Medical school teaches you clinical medicine. It does not teach you how to navigate your first week on the ward — where to find the drug chart, how to answer a bleep, what to say when the nurse asks you to prescribe potassium at 2am, or when it is appropriate to call the registrar versus when you should handle it yourself.
This guide covers the practical knowledge that separates surviving FY1 from drowning in it.
Your First Week: Practical Logistics
Before day one: Get your IT access set up. Log in to the clinical system (EPIC, Cerner, Lorenzo — whichever your trust uses). Get your ID badge. Get your bleep or switchboard number. Find out where the doctors' mess is, where the on-call room is, and where the resus trolley is on your ward. Know your rota for the first two weeks. Set up NHSmail on your phone.
Day one priorities: Introduce yourself to the ward nursing team — they are your most important colleagues and they will teach you more practical medicine in the first month than any textbook. Find the ward pharmacist and introduce yourself — they will save you from prescribing errors. Locate the blood gas machine, the cannulation trolley, and the fluid storage. Know the cardiac arrest call number. Know the critical care outreach team number.
The On-Call Survival Kit
Carry: stethoscope, pen torch, tourniquet, alcohol gel, two black pens, your phone (with BNF app and iatroX installed), a printed or saved copy of your trust's antimicrobial guidelines, and a small notebook or your phone for task lists.
Know before your first on-call: the medical emergency team (MET) call criteria, the sepsis pathway (NEWS ≥5 triggers sepsis screening — NICE NG51), the acute chest pain pathway, the hyperkalaemia protocol, and your trust's blood transfusion policy. You will not remember all of this. But knowing where to find it quickly is the skill. Ask iatroX provides instant NICE-grounded clinical answers — "What is the acute management of hyperkalaemia?" / "What is the sepsis six bundle?" — in seconds on your phone.
Prescribing on Day One
You will prescribe on your first day. Common day-one prescriptions: IV fluids (maintenance and replacement), VTE prophylaxis (enoxaparin — check weight and renal function), antiemetics (ondansetron, cyclizine, metoclopramide — know the differences), PRN analgesia (paracetamol, ibuprofen, codeine — know the ceiling doses and contraindications), and laxatives (for every opioid prescription).
The golden rule: If you are not sure, look it up. The BNF app is on your phone. Ask iatroX is on your phone. Looking up a dose takes 15 seconds. Prescribing the wrong dose takes a Datix form, a difficult conversation, and potentially patient harm.
Know what not to prescribe without senior input: Anticoagulants (first dose), insulin (new regimens), controlled drugs (unfamiliar), antibiotics (check local guidelines first — do not default to "amoxicillin for everything"), and anything you have not prescribed before. Ask the registrar. They expect you to ask. They do not expect you to guess.
Escalation: When to Call the Registrar
Call the registrar when: NEWS score is ≥7 (emergency response trigger), you suspect a clinical emergency (chest pain with ECG changes, acute stroke, anaphylaxis, massive haemorrhage), you are asked to prescribe something you are not confident about, a patient's condition has deteriorated significantly, or your clinical judgment says something is wrong even if you cannot articulate exactly what.
How to call: Use SBAR (Situation, Background, Assessment, Recommendation). "I'm calling about Mr Smith in bed 12, ward 4B. He's a 72-year-old admitted with pneumonia, currently on IV amoxicillin. His NEWS has increased from 3 to 7 in the last 2 hours — he's tachycardic at 120, hypotensive at 85 systolic, and his temperature has spiked to 39.2. I think he's septic and not responding to current antibiotics. I'd like you to review him — I've started the sepsis pathway and taken cultures."
This is infinitely better than: "Hi, can you come and see a patient? He doesn't look well."
Documentation That Protects You
Every clinical decision should be documented. The standard: date, time, your name and GMC number, who you are (FY1 on-call), what you found (observations, examination findings, investigation results), what you think (assessment/impression), and what you did (plan, including follow-up timing).
The medico-legal principle: If it is not documented, it did not happen. If a patient deteriorates and there is a complaint or investigation, your documentation is your evidence that you assessed the patient, identified the concern, escalated appropriately, and acted within your competence. Good documentation protects patients and protects you.
ARCP and Foundation ePortfolio
Your ARCP (Annual Review of Competence Progression) determines whether you progress from FY1 to FY2 and from FY2 to specialty training. The ePortfolio is the evidence. Start collecting workplace-based assessments (WBAs) from week one — do not leave them until month 11.
TAB (Team Assessment of Behaviour): Multi-source feedback from colleagues. Request early. Chase responses. You need a minimum number of completed forms.
miniCEX (mini Clinical Evaluation Exercise): Observed clinical encounters assessed by a senior. Ask your registrar or consultant to observe a focused clinical encounter — history, examination, or management discussion. Two minutes to set up. Five minutes to complete. Do not be annoying about it — ask when they have time and keep it brief.
CBD (Case-Based Discussion): Discuss a case you managed with a senior. Bring the notes. Present the case. Discuss your reasoning. The senior assesses your clinical reasoning and management. This is the easiest WBA to arrange — you can do it during a ward round debrief.
How iatroX helps: Ask iatroX for instant guideline checks when you encounter an unfamiliar condition during on-call. The UKMLA Q-Bank for ongoing clinical knowledge maintenance — 15 adaptive questions on your commute keeps your clinical reasoning sharp. iatroX Calculators for NEWS2, Wells PE, CURB-65, and every other clinical score you will be asked to calculate on the ward.