CZ>UKFilling in the gaps     Friday 28th October 2011          Dr. Shan Keshri          Edited by: Khuram Ahmed In associa...
GMC Registration
Once you finish you final          exam• Join GMC get your reference number.• Get your diploma and diploma supplement, pas...
• After one week you will get an email from GMC  asking you to post diploma copies etc to them.• After they receive them w...
While waiting those 2-3 weeks for                  GMC registration• Sort out your NHS Jobs and REFINE AND REFINE AND REFI...
Clinical Attachment• Aim to start as soon as you have full GMC.• Send CV and covering letter to the consultant in the  dep...
Clinical Attachment• FY1 will share his jobs with you and you are bascially working  for free but that’s good because you ...
NHS JOBS• Signs up and fill out the email alerts. Don’t rely on this  they are usually 48 hours delayed which can make a  ...
JOB APPS•   Clinical Audit experience 150 words•   Teaching Experience 150 words•   Research experience 500 words•   Clini...
Clinical Audit•   Steps•   Who has done one?•   Importance•   Clinical Governence??                      www.muboss.cz
Teaching experience• What teaching experience do you have?• Impact• Use feedback to make yourself sound good  e.g. feedbac...
Team work• Think of an example of yourself working in a team• What was YOUR ROLE and contribution?• Working in a team IS N...
Research• Don’t write your conclusion out give a brief 2 lines  describe how you did it and why you did it and  impact• Th...
• Internship - what did YOU DO???• Organize your thoughts before, and think about  what you know                      www....
Clinical skill• Keep it real! No one cares if you have assisted in  amazing surgeries or you have inserted a chest  drain ...
Relevant Supporting info• USE IT!• Sell yourself,• Illustrate why your good illustrate why ur safe, show you’re an  allrou...
Short-listing•   Follow up at HR / Med staffing•   Based on person specification•   200 applications per post on average• ...
Interview• What is the role of an FY1?• KEY: RECOGNISE AND MANAGE THE CRITICALLY ILL  PATIENT!!!!!• ARE YOU SAFE????• DO Y...
• Acutely ill patient – no time to wait for help to come  you need to know what to do.• Know you limits – first do no harm...
Ill call my senior• What people don’t know: ABC then ill call my senior  equals not interested• Forgettting to call your s...
Think• You are on call and you get bleeped by the nurse.  On arrival she tells you doctor theres an 55 year old  male coll...
Think• You meet a patient who says he has got shortness  of breath. How do you assess this, and what are you  going to do?...
HOW DO YOU COPE  WITH STRESS      www.muboss.cz
ILS•   D – for example?•   R – how (child?) care with?•   S - tell them what?•   A – look sweep open guedal suction•   B –...
B•   30:2•   Bag and mask count loud•   Compressions depth? Rate? Song place•   When help comes set up AED left lat right ...
As you go you should     think what is the cause•   4 h and 4 t•   Hypovolemia - Fluids•   Hyperthermia – Warm with cold w...
Bedside tests•   Cannulate•   ABG•   Pulse oximetry•   3 lead ECG•   Bloods – which, cultures•   Crossmatch•   Temperature...
• Hypoxia – pulse oxi, ABG – COPD? O2 high flow• Hypovelemia – BP -luid bolus ? Adrenaline centralise  BF• Hyperthermia - ...
GCS AVPU  www.muboss.cz
• http://group.bmj.com/group/affinity-and-society-  publishing/NHS%20Guide.pdf• http://doc2doc.bmj.com/assets/youwillsurvi...
Got the job? What now??•   Contracts –, pay, locum work, annual leave•   Before starting and Day 1•   What to wear•   What...
Memberships• Medical Insurance (outright or discretional?)    – MPS    – MDU    – MDDUS•   Doctors.net – case studies, CEM...
Books• Oxford handbook clinical med• Oxford handbook for foundation programme• Foundation doctors guide to medicine and su...
Training courses• First aid• BLS• (ILS / PILS)                 www.muboss.cz
Role and limitations of           FY1 doc•   Stabalise•   Do the work up•   Do the jobs or the ward round•   Review patien...
ILS• DRS ABCDEFG     www.muboss.cz
A+E• 4 hour breach• MAU on call                  www.muboss.cz
Referrals•   Bleep number, await.•   Introduce who, department, patient name, DOB•   SBAR – Situation, background, assessm...
Discharge Summaries /           TTOs• GP letter   o   Why they came   o   What tests we did and results   o   What we foun...
Prescribing• Dose??• Children – paracetamol• Route, dose, frequency, length• Hospital prescriptions• NKDA, plasters, aspir...
Requesting Bloods• Log in FBC U+E LFT+CRP+GLUCOSE+CS• D dimer (blue) Cross match, group and save  pink, hand write, pod• T...
Requesting Imaging• Clinical details•   Specific questions to be answered•   Mobility•   Porters•   NHS?•   Department•   ...
Chasing• Extension then introduce and patient details and  then ask to add or to chase                      www.muboss.cz
Fluids prescription•   dextrose•   Normal saline 0.9NaCl•   Dehydration signs sunken eyes turgor•   1L over 4 hours•   Pre...
Clerking• SOAP!!!!• The default FY1 job• PC SOCRATES – use it !!                      www.muboss.cz
Clerking• VITALS• PC• HPC             www.muboss.cz
Clerking• Systems review  –   Headache, visual changes, LOC, Dizzyness, hallucinations, Confusion  –   Chest pain, Palpita...
O/E• VITALS –Norm? history ?elderly fever?•   O2 sats, Gluc, PEF, PERLA, GCS• Alert and orientated• Look touch smell, see ...
O/E• HS/JVP/Cap refill/ Pulse reg• Chest clear, good a/e bilaterally, no added  sounds, no wheezeing• Abdo – soft non tend...
Impression• Problem list,• Differential diagnosis• Query • Doesn’t matter if you are wrong(assessment)Trauma to left hip ...
Plan•   Short term•   Long term•   Ix•   Px•   Home•   Discharge•   Admit•   D/w / refer / INR tomorrow, Home if in range•...
Plan•   CXR (form )•   X-ray L hip and femur ?NOF#•   Bloods•   ABG – 42s•   Continue Oxygen hi flow 15l/min•   Salbutamol...
Plan• Advised not to drive as medication can cause  drowziness.• Home with GP follow up• Advised to return to A+E if any p...
More information• DON’T FORGET TO CHECK OUT THE ‘CAREERS ZONE’  SECTION OF THE BRITISH OVERSEAS STUDENT SOCIETY  WEBSITE: ...
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Cz uk

  1. 1. CZ>UKFilling in the gaps Friday 28th October 2011 Dr. Shan Keshri Edited by: Khuram Ahmed In association with www.muboss.cz
  2. 2. GMC Registration
  3. 3. Once you finish you final exam• Join GMC get your reference number.• Get your diploma and diploma supplement, passport – photocopy it and send it to GMC with your application.• http://www.gmc-uk.org/doctors/applications.asp (GMC website then click applications – internship)• Work through all the steps and then you will get a reference number (which on approval turn into your registration number).• Use GMC Online to keep track of your application thereafter.• http://www.gmc- uk.org/doctors/information_for_doctors/gmc_online.asp www.muboss.cz
  4. 4. • After one week you will get an email from GMC asking you to post diploma copies etc to them.• After they receive them within another week you get another email inviting you for an ID check at London or Manchester office. Here you basically take your original documents so they verify it and they ask you to sign a declaration then take a photo of you and from that moment you are on the register. www.muboss.cz
  5. 5. While waiting those 2-3 weeks for GMC registration• Sort out your NHS Jobs and REFINE AND REFINE AND REFINE your application answers.• Apply to start a clinical attachment• BLS / ILS / First Aid• Start reading the interview books• Make a SHORT CV• Approach appropriate people to act as referees• Get your Immunizations up to date Hepatitis, tetnus etc etc• Get a baseline blood test so if anyone need proof eg hepatitis immunity you can just get a copy of the test result quick. www.muboss.cz
  6. 6. Clinical Attachment• Aim to start as soon as you have full GMC.• Send CV and covering letter to the consultant in the department and hospital of your choice, and see if they accept you, its their discretion. If yes, med staffing / HR.• Don’t rely on one consultant in one hospital. Go crazy.• Avoid august if possible but it doesn’t matter (rotations change – too much going on!) www.muboss.cz
  7. 7. Clinical Attachment• FY1 will share his jobs with you and you are bascially working for free but that’s good because you get experience which is the whole point.• e.g. DON’T PRESCRIBE even if you know – as a clinical attachment you are not allowed and if you mess up you will get in trouble.• Do practical stuff cannulas, bloods, ordering stuff, requesting, referals, join ward rounds, clerking etc don’t be worried about writing in the notes, consult the FY1 about everything you do, don’t be shy about that. This is the only chance you get to ask silly questions!!• Any questions about clinical attachments? www.muboss.cz
  8. 8. NHS JOBS• Signs up and fill out the email alerts. Don’t rely on this they are usually 48 hours delayed which can make a difference.• DON’T be picky!! You don’t have a choice!! Its only one year and it will fly by• Add to vacancies, then apply. Respect closing dates (early)• All need full registration. www.muboss.cz
  9. 9. JOB APPS• Clinical Audit experience 150 words• Teaching Experience 150 words• Research experience 500 words• Clinical skill 150 words• Team work 150 words• Supporting info 500 words• SPELLING and GRAMMER www.muboss.cz
  10. 10. Clinical Audit• Steps• Who has done one?• Importance• Clinical Governence?? www.muboss.cz
  11. 11. Teaching experience• What teaching experience do you have?• Impact• Use feedback to make yourself sound good e.g. feedback surveys, etc www.muboss.cz
  12. 12. Team work• Think of an example of yourself working in a team• What was YOUR ROLE and contribution?• Working in a team IS NOT the same as leadership!!! www.muboss.cz
  13. 13. Research• Don’t write your conclusion out give a brief 2 lines describe how you did it and why you did it and impact• The point of these qs are to find out you know the importance and basci principles, which you can apply to ANYthing• You can screw yourself over by talking about an audit you did and forgetting to show understanding of the basic framework of any audit!! www.muboss.cz
  14. 14. • Internship - what did YOU DO???• Organize your thoughts before, and think about what you know www.muboss.cz
  15. 15. Clinical skill• Keep it real! No one cares if you have assisted in amazing surgeries or you have inserted a chest drain once at med school• Do mention it to stand out in your answer (especially if you can v confidently insert a chest drain) but 150 words you really need to stick to the basics to show you can do the FY1 job- so get the message across yes I can confidently take a history physical examinations etc• Read clinical sessions!!! www.muboss.cz
  16. 16. Relevant Supporting info• USE IT!• Sell yourself,• Illustrate why your good illustrate why ur safe, show you’re an allrounder show off your prizes, talk about what you want to get out of F1, talk about various experiences in uk or clinical experinces you have had during Uni, what particular things have you learnt about BEING a doctor (not the science of medicine) eg prioritising clincial need this is your chance to shine and stand out• The other questions have to be up to scratch or else u wont get far but remebr everyone applying is a doctor some have more experience than you, every one must have the basic teamwork and clinca skills etc as you.. how u present ti is what maes the difference!!• CHECK PERSON SPECIFICATION!! Essential and desirable! www.muboss.cz
  17. 17. Short-listing• Follow up at HR / Med staffing• Based on person specification• 200 applications per post on average• 3-10 get an interview• 1 gets the job – perhaps!!• Re advertised www.muboss.cz
  18. 18. Interview• What is the role of an FY1?• KEY: RECOGNISE AND MANAGE THE CRITICALLY ILL PATIENT!!!!!• ARE YOU SAFE????• DO YOU KNOW YOUR LIMITS??• THIS IS THE FOCUS OF EVERYTHING www.muboss.cz
  19. 19. • Acutely ill patient – no time to wait for help to come you need to know what to do.• Know you limits – first do no harm and don’t make things worse, don’t try things blatently out of your skill level: don’t say you will put in an ET only a senior A+E physician or anethesist can do this! www.muboss.cz
  20. 20. Ill call my senior• What people don’t know: ABC then ill call my senior equals not interested• Forgettting to call your senior appropriately equals you don’t know your limits you are not safe to employ• Wheres the compromise ???? www.muboss.cz
  21. 21. Think• You are on call and you get bleeped by the nurse. On arrival she tells you doctor theres an 55 year old male collapsed on the floor.• Talk me through your thought process, particularly what you are going to do and what bed side tests you want. www.muboss.cz
  22. 22. Think• You meet a patient who says he has got shortness of breath. How do you assess this, and what are you going to do? www.muboss.cz
  23. 23. HOW DO YOU COPE WITH STRESS www.muboss.cz
  24. 24. ILS• D – for example?• R – how (child?) care with?• S - tell them what?• A – look sweep open guedal suction• B – LLL rise agonal?• C – central, blanching• D – GCS, neuro, reflex• E-?• FG - ? www.muboss.cz
  25. 25. B• 30:2• Bag and mask count loud• Compressions depth? Rate? Song place• When help comes set up AED left lat right clav• Shockable =• Non shockable = www.muboss.cz
  26. 26. As you go you should think what is the cause• 4 h and 4 t• Hypovolemia - Fluids• Hyperthermia – Warm with cold water• Hypoxia – O2 hi flow• Hyper / Hypo kalemia and metabolic• Tension PTX• Tamponade -• Thrombosis - PE• Toxins – drugs, sepsis www.muboss.cz
  27. 27. Bedside tests• Cannulate• ABG• Pulse oximetry• 3 lead ECG• Bloods – which, cultures• Crossmatch• Temperature tympanic Vitals• BP• RR• PR• Cappilary refill• JVP• Urine dip, Blood Glucose, MSU, sputum www.muboss.cz
  28. 28. • Hypoxia – pulse oxi, ABG – COPD? O2 high flow• Hypovelemia – BP -luid bolus ? Adrenaline centralise BF• Hyperthermia - Tympanic - warming• Hyperkalemia – ABG- fluids calcium glucoronate, Kcl• Tension PTX – 2ICS MCL• Tampnade pericariocentesis• Toxins – fluids, abx• Thrombosis – thrombolyse altepase 30 mins more preparation www.muboss.cz
  29. 29. GCS AVPU www.muboss.cz
  30. 30. • http://group.bmj.com/group/affinity-and-society- publishing/NHS%20Guide.pdf• http://doc2doc.bmj.com/assets/youwillsurvive.pdf• http://www.nhsemployers.org/SiteCollectionDocum ents/Rough%20Guide%20to%20the%20Foundation% 20Programme_DR_140910.pdf www.muboss.cz
  31. 31. Got the job? What now??• Contracts –, pay, locum work, annual leave• Before starting and Day 1• What to wear• What to do – ID• Induction• What is where and how?• Nurses• Indemnity www.muboss.cz
  32. 32. Memberships• Medical Insurance (outright or discretional?) – MPS – MDU – MDDUS• Doctors.net – case studies, CEM• NHS Mail• BMJ?• Library www.muboss.cz
  33. 33. Books• Oxford handbook clinical med• Oxford handbook for foundation programme• Foundation doctors guide to medicine and surgery (crash course)• Oxford handbook of emergency medicine• Medical Interviews www.muboss.cz
  34. 34. Training courses• First aid• BLS• (ILS / PILS) www.muboss.cz
  35. 35. Role and limitations of FY1 doc• Stabalise• Do the work up• Do the jobs or the ward round• Review patients and know them• Present cases• Ward jobs – Cannulas, bloods, review, order relevant tests, have info ready for round, fluids, prescribe as needed,, etc chase results, clerk new patients, TTOs, Referals, www.muboss.cz
  36. 36. ILS• DRS ABCDEFG www.muboss.cz
  37. 37. A+E• 4 hour breach• MAU on call www.muboss.cz
  38. 38. Referrals• Bleep number, await.• Introduce who, department, patient name, DOB• SBAR – Situation, background, assessment, request• Document in notes : D/w Dr. Pavel (SHO medic on call), Agreed to admit to MAU. Signed www.muboss.cz
  39. 39. Discharge Summaries / TTOs• GP letter o Why they came o What tests we did and results o What we found and what treatment we gave o What follow up we would like GP to do o What meds the patient left hospital with dose and freq and length o Do in time or else patient cant leave today - prioritise www.muboss.cz
  40. 40. Prescribing• Dose??• Children – paracetamol• Route, dose, frequency, length• Hospital prescriptions• NKDA, plasters, aspirin, penicillin, nuts,• Pain relief• Codeine – constipation• Opiates – resp depression ? #• NSAIDS (asprin, naproxen) – GIT …WARFARIN and Ibuprofen• Asthma – asprin, Bblocker!?• Alpha adrenergics – b blockers www.muboss.cz
  41. 41. Requesting Bloods• Log in FBC U+E LFT+CRP+GLUCOSE+CS• D dimer (blue) Cross match, group and save pink, hand write, pod• Tropinin, amylase, ESR, HB,• Liver INR and albumin www.muboss.cz
  42. 42. Requesting Imaging• Clinical details• Specific questions to be answered• Mobility• Porters• NHS?• Department• Consultant• Sign• CT/MRI• STICKY www.muboss.cz
  43. 43. Chasing• Extension then introduce and patient details and then ask to add or to chase www.muboss.cz
  44. 44. Fluids prescription• dextrose• Normal saline 0.9NaCl• Dehydration signs sunken eyes turgor• 1L over 4 hours• Prescribe for 24 hours• Check urine output• Check intake• Review individually www.muboss.cz
  45. 45. Clerking• SOAP!!!!• The default FY1 job• PC SOCRATES – use it !! www.muboss.cz
  46. 46. Clerking• VITALS• PC• HPC www.muboss.cz
  47. 47. Clerking• Systems review – Headache, visual changes, LOC, Dizzyness, hallucinations, Confusion – Chest pain, Palpitations, Anxiety, sweating, cold clammy hands, pale – SOB, cough ?prod, Rigors, Pressure in throat, cyanosis – N+V, appetite, weight loss, hot cold intolerance – Waterworks, bowels, smelly urine, – Leg pain, swelling, motor sensory numbness www.muboss.cz
  48. 48. O/E• VITALS –Norm? history ?elderly fever?• O2 sats, Gluc, PEF, PERLA, GCS• Alert and orientated• Look touch smell, see what the patient doesn’t say e.g. sinusitis nasal voice• Investigate presenting symptoms first• Then the compulsary systems review www.muboss.cz
  49. 49. O/E• HS/JVP/Cap refill/ Pulse reg• Chest clear, good a/e bilaterally, no added sounds, no wheezeing• Abdo – soft non tender no organomeg BS+• No pedal oedma• DRAW eg recent 4th toe amputation / Facial puncture www.muboss.cz
  50. 50. Impression• Problem list,• Differential diagnosis• Query • Doesn’t matter if you are wrong(assessment)Trauma to left hip ? L NOF# and Contusion of L lateralthigh? Coughing blood ? cause www.muboss.cz
  51. 51. Plan• Short term• Long term• Ix• Px• Home• Discharge• Admit• D/w / refer / INR tomorrow, Home if in range• Senior review www.muboss.cz
  52. 52. Plan• CXR (form )• X-ray L hip and femur ?NOF#• Bloods• ABG – 42s• Continue Oxygen hi flow 15l/min• Salbutamol neb, with HC stat dose 100mg• Paracetamol 1g PO given• Senior review www.muboss.cz
  53. 53. Plan• Advised not to drive as medication can cause drowziness.• Home with GP follow up• Advised to return to A+E if any problems or concerns• # clinic follow up• D/w dr x, agreed to come and review patient• Head injury advice card www.muboss.cz
  54. 54. More information• DON’T FORGET TO CHECK OUT THE ‘CAREERS ZONE’ SECTION OF THE BRITISH OVERSEAS STUDENT SOCIETY WEBSITE: WWW.MUBOSS.CZ www.muboss.cz

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