Foundation Stories

ICM in your foundation year allows for exposure to a wide variety of invaluable skills relying on the ability to adapt and communicate quickly and effectively.

 

See below for accounts by foundation year doctors and their experiences of ICM.

My name is Daniel Law and I work in ITU in the University Hospital of Wales.

My placement on Critical Care has been the hidden gem of Foundation Program options. I applied for this placement as an FY2 to explore Critical Care as a career option, however I ended up with a far more rounded experience.

Currently I work in a busy Critical Care in the University Hospital of Wales. We host a large range of different specialities on site. Consultants closely lead every decision and this creates a safe environment knowing there is large, easily accessible senior input.

Going forward from this placement I am now far more experienced to deal with acute issues on other wards. The close input from seniors allows for greater exposure to trickle-down learning opportunities. I will be leaving with far greater knowledge on managing basic conditions. I can now tackle ward-based problems with a developed perspective on who is concerningly ill and who I can just monitor, one of the more difficult skills being new into clinical practice. My skills set has also expanded exponentially, from difficult cannulas to drains and lumbar punctures.

The other side, of course, is the feeling of being a glorified medical student by another name. I do question my use on the ward. Without the critical care background I can’t help with even the simple questions raised by nurses. Moreover, unlike other jobs where you can perform more independently, I do feel I haven’t developed my decision making skills like I have done on medical/surgical jobs.

Overall, I think a critical care environment is a great place to create a broad foundation training placement. Going to a medical job next, I feel I am taking a huge clinical skill set with me. The exposure to all specialities has developed my clinical knowledge more than any other placement. Finally, it is my confidence in dealing with acute situations that has developed the most.

Why did you take up an FY job in Critical Care:

As a medical student I enjoyed high acuity specialties such as emergency medicine, obstetrics and surgery. I pursued projects in anaesthetics and appreciated the control, pace and understanding of theatre. My student elective in a developing country offered me incredible exposure to unwell patients with advanced but easily reversible pathology. With my interests stoked, my foundation training choices were based on those that offered rotations in anaesthetics and/or intensive care. I wanted to confirm my interests in the specialties and get involved with projects to aid application to further training.

What the FY job involved, how did it increase my interest in Critical Care:

The four month rotation I undertook in critical care was my last of FY1. Based in a small district general hospital, the unit had a 4 bed high dependency and 11 coronary care beds. There were two FY1’s on the unit most of the time, however we would cover the ward alone during annual leave or zero hour days. Coronary care patients were reviewed daily by a consultant cardiologist, and high dependency patients would be reviewed by their parent team on the daily round. It was our role to undertake the level two daily review, support the ward round, perform routine clinical and administrative duties and escalate deteriorating patients. We would often liaise with tertiary specialties in central hospitals for management advice and coordinating transfer if required. The mixed specialty HDU exposed me to post-operative surgical patients, non-invasive ventilation, management of invasive lines and the basics of organ support; whilst in coronary care I witnessed DC cardioversion, unexpected cardiac arrests and insertion of pacing wires. The learning experience was brilliant, I felt I was exposed to the most interesting patients in the hospital, and unlike other FY1 jobs I had more time and resources to learn from the patients before me.

What did my Fellow job involve, what did I get out of it:

Following foundation training I was offered a clinical fellowship in critical care with NHS Lothian. I joined the junior tier rota of a busy critical unit with 19 level 3 beds and 11 level 2 beds, with one day per fortnight of protected development time. It was my first exposure to ventilated patients and the first few weeks were daunting, however I was not overwhelmed and very well supported by the clinical team. My confidence and willingness to adopt responsibilities grew quickly, and I began to review critical care referrals, understand new complexities of pathophysiology and site invasive lines. I have attended the SICS trainee and scientific meetings, a critical care research methods course, FICE and CUSIC courses. With consultants in the department I am working on a quality improvement project and a systematic review article. Throughout the year I have developed my teaching skills through the excellent, easily accessible Clinical Educator Programme. Integrating with trainees and consultants has also given me an insight to potential future training pathways, academic opportunities and the diversity of consultant job plans.

Future plans:

Later this year I will move to New Zealand, having applied for house officer posts in anaesthetics and emergency medicine. I am excited to work in and learn from another healthcare system, and broaden my horizons in another country. My long term goal is to pursue a career in anaesthetics and critical care in Scotland. The future of critical care is exciting, the specialty is still developing and I very much hope I can be a part of it.

Dr Ally Rocke, June 2018

Why did you take up an FY job in Critical Care:

The foundation Programme is a two year training programme that gives junior doctors the opportunity to develop and improve their clinical skills, clinical judgement and decision making. It allows participants to experience a wide range of specialties that will ultimately shape future interests and careers.

Throughout University and my Foundation Year One I particularly enjoyed assessing and managing the acutely unwell patient and working as part of a large team. I had always envisioned by future career to incorporate this, whether that being in the Emergency Department or Critical Care. It was very important to me to spend one of my Foundation placements in Critical Care. I felt this would allow me to experience the day to day running of a busy Intensive Care environment that could potentially shape my future interests and career. This placement would also allow me to develop my skills around the assessment and management of critically unwell patients as well gaining the opportunity to site invasive devices. Critical Care consists of one of the largest and most diverse Multidisciplinary teams. I hoped my foundation placement would allow me to develop my non-technical skills and integrate into this large team. These skills would be invaluable for the future, regardless of the setting.

What the FY job involved, how did it increase my interest in Critical Care:

My Foundation placement consisted of 4 months split between a large 19 bed Intensive Care Unit and a 12 bed High Dependency Unit. Clinical work involved reviewing patients on a daily basis and presenting them to the consultant on-call; admitting patients; inserting invasive devices and communicating consistently with a wide range of different multidisciplinary team members. Non-clinical work involved participation in Quality Improvement projects; active involvement in the Critical Care Research Group; attending weekly Journal club meetings; writing local protocols and receiving excellent teaching through a structured, Critical Care focused programme. This placement increased my desire to pursue a career in Critical Care and Anaesthetics. I was able to spend time in both an Intensive Care and High Dependency environment which gave me an invaluable insight into both the speciality itself and what life as a trainee would involve. Importantly, the non-clinical aspects of the placement allowed me to gain specialist knowledge while participating in various projects that enhanced my interest in the specialty and helped with future applications.

What did my Fellow job involve, what did I get out of it:

My Clinical Fellow year consisted of 12 months split between a large 19 bed ITU and a 12 bed HDU that I started immediately after the Foundation Programme. This was a nontraining post, with development time incorporated, aimed at post-foundation doctors with an interest in Critical Care. It was aimed at doctors wishing to enhance their experience and skill set prior to applying for a training post. During this 12 month role I was able to enhance my clinical experience by taking on more responsibility than I had as a foundation doctor. This involved holding the HDU referral page and assessing patients who may require level 2 care. In doing this I was able to gain a better understanding of both the ethical and clinical issues surrounding the complex decision making in Critical Care. This, again, provides a good insight into the daily routine of an Intensive Care trainee while developing key skills needed to be successful in a training programme. Development days were used for multiple projects including quality improvement, research and protocol writing. This helped enhance my understanding of evidence based medicine in Critical Care as well as the improving the care patients received in our own unit. The time I spent as a Clinical Fellow improved my clinical knowledge, practical and non-technical skills in a Critical Care environment. It solidified my desire to pursue a career in Critical Care, allowed me to gain experience from a large consultant body and allowed me to tailor my portfolio accordingly.

Future plans:

Following my experience from both my Foundation placement and Clinical Fellow year I have accepted a Core Anaesthetics training post in South East Scotland. In the future I hope to build on my previous experience and apply for dual training with Anaesthesia and Intensive Care in Scotland, while maintaining interests in both quality improvement and teaching.

Dr Charles Flanders, June 2018