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.

What are some common presentations they should read about?

• Cardiology – ACS, heart failure
• Endocrinology – DKA, HHS, hypoglycaemia, electrolyte imbalances e.g. hyponatraemia
• Gastroenterology – decompensated liver disease, UGIB, IBD flare ups
• Renal – AKI, pyelonephritis, hyperkalaemia
• Micro – sepsis, pyrexia of unknown origin
• Respiratory – COPD & asthma exacerbation, pneumonia, PE
• Geriatrics – delirium, falls
• Neurology – seizures, headache, stroke, meningitis
• Toxicology – Alcohol withdrawal, paracetamol overdose
• Oncology – neutropenic sepsis, anaemia

What are some common tasks they may be asked to do?

• Clerking patients on the acute medical take
• Documenting on ward round and executing plan
• Discuss with/refer to other specialties
• Discharge letters
• Assist with procedures (e.g. LPs, ascitic drains)
• Initial management of acutely unwell patient (ABCDE) and getting senior review
• For some hospitals you may be a part of the cardiac arrest team (Timing/documentation/CPR)

What are your top tips on how to prepare?

• Getting your jobs organised and prioritising your workload is key as you often can’t finish everything.
• Ask for help & delegate if needed as it is important to have breaks and finish on time.
• Handover any outstanding jobs using SBAR to ensure patient safety at the end of your shift.
• If you are unsure about something just run it past your seniors!

List of top resources to help prepare

• NICE Guidelines
• Uptodate
• BTS guidelines
• MDCalc
• Oxford handbook of clinical medicine
• Mindthebleep have some excellent resources for on calls and referring to specialties!
• Useful apps: Iresus, BMJ Best practice, SmartDr, PocketDr, Microguide, BNF, Foundation Doctor Handbook

References

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)

What are some common presentations they should read about?

• Types of airway and when to use them (OPA, NPA, supraglottic, ETT)
• Basics of intubation & managing difficult airways
• Common drugs used in anaesthetics: induction agents, analgesics, vasopressors

What are some common tasks they may be asked to do?

• Supporting airway skills such as bag mask ventilation, insertion of SGAs
• Cannulation
• Drawing up of medication
• Usual admin including admitting & discharging paperwork for perioperative care, drug charts & liaising with specialties

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

• DAS guidelines

References

List of Contributors

What should a doctor expect from this rotation?

What are some common presentations they should read about?

What are some common tasks they may be asked to do?

What are your top tips on how to prepare?

List of top resources to help prepare

References

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.

What are some common presentations they should read about?

• ACS
• Heart failure
• Infective endocarditis
• Arrhythmias
• Valvular defects

You are recommended to know ACS & heart failure well as these form the large majority of your workload.

What are some common tasks they may be asked to do?

• Requesting Echos, discharge summaries
• Sorting PICC lines for IE
• Liaising with specialties as cardiology patients tend to have multiple other conditions (e.g. diabetes) or require complex anticoagulation (haematology)
• Inpatient workup prior to CABG, PPM, angiography or valvular surgery
• Liaising with microbiology for advice on antibiotics in infective endocarditis

What are your top tips on how to prepare?

Practise your ECG skills

Download MDcalc to add in chads2vasc calculator

List of top resources to help prepare

• Life in the fast lane website for ECGs
• https://howtopace.com/ is advanced but gives an insight

References

List of Contributors

What should a doctor expect from this rotation?

What are some common presentations they should read about?

What are some common tasks they may be asked to do?

What are your top tips on how to prepare?

List of top resources to help prepare

References

List of Contributors

Dr Wern Wei Chin (Vivian) (FY2)

Dr Brandon Ka Chung Bee (FY2)

What should a doctor expect from this rotation?

What are some common presentations they should read about?

• Pain
• Nausea/ Vomit
• Constipation/ Diarrhoea
• Agitation
• Overdose/ Alcohol intoxication
• Electrolytes disturbance (replacement oral or IV)
• Wheeze/ SOB
• DVT Prophylaxis
• Allergies
• Sleep difficulty

What are some common tasks they may be asked to do?

• Analgesia prescription – post-op patients, Palliative, headache
• Antiemetics prescription – post-op patients
• Sedative/ Sleeping tablets – especially during night shifts
• Electrolytes replacement (Hyperkalaemia**)
• Alcohol withdrawal therapy
• Nicotine replacement
• Fasting glucose protocol

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

• BNF
• EMC (medicines.org.uk)
• BMJ Best Practice
• NICE Guidelines, BTS Guidelines,
• WHO Analgesic Ladder
• The Renal Drug Handbook
• Oxford Textbook of Medicine (Chapter 10). Principles of clinical pharmacology and drug therapy
• Palliative care guidelines
• Local trust guidelines
• APPS: MDCalc (dose calculator)

References

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.

What are some common presentations they should read about?

• Seborrhoeic Keratosis – lots of these get referred to dermatology.
• SCC, BCC, melanoma, actinic keratosis – you’ll see a fair few of these and it’s good to be able to present these to your consultant, as it will help you with your confidence in dermatology when presenting more serious cases.
• You’ll also see a lot of psoriasis and eczema
• Familiarise yourself with dermatoscopic views of moles
• Also familiarise yourself with the proper dermatological terminology used when describing skin lesions

What are some common tasks they may be asked to do?

• You may be asked to take referrals. Ensure you obtain the details & a photo of the lesion by email or uploaded to clinical records system
• Look and feel the skin lesion, take good but tailored dermatology history, come up with several differentials, investigations and management plan. You would run this past the consultant or registrar rather and wouldn’t have full responsibility

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

• dermnetnz.org is a really good resource for reading about conditions. There’s also the BAD junior doctors/students handbook that will help you too

References

List of Contributors

Dr S Kulikouskaya (CT1)

Dr C Evans (ST3)

What should a doctor expect from this rotation?

• F1s may be supernumerary, F2s may go on SHO rota (depends on the hospital)
• Large numbers of undifferentiated presentations and therefore a steep learning curve.
• There can be great opportunities to learn/polish skills (suturing / staples, Fascioiliac blocks, cardioversion etc)
• Minors are usually covered by ENPs. ‘Ambulatory’ and majors is where you might end up working most of the time, and sometimes resus.
• There may be a CDU/Observation ward – in some cases the “ward jobs” will be the responsibility of the FY1 after the consultant does a (very brief) ward round. This will include discharge summaries, chasing scans, and referrals
• In a larger centre, you may spend some dedicated time in paeds EM
• An ED rota can feel punishing. It is normal to feel tired. Don’t expect too much from yourself!
• Your senior colleagues are there to help. Expect to run your decisions past them. Quality is more important than speed.

What are some common presentations they should read about?

• CVS: cardia
• c arrest, chest pain, syncope, palpitations, tachy/brady arrhythmias
• RS: acute asthma, CAP, undifferentiated SOB
• GIT: abdo pain, PR/UGI bleeding, paracetamol OD
• GU: renal colic, PV bleeding, urinary retention, testicular pain
• Neuro: headache, limb weakness, back pain, low GCS, EtOH withdrawal, seizures
• Endo: hyper/hypoglycaemia, DKA
• MSK: fractures (#NOF!), nec fasc, cellulitis
• Misc: falls, epistaxis, anaphylaxis, eye/facial injuries, mental health presentations, sepsis

What are some common tasks they may be asked to do?

• Clerk patients, discuss management with seniors
• Refer to specialty / discharge with safety netting advice
• Sign off ECGs
• Bloods, gases, cannulas, catheters, fascia iliaca blocks

What are your top tips on how to prepare?

List of top resources to help prepare

• https://www.rcemlearnixng.co.uk/references/
• iResus app
• Life in the Fast Lane (LITFL) – free resource for emergency medicine and critical care. Huge library of ECGs
• BMJ Best Practice (Trust may have a subscription)
• Orthoflow app is useful (but it’s not free)

References

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.

What are some common presentations they should read about?

• Very broad, this ward is essentially a medical outlier ward. Typically high-yield topics from medical school finals, such as Myocardial infarction/Stroke/Common cancers.
• Read about DKA/HHS and the local protocol for managing these conditions
• Due to the speciality of your consultants it would be worth reading about Thyroid/Adrenal hormones. Although you’re unlikely to have any thyroid storm/adrenal crisis patients on the ward.

What are some common tasks they may be asked to do?

• Prescribe medications
• Rewrite drug charts
• Chase scans
• Write EDNs (discharge letters)
• Take bloods
• Put in cannulas

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.

List of top resources to help prepare

References

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.

What are some common presentations they should read about?

• Epistaxis
• Tonsillitis
• Quinsy
• Otitis media/externa
• Post tonsillectomy bleed
• Stridor
• Epiglottitis (rare but crucial)

What are some common tasks they may be asked to do?

• Referrals
• IDLs (+++) particularly if you cover a day case unit
• You may get to learn procedures such as nasendoscopy, cautery of epistaxis, drainage of quinsies.
• Should be a reasonably okay job as an FY1 as patients tend to be younger and less comorbid allowing you to learn your basics without too many scary moments!

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

• ENTSHO. Com – the gold standard

References

ENTSHO.Com

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.

What are some common presentations they should read about?

• Upper GI bleed and acute management
• Alcoholic liver disease
• IBD and biologics that may be used
• Definitions of cirrhosis, fatty liver, decompensated liver disease.
• Alcohol withdrawal protocols and CIWA scoring
• SBP
• Considerations of hepatic dosing of drugs

What are some common tasks they may be asked to do?

• Common ward jobs including requesting bloods and scans, interpreting basic results and forming management plans with the help of seniors.
• There may be opportunity to learn specific skills under supervision such as ascitic tap/drain
• Likely to require liaising with other teams for help with management plans including general surgery and nutrition
• Organise transfusions

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.

List of top resources to help prepare

• MD calc
• Induction app for phone numbers
• Trust guidelines for antibiotic regimes and protocols
• Zero to finals for general conditions  

References

List of Contributors

What should a doctor expect from this rotation?

What are some common presentations they should read about?

What are some common tasks they may be asked to do?

What are your top tips on how to prepare?

List of top resources to help prepare

References

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.

What are some common presentations they should read about?

• Abdominal pain (appendicitis, cholecystitis, pancreatitis, diverticulitis, bowel obstruction/perforation), falls resulting in fractures (especially the ribs)
• Postoperative ileus

What are some common tasks they may be asked to do?

• Liaise with medical specialities, microbiology and interventional radiology regarding the patients
• Monitor bloods and replace electrolytes as necessary especially in patients who had been NBM for a period of time
• Prescribe admission medications for patients undergoing surgery- regular medications + analgesia, PRN antiemetic, DVT prophylaxis

What are your top tips on how to prepare?

• Familiarise yourself with the types of abdominal surgery (e.g. right hemicolectomy vs extended right hemicolectomy etc)
• Familiarise with types of stoma and how they differ
• Familiarise with common postoperative complications and how to recognise them
• Familiarise with good maintenance IV fluid prescription and monitoring in a NBM patient – not just “2 bags salty, 1 bag sweet”

List of top resources to help prepare

• NICE guidance for IV fluids – this flowchart as a quick reference

References

List of Contributors

Dr Lauren Marsh (FY1)

Dr Gigi Lee (IMT3)

What should a doctor expect from this rotation?

• This is a common F1 rotation with comprehensive medical ward rounds and a holistic view of the patient.
• There can be varying degrees of senior input depending on the hospital. Generally will be in one of the following formats:

1. Daily consultant ward rounds
2. Consultant ward rounds twice a week with registrar led ward rounds remainder of the days
3. Consultant ward rounds twice a week with SHO/F1 led ward rounds remainder of the days

• Therefore you may be expected to conduct ward rounds on your own depending on the hospital and discuss your reviews to seniors after. This may seem daunting initially but is actually a good opportunity to get assessments for portfolio and gain confidence/experience in reviewing patients.
• There is significant MDT input from OT/PT/social services with daily MDT meetings to discuss plans for each patient.
• Each week can be very variable: sometimes there may not be a lot to do if most of the patients are there for rehab/waiting for home support. Other times it may be very busy with a lot of acutely unwell patients.

What are some common presentations they should read about?

• Falls – consider postural hypotension, glycaemic control (hypos) if diabetic, bradycardia etc as causes as well as the mechanical fall. Be mindful to also consider other ways elderly people may be off baseline eg. Infection, anaemia.
• Deficiencies – vitamin D, folate, iron etc. Be confident in how and when to prescribe replacement.
• A comprehensive geris screen – to include the above, a bone profile including calcium, TSH, haematinics and B12.
• Anaemias
• Pneumonias
• Sepsis ?source  
• Constipation
• Delirium – Management, causes and identification
• Be aware of clinical frailty scoring (Rockwood)

What are some common tasks they may be asked to do?

• Day to day jobs will include reviewing bloods and managing common medical conditions such as CAP/HAP, UTI, sepsis ?source etc.
• Conducting Mini-mental state examination (MMSE) for confused patients
• Falls assessment
• Updating relatives regularly is especially important in geris where patients may have significant cognitive impairment or are delirious. This is a skill that develops with practice and experience.
• Liaising with OT/PT/social services to facilitate safe discharge
• Discharge letters (important to highlight any medications started/stopped)

What are your top tips on how to prepare?

• As a new FY1 having recently done finals, you will likely be equipped with most of the knowledge you need as a new FY1 on geris.Being aware of the common conditions as above will be a great start.
• Becoming confident with updating relatives is something you will learn on this job so embrace this early on. There may at times be difficult discussions with relatives, especially if a patient is deteriorating/approaching end of life care. If you don’t feel comfortable speaking with relatives, tell your consultant/registrar and ask to tag along when they have the conversation. You will get a flavour of how different people approach these situations.
• Good organisational skills and prioritisation is key to the job. After ward round organise your jobs and delegate some of the jobs if possible (e.g. some nurses can do cannulas/bloods/ECGs)
• When geriatric patients fall they can very easily fracture something. It’s good to know the signs of a neck of femur fracture, humeral neck fracture and haemothorax/pneumothorax in case of rib fractures. You will become familiar with falls assessment. Always be cautious of a patient falling on anticoagulation.
• Make the most of your shadowing time to get to know the specifics of your department.
• FY1 is a steep learning curve, so knowing when to ask for help and not being too hard on yourself will stand you in good stead!  

List of top resources to help prepare

• MDCalc app for scoring calculations
• Zero to finals for common medical conditions overviews
• Mind the bleep also have a lot of great resources
• Useful apps: BMJ Best practice, SmartDr, PocketDr, Microguide, BNF, Foundation Doctor Handbook

References

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.

What are some common presentations they should read about?

• Fever:

• Neutropenic fever
• Neutropenic sepsis
• Cytokine Release syndrome (in CAR-T patients)
• Weird fungal infections (PCP, candidiasis)
• PICC line infections
• Other common infection sources (Gen Med – e.g. pneumonia/uti etc).

• GvHD (acute vs chronic – in BMTU)
• Mucositis
• Sickle cell crisis
• Thrombocytopenia (low platelets) – bleeding risk for falls etc.
• Tumour lysis syndrome + post chemo bloods to request.
• Broad understanding of chemo regimens and ‘special medications to prescribe’ – e.g. MESNA to be prescribed prior to cyclophosphamide; Allopurinol prior to pts high risk of TLS (bulky disease)

What are some common tasks they may be asked to do?

• Assisting/performing: Lumbar Punctures, Bone Marrow Aspirations, removing central lines
• Difficult cannulations + all usual clinical skills.
• NG tubes (for px w/ mucositis)

What are your top tips on how to prepare?

• Read broadly around AML, ALL, CML, CLL and lymphoma if you’re interested. Otherwise brush up on your normal medicine.

List of top resources to help prepare

• Haembase – everyone I knew in our haematology unit used it (from juniors to regs)
• Bukumedicine
• Chemocare – consultants will prescribe the chemo on this and direct you as to who needs what pre-chemo medication (Allopurinol / mesna etc)

References

List of Contributors

What should a doctor expect from this rotation?

What are some common presentations they should read about?

What are some common tasks they may be asked to do?

What are your top tips on how to prepare?

List of top resources to help prepare

References

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.

• Biliary obstruction e.g. gallstones / cholangiocarcinoma / pancreatic cancer
• Cholecystitis, cholangitis
• Pancreatitis +/- necrotising (gallstones, ETOH and post-ercp main 3 causes.. leave the scorpions out for now haha…)
• HPB cancers: Cholangiocarcinoma + pancreatic cancer
• liver abscess – think about presentation and mgmt
• Post surgical complications: e.g. pancreatic leak
• Intra-abdominal/ retroperitoneal collections / haematomas

What are some common tasks they may be asked to do?

• Ward round and execute plans – both ward patients and post-take
• Depending on your hospital you may also clerk surgical patients in ED when on call
• May spend some shifts in SDEC (almost like ambulatory care but for surgery)
• Liaise with microbiology and interventional radiology
• Request reviews from other specialties – e.g. geriatricians and other medical specialties, medical reg in emergencies, palliative care, psych liaison
• Liaise with MDT – e.g. dietitians, physios, OTs, nursing colleagues, SALT, delirium and dementia team, drug and alcohol team
• Monitor bloods and replace electrolytes as necessary especially in patients who had been NBM for a period of time
• Prescribe admission medications for patients undergoing surgery- regular medications + analgesia, PRN antiemetic, DVT prophylaxis
• Cover out of hours – can sometimes be scary with post surgical patients with drains in

What are your top tips on how to prepare?

• Familiarise self with the above common presentations
• Familiarise with common postoperative complications and how to recognise them incl. Pancreatic leak
• Familiarise with good maintenance IV fluid prescription and monitoring in a NBM patient
• Examination findings: e.g. murphy’s
• Important investigations/ management- understand your LFTs, USS, MRCP, ERCP
• Surgeries to read about: cholecystectomy (look up hot vs interval); Whipple’s vs PPPD; appendicetomies, IND – under local and GA
• Role of interventional radiology and drains in HPB: PTC, PTBD, fluoroscopic guided biliary drainage

List of top resources to help prepare

• Induction app with numbers in your hospital
• Microguide
• iResus /BMJ best practice / MDCalc
• Website: Teach Me Surgery
• NICE guidance for IV fluids – this flowchart as a quick reference

References

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

• Pneumonia
• Infective endocarditis
• Meningitis/Encephalitis
• UTI/Pyelonephritis
• Cellulitis/ Septic Arthritis
• HIV, TB, Malaria

What are some common tasks they may be asked to do?

• Clerking new patients
• Helping with post-take ward round
• Bloods/cultures + ECGs
• Talking to relatives
• If you’re keen, get a senior to help you do a lumbar puncture!

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

• As stated above Microguide is great

References

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.

What are some common presentations they should read about?

• Respiratory failure (and types of respiratory support)
• ARDS
• Sepsis (and use of vasopressors)
• Neurological impairment (seizures, overdose, intracranial bleeds)
• Post-operative care (especially laparotomies)
• Pancreatitis
• Post-resuscitation care

What are some common tasks they may be asked to do?

• Daily A-E assessment and note prepping.
• Present patient to consultant at ward round
• Basic ward jobs (requesting scans, speaking to microbiology, etc)
• Opportunity for procedures eg, arterial lines, CVCs, chest drains, ultrasound (for diagnostics as well as to guide procedures)

What are your top tips on how to prepare?

• Low expectations of FY1s and those new to critical care – reading around is good but don’t feel intimidated like you need to prepare lots (or at all)
• If there’s talk about procedures at handover/WR, ask to get supervised to do them.
• Try shadowing the on-call reg a few days to get a feel for seeing and managing referrals

List of top resources to help prepare

Generally short accessible resources:

• Life in the Fast Lane
• Deranged Physiology
• Revision Notes in Intensive Care Medicine

Reference Textbooks:

• Marino’s Little ICU book (2e available as a PDF on Google) – American centric
• Oh’s Intensive Care Manual – Aussie book but better reflects British practice

References

List of Contributors

What should a doctor expect from this rotation?

What are some common presentations they should read about?

What are some common tasks they may be asked to do?

What are your top tips on how to prepare?

List of top resources to help prepare

References

List of Contributors

What should a doctor expect from this rotation?

What are some common presentations they should read about?

What are some common tasks they may be asked to do?

What are your top tips on how to prepare?

List of top resources to help prepare

References

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?

• Neurotrauma – EDH, chronic and acute SDH, traumatic SAH, skull fractures
• Spines – cauda equina syndrome, intradural spinal tumours, MSCC
• Vascular – aneurysmal SAH, AVMs
• Neuro-onc – various tumours mainly GBM and LGGs. Meningioma.
• Functional – epilepsy surgery, DBS
• Paeds – shunt surgery, tumours, hydrocephalus
• Skull base – pituitary surgery/tumours

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.

What are some common tasks they may be asked to do?

• ward rounds – these will mean ITU rounds too. Yo will probably need to do some jobs in ITU
• removing drains such as subdural drains
• Lumbar puncture/drains
• ICP bolt
• Removing EVDs

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.

List of top resources to help prepare

References

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

What are some common tasks they may be asked to do?

• Clerk antenatal, postnatal and gynaecology cases
• Present these cases to seniors
• Speculum examination
• Postop review – postnatal lady (after C section or normal vaginal delivery)
• TTOs
• Grey cannulas

What are your top tips on how to prepare?

• Familiarise yourself with history taking and common presentations
• Keep in mind there are some medications that are contraindicated during pregnancy and breastfeeding
• You might be a bit overwhelmed at first but take it one step at a time, you will be well supported by your consultants, registrars and midwives

List of top resources to help prepare

Geekymedics Obs & Gyne examination

 Obs and Gynae history taking

References

List of Contributors

What should a doctor expect from this rotation?

What are some common presentations they should read about?

What are some common tasks they may be asked to do?

What are your top tips on how to prepare?

List of top resources to help prepare

References

List of Contributors

What should a doctor expect from this rotation?

What are some common presentations they should read about?

What are some common tasks they may be asked to do?

What are your top tips on how to prepare?

List of top resources to help prepare

References

List of Contributors

What should a doctor expect from this rotation?

What are some common presentations they should read about?

What are some common tasks they may be asked to do?

What are your top tips on how to prepare?

List of top resources to help prepare

References

List of Contributors

Dr Martin Whyte ST5 Paediatrics

Dr Timothy Griffiths FY1

Dr Jay Talbott FY1

What should a doctor expect from this rotation?

• FY1s are often supernumerary (i.e. no nights).
• You are extensively supervised.
• The registrars and consultants are very hands-on, so you will always have someone there to help or teach
• Referrals between teams are often reg-reg/con-con so be prepared to not be the one referring to other specialties as often as in adults
• Great time to build up practical skills supervised if you need it because you are often supernumerary
• If your job is linked with paediatric surgery, utilise time to go to theatre’s if you want to
• You are given opportunities to attend consultant led clinics

What are some common presentations they should read about?

• Breathless child
• Breathless infant
• Febrile child
• Febrile infant
• Vomiting newborn
• Gastroenteritis
• Weight loss in the newborn
• Common exanthems in children
• Non-specific abdominal pain (lots of ?appendicitis)
• Hydatid torsion/testicular torsion
• Neonatal jaundice
• Failure to thrive

What are some common tasks they may be asked to do?

• Phlebotomy and cannulation would only be if you were interested, confident, and the patient was appropriate.
• Keeping on top of the ward list and patients. Paeds often has quite rapid turnaround of patients (more like a medical admissions unit than an inpatient unit)
• Clerking GP/ED referrals, or working in paeds ED depending on setup.
• Discharge summaries and letters
• You may have on-calls in assessment unit, perfect place to get some mini-cex/CBD’s complete

What are your top tips on how to prepare?

• PILS is often recommended, so book early
• Likewise NLS if you’re covering deliveries
• Otherwise chill, nobody is expecting anything of you except for you to be good at keeping on top of the jobs list

List of top resources to help prepare

• https://dontforgetthebubbles.com/
• What0-18.nhs.uk (useful website to safety net parents with)
• Growth Charts app

References

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

What are some common presentations they should read about?

• Signs and symptoms of dying
• Metastatic spinal cord compression
• Hypercalcaemia
• Superior vena cava obstruction

What are some common tasks they may be asked to do?

• Complex discharge summaries and TTOs involving multiple controlled drugs +/- syringe drivers
• Patient reviews looking at symptom management
• Presenting patients at MDT meetings  
• Prescribe anticipatory medications/ syringe drivers
• Take part in family discussions around care and discharge decisions
• Clerking new admissions to the hospice

What are your top tips on how to prepare?

• Familiarise yourself with history taking and skills used in difficult conversations
• Don’t worry as palliative care consultants are some of the nicest doctors to work with
• Always get someone to double check your calculations when converting opioid doses

List of top resources to help prepare

• Recommendations | Care of dying adults in the last days of life | Guidance | NICE
• Palliative Care Guidelines Plus (pallcare.info)

References

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:

• Minor burns
• Major burns including resuscitation / Parkland formula
• Excision and grafting surgery
• SJS / TEN

Plastics:

• Wound management
• Open fractures
• Bites (human and animal)
• Skin grafts and flaps
• Necrotising fasciitis / Fournier’s gangrene

Hands:

• Tendon injury
• Nerve injury (median / ulnar / radial)
• Hand infections (incl flexor sheath infection)
• Metacarpal and phalangeal fractures (open and closed)

What are some common tasks they may be asked to do?

• Venepuncture and cannulation
• Discharge letters / TTOs
• Assessment of unwell patients
• Presentation at MDT meetings
• Assessment of patients in ED / clinics / ward attenders
• Attendance at burns alerts / trauma calls (with senior help)
• Dressing changes: these are a large part of burns management, and can be very extensive (e.g. lasting a few hours!). The type of dressing will be guided by your seniors / nursing team
• Wound management, including dressing choice and suturing in ED
• Involvement in theatre cases, e.g. excision and skin grafting of burns, flaps, SCC removal

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

What are your top tips on how to prepare?

• You will mainly be doing ward jobs, which you will already be familiar with. You will be taught anything more specific on the job!
• Reading around the common presentations will help, as these are often presentations that you won’t have encountered previously
• Have an idea of different wound dressings and their indications
• Practice suturing if you are keen to get involved

List of top resources to help prepare

• Plastic Surgery – TeachMeSurgery
• Suturing – Mind The Bleep
• Wound Dressing Types – OSCE Guide | Geeky Medics

References

What should a doctor expect from this rotation?

• All the psychiatry elements of a psych job are very senior led – you won’t be making changes to people’s meds or making decisions about admission/discharge on your own at all. F1s tend to have a bit more responsibility with the other problems of patients (see below)
• Very few F1 jobs in psychiatry include out of hours/on call work in psychiatry. A lot of jobs, however, will include some medical on calls in a hospital

What are some common presentations they should read about?

• This will depend a little on the type of placement- acute and general psychiatric wards will see people often with various psychoses (including drug related), depressive episodes, and other presentations like patients with personality disorders “in crisis”.
• A common (and probably the most important) reason people are admitted is because of uncontrolled psychosis requiring initiation or changes of medication. Learning a bit about common antipsychotics and their different side effect profiles is useful.
• Old age psychiatry wards commonly have patients with behavioural and psychological symptoms of dementia (BPSD),so in addition to reading about the primary psychiatric disorders, it is worth knowing the different causes of dementia, the drugs commonly prescribed (risperidone, memantine) and conditions that can have psychiatric manifestations (Parkinson’s disease).  

What are some common tasks they may be asked to do?

• As an F1, you will probably not be clerking new admissions on your own.
• Participating in the ward round – documenting (psychiatry documentation is always very thorough) and making changes to meds etc following this
• Doing bloods on wards – some psych wards have access to phlebotomists but most don’t. Psych patients will all have certain bloods on admission, and there will be other bloods accompanying changes to meds, or monitoring (such as with clozapine
• You will often be the first port of call for any little medical complaint inpatients have – including things they would normally see a GP for and things they would normally do nothing about but “hey, there’s a doctor here”. Only act within your competency here – ask seniors if you are not sure. In some cases you will face chronic medical problems that would be better managed by the patient’s GP, and these can either wait until discharge, or if the patient is likely to be admitted for a while, it is sometimes possible to arrange leave for the patient to see their GP (this is an MDT decision, definitely and legally not yours).
• In Older Age Psychiatry you may find that a patient is transferred straight from the community without prior medical clearance, it is important to keep an open mind as you would be surprised what might not have been picked up in the community e.g. chest infection, unintentional overdose due to cognitive impairment, heart murmurs.
• In Older Age Psychiatry you may be doing cognitive assessments with patients (MMSE, ACEiii, MoCA)

What are your top tips on how to prepare?

• Revise not only how to read an ECG but how to physically do one! This is a doctor’s job in most psychiatry inpatient units, and you will be doing it more than you think.
• It is worth understanding the different legal statuses of patients, particular Section 2 and 3, DOLS and Section 17 leave. You will be taught this on the job though.
• Even if you are on an inpatient ward, your seniors will have spent time in other psychiatry services so utilise the source of knowledge for the future, such as management of acute presentations in A&E or General practice. They are also usually very pro taster days with your self development time depending on ward provision.

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.
Maudsley Learning Podcast- includes interviews with prominent psychiatrists in the UK, covering more holistic and historical discussions of various aspects of psychiatry. Even if you are not considering it as a career, there are some very useful perspectives.
NICE have some overviews for managing different psychiatry presentations. We will also be coming out with further articles, particularly in Older Age Psychiatry soon so watch this space.

References

BMJ Learning: Online Courses for Healthcare Professionals
Mental Health Podcasts | Maudsley Learning
Overview | Dementia: assessment, management and support for people living with dementia and their carers | Guidance | NICE

List of Contributors

What should a doctor expect from this rotation?

What are some common presentations they should read about?

What are some common tasks they may be asked to do?

What are your top tips on how to prepare?

List of top resources to help prepare

References

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.

What are some common presentations they should read about?

• Asthma
• COPD – especially carbon dioxide retainers and over-oxygenation
• Bronchiectasis
• COVID
• Pleural Effusions
• Pulmonary embolism
• Type 1 and 2 respiratory failure
• Use of CPAP/NIV
• Sepsis
• Diabetes and insulin (especially from steroid use in particular)
• Atrial fibrillation (patients with respiratory disease often develop AF)

What are some common tasks they may be asked to do?

• Prescribe antibiotics/steroids/nebulisers/other medication/oxygen/VTE prophylaxis
• Perform ABGs  and blood cultures
• Request and interpret bloods, ECGs and chest x-rays
• Requesting scans, such as CTPA
• Formulating management plans with consultant supervision
• Liaise with other specialties for advice, e.g microbiology, gastro
• Have discussions regarding DNACPR or end-of-life situations
• Discharge letters
• HOOF/LTOT – contact resp specialist nurses for any queries
• Capillary blood gas is a useful skill to have if ABG/VBG is difficult, specialist nurses can sometimes perform these for you when around

What are your top tips on how to prepare?

• Familiarise yourselves with the BTS guidelines/Oxford Handbook/NICE guidelines for respiratory conditions.
• Familiarise yourself with the trust guidelines – knowing where to find guidelines for antibiotics or common medical emergencies is invaluable, especially in stressful times when patients are acutely unwell.
• Use apps like MDCalc, BNF app, which will make your life easier.
• Knowing your scoring systems, such as Wells score or PESI score, can help you make decisions if you’re stuck. You don’t have to remember all the components of the score, just that they exist and what they’re used for, then use MDCalc to do the rest. Alternatively, ask a senior.
• Provide yourself with a structure when having difficult conversations, such as end-of-life. It will make these conversations easier to navigate. A commonly-used structure is SPIKES (situation, perception, information, knowledge, emotion, strategy).
• Stay organised with your jobs list and find a system that works for you. The more efficient and organised you are, the more likely you will be able to leave on time.
• Look after yourself – it is easy to let the stress and workload in this rotation mean that you miss meals or go home late. Avoid this unless there is an emergency, as it can quickly lead to burnout.
• Lots of radiology interpretation, great to learn/see but useful to have decent understanding and interpretation skills yourself as you should be reviewing some of your own patients

List of top resources to help prepare

• BTS guidelines
• Oxford Handbook of Clinical Medicine – the medical emergencies section is concise
• Oxford Handbook for the Foundation Programme also has a good breakdown of how to manage common medical conditions, and it is laid out in an A to E format most of the time
• NICE guidelines

References

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.

What are some common presentations they should read about?

• Septic arthritis – many patients who are referred to rheumatology present with a painful swollen joint. Septic arthritis is almost always a differential diagnosis in these patients and therefore it is useful to understand the investigations and management for this condition.
• Gout
• Pseudogout
• Systemic lupus erythematosus

What are some common tasks they may be asked to do?

• Making referrals and liaising with other specialties
• Requesting and vetting scans
• Clinical skills: venepuncture, ABGs, cannulas, catheterisation
• (More advanced skills that you may have the opportunity to learn/do include: joint aspiration/injection, lumbar puncture)
• Prescribe medications such as analgesia and antibiotics
• Write discharge summaries
• Next of kin updates and DNAR discussions
• Present patients at MDT meetings
• As part of on-call ward cover you will be expected to assess patients with problems such as a fall, new oxygen requirement, temperature spike, hypo/hyperglycemia
• On medical on-take shifts you will be expected to clerk, present and manage patients (with supervision from a senior)

What are your top tips on how to prepare?

• When working on the ward, the most important thing is being able to prioritise your jobs and working in an efficient manner

• When making referrals/requesting imaging, make sure you are clear what clinical question you want answered – if you are unsure, ask the consultant/registrar before requesting/referring
• Familiarise yourself with common causes of a hot, swollen joint as well as the investigations and management
• If you ever feel overwhelmed or out of your depth, always ask a senior – they are usually very supportive and helpful!
• Take the opportunity to learn about all the interesting presentations/conditions in general medicine that you will see as part of this rotation!

List of top resources to help prepare

• Download the following apps to your phone: BNF, Microguide (has all the trust antimicrobial guidelines for a wide variety of infections), Induction (has all the contact numbers/bleeps within your hospital)
• Mind The Bleep has a very good page on acute swollen joints

References

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

What are some common presentations they should read about?

• Ischaemic and Haemorrhagic stroke (and subtypes!)
• Migraine
• Epilepsy
• Seizures
• PRES syndrome (detailed understanding is not necessary)
• Fast Afib
• Aspiration Pneumonia
• Malignant MCA syndrome

What are some common tasks they may be asked to do?

• Request scans (and chase). In particular CT Head/MRI Head/CT Angiography Carotid + arch of aorta
• Refer to specialities including Vascular/Neurosurgery
• Prescribe medications, commonly Aspirin/Clopidogrel/Statins
• Write EDNs
• Round patients and score them using NIHSS (National Institutes of Health Stroke Scale)
• Starting anticoagulation
• 4AT scoring
• Starting infusions to control BP in patients with haemorrhagic strokes
• Get slick at your GCS scoring and neuro exam, this will make your life easier when you have to call neurosurgery RE a deteriorating ICH patient

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.  

List of top resources to help prepare

References

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)

What are some common presentations they should read about?

• NOFs, ankles and distal radiuses for the trauma meeting
• Compartment syndrome – know how to recognise on the ward and escalate early
• Brush up on musculoskeletal anatomy and fracture types
• The analgesic ladder (although anything requiring escalation to opioids should be discussed with a senior)
• Common post op issues such as DVT/PE, ?compartment, LRTI/UTI, bleeding wound, delirium, opioid toxicity
• How to review a wound

What are some common tasks they may be asked to do?

• Review weight-bearing status
• Prescribe analgesia
• Sort out most medical issues on the ward
• Review wounds

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

List of top resources to help prepare

• NICE Guidelines
• Rouhen’s anatomical atlas
• Orthobullets
• McCrae’s Orthopaedic Trauma

References

List of Contributors

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.

What are some common presentations they should read about?

• Urology common conditions – common cancers (bladder, prostate etc.), BPH, urinary retention, haematuria, UTI.
• Basic knowledge of urology procedures – helps with postop care and EDNs.
• Urinary catheter complications
• General medicine knowledge does help as patients may have multiple co-morbidities

What are some common tasks they may be asked to do?

• Postop ward care
• Investigations: bloods, blood cultures
• EDNs, TTOs
• Urinary catheter insertion / care

What are your top tips on how to prepare?

• Be organised with jobs
• Getting good with urinary catheters helps – postop patients require TWOCing so if they fail, they need another catheter.

List of top resources to help prepare

References

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

What are some common presentations they should read about?

• AKI
• Hypoglycaemia
• DKA
• Post op pain
• Opiate toxicity
• Diabetic foot sepsis
• rAAA
• HAP

What are some common tasks they may be asked to do?

• Standard ward tasks
• Pain review
• Diabetic control
• Cannulas/bloods
• Bleeding/wound reviews

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

List of top resources to help prepare

References