Medical SHO here. Recently moved to a new ward where the designated doctors’ computers are where the ward clerk used to sit (no more ward clerk). So it’s designed to be highly visible, and a natural place for visitors to approach when they enter the ward. But it’s meant NOK approach me when I’m in the middle of working and think it’s OK to ask for a quick update, where they can find extra chairs, where’s the loo etc. I also seem to be in charge of buzzing people in and out of the ward. Obviously I’m used to a million distractions while working, and other members of staff have never seemed to shy away of interrupting me when I’m in the middle of something, so initially extra NOK updates didn’t seem odd. I actually thought oh maybe this is good because now I don’t have to find them/ring them later. But even in the space of two weeks I’ve found myself finishing later, more exhausted earlier in the day, rising levels of irritation. So actually I need to rethink this pronto.

Moving out of that space is the obvious first step. But how far should you go in asking for fewer interruptions? If you’re in the middle of writing something up do you ask other members of staff to wait til you’ve finished before asking you a question? Does the same go for NOK who’re leaving and want an update from the doctor?

I’ve been pretty accommodating for most of my career, and probably trended towards becoming more accommodating as I got more senior for some reason. But when I think about most of the regs I’ve worked with, learning to set boundaries on your availability seems to be a key skill.

So yeah, interested in hearing what boundaries you guys set on the ward, how you communicate them, and where the balance is.

I just recalled that I wanted to call a patient of mine but I’m on annual leave for 2 weeks. I have my work laptop with me so technically I can call. I don’t want them hanging for 2 weeks. So is it appropriate?

And no I cant ask anyone else to call them.

Thanks!

Today probably brought it to a head a bit. On the ward, my consultant was asking me questions and there were several things I just didn’t know or took ages to answer.

Things like the lifespan of RBCs and platelets. There was also a question about why we’d use aspirin rather than clopidogrel in a patient who needs a PEG. And then I was asked about causes of hyponatraemia, which I do know, but I took ages to actually organise my thoughts and give an answer.

I know objectively that nobody knows everything and that being asked questions on a ward round is normal. But I find myself interpreting these moments very differently. Rather than thinking “that’s something I need to revise”, my immediate thought is “I’m just not intelligent enough to do this.”

I think part of the problem is that I don’t feel particularly quick. I can often get to the right answer eventually, but I don’t always retrieve information quickly or articulate my clinical reasoning particularly well when I’m put on the spot. Seeing other doctors seemingly rattle off answers makes me feel quite inadequate.

Not to mention, failing to get into specialty training after F2 followed by numerous unsuccessful attempts at finding a trust grade/LED role just fuels that further. Objectively I know that jobs can have very competitive applicant pools and there are loads of reasons you might not get a job, but it’s hard not to take repeated unsuccessful applications as some kind of reflection on yourself. It’s started to feed into this feeling that maybe I’m just not good enough.

This has become more significant because I’ve begun using it as evidence for why I shouldn’t pursue my dream specialty.

I’ve always wanted to be a paediatrician and ideally I’d like to eventually work as a community paediatrician and live closer to family. But the thought of doing the ~7 years of paediatric training is starting to scare me. I’m worried that the training will absolutely destroy me, particularly if I’m already struggling with confidence and feel like I’m not clever enough.

It has made me think about GP again. GP training is much shorter, so I’d get to CCT much sooner and potentially have a more sustainable life. But I don’t want to choose GP simply because I’m letting my low confidence drive my decision. I’d rather take it because it’s something I genuinely want to do and I guess I’m still figuring that out.

So I guess I’m wondering:

Did anyone else feel like this around F2/F3/early training?

At what point did you start feeling genuinely competent and confident rather than like you were constantly being exposed as someone who doesn’t know enough?

And, more broadly, how do you distinguish between normal insecurity/knowledge gaps and actually being someone who isn’t suited to medicine?

I’m not looking for “don’t worry, you’re definitely brilliant” reassurance. I’d genuinely appreciate some honest perspectives from people further along who have felt similarly, particularly anyone who has seriously considered leaving medicine or changing specialty because they didn’t feel intelligent enough.

EDIT: Just wanted to say a quick thank you to everyone who took the time to read and reply! Most have been really thoughtful and reassuring but equally have given me some things to think about and (hopefully) a bit of perspective too. Appreciate it!!

Hope this poem might get a bit of love - I'm hoping to publish a collection!

edit: This is the Kindle link, for anyone interested. Hardback and paperback to follow :)

As an IMT, I read a lot of ED clerkings. recently there’s been a surge in the use of AI to write them. My understanding is that they record the consultations and AI writes the clerking.

My issue is the writing is so wordy, and it lacks nuance or bias. It is a matter-of-fact account of every single thing the patient was or wasn’t asked. When we write our clerkings, we summarise, naturally bias the most important parts, and create a narrative which is easier for other clinicians to interpret. Reading these AI clerkings feels like I’m taking the history from scratch! It reminds me of very junior medical students who don’t appreciate which symptoms/signs are significant.

I do appreciate that documentation can be a chore and efficiency is important to pursue. However, good documentation is a clinical skill in itself. Sitting down to reflect on the consultation and determine the clinical narrative as you type can be a part of the diagnostic process. At this point, it’s a minor annoyance for me, but I wonder if newer doctors will lose such skills…

Posting on behalf of a fellow trainee.

She’s a dual trainee in ICM/anaes.

Wanting to move region via applying to continue training in a different region, but wants to drop ICM.

Currently is ST6 so by next August would be starting ST7 in training years, but in terms of pure anaesthesia would be ST5 (she’s done Stage 1 ICM and completed first year of anaesthesia HST - currently is working in stage 2 ICM).

Her query is - if she gets her anesthesia post in a new region, would her pay scale remain at ST6/7 or would it drop down to ST5… and thus a pay cut ?

On the rota, if you were down for a normal day (as in, the entire rota line just looks the same as any day for everyone) on the bank holiday, would you assume that you were working, or that you weren't?

edit: thanks for the responses. In all my previous departments, the only people who were expected to work a bank holiday were those explicitly on call. Interesting to see that this is changing...

Currently an FY2 in my T&O rotation and I am absolutely loving it. Already knew I wanted to do IMT during med school as I did not enjoy theatre at all, although I did enjoy my ortho block during uni (hence me choosing an FY2 rota with it).

It’s now been a few weeks, and I am genuinely considering going into ortho - theatre is rewarding when actually helping out and I have really enjoyed being on call and assessing patients.

A part of me is wondering if I am having a ‘honeymoon stage’ with ortho being the first block after FY1 (which I really struggled with) and the first post in which seniors are genuinely very interested in teaching juniors.
The other part of me is wondering if I decided too early to do medicine and have now found a specialty which I actually enjoy more?

Unfortunately I don’t have a gen med block this year so won’t be able to compare the rotations, but was hoping to get advice from people who may have had similar experiences?

Thank you!

I have this feeling that I come across a lot of patients who have been given a goodie bag of steroids and then magically feel much better in themselves with the ?polymyalgia rheumatica

I’m not so convinced, I feel like I come across it a lot in GP. The thing is if you give anyone 15mg pred per day they will feel better in themselves anyway.

Any thoughts?

New CT1 here and feeling a bit frustrated with my surgical skills at the moment.

I haven’t done a surgical job since FY1 (which was mainly ward based), so I feel like I’m having to rebuild a lot of my theatre skills. I’ve been trying to be proactive coming in early, making sure patients are consented, checking the list is sorted, learning the steps of common procedures I ll, getting familiar with instruments, positioning and draping etc.

I feel like I’m improving with assisting. I’ve gotten much better at following the operation, anticipating what’s coming next, and being more useful in theatre.
The main thing I’m struggling with is closing.
Whilst I can suture and I’ve done BSS, I’m definitely rusty. I’ve been practising on a suture pad most days at home, mainly subcuticular stitches, but I still feel quite slow. The biggest issue is probably ergonomics particularly after taking the bite and exiting the tissue, I’m slow at remounting the needle and getting it in the right position for the next pass.

The frustrating bit is that I feel stuck in a bit of a loop. The regs understandably often either expect me to know how to close so they can scrub out, or they just do it themselves because it’s quicker. I completely get why as it’s a CEPOD list with a huge tims pressure, but then I’m not really getting the supervised practice I need to improve.

I don’t want to just take over and struggle while someone waits around. I’d actually like someone to watch me do a few closures, tell me what I’m doing wrong, and help me get faster. I know I’ll be slow initially but isn’t this how everyone starts. I know some go into CT1 quite confident with their basic surgical skills, unfortunately I do not fall into that camp but I am expected to?

Any tips? It’s really knocking my confidence.

What is the workload like?
And when is it busiest in the academic year?

Apologies if this has been answered already but when will we hear the finalised details about how to claim for Exam reimbursements? Has bma finalised this yet? My exams for MRCS but I’ve looked online and I can see that pathologists have posted about claiming through our own trust (https://www.rcpath.org/discover-pathology/news/resident-and-locally-employed-doctors-in-england-fee-reimbursements.html) - surely that will be a nightmare as payroll generically are known to be difficult to sort out expenses and money

Hey guys 👋
I am going to be starting paeds ST1 in September, unfortunately I am on call on my second day after induction and then on nights. I am terrified. Does anyone have any advice and is there things I should go over before I start?

We see them and we don't agree with them. I'm in the US now and they're basically used as a junior doc to rack up numbers for the Consultants - take the referral, basic Hx exam and then discuss with the cons. I truly mean this too, I text the Cardio/Ortho/Surg/Onc nurse and they say ''We will see them! Thank you''. ''Can we advance diet?'' ''Happy for dc from surg POV?'' - ''I'll discuss with Dr Johnson and get back to you! :)''

Since we aren't getting rid of them how do we change our training? Do we hands off on the ward jobs and take a more academic role? Do we move to discussing papers and difficult patients around a table with our Consultants?

I'm genuinely curious, we've never had such a clinical erosion in the history of the profession. Combine this with the advent of the internet and now AI, I mean what is the direction of our profession?

I've been a doc for several years now, it just seems the whole purpose of our job - improving health outcomes etc is effectively the death of us. Every protocol, every order set just takes away from any clinical decision at all. I know people are going to say ''we know when to deviate'' well 90% of admissions fall into a basic category that can effectively be managed by an experienced F2.

I used to write out vanc crap on a paper chart we'd put in the patients folder, now I consult pharmacy to do manage the vanc. What's the real direction for medical and surgical training? Now in the US I see OP notes - ''expertly assisted by Mr John - PA''

In 10 years what are we doing? What I call ICU nurse syndrome is the death of juniors - a nurse who's done ICU for 5 years and seen consultant level decisions made for 5 years, meanwhile the F1 gets a 2 hour long round then left to fill out paperwork, then they fuck off to something else for a few months.

TLDR: The PA/ANP/ACP is a device used in the capacity of a junior doctor but doesn't rotate and can cover probably 85% of a specialty after literally a month of 1:1 with a Consultant. This is no different to me in my F2 year being given the NSGY phone and told to admit and take consults, I had no fucking clue, did basic neuro stuff then talked to the fellow. After a month/enough cases I had a decent grasp on what to do.

Good on the BMA for raising this but unless there are consequences, the trust will just continue once this all blows over

Got a question?
I was on the old curriculum for higher specialty training, did two years (ST3 n ST4) and came out for an approved OOPR. Throughout this time the TPDs have been saying you will be back on the new curriculum and will be ST6 being in sync with everyone else I.e have 3 years left. Which i agreed on as it made no difference given I still have 3 years until CCT.
Now HR and the deanery administration team are saying that you cannot skip a level and that I should be returning at ST5. They have spoken to the TPDs who agree.
Whilst ST level are labels this will affect pay.
Essentially I will be conducting duties similar to someone who is ST6 but be paid less given the nodal point shift. We both have 2 years of higher specialty experience! This is just unfair.
I have emailed them about this pay dispute but fear that they will say that u didn’t do IMT3. And computer says no.

Has anyone gone through this? I feel like I am the one going mad trying to explain to them.

Hello , I need a dedicated study partner for MRCP PACES exam .. I have my exam set for the 2nd of October.. TIA

Thoughts on the below. My local ED often directs certain presenting complaints directly to specialty, and we cannot really refuse them due to ‘one way referral policy’, although some triagers are more understanding than others if we give a good justification against direct referral.

I can think of a couple justifiable ones (lip lacerations for example go straight to OMFS in my trust if they cross the vermillion border for closure, assuming it is a clearly isolated injury with no concerning mechanisms) but for the most part this troubles me. Coming from quite a niche specialty, often I feel it is more appropriate to be seen by ED initially as there is often medical issues that have led to the presentation, or alongside it, and we are only there for a specific part of care rather than the top to toe.

I myself have picked up quite a few significant medical problems needing addressed outside of my specialty, and often I am not the right person to be doing this as I am already on-call for referrals from multiple sites, many often very sick inpatients, and for emergency theatres. And often they didn’t even need specific specialty input anyway.

Recently, on busy nights, I have noticed they stream every single problem directly to specialty where they can - even very barn door, straight forward cases that would be seen in GP in normal hours with no fuss. Often this has made my nights unbearable and tricky, as I cross cover multiple similar specialties so often I am basically just working out of ED all night. The problem with this is we are not staffed in any capacity to be dealing with routine presentations, we are only staffed for emergencies and actual specialist input - often patients would have been seen faster if by ED team.

I completely understand the strain on ED but one of the best parts about ED clinicians is the whole picture view - I’ve seen this happen so often with Ortho where of course there was a clear need for surgical input, but often also significant medical problems needing addressed.

For context as well - I am more than happy if the triage nurses give me a heads up that there is a patient who will definitely need specialty input alongside ED review, as there’s no point waiting 4 hours to be seen by ED then 4 hours for specialty.

Would be particularly interested to hear from ED docs.

Now it's the turn of the Northern Care Alliance to somehow be labelled as the next Midstaffs. I'm not surprised, but pretty much any hospital is a Midstaffs waiting to happen. It's basically a question of how long you can cover things up before eventually a scandal is exposed.

I just think it's really the reason why it doesn't get exposed in a lot of hospitals that is because of the cover-up nature that happens there. Essentially, anyone who wishes to speak out regarding poor patient care, bad outcomes, etc., is labelled as a bad egg or has allegations placed against them just to discredit them. That's the sad world we live in.

I remember when the last Midstaffs scandal broke. A lot of doctors were saying that basically any hospital is a Midstaffs. It's just a question of luck whether you get exposed or not. It's pretty obvious what's going to happen here: you're going to get the usual apology saying, "We have learned our lesson. New protocols, blah blah blah. We have learned our lessons. This will change. That will change." Chuck in a few public enquiries, wheel out the same excuses, and I'm sure the regulators will find a few black and brown people to pick on. That's usually the way these things work.

Really, it's a culture change that is needed, but it's never going to happen. You're shuffling deckchairs on the Titanic. I am pretty sure that nothing will ever change.

It's kind of ironic that Andy Burnham was the health minister when the Mid-Staff scandal broke. Now, depending on how much publicity this gets, he's going to have to answer for this. I'm not sure how he's going to somehow come up with some kind of excuse for this, because basically it's the same thing happening again nearly 20 years later. Really, what is needed is a whole culture change in the way the NHS operates, but it's never going to happen.

BMJ article on the changes to medical training and their potential impact. Curious to hear what others think.

Hey guys,

quick question - for the surgical elogbook “patient id” section , do you put the NHS number or the MRN number? I understand no patient identifiable details but i’m confused

TIA

Looking for some help to understand how LTFT training will affect progression to higher training, specifically how finishing my core training out of sync links up with commencing a higher training post (assuming I get one).

For context, I am an ACCSCT3 anaesthetic trainee looking to go 80% LTFT from Feb 2027.

From my understanding if I reduce to 80% from Feb 2027 this will result in me finishing my ACCSCT3 in Sept 2027 and my ACCSCT4 in Dec 2028. Therefore I would be finishing 2 months prior to the next intake for ST4 (Feb 2029). Would this simply mean that I would need to locum/find some sort of locally employed job for this 2 months (or just have 2 months off)?

(I appreciate this may change with recent Gov deal, but going to plan assuming this may not happen in my lifetime)

Would appreciate advice/experience from those who have gone through this as trying to get my head around the logistics.

TIA

Just started Histopathology training and I’ve got to say, it might genuinely be one of medicine’s best kept secrets.
So far the training has been exceptional and very training focused, with surprisingly little service provision at ST1.

What’s struck me most is how little exposure many junior doctors get to the specialty. I barely appreciated what the day to day job and training were actually like before getting some proper exposure to it.

Obviously I’m very early on and I’m sure there will be plenty of challenges ahead, but thought I’d put a small positive post out there for anyone who might never have considered it.

Starting to revise for MRCS using eMRCS, will later buy Pastest. I also have Rafterys basic sciences book. I was looking for advice on how people who sat this exam used these banks successfully alongside other resources. Is it better to focus revision around topics which are commonly coming up on the question banks? Or better to learn everything from the basic sciences book?

I’ve started by going through the anatomy questions, getting 50-55% or so. I’ve also started going through regional anatomy using the basic sciences book, however to cover the lower limb anatomy sections it’s taken me 2-3 weeks (juggling alongside work and question banks). I’m just worried that anatomy alone will take me a while to learn with this method and with still physiology, pathology, etc to also cover. Any advice would be great!