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Hello, everyone. And welcome to the weekly in mind a bleed Lebanon on had to prepare for F one. Um, tonight the session is going to be let by myself and Dr Ben Terna, and we're going to teo you some talked. It's for medical and surgical F y once that we have got it delivered issue because of your justified to finish up one before we start. Just a quick shot. A to the MD. He's a response. Er, don't forget to sign. Appetit started your indemnity cover for this year because your student memberships going to expire. We're going to pose dealing in a common section, Um, additionally, Please feel free to ask questions as we go just most of the common section. And then, if you remember questions later, we can always ask them at the end. And then you can always send us any questions by the mind of Facebook Page and, oh, is there anything else I need to mention? I think this is the most important important information before we start, and not just saying that because it's all presentation on the's are really life tips. Some so is going to help with with a Q and A of the end. And we're also going to pose the link for you to sign up for any future weaponize so you don't miss anything on? Uh, just a reminder that all the contents recorded so you can access it later. And you were also the email, the slides. If you sign up for it, it would be nice. So we're post all the links in there in a comment section on ball of this will be available available to you and these please feel free to ask as many questions as you want, because if you're about to start that one, you want to know the answer is that you're getting all right so I'll just send over to hi guys. So we thought we just kick it off with how you're gonna be feeling right now. Don't worry. You're gonna feel anxious. No, only are you meeting a new team on the ward's You're actually doing a job that effectively you've never done before. But don't worry too much about that job because you're not going to be jumping straight into 80 week. You're actually going to be typing and scribing everything. You're consultant on, Reg says on. For that reason, it's actually really important to be organized, be reliable. Make sure you understand everything that they're saying. Okay? And if you're unsure about something, it's a bit of a question of where to start. But one of the things we really recommend is speaking to your essay. Chose because these are the guys that have done the job for a least one year already. They're probably gonna have worked in the center or a similar center to you on going to be able to give you a little top tips on how to order the scouts. How to make those referrals. Where to find this. Who to ask what team to refer to on gonna needle of that over the coming year for sure. Throughout everything. Just remember that or you're trying to do is deliver good patient, cat on. So if things are frustrating, people are being mean to you. Something goes wrong. Just remember, keep the patient's safe, the patient comes first. And if you do that, you're not gonna run into any trouble. Just always put the patient first. All right, so we're just going to see let you know what we're going to talk about. We're going to Teo. You top tips on what to do when you're right in the woods. How to survive. Award rent. We're going to talk a bit by the war jobs that you will have to do probably most days, Mr Summaries and TTS, which will be or Red and Bassa. Um, how do you do an effective hand over some tips for being uncle at. What do you do to get the most out of your showing periods and some tips for the surgery? Right? Asians, there is plenty t to go free. They're going to crack. Um, okay, so arriving on the ward first thing in the morning, you can make such a huge difference in people's days. And you'll be really surprised at this. If you're the chirpy one who comes in and gives ever on a big friendly Hello, you set the tone for the entire day. You can get on with all the nursing staff, make sure you introduce you, say Upsell. Say hello to anyone on. Then it's important to check whether there was anything that happened overnight. Then what? I've seen medical issues that might have been nursing issues. A patient like common, few confused there may have seen a call out or even a medical emergency overnight. So it's important that you is the first medical person who's arriving there. Start of the day does this will check with the team, see how they're everyone's doing. Introduce yourself on. Stop building. This good group Whole is important to ask the nurses because they normally have their hand over around seven o'clock or 7. 30. So they are actually going to be the first part of going well, no. What happened overnight, you can then go and check the notes and take away from that. What? You well, grab a computer, grab a coffee and start dropping those notes cause it especially if you're on a paper system, it can take some serious time. The others so surviving the ward round itself. This convey, uh, this convict quite in arduous task at times, medical world rounds. We'll start it around nine o'clock. A May Well run until one or even two o'clock. I'm so sorry to tell you, you didn't already know this, but especially the Jerries water runs. They can be really long. Um, surgical ward rounds you might be done by 99 30 is much better. The important thing is to be polite. The consultant be punctual. If you're not there on time to start the war drowned, they'll be right, crosses the on Be fast. You need to learn how to document efficiently on. We've sort of come up with a suggested method that's quite a tried and tested one across hospitals that will go through in a minute. If there's something you haven't heard or don't understand on the ward around, make sure you clarify it with the consultant because if they come back the next day and ask you about it and you don't have a response, that's going to be a bit tricky to defense on. Similarly, the consult might go okay, started picks about the picture, and if you know the days, that is a very quick and easy job. But if it's not, then you have to come back later. You have to find the drug charge. Look it up in the banana, so try to have some of those doses of common drugs, like antibiotics anticoagulant with you to hand so you know exactly what you're doing going in. You should be in very never be by yourself a surgeon. Yeah, there should be other. Junior is there with you and you can You can handle the jobs by acting working together as a team so that you say one person's preparing notes while the other person's going into the room with the previous patient on the consultant and documenting for them. You can keep one big jobs less all together so that once yet the end of the war drowned. You don't have to go back through and look at the notes because that takes a significant amount of extra time. So we thought We just walk you through a Mach up of award round and we've done the end of crime job our hospital on. So we got, say, an endocrine ward round prime example here from a doctor Smith. And you can see we put the title of the war around that that's at the top. Don't Smith and we put in brackets that he's a consultant. You put a date and time, which is very important for the medical legal issues. Always put a date and time on every single page, he ever write on on the computers. This isn't so much of an issue, but on paper, very much. It's so we got a 27 year old lady. We've used all the abbreviation said. You can see and incorporate them to save yourself time. She's admitted with abdominal pain, nausea and vomiting. That's the date she was admitted, so we can see how long she's been in hospital for, and we've got her background there of Type one diabetes. Then you move on to the current issues of the of the patients. Stay in a hospital so you can see that we're treating her for number one diabetic ketoacidosis on those were her admission statistics. We can see we treated her with a fixed rate insulin infusion. At five units an hour, we've managed Teo Resolve the acidosis. That's the key. Tones have come down. The bicarb is come up. We've also put in HB a one C there, and that's useful for understanding how good this lady's diabetes control my beer. So you're just trying to make it so that if someone's flicking back through the notes, they can understand really easily what the issues are with the patient on. If something acute has happened, how they might, how they might interpret those in light of the patient's new issue. So second, we're treating her for sepsis, and we put the white blood cell count and the CRP is the inflammatory markers there. And we've also put a bit about the antibiotics and the investigations that now the antibiotics are really useful to have on there, because if the patient starts spiking again and the team comes in the middle of the night, it's not gonna be useful to give them the same antibiotics again. Because, you know, the patient's spiking on those so the team will be able to escalate the antibiotics, and I'll be able to see how long the patients being on four. And then we just put that the this leg has gotten a Chaoda's well. So that's your first part of the war drowned documentation. Then you always put the new score, and if then using to, you might want to put what that news talks. New score of two. It's four. So the the tachycardia there in the slightly low BP got the rest of the obs on. Then, if you've got time. It's really good to put the important blood stem, uh, on that So you can see here that we've put your ear 3.7, and then brackets, it's 8.2. That is a next wave documenting that on these bloods. The your ear is 3.7. On the previous days. Bloods, it was 8.2. On the last result that you've got on the system. It was 8.2, and similarly with their crafting there. And we can see that this is also showing that the CRP is coming down as well. Then you have your review part. So you start writing as the consultant is going through. How do you fill Ms James? Well, I'm feeling okay. My tell your pain is getting a bit better. I still have a builder stinging when I go to the loo. Your your documenting this in a in a medical way, into the notes. Um, you can see that that just talking through the history, you basically just have to write down what the consultant is asking A patient. Um, we can see that she's a bit stressed that she hasn't been checking her blood sugar And then she got some vomiting and that's probably and then she stopped taking her instant in the same and sometimes have to be very quick when you did up because the consult use good for things very quickly. Eso you finish up the war drowned documentation by saying that your impression overall is so It's here is someone. It is diabetic, his associates And that's because she missed insulin basis. She also got some your sepsis and she got naked eye because of dehydration. So then you have to doctor in the plan, which is gonna be a lot These things here in this case, make sure you document everypony on when you come out of the room. Just just run the plan past the consultant, especially right in this starts to say okay dot smith you have with this. So we're going to chase the urine culture. We're going to continue, come up splattered today IV. We'll get the diabetes nurse to come and do the insulin indication will move over to variable rate on. Then hopefully tomorrow we can aim home. I'll start doing the discharge summary. That's a perfect little summary. And make sure you haven't missed anything. And then you must finish by saying your name your position on leave you bleed number so that you could be contacted. I'd also say that especially at the beginning, things can be very confusing and wrapping your head around what has happened to the patient? Why they got the treatment that they they were offered is a bit tricky. So the impression part of that nose rising for me was one of the most important things because this gives you the opportunity, clarify with a consult and what the actual thing has happened. And so I construct enough. That's when you're writing. You're this. Start this. When you write your ward, find entry. Just make sure you ask the consultant by the impression, because that will help you just arrange everything your head and then the plan to make much more sense, okay into a little bit about referral. So especially at the start, you won't be expected to refer to specialties. However, over time, people will forget quite quickly that you're the new kid on the block and they'll just start handing you a referral to do on D. I can really empathize because I found referrals. So scary of the starting. I think it is a very natural thing because you're the new F one on the wart on your referring to a Reg, They might be an ST seven s c a Reg nearly a consultant. And you're there like, uh uh, My cousin told me. I don't say. I mean, um is really scary guy. So there you have a lot going to have heard of s bar before, but it's really important to remember before you even get to us far. Make sure you sit down with everything there. It's so useful. Get the drug chart, get the obs. Make sure you have the bloods up in front of you and get the patient notes. That way, when they ask you like Okay, I'm also BP. You don't have to go. I'm really sorry. Can I just go and get that? And they go? No. But also, if it does happen, the usual thing is if he start realized and they don't have the crucial information you already on the phone with, somebody went to a 30 just trying to come down as them exactly what information they need and give him a call back. So that's your That's a great get out of jail card. Okay, so we got here. Yes, I get a lot stuff together. And then if it projected, just politely ask their name what further information they need, And then basically, just going to talk to your regimen out there for you. So here's the short example. When you're when you need to convey information in a time Critical manna. I'm sure everyone is aware of the bar formats. So we're starting with situations, so you have to quickly introduce yourselves. And here the example is that I'm introducing myself a star of the F I want on A me, which is the acute medical unit. I'm calling to referring patient for a possible stemi, um, for consideration of PCI. Then we have to give a bit of a background information on the patient, and so that's most likely going to be what they presented with how old they are. Um, what has happened and what are some of their investigations and observation results? So in here we have a 44 year old male because the current ex sounding chest pain started for a M but it's not improved of the GN. They also have acute pulmonary edema on the see. Do they have until your ST elevation and the troponin of 2100? They had cabbage last year. They have diabetes too, And hypertension. Then you have to provide your assessments. So in this situation I needed this patient is having a stem. It e on the recommendation. So what I actually went from the patient is on the other side of the phone is to review the patient for a PCI. So that's just a if you need something. Um, yeah, it's time pressure. I need to convey just the most important formacion sick, quite useful and heading to use. Um, so some of us are actually running a project on referrals at the moment because, uh, we may have seen the receiving end of some serious biracial from seniors on. It is a really scary thing to do, eh? So in mind, oblique, we've actually generated their referrals cheat sheet on. It has general stuff about referring Teo medical surgical specialties. But it also has a specific examples for each specialty. I would encourage you to go and use this cheat sheet online blip because it's super useful basically on consider a lot off embarrassment, fear stuff like that on. But if you do use this cici on you like here, or you have some feedback for us, it be super useful to hear about it. And you can just use this. Good performs that we've popped up the bottom of the page here onto another especially scary part off the FBI one, which is going and facing the radiologist. So getting scans falls into two parts. Really? Is booking a scan online on then, depending on the nature of the scan, like CT ultrasound, MRI, those kind of things they'll need to be vetted by a radiologist who basically will read the information you've given online on. They can be quite fierce creatures who were last in by your scan, so it's really useful. Teo, have some tips going into this situation before you put on the back foot, because what will happen? So you're on surgery. The consultant in morning will come around have filled it. Tell me, say the patient, two days postop ago. Get a CT and they won't send you want for. This is when You have to laugh. You don't tell you anything. So this point, this is the best point. Last like Sorry, Mr So and so A CT. What kind of CT? And normally it would be a CT at the pelvis. But you must clarify on. Then the next thing to do is ask them what you're looking for because they just go CT. Now, Uh, you'll have to do this a few times before you start getting it right on. When you never really go to radiology on day. Say okay, You give me all this detail and you've been in a lovely being. It's just a 37 year old man. He is admitted with appendicitis. He had an operation. His CRP is like middling at 70 ct abdomen, pelvis, please. And you'll go down there because it hasn't been vetted on you. Say I'm sorry. Can get the CT better than that. Go. Uh, yeah. What do you What are you looking for with this guy and yours? To stand there like I have no idea. Eso you must You must check with them on when you go down there. It's actually a really good up a learning opportunity. If you say. Listen, I'm a new, uh, Juan. I'm interested in radiology. Well, tell me what? What do we know may look for with this scan on, why is it not justified here? What further information would you like? How can I improve my my referrals information part for next time? And they were They will be helpful in that. So in order to get your scan vetted a done first time, just check with your senior on. If you don't understand anything, check with them again. See what you're looking for, What scan they want because there's nothing worse than actually getting the wrong scan for them on. We've all done it. So if that happens, don't worry either, but it is a little bit embarrassing. You have your tail between your legs on, make sure you put enough clinical detail, including the relevant patient background, but state this stand that you want on what you're looking for. So I would like a a ct abdomen and pelvis. Queery perforated, viscous queery intraabdominal success. You know, that's interventional sepsis. Just aside. Now is quite a good way of getting a CT is a good little phrase to check in there, but just that could be bad habits. But we do get scans. Whatever, um, it projected. Ask the Ask the radiologist. If there's an alternative scan that would be more appropriate or what they think quite often, I just say decide chemically Well, I think when you're starting off, it's the best thing to do to speak with your senior, the consultants or if the consultants, I've a little speaking the register and they will at the beginning will be so helpful and give you all information. They don't help you get this gum, and then you can just learn from that. So take it from there yourself now onto the actual bread and butter off the job. It's discharge summaries on T T A. C, which is to take away medication, I believe, is what it stands for. But who really knows, Actually, Toujeo is. Sometimes they call it T c e o dependable. Yeah, um, so our top tips of ETAC okay, referrals and scans are generally more urgent. However, the pharmacy does close at five on if a patient can go home because their medication isn't ready on the summary of information for the inpatient state hasn't been done, they will be pretty annoyed because people don't like staying in hospital mostly, and also the medication. Even if you do the TD, a first thing in the moment has to be processed by the pharmacy and then hold it and then has to arrive to the woods. Or sometimes especially the patient's transferred to go to a nursing home. So it's a good practice, of course, monitoring locations. Various. Do you require us to your scans? But just get the TTS done quite early in the morning and, uh, our hospital and quite a lot of hospitals you conduce the TT a part, the medications part separate to the summary on because that's the bit that takes time. Perhaps you got medications wrong or they don't have a certain medicine in stock, and they need to get it from a fridge somewhere in the hospital. That's the bed that's worth doing first and then coming back and do the summary information afterwards, even though it can seem a bit on nonsensical to do it that way. And pharmacists always checks or 38. But just to make the pharmacists life easier and your life easier. You can just check with the register. Were there any medication that we want to stop on this shot? Or there's some things. For example, surgical patients will be starting on the left result on the high daughters. And then that's because we think there's one potential diagnosis, but in changes for a course of the hospitals day, so they might not need omeprazole one on this chart. So it's important. Just take to your registry. But it also pharmacists are to be useful sorts of information. Another thing is like anti hypertensives. Quite often they will be stopped in the hospital because of a k I or something. And then the BP stays low and you're thinking, should I restart this on discharge? That's when we can refer to our last point here. And you can just say to the GP, would you mind in, say, a month's time, checking this gentleman's BP and seeing if it's still low? If not, hold on Pap tenses. Otherwise, please restart them on. That's reasonable because the GP this discharge summaries take a while to get to the GP, and there's a pretty much a GP crisis happening at the moment where that totally understaffed and they don't have enough people to action that jobs that needs to be done for all these patients being discharged from hospital. So just don't forget about the GP. Don't ask him to do stuff to close the time interval. Um, in terms of doing the discharge summary itself, try to keep it really simple. Unstructured. You don't need to do a narrative review of why the patient was in hospital. I find the most useful on the best T t a. Serene are the ones where they list the issues, just like you did in the war Drowned on. They show you the treatment that they action for each issue. And that way the GP can look through it very quickly. If their patients with MS is Austin future than the doctor's clocking. Look at that discharge summary very quickly because you'll find when you're on take. It's a very useful resource to have a discharge summary on the T T. A. That was done from a previous admission. So we were just included a really quick example from that diabetes case that we were talking about earlier. So it starts dear Dr Ms James is missing to this hospital on this date with abdominals. Your involuntary she was seeing treated as follows for these issues. 123 told you exactly what they've done All the investigations in the relevant results the antibiotics and the treatments IV. I just stands for IV fluids, by the way. That's worth bearing in mind when you when you start stop. And they just said it would be grateful if the GP could check in HB a one c in three months. Time should be followed up with this routine and try and follow up. She was medically fit for this chart in this day, and you can see how how quick that is to actually right. Rather than going through all the notes know bori asleep on deconstructing the paragraphs and paragraphs of endless writing. It's a quick way to do things in a holler who so at the end of your working day, they're just a few things that you have to quickly switch over and make sure you've done on that will be chasing the blood's making sure that anything Herget has been action, and that might be like large jumps in CRP. Um, particularly if if anyone becomes on while, at the end of the day they hide new score, it's important to alert your seniors to that the end of the day. And then you've got the hand over a swell. So and he blows the on back and he stands up on, but they're on back, or anyone you think needs seeing in the evening because they run well, you must have it over to the ward. Cover on the war. Couple generally operate from five until around 9 30 or nine whenever that whenever the hand there is for the evening. So the handover itself Just remember, hand over to others as you would like to be handed over because it's very easy when you get to the end of the day, just especially after you got a bronze number. Just message you made like, Hey, man can just can just chase these bloods for this patient in this bed at the end of the day. Don't don't do that. It's not kind thing to do because you've told them nothing about the patient. You've not told them what you want to do if they see that these bloods of race. Remember, they don't know who the patient is on. So when you're doing a handout, but we would really encourage you to do it like this, tell them the patient name the bed number on the ward that they're on and then give them the unique patient. Identify so that if it's something like chase this blood, they can do it from anywhere in the hospital. Give them a brief, relevant hand over about the patient so this patient has type one diabetes on. They were admitted with DKA. Tell them the job for your colleagues so she wasn't eating at lunch time. It would be great if you could start the subcutaneous insulin once she's eating at dinner time. And then if it's something like, uh, say a scan is important to give you that you give your colleague a plan for what to do if the result is normal, as well as what's to do if the result is abnormal. So if the ultrasound this evening it's fine, you can just leave it. Nothing further to do would really appreciate if you could just document that the ultrasound was normal because some of the team needs to see the result if the ultrasound is abnormal, would really appreciate if you got in touch with surgical team because you might need something. Also on if you're on the other sites that you're the person he's receiving the 100 for. Um, make sure you ask questions because after it 101st, finish the person he knows all this information about the patient is gone says really important team. Be an active participant in the Honda Go to make sure he if somebody Ms, is the information on, for example, to do this kind of abnormal, just very mind that what we entered it here is the base information that you need and also, if you have any concerns about a patient just important to ask while you're being 100 100 for all the information, because then it just makes the bit tricky ones. This person has gotta hold him on dust, makes your job harder, and you might receive a lot of other things to chase little things to do. So it just makes your life easier. And also, if you're the one who's turning over a two beginning is a bit tricky to decide what needs to be 100 over, of course, has been said not. They're not backs kind of results that need to be chased. That's all kind of self explanatory. The patients were on well, but the beginning. I think it's a good practice. If you're not sure what the harmed over on. That's also being kind of politics. He when they start doing their would cover in their own protests, they like I found it at the beginning, 100 over one thing we wouldn't ask enough questions. And then the result comes and you're like, Okay, and sometimes you know it's if you show yours. Shoot of all the jobs that being handed over to your breath, for example, is on with you for the evening. You might just go through the lesson. Cross loves that stuff on me that things are not know, obviously, but they're they're good for you, good people to ask for help. And also with that TJ's and sister summaries. I haven't mentioned that was your right. When, after you write them, you can ask your feedback so you can go speak to a recipe to essentially and ask them what I think about while you were right and then give you some tips on how to improve. Okay, so most of the time, you're going to be on the wood, and you're going to be very well supported during the day. There's modes of stuff that will be the at your disposal when your uncle you'll be supported. Well, there were people who will be He'll be there all the time available for free. T. Um, is there any questions? But those shifts are much busier. Usually, um, they're sometimes, um, stressful and challenging. But you will get for them. It will be okay in some of the hospitals those incretin night shifts, we can shift where you either take after the ward patients or when you did it. Take shifts. So you see the patients in any so all of those are are called unconscious. So you will be carrying a bleak on down. You start your shaving period to you must, um, there and how Teo to use the sleep. Hydris doesn't have to be by the people that will get to that in a second. Um, so you have Teo, just get a sheet of paper and make sure you write down all their numbers. Eso all the cool. They get valuable. Sometimes you might get you in a hurry. So it's important to write down all the numbers and then go for them and just call them back one by one. And right, I'm old information that they told you, um, that they didn't tell you on having said that because you'll be briefed. A lot is important. Teo, remember that not all the patients need to be seen on do sometimes patient need to be seen straight away. So in order Todt for yourself, you have to ask a lot of questions because the nursing team is there with the patient. They can see the patient. They have the tractor to have their new score. Don't know what the observations are. They know that I just got to where they know why the patient came to the hospital. So sometimes, um, I mean, most of the time it makes your life easier. If you ask questions while you're on the phone with them, there is. You can also give them their system Variable recommendations or variable old is so, for example, if the nurse calls you about a patient, he has low blood glucose, and they are conscious. They're responding, but their blood sugar is low. You can ask them to give the patients and blue crew job because that will bring your blood sugar up straight away. Taken out, um, to give him the group a gel. And you can tell them they're say, you're going to be there in 5 to 10 minutes. But please give the Nuvigil and repeat the blood because in x amount of time, if I'm If I'm not there, just please leave me and tell me. Well, the sugar was after giving the group job. Um, if that's the same, if they're calling your medications very low saturations, you can ask them to put the patient on the high flow oxygen and just make your way there. And it's also important t let them. So you want to just make your life easy on the review of the, um, quicker? Just ask them for all the information. So when they bp, you know, you're busy, have a lot of Just ask them, Teo. Yeah, either all the relevance documents to stop taking the drug church ready. Ask them to repeat the A set of labs as Mt and get a medical note is three or the new school, which is five overall. So sometimes they would just sleep you and say the new is is five. You go. Oh, gosh. But it might be that, say, the new schools being Vival day or sometimes they'll bleep you say the news stands because the rest rate is 28. But you look up, a lot of the other robs, and it's absolutely fine. So just make sure you ask them because quite often do that they won't have the other ARBs air and then you hear from them. And you actually hear that the patient just got out of bed to go for a week on it. It's not serious, is he? Think so? Yeah. Asking questions of the most important thing. And it will come come off, sign that you feel more comfortable. You know which questions to ask us. Well, but of course, intubations and well, you have toc in straight away and sometimes have to think about putting an imagistically vote. Get to that later. And some essential labs that will help you when you are on your uncle shifts. Um R S fellow so d induction up, I think they might not have another hospital. Most hospitals do have injection up on. It has all the important phone numbers bleeps extensions to all the specialties. If you need to refer to anyone, call anyone call X ray called microbiology, called Unnecessary from some other team. It's old in there. It's very useful on a good tip with induction is that if they ask you to contact another hospital, you can contact them from the induction off that other hospitals. Each hospital has an account to say. I want to say I work in Saint Mary's and I want to contact Chelsea Hospital I Congar on the Chelsea input for induction on Find all the contact details on there, and it's a really quick and useful tip. Instead of going through your own switchboard than going through their switchboard and then finally getting to you want to talk to on bear in mind, you have to listen to a 92nd coronavirus message every single time you call the hospital switchboard. So that's one of the academic life. Easier be enough. I think he would have used for out of medical school. It just gives. Gives you information on all on medication dozing, um contraindications, Reno dose. Saying interactions is very, very useful on day. Just use it during the war dry, and then you have to prescribe everything just to double track. If you were corrected by the dozing, and then that will help in there in what what Those doses off company prescribed medications are, um, each hospital trust will have their own local antibiotics, I line, so that's very useful. While it's prescribing antibiotics, Um, M D count is useful when you have Teo calculates cores. So, for example, if you need to calculate creatine clearance or if you need to calculate patients, Blasco score well. School like more hair. It's 65 or so It's all in there. So if you ever have Tomko, it's something it's probably under, Um, I recessed is a useful up, which gives you all all the ribbons for resuscitation for a rest close periscope. Um, for a richness for patients who are acute. Ian. Well, so that's very useful. Um, pocket doctor is enough that I think you have to pay for it on gets not supported by the newest Um US system, which I came to realize the other day, Very sad, but was useful. It gave you. Um, since it's somewhat today when they bp with some common presentation. So yeah, abnormal new score, electrolytes. That's actually you can find all of it on mindedly website. So okay. And so it sounds like things. Um, you might feel like you're stuck. Um, and you might get frustrated, and sometimes being enough, one is emotionally drain in, and their lows of things that can is just difficult. It's a bit different team being a student, and they're a little things that you have to drop below the same time. But having said that, um, after, if one's her working with you, they're probably going through stem. They're things. Even though you're experiences very individual, some problems are common. So people might be frustrated with their scans being rejected two with working late or with their communication with the senior. So some things are just common. So if you feel like you can share it with without everyone's because they're probably going for a similar thing, um, your estrogen goes as we did say before, they're your cortical, uh, on the world. They're always there to support you. They have recently done They have recently been free. What? You're going for an eye? Um, so they're very useful as a first part of you always can get support from your clinical and educational supervises. And so it's important to schedule meetings with them that beginning off placement meetings, everyone, because then they can guide you Friday placement on if you have any issues that always dirty to help you. And they also are very useful to help you with updating a portfolio explaining off what has to be including your portfolio, how t um, make sure everything's signed off, so that just makes the progression for everyone easier. Um, m D U s we did mention before, um, if you you will need a damage cover, So if you have no sign up yet, please sign up to the ent will provide the link later. They're also very useful when you have to do with any complaints which hopefully won't happen. But if it does, there dirt to help. And we had a very small talk on it last week, which you can find on the mind of Leap page at the BMA is another organization, which is they're useful, especially night that you would have received your brightest on your salaries. You can use their service cold BMA I think it's a Roto Rooter track and they go for your lower to send me a writer. And they tell you, if the working hours they have been assigned are safe, right? Um, just some quick tips on surgical occasion if you are surgically inclined. But even if you're not is quite interesting. Probably t describe in the seniors. Are you usually very keen to teach you if you scrub in the states, they let you do some not trying some soup drink. You'll get the cease, um, cool procedures. Um, the post of care is probably what you're going to be more involved in as an F one on a day to day basis. So it's quite useful tea and gets get to know what the colon procedures are. So if you're on the upper GI I rotation, for example, they're probably going to be loaded of your bladder's mostly gold lettuce. Actually, eso knowing what the complications are or, um, what the postop care for the patient is and It's quite useful. Um, knowing went to stump on restart medications. Burial is so important as a surgical if one because you always forget. So again you could probably. Actually, there is a script multiple on that second script module. You can you can get it. You can ask a seeing your cast the pharmacist, because different medications wouldn't need to be stopped. Um, events before before the surgery. But this is just something to burn in mind. Um, the drains are sacred. Never take the trains. I'd just take one out without consultants and know even the senior must be the consultants who did the operation. Do you think that you are allowed to do with the drains? Is, uh, look at them, see what the see what the indication is, because that's actually important. See where they are Because nurses dental able the drains. If there's more than one they label, it can be, for example, but it might be some diaphragmatic, and they might be a pelvic drain. So it's important because you your job will be to document what the output in the drain was the color of the fluids. So just need Teo explored on the drinks and the word replaced in the first place, Um, again, some common prescribed drugs as the surgery, if when you will always be persuaded. Been prescribing allergies, ear antiemetics, laxatives. And so it will come of practice so you don't have to worry about that. But these are just common medications to be worth. But do you remember your wh show pain leather that it never gets? It never gets any more complicated than that. Yes, darling policy small paracetamol plus and says, if it's indicated the patients not too old or their kidneys are they can use to find something like that. And then with strong periods on top, that is, it is a lot of ways to get sometimes more complicated, But, hey, pain Ladder is very at your disposal on during the seven rotation. Making sure you know really with patient's eating and drinking status is on in some specialties. Weight bearing status. It's so important because patients need to be fasted six hours before the surgery, So sometimes we don't know if this is going to happen. It might happen in my not spacious know that life and the nurses call you and ask the patient can eat and you're not sure if the surgery is happening or notes. And you say you tell them the patient can eat and then the consult because you have an hour later to ask to send the patient dancers for surgery. That's hard. Just say no. If you're not sure, say no and then check later. Yeah, so if the nurses ask, the patient can eat. No, just check. All right. Um, we're almost almost done. I feel like we have covered a lot of things. So if you want to listen to it again later, that is okay. Also, if you know, listen to it after you have actually done the job, that is okay as well, Because I feel like you live in then and then you have a different perspective. Um, after you have worked of it. Um, but some things to be aware of now, which will make your life so much easier because when I stopped it, for example and they said, I have to take time off. I have to do my annual. If I was like, Why? I just want to go to work and learn everything. But less is really important on Dalser so ever, and we'll be requesting their leave and in sound trust. You have to do it six weeks in advance, so it's important. As soon as you know, um, we actually tend to request all the days as soon as the rotation starts, but some people do it differently. But if you just want Teo, if you know when you have to be off, just do it straight away. You're allowed to nine days of annually for irritation. Additionally, to that, you have so development days, and for F ones, the allowances know four days per rotation. And these are days where you could work on your performing very candy and the extra extracurricular stuff that's that aimed. They can do what everyone as of this year, it's mandatory. So if they don't give them to you, it's illegal, so you make sure you get them. It's also worth bearing in mind that it's illegal for them to give you septate for annual leave. So if your roads coordinator comes back and says to you, Hi, Sarah, I put you in for the 31st of October to the seventh. Remember, you can turn around Samsara. That is not contractual. It's a very clear statement within the junior doctors contract, so make sure no one's taking advantage of you. And also, once you start working like you really want to have some time off, it's, um and that brings us to exception reporting s so that should be explained a tour induction. But you should be able to exception reports to report any hours that you have to work past. You're finishing time, um, or if you have Ms Teaching, because he should have protected time for teaching and it's part of your obligation is enough. Want to get into the 60 hours of teaching? So if you're missing teaching because of war two jobs, um, it's important to raise it on exception reports on D Trust gets penalized and they have to pay. So you get us hate for that. Would you have the most important of a highlight with the issues are So the point is that the trust get penalized. The trust rub it across, but you get the money back. His junior doctor, so you get paid some of it, but you're guarding a safe Working also gets paid some of that. So you get 3/8 the garden, a safe working. It's 5/8 so just think about the money saved is actually more money for paid a drinks and stuff like that. So it's really important. Teo Exception report. And if you ever get pressure that you're not supposed to do it, that is a GMC Abilify tense for the consultants who is pressuring you, not the exception report. So you could politely say that, or you can go straight over there heads and you can go to the gardening of safe working. Tell them that you'll get receiving this pressure not to exception Report on. They will make it right very, very quickly because the point of the except from avoidance to highlight the issues with the stuffing. So when you accept report to have to tell them why, so you can say that had to say three hours late because there were a lot of patients of jokes. Patients were on well and we were short of free doctors, for example, and if they see it's coming from multiple doctors multiple times, they do You have to address that, alright also, sometimes things can get a bit challenging on down. You are encouraged, Teo, to engage in effective practice. There is a, um there's a section on your keppra folio when you are increased, right perfections, They could be private perfections. Nobody has to see them, but you can choose to share of them, and they can then go for your affection, discuss it with your senior and then discuss what has happened. So if something happens and you feel like, um, you might notice it when I speak to someone, um, at first. But it's quite useful to help you understand why your reaction has been. I don't know why you failed a certain way. So you're using the effect of practice is really useful on, um, even though it sounds really cheesy. But being kind to yourself goes long way because it is difficult. And this is the first thing when you have Teo work and you have Teo try to find time to socialize and also never grow but being around and and so, um, and restrictions and so many pressures and some of the extra curricular things just it's fine. Okay, um, so you're one of the last chance is t make it easy for yourself is your shadowing week, which I think has started for some of the ones we have once it's our trust a day. So this is when you learn orders, essential task, which we have mentioned. So the basic such is the Bloods. There were Pharaoh's, the scans and but also preparing the list So some departments do it loads of the parson's reports that with in different ways. So just ask her. And if one's have to prepare the list, how the printed high they normally do it and use the BLEEP system. So I don't how to sleep. How to respond to a bully. Um, make sure you know what the number is for the emergency Closer. Um, and no. Well, there's emergency Cozaar. So depending on the hospital, you'll have different goals. So you can have an Evan have an arrest call. It could be adult or pediatric. You have a very Aresco. You have a major hemorrhage cold. So you just know, um, when do you use those emergency calls? And also particularly for the major hemorrhage? Just know what happens when you trigger a major hemorrhage and practical. That's important. So no. When you call what you get with blood products. He was going to come now. Just help he when you find yourself into emergency situation and a side note on emergency calls, if you feel you're out of your depth on, you, can't get through to someone, just put it out. If you feel that if you feel that far out of your depth that you're not sure what to do now, put out the emergency cool because it's we set up a star. It's the the patients can. That's the most important thing. It doesn't matter you a zit. A side note. I want to cut a long story short out a medical emergency call for what I thought was a stemi but turned out to be a Hillary colic. So you can't look more stupid. No, no, no, no. Because he's not been sending the line because I was worried and I put out the court and they turned up and they actually sort of a very pretty well on day left again. Nobody. Nobody's going to criticize it so sometimes that putting so it out, just his double to double to putting every every test. Okay, so putting the skull in sometime. Just feels like all your region virus itself, or it's a horrible thing to do. You know, if you're worried about the patient, if you need extra birth hands, just but I have the magical and you will never be shy. Two dots and and also especially in the beginning, When you come across on a well patient, you will have Teo do your 80 assessment. You have to escalate straight away, and you have to do request investigations, and they're so many things going to do. So if you feel already whatever your depth, you feel like it's been putting medicine. Call around and then try to get for two restrooms without the emergency call. And nobody's going to be, um, hold against you all right, but try to have fun as well. Um, so it legs the job so much easier on dear should be plenty Opportunity CD, fun things, Those activities Egan get involved. If wards team social in Your and Ward's seem socials and also subscribe to the mask, they the mess feast that's very important. That's rude. Not pay the fees that just go straight from your paychecks. About 15 lbs a month that it's various, that we both did. The mess, the dresses. Good message, noble. But if you if you want to get active involved, then you can apply for mess comedy positions. Um, there are loads of them and it can be very involved or involved just a little bit. But that helps or socializing on that. There's loads of events as well, hopefully organized by the mess that maybe this I should join some drinks is like a given old trust said Don't want, I mean, the whole trust that's that is you, um, Andi, you could be very knowledgeable on. Um, you can know how to manage the patients in theory, but it's always good to be nice to everyone and the nurses and the colleagues if you get if you find yourself in a pickle. Um, we need advice on anything. If you're nice, the nurse in your colleagues that they will go out of the way Tol pew and with the patient's relatives, the miscommunication or doctor is being perceived as root is one of the most common cause of complaints. To be nice and explain everything. It does help a lot. Um, you noticed yourself. We have covered on to become cover it enough on. But if you have to work with if you faced with difficult colleagues, um, just make sure that if you feel believe this is addressed because this is completely unacceptable. So final tips we're almost done. And my top 10 I'm going to say is flattery will get you far way or reserve covered it with being nice to everyone. But even going out of your way to give people an extra smile toe, say, on your first night you bring in some snacks a swell. It is gonna do no end of goodwill. Okay, Carries. So far, you have no idea how difficult nurses commit your nitrous and how easy that you make them. They couldn't do so much on day. Won't let you know until they trust you. They like you. They don't think you're arrogant. Little what's it? And also they the nurses have been there for so long, is the senior. And we just look up there every year and were so many and just be nice. Um, yeah, Masses do love chocolate. They love any hum snacks. In fact, I think it's better to say that snacks the way to necessarily it's, I think everybody probably ever within the chest market, does get you far always escalate early. If you're worried about something, just use your clinic doctor. Um, um, if you think it's not going the right way, there's anything that worries you. The patient, like some. Well, get it in early, get it up to a Reg level. Okay, because that's a joke. And you take your so far and also in terms off learning, because now you be very busy trying to find your feet, organizing all of those clinical and educational supervising meetings and trying to figure it high to be an F one. Um, but once the dust settles a little bit, just try to get involved in audits or called in a room of projects because some of them take a while tea and to get completed. So it's usually a good idea to retry it to you by the story. Essentially is most of the time that will be working on some kind of ordered or clip, although haven't idea on High t start one on. That's very, very useful for your portfolios and also just um, improved the the patient flow patient safety at the hospital and and if you want a really easy frequent certificate that will get you signed off, quit for your RCP. You can do that referrals form that we had earlier in the presentation. We'll get your certificate for that mind, please. And and also the before you actually has quite a few things that you cover. It's very useful, and it does provide a framework for your practice and where you're expected to do and help encourages did the reflection, as I mentioned before, but it's quite other things to go free. So it's real important to start updating your eat before your early and working on it regularly and also during the first meeting for education signifies, er, make sure you go through all the parts of the portfolio and and also I learned how to map your evidence. Tea. Um, the requirements that supportability realistically, everyone does the correct term mapping the day before your your a RCP. I don't, um, get involved in teaching, um, teaching medical students teaching in your department, so running and journal club and we're doing any kind of didactic teaching that is used for you before there's also teaching at Aries helps. You understands the material better. It's usually very rewarding. And he can set up your own teaching program. And that's, ah, helpful for most applications. Be it's I anti or a CSTO. It's been prices. Never forget that. Very sore, but not tonight. Just start with small steps and he even died. As for it, help. I think this is This is always, always tree. It's always ask, Um, so we're going to scan the feedback form quickly as your heart's kind of feedback for you. Appreciate anything back B s specific as you can. Um, it's very helpful for us t m to improve the sessions in the future. It also improves are teaching, Um, but also for you, if you feel in the feet. But for you, get a certificate for attending this session. So it's useful for you before you. It's what? So it would appreciate any feedback on. We're going to leave alone and see the Q and a section which we have to run ourselves. So we have to commuted over here. So we have, um we have some questions. Um, already owned the grape. Um, please keep on coming because we'll do the Q day for for next couple of minutes and hopefully answer any questions you might have. Um, So the first question from Yousef is how early, Um, or how late that you get a very practical. So actually, that's a really good point. Normally, even though pharmacy closes at five, doing anything pops this point. They're minute after hours. The latest time for a T T A. To be submitted is 4 45 and it can take a good 10 minutes toe. It is a really long one. It can take 15 minutes to get everything on there. Make sure you've checked everything. All the appropriate doses have been started, etcetera, etcetera. So really the latest you could start one is 4 30. Yeah, but they say in general, just try to do them before lunch. Just strike because it has been said like some of them will take 50 minutes, but most of most of them will be quick ish. It's not a very long term, so just getting it out of the way. It's very useful, I think so. We got another one from Strayer. Does it help doing aboard it or quit in an area that isn't necessarily the specialty you're aiming for. Well, you need to feed that for a second. Scan it that stuff. That's an absolute yes. You must do a quick in order to get signed off for your RCP. That's an F one you must do one on. You must do one enough to a swell. So, yes, it does help. Career wise know it may not help, but actually for almost anything, it doesn't matter what the subject of the quick is. The fact that you've done one is important for portfolios on. For example, they're surgical portfolio that were both working towards. Now you need to have done a quality improvement project or an order audit project in which you've completed two cycles, and then you've presented the results at a regional or local meeting. So that's how you score the top oint. It's worth bearing that mind going into the year that you can walk on it. All right, let's see if they're any out of questions. Oh, especially do you guys were going to do is a difficult today. It's really hard. It's a it's a tough It's a tough balance between, like, quality life, like doing something interesting and competitive. We always want the surgery. We're doing an academic faster, this area irritation. So we have to use surgical rotations, general surgeon vascular surgery and then academic block and vascular surgery. Something surgeries there. The erection on day. I think I am a bit torn between plastic surgery and urology at the moment, with the emphasis on at the moment. Yeah, I'm probably unleashing towards author at the moment, or GEN surge. Have record of that. But yeah, who knows that If if anyone wants to get in touch with us about anything, any concerns, any specific career stuff more than happy to Yeah, very happy to help. Um, I yes, but Lincoln, that that's good. But if you were small and normal No, I don't. Normally do I normally do. But if he buckling because is it not possible to scan it? Is that the problem? Because now I can't do it, but I can do it once we're out of him. But that's okay. We're past the feedback form. In the comments afterwards, we're leave the code up now for another few seconds. We will. Yeah. I will open the link in a second. Do you have any other questions? I placed all the links to sign up for the webinar. Is, um the feedback letting the end do you sign up? Yes. All those links Hour post here. That coming right at you. Um So if there are no other questions, I think we're going to Teo. Call is a All right. Thank you, everyone. Good luck next week on please join us for the webinars next week. So next Wednesday, the next preparing for f y one session on choosed a Finance medics Siris. Um, so hopefully that was useful for everyone and I would pose the feedback links in a second. Guys, you're going to smash it. Just remember, by coming to this talk, you've done more than my staff ones. Well, okay. You're gonna be right fit in the feedback 90 to get your feedback and certificate. Yes, All right. Thank you so much. I don't get the quick project