Anonymous #1
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Hi

I've ended up getting a rotation with T&O being my first job as an FY1. Bit scared. Does anyone have any advice/tips/what the job will entail?

Thanks
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Angury
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(Original post by Anonymous)
Hi

I've ended up getting a rotation with T&O being my first job as an FY1. Bit scared. Does anyone have any advice/tips/what the job will entail?

Thanks
Is there anything specific that you're scared about?

Definitely try to speak to current F1s at the hospital to get an idea of what is expected ofyou. Some jobs include general surgery on-calls and some don't. It will depend on the hospital.

As an example, I did T&O for F1. I worked 8am-5pm Monday-Friday with no nights or weekends. The bulk of the job was Orthogeriatrics - mainly neck of femur fractures, although we did have a few pathological fractures. There was quite a bit of medicine as part of the day-to-day job. A lot of the patients had multiple comorbodities and some did become very unwell post-operatively. I was also quite surprised at the amount of 'breaking bad news' we had in the speciality.

It's helpful to have a general read about post-op complications, some idea of common analgesia and anti-emetics as well as VTE prophylaxis, although your hospital will probably have guidelines on this. I was also quizzed quite a lot about dermatomes as we had a lot of spinal surgeries.

T&O at my hospital was a very chilled job. I went to theatre a couple of times, clerked in patients in Fracture Clinic and in ED (as F1s we weren't expected to, I just volunteered) and learnt how to do things like knee aspirations. Surgical specialities sometimes have the reputation of juniors not feeling supported because of senior staff being in theatre etc. I have to admit, this was never my experience. I'm sure there are people here with opposite experiences though, it does depend on the hospital.

If anything, it will make you more confident in reading x-rays.

Here are two websites that I found particularly helpful:

https://radiopaedia.org/articles/des...re-an-approach

https://www.radiologymasterclass.co....ma_x-ray_page3
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Omar_Little
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My experience (as my first FY1 job in T+O) was very similar to the above.

My main day to day tips would be
1. Know where your patients are. Your seniors will love you if you have an up to date list with the patient locations on so they can efficiently go round patients and do what they want to do - be in theatre.
2. Clarify weight bearing status and what kind of wound management is needed. If you discharge anyone with a dressing or stitches is good to know when you might want them taken off/out.
3. Know your 'standard' follow up for different types of fractures and the booking system including who books the and how a patient be informed of the date.
4. As per the poster above, know how to describe a fracture, and ideally some of the classification systems for common fractures.
5. Same as the poster above, post-op complications. I actually say very few VTEs, probably as the profession is pretty good in general at preventing them. atelectasis was pretty common, fair few post-op cases of urinary retention too.
6. Find out what your hospital has in the way of orthogeris support, be it formal or informal. Many SpRs do not get too involved in the medical side and will direct you (inappropriately) to a med reg. A lot of things can be discussed with them. You will learn it fast as well.
7. Be familiar with your neuro exam, the ASIA chart and spinal anatomy. You won't necessarily need to know what to do with these patients, but you will need to know how to examine them.
8. DNAR discussions in my experience are often not done very much in ortho, but ought to be. This may vary a lot from place to place and be generally improving.
9. Do take as many opportunities as you can. I had no intention of being surgical, but that does not mean you should not be actively be trying to learn. Clinic stuff comes in VERY handy in GP, anything to do with fractures will always stand you in good stead for A+E, anything surgical is good for anaesthetics, there is a fair bit of gen mad in there too. Knee aspirates are a great thing to be able to do, and peripheral nerve blocks in hip fractures can prevent a lot of suffering.
10. Do a full medical clerking for your NOF fracture patients. It will save you time in the long run.
11. Don't order a CT scan unless you are clear in your mind why you want it done. If you know why your consultant wants it then fine, but I often wasn't able to work it out. Often due to my lack of ortho knowledge, sometimes because they probably didn't need to be done. But asking saved a lot of uncomfortable discussions with radiologists. Also, very general advice, don't ask for a contrast scan without knowing the renal function!
12. Know what your department expects in the way of anaesthetic pre-assessments as this will often be delegated to you, and what member of the anaesthetic team to call if you are unsure, because you will be. Also knowing the theatre booking system is a good thing to be asking abut on your induction.

Finally, enjoy it! They were a good laugh and they taught me a lot so I had a good experience there.
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Someone123123
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Nothing substantial to add here other than I've heard anecdotally that T&O for F1 is quite chilled, but can vary from hospital to hospital as above. Trying to speak to a current F1 should help allay your concerns
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Helenia
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I also did T&O as an F1, though it was my last job so I was familiar with the hospital and how it worked etc, which made it easier. I think people are a bit intimidated because of the reputation of the surgeons, but the job itself was actually fine even for me with zero interest in orthopaedics. Less busy, with fewer sick patients (bar a few poorly #NOFs) than general surgery, and early starts but often not too much ward work.

Your work will vary depending on what type of hospital you're in and what sort of consultant you're under, but you'll usually have a mix of elective and emergency (trauma) patients. Electives are usually fairly straightforward unless you're in a tertiary centre doing complex spinal/reconstructive work - but they still need drug charts, pain relief, occasionally fluids etc, and of course TTOs! There are often ERAS-type pathways for hip/knee replacement patients, so get to grips with those.

Trauma patients can be anything from super fit to nearly dead, and the nature of the beast is highly unpredictable. You've had lots of good advice above, and I can't think of much specific to add right now. You may get asked to present x-rays in trauma meeting, which can be scary at first but it's good practice for A&E etc! Make sure everyone has relevant bloods, including G&S (x2 if hospital policy!) in time for theatre.
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Ghotay
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My T&O job was a bit of a nightmare. Understaffed on every level. Pressure to do locums and extra shifts. Bleh. The team itself was great, but the system was letting us all down.

In addition to all of the above: Almost of your patients will be on painkillers, usually strong ones, laxatives, LMWH, and PRN antiemetics. Learn what your ward likes to prescribe (ask the ward pharmacist!), because you're going to writing them up a LOT
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