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what is ICU or anaesthetics like as an F1 job?

tpxvs

For someone that's not interested in acute/find it quite daunting - what is it like doing one of these jobs as an F1 both in a busy tertiary centre and in a quieter DGH?

Are there any jobs that are not recommended for F1?
Some of the tracks I am trying to order have jobs in fields such as otolaryngology. Some tracks are 3 x surgery which I assume may not make you as well rounded as having eg. 1 general medicine, 1 general surgery, 1 other etc?

Reply 1

tpxvs

also any opinions/ experience working haematology as f1?

Reply 2

Democracy

Original post by tpxvs

I did anaesthetics and ICM as an FY1 job. Two months of each at a DGH.

The ICM part was okay but the main drawback was it was a small ITU with quite a lot of juniors: an FY1, a medical SHO, 2x ACCS SHOs, and a medical registrar - and of course the actual ITU registrar. The unit probably had an average of four or five patients most of the time which meant that the SHOs/SpRs got first dibs on all the practical stuff - which is understandable since they had to be signed off for various things, but it did mean that my role was mostly more routine things like ward round stuff, updating the daily patient record, discharge/step-down summaries, referrals etc. The job will improve your A-E assessment skills for sure (as that's what the ward round is for every patient) and in terms of practical skills I think I did an LP, a PICC line insertion, and a couple of A-lines. The ITU nurses were very good and the consultants were supportive. It's an acute environment yes, but you will never be asked to make solo decisions and you will never be on call for ITU or do nights (though I've heard some places will put you on the general surgery on call rota - this was not the case for me).

The ward rounds were longer than surgery but there was a good tea and toast culture so you don't feel quite as drained afterwards compared to medicine :wink:

The two months I spent on anaesthetics was the most enjoyable bit of FY1 for me. This was nearly always one-to-one with just the consultant which meant a lot of teaching and opportunities to do practical things e.g. pre-op assessments, learning about the anaesthetic machine, drawing up medications, pre-oxygenation, using airway adjuncts, LMA insertion, endotracheal intubation and then managing the patient during the operation itself - again all under close supervision.

On the whole I think it was an enjoyable and interesting FY1 job. It is acute, but I think because of how well supported it is you shouldn't find it daunting.

Also, I wasn't aware you could have 3x surgical jobs during FY1. I thought all FY1 posts need to have at least one general medical job?

(edited 6 years ago)

Reply 3

4:20

Original post by Democracy

Also, I wasn't aware you could have 3x surgical jobs during FY1. I thought all FY1 posts need to have at least one general medical job?

Yh I was wondering same, maybe by track she's referring to both f1 and f2 years overall. Even then I thought 2 was the most you could get- 1 in each year.

Some budding surgeons will be very glad about that.

(edited 6 years ago)

Reply 4

MonteCristo

Some rotations will look like 3x surgical placements with one labelled as "trauma & orthopaedic surgery" and they get away with this by attaching the FY1 to an orthogeriatrician who acts as their Clinical Supervisor. They will sometimes also participate in the acute medicine (rather than T&O) on-call rota. I guess the hospitals just need to convince the foundation school that FY doctors will get sufficient general medical experience and that can sometimes be achieved in a surgical context.

I advise everyone to try and get jobs (at whatever grade) in GP, A&E, and ICU. Even if you are supernumerary (which is likely) and there isn't much work to do, an ICU job is licence to go and see every sick patient in the hospital, become awesome at venous access, and get stuck into cardiac arrests. It will also be well supported with an experienced nurse at every patient bedside and a SpR +/- consultant physically beside you on the shop floor. You will also make good contacts (ICU/anaesthetic/medical seniors) for when you move into your next job and need help managing sick patients. You won't fear anything after making the most of an ICU rotation.

Reply 5

fishfacesimpson

It's very cruisy and all about education so in theory is a great rotation. I did 4 months in fy2 which was similar except I was given more responsibility with the hdu patients as it was end of fy2 and I had done 12 months of general medicine by that point. You'll improve your assessment of unwell patients and get an understanding of what icu can and can't offer. This is the most important thing really and important if you do any hospital based speciality. A lot of the learning is passive though and seeing how intensivists manage patients is interesting but you should be prepared to learn by osmosis. Practical procedures are nice and if you're intimidated by then it's a nice environment to get more comfortable. Depending on how proactive you are and who else is in the unit you could do lots of procedures or just a few.

I did a month of anaesthetics which was ok. Your cannula skills will improve immensely as will airway skills (jaw thrust, guadel and lma). Learning to intubate is nice but the other more basic skills are what will stay with you forever.

Reply 6

belis

My first ever job was combined ITU and anaesthetics with general medicine on calls. I enjoyed it. I was considering choosing anaesthetics as my career so it was very useful to experience it over a sustained period of time. Ultimately I came to a conclusion that it was not for me but it was not down to the rotation, which was great.

I had a lot of 1:1 teaching and close supervision in this rotation. I would do the morning ITU ward round, any jobs from that and in the afternoon I had lists where I had 1:1 teaching from consultant. I have learnt lots of procedures and by the end of it I could do arterial lines, central lines, uncomplicated intubations with confidence. I have done lots of spinals as well, which came handy on the wards with LPs. I have also been carrying crash bleep in hours daily. I have developed confidence in dealing with emergencies.

All in all it has been a very useful job, I would say my favourite rotation in FP.