It’s that time of year again – changeover week. This changeover, more than others, is a particularly busy time. It’s when our new FY1’s start. No longer are they on the wards or in libraries learning the theory. Now it’s time to put it into practice.
It’s both terrifying and exciting!
This year I was again involved in the ‘Preparation for Practice’ course that our Resuscitation team and Simulation Centre organise. The day takes our new doctors through an array of simulated scenarios using Forth Valley specific paperwork and protocols.
The team involved is huge and varied reflecting the breadth of the expertise involved in caring for our patients and keeping them safe. What I particularly liked was the involvement of our current FY1’s. They were brilliant in offering practical tips but more importantly reassurance that it will all be fine. It was also lovely to see how far they’d come since taking part in the same program the year before.
For some though the reality of it all became a bit much. The day came at the end of a long week of induction and shadowing. The scenarios are specifically designed to be as realistic as possible but with an emphasis on a safe learning environment. However no matter how much you tell yourself the ‘patient’ bears a striking resemblance to your FY1 shadow buddy the situation is real.
There was a dawning realisation that patients don’t behave like they do in textbooks. They don’t tell you what’s wrong straight away. You have to work it out based on the clinical exam. You have to have the confidence that you are hearing crackles in the chest and not just the rustle of the sheets on the bed. Then there’s the tests. Why do they not come back straight away? Of course that’s assuming you can get bloods off them – some don’t have great veins or are so confused they wont let you near them.
However there’s a sigh of relief when it becomes clear what’s wrong. A plan can be made and treatment started.
In my scenario however our patient didn’t respond to treatment and began to deteriorate. In real life that happens and it is stressful. As a doctor (or a nurse) to try your absolute best and see it not working is the worst feeling. The time that you were willing to speed up to get the person better you now wish would slow down to give you more time to fix them.
One of the objectives of our scenario was how to have those difficult conversations when things are clearly not getting better. My role was to demonstrate a positive discussion about a treatment escalation plan. Any conversation that involves resuscitation has to handled with great care and sensitivity but always with the intention of doing the right thing by your patient.
After the scenario had finished we had 15mins to debrief and discuss what had just happened. Pretty much everyone thought they had done terrible. Of course this wasn’t true but that’s what this particular stress does to doctors and nurses.
In real life what also tends to happen (especially out of hours) is they will be asked to immediately go straight into another high stress situation. There is precious little time to write up notes never mind reflect on what went well and check everyone, including yourself, is ok.
This kind of chronic stress was something that was never really talked about or acknowledged when I first qualified. Some twenty years on and induction programs now include sessions on well being and stress management.
As I was writing this Bill Wither’s song came on the radio with the lyrics:
‘When the day that lies ahead of me
Seems impossible to face
When someone else instead of me
Always seems to know the way’
I took this as a sign!
So as our new doctors take to the wards I can’t make the patients behave in a more predictable fashion. Nor can I take away the feeling of nausea. I can however ask how it’s going and buy the coffee. So to that end I know it’s going to be – a lovely day…..