven't had much hands on experience. In shadowing, are we allowed to be 'hands on' or is it simply observing.

[idiopathic]

(Original post by fizz123)
Guys

Im starting my F1 shadowing tomorrow- and I'm really stressed / apprehensive about it. I did my med degree from a non UK school ( another EU country). Therefore, I just dont feel like Im to speed with basic clinical skills and the general know-how of how to adapt to UK wards.

I assume the UK grads will be more experienced in terms of clinical skills etc. I haven't had much hands on experience. In shadowing, are we allowed to be 'hands on' or is it simply observing.

It can be as hands on as you like. I would advise you to get stuck in. Tell your F1 that you want to practice as much clinical skills as possible and that you would like to do everything. If you are really low in confidence I would also advise you to do extra sessions - eg on-calls shadowing, MAU clerking, get to the wards early and do some bloods that are left for the phlebotomists etc.

Get as much out of it as you can. Do not worry though, there is great discrepancies between new F1s in knowledge and skill, but the keen and eager ones will soon catch up.

[Renal]

In my experience, people will be tolerant of poor clinical skills for the first month and they will be available to help you and supervise. They will not be tolerant of someone who does not know how the jobs works and how to run the firm. I would concentrate on finding out what you're actually supposed to be doing, especially if you've never been a student in this country, let alone this hossie.

[digitalis]

(Original post by fizz123)
Guys

Im starting my F1 shadowing tomorrow- and I'm really stressed / apprehensive about it. I did my med degree from a non UK school ( another EU country). Therefore, I just dont feel like Im to speed with basic clinical skills and the general know-how of how to adapt to UK wards.

I assume the UK grads will be more experienced in terms of clinical skills etc. I haven't had much hands on experience. In shadowing, are we allowed to be 'hands on' or is it simply observing.

Let's put it this way-In my third and final week I was handed a bleep and told to 'step up' to fill in for the rota gap when one fell sick. My SHO was unreachable, wasn't carrying a bleep and went off somewhere and my reg was in theatre.

It was awful and after two days of that I took the rest of the week off and went home.

For the first two weeks, it was less bad, quite useful as I just did as much as I could with the other HO and there was another one of my new colleagues shadowing with me. Was quite fun actually. It was quite unlike any other firm I've had before-I think you approach it in a different way. Highlight (?) of that fortnight was having 104 patients on our books one Friday. I left at 6, after spending two hours filling in blood cards. Felt sorry for the two FY1s who stayed on till who knows when.

[graemematt]

Shadowing was great! Got involved and did loads of stuff. The main problem was that, as a medical student, you can't sign anything, therefore everything you did seemed "half-done" if you get me, as in TTOs needed checking, kardexes needed signed etc etc. However, I would advise getting involved as much as possible as it'll make you feel a lot better when it comes to the dreaded DAY ONE :-O

[fizz123]

are surgical 'nights' less busy than the standard medicine ones?. what would a typical night involve for an F1 on a surgical ward.?

[digitalis]

(Original post by fizz123)
are surgical 'nights' less busy than the standard medicine ones?. what would a typical night involve for an F1 on a surgical ward.?

I'm sure some of the older people will be able to give a better perspective, but my job is split into two types of on calls. Either one wing (covering my base surgical specialty, thoracics, ITU/HDU) or another wing (covering admissions, ward cover for colorectal, urology, gen surg and acutes)

Doing jobs left over by the day team, checking bloods, doing time dependent Ix/Mx (vanc levels, trops, Abx dosing), cannulas, write fluids, drug charts, reviewing post op fever/hypotension/pain/low UO and such.

[Elles]

(Original post by fizz123)
are surgical 'nights' less busy than the standard medicine ones?. what would a typical night involve for an F1 on a surgical ward.?

On average... for ward cover - yes. By the end of my FY1 year on my run of surgical nights I got 2-5 hours sleep on each.

The frequency of sickies will probably be less because you'll have a good chunk of elective or minor trauma, relatively healthy/stable people but pre or post-op for some reason.

The jobs will be pretty much the same as the medical ward cover FY1... but perhaps more catheter issues (those urology patients!), the post op problems (pain, fever, hypotension, vomitting, low urine output, stoma/drain output, wound issues, ?DVT, ?PE) & possibly patients without so much of a medical plan (from recent physician ward round) & less support from seniors with issues that don't need or it's not appropriate to fix with more theatre time - so if they go off they can really go off... especially orthopaedic and urology patients*.

If you're involved in take/theatre too though that would add an extra scope for busy-ness.


* Edit - funny how you forget specific events that have such an emotional impact on you at the time & then something triggers recall of that very specific memory...

[fizz123]

Thanks. So nights in a surgical dept is mainly dealing with patients that are already in the ward that are post op? And patients that go come into sau. Regarding catheters- I've never pit them in. And how do I get my head around fluids and prescribing them.

[Helenia]

(Original post by fizz123)
Thanks. So nights in a surgical dept is mainly dealing with patients that are already in the ward that are post op? And patients that go come into sau. Regarding catheters- I've never pit them in. And how do I get my head around fluids and prescribing them.

Erm, these should both be things you've learnt at medical school? Have you not even done catheterisation on a model? I would get your SHO to teach you ASAP, possibly during your shadowing. Female nurses in general will not catheterise men, so you will need to get good at this!

As for fluids, again, this is something you should have covered the basics of at med school, but this is a good bit of background reading. http://www.bapen.org.uk/pdfs/bapen_pubs/giftasup.pdf

That aside, yes, nights as an F1 will be predominantly ward cover. You may have to go and help with admissions if the SHO/SpR is busy, and might have to go to assist in theatre, but the amount of out of hours operating is supposed to be decreasing...

[Skwee]

(Original post by Helenia)
Female nurses in general will not catheterise men, so you will need to get good at this!

While I'm not starting FP this year (besides being an EU student), I was rather intrigued by this statement! If female nurses in general don't catheterise men, does that mean female doctors don't either? I don't have a problem with catheterising men at all (never had any issues so far) - just wondering!

[Helenia]

(Original post by Skwee)
While I'm not starting FP this year (besides being an EU student), I was rather intrigued by this statement! If female nurses in general don't catheterise men, does that mean female doctors don't either? I don't have a problem with catheterising men at all (never had any issues so far) - just wondering!

Oh no, all doctors are absolutely expected to be able to catheterise both sexes.

It is totally illogical to me that nurses can in general only catheterise their own sex, but it's the way it is in most UK hospitals. I have done far fewer female catheters than male because of this.

[Skwee]

(Original post by Helenia)
Oh no, all doctors are absolutely expected to be able to catheterise both sexes.

It is totally illogical to me that nurses can in general only catheterise their own sex, but it's the way it is in most UK hospitals. I have done far fewer female catheters than male because of this.

Ah, that's better! I'd feel like I'd gone backwards a bit if I was only allowed to catheterise females (even if they have the added bonus of being easier to catheterise). :P

Thanks for the info (Super-Helenia as usual)!

[graemematt]

(Original post by fizz123)
Thanks. So nights in a surgical dept is mainly dealing with patients that are already in the ward that are post op? And patients that go come into sau. Regarding catheters- I've never pit them in. And how do I get my head around fluids and prescribing them.

Your best bet is to either follow the links Helenia has given you, or to simply be honest on your ward while shadowing and ask these questions to the FY1 you're currently with. Be honest, after all they're there to help you (as well as obviously doing their own job of course!)

The catheterisation thing is something you need to flag to your base hospital urgently! If you can't do the skill and have never been trained, you'll need training of some sort before you start, ideally at your hospital clinical skills wing. The staff involved in this sort of training are often very friendly and will help

[zippyRN]

(Original post by Helenia)
Oh no, all doctors are absolutely expected to be able to catheterise both sexes.

It is totally illogical to me that nurses can in general only catheterise their own sex, but it's the way it is in most UK hospitals. I have done far fewer female catheters than male because of this.

it's a historical hangover plus some hysterical Urologists not helping the issue with concerns over prostate patients.

this is before the whole 'it';s an extended role ' malarky

as an RN who happens to be of the male persuasion i was taught how to insert uretheral catheters into both male and female patients and how to change Suprapubic catheters.

out of preference i prefer not to catheterise female patients

1. a lot of ladies even if they are happy with male staff doing other care on them don't really want a man fiddling with their bits

2. female catheterisations are hard even if you do have an understanding of the anatomy in part due to the variations of 'normal'

catheterising men uretherally is simple unless they are known to have prostate issues and even then it;s still easy to find the correct hole in the first place ...

depending on the trust you may find that the RNs of either gender on certain wards will happily catheterise men who need it ... but this is because of the attitudes of the nursing management in that clinical area - same with a lot of 'extended roles' some places everyone who has been registered for a few years does the various things other places it;s sporadic or only the chosen few do ...

Sadly people don't always think to speak to other wards before bleeping junior doctors for things like this.

[digitalis]

(Original post by zippyRN)
Sadly people don't always think to speak to other wards before bleeping junior doctors for things like this.

True, true...I don't get why nurses aren't taught how to do bloods, cannulae, male catheterisation (+/- ABGs?) at nursing school as standard. Would make a huge difference if they could.

[zippyRN]

(Original post by digitalis)
True, true...I don't get why nurses aren't taught how to do bloods, cannulae, male catheterisation (+/- ABGs?) at nursing school as standard. Would make a huge difference if they could.

collective professional inertia in some cases

bloods and male catheterisation there really is no excuse why not ( especially as in a lot of places the boys are taught male catheterisation instead / as well - and to be honest unless someone is hugely prostatic male catheterisation is easy ( when was the last time you saw someone doing a male catheter / supra pubic change with a miner's lamp and a safety rope ! )

Cannulation and ABGs is a bit more dubious but it;s also a circular arguement especially with regard to cannulation - if the nurses in nursing homes could cannulate would as many NH residents get sent to AAU for chest infections , dehydration etc etc .... but cannulation is a none trivial skill to be good at - which is where junior doctors in the old days and Nurses who spend a few years in A+E / AAU type settings have the advantage - you lose count of how many you have done after the first thousand ...

ABGs - again it;s exposure certainly more nurses should be doing them were it counts ( or we should be looking at putting art lines in more patients in some settings e.g. acute BiPaP L1 beds on respiratory and neuro wards )