By Dr Roosindu Peris

IMT Resident Doctor

Starting Internal Medicine Training can feel like a steep jump, from managing day-to-day ward jobs to handling acutely unwell patients while preparing for demanding postgraduate exams. This list brings together 18 tips from Dr Peris' personal experience as an IMT trainee that we hope you will also find useful.

1. Make sure you familiarise yourself with the local guidelines and policies with regards to the management of certain conditions (Stroke, STEMI vs NSTEMI). Depending on the trust and hospital this could be treated onsite or off site and they may prefer different medications as per the local guidelines vs what you learnt in Foundation/Med School.

2. The iRESUS app comes in handy when dealing with a cardiac arrest on the wards.

3. Aim to finish off your MRCP asap, you’d have more time to enjoy your programme without exams weighing you down.

4. Start your revision early, especially for part 1.

5. Resources I’ve found useful (2024 exam season) were the passmed question bank and pastest exam papers for the MCQ papers. Cases for PACES is useful to consolidate all your PACES learning closer to your exam.

6. Don’t rely on a PACES course to get you over the edge, while it can be useful make sure you don’t leave it too last minute but not too early so that you aren’t disheartened by how much you don’t know.

7. Long term staff members on a ward (Trust grade regs and SHOs/ Specialist/Nurses/PAs) will know more about very niche subjects related to logistical issues on the ward – ie; referrals, always ask!

8. Make sure to take your breaks! Cannot stress how important this is especially when youre on call. The more tired you are, the less safe you’d be.

9. Make sure you document any and all conversations you’ve had with family and team members (including other specialities) as soon as possible, this will be your patients and your only saving grace if things were to deteriorate in the middle of the night when theres less staff members around and those who may have never met the patient before.

10. Even if the patient has been seen by the ED team during clerking, always make sure you ask critical questions again without going off the clerking from the previous documentation – their symptoms may have changed (chest pain) or they may want to add more detail onto something that was already ask.

11. Make sure you get started on things like ACATs and OPCATs as early as possible – don’t be rushing around last minute.

12. Make sure your study leave is booked in well in advance of the course, certain deaneries have rules around what courses they will fund and up to how much as well as how in advance you need to apply for it so ensure that you clarify this with your deanery as soon as possible to avoid unnecessary expenditures/rejections.

13. Always book in leave (‘Study’ or ‘Other’) for your mandatory teaching if your rota coordinator doesn’t put this on already as this is mandatory and will count towards your final teaching hours.

14. Go to as many clinics as possible, you see a different side of each of the specialities when in clinic (especially endocrine where all the magic happens).

15. Make sure you have an app/ note down the different bleep numbers of the standard points of contact (Med reg, Surgical SHO, Xray, CT, Porters, Path/Haem Lab, certain wards you're covering).

16. On your ITU placement, learn how the ITU runs and more importantly their role in how they can assist you when you call them for help or when its appropriate to call them for help. This is also a great place to get your supervised central line signed off, and if you're keen you will be taught how to do arterial lines (not that you would need it outside ICU) and US guided cannulas.

17. Be open to the fact that different people do things in different ways and try and incorporate any new skills you see into your own practise (as long as its safe).

18. Enjoy it (easier said than done at times)! While it may feel as if you're not learning anything at times the process of learning in this programme has been both an active and passive process on which you will look back on and acknowledge how far you’ve come.