This post is in reference to Emergency surgery rotations as an SHO. A lot of people want to know what the working hours are like and what the job description is.
Emergency surgery is one of th best things that has happened to me so far.It is a very dynamic field that soon becomes monotonous depending on the lack of variety of cases.
As an SHO, i work with core trainees year 1 and 2 some of whom are purely on emergency surgery, some on UGI and some on colorectal firms. Each one of them, when on call is essentially an EMS SHO. Outside call hours, they work with whatever firm they are with. Outside calls, you have normal ward work, lots of food and tea and waaayyy faster ward rounds…less number of ward jobs as they are taken care of by the FY1s
On call rota:
1 week of day calls actually comprises of 4 days in a week with 12hrs call with subsequent 3 days off.
It’s a 1:8 rota which means that in 8 weeks I get 1 week of days on call and 1 week of nights on call. 1weekend day on call and 1 weekend on night.
On call is paid at 1A banding i.e 50 percent.
Annual leaves and days off.
I get 27 days off annually.
Three days off after an on call week.
One day off before starting weekend days or nights.
One day off after weekend days or nights
One week off after every seven weeks so that’s a total of approximately 21 days. This week is sandwiched between two weeks in which you’re on call.
Outside call weeks i work 8:00 to 17:00 with the respective firms. This includes ward round and in- patient management. Year 2 onwards you can do clinics with registrars and consultants.
Allocations:
Once a week in CEPOD (emergency theatre)every week or once every two weeks if you have more than 7 SHOs which basically means you assist, sometimes do emergency procedures.
Once to twice a week on elective lists. With the covid, these lists are independent of the firm’s you’re originally allocated to.
What happens when you’re on call:
I work in a DGH and we are very busy but it keeps fluctuating. There are days when after breakfast, you next eat at about 5pm. On others you might be free till 1pm with a rapid influx of patients after that.
But it’s a very dynamic and interesting, enjoyable experience.
You get to do local abscess and drainage and wound wash outs while you’re on call.
There are three things that will trouble you when you’re on call.
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The pressure of not letting patients breech in the emergency as in the UK it is a law for the patient to be either admitted or discharged within 4 hours of arrival. Whereas, that works well with medicine as they have a team of SHOs and FY1s clerking the patients in emergency. It doesn’t work as well with surgery. Most patients will need some imaging done before they can be admitted. And the A and E will refer the patient to you when they are only and hour away from breeching. On the other hand you will have a surgery consultant who wouldn’t want you to admit a lot of patients. During the day, there’s enough senior cover for you to be safe around admissions. In most DGHs however, you will be entirely on your own at night and you may have to make admission and discharge decisions yourself.
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Having to deal with all sorts of surgical emergencies except gynae/obs and ortho if your hospital is not a Tertiary care hospital. It is very very good for learning…really good actually. But it’s also unsafe and stressful. Also a general surgery SHO has to deal with urology patients at night too. In many trusts, urology registrars do not do night calls so it’s you and the urology consultant.
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In London, the FY1s don’t do night calls. I don’t know about other parts of England. So you will not only be tending to patients in the A and E but also with ward nurses who would just bleep you to get some fluids prescribed for someone who can eat and drink as well. Ahahahhaha. So by chance, the A and E goes silent, the ward will bleep you for paracetamol prescriptions and fluids.
What you will enjoy
Honestly the thrill and drill.
And not to mention the very very funny referrals from A and E and GP according to whom, any right iliac fossa pain is appendix unless confirmed by a surgeon or who would think any lump on the belly is a hernia and if painful, obstructed.
Depending on how your SpRs are, you might get some hands on experience. But obviously not too much.
What will stress you out
As surgeons you are generally expected to know medicine and surgery. You can not survive without knowing simple basic medicine.As immigrants this becomes difficult because like any other international graduate, you will have to learn the system, familiarise yourself with your trust, the referral pathways AND know how to operate, do simple procedures yourself. The most difficult thing to learn is to say NO to referrals. If you’ve come out of housejob, you will be the youngest academically but will be expected to perform at a level of a traineen someone who’s third year into his training including housejob.
You will be very very badnaam amongst the A and E staff because you won’t treat constipation as obstruction. All in all it is funny but sometimes really really frustrating and adds to your work load during on call.
I am happy to help however i can.
Having said that, anyone working in emergency medicine or surgery must have indemnity insurance.