Foundation Year 1 training personal perspective
When people think about jobs in
their first year as a doctor, the mind tends to focus on the
traditional surgical and medical specialties that dominated what
was once the PRHO year. However, with the new foundation year 1
(FY1) year in place, opportunities to step outside these areas at
an early stage have become common throughout the country. I knew
from the start of medical school that I wanted to specialise in
psychiatry, however I was concerned that I may have to dedicate
myself to a training programme with no experience of this specialty
as a qualified doctor, so when the opportunity to work in this area
during my FY1 year arose, I jumped at the chance.
As an FY1 in acute medicine, I
spent little time with my patients as a majority of my day was
taken up with filling out forms and chasing up tests while my
senior house officer saw the ‘interesting stuff’. When I arrived on
my ward on the first day of psychiatry it soon became clear that
this would no longer be the case. As a psychiatric FY1, I would not
be doing on calls or out-of-hours work as I had been used to, but
my responsibilities on the ward were much greater than my previous
job. I was responsible for the day-to-day care of 20 inpatients on
the ward, all over 65 years of age. I would be helping with the
initial assessments of new admissions and monitoring their
treatment and feeding back this information to the responsible
consultant via daily meetings and a weekly New Patient Meeting to
ensure all the patients’ needs had been met. I would be the first
port of call for the ward staff if they had any concerns about a
patient, as well as keeping family members informed, whilst also
planning the long term management of their condition.
Initially, this appeared to be
quite a leap from the FY1 role I had been used to. However, thanks
to the support of the ward staff, I soon found my way. I was
allowed to take responsibility and make management plans of my own
whist having the safety net of senior colleagues at hand. I found
both consultants on site were always available, in addition to
other senior members of the medical staff, if I needed advice or
help. I attended between two to three hours of consultant teaching
a week which helped me to develop my theoretical
knowledge of the specialty whilst also becoming more familiar with
the hands on nature of the job.
I enjoyed the ability to work in a
real ‘multidisciplinary team’ that we were often taught about in
medical school, but so rarely see in practice. I had daily contact
and meetings with the nursing staff, occupational therapists,
physiotherapists and pharmacists and they were all keen to show me
how the system worked from their point of view. I soon became
familiar with home visits, kitchen assessments, art therapy and all
kinds of things you don’t see in the textbooks. I was also given
the opportunity to participate in the Care Planning Meetings that
took place for each patient on the ward. I found this to be really
beneficial as it not only helped me to understand the long term
management of these patients but also to get a better understanding
of psychiatry in practice in the community.
Now, as I reach the end of my FY1
year, I can safely say that the four months I spent in psychiatry
was the most enjoyable and the most informative part of my year. I
was given the opportunity to work independently, making my own
differential diagnosis and management plans whilst having advice of
those around me. I found I developed not only my psychiatric skills
but also my general medical and clinical skills in a way that was
just not possible in other jobs. On top of all this, it helped
confirm the idea that psychiatry is the area of medicine in which I
want to specialise in.
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Foundation Year 2 training
personal perspective
My perceptions of psychiatry were
very similar to the majority of my colleagues and seniors prior to
my Foundation Year 2 (FY2) placement. There are many pre-formed
ideas regarding psychiatry which start from those two or three
weeks as a medical student. I’ve been told by a number of
colleagues “psychiatry isn’t really a proper specialty is it?”,
“none of the patients get better” and “it’s for those who aren’t
good enough to get into anything else.” I started my FY2 job with
these voices and thoughts echoing in my head. One year on, I hold
my own thoughts, my own experiences.
I think back to those four months
in psychiatry and all the patients I admitted, treated and most
importantly helped reform the pieces of their lives – the elderly
woman with schizophrenia who would not leave her house in fear the
police would kill her, the young mother with postnatal depression
who jumped out of a window to save her child from herself, the
suicidal young asylum seeker with post-traumatic stress disorder
following his experiences in war. This may all sound very dramatic
but this was the reality of the ‘wishy-washy’ specialty. These were
the patients who were admitted to hospital not being able to cope
or function, but were able to leave functioning independently. It
was after my contact with these patients that I realised not only
did they get better, but you were able to watch them do so, play a
part in it and experience the reward once they were no longer
unwell. With such a huge role, it’s not just "those who
aren’t good enough" that want to or should do the specialty; it
should be those who care and are aware that psychiatry is both a
consequence and cause of many of the medical and surgical
conditions that are presented to juniors like me currently in the
Emergency Department.
Although I secured an Emergency
Medicine training post, I now plan to reapply for psychiatry next
year. I miss the variety, the continuity of care, the patient
contact and the pleasure and satisfaction of knowing I have helped
someone function again. As clichéd as it may sound, I decided to do
medicine because I wanted to help people. All specialties do this
but for me, none more than psychiatry. If you form your own
opinions you may just find it as interesting and rewarding as
me.
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Page last updated on 16 May 2010 by E
Baker-Glenn