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Helen Carnaghan’s transition from medical student to junior doctor

6 Mar, 09 | by BMJ Group

Helen Carnaghan Over the past seven months my life has drastically changed having gone from a perpetual medical student to junior doctor in the blink of an eye. Looking back on the transition from a more settled position I can see the old adage of “don’t get sick in August” is a true reflection of the fears held by all newly qualified junior doctors.

Transition began with the standard series of lectures on handwashing, sharps injuries and the all important compulsory fire safety talk to which the fire safety officer forgot to attend! The only difference between this and medical school was the glorious fact that I was being paid to sit and do nothing – oh sorry, correction, I mean learn.

The easy life of the lecture theatre soon faded when the following day I enthusiastically strode onto the respiratory ward with my shiny new Dr Carnaghan ID badge, carrying my old faithful Oxford Clinical Handbook and wearing a slightly dazed expression of what am I supposed to do now. My entrance was swiftly followed by “Thank God doctor you’re here! My patient with severe COPD has dropped their SATs…. what do you want to do?”.

As I look around to see who the nurse was talking to it dawns on me she was talking to me. Fortunately at that moment the registrar enters the ward, took the situation off my hands, and I breathed a deep sigh of relief.

The rest of the day entailed a mammoth ward round, working my way through a list of jobs that seemed to only increase in length and answering bleeps regarding patients I barely knew.

It wasn’t until my first on call evening shift that I realised the true meaning of the phrase “a list of jobs a mile long.” With my bleep going off what felt like every 10 seconds it soon became apparent that I was quickly drowning in a sea of jobs, all of which seemed of equal importance to my inexperienced eye. Then the bleep of “doctor my patient is tachycardic with a MEWS (modified early warning score) of 3″ came through and my heart sank.

At least I knew how to prescribe fluids, antiemetics, analgesia, warfarin and sort out the other jobs thrust upon me for simply being a doctor on a medical ward past the hour of 5pm, but a MEWS of 3? What am I supposed to do with that? Panic started to edge its way in as I walked down the corridor trying to remember a medical school lecture that involved how to review patients whilst on call. I arrived and decided the best approach was ABC and then a full head to toe work up, following which I was still none the wiser.

Plan B; I asked the nurse who helpfully replied “oh don’t worry about a MEWS of 3 doctor. I just had to bleep you for legal reasons – he’s an anxious chap and I’m about to give him his diazepam that usually works.”

Lessons learnt from my first on call: 1) Patients won’t die of dehydration if I don’t instantly prescribe fluids. 2) The nurses know more than me. 3) The way to survive is to take a deep breath in and prioritise.

So now I am half way through my first year as a junior doctor, thinner than when I started in August, very slightly more experienced and here to write about the issues and challenges faced by newly qualified junior doctors in modern medicine.

Helen Carnaghan is a Foundation Year 1 doctor in the Eastern Deanery and a member of BMJ Junior Doctor Advisory Panel.

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  • http://www.semeioticabiofisica.it Sergio Stagnaro

    Surely, our job is a very hard one, and that accounts for the reson we are student life long, as I am, after 53 years. In my opinion, the best help to us, in daily practice, is the thought “I love you my patient”, without reddening!

  • Teodor Mitrache

    Hi! I am a medical student from the EU (Romania). I am currently in my 4th year of study, out of 6. I would like to continue my studies in the UK as a medical resident in Cardiology or Internal Medicine. Could you please tell me what are the steps of joining a residency program? Thank you very much

  • Helen Carnaghan

    Hi Teodor, The post graduate training in the UK starts with 2 years as a Foundation Doctor. This consists of 3 jobs per year each 4 months long and are a mix of medicine/surgery with no specific emphasis on the career you would like to do. After these two years the training programs have slight variations depending on the speciality but the majority involve applying for a 2 year core training post, in your case this would be core medical training. After that you apply for a specialist training post in your chosen speciality and in a further 4-6 years you will be a consultant!

    For information on applying for a foundation doctor post visit http://www.foundationprogramme.nhs.uk/pages/home

  • http://medicalmastery.com/ Medical Mastery

    Nice job on promoting the goodness of medical school.
    Keep it up and spread the wings to promote a dream come true.

  • Dr. Anoop C. Dhamangaonkar

    It was great reading the above text.I am a medical graduate who is just about to join as a junior houseman in surgery and the above text has prepared my mindset before my residency begins!!I guess the same drastic transition would hit me soon, in may.The syllabus in medicine is so vast and endless that during this journey, at some distinct points, there is bound to be a dramatic change and a newer facet in medical education being added, may it be newer medical terms (just before joining medical school) , additional responsibility (as a junior doctor), professional earning (once practice begins) and then maintaining a balance between professional and family life (when learning has to go furthur).medicine is like a sea of knowledge and one can know to swim in it only after being thrown into the pool and with the ensuing struggle to stay afloat with water flooding one’s nose!!there is no easier and comfortable way out!im sure these dramatic transitions and actions taken in position of responsibility, along with the errors, will go a long way in making us good clinicians and human beings!!important thing is not to shirk away from responsibility but take it head-on!

    Thanks for sharing your experience.

  • KASHISH

    What a nice article Dr Helen and what a true expression of not only your experience but also mine through which i am going on these days which resembles in both Mental and physical scence. The article really gives me a hope that i am not alone , someone else somewhere else is going through the same and i can do it ! cheers junior doctors !!

  • Dr Andrew Whallett

    Dear Helen

    I was very interested to read your blog about the transition between Medical Student and Foundation Year One doctor. There are certainly things that are not taught at medical school which you are expected to just know or to be able to do as soon as you arrive on the ward. Trust Inductions seem often more geared to what the Trust wants to tell you rather than all those things you needed to know on your first night on call!

    I am currently doing a Masters on this very subject. It also is a subject close to my heart as I look after around 60 Foundation doctors in our Trust.

    My aim is to work with our local University and Deanery to devise a course to help students make the transition as they start work on the wards.

    Can I ask, in your opinion what you might feel are say the top 10 things you wished you had been taught before starting work and how these might be st be taught, by whom and when?

    Many thanks, and enjoy your FY2 year

    Dr Andy Whallett, a Postgraduate Clinical Tutor in the Midlands.

  • Helen Carnaghan

    Dear Dr Andrew Whallett,

    Thank you for your comment!

    I think in general medical school prepares students very well for performing the initial clerking, examination and formulation of a differential diagnosis and management plan for new patients. However, unless you are based in a medical/surgical/emergency assessment unit this is not the main focus and day to day duties of your job.

    Certainly when I started I felt unprepared for being on-call for the wards during the evening/night. I was not prepared for the type of calls I would receive nor how to review sick patients and formulate an idea of what was going on. I think more teaching should be provided on assessment of patients with varying MEWS scores, septic and confusion screens, job prioritisation and what to do when asked to verify a patients’ death.

    My medical school attached the final year students to a ward for 9wks at a time as an extra pair of hands helping the FY1 with their duties. This was very helpful for picking up ‘ward craft’ skills but your experience was very much governed by the helpfulness of the FY1 you shadowed. I felt that although I had written discharge letters as a final year medical student I was never really taught the importance of coding, ensuring all diagnostic and therepeutic procedures are listed and exactly what essential pieces of information are required. In addition, very basic information like the fact warfarin is always given at 6pm and being advised to check fluid/drug charts during the day so that the evening on-call person doesn’t have to pick up the pieces would have been useful (some people do this naturally but others need spoon feeding as I found out when on dreaded ward cover and re-writing yet another drug chart!).

    Finally, I think some training on dealing with difficult inter-colleague interactions would be very helpful. Certainly during my time as an F1 I was put in very difficult situations and caught in the cross fire at the hands of more senior colleagues on several occasions. Having prior advice on how to deal with such scenarios would have been very helpful.

    I think if you were to run a transition course the best time to do it would be during the shadowing weeks (in my deanery this is now 2 weeks in length). If you would like some input from a junior doctor I would be very interested in helping you construct such a course.

    I hope this was of help. Best wishes,

    Helen Carnaghan

  • Charlotte

    hey helen!! Good article

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