9 tips for surviving your first year of Core Psychiatry

This is the first year that I have worked in my chosen specialty. Psychiatry is the only thing I have ever seen myself doing and I was nervous before I started. What if I hated it? What would I do then? What if my dream job didn’t live up to my expectations?

Luckily, a year in and my passion for psychiatry has only grown.

However it certainly hasn’t always been smooth sailing.

Under the current climate of the NHS, lack of funding, demoralisation, understaffing, it has felt like more than an uphill struggle at times.

So here are my top tips for surviving working as a psychiatry trainee in the NHS whilst preserving your own wellbeing.

1. You always have time.
It is easy to feel pressured at times to make decisions that you are not sure of or to see patients immediately. You always have time to stop and read the notes so you are prepared and you always have time to discuss with a senior before making a decision. You also always have time for lunch. Do not let yourself be shamed into thinking you don’t!

2. Not sure? Just ask
Just because you are a doctor does not mean you know everything! Nurses are fantastic resources, particularly at the beginning of a job. A trick my friend taught me was to say “I’m new here, what does the doctor normally do in this situation?” Different sites do work really differently so it’s good to know what the norm is. You can also ask your registrar or consultant at any time. Generally psychiatrists are lovely people and will be keen to turn any questions into learning opportunities for all.

3. Spend time with your patients
It’s so easy to get caught up in trying to get your assessments done quickly as you have a ton of other things to do but take your time. Try to get to know your patients and understand why they do things, what is important for them and what they really want and need. Not only will the patient appreciate it but you will gain so much from that insight in terms of ongoing care and how to approach decisions and difficult situations with them. Overall, my fondest memories over the past year were of times when I felt like I really got to know someone and had a human and compassionate connection with them.

4. Don’t be afraid to speak out
The NHS is a harsh environment to work in and there will be times when you see things that you don’t agree with or think could be done better. Never be afraid to voice your concerns and speak up. We need to learn and grow and we need to create a culture that welcomes criticisms and learning not one that blames or shuts down debate. Trainees are in a unique position as we travel a lot and have lots of great ideas. Don’t feel that your opinions are any less important than anyone else’s. Lead by example and speak out.

5. Be persistent
I found this year that I had lots of ideas and lots of things I wanted to do but it was difficult to get other people to listen to them. Whether it’s a learning opportunity like observing a tribunal or going to a clinic or a quality improvement project, keep asking!
It’s very easy to feel that you are not being listened to or that others dont have time to hear you out. The system and culture does not welcome change so it’s not always going to be easy to get people on board with your ideas or concerns. But the louder you shout, the harder it is to be ignored.

6. Learn when to say no
At times this year, I felt pulled in all directions. You have your base team work load, the oncalls, your portfolio requirements, exams and it can really build up. Tell your clinical or educational supervisor when you feel overwhelmed and they can help re-evaluate your work schedule.

7. Know your rights
Ok so we are now working under a new contract which was enforced on us despite our opposition. Use it to your advantage when you can. Rotas should be sent to you 6 weeks in advance, check your rota complies with the new contract, make sure you get all the annual leave, study leave and lieu days you are entitled to. If you work excess hours or miss training opportunities then exception report it!

8. Preserve your work life balance!
You cannot pour from an empty jug. If you are overworked, tired and stressed, how are you supposed to help your patients? Switch off from work completely on your days off, don’t put in too much of your free time into portfolio and exams. Make sure you still schedule time for you, your friends and family and the things you enjoy.

9. Enjoy it! Each day of your life only happens once. Try to appreciate every day and enjoy yourself!

So those are my top tips, let me know if you are starting core psychiatry training or if you have any tips of your own!

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