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 :)

DAY 2181-2203

Aug 22 - Sept 13

1) Just over a month now into my job as  Foundation Year 1 (or F1) doctor in the UK. A brief overview of a typical "normal working day" (NWD) for me would be as follows: updating the handover list before 9am (if not already done), prepping the patient notes as much as we can after that, starting ward rounds with the consultant at 9am, updating the jobs book as we go along, delegating the jobs after the ward round (usually around 12 or 1pm), completing some jobs before going for lunch, then coming back and completing the rest, or handing over to the night team if there are any outstanding jobs at the end of the day. 

2) A typical normal working day is a 9-5 job, however I had only one normal working day yesterday, before having long days for the next three weeks. Essentially, "long day 1" extends from 9:00-21:00, while "long day 2" is from 9:00-19:00. Most of the time, long days (for me at least) are split between two departments - my day job in the gastroenterology ward (from 9-5), and thereafter in the acute medical unit (AMU), emergency department (ED), or frail and elderly assessment unit (FEAU). Every department sees different types of patients, so I've been exposed to a variety of interesting cases especially outside my day job.

3) These past few weeks, I've been really busy preparing for the Prescribing Safety Assessment (PSA) - which we have to pass before the end of Foundation Year 1 if we are to progress in our training. There are three exam dates in a year, and I sat for mine last week. While it is an open book test (you can search the British National Formulary or BNF), the main challenge is time constraint. There are 60 questions to answer in 2 hours, with the first two sections counting for the majority of marks. After an initial scare in setting up my laptop for the exam, I managed to barely finish in time. According to the website, results should be out in two weeks - so I'm keeping my fingers crossed.

4) In summary, working as an NHS doctor has been really rewarding - I've learnt a lot and have a whole lot more to learn. Time to keep working on building my portfolio then. Thanks very much for visiting my blog, and have a great week ahead. Cheers!

A sunny day today :)

 Made sunnier by the fact that it was my off-day

Back to work then I guess...

Trying out authentic Thai food at the "Art of Siam" in Newcastle

Sharing life stories with my good friend Clarence

Massaman curry with rice was stunning -

rich and creamy curry with just a hint of spiciness on a hot bed of rice

Sticky toffee pudding with vanilla ice cream to end the meal

Apparently the Doctor's Mess organise an official event once a month - this evening we were at the Orange Tree, and in front of me is a massive beef skewer

A ginormous dish of chocolate brownies with vanilla ice cream

The Clinical Education Centre (CEC) - where we have most of our fortnightly teaching

I've recently discovered the library at the Clinical Education Centre - perfect for some quiet time

What I've learnt from the hospital cafeteria is that they do Curry Thursdays and Chippy Fridays

Can't remember what this was called but it tasted really good

I pass by this area on my way back from work every day 

- it's most likely a park but I've never entered yet XD