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PRINCESS OF WALES HOSPITAL
FOUNDATION DOCTOR’S HANDBOOK
Revised August 2019
Original Authored by Amy Butlin (August 2018)
Contributors
Lizzie Grant Hannah Williams
Catherine Richards Rachel Price Chloe Bussell
Hannah Lexton Natalie Hughes
Charlotte Gilbert Tomos Kamal
Alison Edwards
Editors
Amanda Farrow Thomas Mercer
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CONTENTS Top Tips for Being a Foundation Doctor .................................................................................... 4
Getting Around .......................................................................................................................... 5
Wards ............................................................................................................................................................. 5
Door Codes ..................................................................................................................................................... 5
MPEC (Multi-Professional Education Centre) ............................................................................ 7
MPEC Contacts ............................................................................................................................................... 7
On-call shifts .............................................................................................................................. 8
F1 1200-0000 Medical Shifts .......................................................................................................................... 8
F1 0800-2030 Surgical Long Days .................................................................................................................. 9
F1 2100-0900 Medical Nights ...................................................................................................................... 10
F2 2000-0800 Surgical Nights ...................................................................................................................... 10
F2 0900 - 2130 Medical Long Days .............................................................................................................. 12
F2 1700 – 2130 Evening Ward Cover ........................................................................................................... 13
F2 0900 – 2130 Weekend Ward Cover ........................................................................................................ 14
Emergencies ............................................................................................................................. 14
Rapid Response Call ..................................................................................................................................... 15
Cardiac Arrest Calls ...................................................................................................................................... 15
Useful Numbers ........................................................................................................................................... 15
Hospital at night H@N ............................................................................................................. 16
The role of the Out of Hours Nurse practitioner ......................................................................................... 16
The Role of the OHNP acting as Site Manager ............................................................................................ 16
The Hospital @ Night SharePoint site. ......................................................................................................... 16
How to request a weekend review .............................................................................................................. 17
Top Tips for H@N ......................................................................................................................................... 18
The Out of Hours Nurse Practitioner ........................................................................................................... 18
MEDICINE ................................................................................................................................. 19
ACUTE MEDICAL UNIT .................................................................................................................................. 19
STROKE ......................................................................................................................................................... 20
CARDIOLOGY ................................................................................................................................................ 22
RESPIRATORY ............................................................................................................................................... 23
GASTROENTEROLOGY .................................................................................................................................. 24
ENDOCRINE AND DIABETES ......................................................................................................................... 25
GERIATRICS NEATH/PORT TALBOT (F2 ONLY) ............................................................................................. 26
OLD AGE PSYCHIATRY .............................................................................................................. 27
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GENERAL ADULT PSYCHIATRY .................................................................................................. 28
EMERGENCY MEDICINE ........................................................................................................... 29
PAEDIATRICS ............................................................................................................................ 31
ITU/ANAESTHETICS .................................................................................................................. 32
PALLIATIVE CARE ...................................................................................................................... 33
CARE OF THE ELDERLY AT POWH ............................................................................................. 34
GENERAL PRACTICE .................................................................................................................. 35
Travel Expenses ............................................................................................................................................ 35
SURGERY .................................................................................................................................. 36
COLORECTAL SURGERY ................................................................................................................................ 36
UPPER GI SURGERY ...................................................................................................................................... 37
BREAST SURGERY ......................................................................................................................................... 38
E-PORTFOLIO ............................................................................................................................ 39
TEACHING ................................................................................................................................. 41
Mandatory Teaching .................................................................................................................................... 41
Rapid Response Training .............................................................................................................................. 41
Grand Round ................................................................................................................................................ 41
LOOKING AFTER YOURSELF ...................................................................................................... 42
Places to eat ................................................................................................................................................. 42
...................................................................................................................................................................... 42
Fatigue the facts ........................................................................................................................................... 47
Get help early ............................................................................................................................................... 48
.................................................................................................................................................. 49
.................................................................................................................................................. 49
GOOD LUCK .............................................................................................................................. 49
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TOP TIPS FOR BEING A FOUNDATION DOCTOR
Welcome to the Princess of Wales Hospital!
It’s a small and friendly hospital and we hope you enjoy your time here. This guide has been written by Foundation Doctors for Foundation Doctors.
In this handbook we present the most useful information we think you need to know.
We recommend you download a copy to keep on your phone for reference.
Try and have a browse through so you know the contents. It will be a reliable companion in the future!
All that remains to be said is good luck!
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GETTING AROUND
WARDS
SSU (Side entrance) - Surgical Short Stay
AMU (ZONE D) - Acute Medical Unit
Ward 2 (ZONE D) - Stroke
Ward 4 (ZONE D) - Cardiology
Ward 5 (ZONE L) - Respiratory
Ward 6 (ZONE L) - Gastroenterology/Endocrine/Gen Med
Ward 7 (ZONE M) - General Surgery
Ward 8 (ZONE M) - General Surgery
Ward 9 (ZONE N) - Trauma and Orthopaedics
Ward 10 (Zone N) - Trauma and Orthopaedics
Ward 11 (Zone O) - Gynaecology
Ward 12 (Zone O) - Obstetrics / Maternity Unit
Ward 14 - Psychiatry (acute)
Ward 18 - COTE
Ward 19 - COTE
Ward 20 - COTE
Y Bwythyn - Palliative Care Unit
Day Surgery Unit - Day Surgery
Bridgend Clinic (Above SSU) - Private Clinic and Surgical Outliers
Pendre Day Unit - COTE Day Hospital
Coity Clinic - Mental health unit
DOOR CODES LAB OUT OF HOURS – SURGICAL SEMINAR ROOM – DOCTORS’ MESS - SURGICAL SECRETARY –
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MPEC (MULTI-PROFESSIONAL EDUCATION CENTRE) MPEC is your first port of call for all post-graduate administration issues. If you have questions or need help with your portfolio, MPEC can help. They can resolve issues regarding access, navigation, WBPA requirements etc. MPEC is also responsible for authorising study leave expenses. These must be claimed using the trusts online expenses system which can be complicated. If you’re unsure how to use this, ask MPEC. Contact Wendy Jones or go to the MPEC office.
MPEC CONTACTS Wendy Jones Foundation Programme Administrator [email protected] Ex. 52070 Dr. Gwilym McMillan Foundation Programme Director for POW Consultant Geriatrician [email protected]
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ON-CALL SHIFTS
F1 1200-0000 MEDICAL SHIFTS Medical clerking on AMU. Attend AMU for 12pm. No formal handover required. New patients waiting to be seen are stored in the “rack” by the white board. They’ll have a laminated card around them to determine the triaged order in which they’re to be seen – it’s a traffic light system, RED – EMERGENCY, ORANGE – URGENT, GREEN – NON-URGENT. Put your name on the whiteboard next to the patient and a patient ID sticker in the green folder on the desk. Nurses will have triaged, obtained IV access, sent bloods and usually requested an ECG +/- CXR prior to medical clerking. Clerk the patient, making sure to look at old letters and discharge summaries. Make an initial management plan and prescribe any treatment. Ask for senior advice if needed from the on-call CMT or any of the ward day team (there’s plenty of people around until 9pm). All F1 patients need senior review so will be post-taked by AMU consultant during the day or the Medical SpR on-call overnight. Make sure this is done before you leave. After 9pm the department closes so no further referrals will be taken. Patients who have already been referred may still arrive after this time – if there is no-one left to be seen then you can always help out with the jobs on H@N. Otherwise cover ward jobs on AMU and handover any outstanding jobs to the night F1 at the end of the shift.
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F1 0800-2030 SURGICAL LONG DAYS Go to surgical seminar room at 8am for handover (on the corridor of Ward 7/8, it’s a key code door just as you turn in on the left hand side). Clerking shifts are split between the post-take ward round with the surgical team and clerking the GP SURGICAL admissions to ED. ED referrals are seen by the SHO. Use the surgical clerking proforma. If a patient might be a candidate for theatre, make them NBM until the SpR has reviewed. Consider requesting an AXR and taking a VBG. These are often appropriate for most patients. A Group and Save will be necessary if they’re for theatre. Prescribe analgesia / antiemetics / fluids if needed. Wait for a senior review before requesting scans. If there are no patients to clerk, help the day team with jobs – it’s a good opportunity to familiarise yourself with patients who may need to be reviewed out-of-hours later on your shift. After 4pm, cover the wards marked SURGICAL above and do the jobs on H@N (all day at weekends). ED will call you when GP expected patients begin to arrive – you should see these patients as promptly as possible since once the queue starts to build up it is difficult to catch up. If there is a long wait to be seen you should escalate this to your Surgical Registrar or the on call Consultant. Please inform the Nurse in Charge in ED: When you are seeing a surgical patient The plan for the surgical patient once you have finished if they require a bed if they are being discharged from ED - you will also be required to complete a paper discharge summary for the GP. Whilst in ED if you are unsure of where to find anything please ask the Nurse in Charge. Make sure you keep a list of patients you’ve seen and their location so they don’t get lost. You’ll need to update the take lists at the end of the day. Handover at night to the on-call surgical team.
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F1 2100-0900 MEDICAL NIGHTS Meet ED seminar room at 9pm for handover (leave your bag in the mess first). This is on the main corridor as you walk into ED from the hospital entrance in Zone C (opposite Paediatrics). Take the phone from the day SHO. This is primarily a medical ward cover shift, however, you should help the surgical F2 cross-covering overnight with H@N tasks as they have a busy job and ultimately, if their patients get sick, you’ll be called to see them anyway. They may contact you for help. If the wards are quiet, you can help by clerking medical referrals in ED. Don’t be afraid to call the SHO or SpR overnight for advice – they expect it and will be more than happy to help. Try to have all the information to hand and ask a specific question, “I’m not sure what this XR shows”, “I don’t know what to prescribe” etc. The SpR will want to know if a patient is very sick, so tell them. Often you can start the night in AMU and check in with the 12-12 F1 – if they are inundated then help by clerking outstanding AMU admissions. The wards will often call you with jobs but unless it is an emergency, they should be calling the Nurse Practitioner before contacting you or put them on H@N instead. If you feel that the call is inappropriate, ask if they’ve contacted the Nurse Practitioner first and if they haven’t, direct them there. If they have and you’re still not sure, take the details then speak to the SHO. Work through jobs on H@N and remember to save and close it on every computer once you’ve finished. Do not leave it open because you won’t be able to access it from the next ward. If you feel jobs are inappropriate overnight, write on H@N besides the job to register your concern – the Nurse Practitioners audit this and can use it to better the service. You don’t have to do every job. Prescription requests like laxatives at 2am are not essential and ought to be reviewed by the day team. If a patient is impacted, an overnight enema may be appropriate. The lab has a code overnight () and boxes to drop samples for biochem/haematology/microbiology – call ahead if bringing an ABG or urgent sample/ crossmatch as the bloods boxes do not get checked constantly.
F2 2000-0800 SURGICAL NIGHTS
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Surgical nights will vary from ‘alright actually’ to ‘the most stressful night of my life so far’. Work is being done to improve this and your feedback is important. Below are some pearls of wisdom from your predecessors... You’ll be the SHO for General Surgery (SpR on-site) / Trauma and Orthopaedics (SpR off-site) / Urology and ENT (usually a consultant on-call off-site). You are also part of the cardiac arrest / trauma-call / rapid response team. This is a lot of responsibility and you should be prepared to have more jobs than can realistically be done, so don’t try to complete them all. Prioritise them. If it’s not life or limb-threatening then it doesn’t need doing immediately and often jobs may not need doing overnight at all. Be confident. If people try to pressure you into doing a less urgent job, remember, the other patient you should be seeing will suffer because of poor prioritisation so take the details, tell them you will do it as soon as you can and continue to manage your own workload independently. Handover is at 8pm in the surgical seminar room (corridor between wards 7/8) for General Surgery / Urology. The ENT / Trauma SHO works until 2030 and should provide you with a handover. If they don’t, call them for it. You cover wards 7 / 8 / 9 / 10, Surgical Short Stay Unit and GP referrals. The ED staff will let you know when GP referrals have arrived. They’ll generally get bloods on arrival if you ask but you will need to request any XR’s etc. ED referrals for Trauma / ENT / Urology are phoned through to you. Referrals for General Surgery overnight are made to the Surgical SpR. If ED try to refer to you, direct them to the SpR. Most T+O problems require no more than a drug chart and some analgesia. Find out if there are any problems on Ward 9 / 10 early, to allow you to tackle them and hopefully you won’t be disturbed any further overnight. Don’t be afraid to call the SpR’s / Consultants at home. They are paid to be on call and are aware that many of the F2s have little or no experience of their speciality. Make sure you have seen the patient and have all of their information to hand when you call. If you’re wondering whether you should phone someone, phone them, or you’ll worry about it all night. Remember you have support and advice on site from the ED SpR, Medical SpR and ITU on-call. If you’re unsure what to do or have been given advice you’re not happy with, contact any of these people depending on where you are and they’ll be happy to help. Don’t be pressured into consenting for or performing procedures you don’t understand / have no experience of. Ask for help if necessary. If no help is available or it is declined, then document the steps you have taken and who you have spoken to. If there is a patient safety issue, ask one of the SpR’s above for advice. There is a nurse practitioner (sometimes 2) on the wards overnight. They filter calls and will sweep up jobs like bloods, cannulas etc. when they can. Be nice to them. They’re often your only friend at night and can make your life a lot easier. Let them know if you are called to theatre, so they are aware you are not available to see unwell patients on the ward.
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If you find you’re exceptionally busy, try asking the Medical F1 on nights to lend a hand with specific jobs you can outsource – they should be expecting this, since it says above. Direct any non-urgent jobs to be put on H@N. Check this regularly. Any urgent issues will be phoned straight through to you. Always take your break. You’re entitled to a total of one hour on this shift and you’ll perform a lot better if you rest. Unless someone is critically unwell on the wards, referrals can wait for half an hour while you eat/drink something.
T+O For any T&O admissions that arrive before 22:00 the registrar may be around and you can call and ask if
they want to clerk together. If not, use the pink proforma from the white shelves in majors (there is a
separate blue proforma for #NOFs). The proformas are very thorough but just make sure they have
analgesia, thromboprophylaxis and NBM status if required. The ED doctors will do most things for T&O
including blocks for NOFs and reductions / casts for fractures. Around 06:00am the reg will call and ask
about who you have admitted overnight. If you have anything to handover to the SHO in the morning, tell
the surgical F1 on call at 08:00am and they will hand over to the T&O SHO at 08:30am. TIP: download the
app “Orthoflow” for help with x-rays and management plans for T&O problems.
ENT For ENT admissions there is an off-site registrar or consultant on-call overnight. Clerk in patients using
normal continuation sheets – there is no proforma. If you are admitting children – call the paeds ward and
ask if they have beds available first. Make sure to use a paediatric drug chart. If you have anything to
handover to the SHO in the morning, tell the surgical F1 on call at 08:00am and they will hand over to the
ENT SHO at 08:30am. TIP: download the app “Entsho” for information about all kinds of ENT problems and
thorough management plans for each.
F2 0900 - 2130 MEDICAL LONG DAYS
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Start at 9am and track down the post-take round by calling the F1 on nights. If you can’t get hold of them, go to ED. Take their phone and it becomes yours for the day. You are responsible for post-take ward round jobs and then for clerking in ED. During the day it is generally the SpR and F2 from the on-call team clerking in ED. They are joined by the CMT (9am) / F1 (12pm) / 2nd SHO (2pm) in AMU for the GP referrals. Make sure every patient you see has a sticker put in the folder, usually on the main desk in ED as the consultants use this as their post-take list. From 1700-2100 there is another F2 covering the wards, so you don’t have to leave ED (unless you’re not doing anything and want to give them a hand). These are generally straightforward days, involve back to back clerking and tend to be well supported. Handover to the night team at 2100 in the ED seminar room. Please inform the Nurse in Charge in ED: When you are seeing a surgical patient The plan for the surgical patient once you have finished if they require a bed if they are being discharged from ED - you will also be required to complete a paper discharge summary for the GP. Whilst in ED if you are unsure of where to find anything please ask the Nurse in Charge.
F2 1700 – 2130 EVENING WARD COVER
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Collect the bleep from switch before 1700. Shortly after you start, scroll through the H@N jobs and work out an order in which you need to do these. Work through the jobs as you’re able and make sure you sign them off once complete! At the end of your shift, for anything urgent handover at 2100 in the ED seminar room, otherwise put them on H@N and return the bleep to switch.
F2 0900 – 2130 WEEKEND WARD COVER Collect the bleep from switch at 0900. Meet the ward cover CT either in the mess or in ED with the long day team. Work your way through the H@N jobs for each ward together. Generally, the morning involves patient reviews for discharge/fluid balance/IV-PO switch etc. You will be expected to take calls from wards about unwell patients needing urgent review. In the afternoon the nurse prac will help to chase bloods and will highlight the abnormal results that require action. Work through the H@N jobs as able until 1700 If sick patients need handing over, hand over to the CT/F1 in AMU who will cover the wards from 5 onwards Hand your bleep back to switch TIP: on the weekends, phlebotomists will only take bloods from patients in bays on the wards – not the cubicles. If there are sick patients in cubes who you know will require bloods, ask the nurse pracs nicely or take them yourself early on in the day. Also, if there are not an overwhelming amount of jobs in the morning, leave W4 jobs till the afternoon – they are notorious for finding jobs for you and you will be stuck there for hours!
EMERGENCIES
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RAPID RESPONSE CALL Rapid Response Call’s are activated by the nursing staff when a patient is causing serious concern either clinically, or because their NEWS score is high. You’ll get a tannoy over your phone to request an urgent review. You should attend immediately. The members of the rapid response team are:
- Medical CMT - Medical Day F2, Ward Cover F2 and Night F1 - Surgical Day F1 and Night F2 - Critical Care Outreach Nurse or OOH’s Night Nurse Practitioners
The *****Bleep is the Medical BATON Bleep and si the emergency bleep handed over from Medical Day F2 to Ward Cover F2 to Night F1
CARDIAC ARREST CALLS Cardiac arrest calls are exactly that, so attend immediately! The members of the cardiac arrest team are:
- Medical SpR - Medical CMT - Medical Day F2, Ward Cover F2 and Night F1 - Surgical Day F1 and Night F2 - ITU plus ODA - Critical Care Outreach Nurse of Night Nurse Practitioners
The ***** Bleep is the Medical BATON Bleep and si the emergency bleep handed over from Medical Day F2 to Ward Cover F2 to Night F1 F1s are often asked to get IV access / take bloods / ABG. F2’s are usually asked to perform an ABCDE assessment or get an ABG.
USEFUL NUMBERS
NUMBER DAY NIGHT
12-12 MEDICAL F1 ----
MEDICAL F2 MEDICAL F1
SURGICAL F1 SURGICAL F2
MEDICAL SHO MEDICAL SHO
WARD COVER SHO ----
MEDICAL REG MEDICAL REG
SURGICAL SHO ----
SURGICAL REG SURGICAL REG
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HOSPITAL AT NIGHT H@N THE ROLE OF THE OUT OF HOURS NURSE PRACTITIONER The OHNP service starts at 19.30 hrs and ends at 08.00hrs, Monday to Fridays, covering 24hours over weekends and bank holidays. Two OHNP’s should be on duty at any one time, one as a designated site manager, the other as clinical support for both medical and surgical teams.
THE ROLE OF THE OHNP ACTING AS SITE MANAGER The Site Manager will provide site management support and coordinate patient flow, between 19.30hrs and 08.00hrs hours a day, 7 days a week. In addition, the site manager will provide senior nursing support, professional leadership and advice to all adult general clinical areas within the Princess of Wales Hospital. In addition the site OHNP will: .
Participate in and co-ordinate the Emergency Response teams to fire, security alerts, and act as the point of contact and co-ordination within the Princes of Wales site.
Be responsible for scrutinising and receiving the required documentation, which taken to ward 14 for collection by the responsible Mental Health Act administrative staff.
Liaise closely with the ward teams to ensure that appropriate patients are identified to the outreach team and multidisciplinary H@N team.
Provide a single point of access for ward based teams.
Prioritise and filter the work of the multidisciplinary H@N team.
Communicate with outside agencies and escalate information as per appropriate policies.
Coordinating emergency situations i.e. fire, major incident, critical incidents.
Assess nursing staff workload and offer support to staff by delegating and liaising appropriately.
Joins/Leads multi-professional clinical handover out-of-hours as Clinical/Operational workload
allows. Ensure a member the H@N practitioner attends in clinical site managers’ absence.
Support the multidisciplinary H@N Team by providing the first point of contact for ward staff;
undertaking limited clinical work as able and liaising with junior medical staff as necessary.
Ensure practice complies with LHB’s policies and procedures.
Provide clinical leadership and maintain credibility through practice and professional update.
Provide clinical support, professional advice, consultation and direct assistance to colleagues as
necessary.
To be the first point of contact for ward’s and departments, relating to complaints, accidents and untoward incidents involving patients, staff and visitors and to take appropriate actions in response
THE HOSPITAL @ NIGHT SHAREPOINT SITE.
All calls and responses are logged by the site manager and saved on the H@N SharePoint site.
Every ward has a designated computer upon which there is link to the Hospital @ Night [HAN] page. Ward staff have been provided with training on how to use this site.
It is the responsibility of nursing staff to enter tasks on the appropriate section of the HAN page and contact Cisco ***** BEFORE contacting medical staff.
Routine tasks such as venflons, bloods, and prescribing will be entered onto the left hand side of the sheet by the ward based teams
Where a clinical review is required, including a patient fall, details will be entered onto the right hand side of the sheet. The site manager will instruct the staff to contact a most appropriate available member of the HAN team.
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Tasks that do not require action by the Out of Hours team will be deferred to the next day e.g. re writing of drug charts, prescribing of non-urgent medications. To assist with this routine work should be completed by the ward based teams responsible for the day to day management of the patient.
It is absolutely reasonable to leave non-urgent tasks for the morning/day team if deemed unnecessary. Occasionally you may feel that a task is unsuitable for H@N – if this is the case, write this next to the task (in red) and leave your initials for the nurse pracs to audit – it’s a way to help us improve the way H@N is used.
HOW TO REQUEST A WEEKEND REVIEW
- Select the day that the review is required - For a clinical review enter the patients’ details on the right hand side of the sheet - For bloods or prescribing enter these requests on the left hand side of the sheet - To minimise the weekend teams workload please ensure that blood forms are completed, put out
and clearly dated
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TOP TIPS FOR H@N
Do
- Select your bleep number from the drop down box in the ‘sign off’ column - Enter the time you complete a task - Refer to the ‘TASKs’ section to discover where work is outstanding on wards - Save and close ward sheets prior to leaving the clinical area
Don’t
- Open multiple ward pages at the same time – this risks overwriting, duplication or loss of ward sheets, it does happen and you’ll be responsible
- Leave sheets open as they cannot then be accessed by the OHNP / ward staff updating the system
THE OUT OF HOURS NURSE PRACTITIONER Every member of the OHNP team can function as either the site manager or as the clinical OHNP. Every OHNP is an experienced nurse with a wide range of clinical knowledge and experience. When working as a member of the H@N team, they are able to assess patients and request investigations including bloods, ABG’s and XR’s. They are also able to cannulate patients. OHNP’s can set up CPAP and NIPPV while a patient is waiting to be transferred to the correct clinical area for ongoing treatment. If you are seeing a patient, please do not leave cannulas or blood tests for the OHNP to do for you as this may delay patient care. In this case, do them yourself and instead the OHNP will likely do the non-urgent cannulas for you throughout the night.
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MEDICINE
ACUTE MEDICAL UNIT Where are you based? AMU Supervisor: Dr. Hounsell Rota coordinator: Dr. Hounsell
Kate Graham (ED) How to apply for leave: The AMU team uses a Google Calendar for the rota. This is organised by Dr. Hounsell. You can access the Google Calendar using the account [email protected]. The password is penybont. Please only use this whilst you are on AMU. Identify early where you want annual leave, it’s common for everyone to wait until the end of the block and then it becomes nearly impossible to take. Mark any A/L as “? A/L” in your slot on the calendar, then ask Dr. Hounsell if this is ok. He will then authorise it for you. The minimum staffing level is 3 doctors. Top tips for the post:
AMU is divided into AMU and Ambulatory Care
AMU is a short stay inpatient ward for general medicine
Ambulatory Care typically sees GP referrals for ? DVT ? PE
The F1 almost always works on AMU and is paired up with a more senior doctor
If you are the F1 try to ask for learning opportunities, offer to see patients yourself on the ward round with the senior doctor, effectively “swapping” roles. This is a great way to get Mini-CEX’s done
As the F2 you might be left on your own to see patients and may have to work in Ambulatory Care at times
You may be expected to follow – up your own patients in Ambulatory Care for DVT’s and PE’s
Start at 9am for ward round, the AMU consultant will divide the patients amongst the junior doctor team and you will be responsible for carrying out the jobs for those patients throughout the day. Check the board to see which patients you’ve been allocated
At 11am all the doctors gather with the AMU Consultant for board round, this enables the AMU Consultant to be aware of all the patients on the ward and offer management advice
Plenty of opportunities for DOPS – LP’s are done frequently here
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STROKE Where are you based? Ward 2 Supervisors: Dr Bhat, Dr Mukhopadhyay Rota coordinator: Kath Child How to apply for leave: Dr Bhat’s secretary – Debbie Emment Put on intrepid Top clinical tips for the post: How the day works
Board round starts at 9:15. Aim to get there by 9 to update the list. There are new patients almost every day and they all move around a lot.
Scans
Most patients who are ? CVA will have had a CT head in ED. Patients are usually transferred to the ward late afternoon or evening. When you get in the next day every new patient will be seen by a consultant, so one member of the team needs to prepare the notes of the new patients. Start by writing in the presenting complaint, any results so far, observations etc.). The remaining juniors will do the ward round.
Most new patients will get an MRI – if they are mobile they will get a FAST MRI (quicker scan of the brain basically) – you fill out a specific form for FAST MRI (not the usual blue one). If they are not mobile or it is not straight forward then you request a full brain MRI and fill out the usual blue form. For a full brain MRI you need to do a separate MRI questionnaire with the patient too.
Most patients will also get an echocardiogram and a carotid doppler
Some will have a CT Angiogram (you will need to write on the CTA forms -> Whole Brain CTA if ? aneurysm and PLUS neck vessels and Circle of Willis if ? arterial stenosis).
If a patient is found to have >50% stenosis on carotid doppler then you need to call the vascular consultant on call at Morriston via switch and refer them for ? endarterectomy.
If a patient has had an ischaemic stroke and not in AF then they will have a 24 ECG as outpatient for ? PAF.
If a patient is thrombolysed they will need a CT scan 24 hours after the thrombolysis and it’s your responsibility on the ward to arrange that.
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Treatment
Ischaemic strokes will get 2 weeks of Aspirin 300mg and then lifelong Clopidogrel 75mg.
AF patients will need discussion re: anticoagulation with warfarin vs DOAC (apixaban has lowest risk of IC bleed when compared to warfarin of all the DOACs and is generally favoured, although no reversal agent).
If a patient is on warfarin or any OAC due to AF their warfarin will be stopped for 2 weeks whilst they have aspirin and then restart on warfarin. If a patient is on warfarin due to metallic valve then their warfarin can be stopped for 1 week but this is a consultant decision.
If a patient has had a TIA – anticoagulation to be stopped for 24hrs for diagnosis to be made and then they can restart their usual OAC.
If a patient has had a TIA – they get an initial dose of Aspirin and then life long Clopidogrel.
If a patient is on Omeprazole and they are prescribed Clopidogrel then you need to change their Omeprazole to Lansoprazole.
If a patient has had a stroke you start them on a statin (if they’re not already one one) 48 hours later.
Learn how to counsel for anticoagulation – use the All Wales Advice on the Role of Oral Anticoagulants – AWMSG booklet and give the patient the correct brand information leaflet. Both can be found on the ward
ETOCS
Make them detailed as the stroke patients can often be complex. Most importantly document changes in mobility and independence and evolving social needs so that community teams can appreciate how the patients have changed in their ability to cope at home.
Put in the dates as results of all scans.
Follow up for strokes is 6 weeks telephone and 4-6 months outpatient appointment.
No follow up for TIAs
All sent to consultant for review before sending to GP.
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CARDIOLOGY Where are you based? Ward 4 Foundation supervisor: Dr Wallis (F1) Dr Wong (F2) Annual leave coordinator: SpR How to apply for leave: Coordinate with team members, apply via SpR (apply early, aim for at least 2 juniors on wards each day) Put on Intrepid Top clinical tips for this post:
Mornings on Cardiology are busy, so prepare by having a good breakfast and be ready for a late lunch
Try to arrive a little early to update the list, it’ll make the day smoother. There will always be new patients and bed changes so the list will need updating regularly
Check date of last echo for every new admission
Summarise new admissions prior to ward round (where possible)
Be vocal about protected teaching time (e.g. F1 teaching) – it’s your right to attend and your attendance is monitored
Plan annual leave at the start of the post with other doctors
Utilise the team to start doing jobs whilst on the ward round, it takes a long time and you need to be efficient
There is a consultant ward round every day, the consultants rotate on a weekly basis
Keep on top of ETOCs – they build up. If they do not get completed for a few days let seniors know
Ask for help / supervision when needed (don’t try to be a hero!)
Email IT at the start of the placement for access to McKesson (the computer echo program). It will make looking up echo results much faster, and is useful for other jobs/on call as well
Make the most of the nurse practitioners on the ward. They are excellent and will know how to do almost anything required from ward round, such as referrals to Morriston, MDT, requesting specific studies etc.
Even though it is busy, try to attend a cardioversion list. It is a good opportunity to cardiovert in a safe, controlled environment and a great way to get a quick DOPS!
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RESPIRATORY Where are you based? Ward 5 Supervisor: Dr Wooley Rota coordinator: Kath Childs How to apply for leave: Via intrepid Top clinical tips for the post:
Lots of opportunity for practical procedures eg. therapeutic aspirates, chest drains
Opportunity to be part of a junior team on a busy medical ward Please refer to the full handbook available for this job for further information
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GASTROENTEROLOGY Where are you based? Ward 6/7 Supervisors: Dr Lai, Dr Constable Rota coordinator: Kath Child How to apply for leave: Put on Intrepid You will need to set up your own team rota using a google calendar or Rota app to work out who is on he ward and then when you can apply for your study/annual leave. There needs to be a minimum of 2 doctors on the ward, Top clinical tips for the post:
You will cover Gastroenterology and general medical patients on Ward 6 and Medical outliers on Ward 7. The team should split the time during their rotation so you get the opportunity to work on both wards, it is easier if you can try and have continuity through the week so you get to know you patients.
For Ward 7 it is your responsibility to check on clinical portal each day whether any medical patients are admitted to the ward, particularly in the summer months when there may be no outliers.
For patients on ward 6 ensure a results flow chart is completed and kept up to date throughout a patients admission. The consultants will review trend in patients results during their admission. Stool/blood and urine culture results should be documented at the bottom of these sheets. Try and ensure patients have a stool and weight chart at the end of the bed – especially for Dr Lai
Be cautious prescribing IV fluids in gastro patients – ask for advice from seniors.
The Gastroenterology ANP is a fountain of knowledge! Ask her for advice, she knows all the regular Gastroenterology patients very well.
There is a Gastroenterology Day Unit attached to the ward. You may be asked by the nursing staff to review patients they are concerned about or to cannulate if patients are difficult. Again if unsure ask seniors for advice, patients will be receiving treatments you are unfamiliar with.
If patients are admitted with a upper GI bleed, inform endoscopy early if they may need a scope. They will need to be consented once accepted for endoscopy.
If patients are anaemic, add on haematinics to their bloods if these have not be done recently.
If patients have a report of melena, this should be confirmed whenever possible.
F2s and above are expected to attend outpatient clinics. These are really useful and where you will see the most Gastroenterology. Start attending these early in your rotation as there will be little opportunity once everyone starts taking annual and study leave.
Overall it is a great job but busy at times. Both Consultants, SpR and ANP are friendly and approachable and are always happy to give advice.
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ENDOCRINE AND DIABETES Where are you based? Ward 6 and 8 Supervisors: Dr Roy Chowdhury and Dr Cozma Rota Coordinator: Yasmin Hudson / Kath Childs How to apply for leave: Put on Intrepid Top clinical tips for the post:
Sort A/L out early
Consultants like very thorough ETOCs, ETOCs all need to be sent for consultant review prior to sending to GP
Write known microbiology results in notes (eg previous Urine MCS or skin swab sensitivities)
HBA1C for all diabetics within last 6 months, ensure one is done if one not on system
Learn to summarise new admissions with the same structure clearly and neatly
Read DKA/VRII charts they are self-explanatory and useful knowledge for all posts not just endocrine
Learn which insulins are long acting, short acting or mixed
Always examine diabetics feet and check sensation/look for ulcers
Read about hyponatreamia and the common causes including medications, ensure you are able to assess fluid status in a patient in detail
You may be asked to come in 15 minutes early to update new admission summaries etc. REMEMBER – You are not paid to be in this early. If you leave appropriately early to make up the time then this may be reasonable. But, if you’re forced to do this you should speak to the Foundation Programme Director because it is against working time directive.
It’s a great job with plenty of general medicine, try and get to clinic to see endocrine pathology.
Learn as much about diabetes as you can whilst in this job, the consultants are excellent teachers and it’s very useful for other jobs.
Friday’s often have a lunch provided by a drug rep which usually has a short teaching session
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GERIATRICS NEATH/PORT TALBOT (F2 ONLY) Where are you based? Neath Port Talbot Hospital How to apply for leave: Via rota coordinator Top clinical tips for the post:
Patients are pretty stable – you can use the time to further your academic pursuits
Phlebs come once a day, make sure bloods are out the day before
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OLD AGE PSYCHIATRY Supervisor: Dr Colgate Rota coordinator: Denise Richards (Dr Colgate’s secretary) How to apply for leave: Arrange with team on group calendar then liase with Denise. Put study leave applications in early Top clinical tips for the post:
Revise mental state exam prior to starting post
Read around old age psychiatry presentations (dementia, depression etc)
Make an effort to get to know all members of the MDT – established members of the team are an excellent source of support and advice
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GENERAL ADULT PSYCHIATRY Supervisor: Dr Emmerson Rota Coordinator: Aprile Orders (Dr Emmerson’s Secretary) How to apply for leave: Discuss with Dr Emmerson and then inform Aprile Orders when approved. Top Clinical Tips for the Post
This is an acute inpatient psychiatry ward with a PICU attached so expect to see some exciting mental health presentations
The PICU is covered by another Consultant and SHO, but you are expected to help out with urgent medical tasks if the SHO is away but the majority of the job is spent on Ward 14
Think of yourself as a glorified GP! Good to brush up on minor ailments and minor wounds (you will be asked to review self-harm wounds frequently)
Often asked to sit in and write for the Consultant on clinical reviews
Rewrite charts /bloods/ECG – standard FY1 tasks still expected
Supported by staff grade and a registrar on the ward – never expected to deal with psychiatry issues alone
Plenty of time to do QI/Audit
Build rapport with the mental health nurses as you will spend most of your time liaising with them
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EMERGENCY MEDICINE Where are you based? ED Supervisors: Dr Jedaar, Dr Dyer Rota coordinator: Kate Graham How to apply for leave: F1 – apply via Kate Graham F2 leave is pre-allocated during weeks of 8-6 (purple) but can swap with others Top clinical tips for this post:
It’s your responsibility to take breaks – take them, you’ll be more efficient
Lots of variety in patient presentations – you’re not expected to know everything, just ask!
Use the ED handbook (ABMU homepage -> medical info -> emergency medicine -> ED handbook)
The ENPs and ANPs are brilliant and their advice is very often better than that of the doctors, particularly in minors, and so treat them well.
Nurses are very experienced, listen to them but also remember you are responsible for decisions made
Try as many new skills as possible – there are seniors to support you
If you are keen to try any particular skills or see any particular types of cases - let the seniors know early on in the block and they will seek you out when these patients present
Practise explaining diagnoses and management plans to patients (especially in minors when
reassuring patients) - seniors are happy to supervise you as you build confidence
Ask if you are unsure
Get stuck in – the more you try and experience the better your time here will be
Try not to stress, it will make things much easier
Don’t spend all your time in one area (majors, minors etc) as you will lack skills in the other areas you miss out on
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F1 in ED Handover Tips
Get involved from day 1, everyone is very supportive and will review if needed. Go and see the
patient and examine what you think is appropriate and a senior can review/ add things if needed
Make a differential diagnosis- don’t leave for a senior. Even if you’re wrong it’s helpful
Don’t ask the PAs/nurses to do skills for you- do your own bloods and ABGs when it’s not too busy
as it’s good to keep skills up
Ask Nurse in Charge (NIC) where is good to see patients if they’re not on a trolley, they then are up
to date about where patients are.
Don’t leave people in the quiet room- In and OUT! (Always check on PDM if anyone is in the quiet
room, can be where deceased patients wait prior to transfer to morgue)
Don’t be scared of Majors/Resus- always offer to do the ABCDE assessment (with senior if
needed/unstable). This will be your best opportunity to see sick patients and get comfortable with
assessing and initial management.
Don’t worry if you’re unsure or unclear- many patients don’t have a diagnosis when they leave the
department.
You will feel clueless in minors initially, the ENPs/ANPs and nursing staff are AMAZING and know
everything about minors. Ask one of them for a review/help with X-rays and wounds
Ask someone to watch you suture/wound closure if not sure, then you can be more confident when
unaccompanied.
Don’t be scared of paeds, just take a thorough history and examination (don’t forget to always
examine ENT and feel femoral pulses/check nappy)
o Will need senior review anyway but make sure you have a clear story and examination first
Prescribing analgesia for children use BNF or ED analgesia chart every time
Handbook is life- everything you can think of and more is in there (invaluable on call during night
shifts up on the wards!)
Consultants are all very friendly and approachable, don’t be afraid to discuss cases with them
Refer promptly, you don’t necessarily have to wait for all results prior to referral. Be clear what you
want the admitting team to do and why you’re referring
There’s a proforma for everything, use them (makes audit easier!!) and they’re really thorough
Don’t stress about your e portfolio, very easy to do mini-cex and DOPs/CBDs but tell people prior to
a senior review
DO CORE SKILLS HERE, we do them all, every day!
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PAEDIATRICS Where are you based? Paediatrics department (opposite ED) Supervisor: Dr Hilldebrandt Rota coordinator: Currently on maternity leave, unsure who will be there in August How to apply for leave: Email rota coordinator with any requests and discuss with colleagues Top clinical tips for the post:
SpRs are very friendly, always ask for advice
Calculate all drugs using a calculator and check all in the children’s BNF
Don’t let ETOCs build up in PAU
Revise different treatments of children compared to adults (eg. asthma)
Work out feeding requirement based on weight (esp. in bronchiolitis)
Use the early onset sepsis calculator for all babies with risk factors for sepsis.
Look at neonatal guidelines to help. Postnatal guidelines will answer most questions for the postnatal ward.
Please refer to the full handbook available for this job for further information
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ITU/ANAESTHETICS Where are you based? Intensive Care Unit and Theatres Supervisor: Mark Burtonwood Rota coordinator: Shelly Matthews How to apply for leave: Via Shelly – leave is easier to book because as the F1 / F2 you are supernumerary Top clinical tips for the post: Anaesthetics
Days start at 8am, try to be dressed up in scrubs by then
Find out which list you’re doing using CLW Rota (you will be introduced to this)
Accompany the consultant to pre-assess patients for the list and learn how to do this yourself
As you gain experience, you may be invited to intubate or perform a GA yourself – go for it!
Show enthusiasm –ask at the beginning of a theatre list or ICU day if you want to do clinical procedures, the seniors are more than happy to supervise
ICU
Days shift runs 0830-1630, arrive on ICU or in the Anaesthetic Dept. in scrubs ready for handover
Can feel a bit daunting to begin with, there’s a lot of new stuff to learn so don’t worry if you don’t get it even for weeks!
If you’re on ICU try to go with the CT to see new referrals – it can be easy to get stuck on the unit, although sometimes this is necessary
Be vocal if you want to spend more time in ICU or anaesthetics – the rota is flexible
At times you may find you’re on ICU more often to cover the other Foundation doctor’s annual leave
Great job but can feel a bit fragmented due to on call commitments (F2s only)
Ask early for teaching on ultrasound guided venepuncture/cannulation
Be proactive to get what you want out of the job – ask to do skills/see referrals/roles during arrests if that’s what you want to do
Make sure to use this placement to sign off most of your core skills
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PALLIATIVE CARE Where are you based? Y Bwthyn Newydd (YBN) Foundation Supervisor: Dr Clare Turner Annual leave: Agree with team members
Put on office calendar and intrepid Let Karen (Secretary) know
Team Members: Dr Smith (Consultant)
Dr Turner (Outpatient palliative care consultant) Registrar, GP Trainee, F2, F1
Top tips for this post:
Every day starts with a handover from the nursing staff regarding how the patients have been overnight for the F1 / F2
The SpR and consultants will go to a morning meeting and decide on any admissions for the day
There is also an evening handover around 1630 between F1 / F2 and nursing staff to update of any changes to the patients
Ensure the list is kept up to date and that ceilings of treatment are clearly documented, nursing staff must be made aware of any alterations in ceilings of care
Ensure nursing staff fill out nursing section of the CDT paperwork when starting a patient on CDT, you can take the CDT to the evening handover.
Patients with syringe drivers should be seen earlier on in the day if changes to the syringe drivers are required so that nursing staff can set these up as soon as possible
For patients who are being discharged, they will all need an ETOC and a medication compliance sheet, all patients will be followed up by a clinical nurse specialist.
For patients being discharged on syringe drivers, they will need the above as well as a community syringe driver chart with the syringe driver medications prescribed and PRN subcutaneous medications prescribed for district nurses to administer if required.
For patients that have passed away, you will need to complete a death etoc, death certificate +/- cremation form, audit form and cause of death should be documented on the verification of death forms used at YBN. All documentation can be completed from YBN, death certificates are given from here, notes and cremation forms can then be taken down to the bereavement office.
All new patients, either transferred from the main hospital or the community, will need clerking on the YBN clerking proformas. All will require a normal drug chart and a specialist palliative care PRN chart. All new admissions clerked by the F1 / F2 will be reviewed by either the SpR or Consultant on the day of admission.
Medications usually prescribed on PRN chart – PO / SC analgesia, PO / SC medications for agitation, PO / SC antiemetics.
Other common PRN medications – Anti-secretory, Inhalers / Nebulisers, Laxatives / Suppositories.
On Fridays ensure that the list is up to date and make note of any expected deteriorations. Highlight patients likely to require a review from palliative care on-call team by documenting on list. Check to make sure there are documented ceilings of treatment in all patients notes
The list needs to be emailed to the registrar and consultant on-call for the weekend
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CARE OF THE ELDERLY AT POWH Where are you based? Mainly Ward 11
Also cover medical outliers T+O referrals to Medicine on Wards 9 /10
Foundation Supervisor: Dr James How to apply for leave: Agree as a team and put on intrepid. Team Members: Dr McMillan (Consultant for Ward 11)
Dr James (Consultant for Ward 9, 10) Advanced Nurse Practitioner, Registrar, GPST, F1
Top tips for this post:
Meet the rest of the team on Ward 11 in the mornings
Ward 11 has a mixture of T+O, general surgery and O+G patients (only general medicine are covered by this team).
The patient list needs to be updated with the medical patients admitted from the weekend / overnight to the wards that we cover.
Generally, patients are stable and this job is very well supported
Dr Mcmillan does a ward round on Monday and Thursday, Dr James on Tuesday and Thursdays.
Plenty of opportunities to get CBDs/MiniCEXs/skills signed off, as well as practicing capacity assessments etc. and familiarising yourself with discharge planning procedures.
T+O teams can refer patients to Dr James, these referrals are seen twice a week. The T+O doctors will ask you to review Xrays, ECGs, ABGs or ask advice about their patients. Dr James asks that you do not give them advice and instead advise them that if they need a medical review, they need to refer to Dr James/Julie Hayes/the Registrar. If T+O have patients that are acutely unwell they should be referred to the on-call medical team
Make sure ETOCs are thoroughly completed and sent to GP when the patient has been discharged.
With arranging leave, usually need 2 team members on the wards at all times.
COTE meeting every Friday, food is usually provided! You may be asked to present one week, good opportunity to get ‘Developing Clinical Teacher’ signed off.
Anything you don’t know, ask Julie Hayes the ANP, she is amazing and very helpful!
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GENERAL PRACTICE
Where are you based? GP Surgeries in the Bridgend Area Foundation Supervisor: Local Supervision How to apply for leave: Ask at your surgery
TRAVEL EXPENSES
F2 doctors whose F2 programmes contain a GP rotation are entitled to travel expenses
Eligible travel claims are reimbursed by the employer (the host LHB) via the e-expenses system which is then recharged back to the Health Board. If you do not have an e-expenses account, please contact your Foundation Administrator
Only additional actual costs are reimbursed. The F2 doctor may claim for any cost of travel from their home to the practice in excess of the cost of their normal travel to their base hospital (e.g. if driving they may claim any extra mileage over that normally travelled to the hospital).
They may claim for expenses incurred if they have to travel between the practice and their base hospital during the working day (e.g. if they have to attend meetings or educational sessions).
They may also claim for the mileage incurred while doing home visits in the practice.
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SURGERY
COLORECTAL SURGERY Where are you based? Ward 7/8 Supervisors: Mr Appleton and Mrs Singh Rota coordinator: Yasmin Hudson (coordinates on call rota), Lucy Thomas (Surgery) How to apply for leave: Email Lucy Thomas with request (there is an electronic form on the surgical seminar room computers or ask Lucy to send it). Ensure at least one F1 on ward Top clinical tips for the post:
Be organised, have extra forms in your clipboard, put out bloods in advance where possible
Arrive 5-10 minutes early to print the list and check the location of new patients in the hospital
Make sure you know the location (eg ward 7 B1) so you can quickly find notes during ward round
If you don’t understand or know the plan make sure you ask during the ward round
If you aren’t confident to request scans for complex patients ask a senior and go with them to learn
Surgery is really sociable and fun, everyone is very supportive
You may feel like you don’t get much support in managing medical problems but ask medical F2/CT’s on ward 7 and 8 for informal advice or if an emergency/concerned contact the med reg on call and explain the situation. They are usually happy to help.
Use the ED handbook for advice when you are unsure, it has all acute problems and guidance in there!
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UPPER GI SURGERY Where are you based? Ward 7/8 Supervisors: Mr Appleton and Mrs Singh How to apply for leave: Put on Intrepid Top clinical tips for the post:
Top tips for the post are very similar to the Colorectal surgery entry above
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BREAST SURGERY Where are you based? Ward 7, 8, SSU, Bridgend Clinic
Also expected to assist in theatre at Neath Port Talbot Hospital Foundation Supervisor: Mr Appleton and Mrs Singh How to apply for leave: Agree as a team and put on intrepid Top tips for this post:
Mr Shering is the only breast surgeon who does on-call so you will be on take 1 in every 8 weeks
Breast and Upper GI are considered a merged team at the F1 level so when you’re not on Mr Shering’s take you will be expected to manage the upper GI patients
You are expected to assist in Neath Port Talbot Hospital, Maria Mitchell will email you a rota for this, you can swap with the other F1 / registrars if required
Top tips for Neath
o Arrive at 8am, go to ward A, ask for the operation list for the consultant you are assisting. o You will need to fill out medication charts for all the patients on your consultants list – add
the patients regular medications, VTE prophylaxis (unless contraindicated) and TEDS o If the patient is having a sentinel node biopsy, you will need to prescribe 2mls of patent blue
dye SC to be given on induction, prescribe on STAT side of chart o Parathyroid surgery – 5mg/kg methylene blue in 500mls of Dextrose 5% over 1 hour – this is
given via a green cannula and a 10ml test given beforehand (Parathyroid surgery doesn’t happen very often, Mr Shering can provide guidance for methylene blue if required and is the only surgeon who does parathyroid surgery)
o After you finish prescribing on ward A, go to theatre (Door code from day surgery to theatre – 2580)
o Changing room code – 1964, you can get scrubs and a surgical hat from here o Once you’re ready sit in the doctors office and someone will come and fetch you when
theatre starts. o Every patient will need an ETOC (Mr Johnson will usually do his own – useful to check with
the consultants if they want you to do them), for ETOCs import operation notes, add a diagnosis, add any follow up and add any additional medications they need to go home with i.e. antibiotics
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E-PORTFOLIO Best tackled early! It always takes a few weeks to settle into a post and this is normal. Once you’re up and running, start asking people to help you with your portfolio! When you first start F1, log into the Turas e-portfolio (when you google it, click the Turas DASHBOARD link) and under the FORMS tab you’ll find your DECLARATIONS – fill these out to agree to the terms and expectations of you as a trainee for the year. You will be allocated a supervisor for each of your 3x F1 and 3 F2 rotations. At the start of the block you should set up a meeting with them to go through the induction meeting and agree your aims for the job. It’s usually best to e-mail them. You can find their e-mail addresses by searching on the NHS e-mail system at the hospital. Ask someone to help you if you don’t know how to do it.
BEFORE YOU GO: Visit the CURRICULUM & PDP tab on Turas and RECORD A NEW PDP – write down your own personal aims and expectations for the job ahead to discuss with your supervisor at the meeting.
WHEN YOU GO: Your consultant supervisor should fill out the SUPERVISOR GENERIC MEETING form with you on their account. They have to do this, so make sure it gets done!
During each rotation you are required to record SLEs:
2 X DOPS
2 X CBD
2 X mini-CEX
1 X Developing the clinical teacher (only one required for the entire year) If you are unable to get these signed off, make up for the ones you lack in subsequent rotations. These can be sent to assessors as tickets or filled out in person with them. If you’ve seen an interesting patient or discussed a case with someone, it’ll be worth a Mini-CEX or CBD so just ask if you can send it as a ticket. Everyone has to do them, including Core Trainees and Registrars so ask away, most will be happy to help. You also need to sign off the 15 CORE PROCEDURES – utilise HCA, nurse and doctor colleagues. Quiet night shifts are often a good way to sign off the more nursing based procedures. Find someone you get along with. When you click on to the CURRICULUM & PDP tab on Turas, you can view the F1 curriculum. This sets out the expectations of what you should aim to see and manage during your year, but importantly is also the framework to which you should LINK your reflections, SLEs, additional courses, e-learning and certificates throughout the year.
- When you complete a reflection (which you should aim to do right from the start, especially ethical dilemmas, concerns, problems you encounter on call, and new things that you learn along the way that change how you practice or approach tasks) and SLEs etc, there will be an option to LINK TO THE CURRICULUM.
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- Pin these to the framework as you go. - There are 20 Foundation Professional Capabilities. - You need to create 3 or more links for each capability (NOT for each of the descriptor listed
underneath). - There’s guidance on what is appropriate through the Foundation Programme website, which
describes what each of the capabilities means for you in practice. - You don’t have to write an essay for every reflection, 5 – 10 lines outlining the salient points
relating to what you want to link it to is enough. - Each reflection/SLE etc can only be used a maximum of 3 times as a link – i.e. you can’t use a single
reflection and link it to more than 3/20 Foundation Professional Capabilities. - If you struggle to get evidence for certain parts of the curriculum, e-LFH (NHS e-learning for health)
e-learning courses are available and you can view and complete these from the Turas portfolio – there’s a link in the right corner to take you to the page.
TABS: Need to complete 2 TABs with at least 10 participants with a spread of specialties – exact requirements listed on Turas in the TAB section. If you are able to get enough tickets completed to sign off the TAB for the first two rotations, you do not need to complete the third TAB in your final rotation. Ask your supervisor to release the TAB at the end of the rotation if they forget. There is a list of essential certificates that you should upload:
- PSA certificate – download from your PSA account (should be done promptly after graduation as will expire and you will not be able to access it again).
- ILS (if available) - ALS
By the end of the year you need to have completed these forms:
- POST ASSESSMENT forms x3 (best to do immediately after the rotation to give specific feedback about the job)
- Form R (in the FORMS folder on Turas) – a series of declarations around integrity and probity to complete at the end of the year before ARCP sign off. You can usually only do this once the higher education centre has opened it to you.
20 Foundation Professional Capabilities
This number should equal or exceed 3 in total by the end of the year for each of the Foundation Professional
Try to get a good spread of links between the descriptors but it isn’t essential that you have a link for all of them
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TEACHING
MANDATORY TEACHING F1 teaching takes place Thursday 2-3 pm in MPEC. F2 teaching takes place Tuesday 2-3 pm in MPEC. You are expected to attend these and attendance is recorded. You need to attend a minimum of 70% of sessions to pass ARCP so make sure you go! Wendy usually sends out a message in the morning to remind you. If you’re having issues getting cover, even if it’s only for one day, let Wendy know early on that day so that she can make a note of it. If it becomes a regular occurrence and you’ve flagged it MPEC can look into helping you. Sometimes there are additional practical sessions in the clinical skills lab. The teaching timetable is matched to the curriculum and to topics to help with the day job. If you can think of any topics that need covering please let Wendy know.
RAPID RESPONSE TRAINING Rapid response Team training is being introduced as a new educational initiative. These will be half day sessions once a month for small groups by invite only.
GRAND ROUND Grand Round is held every Thursday lunchtime. Meet in the MPEC Atrium for 1330. Lunch is often provided. The meeting starts at 1400 in the lecture theatre and includes contributions from the Medical specialties.
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LOOKING AFTER YOURSELF Medicine is a stressful profession, and Foundation Training can be particularly difficult because of frequent changes of post and a steep learning curve. The GMC makes clear that a good doctor looks after their own health and well-being as well as that of their patients. Remember to take a break. Not taking a break is a potential risk to patient safety. You are not a superhero.
PLACES TO EAT
- Hospital Restaurant / Sandwich Bar (Zone L) - Costa Coffee (Main Entrance) - Shop (Main Entrance) - Doctors Mess (Subscription Required) - Vending Machines (Lower corridor or Restaurant)
Hospital restaurant is open from:
- Breakfast 0800 – 1100 - Lunch 1200 – 1400 - Dinner 1530 – 1730
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FATIGUE THE FACTS
“Fatigue is the subjective feeling of the need to sleep, an increased physiological drive to fall asleep and a state of decreased alertness.” Fatigue is a major concern amongst junior doctors. AAGBI, RCOA and FICM have launched a fight fatigue campaign, this involves raising awareness of fatigue but also informing doctors on facts about fatigue and how to prepare themselves for night shift working.
Restorative sleep Most adults require 7-8 hours of uninterrupted restorative sleep per night.
Sleep debt A sleep debt occurs after restricted sleep for 2 or more nights.
Sleep restriction Moderate sleep restriction to 6 hours per night for 2 weeks impairs performance equivalent to one night of complete sleep deprivation.
Wakefulness Cognitive function is impaired after 16-18 hours of wakefulness.
Dangerous driving 20 hours of wakefulness can cause impaired performance equivalent to being over the UK legal driving limit for alcohol.
Age Sleep patterns are altered and the ability to recover from lack of sleep is reduced by age.
Microsleeps Fatigue induces sleep lapses or microsleeps, which are spontaneous, uncontrolled and often go unrecognised.
Recovery 2 consecutive nights of restorative sleep are needed to recover from sleep loss.
See link below for further resources: https://www.aagbi.org/professionals/wellbeing/fatigue/fatigue-resources
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GET HELP EARLY If you find yourself having a “wobble” then talk to your Educational Supervisor, any of your seniors or one of your peers. There are lots of other places to seek help, either Amanda Farrow (POW Faculty Lead), or Gwilym McMillan (POW Foundation Programme Director) Wendy Jones the Foundation Programme Administrator, you can self refer to Occupational Health or you may wish to make use of the BMA helpline; it is not necessary to be a BMA member to use it: BMA Counselling & Doctor Adviser Service: 0845 9200169.
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GOOD LUCK
Most importantly, enjoy your foundation training.
Embrace all opportunities and do your best.
Don’t forget to be kind to each other and yourself!
