I have been working as a trainee registrar since August, 2019 in acute internal medicine.
I have shared my experience of my first week here:
I am going to share my experience on a regular basis here.
TEACHING:
Registrars are expected to book their teaching sessions themselves. NO ONE will inform them. In core medical training, I used to get an email from the deanery administrator mentioning the mandatory deanery based teaching sessions with dates.
Now, I have to do it.
For York and Humber, there are 2 sets of sessions:
AIM training days which are mentioned here:
https://heeyh-deanery-live.azurewebsites.net/node/306 GIM mandatory training days here:
https://www.rcplondon.ac.uk/events/career-stage/spr/career-stage/specialty-trainee/region/yorkshire-0
GIM is general internal medicine. These training days are for the medical registrar on call
I attended my first teaching session in Leeds. It was attended by around 100 registrars ( unlike CMT teaching sessions which were attended by around 7 to 10 trainees). The session was led by consultants who did not do “death by powerpoint presentations” but discussed relevant, medicolegal and ethical scenarios relevant to our clinical practice.
Topics like cannabis in the NHS, latest management of stroke with very interesting cases ( young people presenting with strokes), care of elderly management ( with clinically relevant scenarios) and hematology cases relevant to the medical registrar on call.
I also got to meet the registrars I worked with as a core medical trainee ( that is the beauty of doing specialty training in the same deanery you worked in as a trainee SHO) and got to meet other registrars, heard their issues, the good things in their trusts and also got tips from registrars working in trusts I am due to rotate into.
Overall, it was a very good experience. It was well organized, the catering was top notch and the teaching session was very good.
I also attend trust based teaching sessions. Scarborough hospital has 3 teaching sessions:
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Acute internal medical teaching in the AMU doctors office in which consultants, registrars, SHOs present cases ( thus get their teaching curriculum points ticked) and there is lunch provided by a pharma representative who also does a small talk on the latest medications they have on the market ( it is not just a random talk, they have very good knowledge and prove everything by showing guidelines and research).
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Teaching session by one of the endocrinology consultants on catastrophic events and clinical governance in medicine. These are misses and near misses which us, as junior doctors do not hear very often unless we are personally involved or make an effort to attend local governance teaching sessions. Again, lunch is provided by a pharma representative.
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Grand round - which is trust based and is attended by all specialties. These are interesting cases seen in other specialties are are clinically relevant for everyone. Lunch is provided by a pharma representative.
As you can see, if I am available, I can attend 3 excellent teaching sessions a week and get free lunch ( free lunch is very important for a doctor no matter what level they are. And I take my free lunches very seriously).
ON CALLS:
I am getting more confident now. I had to lead a CRASH call for a young patient, multiple co morbidities, had a transfer patients from the medical ward and ED resus to ITU and had to palliate patients. I was never alone in these decisions and was always supported by the critical care outreach nurse, ITU reg and consultant, medical consultant on call ( I have now called the consultant thrice on my night shifts - in my first one month) when we were a bit confused on what had been going on.
Some cases were straightforward - like a 90 year old with end stage lung cancer, some were more difficult but in all cases, I was not overwhelmed.
I have shared my experience of my nights here:
https://omarsguidelines.blogspot.com/2019/09/how-to-work-on-nights-medicine.html
MY SPECIALTY:
This is acute internal medicine which is AMU based. I would see a variety of unwell patients related to medicine as a consultant. Hence, this is what I try to do. Currently I am based in respiratory for 6 months but I do not mind seeing specialty’s patients on the ward ( my ward has respiratory patients as well as diabetes and endocrinology patients ) hence the other teams feel supported as well. This also broadens my experience as a AIM registrar as I get used to seeing unwell patients I do not know about at all.
UNWELL PATIENTS:
They have 5 options
- ITU for intotropes, for CPR, inutbation, high flow oxygen , NIV/CPAP
- ITU for intotropes ONLY
- Ward based with NIV/CPAP as ceiling
- Ward based - not for NIV/CPAP , for active ward care. To palliate if deterioates
- Ward based - for palliation.
With time and experience , I have learnt to assess patients and make a decision. When I was a SHO, I hated registrars/consultants who did not make a decision. If I cannot make a decision, I ask someone who can ( be it the ITU team, medical consultant on call).
And of course, which is the most important, I involve the patients and relatives ( if the patient lacks capacity or has agreed for me to contact the family) when it comes to making the final decision - be it at noon or 3 AM.
The family is ALWAYS grateful for me to inform them, even if it is late at night. It is a beautiful thing to spend the last few minutes/hours of ones life with ones loved ones ( I lost both my grandparents in my home country and they passed away comfortably at home holding their childrens’ hands. Everyone was aware of what was going on and it made the journey emotionally and physically bearable for everyone - Even I , who was in the UK at that time was able to say goodbye via Skype. I was very close to them and it helped me overcome my grief). Hence, this is very important to me.
MEDICOLEGAL ISSUES :
I have not personally faced one. However I am aware that I may be involved. When I will be involved, I hope it is not too serious.
To avoid this, I document everything. My typical documentation for an unwell patient is around 3 to 4 pages. My whole SBAR, ABCDE, active issues and why I have chosen one of the 5 options for escalation, discussion with the patients/family , any discussions with critical care, medical consultant on call.
I document enough that in case someone ( like a coroner, medicolegal team) needs to review a patients notes, they have a clear idea of what happened and the reason behind my thinking process which lead me making a certain decision.
ENJOYING MY JOB :
I have seen a few miserable junior doctors, registrars and even consultants. They call in sick on a regular basis and some of them are really struggling with stress. I have decided that when this day comes in my case, I am going to resign and do something I enjoy.
Remember - we are just a cell in a column on Microsoft Excel. If something happens to us, we will be replaced by another name in that column.
Currently, I am thoroughly enjoying my job. I am involved in management, training of junior doctors ( I am trying to secure a position as associate college tutor for IMT trainees to help them achieve their needs), I guide foundation trainees and SHOs, I actively try to help the trust by ensuring discharges are done on time, unwell patients are managed appropriately and a decision is made, patients are admitted appropriately from ED or discharged.
Overall, I want to make the NHS better and help health care professions enjoy their jobs. I have heard a very nice saying (Courtesy- Dr Umesh Prabhu) which I try to apply everyday:
“Happy staff, better patient care- better patient care, no complaints”
WORK LIFE BALANCE :
Your work becomes your life. And yes, you bring your work home. I always come home and very enthusiastically describe my day to my wife and even my 18 month old daughter.
I try NOT to worry about patients and if I do I think of one thing:
“Can I solve the problem?
No - then forget about it
Yes- Do something about it rather than worrying which is a feasible solution”.
FUTURE PLANS:
I plan to apply to flying school and eventually get a pilots’ license. I have not even started on this but eventually, once I get a pilots license I plan to get a small Cessna. This may remain a “dream” but hopefully I will start working on this soon - Watch this space.
To my readers,
***You will hear all sorts of stuff like " The medical registrar does not have a life. Wait till this registrar gets his first complaint. Wait for the horrible *storm to come" - Not only from junior doctors but also registrars and consultants ( An IMG consultant recently commented things like this on a post). It is up to you how you act on this. I personally used to tell those people and myself " I will see when I get to that point. For now, let me explore all avenues and see what is best for me".