Five tips to excel as a foundation doctor

Your first few months on the ward can be exhilarating, but there's also a lot to consider. Here are our tips for new foundation doctors.

Your foundation years can be exhilarating and nerve-wracking. Years of study have equipped you with knowledge and practical skills. But there can be a huge learning curve in assimilating the practicalities of the job.

1. Communicate, communicate, communicate

Effective teams and successful patient relationships are built on open, honest communication. Working on your ability to build rapport with colleagues and patients and develop your listening skills will stand you in good stead throughout your career.

As the most junior doctor, you may be privy to information that your colleagues are not aware of and that you need to share with them. You may be exposed to concerns and frustrations of patients and their families, which may not be immediately apparent to the rest of the team, and which can grow if not addressed at an early stage.

Miscommunication can lead to adverse incidents. Avoid using jargon or abbreviations and check that there is mutual understanding of the information provided or action required. If there is any uncertainty or confusion, it is better to double check than assume what you have said has been understood. Be clear about the limits of your knowledge and make reasonable checks to make sure any information you give is accurate.

2. Develop your handover skills

Developing an effective, structured handover process is an important skill. Handing over patient care at the start and end of your shift may seem routine, but it is key that all the information needed to safely care for patients is shared.

Similarly, care may be transferred from your team to the patient's GP or to another hospital. You have an ethical duty to, "share all relevant information about patients (including any reasonable adjustments and communications support preferences) with others involved in their care, within and across teams" (GMC's 'Good medical practice' 2024, paragraph 65), including when you hand over care as you go off duty, and when you delegate care or refer patients to other health or social care providers.

Having a standardised method of communicating the information may help prevent important information from being missed out. The Royal College of Physicians has published an Acute Care Toolkit that includes templates of handover sheets which you may find useful. Your trust may have its own template, so check what your hospital handover procedure is.

3. Put the record straight

Medical records are important for recording what treatment has been provided and may also play a central role in determining patient care. When writing your notes, try to put yourself in the place of the next doctor to see the patient and remember that, as well as all the clinical details, they will need to know what the patient has been told.

Your notes must be clearly legible, factually accurate and made at the time or as soon as possible after seeing the patient. Clearly identify who made the record and the date and time the record was made. Medical records are a legal document and the patient can request access to their own records. You may also have to rely on the notes to provide a statement for a coroner or respond to a complaint. This task will be made easier if you have recorded your input clearly.

If you need to make an additional note to record extra details, make sure your new note is dated and timed, and clearly marked as having been made in retrospect.

4. Ask for help

When you're starting out, it's inevitable that you'll have questions or concerns. You may feel embarrassed and be reluctant to ask for help from your senior colleagues, particularly if they seem busy or the question appears stupid. But it's important to have a low threshold for asking for help from colleagues.

Bear in mind that all doctors, no matter how senior, need to discuss complex cases with colleagues. You have an ethical duty to work within your level of competence and consult with colleagues where appropriate. You could also be criticised if you don't speak up and a patient comes to harm as a result.

5. Regularly reflect on your practice

You are now a qualified doctor, but this is just the beginning of your career and you are expected to maintain and develop your competence and performance. You will need to obtain feedback for your annual review of competence progression and you may find it helpful to obtain more informal feedback to help you reflect on your own performance.

Paragraph 13 of the GMC's 'Good medical practice' (2024) guidance also sets out a duty for you to reflect on your standards of practice and the care you provide. This includes reflecting on feedback and considering how your own experiences, culture and beliefs may influence your interactions and impact your decisions. If you receive negative feedback, try not to take this personally but act to address any failings in your own performance.

This page was correct at publication on 30/01/2024. Any guidance is intended as general guidance for members only. If you are a member and need specific advice relating to your own circumstances, please contact one of our advisers.

Nicola Lennard

by Dr Nicola Lennard BSc MBBS MRCGP

Nicola completed her post graduate training in general and vascular surgery before taking up post, initially as a senior medical officer, then Deputy Medical Director in the medical devices division of the MHRA. She joined the MDU as a medico-legal adviser in 2013 and completed her graduate diploma in law in 2014.

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