1. CZ>UK
Filling in the gaps
Friday 28th October 2011
Dr. Shan Keshri
Edited by: Khuram Ahmed
In association with www.muboss.cz

2. GMC Registration

3. Once you finish you final
exam
• Join GMC get your reference number.
• Get your diploma and diploma supplement, passport –
photocopy it and send it to GMC with your application.
• http://www.gmc-uk.org/doctors/applications.asp (GMC
website then click applications – internship)
• Work through all the steps and then you will get a
reference number (which on approval turn into your
registration number).
• Use GMC Online to keep track of your application
thereafter.
• http://www.gmc-
uk.org/doctors/information_for_doctors/gmc_online.asp
www.muboss.cz

4. • After one week you will get an email from GMC
asking you to post diploma copies etc to them.
• After they receive them within another week you
get another email inviting you for an ID check at
London or Manchester office. Here you basically
take your original documents so they verify it and
they ask you to sign a declaration then take a
photo of you and from that moment you are on the
register.
www.muboss.cz

5. While waiting those 2-3 weeks for
GMC registration
• Sort out your NHS Jobs and REFINE AND REFINE AND REFINE
your application answers.
• Apply to start a clinical attachment
• BLS / ILS / First Aid
• Start reading the interview books
• Make a SHORT CV
• Approach appropriate people to act as referees
• Get your Immunizations up to date Hepatitis, tetnus etc etc
• Get a baseline blood test so if anyone need proof eg
hepatitis immunity you can just get a copy of the test result
quick.
www.muboss.cz

6. Clinical Attachment
• Aim to start as soon as you have full GMC.
• Send CV and covering letter to the consultant in the
department and hospital of your choice, and see if
they accept you, its their discretion. If yes, med
staffing / HR.
• Don’t rely on one consultant in one hospital. Go
crazy.
• Avoid august if possible but it doesn’t matter
(rotations change – too much going on!)
www.muboss.cz

7. Clinical Attachment
• FY1 will share his jobs with you and you are bascially working
for free but that’s good because you get experience which is
the whole point.
• e.g. DON’T PRESCRIBE even if you know – as a clinical
attachment you are not allowed and if you mess up you will
get in trouble.
• Do practical stuff cannulas, bloods, ordering
stuff, requesting, referals, join ward rounds, clerking etc don’t
be worried about writing in the notes, consult the FY1 about
everything you do, don’t be shy about that. This is the only
chance you get to ask silly questions!!
• Any questions about clinical attachments?
www.muboss.cz

8. NHS JOBS
• Signs up and fill out the email alerts. Don’t rely on this
they are usually 48 hours delayed which can make a
difference.
• DON’T be picky!! You don’t have a choice!! Its only one
year and it will fly by
• Add to vacancies, then apply. Respect closing dates
(early)
• All need full registration.
www.muboss.cz

9. JOB APPS
• Clinical Audit experience 150 words
• Teaching Experience 150 words
• Research experience 500 words
• Clinical skill 150 words
• Team work 150 words
• Supporting info 500 words
• SPELLING and GRAMMER
www.muboss.cz

10. Clinical Audit
• Steps
• Who has done one?
• Importance
• Clinical Governence??
www.muboss.cz

11. Teaching experience
• What teaching experience do you have?
• Impact
• Use feedback to make yourself sound good
e.g. feedback surveys, etc
www.muboss.cz

12. Team work
• Think of an example of yourself working in a team
• What was YOUR ROLE and contribution?
• Working in a team IS NOT the same as leadership!!!
www.muboss.cz

13. Research
• Don’t write your conclusion out give a brief 2 lines
describe how you did it and why you did it and
impact
• The point of these qs are to find out you know the
importance and basci principles, which you can
apply to ANYthing
• You can screw yourself over by talking about an
audit you did and forgetting to show understanding
of the basic framework of any audit!!
www.muboss.cz

14. • Internship - what did YOU DO???
• Organize your thoughts before, and think about
what you know
www.muboss.cz

15. Clinical skill
• Keep it real! No one cares if you have assisted in
amazing surgeries or you have inserted a chest
drain once at med school
• Do mention it to stand out in your answer
(especially if you can v confidently insert a chest
drain) but 150 words you really need to stick to the
basics to show you can do the FY1 job- so get the
message across yes I can confidently take a history
physical examinations etc
• Read clinical sessions!!!
www.muboss.cz

16. Relevant Supporting info
• USE IT!
• Sell yourself,
• Illustrate why your good illustrate why ur safe, show you’re an
allrounder show off your prizes, talk about what you want to
get out of F1, talk about various experiences in uk or clinical
experinces you have had during Uni, what particular things
have you learnt about BEING a doctor (not the science of
medicine) eg prioritising clincial need this is your chance to
shine and stand out
• The other questions have to be up to scratch or else u wont
get far but remebr everyone applying is a doctor some have
more experience than you, every one must have the basic
teamwork and clinca skills etc as you.. how u present ti is what
maes the difference!!
• CHECK PERSON SPECIFICATION!! Essential and desirable!
www.muboss.cz

17. Short-listing
• Follow up at HR / Med staffing
• Based on person specification
• 200 applications per post on average
• 3-10 get an interview
• 1 gets the job – perhaps!!
• Re advertised
www.muboss.cz

18. Interview
• What is the role of an FY1?
• KEY: RECOGNISE AND MANAGE THE CRITICALLY ILL
PATIENT!!!!!
• ARE YOU SAFE????
• DO YOU KNOW YOUR LIMITS??
• THIS IS THE FOCUS OF EVERYTHING
www.muboss.cz

19. • Acutely ill patient – no time to wait for help to come
you need to know what to do.
• Know you limits – first do no harm and don’t make
things worse, don’t try things blatently out of your
skill level: don’t say you will put in an ET only a senior
A+E physician or anethesist can do this!
www.muboss.cz

20. Ill call my senior
• What people don’t know: ABC then ill call my senior
equals not interested
• Forgettting to call your senior appropriately equals
you don’t know your limits you are not safe to
employ
• Wheres the compromise ????
www.muboss.cz

21. Think
• You are on call and you get bleeped by the nurse.
On arrival she tells you doctor theres an 55 year old
male collapsed on the floor.
• Talk me through your thought process, particularly
what you are going to do and what bed side tests
you want.
www.muboss.cz

22. Think
• You meet a patient who says he has got shortness
of breath. How do you assess this, and what are you
going to do?
www.muboss.cz

23. HOW DO YOU COPE
WITH STRESS
www.muboss.cz

24. ILS
• D – for example?
• R – how (child?) care with?
• S - tell them what?
• A – look sweep open guedal suction
• B – LLL rise agonal?
• C – central, blanching
• D – GCS, neuro, reflex
• E-?
• FG - ?
www.muboss.cz

25. B
• 30:2
• Bag and mask count loud
• Compressions depth? Rate? Song place
• When help comes set up AED left lat right clav
• Shockable =
• Non shockable =
www.muboss.cz

26. As you go you should
think what is the cause
• 4 h and 4 t
• Hypovolemia - Fluids
• Hyperthermia – Warm with cold water
• Hypoxia – O2 hi flow
• Hyper / Hypo kalemia and metabolic
• Tension PTX
• Tamponade -
• Thrombosis - PE
• Toxins – drugs, sepsis
www.muboss.cz

27. Bedside tests
• Cannulate
• ABG
• Pulse oximetry
• 3 lead ECG
• Bloods – which, cultures
• Crossmatch
• Temperature tympanic Vitals
• BP
• RR
• PR
• Cappilary refill
• JVP
• Urine dip, Blood Glucose, MSU, sputum
www.muboss.cz

28. • Hypoxia – pulse oxi, ABG – COPD? O2 high flow
• Hypovelemia – BP -luid bolus ? Adrenaline centralise
BF
• Hyperthermia - Tympanic - warming
• Hyperkalemia – ABG- fluids calcium
glucoronate, Kcl
• Tension PTX – 2ICS MCL
• Tampnade pericariocentesis
• Toxins – fluids, abx
• Thrombosis – thrombolyse altepase 30 mins more
preparation
www.muboss.cz

29. GCS AVPU
www.muboss.cz

30. • http://group.bmj.com/group/affinity-and-society-
publishing/NHS%20Guide.pdf
• http://doc2doc.bmj.com/assets/youwillsurvive.pdf
• http://www.nhsemployers.org/SiteCollectionDocum
ents/Rough%20Guide%20to%20the%20Foundation%
20Programme_DR_140910.pdf
www.muboss.cz

31. Got the job? What now??
• Contracts –, pay, locum work, annual leave
• Before starting and Day 1
• What to wear
• What to do – ID
• Induction
• What is where and how?
• Nurses
• Indemnity
www.muboss.cz

32. Memberships
• Medical Insurance (outright or discretional?)
– MPS
– MDU
– MDDUS
• Doctors.net – case studies, CEM
• NHS Mail
• BMJ?
• Library
www.muboss.cz

33. Books
• Oxford handbook clinical med
• Oxford handbook for foundation programme
• Foundation doctors guide to medicine and surgery
(crash course)
• Oxford handbook of emergency medicine
• Medical Interviews
www.muboss.cz

34. Training courses
• First aid
• BLS
• (ILS / PILS)
www.muboss.cz

35. Role and limitations of
FY1 doc
• Stabalise
• Do the work up
• Do the jobs or the ward round
• Review patients and know them
• Present cases
• Ward jobs
– Cannulas, bloods, review, order relevant tests, have info ready for
round, fluids, prescribe as needed,, etc chase results, clerk new
patients, TTOs, Referals,
www.muboss.cz

36. ILS
• DRS ABCDEFG
www.muboss.cz

37. A+E
• 4 hour breach
• MAU on call
www.muboss.cz

38. Referrals
• Bleep number, await.
• Introduce who, department, patient name, DOB
• SBAR – Situation, background, assessment, request
• Document in notes : D/w Dr. Pavel (SHO medic on
call), Agreed to admit to MAU. Signed
www.muboss.cz

39. Discharge Summaries /
TTOs
• GP letter
o Why they came
o What tests we did and results
o What we found and what treatment we gave
o What follow up we would like GP to do
o What meds the patient left hospital with dose and freq and length
o Do in time or else patient cant leave today - prioritise
www.muboss.cz

40. Prescribing
• Dose??
• Children – paracetamol
• Route, dose, frequency, length
• Hospital prescriptions
• NKDA, plasters, aspirin, penicillin, nuts,
• Pain relief
• Codeine – constipation
• Opiates – resp depression ? #
• NSAIDS (asprin, naproxen) – GIT …WARFARIN and
Ibuprofen
• Asthma – asprin, Bblocker!?
• Alpha adrenergics – b blockers
www.muboss.cz

41. Requesting Bloods
• Log in FBC U+E LFT+CRP+GLUCOSE+CS
• D dimer (blue) Cross match, group and save
pink, hand write, pod
• Tropinin, amylase, ESR, HB,
• Liver INR and albumin
www.muboss.cz

42. Requesting Imaging
• Clinical details
• Specific questions to be answered
• Mobility
• Porters
• NHS?
• Department
• Consultant
• Sign
• CT/MRI
• STICKY
www.muboss.cz

43. Chasing
• Extension then introduce and patient details and
then ask to add or to chase
www.muboss.cz

44. Fluids prescription
• dextrose
• Normal saline 0.9NaCl
• Dehydration signs sunken eyes turgor
• 1L over 4 hours
• Prescribe for 24 hours
• Check urine output
• Check intake
• Review individually
www.muboss.cz

45. Clerking
• SOAP!!!!
• The default FY1 job
• PC SOCRATES – use it !!
www.muboss.cz

46. Clerking
• VITALS
• PC
• HPC
www.muboss.cz

47. Clerking
• Systems review
– Headache, visual changes, LOC, Dizzyness, hallucinations, Confusion
– Chest pain, Palpitations, Anxiety, sweating, cold clammy hands, pale
– SOB, cough ?prod, Rigors, Pressure in throat, cyanosis
– N+V, appetite, weight loss, hot cold intolerance
– Waterworks, bowels, smelly urine,
– Leg pain, swelling, motor sensory numbness
www.muboss.cz

48. O/E
• VITALS –Norm? history ?elderly fever?
• O2 sats, Gluc, PEF, PERLA, GCS
• Alert and orientated
• Look touch smell, see what the patient doesn’t say
e.g. sinusitis nasal voice
• Investigate presenting symptoms first
• Then the compulsary systems review
www.muboss.cz

49. O/E
• HS/JVP/Cap refill/ Pulse reg
• Chest clear, good a/e bilaterally, no added
sounds, no wheezeing
• Abdo – soft non tender no organomeg BS+
• No pedal oedma
• DRAW eg recent 4th toe amputation / Facial
puncture
www.muboss.cz

50. Impression
• Problem list,
• Differential diagnosis
• Query 
• Doesn’t matter if you are wrong
(assessment)
Trauma to left hip ? L NOF# and Contusion of L lateral
thigh
? Coughing blood ? cause
www.muboss.cz

51. Plan
• Short term
• Long term
• Ix
• Px
• Home
• Discharge
• Admit
• D/w / refer / INR tomorrow, Home if in range
• Senior review
www.muboss.cz

52. Plan
• CXR (form )
• X-ray L hip and femur ?NOF#
• Bloods
• ABG – 42s
• Continue Oxygen hi flow 15l/min
• Salbutamol neb, with HC stat dose 100mg
• Paracetamol 1g PO given
• Senior review
www.muboss.cz

53. Plan
• Advised not to drive as medication can cause
drowziness.
• Home with GP follow up
• Advised to return to A+E if any problems or
concerns
• # clinic follow up
• D/w dr x, agreed to come and review patient
• Head injury advice card
www.muboss.cz

54. More information
• DON’T FORGET TO CHECK OUT THE ‘CAREERS ZONE’
SECTION OF THE BRITISH OVERSEAS STUDENT SOCIETY
WEBSITE: WWW.MUBOSS.CZ
www.muboss.cz