Your Hospital Post
guidance on starting a hospital post
I'm due to be starting a Hospital post. What next?
Hopefully, the scheme should have provided you with your hospital post rotation. If this isn’t the case, get in touch with either the GP administrator for your scheme or one of the Training Programme Directors (which are called TPDs for short).
Then, get in touch with your hospital department´s secretary and/or consultant. Write a little paragraph introducing yourself and then ask them if you need to do anything further.
The department is likely to send you an induction pack, a timetable and some preparatory homework to do before starting your first day. This preparatory material will help the department and your consultant to determine how to settle you in nicely as well as some educational stuff like identifying your educational needs.
For those of you who are part-time or coming back from sick or extended leave, PLEASE make contact with your department/rota-coordinator EARLY (at least 6 weeks before) to make sure any special arrangements required are all in place, and if not – gives them time to fix. Ask to see the timetable.
Why do I have to do hospital posts when I want to be a GP?
Good question. But actually there are a lot of positives from hospital post training that will help prepare you to become a good GP. Here´s a list of things we could come up with …
- You will gain a lot of useful specialty-specific clinical knowledge
- You will learn a lot about prescribing and safe prescribing
- You will learn how to work with teams and the value of a multidisciplinary approach to patient care (and learning to handover safely)
- You will come into contact with the patient´s family and understand a bit more about family dynamics (how families behave)
- You will learn communication skills – not only between colleagues, but with patients and their relatives
- Sometimes things will go wrong, or there will be near misses, and you will learn from these.
- And of course, you will understand more about the hospital-GP interface as you recieve calls from GPs, contact them whilst you have a patient under your care and write discharge letters. You will also become familiar with the referral pathways that will be available to you as a working GP.
- And in doing ALL of this, you will be exposed to some ethical dilemmas and issues that face us as doctors.
All of these things will help build skills that a transferable to the world of GPs. Having said that, while working in hospitals doing busy shifts at unsociable hours, it is easy to forget that you’re training to become a GP. Have a think for a moment – what can you do to keep grounded and remember where you’re ultimately heading?
5 things to do when you start a Hospital post
Registration is online with an initial registration fee which is confirmed by email. The ePortfolio will be activated between 24 and 48 hours after registration with a welcome pack sent approximately 10 days after. Once registered, you are then called an “Associate in Training” (AiT).
- To register online, go to: https://www.rcgp.org.uk/about-us/membership/become-a-member/ait-trainee-gps.aspx
- There is an enquiry line for AiTs (email [email protected] or telephone 020 7344 3078) for any registration queries
Before you start, make contact with either the secretary or the consultant (or both) of the department you are going to. Introduce yourself. Ask if there is anything you need to do before the start date. As mentioned earlier, for those of you who are part-time or coming back from sick or extended leave, PLEASE make contact with your department/rota-coordinator EARLY (at least 6 weeks before) to make sure any special arrangements required are all in place, and if not – gives them time to fix. Ask to see the timetable.
Ask for a copy of the specialty induction programme AS WELL AS the rota – to see if you are going to be the first one on call on day 1 !!!
In GP and Hospital posts, you are to some extent covered by the Indemnity offered by the NHS. However, you may end up doing (without realising it) other professional activities which may not be covered by the NHS Indemnity. So, if you want peace of mind, you must maintain membership of a recognised medical defence organisation or insurer for these purposes. Nearly all GP Training Schemes strongly recommend all GP trainees to contact a defence organisation – like the MPS or MDU – and take additional personal cover. Belonging to a defence organisation like the MPS or MDU will give you that extra support you will need if you become the subject of an investigation. Organisations like the MPS and MDU provide invaluable personal support. You will regret it if you don’t. For the small extra cost, is it really worth taking the risk of not having it? Oh, and join the BMA too. When things go wrong, you won’t want to be without them. Their support in such circumstances is phenomenal.
There are two inductions you will have at the start of your training.
- The first is an induction to your post – either a GP post based induction or a hospital specialty based induction. These will help you settle into your new specific ST1 post.
- The second induction will be that organised by your GP TRAINING SCHEME. The aim of this induction is to provide a sort of orientation session where you understand THE WHOLE of your GP training pathway and journey (and all the requirements, including exams).
You must attend both. If you don’t know when your GP scheme’s induction is – email your GP scheme administrator. When you have got your dates for your GP TRAINING SCHEME’S induction, don’t forget to book that time as study leave with your first post. PLEASE TELL THEM AND BOOK IT IN AS SOON AS POSSIBLE – they will not automatically know.
Make a good first impression
It’s worth trying to make the best impression you can in the first few days of the post. Be friendly and show genuine interest in the job and all your colleagues at every level. Show a willingness to work hard, a willingness to listen to instructions and advice. If you do this, people around you will find it a pleasure to want to help you.
It would be tactless and inappropriate for us to quote examples, but some trainees have found themselves pigeon-holed either negatively (e.g. as slack, unconscientious or uncooperative) or positively (e.g. helpful, hardworking or conscientious) on very little evidence. Later, when their behaviour has changed, their reputation hasn’t – reputation sticks!
That’s why we say a little extra effort in the first few days is likely to pay immense dividends in the end. Of course, this doesn’t mean that you can be good, hard working and conscientious in the beginning and slack off towards the end. Individuals who go the extra mile are ALWAYS admired, respected and generally liked. Others, in return, will often go the extra mile for you!
What equipment do I need?
Just bring your stethoscope. Anything else will be provided. Hopefully, you´ll get an up to date copy of the BNF to help you prescribe safely. Carry it with you at all times .
I'm worried about my clinical knowledge and my performance in the first couple of months...
Of course you’re going to be worried. Who wouldn’t be. It’s completely understandable. The way you are feeling is quite normal for ANYONE who starts a new job – except that you will be starting “a new post” every 6 months or so!!! So, here are a few tips to lessen that worry, to help reduce the risk of medical error, to help keep patients safe and thus reduce the chances of medico-legal action on you.
- First of all, know your medical/surgical emergencies for that department. Clearly, you cannot be expected to know all the clinical knowledge for that hospital specialty from day 1. Otherwise, there would be no point to training! And the TOTAL clinical knowledge for any hospital specialty is VAST. Hospital consultants and other high grade doctors did not acquire that knowledge over night; so, you can’t be expected to either. But what you can focus on are the emergencies for that specialty. There are only ever a few handful of emergenices for most hospital specialties (except for A&E). Find out what the common emergencies are. Read up about them. Find out what the usual protocol is and digest that information. Most hospital specialty departments have a handbook for new clinical staff detailing this sort of stuff. If they don’t, they can usually tell you where to look. Ask!
- Know your limits. Try not to be the hero and pretend you know everything when you know that you don’t. Seek help from others when you are out of your depth. On a practical level, this means knowing which seniors are available to you at all times during your work (and of course, knowing how to contact them).
- Use your work colleagues around you. For example, the Sister or Charge Nurse of the ward usually knows all the protocols and the individual likes and dislikes of each consultant. They also know where things are kept. And they like to be asked! Make a special effort to be kind and nice to them. Get them to like you and they will go the extra mile to help you – especially when the going gets rough. In fact, treat all those around you with kindness and respect and they too will go the extra mile.
What sorts of things should I be putting in my ePortfolio?
First of all, there is the mandatory things you HAVE to do – called Work Place Based Assessments (WPBA) – like miniCEX’s, Case Based Discussions (CBDs), Multi-Source Feedback (MSF) and the Clinical Supervisor’s Report (CSR – done 2 months before the end of the post). For more information on WPBA and the numbers you have to do for miniCEXs and CBDs – see under the ‘MRCGP intro’ button located in the main Mega Menu.
But what trainees in hospital posts often get confused about is what to write as log entries. Hopefully, you will have an initial meeting with your Educational Supervisor who will TRAIN you and build up your reflective and learning skills. If they haven’t, PLEASE ASK THEM – “Would you mind going through reflective learning log entries and how to write one up that is meaningful and reflective?”.
Here are some of the things you can write about while you are in a hospital post. This list is not exhaustive. I’ve put down the appropriate RCGP’s Professional Competency heading in brackets next to each one, so you have some idea what competency you are demonstrating or talking about.
- Your history and examination technique. History and examination tips that are helpful for specific illnesses. Lab results and how to interpret them in the context of the patient. (DATA GATHERING & INTERPRETATION)
- Your differentials and how you came to your diagnosis. (MAKING DECISIONS & DIAGNOSES)
- Clinical management and protocols. If talking about the standard management protocol, this becomes CLINICAL MANGEMENT but if talking about why you chose one particular management route over another, this is then MAKING DECISIONS.
- Safe prescribing. Remember to be extra careful when prescribing for children. (MAKING DECISIONS)
- Managing multiple co-morbidites and how you manage one illness without adversely affecting the other etc (MANAGING MEDICAL COMPLEXITY).
- Communication Skills – not just with patients but with relatives, colleagues, other team members and in handover (COMMUNICATION & CONSULTATION SKILLS)
- Medical Teamwork & Multidisciplinary teamwork. Try and understand the roles of different team members, and write about them. Especially other health professionals. Respect their skills and contribution to patient care. Work collaboratively. (WORKING WITH COLLEAGUES)
- How an illness affects a patient’s life (PRACTISING HOLISTICALLY)
- How families react and behave. The consequences of a family members illness on them. Many family interactions visible in hospital specialties especially A&E, Paediatrics, Medicine for the Elderly and Palliative Care. In General Practice, families are generally in the background – but in hospital they’re often there for you to observe. (PRACTISING HOLISTICALLY)
- Ethical Issues around things like capacity to consent, informed consent, confidentiality, end of life issues, and also specialty specific issues like reproductive health issues if you are in an O&G post. Take responsibility – if you have misgivings about a practice, even if it is well established, talk to your clinical or educational supervisor or TPD advisor (AN ETHICAL APPROACH TO PRACTICE)
- Significant or Critical Events (or near misses). Other than writing about what happened, remember to explore the feelings of everyone involved. Review organisational systems. Suggest changes to prevent a recurrence. (MAINTAINING PERFORMANCE, LEARNING & TEACHING)
- The hospital-GP interface – understanding what secondary care has to offer. Communication between GPs and hospital docs. Understanding referral pathways, and what you’ll be referring patients for, when you’re a GP (COMMUNITY ORIENTATION)
- Any departmental teachings you have helped out with or done (MAINTAINING PERFORMANCE, LEARNING & TEACHING).
- Any research, audit or projects you have done for your specialty department (MAINTAINING PERFORMANCE, LEARNING & TEACHING).
There’s a wealth of things you can reflect and write about in your ePortfolio. Whatever you write about, make it meaningful! Rather than writing a description of what happened, write about why you chose to write about it, what effect it had on you, what it taught you or what it made you realise.
DON'T FORGET: your ePortfolio & WPBA in the busy'ness of your job
In the busy’ness of their hospital jobs, GP trainees often overlook their ePortfolio and their WPBA requirements. As a result, their Educational Supervisor’s Report will be marked “unsatisfactory progress” and then they will be referred to an ARCP panel who will then grill them about their poor engagement. Clearly, none of us want that to happen to you. So…
- Please make sure you pay attention to both. Keep a notebook or send yourself an email about interesting patients or situations that you’d like to write about as you encounter them on your daily rounds. Remember, do not include patient identifiable data in your write up because you will be breaking the rules of confidentiality (which is serious).
- And don’t forget to do the minimum number of Work-Place Based Assessments like CBDs, Mini-CEXs, MSFs and so on. Click on this link to tell you Which Assessments at Which ST Stage.
DON'T FORGET: to start practising your Communication Skills
Yes, all the communication skills you need to develop for General Practice are also invaluable for safe and comprehensive practice in your hospital posts. So, you might as well get practising now. Most of you will have been taught history taking and examination – BUT THAT IS NOT COMMUNCATION SKILLS. That is DATA GATHERING and accurate data gathering is required for an accurate diagnosis and management plan. But THE WAY you gather this data is also as important because THE WAY you ask can affect the accuracy of what was conveyed.
- We recommend: “The Naked Consultation by Dr. Liz Moulton”
- To learn more…. click here to see how this wonderful hospital consultant demonstrates really good consultation skills in the hospital setting.
DON'T FORGET: to get some appropriate CEPS done
CEPS are thinks like Breast Examination, Rectal, Prostate, Male Genital, Female Genital. So, for example, in your O&G post, consider getting female examinations done. Do the appropriate CEPS in the appropriate specialty.
If you experience any difficulty with the post
If you have a problem with the post, for example, the work load, difficulty getting time to go to HDR, someone not treating you right, rota problems, EWTD etc, please speak to your hospital consultant first to see if things can be easily sorted at a local level.
ALSO talk to one of the Training Programme Directors (TPDs). They are there to help you. And especially get in touch with them if you feel uncomfortable talking with you hospital consultant. TPDs can make things happen as well as providing a listening ear and a supportive hand.
What previous GP trainees say...
- “It’s important to realise, even though you’re doing a hospital rotation, you really need to get out what GP’s actually need to know”
- “For instance, in Obs and Gynae instead of being in theatres a lot, spend more times in Gynae outpatient clinics – see what GPs refer, learn acute assessments in MAC, learn how to insert a speculum etc”
- “HDR attendance – whilst in hospital it is possible if you really try and GP trainees have managed to attend a good number even when doing A&E and Medicine”
- “Try and sit in on lots of outpatient clinics”
- “Get all your CEPS done before finishing hospital posts (much easier getting a reg in A&E watching you do a PR then trying to do it in GP-land)”
- “In A&E – spend as much times as possible in minors”
- “In Paeds – take heart that PAR is really useful for seeing lots of sick kids as you rarely see any in GP-land”
- “In Gynae – do lots of clinics and get good at gynae examinations.”