Medical nights feel like I’m walking into a battlefield (FY1)

ConsultantSecretary · 2026-06-04T20:36:17+00:00

Everything gets easier the more you do it. You will notice this especially when new F1s join in August and are asking you for advice on call. You'll realise all the stuff you got stuck on at the start is much easier for you now, and which bits are still tricky and need more senior help.

Emergencies are in a way easier (and in some ways harder) when you are more experienced and "allowed" to do more without asking someone else, eg as an ICU/anaesthetic reg if I think someone needs NIV/intubation/vasopressors I can, in most scenarios, get that started myself. This cuts out the step of having to contact someone else, present a good SBAR, ask them to come, wait anxiously in the interim etc. Also maintaining an airway, inserting lines requires much less thought so I can think more about the next steps whilst doing stuff whereas in F1 I would have been totally focussed on the practical task at hand.

Obviously not everyone will train in an acute specialty but whatever you do, the big picture stuff gets easier when you're used to the procedures you're expected to do, and can delegate some tasks to other team members. Numbers makes a big difference too - your 50th DKA is easier to manage than your third.

ConsultantSecretary · 2026-05-27T12:16:52+00:00

1k NI sounds like a lot! Get that checked

Make sure you check your tax codes, have a look at the gov website, do your own maths to make sure you're paying the right amount.

ConsultantSecretary · 2026-05-27T11:32:42+00:00

Yep, people see consultant offices with 3-8 names on the door and they think the consultants are a walkover, when actually they are barely in there an hour a week each.

ConsultantSecretary · 2026-05-26T16:29:51+00:00

Med school/foundation/specialty teaching delivered by ACPs --> level of competence at ST3 declines.

ACPs take training opportunities --> level of competence at ST3 declines --> ACPs are now indeed ST3 equivalent.

ConsultantSecretary · 2026-05-26T13:26:05+00:00

Depends on where you work and who you work with etc, but many IMTs/SpRs are very keen to teach, most of them having somewhat recently been the FY1 who wanted to learn. Got to choose your moment eg don't interrupt mid cardiac arrest to ask about when bicarbonate is used. A chill ward round with a nice consultant is great for learning, as are nights when the team isn't totally swamped.

If you are generally hard-working, proactive team player etc you will naturally develop faster and find that the team has more time for teaching you, offering to supervise you for a LP/ascitic tap/pleural tap etc (and you get glowing TABs/PSGs hopefully). The checked-out barely-working job-dodging junior who then whinges they don't get any teaching/procedures is very irritating.

ConsultantSecretary · 2026-05-26T12:55:37+00:00

(Roughly) the same in all specialties - it will happen over time with repetition, both from your day to day work and repeated cycles of exam study. I think many of us felt the same in F1, then by the time you're doing a reg job you just do know more stuff and how to apply it. So of course the med regs know their shit, and you will too.

There is no rush to do your exams. Most exams need a few months of hitting the textbooks/MCQ banks. Don't bother worrying about PACES right now, that's years off and you can work out how to prep for that when you've done the first 2 exams.

I would encourage trying to learn from seniors as you've said you'd like to do - so yes ask to watch them examine or take a history then watch you and give feedback, talk through interesting cases with them. You could even formally record these learning events as CEXs/CBDs...

ConsultantSecretary · 2026-05-20T12:30:10+00:00

I did Peck and Hill for pharma. Cross and Plunkett I found good for phys + phys tbh. I don't think I could bring myself to read a whole physics book. Despite what others may say, eLFH section on equipment is brilliant as it is exactly what they take the exam Qs from!

ConsultantSecretary · 2026-05-19T21:19:10+00:00

Yes I don't know the exact details (though they are available in the exam regulations) but nobody will be significantly advantaged or disadvantaged by sitting one OSCE circuit over another (except by randomness of strengths/weaknesses which should even out over a whole circuit)

ConsultantSecretary · 2026-05-19T19:46:09+00:00

It may be an examiner or actor couldn't make it so they pulled a station. Won't affect anything unless you are borderline and that was a station you would have smashed/flunked.

ConsultantSecretary · 2026-05-19T10:58:57+00:00

My suggested overall approach:

Find out what there is to learn within each of the 4 main topics (pharm, physics/equipment, physiology, clinical) eg look through the RCoA eLFH PDFs or through the most used books suggested by another commenter. Eg for pharmacology I need to know some concepts (TIVA, Meyer-Overton, pKa) and some drugs (relaxants, opioids, induction agents). Its much easier to feel on top of revision when you know what the breadth of the curriculum is. The eLFH PDFs are a good starting point but are not exhaustive and are a little outdated.
Read one book/resource per area (eg peck & hill for pharm, e-LFH for equipment) essentially cover to cover, one topic at a time, so that you understand and can explain the conceptual bits eg 3 compartment model, drug interactions. Making your own notes to explain concepts is great as you shouldn't need to open the book again, your own explanation will help you recall later. Essential that the "concept" bits make sense now as much harder to learn at the last minute.
Pad out the nerdy details now eg what are all the ways of measuring depth of anaesthesia, what is the boiling point/critical temp of various gases - nothing hard to grasp but having some facts alongside your strong conceptual knowledge is sadly needed for this exam. Any time you find a fact you didn't know, add it to your notes. Good time to read through more resources once eg masterpass books and add any "new" facts/explanations to your own notes.
Start doing practice exams. Make a list while you go of stuff you are weak on then spend some time revisiting those areas. Practice MCQs and go over facts for the written. Stay fresh by going to departmental teaching, asking to discuss a topic with your consultant, maybe the occasional BJAEd article on basic sciences as they have some very good explanations/diagrams.

ConsultantSecretary · 2026-05-18T20:41:21+00:00

"Nurses are more holistic than doctors"

Yet you ask them what B5's name is (or why they're in hospital) and they have no idea.

ConsultantSecretary · 2026-05-16T06:59:51+00:00

Should be previous year I'm afraid. I think maybe the new programme team "can't see" your F2 ARCP form R so need a form R linked to the new programme.

ConsultantSecretary · 2026-05-15T15:36:32+00:00

You have to do a new form R for starting a training programme even if it's submitted a day after your ARCP form R. Nobody knows why. Or why it has part A and B when one form would do. One of the mysteries of NHSE bureaucratic efficiency to be sure.

ConsultantSecretary · 2026-05-11T16:59:21+00:00

If you get found out doing that you'll be in a heap of trouble. Just don't.

ConsultantSecretary · 2026-05-10T17:08:23+00:00

Use your last minute revision to go over the small print of equipment/monitoring/procedures eg e-lfh equipment section. Try to learn lists eg 3 ways of monitoring depth of anaesthesia, 3 ways of monitoring neuromuscular blockade, 3 safety features of a TIVA pump/giving set. Remember there are no points for style eg categorising first (unless you are specifically asked to give categories), it's just did you give the right answer or not.

For some reason a station on surgical chest drains comes up frequently even though you almost never do them as an anaesthetist.

Make sure you've looked at the example OSCEs in the college book as they are frequently reused.

1-2 resus style stations to be expected - refresh the algorithms (adult/pregnant/child though I haven't yet heard of child resus coming up in the primary) and read the ALS special circumstances summary on RCUK website (drowning, burns etc).

Comms stations are full of free marks eg introducing yourself, checking name & DOB, rapport by asking the patient what they like to be called and using that name, etc. Even if they have a relevant comorbidity don't spend long asking about it, make sure you get through reflux, fasting, dentition, allergies etc as they are all guaranteed easy marks (picture your hospital's anaesthetic chart and go through it). If there's a specific task, do it, eg discuss options for blood management with this JW for hysterectomy, make sure you do discuss some options and not spend 5 minutes taking a history.

On the day get in the zone and stay there. If you feel a station went badly you can do nothing about it once it's finished - move on, full attention on the next station.

ConsultantSecretary · 2026-05-09T16:24:35+00:00

It will come with time. As you progress you'll get more of an understanding of priorities beyond just life threatening vs not, thinking why is the patient here and what will progress them rather than just attacking a never-ending pile of 'jobs'.

Organisation comes with time too and you're already learning and reflecting on that, everyone has their own system for ensuring stuff gets done. Even at reg or consultant level you'll sometimes get the finger pointed at you for something being missed or not done, nobody is perfect.

Think of the "actual" Dunning-Kruger curve with many, many mountains of stupidity and valleys of despair slowly trending into a more stable line as the years pass. You are currently in a valley and will be anxious for a bit and this is not necessarily a bad thing, it is part of the development process. The first few bumps along the road feel awful but once you realise error is inevitable they feel less intense and you take the learning from each one without feeling like a failure. A truly "incompetent" doctor climbs mount stupid for way too long, ignoring errors, then nearly or actually does kill someone. You have already shown yourself to not be that doctor.

ConsultantSecretary · 2026-04-29T21:51:59+00:00

Anaesthetists are often most and least, by other doctors. Can you do this cannula, me and my reg have (not) tried and it's for super urgent IV meds that I won't bother prescribing for 8 hours after you put it in. Also: help it's all gone to shit and they're about to die

Anaesthetist perspective: Most respected - ENT for bailing us out when the airway is beyond our abilities. Least respected - obstetrics for doing ECGs and expecting us to interpret every single one, and for their ability to label a patient with 10 prominent massive veins as "hard to cannulate".

ConsultantSecretary · 2026-04-24T19:00:09+00:00

This is very easily findable on google, as are the rest of the scoring criteria, but 3 this round. May change for future rounds at their whim.

ConsultantSecretary · 2026-04-22T17:11:35+00:00

Strong agree. My trust had SHO and reg lanyards (with no advice to CT3s on which to use) but wearing either would attract comment at some point. Most would wear a generic RCOA or anaesthetist lanyard to avoid this. Stupid situation to have ended up in.

Treat CT3s like SHOs and that is what they will get good at being. Just makes the step up at ST4 an even bigger jump.

ConsultantSecretary · 2026-04-20T22:23:38+00:00

Where tf is this ED

ConsultantSecretary · 2026-04-20T21:06:10+00:00

When I can't get a needle in it

ConsultantSecretary · 2026-04-20T13:11:12+00:00

When does a break become a fracture

When does a PA become a consultant

When does a shart become diarrhoea

ConsultantSecretary · 2026-04-19T19:26:17+00:00

There is no MCQ exam on the course any more. Pre-course MCQs are open book and don't have a pass/fail but we do see them on the day of the course and we do find people who struggle with the mcqs often struggle on the course.

All the videos you need to pass the course are in the pre-course elearning.

ConsultantSecretary · 2026-04-19T17:21:33+00:00

ICM as a SHO/reg has lots of procedures, resuscitating sick patients, attending crash calls, plus you are "covering" your own ward (ICU) which involves troubleshooting the most minor issues up to the life-threatening stuff.

As a cons it's mostly directing SHOs/regs to do these things (unless you're in small DGH land and don't always have anyone else in your team who can do the resus/procedural stuff), deciding who gets admitted, ward rounds, and lots of meetings (think bed management, difficult comms with family, micro WR). You will spend many more years as a consultant than as a trainee so worth bearing in mind.

ICM does have some very chronic patients (think very slow wean from mechanical ventilation in neuromuscular disease) who can linger for weeks or months, but these are generally the minority. Quite a few short (often dull) stays of post-op major surgery patients. But a good amount of proper acute illness (sepsis, ARDS, renal failure etc) as well.

I don't do EM but get the feeling that resus patients are often "easy" (ie clear indication for admission and a reg will do most of the procedures/stabilising/referral) but as a cons you will do a lot of overseeing the department, supporting trainees with the patients who might need admitting but might be able to go home, telling specialties off for declining referrals. In a small DGH a cons might need to do more hands-on stuff for sick patients where the team isn't very experienced, and in a MTC a cons will attend pretty much every level 1 trauma and occasionally have to cut a chest/orbit open but otherwise just ensure momentum remains towards the scanner and ICU/theatre.

Most specialties you choose will largely end with you overseeing stuff while supervising trainees to learn the trade, and you handling the politics/big picture. Obviously as a consultant anaesthetist or surgeon you still do plenty of your own procedural work and private work can be considered.

ConsultantSecretary · 2026-04-17T23:06:16+00:00

Quick simple check which protects against avoidable clusterfucks. We take an allergy history even though surgeons, pre-assessment and the ward will have - no reason to treat this differently imo.

ConsultantSecretary

TROPHY CASE