Rob Baker

Name : Rob Baker
Employer : George Eliot Hospital, Nuneaton and Hospital of St Cross, Rugby
University : University of Leicester
Subject : MB ChB
Graduated : 2002

PRHO : Glenfields Hospital, Leicester and Peterborough District Hospital
Rotations : medicine, surgery, respiratory medicine
Foundations 2 : George Eliot Hospital, Nuneaton and Hospital of St Cross, RugbyRotations : respiratory medicine, microbiology, genitourinary (GU) medicine
Foundation 2 : Nuneaton (GP), Geroge Eliot Hospital, Nuneaton and Hospital of St Cross, Rugby
Rotations : general practice, medicine, psychiatry

I wasn’t fully sure about the specialty path I wanted to take following my PRHO year. I had an inkling that I wanted to do general practice, but I was also interested in other specialties. I responded to an advert in the medical press for a pilot foundation programme. I thought that taking part in the scheme would give me the chance to experience other areas of medicine. I actually completed two F2 years, as I was offered the chance to complete a second F2, which included a general practice element.

Progress monitoring

Assessment processes are a key part of the foundation programme curriculum. They are used to highlight key skills, but also highlight any areas for improvement. I underwent an appraisal at the beginning of each rotation and from this developed action plans to gain the additional skills I needed. 

Mini CEX (clinical evaluation exercise) and DOPS (direct observation of procedural skills) are used to assess competence and skills, and are performed on a number of occasions during each rotation. For example, a mini-CEX assessment on my GP rotation involved being videoed while in consultation with a patient to assess my communication skills. I was observed by a GP trainer who provided immediate feedback. The DOPS assessment involves being watched by a consultant as you carry out a clinical procedure. 

We were also assessed using TAB (team assessment of behaviour), which is a version of the 360 degree assessment that has been developed in the West Midlands. A TAB questionnaire is given to a number of team members (not just consultants) with whom you have worked and they assess your behaviour and attitude.

Finding support

A lot of support is provided throughout the rotations. It comes mainly from the consultants and the teams in which you work. I have also had a main educational supervisor with whom I can discuss any problems.

The advantages and challenges

The foundation programme has not only helped me to develop my clinical skills, but has also provided the opportunity to develop the more generic skills essential for a doctor. I did find the four-month posts a bit short. It’s a steep learning curve at the beginning of each and just as you feel you are getting to grips with things and feeling confident it’s time to move on. However, I have worked in areas of medicine that I wouldn’t have considered previously and I also experienced working outside the hospital environment in the community. Overall, it has given me time to look at my options and understand how my future choice of specialty will meet my long-term aims and lifestyle.

My next steps

I’ve clarified that general practice is definitely the way I want to go, but the GP rotation also showed me what additional experience I need to gather. I have a six-month accident and emergency post lined up next and I would like to do another six months of medicine.

My working week

The working week has varied on the different rotations: Respiratory medicine was 9.00 am to 5.00 pm, with on-call days, and nights or a week of evening shifts. This depended on the rota of the hospital. Genitourinary (GU) medicine was mainly clinic based. Clinic sessions ran from 9.30 am to 12.30 pm Monday, Tuesday, Thursday and Friday. Tuesdays and Fridays also had afternoon clinic sessions. On Monday afternoons I worked on audit. On Wednesdays I worked a twilight shift in medicine from 1.00 pm to 9.00 pm. The twilight shift was developed by my educational supervisor to provide me with more experience of dealing with acutely-ill patients and keep up my skills in medicine. Microbiology was 9.00 am to 5.00 pm. However, Tuesday was an on-call day in medicine. During the general practice block, I kept normal general practice hours, but spent one Friday in A&E every two weeks. Similar to my twilight shifts in medicine, working a shift in A&E enabled me to keep up my skills and gain more experience. In psychiatry I work 9.00 am to 5.00 pm, with a once-a-week twilight shift that runs from 9.00 am to 9.00 pm.

My unforgettable experience

One of my first on-calls in the medicine rotation was an 18-year old who had come in with asthma. It was satisfying to give him treatment that helped him recover. The first on-call you do will always stick out. It’s one of those ‘oh-my-god’ experiences where you have to ask the SHO for help, and then a year down the line you become that SHO and you realise how far you’ve come.

My top tips

• Throw yourself into each job the best you can – it might be the only experience you get of working in that area of medicine.
• Take advantage of the easier hours during your foundation programme. Do the things you want to do – go out and have fun.
• Make full use of the extra support you get to learn more and gain more experience.