Surviving St3: Lessons from my first year as a specialist registrar in geriatric medicine

Catherine Ashton is an ST4 working in Oxford. Alongside her clinical training she plays an active role in medical education for the University of Oxford and in this blog hopes to share some of the lessons she has learned in her early training.

Transition into higher training is a daunting time. “Being the medical reg is an awful job,” is the general kind of comment that I have heard from many who have never actually done the job and certainly doesn’t make the role an attractive prospect. I have now completed my first year of registrar training in geriatric medicine and I am happy to say that being a registrar in geriatric medicine isn’t awful. It isn’t even just about tolerable. It’s challenging, exciting and some of the time really quite enjoyable!

Thrombolysing my first stroke was quite unnerving but at least I had the stroke consultant to hold my hand. Thrombolysing my first pulmonary embolus was frankly terrifying. Trying to plan a complex discharge or make ethical decisions about feeding tubes can also be quite taxing and stressful. The benefit of being a trainee in geriatric medicine is the support you have around you and the unspoken knowledge that whilst to other physicians geriatric medicine may not be a particularly attractive speciality, to those working within it a small gain for our patient makes our work very fulfilling.

To excel in your first year as a speciality trainee, there are a few things I wish I had known at the start and they are as follows:

  1. Know your team. A consultant once told me that the medicine is easy, it’s managing people that is more difficult and on reflection now, I think this is true. Try to ascertain quickly the strengths and weaknesses of the doctors working around you and allocate tasks accordingly. That isn’t to say that we shouldn’t support the weaker members in developing their skills but choose the right moments to support and educate them. A busy take, in the depths of winter, is not the time.
  2. You won’t know everything. Dating back to medical school I remember more senior doctors telling me that you can’t possibly know everything and it is very important to remember that when you’re giving yourself a hard time. When you’re unsure, take a step back and evaluate the clues in front of you and use the resources you have around you. Sometimes you do just have to call the consultant in the middle of the night.
  3. A problem shared... It may not be halved but is always less of a problem when you talk it through with someone. Try to find yourself a more senior trainee buddy to help solve problems in your training posts and give you reassurance after a bad day. I really didn’t think this was necessary as I was doing my registrar training in the same hospital as CMT but actually the more senior trainees have probably faced all the same problems in particular hospitals or achieving particular curriculum sign-offs – they can be a very valuable resource to have around you.
  4. Think ahead. ST3 seemed to fly by and if I’m not careful, I’ll be out the other end without really realising it. Think about what interests you and what you may want your role as a consultant to be like. Medical education is a big interest of mine and therefore I have spent time early on in my registrar training establishing this role for my future career.

There clearly are more difficult aspects of training. The inevitable rota gaps can mean that your days are busy and the last thing you want to do is look at your e-portfolio. Unfortunately all jobs have some less appealing sides to them but there is a balance to be found. I find it’s easier to keep going and have a smile on my face when I know I’m doing my best in what is overall a very rewarding speciality.

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