Dev Lall

A bit of advice for all those newbie F1s

It is hard to ignore the popular press denigrating the influx of new doctors on 1 August. Every year it is the same: black Wednesday, the killing season and higher mortality rates prevailing, all due to the new F1s.

One would be forgiven for thinking these new doctors were single handedly running the NHS without anyone to help, advise or support them at the limits of their competence. Of course, this is not the case, or is it? Because there are indeed two sides to every story.

I am heavily involved with medical student teaching and training in general, and specifically with the Preparation for Practice (PfP) weeks which all final year students at Glasgow university complete before 1 August. I am also responsible for delivering a PMetB compliant departmental induction to the new intake of anaesthetists of all grades at my hospital.

Help, in all it’s forms, is a difficult topic for both groups.

In PfP we run through some common, unwell patient scenarios. We begin by asking them what they want to get out of the day.

By this stage they know to send off basic blood tests (even if not yet acquainted with the subtle abnormalities they may reveal). They know IV access is good (although usually choose the pink over the brown). They generally know 0xygen, and lots of it, is good thing (apologies to any respiratory physicians reading).

Their main objective is inevitably when to call for help and how to convey their request to ensure they get the help they want.

On the other hand,anaesthetic trainees are very good at asking for help. They’ve been brought up in a training programme endorsing and encouraging it. They inevitably want to know how to deal with requests for help from F1s who have not called the senior members of their own team.

And why do new doctors not call their senior help? The reasons are varied. In my experience they state they don’t know them, assume they’ll be too busy, haven’t met them, know they’ll be at home etc.

What they really mean is they are too scared to ask them. They are too scared that they will look stupid or have not managed long enough on their own. They are worried they will lose face.

This is born out repeatedly in scenarios when help is called too late or a cardiac arrest call is not put out. This is not right. Senior doctors want to know when patients under their care become unwell.

The time for any doctor to call for help is when they have reached the limit of their competence. The limits of skill and competence across grades, specialties and practitioners in extended roles, are very varied.

One has to recognise and acknowledge reaching these limits but should never feel embarrassed by it. This is not about looking clever or stupid. It’s about patient care. Providing the best we can. The reason we are all here in the first place.

Of course F1s want more help than they probably need. This is due to inexperience. Bear with them. They need to be allowed to find their own limits of competence within reasonable security. They need to be allowed to mature clinically and emerge from their shells gradually rather than have them smashed to smitherines while they are still timidly cowering inside.

We have no F1s in anaesthesia in my hospital but we are there and can help them out.

A CT1 in anaesthesia is not a venflon service, central line inserter or a general sick patient assessor, but may be the most senior doctor physically present in the hospital.

I hope they would respond to requests for help in the same way they expect their requests to be met.vI know I can phone my consultant colleague on for ITU for help and that request will be met the same way I would respond to a similar request from them.

So my advice for F1s starting work this morning is don’t be afraid to ask for help.

Unhelpful, grumpy or rude responses from your superiors are often a sign of their stress, distress, uncertainty or overload. Don’t take it personally, and don’t be put off.

Refusal of the help you wanted does not change the patient need for same. You have seen the patient. You decided help was required. Get that help from the next level, from a colleague, from somewhere. Don’t give up.

And if you’re really stuck, phone the on-call anaesthetist.

Read the Chief Medical Officers’ views.

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4 Responses to “A bit of advice for all those newbie F1s”

  1. js says:

    It is the training that needs denigration- not the individual. Senior doctors just don’t train students- despite the huge sums of SIFT funding given to hospitals. Each student should be allowed to commission their own clinical training from any NHS hospital in the land. By forcing the hospitals into competition for students – training standards and facilities would have to improve to get students in the door. As it stands – hospitals get paid for doing nothing.

  2. London Med Student says:

    With all the training in the world, I’m sure that come next year I’m going to be panicky and make mistakes (hopefully not too serious ones) on my first day.

    That said, I’m inclined to agree that hospitals can receive a lot of funding for training that doesn’t necessarily appear… the amount of times I’ve been palmed off from seniors onto reg’s, to juniors, to F1’s, to nurses, even to other higher-up medical students… In my experience teaching hospitals are the worst for training as there’s so many of us around, whereas DGH’s aren’t completely fed up of us yet!

  3. Caroline w says:

    That’s why DGHs are called Learning hospitals as opposed to Teaching hospitals.

  4. TTBA(v)JD says:

    I wish I’d seen this in July/August. I’ll probably read it again in 2 months as I’m expecting my next F1 rotation to be a big step up from my well supported current position in gynae.

    Thanks for writing it!

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