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Top tips for F1s – foundation year 1

Don’t panic! Read our top tips for F1s. Image credit: ~John~, flickr

Dr Laura Davison, a GP ST1 from Milton Keynes, looks back at her foundation years and shares her top tips for all new doctors.

Congratulations, you’ve passed your finals! You’re finally a real doctor, but that was the easy bit – now the real work begins.

Medical school is a necessary evil to obtain the prestigious title and status “Doctor”, but I will warn you everything you learnt in the safety of the lecture theatre will be forgotten as soon as you set foot on the ward. But, never fear, this is normal! All you need to know to be a good doctor you will learn working in hospital.

After three years’ clinical experience, I’ve realised that the key to all medicine is knowing what is normal. Your first few weeks will be terrifying and feel alien, but it is reassuring to think that this is normal.

Foundation year one, aka the dogsbody year, is definitely the deep end: you have to learn to swim fast. It sounds scary and it feels it. But it gets easier I promise!

You may cry during your first weeks as a new doctor, when your first patient dies, when your consultant throws a strop or when you’ve had a beastly on-call and you haven’t even had time to pee, but remember this mantra – “It gets better as I get better”. It does and you will.

Your first day

On your first day you are likely to have to ask how to spell paracetamol and then have to look up the dose too, in secret (well I did, and this is normal). The BNF is every doctors’ best friend, and will be for many years. Don’t be ashamed to use it for every drug you prescribe if need be. It’s the only way you learn practical pharmacology and be safe for your patients..

F1s are newbies, the babies, hence expect to be treated as such. However, you will mature quickly and this lowly status and work life will improve as the year goes on, as you earn trust and respect from the already hardened NHS workers.

Handling seniors

It is normal to get grilled by seniors – in every department, in every profession – and though you may feel tiny at the time, you will learn quickly how to survive future grillings.

Preparation is key. If you know you have to go and discuss a patient with another colleague (usually a radiologist to beg for a CT spot, or a referral to another team to beg they take a high maintenance patient), be prepared: know your patient’s details inside out. Bloods, images, home situation, which leg is weak, which arm hurts, how the problem started, what their favourite hobby is, are they big or small, are they claustrophobic etc….

The senior doesn’t need to know all this gumph 99% of the time, but they will ask for it just to make sure you don’t cut corners and are kept on your toes.. They know when you don’t know what you’re talking about, so make sure you can surprise them!

Performing dreaded tasks

The first time you’re asked to confirm a death is one of the things that any newbie dreads. The first time will freak you out, either because

a)      you have watched too many horror movies and are expecting the dead to suddenly open their eyes, reach up and grab you

b)     because you will swear that you can still hear the patient’s heart beating.

To be honest, you can tell someone is dead just by looking at them – a pale waxyness, the “O-sign” of the mouth, cloudy eyes – you know it when you see it, but you have to listen and feel for a heartbeat, check breathing and their pupils for completeness. I will warn you, dead bodies creak – and one heart thud in 30 seconds does not constitute a life-sustaining heartbeat.

Coping with the stresses

When you get home from work, you will want to vent about the strains and idiocies of your day – so give housemates, spouses, parents a warning now, that being a doctor will turn your home life into a rant-zone! There’s nothing worse than bottling up fear, frustrations, anxieties and stresses. You won’t last the year. Get it off your chest somehow. Taking it out on the nurses and patients the next day will only come back and bite you harder than you can imagine.

The friends you live with during your house officer year will be your new bosom buddies. From my experience, the best thing I ever did was live in the hospital accommodation. Noone will understand how rubbish your day was better than someone who has gone through it too. It’s soothing to be able to vent your frustrations about the day, the patients, the staff, the seniors, the system, the canteen food, to someone else who has also witnessed it. Bitching sessions postshift are enlightening too. Maybe you didn’t have the “worst day ever”.

Acclimatising to life outside hospital

At the end of a day you will be so tired you will be willing to watch anything on TV, including The One Show. You will not be able to get the hospital smell out of your clothes or hands until the weekend. You will bring up inappropriately graphic topics and stories at non-medical dinner tables and in the pub but never, ever breach confidentiality.

A few tips – lay-folk don’t appreciate you saying that Holby City is medical tosh, TCP is not an acceptable odour to wear in public and describing what colour vomit you got on your shoes today at the dinner table is not acceptable – unless you’re with other medics.

On the plus side, as a junior doctor you have few outside work commitments, so relish it! For the first time in five years you have no homework, no assignments due, no tutor chasing you, no exams looming. In the words of Ferris Bueller: “If you don’t stop and look around once in a while, you could miss something”. Embrace this freedom and enjoy it

The wider picture

Being a real-life doctor is not glamourous; it is hard work and can be an unforgiving and thankless task at times, but it also can be extremely rewarding if you go about it in the right way. Respect your colleagues, care for your patients treat others the way you would want to be treated and above all treat yourself to the canteen pudding at lunch and you’ll enjoy work much more, guaranteed. Good Luck, and remember, it gets better as you get better.

Here are my top tips all “Newbies”:

1. Nurses are your best friends – You are not above them and you never will be. Realise that now. Even when you get to consultant level, the nurses test (?)you. Keep them sweet, ask them for their opinion (even if you decide not to follow it) – they have been there a lot longer than you! . If you want people to help you, help them, so offer to help out,.– the sentiment will hold you in excellent stead. Buy them the occasional box of biscuits and ask about their weekend Treat a nurse like a slave and you will NEVER have a peaceful shift.
2. Locate the nearest BNF – and don’t be embarrassed to use it! The more you use it the more you remember – the easier it is to spot when a prescription is wrong.
3. Wear comfortable shoes – You will walk miles every day. Girls, beware of heels, it is very embarrassing to walk down a quiet ward in clip-clop heels.
4. Smile – You get away with (almost) anything.
5. Communication is the magic word – To ensure what you want doing is done – communicate it! Write instructions down CLEARLY (there is no excuse for illegible handwriting. Hand it over, inform the nurse – every time.
6. Ask for help – You’re new. You are not expected to know everything (or even anything in your first few weeks). Use your team. Don’t worry about asking for help from the SHO, reg or even the boss. If you are struggling with the work load, tell someone. What’s harder, asking for help, or explaining to the boss why it all went tits up?
7. Don’t stay late – Well, don’t make a habit of it, no-one will thank you for it and you will hate it. Good handovers are essential. Don’t handover day-time dross though (like drug-charts and TTOs), it will come back to haunt you. “House Officer Hand Over Revenge” will be inevitable.
8. Lunch and pee-breaks come first – If you don’t eat you are no good to anybody. Even if you think you don’t have time for lunch, you DO!. LUNCH! The only reason to miss a lunch break is a crashing patient.
9. Get an Oxford Handbook – the Foundation Programme Guide is excellent. Have it nearby, particularly if you’re on-call. It’s a Godsend. I still use it now in ST1.
10. Be organised – To your team, you are the dogsbody, the “Gofer”, the team PA. You need to know who your patients are and where they are, so keep an up-to-date list every day. Have investigation results on all patients to hand, a spare pen, a stethoscope and a tournequet. Know where your SHO, registrar and consultant are to ask for advice and avoid when you’re on a break. Lots of house officers use folders or clipboards to store their information in, but there’s no hard and fast rule – use what works for you. Also you’ll see many, mainly female junior docs carrying around little shoulder bags brimming with stuff; I just recommend pockets and belt-loops. Bags get in the way when leaning over patients all day long.

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