Day One tips

The first day on the job can be overwhelming, with loads to learn including procedures, paperwork, and trust politics. But don't worry, I've broken it down. Here you can find a step-by-step guide on how to approach working for the first time as a doctor, and key things you need to know for day one.

What to do BEFORE your first day

Preparation is so important for a strong start, if you're not prepared it might be more challenging. I've made a list of things to consider before starting your job:

Get comfortable shoes.
Dress appropriately - check your hospital policy regarding scrubs or formal clothing.
Pack some biscuits in your bag.
Carry a bottle of water with you. Hydration is the key to success.
Ensure you have essential tools such as a pen torch, pen, and stethoscope.
Check your rota to ensure it's correct and does not breach safety limits. Refer to: BMA Working Hours.
Join the BMA – professional association and trade union.
Ensure you have medical indemnity, e.g., MDU or MPS.
Get useful apps: link to apps page.

What to do DURING your first day

Arrive Early!

Getting out of bed 5 minutes before a 9 a.m. lecture will be a thing of the past. In some departments, it may be expected for you to have the patient list ready for 9 a.m. As a result, you will have to arrive at the hospital a bit earlier to update the list with any new patients that have arrived. Alongside this, by arriving early you can give yourself more time to get from the car park (if you're lucky) and find your ward.

Introduce and communicate

You must introduce yourself to team members and communicate clearly. Just like during medical school, start by introducing yourself with the phrase "Hello My Name is ____". This phrase has become commonplace in hospitals across the UK following a campaign started by Dr Kate Granger and her husband Chris. Click here to read more. Get to know your ward team! Learn their names and be polite.

Day-to-Day Structure

Prepare notes & the Ward Round
Complete jobs generated from the Ward Round
Go home (with, or without a handover)

1. Preparing the Notes & Ward Round

Every team works differently; some will want to prepare the notes with you, and some will expect that it's done before the ward round.
This involves you reading through the past notes and writing a summary so your consultant and the MDT can refer to this when reviewing the patient and when producing a treatment plan.
One thing you'll notice very quickly is everyone has a different way of documenting notes. I've created an example that you can see below. By starting with a structure similar to this, you won't miss out on any key sections, and you can tailor your notes to your practice. Usually, at the top of the page, there is space for the patient identification sticker to be placed.
If your trust uses electronic notes then the following will still help guide you despite the different layout.

As the Ward Round Begins, pay attention to a few things:

Listen carefully to what your senior says - they won't always explicitly say "Document that the patient has chest pain," but the patient might say "My chest hurts" before pointing to their left anterior chest wall. At this point, you can document "Patient reports left-sided chest pain," for example. This skill comes with practice, and you'll improve rapidly with time.
Take note of examination findings. These can be documented using both pictures and words. For instance, if there's an abdominal or chest examination, record your observations. If you have any questions or want the consultant to review what you have written, ask them to have a look at the notes to see if you’re on the right track earlier rather than later. They may have certain key things that they’d like documented, such as neurovascular status in orthopaedics, for example.
Document the plan - write this in numbered bullet points and include whether the patient is fit to go home (Medically fit for discharge MFFD). From this plan, you can generate a jobs list for you and the team to work through.
One thing I must mention here is the topic of medical abbreviations. Sometimes it feels like you're reading Hieroglyphics without any training. Don't worry I've made a list of frequently used abbreviations, test yourself and see what you already know!

2. Complete Jobs

Efficient time management is a skill that takes time to develop. Prioritise tasks based on urgency and importance and don't hesitate to ask for help if you feel overwhelmed. Balancing multiple responsibilities is a common challenge, so by writing a jobs list you can stay on top of things.

Although not that complex, the way different people work through their jobs list varies. See the diagram and text below.

In this example you can see that there are five jobs to do on this ward with each having differing degrees of completion. For jobs that require following up, for example if a CT scan is required then you need to first request the scan, then review and act on the results. These steps are shown by either half filling in the box or drawing a line through it. Different people have different ways. I prefer to colour in as it's more satisfying!

Ideas on how to approach job types:

Scan request

When you're requesting certain scans or tests, you may need to discuss with another clinician, e.g., a radiologist, over the phone. As we know, everyone's busy, so a way to make their job easier is to bring all of the relevant information. There are so many different requests, but some tips would be to have the patient's notes with you, understand the case (read through the recent notes), have the blood tests in front of you, and check with a senior if there's any uncertainty about the requirement of a test.

Referrals

Check out this Referral Cheat Sheet over at Mind The Bleep.

Discharge Summary & TTOs

TTOs or "to take out" are forms that are completed when a patient is discharged from hospital. Within it you'll write a brief summary of the stay alongside any medications required for the patient "to take out" with them.

For this you are required to write a summary of:
3. Handover

As i'm sure you'll know handover is vital to ensure continued patient care and that patient safety is a main priority.

Now, in every hospital there will be a set room or office that you will attend at the start and end of on-call shifts and out-of-hours shifts (OOH) also known as, Hospital Out of Hours (HOOH). During this meeting the Clinicians who are ending their shifts will hand over any outstanding urgent jobs as well as the bleep or emergency bleeps to those starting their shifts. My advice would be to (guess what i'm about to say next) arrive early! After a long shift the last thing you want to do is have to wait for someone to cover you and end up in that all-so-familiar Situational Judgement Test scenario of what to do. Alongside this, ensure you have some paper and a pen to make notes of any jobs or patients that have been handed over to you.

What to do AFTER your first day

Relax

Congratulations on completing your first day! It's a significant milestone, and you should take a moment to acknowledge your hard work and dedication. Remember, transitioning into a new role can be challenging, but it's also an exciting opportunity for growth and learning.

As you continue to settle in and become more familiar with your team, ward, or department, things will naturally become easier and less overwhelming. It's okay to feel a bit nervous or uncertain at first, but trust in your abilities and know that you're not alone.

If you ever find yourself with questions or needing guidance, don't hesitate to explore the resources available on our website. Whether it's reviewing clinical apps, understanding finances, or simply seeking advice, our platform is here to support you every step of the way.