Dr Tilly Gardener is a FY1 Doctor at Chesterfield Royal Hospital NHS Foundation Trust. She is a Junior Members representative on the BGS Trainees Council.
Congratulations on graduating!
After years of lectures, exams and supervised placements, Changeover Day marks the moment you become the doctor others turn to. The person holding the bleep, managing the jobs list and making decisions for your patients. The strangest part? Realising that when someone says, "I'll go and get the doctor"... they mean you.
Feeling nervous is normal. It reflects the responsibility of the role. Those nerves soon become excitement as you experience the many firsts of being a doctor: your first independent ward round, your first Medical Emergency Team (MET) call and your first difficult conversation with a patient or family. If you are reading an article about preparing for FY1, you are already showing that you care about doing a good job, which is a great starting point.
Looking back on my first year, I realised that being a good FY1 wasn't knowing all the answers. It was learning how to approach uncertainty, prioritise what matters and recognise when to ask for help.
Although my first rotation was in geriatric medicine, these lessons have shaped the way I approach every patient.
1. See the person, not just the problem
A key lesson from geriatrics is that patients are more than their presenting complaint. A fall is rarely just a fall, and confusion is rarely just delirium.
Ask yourself:
- What was their baseline?
- What matters most to them?
- What does a good outcome look like?
Understanding a patient's function, independence and priorities can completely change your management.
2. Use your multidisciplinary team (MDT)
One of the best parts of geriatric medicine is working closely with the MDT. Each member brings expertise and a different perspective that can change how you understand and support a patient.
Discharge delays can be frustrating, but everyone is working towards the same goal. Your role is to advocate for your patient while understanding the priorities of the wider team.
3. Ask for help, but don't outsource your thinking
Recognising your limits is a strength, not a weakness. Your seniors expect questions, but before asking for help, think the problem through, review the guidance and gather the relevant information. Conversations are far more useful when you can explain your reasoning.
If in doubt, nobody will ever criticise you for putting out a MET call. It is always better to escalate early than worry about overreacting.
4. Practise sensible medicine
Don't order investigations because they are routine or request 'monitoring bloods' without a clear purpose. Every blood test should answer a clinical question or have the potential to change management.
Use each patient encounter to think holistically:
- Is this medication still appropriate?
- Could anything be deprescribed?
- Is there an opportunity for health promotion?
- Have we discussed the patient's wishes and future care planning?
Sometimes the best medicine is recognising when less is more.
5. Remember you are still learning
It is easy to become consumed by jobs and service provision, but your development matters too.
Be proactive. Attend clinics, spend time with other teams, make use of study leave and seek out opportunities that interest you. If there isn't a geriatrics teaching programme, create one.
Your first year is not just about getting through the jobs list. It is about becoming the doctor you want to be.
Finally...
If you are lucky enough to start FY1 in geriatric medicine, make the most of it. The British Geriatrics Society's Learning objectives for your geriatric medicine placement is an excellent place to start.
Even if you don't rotate through geriatrics, you will care for older adults throughout your career. The principles of geriatric medicine - seeing the whole person, working with the MDT, practising sensible medicine and knowing when to ask for help - will make you a better doctor.
Good luck with Changeover Day!
