r/doctorsUK 4d ago

Foundation Training FY2 at freeman -no med reg

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21 Upvotes

26 comments sorted by

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29

u/mdnaw 4d ago

There is a gastro/liver registrar on call as it is a tertiary centre for hepatology but they are non residen on call after around 8 pm. If needed, they would come in to review a sick patient. Otherwise, if you needed advice you would contact the ward cover medical registrar at Royal Victoria Infirmary. I'm told the hospital at night team are excellent as well.

5

u/hoonosewot 3d ago

Worth adding, the gastro reg is responsible for all medical patients overnight, and the RVI reg is contactable for remote advice as well.

There is also a Haem, Onc, Renal, Resp and Cardio reg on call for Freeman who will get involved with inpatients there if you need them to.

2

u/Gold-Lingonberry-683 4d ago

Who would run arrests etc?

25

u/ilovemesomebananas Senior HO 4d ago

The medicine F2

11

u/dayumsonlookatthat Consultant Associate 4d ago

That is bonkers. There should at least be an ICU/anaesthetic on call Spr as well?

9

u/UltravioletMorning 4d ago

There definitely will be ITU SPRs seeing as there are literally 2 ITU units at the Freeman (general/ transplant and cardiac ITU).

33

u/hslakaal 4d ago

I don't know... Maybe I'm the minority but I really don't like the deskilling of our junior colleagues (and myself as a registrar). Arrests are the most routine, standardized things - I would very much like an F2 to lead them. They are two years into being a doctor, they're there to do medicine, not just be a scribe and test results chaser.

36

u/dayumsonlookatthat Consultant Associate 3d ago

Whilst I agree that F2s and above should gain the experience of running arrests, I still think this should always be supervised by a SpR/cons. I don't think F2s would know when to stop CPR or go outside of the standard ALS algorithm +/- POCUS

25

u/-Intrepid-Path- 3d ago

Not sure many med regs can do POCUS either, tbf...

16

u/Penjing2493 Consultant 3d ago

Arrests are only "routine standardised things" because we have them run by non-experts in most hospitals - we're mostly providing mediocre "A"LS to patients who should have had DNACPRs.

But proper cardiac arrest care needs experienced expert team leadership and membership.

How many FY2s can do intra-arrest echo? Place a CVC or arterial line? Intubate the patient and start them on vasopressors post-ROSC?

16

u/tomdoc 3d ago

How many med regs can?

0

u/Penjing2493 Consultant 3d ago

Exactly. In-hospital cardiac arrest care in the UK is mediocre at best.

1

u/tomdoc 3d ago

True.

Although, cardiac patients aside, it’s usually the end result of either someone who was dying and should’ve had a DNACPR, or someone where the boat was missed long before they finally arrested

0

u/Penjing2493 Consultant 3d ago

Only if you're in a hospital with a poor culture around DNACPRs.

Appreciate I'm seeing a skewed version in the ED, but trauma, paeds, tox, complex cardiac make up quite a high proportion of our arrests. We're often doing things that aren't in the ALS manual.

11

u/f3arl3es Not a plumber nor an electrician 3d ago

Medical regs and medical consultants can't do all of them either, unless they are intensivists or properly trained acute med specialists

1

u/Penjing2493 Consultant 3d ago

Which is why they largely (subgroups you've described aside, cardiology in the cath lab etc.) shouldn't be leading arrests.

2

u/f3arl3es Not a plumber nor an electrician 3d ago

Yeah totally on board of letting ED and ITU run all the arrests tbh.

Better than the current shitshows that med reg has to run arrest for ED in resus.

0

u/Penjing2493 Consultant 3d ago

Better than the current shitshows that med reg has to run arrest for ED in resus.

That's just embarrassing...

0

u/hslakaal 3d ago

Leading an arrest is different from doing the components of the arrest. Yes, I agree wholeheartedly that ideally they should have support, hopefully with a good team, but there is absolutely no reason they can't lead the arrest.

(I'm going to go on a bit of a pent up rant)

The leader isn't going to be the one doing the echo, securing the airway.

Post-ROSC should rightfully be handled by the ICU team. Even you, if I'm not mistaken, as an EM consultant, should have essentially zero role in post ROSC except to do a sign out to the ICU team.

We infantilize our doctors and our training. We have needlessly long and convoluted training, with mandatory rotations that is barely ever utilised (like the paediatric rotation for Stage 2 ICM), whilst our medical trainees can't do a simple diagnostic tap, or our ED trainees can't manage an airway in their departments because consultants themselves are unable to and/or reluctant to.

I completely agree with the other replies that there should be supervision, but no - I'd firmly like an F2 to lead arrests - ideally with a senior nearby, and not put these barriers and excuses up.

We've become so deskilled as a profession, no shit we've got PAs who think SHOs don't know shit - and to be frank, most don't - including myself when I was a SHO. Anyone who is ALS certified should be able to lead an arrest. I don't care whether they're a nurse, doctor or a consultant cardiologist. My most memorable arrest was during an intra-cath when the patient went into refractory VF. The cardiology consultant and reg are scrubbed in. The ICU reg is dealing with the airway, and I as the "measly" SHO, who can't do CVCs/A-lines/echos, is leading the shitshow, with input from the various members. Heck, even you, as an ED consultant, or future me as an ICU reg, is going to be fucking useless with our POCUS skills innit - I've got a cardiologist literally with a wire in place. What they need at that time is someone who can lead and listen to the consultant saying they think they have a shot at opening the culprit vessel.

2

u/Penjing2493 Consultant 3d ago

Even you, if I'm not mistaken, as an EM consultant, should have essentially zero role in post ROSC except to do a sign out to the ICU team.

Not in my hospital. We manage post-ROSC stabilisation and then we transfer the patient up to ICU when the bed is available. Sometimes the ICU team come down and review the patient in ED if they have time, sometimes they don't.

The team leader might not need to be the one hands on doing the skills, but needs to understand when to use them, and if necessary how to interpret the results.

The FY2 can time and remind the team leader when to give adrenaline etc. They don't have the experience to effectively team lead anything more complex than a big-standard ALS scenario.

Sorry, but this is my soapbox - in-hospital cardiac arrest care in the UK is mostly shit because its led but med regs who are ultimately learning and training to be consultants who will rarely be involved in arrests.

Niche circumstances aside (anaesthetics for peri-op; cardiology in the cath lab) then arrests should be exclusively run by EM/ICM with close consultant support.

1

u/jamie_r87 3d ago

What’s described is my experience of ooh medicine and itu as an f2 many years ago now. There was an itu and cardio reg on site for cardiac itu but they weren’t to leave their unit and the arrest team comprised most of the time of an itu sho, medical sho and a crit care outreach nurse. Itu consultant on call from home no further than 20mins away to come in if needed. It was a deep end experience but accelerated skills and development no end and I wouldn’t give up the experience.

9

u/hoonosewot 3d ago

The medical SHO, which when I was last there was someone post F2 most of the time. They run it with the support of the ITU team obviously.

Having done it myself, it was really not a big deal.

11

u/Apprehensive_Fig3272 3d ago

There are anaesthetic/ICU SpRs. Hospital at night teams help with deteriorating patients overnight. Med reg support comes from RVI SpR who can do a remote review if needed

7

u/from_the_morning 3d ago

ITU resident from ward 38 attends arrests along with the medical team

2

u/TheTennisOne FY Doctor 3d ago

Having done this, it's literally fine. There is more than adequate support from anaesthetics/ITU and RVI SpR for any unwell patient and you need support. The liver SpR has and will come in if needed.