Preparing for life as a core trainee

This blog post by Dr Yasmine Young is part of the 2024 Choose Psychiatry campaign.

My non-clinical “F3” 

After completing the foundation programme, I worked as a university teaching fellow for undergraduate medical students. My time was split between teaching, project work, educational research and scholarship.  Flexible working and working from home were encouraged.

There was no clinical component: no rota, no night shifts, and no-on calls. Altogether, it was a welcome break. I finished refreshed, energised, and ready to start training. 

Nervous about returning to clinical work 

I was nervous about going back to full time clinical work. Mainly, I was apprehensive about the hours: a full rota, night shifts, and long days. Working nine to five had done wonders for my physical and mental health, and I did not want to end up exhausted and miserable. 

My clinical skills also felt a bit rusty. By teaching medicine, I had at least kept my nose in, but, naturally, I was not the same clinically as I had been when I finished F2. Back-to-back rotations in A&E and general medicine had resulted in two years of near constant patient clerking.

By the end, the basics - histories, examinations, procedures, emergencies etcetera - felt slick and on autopilot. Now, I needed a refresher, for example, to get the pesky cranial nerve examination back up to scratch.  

I had not had a job in psychiatry, so I was keenly aware that I would be out of my comfort zone. I admit that I had not done a proper mental state examination since fifth year of medical school. The ones I did at three in the morning as a harried F2 in A&E were certainly too brief to count!  

Before starting 

There were a few administrative things to do. I needed to reactivate my GMC licence to practise and tell my medical defence union I was starting training. This was surprisingly easy and consisted of just a few online forms. Then there was the usual mountain of new starter paperwork, plus a new and welcome one from the training programme asking what placement we would like.

My placements in the foundation programme were exclusively hospital based due to the pandemic, so I requested an inpatient job, thinking this would be more familiar, and explained I was returning from time out. 

To brush up clinically, I watched some physical examination videos on YouTube (Geeky Medics, which I used throughout medical school) and ran though these by myself at home. My (non-medical) partner came home to me listening to our pillow’s “heart sounds”, which made him chuckle.

I flicked through the book Psychiatry: Breaking the ICE (Stringer, Hurn, and Burnside, 2015) paying particular attention to chapters on the mental state examination and risk assessments. I wrote a crib sheet with the headings on it and tucked it in my notebook. I briefly had a look at The Oxford Handbook of Psychiatry (Semple and Smyth, 2019), but found this a bit overwhelming, so didn’t continue with it.  

Most importantly, I wanted to start well rested, so I made sure I had a few weeks break between jobs. I would do the same again and highly recommend it. 

Starting 

I should not have worried about being brand new to psychiatry, as almost every other new core trainee was too. We had a very thorough induction, lasting several days, which covered everything I had read about and more, such as breakaway training, cutting ligatures, and seclusion reviews.

The Trust had a policy of taking all new CT1s off the on-call rota for the first month. This was really helpful, as it meant I had time to acclimatise and get a sense of how things worked. My ward’s consultant was very present. He led ward rounds almost daily and was contactable all day, so I never felt left alone and out of my depth. I told him straightaway about being non-clinical for a year. He was very relaxed about it and assured me I would be fine. He understood that a new CT1 is just that - new.  

Being on a busy inpatient ward, with lots of new admissions and patients who needed physical exams, bloods, and ECGs etc, meant that my clinical skills came back quickly. 

As I had suspected, when I started on-calls I found them tiring. Physically, nights felt worse than before; perhaps being a bit older, and more aware of how comparatively bad I felt afterwards. Mentally, there was a lot of decision making, and in the beginning, each question was a new one.

This patient is threatening to leave, what should we do doctor? Should I give this medication, or that one? The latter has become easier, as I am now more accustomed to psychiatry. Physically, it remained difficult, so recently I applied and was approved to go less than full time, to 80%, which has made a big difference. 

Top tips 

If I were to do it again, I would give myself three pieces of advice.

Firstly, consider applying for less than full time training straightaway to help ease the transition from non-clinical back to clinical work.

Secondly, be patient, as things do get easier over time. A cliche, but true.

Thirdly, remember that regardless of whether someone has taken time out of clinical work or not, starting a new training programme will mean nerves and a steep learning curve, so you won’t be alone. 

Summary 

• Be open and communicate with the training programme about your situation. Your clinical supervisor, educational supervisor, local tutor and training programme director will all want to know. If they don’t know, they cannot support you.  

• Don’t worry too much about not knowing much psychiatry when you start, as that is what the training programme is for. 

• Consider applying to be less than full time to help with work/life balance. 

• Try to have a break or holiday before you start. 

• Go for it!