DAY 2267-2288

Nov 16 - Dec 7

1) Four months have passed since I started working here in the UK. And just like that, my first rotation (in gastroenterology) is over. As I walked through the double doors one last time, I couldn't help but reflect on my journey so far. From our first week of shadowing and induction, and not knowing where the antibiotics section was on the drug chart, to gaining confidence in performing my own ascitic drains / taps - it has been a very rewarding journey indeed. 

2) I had previously assumed that being in gastroenterology meant that I would spend most (if not all) my working hours here. Interestingly, that has not been the case. In fact, I have often been called to work in other medical departments including the Acute Medical Unit (AMU), Emergency Department (A&E), and Frail & Elderly Assessment Unit (FEAU). While I definitely appreciate the exposure to other wards, I feel that this has somewhat disrupted the continuity of care towards my patients in the gastroenterology ward. On the plus side, I have now become a bit more confident working in other departments.

3) Now on to my next rotation - trauma and orthopaedic (T&O) surgery. I have recently been attending their Monday teaching sessions, which I have found very useful. Of course, the excellent free lunches may also be part of the incentive to attend. Regardless, I start my first "official" working day in T&O today. Having previously shadowed a fellow colleague, I hope that I have developed enough basic skills to survive the next four months. I'll share my thoughts working here in the next blog post.

4) This brings me to my last update - the formal assessment for the "Research Methods in Health" module, which is a pre-requisite for doctors on the Specialised Foundation Programme (SFP). We have two exams coming up - an online exam (MCQs and SAQs), as well as a 2,000 word essay to write. Fortunately, I have already submitted my essay, so it's just the online exam which I need to worry about. If I'm honest, I had not expected how challenging it might be to juggle between studying for exams and working at the same time.

5) And that's about it for this edition of my blog. As always, thank you for visiting and have a great week ahead. Cheers! 

This is ascitic fluid for analysis - patients with liver cirrhosis tend to present with fluid in the tummy (ascites) which can be really uncomfortable. If it's large enough, the ascites can be drained, and we can do this manually in the ward itself. Whenever we do an ascitic drain, we also send some ascitic fluid to the lab to rule out an infection.

This is blood for blood culture - patients who appear septic / spiking temperatures would require a septic screen, which includes (among other tests) a blood culture. We send a sample of blood to the lab for analysis, to find out if any microorganisms have invaded the bloodstream, and if so, what antibiotics they are susceptible to. This guides our choice of antibiotics.

A very useful 2-in-1 clipboard / file

So you can store notes and use it as a clipboard

Bought myself a sturdy umbrella after my old one broke

Hits a little too close to home XD

Meet Anas - RCSI Bahrain graduate, fellow F1 doctor, and lunch buddy for today :)

Before it was cold, it was foggy

This is the foggiest night I have ever encountered anywhere

Literally can't see 50m ahead

Chylous ascites?

Literally my last ascitic drain for the rotation

Ward 230 - Missed but not forgotten

What I walk into pretty much every morning

DAY 2240-2266

Oct 20 - Nov 15

1) After what seems like an eternity, I am finally back with another edition of my blog. It's hard to believe that almost a month as passed since then. Anyway, we're approaching the tail end of our first rotation, mine being gastroenterology in Ward 230. Honestly, gastroenterology has been a great rotation thus far, and I could not have asked for more support and guidance from my seniors and colleagues alike. I've found myself on the liver team (hepatology) more often than gastro, but overall working in both sides has been really rewarding. 

2) For my next rotation, I'll be in trauma and orthopaedic surgery. Like my current rotation, it is also split into two sides - two months in trauma and two months in spine. Recently, the T&O team have been organising weekly teaching sessions, which aim to cover common conditions encountered in the ward - such as cauda equina syndrome and spondylodiscitis. I have been attending these and have found them really useful. I have heard stories about this rotation from my colleagues, so I am hoping that by reading up on some basic managements before starting, I would be able to settle in a bit better. 

3) Working is honestly quite different from studying for exams. Firstly, the learning is a lot more opportunistic and less structured. There are of course teaching sessions but they cannot hope to cover the vast knowledge required to manage the ward jobs efficiently. Therefore, you have to be proactive and keep asking around to understand how and why things are done the way they are. I've found the trust guidelines really useful in that respect. It provides a brief overview of steps to manage many common conditions encountered in the wards. 

4) Secondly, you can get as little or as much as you want out of working. For example, you could spend the whole day in the wards carrying out ward jobs like a clerk, and not getting anything out of it at the end of the day. Or you could choose to take the time to understand why certain changes to medications were made, why certain scans were ordered, or why certain patients require additional close monitoring. All of this is part of personal development, which is something heavily emphasised in our portfolio.

5) In addition to all this, as a foundation doctor on the academic pathway (SFP), I am also required to undertake a module called research methods in health, taught by Keele University. It basically comprises statistics and study designs that will be useful when we are start our research block in Foundation Year 2. At the end of the module, we have a written exam consisting of MCQs and SAQs, as well as a 2000-word essay to submit. All in all, plenty to keep me occupied for the rest of this year. And with that, I shall end my blog post here. Thank you for visiting as always, and have a great week ahead. Cheers!

Breakfast after a long night shift (9pm-9am)

Some people get a little queasy at the sight of blood, but for most of us here, it's a relief that we've gotten the blood required for analysis

Remembrance Day today

My first real purchase of anything other than basic food and amenities

Back to being a student then :)

Trauma and orthopaedic teaching Mondays

Unfortunately yesterday's session had to be postponed due to last minute changes

You know it is the correct location when there is a model of the human spine lying around

Free teaching and free lunch - what's not to like?

A nice assortment of sandwiches for lunch

DAY 2218-2239

Sept 28 - Oct 19

1) Finally some time off to manage my blog - it's been a while since I last updated this. Anyway, I've been busy these past few weeks, starting with my first set of night shifts (from 21:00-09:00), then switching back to regular day shifts, then back again to nights. Night shifts are quite interesting in that generally, the management is less curative than it is supportive. For one, the management plans have already been laid out by the consultants on the day team. As the night team, our aim is to ensure these plans are actioned throughout the night. We'll also adjust any medications / intervene according to the patients' condition, and basically keep them going until the morning handover.

2) Conversely, patients also tend to do poorly at night. Whether this is sundowning in patients with dementia, or diurnal variation in patients with asthma, patients tend to deteriorate easily overnight. Given that there are less staff in each ward, the burden then falls on the night team to prioritise patients who are the most unwell first. During my short stint in the AMU (Acute Medical Unit), we would clerk and examine all newly-admitted patients that had not been seen in the ED. Over the course of the night, some patients would desaturate, some would spike temperatures, yet some others would self-discharge against medical advice, and some would unfortunately pass on. Come morning, we would post-take (i.e. see) the new patients with the consultant, before handing over any outstanding jobs to the day team.

3) In addition to ward work, doctors on any training pathway are required to maintain a portfolio. At the end of each year, this portfolio is reviewed by a committee that decides if the doctor is allowed to progress to the next stage of training. To fulfill the criteria set out in the portfolio, we are required to engage in a variety of supervised learning events, including case-based discussions (CBDs), direct observed procedural skills (DOPS), and mini clinical evaluation exercises (mini-CEXs). In addition, we need to log in a minimum of 60 hours of learning, write some reflections, and get involved in an audit / quality improvement project. In short, there is always something to do throughout the year. 

4) All in all, while it is indeed challenging, there are many good learning opportunities working as a junior doctor in the NHS. And with that, I'll end my blog post here. Thanks very much for visiting as always, and have a great week ahead. Cheers!

An apple a day might keep the doctor away, but a cup of coffee keeps the doctor awake

(My first set of night shifts was brutal if I'm honest)

Privileges of being a member of the doctors' mess

Stocked up on some white boards - very helpful in penning my thoughts or for doodling...

Doodle exhibit A: One can dream XD

View from home

Hearty breakfast after a long night

Still happy as always :)

Full moon tonight

DAY 2204-2217

Sept 14 - 27

1) It's been two months now, and the F1 doctors are halfway through their first rotation. For the past week, I've been assigned to the acute medical unit (AMU), and specifically to see patients in the Emergency Department. I thoroughly enjoyed my brief time here, as it gave me the opportunity to see undifferentiated patients and develop an approach to examining and managing common presentations. 

2) An update from my previous blog post regarding the Prescribing Safety Assessment (PSA) - I passed! This means that I have fulfilled one of the mandatory requirements for progression to the next year (F2). It also means that I have one less item to worry about, as if working and learning on the job weren't stressful enough... 

3) Recently, we've had Keele medical students (usually in their final year) shadow us throughout our shifts. They would clerk and examine patients, and present them for discussion before getting signed off. They were also allowed to prescribe medications using their "purple pen" - an excellent initiative by the university to expose medical students to prescribing before actually starting work. Of course, each prescription would need to be checked and countersigned to ensure patient safety. I've relished the opportunity to assist and guide these medical students, as i) I've only recently graduated and so can relate very much to their challenges, and ii) because I hope they will learn from my mistakes and become better doctors. 

4) With the PSA out of the way, I can focus on doing my job, and also look through the requirements for progression into F2. Essentially, every junior doctor keeps an online portfolio which records any procedures, skills, teaching, and reflection done. Certain assessments (such as the PSA and ALS training) are mandatory for progression. At the end of the year, a review is carried out by senior consultants to decide if the doctors are allowed to progress into F2. I have only just started skimming through the requirements for my e-Portfolio, and hopefully I'll be able to get started soon.

5) Other events that have transpired in the past few weeks include the temperature dropping quite significantly (especially in the past week), and me getting a haircut. I also got some proper winter clothing to keep me nice and warm for the coming winter. So far so good - I'm happy to be working here and looking forward to learning more on the job. That's it for this blog post, wishing everyone a great week ahead, take care and stay safe. Cheers!

Unplanned lunch and catch up with Ivan - fellow F1 and proud Trinity graduate :)

Back at the Health Library - very conducive place to revise or relax

This overhead bridge connects the Health Library to the Lyme building of the hospital

View from the overhead bridge

Different venue today for our fortnightly academic training sessions

The hospital cafeteria does really good Sunday roasts

Post haircut smile - on my way to Newcastle today

Our Lady of the Angels and St. Peter in Chains - a Roman Catholic Parish church built in 1857

Costa Coffee for a light lunch after walking the better part of 4 km

This is the largest cappuccino I've ever had

On the way back home from Newcastle

Got some new threads for the cold :)