This post is about observing your colleagues when you start working in the NHS in your first job.
We all have the clinical knowledge. All we need is the '' Logistical Knowledge'' like
- How to document
- How to do ward rounds
- How to chase jobs
- How to prioritize jobs
- Cannulation equipment
- How to make referrals
- How to make discharge summaries
And the list goes on...
I have made a few blog posts on this here:
https://omarsguidelines.blogspot.com/
And my colleagues have shared their experience and advice in the blogs here:
https://naseersjourney.com/useful-links/
But despite all of this, we still need to actually observe these things we can easily read on blogs/websites.
A lot of IMGs struggle with settling into their first jobs in the NHS for this reason.
Plus the HR and management does not help. The reason being:
1. They assume that you have prior NHS experience
2. You have not asked hence they do not offer this.
FAQS:
How should I arrange this?
When you are about to accept a job offer, email your trust something along these lines:
' Hello,
Many thanks for accepting me into your prestigious trust. It is an honor for me to work here.
However I have a few concerns:
1. As you are aware, this is my first job in the NHS and although I have the clinical knowledge and accumen, I will struggle with understanding the local protocols.
I have spoken to a few other colleagues who have suggested a few days of observership in the ward I am starting in would help me immensely.
Hence, I would kindly suggest if you could possibly ask my supervising consultant to request one of the doctors working on that ward to allow me to observe them for the first week. I will learn how they do ward rounds, procedures, document in the notes, use the IT system and communicate with other members of the MDT. This transition period woiuld help me settle well and this way, I can provide a service expected of me.
I would also kindly request you to not put me on the call rota till I have shadowed a few on call doctors so that I am comfortable with how to manage patients out of hours once I am used to my 0900 to 1700 regular ward day job.
I am very keen to learn however I would appreciate the team to kindly understand that I just need a bit of observing early so that I do not struggle. This favor will make an immense difference in my settling in, confidence and my ability to manage patients independently.
As I have never worked in this trust before, I would also need an induction for IT systems and bleeps. I was wondering if this could be arranged before I start my period of shadowing.
Many thanks,
Dr ****'
Also take this oppurtunity to ask any questions mentioned here:
http://omarsguidelines.blogspot.com/2015/09/what-to-do-once-your-job-has-been.html
But I am a new doctor. I mentioned that I am new to the NHS in my application and they knew about this in my interview.
Unfortunately, HR takes very few things on board during the interview when they ask if you have any questions. They 'forget', 'loose the paper they were writing everything on' or just forget about this.
Hence it is very important to email them and request a few days observership when you start.
What about induction?
Ask about this as well. Ensure you have a session with the IT team on:
- IT systems
- Bleep systems
Other parts of induction may include:
Teaching on clinical governance, Basic life support, fire safety, etc. This may/may not be done when you start but it is very important you have an induction for IT systems and bleeps.
So when should I request this shadowing period?
When you come to the UK on your work visa. Once you have sorted out your
-BRP
-Bank account
- Accomodation
- Have had your IT induction
What would I do during my shadowing period?
You will be expected to come at 0800/0900 AM to the ward
Attend the morning handover
Go on the consultant ward round
Observe how the consultant leads a consultation
Observe how the junior doctors document the ward round
Observe how juniors then meet and make a list of urgent and non urgent jobs
Observe how they divide and delegate jobs
How they do procedures like bloods, cannulas, ABGs, etc.
How they make discharge summaries
How they do referrals
How they request and discuss investigations
How they present in the afternoon huddle with the ward manager and discharge coordinators
How they conitnue doing jobs
How they handover any outstanding jobs to the on call team
What will my role be here?
Just observing
What if there is no doctor and I am expected to just work as if I know the system?
You will struggle. You will get overwhelmed. However you must escalate this early to:
1. The consultant on the ward
2. The HR team
The consutlant has said carry on.
This is unacceptable. Ensure you are well supported and do not have to do anything you are not comfortable with.
Yes, sometimes due to cock ups by HR, you do end up on your own/with mimimal staffing on the ward on your first day in the NHS and in this case, this is what helps:
- Introduce yourself in the morning MDT. Let them know you are new and you will try your very best to help with whatever you can but you might struggle
- Ask for help whenever you struggle.
- Send an email to HR ( a reply to the email you sent to them when you requested them to arrange shadowing and CC the consutlant into this).
-Keep reminding the consultant that you need support.
This is scary! What if I end up seeing an unwell patient or asking do something which I am not sure about?
Ask!
What if no one is around?
Call your consultant. Your consultant/registrar are paid to support you on the ward. I am a medical registrars and one of my job descriptions is to support the team on the ward. There is no excuse not to.
Why is this not a national protocol whereby all doctors starting in the NHS are allowed to observe for one week and then start with support.
Unfortnately, in the NHS this is how it works:
Medical students start placements on wards from third year.
A few months before they start their foundation training, they are added as supernumerary FY1s on the rota. They shadow their FY1 colleagues on the ward and on call. They slowly start working and helping.
Procedures are not an issue for them as they have already been doing them since third year. It is part of their cirruculum to get basic procedures like cannulas, venepuncture, ABGs, catheters signed off in their medical school.
Sadly, when IMGs accept jobs equivalent to SHOs, or even FY1, the trust 'assumes' they know the system already.
But IMGs have been here for ages! Why can they not fix the system.
This is what I plan to do - if anyone else wants to take the initiative, they are more than welcome.
I am planning to have a set one week agenda for all IMG doctors starting in the NHS. It will be a tickbox paper which has the following points:
1. Ensure the doctor has had one week of 'hands off' shadowing
2. Ensure the doctor has had induction for IT systems
3. Ensure the doctor is not on call
4. Ensure the doctor has access to their supervisor and have had a meeting with them at the end of their shadowing period.
This form should be signed by the new doctor and then countersigned by their line manager to ensure these support measures have been put in place.
If anyone has a better idea, please feel free to share.
I have not started here. And I am already scared!
Do not worry. You are coming to a new country. Everything from your work environment to daily living like paying bills, accomodation, driving, the annoying self serve tills at grocery stores are new. But slowly you learn and get used to it.
How did you manage?
I had a hands off period of observership in my first 1 week in the NHS. My ward was well staffed and I ensured
1. I was given this period of observship before I accepted the job
2. I introduced myself to the whole team
3. Asked for help.
4. I ensured I was not put on the on call rota till I got used to the system and had shadowed a few colleagues on call.
What my trust did:
1. My supervisor met me in my first week and said - you are no longer a foreign doctor. You are now part of the team and my door is always open for you.
2. The HR was very supportive - they ensured all my queries were answered via email before I accepted the post
3. They ensured I had the necessary support in place.
I feel I am asking a lot of questions from HR.
Do not worry. They are paid to ensure the doctors they are recrtuiting are well supported.
The HR is not responding.
Remember to email them and wait for 2 working days. They do not work on weekends. If they do not respond, call them. After talking to them on the phone, email them again to clarify whatever they have agreed to on the phone so that you have documented evidence.
https://omarsguidelines.blogspot.com/2019/03/communicating-with-hr-in-nhs.html
I have tried calling them. They are not responding.
You need to get in touch with IMGs working in that trust.
Join this group:
https://www.facebook.com/groups/IMGs.in.the.UK
Search for your trust in the search bar
Tag/message the IMGs who have posted about this trust. Please note that messages from people who are not in our friends list may go into our spam inbox hence tagging them might help.
Get in touch with them and they can even help with other things. Suggest to them that they can even start an IMG representative programme I have mentioned here:
https://omarsguidelines.blogspot.com/2021/10/when-i-become-consultant.html
How can I ensure my shadowing period is as structured as possible?
WEEK 1
Hands off from clinical work for 1 week
Introduction to how the trust functions on day 1 - walk around , showing how to use your badge , where the doctors mess is , cafeteria is , public transport / where to park your cars ( this is in addition to the usual IT and e learning induction we all have )
Day 2 to 5
Observing colleagues working at their level from 0900 to 1200 as a supernumerary doctor.
Simulation lab for ILS , taking bloods , cannulas , catheters , NGT tube insertions 1300 to 1600
So, the bottomline is :
1. Ask for shadowing as soon as you accept the post. If you have not asked at that point, ask ASAP
2. Ask ask ask! We are all paid to help our colleagues.
3. Make your life easier here by ensuring you get the adequate support.
PS:
This may not always be possible in training posts like IMT, GPST, ST3/4/ACCS, etc as they expect you to have already worked in the NHS. Hence my advice here not to go for training posts directly:
https://omarsguidelines.blogspot.com/2019/03/when-should-i-apply-for-training-post.html
Post a Comment