Introduce yourself to the current juniors in the K3 office on a weekday afternoon and take a brief handover. You may need to collect the crash bleep on the first day so make arrangements to do so.

A couple of weeks before starting e-mail the ward clerk to introduce yourself and ask them to set up a PRIS account for you. PRIS is how you refer patients to Papworth for angiograms/surgery so it's really important to sort this out early.

The main wards are K3 and CCU (CCU is the last two bays and some side rooms on K3). There may also be some outliers, usually on MSEU. K2 ward is where the consultant offices are, and also the angio/pacemaker suite. Occasionally you get called down to K2 to clerk a patient staying overnight, this is your responsibility.

Meet in K3 doctors office at 8.30am. One of the juniors is expected to have printed a list, so arrange this amongst yourselves. Morning MDT meeting is at 8.45am in the doctor's office where you go through each patient, EDD, physio/PT requirements etc. Most medically managed ACS patients go home after 5 days. The ward round structure varies by consultant, so ask if unsure.

Consultants rotate roughly weekly, sometimes every 2 weeks, as does the registrar on the ward. The only constants will be you and usually a CMT.

Team of doctors is made up of one FY1/2, one CT, one SpR, and one consultant.

People to get to know are 1. The echo team, first door on the right after you pass the ward clerks desk. You'll be asking them for a lot of favours. 2. The electrophysiologists, you'll see a lot of people with pacemakers and sometimes they go wrong. 3. Richard, Richard, and the other cardiac nurse practitioners - really helpful and very knowledgable.

Tuesdays at 1pm there is a radiology meeting just outside the entrance to N3.

If assigned cardiology you will spend 2 months doing acute medicine (clerking medical patients in ED and ward work on the short stay unit -MSEU/EAU5) and 2 months on the cardiology ward. There will need to be at absolute least one junior on K3 on any day, but this should be two. Discuss with others on the ward if taking annual leave during the cardiology block. Whilst on the 2 month cardiology ward block you will work roughly 2-3 weekends (8.15am-9.15pm), 10 twilight shifts (8.30am-9.15pm) and 30 day shifts (8.30am-6pm).

Weekends are generally covering Cardiology and Infectious Diseases. There is a registrar for each and a ward round. The current dynamic is for the junior to help cardiology for the Saturday ward round, and be on call for both wards, and on Sunday help ID.

The cardiology list usually has between 15 and 30 patients. One of the junior doctors (House officer or SHO) carries the crash bleep. Patients who have been transferred back from Papworth or are staying overnight post pacemaker insertion (every Wed and Thur) need clerking. Remember to add any patients you clerk to the cardiology list as they should be seen in the morning and can easily be missed. .

Like most medical teams print the list from EPIC after adding new patients accepted by the consultant of the week at morning report. It is useful to create a consult list as well as consultants are often asked to offer cardiology opinion for a patient who belongs to other teams.

Common cases include NSTEMIs (If a patient has a STEMI they are transferred immediately to Papworth), infective endocarditis, pericardial effusions and arrhythmias.

Learn on the first day how to enter patients on PRIS for transfer to Papworth. When you enter someone on PRIS make sure you transfer their Echo (call 58111 and ask the Echo team to do this) and Angio (call PACS office on 2323 to do this) as well as faxing across the reports of each.

Differences between angiography options etc. can appear subtle - if in doubt, ask precisely how a given patient should be entered to avoid confusion later. PRIS is not always intuitive - for example, sometimes will not accept apostrophes in a consultant name, but not tell you what the issue is (the error is called 'Jim'). Despite this, patient exchange with Papworth appears faster from Addenbrooke's than with outlying DGHs and you will need to be on your toes with discharge letters and incoming clerkings. Movement is often dependent on reciprocal bed statuses and consultant to consultant communication.

Check PRIS daily to look for any new messages (eg requests for further information) or transfer dates for ward patients. The 'electronic white board' on PRIS gives information on transfer and procedure dates in Papworth. It is especially important to check for patients on outlying wards such as MSEU - often this information is not otherwise communicated to the ward staff and patients may miss their slot in Papworth.

Handover in the week is to the twilight covering cardio/resp. The person covering cardio/resp must collect the crash bleep from the cardiology doctors at 6pm. You will also need to collect another bleep from the F&G5 seminar room. You can find which number bleep to pick up on rotawatch. Handover on the weekend is to the night SHO covering cardio/resp/ID/MSEU.

See board in K3 doctors office.

Varies by nights/weekends/hours as per the new contract. Consultants, with some exceptions, are generally responsive to exception reporting and usually facilitate you leaving on time, or thereabouts.

Your SHO will carry the crash bleep most days, but be familiar with the ALS protocols as sometimes you are required to hold it for periods of time, and you may be the first doctor on scene (especially if the arrest is in ATC).

Arrest calls can be interesting if you are keen to get involved. If the call is “PART team only” you do not need to attend, this is the public area response team. However, these calls are sometimes upgraded to a full-blown arrest call if the individual is very unwell.

Typically a very large number of people arrive in support for an arrest call inside working hours. The arrest team is led by the Rapid Response Team doctor, usually an ITU registrar. There will also be an anaesthetist, senior nursing staff, PA's and porters. This can lead to disorganised management but equally, when well led, excellent care. It is usually advisable to get involved and stay involved if early on the scene but if a late arrival to check that you are not needed and then give the team space to operate.

Consultant management styles vary massively and with the frequent rotations this can be a big challenge for juniors, especially over Christmas when the boss will change every few days.

Dr Pugh performs many of the procedures, both angiographic and device-based and it is worth liaising with your registrar and him to ensure that available capacity is effectively managed - for example, if patients are not fasted for a procedure but there are gaps on the list then discharges can be delayed and everyone gets annoyed.

There is a registrar assigned to the ward each week, and a separate registrar taking inpatient referrals to cardiology. The reg on referrals is always extremely busy, so if you need senior advice, ask your ward reg first. As an FY doctor if you rotate on to work with an SHO who has done cardiology for a few weeks things will be much easier than if you are both new.