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Mm So, yeah, don't worry too much about making notes from the slides because you'll have all that a, a access afterwards. So, um don't worry too much about that. Um So yeah, just going into the sort of er objective objectives of this, of this session is mainly just to understand the role of an F one really. Um And to um best prepare you guys into, into making that transition. Um Obviously, we'll, we'll talk through sort of um what you do on your different jobs, um tips to how to sort of organize the jobs, what, what are the most common jobs you'll be doing? So you have an idea of what to expect um commons, a war tasks. Um And also um to try and practice applying this or learning to common scenarios that you'll be asked to do as an F one in a range of different shifts as, as, as I'm sure you guys are, are aware of. Uh So we'll just briefly talk about the structure of, of the shift. So um you guys who have uh come to previous sessions would have seen this slide before. It's just showing you the different type of shifts that you'll be doing is an F one. So there'll be your normal sort of day team work, sort of 8 to 5. That'll be the majority of what you'll be doing if you're either doing a medical or surgical, um, placement and then from five till, uh, sort of, um, got midnight there, but it's normally eight is your sort of on call period where sometimes you'll be asked to, um, cover that sort of time, you know, doing an extra sort of a long day between eight and 8:08 a.m. and 8 p.m. where there's obviously most, most of the day teams have gone home. So you're just having to sort of cover for, um, potentially more wars and more patients that you might not have seen earlier on in the day. Uh And then obviously you've got the night team that, um, will normally start it eight o'clock and you'll have handover between the day team and the night team. And that's a really important sort of meeting where you'll go to, um, as an F one. So you'll go to one of those handover meetings that either, you know, if you're coming into the day or if you're coming into the night, um, and each team will just sort of go through the patients, they've seen highlight any patients who are particularly sick or highlight any jobs that need to be handed over so that you're uh aware of what you're doing. And this is a, just a really good opportunity for people coming into the shift to sort of meet the rest of the team you'll be working with, you can exchange numbers, you can sort of talk about different roles that you might have and you can, um, really use those handover periods as a, as a, um, as a, as a really good way of, yeah, getting to, getting to know your team and getting to know your role for that shift. So if you have any questions, you know what you're doing or what, you know, what's expected of you, that's the time to sort of, uh, iron those, those things out. Ok. So, yeah, and then moving on to sort of the roles and responsibilities, um, of the, of the F one. So this is what you guys will be doing sort of day to day. Um, so normally sort of say we'll go for a normal working day. So eight till five or, um, eight till 530 or whatever, whatever you're doing. So, um, obviously, er, surgery will start earlier at eight o'clock and, um, medicine sort of typically starts at nine. Um, so the main thing that you need to do in the morning is an F one is that you will come in and you need to sort of print off the list. So this is the list of all the patients, uh, patients on your ward or in your team that you're looking after. Um, this is a sort of your sort of um main responsibility. And as an F one is, it's really important to make sure this list is up to date. It's, it will have obviously the patient's details, the recent scans and recent blood tests, potentially that they've had. And also you can put the patients sort of rough plan on um on that list as well. So, um I'm sure you guys would have seen it on your placements and things. But, yeah, it's just really important that you keep that list up to date. I think the main, the main skill you need to have to be a good f one is to be organized and to be well prepared. So, say you're coming in for a shift in the morning, make sure if the war down starts at nine, make sure you get in, you know, quarter to nine or however long it takes you just to, um, potentially prepare the list, print off the list. Have a look at the patients to see if there's any, um, sort of investigations that you can just sort of, um, know for the ward round and it, it just makes your life a lot easier and it makes the, you know, your impression on the consultant and the rest of the team, er, a lot better if you know your patients really well and you're well prepared and you sometimes can even second guess, for example, if you have, you know, the plan from the previous day was to, I don't know, check the patient's weight or something if they're on, uh, daily weights and you can come in a little bit earlier and have that information ready for the ward round. So that when the consultant asks, what's the weight you'll have it there, um, and that can just, again, make your life easier and also just, um, make a really good impression on the rest of your team and that, and that you are prepared and you know what you're doing basically. So it's just, yeah, having those sort of things at hand and being really organized, knowing your patients really well and knowing your list really well, that's the main thing is an F one. And then obviously, then, yeah, you go through your ward round, you will have, um, sometimes there's a consultant led ward round, sometimes there's a reg who will lead the ward round and sometimes you will lead the, you will do the ward round on yourself. Um, obviously, patients, if you're asked to see patients yourselves, quite often, they might be sort of medically fit or stable for discharge or waiting on packages of care and things like that. Or you might be asked to see people who already have a clear plan in place. They may be on sort of, um, you know, different plans, you know, with the example of someone on daily weights who are having sort of IV diuretics and uh coming in for sort of heart failure, those sort of things. If they have a stable plan and, and you know what you're doing, then sometimes you might be asked to see that patient and the consultant might not see that patient. Um Typically the consultant or your reg will see all the new patients. So you don't need to worry about formulating those plans yourself. But um sometimes you might be asked to see your own patients, but again, you would just approach, approach it exactly the same as you would otherwise. So, yeah, going through the ward round, um they can take different lengths of time. So sometimes on. So I'm on uh care of the elderly at the moment. So, geriatrics and sometimes the ward round can go on until four or five o'clock in the afternoon. Um which sounds, er, horrendous. But um that's sometimes it's just what, what happens and sometimes you will be sort of um having to sort of work, work around that and um doing a lot of your jobs and stuff earlier on in the day. Um, but then some sort of, for example, surgical ward rounds can last up to, you know, 45 minutes depending, is so really, really variable. So, um that's, that's another reason why you need to be really organized because some ward rounds that take 45 minutes, for example, um can be really, really quick when you're going between patients. So if you know your patients and you know, your, your list really well and you've got the notes prepared and you've prepped them already. You've come in early and you're, you've got everything sorted and you're ready for the ward round that just makes your life so much easier. And again, um, just makes a really good impression and your, and your, um, do really well as an f one if you are prepared and you come in and you're organized and you know what you're doing. So I think that's the main thing uh to take any, if you're gonna take anything away from this session is, is be organized and be prepared um and know your patients really well. So, uh yeah, after the ward round, then you will, um quite often you might have a coffee break or something and you might then gather the team together and go through the list and make sure you've all got your jobs and you make sure you've got, you know what you're doing. So you might share the jobs uh between the different juniors in the team. So the consultant will do the ward round and then leave and then you as a junior team. So it might be you as the F one, you might have an F two, you might have um some sort of clinical sort of fellows or um sometimes you might have a pa a as well, a physician associate. Who, um, might sort of help you in on the ward as well. So you would divide jobs and you would, um, make sure, you know, your responsibilities and which patients you need to be sort of looking after. And then after the ward round, you would just get on and do those jobs. Um, and obviously after the ward round, you know, you, you do those jobs but then sort of nurses might come and ask you and say, oh, I'm worried about this patient or, um, their new score might have gone up, for example, and you might need to go and review those unwell patients. Um, and then, yeah, once you've done your jobs, then you can, um, once you've done your jobs you can go home with. Obviously, if you're, if you're not carrying a, um, if you're not carrying a bleak, for example. But if you have, er, jobs to hand over, for example, say, um, one of the jobs in the ward round was to have a get act head, if that hadn't been done, if you'd requested that earlier on in the day, but it hasn't been done by the time you go home, then you might need to, um, hand that over to the on call team. So that's another really important part of your job is that you keep, you're less organized and you know, what hasn't been done and what has been done. Excuse me? And then you can, what hasn't been done. You need to uh hand over to the um on call team and it's important to say. So, obviously, some things need to be handed over if you think they're gonna happen overnight. For example, if you have act head, for example, um with someone with sort of new confusion or who's had a fall, you need to hand that over. But other things that can wait until the next day, hopefully discuss this with your, with your colleagues and your seniors. But some things don't need to be handed over if they're not gonna change that patients management plan. Obviously, if you're waiting on a CT head and they um that gets done overnight and they, that shows that patients got a new stroke or something like that, then that needs to be action. So you need to make sure that you've hand it over to the appropriate team to chase that CT. So they, they're aware and they can action it. Um Also, yeah, so there are other things you'd be expected to do. So sometimes um people, uh patients can be quite difficult to bleed or uh can be difficult to put Cannulas in, obviously in different hospitals, they'll be different with sort of nurses being able to do different things. And um obviously you might have, er, Phlebex as well who come round and do all the bloods. But if um if you don't, you might be, you might need to do your own bloods, you might need to do Cannulas catheters, those sort of things. ABG S PR S as well can be, depending on your rotation. You might have to do some PR S. Um, but that's, you know, that's just a part of the job. I'm afraid. Er, obviously another thing to expect is depending on where you're working, particularly if you're working on sort of care of the elderly, which I'm on at the moment. Um, you might have to do some, er, death, er, death verification. So, uh, obviously patients, you know, um, do, do sort of die in hospital and you need to go and verify the deaths and then you will need to go and obviously, um, go to the bereavement office potentially and, um, put in the, er, and do the deficit certificate yourself. Um, that's part of the job and, um, something you need to be aware of, obviously, if you are asked to go and, er, write the deficit certificate, make sure, you know, and you've got a clear plan from your consultant, um, as to what the cause of death is. Um, so there's obviously, um, one, a, one B and, er, part two as well to, um, show you what, um, what the cause of that was. So, it's really important that you've had that discussion with your consultant before going down just so that, you know, exactly what to put, so that you don't put anything, um, that you shouldn't um Also, yeah, just interpreting the scans that you order. So if you order a chest X ray, you have to have a look at that. Um And yeah, another thing, the most important thing and another thing to take away from this session is the importance of documenting everything. Um So you know, any sort of an anything you do and you review, if you're asked to go and review an unwell patient document, exactly what you've done document, you know, your discussion, if you've, if you needed to discuss that with the senior document that you, you know, discuss with senior and plan as follows or whatever, but make sure you document everything that you do because you might not feel it's important at the time if you've got um quite an unwell patient, but it is really important because otherwise if you don't document it, you haven't done anything. Um Basically, so that's just really important. And also as an F one sort of final thing is you quite often have sort of teaching either that might be within your own department or it might be sort of foundation teaching for F ones and F twos, um really do try and go to those teaching events. Um It will be part of your portfolio that you need to get a certain amount of hours uh of sort of core teaching, which normally happens sort of uh at sort of lunch time. So, uh it's a good way sort of to go to teaching while you have your lunch, uh, to get your hours in that you need. So make sure you, er, know what's required of you when you start F one. So this will all be in, in your induction. So don't worry too much about it now. But, um, make sure you, again, it's just making sure you're organized, making sure you know what is expected of you and what you need to sign off. Um So yeah, just, just um be aware of that. Really? Ok, so yeah, II we we've just discussed this a little bit about ward round. So um yeah, they can either be consultant led, they can be there by a reg or, or you can do it yourself uh potentially if um like I say, it's completely dependent on the wards and what consultants are available and what the staff thing is like. Um So yeah, you'll just see, you need to, when you first come in for a sort of handover in the morning, you just need to make sure that you have a clear plan of which patient the consultant is seeing, which patient that they want you to see. Um So make sure that no one is sort of missed. Um So yeah, you just need to make sure you're aware of your jobs at the start of the day. Um Quite often, then if you know, the consultant goes to see, there'll be lots of patients on the ward and then you might sort of have some time then to sort of prep the notes that you know, the the of the um patients that the consultants are gonna see. So that will involve um I'm sure you might have done this on the wards yourself. So just obviously writing in the ward round entry and just making sure you have all the sort of background and the relevant sort of history why they came in recent blood tests, recent scans, all those sort of things. So you can prep all that before the consultant comes around and then when they come and once they're ready to come and see the patient, you can have a really succinct sort of summary of what's going on, what test they've had and what the plan is uh from previous. And um then they can, you know, um go and see the patient much quicker and you can, again, you can present that back to your patient uh to the consultant and you can get things signed off as well for that. So, um that's a big part of your job is, is prepping notes. Um We've got Curt and GC there. So that's basically just um when, when you go and see the patient uh with your, with your team, basically, the, the F one is just um there to draw the curtain basically and er have patient dignity. Um but then you'll be writing in the notes and you'll write the wall down entry. It's really important that you write down everything that's, that's discussed. So you might think it might not, that might not be that important what the consultant is discussing, but it's really important that you just document everything, uh, obviously paraphrasing but, um, to make sure that uh, every sort of discussion, er, that's had is, is in the notes and there's a record of it and it's a, and it's important, obviously, if the patient is there with a relative or, um, friend or whoever, you, you document that as well and you can say, you know, just as discussed with a patient and, and their relative. Um, so, yeah, that's the main thing is just making sure that you've got good documentation. Um, and you, you've cut the notes well, with their, um, patients news score on the day, their obs charts that, you know, if they've opened their bowels particularly important, obviously on care of the elderly, um, their fluids sort of input and output. So, um, making sure that, you know, you've got that all that information to hand before, before the patient, uh, before the consultant comes and sees the patient, you can also have a look at what medications they're on as well. Um, and you can write that in your, um, in your notes. Um, so that everything is, is ready for, for the consultant to come round and see. So, yeah, I mean, you know, we we're doing this to death really. But yeah, documentation is, is just the most important thing is, is an F one. Both that being sort of documenting what other people are doing, say on a ward round and also document what uh what you've done, you might need to document. So if you've had, you know, reviewed some blood tests in the afternoon, you need to document that. So you, you, you can write in the notes, you know your name and you can write the bloods and you can say what, what you, what the plan is from that. If that's if you know the plan then great or if you need to discuss with a senior, then do that and, and write that you've done that so that, you know, you, you do literally document everything that you do. Um And it's really important as well just to make sure that the, the notes are organized and it's, you know, it, it sounds silly but, you know, I there's been multiple occasions, you know, throughout my experience and I have one where the wrong patient's notes, you know, that we notes from a different patient in, in the, in the wrong folder. Um It happens more often than, than you would expect. So it's just really important that whenever you write anything that you have the right patient's notes and you have the right um sort of right patient details and you put patients sticker on each page so that nothing gets put in the wrong place or nothing gets lost. So it's just really, you have to be really, really diligent with it. Um, and just double check because quite often on ward rounds you'll be given some notes and it's just the wrong patient's notes and you just need to check every single time because it does happen and things get mixed up. Um, and again, yeah, make sure you've got the date and time and that as well so that things can be er ordered and when you're having a look back in the notes, everything seems to make sense. Um And yeah, you, you guys would have seen. So I think we've got a, a picture here. So this is sort of a rough guide of how to make a ward round entry. So you've got the, you need to write the consultant's name at the top or your name if you're seeing the patient yourself, um and then write the date, the time and then you, what we normally do is put the patient's new score in the column there on the, on the side and actually detail everything that they're scoring for. Um And then, yeah, this is just the main way of, of how we sort of right ward round entries. I'm so I'm sure you would have seen it. II don't want to sort of patronize you guys, but um having the patient's age at the top, there is really good having when they were admitted is really important because that could be, you know, they could be admitted sort of two months ago or they could be admitted the day before what they came in with. So in this case, the patient came in with um increased work of breathing str struggling to read. That that's another point as well. Make sure your handwriting is really um legible um and easy to understand. That's another difficult part of, of an F one is to sometimes reader consultants handwriting because that can be really, really bad. But yeah, make sure that your writing is clear. So yeah, document sort of their age, their gender, what they came in with when they were admitted, what their current problems are. So they may have a list of three or four things that are currently keeping them in hospitals or relevant things. You don't need to say every sort of past medical history either, but just the relevant things that are important for this admission. Um And any sort of, you can write the past medical history later down the line, you can put their recent investigations, their most recent blood tests, um what medications they're on as, as we've discussed and then you then write in what was discussed in the ward round. So, you know, things that you've explained to the patient or patients, uh might ask some questions and you can document exactly what you've um discussed with the patient and then you need to document your examination as well. So, on the um second page that you can see. So um ee everything that you've done on your examination, whether that be a abdo exam or a respiratory exam or the whole lot um neurological exam, things like that. So um make sure, you know, um drawing pictures as well can be an easy way as you can draw the lungs there and draw the abdomen. Um It's sort of quick ways to document, always try and put an impression as well. So even if the diagnosis is really obvious or um you've got it and the issue is let's just have the impression there. So you can say what's, you know, so here we've got, you know, right lower lobe pneumonia and also say if it's improving, getting worse if, um but you can ask your consultant is, is, you know, what they think should be put in the impression. Uh And then obviously have your um plan nice and clear at different points to say um what you want. And also it's really important to document sort of, you know, when you want these tests. So if you just put, you know, bloods, for example, you know, the nurses will have a look at that and won't understand what that, you know, they won't, they, they might just not think that's today or they might, you know, so just really make the plan nice and clear so that nurses or anyone looking at, at the notes can see exactly what you want to do. And when. So, yeah, so we're just going through sort of competing the ward round. So, um most things that we've, we've, we've discussed already. So most of the time it'll be a consultant led ward round or a reg led ward round. Um when you're seeing the patients with them and you need to document everything when obviously there will be lots of different juniors on your, on your team. So sometimes you'll have time to prep the notes beforehand. Um So do that. Um if you are seeing the patients yourself, then obviously you would just do everything as, as normal um as you would with the consultant, but you would prep the notes, obviously yourself, you would do all the preparation again, just make sure you're organized, make sure before you see the patient, you know, exactly what's going on with them. You know, exactly what um tests they've had, you know, exactly what previous tests they've had. You know, you've gone through their previous letters, you've seen their clinics um from the past and, you know, sort of what problems they've had in the past and things like that. So, you know, that patient inside out before going to see them and then you can quite often you can sort of have an idea of what you think is gonna happen when you see the patient. And then obviously you um you know, ask the patient the same questions and um tailor that to sort of what they've come in with and, and have your own sort of plan. And again, if you're, if you're ever unsure or you're not sure what the best management plan is or you're not sure, then just speak to your seniors. There'll be uh sh OS, so there'll be F twos and there'll be um clinical fellows around. If there's not yet, then you need to speak to the consultant. If you're, if you're worried about a patient that you're seeing on your own. Um So never do anything that you're uncomfortable with, never do anything that you're, you know, if you've got any, any seed of doubt, you know, speak to speak to your seniors about it quite often, the patients that you will be asked to see will be fairly stable, they'll have a plan in place and you just need to follow that plan. So um just make sure that they're getting the right treatment and make sure they're getting the right investigations as, as previously planned and quite often that can be quite simple. Um But if there is any, any doubt and like I say, yeah, just speak to your seniors about it. Um Good. Right. So I think we're gonna hand over Tara and taking this. Yeah. Um So yeah, so for organizing your jobs. So during the ward round, really you as you're seeing people, you'll have a list and you'll be writing the stuff down that you need to do. Some people write on the list that was printed. Sometimes you make your own. It depends what you prefer. It doesn't really make a difference. I think it's just personal preference. And then most people use the box system. So empty box for something you haven't done at all. And then, for example, if it was blood that you needed to put out and then chase, you could sort of or like a scan that you needed to request and then chase, you could shade half of it when you've requested it because you're still waiting to chase it. So, you know, it's not completely done, but it's half done and then fully when you've done it fully. And then especially on, I think on surgical jobs, especially sometimes they do things like make a master list because not everyone may have seen every patient and sometimes some patients have tons of jobs that need to be done and others patients have nothing to do because they may just be medically fit and waiting for discharge planning and stuff. So to make it fair, sometimes making a master list just means that everyone on the team knows all the jobs that need to be done that day in total. And so that won't be one f one who's doing like 20 things and someone else who's just got two things to do because everyone knows what everyone else is doing, which can be quite helpful and everyone also knows who's doing what. So you don't have two people trying to do the same thing and just like wasting time. Um And then also it's easier to tell which things need to be done urgently and which ones can wait till later that day or even the next day, it really can't be done. So I think a big bulk of what you do as an F one is sort of doing bloods and requesting scans um for bloods. I think it's always good to know the day before. So like so about four or five the day before you already start thinking about who's gonna need bloods the next day and then put those bloods out. You can't just always assume that someone else is gonna do it for you cause often just cause you write in the notes bloods tomorrow nn no one's gonna print those bloods unless you print those bloods. Um And then most hospitals I think have fleb but if not, then it will be you or you'll have to like ask a nurse if they can help you take the bloods the next day. Sometimes we'll see you have some bloods that need to be done at specific times. So like a cortisol, if you want it to be done at 7 a.m. that's something that you need to specifically tell someone that it should be done at 7 a.m. cause it would be like the night team nurses who would do it typically or if there are certain bloods that sometimes the consultant might want the results to be back in time for the ward round, you might need to write on the request form like for them to be done at 6 a.m. So that by the time the ward round starts at eight or nine, the results are likely to be back. That's not always done. It's usually done for specific reasons. If it's someone really unwell or it's something that they need to see on the ward on that day. But again, it's good to know that you, you should probably tell someone that that needs to be done at 6 a.m. or 7 a.m. or whatever time. Um And then, so that's for bloods and then yeah, for, for imaging, especially chest x-rays and CT s the earlier you request them, the more likely they are to come back by the time you leave. And often if you've left all your requests to be done at like 3 a.m. at 3 p.m. If you're only requesting them at three, they're definitely not gonna be done by five. And you're just gonna have like 50 scans to hand over to the oncall team to chase which is ok. And that's what that is like the on call team is there to help. But then if it's all patients that they don't know and are unfamiliar with. It's much more useful if you're, if you're there when the scans actually come back. And so if that's the sort of thing that ideally you do right after the ward round finishes, and then sometimes even calling radiology, just to tell them that you've made all these requests, make sure that they're vetted and ask them if those scans are actually gonna happen and what time they're going to happen, that's also helpful because then you're, you're more likely to get them done early and be able to chase them and see what the report actually says. And then again, if there's something that needs to be done, you can actually sometimes do it even before five, before you leave and it just makes your life easier. It makes everyone on call, it makes their life easier. And yeah, so again, if, if the CT scan is urgent and you need it to be vetted and done urgently, that's you would need to call the radiology department or, and speak to the radiologist so that they can be it and do it urgently. Um What else? And yeah, if you, if you are calling radiology or the radiologist to send to that or brush a scan, it's easier if you have their notes so that you can actually justify why you need this done so urgently, cos they will ask you questions and if you don't know the answers to anything, you're much less likely to get what you want basically. Can we have the next slide? Oh yeah, making referrals. So um at the hospital that we're at that this is mainly done online, but I think every hospital probably has its own system. Um Very often I think what happens a lot of the time is like your consultant will say, oh, refer to this person or at least that's what I found, especially in my first job. Sometimes consultants tell you to make referrals to other departments or other specialties, but they might not be very clear about exactly what you're referring for or like what your specific question is. And so then you can sometimes get some not angry but impatient calls from other like registrars or consultants cause they don't really know what you're asking them. So even before you're about to do the referral or speak to whoever, it's useful to know why you're actually asking them like what specifically you want them to do, whether you want them to just give advice or whether you actually want this person to come to the ward and see your patient themselves. And if you do want them to see your patient, why you want them to see them. What exactly it is that you're looking for, what specific problem you're asking for advice about all of that just makes it way easier for them, makes it way easier for you. And so again, having your notes there when you're actually sending the request or speaking to whoever is, makes everyone's life a lot easier. Also, if you've clarified with your consultant or your w what specifically you're making the referral for, that's also really helpful. And then, yeah, again, you, you, if you're on the phone, especially using the SBAR system to hand over, makes things easier because even from the first line, they know exactly like they know how urgent it is, they know what, how much they need to do and they know how urgently they need to do it. And so yeah, as far as just situation, background assessment and then recommendation, um and yeah, if you have made some sort of a referral and they've said what they want to do, it's good to document it. Cause again, you may not be the one who's looking after that patient every single day. And if you don't write it down, no one will know that it's happened also sometimes when you make referrals, like a registrar might come and see that patient and they might make a plan, but that doesn't necessarily mean that they're going to do it. And so it's good to clarify if they've said like do a chest X ray or do this specific type of scan or investigation to clarify. If that's something that they're going to organize or they, they want you to organize it. And a lot, a lot of times they will want you to organize it unless it's something very, like, specific and niche that they spe, they need to do themselves. And so it's just good to clarify what they then expect you to do after they've come to see a patient. Yeah. And then writing discharge summaries. That's probably the least interesting part about being at F one, but it's typically what you do. A lot of, it's, it, it is what you'll be like, asked to do very often and it can hold up, it can make life quite difficult for everyone else, especially the nurses when you don't do them on time. Because obviously they, the rest, like everyone wants to get the patient to the discharge lounge and clear up the bed and the nurses need to request all their medications and order them from pharmacy. And so when there's a delay, it sort of affects lots of different people. It affects the transport people. It can all just become quite a mess. So ideally, it's in a perfect world. You'd always be on top of all your discharge summaries. So sort of like updating them from time to time, especially for, especially if you're like on a Jerry's ward where you've got patients who stay for months and months and have multiple different things happen to them like a hap which then resolves and then they get something else and then something else. So it's useful to sort of think when the last time you actually looked at someone's discharge summary was because sometimes you may not even realize that the patient has been there for up to a month and no one's even started it and it just makes your life easy because ultimately, it'll be you who gets called to do it. And sometimes they'll tell you at like 9 a.m. Oh, this patient's going at 11 today, the transports booked, they're going to some care home and you don't realize until then that no one's done this discharge summary. Um, yeah, especially with, with, with most discharge summaries, even on the, the, on the whatever system you use, whether it's, er, or whatever, they'll have a structure for you to follow and it's quite self-explanatory. Like what actually happened, their past medical history, the key sort of investigations are results. So you don't need to put every single blood test that happened, but like scans and chest x-rays are quite good to include cause sometimes GPS can't, they don't have access to the scans. Um, and then what the main diagnosis was. And then if you've made any changes to the medication, that's really, really important cause very often you have patients who get discharged and if it's not clear, the GP is not going to make those medication changes. So all the like hard work that you put in during this patient's admission in terms of reconciling their medications is for nothing because the GPD didn't realize that you made those changes and they just continue on whatever they were on before, which is kind of a waste. Um Yeah, so again about what the GP needs to do specifically. So if there's anything that if there's any ongoing in interventions or investigations, like if you want them to do any repeat blood tests, that's something to mention if, like I said, so if you started any new medications change doses of medications or just stop them entirely. So very often you get, especially with Jerry's, you get patients who come in on like five different antihypertensives and you may like stop two of those and reduce the dose of one. And it's good to mention to the GP that you've done that because otherwise they won't really know, um, controlled drugs are often like the most, just painful to sort out cause you need to order them from pharmacy. There's often a very specific, it, it's often not just like with the other medications where you can just put them on the discharge summary, there's usually something else that needs to be sent to pharmacy for them to request the controlled drugs and most pharmacies they close at five, but sometimes they stop dispensing medication even before that. And so if you leave all your discharge summaries late in the day, even if you're leaving the summary part till the end, try to do the medication bit before so that at least the nurses can request all the medications and then you can just write the, the story part of it later. But at least you won't end up in a situation where the pharmacy is closed and the patient's going. But all the medications that they need haven't been requested and haven't been supplied because then you have to sort out things like FP TENS, which you can't even sign as an F one and it just all becomes complicated. So, I think doing the T TA S especially early on in the day and also keeping on top of the discharge summaries in general just makes your life easier. It makes everyone's life a lot easier. Um Communication with relatives again. Yeah, sometimes this is like face to face, sometimes it's on the phone. Sometimes this sort of thing is done by consultants and reads. But often, quite often it, it will be you and that can make it quite difficult because often you'll be having to justify or explain decisions that aren't really your decisions. So for example, just using an example that happened to me yesterday, a patient for whom they were supposed to have a flex sig and that's what they've been waiting for. And then the consultant decided, actually he doesn't need it. We're going to cancel the request, we're making him medically fit. That's obviously not a decision that you are ever gonna make as F one, but it might be you who has to call this person's wife and explain to them why you've now canceled this request for a scan or whatever that has been keeping this person in hospital for days. And they will usually have many questions about why you've done that and they're going to have thoughts and feelings and opinions about why you've done the things that you've done. And so it's helpful before you even call a relative. If you're giving them an update to actually know to, to be prepared to be asked lots of questions. And if you don't think you fully understand why you, why the plan is the way it is, I would try to clarify that before you even call because whoever you call is going to ask you why you're doing what you're doing. And if you don't know the answers to everything, obviously, it's fine to tell relatives, I'm not sure I'll, I will check and I'll get back to you and I'll give you an answer as soon as I can. But ideally if you know what the answer is before you even update them, I think it just makes communication a lot more, a lot easier. They'll, there's always, they're always gonna ask you something that you just don't know and that you will have to ask someone else. But if you can try and gather as much information as you can before you call them, that's really helpful. Um And yeah, I think especially when it comes to doing like documenting conversations with next of kin, that's really, really important because sometimes you can get families that are a bit, that are a bit difficult and that will say that, you know, they haven't had updates in, in days or that no one's told them this or no one's told them that. And if you've not documented the things that you have done, even if it was just like a short conversation, then no one can really prove that what they're saying isn't true. And so it's good to write down exactly what you've said exactly what they've said, especially if they have concerns or things that they're not happy about. It's really important to write that, write that down and write down exactly what they're not happy about. And I think it's also really good to mention that then the next day during the war round to your consultant because obviously as the f one, you often are the one who does a lot of the next of kin communication. But if you have a family that's sort of persistently not very happy. Ideally, someone like a reg or a consultant should speak to them as well. See you. Yeah. Um, and then preparing for the weekend, whether it's on medicine or surgery, there's always gonna be an oncall team over the weekend. The, the specific system that they have might be slightly different. But usually you make AAA list that you want the oncall doctor to do. And this is, I think, I think it's just really important to remember that one day, you will be the, you will be the person who's on call over the weekend. So try and put yourself in the position of that person when you're trying to like, explain what the task is for them to do over the weekend, because whoever's on call isn't gonna know your patient at all. And I think sometimes people forget that when they make the weekend plan. And so it's really important to be really clear about why whatever you're asking them to do. So if you're asking someone to chase ese to, to explain why that's so important that it needs to happen over the weekend, like does this person have C KD? Do they need to be fluid reviewed? Why do they need to be fluid reviewed and just like explaining the story so that it makes sense to someone who's never met this patient before and knows nothing about them. And if you are asking people to chase bloods to remember on Friday that you need to actually put those bloods out for the weekend for Saturday and Sunday because oftentimes you'll be trying to chase bloods that haven't even been done, haven't even been requested that no one's put them out and it just slows everything down. Um And if you've got patients who are unwell and need like actual clinical review, not just bloods to be chased, to give a picture of why they've been unwell, what specifically you're concerned about what scans you've done so far. And then also to specify if, if you want an F one, an sho or a reg to, to see that patient cause sometimes it might, it, you might just need an F one. But if it's someone who's really unwell, you, you may just want the reg to come straight away. Um, what else? And yeah, if you're putting anybody on the weekend discharge list to be discharged over the weekend, try to make sure that you've done everything else that needs to be done. So like you've done the discharge summary, you've done all the meds, you just need someone to come in like cast an eye over them to make sure that they're still clinically well enough to go home. But it, it shouldn't be that person's job to then do all the paperwork side of it cause again, they don't know your patient and it'll be much harder for them to try and do all that than if, if you did it yourself. Um And yeah, if you've got, again, if you need people who need daily bloods, whether it's for an inr, whether it's for daily eutheia, whatever it is, just make sure that you've actually requested them and told someone that they need to be done because it, again, it just makes everybody's life much easier. Ok? So just in summary, just to cover everything, try to get to know the patients on your ward. I think my what I like the most about being an F one is you're actually there more than anyone else most of the time and you can get to know your patients better than anyone, not just medically in terms of like, these are all the scans that they've had, these are all the medical problems that they've had, but like, just getting to know them as people as well, like you, you actually do kind of have the more time than anyone else to do that. And that can be really rewarding because even though you may not be making the decisions about their care, you can often really like influence how they feel about being in hospital. And yeah, again, if you can help, try and help out the nurses and physios and dietitians as much as you can, they, they'll help you as well. So if you have a good relationship with the nurses, then if you're having a really stressful day and you need them to help you, they will be much more inclined to help you than if you don't really have much of a relationship with them. So again, like if, if you have, if there are plans or things that you need the nurses to do to just like have good communication with them and actually tell them and not just expect them to read your mind and yeah, try to be organized, try to find a system that works for you, write everything down as much as you can, sometimes you won't have time to write it when it's happening. You might have to write things in retrospect. Like that's fine, even if sometimes I've written things in retrospect from like the day before, just because on the day itself, I really didn't have any time to do it. Um And yeah, there will always be extra work. I think that's something I really didn't do in my first job. I always try to do everything every day, but you just can't and some things can wait like it's not a big deal. And so it's just about and, and if you're not sure what can wait until the next day, you can just ask your, your consultant. Are you, are you happy for me to do this tomorrow or do you really want me to do it today? And they will tell you um Yeah, try to make things as easy as possible for the on call team, whether it's the day, weekday on call team or the weekend on call team because it will be you at some point. Um And look after yourself, take breaks, go off the ward, try to have lunch with like your other F ones cos even though you spend a lot of time together on the ward, it's different when you're like just in the mess and not doing work together. And then yeah, download all the apps that you need cause that makes things easier for you. Nice. Yeah, I mean, um, if you guys do have any questions, um, about anything that we said, you know, in this, um, in this session or any, anything in general, you know, if there's anything you're worried about, um, or then, yeah, please just do, um, message in the chat obviously, you know, um, it can be quite sort of, um, daunting sort of making that, uh, change from obviously student to, to f one. So, um, you know, we've been through it, we sort of understand, you know, that, you know, that sort of first sort of couple of weeks is tough and, um, do be aware as well that, you know, your consultants and, and the rest of your team will know, you know, that you're, you're starting as an F one, so they won't expect much from you. So, uh, do bear that in mind as well because, um, you know, especially, you know, I think the, the first day that you start as an F one is called like Black Wednesday. And, um, because historically, more people die on that day. Um, so, um, teams and consultants will put a lot more staff in on, on that day as well on your first day. So you'll be really, really well supported on that first day. Definitely. So, don't worry too much about your first day because you'll have loads of support and you won't really be asked to do that much, you know, um, yourself um, and, yeah, especially in that first couple of weeks, your whole team will, will know that you're just starting as an F one and will know that it does take time to sort of get bedded in and to sort of get to know the systems you're working with and get to know how things work in terms of, you know, how, how to get things done really. And like, a lot of your work as an F one is um getting, you know, getting things organized as a, as admin, you know, a lot, a lot of the stuff that you're doing is, you know, organizing scans, making things, making sure things happen, you know, hassling radiologists getting, getting bloods done on time, you know, all the sort of stuff that we've talked about in this session. A lot of it is sort of admin and making sure that you're organized and that's, that's the best thing and, and the only way to prepare as an F one is to make sure that you aren't organized and you know what you're doing and you're well prepared. That's the best advice. I think that we can, we can give you really um is, yeah, knowing your patients, knowing your role and whenever you're unsure about anything, you know, asking your seniors, um they won't mind, obviously, especially at the start as well. They know that you're getting to know the job, getting to know completely different systems to what you've trained in, um, you know, you might have done discharge summaries, for example, in a, in a different trust and you come to this new trust and everything's completely different. You don't know, um, it will just take a little bit of time for you to sort of get to know those sort of systems. And once you're up and running, obviously it will be, you know, it will go really, really quickly and the first rotation will be over really, really quickly and you'll learn so much obviously in that 1st 1st rotation. So just as long as you're aware of that, you know, you, you will be, you know, you will learn a lot and you will be, it will take time for you to obviously get those things um in place and sort of get efficient with those sort of things. But yeah, as long as you're aware of that, then it's absolutely fine. The other thing to mention is, um yeah, the most important thing is, is, is knowing your patients and knowing your sort of role. And sometimes, for example, you'll have on calls and you'll have annual leave and things like that. So sometimes, you know, you need to work, work together with your teams that you'll have your consultants and you'll have say however many juniors on your rotation. So, you know, in care of the elderly, which I on at the moment, there's four juniors, there's me and another f one, there's an F two and there's two teaching fellows, there's a reg as well. And obviously, that team is, is stays the same. But quite often, you know, one of us will be on call, one of us will be on annual leave. So our responsibilities and will change quite a lot. So as as long as you're aware, as a team of who's in what day, who's doing what on what day, then you can be really organized yourself as a team to sort of. So, you know, say, you know, for example, if you've been working on the weekend and you've got Monday and Tuesday off when you come in on that Wednesday, you know exactly what you're doing, um, you might want to come in a little bit earlier on that Wednesday because you've missed obviously Monday and Tuesday. You don't know what's happened on those two days. You might want to come in a little bit earlier, make sure, you know, which patients you're seeing, you might take, you know, a certain bay. For example, you might take a certain number of patients as your sort of the ones you're looking after. But if, then if you come in a little bit earlier and then you can have a look at those notes, you can have a look at the plans that were made on those on that Monday and Tuesday, you can really update yourself as to what is going on and what, what's expected of you. So just make sure you are organized with those sort of things and, you know, um, what your responsibilities are. And sometimes, for example, yeah, you come in early on that Wednesday morning and you can have a look at the, the plan from the previous day and sometimes you can even do some of those jobs before the ward rounds even started. And then you've just made your life, you know, you can just start getting to work and you can, you can make your life a lot easier and you can make again a really good sort of impression on your, on the rest of your team. If you, you know, the plan from the previous day was to, you know, check these things you can get on and do that if you feel comfortable doing those things, you know, if you, um, if the panel was to get act in a few days or, um, for example, and you can, you can order those scans and just, yeah, the best thing is to be organized and to know your patients and sometimes that, you know, you might need to come in a little bit earlier just to make sure you do that. But that will save you time as well. So, um, you know, if you do come in 15 minutes earlier, that can allow you to leave on time, for example, you know, um, and not, you know, sometimes that's another thing, a part of the job is an F one. Sometimes you will stay late. Um, that's, you know, some days are busier than others. It really variable with staffing levels. So sometimes you might have a full, you know, all, everyone from your team might be on the ward at the same time and you'll have, you know, a lot less people, you know, a lot less responsibility and a lot less patients to see. And then sometimes the next week you might have half your team on annual leave. Some of them might be sick, some of them, you might be on call and it might just be sort of you and another junior, for example, and you might be looking after a lot more patients. So it's really, really, really variable how busy you are as an F one. So sometimes you can be really, really busy and you can be really short staffed and sometimes you can basically be supernumerary and not really have anything much to sort of many responsibilities and much to do. So when you have that time where you've got really good staffing, that's a really good opportunity to focus on things like other things. So focus on your portfolio trying to get some sort of, um, KS and CBD S trying to get things signed off, make sure, you know, those sort of things that you can, you know, don't just sort of sit there and play on your phone, you know, or do anything like that. You know, just when you, when you do have that time, try and, you know, use it to your advantage and get these things done that you need to do. And obviously, then when you are really busy, um, it's just about being organized and just, um, trying to get things done as, as soon as you can. And obviously, then if you've got jobs outstanding at the end of the day, you know, that's why it's really important to prioritize stuff. So as soon as you finish the ward round, get those important jobs. So things that Tara mentioned, you order those scans straight away so that you can, so they, they can be ready for the end of the day, obviously, see the most unwell patients and, you know, once, you know, you can prioritize your jobs basically and, and get things, you know, done, you know, that are really important earlier on in the day. Um, and then things that you might need to hand over or things sometimes, like you say, it might be a fine just to say, oh, you know, the plan was to update the relative today, but I didn't have time. I'm gonna have to do that tomorrow. That's that. So updating the relatives. That's an example of something that can be done. Obviously, if, if this patient is, um, you know, nearing the end of their life, if they, if you've made them palliative or something like that, then that's obviously a really important discussion you have with the family. But if it's just, um, an update as to, you know, um, they've finished the antibiotics for a, um, cap or something and you just want to update the relative of, of sort of what the plan is and discharge planning and things like that. Those sort of things can, can wait to the next day. But, um, again, just use sort of, it's, it's common sense, really just anything that's urgent, get it done quickly. Um And then the rest, you can either hand over to the on call team, um or just, um, do the next day. And again, it, it's really important that you organize if you do have jobs that you need to sort of do the next day and make sure you update the list at the end of the day, say, you know, on the plan bits and say, right, you need to update the relatives so that you don't forget. Um, and have that on your list so that, you know exactly what you need to do the next day and see you. That's the main thing I think that that was, is sort of most useful in terms of what makes it good. F one I think really um is just being organized, being well prepared. Um But yeah, like, like I say, if you do, if you guys do have any questions, obviously, we're coming to eight o'clock now. So if you wanna go, that's fine, but we'll probably stay around for a few minutes if you guys do have any questions. Um Anything that you're worried about, um, anything you're unsure of, please do put a message in the chat. We're happy to answer any of your questions. Um, because like I say, yeah, it's, it, it is a daunting sort of, um, switch, you know, making that sort of, um, first day as a, as a working doctor. But, um, like I say, it's, you know, everyone's going through the, the, the same sort of things, you know, there's, you know, we have a load of new F ones on that first day. Everyone's in the same boat, everyone has the same experience. Um And your colleagues know that. So don't be too worried about it. Um But yeah, we'll, we'll, we'll stick around for a few minutes if you do have any questions, just put him in the chat. Also. You, you guys will get a lot of information in your induction sessions as well. So, um you know, you'll have a, a week's induction before you start as an F one and that will help you get to know the systems you'll be working with quite often. Hopefully you'll have some shadowing as well. So we had some shadowing in our induction where we just literally shadowed the F one that we were going to start doing that job. So, you know exactly what's expected of you. So you will see um what that F one does in a, in a normal day and then you can just do what they do, you know. Um, so that can be really useful as well. Um And it is just little things, you know, just knowing how to request things, how to get things done. Um, little tips and tricks that can make your life easier and, you know, get, get things done basically is the aim of the game as an F one is just to be um you know, be efficient and make sure that the plans made made for you by the consultants, get action and you can do them as quickly as possible and then obviously get the patient home as quickly as possible. And is the main thing cool. Also guys forgot to mention as well. Um We'll have uh we can send you guys some certificates as well that you've um attended the session. Um We'll send over some feedback forms as well. Be really, we will be really appreciated. Uh If you fill out the feedback forms and once you've done that, then we'll give you the uh you get the certificate automatically then and it just goes, um you can put it in your portfolios or um just as evidence as, as, as um that you've so I have attended these sessions and yeah, join us for the next one. Obviously, we've got this sort of series of, of sessions that are hopefully um preparing you well for, for F one. OK? I mean, yeah, it looks like you, you guys don't have any questions, so hopefully um you've explained everything um pretty well. So uh yeah, we will send you the, the fe about forms and yeah, join us, join us for the next session. All right. Thank you very much.