Get your bearings
The first week at work involves getting orientated and getting to know the service processes and procedures – for example, how to fill in hospital notes and request forms, drug charts and discharge summaries.
- find out where clinics are held - use your hospital map if you need to - and make sure you know what time to arrive for each of your rota’d duties
- wear your name badge at all times
- locate the 'hospital mess' to meet and chat to other junior doctors
- familiarise yourself with the different types of software you will have to use - have a good system to remember all the passwords you will need
- find out whether there is a formal teaching programme in your department which you can attend
- get to know the format of drug charts and the medical notes
- consider carrying a folder to hold a jobs list, spare clerking paper, drug charts, theatre lists and spare request forms.
Despite my experience of training in Europe, I was still taken aback by the level of paperwork in the NHS – for the first few months, that is what overwhelmed me.Konstantinos Andreou, Greece
- Get to know the staff on the wards, clinics and all the areas you will be working.
- Start developing your own network of contacts – for example, a WhatsApp group for junior doctors, for if you are late or need to swap a shift.
- Make a list of your team’s activities so that you know where to find other members of the team if you need to speak to them.
- Remember medical teams in the UK includes pharmacists, physiotherapists, speech and language therapists and social workers, whom you may contact regularly.
- When greeting a patient introduce yourself.
- When taking bloods, ask the nurses where the equipment is kept, how to dispose of it once used and how to send the blood to the lab.
- Get to know the layout of the wards and the general process of doing things, which the ward/clinic/theatre staff can fill you in on.
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Find out what is expected of you
- Find out your role – for example, during ward rounds, are you expected to write in the notes, look at observations or identify what medications the patient is taking?
- Find out when your consultant performs a ward round.
- If you have any questions, ask members of the team or the nurses, who have often been working in the department for many years and therefore are fully able to answer questions.
- If you feel nervous about approaching senior staff, ask whether they would mind you asking a question about Mrs X’s plan/care/discharge etc. If busy, they may redirect you to another colleague.
- Try to answer your bleep in a timely manner; if you get several calls at once, go through them systematically and apologise if you miss one.
- If you are unsure about what to do with a patient, pick up the phone and speak to your senior.
- If you are unsure about how to order an investigation, check with the ward staff or another doctor.
- Before you go home, make sure that you have completed the key tasks for each patient you have seen (eg investigation requests).
Find out how things are done
- Get to know common abbreviations within your department – for example TTA or TTO are commonly used to refer to 'to take away' or 'to take out', which is a discharge summary sent to the GP to highlight why the patient has been admitted.
- Before examining or taking blood, make sure you wash your hands and wear gloves where appropriate. If you do not, this may be reported by a patient, relative or staff member.
- Find out where you can keep your belongings, where you can have lunch and where you have access to computers.
What you might be asked to do
- Clerk patients – which includes history taking and examination - make sure you document your findings in the notes clearly.
- Speak to patients and their relatives to update them on their progress. Make sure you do not release confidential information without the patient’s consent – eg HIV status.
- Update patient lists which are relevant for your team, and find out where patients are after your team has been on call.
- Review your team’s patients on ward round and potentially be asked to request investigations or chase their results. To make sure you do not miss anything, spend a few minutes at the end of the ward round to review the jobs and task allocations within the team, so that you are clear on who is doing what.
- Undertake practical procedures; if you are unfamiliar with doing these unsupervised or would prefer to be supervised, make sure you ask for a senior colleague to be with you.
- When you are on call, always take a careful handover from your colleagues.
- Common administrative tasks include writing prescription charts, death certificates and discharge summaries.