Tips for Locuming in a New Specialty – General Medicine

You may have chosen to do an F3 year for lifestyle reasons, to try out different specialties you didn’t get during your foundation rotations, or to gain more experience in a specialty you’re particularly interested in. Of course, if you’re a current F2 or F3, you might've missed out on rotating on to different specialties because of the coronavirus pandemic.

Whatever the reason, at some point you may find yourself working in General Medicine for the first time, with no previous experience, and this can be a bit of a daunting prospect for some doctors.

Fortunately, managing patients on any specialty ward will have given you a background of handling various medical problems, so you won’t be starting completely from scratch. And this article will help you gain a better understanding of what it will be like working as a locum in General Medicine, as well as providing some tips to help you prepare in advance of starting your job!

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Where Will I Cover?

Most hospitals have a similar spread of clinical areas you may work in as a General Medicine SHO, but it’s worth finding out in advance – either from your locum agency or the hospital itself – which specific areas you’ll be covering, if you want to prepare ahead of time. These could include:

Accident and Emergency

Acute Medical Unit (AMU)

Medical Wards – These may include Cardiology, Respiratory, Gastroenterology, Frailty, or Geriatrics. In some places you might also cover Neurology or Stroke units.

Ambulatory Care Unit – This is a same-day care unit where patients can be admitted from GPs for assessment. The aim of these units is to both see and discharge people on the same day. For example, patients may be admitted for a Doppler ultrasound to rule out a DVT. Those patients who are deemed to require admission can then be admitted to a ward without going through A&E.

Clinics – You may or may not spend time in clinics as an SHO. If you do, it will be well supported by senior colleagues, so the rest of this article will focus on your ward cover and on-call role.

What’s the Day-to-Day Like?

Daily Ward Job

In most hospitals, SHOs will be assigned to a specific ward for their daily job. For example, you might find yourself assigned to Cardiology if you’re in a long-term rota gap, or you could just be assigned to random wards on different days.

Common ward tasks would be taking part in the morning ward round – either independently or with a senior colleague – and ward jobs such as requesting and chasing investigations, managing unwell patients, prescribing, and discharge planning.

“Take” Shifts On Call

There's usually an SHO available at all times for “Take,” which is clerking new patients that are admitted. This can be in A&E or on AMU, but they may also cover the Ambulatory Care Unit. Sometimes there's also a separate SHO to cover the Ambulatory Care Unit, depending on the size of the hospital.

Usually you'll clerk patients independently, request initial investigations and management, and then present to the “Take” Registrar or Consultant to get further advice about managing the patient.

These may be 12-hour shifts during the day, or at night, and are sometimes twilight shifts where you'll work through the afternoon and late evening.

“Cover” Shifts On Call

On "Cover" shifts, you'll generally cover inpatients on AMU and the medical specialty wards. There may be more than one SHO on “Cover” depending on the size of the hospital. If that's the case, you'll usually split up to cover different areas.

During these shifts, you may be asked to manage unwell patients, prescribe, and chase up investigations requested during the day. You could also be asked to take part in the Post-Take Ward Round, where the consultant who was on call the previous day will do a round to review all the patients who've been admitted under them.

Our Top Tips to Get You Started

    1. Get some taster experience if possible, to try it out before you start

    2. Use the Trust guidelines to help you, including antibiotic guidelines

    3. Be confident in clerking medical admissions and presenting them to Registrars or Consultants

    4. Be flexible, and stay prepared to be moved to different medical wards as a locum to cover last-minute gaps

    5. Stay up-to-date on life support training, as you'll likely hold the crash bleep on either a Cover or Take shift

    6. Read up on common medical issues you may come across, using resources such as Pulsenotes

    7. Always ask for help if you need it! 

Going into an unfamiliar speciality is never easy, but the key thing is to remember you’ll have plenty of support around you. For instance, if you need advice about managing a patient, either your own Ward Registrar or Consultant, or the Medical Registrar on call, should be eager to lend a hand. If you’re with a patient who you think is peri-arrest and you need urgent help, put out a crash bleep to get your team members there quickly. Whatever the situation, be sure to remain calm and trust your past experience.

Following the above advice will make the process of starting work in General Medicine for the first time less daunting, and taking our tips on board will allow you to hit the ground running when you start!

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Specialty-Specific Guides

We've also written guides for each of the main specialties, giving you detailed advice on how to settle into those departments. These are especially useful if you haven’t rotated through that specialty in your Foundation Training rotations.

Tips for Locuming in a New Specialty – Obstetrics and Gynaecology

Tips for Locuming in a New Specialty – Paediatrics

Tips for Locuming in a New Specialty – General Surgery

Tips for Locuming in a New Specialty – Emergency Medicine

Tips for Locuming in a New Specialty – Trauma & Orthopaedics

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This article is part of a wider series, supporting doctors like yourself with a comprehensive set of guides to ensure your F3 year is a success. These guides cover everything from initial planning, options for moving abroad, help with finding work, and tips for making the most of the experience. Click here to visit our F3 Resource Hub to explore the full list of guides and articles.

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