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on that cyst going live. Okay, Okay. And everyone, welcome to our fifth mindedly webinar. You know, if I want survival quite serious. Um, today's talk breaks down organization skills on seeking sport. It's going to be delivered by my colleague, Dr Pamela Surges left. Why wants you to be at, what, two in the West Midlands? Just a reminder that this weapon I will be recorded in the blood to meddle under mindedly future channel. He's a moment to ask questions in the chopped myself with my colleague hams that will be available throughout the talk. Talk to any questions. I will have a Q and A session with doctors. Surgeons at the end on go through everything that you guys are worried about, we'll have any concerns with Yeah. Remembered. Some free weekly, webinars or post Think in the chart. Well, supposed to think for the feedback forming the chapped, the end of the webinar, which will enable you to guess to figure of attendance for your F well on portfolio without further ado. More 100. It's Pamela. Thanks. Hi, I'm Pam. I'm F one in the same hospital as on. They've asked me to talk to you today about organizational skills and seeking support. Um, firstly, I'd say organizations, girls comes with practice so I can give you a couple of tips, which you might have picked up already throughout medical school. Um, but on the whole, the sort things develop as you work through your different departments and pick up tips from each other and seen your colleagues. Um, and lastly, seeking support was always a train of escalation. Whether it's I have a personal advice or for professional advice or with the patients that will touch on that at the end of well, so in this session, we'll just do a brief introduction. Um, talk about effective lists, how to prioritize your jobs for the day. And what typically war today might look like who you hand over to at the end of the day on day when you escalate things on, do what to do if you're working overtime. So they had the introduction. This is picture of me and my colleagues on first rotation. New fresh F ones. Um, we started in Upper GI I surgery, um, four months there, then moved onto medicine. I did in elderly care on then. Currently now I'm on psychiatry doing the old age psychiatry. All three rotations are very different. Expectations of you are very different on, But, um, I'll try and talk it through tips for the more surgical medical side of things. So firstly effective lists some people make 100 lists on Do. Some departments will have Excel spreadsheets. Some will have word documents on, but that's all dictated by the team that you're working with. So, for example, in surgery on this, a spreadsheet and on day that will be different based on what hospital you were placed in. But generically, a list would contain the patient's name, the patient's date of birth. So you've got their age on the hospital number. Usually the presenting complaint will be on that list on Ben. Either the working diagnosis or the diagnosis. Um, it's important. Have some background so that you are up to date with what other medical conditions they've got on. While she'll need to look after well, so they're in hospital. On that list, you'll have bloods, so you need to keep that list up to date. If it's Elektronik on back, sure that blood results are kept up to date as well, so that people can keep an eye on trends. Um, and at the end of that list, you always have rolling jobs or ongoing things to chase. So this is where this box of drawn with half filled is the important box that we all draw. So we will draw an empty box if it's a job today and then we'll half filled that box. If we have requested the scan or we're waiting on results and then once the job is done, we feel that box out, and that's written on our own sheets. What sometimes important to do is when you're making notes in the patient. Voldermort is to also put boxes next to the plan so that the nurses and other stuff can see where you're up to with the jobs on. This is often missed, I think, by a lot of people because they're so focused on their own jobs and what they've got to do in their own list. But as you go around to make notes on your wall, drowns and make Parton's, you should also put a little box next to each task and take them off. I should go along and then everyone is on the same page and then know where your to. Um, what do you have? All? Haven't requested a scan in the morning when you go to a hand over. Sometimes this might be hand over from the night team who have been on call. Or it might just be a board round if you're meeting your ward team, but always just have a pen and paper with you anyway, Whether or not it's an Elektronik system, I think it's important to always have that pen and paper with you in case there's something important you need to note down that you might forget or somebody asks you as the f want to do something specifically again, just note down the patients i d. So you can look them up on the computer on do weather at and what the task is that you've been asked today with war drowns. Like I said, a rolling glasses updated every day throughout the day, and at the end of the day, it might be you get to a ward. A new awards doesn't have a list, and you might be the first person to start that list. But it's important to get to know your team on see what works for them. Onda for you Making a job list. You just have that pen and paper ready on day. Write down everything because some things might get handed to you. That wasn't obvious. But if you've got it written down, you can ask about it at the end of hand over. So the typical jobs that you'll be writing on your list will be to chase bullets, to print blood forms or to do the Bloods. Um, you might have to review easy. Geez, you might be writing referrals to another department that might be online. Or it might be over the phone that you're asking for a opinion or someone to come in. Review a patient, um, scan requests. So whether that's an X ray or CT scan or MRI, and make sure that seniors have vetted the's before you request them. Because if one is, you shouldn't really be requesting scans until a senior said so and then, obviously throughout the day, if you've requested that scan, you need to make sure that you follow up. That scan is well, you can't just leave it and expect that your senior will be chasing that. So make sure that you write that down on your list. So you don't forget that you need to check if this patient has had the scan and what the results show. Sometimes guns come back and they haven't got a report with them. So you'll need your senior to look at the scum with you as many X rays as you might have seen. We all miss things on CT scans. I'm still not okay with reading them. So a senior will always need to look at the scan with you. But it's still your responsibility to check. This comes been done and the results are back. Other jobs are ongoing. Our drug cards, whether it's prescribing new medications or putting out more fluids or rewriting the whole card again. Some of you might have Elektronik systems he might do Elektronik describing, so that's much easier. But again, it will be something on your job list. Somebody from the night might not have gotten around to doing the V T or doing the drug chart, so it's something to add to your list on then distrust Summers. We often in our hospital. Just put hates next to a patient and circle it, which means they're going home, which we know means we need to do a discharge summary. It's it's better to just write that you've got to do the discharge summary, or TTL, because you will need to review all the medications before they go home, whether or not you need to order anything with pharmacy, whether you need an F P 10, which you will need an S h o r above to write for you or whether you're just going to restart all the meds that they came in on a swell asses. Add any additional ones like antibiotics. So these are the generic jobs have always gonna be the old other thing filtering through. But these are your mainstay everyday jobs in terms of how you prioritize these jobs. Obviously, at handovers, senior doctors will highlight who are the poorly patients for you to look after on who you need to be aware off on any tasks that need to be done for that patient will need to happen. First is important that radiology scans are requested a surly on in the day as possible. Um, most radiology department's Don't open until nine o'clock. But again, that's different for every hospital. Um, soon as you've done those radiology requests or reviewed a poorly patient, then you can get on with all the other tasks. Getting blood stone early is good because then you can see the blood results throughout the day on discharge summaries. You need to prioritize whether transport is being booked for a patient or if they're going to a nursing home. And you need to get that patient out quickly so it depends on the patient as to how quick the discharge somewhere is. NASA's will always come and knock you before discharge summaries on. That's a constant daily thing, but you need to prioritize yourself whether that patient is okay to wait until you do another more important task, or whether that patient can go home imminently on there waiting on carers and package of care throughout the day. Um, like I said, you will be tracing of those bloods on the scan requests that you've made, and you'll also need to update your seniors. I should go along so you're not by yourself all day. Is the F one left alone to do the jobs now There it is, the order cation where that might happen, but it's rare on. But once you've done a job, say you get the results back off the patient's blood that you took earlier that day on they've got a raise. CRP. You'll need to let your senior know, because you need to find the source of that race. CRP, Onda formulate another part. So it is important to make sure that once you've checked bloods, you informed the rest of your team that might be the S H O or it might be the registrar. But either way, communication is the key to all of these jobs as well. At the end of your day, things that you do last will be putting out new blood form for the morning. So this will save you a task the next day that you won't have to blow the patient the phlebotomist, so we'll be able to do it for you. If you've been organized on put out your blood forms. There is no need to bleed every patient every day unless your seniors asked for that. Unless it's really feeding bloods on the patient. Is that red at risk of re feeding syndrome. So then, yes, they'll have daily birds. So check which patients need bloods put in out printed forms ready ordered the tests ready, and that'll save you a job the next day. If you have been really efficient and got so many jobs done and you know the patient will be going home. But you're just waiting for a package of care. Then you could prep the discharge ready. So then the next day or you have to do is update it. Um, also, at the end of the day, check that patients who are about to finish and eight hours back 10 hour bag if they still need fluid if they a bowel obstruction. Or they're in a K I patient that make sure that you put in the fluids to get them through the night because that's helping your night colleagues that are on call or during the night shift, and they won't get believed just to come and prescribe fluids on awards that you've been working on on. The same goes for warfarin prescriptions. Just at the end of the day, check all your patients drug chart, see who needs warfarin prescribe and see who needs fluid prescribe in on day. It's just tying up the loose ends at the end of the day. Now none of us are perfect, and we won't all get this organized straight away, and they'll be times where we just want to make it through the day and get the important job stone. But with time, you'll pick up on these tasks where you are just preparing for the next day and helping your colleagues who are coming on the next shift. So a typical day on the ward, like a sets handover or bald round, will be the first thing that you do. I often would come in 10 to 15 minutes early to make sure the list is up to date. Um, the list is like the Bible. In some departments, other departments function without it. There's been many times I've been sent to another ward on down the only one that, and they don't have a list. So then I make my own list. But it's just important to know who your patients are on where they are, because overnight they might have moved to a different ward on before the rest of your team comes in. You want to make sure that you've got all the locations of those patients and where they are in the hospital if they've moved. Um, before you go on a walk around, make sure you have some blank request forms with you. Say, um, this is if it's all 100 have a radiology card ready with you. Any spare continuation sheets in case of on and in the notes. Any consent forms ready if you're working on surgery and you know that patient might be going in for a lot cooler, so just have a couple of forms blank and spare, and it'll save you later because you can fill them in as you're going around on the wart, Um, prepping patient notes. So a lot of the time consultants will come to see the patient or the registrar on, but they'll want to see that the notes are ready for them. They don't want to come and the notes of blank they want to see on the notes that you've got the patient's sticker in place. You've written the date and time on location and all their background, including any symptoms, have come in with what's happening in the past 24 hours. What are their up to date? Blood? Somewhat Other observations. I know you've already had a talk on documentation and things by Hamza's, so I won't go through that. But that is a way to get organized. To start your day is to start prepping those patient nights before and the consult it comes. And sometimes the consultant might not come until 10 to see your patients because they're on another ward. And in surgery, it's not always the consultant comes. It's a much stronger, but you know they will have to go around different wards. So just get yourself prepared for the rest of the day whilst you on the ward is just staying on top of that list and taking off the tasks that you've been asked to do. You're task list will be dependent on the management plan that you've made on the wall drowned. So as you're making in a patient plan in the notes for the management, you need to add those jobs to your list on. That's why it's important to have that spare piece of pen and paper with you or the list with you so you can add those jobs on you don't want to finish the war drowned and then go back through every patient notes to find out what the jobs were. So just have your piece of paper ready to write the plan on to that job list. Um, so yes, so you'll again table. It's her discharges. Request scans, drug charts, and those will be the main jobs that you have today. So when you have finished at the end of your day, sometimes you might not have got all the job stone. On day, when you're new, you feel that it's important that you stay in, you do it. It's your responsibility on DTA a certain extent that is correct. You should stay on. Do you should finish some of the tasks, say, if you're halfway through right in the discharge summary doesn't mean you can just clock off a 500 over you finish that summary, but there are some tasks that might require a few more hours of work, and it's okay, Tom, those jobs over, um, but some things you need to determine whether it's okay for them to wait till the next day. So if you're working in medicine, normal is award. Call for Dr Ron from five o'clock and they will have a bleed and you can bleed, thumb and hunt over any important tasks that need to happen before you come back in the next day. So they like this hand over to be quite efficient, whether it's impersonal over the phone, they want to know what the task is, what the background of the patient is. Why does this test need to be done tonight and tell them where the patient is? So, for example, say that a lady has come in on day, she's hyperkalemic on their four in the day. You put her on some IV potassium, and that's not going to finish till 10 o'clock at night. You then needs that potassium level. Check in after the infusions finished so you can have that job over whether that's to some phlebotomist that is on the ward at night or hospital at 19 more medical assistant. You can get somebody else to bleed them, but you need a doctor to chase it that result to see if that doctor needs to give him another backup. Potassium so these are appropriate jobs. 200 over. Also. Any patient that you're concerned about say they've been scoring all day. Normally, the registrar will be aware of them, cause you should have already highlighted it. But you can hunt over these shops a swell, um, these handover jobs normally or two in a safe year and above. But sometimes there isn't a breath one that will be covered in the wards. So when to escalate when you're working on. But you know, to a job as much as five years, you think might prepare you. There are times where you're worried or concerned, and you don't know what today on D you should have a low threshold to start with, especially when you have not work so low by yourself. So no your limitations. And if you feel concerned in your gut feelings as I need help, then call for help. That will be go to your senior, which will be your S h o or go to straight to the registrar. If that person is gone home, there's no shame and asking for help. And what you'll find in the hospital is that the related people to help even nurses that are on the award who have got years more experience in you. We'll say, Do you want me to call someone? Or do you think we should do this or what? Do you think about this? Work together? Always do a thorough 80 assessment. There are really good APS, like the F Y one hand book that shows you exactly step by step, how to do in a two a assessment, and then you won't be missing anything. Gather all the information because if you are going to escalate, you need to give the right information to that senior doctor. So Diovan, eight way get their recent results. Get their recent observations if they are scoring 31 parameter, which is a new thing for actress or you think it's sepsis and you you need to act on that on. We've been trained to deal with things like that, but you still need to escalate to a senior. Sometimes different departments will say a year score of five is when you escalate or a you score of seven is when you escalate, you need to escalate when you feel that you need the help, but don't leave it too late. And don't think that you can handle everything by itself because none of us can. Um and there is a big big team around you in the hospital. Um, it's all about communication. I would say a lot of mistakes happen because people are too scared to ask or too proud to ask for help. So escalate as soon as you feel uncomfortable. And even if they said that's an inappropriate skull, a shin at least all you were thinking about his patient safety and patient care with working overtime. So to start with, I was told this was a choice you're choosing to stay late on. But sometimes, yes, that was true because I wanted the next day to be more organized, so I stayed a bit later the day before, Um, whether that was just making the list I d or putting Apple it forms. This will come with time. We all work late. Sometimes on there are situations where you can't help whether patients got into cardiac arrest or a patient disguise that they're going to score in 11 on the you system on. But it's 5 to 5, and you've just been alerted by the nurse about it now, a lot of people would say That's something you should hand over. However, Sometimes, if that's the patient you've been looking after all day and you know a lot about them, then you might have to stay half in our later just to make sure things have handed over properly. So there are circumstances where you will work over time and it can't be helped. There are other times where you work over time because there aren't enough stuff on the ward and that's not your fault. Or the road has not been done, probably, or people have phoned in sick on. But there's a thing called exception reporting where you can log, how many hours have stayed over, why you stayed over on. Do with these hours. Sometimes you can clean these hours back, or sometimes you can be paid for the hours you've done. However, it is quite a long process to do exceptionally important, and I have to be honest. I've never done it myself because initially when you start off is enough. One. You expect that you're going to stay late sometimes while you're learning the job, and then as time went on, I learned I don't need stay late. I know how turned over. I know which things can wait till tomorrow on which things can't on Sometimes if I did say that it was my own choice because I might be doing a Nordic or I might actually just want to follow a case through, Um, sometimes if you in surgery, you want to see a case and 50 people states. So, yeah, it does become a choice sometimes, but sometimes it's circumstances, and you are well within your rights to report any time that you've done over, because it was out of your control and stuffing was poor or you didn't have the support there. There's also is called something called the Garden of Safe Working Again. I've not used it. So happens only home might be out of a trip in at the end about this, but we do get a lot of emails about they are around for droppin sessions. You can talk to them about the hours that you've been doing or circumstances off your working day on, but I know as it's very good. She's really nice, but I have not personally gone to her with any concerns because everything has been out a deal with within the team on. But that's because of communication. It's really important that you communicate everything with your team. Andi, don't think that you're in it by yourself. So if you do need to, you can talk to the God in the safe, work in about you hours about your working conditions. But again, that's going to be based on whatever trust urine on how active they are. That was really quick because I felt that this session is more important for you to just ask questions about, um being enough one day to day things on. Do anything avoided, mentioned. If you want me to go into more detail, you can. But I do feel it's more important for you to learn this stuff as you go along on. Do ask questions as you go along and I'm happy to ask. And so any questions you have, thank you. We're just going to very short video by the MD you before we go on toe a Q and a session. So Shanghai scream. Can you go to see the video? Yeah. Okay. Thank you. So, um oh, well to the Q and A session now. So began guys, for your questions and chanting will ask a doctor Pamela, about these questions. So the first question family have a question by, uh, one of our viewers when documenting notes, is so Method good or ABC up? It's a media with the so for ABC method, Pamela, or do you have in your message? Works. So in surgery, I was taught to use the soap method on diet. Think, answer. You've probably talked about that in your documentation. Talk a swell and it's nice and so sink. The difference you'll find between rotations is that clocking and making notes in surgery is very different when you do it in medicine. So in surgery, they're like one sentence. No, it's very quick to the point, and using soap is really still there. However, in medicine each day and see a patient would be a good page and a half of notes. They're much more thorough, and they don't use the soap method. Um, they want to know what the patient came in with, what the new symptoms are, what the diagnosis is or what the working diagnosis is. They want to know the Bloods. Their observations. Whether you reviewed their drug card, what's changed, what the urine output is, what their dietary intake ear's on. But then you will examine the patient. So is a lot more thorough and medicine. Um, so I wouldn't suggest using the soap medicine for medicine method for medicine. Sorry. So, um, anything house? I mean, they'll come up with different ways of doing it when you're on your rewards. And I'd have a look at how people Clark and how they make notes, so you'll have to go with what your team prefers. But medicines, surgery very different. There's nothing wrong with either a song that you've got the key details. Then keep it up. Another question from the same Buerk. Is it advisable to write date and time in observation on the patient's she before seeing them on a war drowned? And have you ever got into trouble because of pre writing notes or pre prepping notes? Before seeing this patient, would you advise this technique? Yeah, absolutely. Like a said, getting organized part of being organized is prepping those notes with the dates. Don't put the time because until that patient's been seeing it's wrong to put the time of eight o'clock just cause your prep, you know it's the eight doesn't mean the patient was seen at eight. You need to put the time as you're seeing the patient. But yes, you can put their observations for that morning and the most recent blood results as long as you put the date next to those blood results. So if those blood results are from two days ago and you've written them all down, make sure you write in brackets that these are from the 21st because of the wise. You're leading people to believe that there's a fresh bloods today. I haven't got in trouble for pre right again, you know, it's probably in trouble for not prepping enough notes, but, yeah, you wouldn't get in trouble for prepping notes as long as you're doing it right way. Have a question from Chloe. How do you establish which jobs are within your, um, it's It's something you haven't encountered before. Or is it just something you got for experience? That's a really good question. Um, because there's sometimes where I say as an F one, um, I allowed to do this. So yeah. Um, like I said, with scans, it will be expected. You know, if you listen to a patient's lungs and you can hear crackles, it'll be expected that you order that chest X ray, and there's no harm in that. However, it is not expected that you are going to go in order a CT, abdomen and pelvis by yourself to go and discuss it with radiology. Once your seniors requested that, then yes sizes with your email saying with MRI scums, they have to be signed off by a consultant in actress. I don't know if it's same everywhere else, but you'll soon learn with experience what you can and can't do. And there's always a day where there's something you've never done before, but you're still expected to do it, whether it's a new form or a new referral or a new procedure. But don't do something to a patient that you've never done before. Always get someone to teach you or observe you doing at first because you need to cover your own back as well as look after the patient. So, yeah, you will learn it. I should get along on Do you want Also be told as an F one. You cannot write this, Peter. It has to be in. Shh. But yeah, they don't tell you these things. That medical school until you go to the shop, Um, you learn I should get along. Yeah, I definitely agree with that. That's something you learn on the job. Wouldn't experience. I don't know if you have anything to add to that. Me? How? Oh, you know, if you mean how Would agree with both of us. Agreed. Always think it's something you love with experience. Um, yeah, ordering scans. We can order things that chest X rays, abdominal X rays if we think they're indicated. But things like CT's and MRI's. We talk to our seniors again with other things. Yeah, you learned on a day to day basis what you do and what the seniors do. So I agree with family Comes in. Yeah, just be careful with this gun's every every hospital. Be different about what you can and can't older. It's an F one, Um, but find the hours soon as you can. So prion car on has another question for you. Pamela. She's asking about writing fluid for patients overnight. You do that notation. So would you do that for the quality to do? Yeah. So I mentioned this is one of your end of day jobs. So So you have got a patient that is in a K I on drip mint for that is obviously lots of IV fluids on, depending on the age. And how about the A K? So if you have written up in eight hour bag or 10 are back, you need to be aware of what time that bag of fluids going to finish on. D. You should have made a plan with your day team and your seniors as to how long this patient will need to be on fluids fall. So, yes, you should write up fluids before you go home for any patient that needs that, because it's not fair for someone to be woken up, probably just for back of fluid on, because it takes all of 10 seconds for you to write that up. So at the beginning of your day, when you're doing your wardrobe, just make sure you've got that part in place of this patient's going to need IV fluids for the next 24 hours and make sure you've written those bags up already. It can be done at the beginning of the day. Just calculate how many hours you've given on day where that takes you up to, um, because it's just a really nice gesture, a swell for your nighttime TV. Yeah, I agree, because you will know this patient as well of being a spot of the dating. The Uncle T might not necessarily necessarily know this patient is in a K. I might be busy as well, so things might get delayed. So try to need less, a little less you can to be on. Whole team could still have other emergencies. Another pressing jobs to do well just after that. Guys as one of our consultants, he says. You know, if a patient is on maintenance fluids, do they need to be having fluids overnight so we don't drink fluids overnight? Do a while we're sleeping. So unless it's you know, for something that we need for you is like a K R. Whatever. You don't need to be prescribing fluids for patients on Maintenance IV's overnight. Okay, Number up has a question she has. She's asking you. Pamela, Do you have any tips for someone who's going from paper to electronic mode of documentation? Oh, prescribing. Yeah. So, luckily, whilst time in psychiatry at the moment I've actually gone from 100 notes to Elektronik notes. Um, And when I did on elective in Great Ormond Street, it was all Elektronik prescribing as well. So I find that anything collect tronic is a lot safer. Um, when you do, Elektronik notes, you've seen to write a lot more throughout the day, so it's a better way of communication years. So if I've gone to review a patient because they said they've got chest pain and I can type that up straight away, it's legible for everybody on. Everyone can see what time it happened. I haven't had to log what time it's happened to haven't had to look. The patient details. It's a lot. They're ready. Um, so it is really useful to use Elektronik, and it's a lot easier. Saves you a lot of time. Elektronik prescribing. We use that only when we're due in discharge summaries, studies a searching for medications. Um, you don't have to be enough. Everything. All the formulations around there so you can pick what strength medication you want. Um, and you know, alerts will come up to stop you from doing things that you shouldn't dio. Same with saving things. So it is a lot safer in NATO. There's not really any tips for it's just that it's a lot easier when if you get the chance to work that way on gets, just say for that, everyone can read what's going on and plans up today, and nurses will also be out of right in the same notes. So when it's paper notes, the nurses have the separate folder on the doctor's right in a separate folder. Where's on Elektronik notes. Everyone's right in the same place, so you can see in really time what's been happening with that patient over 24 hours. Yeah, the end of the day, the same principles life, both Elektronik and people nodes. But as Pamelor is pointed out, it's easier with Elektronik notes, and everyone starts getting seen in the chance in the hall, and I have posted the link for the feedback forms, so we'll help us and your help with that as well to deliver future talks. But you also get a certificate of the tendons, which you use for your or video on filling out to skip that form to please fill it on the few that form. Do we have any more questions? Feel free to put them in the chances we go. Any more questions for you? Right. I think that's it for today. Thank you for your talk. Pamela. Certainly learned a lot. I was. Well, you should know by now. Basically, we got one more question. Problem. Do you want to give the question? Yeah. Actual. Chloe has also How do you manage moving between specialties? Yeah, that's good. Um, to be honest, it is quite daunting moving from surgery two medicines that Oh, my goodness. This is gonna be horrible. However, What? I don't know whether everyone has this in the trust, but it is part of the curriculum. I think that on training that you have space a shadow, somebody in your next rotation for a day or two so you can learn what the job is and how it runs before you just get dumped. Their So normally that happens within the last few weeks, and it's up to you to organize it. Find which F one is currently doing the job that you're going to be doing in the next specialty on Just arrange a day to follow them and get some tips of thumb. We all share tips such a lot on Be on DWI, have group chats and just give each of the tips along the way. So there's always another F one that you're probably shadow. Um, so save moving from surgery to medicine. You're going to have an area within medicine that you're going to be based on whether that's gastro, well, cardio. And you'll probably want to just read up a little bit on the area, revise some of your medical stuff, see what the common disorders that you're going to encounter. Um, but, yeah, just speak to your colleagues that are already in those specialties and arrange your shadowing day. Um, yeah, moving specialty is within the first few weeks. It's always hard to find in your feet again, but once you've done one, it really becomes easier. You settle down quite quickly. Um, expectations can be different. Um, what medical registrar expects of you. Compared to a surgical, a straw is very different. compared to what My psychiatric registrar expects, that there are different expectations. But that can be a person dependent, not just specialty dependence on the same with consultants. I think because you're off ones, they'll think that, you know, everything kind of fresh out of meds school. But you certainly lose what you've learned because you're so busy trying to do bloods and chase guns that you've forgotten the whole process of diagnosing a patient and managing them. So you know, every person's going to question you different and ask you to different, different things. But you, honestly, you just learn it as you go along. And it's not as daunting as everyone makes out to be way. Have another question, which is common. Is it advisable to have a war war jobs list or personal jobs list? Or just this, as in a book for the whole team to use or your own personal list of jobs? So again, this is dependent on the team that you're working in. So currently in psychiatry, we have, like a shared document where we put a lot of jobs on, and then we assign the tasks to each of us and share them out. Um, if you're doing a wardrobe and there's two or three of you, whether it's F one S h O or a C P on do you make the management plan, you make the list at the end of that war drowned. Usually, you all go through that list of jobs on. Do you share them out? Some days you might have teaching in the afternoon, so there's no way you're going to about to get those jobs done. Um, or the registrar is in clinic, and you were about to contact them to do anything, so you know they will need to communicate with you just a much about those jobs. So I make a personal list anyway, and I'm just organized in the sense that I like to make a list of everything and then put my name next two things, but also just to help my colleagues out to know what jobs there are to do is a whole team on D. We can help each other, so depends on the ward that you're on and say Make a personal list anyway. And there's no harm in having your list that you keep a song that you're not taking patient details home with you on that list. Yeah, I agree. It's good to have your own personal this so you can keep on top of your jobs. Your where's well, but the advantage of having a war draw this is well, is then, if you're not in the next day, your colleagues know what jobs have been done and as families that you you can share the jobs as well as you go. So there are advantages to both, and it will depend on which TV working. Oh, just a reminder. So, for your certificate of attendance, you can use this as your non call teaching hours. We at one. So it's part of one. You have to attend to you, Jane, to $30 of course, and 30 hours of non courted gym. So attending this talk and getting the certificate, you can use it for an hour off non court itching session. So that's beneficial for you guys as well. Okay, We have the old questions from the audience for Pamela. I think that's it. Thank you, ma'am. Thank you for this. Thank you. Hi.