No need to meet anyone specific before starting but go through all your shadowing on the wards, get stuck in to ward rounds, get to know the current FY1s and if possible the SHOs, registrars and consultants a bit as well.

Preparation: Oxford Handbook of Clinical Surgery is excellent. However time management, bleep management, delegation and organisation are the main helpful skills.

The registrars and SHOs have an allergy to bleeps so rarely carry them. Best to all swap mobile numbers and just call them. We had a whatsapp group for the team for things that weren't urgent or when we needed to catch up (use initials etc). Make sure that the previous F1s add you to that group before they leave. It will contain all the numbers of the Registrars as well. We also found it quite useful having a firm F1 group.

Consultants x5: - Mr Richard Hardwick (lead clinician): - Mr Peter Safranek: - Mr Andrew Hindmarsh: - Mr Vijayendran Sujendran: - Mr John Bennett

Registrars: - Mr Aggelos Laliotis - Ms Antonia Wells - Ms Loveena Sreedharan

SHOs: - FY2 bleep: 154232 - new bleep number

F1 bleeps: 154488, 157248, 154659

UGI nurse practitioners: Ben Smith - 07623 612516, ext 6383 Sarah Wilkinson - 154348, ext 6383

Secretaries Patz Harradine (RHH and PMSA): 3421 Andrea Pullen (ACH and VSUJ): 58024

Surgical coordinator Sally Watson

Upper GI Clinic (clinic 4): 2261, 2430

Main office: doctor's office, ward C7 (shared with HPB surgery - which makes the FY1 experience better and allows you to interact with fellow FY1s). Contains 4 computers (Printer is based at the nurses station). This is also the site of the general surgery morning (7.30) and evening (19.30) handovers.

Most patients you will see on ward rounds will be on C7 or in the 'ATC' (Addenbrooke's Treatment Centre, comprising wards M4, M5, L4, L5, and the endoscopy unit). Sick patients go to D4 (IDA), and very sick patients are in ITU (John Farman unit, D3) or NCCU in A-block. You can get outliers in any ward.

A lot of day surgery patients come in and all need TTOs - usually these patients are on J3 or L2DSU in the ATC - mostly the SHOs and regs in theatre will complete these, but if the theatre lists are particularly heavy you may be called on to help. With the new EPIC discharge system typically these patients will not need a medication TTO review and will just need a letter and this will save you time and mean the TTO does not need to be reviewed by the Pharmacy

Day Surgery cases will not always appear on the Upper GI patient list so it is important to make sure TTO's etc for these patients are completed during the day. You may be contacted by the team or the day surgery wards (J3 and L2DSU) to complete discharge summaries. Firstly check that the patient is under the UGI team and if the seniors are busy then complete it. Day surgery patients may not appear on the UGI team list but usually will be on the UGI list in “shared lists”

There are two laptops availble to use - new chrome books - you can take them with you for a ward round which will save you lots of time!! (hint - make sure you are using upper GI WR template). They are normally stored in secretaries office (left from the door, then on the shelf behind the desk on your right), please make sure they are always on charge.

Booking a patient into a clinic you will require the specific code: on the TTO enter Ref500 to bring up clinic follow up

Mr Hardwick ADD RHH

Mr Safranek ADD PMSA

Mr Hindmarsh ADD ACH

Mr Sujendran ADD VS VSUJ

Mr Bennet ADD JMB JMHB

ADD UGINP

4 month rotation, normally split into three 'blocks' as there are three FY1s on the team. At any one time, one person will be on their 'acute block', comprising some nights and some days in the surgical A&E team (seeing all the acute abdo pain / surgical problems that come in). Your other two blocks comprise ward work and are mainly similar, however in one block you are working normal days (7.30-5.30pm), whereas in the other block you work some normal days, some late shifts (11-8pm) and some weekend shifts - typically this period includes at least one exhausting 12 day stretch (two full weeks with a weekend in between). You get 9 days annual leave plus a decent quantity of zero days.

Typically the upper GI 'on call days' are Tuesdays and Thursdays and every other weekend (we basically do 1 : 2/3 with colorectal), meaning that post-take ward round days (all your regular patients plus all the new ones from the previous 24h) are Wednesdays and Fridays. This means that general surgical patients admitted on Tuesday and Thursdays will come under the UGI team unless they are handed back to a specialist team.

Monday: check weekend bloods. Ward round may be one consultant or multiple consultants doing the ward round. When multiple consultants do ward round each junior goes with one consultant

Tuesday: SpR-led ward round. RHH is in theatre. One of the consultants will be on-call.

Wednesday: 8-9.30am: consultants & SpRs are in Upper GI MDT. Mr Safranek is in theatre. FY1s not expected to attend. During MDT time order any tests needed for new patients. Prepare list of discharged patients in last 7 days (see instructions at bottom- discharge list) After this (and sometimes before this): post-take ward round. Ward round on wednesday is typically multiple consultants. They will go through the list in C7 then split the patients up. One junior goes with each consultant. After this at about lunchtime: General Team Meeting, usually in the Concourse. Consultants buy coffee and juniors provide biscuits or cake (they will love you if you have cake, especially if you bake). In the afternoon there is an endoscopy list.

Thursday: SpR led ward round. VSUJ in theatre. One of the consultants will be on-call.

Friday: Post-take ward round. All consultants have a morning clinic, the registrars and SHO almost always go as well. Endoscopy list in the afternoon. Friday afternoon jobs include updating weekend list very thoroughly with weekend plans; writing a handover for the weekend FY1, preparing TTOS for patients who may go home at the weekend and ordering bloods for Saturday, Sunday AND Monday.

7.25: arrive, prepare for ward round, find out if any overnight happenings, print out several copies of patient list (in landscape!). Grab the Laptops from the Secretaries office.

7.30: (meet in C7 doctors office) Handover from night team and patients are divided up between colorectal, upper GI and sometimes HPB team depending on clinical details. Usually helpful if a junior logs onto the computer so that the treatment teams can be amended for any patients, and imaging can be reviewed if needs be.

8.00am Usually UGI do a board round, going through the patients- observations, bloods, and imaging, Ward round begins. Try to keep up, write down jobs as you go along.

?: ward round ends; discuss with team re delegation of jobs and how to prioritise (we often write a jobs list), then start. Try to get discharge summaries done in good time (before evening) so that pharmacy has time to get the medications out. Often the most urgent jobs are seeing very sick patients and booking urgent investigations including endoscopy, theatre lists and radiology scans.

In the afternoon: check the day's blood results and if any scan results have come back; review any sickies if needed, put out bloods for the next day, discuss what remains to be done with the team, try to give a report of the day to a SpR or consultant and see if there is anything that remains to be done. Then hand over to the on-call late person (or night person if you are that late!), either by phone (bleep the twilight on call- you will find the number on rotawatch) or in person. Finally, update the patient list (or you could do this earlier in the day)- the seniors like to have up to date bloods on the list).

16.30-17.00: Meet up with either one of the SpRs or consultants to run through the list. They will want to go through the list on a computer and be updated with any developments and investigations from the day. Make sure that the list is up to date and you know what the plan for each of the patients was in the morning. The consultants are very approachable and before going home if you have concerns you can see if they are in their office on level 7.

Try to make sure you get a break / lunch in the middle of the day but it's often difficult!

The team has also acquired 2 laptops which you will be taught to use to avoid having to find and log into a computer on each ward (the team has a lot of outliers).

Range of cases from the routine common cases e.g. appendicitis, acute cholecystitis, acute pancreatitis - US upper abdo ?gallstones - US pelvis ?appendicitis (if male the addies special of CT proven appendicitis) - MRCP ?obstructing stones - ERCP - if obstructive picture and not recovering - Occasional cholecholostomy drain

Large resection operations for cancer patients (oesophageal ca, gastric ca) - CT ?leak ? Collection

Often VERY fast patient turnover - day surgery, appendicitis, gall bladder operations etc.

Cancer patients (oesophagectomies, gastrectomies) typically stay 10-20 days. Oesophagectomies are usually on an enhanced recovery pathway which involves IDA and then ward stepdown. Consider reading the pt info leaflets on connect as they give you an overview of how their post-op course should go. Both these patients require a total of 28 days of prophylactic dalteparin starting from the day of operation (ensure prescribed on the TTO) and a two week follow up in clinic with their consultant. The gastrectomy patients also require a review of their B12 and folate levels by the GP.

Often get elderly patients with general problems which you will need to keep an eye on and ask advice from relevant teams. May ask for a DME consultant to review (this is an order on EPIC) and this can be very helpful! The MDT is not as geared towards the elderly on a surgical ward so it is worth being on top of these pts social situation as this will facilitate earlier discharge and save you hassle when they become medically fit.

Occasionally get palliative care cases. Refer to palliative care early as they will be invaluable for advice on symptom control and community follow up.

Occasionally get very sick patients transferred from other hospitals, e.g. perfed oesophagus with mediastinal infection.

Most common jobs:

- practical jobs (taking bloods, cannulas, catheters, blood cultures, ABGs, removing chest drains are the main ones). As part of the UGI team you wll get used to taking out chest drains as oesphagectomy patients get chest drains. Once you get the hang of it, its fairly simple. PAs are available on Ward C7 till 3pm.

- reviewing sick patients (febrile, high resp rate, low BP, low urine output, blood in stool, vomiting, elderly patient who has fallen, delirium).

- ordering investigations (all investigations and bloods are now ordered through EPIC): CTs, MRIs and USS will all need to be discussed with the radiology departments. CT is on 6718 and US is on 2778. Then ring the coordinator. If you need an US urgently/US guided biopsy etc then go down to the department and speak to the radiologist who is doing the list that day. There is a current audit ongoing about unnecessary blood ordering - recommend alternate days if not clinically relevant.

- OGDs and ERCP/MRCP are ordered on EPIC and then triaged. If you want it urgently the best thng is to ring endoscopy and find out which consultant has a list and ring them directly to discuss the case (ogd) or again ring MRI and find out who is around who does MRCP and speak to them. There are only a few consultants who do ERCPs.

- Requesting reviews from other teams e.g. geriatrics, medics etc.

- Mortality and Morbidity meetings (once a month, or once-in-three-months over the summer)- try to keep an ongoing list of patients that need to be included. - There is a red book in the C7 doctors office that is currently used for this

- discharge summaries.

- Booking patients for theatre: more common on-call but may need to do this for patients who cme on take. If they decde on WR for theatre today, make sure it has been booked! If not you order it on EPIC as either elective or emergency (usually the emergency list)

You do have good support from SHO/SpR. The consultants like to be updated on their own patients as well. Do not hesitate to go to theatre 3 if you need to speak to the reg or consultant about a patient. For OOH, you need to escalate to oncall SHO or SpR if needed- either bleep them, call them or find them in emergency theatre (4).

I found the consultants to be very supportive if you have fairly urgent questions and if in the evening no-one has come to do the evening boardround they seemed happy for us to find them in their office. Just knock and see if anyone is there.

Switchboard: 100

A word on bleeps: 151-bleeps are voice bleeps, just leave your own extension number that you're calling from, twice - 'please call back on 4751, 4751, thank you' and hang up. 156-bleeps are direct dial bleeps, i.e. to call the bleep, dial the bleep number then your own extension number without a pause, then hang up. e.g. 1560544-4751. All other bleeps (152, 154, 157 etc): dial the bleep number, wait for a message inviting you to dial your extension; then dial your extension; then wait for confirmation that the message has been accepted; then hang up.

On call bleeps: Ward HO: 156-0544 A&E HO: 156-0545 SHO: 156-0543 SpR: 156-0316 Consultant: contact switchboard.

Banded 1b (40%). Most days you leave on time. The days when you stay till 7/8 are usually balanced out by the very light days when one of you can leave at lunchtime. Of most of the General Surgical specialties UGI has one of the nest workloads/work life balances. It can vary at times the patient list is fairly long and other times can be amazingly small (the consultants pride themselves on keeping the list as small as possible). If there are multiple of the FY1s on the wards and the workload is light its always worth letting one of the F1s go hom early then the next day the other FY1 can go home early.

CONNECT has everything you need pretty much including hospital policies, bleep numbers.

Useful patient info leaflets: Gallstones dietary information sheet Laparoscopic cholecystectomy consent form

Call 100 for Addenbrooke's Switchboard and access to other hospitals' numbers, ward / clinic / bleep numbers of anyone you want. ===== Other important information (top tips, the reality, what you wish you'd known)

Discharge list: The consultants like the FY1s to go through all the patients discharged in the last week and create a list. 1) What was the diagnosis 2) Do they have a signed off completed discharge summary (chart review- patient summary extracts- if current CUT IP discharge summary report there then has been sent to GP, if not need to go to chart review- encounters- click on recent admission from list- click on encounter stethoscope button- then you can finish and send discharge summary) 3) Do they have the correct follow up organised (patient station- appts) 4) Has this follow up been ordered (and if so has it been booked)

How to create the list (you can create loads of different reports in this way) 1) click red 'EPIC' top left 2) click 'my reports' 3) click 'library' 4) tick 'show templates' 5) CUH ADT previous 7 day discharges- click ' new report' 6) effective date from- delete and write T-7 (press enter) 7) effective date to- delete and write T (press enter) 8) provider- lead consultant (add all 4 consultants) 9) click save as, name it and then run (will include endoscopy patients who don't need summaries)