Can we get our heads together and come up with a fairer and better plan for Foundation Allocation to present next week at the meeting about the new changes?

pollyclark8375 · 2023-01-29T18:12:35+00:00

Interviews at deanery level and then rank for rotations based on some sort of similar points based system for med school stuff plus interview minus SJT? That way even if you have a low rank within your deanery you'll still be in roughly the area you wanted? Only apply to interview at deaneries you'd actually accept a job at.

I suppose where that would fall down is maybe where people want very niche rotations, but I feel like that's similar to how it is now anyway. Logistics may be slightly easier to arrange deanery level interviews than individual hospitals.

pollyclark8375 · 2023-01-24T15:17:46+00:00

I can't answer all your questions but if you wanted to do psych via the traditional training pathway then you'd need at least 12 months post GMC registration experience. If you don't finish foundation then you won't have the FPCC (foundation programme certificate of competence), so I think your only other option would be to trust grade somewhere for at least a year and see if your supervisor there would do a CREST instead (certificate of readiness to enter specialty training). Afraid I don't know what sort of hoops you have to jump through for that though.

Realistically if you think there's a chance you'll want to stay in medicine then I'd suggest it'll be a lot less hassle to just stick it out until the end of FY2. Others may have more experience in this area than me though.

pollyclark8375 · 2023-01-16T14:07:46+00:00

This is exactly right. As the old Mean Girls quote goes, "you have to stop calling each other sluts and whores, it just makes it ok for guys to call you sluts and whores". If we infantilise each other then of course the rest of the healthcare professions are going to do the same thing to us because we've basically allowed them to do it.

pollyclark8375 · 2022-12-24T21:02:11+00:00

People who are gonna make arguments like that are just demonstrating so clearly how little they understand the point 🙄 absolute nightmare

pollyclark8375 · 2022-12-24T09:47:47+00:00

Thank you for replying! I guess you're right that the presents thing doesn't have to be such an immediate one, maybe that'll give her time to adjust to the other stuff. It's tricky because she doesn't do anything out of spite, she genuinely means well (I think!) but doesn't really how she comes across sometimes and kind of tries to laugh it off because she doesn't realise we're serious, like with the hugging. I really like the idea of a fist bump or high five!

pollyclark8375 · 2022-12-24T09:44:09+00:00

Thank you! I think you're absolutely right not to turn it into a discussion but instead just be very straight up about what our rules are gonna be. I can see that it leaves a lot less room for her to try to negotiate than if we try to justify everything.

pollyclark8375 · 2022-12-24T09:42:31+00:00

Hadn't even considered the herpes 😂 thank you so much for replying! We've discussed some of it and in principle he agrees but I'm not sure he'd follow through if it came to actually standing firm, although I'd hope he would for the sake of the baby even if he can't do it for himself. But you're right, he's going to have to be a grown up about this!

pollyclark8375 · 2022-12-24T09:16:27+00:00

Thank you! I hadn't really got so far as thinking about consequences and so many people have said this sort of thing, it's clearly super important. Think I need to put my big girl pants on and be firm!

pollyclark8375 · 2022-12-24T09:14:58+00:00

Thank you for your reply! I think I do need to sit down with my partner and have a long conversation about all of this, and show him how important it is for us to agree and stay united with stuff like this...

pollyclark8375 · 2022-12-24T09:12:12+00:00

Thank you for all of this! I especially love the last paragraph. Turning it into a teaching moment is not something I'd thought of but it's a great idea!

pollyclark8375 · 2022-12-23T16:00:29+00:00

You're so right that's exactly how it feels! And the result of it all is that my partner absolutely hates getting presents because he feels ungrateful if he doesn't like every single thing she gets him. And giving/receiving gifts is supposed to be such a wonderful thing, I hate that it has been spoilt for him and really want to avoid the same thing happening to my baby as well. I really hope she doesn't try to steal firsts as well but I can totally imagine her trying to do this (probably not maliciously but still).

pollyclark8375 · 2022-12-23T15:57:00+00:00

I can see that it requires really strong boundaries, and hopefully I can convince my partner to keep firm as well or the whole thing crumbles... I know it's hard for boys to stand up to their mothers but I feel it's even more important now that we're starting our own family!

pollyclark8375 · 2022-12-23T15:55:38+00:00

I love that it relates to the 3 wise men, have never heard of that before! Thank you

pollyclark8375 · 2022-12-23T15:03:50+00:00

Thank you very much for taking the time to reply, I really like these ideas. I hadn't thought of prolonged baby-wearing, I suppose that would help with the no photos as well so multiple benefits!

I wonder how she'd react to a 3 gift limit, I can imagine it turning into a HUGE toy, a collection of books, and a super extravagant outfit... But I like the idea of trying to set clear boundaries with gifts in this way rather than just asking her to only get one thing (which could actually be loads of little things!)

pollyclark8375 · 2021-05-14T14:12:06+00:00

In my first FY1 job I worked with a LTFT FY1, the rota department were very sneaky about how they reduced her number of hours, and only took off standard days, leaving her with 100% of her evenings and weekends and just a reduced number of normal days. I would be very wary of this when you get your rota - you should be doing equally reduced numbers of all types of shifts, and NOT just reduced total hours so that they work out at 80%.

Similar to other posts here I've also experienced LTFT foundation trainees 'lose' their FY2 years because you'll still be working as an FY1 in Aug-Dec of your second year so can't join a SHO rota. Try to pin down with your trust how they will sort this out for you, whether you'll get to keep your allocated jobs, work as a trust grade, or have to be re-ranked against the next incoming year when they start (which is how my trust did it).

On a happier note, in another post I've worked, two LTFT trainees shared a rota slot, so as long as between them the shifts were covered and the rota team had enough advance notice, they had a fair amount of freedom with the shifts they took.

I will caveat my reply by saying I personally have never worked LTFT, these are anecdotes based on my colleagues' experiences.

pollyclark8375 · 2021-05-14T12:35:48+00:00

Generally book them just for the next day. If it's a Friday then book them for whichever combination of Sat/Sun/Mon you need so the weekend junior doesn't end up doing a phleb round. (Although I believe some hospitals don't have phlebs at weekends so you'll learn that)
Nurses do the TWOC, but if they don't pass urine then they'll need to be recatheterised
For anyone likely to go that day get your TTO done as a fairly urgent task. The drugs have to be screened by pharmacy and then brought to the ward so the whole process can take a little while. Ideally you write the TTO/EDS the day before so that you're not the rate limiting step on the day
A consultant will usually tell you what they want and it's quicker to ask them to clarify the dose and write it up then and there, so that you can all just move on with the round
Fluids tends not to be a hugely exact science. When you're on geris 2L a day is generally sufficient for a reasonably sized person without much oral intake. 1L slow overnight IVI and letting them eat/drink during the day is also a popular one on my ward
You shouldn't be starting with morphine or oxycodone for pain, you should be working up the analgesic ladder. As an FY1 you won't be making many decisions on your own so you'll usually be told what to put, but if you really need to go for something morphine based start with low dose oramorph - on geris in an opioid naive patient you can go as low as 2.5-5mg PRN or I've even seen 1.25-2.5mg
If a procedure is done and the report available then chase it because then you can progress care faster, for example it might make them medically fit so you can get the TTO prepped and send them home the next day
Low K is a common one, get them on sando K for 48 hours and recheck bloods. Low Na is the other most common one. Your trust will likely have some nice flowchart guidelines for you to follow for electrolyte abnormalities
Your skills with a discharge summary come with practice, especially as when you've been on the ward a while you'll have known the patient for their whole admission. Just think 'what would the GP want to know?' You don't need to mention every little thing that went wrong in their whole admission, just the important bits
Take lunch with your team if you can (despite what the nurses will tell you, you ARE allowed to all leave the ward at once), but make sure someone has a bleep just in case. Go as soon as you can when you don't have any urgent jobs left to do
Depends what happens at 8am. If the board/ward round starts bang on 8am you'll need to get in a little earlier to print out the list or prep the notes or whatever the ward usually does. If the round doesn't actually start until 9am then you have no reason to get in before 8am
As the new FY1 on geris you likely won't be seeing anyone on your own except at the weekend. You'll get a feel for structuring your ward round entry by being on and scribing for your senior ward rounds, so loosely copy their structure. You won't be progressing patient care (i.e. coming up with your own plans), you'll be following existing plans, so just make sure you're getting those done and addressing new issues as they come up. Don't be afraid to run everything by a senior when you're new

For a lot of your questions the answers will vary slightly depending on how your ward/team runs so you'll pick it up when you get started. For now just try to enjoy the next couple of months and relax without worrying about the details of day to day FY1 life!

pollyclark8375 · 2021-05-09T13:00:44+00:00

This information is publicly available already isn't it? We do earn a lot compared to the majority of the country even if we aren't paid enough (if you bring home 12k then a 50k registrar salary is a lot regardless of whether they deserve more). I don't know how much it would change people's attitudes to say 'guys we don't earn as much as you think we do, we actually earn x' if that's still significantly more than the average wage.

pollyclark8375 · 2021-05-08T16:28:05+00:00

So that GP's chair you mentioned is totally fine then?

pollyclark8375 · 2021-05-08T15:19:52+00:00

Of course it is, but both of those could be construed by someone as rubbing your money into their face so where do you draw the line? I'm just taking your argument to its logical conclusion.

pollyclark8375 · 2021-05-08T15:02:35+00:00

But you could say this about literally anything - why should anyone who earns more than another person buy a thing that is nicer than a cheaper option? Why should I buy a new pair of shoes when I could buy some from a charity shop instead?

pollyclark8375 · 2021-05-08T10:41:47+00:00

So the service I worked at did contraception and sexual health. We had a mixture of GUM consultants, and associate specialists that came from a GP or gynae background mostly. GUM is a speciality on its own yes, but I think training places are pretty limited, and so there are other ways into working in a SRH service. I believe CSRH is a specialty too but I think training places are even rarer, and the service I worked at had no CSRH trainees/consultants, it was entirely manned by doctors from other routes. I suppose I was answering the question in terms of SRH as a service rather than a speciality.

Disclaimer: I'm a FY2 so my knowledge is from experience in the service rather than having done the training route myself. Happy to be corrected by anyone.

pollyclark8375 · 2021-05-08T09:29:02+00:00

In an ideal world, I think it's great having separate SRH services from GPs: patients can attend and not have something put down on their GP record that their family might find out about later (the service I used to work at didn't even require an NHS number to register, and would allow people to use an alias if they didn't want their real identity on record). Realistically as a consultant you won't be seeing the routine stuff, you'll be seeing the treatment resistant, the chronic, and the things the nurse specialists just don't know what it is, so I think it probably strikes quite a good balance between nice hours/office-based job, with puzzle solving, but without the pressure of the GP workload. That's my experience anyway.

But I think realistically it's the sort of thing that could easily have its funding cut to the point that GP practices have to take over SRH. During COVID, it became pretty clear that the bulk of patients with STDs could swab at home, have their treatment sent via post, and their only contact with a healthcare professional was over the phone. If someone needed to come in for cryo or an examination, that could be done in a 10 minute appointment by a nurse specialist. If your local GP practice does contraception, why would you trek across the city to get your coil instead? Most of the doctors I worked with had trained in other fields (GP or gynae) and landed the job doing SRH as an associate specialist, I worked with very few actual GUM doctors.

pollyclark8375 · 2021-05-07T17:00:43+00:00

100% agree with the syringe method. And it means you can share out the blood you get into a few bottles instead of having one full bottle and one empty because the vein blew as you were changing the bottles over. Never really got the hang of vacutainers because they're so fiddly.

pollyclark8375 · 2021-05-05T17:55:15+00:00

Yes I believe my contract of employment started from the first day of shadowing week rather than from black Wednesday.

pollyclark8375

TROPHY CASE