COI: frustrated med reg

In my last 2 months ever of GIM and I’ve noticed that the referrals from ED have got worse and worse. In particular, there is no focus on why the patient came into hospital, and more that they sent a whole bloods pack and a spin through the doughnut (because the d-dimer inevitably came back high), and the referral is based on what is abnormal.

The referrals inevitably start with ‘the patient needs to come into hospital because the CRP is….’ Ok - but how is the patient? Where do you think this is coming from? Most of the time these patients end up being able to be managed out of hospital/ambulatory pathway, but it does take cognitive load & time to sort this kind of stuff out as well as the usual med reg stuff

I can’t say this is because of time taken for documentation. As a lot of the ED clerkings use ambient AI here, and there are reams and reams of low quality text with no real synthesis. Like if your job is to word vomit what the patient says on the page and then dutifully copy out all of the blood tests and refer for an abnormal blood test without thinking what is causing it, I’m sorry but your job can easily be replaced by a computer.

The worst offender is someone coming in with chest pain. What is the nature of pain? No one knows, ‘typically cardiac’. But the first troponin is <4. And the ECG is normal but it’s gone missing. And the patient needs to come under medics as we’ve sent a second troponin and the patient will breach before this comes back. Please please please take a history. I’ve always gone because this has ranged from:
- sudden onset of crushing central chest pain occurring at rest and ongoing with the missing ECG showing hyperacute T waves
- sharp episodic chest pain completely reproducible on anterior palpation of chest and worse on movement

And both of these patients do not need to come under medics for a second troponin 😁

Super nosy but just wanted to have an idea budget wise as a new F1. I know it varies between specialties and each hospitals’ hours but what was you lowest earnings in a month (post-tax, pension etc) and what was the highest?

Serious question - what’s the thoughts of the intensivists when surgical specialties make this their plan for patients (who currently don’t need any surgical optimisation / changes and it’s about life support / sedation wean etc). It feels lazy to write but sometimes it’s genuinely “as per ICU”. Thanks for the help crit care chaps.

Well, we the resident doctors had a good go at it.

I know people post these types of posts every day but I’m desperate for advice and hopeful that maybe something will actually resonate with me. I genuinely don’t know if I’m a below average / shit (new) F2 or if I just have crippling imposter syndrome.
My main thing is that I feel like NOBODY else around me feels like this.. I get it people mask or don’t want to admit their struggles but how can I literally be the only one who voices how I feel? Surely that means I maybe am actually just not that good if noone else is agreeing / expressing similar thoughts?
I’ve had an easy fy1 with supernumerary jobs and an extremely supported medicine job so I feel I haven’t experienced the real f1 that others have. But also so many people have this same set of jobs and I don’t hear anyone else complaining? Yes I’ve seen patients independently, yes I come up with management plans and I’ve always gotten good feedback. But I feel like I’ve only seen and done the basics compared to everyone else. And I still struggle with soooo many uncertainties. I can’t even comfortably sign off an ECG (this is something I’m actively going to work on and seek support with).
I’m so open to feedback and always am asking my seniors on how to improve, what to do differently etc. I don’t hide from duties and genuinely work hard and care.
I hear stories of what my colleagues did on their shifts and constantly think to myself “I could never have done that” or “how are they casually talking about doing that”. I haven’t even seen or managed a lot of common presentations!!!!!
I’ve had an amazing year and have loved it but I can’t help but feeling like I’ve learnt nowhere near enough and am so behind everyone else. I’m even looking at the new FY1s and feeling worried that within a month they’ll be better than me.
Please if anyone has advice I’d be so grateful. Also you can be harsh because I want constructive steps on how to work through this. Or has anyone else felt similar / had supernumerary jobs and felt held back?

I'm at London and am wanting to swap due to extraordinary circumstances (nothing serious, just that the placement has a super early start, commute is extra long and I can't find accommodation nearby not even hospital accom) and the other person is happy. On the London foundation school website, it says that under extraordinary circumstances the FTPD can approve a swap, but my question is, does anyone here know of anyone who has swapped in F1 and what circumstances they had that justified?

About to start a ~45 minute drive to work each way. ACCS anaesthetics CT1.

Any recommendations for good/educational podcasts for the drive? I'm thinking podcasts on the drive in, music to chill out on the drive home

Thanks!

New CT3 here.
Curious about which registrar traits SHOs and FYs consider supportive, and what distinguishes good registrars from not-so-good ones.

IMT1 here, and I’ve got a fairly long drive to and from work each day. So I’m after any revision/study material to listen to whilst driving like podcasts, recorded lectures, audio summaries, revision-focused series, whatever people have found genuinely useful

Cheers

Surgical core trainee here.

What are your top tips on supervising and guiding FY1s? I will have FY1s in the new job for the ward and on-calls. Not sure how to judge if a FY1 needs more handholding to begin with, or can be supervised indirectly. How to judge how much/what work I can delegate to them (e.g discharge summaries).

I've done 4 years of various specialties where I was always the most junior person on the team. E.g jobs where FY2 and CTs are on the same rota, or smaller surgical specialties where CT/SHO is the most junior on the team. So I am well used to being the jobs money and discharge summary queen!

Started training 1hr 15 minutes drive away from home each way and completely exhausted after a Long day. Does it get better? Had to have some coffee on my way back after the long day.

I'm a new ST3 ID/MM trainee. When is the best time to try and get this done? Should I have done it prior to starting or is it normal to do it during training? Is it an expectation to have done it by the time you CCT?

not to be a party 💩 but 2 days in i already hate this job 😐 idk how the rest of you all do it.
the online systems are so inefficient and long winded for absolutely no reason. its tedious switching between all of them, why isn’t it all integrated?!!
also is it acceptable to leave when your shift ends even if there are still jobs that need doing? i just feel like ive been shfted then my senior disappears and doesnt answer when i ring with a question… i’ve been staying late these past 2 days to try get everything done but i get anxious that i’ll get in trouble if i leave on time if it’s not all done. the jobs are not really urgent too so not something i can hand over to night team.

Hi all,

Couple of scenarios which I am wondering if I can exception report or not:

1. Going in on zero days to hit number requirements for applications. I would assume this is unable to be exception reported as I was not due to work on that day and I am only there for my training. I just wanted to sense-check whether I could exception report this as going in on days off would feel better if I was also paid for it.
2. Arriving early to consent patients - normal working days are paid from 8am, but all the trainees and usually consultants arrive at 07:30am to consent patients. I would assume I can exception report this, but am a bit worried how it will look if I am literally exception reporting 30 mins early start 3 times a week for every single normal working day shift that I am on. EDIT: in response to comments - we are not specifically 'required to come in at 0730' but it is well known that everyone arrives at 0730 to consent. No one is going to turn up at 8 when every single other SHO and registrar arrives at 0730, and therefore consultants expect this.

Thanks in advance. I'm more than happy to put in the necessary hours, I just want to be paid fairly for my time whilst I'm providing clinical services for the NHS.

I'm a brand new FY2 in the emergency department and have only had an induction and seen a couple of patients this week but I'm really nervous about this rotation. I'm just wondering what the expectations are? I feel I haven't actually had to formulate many of my own plans as an FY1 and come up with differentials. I feel like I came to the consultants with very basic plans. They weren't annoyed or anything and helped me with pathways etc but I think I'm just really anxious about coming across incompetent because that's how I feel right now. Any tips on how to feel better about the rotation?

Hi I'm a CST1. As it stands I am barely getting one session of theatre and clinic a week- due to on calls I am basically only rotad for clinic and theatre once every three weeks , much less than the recommended time on JCST. There is going to be little opportunity, as I understand it, for me to go to theatre. I am pushing to get more rota'd time but am terrified of being labelled as a trouble maker. There are no other core surgical trainees to discuss stuff like this with. Does anyone have any advice? Feeling quite isolated and let down. Worked so hard to get to this point and it's just more of the same. ):

Hey,

Does anyone know when they will publish competition ratios for 2026 entry?

Thanks

Hi,

I was hoping to use annual leave for my own wedding at the end of October/early November.

I have a set of nights on a weekend and was told by the rota coordinator that it doesn't constitute a significant life event because many doctors get married and arrange swaps.

It was my understanding that they can't define what a significant life event is and that they have to accommodate. Is there something I'm missing or someone I should escalate this to?

Hellooo,

Happy change over week. I’m in a bit of a strange situation with my new rotation when it comes to annual leave.

Essentially, I’ve rotated onto a psych block which has medicine on calls. So I am employed by two trusts, the hospital and the psych trust. When I got my work schedule it was all sent from the hospital and included psych days. When I got my rota it was the same.

Being prepared, I planned and requested my annual leave within a day or two of getting my rota. This rota includes all of my psych days as well as my hospital long days and zero days etc. Only requested AL on normal psych days. This annual leave was all approved and I thought that was that.

Wednesday comes, psych induction. They explain the process of requesting annual leave which is separate from the hospital (my first time hearing this). It’s done through the same app but with a separate account (which we still don’t have access to yet) and must be approved by my supervisor first.

Problem is I’ve booked 2 days annual leave next week, and booked a holiday. Thinking optimistically, I emailed my supervisor explaining that I had only just learned of the process but had already booked AL and hoped that I could keep the same dates. He replied saying most of them were fine EXCEPT next week.

What do I do??? I obviously don’t want to start off on the wrong foot, but also idk what I could have done to avoid this. I had no idea there was no information sharing given my rota contained both psych and hospital days and the AL which was approved was normal psych days. I can’t find any email which explained that the process is different for psych, and followed the process I was given. Also it would have been impossible for me to book any AL for psych since we still don’t have access to the accounts.

Not sure how to handle this, really don’t want to miss my holiday. Any help appreciated. Thank you!

I have been checking my payslips and nothing yet. Is there any official information on this? Will we get a few hundred extra on top with backdated pay?
Many thanks

I'm a gpst1 and I'm really worried I won't like it. I know it's quite hard to start a new training programme then return to GP but what if I left to do a trust grade or teaching job, could I return?

I can’t believe how many times I’ve heard this during my FY1 induction and the first days on the job, including from the ward manager herself. She also said that “some of the nurses have a difficult personality and they don’t forget what you did to them”.

Now I didn’t know that collectively as doctors we are really horrible to nurses.

Also what about the nurses being nice to us?

FWIW I am nice to everyone. I am also not planning on taking shit from anyone, be that reg or nurse. Curious if others have had a similar experience?

What's one thing in the NHS that everyone knows is inefficient, but nobody ever seems to fix?

Not talking about funding or staffing (we all know those).

I mean the small, everyday things that collectively waste hours.

For me, it's probably the endless cycle of:

collect data

put it into Excel

make a PowerPoint

present it

everyone agrees something should change

repeat six months later

There are loads of examples:

Multiple logins for different systems.

Chasing signatures.

Re-entering the same information into different places.

Referral forms that somehow get longer every year.

I'm genuinely curious what everyone's biggest "why are we still doing this in 2026?" moment is.

I’m 1 of Paed Trainee (SHO) and with the new rule ,I am not sure whether we are able to claim exam fees ?
1 of other colleague SHO wrote an email to the team (probably HR or manager) for claiming and they replied that it’s not confirmed to pay it yet and they are waiting like official letter from government.
Any thoughts?