Placement changeover

With most foundation trainees switching over to a new placement around this time, I just had some ideas regarding changeover week that I thought is worth reflecting on and sharing.

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For those who don't know, most FY1 and FY2 doctors divide their year up into three placements lasting approximately 4 months each, and you rotate to your next placement on a designated changeover day, of which the most recent one for me (and I believe it is a nationally agreed date) was on the 7th of April, just 2 days ago.

Just for a bit of context, I have a well-rounded track comprising of A&E, general surgery and geriatric medicine for my FY1 placements. I have therefore just started in my new medical placement for three days now. With this in mind, my overall experience in a ward environment was very different to my previous two placements, some main differences include:

• I am now based entirely on a single ward (the Care of the Elderly ward in our trust), whereas in general surgery due to disruption from Covid-19, we had to cover plenty of outliers; A&E is completely its own thing as you do clerking and initial management throughout the whole placement

• Medical ward rounds seem to pass a lot quicker than the surgical counterpart (probably specific to my trust, where the surgical department is not as well staffed), and you quickly pick up a very distinct approach to reviewing patients on a daily basis; medics will look at the prescription chart for changes to doses/interactions a lot more, whereas surgeons tend to be very particular about drains and stoma input/output for example.

• I have yet to experience medical on-calls myself, but from word of mouth it seems to be a lot busier, the bleep is incessant and the jobs can range from the 37th fluid prescription to an actively dying patient; although on the bright side, because the number of patients is much greater, there are more cover for said jobs

For changeover week, there was a part of me that was glad the busy surgical placement is over, but also the slight anxiety of moving to a completely new environment, mostly new colleagues, with a new approach to caring for a new demographic of patients.

I believe how well one eases into the new environment depends a lot on how organized the new department is, especially when it comes to the induction programme. Some of the most useful points I get out of induction are:

• Key contacts (bleep numbers, emails etc.)

• Brief run through of responsibilities on a normal day VS on-calls

• Very, very short section of emergencies - induction is not meant to be teaching sessions, but making trainees aware of how to recognize crucial presentations and escalate appropriately is sufficient

• Opportunities for personal development - you really only have 4 months in the department, so if you want to carry out any projects for your own interest or portfolio, especially if its a placement relevant to your career choice, it would be helpful if they introduce some ongoing projects, or at least point you towards personnel that can help you (e.g. the audit lead)

A useful programme introduced in my trust was a half-day shadowing in place of one of the weekly FY teaching before changeover, to allow juniors to get an inkling of how the new ward/department functions.

A useful checklist for changeover:

• Supervisor sign-offs on Horus (more on this here!)- you need a clinical supervisor end-of-placement one for your old placement, and a start-of-placement one for the new placement; and separate ones for your educational supervisor as well

• Ensure you know your rota and your rota coordinator- you may get thrown straight into on-calls/nights from day 1 in your new placement, but please do make sure you get the appropriate amount of time off work/rest days. As an example, I was put on nights for 2 days prior to my changeover when I start on a normal day, in other words I would have worked from 8pm to 5pm the next day for a 21-hour shift. Fortunately I managed to get the two rota coordinators to liaise amongst themselves and they arranged locum cover for my nights so that I could attend the induction on my new placement.

• Get familiar with the new ward environment and the staff members. For changeovers within the same trust, you should largely be familiar with using the computer system, referral pathways etc. But also learn things specific to the ward like the codes to clinical rooms.

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Comment below if you have any thoughts about the changeover week, or how you think changeovers can be done better.