Monday, 18 January 2016

Surviving FY1 - Your First Day

Nothing is more terrifying than your first day as a doctor. Shadowing is gentle introduction, but then BAM. You are on your own.

BUT. You will be ok. I survived it, the twitfrg team all survived it, and hundreds of doctors before you have survived it. Here are a few hints and tips to make it easier.

Survival Kit

My friend made me an "FY1 Survival Box" for my first day, and this is something I have done for friends every year since. If you and some friends are starting FY1 together, make kits for each other to exchange the night before you start. They can contain both practical and silly things. Here's a list of things I put in one of my boxes for a friend, to give you some ideas:

  1. Emergency Chocolate. Enough said.
  2. Coffee To get you over that 4am wall of tiredness.
  3. Cereal Bars. You will run late at some point. Breakfast is good. Also a good rescue snack in the middle of the night
  4. Pens. The NHS is full of prolific pen thieves (consultants, registrars, nurses) so always have a spare pen. You’ll also write so much on ward rounds etc that you’ll burn through pens like there’s no tomorrow.
  5. Tissues. For when you get the NHS equivalent of Freshers’ Flu. Or for when you need a little cry during those first few weeks.
  6. Hand cream. The hand washing will ruin your hands - look after them, they’re precious.
  7. Mini Notebook. This will be your Bible for the first few weeks - use it to write down ward phone numbers, useful bleeps, commonly used drugs etc. It’s great to have as a quick reference guide in your pocket.
  8. Toothbrush/toothpaste. To stave off “night breath”.
  9. Plasters. You would not believe how impossible these are to find in a hospital.
  10. Vaseline. Your lips will be as dry as the Sahara on days and nights when you’re run ragged.
  11. Shower gel. There will be at least one shift where you have to shower and change into scrubs. (Make sure you have spare underwear and socks in your bag - TRUST ME on this one).
  12. Body spray. There is nothing worse than smelling to high heaven after doing a long shift, or a round of chest compressions on a well heated ward. 
  13. Tea Bags. Use these to bribe the nurses when the ward supply runs out. Also good on nights or when you’re in early preparing the ward round sheets before the registrars get in.
  14. A mug and teaspoon. Preferably one with your name on it. Preferably more than one teaspoon - the NHS tends to be in short supply of these.

Dress to Impress

Most impressions of people are formed in the first 30 seconds you meet them. Treat day one as a job interview, and dress in smart, but practical clothing. (Ladies, this is not the day for stilettos. Men, this is not the day for your favourite bright orange trousers). You don't want your consultants to remember you as the one who turned up in jeans on the first day. Also, make sure your face and hair are smart. First days tend to involve inductions, and photos. I had a surprise photo taken on my first day for our ePortfolios.... It is STILL there, and the consultants see the photo every time I send them a ticket request. I was NOT looking my best.

Look Up

If you're not sure about something on your first day, say so. Nobody expects you to know everything. Look it up in the BNF, your Oxford Handbook, or look to your SHO/SpR for advice. 

If in doubt, remember the TwitFRG mantra - Stop, breathe, ABCDE. You will find most things are easily fixed this way. You don't have to have a diagnosis, or know exactly what's wrong, but you can have a plan and buy yourself some time to get help.


Use your time on shadowing to get to grips with the bleep system. It's different in every hospital. Learn how it works, how to answer bleeps, and how to bleep other people. When I first started, I found it useful to make a list of the jobs from bleeps as they came in, so I could prioritise and group things together on nearby wards. If I didn't do this, I found I was running back and forth to places I'd just been, with no sense of organisation or order

Some of you will spend your first day with a Cardiac Arrest Bleep. It's scary, but you will have done ILS or ALS and you WILL know what to do. If you've never been to the hospital before, find a map of it to print out (lots of hospital websites have these for patients) or have a quick look around 30 minutes before your shift starts. If you can, go in the day before for a good look around to orientate yourself.

If the bleep goes off, DON'T PANIC. You won't be the only person going. Don't kill yourself by running at full pelt - you'll be no use if you pass out when you get there or are too breathless to talk. You *might* be the first person there. If you are, take charge. Get a quick history, grab the notes, get a rhythm, and start timing. Other people can do compressions, and do other stuff. If someone more senior arrives, they may take over, they may not. Ask what they want to do as and when they get there (If you have no idea who they are, ASK!). Remember, you are part of the TEAM. You won't be alone.

SO, that's how to survive your first day.

Over the next few weeks, I'll write a bit more about FY1 - ePortfolio, Nights, on calls. Let me know if you've found this useful, and if you want me to write about anything specific.


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