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Anonymous #1
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Hey Guys , IMG here who has recently started FY1. I am currently on General Surgery and am having a lot of trouble. It's only been 2 days into the job but I really feel like I am struggling compared to the other FY1's. I will give some examples.

Firstly I am struggling to remember patient details. The F1 colleagues im working with seem to remember the details of all the patients after reading their documentation once and can then proceed with jobs much easier (easier to talk to a consultant or pharmicist about managing a patient when you know everything thats going on with them). How am i supposed to rememeber when patient in

Also I feel like i just don't know whats going on most of the time. Everyone is just sort of doing jobs and i feel like I am the last one to figure out what needs to be done. When the attending comes in to review the patient I'm struggling to keep up with which patient i need to prep next and to write down all the jobs. Eventually another one of my F1 colleagues takes over and records all the jobs but then i find that i am out of the loop because i have no idea whats going on with the patient. How am i supposed to know when was the last time patient is bed 5 passed stools?

really confused but certain other concepts. First of all what does ''on call'' mean??? , I've googled it and am still confused . Way to embarrassed to ask anyone as its seems like something obvious. Also how do night shifts usually work?? , will i be responsible for covering every surgical ward?? , right now I've just been covering 1 ward.
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Chowoski
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First of all relax, take a deep breath.

The way you are speaking, it sounds like as if you haven't even gone through 5 years+ of medical, of which 3 years were clinical based. BUT YOU HAVE. You worked hard and now you made it to FY1. A lot of people don't make it this far trust me!
You need to take some steps to ensure what needs to be done.

You have just started FY1 - relax - most of your colleagues feel the same, its not just you. They may just not show it in the workplace but inside theyre scared and terrified. But dont worry its part of the job. You have to learn by testing the waters & making small mistakes.

Here are some pro-active steps you can take to fill in the gaps.

1) Carry a mini A5 note pad with you at work, all the time. On here you will write down the jobs you need to do. You will find time to write everything. Print out the list of patients from the computer and carry this with you aswell, so you can write notes on this & add and remove info about patients that is necessary. When listing jobs in your note pad, you need to measure by importance and prioritise. You will only realise which jobs are more significant/important by communication so thats step 2. On the list of patients paper, you can write all info on it eg. when blood was taken last, when last stool was etc. You seem to need that info so write it like your life depends on it. It doesn't need to be neat. Write it in a form, which you can understand.

2) Find a FY1 Buddy or 2 from the same ward/neighbouring wards., everyone does. All the FY1 generally work together cause youre all noobies - so dont worry. All of you will need to work together anyways so make friends now! For example, everyone needs to eat lunch, "so maybe one day tell one of them hey do you wanna grab lunch, its on me" - thats when you go to the hospital cafeteria. Communicate with everyone, FY1, FY2, Senior House officers (SH1), Registrar, consultant & nurses...they all have experience. Communicate and learn off them.

3) Every few hours, take 3-5 mins out to relax somewhere quiet, drink water. And restart. Break this long exhausting shift into mini shifts, 4-5 parts/chunks & have mini breaks in between to console yourself. This is a new job, this is the real deal & you are good enough. Sometimes we seem weaker, but we have all the skills. You just need to take extra measures to catch up so you can excel in your own unique way.

4) Try get an older mentor who has done FY1, even if you need to pay them for their time. Find someone who is willing to give you guidance on what jobs to do or what patients tend to commonly need etc when they have a certain problem. Most problems on ward are common, they have many common procedures. Find them, search them, record them.

Listen carefully, its going to be tough for a few months. The time is going to fly. You need to get through this and you will. Do what you need to do, you've got this far. Exercise whenever you can outside of work hours, even for 30 minutes. Love football? play some football with friends, Love Badminton? get a friend and play. You need to exercise & have fun too, if you want to get through this busy period of learning, research & being active on ward. Have parents? gift them flowers.

You are going to make this work.
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ecolier
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Hi Chowoski, I don't think you are a junior doctor (yet) are you?

(Original post by Chowoski)
...Communicate with everyone, FY1, FY2, Senior House officers (SH1), Registrar, consultant & nurses...they all have experience. Communicate and learn off them.
There is no one called SH1.... Senior House Officers isn't officially a grade any more.

3) Every few hours, take 3-5 mins out to relax somewhere quiet, drink water. And restart. Break this long exhausting shift into mini shifts, 4-5 parts/chunks & have mini breaks in between to console yourself. This is a new job, this is the real deal & you are good enough. Sometimes we seem weaker, but we have all the skills. You just need to take extra measures to catch up so you can excel in your own unique way.
Sometimes there simply isn't time to take 3-5 mins every time. Ideally of course he / she should but you'll need to be realistic too. Otherwise you'll end up staying late after work.

4) Try get an older mentor who has done FY1, even if you need to pay them for their time. Find someone who is willing to give you guidance on what jobs to do or what patients tend to commonly need etc when they have a certain problem. Most problems on ward are common, they have many common procedures. Find them, search them, record them.
No, no, please don't pay registrars or your seniors. It could constittue as bribing. Getting them a cup of coffee - possibly. But if an FY1 asked me for my help, I will get them something to drink and not the other way round!

Listen carefully, its going to be tough for a few months. The time is going to fly. You need to get through this and you will. Do what you need to do, you've got this far. Exercise whenever you can outside of work hours, even for 30 minutes. Love football? play some football with friends, Love Badminton? get a friend and play. You need to exercise & have fun too, if you want to get through this busy period of learning, research & being active on ward. Have parents? gift them flowers.

You are going to make this work.
Remember those post-grad exams too... That's when things really get interesting.
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Cheesychips1
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(Original post by Anonymous)
Hey Guys , IMG here who has recently started FY1. I am currently on General Surgery and am having a lot of trouble. It's only been 2 days into the job but I really feel like I am struggling compared to the other FY1's. I will give some examples.

Firstly I am struggling to remember patient details. The F1 colleagues im working with seem to remember the details of all the patients after reading their documentation once and can then proceed with jobs much easier (easier to talk to a consultant or pharmicist about managing a patient when you know everything thats going on with them). How am i supposed to rememeber when patient in

Also I feel like i just don't know whats going on most of the time. Everyone is just sort of doing jobs and i feel like I am the last one to figure out what needs to be done. When the attending comes in to review the patient I'm struggling to keep up with which patient i need to prep next and to write down all the jobs. Eventually another one of my F1 colleagues takes over and records all the jobs but then i find that i am out of the loop because i have no idea whats going on with the patient. How am i supposed to know when was the last time patient is bed 5 passed stools?

really confused but certain other concepts. First of all what does ''on call'' mean??? , I've googled it and am still confused . Way to embarrassed to ask anyone as its seems like something obvious. Also how do night shifts usually work?? , will i be responsible for covering every surgical ward?? , right now I've just been covering 1 ward.
Hi there, sorry to hear you’ve been finding it tough. I’ve only just started f1 as well.

ecolier (as per) has provided solid advice but I just picked up on a few specific things.
Regarding jobs - normally there is a system on the ward whereby you see the patients your looking after on the ward round, then write a list of jobs to be done. These can be seperated different ways - we have a little meeting with the other f1s and f2s after the ward round where we say whose doing what, and then a catch up after lunch to see how everyone’s getting on. Our patients are split by which consultant were covering so know which patients are ours.

in terms of when the patient last opened their bowels, and I hope this doesn’t sound patronising, but that’s quite important on general surgery?. Normally you can find this out via the nursing notes (usually a folder at the end of the bed, where the obs etc are) or it will be different if you have electronic notes. That sort of stuff (bowels opened) should be part of your patient review in the morning.
Normally on a ward round you want to check bloods, imaging, any drains/ catheters, wounds, obs, med changes and then a brief systems review (it will be different for every speciality and ward - i.e on general surgery - pain levels, bowels, passing gas, eating, vomiting etc).

As for ‘on call’ this again will vary based on your job so ask someone, but it normally means you’re responsible for clerking new admissions and might stay longer areas / cover extra wards or specialities.
Similar for nights, asked what’s required. You normally attend a handover, are given outstanding jobs to do and then will bleeped throughout.

As echoed above did you not have an induction or shadowing period?
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Anonymous #1
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ecolier - we don;t have jobs list. we only print out the list of patients and we have to add jobs under their name as we go to the ward round with the consultant and what they think should be done at the time. all the info of the patient is on the computer , we have to scroll through all the entries from the time the patient was clerked to the most recent ward round to figure out whats been going on with patient.
Also on my patient list it there is a column called attending which says which consultant is with which patient , so the term is something I picked up from a UK hosptial. Also i did all my med school abroad, didn't ever have to be in the hospital out of hours.


Chowoski - thanks for the words of encouragement. Reason I feel bad is cause I really feel like i am falling behind and its only been 2 days into working. People are discussing patients without me all the time (cause they know i wouldn;t know what to do anyway) and i feel like im just standing there just doing nothing. I think your right I probably need to start carrying a notepad and writing details down cause i simply just cant keep it in my head.
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Cheesychips1
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(Original post by Anonymous)
ecolier - we don;t have jobs list. we only print out the list of patients and we have to add jobs under their name as we go to the ward round with the consultant and what they think should be done at the time. all the info of the patient is on the computer , we have to scroll through all the entries from the time the patient was clerked to the most recent ward round to figure out whats been going on with patient.
.
That IS a jobs list, everyone writes jobs on the piece of paper with patients names as they go. I’m sure this will get easier with time.
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Zoe_bird
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Ahhh I’m really sorry to hear you are having a bit of a rough start to FY1! Definitely don’t feel disheartened I am sure everyone feels somewhat out of depth when they first start. Your FY1 colleagues who trained in the U.K. are more likely to find the transition a wee bit easier as they’ve had more time in local hospitals, and many medical school curricula tailor to the NHS, and many schools have this dedicated assistantship module close to graduation to better prepare graduands. You have basically been thrown into the deep end. To echo other people’s advice, don’t feel like you need to remember everything. I definitely recommend making job lists on plain A4 pieces of paper then throwing them away in confidential waste at the end of the day. Put a little square next door and shade it in once the job is done. Practice presenting patients to consultants/registrars/other doctors - it’s definitely a skill to learn to highlight all the salient points.

I am a medical student. The one thing about being a junior I’ve learned from doctors is never being afraid to ask for help, even if you feel like it makes you look stupid or “incompetent” because that’s not true. Patient safety comes first. If you are willing to learn, with time you will get better! I also recommend speaking to your educational supervisor about your worries; they can offer you more support and help. Good luck!
P.S with the jobs list, some doctors I’ve seen scribble on the handover sheet then they make a proper jobs list after ward round that’s neater and on a piece of paper!
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belis
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(Original post by Anonymous)
really confused but certain other concepts. First of all what does ''on call'' mean??? , I've googled it and am still confused . Way to embarrassed to ask anyone as its seems like something obvious. Also how do night shifts usually work?? , will i be responsible for covering every surgical ward?? , right now I've just been covering 1 ward.
Don't forget that if you have studied abroad your colleagues are at least 3 years ahead of you in terms of getting used to how NHS operates. You need to do some catching up fast as there is a point when people will stop cutting you slack and just start getting annoyed if you aren't up to speed. Find out if your local foundation school offers any additional induction. We have a number of 'New to the NHS' training days for IMG to help them settle in.
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Jckc123
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Where are you based?
Maybe some doctors from the same trust (or been in the same trust) here can offer some face-to-face advice.
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Helenia
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(Original post by Jckc123)
Where are you based?
Maybe some doctors from the same trust (or been in the same trust) here can offer some face-to-face advice.
This - or there's also a facebook group called Tea and Empathy which runs an FY1 mentoring service you may find helpful.
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girl_in_black
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Also, just to point out, it is still very early to panic - you have only been a doctor for 3 days! I have been a doctor for 3 years and and it still takes me a couple of weeks to work out what's going on when I start a new job.

General surgery is inevitably very busy, and if you have never been exposed to how things work in the NHS, it will be hell initially. Your patient list is your best friend - keep it updated and carry it with you everywhere and just take it out when someone starts talking about a patient. Everyone does this, including consultants and nurses (who have just a handful of patients to look after - not the whole ward!). Do not write your jobs down on the patient list on the WR - there is no time; write them down on another piece of paper and then transcribe them onto the patient list later. Prioritise your jobs - order scans first, then bloods if there is no phleb, then discharge letters, then anything else. As for when patients opened their bowels - there will be a chart with this next to the bed, you just need to look at it very quickly alongside checking the obs on the ward round. If there are other juniors on the ward rounds with you, maybe alternate writing in the notes, so one person writes and the other looks at charts and writes on the jobs list, and then swap. That way, you will have more time to finish off writing and won't miss any jobs.

It will be easier once you learn what your seniors prioritise and want to know, I promise! Your FY1 colleagues probably learnt this coming along on on the ward rounds as students, and it will take you a little time to work this out but you will get there. Good luck, general surgery is likely to be one of the busiest jobs you'll do, and it will prep you nicely for being efficient in your future jobs.
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Anonymous #1
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(Original post by Jckc123)
Where are you based?
Maybe some doctors from the same trust (or been in the same trust) here can offer some face-to-face advice.

Yea that could be helpful but i am worried about revealing the specific trust i work in as someone i am currently working with might realize who I am
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Anonymous #1
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(Original post by ecolier)
The region where you work?
east anglia, but don;t really know how that helps.
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Anonymous #2
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Thought to type this out so you do not feel alone but I am an IMG as well an I feel exactly the same as you. I feel out of my depth a lot of the time and I feel like people just expect you to know things a lot of the time like what a 'TTO' is?! I mean I do know what it is now but I remember my first day and hearing the word being thrown around and just thinking what the hell. I recently just failed my ILS course as well that all FY1's are mandated to do and tbh that has not helped my self esteem. I just learnt to do things a little differently and it was hard to get out of that mindset, guess I did not help matters by not reading the booklet before hand. Anyway, we have to keep pushing! We know this stuff. I have days where I feel confident and happy about how much I know and other days where I feel like a rubbish doctor. Sometimes, I feel like people in the UK are not friendly. I mean, they might give you a fake smile here and there and say hi but no one really cares cares, you know?! Sorry for my long rant but its hard when you're from a place where everyone is so friendly and appears to genuinely care about everyone.
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DrDanB
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(Original post by Anonymous)
Hey Guys , IMG here who has recently started FY1. I am currently on General Surgery and am having a lot of trouble. It's only been 2 days into the job but I really feel like I am struggling compared to the other FY1's. I will give some examples.

Firstly I am struggling to remember patient details. The F1 colleagues im working with seem to remember the details of all the patients after reading their documentation once and can then proceed with jobs much easier (easier to talk to a consultant or pharmicist about managing a patient when you know everything thats going on with them). How am i supposed to rememeber when patient in

Also I feel like i just don't know whats going on most of the time. Everyone is just sort of doing jobs and i feel like I am the last one to figure out what needs to be done. When the attending comes in to review the patient I'm struggling to keep up with which patient i need to prep next and to write down all the jobs. Eventually another one of my F1 colleagues takes over and records all the jobs but then i find that i am out of the loop because i have no idea whats going on with the patient. How am i supposed to know when was the last time patient is bed 5 passed stools?

really confused but certain other concepts. First of all what does ''on call'' mean??? , I've googled it and am still confused . Way to embarrassed to ask anyone as its seems like something obvious. Also how do night shifts usually work?? , will i be responsible for covering every surgical ward?? , right now I've just been covering 1 ward.
Pace yourself, talk to your seniors about your issues if they get serious, take a break every now and then, but most importantly give it your all and things will improve.
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