Preparing for FY1

Dr Martha Martin graduated from King’s College London in 2016 and is about to complete her first year working at Homerton University Hospital in East London. Here she recalls the concerns she had before starting her first job and offers some tips to newly qualified doctors who are about to embark on their foundation training.

I have heard from doctors further along in their training that the camaraderie that exists among doctors during their foundation years is unique. Indeed, some say that these years were the best times in their careers so far. When there are lows there are people to talk to, seniors to seek help and advice from and processes to follow.

Looking back to this time last year, there were four main worries that I shared with many of my FY1 colleagues. Here they are, together with some tips that this year’s FY1s might find helpful.

I won’t be able to remember treatments or drug doses

Thanks to technology and the BNF you will always have time to look up a medication dose if you need to - it is crucial to patient safety. Download the BNF app or have the tab open in your browser if you’re working at a hospital with a computer system (my preference since it doesn’t look like as if you’re using your phone during the ward round). Alternatively, have the paper version to hand if you prefer.

Pharmacists work on each ward and are the people to consult about dose adjustments, interactions and general advice. Introduce yourself when you start work on the ward (know their names) and your life will be much easier.

We learn doses and treatments as we go along and it can feel overwhelming the first time you manage and prescribe the treatment for a certain situation. To get off to a good start, learn doses for emergency scenarios (even though you will have time to look these up) and know that you dose adjust by weight for low molecular weight heparins.

During your shadowing period ask the current F1 where the hospital keeps its Management and Antibiotic Guidelines – ours are on the hospital intraweb – as they are useful and crucial when you are on call.

I won’t be able to perform practical procedures like bloods or cannulas when they’re really needed

This was my biggest concern. I panicked at the idea of being asked to do crucial bloods and being unable to get them. The only thing I can say is practise, practise, practise. Experience and circumstance count for so much with these procedures.

If a patient is dehydrated it may be very difficult to find a vein. A colleague coming back an hour later after the patient has started fluids may well have more luck. The general anecdotal rule is to try three times and then ask for help. Try not to blame yourself if you are unable to get it. Instead, watch the person you asked for help, as you will probably acquire a trick or two.

The best tip around is to get the position right. Use the bed controls to adjust the bed height so you are not straining your back, turn on the lights in the bay and maybe put a pillow underneath the patient’s hand.

If it doesn’t work, there is always help at hand - your SHO, the nurses on the ward, your registrar or, if the worst comes to the worst, anaesthetics or the vascular access team.

I will be alone when someone becomes acutely unwell and I can’t ask for help

Knowing your ABCDEFG has never been so useful. As an F1, you may well be the first person to see an unwell patient. Following this simple but effective assessment structure will keep your patient safe, and allow you to get your thoughts in order. There is a reason it has been drilled into us at medical school. Following a well-rehearsed routine will give you some space to think about what is going on.

If you find you are not able to move on from A-B or from D-E because there is a problem you cannot identify or solve, dial 2222 to put out a Medical, Surgical, Trauma, Code Red (for Major Haemorrhage), or Paediatric Emergency call. You will never regret doing so but may well regret it if you did not.

Asking for help earlier rather than later is best for your patient and seniors prefer this too. Don’t persist through an assessment if you feel someone is very unwell or if you feel out of your depth. There are hospital guidelines for acute emergencies - make sure you know where to find them if needed.

I’m going to make a mistake

At this stage, and in fact throughout our careers, mistakes are made as part of a wider team. As an F1, the consultants are ultimately responsible for the safety of your patients. The most important role you can take when a mistake has been made is to inform your seniors, seek advice and speak with the patient.

There will be guidelines to follow to help report mistakes. If you have a gut instinct that something is wrong, it most probably is. It is our job to ask questions, be critical and analytical of decisions and care and speak up if and when something might be wrong.

Admittedly this may be tough in situations where hierarchy makes it difficult to speak up. However, remember it is patient safety that is your driver for speaking up and you are doing so because you care for your patients’ and colleagues’ welfare.

Talk to your friends and colleagues about the most strategic way of reporting it. You will be supported by seniors – if not in the department you are working in then go to your Clinical/Educational Supervisor or Director of Medical Education. Speak to the Senior Sister in charge of your ward and get a Datix raised.

We will all make mistakes in our careers but we are lucky to work as a wider team with a shared aim of improving patient health.

As long as you put patient safety first, take an ABCDEFG approach and practise with empathy, most doctors sail through FY1 with all its ups and downs. These come together to make us all better doctors.