This amazing guide was created by so many amazing doctors like yourself helping each other. It is a snapshot of the freely editable guide that can be found here. As you use this resource, we request you please keep it up to date as we will constantly update this article based on the changes you make. We particularly welcome contributors to fill in the remaining gaps!
Acute Medicine
List of Contributors | Dr Sana Shakeel (FY3) Dr Gigi Lee (IMT3) Dr Miranda Clarke (FY2) |
What should a doctor expect from this rotation? | Fast-paced rotation with a quick turn over of patients. Most patients stay for 48-72 hours before being discharged or moving to a ward. You will see a mixed variety of acute presentations, therefore it is an excellent rotation to tick off a lot of the competencies and procedures. However typically the rota & workload can be quite tough because of the turnover of patients and patients can be quite unwell if they’ve only just come in. There is usually great senior support compared to other F1 rotations. Use this to your advantage to ask for teaching and getting procedures signed off as mentioned above. Tag along with seniors to review acutely unwell patients as part of your learning experience. You will learn a lot and some of the skills gained will stand you in good stead for the rest of your career. |
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Anaesthetics
List of Contributors | Dr D Williams (ST4) Dr Balazs Hollos (SpR) |
What should a doctor expect from this rotation? | You are supernumerary which means you’re there to observe & help rather than independently carry out tasks. There are minimal expectations on you and generally no on calls. As the workload tends to be light, use this extra time to develop your CV. There is an excellent opportunity to learn procedures & practical skills (managing an airway, intubation, line insertions) as well as teaching on pharmacology, physics & physiology. You should get an opportunity to learn basic ultrasound skills. You may also be involved with intensive care (see this section) |
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What are your top tips on how to prepare? | Read introduction to anaesthesia/critical care literature – LITFL/EM Crit and ABCs of Anaesthesia on YouTube can guide you for this. However, no preparation is fine too as you’ll learn on the job! |
List of top resources to help prepare |
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Breast Surgery
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Cardiology
List of Contributors | Dr Samsul Islam (FY2) Dr Tharusha Gunawardena (SPR) |
What should a doctor expect from this rotation? | The ward typically has a high turnover with lots of referrals & quite unwell patients. Cardiology nurses tend to be very knowledgeable – particularly those in the critical care unit. There tends to be lots of consultant and registrar input because care can be quite complex. There is an excellent opportunity for echocardiography & ECG teaching. |
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You are recommended to know ACS & heart failure well as these form the large majority of your workload. |
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What are your top tips on how to prepare? | Practise your ECG skills Download MDcalc to add in chads2vasc calculator |
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Child & Adolescent Psychiatry
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Clinical Pharmacology
List of Contributors | Dr Wern Wei Chin (Vivian) (FY2) Dr Brandon Ka Chung Bee (FY2) |
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What are your top tips on how to prepare? | Learn from ward pharmacists/ peers discussion, and always ask senior if in doubt. If unsure on a prescription, always go to the resources as recommended below as reference. Cross-check with pharmacists if not confident at the first stage of prescription, they are really helpful! Understanding of the side effects and contraindication of common medications are really important. For example: avoid Magnaspartate in patient with diarrhoea. Cautious in medication dosage especially in patient with renal impairment. ALWAYS CHECK FOR ALLERGIES BEFORE PRESCRIBING ANY MEDICATION. Sooner and later you will gain confidence and experience through your first year! |
List of top resources to help prepare |
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Dermatology
List of Contributors | Dr Aparna Potluru (FY2) Dr V Bajaj (FY1) |
What should a doctor expect from this rotation? | This is a rare rotation and is frequently combined with acute medicine so you get a well rounded experience. Expect to get involved with clinics, minor surgery & receive plenty of teaching as dermatologists tend to be very friendly. You will get plenty of supervision. You tend to be supernumerary so you’re there more to observe and learn rather than carry out complex outpatient management, but it helps if you can describe lesions well. Ultimately, you tend to have plenty of time to develop your portfolio. Dermatology is a very academic specialty so you’ll attend lots of CPC meetings, journal clubs, combined case discussions and MDT meetings. If you’re interested in surgery, try to get involved with as many procedures as you can & keep a logbook. You’ll get plenty of practice with suturing & incisions. |
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What are your top tips on how to prepare? | Have a look at the dermatoscopy course in Dermnet (https://dermnetnz.org/cme/dermoscopy-course) |
List of top resources to help prepare |
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Emergency Medicine
List of Contributors | Dr S Kulikouskaya (CT1) Dr C Evans (ST3) |
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Endocrinology & Diabetes
List of Contributors | Dr Haroon Khokher (FY1) |
What should a doctor expect from this rotation? | Round patients every morning with either the Consultant/Registrar (hospital/trust dependant) Request bloods and imaging Prescribe on and re-write drug charts Join the acute medical take every few weeks on-call (this is the hot on-call in which you admit patients) Cover a ward on-call by yourself out of hours/on the weekend (cold on-call) This job is essentially a medical job with a diabetes theme (at FY1/FY2), there is very little Endocrinology apart from in clinics. Most of your patients will be medical out-lier patients (patients which have no other ward to go to). This is assuming you’re based at a DGH hospital. |
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What are your top tips on how to prepare? | Brush up on Diabetes and general medical knowledge before you begin. During shadowing ask the current FY1s/FY2s how to request peculiar investigations such as Syncathen/9AM Cortisol/some auto-immune tests. Learn the fastest/most efficient ways of requesting all the blood tests you need in one go. |
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ENT
List of Contributors | Dr Stephen J Davison (Clinical Development Fellow) |
What should a doctor expect from this rotation? | Relatively well patients. Good senior input. Unlikely to have any airway emergencies on your own as an FY1 but be prepared! Might be different at SHO level. You may get time to head to theatre and learn procedures. You may get clerking experience as well. |
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What are your top tips on how to prepare? | Read about airway emergencies Nasal packing/ epistaxis management Post thyroidectomy complications Learn where all of the airway equipment is in the ward |
List of top resources to help prepare |
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References | ENTSHO.Com |
Gastroenterology
List of Contributors | Dr Lauren Marsh (FY1) |
What should a doctor expect from this rotation? | Acute presentations of gastro illnesses. Depending on the centre, may also have some general medical presentations on the ward. Generally will be ward rounds with senior support. There may be some opportunities to attend endoscopy or be involved in procedures such as ascitic drains. There may be opportunities to attend clinics if interested. |
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What are your top tips on how to prepare? | Always escalate and ask for help if unsure as patients on a gastro ward can deteriorate acutely and an FY1 will not be expected to manage this independently. Briefly read up on the common conditions listed above. Make the most out of shadowing by learning how to request specific things such as endoscopy and liver antibodies. |
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General Practice
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General Surgery
List of Contributors | Dr Pik Kwan Lau (FY1) Dr A James (Teaching fellow) |
What should a doctor expect from this rotation? | Mostly doing jobs that were asked by seniors In some hospitals surgical FY1s don’t do nights May clerk patients (depending on the trust/hospital) After ward wound, seniors may be in theatre, but if you need help, you should be able to find them in theatre to ask for their advice. |
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Geriatrics
List of Contributors | Dr Lauren Marsh (FY1) Dr Gigi Lee (IMT3) |
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Haematology
List of Contributors | Dr P Moghbel (FY1) Dr E Crockett (FY2) |
What should a doctor expect from this rotation? | Depending on the unit, this may be a Bone marrow transplant unit (BMTU) or general haematology. Very specialised, so again you do not need to be aware of the patient’s complex condition – the reg and consultants are usually very supportive and always around for help. |
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Hepatology
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HPB Surgery
List of Contributors | Dr Miranda Clarke (FY2) |
What should a doctor expect from this rotation? | In some hospitals this is part of general surgery, in others they have dedicated HPB team and ward – find out which yours is. Very interesting presentations with often very sick patients that need to be carefully managed. Patients are often long-term patients and you are able to form longer term relationships with them. Opportunity particularly on call to do small procedures such as NG tubes and incision and drainages. Opportunity to scrub into theatre if you are interested – make this known to the team if you are not already rostered into theatre. Sometimes it can be a tough job because you get left with a lot of the medical side of care as surgeons are in theatre / not as confident managing medical presentations once very specialised – don’t be frightened to ring the medical registrar from the surgical ward if you are concerned. Build strong relationships with MDT – e.g. dietitians, physios, OTs, nursing colleagues, SALT, delirium and dementia team, drug and alcohol team |
What are some common presentations they should read about? | Although most patients will be HPB patients, there will be ovep with all gen surg presentations especially during on calls.
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Infectious Diseases
List of Contributors | Dr Prabhav Singhal (FY1) |
What should a doctor expect from this rotation? | Fascinating specialty with a high variety of presentations. One minute you could be dealing with cerebral abscess and the next patient may have infective endocarditis. People often confuse ID (ward based job) with microbiology (lab based) so ID is just like most other FY1 rotations – morning ward rounds with classic jobs in afternoon such as doing blood cultures, discharge summaries and ordering scans etc. Generally, has good senior support and is very consultant led. As an FY1 you don’t need to know all the specifics about antibiotics – just be aware of common ones like flucloxacillin for staph aureus bacteraemia. Majority of patients are usually stable (e.g. with cellulitis or discitis) but there will be a few acutely unwell patients – just know your A-E assessment and escalate to senior and you will be fine. |
What are some common presentations they should read about? | Know common ones for each organ system
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What are your top tips on how to prepare? | 1. Download Microguide 2. Get Induction app for easy contacts to other specialties 3. Study smart – learn common infections for each organ system as stated above but don’t try to learn about absolutely every pathogen (it’s impossible) |
List of top resources to help prepare |
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Intensive Care
List of Contributors | Dr Daniel Last (FY1) Dr Rishil Patel (FY1) Dr Balazs Hollos (SpR) |
What should a doctor expect from this rotation? | Supernumerary job. No on-calls. Close supervision from seniors. A chance to learn new practical skills and brush up on management of acutely unwell patients. |
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List of top resources to help prepare | Generally short accessible resources:
Reference Textbooks:
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Microbiology
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Neurology
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Neurosurgery
List of Contributors | Anonymous (Neurosurgery ST1) |
What should a doctor expect from this rotation? | Neurosurgery is a niche but busy speciality. You will do on-calls and nights. During on-calls you will cover the wards and you may need to clerk patients admitted to the ward. You should usually have a reg on site but there are some centres where the Reg is off site at night. This rotation will familiarise you with common and rare brain and spine problems. You will see patients from babies to 100 year olds. You will see some of the sickest and most vulnerable patients in the hospital. You will have some patients who have been under the neurosurgeons’ care for decades and may be well known to the team. |
What are some common presentations they should read about? |
From the above focus more on trauma, spines (depending on if your centre does a lot of spines), vascular and skull base. Post op complications and management to read about: seizures, intracranial or spinal haemorrhage, spinal epidural collection/abscess, hyponatraemia, hydrocephalus, delayed cerebral ischaemia following SAH, diabetes insipidus following pituitary surgery, CSF leaks. |
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Don’t worry about the above – if you are keen to learn how to do the procedures you will be taught so that by the end of the rotation you can do them independently. Equally if you don’t want to learn then a senior SHO or SpR will do them. |
What are your top tips on how to prepare? | Read about the management of the above complications. It would be beneficial to learn how to read a CT head. You should focus most of your reading on post op complications and how to manage these. And definitely read about causes of low sodium and their management – we love our sodium balance. Practice communication skills – you may need to talk to families and patients about bad news and DNACPR decisions. Help from seniors is always there to have the discussions. |
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Obstetrics & Gynaecology
List of Contributors | Dr Oluwadara Dare (FY1) Dr Chi Yan Bonnie Cheung (FY1) |
What should a doctor expect from this rotation? | F1s have a supernumerary role with no on calls or night shifts Usually quite supported You will be assigned to wards (obstetrics or gynaecology), Maternity assessment unit (MAU), Gynecology assessment unit (GAU), Pre-assessment clinic, theatres |
What are some common presentations they should read about? | Obstetrics Abdominal pain PV bleeding Reduced foetal movement Premature rupture of membranes Gynaecology Postmenopausal bleeding |
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List of top resources to help prepare | Geekymedics Obs & Gyne examination Obs and Gynae history taking |
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OMFS
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Ophthalmology
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Oncology
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Paediatrics
List of Contributors | Dr Martin Whyte ST5 Paediatrics Dr Timothy Griffiths FY1 Dr Jay Talbott FY1 |
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Palliative Care
List of Contributors | Jessica Peto GPST1 |
What should a doctor expect from this rotation? | Depends whether it is an inpatient or hospice placement Generally well supported by consultants and specialist nurses and FY1 job is usually supernumerary The rotation involves patient reviews looking at symptom control, holistic care, supporting patients with psychological, practical and spiritual issues as well as supporting relatives |
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Plastic Surgery
List of Contributors | Dr Emma Whiting (Junior Specialist Doctor) |
What should a doctor expect from this rotation? | In larger centres, plastic surgery is subdivided into plastics, burns and hands. It would be worth finding out which of these you are likely to be working in, as the job will differ. It may be that you cover all three subspecialties during on-calls (if you do them). Smaller centres may have one single department, or not provide burns / hands cover. Burns surgery ranges from major burns patients in ITU, to elective admissions for excision and grafting of smaller burns. Many patients need management of medical comorbidities, critical care input and psychiatry reviews. You may be involved in reviewing burns patients in resus as part of a ‘burns alert’ team, but would be very well-supported in this. Plastic surgery encompasses trauma reconstruction, as well as elective admissions for extensive flaps (e.g. in onco-plastics) and day-case surgery (such as skin cancer excisions). You may attend trauma calls, often alongside T&O. Again, you would be well-supported in this. A large aspect of the job following reconstructive flap surgery is monitoring the flap (for example, by assessing blood flow) – you will be shown how to assess this. Hands surgery may be predominantly clinic-based, with hand injuries presenting to ED and a few hand surgery inpatients. As with any surgical job, a large proportion will be ward-based. In all three subspecialties you will be expected to review patients in ED. Theatre time will involve a mix of small day-cases and more extensive surgery, with a great variety. |
What are some common presentations they should read about? | Burns:
Plastics:
Hands:
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What are some common tasks they may be asked to do? |
NB the decision to start antibiotics is generally a senior decision in burns patients, as many will show signs of inflammation (including fever) without infection |
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Psychiatry
List of Contributors | Dr A James (teaching fellow) |
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List of top resources to help prepare | BMJ elearning has some helpful elearning modules, such as managing agitation in dementia patients. Doing these also gives you CPD points for your portfolio so doubly beneficial! This is free to access if you are with the BMA union, otherwise it is reasonably priced per month. |
References | BMJ Learning: Online Courses for Healthcare Professionals |
Renal
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Respiratory
List of Contributors | Dr Kaki Tsang (FY1) Dr Timothy Griffiths (FY1) |
What should a doctor expect from this rotation? | This can be a fast-paced rotation usually with a high turnover of patients. Although the majority of conditions will be respiratory, there will often be other common medical emergencies. Patients can also deteriorate rapidly with respiratory conditions. It can be of use to familiarise yourself with common respiratory conditions and how to manage them. It is a good rotation to develop practical skills, from doing simpler skills like ABGs, to more respiratory-focused skills, such as pleural taps/drains. To gain more out of the rotation, attending clinics or bronchoscopy could be helpful for a fuller scope of respiratory, so it may be worth discussing opportunities like this with your supervising consultant. Knowing when and to whom you should escalate is important, and it is better to be overly cautious rather than under-cautious. For most respiratory departments, there will be medical on-call requirements, including weekends and nights. This may not be limited to respiratory wards, which makes knowing other common medical emergencies also very useful. |
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Rheumatology
List of Contributors | Dr Emily Ching (FY1) |
What should a doctor expect from this rotation? | An F1 job in rheumatology is likely to involve a lot of general medical patients in non-tertiary centres. You will get to see a wide variety of interesting presentations and conditions whilst looking after general medicine patients. This is a great opportunity to learn and revise your medical knowledge and get to grips with the management of common conditions. Rheumatology patients on the ward are likely those admitted with acute joint swelling/pain. As a medical specialty, your job may include doing acute medical take shifts (clerking patients on the medical team who have been referred from A&E), post-take shifts (seeing new medical patients with the consultant after they have been clerked) and on-call ward covers. Learning opportunities include attending rheumatology clinics, musculoskeletal radiology MDTs, bone MDTs (joint with orthopaedics), and rheumatology departmental teaching sessions. |
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Stroke
List of Contributors | Dr Haroon Khokher (FY1) Dr Stephen Davison (Clinical Development Fellow) |
What should a doctor expect from this rotation? | FY1/FY2 level: Clerking in patients presenting with acute stroke symptoms to an emergency department and initiating thrombolysis protocol under Consultant supervision (trust dependant) Taking part in post-take ward rounds on HASU (hyper-acute stroke service unit) Liaising with local neurosurgery centre Attending medical outliers patients on the ward |
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What are your top tips on how to prepare? | ALWAYS ask if you’re unsure. Examples would be when asked by the Nursing team to start an IV infusion such as Labetalol to drop blood pressure. Many times it’s safer to ask the Consultant/Reg before any intervention. Learn the local protocol for seizures. They will happen a few times on your rotation and it’s best to be prepared. Remember Keppra needs loading before starting it regularly. Don’t be afraid to ask for help. HASU units in particular are well staffed and seniors want to be aware who is unwell. |
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Trauma & Orthopaedics
List of Contributors | Dr Armin Benjamin Bassi (FY2) Dr Jeremy Telford (CT1) |
What should a doctor expect from this rotation? | This is mainly a ward based job but if you’re organised you’ll get chances in theatre Document discussions during morning Take including putting patients on fracture clinic list, as well as documenting dashboard/blackboard updates for upcoming theatre cases. Going on post take ward rounds with the consultants and documenting their rounds. Documenting during the SpR ward rounds as well In my trust we didn’t do night shifts as F1s and we didn’t clerk. Our jobs were mainly ward cover and doing all the job plans outlined by the Surgeons. Weekend jobs were for the most part a continuation of the above including jobs handed over by weekday team as well as responding to bleeps. For the most part it would be nursing colleagues asking for reviews, medication changes, cannulas etc. occasionally, patients would be in pain postop despite analgesia regimen or complain of bleeding at surgical site etc. There is always a surgeon on call who can provide assistance if you need it. Patients very rarely become medically unwell but you will be expected to assess patients if nurses are concerned. If you are concerned a patient is unwell you need to escalate appropriately. You do get to scrub in for theatre on occasions to assist the surgeons,which is always interesting (and a great opportunity to test anatomy knowledge) |
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What are your top tips on how to prepare? | As an F1 it is really important to know that you are looking after for the most part, the medical aspects of a patient’s care. As such, make sure to brush up on common medical scenarios that you will likely encounter in a postop patient. Like constipation, delirium, hypo/hypertension, Hb drop, AKI etc. Recognising the unwell patient is also critical and know how to be able to undertake a A to E assessment is a must as postop Pyrexia or worsening NEWS is always concerning At times you might be the most senior doctor on the ward. The Orthogeriatricians are your friends – make a good impression early, and the Med reg is always very sympathetic to you Stay organised on the ward and you’ll get chances in theatre |
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Urology
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What should a doctor expect from this rotation? | As an F1, this is a ward based job where you mainly look after postop patients. There is high turnover of patients. There are usually no dedicated theatre days but if the ward is quiet or well staffed, you might be able to get into theatre. |
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Vascular Surgery
List of Contributors | Dr Stephen J Davison (Clinical Development Fellow) Dr Timothy Griffiths (FY1) |
What should a doctor expect from this rotation? | A busy specialty with many unwell, multimorbid patients. Includes Renal, diabetics and PWID. Patients recovering from “big surgeries” This will be fast paced and fun! You’ll upskill on practical skills fast, especially with the busy on-calls. If you can practise before the rotation would recommend you do so. US assisted/guided cannulation/blood skills will make life easier if you have/can get skilled up Ward rounds are very fast paced and usually lots of wound reviews – carry wound care kits with you on ward round, will help keep things moving along so you have time to complete the jobs |
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What are your top tips on how to prepare? | Remember, these patients are physiologically frail. Don’t be afraid to ask for help early. Practise practical skills – on call will be a lot more manageable if you can get these done yourself when reviewing unwell patients |
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References |
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4 thoughts on “Prepare for FY1 Guide by Specialty”
Hi,
I was wondering how I can add to this list. I am an FY1 working in ITU. About 6 weeks into the job.
Of course you can. Link to edit is here.
Hi,
I was wondering if there are any plans to add to the Renal section, thankyou!
Of course. It is freely editable so just waiting for people to update each section!