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Okay. Um Hi guys. I hope everyone can hear me. I'm sorry, a bit late. Um We're just getting the slides up now as well. Um Fight issues. Um just to say that if you could do the feedback form at the end of the session, um That's great. Um And if you have any questions throughout pop of it in the chat, um we've got a couple of us on the call so we can respond to questions as we're going through as well. Um Today I'll be going through um tips and tricks for F One. So it's not really clinically based. It's more lifestyle things, rotor things, things that I found useful as an F one. Bevil Me, I'm one of the F ones in London. Um I've done respiratory psychiatry and I'm now I'm cardiology, so I've done lots of acute med uncles and things. So picked up some things along the way to help myself. Um Are you able to just move this, move the slide on for me at all? Yeah. Mhm. Okay. Um So what we'll cover today? So just some useful apps that I've found um that have really helped me throughout basically. Um and then note taking um routine bloods today. That's like what consultants always ask for a little bit on discharge summaries preparing for night shifts because I know a lot of people worry about that. Um exception reporting. I don't know if anyone has mentioned to you that, but it's important and so we'll get onto that well being annual leave and then some stuff about pay slips and I think um can we get to the next slide, please? Sorry. Perfect. Um So on my phone, I just have a little folder with useful apps that I found um that help me on my uncles or even days today. Um So we'll go through them all individually. Um We could just go on to the next slide. Sorry. Perfect. So be enough, I'm sure everyone knows about the BNF. Um It's basically for every drug ever and it's amazing. Um You can check the dosage for every single indication. Um You can see on there just that codeine because obviously it's a really common drug that we use. Um They're all the different sort of tabs on the app that you have. So as I said, indications and dose contra indications, caution, side effects. Um what I would say is that the hepatic and renal impairment sections tend to be a little bit rubbish. They kind of just say using caution. So for that, that type of thing, it's best to speak to your pharmacist because they're the best person to know, like which dose it needs to be reduced to or you may have trust guidelines on it as well. Um This isn't really specific to codeine. It's more antibiotics where that comes in but just something to think about. Um, yeah. And um, for the like interactions, if you're working in a hospital that has a system like senna, then your prescribing system will automatically sort of indicate to you if there's an interaction with a drug that the patient's already on. Unfortunately, for me, it's been paper prescribing. And if you have that in your hospital, it takes a long time because obviously have to go through all the different drugs and make sure that there's no interactions but the BNF on their interactions thing and you just click on that and then it lists any interactions with that specific drug. So you don't have to keep talking through every single different drug type. Also, it doesn't have it on the app, but on the online system, on the interactions page, you can actually just type the drugs um to see if there's any interaction as well, which is handy and next slide, please. Thank you. And so BMJ, best practice. This one is really good. I found it really useful when I was on call and I was like, I've done my 80 I've got my history. I'm pretty sure I know what's going on. For example, that have an exacerbation of COPD. I was like, I just can't remember exactly what I need to do, um, with the BMJ. Best practice. If you type in COPD, it will give you the symptoms, it will give you investigations, it'll give you the national guidelines um for the management plans. Um So it's really, really helpful in that sense. Obviously, the caveat to that is every hospital will have its own interest guidelines. So in terms of antibiotics, especially um under the certain drugs, they may be slightly different to the national guidelines. So always check with your internet first, if there's any guidelines for the condition that you're worried about before you base it all on B and J. Best practice. What I found useful with like the BMJ up though is that sometimes there's some niche investigations that you're not entirely sure about rather than just just standard chest X ray and bloods. Um and they kind of go through them again. The only negatives are you can't search by symptoms. So if you've got a wheezy patient and you're not sure what's going on, you can't just type in weeds, you have to know what the disease is. Um But hopefully your assessment of the patient will kind of guide you to the right direction. Um Next slide, please. Thank you um induction. So every single hospital in the UK, as far as I'm aware has in like their system uploaded into induction, what it is is just a load of extension numbers and bleak numbers for the hospital. Um So it means you don't have to go through like switchboard every single time. Um So if you're ringing from a hospital phone, you can literally just dial the extension number that you found. For example, on my slides, they've just typed in cardio and all of these options have come up. Um And yeah, you'll get through directly. So you don't have to wait on hold for ages through switchboard. The only thing to know with that is that for example, in my trust, some services are done at this hospital that done uh sister site and it will, the number will come up on there as an extension, but it won't work because it's a different switchboard. So only then will you have to ring the other hospital switchboard and then put the extension number in induction, doesn't tell you what is on site though. So, um but otherwise it's really good. Okay, let's slide. Okay. Um Micro guide again, really good. Um Is just best to have it in an app, to be honest because it just means it's in your pocket the whole time. Um As I said at for antibiotics, they kind of differ from national guidelines to locally because of sort of the bacterias that around and the resistance and things like that. Um So if you go on Micra guide and say your consultant has said, or can you prescribe co amoxiclav for this patient, you can see what dose for that specific illness. Um You can also see the dose ng for any renal impairment and things like that. Um Also if you've got a patient that you've seen in a and a and you know that actually they've got a diabetic for ulcer, but you don't advocate what antibiotic to start them on. You can also just type in a disease and it will tell you they're antibiotic guidelines for that disease at your hospital. Um It'll also tell you when to take a peak and trough levels for antibiotics if that's needed. Um And it will tell you how to adjust the dose depending on those results as well. So it's just really handy guide to have. Um Yeah, definitely have that one. next slide, please. Thank you. Um So tidy recess. I luckily haven't had to use this myself, but it's, I've heard that it's really good. I keep it on my phone just in case basically what you do. Um You just click on the app and you say start new recess and I'm not sure if it's clear on the slides here, but basically you can say what rhythm there in. So VFED Asystole, um pulseless electrical activity and it times the whole thing you can then like press plus if a shock was given or plus press plus by the adrenaline when adrenaline is given. And then once you've finished at the end of the like resuscitation episode, you can then log it and it will give you every single time that when it started, when the shot was given, when adrenaline was given, when Ross happened or anything else, changes of rhythm, everything like that. So you don't have to carry around. A piece of paper would have to scribble down really quickly and you don't really know what's going on because it just does it all for you and it's amazing. Um So that's a great one because it is an F one you are going to be described really. Um OK, next slide. Thank you. Um So again to do with recess, um the Resource Council guidelines actually have their own app. Um And it basically just outlines all of the guidelines for you. Um Obviously, you'll probably have a less when you start F one and that they will go through what you have to do in a recess situation. Um But to me, in a high pressure situation, it can get stressful and you can forget things. So it's best to just have the guidelines out on your phone to know exactly when the shot needs to be given in what scenario, at what time and when adrenaline needs to be given and amiodarone and all of that kind of thing. Um So I just found it really useful to have it in my pocket, so I don't have to remember it off my heart. Um Next slide, please. Thank you um MD CALX again, I'm sure a lot of people probably have heard of this basically is just calculators. But every typical goals scoring system there is a medicine. Um So for example, on rust, there is loads of well scores for a P person in clearance for drugs, um cuties as well for your A CGs. Um In fact, the QT is really good because it can, you can change it to small, like small, like squares on the ECG. So you don't have to like count milliseconds or whatever. Um And it just calculates the QT for you. So that's really helpful. Um Next slide, please. Thank you. Um So, note taking, everyone has their own style with this. Every consultant has their own style with this and so every ward round you do will be slightly different. Um This is a way that I found that most consultants have seen have been okay with and like happy with. Basically, it's trying to make sure that you've got all the important information in there that's necessary, but you're not waffling on for ages because if you're on an uncle and it's been called to see a patient with chest pain and you want to know why they've come in, you don't have to read through trolls and trolls of notes to know why they're Reuben in, in the first place. So why do again, you can find what works for you? But what I do is I put the age of the patient, I put when they were admitted their treatment escalation plan. So their recess status, um you know, are they for CPR are they for itur they for medicals? Um And then I put why they've come into hospital? What the issues we've found while they've been in the hospital. So for example, have they got acute coronary syndrome and waiting for an angio and then I put on review and that's them today in this specific moment. So what's their new score before the ward round? What's their blood's like? What, what are they like when you examine them? And then for certain patient's, you can tailor as well. So if you're monitoring the fluid balance, what's the fluid balance and then you put the plan as well? Um But again, as I said, everyone has their own style, it's just about what, finding out what float works for you and also what your consultant likes. Um But that's just something you'll pick up as you go. It's not really something to stress about either. Um As long as you've got the important information next slide, please. Thank you. Um So routine bloods, these are the routine bloods that I found that the consultants have wanted at my hospital. Obviously, you may find that um your consultants want more or less, but they're probably the main ones I would say. So most patient's get these on a regular basis. Um Obviously use the knees and magnesium. You want to make sure that you know, they're getting the electrolytes with the need because hospital food is a little bit shoddy. So, you know, you want to make sure that they're actually okay on that front, make sure they're not getting in an infection while they're in hospital, things like that. So those are the blood that recommend just ordering. You know, obviously, if there were on Warfarin, you can have to get an iron are and that's specific to the patient, but most patient's get these bloods. Um next slide, please. OK. Discharge summaries. So again, this is something that you want to keep quite simple. You don't want to be writing essays because there's gonna be a GP having to read through it all to work out what they need to do for the patient. So what I tend to do is I say Mrs Blogs came in with this on this date. Um And then you can add some people bullet point it as well. It doesn't have to be paragraphs or pros. Um So basic information, what did, what did they come in with? What was found when they first came in? What were they treated for and what were they treated with any investigation? So for example, any echoes any Anjos chest x rays that showed anything um safety lifting advice for the patient's, obviously the patient gets a copy, copy of the discharge summary as well. So, um for example, if you get new chest pain or shortness of breast to please come back to any that sort of thing. And then also really importantly, you want the follow up. So what I would say is if it's something that you want to be done within two weeks, it's a bit unreasonable to try and get your GP to do that. So if your hospital has like an ambulatory care unit, I'd recommend referring them to them for repeat bloods within two weeks if that's needed. Other than that, you can say, please GP to do this. Um But I definitely make use of the A see us if you can because they say it takes up to two weeks for the GP to everyone be used to their discharge summary. So you don't want, you know, urgent blood's to be dependent on a GP doing them. So just something to look out for next slide, please. So preparing for night shifts, everyone does it differently again, it's finding out what works for you. Everyone eats differently, eats different times and things like that. So it just is a bit of trial and error and working out, you know, what you like to do and what works for you and what keeps you awake. So for what I do is the night before my night shift, I try to stay up as much as possible. So if I can get to 1 a.m. two AM, that's great. So Netflix is really helpful for that. Um, and then I try and lie in as much as possible the next day. Um, again, if I can try and get past a day, that's great. On the first day, it's really difficult. Um, everyone finds it difficult but if you can try and have like a nap, if you haven't managed to sleep in, then that's also great. I tend to do it where I have t, as I normally would. Um, so I'd have my usual dinner and then I would go to work. Um, and then once I finished my shift and then have breakfast just cause I find that, that helps me get back into the daytime routine when I'm then off nights. Um, but some of my friends do it differently. They have breakfast at usual dinner time and then when they come home from the night shift, they have a dinner. Um, but again, it depends what's worked, what works for you. Um, some people like to have the equivalent of lunch in the middle of the night. I just found that I just felt too sick and just really didn't fancy in the past a salad at what I am. Um, but what I would say is snacks and like diet Cokes coffee. They help otherwise that, you know, you would be falling asleep, especially on the first night. Um But yeah, so I normally take, tend to take like Crests or fruit. Um, just for a little snack to keep me going, but I wouldn't take a full meal. But as I said, some other friends taken a full lunch. So it's just trial and error and you know, the first night it's gonna be rough and then you'll get used to it. Um Next slide, please. Thank you. So exceptional reporting before. As an F one, I had no idea this was a thing. Um So I'm not sure how many of you are aware of this. Basically. It's where you report any hours that you've done, where you were not meant to be at work. For example, you know, staying late or having to come in early to do um ward round notes or whatever you need to report it. Every trust has a different way of reporting the information. Um and just part of your induction to that trust, they should go through that with you. It's part of the part of our contract, I think. So there'll be an online system for us. It was you documented what day that you went over hours, how many hours and you went over by and what you did to try and rectify it and then that just goes to your clinical supervisor. But the guardian of safe working also gets copied in. So they're a person who is in charge of making sure that we don't go over any hours that would be illegal. Basically. And if too many people are going over hours that would be illegal. The trust actually gets, find. Um, which is why this is a thing and why it's important to report it is because you can get time off in lieu, um, or you can get, like, paid for those hours. Um, you can decide as well which one you'd rather get. Obviously, if you're only working an hour over a week, then, well, it depends if you want to leave an hour early. But I find that that's quite difficult. Um, when you're in a ward situation, like if you've still got jobs, you end up kind of just saying. So I would always go for the payment. But again, it's personal preference where you choose. Um, next slide, please. Thank you. Um So well being um starting F one, it's, it is tough. Um, is a very different like change of pace, change of scene, you may be shipped off to somewhere that you don't know anyone around. You don't have any family or friends. Um And that can be quite stressful and like nerve wracking, but at the same time can be really good if you allow yourself to go full throttle into it and make all friends that you can. What I'd recommend is trying to get involved with the mess at your hospital. So that's basically just a massive social club at your hospital. Um It, you do have to pay for it unfortunately. So, um normally it's around 10 to 15 lbs a month but with that you get sort of social. So payday drinks at the end of every month and the drinks are all free because they paid for by the mass. Um, you might have a ball at the end of the year, like Christmas dinners, um, things like that. We also have like a cricket tournament thing. Um, yeah, it's just really good. You get to know all the F ones and F two S um, as well really closely if you go to the mess events. Um And that's really helpful because then you have someone to sort of vent to, you've had a bad day and you don't really know if you've done the right thing or, um, you know, it's, it's good to have someone to bounce off and talk about work things, especially if you don't have anyone medical at home to talk about them with. Um So two highly recommend going to the mass events if you can, um, headspace as well. Um I, I didn't even know this was a thing but you can actually get it for free with the NHS. So you just, you have to go on to the online version of headspace, not the app and then you just sign up using your NHS email. Um But then after that, you can just log in on the app with your user name that's created through that. Um And it's good if you like to sort of meditate and things like that. Um What I found useful is have like things to help you sleep. So for example, when I was on nights, um if I couldn't sleep in the day, I'd put on one of those things and they help me fall asleep. Um Obviously, if you define that doesn't really work for you again, that's fine. But, you know, just in case, um and said colleagues, making friends with colleagues, um having a good relationship with your colleagues as well is really helpful because they, they know your hospital better because they're living through it with you. Um You can ask them about certain situations or if you're having a tough time at work or whatever. Um They're like a good person for people to go to. Um You may find that especially in the first couple of weeks, everyone's feeling a bit out of that up. So it's quite nice to just feel like you're not alone. Um And if everyone feels like that, it's like, uh actually I'm okay, you know, um and then again, friends and family, um they might might not be medical but doing things that you would normally do, like having hobbies or going out for brunch is lunches, meals. Um That's also really important, as I said, in the first couple of weeks, you will probably end up staying late because you're getting used to the job and you can almost neglect your well being through that and you end up counseling events and things because you're working late. But I would say it's really important to just try and make some time for yourself, especially in those first couple of weeks as you're trying to get used to it because otherwise it can feel quite overwhelming, but you honestly will only take a couple of weeks and you'll swing into gear and you'll know what's expected of you and what you have to do day to day. Um And then it gets a lot better but definitely make time, time for yourself. It's important next slide, please. And you leave. Okay. So, um I'm pretty sure you shouldn't go by now if you don't, you get nine days per rotor per rotation. Sorry. So in total, it's 27 days a year. Um You're not allowed to take annual leave if you're on call. So if you're doing any like take shifts, post take or water cover shifts, you can't take annual leave. You can swap them though. So if you have a friend or whatever, um that wants to change it for a different day, you can do that as long as the rota works that way. It just is a case of filling in a form and speaking to the rate of coordinators and things like that. Um What I would also say is try and maximize your time off, obviously, if you've got certain events. So, you know, for example, this coming August, you might have a holiday already booked. So you're gonna need annually for them. But if you just want to take random days off, try and take it off where you'll get the most days. So for example, here on my, this is literally my rosa. Um and then, so you can see the first week I'm on call, I have the weekend off and then I have to normal days and a day off, I could take the seventh and the eighth off and then I get six days off rather than just the two annually of days that, you know, I've requested. Um And again for the last week as well. So that's kind of what I would do to try and maximize my time off from work and then you're able to go and do things that you want to do, um visit different places, go on holiday, things like that. And your ratio should allow for that. You will have random midweek days off which allows you to have more time off, which is good. Um Next slide, please. Okay. Um This is the last slide. Um So this one is just a little, a bit about pay slips. Um When I first started as an F one, a couple of my friends got put on emergency tax codes. And basically that means you get taxed at the highest rate of 40% rather than the 20% that were meant to. So they ended up getting less money Um, so things you need to check is your tax code. So, if it says non cumulative, cumulative, that's the emergency tax code. So you'd want to speak to hr, um, as quickly as you can, because you want to be on a communicative one. And that's where they kind of, um, see your salary constantly and adjust your tax according to that. When it's the emergency tax code, it just a shame that you're gonna earn a fortune and takes all your money away from you. Um, hr are quite good at rectifying that though if they've put you on the wrong tax code, um, it should only take a couple of weeks to like, change it and get your money back, um, which is quite good. Um, if you want more information about tax codes and things as well, and there's a website called Medics Money and they're quite good. They kind of go through every single sort of option on your pay slip and what comes out and things like that, which is useful. Good. Obviously for a lot of people, like F one is the first time of earning a salary. Um, with that, there's not like a summer job and having a proper pay slip. So sometimes it can be a bit confusing about what all the numbers mean. Um, obviously as well in the NHS the pace that's slightly different because you get paid based on how many nights you do, how many on calls you do. Um, and so it's always useful to check your pay slip every month just to make sure that you're on the right banding for weekends and things like that. Um, normally they do it that it's not done on a month to month basis. So for example, say I worked three weekends in August, but no weekends in September, they don't, I wouldn't get paid loads more in August compared to September. It's done from the average of the whole rotation. So you'll get paid the same amount every month throughout the rotation. Um The caveat to that though is when you're starting F one, your, your first wage will be loads because you've not been very much. So you won't be taxed on it yet. And then when you hit the tax threshold, you'll get tax come out and it will drop unfortunately. Um Yeah, so night duty weekends, spoken about if you pay for the mess, as I mentioned earlier, that will come directly out of your pay slip. So you don't see the money come out, to be honest. Um And then student loan as well. So you shouldn't be paying student loan until the April after you graduated. If you've done an undergrad, medical degree or like installation without doing a degree beforehand. Um A lot of my friends who integrated had student loan taken out from the very first paycheck because the student loan company presumed that they graduated when they graduated from there. Insulation, not from um when they graduated from medicine. So you can ring your uni and then they will change your graduation date. So when you finish medicine and then you ring student finance, um, and they will give you the lumps and back from what you've paid, which you were not meant to pay, um, which, you know, is always helpful to get some money back when you don't need to spend it. Um I believe that is everything. Um Yeah, so it's a bit of a quick session. As I said, it wasn't really clinical stuff, it was more just getting into the life of being enough one and things I found useful. Um You will find what works for you, as I said, um and I wouldn't be, you know, worried if you're feeling out of depth in the first few weeks because everyone feels like that. Um Obviously there's people there to help you during that time and if you feel particularly worried about something, then you have your CS and your es and obviously colleagues, friends and family. Um But yeah, if anyone has any questions, um please feel free to put it into the chat and if you could fill out the feedback form as well, that'd be great. Okay. So someone's put any tips for referring to other specialties. Um So it depends on the specialty, whether they like you to bring them or do an ice referral. Um Ice is just the system used to request bloods and things you'll have training on how to use it. Um So for example, if it's an ice referral, then you like click for example, ent referral on ice um under that specific patient and then you'll put like uh they'll have all the patient details anyway, so you don't need to put a Jor anything like that. You'll put this patient presented with epis taxus and it has been ongoing for two hours. Um We can't stop it. Um And it can be as simple as that and they might accept it depending on what it is. If it's, for example, of respiratory regress, you might have to be more detailed in terms of shortness of breath saturations, um respiratory rates, you know, any past medical history, um that's related to rest conditions, what medications they're on? Why? Actually you want them to see them. Like do you want them to change the medications? Do you want them to put a drain in? Um And again, you can do that through ice. Um If it's not through ice, then you can just ring them which the induction app is useful for. So they'll have the bleeps for all the specialties and the extension numbers for those wards as well. Um Some people find that, you know, the Aspart all is helpful and I think that's something that most people get to med school. It's like talking about the situation and that you're in. And for example, you know, I think my patient's having an M I um and then you talk about the background of patient so why they've come in what they've been treated with and then assessment. So news, examination findings and then recommendations. So that's uh I think I'm going to do this for this patient and I think I'm going to give them a fluid bolus, but I'm not really sure I'd really be grateful if you could come and assess them. I'd say in the first couple of weeks, you'll probably use that the most. And then as you get to know people in your hospital and as they get to know you, um you can be a bit quicker and you don't really need to give all of the information. Um What I would suggest as well is because everyone has access to the computer system if you have um computer notes is that I always say, um so for example, if I'm trying to ring a respiratory reg, I'll go highs out there spiritually reg and I give you and then um I'd be like, I'd like to ask you a few questions about a patient. Is that okay? Kind of give you their hospital number and then they'll get the notes up as well. So while you're given the history, they also have all of the notes of the patient. So if you missed anything in the history, they'll be able to see it as well and they can see blood, they can see, um, any other investigations and then to, you don't have to give all of that information and I find it really helpful. Um, has that answered your question? Let me know if you want any more information, so, or any other questions at all? Mhm. Yes. I think we're gonna end it there then guys, if no one has any more questions, um, I hope that was helpful. Um And yeah, this has all been recorded as well. So um if you want to keep it for further reference, um you can always come back to it because obviously August is still a month in a better way. Um Yeah, good luck for fun and I'm sure you'll all be amazing, don't worry.