Zoe Hughes will sort you out with a fantastic 'welcome to urology' document. This has a list of consultants, teams, guide to on call and loads of other uro gems to read and digest before you start. Team is very friendly! You will have a local induction at some point. They will email you about this.

Based on N2 - 22 beds all side rooms.

Senior Sister Lourdes Samson

Main doctors office is in corner of ward.

Staff room at the entrance of the ward.

Kitchen where you can make tea, get a drink etc.

Catheters cupboard - opposite nurses station in room with a bed.

Downstairs in ATC theatres there is a much better range of catheters inc tiemann, dufour, council tip, 3-ways… clinic 4a is another useful place to find consultants, along in outpatients on the 3rd floor

There are 6 key teams: 1) Bladder Oncology - Miss Colquhoun, Mr Thomas, Mr Turner 2) Kidney Oncology - Mr Aho, Mr Armitage, Mr Riddick, Mr Stewart 3) Prostate Diagnostics - Mr Kastner, Mr Gnanapragasam 4) Prosate Oncology (Robot) - Mr Bratt, Mr Shah 5) Reconstruction and Female - Miss Biers, Mr Thiruchelvam 6) Stones - Mr Hayek, Mr Wiseman

There are registrars and clinical fellows who rotate between the above teams

Jane is the stones specialist nurse - any patient with a stone - let her know. Lourdes Samson is the charge sister and can be an invaluable source of advice/liaison with nursing team. (She also loves cake!) Generally, each week, the consultant on call changes and the registrars on call change daily.

Usual day set-up, involves FY1s and clinical fellows helping with several ward rounds which take place from 0730. Reviewing patients from different teams (looked after by different Consultants and Registrars). Carrying out the various jobs throughout the day. FY1s may also get bleeped by day surgery to do various jobs (TTOs, prescribing, catheters).

For clinical fellows: rotas are 7 weeks long (7 clinical fellows) We've recently been attached to a specific team so Stephanie will email you which team you are with and their rota. 1) 4 days on call, fri off 2) normal week, fri/sat/sun oncall 3) normal week, half day fri 4) mon-thurs off pre nights, start nights on the fri 5) week of nights 6) annual leave 7) normal week

For FY1s, there will be a general split of 2 month acute block/2 month ward block. Acute block involves more of your acute shifts, i.e. general surgical nights, general surgery ED days, and weekend on-call shifts. Ward block places you predominantly on the ward with a few on-call weekends. These do not include covering urology.

Depends on what team you are with but will include a mix of clinic work and theatre time. There is flexibility to attend things not on your specific rota but you'll just need to check with your team that you're not needed at that session (ie if there's no reg you will be needed in theatre) Also room to spend time doing research/audit work. There's a lot going on so just ask around for projects.

FY1s: normal ward days (0730-1730) will consist of being on the ward (N2) and the requisite duties; i.e. ward round + jobs. Twilight shifts (1100-2100) means you cover ward duties on N2 between 1100-1730, then general surgical wards/ATC cover from 1730-2100, collect the relevant bleep at 1730 - you will be expected to go to evening surgical handover in C7 office (1930) to pass on any outstanding/follow up jobs to the night F1. ED days (0730-2000) means you will be covering general surgery admissions in ED on surgical bleep - go to C7 office for surgical handover at 0730. If things are very quiet, you may want to lend a hand to your urology colleagues if they are busy, but your priority is still most definitely ED general surgery. ATC/Mainblock weekend ward days (0730-2000) means you cover surgical ward duties on the weekend for either ATC (colorectal/vascular) or main block (UGI/HPB) - go to C7 office for surgical handover at 0730. Sometimes, it may be better to swap with your F1 counterpart so that they are allocated to their home team/consultant i.e. swap if an HPB F1 is allocated to ATC, and you are allocated to main block - but this depends on the situation and may not be necessary.

Be aware that you may also need to cover L2 (day surgery) to ensure day surgery cases PTA medications and VTE assessments are completed.

To note: FY1s do not cover urology when on call!

If you want to go into theatre, the SpR's are normally very happy for you to come in, you don't have timetabled theatre time. Just speak to your fellow FY1 and organise someone to stay on the ward.

For normal shifts get in before 0745 to help out with ward round (before 0730 for FY1s to secure a WOW and print lists). There is a laptop for the N2 ward if you can not find a WOW. Lists can be compiled from 'Services; Urology' and 'Teams; Urology' on e-hospital. There is also a handy list called 'VTE urology' that the clinical fellows can share with you as this will have all the urology patients on and sometimes there are Gen Med patients on N2 as they are all side rooms. There will be a few rounds going on simultaneously (usually the reg from each team). They will see who's free in the office F1-wise/CF but plan was to try to stick with your team. Check F1s are happy with jobs/ help out if there's just one F1 on the ward. Clinical fellows & SpRs then head to clinic/theatres after WR. They tend to pop back to the ward around lunch time, check all ok, and then go to theatre/clinics again in the afternoon.

For FY1s:

To handover jobs to on call clinical fellows in the evening, write a list of jobs and ideally contact the on call CF to give a formal handover. It is best to tape the handover sheet to one of the computer screens so it is easy for them to locate when they return to the office. When creating a list of jobs for the weekend, update the “To do” section on the VTE urology list and print off a copy and again tape it to one of the computer screens in the office. The registrars will do a weekend summary for each of the patients on their notes with a list of jobs to be done over the weekend as well.

For clinical fellows: On call handover is 8am and 8pm. Reg cover is from 5pm to the following morning so during the day you contact the consultant on-call directly. They do a week on-call whereas the regs' do one day a week or the weekend. SHOs will see acute admissions and get ward referrals during the day. Try to see the refs if you have time then any issues you can go with the reg after 5 and see them together. Depends on which consultant is on (some are really hands on and want to see patients as they come in, others hands off and leave you to your own devices) We've been trying to do an on-call list on epic with access given to whoever's on-call that week.

See the urology guide doc. that Zoe Hughes (helpful as an initial guide) will send you but in a nutshell… commonly:

frank haematuria with complications (clot retention, symptomatic anaemia) urinary retention >1l renal colic pyelonephritis (comes under urology here!) post-op complications torsion

and some not so common trauma priapism paraphimosis penile fracture zipper injury…

For those patients that go into ileum - try and organise TPN (if required) early and do not forget TPN bloods everyday. Speak to the dietician for any advice!

Urology is an excellent time to get catheterisation signed off (you can get it as DOPS if you put a 3-way!!)- do not be afraid to ask the nurses to show you how to do bladder washouts!

ED admission and GP referrals Elective admission (usually down in L2 day of surgery unit) High ward turnover as most are relatively well Cystectomy patients are the main 'unwell' group but the bladder onc team are very hands-on and supportive Bladder team are quite specific and would like to know if there is any deterioration in their patient. District nurses can do twocs and catheter/nephrostomy care Specialist nurses can remove stents But follow up is usually clearly stated on op note/SpR note on WR and sorted by the managing surgeon/SpR/FY1.

Will have to call barium suite & angio suite often to organise loopograms, pouchograms, nephrostomy insertion, stent insertion etc.

(always ask the 1st time you do these- and get them signed off as DOPS etc). Seniors are happy to supervise as long as they are not in a rush to be anywhere.

Catheters - use a couple (2) of instilla gels, go bigger / smaller / dufours / etc etc until you get really stuck. Tiemann tips for prostate problems!

Bladder washouts - 50ml bladder syringe, sterile water, sterile pot and other cardboard bowls. Gentle 20 - 50ml in, slowly draw out. Use with a 3 way catheter

Post robot patients needs FBC at 6am the next morning - normally ordered by the surgeon but ensure they are done. Also ask for the EPIC ward round short cut for the post robot patients as it has all the relevant follow up information and instructions which you can use for the TTO and explain to the patient if they do not remember from the Ward Round. Do their TTOs first as they tend to go home at lunchtime.

Post cystectomy patient's are extremely precious and tend to a large proportion of the more unwell patient's on the ward. This means that as a junior if you are the only person on the ward and cystectomy patient is deteriorating or looking poorly, it is important to inform the bladder team registrar as soon as possible. The earlier these patient are picked up as being unwell, the greater chance they have of recovering from it.

When doing discharges, there are two printouts pinned to a pinboard over one of the computers. These have details of any follow up imaging required for each patient and the duration of dalteparin required. It also tells you when the patient requires follow up with a consultant and their clinic codes are all available on the sheet next to it.

For SHOs: Handover for on call is 8am and 8pm in M4 doctors' office When on-call, it is SHO and the consultant during the day. On call reg's start at 5pm and usually see the ward referrals then will r/v day admissions if the consultant hasn't seen them. They'll usually head home in the eve and you can contact them on their mobile. On-call days, SHOs generally get GP queries in a.m, then A&E and ward referrals. Any acute testes, notify consultant immediately and see immediately. During normal days Clinical fellows are assigned to a team but are pretty flexible in what they do (clinics, theatres etc) and we don't have a bleep! Important to keep up-to-date with the F1s and ward jobs.

When first starting out on the urology rotation, put your number on the board in the doctors office in N2. Also, get the phone numbers for all the SpRs on the various teams and clinical fellows so you are able to contact them for advice/to update them on their patients. At first, the number of people and various teams can be overwhelming but they are all really friendly and helpful!

157 707- FY1 bleep

154 234- clinical fellow on call bleep

Personal mobiles- to contact the SpRs

If you need to book stone MDTs, the best person to email is Jennifer Ann Gore, with a summary of the patient's admission and she will arrange the MDT date. Alternatively, send her a message via Epic inbox.

A useful way to find Registrars is via seeing which theatre his/her specific team is operating on, using the EPIC 'theatres' tab - they will all be in the ATC (Theatre 33), and often it is more convenient for both you and them to go down in person and pass a message along than continually text mobile numbers (which may not be read promptly)

7 nights in a row is a bit of a killer (for clinical fellows) normal weeks are more easy going but theatres etc can often over-run 2 in 7 weekends…

The banding is 1A for clinical fellows The banding is 1B for FY1s

Good work life balance, generally leave on time

There are some info sheets on the board in N2 doctors office. They explain 'urology follow up' (particularly handy for TTOs), 'urology clinic codes' (for f/u relevant to the ops & teams), 'urology department team structure' and 'SpRs in urology & their phone numbers'.

Cambridge hospital urology website - good info for GPs and referrals. Worth having a look to know what info to give GPs, who can be referred (ie haemturia 2 week wait ) and who needs to come in

FY1s should make the most of opportunities to go learn new things in clinic/theatres if possible, especially if/when ward duties are light; the urology team is very friendly and consultants/SpR will be more than happy to accommodate you if they can - be proactive about it. Overall, the clinical fellows and SpRs are incredibly friendly and easygoing. SpRs are happy to be texted about advice and if there are any queries. They would rather know about their patients than not know!

If you happen to be the only F1 on the ward, do not be afraid to ask for help from clinical fellows. They may be in the ATC/theatre but free to help out for the majority of the time, just remember to check the weekly rota sent via email by Zoe Hughes!

Download the app “Induction” - it has every extension for the hospital and saves so much time!