Surviving and Thriving in the Advanced Trainee Year

So, as I type, the countdown app on my phone is telling me that there are 69 days 10 hours 4 minutes and 6 seconds until my CCT day.  Having graduated from medical school 16.5 years ago there have been periods when my training has felt like wading through treacle but as I approach the final hurdle of securing a Consultant post, time seems suddenly to be speeding up with alarming ferocity.  Having just completed my Stage 3 Intensive Care placement (the AT year) I’ve spent the recent weeks reflecting on what I’ve learned in that year and what I wish I’d known before it began.

Location, Location, Location

Most Deaneries will try to accommodate your preferences on which units you’d like to undertake your placements in – typically two 6 month placements at full time but longer if you’re working less than full time.  Think carefully about what you want to gain from the year.  Is there a hospital you know you’d like to end up in as a boss? If you haven’t been there recently it’s worth going back to check you still like it and to remind everyone how lovely and helpful you are.  Is there a specialist skill you’d like to add to your repertoire that is best achieved in one location? Is it just about minimising the commute for at least half the year so you can stay sane? I chose to work in the two units I felt pretty sure I would like to be a Consultant in.  Whilst there were huge advantages to that – working with people I love across two brilliant and different hospitals and the fact that it did definitely help me to make my decision about where to pursue a forever job.  But at times the pressure to impress felt pretty gruelling and I think there’s a lot to be said for working somewhere you like and can learn valuable skills but where if you have a below par day you don’t then worry that no-one will want you as a Consultant colleague!

Learning the Art of Delegation

By the time you become the AT you’ll have years of being the person putting in the lines and doing the transfers and it took me a while to get used to the fact that during this year the most obvious answer to “who can do this?’ wasn’t always “myself”.  It feels hard asking colleagues to take on the brunt of the practical work, I felt less of a team-player initially but you have to remind yourself that those skills are ones you already possess and that the focus of this year is managing the case load, the decision making, the challenging conversations and that it is right and proper that you focus on those aspects. There will still be days that are so busy that there are lines and transfers that you need to pitch and do and actually they take on a refreshing novelty again.

When to Lead and When to Follow

One of the most important aspects of the year was learning to lead a ward round, not just a few of the patients and not just one morning but all of the patients for several consecutive days.  It was challenging, rewarding and often mentally tiring as you tried to progress patients but always wondering if your supervising Consultant would be approving of your rationale.  One Consultant told me they felt I needed to do more of these weeks but another pointed out that Consultants don’t do back-to-back weeks on the unit and I found this advice was hugely helpful.  In the AT year most rota’s have non-resident on-calls to enable us to learn the art of remote decision making but this often increases the number of days you are in work.  You can’t lead the ward round every week – it simply isn’t sustainable so it’s fine to sometimes go round together and learn from other people’s styles, focus on some bedside teaching for junior colleagues or a few patients that you feel drawn to.  One of my most rewarding days was when I looked after just two patients, both of whom were at the end of their life and whilst the Consultant focussed on the other patients, I was able to dedicate my time to these two families, building deep rapport and providing them with regular updates during an unbearably awful day for them.

Study Leave – Take it or Leave It?

For years you’ve needed all your study leave for exam courses, mandatory training, resuscitation courses and it felt like you didn’t have enough…. Now you’re post-FFICM, your ALS is up to date and you have all this study leave at your fingertips.. But don’t be tempted to use it all.  Ask yourself: what gaps do I need to address to make me a better clinician and what gaps do I need to address to help me get a Consultant job and if the course doesn’t help with either of those aspects then you might be better off just enjoying time on the unit getting to learn the job.

Don’t Underestimate the Job Pressure

For years you’ve been in rotational posts and although every time you move your pay gets messed around you do still eventually get paid.  As I approached CCT the fear of not being able to pay my mortgage became pretty strong and the pressure to have a job to go to was huge.  To allay my anxiety, I arranged a post-CCT fellowship on the ICU where I wanted to be a Consultant so that should the dream boss job not materialise in the right time frame I’d at least remain solvent!  Be prepared for the anxiety, for constantly being asked where you want to work, for the excruciating conversations approaching the department(s) you want to court.  And early on in the year print off the application form for an ICU Consultant post (through NHS jobs) and work out if you have something to put in all the boxes currently.  Then only put your energy into projects that fill those gaps and don’t waste time duplicating good work you’ve already done. 

Be Kind to Yourself

It’s a brilliant but challenging year and life outside of work carries on with all the good and bad bits that entails.  My AT year coincided with a deeply personally challenging time in my life and there were days when I just needed to get through and keep my patients safe without trying to excel.  Eventually I accepted a short period of time away from work which felt difficult at first but turned out to be exactly what I needed and I returned refreshed and re-energised.  Similarly, if it’s ever super calm and the boss offers to let you go an hour early in lieu of all the times you’ve stayed late – just say yes!

Don’t Expect to Be the Finished Product

Completing the AT year and getting that elusive Outcome 6 at your final ARCP doesn’t mean the work is done in moulding you as an Intensivist.  I watch Consultant’s at work and feel I lack their poise and grace in decision making but I’ve made peace with the fact that this is not the end of my training but just the end of one phase and the beginning of the next and that I’ll always be learning and evolving.  Stage 3 has been a brilliant year, I’ve learned so much about myself and am excitedly looking forward to post-CCT life.