Turn on thread page Beta

What makes a good F1? watch

Announcements
    • Thread Starter
    Online

    16
    ReputationRep:
    Partly for the benefit of the new soon-to-be F1s, and party out of sheer curiosity, what do you think makes a good F1?

    Would be good to know how views differ depending on stage of training so say what level you are at

    Students welcome to reply!
    Offline

    20
    ReputationRep:
    (Original post by girl_in_black)
    Partly for the benefit of the new soon-to-be F1s, and party out of sheer curiosity, what do you think makes a good F1?

    Would be good to know how views differ depending on stage of training so say what level you are at

    Students welcome to reply!
    I'm an anaesthetic registrar, so don't have a lot of contact with FY1s these days in that capacity. I do a lot of ICU on-call though, so we have some FY1s working on our unit and I meet them when they make referrals.

    I think there are two broad categories of skills that make an FY1 good. The first is clinical, the second more organisational. You have been at med school for 5+ years, you are qualified, so have some confidence in your abilities! If you're bleeping your reg every 5 minutes to ask if it's ok to prescribe paracetamol, it doesn't reflect well on you, but at the opposite end of the spectrum if you're trying to manage a profoundly septic/otherwise unwell patient without telling anyone else what you're doing, that's not ideal. Being able to make an initial assessment, come up with a sensible differential and management plan and communicate that succinctly to your seniors is very important. I hate getting calls saying "I want you to review this patient because their NEWS is 9." I don't give a **** what the NEWS score is, and on its own it will have no bearing on whether I want to admit someone to ICU or not. I want to know what is wrong, what has been done already, and what you/your team think needs to be done next, including an idea of what ICU will add. I think at least some of that is down to people not really knowing what ICU can/can't do though.

    Practical skills are also important, but nobody expects you to be perfect initially. You should be able to take bloods, cannulate, do an ABG (with local, IMO! ) but some patients are difficult and if you've had an honest try then escalating is ok. Likewise if there's a procedure you're not confident with, get someone to supervise you, get feedback and work out how to improve next time.

    The second aspect is all about the administrative side of being an FY1, which is unfortunately a)you being an overpaid secretary and b)not something that is particularly taught at med school. Make The List your baby, keep it up to date, know where patients are and how things are progressing with investigations etc. Learn how to request imaging, procedures, specialty reviews. Keep on top of paperwork like discharge summaries. Turn up on time, look smart, be polite to everyone and be reliable - if someone asks you to do something, do it, and if you can't, tell them or make sure someone else does it.

    It will be a tough year, there's always a steep learning curve, but if you have a supportive team (both other FY1s and your seniors) you'll get through. Good luck!
    Offline

    19
    ReputationRep:
    Realise that Nurses are potentially your best friends and your worst enemies - there are nurses who might 'only' be a band 5 but they know more aobut the speciality and the patients than you will ever have chance to learn unless you come back to thatspecialisty as Specialist trainee in a few years time.
    Offline

    15
    ReputationRep:
    As above + be kind. The hospital is a scary place. Please be kind to your patients.
    Offline

    13
    ReputationRep:
    1. Working hard. Expect to stay late and don't fill your evenings with social plans, particularly during the first job when you are finding your feet. You will learn faster and become better at the job the more hours you put in, at least initially. Try to get to know your patients (and their relatives) well as this will make the job more interesting and remind you why you are there... *

    2. Manners. Smile and be unfailingly polite to patients, nurses, specialty doctors, receptionists, consultants, etc. You can be an absolutely awful doctor but do extremely well if people enjoy working with you. *

    3. Getting the balance right. During normal work hours, your job is to write down what your boss says and find a way to action his/her plan. Outside of normal hours, you will feel as if the weight of the world is on your shoulders but it really isn't. Your job is to see the patient, find out what is going on (history, examination, charts), and then call someone else for a plan. By all means design a plan in your mind beforehand but, in my view, FY1s shouldn't be doing much clinical decision making, and certainly not in their first job. *

    You will learn everything else you need (clinical knowledge, practical skills, etc) with time. All you need to do in the meantime is work hard, smile, then call the boss... ;-)
    • Community Assistant
    Offline

    21
    ReputationRep:
    Community Assistant
    1 - Be a fast writer
    2 - Be a fast typer
    3 - Write brief discharge summaries. Like really brief. GPs hate it when a discharge summary is 3 paragraphs describing an uneventful appendectomy or simple pneumonia.

    And some minor medical stuff I think.
    Offline

    6
    ReputationRep:
    My tips would be (though not confined to) :

    Be nice to your colleagues
    Work hard
    Don't ***** if you stay late
    But Don't stay too late, too often
    Play hard (but don't turn up to work pissed - obviously)
    Embrace the fact that you are a doctor and not just a secretary
    But don't think you're gods gift to earth
    Ask for help if you're not sure about something
    Don't say "my consultant wants it" as a reason for a scan, a review etc.
    Get to know your patients, talk to them, listen to them, examine them - they are better than any textbook
    Realise that everything around you is a learning opportunity - a complex discharge, a specialist nurse review, a question for a pharmacist, a short synacthen test - whatever.


    (Original post by nexttime)
    1
    3 - Write brief discharge summaries. Like really brief. GPs hate it when a discharge summary is 3 paragraphs describing an uneventful appendectomy or simple pneumonia.
    If it's a simple thing then yeah. But a lot of medicine and patients these days are not that simple and straight forward.

    But the point of a discharge letter is not just for GPs but acts as an invaluable piece of documentation for the next time the patient is admitted. So if the COPD patient comes in for another exacerbation their last ABG on air is damn helpful. If the MoCA the OT kindly did before discharge that would be helpful for the next time the patient comes in delirious. The examination findings for aphasic, hemiplegic stroke patient etc etc etc

    The number of times I've had to type or dictate a letter after reviewing a patient and spending an hour with them only to see the really poor discharge letter is really bloody annoying. I'm not doing it for the GP, I'm doing it for for the purpose of electronic hospital documentation (we don't have a unifying EPR).
    • Community Assistant
    Offline

    21
    ReputationRep:
    Community Assistant
    (Original post by fishfacesimpson)
    If it's a simple thing then yeah. But a lot of medicine and patients these days are not that simple and straight forward.

    But the point of a discharge letter is not just for GPs but acts as an invaluable piece of documentation for the next time the patient is admitted. So if the COPD patient comes in for another exacerbation their last ABG on air is damn helpful. If the MoCA the OT kindly did before discharge that would be helpful for the next time the patient comes in delirious. The examination findings for aphasic, hemiplegic stroke patient etc etc etc

    The number of times I've had to type or dictate a letter after reviewing a patient and spending an hour with them only to see the really poor discharge letter is really bloody annoying. I'm not doing it for the GP, I'm doing it for for the purpose of electronic hospital documentation (we don't have a unifying EPR).
    I agree with your specific examples. I often see long rambling discharge summaries though. Take that COPD patient - I did always include their final ABG on the summary as well as the antibiotic used,... but that's about it routinely. And to be honest if you left out both of those it wouldn't be a disaster either - if they're readmitted acidotic then you know its acute. If you're thinking about antibiotic inadequacy then either you're going for IV taz or similar or they can wait till morning. What I would see though is colleagues writing paragraphs about how they were short of breath and wheezy and hyperexpanded and their sats were initially low but improved... of course they had that stuff they had an exacerbation of COPD! How does that help the GP or future hospital team? How will you spending that time (which will add up to multiple hours per day if you're doing it for every patient) change management?

    You've got to be targeted but most I see are far too long. And then once you can pump them out quickly the nurses like you, beds get cleared, and you have time for other things.
    • Community Assistant
    Offline

    21
    ReputationRep:
    Community Assistant
    (Original post by fishfacesimpson)
    If it's a simple thing then yeah. But a lot of medicine and patients these days are not that simple and straight forward.

    But the point of a discharge letter is not just for GPs but acts as an invaluable piece of documentation for the next time the patient is admitted. So if the COPD patient comes in for another exacerbation their last ABG on air is damn helpful. If the MoCA the OT kindly did before discharge that would be helpful for the next time the patient comes in delirious. The examination findings for aphasic, hemiplegic stroke patient etc etc etc

    The number of times I've had to type or dictate a letter after reviewing a patient and spending an hour with them only to see the really poor discharge letter is really bloody annoying. I'm not doing it for the GP, I'm doing it for for the purpose of electronic hospital documentation (we don't have a unifying EPR).
    I agree with your specific examples. I often see long rambling discharge summaries though. Take that COPD patient - I did always include their final ABG on the summary as well as the antibiotic used,... but that's about it routinely. And to be honest if you left out both of those it wouldn't be a disaster either - if they're readmitted acidotic then you know its acute. If you're thinking about antibiotic inadequacy then either you're going for IV taz or similar or they can wait till morning. What I would see though is colleagues writing paragraphs about how they were short of breath and wheezy and hyperexpanded and their sats were initially low but improved... of course they had that stuff they had an exacerbation of COPD! How does that help the GP or future hospital team? How will you spending that time (which will add up to multiple hours per day if you're doing it for every patient) change management?

    You've got to be targeted but most I see are far too long. And then once you can pump them out quickly the nurses like you, beds get cleared, and you have time for other things.
    Offline

    17
    ReputationRep:
    Willingness to ask questions and admit that they don't know. If there is anything that drives me mad is people making it up as they go along until they create a disaster.*

    Willingness to learn. You may end up working in specialities that really aren't your cup of tea. Be open minded.*
    Offline

    15
    ReputationRep:
    (Original post by nexttime)
    I agree with your specific examples. I often see long rambling discharge summaries though. Take that COPD patient - I did always include their final ABG on the summary as well as the antibiotic used,... but that's about it routinely. And to be honest if you left out both of those it wouldn't be a disaster either - if they're readmitted acidotic then you know its acute. If you're thinking about antibiotic inadequacy then either you're going for IV taz or similar or they can wait till morning. What I would see though is colleagues writing paragraphs about how they were short of breath and wheezy and hyperexpanded and their sats were initially low but improved... of course they had that stuff they had an exacerbation of COPD! How does that help the GP or future hospital team? How will you spending that time (which will add up to multiple hours per day if you're doing it for every patient) change management?

    You've got to be targeted but most I see are far too long. And then once you can pump them out quickly the nurses like you, beds get cleared, and you have time for other things.
    That awkward moment when you're reading through an old discharge summary for a new patient thinking "this is so ****, who wrote this?" then you see your own name at the bottom.
    Offline

    17
    ReputationRep:
    To be a good FY1 you need to be organised and friendly, simple as. Being vaguely good at practical skills and knowing when to and how to call for help is also very useful. We have a couple of moaners in my cohort and by now everyone hates working with them (even if they are nice people underneath), and things are harder for them because people don't go the extra mile to be helpful for them - it also gets pretty grating when they start complaining about being late one evening because a patient was ill when you have been late multiple nights for similar reasons on the same shift.

    *
    (Original post by Etomidate)
    That awkward moment when you're reading through an old discharge summary for a new patient thinking "this is so ****, who wrote this?" then you see your own name at the bottom.
    Haha yep, this has happened to me - sometimes the opposite happens when I wonder if it was even me who wrote the letter though because it doesn't sound like anything I would write!

    (Just finishing F1)*
    Offline

    20
    ReputationRep:
    I am currently a GP reg so I don't currently work with F1s but I spent many years in the hospital supervising so this is what I have said

    1) If you are worried, struggling, being picked on anything the contact whoever is supervising you. You have just finished medical school it will take time before you feel comfortable and I would much rather have an F1 who is over cautious initially but who I can talk through the issue with an explain my advice than someone who is going around being over confident and not calling me until things are really bad.

    2) Someone who has a life away from the hospital. By this I don't mean someone who runs off at 5pm and dumps on everyone else. But have plans, make friends etc. Having these things and not just living for the hospital for a year (which I have seen many people do) will mean that you are much more resilient are are less likely to start struggling come Feb/March

    3) Someone who works as part of the team so they are friendly to all staff not just doctors and patients and take the time to explain things to relatives etc. You will be their first point of call.

    4) Write detail in your discharge summery. If you want the GP to follow up something then fill in enough information to explain why. For example don't just say refer to memory clinic do the tests that you can do in hospital (blood ecgs - much easier to get in hospital) and write the results of things like an MMSE or an AMTS in the discharge summary if you have done it. If you want us to repeat a blood tests explain why etc!
    Offline

    19
    ReputationRep:
    All of the above are good.

    Also I personally think that one of the things which makes a good FY1 is to master the art of butlering in the ward round. Namely to anticipate the needs of your superiors before they have actually asked you to do something. This means always getting the notes before you're asked, always having the obs to hand, always getting the blood results up, always having the drug chart and knowing what to highlight to them (VTE prophylaxis & antibiotics mostly!) so that if they go storming round, you stop them from missing these things, and that you don't let parts of a patient's care slip without having a plan. Especially because you may get asked later in the day by a nurse about whether the antibiotics are to continue or what, and depending on what it's about may end up wishing you'd got an answer on the ward round... always clarify the plan! Also if somebody is very unwell always think about things like escalation because when you ring round searching for literally anyone to help later that's what they want to know, and as an F1 you're obviously not going to know/make any decisions on that at all, but you can point it out to seniors if you feel it's being missed. IMO anyway! Depends on your seniors and how much they tend to think about this kind of thing.

    Before you go to refer any patient to any specialty, at least to begin with I would also urge you to have:
    1. Drug chart
    2. Obs chart
    3. Notes
    4. Easy access to NHS number and DOB
    5. Latest bloods/relevant investigation results
    At a minimum, all in front of you. And ideally to have already checked the most relevant bits of each, like coagulation if you're ringing for a CT Head after somebody has bumped themselves and so on. If you're referring to microbiology, write a little time line of which antibiotics they've had, when and for how long and the same for any culture results as relevant so you can provide that info because you know they'll ask you. I like to write all the bits I think are relevant on a little piece of paper before I call somebody so all the predictable information is to hand. And if you're not sure exactly *why* you are making the referral, as in the indication makes no sense to you, try to get that out of your seniors and never phone somebody going ???not 100% why I am referring to you, if you can possibly help it.
    Most of it is common sense I think but you'd be surprised how easy it is to forget/not think about at least in your first few weeks! :P

    One last thing I guess is prioritisation and organisation. Trying to think when things need to happen and using that to dictate the order you do things in. Like if you want to go through blood results before you go home... those bloods need to have been sent off to the lab by lunch time really, so you're pretty sure they've been processed by the end of the day. Scans need to be ordered first thing so your patients are high up in the queue for them - if you order the scan later in the day you can basically guarantee that unless it's urgent, it's not getting done until tomorrow at the earliest. Remember the phlebotomists probably won't take all the bloods and to search for a pile of forms early rather than discovering them all at 15:30 in the afternoon and handing over ridiculous bloods. Prioritise your discharge summaries - ask the nurses who needs to have theirs done first, the nurses know all sorts of stuff like so-and-so will need to be back at a home before X time or they won't be accepted - and remember that even after *you* have done it, pharmacy will add on another few hours to sort it out most of the time so crack on with these things early or you'll be seeing a patient again tomorrow morning on the ward round who could have been at home! And be super unpopular with both the patient and the sister in charge who told the bed manager they'd have a spare bed. Make lists. If you know that a team doesn't pick up online referrals until 9AM then that's the bottom of your list because whether you do it ASAP or last thing in the day, it's not going to make a difference.

    Sorry for writing so much I am just at the end of F1.
    • Community Assistant
    Offline

    21
    ReputationRep:
    Community Assistant
    (Original post by seaholme)
    Namely to anticipate the needs of your superiors before they have actually asked you to do something.
    Seniors - give yourself some credit
    • Aston Villa FC Supporter
    Offline

    3
    ReputationRep:
    Aston Villa FC Supporter
    A good F1 should be be able to corner really fast. I mean stonkingly fast. 0 - 60 in 0.5 seconds, and 100% carbon fiber.
    Offline

    6
    ReputationRep:
    (Original post by nexttime)
    I agree with your specific examples. I often see long rambling discharge summaries though. Take that COPD patient - I did always include their final ABG on the summary as well as the antibiotic used,... but that's about it routinely. And to be honest if you left out both of those it wouldn't be a disaster either - if they're readmitted acidotic then you know its acute. If you're thinking about antibiotic inadequacy then either you're going for IV taz or similar or they can wait till morning. What I would see though is colleagues writing paragraphs about how they were short of breath and wheezy and hyperexpanded and their sats were initially low but improved... of course they had that stuff they had an exacerbation of COPD! How does that help the GP or future hospital team? How will you spending that time (which will add up to multiple hours per day if you're doing it for every patient) change management?

    You've got to be targeted but most I see are far too long. And then once you can pump them out quickly the nurses like you, beds get cleared, and you have time for other things.
    I don't disagree with any of that

    But I would encourage people initially to use detail. You'll naturally hone that into being more succinct over time but getting into a habit of 1-2 line summarises when more detail is required is far worse than 2 paragraphs for a UTI

    I'm biased, I do neurology and actually what I want in the dc summary for a pt with a headache or a seizure etc is the history and examination, not the test results because anyone can look those up. You can't go back and take a history from 3 months ago though. My heart sinks when I see a pt on their 10th admission this year and each and every discharge letter is next to useless.

    Learn to touch type also, will make life a whole lot easier.
    • Community Assistant
    Offline

    21
    ReputationRep:
    Community Assistant
    (Original post by fishfacesimpson)
    I don't disagree with any of that

    But I would encourage people initially to use detail. You'll naturally hone that into being more succinct over time but getting into a habit of 1-2 line summarises when more detail is required is far worse than 2 paragraphs for a UTI

    I'm biased, I do neurology and actually what I want in the dc summary for a pt with a headache or a seizure etc is the history and examination, not the test results because anyone can look those up. You can't go back and take a history from 3 months ago though. My heart sinks when I see a pt on their 10th admission this year and each and every discharge letter is next to useless.

    Learn to touch type also, will make life a whole lot easier.
    I think it is different for complex chronic conditions where the examination is crucial. I suspect your perspective is very different to a routine DGH general take.
    Offline

    12
    ReputationRep:
    As a medical student, a good [anyjob] at [anygrade] is someone who acknowledges my existence. Anything beyond that is a bonus...
    Offline

    6
    ReputationRep:
    (Original post by nexttime)
    I think it is different for complex chronic conditions where the examination is crucial. I suspect your perspective is very different to a routine DGH general take.
    Not really. I was a medical SHO and SpR previously. I work in a district general hospital and routinely see 2-3 patients a day who have come in on a take and see people in a general clinic who have come and gone from a routine medical take. I'm not seeing patients with 10 autoimmune conditions with complex work up I'm seeing people with a headache, seizures, tingling, weakness etc. The Neurological equivalent of chest pain, SOB or abdominal pain.

    I regularly dictate or type *letters after the patient has gone home because the discharge letters have little to no detail in them. Now that is solely my own choice and largely done to make life easier for the person seeing the patient in clinic or to alleviate the need for them to be referred to a clinic in the future if they've just seen me for an hour and I've discussed everything with a consultant. But it's also to provide details (simple ones not details of their birth history) like what someone's complex partial seizure looks like or migraine presents that I think are absolutely essential to a patient's documentation on discharge.*

    I'm all for detail and would encourage F1s to think about the detail even if it doesn't go into the discharge letter (as you say you don't need to mention everything about someone's breathlessness if it's their 6th COPD exacerbation this year but if it does then big deal) because it teaches you to synthesise information and work out how a patient has gone from admission -> discharge even if you haven't directly made any decisions regarding their management. It's how a discharge summary becomes a learning event and not just a typing exercise (secretaries have not been through 6 years of medical school to help them synthesise the information they type)

    * Of course I sympathise that if you've got 15 discharge letters to do on a Monday morning that's not always so easy so you have to play it by ear and learn to be as quick and efficient as possible which is the ultimate difficulty of being an F1
 
 
 
Poll
Do you think parents should charge rent?

The Student Room, Get Revising and Marked by Teachers are trading names of The Student Room Group Ltd.

Register Number: 04666380 (England and Wales), VAT No. 806 8067 22 Registered Office: International House, Queens Road, Brighton, BN1 3XE

Write a reply...
Reply
Hide
Reputation gems: You get these gems as you gain rep from other members for making good contributions and giving helpful advice.