After 4 years working as a BPT in Sydney (due to being English and not having prior learning recognised!), finally being allowed to sit the physicians exam and fortunately passing, I was subsequently allowed to choose my specialty. I agonized over the choice between neurology and cardiology essentially for a year but after some soul searching and really helpful advice from a mentor settled on neurology.
The advice, for those in the same position as I was, was that no decision is completely final. If you need to change after a year you can and that is totally ok. In addition something really useful was to look at where you are in life, look at where you want to be and if you are not on that path or have gone the wrong direction then you can change it. I looked at what I would have loved about cardiology, which would be the direct lifesaving and angiography, but realised that those things wouldnt sustain me and may prevent me from being around for family and friends as much as I would like. Neurology was always in my heart since before medical school and the combination of logic, continuous learning, occasional procedures and diversity of options when you finish helped to sell it for me. At the end of the day you should choose something that will keep you stimulated mentally for as long as possible, ideally for a whole career. Neurology also has the hyperacute element of stroke treatment which I find incredibly exciting and rewarding at this stage also.
So my first year of training is complete and I feel very positive about the experience, although I must emphasize it was certainly not all plain sailing and there were a few bleak times throughout.
The first few weeks were very nerve wracking, I felt very "less than" in terms of knowledge and ability and had also missed registration and sign up for some courses and some college deadlines. These were all relatively minor but exacerbated my feelings of stupidity early in the picture. In clinics I found getting used to the administrative side of things really tough. I had very little clue how to structure a patient letter and was quite self conscious writing down what would be seen by a consultant and then a GP.
Then there is dictation....
I am used to seeing professors casually leaning back in their chair mumbling quietly into dictaphones and producing these perfect summaries of a patients visit. It was a nightmare at first and I'm sure the people transcribing the letters had a good laugh at some of my word fumbles and the intermittent profanity I would utter throughout the recording.
I couldnt have been luckier with the staff however, the fellows, consultants and admin support staff got me setlled in and comfortable in the departments, they encouraged questions, gave constructive criticism and invited me for coffees to debrief. I was lucky to do clinics in epilepsy, multiple sclerosis and nerve and muscle - Things that as a BPT you really don't get to experience so the learning curve was quite steep but not too daunting.
I think at this point its important to note that you are a trainee at this stage and whilst there are expectations you are still learning so if you dont know something that is totally fine, ask, learn it and try not to forget again but your seniors are here to teach you not to simply berrate you.
Working across 2 sites was interesting and a good opportunity to work with multiple people. The team at the second site also welcomed me with open arms. It was also here I got my first tastes of EEG and nerve conduction studies and EMG which I have been enjoying much more than I anticipated.
With a bit of stress building through the work year due to a slightly increasing work load and some interpersonal conflict, nerve conduction clinic was an oasis of calm. My mentor was endlessly patient with me and really fun to be around and his method of teaching was perfect for me. Muscle memory of the procedure first and then gradually we brought in the theory and interpretation which really made it more enjoyable. The only issue for me was that it was only fortnightly!
Another interesting change is that you stay for the whole year whilst the JMOs rotate around you. this means that you get a disrupted rhythm and have to adapt to new personalities pretty frequently. I really enjoyed this and got a wide spread of people to work with and learnt to adapt to the capabilities and needs of them as we went along. It also highlighted how important the constant fixtures in the team were such as the wonderful CNC and nursing staff. I think it also brings you closer to the consultants as you are more of a point of contact and consistency.
Something I should mention is that shortly before starting AT my mother passed away from a sub arachnoid haemorrhage. During her admission I was unfortunately shown her CT brain which I now cannot unsee. I think having the knowledge of what you are looking at when it is someone you love so much makes it so much worse.
As you can imagine this made looking at brain scans, CTs in particular, almost impossible at the start of the year. This has improved but talking to families in ED with intracranial haemhorrage has become quite an emotional task and more difficult to detach from. On the counter side I think I am more empathetic as a result and really work for the families and patients in stroke calls because of this experience.
It also meant that I wasn't quite myself for perhaps the first 3 months of training and felt very weighed down with emotions, felt quite useless at the job at times and unfortunately felt quite unsupported on occasion. I did consider stopping the programme at one point but am glad I continued and am grateful to the positive influences around me at work that kept me going. I should have possibly told people about how bad the work environment was becoming earlier and would almost certainly have received more support sooner but as with everything hindsight is always 20/20.
I know this was a little rambly but I hope some of that can resonate a little with you. As with anything in life there are ups and downs through training but overall I'm glad I had the experience.
And finally, as you may have noticed, it takes up a lot of time and medicine daily has suffered a little! Regular content became very hard to produce and belief in my knowledge and enthusiasm waned, but on reflection it is returning and I'm looking forward to a new year!
My overall advice for first year AT is:
- Dont be so hard on yourself, you are a beginner, just try your best
- Find consultants and fellows to emulate and who you can talk openly to
- Support your juniors, set out your expectations and what you can offer them
- Get help with the admin systems early on and spend a little extra time learning dictation
- Dictate, dont type, don't get behind
- Find a doctors letter style that you like and copy it and stick to it
- Enjoy your life outside work as much as possible because you don't know how long you've got
- Call your parents
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