Advice for final years (from a group of doctors who have been there) You’ve got a lot to think about over the next 12 months. Which I’m sure you’re fully aware of. We’ve tried to come up with tips and advice to help you through this. 1. FPAS I know this is coming up very soon for you guys and most of you will already know where you want to apply. Everyone has their own thoughts about this, but honestly I don’t think you can really go wrong when choosing. I don’t know anyone that hasn’t enjoyed their F1/F2 in any location. All I would say is something that my tutor said to me before applying: The transition from medical student to F1 is probably the most difficult transition of your medical career. You will have long days, nights, new people, new systems and new responsibilities. Therefore it makes sense to choose a deanery where you know some people already, or know the area. This may be the area in which you grew up, Trent, London or anywhere else. You want someone you know to be close enough to have a drink with you after a hard day or cook you a meal post nights. In terms of ranking all your other options (the vast majority of you will get within your top 5), this doesn’t really matter. Just make sure you put the places you really don’t want at the bottom! Don’t leave this all until the last day FPAS is open, the website has a tendency to crash! Academic Foundation Programme These generally are (slightly) harder to get however, looks great on a CV! To do this you will have to do some extra work when everyone else ranks their deaneries on FPAS around September/October time. This includes checking a box, picking 2 health areas (eg East midlands which is both Trent and LNR deaneries job) There are 3 main kinds of academic jobs, the main one is research (~80-90% of jobs) and this is the most competitive one as we have all done some research. If you are keen in doing more research then this is the one for you. The next largest is education, if you like teaching then this might be the one to apply for, it’s much easier to apply to as not many people will have a huge amount of teaching experience unlike those applying for research. I have recently heard however that these posts are being reduced and educational fellowship jobs are being created in their stead (for CT1+ grades), so there may not be many/any left. The final kind of academic job is clinical leadership and management, only 2 places in the country offer this, Leicester and Brighton. Finally there is rarely/never any difference in FY1 years between academic and non-academic foundation trainees, most of the academic stuff kicks in at the FY2 stage. If you would like to get involved in any of the academic programmes I would recommend looking at them on the FPAS website and trying to go to as many conferences as possible/getting experience in the relevant fields in 4th year/5th year prior to applications. 2. SJT There are multiple approaches to SJT. Everyone has the tendency to over revise, because as medical students we are trained to do this, and we don’t like the feeling of not doing anything. The best thing you can do, is to do the practice paper online in about mid October, and then again the weekend before the exam, the first time to get a feel for the style and content of the questions and the
second time to reassure you that it will be okay. Do not spend money on expensive revision books. This is a waste. If you really want to revise, then read good medical practice – this is basically the syllabus and all the answers. Before the exam the medical school will put on revision sessions, go to one of these to familiarise yourself with the answer sheet, timings etc. You don’t want to be that person who doesn’t realise the answers go on the answer sheet and loses half the marks as they only managed to transcribe half the answers in the last 5 mins. In the exam, take your time, read the questions carefully. Initially identify the top and bottom answers, you’ll get most marks for getting these right, and then move on to the others. It’s a strange exam and you will feel that you have no idea how it went/that it went terribly. Chances are, you’ll all be fine. People who over revise tend to second guess themselves because in a certain book it lays it out in a certain way and that’s not the same as the GMC want. 3. Revision for finals. Hopefully you’ll have all (gently) started thinking about revision now. Don’t underestimate the beast, there’s no doubt that the breadth of knowledge is huge. Make sure you spend time in clinics – these are really good learning experiences, and ask your registrars/consultants for ward based teaching, they will be happy to help and it will be much more worthwhile than the same amount of time in the library. a. Knowledge No matter how much you revise for knowledge, you will think it went terribly. Don’t panic. However do revise as much as is humanly possible. Don’t skip over areas because you think they are less likely to come up – they will be the areas that come up. For example we had a 10 mark question on palliative care. There will always be investigation interpretation questions – these are easy marks, learn them. The majority of questions are still focussed on diagnosis, and the main treatment questions are around emergency situations. Start revision regularly and slowly and build it up over the next few months. You can’t cram for finals. Find a revision partner, this will make it slightly more bearable. Take a few days off for Christmas – you’ll need a break! Plan this and then don’t let revision hang over your head whilst you relax. b. OSCE In the next couple of weeks you should be trying to find a group to do OSCE practice with. I think this should be a group of 6-10 of you who can meet regularly, for example every Friday afternoon/early eve. You’ve got to commit to this, and if you do it will be really rewarding. Ideally one person should be in charge and put together a rota in order to get everyone to do everyone else’s stations. Start with the straight forward ones – cardio/resp/abdo/radiology and build it up to include more complex stations. Towards the end of January maybe team up with another group and do OSCE stations for each other, so you can get an idea of the timings and stamina required to do lots in a row. Don’t forget to practice skills – the skills lab will be open nearer the time, make the most of it. There will be probably at least 2 MACCS type stations, make sure you practice all of them.
In terms of OSCE2 – this can be practiced in your group revision sessions too. It’s all about taking a concise history and examination and moving on to differential and investigations. These will change from morning-afternoon sessions so just because someone the day before had a meningitic patient doesn’t mean that you’ll have the same. There will be loads of rumours flying around about 2-3 weeks before the exam. Some of them will turn out to be true, and some will not. Have a think about these stations, and practice them, but not to the extent that you don’t practice anything else. More people will fail the OSCE – don’t be too upset if this is you. A lot of good people failed the OSCE because of a bad experience on the day, the majority of these people will pass at retakes. My best OSCE tip is to go and buy yourself a new OSCE outfit. Do this as a revision break at some point in Jan/Feb - you’ll need a pick me up and it’s a good start to the OSCE to be wearing something new, it will give you a much needed boost. 4. MAST This is the best opportunity you’ll have to learn how to be a good F1. These guys will have been doing the job for 8 months and they’ll be pretty good at it. Yes it might not be at the hospital that you will be working at in August but there are some F1 skills that are universal. Learn to do TTOs, which bloods to order, documenting ward rounds – this will be your bread and butter. As horrible as it may seem try and do a night shift at some point – the hospital is a different world at night and will be significantly less scary if you’ve done it with someone first. Other than that, ENJOY YOUR FREEDOM! If your F1 tells you to go home early, then go, see friends that were beginning to doubt your existence, go on trips, make the most of your time! Equally, elective, whatever you are doing, it’s going to be a long time before you can do anything like this again, so make the most of it.
5. Starting F1 As said previously, this is going to be the worst transition of your medical careers. However the good news is that everyone else in the hospital knows this and is expecting it. In most places you’ll probably have about 2 days of shadowing the old F1s, who will be absolutely amazing by then and then you’ll be dropped in on Wednesday morning expected to do it yourself. I think one thing is to be realistic. This is real life, not medical school anymore. You don’t get to follow your consultant to surgery, or to clinic. Your job is to look after the ward patients so that they can go and do all the other important things that they need to do. You need to be on/do a ward round, review sick patients, write TTOs, chase bloods and imaging. Therefore just because you’ve got a Neurosurgery job, it doesn’t mean you’ll be going to theatre everyday. However there will be times that you can go, when the ward is well staffed, or quiet, and you’ll certainly be getting a lot more Neurosurgery training than a colleague who has a job on Urology, or Vascular etc. Your priority is to know all your patients really well, and if you can go through your list and reel off facts about them all then you’re doing okay.
On calls – a necessary evil, and probably one of the best learning opportunities you’ll have. Make sure you know who to call if you need help, and make sure you take adequate snacks – you may not get a proper break. This is one of the areas that is really different to medical school. You’ll start off asking for help with most patients and over the course of your 4 months you’ll improve, be calling less and be enjoying it more. In most hospitals these will be either clerking, or ward cover. Really good opportunity to learn to prioritise and also to initiate treatment for really sick patients. Make sure you are tied to your bleep – seniors do not take well to these being abandoned! 6. Other things to think about As if thinking about the present wasn’t enough, you’ve also got to start thinking about the future. The second half of this year (post finals) is a great opportunity to start CV building. In the future you’ll get points for teaching (think about putting on some sessions for CP1 students during MAST, whist your knowledge will be there from finals and you’ll have time to create something), you get a lot of points for achievements outside of medicine (eg charity work, sporting events, music) or even if you wanted to complete the audit cycle on your GP audit (should be easy points!) The most important thing about any of these is to make sure that someone gives you a certificate, or a letter to say that you’ve done it. None of this is worth anything if you haven’t got written proof, and it’s much easier to do this at the time rather than chase it later. 7. Junior Doctor Contract I hope most of you have at least heard about and are up to date with the developments of the junior doctor contract which the government are trying to impose on junior doctors for next August. This will have a massive impact on you, your pay, your working hours and your future patients. Unfortunately students can’t strike, but there are many other things that you can do, follow the Medical Students Committee (MSC) on facebook or twitter, speak to your families and non medic friends about it and spread the word. We all need to work together on this!
If you’ve got any other questions then please ask any of your F1s/F2s, they’ve all been there recently and will be more than happy to help. Alternatively, I’m happy for anyone with any questions to contact me: Jessica Gates F2 at QMC Jessica.gates3@nhs.net