📋 Overview

Acute medicine is fast-paced with rapid patient turnover — most patients stay 48–72 hours before being discharged or moved to a ward. You will see a wide variety of presentations, which makes this one of the best rotations for ticking off competencies and procedures. Patients can be quite unwell on arrival, so the workload and rota can feel tough. That said, senior support is generally excellent on acute medicine — use it. Ask for teaching, get procedures signed off, and shadow seniors reviewing acutely ill patients. The skills you build here will serve you for the rest of your career.

🩺 Common Conditions

• Cardiology: ACS, heart failure, AF
• Endocrinology: DKA, HHS, hypoglycaemia, electrolyte imbalances (hyponatraemia)
• Gastroenterology: Decompensated liver disease, upper GI bleed, IBD flares
• Renal: AKI, pyelonephritis, hyperkalaemia
• Infection: Sepsis, pyrexia of unknown origin
• Respiratory: COPD and asthma exacerbations, pneumonia, PE
• Geriatrics: Delirium, falls
• Neurology: Seizures, headache, stroke, meningitis
• Toxicology: Alcohol withdrawal, paracetamol overdose
• Oncology: Neutropenic sepsis, anaemia

🔧 Daily Tasks

• Clerking patients on the acute medical take
• Documenting on ward rounds and executing the management plan
• Liaising with and referring to other specialties
• Writing discharge summaries
• Assisting with procedures (e.g. lumbar punctures, ascitic drains)
• Initial A-E assessment of acutely unwell patients and escalating to seniors
• In some hospitals, participating in the cardiac arrest team

💡 Top Tips & Resources

• Prioritise your jobs list — you often won't finish everything, and that is normal. Triage ruthlessly.
• Ask for help and delegate where possible. Take breaks. Finishing on time matters for your wellbeing.
• Hand over outstanding jobs using SBAR at the end of every shift — patient safety depends on it.
• When unsure, escalate early. Running things past your senior is a sign of good practice, not weakness.
• Resources: NICE guidelines, BTS guidelines, MDCalc, Oxford Handbook of Clinical Medicine, Microguide (antibiotic guidance), BNF app, iResus, BMJ Best Practice

🔥 AKT High-Yield — What to Learn From This Rotation

📋 Overview

Emergency medicine offers a steep learning curve with a vast range of undifferentiated presentations. FY1s may be supernumerary depending on the hospital; FY2s typically join the SHO rota. You will work across ambulatory care, majors, and occasionally resus. The 4-hour target creates pressure — aim to work efficiently, but never at the expense of patient safety. Senior support is always there; quality of decision-making matters more than speed. Some departments also run a clinical decisions unit (CDU) where ward-style jobs fall to the junior doctor. An ED rota can be physically tiring, particularly nights and weekends — look after yourself.

🩺 Common Conditions

• CVS: Cardiac arrest, chest pain, syncope, palpitations, arrhythmias
• Respiratory: Acute asthma, CAP, undifferentiated breathlessness
• GI: Abdominal pain, PR/upper GI bleeding, paracetamol overdose
• GU: Renal colic, UTI/pyelonephritis, PV bleeding, urinary retention, testicular pain
• Neurology: Head injury, headache, limb weakness, reduced GCS, seizures, alcohol withdrawal
• Endocrine: Hypo/hyperglycaemia, DKA
• MSK: Fractures (especially NOF), necrotising fasciitis, cellulitis
• Other: Falls, epistaxis, anaphylaxis, sepsis, mental health presentations, drug overdose

🔧 Daily Tasks

• Clerk patients and discuss management plans with seniors
• Refer to specialties or discharge with appropriate safety-netting advice
• Interpret and sign off ECGs
• Take bloods, blood gases, insert cannulas, catheterisation
• Fascia iliaca nerve blocks for hip fractures
• Documentation — thorough and detailed, every time

💡 Top Tips & Resources

• Keep a pen torch, pen, and tape on your person at all times — you will use them constantly.
• Document everything thoroughly, including any senior discussions and safety-netting advice given.
• You know more than you think — the clinical knowledge from finals is largely intact. Trust your training.
• If in doubt, always discuss with your senior and include that discussion in the notes.
• Resources: RCEM Learning (rcemlearning.co.uk), iResus app, Life in the Fast Lane (LITFL), BMJ Best Practice, MDCalc, Orthoflow app (for MSK)

📋 Overview

These rotations are often combined. In anaesthetics, you are supernumerary — your role is to observe, assist, and learn, rather than work independently. There are usually no on-calls, which gives you valuable time to develop your portfolio and CV. The learning opportunities are excellent: airway management, intubation, line insertions, basic ultrasound, and teaching on pharmacology and physiology. In ITU, the language feels unfamiliar at first but quickly becomes intuitive. You are again largely supernumerary, with close consultant supervision. There is rich opportunity for audit and research. Both rotations are excellent for procedural skill development in a supported environment.

🩺 Common Conditions

• Airway types and when to use them (OPA, NPA, supraglottic airways, ETT)
• Respiratory failure (types 1 and 2) and respiratory support (CPAP, NIV, intubation)
• ARDS
• Sepsis and use of vasopressors
• Neurological impairment — seizures, overdose, intracranial bleeds
• Post-operative care (especially post-laparotomy)
• Pancreatitis, post-resuscitation care
• Common drugs: induction agents (propofol, thiopentone), analgesics, vasopressors (noradrenaline, metaraminol)

🔧 Daily Tasks

• Supporting airway skills: bag-mask ventilation, insertion of supraglottic airways
• Cannulation and drawing up medications
• Perioperative admin: admitting and discharging paperwork, drug charts, liaison with specialties
• ITU: daily A-E assessment and note preparation; presenting patients at ward round
• Procedures (supervised): arterial lines, CVCs, chest drains, ultrasound-guided cannulation
• Attending crash calls to understand how cardiac arrest calls work in practice

💡 Top Tips & Resources

• No preparation is absolutely required — you will learn on the job, and expectations are low. But reading around helps you absorb more.
• If procedures are being discussed at handover or on the ward round, ask to be supervised through them — that is how you learn.
• Try shadowing the on-call registrar for a few days to get a feel for managing referrals in ITU.
• Attend crash calls whenever possible — understanding how a cardiac arrest call unfolds is invaluable.
• Resources: Life in the Fast Lane (litfl.com/ccc-critical-care-compendium/), Deranged Physiology (derangedphysiology.com), LITFL and EM Crit on YouTube (anaesthetics), DAS guidelines, Oh's Intensive Care Manual

📋 Overview

Cardiology wards tend to have high turnover and some very unwell patients with complex needs. There is significant consultant and registrar input, and excellent opportunities to learn ECG interpretation and echocardiography. The MDT input is strong. From a GP perspective, this rotation gives you a deep grounding in the conditions you will manage long-term in primary care — heart failure, AF, post-MI care, and hypertension are your daily bread in GP for the rest of your career.

🩺 Common Conditions

• Acute coronary syndrome (ACS) — STEMI and NSTEMI
• Heart failure (HFrEF and HFpEF)
• Atrial fibrillation — rate and rhythm control, anticoagulation
• Infective endocarditis
• Arrhythmias — tachycardias and bradycardias
• Valvular heart disease
• Hypertension management

🔧 Daily Tasks

• Requesting echocardiograms and writing discharge summaries
• Arranging PICC lines for infective endocarditis patients
• Liaising with specialties — patients often have diabetes, complex anticoagulation, or renal issues
• Inpatient workup prior to CABG, pacemaker insertion, angiography, or valvular surgery
• Liaising with microbiology for antibiotic advice in endocarditis
• ECG interpretation — you will read a lot of these, so develop confidence early

💡 Top Tips & Resources

• Practise ECG interpretation from day one — your confidence with ECGs will grow rapidly if you make it a daily habit.
• Download MDCalc for the CHA₂DS₂-VASc calculator — you will use this regularly for AF anticoagulation decisions.
• Know ACS and heart failure management inside out; they make up the majority of your workload.
• From a GP lens: understand the step-wise management of hypertension, post-MI secondary prevention, and heart failure titration — you will monitor all of these in primary care.
• Resources: Life in the Fast Lane (LITFL) for ECGs — free and comprehensive; howtopace.com for pacing insight; MDCalc; NICE guidelines for heart failure and AF

🔥 AKT High-Yield — Key Facts for This Rotation

📋 Overview

Geriatrics is one of the most common foundation rotations and one of the most valuable for GP training. It involves comprehensive medical ward rounds with a strongly holistic approach. The degree of senior input varies — some posts have daily consultant rounds, others have SHO-led rounds with consultant oversight twice weekly. You may find yourself leading ward rounds and presenting to MDT meetings earlier than you expect. That can feel daunting at first, but it is excellent for your development. Each week can be variable — sometimes quieter with rehabilitation patients, other times very busy with multiple acutely unwell patients. Delirium is common, communication with families is frequent, and end-of-life care is a significant part of the role. Embrace it — these are skills you will use constantly in GP.

🩺 Common Conditions

• Falls — assess for postural hypotension, glycaemic issues, bradycardia, infection, anaemia, and mechanical causes
• Nutritional deficiencies — vitamin D, folate, iron, B12; know when and how to prescribe replacement
• Comprehensive geriatric screen — bone profile, TSH, haematinics
• Anaemia, pneumonia, UTI, sepsis (often without classic features in elderly patients)
• Constipation, confusion screen, delirium — PINCHME mnemonic for causes
• Delirium — identification, management, non-pharmacological approaches first
• Frailty — Clinical Frailty Scale (Rockwood), functional assessment
• Osteoporosis — FRAX score, NOGG guidance, bisphosphonate prescribing

🔧 Daily Tasks

• Ward rounds, board rounds, and reviewing bloods; workup for falls and confusion
• Mini-Mental State Examination (MMSE) for confused patients
• Falls workup and formal falls assessments
• Clinical skills: venepuncture, cannulation, catheterisation, ABGs
• Fluid status assessment, PR examination, death verification, comfort reviews
• Updating relatives — especially important when patients have cognitive impairment; includes DNACPR discussions, end-of-life conversations, collateral history
• Liaison with OT, physiotherapy, and social services for safe discharge planning
• Prescribing anticipatory medications for patients approaching end of life
• Discharge letters — always highlight medications started or stopped and the reason

💡 Top Tips & Resources

• Your finals knowledge covers most of what you need — familiarity with the common conditions above is a great start.
• Updating relatives is a skill that develops with practice. If you feel uncomfortable, ask a senior to join you initially so you can observe different approaches.
• Good organisation and prioritisation are key. After the ward round, list your jobs and delegate where possible.
• Falls in elderly patients can cause fractures — know the signs of NOF, humeral neck, and rib fractures. Be particularly vigilant in patients on anticoagulation.
• Delirium patients can be distressed and at times agitated — stay calm and remember it is almost always the illness, not the person.
• You will face patients approaching end of life. Recognising when comfort care is appropriate is not a failure — it is the right thing for that patient.
• Resources: MDCalc (scoring calculations), Zero to Finals (common conditions), BMJ Best Practice, BNF app, Microguide

🔥 AKT High-Yield — What to Learn From This Rotation

📋 Overview

Dermatology rotations are relatively rare and often combined with acute medicine, giving you a well-rounded experience. Expect to be involved in clinics, minor surgery procedures, and receive regular teaching — dermatologists tend to provide strong educational support. You are largely supernumerary, so you are there to observe, learn, and gradually contribute rather than manage complex outpatient cases independently. There is real opportunity to build your portfolio, develop suturing skills, and explore dermoscopy. Dermatology is a strongly academic specialty with CPC meetings, journal clubs, and MDTs — attend as many as you can. If you have any interest in surgery, keep a logbook of procedures.

🩺 Common Conditions

• Seborrhoeic keratosis — very common referral; learn to recognise and reassure
• Skin cancers: SCC, BCC, melanoma, actinic keratosis — develop your ability to describe and present these confidently
• Psoriasis and eczema — the bread and butter of dermatology outpatients
• Dermoscopic views of pigmented lesions — learn to describe what you see
• Proper dermatological terminology for describing skin lesions (macule, papule, plaque, vesicle, etc.)
• Cellulitis, impetigo, tinea infections

🔧 Daily Tasks

• Taking referrals: obtain clinical details and a photograph of the lesion (by email or uploaded to the clinical records system)
• Examining skin lesions: look and feel, take a tailored dermatology history, generate differentials, investigations, and a management plan to discuss with the consultant or registrar
• Attending clinics and minor surgery lists, including suturing and incisions
• Presenting cases at MDT and CPC meetings

💡 Top Tips & Resources

• Look up the dermoscopy course on DermNet (dermnetnz.org/cme/dermoscopy-course) before or during the placement — it is free and excellent.
• Learn your descriptive terminology early — using the correct language when presenting lesions will make you stand out and builds confidence.
• From a GP perspective: learning to triage skin lesions confidently — when to refer urgently, when to photograph and send, when to treat — is one of the most practically useful skills this placement develops.
• Resources: DermNet NZ (dermnetnz.org) — comprehensive and free; BAD (British Association of Dermatologists) resident doctors/students handbook; NICE guidelines for skin cancer referral

📋 Overview

At junior doctor level, this is essentially a general medical job with a diabetes theme. Most of your patients will be medical outliers — patients who have no other ward to go to — so you see a very broad mix of conditions. True endocrinology is mainly encountered in outpatient clinics, which are worth attending when you can. Day-to-day structure involves morning ward rounds, reviewing bloods and scans, prescribing medications, and on-call ward cover. Joining a diabetes clinic is an excellent use of time and great for your ePortfolio.

🩺 Common Conditions

• DKA and HHS — read your local protocol; these are the most common diabetes emergencies you will manage
• General medical presentations (as this is often an outlier ward): MI, stroke, common cancers, pneumonia
• Thyroid disorders — hypothyroidism, hyperthyroidism; know how to start levothyroxine and when to refer
• Insulin regimes — understand variable rate insulin infusions (VRIII) and how glucose charts work
• Adrenal issues — sick day rules for steroid-dependent patients; Addisonian crisis recognition
• Synacthen test and 9am cortisol — ask how to request these during induction

🔧 Daily Tasks

• Prescribing and rewriting drug charts
• Chasing and acting on scan results
• Writing discharge letters (EDNs)
• Taking bloods and inserting cannulas
• Ward cover on-call — both acute medical take shifts and out-of-hours ward cover

💡 Top Tips & Resources

• Brush up on DKA and HHS before you start — including your local protocol — as these will come up early.
• During shadowing, ask how to request specialist investigations such as Synacthen tests and 9am cortisols — the processes vary by trust and are easy to miss.
• Get comfortable prescribing insulin regimes and understanding glucose monitoring charts — a skill that directly transfers to GP practice.
• Attend a diabetes clinic when you can — it broadens your perspective and is excellent ePortfolio material.
• Resources: NICE guidelines for type 2 diabetes, Joint British Diabetes Societies (JBDS) guidelines for DKA and HHS, BNF app, local trust protocols for insulin prescribing

📋 Overview

Hospital posts in drug and alcohol services (often called DALS — Drug and Alcohol Liaison Service) are relatively uncommon but hugely valuable for GP training. The service is usually ward-based or liaison-based, supporting medical and surgical teams to manage patients with alcohol or substance misuse. You will develop skills in motivational interviewing, assessment of dependence, prescribing detox regimes, and understanding the community services available. Patients can be complex and vulnerable, and a non-judgemental, compassionate approach is essential. The team typically includes specialist nurses, social workers, and community workers — learning from them is as important as learning from the medical staff.

🩺 Common Conditions

• Alcohol withdrawal — severity assessment using CIWA-Ar scale; chlordiazepoxide prescribing protocols
• Alcohol-related liver disease — acute presentations, decompensation
• Wernicke's encephalopathy — recognition and urgent Pabrinex treatment
• Opioid dependence — methadone and buprenorphine prescribing; supervised consumption; withdrawal management
• Benzodiazepine dependence
• Stimulant intoxication and withdrawal (cocaine, amphetamines)
• Dual diagnosis — mental health and substance misuse occurring together
• Safeguarding issues — domestic violence, self-neglect, child protection concerns

🔧 Daily Tasks

• Assessing patients referred by ward teams for alcohol or substance misuse concerns
• Using the AUDIT and CAGE tools to screen for harmful drinking
• Prescribing alcohol withdrawal regimes (using local trust protocol — these vary)
• Delivering brief interventions — motivational conversation, harm reduction advice
• Referral to community drug and alcohol services
• Supporting ward teams with withdrawal management advice
• MDT discussions and discharge planning for patients with complex needs

💡 Top Tips & Resources

• Familiarise yourself with the FRAMES model (Feedback, Responsibility, Advice, Menu, Empathy, Self-efficacy) for brief interventions — a framework directly applicable in GP consultations.
• Learn your local trust's alcohol withdrawal protocol before starting — these vary significantly between hospitals.
• Always check Wernicke's risk before and during detox. The threshold for Pabrinex should be low — it is very safe and the consequences of missing Wernicke's are severe.
• A non-judgemental approach is everything in this specialty. Patients are often in a very vulnerable position and your demeanour has a real impact on engagement.
• From a GP perspective: understanding the community drug and alcohol pathway, when to prescribe shared-care opioid substitution therapy, and how to deliver an effective brief intervention are core GP skills built here.
• Resources: NICE guidance on alcohol-use disorders (CG115); NICE guidance on drug misuse (NG64); CIWA-Ar scoring tool on MDCalc; local trust alcohol withdrawal protocol; NADA (National Alcohol and Drug Advisor) resources

📋 Overview

ENT tends to involve relatively well patients with good senior support. Airway emergencies are rare but you should be prepared for them — know who to call (registrar or anaesthetics) and where the airway equipment is kept. At SHO level, you may cover on-calls alone with a registrar off-site, so being the first port of call for emergencies feels more real. For FY1s, the job is generally more manageable. It is a hands-on specialty with real opportunities to learn procedures — nasendoscopy, epistaxis cautery, quinsy drainage, micro-suction of ears, and abscess drainage. Patients tend to be younger and less medically complex, which makes this a good placement for building clinical basics with fewer frightening moments.

🩺 Common Conditions

• Epistaxis — first aid management, nasal packing, cautery, when to refer
• Tonsillitis, quinsy (peritonsillar abscess)
• Otitis media, otitis externa
• Post-tonsillectomy bleed — an ENT emergency; know the protocol
• Stridor — causes, assessment, escalation
• Epiglottitis — rare but critical; do not examine the throat without senior support
• Post-thyroidectomy complications — bleeding, hypocalcaemia, recurrent laryngeal nerve injury

🔧 Daily Tasks

• Managing referrals from A&E and ward teams
• Writing discharge letters — particularly high volume if you cover a day case unit
• Learning and assisting with ENT procedures: nasendoscopy, epistaxis cautery, quinsy drainage, micro-suction of ears, abscess I&D
• On-call cover — assess, manage, and escalate ENT emergencies appropriately

💡 Top Tips & Resources

• Read about airway emergencies before you start — even a brief overview of stridor, epiglottitis, and Ludwig's angina will give you confidence.
• Know the nasal packing and epistaxis management protocol — you will use it.
• Find out where all airway equipment is kept on the ward on day one. In an emergency, knowing where to look could be critical.
• Always know who the senior on call is and how to contact them quickly.
• The MDT — including speech and language therapists — are highly knowledgeable. Utilise them.
• Resources: ENTSHO.com — the gold standard free resource for ENT juniors; NICE guidelines for tonsillitis, epistaxis, and head and neck cancer referral pathways (2-week wait criteria)

📋 Overview

Gastroenterology is described by many as the "surgical" medical specialty — fast-paced ward rounds, patients who can deteriorate quickly, and registrars often in clinics or endoscopy rather than immediately available on the ward. You will see acute presentations of GI illness and sometimes general medical patients too. There are good procedural opportunities: ascitic taps and drains, and access to endoscopy lists if you show interest. Patients with decompensated liver disease or upper GI bleeding can deteriorate rapidly — escalate early and don't wait to be confident before calling for help.

🩺 Common Conditions

• Upper GI bleed — acute management, major haemorrhage protocol, endoscopy request
• Alcoholic liver disease, decompensated liver disease (cirrhosis, ascites, encephalopathy)
• IBD and biologics used in management
• Hepatic encephalopathy, spontaneous bacterial peritonitis (SBP)
• Alcohol withdrawal — CIWA scoring, local detox protocol
• Definitions: hepatitis, cirrhosis, fibrosis, NAFLD, fatty liver — and how to interpret LFTs
• Hepatic dosing considerations for drugs

🔧 Daily Tasks

• Requesting bloods, scans, and acting on results with senior guidance
• Abdominal examination (including assessing for ascites), PR examination, fluid balance management
• Requesting the non-invasive liver screen (HIV antibodies, HBsAg, Hep C IgG, Hep A IgM, immunoglobulins, alpha-1 antitrypsin, alpha-fetoprotein, caeruloplasmin, autoantibody screen, liver ultrasound)
• Requesting endoscopy and ERCP for appropriate indications
• Prescribing alcohol withdrawal management per local protocol
• Organising blood transfusions
• Liaison with other specialties: general surgery, nutrition team, haematology
• Ascitic tap and drain — learning this skill under supervision

💡 Top Tips & Resources

• Always escalate if you are unsure — gastro patients can deteriorate acutely and unexpectedly. Calling for help early is expected and correct.
• During induction, learn how to request an endoscopy and order a liver antibody screen — the process varies by trust and isn't always intuitive.
• Briefly read about the common conditions above before starting — even 30 minutes per topic makes a real difference in your confidence on the ward.
• Resources: MDCalc (Glasgow-Blatchford score for GI bleeds, Child-Pugh score, MELD score), Zero to Finals (general conditions), Geeky Medics (ascitic drain guide), trust guidelines for major haemorrhage protocol and antibiotic regimes

📋 Overview

General medicine rotations vary enormously depending on the centre. You may be based on an acute medical unit, a general medical ward, or rotating through multiple wards. The breadth of presentations is vast — which is what makes this rotation so valuable. Senior cover is usually good, but you will progressively take on more independent decision-making as your confidence grows. This is one of the best rotations for building a broad clinical foundation and for seeing conditions you will manage long-term in GP.

🩺 Common Conditions

• Undifferentiated medical presentations — breathlessness, chest pain, collapse, confusion
• Pneumonia (CAP and HAP), heart failure exacerbations, COPD exacerbations
• Sepsis — recognition, Sepsis 6, and escalation
• AKI — causes, staging (KDIGO criteria), management, and drug review
• Electrolyte abnormalities — hyponatraemia, hypokalaemia, hypercalcaemia
• Pulmonary embolism — CTPA pathway, Wells score, anticoagulation
• DVT management
• Decompensated conditions in patients with multiple chronic diseases

🔧 Daily Tasks

• Clerking patients on the medical take with senior supervision
• Ward rounds, documenting plans, and executing jobs from the round
• Requesting and interpreting investigations — bloods, ECGs, chest X-rays, CT scans
• Prescribing medications, IV fluids, and VTE prophylaxis
• Liaising with specialties for cross-specialty advice
• Discharge letters and planning safe discharge with allied health professionals

💡 Top Tips & Resources

• Learn your trust's antibiotic guidelines (Microguide) early — you will use them constantly.
• Develop a systematic approach to common presentations (e.g. A-E for the acutely unwell, NEWS-based escalation).
• From a GP lens: understanding community alternatives to hospital admission — ambulatory assessment units, SDEC, virtual wards — is increasingly important in GP referral decisions.
• Resources: Oxford Handbook of Clinical Medicine, NICE Clinical Knowledge Summaries, MDCalc, Microguide, BNF app, local trust guidelines

🔥 AKT High-Yield — What to Learn From This Rotation

📋 Overview

General surgery at junior doctor level is largely ward-based, carrying out the jobs directed by seniors. Some hospitals do not have FY1 night shifts. Ward rounds happen in the morning, then seniors move to theatre, leaving you to execute the plan. If you need help, seek out your senior in theatre — this is always acceptable. The job involves a mix of routine ward work and on-call cover responding to bleeps, reviewing unwell patients, and occasionally assisting in theatre for straightforward procedures. Getting organised early each day is key to getting theatre time if that interests you.

🩺 Common Conditions

• Acute abdominal pain: appendicitis, cholecystitis, pancreatitis, diverticulitis, bowel obstruction and perforation
• Postoperative ileus
• Post-operative complications: VTE, ACS, haemorrhage, wound dehiscence, surgical site infection
• Hernias — types and management (obstructive vs non-obstructive)
• Rib fractures, pneumothorax, and haemothorax following trauma or falls

🔧 Daily Tasks

• Liaison with medical specialties, microbiology, and interventional radiology
• Monitoring bloods and replacing electrolytes — especially in NBM patients
• Prescribing admission medications: regular drugs, analgesia, antiemetics, DVT prophylaxis
• Writing discharge letters and TTOs
• Assisting in theatre for simple procedures (abscess I&D, appendectomy) when given the opportunity

💡 Top Tips & Resources

• Familiarise yourself with common abdominal surgeries (e.g. right hemicolectomy, Hartmann's procedure) so you can understand post-op care and write informed discharge letters.
• Know stoma types — ileostomy, colostomy, urostomy — and how they differ clinically.
• Understand common post-operative complications and how to recognise them early.
• IV fluid prescribing for NBM patients requires thought — it is not just "2 bags salty, 1 bag sweet." Know the NICE guidance.
• Resources: NICE guidance for IV fluid therapy in adults (CG174 — flowchart available as a quick reference); TeachMeSurgery; Geeky Medics for procedural guides

📋 Overview

Haematology is a highly specialised rotation that may be on a bone marrow transplant unit (BMTU) or a general haematology ward. You do not need to understand every complex condition in detail — the consultants and registrars are very supportive and always available for guidance. Your role involves standard ward work alongside more specialist tasks. Patients can be very unwell, particularly those on chemotherapy or following transplant, but you will always have senior support. This is an excellent rotation for learning unusual clinical presentations and building your practical skills in a setting where difficult cannulations and complex prescribing are routine.

🩺 Common Conditions

• Neutropenic fever and sepsis — know the trust protocol; treatment should be immediate
• Cytokine release syndrome (in CAR-T patients)
• Unusual infections: PCP pneumonia, candidiasis, PICC line infections
• Graft-versus-host disease (GvHD) — acute versus chronic (BMTU setting)
• Mucositis — NG tube feeding may be required
• Sickle cell crisis
• Thrombocytopenia — fall risk implications
• Tumour lysis syndrome — monitoring and management including allopurinol and MESNA use

🔧 Daily Tasks

• Assisting or performing lumbar punctures and bone marrow aspirations
• Difficult cannulations — common in this patient group
• NG tube insertion (for patients with mucositis)
• Prescribing blood transfusions
• Reviewing patients on day chemotherapy units
• Prescribing pre-chemo medications (e.g. Allopurinol, MESNA before cyclophosphamide)

💡 Top Tips & Resources

• Read broadly about AML, ALL, CML, CLL, and lymphoma if you are interested — even a basic understanding enriches your experience on the ward.
• Focus on the conditions you will manage: sickle cell crisis, neutropenic sepsis, and tumour lysis syndrome are the highest-yield areas for day-to-day competence.
• Brush up on your general medical knowledge — many haematology patients have multiple comorbidities and you will be managing their general medical needs too.
• Resources: Haembase — widely used across haematology units by staff at all levels; Chemocare (consultants prescribe chemo here and direct pre-chemo medications); BNF app for prescribing; Bukumedicine

📋 Overview

Homeless health placements are not universally available but are increasing as the NHS recognises the health inequalities faced by people experiencing homelessness. These posts may be community-based (embedded with outreach teams or specialist GP practices for homeless people) or hospital liaison roles. The clinical work is diverse — you will encounter conditions rarely seen together in other settings: TB, hepatitis, skin infections, severe mental illness, substance misuse, and complex trauma. The most important thing you bring is a non-judgemental, trauma-informed approach. This placement transforms how you think about the social determinants of health, and has direct application in every GP consultation you will ever have.

🩺 Common Conditions

• Tuberculosis — UK rates are higher in homeless populations; know the symptoms and referral pathway
• Hepatitis B and C — screening, management, and community referral
• Skin and wound infections, cellulitis, infestations (scabies, head lice), abscesses from injecting drug use
• Alcohol and substance dependence — often severe by the time of hospital contact
• Mental illness — often severe, with frequent comorbid substance misuse (dual diagnosis)
• Complex trauma and PTSD
• Nutritional deficiencies, dental disease, foot problems

🔧 Daily Tasks

• Comprehensive assessments — physical, mental health, social, substance use, and safeguarding
• Advocating for housing and social support referrals with a multidisciplinary team
• Working with voluntary sector organisations, link workers, and outreach teams
• Practical prescribing challenges: supervised dispensing, medication storage, lost prescription management
• Health promotion and harm reduction advice
• Registering patients at GP surgeries — remember, homeless people have a right to register at any surgery

💡 Top Tips & Resources

• Read about trauma-informed care before starting — it is the foundation of effective work with this population and has wide application in general GP practice.
• Patients without a permanent address are legally entitled to register at any GP practice. Refusing registration on grounds of no fixed abode is unlawful — know this so you can advocate for your patients.
• Understanding safe drug prescribing in this context — supervised consumption, appropriate quantities, alternatives when storage isn't reliable — is directly relevant to GP practice.
• The voluntary sector partners you will meet are invaluable. Spend time understanding what each service offers so you can refer appropriately.
• Resources: NICE guidelines on drug misuse, alcohol, and homelessness; Faculty for Homeless and Inclusion Health (pathway.org.uk); Crisis (crisis.org.uk); Groundswell (groundswell.org.uk)

📋 Overview

Infectious diseases (ID) is a ward-based specialty — do not confuse it with microbiology, which is lab-based. ID is like most other medical rotations: morning ward rounds, afternoon jobs, standard ward tasks. The breadth of presentations is fascinating — one patient may have a cerebral abscess, the next infective endocarditis. Senior support is consistently strong and the specialty is very consultant-led. The majority of patients are stable (e.g. with cellulitis or discitis), but you will encounter some acutely unwell patients. Know your A-E assessment and escalate early — that is all that is required of you in those situations.

🩺 Common Conditions

• Pneumonia — community-acquired and hospital-acquired
• Infective endocarditis — management, PICC lines, echocardiography
• Meningitis and encephalitis — lumbar puncture indication and CSF interpretation
• UTI and pyelonephritis
• Cellulitis and septic arthritis
• HIV, TB, and malaria — especially in returning travellers or at-risk groups
• Know common infections by organ system — don't try to memorise every pathogen

🔧 Daily Tasks

• Clerking new patients and assisting with the post-take ward round
• Taking blood cultures, bloods, and ECGs
• Speaking with relatives and updating them on complex infectious diagnoses
• Lumbar punctures — ask your senior to supervise you through one; this is an excellent opportunity
• Liaising with microbiology for antibiotic advice

💡 Top Tips & Resources

• Download Microguide on your phone before starting — it has all local antibiotic guidelines and is your most used tool in ID.
• Study smart: learn common infections for each organ system rather than trying to memorise every pathogen. Breadth before depth.
• Get Induction app for easy contact with other specialties within your hospital.
• From a GP perspective: knowing when to treat empirically and when to investigate, antibiotic stewardship principles, and recognising which community infections need inpatient assessment are core GP competencies built in this rotation.
• Resources: Microguide (antibiotic guidelines); NICE CKS for common infections; Oxford Handbook of Infectious Diseases and Microbiology; BNF app

🔥 AKT High-Yield — Key Facts for This Rotation

Sepsis 6 — initiate within 1 hour of suspected sepsis:

📋 Overview

Orthopaedics is primarily a ward-based job, focused on the medical aspects of patients who have had or are awaiting surgery. As an FY1, your main job is to look after the medical care of predominantly post-operative patients — managing pain, preventing complications, reviewing bloods, and escalating deterioration. The senior surgical team is often in theatre; if you need them, go to theatre and ask — this is always acceptable. Weekend cover involves responding to nursing bleeps, reviewing patients in pain, and managing common post-operative problems. If you stay organised, you can get opportunities to assist in theatre. Orthogeriatric colleagues are invaluable — make good relationships early.

🩺 Common Conditions

• Hip fractures (NOF), ankle fractures, and distal radius fractures — know the trauma meeting structure
• Compartment syndrome — know how to recognise on the ward and escalate early; this is a limb-threatening emergency
• Common post-operative complications: DVT/PE, pneumonia, UTI, AKI, wound haematoma, wound infection, delirium, opioid toxicity
• Analgesic ladder — know when escalation to opioids requires senior discussion
• Musculoskeletal anatomy and fracture classification — worth brushing up for ward round discussions and theatre

🔧 Daily Tasks

• Reviewing and documenting weight-bearing status for each patient
• Prescribing and adjusting analgesia regimes
• Managing common medical problems on the ward: constipation, delirium, hypo/hypertension, Hb drop, AKI
• Wound reviews — learning to describe wound appearance accurately
• Documenting during ward rounds and trauma meetings
• VTE prophylaxis prescribing and reviewing

💡 Top Tips & Resources

• Brush up on common medical scenarios in post-op patients: constipation, delirium, AKI, electrolyte disturbance, and Hb drop. These are your daily bread.
• Recognising the deteriorating post-op patient is critical. Worsening NEWS or post-operative pyrexia requires a systematic A-E approach — escalate appropriately.
• You may at times be the most senior doctor on the ward. The orthogeriatric team and medical registrar are always available — do not hesitate to call.
• Staying organised means getting theatre time — something most FY1s find genuinely interesting.
• Resources: NICE guidelines for hip fracture management; Orthobullets (online); Rouhen's Anatomical Atlas; McCrae's Orthopaedic Trauma; Geeky Medics

📋 Overview

Pure inpatient neurology is mostly based in tertiary neuroscience centres. Many foundation doctors will experience neurology through acute medical units or stroke units rather than a dedicated neurology ward. Regardless of setting, neurology teaches meticulous examination and documentation skills that are invaluable for the rest of your career. Neurological emergencies — status epilepticus, stroke, meningitis, GBS — require confident initial management, and knowing the relevant local protocols before you need them is essential.

🩺 Common Conditions

• Stroke — ischaemic and haemorrhagic; know subtypes and the NIHSS scoring tool
• Intracerebral haemorrhage and subarachnoid haemorrhage
• Seizures — first seizure workup, status epilepticus management, antiepileptic prescribing
• Headache — differentials including meningitis, SAH (thunderclap), migraine, raised ICP
• Meningitis and encephalitis — LP indication, CSF interpretation
• Dizziness — BPPV vs vestibular neuronitis vs central causes
• Reduced GCS — systematic differential including metabolic, structural, and toxic causes
• Guillain-Barré syndrome, myasthenia gravis — rarer but important to recognise

🔧 Daily Tasks

• Lumbar punctures — a core neurology skill; ask to be supervised early in the rotation
• Nerve blocks for headache management
• Blood pressure monitoring and management in acute cerebrovascular events
• NG tube assessment and insertion for dysphagic patients
• CT head interpretation — develop a systematic approach
• Family discussions around DNACPR, treatment escalation, and prognosis

💡 Top Tips & Resources

• Know how to initiate management of acute neurological presentations before you are called — particularly seizures and stroke deterioration (aspiration risk, reduced GCS).
• Have a clear, practised process for performing and documenting a neurological examination — this will be tested repeatedly.
• Find your hospital's protocol for seizure management and stroke thrombolysis on your first day.
• Practise having DNACPR discussions — neurology involves some of the most complex prognostic conversations in medicine.
• Resources: Mind The Bleep Neurology series; ABN Acute Neurology Bootcamp (theabn.org); Book of Neurological Signs by Matthew Jones (freely available on Apple Books)

📋 Overview

FY1 doctors are usually supernumerary in O&G, with no on-calls or night shifts — so take-home pay is lower but the learning environment is excellent and well-supported. You will rotate through obstetric and gynaecology wards, assessment units (MAU and GAU), pre-assessment clinics, theatres, and outpatient clinics. The variety is wide: from the labour ward to gynaecological day surgery. Midwives and specialist nursing staff are highly knowledgeable — work alongside them and learn from them. This placement gives you skills directly applicable in GP: taking obstetric and gynaecological histories, speculum and bimanual examination, and managing common presentations in women's health.

🩺 Common Conditions

• Obstetrics: Abdominal pain in pregnancy, PV bleeding, reduced foetal movement, premature rupture of membranes, postnatal assessment
• Obstetric emergencies: Pre-eclampsia, postpartum haemorrhage, shoulder dystocia — understand the principles even if you won't manage these alone
• Gynaecology: Miscarriage (complete, incomplete, missed), ectopic pregnancy, acute abdominal pain, postmenopausal bleeding, heavy menstrual bleeding
• Contraception prescribing — including postnatal options

🔧 Daily Tasks

• Clerking antenatal, postnatal, and gynaecology cases and presenting to seniors
• Speculum and bimanual examinations (excellent opportunity to build skill in a supported setting)
• Postnatal review of women following C-section or vaginal delivery
• Writing discharge letters (TTOs)
• Inserting large-bore (grey) cannulas — used frequently in O&G for potential theatre cases
• Urinary catheterisation — frequently needed in theatre patients

💡 Top Tips & Resources

• Revise obstetric and gynaecological history-taking and examination before starting — the frameworks differ from general medicine.
• Be aware of medications contraindicated in pregnancy and breastfeeding — this is tested frequently and directly relevant to GP prescribing.
• The learning curve can feel steep initially, but the team is supportive and you will be well supervised. Take it step by step.
• Attend as many theatres sessions as possible — catheterisation, suturing, and speculum skills are easier to learn in a supervised, non-hurried theatre environment.
• Resources: TeachMeOBGYN (teachmeobgyn.com) — excellent free resource for most O&G topics; Geeky Medics for examination guides; the "10 Bs of postpartum assessment" mnemonic for postnatal reviews

🔥 AKT High-Yield — What to Learn From This Rotation

📋 Overview

Oncology involves working alongside a wide range of subspecialties and a large MDT. The team is generally supportive and expects you to ask for help frequently — specialist nurses, pharmacists, and dietitians are particularly valuable sources of knowledge in this setting. Patients vary from those receiving chemotherapy on a day unit to seriously unwell inpatients with complex acute presentations. Getting involved in ward teaching, reflecting on cases, and discussing with pharmacists about chemotherapy regimens is strongly encouraged.

🩺 Common Conditions

• Neutropenic sepsis — must be treated immediately; know the trust protocol
• Electrolyte disturbances: hypercalcaemia, hyponatraemia, hypomagnesaemia
• Chemotherapy extravasation
• Treatment-related nausea, vomiting, and diarrhoea
• Immunotherapy side effects (pneumonitis, colitis)
• Radiation skin reactions
• Steroid-induced hyperglycaemia
• Metastatic spinal cord compression (MSCC) — an oncological emergency
• Malignant pleural effusion, pericardial effusion, bowel obstruction

🔧 Daily Tasks

• Clinical skills: cannulation, venepuncture, ECG, blood gas, catheterisation, blood cultures
• Daily reviews, ward rounds, and discharge letters
• Elective clerk-in for chemotherapy and radiotherapy admissions
• Reviewing and responding to deteriorating or acutely unwell patients
• Discussing management with seniors and specialist pharmacists

💡 Top Tips & Resources

• Ask for help from the team — always. In oncology, there is enormous specialist knowledge available and no expectation that junior doctors know it independently.
• Discuss chemotherapy regimens with the pharmacist — they are experts and very helpful.
• Attend departmental teaching sessions to build understanding of oncological emergencies.
• Reflect on cases you find interesting — log entries linking oncology cases to GP practice are excellent ePortfolio material.
• Resources: Microguide (antibiotic protocols for neutropenic sepsis); Oxford Handbook of Oncology; local trust protocols for oncological emergencies; Scottish Referral Guidelines for Suspected Cancer

📋 Overview

Ophthalmology is a supernumerary role with strong senior oversight and no night duties. You will be based predominantly in the outpatient department, with exposure to inpatient referrals, emergency eye casualty, and a range of subspecialty clinics (glaucoma, vitreo-retina, oculoplastics, cornea, paediatrics, neuro-ophthalmology). Theatre sessions are available to observe. General medical jobs (blood tests, ECGs, requesting scans, specialist liaison) remain your responsibility alongside eye-specific clinical tasks. An ophthalmology post builds practical skills that are directly useful in GP: fundoscopy, recognising red eye differentials, and managing acute visual loss presentations confidently.

🩺 Common Conditions

• Conjunctival haemorrhage, chemical eye injury
• Corneal abrasions, corneal foreign bodies, corneal ulcers
• Glaucoma — open-angle and acute angle-closure (emergency)
• Infections and inflammation: conjunctivitis, keratitis, anterior uveitis, orbital cellulitis, endophthalmitis, scleritis
• Cataracts — types and surgical management
• Vitreo-retinal: vitreous haemorrhage, retinal tears, retinal detachment, CRVO, CRAO (ocular emergencies)
• Diabetic retinopathy screening results

🔧 Daily Tasks

• Pre-operative assessment for GA cases — detailed history, general examination (CVS, respiratory), reviewing bloods and ECGs, liaison with anaesthetics and specialist teams
• Ward round for pre/post-op patients — reviewing, ordering scans, checking bloods, documentation
• Emergency eye casualty: clerking presenting complaints, performing eye examination, reviewing OCT scans under supervision
• Eye-specific assessments: visual acuity, colour vision, intraocular pressure measurement, eye drop instillation, direct/indirect ophthalmoscopy, slit lamp examination

💡 Top Tips & Resources

• Watch YouTube videos on ophthalmoscopy and slit lamp examination basics before starting — then practise every day. Practice is everything in ophthalmology.
• Refresh eye anatomy and the key conditions listed above — enough to present cases sensibly to your consultant.
• Ask to be added to the departmental teaching mailing list on day one.
• Ask whether a microsurgical simulator (EyeSi or wet lab) is available — these are excellent learning tools if offered at your centre.
• Resources: Tim Root free ophthalmology textbook; Oxford Handbook of Ophthalmology; YouTube "Learn about eyes" channel; RCOphth Curriculum for Foundation Doctors; DVLA guidance on visual field requirements

📋 Overview

FY1s are often supernumerary in paediatrics, with no night shifts and extensive supervision. The registrars and consultants are very hands-on — you will always have someone to help or teach. Referrals between teams are often done at registrar or consultant level, so you may not be making those calls as frequently as in adult medicine. The patient turnover is often more rapid, similar to an admissions unit. It is an excellent rotation for building practical skills in a supported environment — venepuncture and cannulation in children are genuinely different from adults, so observe before attempting. Learning to communicate with children of different developmental stages and with anxious parents is an underrated skill that translates directly to GP consultations.

🩺 Common Conditions

• Breathless infant or child — bronchiolitis, croup, asthma, pneumonia
• Febrile child — NICE traffic light system (red, amber, green features); sepsis recognition
• Vomiting newborn, gastroenteritis, constipation
• Weight loss in the newborn, failure to thrive
• Common childhood exanthems (rashes) — chickenpox, measles, scarlet fever, roseola
• Non-specific abdominal pain and suspected appendicitis
• Neonatal jaundice — causes, assessment, when to treat
• Hydatid and testicular torsion — recognise and escalate immediately

🔧 Daily Tasks

• Phlebotomy and cannulation (observe first — technique differs significantly from adults)
• Keeping on top of the ward list and patients — rapid turnover means this requires vigilance
• Clerking GP and ED referrals; some hospitals have a paediatric ED attached
• Discharge summaries and letters — often needed quickly given the turnover
• On-call assessment unit shifts — excellent for WPBA: Mini-CEX and CBDs

💡 Top Tips & Resources

• Go over paediatric history-taking frameworks before starting — they differ from adult medicine and include developmental history, birth history, vaccination status, and family history.
• Observe venepuncture and cannulation in children before attempting independently — technique and patient management are genuinely different.
• Book PILS (Paediatric Immediate Life Support) early — it is often recommended and spaces fill quickly.
• Nobody expects perfection. Staying on top of the jobs list and keeping patients safe are the core expectations at FY1 level.
• Resources: Don't Forget the Bubbles (dontforgetthebubbles.com) — an excellent free paediatric resource; What0-18.nhs.uk (useful for safety-netting parents); Zero to Finals Paediatrics; TeachMePaediatrics; Growth Charts app

🔥 AKT High-Yield — What to Learn From This Rotation

📋 Overview

Palliative care placements are either inpatient hospital-based or in a hospice setting — the character of the two is different, though both are deeply rewarding. You will be well-supported by consultants and specialist nurses, and the FY1 role is usually supernumerary. The work centres on symptom control, holistic care, and supporting both patients and families through the most difficult time of their lives. This rotation will change how you think about medicine — not as fixing, but as caring. The skills you develop here — difficult conversations, shared decision-making, prescribing for comfort — are some of the most important you will ever have as a GP.

🩺 Common Conditions

• Pain management — WHO analgesic ladder, opioid titration, breakthrough doses, syringe drivers
• Nausea and vomiting in advanced disease — causes and antiemetic choices
• Breathlessness at end of life — non-pharmacological and pharmacological approaches
• Terminal agitation and delirium — palliative sedation principles
• Hypercalcaemia of malignancy
• Superior vena cava obstruction (SVCO) — recognition and management
• Identifying when a patient is dying — recognising the last days or hours of life

🔧 Daily Tasks

• Complex discharge summaries and TTOs involving multiple controlled drugs and syringe drivers
• Patient reviews focused on symptom management — not investigation-heavy
• Presenting patients at MDT meetings
• Prescribing anticipatory medications and syringe drivers — always double-check opioid dose conversions with a senior
• Family discussions around care planning, discharge preferences, and DNACPR
• Clerking new admissions to the hospice — including social, spiritual, and psychological history

💡 Top Tips & Resources

• Familiarise yourself with the structure and language of difficult conversations before starting — there are good frameworks (e.g. SPIKES) that help in these consultations.
• Palliative care consultants and specialist nurses are consistently among the most supportive colleagues in the hospital — you will feel well looked-after in this role.
• Always get a second check on opioid dose conversions when prescribing syringe drivers. Errors in this setting can cause significant harm.
• The NICE guideline on care of dying adults (NG31) is short and worth reading before you start.
• Resources: NICE NG31 (Care of dying adults in the last days of life); Palliative Care Guidelines Plus (book.pallcare.info) — the clinical reference used by most palliative care teams; Hospice UK resources

📋 Overview

Psychiatry is highly senior-led — you will not be making medication changes or admission/discharge decisions independently. As an FY1, you are expected to manage the general medical needs of inpatients (the things they would normally see a GP for) and to be the first point of contact for any medical complaints on the ward. This can range from a simple prescription query to an unwell patient who needs a medical review. Very few FY1 psychiatry posts include out-of-hours on-call in psychiatry, though some include medical on-call shifts in a general hospital. Psychiatry can be emotionally demanding — particularly around conversations involving self-harm, trauma, or significant mental illness. It is important to be aware of your own emotional responses and seek support when needed.

🩺 Common Conditions

• Psychosis (including drug-induced) — antipsychotic choices and side effect profiles
• Bipolar disorder, mania, and severe depression
• Personality disorder — particularly in crisis presentations
• In older age psychiatry: behavioural and psychological symptoms of dementia (BPSD), Parkinson's disease with psychiatric manifestations
• Medications to know: antipsychotics (including clozapine monitoring requirements), antidepressants, mood stabilisers (lithium blood levels), MAOI interactions
• Legal status of patients — Section 2, Section 3, DoLS, Section 17 leave

🔧 Daily Tasks

• Ward round documentation — psychiatry notes are thorough and detailed
• Taking bloods for medication monitoring (e.g. clozapine monitoring, lithium levels, metabolic bloods)
• Performing ECGs — more frequently than you might expect, given QTc monitoring for antipsychotics
• Managing general medical complaints on the ward — including conditions patients would normally see a GP for
• Cognitive assessments (MMSE, ACE-III, MoCA) in older age psychiatry
• Outpatient and early access clinics — read notes before clinic and check alert statuses

💡 Top Tips & Resources

• Practise your ECG skills before starting — you will perform more ECGs in psychiatry than in many medical rotations, largely for QTc monitoring.
• Learn the basic legal frameworks (Section 2, Section 3, DoLS) early — you will be asked about these regularly by patients, carers, and colleagues.
• If any areas feel personally difficult (e.g. conversations around self-harm, abuse, or trauma), raise this with a senior early. Many people find elements of psychiatry emotionally challenging. You are not alone, and support is available.
• Always check the "no lone worker" alert before seeing a patient in an outpatient or community setting.
• Resources: BMJ e-learning (free with BMA membership) — managing agitation in dementia; Maudsley Learning Podcast — broad psychiatric topics; NICE guidelines for dementia, depression, and schizophrenia

🔥 AKT High-Yield — What to Learn From This Rotation

📋 Overview

At FY1 level, renal medicine is similar to most hospital medicine ward jobs, with comparable on-call responsibilities. FY2s may act as the renal SHO, managing patients on-call and responding to urgent lab results. If your centre has a dialysis ward, patients requiring regular dialysis often default to the renal team regardless of their presenting problem — so you see a broad mix of pathology. Renal is senior-led and investigation-heavy, but renal emergencies (particularly hyperkalaemia) are common and need prompt management. Patients are almost always multimorbid; big decisions should always involve your seniors. The AKI is a barometer of the body — a rising creatinine is always meaningful.

🩺 Common Conditions

• AKI — pre/intra/post-renal causes; what to do and how to escalate for each
• Hyperkalaemia — emergency management; when to escalate for dialysis
• Hyponatraemia — a complex topic; have a working understanding and know when to seek help
• Pulmonary oedema — diuresis only works if the kidneys can respond
• CKD — staging, mineral bone disease, anaemia of chronic disease
• Peritoneal dialysis and HD complications — including PD peritonitis, line clots, and fistula bleeds
• Autoimmune and vasculitic nephropathies — presentation and investigation
• Drug prescribing in renal impairment — opioids, penicillin, trimethoprim (creatinine effect), enoxaparin dosing

🔧 Daily Tasks

• Standard ward tasks: notes on rounds, ordering investigations, initiating treatment plans, referrals
• Administering IV calcium for emergency hyperkalaemia management — know the correct dose and technique
• Fluid balance monitoring and daily weights — critical in AKI and dialysis patients
• Clerking patients (sometimes unsupervised out of hours at FY2 level) — always do a full multi-system examination in new renal admissions
• Acting on out-of-hours alarming community bloods (e.g. GP-identified hyperkalaemia)
• Assisting with procedures: ultrasound-guided cannulation, lumbar punctures, renal biopsy

💡 Top Tips & Resources

• Fluid balance and daily weights are your friends — in severe AKI, urine output changes earlier than blood tests.
• A creatinine of 300 means very different things depending on trend: rising acutely vs stable in dialysis. Always look at the trajectory.
• Don't be heavy-handed with IV fluids — 250ml boluses, little and often if needed. IV fluids are a drug.
• Not everything stopped in AKI is nephrotoxic — beware drug accumulation (opioids, penicillin neurotoxicity). Trimethoprim falsely raises creatinine without true nephrotoxicity.
• Speak up when you don't understand something or disagree — renal teams encourage questioning and intellectual challenge.
• Resources: Renaldrugdatabase.com (like the BNF but specific to renal dosing at each eGFR level); Renal Drug Handbook; LITFL for renal emergencies; Geeky Medics; BNF app; Core IM podcast (renal episodes, particularly hyponatraemia)

🔥 AKT High-Yield — Key Facts for This Rotation

AKI is extremely high-yield. The most common AKT questions focus on which drugs to stop in AKI and which drugs are nephrotoxic.

📋 Overview

Respiratory is a fast-paced rotation with high patient turnover and frequent deterioration — patients with respiratory conditions can go from stable to critical quickly. Most departments include medical on-call requirements including nights and weekends, often covering beyond the respiratory ward. This makes understanding common medical emergencies beyond just respiratory conditions very important. There are excellent opportunities to develop practical skills: ABGs, pleural taps and drains, and attending bronchoscopy if you show interest. Knowing when to escalate is key — be overly cautious rather than under-cautious. Stay organised and eat well — it is easy to let this rotation's pace lead to missed meals and burnout.

🩺 Common Conditions

• Asthma — acute severe and life-threatening; know the criteria
• COPD exacerbation — especially CO₂ retainers; O₂ target 88–92%
• Bronchiectasis
• Pleural effusion — transudates vs exudates; Light's criteria
• Pulmonary embolism — Wells score, CTPA, anticoagulation
• Type 1 and type 2 respiratory failure — causes, management, when to escalate to NIV or intubation
• Use of CPAP and NIV — indications and monitoring
• Pneumonia — CAP severity assessment (CURB-65)
• Sepsis — early recognition and Sepsis 6
• Steroid-induced hyperglycaemia and AF in respiratory patients

🔧 Daily Tasks

• Prescribing antibiotics, steroids, nebulisers, oxygen, and VTE prophylaxis
• Performing ABGs and blood cultures
• Requesting and interpreting chest X-rays, CT scans (CTPA), and spirometry
• Formulating management plans under consultant supervision
• Liaising with microbiology and gastroenterology for specialist advice
• DNACPR and end-of-life discussions — common in respiratory medicine
• Discharge planning including LTOT (home oxygen) — contact respiratory specialist nurses for queries
• Capillary blood gas — a useful skill when ABG or VBG is difficult

💡 Top Tips & Resources

• Know the BTS and NICE guidelines for COPD, asthma, and pneumonia — these are directly tested in the AKT and constantly applied clinically.
• Find where your trust guidelines are stored on day one — knowing where to look during a stressful on-call is invaluable.
• Use scoring systems (Wells, PESI, CURB-65) — you do not need to memorise all components, just know they exist and use MDCalc.
• Have a structure for end-of-life conversations — the SPIKES framework (Situation, Perception, Information, Knowledge, Emotion, Strategy) is widely used and helps in difficult moments.
• Stay organised and manage your time well — the workload makes it easy to go home late. Staying on top of the jobs list protects your wellbeing.
• Resources: BTS guidelines; NICE guidelines for respiratory conditions; Oxford Handbook of Clinical Medicine (medical emergencies section); Oxford Handbook for the Foundation Programme; MDCalc; BNF app

🔥 AKT High-Yield — Key Facts for This Rotation

📋 Overview

Rheumatology at junior doctor level often involves a significant proportion of general medical patients, particularly in district general hospitals. You will manage a wide variety of interesting presentations while also being involved in acute medical take shifts and ward cover. The clinical learning opportunities are broad — rheumatology clinics, musculoskeletal radiology MDTs, and departmental teaching sessions. Specific rheumatology patients on the ward are often admitted with acute joint swelling or flares of systemic disease. Referrals, requesting imaging, and managing common medical co-morbidities are central to the day-to-day role.

🩺 Common Conditions

• Septic arthritis — almost always a differential in acute joint swelling; know the investigations and management
• Gout and pseudogout — clinical features, joint aspiration, management, and initiation of urate-lowering therapy
• Systemic lupus erythematosus (SLE) — multisystem presentation and investigations
• Rheumatoid arthritis — DMARDs used, monitoring requirements, complications
• Polymyalgia rheumatica (PMR) and giant cell arteritis (GCA) — recognise and start steroids promptly in GCA
• Vasculitides and autoimmune screening

🔧 Daily Tasks

• Making and coordinating referrals to other specialties
• Requesting and vetting scans (X-rays, MRI, CT, USS joints)
• Clinical skills: venepuncture, ABGs, cannulation, catheterisation, joint aspiration (with supervision)
• Prescribing analgesia and antibiotics for joint infections
• Discharge summaries and next-of-kin updates
• Presenting patients at MDT meetings
• On-call ward cover: assessing patients with falls, oxygen requirements, temperature spikes, glucose disturbances
• Acute medical take shifts: clerking and managing new admissions with senior supervision

💡 Top Tips & Resources

• Familiarise yourself with the hot swollen joint — the key differential between septic arthritis and crystal arthropathy, and why the distinction matters urgently.
• Prioritising and working efficiently are the most important skills in this ward-based role.
• When referring or requesting imaging, be clear about your clinical question — if unsure, ask the consultant before requesting.
• Take full advantage of the interesting general medical and rheumatological presentations you will see — this rotation rewards curiosity.
• Resources: BNF app; Microguide (antibiotic guidelines for septic arthritis); Induction app (contact numbers); Mind the Bleep — acutely swollen joint article; NICE guidelines for gout, RA, and PMR/GCA

📋 Overview

GUM is predominantly an outpatient specialty with limited on-call commitments. Services are increasingly community-based, although HIV care is usually delivered from acute hospital settings. You will work alongside a multidisciplinary team including specialist nurses, health advisers, pharmacists, and psychologists. Communication skills, a non-judgemental approach, and sensitivity are the cornerstones of excellent practice in this setting. The patient population is diverse and often includes young adults, men who have sex with men, and other vulnerable groups. GUM consistently scores highly in trainee satisfaction surveys. This rotation develops skills in sexual history-taking, STI management, and HIV care that are directly applicable in GP.

🩺 Common Conditions

• STIs: chlamydia, gonorrhoea (including treatment-resistant strains), syphilis, herpes simplex (HSV-1 and HSV-2), HPV and genital warts
• Vaginal discharge: bacterial vaginosis, candidiasis, cervicitis — differentiated largely on history and examination
• Male dysuria — urethritis, STI screen
• Genital lumps: benign variants (Fordyce spots, pearly penile papules) vs condylomata vs molluscum contagiosum
• HIV: acute seroconversion illness, management of established HIV, antiretroviral therapy
• PEP (post-exposure prophylaxis) and PrEP (pre-exposure prophylaxis) for HIV
• Emergency contraception and contraception management

🔧 Daily Tasks

• Sexual history-taking — practise the framework; no two consultations are the same despite similar presenting complaints
• Genital examination and specimen collection (swabs, blood tests)
• Delivering test results — often face-to-face; requires sensitivity and good communication
• Prescribing treatment per local antimicrobial policy (resistance varies by region)
• HIV clinic reviews — monitoring patients on antiretrovirals, recognising side effects
• Partner notification and contact tracing
• Always offer a chaperone — regardless of patient or doctor gender. Document the outcome.

💡 Top Tips & Resources

• Review sexual history-taking and genital anatomy before starting — confidence in this area makes the placement significantly more rewarding.
• Read the information leaflets given to patients at your clinic — they answer the questions patients actually ask, in appropriate language.
• Obtain a copy of your department's local antimicrobial policy for STIs early — resistance patterns vary and you should always treat according to local guidance.
• Spend time with the health advisers — they have invaluable experience in sensitive communication and patient support.
• Watch out for safeguarding concerns — sexual abuse may present in GUM. Always discuss any concerns with your supervisor on the same day.
• Be aware of the varied presentations of HIV and the risk factors to actively screen for in a sexual health context.
• Resources: BASHH guidelines (bashh.org) — the gold standard for STI management; BHIVA guidelines for HIV; STASHH monthly webinars (for medical students and pre-specialty trainees); NICE guidance on STI testing; BNF app for prescribing

📋 Overview

Stroke medicine involves clerking patients with acute neurological presentations and working on a hyper-acute stroke unit (HASU) or acute stroke ward. You will be involved in the post-take ward round, liaising with neurosurgery, and managing medical outlier patients on the ward. HASU units tend to be well-staffed with experienced nurses and therapists — senior support is generally excellent. The workload can include initiating thrombolysis protocol under consultant supervision (trust-dependent). Always ask if unsure, particularly before starting IV infusions like labetalol for BP management in haemorrhagic strokes — double-checking with the senior first is the correct approach here.

🩺 Common Conditions

• Ischaemic stroke — subtypes (TACS, PACS, LACS, POCS), thrombolysis criteria
• Haemorrhagic stroke — intracerebral and subarachnoid haemorrhage
• Malignant MCA syndrome — recognition and escalation
• Migraine (TIA differential), epilepsy, and seizures
• Fast AF — commonly associated with cardioembolic stroke
• Aspiration pneumonia — extremely common in stroke patients with dysphagia
• PRES (posterior reversible encephalopathy syndrome) — awareness is sufficient

🔧 Daily Tasks

• Requesting and chasing CT head, MRI head, and CT angiography (carotid and arch of aorta)
• Referring to vascular surgery or neurosurgery as appropriate
• Prescribing antiplatelet therapy (aspirin, clopidogrel) and statins post-stroke
• Starting anticoagulation for cardioembolic stroke
• Scoring patients using NIHSS (National Institutes of Health Stroke Scale) and 4AT (delirium screening)
• Blood pressure management in haemorrhagic stroke — IV infusion initiation with senior oversight
• Developing fluency in GCS and neurological examination documentation
• Writing discharge letters (EDNs)

💡 Top Tips & Resources

• Know your local seizure management protocol before the rotation begins — seizures in stroke patients happen, and being prepared makes a real difference to your confidence.
• Levetiracetam (Keppra) needs loading before regular dosing — know this before you are asked to prescribe it.
• Don't be afraid to ask for help — HASU units are well-staffed and seniors want to know when patients are deteriorating.
• Get comfortable with CT head interpretation — you will review many of your own patients' scans and a systematic approach saves time and builds confidence.
• Resources: NICE stroke guidelines; Intercollegiate Stroke Working Party (ICSWP) national guidelines; Mind the Bleep Neurology series; NIHSS scoring tool on MDCalc

📋 Overview

See Musculoskeletal Medicine & Orthopaedics above for the main guide to this rotation. Trauma and orthopaedics is primarily a ward-based job managing the medical care of predominantly post-operative patients. Some hospitals do not have FY1 night shifts. Ward rounds happen in the morning, then seniors move to theatre, leaving you to execute the plan. If you need help, seek out your senior in theatre — this is always acceptable. Getting organised early is key to getting into theatre. The orthogeriatric team are your friends — build those relationships early.

🩺 Common Conditions

• Hip fractures (NOF) — the most common trauma admission; know the NHFD (National Hip Fracture Database) standards
• Ankle and wrist fractures, fragility fractures
• Compartment syndrome — recognise early (5 Ps: Pain, Pallor, Paraesthesia, Paralysis, Pulselessness) and escalate immediately
• Post-operative complications: DVT/PE, UTI, pneumonia, constipation, delirium, AKI, Hb drop, opioid toxicity
• Wound problems: infection, dehiscence, haematoma

🔧 Daily Tasks

• Reviewing and documenting weight-bearing status for each patient daily
• Prescribing and adjusting analgesia
• Managing common medical problems: constipation, delirium, hypo/hypertension, Hb drop, AKI
• Wound reviews
• Documenting during ward rounds, trauma meetings, and board rounds
• VTE prophylaxis prescribing and review

💡 Top Tips & Resources

• The A-E approach for post-op pyrexia or worsening NEWS is essential — recognising the deteriorating patient is your most critical skill on this ward.
• At times you may be the most senior doctor on the ward. The medical registrar is always available and very supportive of surgical FY1s.
• Staying organised means getting into theatre — which most trainees find genuinely interesting and educational.
• Resources: NICE guideline on hip fracture (NG124); Orthobullets; McCrae's Orthopaedic Trauma; Geeky Medics; NICE guidance for VTE prophylaxis in surgical patients

📋 Overview

Urology at FY1 level is a ward-based job focused on post-operative patient care. Turnover is high and there are usually no dedicated theatre days — though if the ward is quiet or well-staffed, there may be opportunities to get into theatre. You will be responsible for preparing and updating the theatre list. Post-operative urology patients can have medical comorbidities, so general medicine knowledge is very helpful. Getting comfortable with urinary catheterisation early will make a significant difference — it is a core and frequently required task in this rotation.

🩺 Common Conditions

• Common urological cancers — bladder, prostate, renal — including staging and management options
• Benign prostatic hyperplasia (BPH) and urinary retention
• Urinary tract stones — renal colic, ureteric obstruction, nephrostomy indications
• Haematuria — visible and non-visible; 2-week wait criteria (NICE NG12)
• UTI, pyelonephritis, and urosepsis
• Testicular torsion — a surgical emergency; time is testicle
• Epididymo-orchitis
• Urinary catheter complications — blocked catheters, bypassing, catheter-associated UTI
• Urology procedures to understand: cystoscopy, TURBT, nephrostomy, ureteric stent

🔧 Daily Tasks

• Post-operative ward care and reviewing patients following surgery
• Preparing and updating the theatre list
• Investigations: bloods, blood cultures, urine cultures
• Writing discharge letters (EDNs) and TTOs
• Urinary catheter insertion, care, three-way catheter management, bladder washouts
• Post-operative TWOC (trial without catheter) — if the patient fails, a new catheter is needed

💡 Top Tips & Resources

• Become confident with urinary catheterisation early — post-op patients frequently require TWOC and if they fail, a new catheter needs inserting promptly.
• Get organised with your jobs list at the start of each day — this is how you create time for theatre opportunities.
• From a GP perspective: understanding when to investigate haematuria urgently (NICE thresholds), when a UTI in a man needs investigation, and PSA interpretation are directly applicable skills.
• Resources: NICE guidelines for bladder cancer (NG2), prostate cancer (NG131), and haematuria referral; TeachMeSurgery — Urology section; Geeky Medics for catheterisation guide

📋 Overview

Vascular surgery is a busy, fast-paced specialty with often very unwell, multimorbid patients — including those with diabetes, renal disease, and peripheral vascular disease. Patients are frequently recovering from major surgeries and ward rounds are rapid with lots of wound reviews. Carry a wound care kit during ward rounds to keep things moving efficiently. On-calls can be demanding and will rapidly improve your procedural skills — ultrasound-guided cannulation is particularly valuable in this patient group, who are often difficult to access. Building practical skills quickly is a real strength of this rotation. The patients can be physiologically vulnerable — don't hesitate to escalate early and use specialist support from orthogeriatrics, diabetes teams, and the medical registrar.

🩺 Common Conditions

• Acute limb ischaemia — a surgical emergency; the 6 Ps (Pain, Pallor, Pulselessness, Paraesthesia, Paralysis, Perishing cold)
• Chronic limb ischaemia and peripheral arterial disease
• Ruptured abdominal aortic aneurysm (rAAA) — a life-threatening emergency
• Diabetic foot sepsis and Charcot foot
• Carotid artery disease — TIA and stroke implications
• Lower limb ulcers — arterial, venous, and mixed; management and dressings
• Hospital-acquired pneumonia (HAP) in post-operative patients
• Post-operative: AKI, hypoglycaemia, DKA, opiate toxicity

🔧 Daily Tasks

• Standard ward tasks: reviewing patients, documenting ward rounds, acting on plans
• Pain review and analgesia adjustment
• Diabetic blood glucose monitoring and insulin management
• Cannulation and blood-taking — often difficult in this patient group; ultrasound guidance is invaluable
• Bleeding and wound reviews
• Referrals to care of the elderly, diabetes, and psychiatric liaison services
• Discharge summaries for elective day surgery patients
• Updating the theatre list and printing referrals

💡 Top Tips & Resources

• These patients are physiologically frail — don't be afraid to ask for help early. The medical registrar is very sympathetic to surgical FY1s, and specialist teams (diabetology, geriatrics) are your allies.
• Practise practical skills before the rotation if possible — ultrasound-guided cannulation in particular will make your on-calls significantly more manageable.
• Read up on common vascular presentations and review the peripheral vascular examination technique before starting.
• Resources: TeachMeSurgery — Vascular Surgery section; NICE guidelines for peripheral arterial disease (NG19) and AAA; Geeky Medics for vascular examination guide; Microguide for antibiotic protocols in diabetic foot infection

Be aware of your cognitive biases. You are statistically more likely to diagnose a condition that A&E have already suggested, something you have seen recently, or something that has been emotionally salient (for example, a condition that was recently missed causing patient harm). These biases arise from System 1 thinking — fast, instinctive, unconscious — and include anchoring, availability bias, and premature closure.

Further reading: Thinking, Fast and Slow by Daniel Kahneman; Trimble M & Hamilton P (2016). "The thinking doctor: clinical decision making in contemporary medicine." Clinical Medicine 16(4), 343–346.

Patient presentations on ward rounds are a communication skill in themselves. A well-structured, concise presentation impresses consultants, builds your confidence, and directly translates to referral communication in GP.

SBAR framework for patient presentations:

• S — Situation: "I'm presenting Mr Smith, 58, admitted last night with acute dyspnoea."
• B — Background: Known COPD, ex-smoker, on tiotropium and salbutamol. Previous admission 6 months ago."
• A — Assessment: "Clinically he has bilateral wheeze with reduced air entry at the bases. Sats 89% on air. CXR shows hyperexpansion, no consolidation. ABG shows type 2 respiratory failure."
• R — Recommendation: "I think this is an infective exacerbation. I'd like to start nebulisers, IV hydrocortisone, and antibiotics as per the protocol. I'd also like your thoughts on NIV thresholds."

Practise this on every ward round. Ask your consultant for feedback on your presentation style regularly.

Hospital gives you the opportunity to be involved in breaking bad news with senior support. This is an extraordinary learning experience. In GP, you will frequently break bad news — often without a consultant by your side.

Key principles (Buckman's framework adapted for trainees):

1. Check what the patient already knows
2. Find out how much they want to know
3. Share information gently and gradually — "warning shot" before the hard news
4. Respond to emotions before moving to management
5. Summarise and plan next steps together
6. Ensure patient is not alone, and that support is available

Useful phrases for difficult moments:

• "I'm afraid the news isn't as straightforward as we'd hoped..."
• "I want to be honest with you, because I think that's what you deserve..."
• "Take your time — there's no rush."
• "What's going through your mind right now?"
• "I know this is a lot to take in. What questions do you have at this point?"

Log every bad news conversation. These make excellent, high-capability log entries and demonstrate holistic practice, communication, and ethical approach.

Hospital is full of worried, frustrated, or frightened relatives. Learning to handle these situations calmly is directly transferable to GP — and directly tested in the SCA.

• Never match the emotional temperature. Stay noticeably calmer than the relative.
• Acknowledge before explaining: "I can hear how worried you are. That makes complete sense." Only then move to information.
• Avoid defensive language: "I understand your frustration" is better than "I'm sorry you feel that way."
• Find common ground: "We both want the same thing — to get your mother better and home safely."
• Know when to pause and offer to continue in a private space
• Always involve your senior if the situation escalates

MDT meetings are a core part of hospital life — and increasingly a core part of GP practice. Observing and contributing to MDTs in hospital builds skills you will use for the rest of your career.

• Don't just sit silently. Contribute — even if briefly: "I was the one who clerked this patient. From my assessment, the key concern is..."
• Ask questions about the social worker's role, the OT assessment, the palliative care plan — these are capabilities you need to demonstrate
• Write an MDT attendance log entry. Link it to HPHS capability (holistic practice, health promotion, safeguarding)
• Think about how the MDT's decision will affect the patient's GP after discharge

The PPM should happen within your first 2 weeks. It is a formal meeting with your CS (or a nominated supervisor) where you agree your learning goals for the post. Prepare by:

• Reviewing the 13 Professional Capabilities and identifying 3–4 to focus on in this post
• Thinking about your PDP (Personal Development Plan) goals — what do you want to improve?
• Looking at the Bradford VTS Placement Planning guide for hospital posts
• Writing a brief summary of where you are in training and what you hope to achieve
• Asking your CS: "How does this specialty commonly present to GP? What should I look out for?"

After the meeting, write a log entry about it. This is mandatory — the ePortfolio requires you to record a PPM log entry.

Many consultants don't know what's expected of them with GP trainees. A short, friendly email on Day 1 or 2 makes a huge difference:

• Briefly introduce yourself and your GP training programme
• Ask to arrange a Placement Planning Meeting in the first 2 weeks
• Mention you'll need them to sign up for a free FourteenFish account to complete WPBAs
• Share the Bradford VTS link for hospital consultants: bradfordvts.co.uk/teaching-learning/hospital-consultants-and-gp-training/
• Keep it brief, warm, and professional

The CSR is a structured written report completed by your CS at the end of each hospital post, within your ePortfolio. It:

• Covers the 13 Professional Capabilities (grouped into 4 clusters)
• Is completed by the CS who has directly observed you most — usually the consultant who did your CBDs and Mini-CEXs
• Is submitted at the end of the post, before your ARCP
• Does NOT need to be completed if the CS is the same person as your ES (this applies in some GP post arrangements)
• Should reflect evidence from Mini-CEXs, CBDs, and day-to-day observations

Trainee tip: Don't leave this until the last week. Remind your CS 3–4 weeks before the end of the post that the CSR is due. Busy consultants often forget.

The Mini-CEX is an observed clinical evaluation — a consultant or senior watches you consulting with a real patient and then gives structured feedback. It is NOT a scary viva. It IS a fantastic learning opportunity if you approach it well.

• Duration: ≤15 minutes of direct observation, then feedback
• Choose carefully: Pick a case that allows you to demonstrate good communication and clinical reasoning — not just a routine drug chart check
• Variety matters: Each Mini-CEX must involve a different clinical problem. Don't do three Mini-CEXs on chest pain.
• Who can do it: Your named CS (best practice), or any ST4+, SAS doctor, or consultant in the department
• Request it yourself: The onus is on you to ask. Say: "Would you be available to do a Mini-CEX with me on Mr X today? I'd appreciate your feedback on my consultation skills."
• Link to capabilities: Your assessor will grade specific Professional Capabilities. Make sure you know which ones a Mini-CEX covers.

The most common piece of feedback from ARCP panels and Educational Supervisors is: "The log entries are descriptive but not reflective." This is almost a universal trainee failure point — and it is completely fixable.

What a poor log entry looks like:

"Today I saw a patient with chest pain. I clerked him in and ordered bloods and an ECG. The consultant reviewed him and agreed with my management."

What a good log entry looks like:

"I clerked a 52-year-old with atypical chest pain. My initial differential included musculoskeletal, GORD, and cardiac causes. I found myself initially dismissing the cardiac option too quickly because he was young and fit — I reflected that this is a common cognitive bias (availability error) and discussed it with my consultant. The ECG was normal but his troponin was mildly elevated. This reminded me that in GP I should always treat atypical features in younger patients with appropriate caution, and that a normal ECG does not exclude ACS. I have now read the NICE guideline on chest pain assessment in primary care."

The difference is reflection + learning + GP link. Use Ram's Easy Peasy log entry method on the Bradford VTS site to make this easier and faster.

These are the avoidable errors that cause unsatisfactory ARCP outcomes. All of them are preventable with early action.

1. Missing ESR (Educational Supervisor's Report) — Sometimes both parties think it's been signed off but it hasn't. Check your ePortfolio compliance passport before the ARCP deadline. An unsigned ESR is an automatic problem.
2. Form R not completed correctly — Must be submitted on TIS (Trainee Information System). Both Part A and Part B must be uploaded. The TOOT (Time Out Of Training) declaration must match your ePortfolio records exactly. Discrepancies raise flags.
3. BLS certificate invalid — Must be face-to-face, cover adult AND child life support, cover AED use, be within the past 12 months, and show the trainee's name clearly. Online-only certificates do not satisfy this requirement.
4. Safeguarding training not up to date — Level 3 for both adult and child safeguarding is required. Training must include clinical case reviews. Check your training record — many trainees are surprised to find their certificate has expired.
5. WPBAs incomplete — The CSR for every hospital post is mandatory and the most commonly missed item. CbDs and mini-CEXs are the next most frequent gap. Count your numbers explicitly — don't assume they're complete.
6. QIP/QIA gap — A Quality Improvement Project (QIP) must be completed in a primary care placement. Quality Improvement Activities (QIAs) are needed in other training years. Trainees who reach ST3 without having started this are in difficulty. The best time to start is an ST1 hospital post.

Medication errors at the primary–secondary care interface account for up to 50% of all medical errors. As a GP trainee in hospital, you can actively reduce these by understanding what happens when your patient leaves the ward.

Write Discharge Summaries You Would Want to Receive as a GP

• State the indication for every new medication started in hospital
• Specify monitoring required — bloods, BP, weight — with exact timeframes
• Identify medications stopped in hospital and explain why
• Specify who is responsible for follow-up — GP, outpatients, community nurse, or specialist?

• Use the ISCE framework (Issue/Situation — Change/Learning — Evidence) from Bradford VTS to structure entries
• Always link entries to at least 1–2 Professional Capabilities explicitly
• Include what you did differently as a result of the learning — this is what "evidence of learning" means
• Don't just write about clinical cases — include MDT meetings, teaching sessions, difficult conversations, ethical dilemmas
• Write about your positive experiences too — not just problems. A log about a brilliant outcome you contributed to is valid and encouraging evidence
• Avoid writing entries that criticise colleagues by name or imply others behaved badly. It reflects poorly on you, not them.

The simplest system that works consistently:

1. Week 1–3: Write 3 Clinical Case Reviews in ePortfolio
2. Week 4: Write 1 "other" entry (HDR session, MDT reflection, teaching received, audit involvement)
3. Every 6–8 weeks: Complete a Mini-CEX or CBD
4. End of month: Review your PDP — are you working towards your stated goals?
5. Mid-post: Check WPBA progress — are you on track? If not, catch up now, not in the final week.

Set a recurring monthly calendar reminder: "Log entries check — 4 done this month?"

All 13 capabilities must have evidence by the end of training. Hospital posts are rich with opportunities — but trainees consistently miss several of them. The ones marked ← are the ones most often neglected and most worth targeting actively.

Tagging tip: Every log entry can be tagged to up to 3 capabilities. Build breadth — if you have five entries all tagged to "Clinical Management", add tags for "Practising Holistically" and "Community Orientation" to existing entries where they genuinely apply.

Every rotation covers at least 2–3 clinical experience groups. Map your placement actively from week one. This ensures your log entries are tagged to the right groups and builds the breadth of evidence the RCGP expects.

Not acceptable: Descriptive lists only. "I saw a patient with heart failure. I learned about fluid management." No reflection, no learning outcome, no capability evidence.

Acceptable: Identifies what happened, what you learned, and what you'll do differently. References a guideline. Shows some self-awareness.

Excellent: Integrates multiple sources (guidelines, feedback, patient interaction). Demonstrates genuine self-awareness. Critically appraises the evidence. Shows how learning changed your behaviour. Considers the perspectives of others (patient, colleague).

Mini-CEXs in hospital posts. COTs in GP posts. They are not interchangeable. If you are in a GP post within ST1 or ST2, do COTs. If you are in a hospital post, do Mini-CEXs. If your year is split (e.g. 6 months GP + 6 months hospital), you do a proportional mix.

This is very common. Many hospital consultants have never supervised a GP trainee before. Send them the link to the Bradford VTS page for hospital consultants, and the RCGP WPBA guidance for assessors. Offer to walk them through the FourteenFish form — it only takes a few minutes to complete once they have the account. Most consultants are very happy to help once they understand what's involved. If problems persist, escalate to your TPD.

Yes — and it's actively encouraged to use a range of assessors. CBDs can be done by your named Clinical Supervisor, any other consultant in the department, or your GP Educational Supervisor. Variety in assessors strengthens your evidence base and is expected. Aim for at least 2–3 different assessors over any 6-month post.

Contact your TPD immediately. HDR attendance is mandatory and below 70% is documented. Your TPD can help negotiate with the hospital department, arrange alternative educational activities for sessions missed due to legitimate rota clashes, and document this appropriately. Do not simply skip sessions without flagging this — proactive communication protects you.

Register as an RCGP Associate in Training (AiT) at rcgp.org.uk/training-exams/mrcgp-exams-overview.aspx. You'll need your National Training Number (NTN), which should have been provided before the start of training. Once registered, you can access the Kainos ePortfolio. Contact your GP scheme administrator if you haven't received your NTN — don't wait.

Honestly — all of them have value, and the "best" specialty depends on your learning needs. That said, trainees consistently report that general medicine, psychiatry, paediatrics, care of the elderly, and obs/gynae are the most GP-relevant. Even surgical posts have unexpected value — understanding surgical pathways, perioperative medicine, and surgical safety improves your GP practice. The single most important factor is the quality of your CS and the learning culture of the department.

Several things commonly catch IMGs off guard in UK hospitals: the flatter professional hierarchy (nurses have significant authority and expertise — respect this genuinely, not just formally); the expectation that asking for help is a sign of good practice, not weakness; the emphasis on documentation and consent; the importance of safeguarding awareness; and the 15-minute consultation expectation that starts in GP posts. The Bradford VTS scheme induction is designed to address many of these — attend it with questions ready. You are also very welcome to use the IMG New Starter Baseline Form available in the downloads section.

Yes — LTFT training affects the total length of your training programme and the proportion of training in each post. WPBA requirements are adjusted pro-rata. ARCP panels may occur more frequently (at least annually, and at gateway transition points). Hospital departments vary in their ability to accommodate LTFT arrangements — some job shares are possible, others are not. Discuss with your TPD as early as possible if you're considering this. Refer to the Gold Guide (currently 10th Edition) for formal requirements.