Hi, I am Abhishek, an IMG from India and a former MTI trainee in Medicine in 2018 - 2020. I passed my MRCP in 2021 and I am currently a Speciality Trainee (ST3) in Gastroenterology and Hepatology in the NHS, UK. Today I would like to share with you some elements from a day in the life of an SHO in the NHS.
Congratulations on securing your first job in the UK! The day, which every doctor newly registered by GMC dreams about. The day when you feel that all your hard work has finally borne fruit. You deserve all the success as you have worked hard for this. Slowly as the day comes, the excitement gets mixed with anxiety. The anxiety about starting in a new place, coping with the expectations and most importantly learning the system - the NHS way of working. So in this blog, I am going to mention ways in which you can make your life easier at your new workplace and also fulfil your objective of getting your CREST form signed.
What is the CREST form? CREST stands out for Certificate of Readiness to Enter Specialty Training. Read our blog on Getting your CREST form signed: guidance and tips
Generic advice
The NHS hospital buildings are a maze, especially the ones in the big cities. Make sure you are well planned in terms of route guidance if availing of public transport. If you are driving, keep 10 mins in hand to get a place to park inside your hospital (it has been terrible in the hospitals I have worked in, but could be different elsewhere). Reach a little in advance to find your department and settle yourself down in that new environment. Usually, the F1 doctors reach there a little ahead of time, introduce yourself to them. Introduce yourself to the nurses, ward clerk, the therapists (Physios and OT), remember they are all an equally important part of the team.
The usual 9 to 5 ward job (sometimes 8 to 5 or accordingly)
Start prepping the ward round sheets. Some trusts have a pre-designed proforma and you just need to fill in the details. Some trusts have an electronic records system and things need to be typed.
Ask the nurses if there have been any concerns for any particular patient that needs to be addressed urgently. That could be anything from a clinical concern to an urgent TTO/Discharge summary.
The F1 doctors usually update the patient list with clinical details, so see them do it. There would be days when the F1 would be off/on-call so then it's on you to do it as the junior-most member.
Accompany the consultant during the ward rounds. They usually do the ward rounds twice a week unless it's acute medicine unit which gets consultant rounds daily. The other days could be registrar led and some days it’s led by you.
Following the ward round, go about with the jobs. These would be mostly updating drug charts, sometimes doing bloods, putting referrals to other specialities and radiology requests. In addition to this, it would be doing TTO and discharge summaries.
Update the patient list towards the end of the day (either you or F1).
Handover to the ward on-call team if there is something that needs to be looked into. You do not need to handover every patient.
On Friday, sick patients need to be put on the handover list for review by the weekend on-call team with a clear division as to who needs to see. (F1/SHO/SpR).The SpR usually sees the sickest ones but there is no clear division.
On-calls (8.30 am to 9:00 pm)
Come to the on-call area and introduce yourself to the team. This would be a mixture of doctors from various wards of your speciality (if medicine) and not necessarily your ward.
Start clerking patients on the clerking proforma of your trust. Try to keep everything within 1 hour to 1.15 hours, this includes taking history, clinical examination, filling up drug charts.
Get the patient seen by the consultants - called 'post-taking'.
Following the post-take, finish the jobs given by the consultant and take the next patient. Sometimes it could be 2-3 patients together depending on the time of the day and workload.
Handover to the next shift members if any pressing issue.
Weekends
If clerking shift then as above.
If ward-cover shifts, then print out the weekend handover list to see the patients who need to be reviewed.
Escalate any concerns to your registrar who would be usually the most senior person that day. Some hospitals have only one registrar and some two: 1 for the clerking and 1 for the wards.
Nights
More or less as above but on nights you work with minimal staff.
Escalate to the registrar if any concerns as consultants do not stay on site.
Kindly take adequate rest just before leaving if you are driving. Risks of accidents are higher if you drive due to deprived sleep.
Golden Tips
DO ask questions, that’s how you will learn. If you remain silent, that is a sign of non-engagement from your side.
DO try to leave on time. Overstaying to impress people doesn’t work here, rather your time management skills would be questioned.
DO take breaks, it's very important.
DO NOT skip meals because of workload. Your well-being is your number one priority. You can only care for your patients if you are well yourself.
DO NOT discuss patients in public areas of the hospital. Remember patient confidentiality. If you need to, do not take names, just bed numbers, but only if pressing needs.
DO NOT behave rudely with nurses or anyone. You will be in trouble. But don’t tolerate any misbehaviour and escalate appropriately.
Webinars with Abhishek
TrewLink, in collaboration with Dr Abhishek, has recently hosted an informative webinar about the Medical Training Initiative (MTI) scheme for International Medical Graduates (IMGs).
If you would like to know more about the MTI scheme, please watch our FREE webinar with a Q&A session “Medical Training Initiative (MTI) for IMGs: process, requirements, top tips” at TrewLink.com
MTI is the sponsored route of GMC registration which allows IMGs with considerable work experience to come and work in the UK for a period of 2 years. After their training, they return back to their home country and utilize their expertise to improve/suggest modifications to the existing health care there. NHS gains by reducing dependence on locums to cover for the shortage of doctors, getting experienced doctors on board and learning from their experience. Read more in our blog Medical Training Initiative (MTI) for IMGs or watch the webinar Medical Training Initiative (MTI) for IMGs: process, requirements, top tips
If you have any questions about MTI or the SHO life in the NHS, I would be happy to answer them at trewlink.com.
Good luck,
Abhishek Ray
ST3 Gastroenterology and Hepatology
Written by Abhishek Edited by Julia