rotations, providing they have the support of their educational supervisors. Some Foundati on schools will organize swap shops to facili- tate this process. You can also arrange we ek-long \200\230tasters \200\231 in another spe- cialty to help plan your career; to arran ge these talk to your educational supervisor and a consultant in the relevant specialty. If you are unsuccessful In recent years, the supply of applicants has threatened to exceed pl aces on the FP. Those whose FPAS scores place them below the cutoff to be guaranteed a FP p ost will be placed on a reserve list and are often able to gain a training post when an une xpected event befalls another candidate. If you are not successful in securing a post fi rs t time round do not give up hope! If you feel you have been unfairly marked you may be able to appeal; discuss this with your medical school dean. Try to seek feedback from the appli cation process in order to identify weaknesses that you may be able to amend in case you ha ve to wait to reapply the next year. Should you still be without a post after you know you have qualifi ed from medical school, contact LETBs and hospi- tals directly; some of your p eers may not be able to take up their posts due to exam failure so you may be able to apply directly to these posts. Finally, consider taking a year out to either strengthen your application by doing research , further study, or other activities that add to your skills. Also consider applying overse as; it has been possible in previous years to do some or all of foundation training in Aust ralia or New Zealand with prior approval of posts from a UK LETB. Alternatively, it is poss ible to apply to any post within the EU or to consider equivalency exams for other countrie s. Finally, there is always the option of a career outside of medicine. Advice on this and oth er options will be available from your university careers offi ce, or from websites such as Prospects ((cid:27)www.prospects.ac.uk). OHFP.indb 6 OHFP.indb 6 30/05/2014 16:17 30/05/2014 16:17 7 APPLYING TO THE FOUNDATION program Linked applications During the FPAS application process, it is possible for any two individ uals to link their applications. In this case, you must both supply each other s email addr esses in the relevant section of the applica- tion form, and rank all UoAs in identical ord er. The score of the lower scoring applicant will then be used to allocate both applicants to the same UoA. Although policies vary between UoAs, linking does not necessarily guarante e appointment to the same trust or town \200\223 check individual UoA websites for their p olicies. Note also that if one of you accepts a place on an Academic Foundation Program, th e link is broken. Special circumstance For those who meet specifi c criteria, it may be pos sible to be allocated to a specifi c Foundation school, regardless of your FPAS score. Thes e cases include if: \200 You are a parent or legal guardian of a child <18, who lives wit h you \200 You are a primary carer for someone who is disabled (defi ned by the Equality Act 2010) You have a medical condition or disability for which ongoing follow-up in the specifi ed location is an absolute requirement. If any of these apply to you, discuss with your medical school dean or tutor well in advanc e of the application process opening. Less than full-time training Those wishing to train less than full- time should apply throu gh the FPAS alongside other candidates; upon successful appointment, they should contact th eir new Foundation school to discuss training opportunities and plans. _OHFP.indb 7 _OHFP.indb 7 30/05/2014 16:17 30/05/2014 16:17 8 CHAPTER 1 Being a doctor The FP curriculum and assessment The Foundation Program Curriculum acts as a guide for what you will be expected to achieve over the 2 years of the FP, how you will get there, and ho w you will be assessed. Core to the curriculum is a syllabus that lists a large number of c ore competences that you will be expected to achieve, divided into subsections. Each subs ection is headed by outcome descriptors indicating the broad levels of performance that you must achieve in each year, and the subsections grouped into principal sections with core t hemes. Principal sections of the FP curriculum (2012 version) 1 Professionalism 2 Relationship and communication 7 Good clinical care 8 Recognition and management of the with patients acutely ill patient 3 Safety and clinical governance 4 Ethical and legal issues 5 Teaching and training 6 Maint aining good medical practice 9 Resuscitation and end of life care 10 Patients with long-term conditions 11 Investigation s 12 Procedures ePortfolio The ePortfolio tool forms an electronic personal record of your progress through the FP. At the core is a copy of the syllabus to which you can link evidence of achievemen t of competences using a variety of tools. Alongside this sits a record of all meetings tha t you have with your supervisors and your end of year reports. It may also be used in inter views for specialty training programs to demonstrate competence and high- light your achiev ements. You can also upload a wide range of supporting material (see box b p10). It is abso lutely vital that you engage with your ePortfolio early on and continue to keep it up to da te since this forms a measure by which you will be judged. The eff ort required is not mini mal, but nor should you underestimate the burden placed on your supervisors who will also b e required to access and inspect your ePortfolio. You can certainly help them by keeping yo ur ePortfolio current and complete. Assessment It would be impossible to document evidence of achieve- ment of every one of the competences in the curriculum. Instead, you need to provide evidence that you have achieve d the outcome descriptors for each subsection appropriate to F1, and subsequently F2. In or der to do this, a variety of tools are available (see Table 1.2). For some subsections, the descriptors for F1 and F2 are the same, in which case in your F2 year no further evidence may be required, or you may wish to document evidence of ongoing achievement. In previous y ears the burden of documentation was overwhelming, both for FP doctors and their seniors, w hilst the cur- riculum used forms designed to allow for formative feedback as a means of su mmative evaluation. This risked creating a checkbox mentality amongst many concerned. Sen se has (partially) prevailed in the 2012 curriculum, with the number of assessments signifi cantly reduced and a shift towards use of assessments for formative feedback. Meetings The re are a number of meetings you need to record in your ePortfolio. These are detailed in th e box b p10. OHFP.indb 8 OHFP.indb 8 30/05/2014 16:17 30/05/2014 16:17 9 THE FP CURRICULUM AND ASSESSMENT Table 1.2 Supervised learning events (SLEs) and assessments SLEs provide a means to record evidence of clinical learning. They off er a framework for f eedback from a senior colleague whenever a learning opportunity presents itself, and for yo u to refl ect on the experience. A number of diff erent formats are available and you will be required to document a minimum number each year \200\223 though you may record far more . You should cover a spread of acute and long-term conditions in a range of clinical settin gs. SLEs do not always need to be planned in advance and can be used to record a useful edu cational experience after it has occurred. You can generate a form for each SLE through you r ePortfolio \200\223 this can be fi lled out at the time by your assessor, or you can sen d them an email link to the form, in which case you should include as much information as p ossible to remind them of the event. \211 9 per year \200\223 including \211 6 mini-CEX ( \211 2 per attachment)1 Direct observation of doctor/patient encounter: \200 Mini-clinical evaluation exercise (m ini-CEX) \200 Direct observation of procedural skills (DOPS) For mini-CEX, you will be ob served speaking to and/or examining a patient and receive feedback on your performance. For DOPS, you will be observed performing a clinical skill and receive feedback on your intera ction with the patient. \200 Case-based discussion (CbD) \211 6 per year ( \211 2 per attachment) You will present and discuss a case (or an aspect of a complex case) you have been closely involved in and discuss the clinical reasoning and rationale. \200 Developing the clinica l teacher This requires you to deliver an observed teaching session \200\223 you will rece ive feedback according to the very latest in educational jargon. Assessments diff er from S LEs in that they are summative \200\223 they evaluate your progress and achievements. In a ddition to your end of placement and end of year assessments with your supervisors, you wil l also complete two other assessments: \200 Core procedure assessment forms 1 per procedu re during F1 By the end of F1 you need to be signed off as competent in 15 core procedures: \200 Injection of local anesthetic to skin \200 Venepuncture \200 SC injection \200 IV cannulation \200 IM injection \200 Giving IV medication and fl uids \200 Perform and interpret an ECG \200 ABG \200 Perform and interpret peak fl ow \200 Blood cultu re (peripheral) \200 Urethral catheterisation (5) \200 IV infusion including the prescr iption \200 Urethral catheterisation (4) \200 Airway care including simple adjuncts \211 1 per year of fl uids IV infusion of blood and blood products Team assessment of behavior (TAB) You will be required to engage in a Maoist process of sel f-criticism, then select up to 15 colleagues who will be invited to feedback anonymously to your educational supervisor who will collate the results and share them with you. Your ass essors must include \211 2 individuals from the following groups: doctors (more senior tha n F2, including at least 1 consultant or GP principal); nurses (band 5 or above); allied he althcare professionals; any other team members (eg ward clerks, secretaries). 1 per year 1 There is no minimum number of DOPS required per year. _OHFP.indb 9 _OHFP.indb 9 30/05/2014 16:17 30/05/2014 16:17 10 CHAPTER 1 Being a doctor Keeping the ePortfolio As well as recording your structured learning events, you can upload a wide range of other documents to your ePortfolio to serve as evidence of your progress. Some suggestions include: Clinical work \200 Copies of discharge/referral letters (anonym ised)1 \200 Copies of clerkings (anonymised)1 \200 Attendance at clinic (date, consulta nt, learning points) \200 Procedures (list of type, when, observing, performing, or teach ing) \200 Details of any complaints made against you and their resolution \200 Incident forms you have been involved in (useful for refl ective practice and demonstrating that you have learned from mistakes) \200\230Triumphs \200\231 \200\223 diffi cult patients you \200\231ve diagnosed/treated \200 Praise \200\223 all thank you letters/cards/emails. Presentations, teaching, audit, and research \200 Copies of presentations given \200 Details of teaching you \200\231ve done (with feedback if possible) \200 Copies of audit or research you \200\231ve been in volved in \200 Copies of your publications. Training \200 Details of courses you \200 \231ve attended (with certifi cates of attendance) \200 Online course modules completed \200 Refl ective practice notes on key learning experiences \200 Study leave and associa ted forms (F2 only). 1 Remember that all data you upload is subject to the Data Protection Act. This means that you should avoid recording patient identifi able information within your ePortfolio, since this is not the purpose for which it was collected. Using hospital numbers rather than name s, or completely obscuring personal details is considered acceptable. Meetings during the FP There are a number of required meetings which you should record in y our ePortfolio. The onus is on you to schedule and prepare for these meet- ings: you and yo ur supervisors are all busy clinicians, and it can sometimes be diffi cult to arrange these in a timely manner. Be fl exible but persistent! Induction At the start of each placement you should meet with both your educational and clinical supervisors2 to agree learning obje ctives and review what opportunities are available during the placement. Midpoint Meetings in the middle of each placement with your supervisors to review progress are encouraged, pa rticularly where you or they have concerns, but are not compulsory. You may also decide to have a mid- year review with your educational supervisor. End of placement Both your superv isors should meet with you separately to review your achievements, feedback the observation s of the team, provide advice and listen to your feedback. End of year You should meet your educational supervisor to discuss your total progress. Your supervisor will complete a rep ort for the panel per- forming your annual review and inform their decision to sign you off . 2 Separate meetings: your clinical supervisor should address what is expected of you and what is available to you; your educational supervisor should take an overview of your pro- gress and goals. In reality, for some placements they will be the same person. OHFP.indb 10 OHFP.indb 10 30/05/2014 16:17 30/05/2014 16:17 11 BEFORE YOU START Before you start Important organizations The prices quoted change frequently; they are inte nded as a guide. General Medical Council (GMC) To work as a doctor in the UK you need GMC r egistration with a license to practice; 90 for F1 (provisional reg- istration), 185 for F2 (full registration), 390 thereafter. NHS indemnity insurance This covers the fi nanci al consequences of mis- takes you make at work, providing you abide by guidelines and proto cols. It automatically covers all doctors in the NHS free of charge. Indemnity insurance Th is is essential; do not work without it. These organi- sations will support and advise you in any complaints or legal matters that arise from your work. They also insure you against work outside the hos- pital. There are three main organizations, all off er 24h helplines ( b p600): \200 Medical Protection Society (MPS) \200\223 10 for F1, 40 for F2 \200 Medical Defense Union (MDU) \200\223 10 for F1, 40 for F2 \200 Medical and Dental De fense Union of Scotland (MDDUS) \200\223 10 for F1, 35 for F2. British Medical Association (BMA) Political voice of doctors; campaigns for better conditio ns, hours, pay, and comments on health issues. Membership includes a weekly subscription to the BMJ. Costs 113 as an F1 then 222 as an F2. Income protection Pays a proportion of your basic salary a lump sum (rates vary) until retirement age if you are unable to work for health reasons. Check if it covers mental health problems, and if it still pays if you are capable of doing a less demanding job. NHS sickness benefi ts are not comprehensive (a nd only provide 1mth as an F1 and 4mth the next year): \200 Available from various provid ers, typically starting at 24/mth as an F1, rising according to age, pay, illness, and risks. NHS pension scheme Despite various changes afoot, this remains the best pension available, do not opt out; a percentage of your pay will be diverted to the pension. Important documen ts for your \201 rst day1 P45/P60 tax form When you leave a job you will receive a P45; i f you continue in the same job you will receive a P60 every April. These need to be shown w hen starting a new job. Bank details Account number, sort code, and address. Hepatitis B Yo u need proof of hep B immunity and vaccinations. You should keep validated records of your immunisations and test results. GMC registration certi \201 cate Proves you are a register ed doctor. Disclosure and Barring service (DBS) certi \201 cate (formerly CRB checks) It i s the employer s responsibility to perform these checks. You must complete all paperwork in good time, but payment is the responsibility of the trust. Induction pack and contract Sen t by the trust before you start2; otherwise contact human resources to fi nd out where and when to meet. 1 In theory, the medical staffi ng department of your acute trust should sort a lot of this out in advance of your fi rst day; in reality, do not underestimate their ab ility to mislay your paper- work and request multiple copies \200\223 keep plenty of photo copies and do not part with originals. 2 There has been a trend towards online induction. U nfortunately, some trusts occasionally attempt to force new starters to complete this prior to starting work for the trust with threats of loss of employment There is a clear BMA pos ition on this: induction is work, and should be undertaken during work time or, if undertak en outside work time, should receive additional payment. _OHFP.indb 11 _OHFP.indb 11 30/05/2014 16:17 30/05/2014 16:17 12 CHAPTER 1 Being a doctor Your \201 rst day Leave plenty of time to fi nd the hospital and your accommodation on yo ur fi rst day. Many hospitals organize a session for new doctors to speed up the signing-in process. The following are the essentials: House If you are living on site this is your to p priority. Phone the accom- modation offi ce before you start to check their opening hours . It may cost up to 700/month. Avoid leaving your car fi lled with all your possessions. Pay roll It can take over a month to adjust pay arrangements so it is vital to give the fi nance dept your bank details on or before the fi rst day if you want to be paid that month. Hand in a copy of your P45/P60 too. Parking Check with other staff about the best places to park and \200\230parking deals \200\231; you will probably need to get several people to sign a form. ID badge This may also be used to access secure sections of the hos- pital. If so, insist o n getting access to all clinical areas since you will be on the crash team. If the card doe sn \200\231t give access to all wards return it and get it fi xed. Computer access This allows you to get results, access the internet and your NHS email. Mem orize all the passwords, usernames, etc and keep any documents handed out. Ask for the IT h elpdesk phone number in case of diffi culty. Work rota This should have arrived before the job starts. If it hasn t, you should contact the medical staffi ng department to request it. Colleagues \200\231 mobile numbers This will probably be the last time you are all gathered in one place. Getting numbers makes social activi- ties and rota swaps much easier. Arrang ing swaps on the fi rst day is also easier. Important places in the hospital Try to get hold of a map; many hospitals have evolved rath er than been designed. There are often shortcuts. Wards Write down any access codes and fi nd out where you can put your bag. Ask to be shown where things are kept including the crash trolley and blood-taking equipment. Canteen Establish where the best food options are at various times of day. Note the opening hours \200\223 this will be invaluable for breaks on-call. Cash and food dispensers Hospitals are required to provide hot food 24h a day. This may be from a machine. Doctors \200\231 mess Clearly essential. Write down the access code and estab- lish if ther e is a freezer. Microwave meals are infi nitely preferable to the food from machines. Radiology Find out which consultants deal with diff erent imaging. You will spend a lot of time chasing investigations so make friends early, including with their secretaries! OHFP.indb 12 OHFP.indb 12 30/05/2014 16:17 30/05/2014 16:17 13 OCCUPATIONAL HEALTH Occupational health Most hospitals have an occupational health department that is respon- s ible for ensuring that the hospital is a safe environment for you and your patients. This i ncludes making sure that doctors work in a safe manner. You can fi nd your local unit at (c id:27)www.nhshealthatwork.co.uk Common visits During the Foundation Program your contact with occupational health is likely to be one of the following: \200 Initial check you will have a blood test to show you do not have hepatitis C HIV; they will need to see photographic proof of identity, eg a pa ssport Hepatitis B booster depends on local policies and your antibody levels \200 Needle-stick/ sharps injury/splashes (b p106) \200 Illness that aff ects your ability to work may requi re a consultation. Infection control Patients are commonly infected by pathogens from the h ospital and ward staff . The infections are more likely to be resistant to antibiotics and can be fatal. It is important to reduce the risk you pose to your patients: \200 If you a re ill stay at home, especially if you have gastroenteritis \200 Keep your clothes clean and roll up long sleeves to be bare below the elbows in clinical areas White coats, ties, and long sleeves are generally discouraged \200 Avoid jewelry (plain m etal rings are acceptable) and wrist watches \200 Clean your stethoscope with a chlorhexi dine swab after each use \200 Wash your hands or use alcohol gel after every patient cont act, even when wearing gloves; rinsing all the soap off reduces irritation. Clostridium diffi ci le spores are resistant to alcohol, so always wash your hands after dealing with aff ected patients Be rigorous in your use of aseptic technique \200 Use antibiotics appropriately and follo w local prescribing policies. Sharps and bodily \202 uids As a doctor you will come into contact with bodily fl uids daily. It is important to develop good habits so that you are s afe on the wards: \200 Wear gloves for all procedures that could involve bodily fl uids o r sharps. Gloves reduce disease transmission when penetrated with a needle \200\223 consider wearing two pairs for high-risk patients Dispose of all sharps immediately; take the sharps bin to where you are using the sharps an d always dispose of your own sharps \200 Vacutainers are safer than a needle and syringe. Most hospitals now stock safety cannulas and needles for phlebotomy, use of which decrease s the risk of needle-stick injuries yet further Mark bodily fl uid samples from HIV and hepatitis B+C patients as \200\230High Risk \200 \231 and arrange a porter to take them safely to the lab Consider wearing goggles if bodily fl uids might spray \200 Cover cuts in your skin \200 Avoid wearing open-toed shoes or sandals \200 Make sure your hepatitis B boosters are u p to date. _OHFP.indb 13 _OHFP.indb 13 30/05/2014 16:17 30/05/2014 16:17 14 CHAPTER 1 Being a doctor What to carry Essentials Pens These are the most essential piece of equipment. Remember you need a biro f or writing on blood bottles; all writing must be in black (better for photocopying \200 \223 allegedly). Stethoscope A Littmann Classic II or equivalent is perfectly adequate, h owever, better models off er clearer sound. Money Out-of-hours, loose change is useful for food dispensers. ID badge This should be supplied on your fi rst day. Bleep This will be on the ward, at switchboard or with a colleague. Optional extras Clipboard folder See b p17. Smartphone/PDA There is a wealth of medical app s available for these devices allowing you to carry vast amounts of information in your poc ket. Always check who has written the program and whether they are a reliable source. Many of the books in the Oxford Handbook Series, including this one, have been made available in this format by a 3rd party developer. Pen-torch Useful for looking in mouths and eyes; very small LED torches are available in \200\230outdoors \200\231 shops or over the internet and can fi t onto a keyring or attache d to stethoscopes to prevent colleagues borrowing and not returning them. Tendon hammer These are rarely found on wards. Collapsible pocket- sized versions can be bo ught for 12 \200\22315. Ward dress Patients and staff have more respect for well-dressed doctors, however it is imp ortant to be yourself; be guided by comments from patients or staff . Hair & piercings Long hair should be tied back. Facial metal can be easily removed while at work; while ears are OK, other piercings draw comments. Shoes A pair of smart comfy shoes is essential \200\223 you will be on your feet for hours and may need to move fast. Scrubs Ideal for on-calls, especially in surgery. Generally they should not be worn for eve ryday work. Check local protocol. Mobiles Almost all doctors carry a mobile phone in hospital and it is often the best way to contact other members of your team. Previous rules restricting their use have largely been eased, though it remains the case that they can interfere with monitoring equipment in use in ICU, CCU and theaters. OHFP.indb 14 OHFP.indb 14 30/05/2014 16:17 30/05/2014 16:17 15 HOW TO BE AN F1 How to be an F1 Being an F1 involves teamwork, organization, and communication \200\223 qu alities that are not easily assessed during fi nals. As well as settling into a new work en vironment, you have to integrate with your colleagues and the rest of the hospital team. Yo u are not expected to know eve- rything at the start of your post; you should always ask so meone more senior if you are in doubt. As an F1, your role includes: \200 Clerking patients (ED, pre-op clinic, on-call, or on t he ward) \200 Updating patient lists and knowing where patients are (b p17) \200 Partic ipating in ward rounds to review patient management \200 Requesting investigations and ch asing their results \200 Liaising with other specialties/healthcare professionals \200 Practical procedures, eg taking blood (b p514), cannulation (b p518) \200 Administrative tasks, eg theater lists (b p112), TTOs (b p78), rewriting drug charts (b p169), death certi fi cates (b p96) \200 Speaking to the patient and relatives about progress/results. Break s Missing breaks does not make you appear hard-working \200\223 it reduces your effi cienc y and alertness. Give yourself time to rest and eat (chocolates from the ward do not count) ; you are entitled to 30min for every 4h worked. Use the time to meet other doctors in the mess; referring is much easier if you know the team you are making the referral to. Know your limits If you are unsure of something, don \200\231t feel embarrassed to ask your seniors \200\223 particularly if a patient is deteriorating. If you are stuck on simple t asks (eg diffi cult cannulation) take a break (the patient will welcome this) and try later or ask a colleague to try. Responsibility As an F1 you will make many diffi cult decisions, some with potentially seri ous consequences. Always consider the worst case scenario and how to avoid it. Ensure you c an justify your actions; carefully document events and discussions with relatives. Expectations Seniors will expect you to know Mrs Jones \200\231 current medication dose, th e details of the operation they performed yesterday, and the blood results from 5d ago. Ini tially this seems impossible, but with time your memory for such details will improve. _OHFP.indb 15 _OHFP.indb 15 30/05/2014 16:17 30/05/2014 16:17 16 CHAPTER 1 Being a doctor Your bleep What at fi rst seems like a badge of having made it quickly becomes the bane o f your existence. When the bleep goes off repeatedly, write down the numbers then answer th em in turn. Try to deal with queries over the phone; if not, make a list of jobs and priori tize them, tell the nurses how long you will be and be realistic. Ask nurses to get useful material ready for when you arrive (eg an ECG, urine dipstick, the obs chart and notes). En courage ward staff to make a list of routine jobs instead of bleeping you repeatedly. The b leep should only be for sick patients and urgent tasks. Learn the number of switchboard sin ce this is likely to be an outside caller waiting on the line. Crash calls are usually anno unced to all bleepholders via switchboard. If your bleep is unusually quiet, check the batt eries. Consider handing over your bleep to a col- league when breaking bad news, speaking t o relatives or performing a practical procedure. \200 Dropping the bleep in the toilet Th is is not uncommon; recover the bleep using non-sterile gloves. Wash thoroughly in running water (the damage has already be en done) and inform switchboard that you dropped it into your drink. Other forms of bleep destruction You should not have to pay for a damaged bleep, no matter how dire the threats from switchboard; consider asking for a clip- on safety strap. Learning You need to be proactive to learn interpretation and management skills as an F1. T his is especially true when most of the decisions you make will be reviewed by a senior alm ost immediately. Despite this, Bloods, CXR, senior r/v is not an adequate plan and repres ents a failure to engage with a potential learning opportunity: Formulate a management plan for each patient you see and compare this with your senior \200\231s version; ask about th e reasons for any signifi cant diff erences. Service provision vs training? Acute trusts need doctors to see patients so that they can b e treated, discharged and the trust reimbursed. Behind this simple fact lies an important p oint of tension between the aims of the trust and those of the individual doctor who will w ant to develop and acquire new skills. As a foundation doctor, you are in an educationally approved post, for which the LETB releases funds to the trust. It is therefore important th at you should be given the opportunities to train and develop, and that you should be relea sed from routine ward work to attend all dedicated training sessions. At the same time, the discharge summaries need to be typed, the drug charts rewritten and a seemingly endless nu mber of venfl ons resited. The challenge for all involved is to achieve educationally usefu l outcomes within these constraints. This situation is not unique to the foundation program \200\223 all doctors within the NHS have to balance these demands and some of those tasks you aspire to be able to perform will be the same tasks that have become routine and even frustrating for your seniors. There are no magic answers, but a preparedness to work hard, a keenness to seize educational opportunities whenever they present and a supportive educat ional supervisor will all go a long way. OHFP.indb 16 OHFP.indb 16 30/05/2014 16:17 30/05/2014 16:17 17 GETTING organized Getting organized Your organizational abilities may be valued above your clinical acumen. W hile this is not why you became a doctor, being organized will make you more effi cient and ensure you are soon going home on time most days. Folders and clipboards These are an exce llent way to hold patient lists, job lists, and spare paperwork along with a portable writi ng surface. Imaginative improvements can be constructed with bulldog clips, plastic wallets , and dividers. \200 Contents: spare paper, drug charts, TTOs, blood forms, radiology for ms, phone/bleep numbers, job lists, patient lists, theater lists, spare pen, computer and w ard access codes. Patient lists Juniors are often entrusted with keeping a record of the team \200\231s patie nts (including those on diff erent wards, called \200\230outliers \200\231) along with the ir background details, investigation results and management plans. With practice most peopl e become good at recalling this informa- tion, but writing it down reduces errors. One means of keeping track is updating an electronic patient list; this also allows every m ember of the team to carry a copy. It can be invaluable for discussing/referring a patient whilst away from the ward (b p81). These must be kept con \201 dential and disposed of sec urely. Job lists During the ward round make a note of all the jobs that need doing on a sep arate piece of paper. At the end of the round these jobs can be allocated amongst the team members. Serial results Instead of simply writing blood results in the notes try writing them on ser ial results sheets (with a column for each day \200\231s results). This makes patterns easi er to spot and saves time. Timetables Along with ward rounds and clinical jobs there will be numerous extra meetings, teaching sessions, and clinics to attend. There are three blank timetables at the end of th is book. Important numbers It can take ages to get through to switchboard so carrying a list of comm on numbers will save you hours (eventually you will remember them). At the end of this book there are three blank phone number lists for you to fi ll in. Blank stickers on the back o f ID badges can hold several numbers. Ward cover equipment Finding equipment on unfamiliar wards wastes time and is frustrating. You can speed up your visits by keeping a supply of equipment in a box. Try to fi ll them w ith equipment from store- rooms instead of clinical areas. Alternatively if you are bleeped by a nurse to put in a cannula, you could try asking them nicely to prepare the equip- men t ready for you for when you arrive (it works occasionally). _OHFP.indb 17 _OHFP.indb 17 30/05/2014 16:17 30/05/2014 16:17 18 CHAPTER 1 Being a doctor Being effi cient Despite the many years spent at medical school preparing for fi nals and b ecoming a doctor, being effi cient is one of the most important skills you can learn as a h ouse offi cer. Working hours When you fi rst start as an F1, you will always work longer ho urs than those you are paid for, especially towards the beginning of your career. The best way to make your day run as smoothly as possible is to come in early to prepare for the war d round \200\223 you will be expected to have the latest bloods, investigation results, an d any overnight interventions at hand, before your seniors arrive. Time management You will nearly always seem pressed for time, so it is important to organiz e your day effi ciently. Prioritize tasks in such a way that things such as blood tests can be in progress while you chase other jobs. Requesting radiology investigations early in th e day is important as lists get fi lled quickly, whereas writing blood forms for the next d ay and prescribing warfarin can wait till later on. TTOs should also be written as soon as the team decides a patient is almost ready for discharge \200\223 this will save any unnec essary delays on the day they go home. On-call It will seem like your bleep never stops going off , especially when you are at you r busiest. Always write down every job, otherwise you run the risk of forgetting what you w ere asked to do. Consider whether there is anyone else you could delegate simple tasks to, such as nurse practitioners or ward staff whilst you attend to more urgent tasks. How to be effi cient \200 Make a list of common bleeps/extensions (see b p608) \200 Est ablish a timetable of your fi rm \200\231s activities (see b p609) \200 Make a folder/cli pboard (see b p17) \200 Prioritize your workload rather than working through jobs in orde r. Try to group jobs into areas of the hospital. If you \200\231re unsure of the urgency of a job or why you are requesting an investigation, ask your seniors \200 If you are worki ng with another house offi cer split the jobs at the end of the ward round so that you share the workload Submit phlebotomy requests at the start/end of each day (fi nd out what time the phlebotomi sts come); if a patient will need bloods for the next 3 days then fi ll them all out togeth er with clear dates Be aware of your limitations, eg consent should only be done by the surgeon doing the procedure or one trained in taking consent for that particular procedure Bookmark online or get a copy of your hospital guidelines/protocols, eg pre-op investigations, anticoagulation, DKA, pneumonia etc Get a map of the hospital if you haven \200\231t got your bearings. OHFP.indb 18 OHFP.indb 18 30/05/2014 16:17 30/05/2014 16:17 19 PATIENT-centered CARE Patient-centered care The traditional medical model made the patient a passive recipient of care. Healthcare was done to people rather than with them. Many patients were happy with t his, but the patient should be able to be in charge of their own healthcare should they so wish. Our task as clinicians is to fi nd out our patients \200\231 expectations of their relation ship with their doctors and then try to fulfi l these. From \200\230what- ever you feel is best doc \200\231 to reams of printouts and self-diagnoses from the internet, neither extr eme is wrong and our task is to help. Patient expectations Find out whether your patient wa nts guidance regarding what treatment may be best. Respect their right to make a decision you believe may be wrong. If you feel that they are doing so because they do not fully understand the situ- ation or because of fl awed logic, then alert your team to this so that things can be explained again. Find out their other infl uences, these can be very powerful. Examples include: religious b eliefs, friends, the internet, and death/illness of rela- tives with similar conditions. Tr eatment expectations Patients may have clear expectations of their treatment (eg an operati on or being given a prescription). These expectations are important sources of discontentme nt when not ful- fi lled. Find out what their expectations are and why. Useful questions ma y include: \200\230What do you think is wrong with you? \200\231 \200\230What are you wor ried about? \200\231 \200\230What were you expecting we \200\231d do about this? \200\231 Yourself in their shoes Make time to imagine yourself in your patient \200\231s place. Isol ation or communication diffi culties will heighten fear at an already frightening time. Lon g waits without explanation are sadly common. Aggression from friends or relatives is often simply a mani- festation of anxiety that not enough is being done. Ask yourself \200\230H ow would I want my family treated under these circumstances? \200\231 then do this for ever y patient. Ensuring dignity Hospitals can rob people of their dignity. Wherever and whenever possible help restore this: \200 Keep your patients covered (including during resuscitation) \200 Ensure the curtains are around the bed on the ward round \200 Make sure they have their false teeth in to talk and glasses/wigs on whenever possible Help them self-care when possible. Over-examination Patients are often clerked over four ti mes for a single admission. This is frustrating for them and often seen as indicative of a lack of coordination within the hospital. Patients may need to be clerked and examined more than once, but the context of this should be explained carefully \200\223 is this to gain more insight about their condition or to allow a training doctor to learn? People rarely m ind when they understand the reasons. Keep examinations which are invasive or cause discomf ort to an absolute minimum. _OHFP.indb 19 _OHFP.indb 19 30/05/2014 16:17 30/05/2014 16:17 20 CHAPTER 1 Being a doctor Communication and conduct Good communication with patients and colleagues is a vital part o f the job. All communication Whenever you are communicating with another health professional you shoul d include the following details: \200 Your name and role (eg Dr Charles Flint, F1 on Merc ury Ward) \200 The patient \200\231s name, location, and primary problem (eg Eleanor Rigb y who has suspected appendicitis in bed B4 on Neptune Ward) \200 What you wish them to do ( eg please keep her nil by mouth) \200 Urgency (eg immediately) \200 How to contact you if there are any problems (eg I \200\231m on bleep 3366).