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? | Cardiology – ACS, heart failure, AF 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 rounds and executing the planDiscuss with/refer to other specialtiesDischarge lettersAssist with procedures (e.g. LPs, ascitic drains)Initial management of acutely unwell patients in(ABCDE) and getting senior reviewFor 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 |
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? | Types of airway and when to use them (OPA, NPA, supraglottic, ETT) Basics of intubation & managing difficult airwaysCommon 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 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 |
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? | Breast cancer and treatment options (e.g. WLE vs Mastectomy etc) Breast abscess General surgery conditions |
| What are some common tasks they may be asked to do? | Assisting in theatre Discharge letters and TTOs Ward rounds of breast inpatients (See general surgery for on-call jobs) |
| 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 | Teach me surgery Local trust guidelines for breast abscess management |
| References |
Cardiology
| List of Contributors | Dr Samsul Islam (FY2) Dr Tharusha Gunawardena (SPR) |
| What should a doctor expect from this rotation? | The ward typically has a high turnover with lots of referrals & quite unwell patients. Cardiology nurses tend to be very knowledgeable – particularly those in the critical care unit. There tends to be lots of consultant and registrar input because care can be quite complex. There is an excellent opportunity for echocardiography & ECG teaching. |
| 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 the 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 |
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? | Post-operative pyrexia Management of post-operative Atrial Fibrillation Coronary Artery Disease Aortic Stenosis and valve disease Heart Failure Aortic Dissection Pneumothorax/Haemothorax management CXR interpretation Lung Cancer |
| 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: Ward round documentation Pre-operative assessment of patients (usually follow a proforma) Warfarin dosing/bridging with LMWH Discharge letters Clerking trauma patients in from ED Teaching and audit in the department |
| 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. https://teachmesurgery.com/cardiothoracic-surgery/ |
Child & Adolescent Psychiatry
| 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 |
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? | Pain Nausea/ Vomit Constipation/ Diarrhoea Agitation Overdose/ Alcohol intoxication Electrolyte disturbance (replacement oral or IV) Wheeze/ SOBDVT 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 in shifts Electrolyte replacement (Hyperkalaemia**) Alcohol withdrawal therapy Nicotine replacement Fasting glucose protocol |
| 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 | BNFEMC (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 |
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? | 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 eczemaFamiliarise yourself with dermatoscopic views of molesAlso, 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 upload it to the clinical records systemLook and feel the skin lesion, take a good but tailored dermatology history, come up with several differentials, investigations and management plan. You would run this past the consultant or registrar 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 |
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? | F1s may be supernumerary, F2s may go on SHO rota (depending 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 referralsIn 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.Some EDs have a timeframe target of 4 hours from moment of triage, for clerking, investigating and referring/discharging patients. Once a patient passes this timeframe, the patient has “breached”. Aim to see and assess your patients as quickly as possible, but don’t let this compromise patient safety! |
| What are some common presentations they should read about? | CVS: cardiac 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, pyelonephritis/UTI, PV bleeding, urinary retention, testicular pain Neuro: head injury, headache, limb weakness, back pain, low GCS, EtOH withdrawal, seizures Endo: hyper/hypoglycaemia, DKAMSK: fractures (#NOF!), nec fasc, cellulitis Misc: falls, epistaxis, anaphylaxis, eye/facial injuries, mental health presentations, sepsis, drug overdose |
| What are some common tasks they may be asked to do? | Clerk patients, discuss management with seniorsRefer to specialty/discharge with safety netting adviceSign off ECGsBloods, gases, cannulas, catheters, fascia iliaca blocks |
| What are your top tips on how to prepare? | Keep a pen torch, a pen, and tape on your person! Document thoroughly and in detail Remember- you know much more than you realise! If in doubt, discuss with your senior and include this discussion in your documentation |
| 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) MDCalc for calculating clinical scores (eg Wells Score) |
| 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? | Very broad, This ward is often a general medical 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 conditionsDue 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. 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? | 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, micro suction of ears, abscess incision and drainage. 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 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 | ENTSHO. Com – the gold standard |
| 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. |
| 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 Hepatic encephalopathy Considerations of hepatic dosing of drugs |
| What are some common tasks they may be asked to do? | Common ward jobs include requesting bloods and scans, interpreting basic results and forming management plans with the help of seniors. Abdominal exam (incl ascites), PR exams, fluid balance exams Be familiar with the non-invasive liver screen (HiV 1 & 2 antibodies, HBsAg, Hep C IgG, Hep A IgM, immunoglobulins, alpha-1 antitrypsin, alpha-fetoprotein, caeruloplasmin, autoantibody screen & liver ultrasound scan) There may be an 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 incl major haemorrhage protocol in the event of acute upper GI bleeds Zero to finals for general conditions Geeky Medics for ascitic drain guide |
| References | Ascitic Drain (Therapeutic Paracentesis) – OSCE Guide | Geeky Medics |
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. |
| What are some common presentations they should read about? | Cough Sore throat Ear pain Low energy Contraceptive prescribing Joint pain Backache Hypertension PR bleeding Altered bowel habit Headaches Urinary tract infections Shortness of breath Palpitations Mental health – depression, anxiety |
| What are some common tasks they may be asked to do? | Patient consults- may be supervised or unsupervised Telephone consults Medication reviews Mental health reviews Phlebotomy Common examinations you may do- MSK exams, speculum, PR exam, genital exam, otoscopy, mental state exam |
| What are your top tips on how to prepare? | Read about some typical presentations as listed above, practise basic examination skills. Allow patient time to speak at the start of the consult- golden minute Be open-minded and inquisitive, chance of unusual presentations to be seen Know RED FLAG signs – know when to refer and who to refer to Escalate early for help when you are unsure- supervisors will be happy to help and you can learn from asking when unsure Utilise safety netting when needed |
| List of top resources to help prepare | GP notebook- free to sign up and very useful |
| 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. |
| 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 Post-operative complications (e.g. VTE, ACS, haemorrhage) Hernias (the different types of hernia and how they are managed e.g. if obstructive/ non-obstructive) |
| 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 have been NBM for some time Prescribe admission medications for patients undergoing surgery- regular medications + analgesia, PRN antiemetic, DVT prophylaxisY ou may be asked to be the assistant surgeon for simple procedures (abscess incision and drainage, or appendectomy) |
| 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 is a quick reference |
| References |
Geriatrics / Care of The Elderly
| 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? | 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: Daily consultant ward rounds Consultant ward rounds twice a week with registrar-led ward rounds remainder of the days 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 with seniors afterwards. This may seem daunting initially but is 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. You may be expected to lead MDT discussions for patients you’ve seen during board rounds. 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 Urinary tract infections Sepsis ?source Constipation Confusion screen Delirium – identification, causes (PINCHME is a useful mnemonic!) and managementBe aware of clinical frailty scoring (Rockwood) Osteoporosis – FRAX score, NOGG guidance |
| What are some common tasks they may be asked to do? | Day-to-day jobs will include ward rounds, board rounds, reviewing bloods, workup for falls/confusion, managing common medical conditions such as CAP/HAP, UTI, sepsis ?source etc. Conducting Mini-mental state examination (MMSE) for confused patients Falls workup/falls assessments Skills such as venepuncture, cannulas, catheterisation, ABGs Exams such as fluid status, PR, death verification and comfort reviews 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. Other common discussion topics may include explaining end-of-life care, DNACPR, and taking collateral histories on the patient’s home life (ADLs, mobility, existing package of care, etc) Liaising with OT/PT/social services to facilitate safe discharge Discharge letters (important to highlight any medications started/stopped) Prescribing anticipatory medications for patients approaching end-of-life Death verification |
| 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 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 them 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 are 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 including how to request bloods/scans, how to write discharge summaries 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! Many patients have long complex histories with multiple comorbidities, so it’s easy to get overwhelmed with all the information! Just remember that you mainly need to focus on addressing and treating their presenting problems while optimising their care so they can go home safely Delirium is extremely common, and you will likely face situations with disoriented patients who can become aggressive. Stay calm and know that most of the time, they’re not intentionally trying to make the job difficult! Some patients you will meet may be very frail, and you will inevitably be exposed to patients approaching end of life. It is important to understand that deterioration and death cannot be prevented in some of these patients – recognising this fact and prioritising comfort care will be in their best interests. This is not always easy to accept, but know that this is no fault of the medical team, and is part and parcel of working in care of the elderly. |
| List of top resources to help prepare | MDCalc app for scoring calculations Zero to finals for common medical conditions overviews Mind the Bleep also has a lot of resources Useful apps: BMJ Best Practice, SmartDr, PocketDr, Microguide, BNF, Foundation Doctor Handbook |
| References |
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. |
| 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 before cyclophosphamide; Allopurinol for those at 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) Prescribing for blood transfusions Reviewing patients on day chemotherapy units |
| 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.Read up about sickle cell anaemia/crisis, neutropenic sepsis, tumour lysis syndrome |
| List of top resources to help prepare | Haembase – everyone I knew in our haematology unit used it (from juniors to regs) BukumedicineChemocare – consultants will prescribe the chemo on this and direct you as to who needs what pre-chemo medication (Allopurinol/mesna etc) |
| 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? | Alcohol withdrawal protocols, CIWA scoring Hepatotoxic drugs and those that should be reviewed in acute liver failure Decompensated liver disease Common types/causes of liver disease: alcoholic liver disease, NAFLD, viral hepatitis, autoimmune Management of upper GI bleed Recognising and managing spontaneous bacterial peritonitis (SBP) Alcoholic pancreatitis |
| What are some common tasks they may be asked to do? | Request a full liver screen (read up on what that entails) Requesting imaging e.g. ultrasound abdomen/liver, MRCP Requesting endoscopy e.g upper GI bleeds or ERCP for obstructive jaundice causes Opportunity to learn procedures such as ascitic taps and drains Prescribe alcohol withdrawal management (usually different protocols for each Trust) Common ward jobs such as preparing notes for ward round, liaising with other specialities (e.g. haematology, surgery, nutrition are common in hepatology) |
| 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 | MDCALC BNF app for reviewing hepatically cleared/hepatotoxic medications Induction app for phone numbers for different specialities The Gastroenterology section on Mind the Bleep has articles on ascitic taps and drains, upper GI bleed and jaundice and deranged LFTs and alcohol withdrawal. |
| 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. |
| What are some common presentations they should read about? | most likely to get simple cases- basic skin biopsy or specimens, gastric biopsy, duodenal biopsy, colon polyps, gallbladders Helpful to know the basic histology of skin, oesophagus, stomach, and intestines |
| What are some common tasks they may be asked to do? | You may be asked to prepare specimens and black samples To analyse slides under a microscope and formulate a diagnosis and write a report This will then be reviewed by a senior staff member |
| What are your top tips on how to prepare? | Helpful to review basic histology Looking through textbooks helps you get used to what is normal |
| List of top resources to help prepare | |
| References |
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. Biliary obstruction e.g. gallstones/cholangiocarcinoma/pancreatic cancer Cholecystitis, cholangitis Pancreatitis +/- necrotising (gallstones, ETOH and post-ercp are the 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, BILE 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) Assess patients in the surgical assessment unit 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 have been NBM for a period of time (REFEEDING SYNDROME*) 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 yourself with the above common presentations Familiarise yourself 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 sign Important investigations/ management- understand your LFTs, USS, MRCP, ERCP Surgeries to read about: cholecystectomy (look up hot vs interval); Whipple’s vs PPPD; appendectomies, 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 |
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 Pneumonia Infective endocarditis Meningitis/Encephalitis UTI/Pyelonephritis Cellulitis/ Septic Arthritis HIV, TB, Malaria Discitis (spondylodiscitis) |
| 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 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 | As stated above Microguide is great |
| 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 |
| 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 for a few days to get a feel for seeing and managing referrals Attend crash calls – this will help prepare on how a cardiac arrest calls goes/when to put out 2222 calls |
| 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 |
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. |
| What are some common presentations they should read about? | Clostridium Difficile Infective Endocarditis Necrotising Fasciitis Staphylococcus Aureus Urinary Tract Infection (E.Coli) Streptococcus Pneumonia. Biliary infections |
| What are some common tasks they may be asked to do? | Review and interpret blood cultures on computer software, correlating these results with the patient’s presentation and current treatment from the online notes. You would discuss with a Microbiology Consultant or Registrar if the management plan needs modification based on the results. Contact the parent team regarding the blood culture results and negotiate a targeted management plan for the patient. Attending Microbiology Ward Rounds where Microbiology Consultants or Registrars discuss with Anaesthetists in Critical Care. You will need to scribe all of the discussions. In the afternoon, the Microbiologists will meet to discuss the cases from the Ward Rounds, what treatments have been proposed and if the management plan needs further modification. Interpreting Clostridium Difficile results and checking these with the Senior doctors. There is also the opportunity to take calls made by other clinicians who wish to get the Microbiologist’s opinion regarding care of a sick patient. This is usually done by Microbiology Registrars but FY2 doctors can also answer some of these calls with supervision from the Consultants. |
| What are your top tips on how to prepare? | Try to read up about the common antibiotics (mechanism of action and side effects) before starting the Rotation. Read up on the classification of bacteria (e.g. Gram stain etc.) Be aware of common infections that can lead to sepsis. Read up on your local trust antibiotic guidelines. |
| List of top resources to help prepare | BNF MicroGuide Oxford Handbook of Infectious Diseases and Microbiology |
| References |
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. |
| What are some common presentations they should read about? | Stroke Intracerebral haemorrhage Seizures Headache Meningitis and encephalitis Dizziness Loss of consciousness/ Reduced GCS Limb weakness Behavioural disturbance Myasthenia Gravis Guillain Barre syndrome MND |
| What are some common tasks they may be asked to do? | Lumbar Punctures Review blood pressure in acute cerebrovascular events NG tube assessment CT head scan interpretation Family discussions around treatment escalation plans and resuscitation |
| 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 | Mind The Bleep Neurology series ABN Acute Neurology Bootcamp is a more advanced resource: https://www.theabn.org/general/custom.asp?page=ANBootcamp2022 Book of Neurological Signs by Matthew Jones (Freely available via Apple Books) |
| 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? | 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. You 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 |
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: Wards Obstetric ward, labour ward Gynaecology ward Maternity assessment unit (MAU), Gynaecology assessment unit (GAU) Good place to brush up on speculum and bimanual exam skills Lots of opportunities to learn from seniors, midwives, specialist nurses Pre-assessment clinic Theatres Good opportunity to practise urinary catheterisation, speculum/bimanual exams, suturing skills Gynaecology outpatients clinic (GOPD) Just like GAU, but non-acute Antenatal clinics |
| What are some common presentations they should read about? | Obstetrics Abdominal pain PV bleeding Reduced foetal movement Premature rupture of membranes Postnatal assessment Gynaecology Miscarriage Acute abdominal pain Postmenopausal bleeding Heavy menstrual bleeding Postnatal contraception advice |
| What are some common tasks they may be asked to do? | Clerk antenatal, postnatal and gynaecology cases Present these cases to seniors Speculum and bimanual 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 some medications are contraindicated during pregnancy and breastfeedingYou 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 Teachmeobgyn.com is a good resource for most things 10 B’s of postpartum assessment mnemonic |
| References |
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. |
| What are some common presentations they should read about? | Dental abscesses Facial and mandible fractures Head and neck cancers Wound management Dental trauma Skin cancer |
| What are some common tasks they may be asked to do? | Ward work Clinics managing GP/dentist referrals and trauma follow-ups from ED while being well supported by registrars and consultants Assisting in elective and emergency theatre On-call work |
| What are your top tips on how to prepare? | As DCTs typically have more dental experience than medical, your knowledge will be important for the medical management of ward patients. E.g. confidence with interpreting bloods and ECGs will make you very popular! Familiarise yourself with history-taking for trauma cases: ascertaining details about the nature of the injury is very useful for OMFS trauma (e.g. mandible fracture; orbital floor fracture etc). Revise some basic head and neck anatomy. Attending neck dissections in theatre is a great way to anchor this learning (and have the surgeons grill you on anatomy!), and knowledge of surface anatomy and nervous innervation is useful for understanding the extent of OMFS problems (e.g. how might the eye become compromised in an orbital floor fracture?). Learn some basic dental anatomy (see the resources below) Remember that everyone will know that you are only medically qualified, so you will be extremely well supported and only given work that you feel comfortable with. |
| List of top resources to help prepare | OMFS SHO: like ENT SHO, an amazing place to start for becoming familiar with common presentations & management, ward responsibilities, and niche examinations (e.g. check out ‘MANAGEMENT OF THE FLAP PATIENT’ and ‘EXAMINATION OF FACIAL TRAUMA’). Basic Dental Terminology – UPDATED (YouTube): the ‘Tooth Numbering’ part is useful for learning how to identify teeth – essential for documentation and SBARing to colleagues (e.g. XGA UR6 = extraction under general anaesthesia upper right 6) British Association of Oral and Maxillofacial Surgeons (BAOMS) Illustrated Guide: a useful PDF to have on your phone for when you want to learn more about anatomy and presentations. On-Call in Oral and Maxillofacial Surgery 2nd Edition: AKA the bible for DCTs – there will hopefully be a copy or two in your doctor’s office. A great reference for the typical jobs that on-call DCTs get called to – try to shadow them and help them if you get time (e.g. this is where you can get practice suturing lacerations and administering local anaesthetic)! It’s also a great quick reference for surface anatomy and the ‘An Introduction to Teeth’ chapter. |
| 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: British Association of Oral & Maxillofacial Surgeons European Association for Cranio Maxillo Facial Surgery International Association of Oral and Maxillofacial Surgeons 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. |
| What are some common presentations they should read about? | Conjunctiva: haemorrhage Chemical eye injury Cornea: abrasions, foreign body, ulcers Glaucoma: open-angle and acute-angle closure Infections/Inflammation: scleritis, conjunctivitis, keratitis, anterior uveitis, endophthalmitis, orbital cellulitis Cataracts: types Vitreo-retinal: haemorrhages, tears, detachment, CRVO/AO |
| What are some common tasks they may be asked to do? | Pre-operative assessment for patients undergoing surgery under general anaesthesia. This involves taking a detailed history and general examination (cardiovascular, respiratory and eye examination using a slit lamp). Reviewing blood tests (FBC, UEs etc) and ECGs and liaising with anaesthetists, specialist teams (e.g. rheumatology, endocrinology, cardiology) or GP when needed. Ward round for pre- or post-op patients – usually procedures are day cases however medically complex patients or ward referrals may need to be examined by seniors. May be responsible for ordering or chasing scans, reviewing bloods or documentation. Emergency eye casualty clinic – clerking presenting eye complaints, eye examination and reviewing OCT scans (under supervision). |
| 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 | NICE guidelines Trust guidelines (peri-operative advice) DVLA (driving advice) Oxford Handbook of Ophthalmology Youtube (‘Learn about eyes’) Tim Root (free ophthalmology textbook) RCOphth Curriculum for Undergraduates and Foundation Doctors |
| References | Health Education EnglandRCOphth website |
Oncology
| List of Contributors | Dr Wern Wei Chin (Vivian) (FY2) Dr Anna Evetovits (IMT1) |
| What should a doctor expect from this rotation? | Supportive team and wide range of oncology sub-specialtie (tumour sites). Work along with MDT and specialist team |
| What are some common presentations they should read about? | Neutropenic sepsis/febrile neutropenia (and SACT related pancytopenia/thrombocytopenia) Electrolyte disturbance – Hypercalcaemia, hyponatraemia, hypomagnesaemia Chemotherapy extravasation Treatment-related (diarrhoea/ nausea/ vomiting) SACT-related (hypersensitivity/ skin toxicity) Radiation skin reaction Steroid-induced hyperglycaemia Immunotherapy side effects (pneumonitis, colitis, hepatitis) Metastatic spinal cord compression Malignant effusions (pericardial/ pleural/ascites) Bowel obstruction |
| What are some common tasks they may be asked to do? | Clinical skills (cannulation, venepuncture, ECG, blood gas, catheterisation, blood culture etc) Ward tasks (daily reviews, discharge letters, ward rounds) Elective clerk-in (chemotherapy/ radiotherapy) Review deteriorating/ unwell patients (see above common presentations) |
| What are your top tips on how to prepare? | Review patients and discuss with seniors on management plan Discuss with pharmacists on chemotherapy regimen Attend departmental teaching Reflect on cases, read up on cases reviewed, ask for a senior to debrief with you in eg a difficult death Always ask for help/ advice when needed (Oncology specialist nurses/ pharmacists/ diabetic specialist nurses/ MDT/ senior colleagues) Learn the difference between Clinical Oncologists and Medical Oncologists: Clin Onc plan and give Radiotherapy as well, Med Onc only give SACT/targeted therapies but no radiation. |
| List of top resources to help prepare | Microguide St Luke’s SACT Protocols and Policies Scottish Referral Guidelines for Suspected Cancer Common acute oncological emergencies: diagnosis, investigation and management (article) Oxford Handbook (Oncology) Ward induction, departmental teaching |
| References | https://www.royalsurrey.nhs.uk/chemotherapy-policies-and-protocols/ |
Paediatrics
| List of Contributors | Dr Martin Whyte ST5 Paediatrics Dr Timothy Griffiths FY1 Dr Jay Talbott FY1 Dr Vanessa Chan 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, eg. venepuncture, finger/heel pricks, cannulation, even lumbar punctures Learning how to communicate/interact/distract children of different ages If your job is linked with paediatric surgery, utilise time to go to theatres if you want to You are sometimes given opportunities to attend consultant-led clinics You are sometimes asked to run an observation clinic where you review patients who have been recently discharged, babies with prolonged jaundice and do GP/clinic bloods. |
| What are some common presentations they should read about? | Breathless child/infant Febrile child/infant Vomiting newborn Gastroenteritis Constipation 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 Keeping on top of the ward list and patients. Paeds often has quite a 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, the perfect place to get some mini-cex/CBDs complete |
| What are your top tips on how to prepare? | Go over paediatric history taking and common paediatric conditions Observe venepuncture, finger/heel pricks and cannulation before practising as it is quite different to bleeding adults 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) Zero to finals paediatrics Teachmepaediatrics Growth Charts app |
| References |
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 |
| What are some common presentations they should read about? | Supporting patients with 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 |
Peri-operative care for older people undergoing surgery (POPS)
| List of Contributors | Nikita Patil (FY1) |
|---|---|
| What should a doctor expect from this rotation? | POPS are a small team that care for patients admitted under the surgical teams with complex medical problems or frailty. It is senior-lead, usually by medical geriatric consultants and a small team. Highly supervised. Day-to-day job includes: Carrying out Comprehensive Geriatric Assessments (CGA) – roughly each CGA takes >2 hours and is a detailed, holistic assessment of the patient, similar to clerking. Prepping patient reviews. Attending MDT meetings. POPS also run clinics optimising care pre-op or post-op. Seniors are mostly involved in these. Seniors will help you to provide recommendations for the surgeons/nurses/ other MDT members on how to manage each of your patient’s problems. This job could include medical or surgical on-calls. |
| What are some common presentations they should read about? | Falls Head injuries Common surgical problems (inc. fitness for surgery) Palliative care and end of life care principles 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 Urinary tract infections Sepsis ?source Constipation Confusion screen Delirium – identification, causes (PINCHME is a useful mnemonic!) and management Be aware of clinical frailty scoring (Rockwood) Osteoporosis – FRAX score, NOGG guidance |
| What are some common tasks they may be asked to do? | Comprehensive geriatric assessment Preparing patient reviews Venopuncture + cannulation ECGs Bladder scans Handovers and delegation of tasks to other teams Liaising with members of the MDT |
| What are your top tips on how to prepare? | Read through what a CGA entails. Look at the common presentations and how you would manage each one. Go through ECG interpretation |
| List of top resources to help prepare | |
| References |
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: 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 |
Public Health
| 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 |
Psychiatry
| List of Contributors | Dr A James (teaching fellow) Dr I Platt (FY1) Dr H Trippe (FY1) |
|---|---|
| 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”. Bipolar disorder, mania, depression. Be familiar with the bio-psycho-social approach and medication used to treat different psychiatric conditions 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 Doing ECGs 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, mocha) Outpatient clinics – Some psychiatry hospitals have outpatient clinics onsite so you may be allocated a clinic – take the time to read patient notes and previous clinic letters before seeing the patient. It is really useful to shadow a clinic first for experience and always check the patient’s alert before seeing them as many patients have a ‘no lone workers’ marker so it’s worth having someone else sit in for safety. Early Access Services clinic – this is a service where patients are booked in for an hour appointment to enable a thorough psychiatry history. Patients will have been referred by either their GP, or primary counselling service to get some advice from a psychiatry-specific team. They can be very intense as often it’s the first time people have been seen by psychiatry, so shadow a consultant first. It differs by teams whether as an F1 you will be expected to do it but it’s worth being aware of. |
| What are your top tips on how to prepare? | Revise not only how to read an ECG but also 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, particularly 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. If you have any areas that you think you may find difficult for any reason (e.g. conversation around abuse, self-harm, specific conditions) it is worth mentioning this to someone on your team who you get on with. It can be difficult, and it’s important you are able to separate work and personal but psychiatry can be very challenging with this – don’t be afraid to get advice and talk to people about this, as a lot of people probably have similar experiences, even if about different topics. |
| 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. 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 has 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 |
Renal
| List of Contributors | Sanjana Mathew and Jonathan YeatsDr Maarij Mirza (FY1) |
|---|---|
| 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? | Basic understanding of AKIs is your bread and butter Basics of pre/renal/post and basic understanding of what to do and how to escalate for each is key. Deeper understanding of the renal pathologies (TIN, ATN, AIN, nephropathies/nephritides etc) is great and will help you get the most out of your rotation, though isn’t necessarily essential. Hyperkalaemia is very common, knowing how and when to initiate emergency management is essential but likewise knowing when hyperkalaemia is “safe” to not treat aggressively is important. Other Electrolyte abnormalities Hyponatraemia is confusing at the best of times, but a working understanding of hyponatraemia can be a great help, or at least a good flowchart/trust guidance Hypercalcaemia and hyperphosphataemia are common and confusing but often senior-led Pulmonary oedema Don’t forget furosemide is your friend but won’t help someone who is anuric Basic understanding of Peritoneal Dialysis (PD) and PD peritonitis in particular Basic understanding of Haemodialysis (HD) and the complications surrounding it Basic management of bleeds Bleeding line sites/fistulas are not uncommon, but renal patients are particularly prone and vulnerable to bleeds If you don’t have a dedicated transplant service, you may get asked to deal with fistula issues of which bleeds are certainly the most dramatic and serious Line clots are not uncommon either, chronic renal disease (especially if nephrotic) is a prothrombotic state CKD – MBD (Mineral Bone Disease) This would involve understanding how dysregulated calcium and phosphate homeostasis can lead to renal osteodystrophy. Autoimmune and vasculitic disorders 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? | Mostly normal ward tasks- taking notes on ward rounds, ordering tests and investigations, initiating treatment plans, making referrals to other specialties and specific MDTs etc. If you are taking renal on-calls, you may be asked for advice on renal issues by other hospital doctors. Check with your seniors what your responsibilities are in this regard. As mentioned above, hyperkalaemia is going to be one of your most common emergencies to deal with. In some cases nurses may not be comfortable with bolus IV medication so you may be asked to physically draw and give the emergency doses of calcium, if you are not already, it may be worth familiarising yourself with preparing and administering especially IV calcium to give in an emergency. Remember to warn the patient of side effects, most patients seem to feel strange and generally dislike the sensation, give it slowly and be alert to any symptoms of arrhythmia/adverse reaction Clerking of patients. Out of hours, you may be doing this unsupervised, especially at F2 level. You should always do full body and multiple systems examinations when clerking in renal patients (at a minimum cardio, respiratory and abdo examinations on all new admissions). Also common to do VBG & bloods immediately to know if a patient needs dialysis for example. You may be expected to act on out-of-hours alarming blood results in the community (e.g. hyperkalaemia picked up on GP blood tests). This usually involves calling the patient to get them to come to ED to repeat the test +/- ECG and VBG. Ask your seniors for the first few. You may be able/asked to assist with procedures, lines and biopsies predominantly, this might be a good opportunity to increase your practical skills if interested. Aside from common procedures taught at medical school, as a general medical ward you can expect to find opportunities to be involved with ultrasound cannulations, drawing blood from lines, lumbar punctures too. You may be asked to “clear” a scan with IV contrast if eGFR is low. Contrast nephropathy is a controversial subject and a matter on which many nephrologists are passionate. It may be worth discussing with seniors about this early. In most cases, it is for the clinical team to decide if the risks of a scan are outweighed by its potential benefits. |
| What are your top tips on how to prepare? | Fluid balances and daily weights are your friend Daily bloods are common practice in AKI but otherwise probably aren’t necessary without other good reason In severe AKI urine volume is more sensitive and responds earlier than blood tests in both recovery and deterioration which is why UO is so important Results trending is useful: a creatinine of 300 means different things if it’s the first one or the patient is on dialysis or if the last was 400 in AKI CKD patients will often know when something is wrong with them (and will know their last 20 eGFRs) Not everything suspended in AKI is nephrotoxic, don’t forget the importance of drug buildup if the kidneys can’t excrete (opioids will build up fast and penicillin neurotoxicity can occur) Interestingly trimethoprim (and thus co-trimoxazole) isn’t nephrotoxic but can falsely flag an AKI by pushing up creatinine readings artificially! On the topic of prescribing, it is a good idea to remember renal doses for common antibiotics and enoxaparin for VTE assessments as these are common tasks expected by juniors – if in doubt, can consult pharmacists /BNF/ renaldrugdatabase/ seniors. Don’t be heavy-handed with your fluids! 250ml boluses are best – a little and often if required IV fluids are a drug, respect them like one (almost) All renal patients are multimorbid. Care is complex and delicate, and often a balance of risks and benefits. Big decisions should be made by seniors AKIs are serious, kidneys are the barometer of the body. If you are so unwell that your kidneys can’t cope, you are unwell. It is too easy to forget just how strong an indicator AKIs can be for poor outcomes Renal (at least where we work) is a specialty that encourages you to question things you don’t understand or challenge what you don’t agree with; if in doubt speak up. |
| List of top resources to help prepare | Renaldrugdatabase.com (like the BNF but will tell you what is safe at each level of kidney disease and dialysis) – ask for your hospital’s login info Renal Drug Handbook LITFL (particularly helpful for assessing emergencies) Geeky medics (particularly helpful for managing emergencies) The Renal System at a Glance, Chris O’Callaghan BMJ Best practice/up to date There are some good podcasts out there: Core IM (an American gen med podcast, so not everything is transferable but there are some good episodes on renal medicine esp hypoNa) Local trust guidance etc |
| 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? | 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 |
Rheumatology
| List of Contributors | Dr Emily Ching (FY1) |
| What should a doctor expect from this rotation? | An F1 job in rheumatology is likely to involve a lot of general medical patients in non-tertiary centres. You will get to see a wide variety of interesting presentations and conditions whilst looking after general medicine patients. This is a great opportunity to learn and revise your medical knowledge and get to grips with the management of common conditions. Rheumatology patients on the ward are likely those admitted with acute joint swelling/pain. As a medical specialty, your job may include doing acute medical take shifts (clerking patients on the medical team who have been referred from A&E), post-take shifts (seeing new medical patients with the consultant after they have been clerked) and on-call ward covers. Learning opportunities include attending rheumatology clinics, musculoskeletal radiology MDTs, bone MDTs (joint with orthopaedics), and rheumatology departmental teaching sessions. |
| 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 of 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 acutely swollen joints |
| 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? | 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 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? | 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 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 | NICE Guidelines Rouhen’s Anatomical Atlas Orthobullets McCrae’s Orthopaedic Trauma |
| 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? | Urology common conditions – common cancers (bladder, prostate etc.), BPH, urinary retention, Urinary tract stones, Haematuria, UTI, Testicular torsion, epididymo-orchitis, Urinary retention Basic knowledge of urology procedures – helps with post-op care and EDNs Nephrostomies, ureteric stents, cystoscopies Urinary catheter complications General medicine knowledge does help as patients may have multiple comorbidities |
| What are some common tasks they may be asked to do? | Post-operative ward care Preparing and updating the list Investigations: bloods, blood cultures EDNs, TTOs Urinary catheter insertion/care, Three-way catheters and irrigation, bladder washouts Suprapubic catheter change/reinsertion shortly after accidental removal (as tract closes up) |
| What are your top tips on how to prepare? | Be organised with jobs Getting good with urinary catheters helps – post-op patients require TWOC so if they fail, they need another catheter. |
| List of top resources to help prepare | NICE guidelines Teach me surgery – Urology |
| 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 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? | AKI Hypoglycaemia DKA Post-op pain Opiate toxicity Diabetic foot sepsis rAAA HAP Acute limb ischaemia Chronic limb ischaemia Carotid artery disease Lower Limb Ulcers |
| What are some common tasks they may be asked to do? | Standard ward tasks Pain review Is Diabetic control Cannulas/bloods Bleeding/wound reviews Referrals to other specialities including care of the elderly, psychiatry and diabetes Discharge summaries for patients including those who have had elective day surgeries Update the list, print off referrals |
| 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 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 | Teach Me Surgery Foundation App NICE guidelines Geeky Medics MicroGuide |
| References |
16 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 🙂
Any information provided for Public Health Rotations?
I’m so sorry for the very late reply. Generally, these rotations are supernumerary, office-based, and heavily focused on epidemiology, audits, policy making, and attending stakeholder meetings. It’s a great rotation for getting your portfolio sorted. Assuming you’ve done the job – please do update the guide!
Hello, this post is extremely helpful as a medical student who’s constantly doubting her abilities! Thank you!!
Our pleasure!
Book doctors would find interesting is Trust me I’m exhausted by Dr Harry Stone
Published on Amazon. Looks at NHS patient and doctor experience now and in the 1980s.
Tim Newson retired Paediatrician
That’s a fantastic book recommendation, Tim! Thank you for taking the time to share this!
Hi, I’d love to add to the blank CAMHS section, how do I help? Thanks!
Of course – it’s a freely editable document so go ahead!