A day in the life of an SHO in Acute Medicine
Hi there! I’m Uma, an IMG from India and I am currently working as a Junior Clinical Fellow in Cardiology and Medicine. I am in the Acute Medicine Unit (AMU) rotation and with this blog, I aim to share my experience working in this department with the hope that it may help someone who is navigating their way around in a new department.
Honestly, when I moved to the AMU, it was quite overwhelming as I felt it worked very differently from the other wards. However, with time, I got the hang of it and currently, I’m enjoying my rotation very much. Let me take you through what a day in the AMU looks like and what is expected of an SHO.
What's the day look like?
Firstly, the whole team gathers around for a board round and the nurse in charge highlights any unwell patients and new patients in the wards. After the board round, the junior doctors usually divide the total patients amongst themselves. Every trust might have a different functioning pattern, in my trust, we do three board rounds due to high patient turnover rates.
Board round is a formal meeting with which the day begins in every ward usually attended by the nurse in charge, junior doctors, registrars, consultants, occupational therapists, physiotherapists, pharmacists and the discharge team specialist nurses. Any issues regarding unwell or new patients are highlighted in this meeting.
AMU is a highly consultant-led ward so most of the time the consultants like to see all the patients, if not at least all the new patients. Depending on when the new patients have arrived, some may need to be post-taked. Sometimes they have been seen by the ED team and already been post-taked by a medical consultant in ED. However, if that's not the case, then they need to be post-taked here.
Post-take - once the patient has been clerked, they are for post take. The post take consultant usually has a doctor(s) with them who scribes/requests relevant investigations.
So, your first task of the day is to prepare the notes of the patients that the consultant would like to see. This involves quickly going through ED clerking notes, post take notes (if they have been post-taked) and highlighting the current issues that need to be addressed, mentioning the recent observations, bloods and any significant tests. Then you present these findings to the consultant and then go see the patient together during the first board round. While the consultant is leading the discussion, you’ll be expected to scribe. Then a plan is made by the consultant about admission, discharge, or stepdown to specialty wards along with a list of jobs. Ward rounds are an excellent learning opportunity as you will see a variety of cases and most of the consultants make it a point to teach while going through the notes. The aim is to see all the patients before the second board round and raise any issues.
After the board round, I usually feel benefited by making a jobs list and ticking them off as they are done. The various jobs may include chasing bloods/tests, preparing discharge summary, updating next of kin, making referrals to various specialties, or getting a scan vetted. Make sure to prioritize the jobs efficiently for example an unwell patient may need an ABG/ lumbar puncture immediately or if the ward is full, then discharge summaries should become your priority to maintain patient inflow. After the lunch break, it’s time for getting the remaining jobs done and helping out a colleague if they are extremely worked up. We also have a third board round at around 15:00, it's a quicker one highlighting any changes in the plan that was discussed previously. If you have any pending jobs which need to be done on the same day, then you will have to hand over them to the on-call team.
Benefits of working in AMU
Overall, AMU is an interesting place to work and also an excellent place to get your various assessments signed off as you have a lot of opportunities to get hands-on experience. As AMU has a lot of unwell patients so the crash bleep can go off at any point which is another important learning opportunity to brush up your ALS skills. There will also be a lot of teaching opportunities to keep yourself updated academically. You may find it to be a daunting experience at first, but with the support of your colleagues and self-reflection you will figure out the best way to go about it. All in all, you will have learned a ton of new skills by the end of your rotation.
If you have any questions about the NHS career in Acute Medicine, I would be happy to answer them at trewlink.com.
Written by Uma
Edited by Julia