Overview
Hey everyone!
Welcome to this week’s article on how to survive (and thrive) in Day 1 of a new rotation as a junior doctor.
In this article, we will cover the following topics:
Introduction
Camp one vs Camp two. Which one are you?
Tip #1: Check your Roster
Tip #2: Receive (and Give) a Thorough Handover
Tip #3: Do Some Pre-Reading
Tip #4: Adjust your Body Clock
Tip #5: First Day Jitters (are normal)
Tip #6: Come Prepared on Day One
Tip #7: Ask for Help
Tip #8: Find the Right Forms / Systems Early
Tip #9: Mistakes Maketh the Doctor
Tip #10: Embrace the uncertainty
Introduction
Firstly, congratulations to all the interns who have finished (or are about to finish) their very first rotation as a doctor!
This week Australian junior doctors switched over to their new rotations. After 3 long months of honing their skills in one rotation, they’ve been asked to pack up and head on to a different department in the hospital (or town!). This happens every 10 to 12 weeks months for the first 2-3 years of a junior doctor’s career.
It is a great way to gain experience in different medical specialties, but it can also be a daunting time for many junior doctors, especially interns, for whom this will be the first transition to a new rotation.
So I’ve put together my top 10 tips and tricks on how to make the transition as stress-free as possible. In this article, I’ll cover how to survive and thrive in your new rotation (and conquer those first day jitters).
Camp One versus Camp Two. Which one are you?
As a junior doctor, it can take weeks to get used a new rotation. Just as you were beginning to get comfortable with your old rotation, the medical system throws you a curve ball and sends you into a completely foreign environment to live out your next three months.
When it comes to switching rotations, most junior doctors fall into one of two camps. The first camp consists of junior doctors who welcome the change of job. This can be due to a dislike for their old job or a genuine eagerness for their new job.
The second camp includes junior doctors who feel like they’ve JUST found their groove (or at least feel semi-competent) in the job that they have been doing for the past 3 months. There is often a feeling of dread or disdain at having to repeat the process all over again in a different department in the hospital.
Whichever camp you fall into, it’s important to remember that transitioning from one job to the next is never easy or smooth.
Here are my top 10 tips to help you navigate the transition:
Tip #1: Check your Roster
Always check the roster for your new rotation a few weeks before you are due to begin. Often, there can be rostering issues that violate your contract. It is important to recognise and rectify these early!
In larger hospitals, each department is responsible for their own rostering of junior doctors. This can mean that the person rostering your old rotation is different to the person rostering your new rotation. And these two people rarely communicate with each other. If you find that your rostering transition is unsafe or too difficult, talk to them! I can guarantee you, they haven’t checked for this error.
Tip #2: Receive (and Give) a Thorough Handover
The best way to prepare for a new rotation is before it begins. As you near the end of your previous rotation, take the initiative to get in contact with your fellow junior doctor on the rotation you are about to start. They are the BEST person to give you handover of what your new job will entail.
Contact them via a work email or hospital phone and arrange a succinct but thorough handover. You can meet over coffee. My personal preference is to on the wards. That way, you get a chance to see where you will be working and surreptitiously meet any pertinent staff members who will be helpful on your new rotation.
During the handover, ask LOTS of questions. Here are some examples:
- What does a usual day look like?
- What time do you usually arrive to prepare the list/ward round?
- What are the common roles and responsibilities?
- Where do you have to be? e.g. ward, clinic, theatre
- Are there any weekly/monthly meetings you have to attend? Teaching? Journal clubs?
- Where can you put your lunch?
- Where is the bathroom?
- Where are the batteries for the computer?
- Any specific logins or special programs that the department uses?
- What are the expectations regarding overtime? Is it paid? How do you claim it?
Be sure to repay the favour to the incoming junior doctor who will be taking over from you. Give them a thorough handover as well as any tips and tricks you’ve picked up on the rotation. This can be anything from the nearest toilet or the best place to get coffee or the boss to avoid when the proverbial s**** is hitting the fan. Be kind to your colleagues.
Tip #3: Do Some Pre-Reading
This is a controversial topic. Some junior doctors like to study before starting a new rotation. Some just arrive with a great can-do attitude and learn on the job. I fall somewhere in the middle. I believe in having enough knowledge to get you through the first week without undertaking PhD-level research the weekend before the rotation. Essentially you don’t want to look like a muppet in front of your colleagues. The remaining minutiae of a specialty can be learnt on the job. After all, that’s why you’re there, right?
For example, before I began my Obstetrics & Gynaecology rotation, I spent 30 minutes reading through the rotation handbook. In a specialty with more acronyms than you can throw a stick at, I am SO glad I took the time to re-learn the basics. I rocked up on day one knowing how to “talk the talk” even if I couldn’t “walk the walk”.
As a junior doctor your primary role is to document and make referrals. Having a working understanding of certain terminology, medicines and treatments only makes this job easier. So why not dedicate a small amount of time to making your future life easier.
Tip #4: Adjust Your Body Clock
For those of you who don’t have the luxury of starting a new rotation on 8am on Monday morning, take the time to adjust your body clock to your new schedule. For example, if you start on night shifts, ensure you get plenty of rest over the weekend to be ready to hit the ground running in that first week.
I remember starting my first after hours shifts on a stretch of three night shifts. I was petrified. Firstly, the actual job petrified me (looking after sick patients) and secondly, having to do so in the middle of the night when resources would be stretched-thin.
By the same token, if you finish your previous rotation on a night shift, take the time to rest and recuperate before diving head first into your new rotation.
You should always have at least 10 hours between shifts. For example, you should not be allowed to finish a shift at midnight on Sunday and be expected to start a new rotation at 8am on Monday morning. It’s just not on.
Tip #5: First Day Jitters are Normal
Many junior doctors feel a low level degree of anxiety before their first day. The Sunday night before a new rotation is often spent pondering how the next will go and can often result in disturbed sleep. This can translate to feeling nervous or worried on your first day. Remind yourself that this is a completely normal feeling and it will get better with time.
Remember, the first day is always the toughest. It gets easier from there.
Tip #6: Come Prepared on Day 1
Sometimes, starting a new rotation can leave you feeling like a deer in the headlights. There is so much new information and so many new faces to process. You end up smiling and nodding through all the various introductions whilst internally wondering how many hours are left until you can go home.
Do yourself (and your team) a favour and arrive 15 minutes earlier than expected/necessary on Day one. Yes, you may lose 15 minutes of beauty sleep but starting a ward round on time, with the correct equipment (i.e. batteries in your computer on wheels) and an up to date list, can set the tone for the rotation. It tells your seniors that you are organised and prepared. Also, its a much nicer feeling that being frazzled and stressed from the get go.
It’s hard to gauge how busy a rotation is going to be until you’ve been in the throes of it for a few weeks. So to avoid hypoglycaemia and a systolic blood pressure below 80mmHg, ensure you bring plenty of food, snacks and water to keep you fuelled.
Tip #7: Ask for Help
As a junior doctor, we often get so caught up in our day to day jobs lists that we forget to think of the bigger picture. Everyone from the cleaner to the administrative officer to the CEO (and those in between) are aware when junior doctors transition to a new rotation. So they are expecting their to be hiccups.
Use this to your advantage. Ask for help early and frequently. Those first few weeks are when the majority of your ‘on-the-job’ learning will take place. Identify who you can ask for help and who will be willing to provide it. This may your fellow junior doctors, registrars or consultants. It may also be the nurses, pharmacists and allied health staff. These guys are the permanent or long-stay staff on the ward and they know how it is run.
Tip #8: Find the Right Forms / Processes Early
Finding the right forms and processes can make your job easier. Regardless of which department you are working in, your job as a junior doctor is to ensure that patient care keeps moving.
Common tasks for a junior doctor including making referrals to other specialties/asking for consults, contacting radiology to request imaging or completing discharge paperwork (scripts, medical certificates, discharge summaries). Determine how your department likes things done.
For example, does the pharmacist want to see every discharge prescription, or only the medicines that have changed during the inpatient stay. Find out which forms are important (e.g. to outpatient clinics) and how they are sent (e.g. via fax or email).
Once you’ve worked these processes out, it is just rinse and repeat for the remainder of the rotation. The more efficient you become, the more time you can dedicate to actually learning medicine and seeing patients.
Tip #9: Mistakes Maketh the Doctor
Accept that you will make mistakes in your first few weeks. This is normal. Luckily, the level of responsibility entrusted to junior doctors is usually not enough for a mistake to result in serious patient harm. Most of the time it just means you filled out the wrong form or sent it to the wrong fax. No. Big. Deal.
Accept that you may be slower at certain tasks. For example writing referrals or completing discharge paperwork. This is also normal. It is challenging to switch from one specialty to another in a 48 hour period. Each specialty has its own set of key history taking, examination findings, investigations and management plans. Familiarise yourself with these, but do not stress if you can’t absorb it all on day one. That’s what the next three months if for.
Most of all, never feel bad/ashamed/worried about your performance in the first few weeks of a new rotation. You will naturally become faster at the job. Be kind to yourself.
Tip #10: Embrace the Uncertainty
Finally, as junior doctors there is a lot of uncertainty attached to every day and every job. We are constantly transition from rotation to rotation, meeting new colleagues, using new resources, treating different (and challenging) patients at all hours of the day and night.
At the end of the day, no matter how much preparation you do, there will always be an element of uncertainty to your new job. Embrace this uncertainty and recognise it as something that you cannot control. Take solace in the fact that every other rotational doctor in the hospital is feeling exactly the same as you do, especially in your first few weeks of a new rotation.
Final Thoughts
I hope some of the tips I’ve shared here have helped make the transition to a new rotation less stressful. Even if I’ve just reaffirmed that you are not alone in your experiences. Feel free to cherry-pick the tips that are most applicable to your situation. There will come a time in your career where you are no longer rotating between specialties, so enjoy the variety of medicine, the ensuing chaos and all the learning that’s bundled in between!
Share this post!
