DAY 2448-2534

May 16 - Aug 10

1) Where to even begin? In the span of three months, so much has changed. For one, I have completed my third and final rotation, Emergency Medicine (ED) This was definitely the rotation with the most variation in terms of cases seen. Polytrauma patients air-flown via helicopter, pregnant patients with uncontrolled bleeding and hypertension, paedatric patients whose parents watched me like a hawk as I tried to examine them, patients who were convinced that insects had crawled into their ear and infiltrated their brain, young IV drug users seeking cannulas so they could disappear for a convenient cigarette and a much-needed "quick fix", and elderly patients with broken hips or brain bleeds, who were unable to tell me anything about what brought them to hospital. I've encountered all of the above, made many mistakes along the way, and also learnt a bit about managing these scenarios. I've learnt some really interesting stuff, including fascia iliaca blocks (a nerve injection to provide adequate pain relief in patients with neck of femur fractures), ring blocks (a nerve injection for finger wounds and / or fractures), haematoma blocks (injecting local anaesthetic before manual reduction of distal radius fractures), suturing techniques, applying thumb splints, and how to use the slit lamp for eye examination, among others.

2) Of course, with the end of my ED rotation also comes the end of my journey as a Foundation Year 1 doctor. Long story short, I have passed my final Annual Review of Competency Progression (ARCP) with an Outcome 1 - Satisfactory Progress. This means that I am now officially a Foundation Year 2 doctor, and with that I have also obtained full registration with the General Medical Council (GMC). Finally, the ability to prescribe FP10s and to declare patients medically fit for discharge, along with all the duties and responsibilities that come with being a Senior House Officer (SHO). I'm not sure I'm actually ready for any of this yet. What I am ready for is my first rotation as an F2 doctor, which is going to be in rheumatology at Haywood Hospital. As I am on the academic programme, I'll only be in clinics two days a week, with the remaining three days for academic research.

3) As if moving jobs and hospitals is not challenging enough, I am also moving - literally. The contract with my landlady ends in August, and I have decided to move closer to the hospital. In addition to being closer to Newcastle-under-Lyme, I will only need to take one bus to get to Haywood. One of the biggest challenges for me so far has been packing up all the stuff I've hoarded over the past year. Thankfully, I am mostly done with that, and can look forward to starting my new job in rheumatology. I am sure it will be quite a bit different sitting in a clinic accepting referrals compared to my previous job in emergency medicine, but as always, I am open to learning new things. After rheumatology, I will look forward to a rotation in general practice (GP land as it is sometimes called) followed by geriatric medicine. That would sum up the rest of my F2 year. 

4) And this sums up my blog post today. I am really happy to have lasted this long in medicine so far, and I'm looking forward to all the ups and downs that the road ahead has in store for me. Thanks very much as always for tuning in, and I wish you all a good week ahead. Take care and stay safe, cheers!

First day as a Foundation Year 2 Doctor

(Also my first day in Rheumatology at Haywood Hospital)

Associate Membership of the Academy of Medical Educators

All aboard the free shuttle from the Royal Stoke to County Hospital

Mandatory Clinical Skills Course for F1 doctors

Re-familiarising myself with equipment used in emergency crash calls

Slow walk back home after a long day shift

Event today at the Double Tree Hilton

Presentation by yours truly, on introducing a neurosurgical unit day case service

Learning how to apply a thumb splint in ED

Beautiful scenery out of the hospital cafeteria window

Back at it with the blood and blood culture bottles and forms

A double rainbow after a brief spell of rain

Main entrance to County Hospital

County Hospital has some really good breakfast options for a reasonable price

Fish and chips with all fixings - a Friday staple at the Royal Stoke cafeteria

Haywood Hospital first day :)

My own trust laptop and dictaphone :)

Beautiful bus terminal

My last day as F1 doctor

Handing in my ID badge...

My new ID badge

DAY 2343-2381

Jan 31 - Mar 10

1) Another day another dollar - or pound here in the UK. It's been just over a month since my last blog post, and if I'm honest, not much has happened since then other than the fact that I've been rather busy with work. Reflecting on the past seven months, I have learnt a lot about medicine as a career. While medical school tends to place emphasis on book knowledge and passing structured exams, the real world is a completely different kettle of fish. Everyday, I find myself challenged by different scenarios, many of which require me to actually apply knowledge rather than regurgitating it out on a test paper. 

2) Spring is just round the corner, and yet this week we received a weather alert warning us of possible snow. Indeed, in these past few days most of the country has seen sub-zero temperatures, with Scotland recording a freezing -16C yesterday. If there's one thing I've learnt since coming here, it is that "as unpredictable as the British weather" was meant to be taken literally. Thankfully, the winds here are nowhere near as strong as they tend to be in Ireland - so I can get off with just a winter jacket.

3) So I have an exciting announcement to make - I'm coming back after seven months working here in the UK. It will be my first time home after as many months, and I cannot wait. Frankly, I'd used up all my annual leave for this rotation in planning my holiday. I am therefore looking forward to maximising the measly two weeks I have with my family and friends back home. It goes without saying that food will play a huge part in this. Recently, I had a shock after weighing myself - I had lost almost 10kg since coming here! Even more reason to replenish some of the lost pounds back home then.

4) I should probably finish packing up now. Thanks for visiting my blog as always, and hope you have a great week ahead. Take care and stay safe, cheers!

Nothing better to do on an off-day

This is the lightest I've been since high school - not sure how to feel if I'm honest XD

Looking forward to a haircut back home

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