The way I see it

What to know on day 1

Authors: Teresa Tsakok 

Publication date:  03 Aug 2011

Five things Teresa Tsakok wishes she’d known at the start of the foundation programme

1: Know your place—and what to do on a ward round

Foundation doctors or house officers are sometimes fondly referred to as “house plants,” and it’s true that we sit on the bottom rung of the firm’s hierarchy. It is a mistake, however, to underestimate the importance of your role. A good house officer is akin to the lubricant that can make or break the well oiled running of the firm. Take the consultant ward round as an example: aim to facilitate a slick performance, and your team and your patients will be grateful. How? Ask your senior house officer or specialist registrar what your consultant expects. Then update the list and revise its salient points. Consider printing off the latest bloods or investigations. Get the correct sets of notes ready to avoid last minute scrambles, and carry spare paper and pens—the only person who will lose out if you don’t manage to scribble down the plan is you (and of course the patient). Steer your team round the ward or hospital in a way that makes geographical sense—this saves time and helps avoid the cardinal sin of missing a patient. Make a note of each job on your own list; if you need clarification, catch the specialist registrar at the end of the round before he or she disappears. Finally, don’t live in fear. The upside of being a dogsbody is that the buck emphatically does not stop with you. Never be afraid to ask for help, and take the opportunity to learn new things whenever possible. Foundation year 1 will be the most carefree of your career, so try to enjoy it while it lasts.

2: Know how to make a good referral

This is an art—perfect it and you will become an asset to your team. Remember that you are effectively asking a specialist to take the time to hear you out and then help you out, so never be blasé. You will need these essentials to hand: patients’ notes, drug chart, and observations chart. Review all three and clarify in your mind the key points in the history and the key questions you would like help with. Find a phone next to a computer so that you can look up further imaging or blood results if needed. Always start by stating who you are and where you are calling from. You should give the age and sex of your patient before presenting a clear and concise story, culminating in your questions. If you ramble tangentially and incoherently you will simply be asked to call back when you know what you are talking about. This is a waste of everybody’s time, so it’s worth presenting a persuasive argument in the first instance. After your discussion, document the outcome in the patient notes.

3: Keep calm (and don’t just carry on)

Hunger and sleep deprivation do not a happy doctor make, and you won’t impress anyone by skipping lunch on a regular basis. Keep hydrated and keep things in perspective—there’s always time for that loo break. You will inspire more confidence in patients and colleagues if you are not flapping around like a headless chicken. At home time, knowing how and when to hand over is a crucial part of your responsibilities; pay attention to the specialist registrars to see how it’s done. Night shifts are an exercise in knowing how to prioritise; keep a list and write down every single job you are asked to do, together with patients’ hospital numbers and wards. Sit down, take stock, and group tasks by urgency and location; then it’s just a matter of working through them to the best of your ability. If you don’t get to the end of your list it’s not a failure on your part—sometimes it just won’t be possible. Your colleagues will understand because they will have been in similar predicaments.

4: Appreciate the people around you, especially your patients

Although you are responsible for the smooth running of your firm, a host of people in turn dictate how easy your life will be. For instance, administrators are the guardians of rotas and payslips, so it pays to stay in their good books. Chief among your potential sympathisers are nurses, the stalwarts of any ward. They are likely to be familiar with the system and the patients in a way that you are not and adept at procedures you didn’t even know existed. Make an effort to enlist their invaluable support as early as possible, because it is only by collaborating with them that you can provide the best care for your patients. This principle also applies to the therapists (physio, occupational, speech and language, dietetic), who will help you take a holistic view of patients’ needs in preparation for a happy discharge. Remember: more than any other member of your firm, you know the patients best and can act as their champion. Their gratitude will make it all worth while.

5: Look ahead

Have a healthy awareness of the tick box culture—don’t let it rule your life, but don’t bury your head in the sand. Applications for core medical or surgical training happen a few months after the end of foundation year 1, so it is useful to start nurturing your CV sooner rather than later. Firstly, learn to make full use of the ePortfolio, the online record of your post’s details and achievements. If you form the habit of entering “self reflections” about your experiences as they happen, you can avoid the tedium of trying to fill everything in at the 11th hour. Secondly, consider committing to one or two small projects on top of your day job. This requires motivation, so be realistic about what you can achieve. You may choose to prepare for membership exams; alternatively, audits and case reports may prove easy wins. Either way, use your first foundation year to start building a network of contacts. You will benefit hugely from finding mentors who can help guide you through the process of deciding what you want to become—and how on earth you’re going to get there.

Teresa Tsakok academic foundation year 1 doctor Guy’s and St Thomas’ Hospitals, London, UK

Cite this as BMJ Careers ; doi: