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Author: Dr Rhiannon Jones

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What is Foundation Year 1 like?

Throughout FY1, there are certain things you have to do to pass your appraisal at the end of the year, and thus gain a full GMC license to practice. These include the following:

  • to attend mandatory training days throughout the year (in my trust, I attended 6 days as an FY1),
  • to complete written reflections (roughly 2-3 per week) of patients you have seen and managed,
  • to have regular meetings throughout the year with your academic and clinical supervisors,
  • to gain competencies in specific skills, i.e. cannulation, catheterisation,
  • to complete a ‘TAB,’ which is where you ask for feedback from 10 colleagues on how well you have worked over the placement,
  • to complete certain online modules, including prescribing.

Each doctor has their own personal experience of being an FY1. This is due to many factors that include; different specialities, staffing levels, hospital selection and much more…

As an example, I have included a ‘typical week’ for each job I had as a foundation doctor.

Anaesthetics and Urology

Wednesday and Thursday, 8 am-8 pm, Urology ‘on-call’ doctor

  • 8 am -10 am: Ward round with consultant and registrar. Reviewed all the urology patients who had been admitted urgently overnight. Patients were located on 3-6 different wards across the hospital. My role in the ward round was to provide the seniors with recent observations (i.e. Recent BP readings) blood test and scan results. I wrote in the patients’ notes and created a job list for the rest of the day.
  • 10 am-12 pm: Ward round over – requested all necessary types of blood and scans for the day. Reviewing sick patients as necessary.
  • 12 pm-2 pm: Discharging patients identified from ward round from the hospital.
  • 2 pm-5 pm: Reviewing and managing sick patients as necessary, finishing jobs, checking test results.
  • 5 pm: catch up with urology registrar to assess the day’s progress. They reviewed patients then as well if needed.
  • 5-7:45 pm: Finishing jobs, preparing discharges and printing blood cards for the following day
  • 7.45 pm-8: Handover with night FY1. Specifically highlighting sick patients who could deteriorate overnight. Handing over any outstanding test results to be chased.

Friday, Zero day 

This is when you have a day off ‘in-lieu’ of the extra hours you have worked in the last few days – I had completed 4 12 hour shifts, so had a ‘zero day’.

Saturday and Sunday, Off work

Monday, 8 am – 5 pm, Anaesthetics 

  • 8 am: Go to the assigned anaesthetic room in theatres, dressed appropriately. (scrubs, hair net, theatre shoes) Introduce self to the anaesthetist for the day. Get patient theatre list. Take an anaesthetic history from the patients.
  • 9 am: WHO checklist debrief in theatres, the first patient called through.
  • 9:15 am: Work with the anaesthetist to prepare the patient for surgery. Cannulate patient, administer anaesthetic medications, help intubate patient, practice at bag-mask ventilation.
  • 9:45 am: Help team bring patient through to theatre. Help roll patient and get into the correct position for surgery.
  • 10 am-12 pm: Whilst the patient is asleep, monitor and record patient vital signs on the chart. Administer medications as needed. Teaching delivered by the anaesthetist
  • 12 pm-12:15 pm: Assist anaesthetist in waking the patient up from the anaesthetic. Manage airway appropriately. Give handover to the recovery team.
  • 12:15 pm: Lunch break.
  • 1 pm-5 pm: The same process, depending on the number of operations scheduled.

What I wish I’d known before starting medical school.

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Acute and General Medicine

Wednesday and Thursday, Ward 21, 9 am-5.30 pm

  • 8.55 am: Arrive at the ward, print patient list for the day.
  • 9 am: consultant arrives at the ward. Discusses which doctor will cover which patients for the day (or week). Typically assigned about 10 patients. MDT meeting to discuss each patient in detail covering issues from the day before.
  • 10 am: Ward round commences. I run these independently. I see all 10 patients, take histories, examine each patient, address issues and form management plans accordingly. I raise any issues with the consultant who reviews patients I think are fit for discharge (as an FY1 you cannot discharge patients) or patients who are very unwell.
  • 12:30 pm: ‘Board round’ – all MDT members again present. Discuss each patient again and management plan for each.
  • 12:30 pm-1 pm: Lunch in the mess
  • 1 pm-5.15 pm: Complete jobs in order of priority. Review sick patients as needed.
  • 5.15 pm-5.30 pm: Hand over any outstanding jobs to the night doctor or patients at risk of deterioration, so the doctor is aware

Friday, Ward 21, 9 am-5.30 pm

  • Similar structure to the day above.
  • Make a list of jobs for the weekend staff covering ALL the medical wards.
  • Prepare discharge summaries for the weekend so patients can go home if remain well.
  • Put out blood cards and request scans for the weekend if needed.

Saturday and Sunday, Off work

Monday, Acute medicine On-call, 9 am-9.30 pm

  • 9 am: Get bleep from the office, go to the ward. Staff meeting to discuss patients who have been admitted overnight and who still needs clerking.
  • Assigned patients to doctors and establish who will clerk the remaining patients.
  • 9.15 am: Commence ward round (typically 8 patients). Take histories from all patients, examine and determine management plans accordingly.
  • 12pm: ‘Board round’ consultant runs board round, summarising patient cases and management plans. Opportunity to ask questions or request senior reviews.
  • 1 pm-5 pm: Complete jobs for patients including discharges, cannulations/ simple procedures, requesting and reviewing scans,
  • 5 pm: Day staff leave and give you the handover.
  • 5-9 pm: complete outstanding jobs, review sick patients, clerk patients when necessary making sure to check clerking’s with a senior (as an FY1)  

Tuesday, Acute medicine On-call, 9 am-9.30 pm

  • A similar structure as above.
  • Meetings at 1-2 pm where free lunches provided by drug reps. Meetings typically involve presentations of audits or QI projects.

Cardiology

Monday, Tuesday and Wednesday, Standard day, 8 am-4 pm

  • Arrive at the ward for 8 am.
  • 8 am-8:15 am MDT meeting to discuss all sick patients on all wards, highlight staff for each ward, reminders to countersign DNACPRs etc
  • 8:15 am: commence ward round. Typically 12 patients assigned to you. Consultant lead ward rounds, typically on Monday, Wednesday and Friday depending. Otherwise, independently led ward rounds.
  • 11 am: Board round to discuss management plans for all patients.
  • 11 am-1 pm: Book all urgent scans and blood tests for the same day. Prioritise jobs. Start working through the job list.
  • 1 pm-2 pm: cardiology teaching (weekly) delivered to all junior doctors by registrars. Often free lunch too.
  • 2 pm-3.45 pm: finish jobs, review sick patients as required.
  • 3.45-4 pm: Handover outstanding jobs to FY1 on-call/ on long days. Highlight patients likely to deteriorate so doctor aware of patient history

Thursday and Friday, Zero days

Saturday and Sunday, On-call, 8 am-8 pm

  • 8 am: Arrive for the daily meeting.
  • 8:15 am: Go to the ward round to review outlying patients with registrar first. Then go to general cardiology wards and review patients highlighted by the week teams.
  • 11 am-8 pm: Complete all jobs for outlying patients and ward patients. Review sick patients as needed.
  • 8 pm: Handover to FY2 on nights – specifically any patients expected to deteriorate

So, you want to be a Medical Student? We can help with that…

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