Dr Priya Patel is a first-year consultant at John Hunter Hospital. She is currently co-lead of the national standard 8 portfolio, course convener for BASIC and co-lead of the John Hunter mentoring program. She has an interest in ICU finances, organ donation and staff welfare.
I am beginning to write this on my last day in Perth. I have just spent two years here after completing my Fellowship exam and core training at John Hunter in Newcastle, NSW. I did an extra senior registrar year split across Royal Perth Hospital (RPH) and Fiona Stanley Hospital, before commencing my Transition Year at RPH (known locally as the The Royale).
In the lead up to my transition year, I was starting to feel a bit twitchy as an SR. I felt frustrated when I wasn’t allowed to decide a management plan or lead a family meeting, so I knew I was ready to move on. This didn’t mean that I thought I knew everything. Far from it. The fellowship exam and working with such incredible consultants across NSW and WA had humbled me and taught me that I will never know everything. However, I was ready to lead and take responsibility for my decisions with the added benefit of knowing I had an FCICM on speed dial if I needed it.
I remember feeling like I was already failing at my job as a Fellow before I even started. At RPH, it is the Fellows responsibility to write the SR and JR roster and you get handed this responsibility even before you start working there. Luckily, I’d worked in the hospital 6 months before, so I knew how it worked, but working out who your incoming staff were and how to contact them was a gargantuan and complex task that felt on the same level as asking someone for nuclear war codes. Writing that first roster almost made me quit before I started. However, I’m glad I didn’t.
Working at RPH as a fellow was one of the best years of my 13 years of training. Stepping up from SR to Fellow in a hospital you’ve previously worked in can be a double-edged sword. On one hand, people don’t see the distinction and you must remind everyone that you are different now. I was more senior, with more responsibility. On the other hand, I knew the department and they knew me. I could hit the ground running with my non-clinical portfolios. I knew where work needed to be done, who I needed to speak to, and I already had a network throughout the hospital.
Addressing the first issue regarding newfound seniority was hard. Some people have addressed this by wearing scrubs that say ICU Fellow on it or at least making sure that their ID badge had their new role. A lady behind a desk told me I should keep my old Senior Registrar badge when I went to ask on my first day as a Fellow, and I didn’t argue it. I don’t know why, but I do wish that I had insisted on day 1. I never did change that badge. In addition, the role of the Transition Year trainee is still relatively new at the Royale and it is still going through an evolution on a yearly, sometimes monthly, basis. This was another double-edged sword. The role wasn’t perfect, and I couldn’t walk into it and just “press go”. However, it wasn’t perfect and the department wanted it to be. They were open to new ideas and for me to take my role in any direction. They wanted me to walk away from the year and tell other trainees to do their transition year at RPH. This meant I got to add my own touches, it was fluid, and it was mine to design. Not rigid. Not prescribed. For those that know me, I’m quite a loud and assertive person, so although I didn’t have the badge, the scrubs or the defined role, I confidently introduced myself as the ICU Fellow and reminded everyone that I was a Fellow when I was being slowly boxed back into my SR role. Not everyone got it by the end of the year, but the vast majority did.
My first clinical goal as a fellow was to develop good independent decision-making skills and to be able to run ward rounds efficiently, whilst also making them interesting for the juniors. I got to practice this with some consultants at RPH, but was more supervised with others. However, all the consultants were open to my ideas and keen for clinical debate and discussion. That is a huge strength of the consultant group at RPH, in that they have assembled a group of people that are kind, interested and keen to teach. I also got a lot of independence in running “the outside”, which at RPH means you take calls from within the hospital, retrieval calls from the Pilbara and Kimberley and trauma calls from the entire state of Western Australia. This means a call from Kununurra with multi-trauma MVA victims is like taking a phone call from Moscow, when you’re in London. I also wanted to improve my echocardiography skills, so I used my non-clinical time to go to the echo department once a week and scan with the experts, something that you can just organise as part of your tailored Transition Year.
My non-clinical portfolio was a huge learning curve for me. First bit of advice: get organised. Set up your calendar with colour codes and create folders in your email and on your computer for every project you’re working on. Second bit of advice: learn to say “no”. I wrote the rosters and organised orientation twice a year. Writing the roster is a poisoned chalice and is something you are on call for 24 hours a day, 7 days a week. If you are reading this, find your roster person and give them some love. It is an all-consuming job, where it doesn’t matter if you put 1000 hours into it, someone will always be unhappy and it will always be derailed at least once a term. It did teach me management skills however and most importantly I learnt to say “no”. This is a hard skill to learn, especially if your baseline is to always say yes. It meant that I could also say “no” to more work if I felt like my plate was already full.
My other non-clinical activities included representing ICU at the monthly hospital trauma meetings; undertaking research with the esteemed Kwok Ho; helping improve our procedure credentialling process; and helping to run some BASIC and Beyond BASIC courses. It was a busy year where I learnt how to be a consultant beyond the clinical work. One of the best pieces of advice I got during my TY was that any committee you join, stay silent (or close to it) in meetings for 2-3 months. People in that room have probably thought of what you are about to say, have already considered your suggestion and have more experience than you of local processes and history. It is important to gauge the personalities in the room and to listen before you speak. That is the third bit of advice I pass on to you, because it served me well.
I am now finishing writing this piece 5 months into my first consultant year at John Hunter Hospital. It’s not because I write slowly but is an indication of how busy the move and the first few months of consultancy have been. Overall, this is what I took away from my Transition Year and beyond:
It's full of double-edged swords. Try and find the positive edge and how it will help you be a better consultant and help you sound interesting in your interviews.
Get the scrubs or the badge that show you’re a fellow. It’s hard enough making your mark.
Your non-clinical work is a huge part of your consultant practice so don’t avoid it as a fellow.
You’re not suddenly alone once you get letters. Everyone still calls each other for help.
Yes, I would recommend a Transition Year at Royal Perth, if you are happy to be innovative and tailor it to your needs.