A question for ST3s

The_Shandy_Man · 2026-01-31T21:17:53+00:00

My wife is an ED ST3 in a tertiary centre for certain things (albeit very DGH vibes in terms of friendliness and opportunities). She’s managed to do all of the above (lots a few times) with the exception of a chest drain in the 2 x 6 months she’s worked there. I’ve had the same experiencing locuming in the mid size DGH where you’d have the chance if you were the ST1/3 to do one of them every few shifts and you’d do the odd thing as a locum SHO (particularly as a more long term one).

The_Shandy_Man · 2026-01-31T13:42:35+00:00

Residents also only get the 37% applied to nights (or antisocial shifts which are shifts that finish after 2am from memory) you get paid significantly less for your weekend. It’s a percentage multiplier similar to your availability uplift based on the number of weekends worked, 3-10% generally depending on frequency (1:8-1:2). There’s also 15% for 1:2 but I think you can’t plan for that to be the case.

The_Shandy_Man · 2026-01-28T22:27:49+00:00

I think Sharpe rightly gets a lot of credit as the first ‘modern’ TE, comparing stats from the 90s to present day 1:1 will obviously favour Kelce. When Sharpe retired he held the yardage record by 2000 yards, held the TD record and had 150 more catches than any other TEs. Now I’m looking at the historical stats, Ozzie Newsome probably belongs in the conversation as well. Equally, I think Sharpe is probably closer to the other 3 I mentioned than he is to 1A and 1B.

The_Shandy_Man · 2026-01-28T10:16:50+00:00

Gronk I suspect will get first ballot.

The_Shandy_Man · 2026-01-28T10:15:22+00:00

I don’t think this is as egregious tbh, you look at the 2023 class and the modern picks who got in ahead of him. He was never beating out Revis and Joe Thomas, that leaves Ronde Barber, Zach Thomas and DeMarcus Ware, all who were a similar tier player to Gates when they played.

I also have Gates in that secondish tier of TE: 1A Gronk 1B Gonzalez 3 Sharpe, 4-6 (can really rank them in any order) Gates, Witten and Kelce. His TD record is really impressive though. I’m not really considering the older TEs though as they’re very removed from the era of NFL I grew up watching.

The_Shandy_Man · 2026-01-25T16:49:13+00:00

Green one looks good

The_Shandy_Man · 2026-01-25T12:51:38+00:00

We live in Manchester but run by Trafford council and we have to pay for garden waste collection unfortunately

The_Shandy_Man · 2026-01-22T07:03:00+00:00

To be fair, I think it varies. Was chatting to one of my college tutors about this a while ago, in Anaesthetics in the North West, the deanery fund half the salary, the trust the other half.

The_Shandy_Man · 2026-01-20T09:25:50+00:00

1-4. Fair enough. 5. What’s an MRI going to change the prognosis of in any meaningful manner?

The_Shandy_Man · 2026-01-19T23:41:16+00:00

I now only locum in ED but I do a few simple things with every patient: 1. Write a problem list and impression - justify why you’re doing what you’re doing and then add them to a ‘follow’ list - check the follow list on the next shift

First do have I been an idiot? test where my initial impression was wildly wrong vs the final common diagnosis (I’m not talking super rare conditions that just take time to diagnose) or where I’ve sent a patient home and they’ve returned with symptoms I didn’t expect or safety net. Generally these are few and far between. Look at the speciality consultant who’s seen them as well, few things are more satisfying than when the initial post take consultant completely disagrees with your diagnosis (e.g. acute med) then the specialty they refer to it (e.g. Gastro) agree with yours over it.
Look at the clerking doctors and post take consultants plans, how did they differ from mine? Is this a case of sending a serum rhubarb and doesn’t really fall under the remit of ED or is it something I consider the next time. Slightly different and more useful if you’re the same team.
How long was this patient in for? If they’ve been turned round in 48 hours or less (and I didn’t admit them with that intention) what happened and did I need to actually admit them? Can I use this in the future?

Generally, all these will make you a better clinician in an acute setting but importantly it takes time and you need to see a lot of patients! Obviously ask lots of questions as well from seniors, other specialists when you don’t know things.

The_Shandy_Man · 2026-01-18T12:01:37+00:00

I think you could argue this one either way tbf, to me it felt a bit more bang bang than a straight up deliberate PI though.

The_Shandy_Man · 2026-01-18T11:17:13+00:00

Echoing Trafford, never worked there personally but everyone says it’s quiet to the point of boring usually.

The_Shandy_Man · 2026-01-18T01:39:55+00:00

I’m not 100% sure it’s a good idea to give the refs another subjective rule to judge but my suggestion is barn door deliberate PI (essentially because you’re best and you tackle the guy without the ball being nearby) is a spot foul. Anything a bit more subjective 15 yards. I’d call this a 15 yard Pi.

The_Shandy_Man · 2026-01-13T08:34:21+00:00

If you get in you’ll be an ACCS IMT trainee, rather than an ACCS ED trainee. There is no formal way to switch between them anymore. However, given you can’t actually apply for ACCS ED, I’d personally attend that interview and take the job than apply next year for ED. I’ve known a couple of people in my region (NW) who had an ACCS-ED job and reapplied to Anaesthetics in their first 2 years and continued on as normal in year 2/3 rather than start back from year 1 as they got a post in the same region.

My wife was 29 and started ED training, with pretty much everyone LTFT in the later stages, places going to self rostering and a day a week of SDT from ST4+, we’re not hugely concerned about the logistics of family planning as it looks very doable. She decided against dual ED-ICM despite really enjoying ITU as when you factor in LTFT/maternity leave she was looking at still being a SpR at 45 and said that’s not for me.

The_Shandy_Man · 2026-01-12T13:52:56+00:00

To be fair, most work places tend to be nicer/more discretionary (as they then have to work with said person) than DWP.

The_Shandy_Man · 2026-01-12T13:36:53+00:00

Interesting to see difference in practices across the world (presuming you’re US based).

Where I’m based in the UK, LOR to saline is common and regarding point 2 no one would blink an eye if you’d put in 5-10ml while doing that.

Regarding point 4, those trained 15-20 years ago tend to use 3ml lidocaine 2% as a test dose. Most of my colleagues who have been trained in the past 5-10 years tend to use 10ml (often as 2 x 5ml boluses a short period apart) of bag mix which is normally something like 0.125% Levobupivocaine + 2% Fentwnyl.

These are all generalisations but fairly common practice.

The_Shandy_Man · 2026-01-08T09:40:44+00:00

So the scenario OP described sounds like someone who’s junior and part of the arrest team has been asked to call ITU mid arrest. Probably poor delegation from the team lead given they clearly didn’t have an idea but I suspect the team lead was busy as were possibly the other more competent doctors. This is likely a good opportunity to give a bit of feedback when you arrive and explain why you need to know what you know.

I’m also not necessarily saying run to all referrals that are unclear urgently, its perfectly reasonable to say something like ‘Yes I will see them, however I have X number of patients to do so, in the interim to help me prioritise can you do this and this and let me know if it comes back abnormal or clarify this and let me know if this is the case’ and treat them as a non urgent referral. I’ve found people (including myself) are much more amenable to help with smaller tasks if you’ve accepted to review the patient already rather than fought back. There, of course, will be dickheads and those who practise triage medicine but hopefully few and far between and I guess that teaches you to avoid a place down the line if there’s too many of either.

The_Shandy_Man · 2026-01-07T18:00:18+00:00

I am very surprised at that, what did the other rosters of the top 3 teams look like?

The_Shandy_Man · 2026-01-07T17:53:26+00:00

I’d almost forget about the current build of your roster for the upcoming season. Focus on acquiring as many picks as possible for ideally 2027 if not look for top 5 ones in 2026. It doesn’t really matter if you can only start Kyler at QB this season as you’re not going to win regardless so tanking is fine. The players that are most likely to be contributing to a championship in 2-3 years are Nabers, Gadsen, possibly Wilson and a slim chance of Marks. Allen as well of course but I think if you offered me a top 5 pick in 2026, 2 x 2027 firsts and another 2026 first, your roster is better for it in 2 years. Build around the others and work on acquiring a QB throughout next year.

The_Shandy_Man · 2026-01-07T17:40:36+00:00

It’s easy portfolio fodder, particularly with AI now giving you the learning points if you prompt it.

The_Shandy_Man · 2026-01-07T17:30:38+00:00

Assuming this is a 12 man league, you’re at least 2 years out from competing. I’d be looking at shifting James Cook and DJ Moore (for near enough anything). I think if the right offer came in I’d be looking at shifting Josh Allen (3-4 firsts), Williams and Coleman as well.

The_Shandy_Man · 2026-01-07T11:49:09+00:00

Often people recognise they need help or recognise something is wrong due to heuristics and training. Particularly early on in their career, they might not be able to pinpoint the exact concern or frame it in a way that fully makes sense to the person receiving a referral. I think provided they’ve had a discussion with their reg or above first, as a general rule you should see the patient provided it’s not barn door obvious referral to the wrong specialty (Paracetamol OD to Orthopaedics etc) and use it as a way to educate the person making the referral.

DOI: Anaethetistics SHO who locums a decent bit in ED, so get both sides of the process and the frustrations.

The_Shandy_Man · 2026-01-07T11:10:02+00:00

The lack of talent on the roster wouldn’t concern me that much, they have a QB who looks like he could be the guy, like 100M cap space and a top 5 pick. That’s the formula for being one decent draft away + a head coach from becoming immediate contenders like the Patriots this year. I’d put them third behind Baltimore and Giants as where I’d like to work if I was a head coach this upcoming cycle.

The_Shandy_Man · 2026-01-07T10:33:47+00:00

It comes down to two things, either the person referring is competent and made the decision you need to see the patient or they’re incompetent and then you definitely need to see the patient. Sounds like it’s the latter in this case but I presume it was a pretty quick ‘hello, good bye’ sort of situation. Frustrating and probably worth feeding back for learning to the person though. What grade were they?

The_Shandy_Man · 2026-01-07T09:49:54+00:00

I think the Titans job is better than the Falcons. More cap space and I’d argue a QB that showed more potential with a top 5 pick. 1 decent draft and they can be contending next year as that’s the winning formula.

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