My previous article summarised the common experience of many FY1s. I apologise if it was dark, but I hope you could relate to some of it and can recognise that your struggles as a new doctor are understood. But I’m not here to bicker - far from it. This next article is designed to equip you with skills and tips that will enable you not just to survive through FY1 but thrive through it and beyond! It’s a lengthy article but I hope it's useful.
Prioritisation: This is spoken of later but not really taught in medical school. Prioritising ensures that you tackle the most urgent and important first:
Urgency focuses on time. Importance focuses on its impact.
Below is a rough guide. However, there is no clear-cut rule for this! The urgency and importance can change on a day-to-day basis according to the patient’s clinical stability and circumstances, hospital status (beds, politics) and the registrar or consultant – so ask your seniors if you are not sure:
Urgent important jobs:
Discharge letter and medications if discharge is today;
Investigations and referral for a sick patient
Non-urgent important jobs:
Discharge letter and medications if discharge is tomorrow
Investigations and referral for a stable patient
Repeat follow-up tests – CXR, bloods
Urgent/Non-urgent non-important jobs:
Updating relatives/a colleague or senior (some cases vary)
Lists: Write a list and break it up by type of job and priority. This can be separate from the handover sheet.
Division of labour: A good doctor recognises their limitations and when they need help. A common occurrence amongst junior doctors is when they try to save face or look amazing, by showing they are competent and capable of doing jobs assigned to them, even when the jobs list is long. This can be unwise – it is better to complete a few jobs very well and correctly, than many or all jobs incorrectly and/or incompletely.
Post-ward-round handovers are very useful as you and your colleagues discuss and allocate jobs. Other healthcare professionals can assist you with jobs such as nurses (band 6 and above, specialist nurse practitioners), physician associates and senior medical students (unfortunately, not all are clinically confident so do this with discretion).
Also, note that an end-of-shift handover is also a form of division of labour.
SBARD: This has been one of the most useful tools. It helps you to organise your thoughts and for the recipient of the phone call to understand what is going on and what needs to be done. Make sure you give information that will affect the management or decision that the clinician will make. The order I recommend is: confirming the recipient of the phone call, introducing yourself, stating clearly why you are calling (advice, review etc.), noting significant observations and investigation results (e.g. ABG, radiograph, scans, swabs and samples from microbiology); interventions so far and the outcome. The information you give and your concerns will demonstrate and thus determine the urgency.
Document everything: It is very important to document every conversation, decision, clinical change and interaction involving the patient. Not only is it for safety and to be able to keep a record of the patient’s clinical care, but also as evidence in case of any clinical errors or medicolegal purposes.
Useful apps: We live in an age of technology whereby medical information is very accessible! If you are not 100% sure about the management/drug required, it is safer to check medical information.
Some apps I highly recommend downloading include:
BNF/C: also includes treatment summaries!
Microguide: antimicrobial treatments for infections according to your local hospital protocol
Induction: directory of most contact numbers for different persons and departments in your hospital
MDCalc: calculator for various clinical scores
Arrive early: Arriving 10-15 minutes early gives you time to get into the mindset of work, print out handover sheets and overall being prepared for the day ahead– including a cup of coffee! The worst thing is to arrive just as your shift starts, rushing around – especially if the consultant comes early!
Learn to say no – nicely: This is for all my fellow “yes-people” who find it hard to say no. One thing I certainly changed after my first rotation as an FY1 was my accessibility. Now a doctor needs to be accessible – even during their break. But you do not need to be accessible for every request. The more skilled and efficient you become as a doctor, the higher your accessibility becomes, but use with discretion.
An example would be being asked to change paracetamol from regular to PRN - a non urgent, non important job. In this case politely saying that you are aware and will do it when you can is appropriate. Just remember to write it down on your list.
But remember, non-urgent still means it needs to be done by the end of the day if possible!
Speak up and ask questions: “There’s no such thing as a stupid question”. This does not change even after medical school. It is better to be safe and “stupid” rather than “smart” and dangerous. Many juniors have made clinical errors because they were afraid to ask questions for a variety of reasons: forgetting to ask, fear of looking incompetent, or an unapproachable senior. If you unfortunately have an unpleasant senior, you can ask other seniors within the department. Always clarify instructions and jobs given to you if you are unsure. If they have a problem with you asking questions, you may need to raise this with your clinical supervisor or just realise they’re probably having a bad day.
If you are not comfortable with a clinical decision, you can question this by respectfully asking for the reason. Most seniors are happy to answer your question and explain their justification. It may also make them realise a mistake and change their plan. Asking questions also demonstrates being thorough, attentive, safe and teachable.
Take breaks: Unfortunately, major incident reports have demonstrated continuously that human error is largely contributed to fatigue and overworking! Not just that but, your bad day may be due to failing to rehydrate, refuel and relax - it’s important to recognise and be aware of your emotions. Remember to take not only lunch breaks, but coffee breaks, water breaks and toilet breaks.
Unless there’s an emergency and it is safe to do so, it’s perfectly fine to walk out from a very stressful and emotional situation; an example includes challenging communications between colleagues or patients. This allows time and space to process your thoughts and emotions even if it means having a good cry. Having a trusted colleague or friend is also ideal.
Talk to someone: What develops a doctor is not just teaching sessions or training courses, but their interactions with others. Don’t be a lone island at your workplace. Even if you don’t get along with all your colleagues on your ward, there are definitely other juniors around the hospital that you can develop a work relationship with, even nurses and other allied healthcare professionals. It’s important to find at least one person that you can open up to, are comfortable around and enjoy spending time with at work - they can teach you a lot.
Voice your concerns and opinions: If something does not sit right with you, it’s vital to speak up or act on your instinct. No matter how junior you are, your voice matters. If a colleague has offended you or made an error, speak to them directly before you speak to someone else about them. This is hard for those of us who are not confrontational, however, silence does not guarantee peace. Maintaining peace may mean speaking up.
Pat yourself on the back: In case you’ve forgotten, you have completed one of the hardest degrees out there. Whether you failed OSCEs, repeated an exam, assessment or academic year, ranked low, took longer to complete your degree, you still secured an entire MBBS!
Out of 7000 applications, out of 700 interviews, out of hundreds of starting students, you were one of the few who made it and became a doctor. You should be proud and walk with your chest held high.
So, don’t ever feel like you do not belong or you are not good enough. Imposter syndrome is real and can rob you of your confidence, joy and work satisfaction. You earned your title and one of the most secure careers in the world; pat yourself on the back with positive words.
Sleep: You may have been able to get away with sleep deprivation at medical school, but you certainly cannot as a doctor. We all know about the importance of sleep and the detrimental effects of sleep deprivation – it equates to alcohol intoxication. If drink driving is dangerous, then so is “sleepy” driving, and thus “sleepy-practice”.
Sleep deprivation affects your ability to work safely, efficiently and your mood (hence, “continuous bad days”). It also has short-term and long-term effects on your brain, body and life span (many doctors die from “sleepy driving”).
Sleep quality and quantity can be affected by alcohol and coffee consumption, phone use, life issues, depression, anxiety and a lot more. Please make sure you try and work on these areas with the appropriate help, such as your GP. Remember, sleep is a form of self-care.
Take care of yourself and rest: It’s important to be mentally and physically happy as this affects your ability to work and clinical practice. The best way is to rest passively and actively and fuel yourself with a highly nutritious diet. Passive rest allows us to empty out all the stress and tension we have accumulated – this involves venting to friends & family, watching shows, using social media, having a lie in etc. which all give the brain a break from thinking.
Active rest allows us to replenish and revitalise ourselves with positive energy – this involves engaging in hobbies, various forms of self-care, exploring new activities, socialising with friends & family, responsibly spending money on holidays, gifts and experiences.
I hope these tips help you all as you start or continue on your journey as thriving happy doctors!