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Revise MLA student guides · Preparing for F1

Practical skills to develop before starting F1

By Dr. Elle FangF1 doctor · Yorkshire7-minute read

“In my final year, I struggled to know how to prepare myself as best as possible for foundation training.”

Dr. Elle Fang

I am a foundation year 1 doctor based in Yorkshire, currently on acute internal medicine, where I am involved in general medicine ward rounds and acute medical on-calls. In my final year, I struggled to know how to prepare myself as best as possible for foundation training.

Question banks, textbooks and flashcards will help you in your UKMLA preparation, but being on placement allows you to take initiative and recognise your strengths and weaknesses so that you can adapt your clinical learning accordingly.

As you approach your senior years of medical school, clinical placement helps you develop a wide range of skills that will be vital in settling into foundation training. Here are six areas to focus on.

Writing notes

Good documentation is an important part of being a competent doctor. It keeps track of your activities and decisions so that you and others can understand a patient's clinical journey. Thorough documentation of your assessment of an unwell patient can help when you hand their care over to the next team. It is also important in medicolegal situations and for auditing.

During medical school placements, joining ward rounds gives you an opportunity to practise your note-taking skills. Ask to shadow the current foundation doctors and understand how they prepare and take notes during the ward round. Different doctors will have different approaches, so it is useful to look at a range of notes to understand what people prioritise.

When you're more confident with what is expected, try writing your own notes during the ward round and then compare them with the foundation doctor's notes.

Bedside teaching also offers the opportunity to practise. After you take a history or examine a patient, write down your findings, making sure to include relevant positive and negative findings. If possible, ask your tutor to review your notes. When practising for clinical exams, you can also practise note-taking with your peers and offer each other feedback.

Another important skill is knowing how to search through previous notes for patient information, which can be daunting! This may involve reading previous assessments to understand clinical changes, GP notes to understand a patient's past medical history, and notes from allied health professionals to develop a holistic view of the patient. This develops with practice and helps you get to grips with the hospital's patient system.

Discussions with doctors, nurses and allied health professionals should also be documented. When discussing patient cases, whether in person or on the phone, note down the job title and name of everyone involved. Discussions with a patient or their next of kin are also important to document, including their ideas, concerns and expectations.

Be aware of whether your placement uses electronic records, paper records or a combination. Practising your typing speed can help you become more efficient, and legible handwriting is vital for ensuring people can understand your notes.

Keeping track of tasks

Whether you are on ward rounds or providing an out-of-hours service, keeping track of tasks is vital for staying organised. This includes prescribing medications, ordering bloods and scans, communicating with other specialties, nurses and allied health professionals, and updating patients and families.

Different doctors will have different approaches. Make sure you develop a method that works well for you. This usually starts with a piece of paper that can be folded into sections for different patients and updated throughout the shift. Make sure you always have pens to hand!

For ward rounds, you will have a set number of patients with tasks, but during on-calls you may constantly add new patients to your list. Make it obvious which tasks are for which patients. Do not simply rely on bed numbers, as patients may be moved with little notice. Instead, note down the patient's name and hospital number. If you are working between wards, keep track of which patients are on which ward.

During placements, ask to see the jobs lists of the foundation doctors you are shadowing. If you are given jobs to do, create your own list to familiarise yourself. Just remember to discard it in the confidential waste bin if it contains patient information!

Procedural skills

Keeping on top of procedural skills throughout medical school can help you feel much more prepared for the tasks you will be asked to perform as a doctor. Supervision as a medical student gives you the chance to receive feedback from doctors and nurses about your technique. Keep a note of that feedback for reflection.

Reaching your sign-off goals is important, but don't stop looking for opportunities just because you've ticked all the boxes. Take opportunities to practise venepuncture and cannulation when they arise. Observing more difficult procedures, such as lumbar punctures and chest-drain insertions, can help you understand them for future training and explain them to patients in plain language.

In some instances, patients may refuse to let you perform a procedure. Do not feel offended. Offer to hand the task over to a member of staff and ask if you can observe instead. Similarly, if you fail to take bloods or insert a cannula, try not to feel downtrodden. Take feedback on board and apply it next time.

If your medical school offers training in ultrasound-guided venepuncture and cannulation, it can help you develop skills for patients with difficult venous access.

If you lack confidence with procedural skills, make your placement's clinical skills team aware as early as possible. They can help by providing extra practice sessions before you practise on the wards, or consider ways to meet sign-off deadlines. This demonstrates an understanding of your capabilities and limitations and gives you access to extra practice and feedback.

“Making sure that you reach your sign-off goals for procedural skills on placement is important, but don’t stop looking for opportunities just because you’ve ticked all the boxes.”

Dr. Elle Fang

Clinical examination

Learning clinical examinations on your peers helps you develop your fundamental technique, but practising on patients during placement offers opportunities to build those skills. On ward rounds, ask the doctors whether they know of patients with positive examination findings who may consent to being examined. When you are free, visit the patient and gain consent. If they are busy, you may have to try again later.

You will often need to tailor your examination. For example, confused patients may struggle to take deep breaths on request. By experiencing a range of patient cases, you will learn to adapt. If you are on placement with a peer, you can examine the same patient in turn and compare your findings afterwards. Make sure to thank the patient!

Bedside teaching lets you practise with feedback from a tutor and your peers. Simulation sessions also help develop your A to E assessment skills, combining examination with management plans to build your confidence in assessing unwell patients.

Intimate examinations are also an important skill to develop but may be more difficult to practise. Make the most of opportunities to practise on models during clinical examination sessions.

Examining children comes with additional challenges, as they may become agitated. GP placement can be a useful opportunity to develop your paediatric examination skills. Tailor your examination to start with less overwhelming parts, such as auscultation, and leave otoscopy and throat examination until later, as these are more likely to upset the patient.

After a clinical examination, practise documenting your findings. This can help you draw your thoughts together and combine them with the history to develop a list of differentials, potential investigations and a management plan.

Handovers

Handovers are an important part of maintaining patient safety, but they can initially feel daunting. When handing over a patient, include their name, hospital number and location in the hospital.

Giving a summary using the SBAR technique helps communicate what has happened and what the next team needs to action. For example, a patient may have had a blood test that needs following up to see whether their electrolytes need adjusting.

When clerking a patient during placement or bedside teaching, try developing an SBAR handover and present it to your tutors for feedback. In acute specialties, listen to handovers from other doctors and think about what makes a good handover. Put yourself in the shoes of the team receiving it. Have you received enough information about the patient? Have you been told the plan and what you need to do to take over their care safely?

Writing reflections

Medicine is a career where learning is lifelong, and reflection is an important part of that process. Reflections are part of the foundation programme portfolio. Developing an approach during medical school will make future reflections easier to write.

You might reflect on your performance during taught sessions or your approach to patient assessment, care and communication. You can also reflect on interactions with colleagues and other healthcare professionals, particularly when they offer feedback.

Using a structure helps organise your reflection and identify a plan for moving forwards. The “What Went Well, Even Better If” approach can be useful. If you want more structure, there are other approaches, such as Gibbs' Reflective Cycle. Once you find one that works, you can stick with it and become more familiar with the process.

Making reflection a habit will make it easier to write regularly. Writing reflections down creates a helpful record of your journey through medicine, showing how far you have come and what you still want to develop.