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I'd be incredibly surprised if you'd be the most senior doctor in A&E at night at FY2/SHO level... Is this a 'proper' A&E?
Original post by Anonymous
Does the new rotation anxiety ever go away? I'm an SHO now and despite it, everytime I rotate onto a new specialty I feel so anxious I can barely keep it together (will I cope? how will I ever get so many assessments done?).
It always works out and by the end of the 4 months I realise how silly it was for me to feel that way.. and yet it still happens.. Am I alone in feeling this??


We were discussing this during our Induction yesterday and everyone verbalised what you've just said. I find it all fits nicely after the first week or so.

I am due to start my first A&E rotation today and am rather apprehensive as well!
Original post by Anonymous
Does the new rotation anxiety ever go away? I'm an SHO now and despite it, everytime I rotate onto a new specialty I feel so anxious I can barely keep it together (will I cope? how will I ever get so many assessments done?).
It always works out and by the end of the 4 months I realise how silly it was for me to feel that way.. and yet it still happens.. Am I alone in feeling this??

I find ~4 months to be the point at which I begin feeling settled into a new department and somewhat confident about what I'm doing. Obviously it's also the point at which foundation jobs rotate, which isn't very helpful. But yeah, what you're describing is normal and relatable.

I really do think foundation jobs should be six months rather than four.

Anyway, I was off yesterday so today will be the first time I'll be staying on while practically everyone else has moved on :moon:
Original post by Democracy
The rota is draining and you will probably feel quite tired compared with psych, but it's a very good learning experience on the whole.


Bizarrely I found nothing more draining that sitting around having a chat in psych. In many ways I am sincerely looking forward to being properly busy again, I usually find it energising. But am definitely thinking that towards the end of some of those long stretches I'm going to flip into being exhausted yeah.

Are you still planning to do EM btw?

Original post by Etomidate
Are you sure about this? What grade are you?


I'm an F2. It turns out I was wrong, there is an EMP (Emergency Medicine Practitioner GP) on overnight with you. I got confused with some other hospitals in the region where the F2 IS the most senior on overnight, but they are also smaller hospitals. I guess my hospital is still quite unusual in that as an F2 you are expected to see/discharge many patients independently, whereas I know in most hospitals that is not even allowed.

And yeah consultants and anaesthetist etc are on-call so all are available.

After induction I feel a bit better about the whole thing. Hoping I can get hands on and have some fun. Start on leave for a week though so a wee holiday first :biggrin:
After a cushy first rotation in F1, doing a medical ward-based job as a second rotation is pretty daunting. I feel like I am moving at a glacial pace and I'm badgering seniors with questions too often. But at least it feels more like being an actual doctor instead of a cannula/discharge letter monkey.
(edited 5 years ago)
Transitioning from surgery to medicine is proving interesting... I wonder how quickly I'll get use to the lack of autonomy.
Luckily I already knew the team I was joining well as we shared a ward.

How is everyone else finding their new jobs?
Original post by Ghotay
Bizarrely I found nothing more draining that sitting around having a chat in psych. In many ways I am sincerely looking forward to being properly busy again, I usually find it energising. But am definitely thinking that towards the end of some of those long stretches I'm going to flip into being exhausted yeah.

Are you still planning to do EM btw?

Oh yeah, I find chatty specialties really draining. I think A&E is tiring and busy but in a good way (mostly). But no, it's not something I'm planning to do long term.
I think I got a lesson in economics today. Omfg the stroke ward is soooo well funded. So many staff, so much space, able to completely decline any outliers in case it messes up their targets and hence their funding. Their own rehab ward so they can get discharges way faster than literally anywhere else. As in, around here a fast-track discharge for carers or NH takes like 3-4 weeks, on stroke their patients wait on average 3-4 days. As such their care is so much better - we actually spend time carefully assessing the patient and doing geriatric depression scores and the like, not just rushing around doing the bare minimum like acute med!

Hopefully a much better job than my last 4 months!
Original post by Anonymous
I think I got a lesson in economics today. Omfg the stroke ward is soooo well funded. So many staff, so much space, able to completely decline any outliers in case it messes up their targets and hence their funding. Their own rehab ward so they can get discharges way faster than literally anywhere else. As in, around here a fast-track discharge for carers or NH takes like 3-4 weeks, on stroke their patients wait on average 3-4 days. As such their care is so much better - we actually spend time carefully assessing the patient and doing geriatric depression scores and the like, not just rushing around doing the bare minimum like acute med!

Hopefully a much better job than my last 4 months!

HASUs are like CCUs were i nthe days of thrombolysis
Original post by Ghotay
And another changeover day rolls around...

Honestly cannot wait to see the back of this job. Have had more problems on it than I could ever have imagined. Suffice it to say I have definitely concluded psychiatry is NOT for me.

That said although I've been looking forward to A&E all year, now that it's upon me I'm kind of scared. The rota is brutal, the hours unsociable, I don't know how to suture, I haven't really done any medicine in 4 months, and in my hospital I could be the most senior person in the department overnight (supported by NPs).

Any advice anyone?

Out of curiosity what discouraged you so strongly from psychiatry? The increase in foundation posts is supposed to be the answer to our recruitment crisis but it seems that the majority are put off as opposed to encouraged after rotating through psychiatry.
Original post by Anonymous
I think I got a lesson in economics today. Omfg the stroke ward is soooo well funded. So many staff, so much space, able to completely decline any outliers in case it messes up their targets and hence their funding. Their own rehab ward so they can get discharges way faster than literally anywhere else. As in, around here a fast-track discharge for carers or NH takes like 3-4 weeks, on stroke their patients wait on average 3-4 days. As such their care is so much better - we actually spend time carefully assessing the patient and doing geriatric depression scores and the like, not just rushing around doing the bare minimum like acute med!

Hopefully a much better job than my last 4 months!

I wanna know which stroke ward you're working at. Mine had multiple patients who had been delayed discharge for 4+ months (one bloke came in with a PACS in Christmas and is still on the ward the following Christmas - he completed stroke rehab after about 8 weeks). Whereas the thrombolysis fairies would come in and wisk all our TACSes away within a week hehe (facetiousness aside, this is because people who are thrombolysis candidates tend to do better and can go home without waiting for social care - and can just go home with reablement, or to bridge the gap alone while awaiting reablement). .

I've gone the other way: from stroke to acute med. I agree with the sentiment of doing the bare minimum to make the patient safe and start them in the right direction, then sending them off. Not really holistic care!
The HASU model generally works very well but situations in which patients are transferred to hasu centres from non hasu hospitals (Ed or inpatients) sometimes has the potential to cause more harm than good
It will truly mark the end of an era :moon:

https://www.bbc.co.uk/news/uk-46497526

(If it actually comes to pass :rofl2:)
Original post by Democracy
It will truly mark the end of an era :moon:

https://www.bbc.co.uk/news/uk-46497526

(If it actually comes to pass :rofl2:)


I was just talking about this.

It annoys me so much when x speciality's secretaries are like:

'Ah yes just type out a referral and fax it to us we will give it to the consultant'
'Erm, why don't I just email it. Then I can save paper, it saves me 10-15 mins of faffing with the fax machine, its more reliable and there is a record of it, I can copy it to my seniors, and I can even just copy in said consultant so they can see it direct saving you work too'
'Errrr... no just fax it'
:mad:

I am surprised that a key motivation seems to be cyber security though. Fax is so old and outdated and absolutely nowhere else uses it that I'd imagine most cyber criminals wouldn't even think to try to hack it :p:
Did anyone else feel the need to look over their medical school notes during F1? I feel like whilst I did learn a lot of more admin-y things about how wards and hospitals work and the immediate management of acutely unwell patients, I've pretty much lost most of the medical knowledge that I had just before finals.
Any tips on how to survive a rotation that you hate?
I'm currently in a job with dreadful on-call pressures, I'm terrified of making a mistake and getting shouted at by a senior, and everyone around me seems constantly angry and/or fed-up and it's really getting to me.

I feel I just need to switch off any emotional connections to the job and just clock-in and clock-out over the remaining months, which is difficult as I went into medicine so that I could enjoy my work and have always tried to be as invested as possible in whatever I do. I feel however I won't be able to cope if I keep doing this.

Any tips??
Original post by Anonymous
Any tips on how to survive a rotation that you hate?
I'm currently in a job with dreadful on-call pressures, I'm terrified of making a mistake and getting shouted at by a senior, and everyone around me seems constantly angry and/or fed-up and it's really getting to me.

I feel I just need to switch off any emotional connections to the job and just clock-in and clock-out over the remaining months, which is difficult as I went into medicine so that I could enjoy my work and have always tried to be as invested as possible in whatever I do. I feel however I won't be able to cope if I keep doing this.

Any tips??


How long have you been in this job?
Anyone know how I change my f2 jobs to a different trust ? I’m guessing through oriel but can i apply for a teaching f2 ?
Original post by Anonymous
I'm currently in a job with dreadful on-call pressures,

Can you expand any more on this? In many hospital jobs the workload is high but this is usually made more manageable by taking your breaks and leaving on time to ensure adequate rest, and having appropriate access to senior support/advice. If these things are not happening then if you work in England you should exception report. If you don't work in England then ask for a meeting with your supervisor to escalate your concerns.
You can't do much about people being grumpy around you but try not to let it rub off on you. Do your best for your patients and take satisfaction in that. If you are in F2 you could book some taster days in another specialty to give yourself time away from this one you dislike.
Original post by belis
Out of curiosity what discouraged you so strongly from psychiatry? The increase in foundation posts is supposed to be the answer to our recruitment crisis but it seems that the majority are put off as opposed to encouraged after rotating through psychiatry.


So many things I don't even know where to start. I recognise that some of these weren't specific to psychiatry, but still soured the whole experience

1) Extremely difficult, micromanagey supervisor who didn't listen to a word I said. No one else in the department got on with him. And for that matter, no one else warned me or helped me manage him
2) Firm system that meant that I spent ALL of my time working under the direction of my supervisor, and very limited time with anyone else
3) I was doing home visits much of the time so could be rather lonely. I also found out after a brutal TAB that almost no one realised that was my job, and they thought I was playing hooky. I literally got 'I don't know where this trainee is most of the time' in my feedback
4) I was also criticised for spending too much time working alone and in the office, rather than chatting to patients, CPNs etc. I did all of the work that I was required to do, and when there is nothing to be done I prefer to work alone quietly at a computer or something. I resented the fact that chatting with a cup of tea was considered a mandatory part of the job
5) Huge amounts of dictation, which I didn't particularly enjoy but was manageable, however the system also basically mandated that we write everything separately on separate systems - write it in the notes, in the A&E notes, in the letter, in the email to the GP, on the discharge summary. ended up writing most things at least in triplicate and felt utterly pointless
6) Literally not enough work to go around a lot of the time. This was related to the rota because we ended up having 4 trainees where there were usually only 2 or 3. So I spent a lot of time sitting around and really resented having to go to work at 9am when I didn't do anything useful until 11am, but also wasn't allowed to go and entertain myself elsewhere. It felt like a prison. And even when there were things to do, the pace felt glacial. I very rarely felt like I 'achieved' anything
7) Having less to do somehow created MORE bickering amongst the trainees about who should do what, and there were some significant personality clashes amongst us.
8) Something about the whole atmosphere of psychiatry and how mental illness was spoken about felt very invalidating to me as someone who has always struggled with my mental health, but never to a psychiatric-input level. The chat was all very despondent and negative. Most of the psychiatrists freely admitted that they didn't really help people. One said that he felt he treated a patient about once every 6 months.

It wasn't all terrible, obviously I'm only going over the bad bits, nevertheless the overall experience of the job was definitely a negative one. Of the 4 trainees, 2 of us definitely hated it, 1 I don't actually know if she enjoyed it or not, although I suspect not, and 1 really enjoyed it and ended up putting psychiatry as her second option on speciality applications having never considered it before. I think she enjoyed the slow pace because she struggles with stress, so it perhaps suited her personality. It made me want to chew the walls