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 turnover 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 many 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? |
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What are some common tasks they may be asked to do? |
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What are your top tips on how to prepare? |
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List of top resources to help prepare |
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References |
Anaesthetics
List of Contributors |
Dr D Williams (ST4) Dr Balazs Hollos (SpR) |
What should a doctor expect from this rotation? |
You are supernumerary, meaning 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? |
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What are some common tasks they may be asked to do? |
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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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References |
ITU
List of Contributors |
Basit Ahmad (FY1) |
What should a doctor expect from this rotation? |
As a supernumerary member of the team, your main job is to learn. Initially, ITU feels like a different language to the rest of medicine but with time, it becomes easy to understand what is happening and your role in the team. Most of the time you will observe & help rather than independently carry out tasks. There are generally no on-calls but some long days. Excellent opportunity to take part in Audits and research as many are always available. There are many opportunities to learn and improve practical procedures such as ultrasound-guided cannulas, arterial lines as well as teaching on pharmacology, physics & physiology. ITU is often combined with anaesthetics 2 out of your 4 month rotation. |
What are some common presentations they should read about? |
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What are some common tasks they may be asked to do? |
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What are your top tips on how to prepare? |
A lot of opportunities to learn on the job so no preparation is acceptable but consider looking at Critical care literature. |
List of top resources to help prepare |
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References |
Breast Surgery
List of Contributors |
Dr C Phillips-Clarke (FY1) |
What should a doctor expect from this rotation? |
This is quite a relaxed role which is almost supernumerary day to day. Depending on the trust you may spend most of your time in theatre or clinics. You may carry a bleep and be the first port of call for the breast team. Most breast emergencies day-to-day are abscesses, which you may have to review. Mostly you are assisting in theatre and carrying out tasks set by seniors. You are part of the general surgery team and also the on-call shifts. This can be quite daunting in comparison to the rest of the breast job, as you’re not often seeing emergencies. Depending on your trust this will involve weekend and night shifts. There are lots of opportunities to get involved with theatre and with projects and audits. There is time, which you don’t get in other jobs, where you can boost your CV. |
What are some common presentations they should read about? |
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What are some common tasks they may be asked to do? |
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What are your top tips on how to prepare? |
At the beginning of the rotation, spend some time with the General surgery team in less busy periods so that the on-call shifts are less daunting. Familiarise yourself with surgical options for breast cancer |
List of top resources to help prepare |
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References |
Cardiology
List of Contributors |
Dr Samsul Islam (FY2) Dr Tharusha Gunawardena (SPR) |
What should a doctor expect from this rotation? |
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What are some common presentations they should read about? |
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? |
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What are your top tips on how to prepare? |
Practise your ECG skills Download MDcalc to add in the chads2vasc calculator |
List of top resources to help prepare |
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References |
Cardiothoracic Surgery
List of Contributors |
Dr Prabhav Singhal (FY2) |
What should a doctor expect from this rotation? |
I did this as an SHO. You will predominantly be based on the wards but will also have theatre sessions and clinics. I had 8 theatre sessions over the 4 month period. On the wards you will do ward rounds in the morning and jobs in the afternoon. Unlike general surgery, the ward rounds are longer with a lot more emphasis on the medical management (BP, AF management etc). You will also have opportunities to do chest drains for patients on the ward. In theatre, you can scrub in and help with saphenous vein grafting and closing the chest for cardiac cases and doing thoracotomies in thoracic cases. |
What are some common presentations they should read about? |
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What are some common tasks they may be asked to do? |
It is a very senior-led specialty, so on the wards, your tasks will be similar to other FY1 jobs such as:
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What are your top tips/ resources on how to prepare? |
Not all of us had a cardiothoracic rotation in medical school but not to worry, you will pick up key things during the rotation. Would recommend going over your cardiology, respiratory notes and the common presentations mentioned above. |
Child & Adolescent Psychiatry
List of Contributors | |
What should a doctor expect from this rotation? | |
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List of top resources to help prepare | |
References |
Clinical Pharmacology
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? | |
What are some common tasks they may be asked to do? |
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What are your top tips on how to prepare? |
Learn from ward pharmacist/ peer discussion, and always ask seniors if in doubt. If unsure about a prescription, always go to the resources recommended below as a reference. Cross-check with pharmacists if not confident at the first stage of prescription, they are really helpful! Understanding the side effects and contraindications of common medications are really important. For example: avoid Magnesium aspartate in patients with diarrhoea. Cautious in medication dosage especially in patients 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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References |
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. |
What are some common presentations they should read about? |
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What are some common tasks they may be asked to do? |
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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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References |
Emergency Medicine
List of Contributors |
Dr S Kulikouskaya (CT1) Dr C Evans (ST3) Dr Chinonso Ojukwu (FY1) |
What should a doctor expect from this rotation? |
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References |
Endocrinology & Diabetes
List of Contributors |
Dr Haroon Khokher (FY1) Dr AbdulRehman Ammouni (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 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 outlier patients (patients who 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? |
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What are some common tasks they may be asked to do? |
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What are your top tips on how to prepare? |
Brush up on Diabetes and general medical knowledge before you begin. Particularly read up on DKA and HHS and this is a very common presentation. 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. To make the best out of this rotation I’d suggest reading up on different insulin regimes, getting used to prescribing them, understanding how blood glucose charts work. Also, try to join your reg or consultant in a diabetes clinic. Great opportunity to work outside the ward and fill up your eportfolio. |
List of top resources to help prepare | |
References |
ENT
List of Contributors |
Dr Stephen J Davison (Clinical Development Fellow) Dr Chloe Maxwell (FY3) |
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! At SHO level you may cover on calls and nights alone, typically with registrar off-site. First point of call for emergencies- don’t panic! Know who to call for help (registrar or anaesthetics) and get all the details of the patient, location and clinical situation. Lots of new skills to learn and observe, very hands-on job in some locations. |
What are some common presentations they should read about? |
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What are some common tasks they may be asked to do? |
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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 Always know who the senior on call is and how to contact them in case of emergencies Utilise expertise of members of the MDT- nurses, speech therapists etc- they are very knowledgeable and can help you |
List of top resources to help prepare |
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References |
ENTSHO.Com |
Gastroenterology
List of Contributors |
Dr Lauren Marsh (FY1), Dr Francis Elechi (FY1), Dr Vanessa Chan (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 although you may be asked to lead ward rounds occasionally. There may be some opportunities to attend endoscopy or be involved in procedures such as ascitic drains and taps (and the opportunity to use an ultrasound machine to help). There may be opportunities to attend clinics if interested. Overall tends to be quite a chaotic environment, described as the ‘surgical’ medical specialty due to fast-paced ward rounds, your registrars are often in clinic/endoscopy and patients can become unwell quickly. |
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What are some common tasks they may be asked to do? |
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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. |
List of top resources to help prepare |
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References |
General Practice
List of Contributors |
Chloe Maxwell FY3 |
What should a doctor expect from this rotation? |
A very varied rotation. Expect a wide range of ages from babies to elderly patients. A mixture of acute, chronic and acute on chronic conditions. You may see patients with very complicated medical backgrounds and many patients are comorbid with polypharmacy. Diagnosis and review of common mental health problems. Some more straightforward presentations- sore throat, ear infection, skin problems, cough etc. Some critically unwell patients require hospitalisation. Expect to see patients either supervised or independently and then to discuss diagnosis and management with supervising GP. There will be lots to learn and very useful to see medicine from a primary care perspective. |
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References |
General Surgery
N.b. there is a separate HPB surgery prep further down
List of Contributors |
Dr Pik Kwan Lau (FY1) Dr A James (Teaching fellow) Dr Lucy McCann (FY1) |
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 patient b s (depending on the trust/hospital) After ward round, 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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References |
Geriatrics
List of Contributors |
Dr Lauren Marsh (FY1) Dr Gigi Lee (IMT3) Dr Jade Lene Yong (FY1) Dr Vanessa Chan (FY1) |
What should a doctor expect from this rotation? |
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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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References |
Hepatology
List of Contributors |
Dr Zahra Mohamedali (IMT1) |
What should a doctor expect from this rotation? |
Hepatology is an acute speciality and you will see lots of acute presentations. It is also a great rotation to have some procedural experience and with senior support, you will get the opportunity to learn how to perform ascitic taps and ascitic drains. The day-to-day job will usually consist of senior-led ward rounds. As an F1 you will be expected to join, document and carry out jobs from the ward round plans which will usually include requesting bloods and other investigations, scans, prescribing medication and liaising with other specialties. During the day, you will also be expected to review patients when nursing staff express concerns about their NEWS score or other aspects of their care. There should always be a senior that you can seek help from. Be aware that liver patients have the potential to deteriorate rapidly so always escalate to senior if unsure! |
What are some common presentations they should read about? |
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What are some common tasks they may be asked to do? |
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What are your top tips on how to prepare? |
Always escalate to a senior and ask for help when unsure as liver patients can deteriorate acutely. Read up on the common conditions mentioned above. Read up on the definitions of hepatitis, cirrhosis, fibrosis and how to interpret liver function tests (LFTs). Learn how to access your hospital’s local guidelines |
List of top resources to help prepare |
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References |
Histopathology
List of Contributors |
Dr Chloe Maxwell (FY3) |
What should a doctor expect from this rotation? |
Only offered in some trusts, mainly FY2 posts. Expect to learn the basics of histopathology, how to use the microscope, dissect and block specimens, diagnose common pathologies, assist or watch post mortems and learn about cytology. You will have a lot of teaching and support learning about pathology. Senior staff lead and you will always have someone to discuss cases with. |
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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 a dedicated HPB team and ward – find out which yours is. Very interesting presentations with often very sick patients that must be carefully managed. Patients are often long-term patients and you can 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. endoscopists, 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 overlap 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 the 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 contact with 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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References |
Intensive Care
List of Contributors |
Dr Daniel Last (FY1) Dr Rishil Patel (FY1) Dr Balazs Hollos (SpR) Dr Sruthi Arakkal (FY1) |
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 the management of acutely unwell patients. Great rotation to work on our portfolio, and get all the hubs/sims done Daily teaching is done by the consultants |
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List of top resources to help prepare |
Generally short accessible resources:
Reference Textbooks:
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References |
Microbiology
List of Contributors |
Dr Abhrajit Giri (FY2) |
What should a doctor expect from this rotation? |
Usually, Foundation rotations in Microbiology are organised for FY2 doctors. You will be supernumerary, there is no out-of-hours work, and usually, you will not have any direct patient contact. You will interpret patient blood cultures and contact the parent team by telephone to explain the results. There is very good supervision from both Consultant Microbiologists and Senior Registrars with whom you will discuss the majority of cases. |
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Neurology
List of Contributors |
Alex Gordon ( F2) |
What should a doctor expect from this rotation? |
Neurology is a surprisingly uncommon inpatient specialty despite how common neurological problems are. Pure inpatient neurology tends to be isolated to tertiary neuroscience centres in big cities, whereas the experience of the majority of foundation doctors will be in management on acute medical units or acute stroke units. |
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What are your top tips on how to prepare? |
Knowing how to initiate management of acute neurological complaints will be helpful, particularly things like managing seizures and acute deterioration in stroke patients (evidence of aspiration pneumonia and reduced GCS). Try to find any hospital policies for these during your induction. Have a clear process for undertaking a neurological examination and documentation of this examination. Think about having DNACPR discussions. |
List of top resources to help prepare |
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References |
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. |
What are some common tasks they may be asked to do? |
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 |
Obstetrics & Gynaecology
List of Contributors |
Dr Oluwadara Dare (FY1) Dr Chi Yan Bonnie Cheung (FY1) Dr Shin Ying Chieng (FY1) |
What should a doctor expect from this rotation? |
F1s have a supernumerary role with no on-calls or night shifts (so be prepared for a lower take-home pay) Usually quite supported You will be assigned to:
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OMFS (MaxFax)
List of Contributors |
Dr Janhvi Shah (OMFS Specialty Doctor) Dr Andrew Whitehead (F1 Doctor) Dr Alex Barrow (F1 Doctor) |
What should a doctor expect from this rotation? |
The department will mostly be staffed by Dental Core Trainees AKA ‘DCTs’ (SHO-level dental doctors who have completed a dentistry foundation year), registrars, and consultants. As most of the other juniors in the department are dentally trained, there will be a limited amount that you can do related to dental presentations. Nevertheless, you will be required for the common medical and surgical ward jobs (e.g. bloods, ECGs, catheterisation and other typical clinical skills) & presentations (i.e. typical post-op symptoms – e.g. nausea and/or constipation – or ATSP for acutely unwell surgical patients – e.g. fever in the postoperative patient). F1/2s may have a supernumerary role, but in some units, they might be expected to do day and night on-call shifts. Depending on the number of patients on the ward, there will hopefully be some free time to get a variety of learning experiences: shadowing the on-call DCT in ED and trauma clinics (including clerking and management of emergency presentations); consultant/registrar clinics; assisting in theatre etc. There will also be the opportunity to improve your practical skills in suturing in surgery or ED if wanted. There is a large overlap with other surgical specialties such as ENT, plastics, critical care and dermatology. |
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Other Useful Link |
e-Face (elfh): a free e-learning course for everything MaxFax, which can count towards your non-core learning in Horus ePortfolio. Suggest modules include ‘Tracheostomy Management’ and ‘Radiology for maxillofacial trauma’. Mind The Bleep: Introduction to Dental Traumatology: great for understanding patterns of dental injury as this isn’t covered in medical school. To learn about the specialty:
For practical details for DCTs and OMFS Foundation doctors specifically at QMC (Ward C25), please check this guide: https://docs.google.com/document/d/18BW8mUQCl2WFqYj58lkBU_hk0TiVRUWdCqbLh1eT7Gw/edit?usp=sharing |
Ophthalmology
List of Contributors |
Dr Zahra Karmally (FY2) |
What should a doctor expect from this rotation? Ex |
Supernumerary role with lots of senior oversight. On-calls under supervision (no nights). Based mainly in the outpatient department with inpatient referrals getting to see both acute and chronic ocular pathology. Attend theatres, emergency eye casualty as well as a variety of subspecialty clinics: paediatrics, glaucoma, cornea, vitreo-retina, oculoplastics, neuro-ophthalmology, medical retina and medical ophthalmology. General jobs: taking blood, performing and interpreting ECGs (escalate to ED / Med reg for a second opinion if needed), requesting scans, liaising with other specialties. Eye job no s: visual acuity, colour vision, intraocular pressure (Goldmann’s applanation tonometry), eye drops, direct/indirect ophthalmoscope, slit lamp examination. Working with MDT: optometrist, orthoptist, ophthalmic nurses, ophthalmologists. |
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What are your top tips on how to prepare? |
Refresh knowledge of eye anatomy and key conditions listed above. Watch YouTube videos covering ophthalmoscopy and slit lamp examination basics – remember PRACTICE is everything! Embrace every patient as a learning opportunity. Attend departmental teaching (ask to be added to the mailing list or buddy up with a trainee). Enquire whether microsurgical simulator (EyeSi, wet lab or equivalent) available in departmental induction. |
List of top resources to help prepare |
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References |
Health Education England RCOphth website |
Oncology
List of Contributors |
Dr Wern Wei Chin (Vivian) (FY2) |
What should a doctor expect from this rotation? |
Supportive team and wide range of oncology specialties. Work along with MDT and specialist team |
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Paediatrics
List of Contributors |
Dr Martin Whyte ST5 Paediatrics Dr Timothy Griffiths FY1 Dr Jay Talbott FY1 Dr Vanessa Chan 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 hand in s. 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. Hand 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 |
What are your top tips on how to prepare? |
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List of top resources to help prepare | |
References |
Psychiatry
List of Contributors |
Dr A James (teaching fellow) Dr H Trippe (FY1) |
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What should a doctor expect from this rotation? |
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What are some common presentations they should read about? |
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What are some common tasks they may be asked to do? |
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What are your top tips on how to prepare? |
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List of top resources to help prepare |
BMJ e-learning has some helpful e-learning 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
List of Contributors |
Sanjana Mathew and Jonathan Yeats Dr Maarij Mirza (FY1) |
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What should a doctor expect from this rotation? |
At F1 level, this is a similar job to most hospital medicine ward jobs, with similar on-call responsibilities (likely to be on the gen med rota). F2s may be required to act as the renal SHO, managing renal patients on call, possibly taking bleeps and urgent lab results. If you work in a centre with a dialysis ward, most patients who require regular dialysis will typically default to renal regardless of their presenting pathology so you should get plenty of gen med experience. Renal tends to be senior-led, slower-paced and heavy on investigations, though renal emergencies are common, especially in dialysis units. The complexity and severity of renal pathologies you will face are partially dependent on the renal services offered at your hospital. Tertiary renal hospitals tend to have dedicated renal HDUs with bigger renal teams and specialist nurses. DGH’s may be more limited. There may well be opportunities to get involved with research and expect journal clubs aplenty. Specific opportunities in renal medicine outside of day-to-day ward work could involve going to clinics, shadowing AKI nurses, the renal registrar on call taking referrals, attending kidney biopsy sessions. |
What are some common presentations they should read about? |
This would involve understanding how dysregulated calcium and phosphate homeostasis can lead to renal osteodystrophy.
Contribute to nephritic/nephrotic syndrome presentations. Would be good to understand the presentation of these patients symptom profile-wise and the investigations needed such as autoimmune screens. |
What are some common tasks they may be asked to do? |
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What are your top tips on how to prepare? |
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List of top resources to help prepare |
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References |
We both worked as F2s at the same tertiary renal centre with IP and OP dialysis and renal HDU. This advice is predominantly from our experience and advice we were given and not everything (especially duties) will be universal. |
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. |
What are some common presentations they should read about? |
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What are some common tasks they may be asked to do? |
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What are your top tips on how to prepare? |
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List of top resources to help prepare |
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References |
Rheumatology
List of Contributors |
Dr Emily Ching (FY1) |
What should a doctor expect from this rotation? |
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? |
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What are some common tasks they may be asked to do? |
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What are your top tips on how to prepare? |
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List of top resources to help prepare |
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References |
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 |
What are some common presentations they should read about? |
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What are some common tasks they may be asked to do? |
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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 of who is unwell. |
List of top resources to help prepare | |
References |
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 post-op despite analgesia regimen or complain of bleeding at surgical site etc. There is always a surgeon on call who can assist 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 occasion 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? |
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What are some common tasks they may be asked to do? |
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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 post-op patient. Like constipation, delirium, hypo/hypertension, Hb drop, AKI etc. Recognising the unwell patient is also critical and knowing how to be able to undertake an A to E assessment is a must as post-op 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 |
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References |
Urology
List of Contributors |
Dr Laura Miller (FY1) |
What should a doctor expect from this rotation? |
As an F1, this is a ward-based job where you mainly look after post-operative 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. You will be in charge of preparing and updating the list. |
What are some common presentations they should read about? |
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What are some common tasks they may be asked to do? |
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What are your top tips on how to prepare? |
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List of top resources to help prepare |
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References |
Vascular Surgery
List of Contributors |
Dr Stephen J Davison (Clinical Development Fellow) Dr Timothy Griffiths (FY1) Dr Matilda Hallett (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 I 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 rounds, will help keep things moving along so you have time to complete the jobs |
What are some common presentations they should read about? |
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What are some common tasks they may be asked to do? |
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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 Read up on common vascular presentations and review the peripheral vascular examination |
List of top resources to help prepare |
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References |
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10 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!
Hello, is there any information on Histopathology?
There is some information in the guide but it still needs to be fully completed
Hi, can you add something for cardiothoracic hopefuls?
Of course! I’ve added it & waiting for someone to complete it 🙂
Hello, this post is extremely helpful as a medical student who’s constantly doubting her abilities! Thank you!!
Our pleasure!