Hello, my name is Ethan and I carried out my foundation training in Birmingham.

The step up from medical student to the foundation training programme can be significant and daunting. Although medical school may provide clinical teaching and exposure, a vast amount of skills and knowledge can only be learned on the job. Here are some top tips on making your life easier when starting your first job on the ward.

1. Get access to the IT systems early.

- Whether you are good with computers or not, you will rely on them to do your job. Get familiar with your IT system early. Contact your IT support to troubleshoot any issues you have gaining access. This will ensure that you are well-equipped when you are largely on your own on a night shift.

- Of note: Technology can improve your productivity however the systems used in your hospital may not be the most user-friendly.

2. Get familiar with the team, especially the nurses.

- Medicine is a team effort and you cannot do it alone. You will rely on the experience of others. Gaining a rapport with the nurses (and other healthcare professionals) can really help.

- Remember: Treat your colleagues with respect even if you may not receive it. Staff in a stretched healthcare service may sometimes be grumpy, but you will need them!

3. Know when to escalate and ask for help.

- You need to appreciate that you are only a ‘baby’ doctor. Be kind to yourself as you will likely not know what to do in many instances. Confidence will come in time. Your seniors will understand this and will expect you to escalate issues you cannot deal with or to run things past them, even if it is minor.

- Remember: You hold the risk if you do not escalate. Get top cover as much as possible, especially if and when you feel out of your depth. Know what you can do and what you should not do is important. Never feel bad about escalating early - there may be many things that you can do to help the patient along, e.g. arrange a CXR, gain IV access, read the notes and understand the patient’s medical history. All of these things take time and your senior will thank you for having done this.

- Think: What can I do? What can I do now? Who else can do it?

4. Know how to write a jobs list.

- You can quickly accumulate jobs so make sure that you write them down. Remember to complete jobs based on clinical priority, however also think about grouping similar jobs to get them out of the way. For example, carrying out all the tasks requiring a phone/computer together. You will need to think about doing some tasks before a certain time, e.g. all the bloods in the morning so that you will have the results to review in the afternoon. Be savvy when answering bleeps from nurses/referrals and taking on further tasks. What must be done prior to you seeing them so that your time is not wasted? E.g. If a nurse bleeps asking you to prescribe warfarin make sure that the patient has actually had an INR taken and that you have the result!

- Remember: Prioritise. Work as a team. Divide and conquer.

5. Prepare for consultant ward rounds.

- Ward rounds can be fast-paced, especially if you are on a surgical job. It pays off to get things prepared in advance (e.g. do you have a COW ‘Computer On Wheels’, patient notes/list ready?). Make sure to have had a quick look through the patient’s notes so that you can provide a quick summary to the consultant.

- Remember: You will be executing the consultant's plan from the ward round so make sure you are clear about what they want. If you are not, then ask for clarification! It will make your day more difficult if you don’t as the consultants may disappear to undertake other commitments.

6. Learn to get your point across in a concise way.

- Nothing is more annoying to fellow busy colleagues than a person who 'beats around the bush' and does not get to the point. Using a framework such as SBAR (Situation, Background, Assessment, and Recommendation) or ‘What? - So What? - Now what?’ can be useful, especially when talking over the phone.

- Remember: This goes for writing in the notes as well. Try not to make long convoluted entries.

I hope this helps and I wish you the best of luck!