30 doctors give advice to new FY1s
Illustration by Dr Merili Pugh
It’s not long now until a huge number of newly graduated Foundation Year 1 doctors hit the wards. I happened to be married to one of those brand new FY1s, and know many of her recently graduated peers. Not long ago, I found myself chatting to a soon-to-be doctor, and she asked me if I had any advice for her. After some thought, I decided the best approach would be to crowd source advice from doctors of every location, stage and specialty.
Before getting into all the excellent advice provided by the many doctors below, I want to offer my three things for new doctors to remember:
Take advice from anyone willing to offer it, follow the stuff you like and ignore the stuff you don’t.
Develop your own style and do things the way that works best for you.
Always remember how lucky you are to be in a career where you are challenged, well paid and make a real difference to the lives (and end of life) of countless people. You will come across a lot of negative influences during your career, but focusing on the negatives doesn’t help anyone. I have previously put together a list of the rules I use to stay happy as a doctor that may offer something of value to you.
1) Get organised
Ajay Sudan says
“Be organised. Write down every job you’re given. You’ll be given more than you can remember.”
Rachel Boughen (GP) says
“Organisation is worth more than your graduation certificate. You need a clipboard to put your patient list and jobs list on but with storage to keep biochemistry forms, radiology requests etc etc etc in. That way you’ll have what you need already and won’t waste time trying to find a form on a new ward.”
Thomas Gedman (GP ST1) says
“Buy a clip board/storage folder and carry your list on it … harder to lose than in your back pocket and you can store all forms needed for ward round to fill out there.”
Abi Watson (GP) says
“Have a notebook – we had a ward book – that has each patient written in it with admission date, diagnosis and a list of jobs next to each one.”
2) Be reliable and get it done
Jenny Abthorpe (ST6 ICM & Anaesthetics) says
“None of your seniors expect you to know everything. Just be sensible, punctual and reliable. That’s all we want. If you’re those 3 things your team will love you.”
Adele Flowerdew (CT1 Anaesthetics) says
“Just Do It: If you have been asked to do an ECG / cannula / bloods / catheter because no-one else is trained or everyone is too busy – just do it. Wondering around trying to convince someone else to help tends to take more time and often results in you going back an hour later to find it hasn’t been done. This will make you popular with nursing staff and is a (working) life changer.”
Johanna Danhof (GP ST2) says
“Assumption is the mother of all f**k-ups; never assume anything.”
Ajay Sudan (Geriatrics Specialist Registrar) says
“Do it yourself. Never presume a job has been done. It was only done if you did it.”
3) Be practical and come equipped
Ramara Collins (FY1) says
“This one is mainly for the ladies since men’s trousers usually have pockets: Buy yourself some clothes with pockets otherwise you will lose your list of jobs on ward round. You will need that list because the volume of jobs can be overwhelming at the start, with all new info you’ve tried to retain from endless inductions plus all your new patients, you will forget things. Pockets are also useful for stuffing pens, tourniquets and food into when on-call/nights!”
Lucy Cooper (ST8 T&O) says
“Bring your own stationery… they have nothing useful on the ward… I made my house officer stint easier with a pencil case full of highlighters, post its, a mini stapler, hole punch, sellotape, paperclips, a couple of marker pens and a whiteboard marker and a stash of really nice coffee. So much easier if you haven’t got to beg for the essentials… yes being an F1 is like being a secretary without a functional computer!”
Mark Chen (FY2) says
“Emergency sweets are a useful thing to have on you. Carry two packs – one for yourself, one for a colleague having a bad day.”
Abi Watson (GP) says
“Have an emergency cereal bar/chocolate bar/sweets stashed somewhere easy to get to.”
4) Make a note of key resources
Mark Chen (FY2) says
“Do NOT sit in the ward clerk’s chair.”
Eugene Yu (FY2) says
“Look out for any protocols that will come in handy (i.e. protocol for electrolyte abnormalities, antibiotics, pain relief).”
Sukey Elsesser (CMT1) says
“Find out before you start where they keep the paper forms on the ward you start on and in A&E/CAU for X-ray/ prescriptions/ all the weird shit like TWOC clinic or home IV services etc. If you work with an electronic system find out where they keep the back-up forms for when it inevitably crashes while you are on nights!”
Kit Jacoby (FY1) says
“It’ll take a couple of weeks to learn where things are on the ward and how to actually order things. People will ask for scans you’ve never heard of, and your arcane IT system will compound that. That happens every time we rotate. Nurses/HCAs know where things are on their ward and what the consultant means when they ask for a CPET (not “sea pet” as I first thought…my offer of a hag-fish went down poorly).”
Thomas Marks (FY2) says
“Be prepared for oncalls. Make sure you have a list of people you can contact if you need help (the induction app is great if available at your hospital, to look up numbers fast). Also the BNF app and ATSP resources are useful.”
Illustration by Dr Merili Pugh
5) Value your colleagues
Onyibo Okafor (GP ST1) says
“Attend work socials and get to know colleagues. Soon you’ll all be the SHOs on call for different specialities. Knowing the person on the other end of the phone is invaluable.”
Thomas Gedman (GP ST1) says
“Go out for team building drinks within the first week to bond as a team… easier to share the load of work with people you get on with.”
Alice Dimbleby (Nurse Practitioner) says
“Remember we all have good and crap days. Share with your colleagues when you’re finding it tough. I can assure we have all been there and will help carry you until you’re back on your feet running again.”
Ashley Cowton (ST3 Anaesthetics) says
“Look after each other. Some jobs are heavier than others. My FY1 year the breast and psych jobs were much less intense. If you have an “easier” job consider offering a hand to colleagues on more intense jobs rather than sitting in the mess (obviously have a break within reason).”
Mark Chen (FY2) says
“The job of the day team is to make the on call’s life easy. The job of the on call is to help the day team leave on time. Life is infinitely better if everyone follows the above principles.”
Matthew Kimberley (FY2) says
“Remember that you and all your junior colleagues are in the same boat. Always offer your help to those who are struggling. There will inevitably be a time where you need help and will rely on the kindness of others to share your burden. Finish at the same time as your colleagues and always ask if anyone needs help. Your days will inevitably vary in workload. By sharing the jobs you will ensure that the number of times you feel like you are sinking below the surface dramatically fall.”
6) Get to know the nurses
Helen Grimsmo (ST5 Emergency Medicine) says
“The nurses are your friends, they know the secrets, the consultants and where to get tea!!”
Eugene Yu (FY2) says
“If the hospital has night nurse practitioners, see what they can offer you.”
Alice Dimbleby (nurse practitioner) says
“Ask us nurses for help if you need it. I.e. Some of us can cannulate, bleed, catheterise and take ABG’s.”
Felicia Roberts (GP) says
“Befriend the nurses, they can make or break you in a job. The more they trust you and know you often the less they’ll bleep you and thus the more productive you can be! Similarly if you help them then they’ll help you!”
Ramara Collins (FY1) says
“If a nurse expresses serious concerns about a patient, they are invariably right. Many of them have been nurses longer than we’ve been alive! They’re a wealth of knowledge and experience.”
Mark Chen (FY2) says
“Beware nurses bearing charts”.
7) Be proactive and willing to learn
Sukey Elsesser (CMT1) says
“Get your own PACS password. Consultants respect you more if you make the effort to look at decent imaging on a proper PACS computer and it will make you a better doctor.”
Antonia Hoyle (ST4 T&O) says
“If you don’t understand something, or can’t see what seniors are talking about on the scan/results, ask them to explain it to you. You won’t come across as stupid, you’ll come across as interested and keen, and will learn more that way for the next time too.”
Onyibo Okafor (GP ST1) says
“Never be afraid to question actions and ask why. Helps you learn faster. Unless it’s a life threatening error this is better saved for quite moment.”
Matthew Kimberley (FY2) says
“Learn about the things that scare you and face them head on. If you’re worried about being on call and getting asked to do a catheter make sure you go out of your way to do one under supervision. If you’re worried about putting a patient on a sliding scale, find out how to write one up and what you have to consider. The more you are comfortable with, the less you will feel trepidation towards. Trust me, your work will become a lot more manageable.”
8) Keep on top of portfolio
Sukey Elsesser (CMT1) says
“Do your portfolio a little bit every week. Absolutely nothing worse than leaving it to the last minute or having an outcome 2. Also take a look at the point system for whatever you want to go into (eg. CMT) and try and organise a teaching program / do a poster that will tick that box as points mean prizes.”
Nicholas Plummer (ACCS CT2) says
“Portfolio is easy. QI, audit, research, presentations, and publications can all be the same thing. Do one thing, do it well, and reap maximum rewards per unit effort.”
Helen Grimsmo (ST5 Emergency Medicine) says
“It’s boring… but… stay on top of eportfolio. Get your WBPAs done. Don’t leave it all until it’s stressful. I try and say when a case being discussed is a great CBD and it’s surprising how few new doctors send me an assessment (until the week before your end of year sign off). The eportfolio is such a bug bear for us seniors as trainee doctors see so many great cases… but leave the wbpas to the last few weeks of placement, missing these cases! Put everything in it. Get a group together once a fortnight and put your education days in, log even simple procedures. It’s your evidence of achievement.. own it!”
Iheuk Duru (Opthalmology ST1) says
“Start thinking about which professional exams you need for your chosen specialty and do them (or at least attempt them) early (e.g MRCP /MRCS or FRCOphth).”
Illustration by Dr Merili Pugh
9) Develop thick skin
Johanna Danhof (GP ST2) says
“Don’t be afraid to admit that you don’t know something or need to look something up. “
Kit Jacoby (FY1) says
“The other F1s will inevitably seem to know more than you. So what. You won’t accept it, but there will be things you know that they don’t, things that you can do that they can’t. That’s life (even consultants get stuck and talk to each other about things) so don’t let it get to you”
“There is no reason at all for anyone to be a knob towards you. You are a small but vital cog in the machine. Without you, jobs generated in WR don’t happen, patients don’t get TTOs, bloods don’t get taken etc etc. In the event of that happening, without necessarily being rude, explain that just because they were born and therefore started their medical career before you doesn’t mean that they are any better than you. Speaking as (currently) a surgery F1 where every middle grade/consultant is Mr/Miss and the juniors aren’t, I found a derisive use of a first name at this point sometimes helps…”
Ajay Sudan (Geriatric Specialist Registrar) says
“Don’t take it personally when people shout at you. They’re either having a bad day or an arsehole.”
Mark Chen (FY2) says
“Everyone has bad days. If someone’s an arse to you, it might just be theirs. Or they might be an arse. Keep an open mind either way.”
10) Don’t be afraid to speak up
Matthew Kimberley (FY2) says
“Never be afraid to listen to your instincts. You are a doctor and you have been training for a number of years to get where you are. You have a wealth of knowledge in your head and if something doesn’t feel right then challenge it. You have to remember that your name goes with every decision you make and prescription you sign. Don’t be forced into situations you’re not comfortable with.”
Nicholas Plummer (ACCS CT2) says
“Nurses are always right, except when they’re wrong. Learn the value of their experience, but also don’t be scared to speak up when you know you’re right. As long as your intentions are honourable (in memory of the late John Hinds) you won’t be criticised for speaking up for patients.”
Helen Dixon (FY1) says
“Real life isn’t like the SJT exam. It can be lot more difficult to raise concerns than you think. Work relationships and the pressure of not wanting to rock the boat can stand in the way but if you don’t think something is right, chances are you’re not the only person who has noticed – stick to your guns and get advice from someone more senior.”
11) If in doubt, ask for help
Onyibo Okafor (GP ST1) says
“Never be afraid to ask for help.”
Eugene Yu (FY2) says
“Don’t be afraid to ring your seniors even if it’s to double check that your plans are correct.”
Haider Ali (GP) says
“IF you feel out of your depth, ask, a million times, if your senior doesn’t seem to like you asking lots of questions just remember they were where you are not so long ago.”
Felicia Roberts (GP) says
“Ask for help when you need it, you’re seniors have been there before and should be happy to help plus the vast majority of nurses are brilliant and will likely know the answer or know who’s the best person to ask! “
Kit Jacoby (FY1) says
“The chances of you being entirety on your own are actually quite small. If you don’t know something medical, there is usually someone physically around to ask. If there isn’t, call one of the on-call team… you don’t always have to go straight to med reg though – the F1 on call may well know the answer, or be next to someone who does, or else go for one of the SHOs. They usually know heaps and can answer most medical questions.”
Ulla Ahlmen-Laiho (Consultant in Anaesthesiology & Intensive Care) says
“When consulting a colleague, PREPARE for it! Examine the patient yourself, make all the imaging and lab results readily available to you and say “I don’t know yet but I will find out stat” if you don’t know an answer to a question. Formulate a very very brief summary of the reason you’re asking for advice, and START with that. Formulate a clear question to present at the end. Ask if it’s a good time to talk before launching into the patient case, and thank the colleague for the advice. ‘This is Dr X calling from Ward Y. I have an immunocompromised patient with fever and am in need of advice for selecting an antibiotic….’”
12) Be prepared for radiologists
Ashley Cowton (ST3 Anaesthetics) says
“Radiologist can seem mean when requesting scans. If you know 1) what you are actually looking for / why you are doing the scan and 2) How that is going to affect the patients management, then very few scans will get bounced. (By scan I mean whatever form of imaging you have been asked to request).”
Thomas Gedman (GP ST1) says
“Remember the first name of radiology booking clerks and be nice to them over the phone even if they’re harsh to you initially… they will appreciate it and soon warm to you and make your life so much easier!”
Lynsey Wells (GP) says
“Ask if you don’t know what to do! Especially when seniors ask you to request that CT CAP (regular occurrence as a surgical FY1) and I never knew why unless I asked! I remember the shame of standing in front of the consultant radiologist with absolutely no idea what I was asking for! Quite glad I can now request scans from the safety of my desk (GP)!!”
Clare Routledge (GP ST2) says
“If your consultant asks you to request a scan and it needs discussing, such as same day CT scan, be sure to ask them what the “question is” and how that scan will help in patient management, phrase it in a way so it is for your learning too. Having scans refused is horrible, and radiologists can be understandably quite resistant against unnecessary investigations (and on occasion, make you feel like an idiot!)”
13) Manage acute patients
Jenny Liddell (GP) says
“Learn to recognise an unwell patient and know to ask for help (try to have an idea as to what you think is wrong with the obs for your senior).”
Ramara Collins (FY2) says
“Never underestimate the power of eyeballing a patient, you will quickly learn when something is actually urgent… If you aren’t sure about something, no matter how simple it may seem, never be afraid to just ask. Sometimes you may feel silly for asking but be comfortable in the knowledge that you are a safe doctor!”
Antonia Hoyle (ST4 T&O) says
“Keep an ABCDE approach with every patient assessment; even if the excrement is hitting the fan you can make a big difference with this whilst senior help is on its way. You have lots of knowledge and skills already to have made it this far, but nobody expects you to know everything, so ask for help when you need it. But get the essential stuff going with ABCDE, then you’ll probably pick up the important issues and you will feel more in control.”
Helen Dixon (FY1) says
“You don’t have to stay with someone who is acutely unwell – it’s ok to make some changes and come back later as long as they are stable… You will be busy and you can’t sit with them just because they are scoring!”
“Nothing happens fast! Even if someone is having a heart attack it takes time to make your assessment, take the bloods wait for the results and get senior help. In medical school acute scenarios always take about 5 minutes to run through, in real life it is never this quick and that’s ok!”
Illustration by Dr Merili Pugh
14) Right cannula, right place
Jenny Liddell (GP) says
“If putting in anything bigger than a pink remember to advance the needle further than you think – otherwise when you withdraw to advance the plastic it won’t be in the vein (having only done pink cannulas as a student it took me a while as a FY1 to realise why I could get pinks into tiny veins but would miss huge veins with a green…”
Ulla Ahlmen-Laiho (Consultant in Anaesthesiology & Intensive Care) says
“Remember to survey the veins up to near the shoulder. Many times an anaesthetist is called in to start an IV and there are perfectly good veins available but the previous attempters had only looked at the back of the hand. If all else fails, there are usually 1-2 veins on the palm side of the wrist nicely visible but they tend to only be big enough for a blue and might not work so well when the wrist is flexed. Still better than nothing when needing to transport someone or to start antibiotics stat. Pro tip: learn to use an ultrasound to find veins in the crook of the elbow and arteries near the wrist. Will save you many a call to a anaesthetist/senior.”
Adele Flowerdew (CT1 Anaesthetics) says
“Anaesthetists are not only better at gaining IV access because they have had loads of practice, they are better because they have had loads of practice using a good technique. This is unfortunately not what you are taught in medical school. Find an anaesthetist / other cannula wiz (there are loads of them around and they tend to love teaching), get them to show you and it will change your (working) life.
N.B. Small tip to tide you over, drop your angle!”
15) Pace yourself and prioritise
Clare Routledge (GP ST2) says
“Don’t run – walk briskly. Turning up to an arrest a breathless mess is not helpful and you can’t think straight. If a crash call has gone out then that means the people there can do at least BLS (if it is CCU/Resp/A&E/ITU the nurses are probably better at ALS than most doctors). Undoubtedly, everything will also fall out of your pockets on the way if you run which is a major pain in the ass. The only things I ever run for are obstetric emergencies as they are young stable patients who get sick crazy fast and you are often trained to do things mid-wives can’t.”
Thomas Marks (FY2) says
“Don’t stress. If workload gets to much, take a stepback and think what actually needs to be done now and what can wait. There aren’t many jobs which are an emergency despite how it can feel when you are overwhelmed.”
Mark Chen (FY2) says
“The hospital will not implode if you take a few minutes to answer a bleep. If they need you that badly, they’ll bleep you again.”
Alice Dimbleby (Nurse Practitioner) says
“Take 5 after ward rounds and grab a drink/go for a wee. Use the time to delegate tasks between the team.”
Clare Routledge (GP ST2) says
“Sometimes volume of work can seem daunting especially post ward round. Acknowledge early that everyone has different priorities. Speak to your consultant or ward sister if you feel the volume of work is high “There is a lot to do here, what would you like me to prioritise?” or “I can see there are 3 patients fit for discharge, whose paperwork should I do first?” will help you to prioritise work and keep the rest of the team on board.”
Antonia Hoyle (ST4 T&O) says
“Every bleep will seem like the number 1 priority to the person bleeping you, but only you know all the jobs you have to do. And you are only human. So be organised, prioritise, have a checklist, and be realistic. Deal with sick patients first, get the ball rolling with bloods and investigations where you can, give realistic timeframes to your colleagues (e.g. “I’m just seeing a poorly patient on ward x, but I will come to your ward in 20 minutes to do the job you want”) and try to keep to them. And looking after yourself with a drink, a snack and a loo break is important; you will think and function better when you are refreshed.”
16) Keep calm and do your best
Jim Crawford (consultant in Emergency Medicine) says
“Yes, you are now a doctor, but that does not mean you are suddenly responsible for doing everything and knowing everything all by yourself. Seek advice, share the workload, know your limitations. There is (almost) no such thing as a stupid question.”
Mark Chen (FY2) says
“You are a Junior Doctor – nothing more, nothing less. You know more than you think you do and less than you think you should. Be confident – both in admitting what you do know and admitting what you don’t.”
Haider Ali (GP) says
“Do not panic. When your bleep goes off , make sure you write down what / where / when and get a clear history of why it is you’re needed – often it is because a patient is ‘scoring’ something on the early warning score.”
Abi Watson (GP) says
“At a cardiac arrest – the patient has no output. You cannot make it worse. Just do your best and listen to whoever is leading it.”
Thomas Marks (FY2) says
“We all make mistakes, don’t beat yourself up about them and reflect on them.”
Kit Jacoby (FY1) says
“Just keep going. Sometimes it’s awful, sometimes it’s great, most of the time it’s bearably mundane, but all rotations come to an end and you’ll move on having learned one or two things (even if it’s how you *don’t* want to behave to your juniors when you get them).”
Illustration by Dr Merili Pugh
17) Take breaks, eat and go home on time
Iheuk Duru (CT1 Opthalmology) says
“Take a break during work hours. You are only human. People were sick before you started working and will continue to be sick after you retire.”
Nicholas Plummer (ACCS CT2) says
“The secret to being happy on the wards is full stomach, empty bladder. Bring snacks, and make time for coffee with your medical, nursing, and AHP colleagues. “
Johanna Danhof (GP ST2) says
“Never ever skip lunch; even if you only have 10 minutes for your lunchbreak – you will be more focussed and less prone to making mistakes.”
Felicia Roberts (GP) says
“You can only look after others if you look after yourself first – i.e. eat, drink, pee, go home on time as much as possible.”
Jenny Abthorpe (ST6 ICM & Anaesthetics) says
“The wheels won’t fall off without you. Take time to pee, eat, take sick leave, study leave and annual leave. You’re human too.”
Mariana Williams (FY2) says
“Try to go home on time. Hand over stuff to the twilights or nights. There’ll always be work to do.”
Onyibo Okafor (GP ST1) says
“You don’t have to complete your job list. Prioritise and work hard. Whatever’s left at the end of the day should be handed over as appropriate.”
Adele Flowerdew (CT1 Anaesthetics) says
“Leave on time. This may seem an impossible task (especially when you have just started) but it rarely is. It is important to look after yourself and not allow yourself to be consumed my the job; contrary to popular belief, you are in control of this. I found a good way of achieving this was to imagine I had a plane to catch at the end of the day. Learn to do this by analysing your day and organising your time, this does not need to result in rushing or handing over unfinished day jobs to the on call team. Being efficient and happy makes you a better doctor.”
18) Stay balanced
Jenny Liddell (GP) says
“Plan dinner with friends / time with your kids or just some relaxing time and make sure you book your holidays early.”
Iheuk Duru (CT1 Opthalmology) says
“Gain a good support network. Keep in touch with friends and family. You’ll need them.”
Haider Ali (GP) says
“Make sure you leave and switch off, speak to friends, family, other colleagues, get a mentor – you aren’t alone in feeling the way you do, I guarantee a few if not a lot of your colleagues will find they question themselves ‘is it meant to be this hard?’”
Helen Grimsmo (ST5 Emergency Medicine) says
“Eat well. Sleep well. Get some exercise. Don’t worry. Keep talking, asking… we’ve all been there! We’ve all made mistakes.”
19) Don’t loose your humanity
Adele Flowerdew (CT1 Anaesthetics) says
“Be nice to your patients, no matter how horrible they are being to you, this is the best way of avoiding complaints and negative feedback. Be nice to your colleagues, even if there is a personality clash, you will spend a lot of time together and team work isn’t just a buzz word – it is important.”
Jenny Abthorpe (ST6 ICM & Anaesthetics) says
“Never forget the patient. No matter how crappy your day is, theirs is worse. Always give them those few special extra minutes of your time. They will teach you so much!”
Matthew Kimberley (FY2) says
“No matter what pressures you are under or how someone may have just treated you, always always always treat your colleagues, patients and relatives with respect and kindness. You will inevitably work in high stress environments and possibly even toxic ones, so be the change you want to see. Colleagues who you get on well with are much more likely to help you out. Patients who enjoy talking to you are much more likely to adhere to your advice and much less likely to complain. Love and respect will take you further in this job (and life for that matter) than any other characteristics.”
20) Nothing is more important…
Micayla Telfer (Acute Medical Consultant, Foundation Programme Director) says:
“Nothing is more important than going for a poo if you need one.
Nothing.”
Illustration by Dr Merili Pugh