My first year of specialty training

Authors: Nida Ahmed, Ali Hassan, Clinton Vaughn, Tabassum Khandker, Yasmin Akram 

Publication date:  14 Aug 2012

BMJ Careers has been tracking a cohort of doctors since their first day at work. This week the five doctors report on their first year as specialty trainees

Nida Gul Ahmed (core trainee year 1, psychiatry)

I have many fond memories of my first year in psychiatric specialty training. I can honestly say that no two days were the same, and each day brought new challenges. As with many specialties at present, changes are occurring in psychiatry at a startling pace. Being involved with these has been beneficial to me, however, as I have gained character building experiences that I would not otherwise have had. I learnt to expect the unexpected every morning.

My first rotation was primarily an acute adult inpatient job. Owing to bed management changes, the firm became very busy in the latter half of the rotation, which allowed me to see a wider variety of acute presentations alongside psychosis. Although patients were difficult to manage at times, I enjoyed working with the excellent seniors and nursing staff. They had a wealth of experience and skills and were very supportive of a novice like me. I was given a clinic afternoon one day a week, where I was able to see patients in the community who were less unwell, while enjoying being part of a team at a busy inner city community mental health trust.

Changeover came all too quickly in February, and I progressed to an old age psychiatry rotation. Part of my time was spent in the community, and the rest was based on the ward. I enjoyed the overlap between the organic and psychiatric aspects of the job, and by this point I realised that my psychiatric knowledge was increasing daily. This was, however, potentially at the expense of my medical knowledge, and so working with elderly people allowed me to partially reconnect with what I had learnt in the foundation years. Senior support during this rotation was outstanding. It was a real privilege having weekly one to one supervision with my clinical supervisor.

As the psychiatric senior house officer on call I was able to observe the interface at which psychiatry meets other branches of medicine. My predominant reflection is on how psychiatric patients are perceived and treated in the NHS and how psychiatry, as a specialty, is viewed by other healthcare professionals. I do feel that we have come a long way in this regard, but more needs to be done to challenge preconceptions that are easily and hastily made.

I left my training post in early May to get married. I have since moved abroad, and I am currently enjoying settling into married life. I look forward to assessing my career options in Dubai. Although I am happy with the decision to move abroad, being a core trainee year 1 in psychiatry was an amazing experience, and I take with me many important lessons that have made me a more rounded person and therefore a better doctor.

Ali Hassan (specialty trainee year 1, ophthalmology)

My specialty trainee year 1 in ophthalmology has been an intense year, packed with ups and downs, but thankfully mostly ups. The immensely varied clinical exposure has kept me on my toes, and there has always been a new challenging case around the corner. The working week has been made up mostly of outpatient clinics, two theatre sessions, and one eye casualty session, although getting my allocated theatre session has been a bit of an uphill battle at times.

Ophthalmology is mostly an outpatient specialty, and therefore I spent much of the year getting up to speed on the fast pace of outpatient clinics. Having started seeing just seven patients in a clinic, I am now up to nine. I am just about managing to squeeze clinical assessment, documentation, and dictation of a letter for each patient into the allocated time, but it takes just a few complex patients to throw the whole session off. I’m still amazed at how my senior colleagues seamlessly see 14 patients in a session.

Having so many clinics in a week ensures a large throughput of many different patients, and it is from them that I have learnt most this year. These interactions involve all the subtleties of clinical consultation skills. Over the year I have practised building a rapport with people of all ages and from many different walks of life. Importantly, I am learning how to maintain an effective clinical relationship when there are problems with establishing a rapport.

This year in ophthalmology has also exposed me to the high pressure working environment of a walk-in eye casualty clinic, which has been an education in the true meaning of working under pressure. The experience has been testing at times, but looking back I am glad to have gone through it.

The transition into specialty ophthalmology training has been accompanied by a slight sense of isolation from the rest of the trainee doctors in the hospital. There is a lot less interaction with the other specialties and hence other trainees within the hospital; I had grown accustomed to this interaction throughout the foundation years and medical school, and it is something I miss.

Memorable highlights of the year have included completing my first independent cataract operation and passing my fellowship of the Royal College of Ophthalmologists part 1 exam. The sustained pleasure of the job, however, has been the day to day satisfaction of happy patients, and thankfully ophthalmology is a profession in which you can please most of the patients most of the time.

I am glad to say that the year has provided me with a fantastic grounding in ophthalmology and has continued to fuel my love for the specialty.

Clinton Vaughn (core trainee year 1, acute care common stem, emergency medicine stream)

I am now a core trainee year 1 going on core trainee year 2 in the grand adventure that is emergency medicine. There have been (small) triumphs, frustrations, and disappointments along the way, but I believe I am becoming a better doctor because of them. So although it may not always be a pleasant ride, long may the refinement continue.

The first two months of emergency medicine were tough. I had to adjust to a new hospital and try to reach the standards expected of me, but thankfully I found equilibrium. A nicely organised resus case, joint reductions, a very large scalp laceration, and the odd injection of adrenaline into a very bradycardic patient were the moments that confirmed my decision to do emergency medicine.

The most enjoyable period was the fifth and sixth months. The notion of going to work feeling comfortable and unfazed (or maybe ignorant) of the challenges ahead was very liberating. Working with a fantastic and supportive team was often the best aspect of the day.

Of course there were times when I got things wrong, but to be honest those moments were the most educational. Nothing teaches you like being humbled. When it all ended I was genuinely sad to leave.

My second rotation was in the medical assessment unit, and I began it with a sense of trepidation and fear. I hadn’t done any real medicine since foundation year 1 and was expecting to feel very stupid 95% of the time. As I was presenting a patient to a consultant I got a genuinely sympathetic laugh and smile when I said that I knew no internal medicine. Thankfully the principles of emergency care are the same whether in the medical assessment unit, surgery, or the emergency department, and soon my weeks on call became a genuinely exhilarating mix of sepsis, arrests, myocardial infarctions, heart failure, lumbar punctures (not all successful), tuberculosis, and sickle cell anaemia. In general, acute medicine was brilliant. I learnt more useful practical things than on any other firm to date. Medics are intelligent, but they are also very supportive (which was a pleasant and relieving lesson to learn). I am sure the experience will make me a more competent registrar, and I hope my referral quality will have increased as a result. So to any medical registrars reading this, please accept my patient.

The future is always slightly daunting, whether it be exams or intensive care on calls. The College of Emergency Medicine membership exams B and C beckon, so there will be a period of solitary confinement to come. I hope in the future to take an out of programme experience and work abroad for a year. I have also been dabbling in medical education. Teaching is something I have loved since medical school, and I am now considering applying for a postgraduate diploma in medical education. The simple pleasures of teaching a student about anaphylaxis or a foundation year 2 about a procedure are too attractive to be ignored.

There will be further refinements, exams, humbling experiences, and annual reviews of competence progression to come. But they will make me a better doctor, so I will thank God for them right now.

Tabassum Khandker (specialty trainee year 1, general practice)

As my general practice specialty trainee year 1 draws to a close, and after conquering the stresses of the annual e-portfolio sign off, I find myself reflecting on what I have learnt in the past year and what I still have to learn. Medicine is a lifetime of education, and the range of subjects increases as you progress through training.

During the past year I have had rotations in general practice, paediatrics, and psychiatry. Some of this work was new to me, but some I had experienced during foundation training and so I was more confident in it, as my expectations were realistic and I felt able to cope with the challenges. I was able to hone previously acquired skills, such as procedural and communication skills, but also to identify areas for improvement, such as gaps in my knowledge base and dealing with difficult situations or ethical dilemmas. Specialty training year 2 will be based in hospital, and I hope to build on my strengths and look at my weaknesses in preparation for independent practice after training.

I have identified areas of special interest and have worked towards achieving further qualifications such as a diploma in child health; having a defined focus has enabled me to prioritise my non-clinical training. For the first time I have been thinking in concrete terms about my future as a clinician, rather than thinking in terms of working as a doctor somewhere doing something.

Competition and ambition are integral to progress in medicine, but so is teamwork and encouraging others to achieve their goals. I have appreciated the scheme based training structure, where trainees can support each other and learn together, which reminds me of medical school. I am a scheme representative for the deanery committee and have appreciated the opportunity to be involved in my training and to suggest improvements for future trainees.

There are many changes happening within the NHS, and I think cohesion during upheaval increases the chance of success. By understanding from seniors what has worked and what should be improved on I hope the changes will be for the better. I strive to be aware of these developments so that I can understand my future role as a general practitioner within the new framework.

As I progress further in training I have realised that those skills I reluctantly learnt in foundation training—managing time and tasks, administrative proficiency when producing discharge summaries and reports, and confidence when presenting cases and conducting audits—contribute to making me a manager, administrator, and negotiator as well as a clinician, which is increasingly essential in the NHS. During the next few years as I work towards membership of the Royal College of General Practitioners, I aim to become not just a jack of all trades but a master of all of them.

Yasmin Akram (specialty trainee year 1, public health)

Public health, one year on: how do I feel? I think it would be fair to say that although I have found my calling, at times I still feel somewhat of an impostor. I am not yet quite in a position to explain to someone at a dinner party exactly what my job involves.

The first year has largely been spent doing a masters in public health, and although it was certainly nice to be back in scruffy jeans and hoodies, I was fooling myself when I thought it was going to be an easy ride. Having thought, “I’ve done a medical degree, how hard can a masters be?” I was in for a shock. The masters has put me through my paces and has definitely taken to the next level the need to manage my time. Each module has been in week long intense blocks and necessarily demanded hours poring over research papers and constant struggles to finish assignments well beyond the witching hours. As one deadline has been met, the next has loomed.

The weeks not at university have been spent at work learning the ropes and doing small pieces of service work, in what is for the next few months still the primary care trust. With the transition in progress of public health to local authorities, it has not been easy to get a grip on exactly which direction the organisation is heading, but despite that I have been well supported both in the masters and at work.

The public health registrars’ network is a fantastic wealth of information and support, and it has been my public health version of “googling” the answer to a question. Being on a first name basis with everyone from the director of public health to public health consultants to administrative staff has made it easy to ask for advice as and when I have needed it.

As for missing clinical medicine, maybe I do at times. Public health does not have the quick fix moments of satisfaction that clinical medicine has, but I can rest assured that I will be doing what I went in to medicine to do: make a difference. I can’t wait to get the masters finished and start doing some real public health work. I just have the (not so) small matter of my dissertation to get through first.

Read the doctors’ earlier accounts of their careers on the BMJ Careers website

Competing interests: None declared.

Nida Ahmed specialty trainee year1, general adult psychiatry  South West London and St George’s Mental Health Trust, London, UK
Ali Hassan specialty trainee year 1, ophthalmology  Northampton General Hospital, Northampton, UK
Clinton Vaughn core trainee year 1, acute care common stem  Homerton University Hospital NHS Foundation Trust, Hackney, London
Tabassum Khandker specialty trainee year 1, general practice  Epsom and St Helier NHS Trust, Surrey, UK
Yasmin Akram specialty trainee year 1, public health  Birmingham East and North Primary Care Trust, West Midlands, UK

Correspondence to: Y Akram

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