Brainfog

Beanie has just explained less-than-fulltime stuff to me in a way that makes actual sense. Gogocaptainbrainfog. (Although it does seem that to do so has required a more sensible website than any I managed to find on my own.) It looks like we've made our decision, despite the best efforts of the med school to confuse everything. We link applications, go where the wind blows us, hope it's our home deanery so that we have a support network to do this thing, and I apply for less-than-fulltime and hope that wherever I end up is a flexible as it sounds they can be.

Please remind me of this very sensible, and not all that complicated plan the next time I have a meltdown*?

I will aim to return to less panic-stricken, more on-topic posts in the next few days, everything being as it is. Although what with the imminent dissolution of the NHS and the welfare state, there is no guarantee that on-topic posts will be any more relaxing.

*All forecasts seem to indicate 7.30am tomorrow when I'm about to leave for placement.

On fuckwittery, and paperwork.

This is a really long post, which is in essence two joined together, but I'm too tired/fogged to figure out a more sensible arrangement.

I promised myself that I wouldn't let this blog make this look easier than it is. Every time someone tells me to 'just' apply for DSA or 'just' take a year out to sort stuff out or 'just' apply for less-than-fulltime work, it cuts a little deeper. I promised myself that I wouldn't gloss it into 10 simple tips to deal with being the 'problem' in the system.

The truth is chaps, within the current system, it's bloody difficult. There will be a lot of fuckwittery and a lot of paperwork. You will have to overcome the urge to punch each person who says "but that's 'just' the way we do things (so deal with it)" and can't understand why that's not justification for not changing something. Med school will make you find your physical and mental limits, and struggle like mad to defend those limits. And a lot of the time, when the training programme looks like it's just going to be a shitload more of the same nonsense you will wonder why you couldn't do something else with your life (before you remember that you'd probably just revisit the same issues in a different form).

The only advice that I, or anyone else can truly offer is this : always keep in mind why it is you're doing this (and recognise that this will change over time), and know what you are willing to sacrifice to get there, and what you are not.

Things are really rough at the minute, and I offer the reasons why as an example of 'just' how difficult it can be to play this particular game. This is a pretty bog-standard worry list.

1) My SI joints are out and my back is in spasm. I have considered phoning the GP to ask for some drug-related assistance on that front, but being as he thinks that the tramadol is far more than a 23 year old should be taking, that seemed pointless.

I still haven't found a way to sort things out with my GP, and now whenever I think about trying to talk to him about anything I cry. [now is not the time to suggest that I 'just' switch GPs] Advice from any fellow medics on this score would be appreciated. I fear that most other GPs would present similar problems.

2) Placement is a 40 minute bus journey away, which is tiring and sore. I can't take the current wheelchair on the bus, because it's too heavy for me to push outside, and to lift (rush-hour buses "don't do" ramps), so that means a £10 taxi journey, which I can't afford because I still don't have DSA (because no matter how easy it is once you've actually applied, my very best efforts are not enough to persuade my mother to sign a form and send it to me so I am as yet un-funded for the year, thus have no funding body to claim from). There are several closer hospitals, but I am in the current one for most of the year. In many ways it's better in terms of input, but that's useless if I'm too much of a zombie to take it all in.

3) Job applications. We have decided (almost) not to apply for special circumstances after I spent the best part of 2 days sobbing every time I thought about it. Not because of me, but because of the stupid, agressive questions that Beanie (which is now the mrs's's's pseudonym, bien sur?) would have to answer. (I just opened the form to find an example am now crying again - see the end of the post for these questions)

BUT we're not quite sure of one thing - if special circs can dictate more than ending up in a specific part of the country we might need them, because I'm having serious concerns about slotting into part of a regular rota (I think that 13 hour long days would end with fainty, vommy junior doctor, and that's not really what you want as a patient...). The deadline is coming up soon, and we have no idea what to do / if it's possible for part-time foundation years not on a pro-rata basis. We can't meet with the person who might know until a couple of days before the deadline (and not for want of trying to bring it up earlier...)

4) And in the middle of this, I'm pretty sure that depression has slipped in without me noticing again. Of course, it's hard to tell amidst fatigue and big'n'scary decisions. I am so scared of getting ill in this particular direction again, because services screwed up pretty dramatically last time, and I'm pretty sure that this fear clouds the waters still further.

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And you know what? I am so keenly aware that I'm one of the privileged ones - I'm one of the ones who made it to medical school in the first place - other disabled people, other folk from less-privileged backgrounds (especially now with the tuition fee hikes), other women in some parts of the world - so many folks don't get to this point of being on the inside and bitching about it. That's the part of this I don't talk about often, but it doesn't mean that I'm not thinking about it. I know that the system's not only broken for me.

I'm so tired of fighting fires distracting me from trying to make the course that I love truly and joyfully accessible. That is one of the reasons that I started this blog, and that I'm exploring the possibility of forming a support and campaign group for disabled students within my med school. I have to leave it that bit easier for the next person.

So, here are some of the questions necessary to answer should Beanie wish to apply for Special Circumstances in FPAS as my carer :


"What happened (or will happen) to the person you care for while you were (or will be) on your elective? Who cared (or will care) for them during this time?"
- answer : So many assumptions in one little question! It assumes that everyone can travel for their elective, it assumes that the care-ee isn't doing their own elective...

"What other services does the person you care for utilise e.g. social services, private carers...primary health care team? Have all local support resources been fully considered?"
- answer : Once again, I am also a medical student. I cannot consider "local support resources" until I know where I'll be living. Secondly, non-professional carers often take on that role because outside help does not fall out of the sky. (Remind me to tell you about trying to access a Social Work assessment during another rant...)

"How do you plan to combine these responsibilities with a full time F1 post, which involves irregular shifts, nights and weekends? (Foundation doctors cannot necessarily guarantee to leave exactly at the end of their shift every day.)"
"What arrangements will you have in place for unexpected or planned periods when you will be unavailable? What will happen, for example, if you have a week of nights, you are unwell, or you go on holiday?"
- answer : We don't know, for several reasons. Firstly we don't know if we'll be living here, in which case there is always someone I can call for help if I really need it. Secondly, we don't know how accessible the housing we will be living in is.

However, the main thrust of the answer is that when Beanie is working odd shifts, unless I manage to get a level of DLA/PIP that means I can pay for some help, I will be severely limited in some activities (those that involve leaving the house), and other things will have to work around her schedule (like showering). I will also be at risk when I'm in the house on my own (for example during the night I often fall down and need help to get back up).

It should be pointed out at this point that medical school is anything but a regular schedule or commitment, so anyone applying for special circs as a carer will already have been dealing with these issues to some extent.

--

If you think that I'm being unreasonable, please note that parents do not get asked any of these questions, or any like them (nor should they). These questions are designed to catch out people who are claiming carer-dom for the convenience of staying put, but surely getting a GP / Social Work to certify that someone is a primary carer would be as effective a way to deal with that (being as if someone was determined to lie their way into this, they could do it anyway...). Although even with that suggestion there are problems, for those who do not have supportive professionals around them to confirm their caring role (this is a big problem when applying for benefits etc).

They also require a copy of a 'care plan'. When will people realise that not all of us who need input from professional services get it? What is the point of Beanie preparing a written care plan, just adding to the work she has to do for me? And plus, the variable nature of my condition would make that bloody difficult anyway.

I'm sure that if I brought these points up with whoever decided on these questions they would say "Oh, we didn't think about the fact that the care-ee could be another medic" or "We need to make sure that people aren't trying to play the system". To me, and others like me, the intent doesn't matter - what matters is that my partner is being made to prove herself yet again to a bunch of strangers, that once again noone has considered our situation as a possibility, that this is just another way to make the application process harder and more complicated for those who don't tick the right boxes.

News Stories : Doctors with Visual Impairments

Over the last few years there have been several stories in the national press about disabled doctors or medical students. Most seem to focus on those refused entry to medical school or jobs because of their impairment, although there are a few "Dr Suchandsuch is a surgeon even thought he's in a wheelchair!!!?!". A lot of these stories make for sobering reading, and show the variety of attitudes that are held about disabled doctors, by both patients and colleagues.

The first story I would like to draw your attention to is that of Dr Jemma Saville, who acquired a visual impairment during her time at Southampton medical school. She has shared her story in her own words here on the BMA disability pages, please go and take a look. Dr Saville was unable to find a job after graduating, despite having provisional GMC registration.

"Disabled doctors have so much to give; granted that with a disability you can’t fit into all areas of medicine. I know I can’t be a surgeon, and I don’t want to be. But the system should recognise people’s strengths, and play to them, not just quash anyone who can’t do every single thing. Every person and every doctor has strengths and weaknesses, and disability is just an extension of this. In closing the doors to people with disabilities, the doors will be closed to all sorts of amazing talent..."

She wants to train as a psychiatrist, a field that she believes would play to her strengths, but this has not been possible for, I imagine, two reasons :
1) Concerns over patient safety / her ability to do the job
2) The design of the training programme after medical school

The first point I will not go in to - I believe that if a medical graduate, their medical school and the GMC all consider them capable of proceeding, then it is not anyone's place to argue otherwise.

However, it makes clear what I have found to be true in my trawling of the internet - there is a lot of prejudice and ignorance surrounding the idea of doctors with visual impairments. It provokes some of the most extreme views. For some reason folk seem less able to understand that there is a spectrum of visual impairment - they seem to understand that concept much better in relation to something like mental health problems*.

The (very) general(ised) view seems to be that "if you can't see, of course you can't be a doctor" - which I would argue shows ignorance of both visual impairment and the nature of the medical profession. (Although add 4 little words "...in the current system", and you probably have a not-unrealistic idea of the current state of affairs - for example, see this news story as an idea of the kind of adaptations that are possible) The clincher of such arguments is "and they'll always need to have someone with them to look at stuff so it's inefficient" - but in an age of holistic, multidisciplinary, patient-centred care, no one clinician would be expected to do everything anyway. Very little of my training has been to do with sight - far more to do with communication, with problem solving, with knowing how to react when the [bad word] hits the fan.

The concept of "limited registration" whereby Dr Saville could, for example, be licensed to work as a psychiatrist, but not a surgeon, doesn't exist in the UK (at least, it happens in practice, but it is not part of the regulations governing the licensing of doctors). It happens in parts of the States, I think. There are advantages and disadvantages - namely reassuring everyone that noone's trying to do anything they can't, and not wanting to ghetto-ise a group of doctors or make their license somewhat second class.

My second point was linked to the design of post-graduate training in medicine. You've already explored with me the challenges of trying to fit my non-standard self into a one-size-fits-all training system. Having a national application system is good in some ways - it streamlines the application process by avoiding filling out numerous applications and it is standardised which (is supposed to) reduces bias. My major problem with the system (other than such a heavy weighting being placed on a set of ridiculous questions) is this :

In order for the system to work a set number of 2 year posts have to be created out of the need for various numbers of doctors to staff various wards in various specialities. Once these posts have been created, it makes the system hugely difficult to navigate as a "non-standard" applicant.

For example, in order for Dr Saville to complete her 2 foundation years all in psychiatry (besides drawing up obvious questions about what the minimum general skill set is that you need to acheive before passing on to specialist training, and whether you could get enough exposure to other specialities - no system of the body existing in a vacuum) it would involve chopping and changing up to 6 other roles, which have at that point already been advertised and applied for as is (because under the current system Dr Saville would not have been able to disclose her needs until after the point at which she had been offered a "standard" role). The same will be true, for example, when I apply to complete my foundation years on a less than fulltime basis - other roles will have to be created or adapted to "fill in the gaps" for me.

From all of the peope I have talked to, and the stories I have read where I can find them, it seems that folk have a much easier time - in terms of work - when they acquire an impairment later on in their training or career. It is not unusual, for example, for those organising specialist training to deal with less-than-fulltime arrangements, as by that point a lot of doctors are having children. Colleagues are much more likely to make an effort with adaptations for someone who is already a known and respected part of the team. Of course this is not always the case, but it seems to be the general pattern.

There are many stories like this, many thousands who have been rejected by our profession at whatever stage. I don't know how to make change - I don't know how to make medicine an accessible career, or how to make the NHS an employer that delights in the diversity of its workforce. I'm just reminded of the words of Kaliya Franklin and The Broken of Britain :

"Alone we whisper, together we shout"

On which topic, I had some interesting chat with my disability advisor today about how we could start a conversation between medical students who are disabled or living with chronic illness at my uni. I think it has potential to be quite exciting. =)

Would you like to write a blog post about your experiences as a medic who is disabled, living with a chronic illness or a carer? Leave a comment or email disabledmedic[funnyatthing]hotmail.co.uk

*That is not to say, unfortunately, that there is not prejudice surrounding mental health problems in the medical profession. Indeed, I have experienced more stigma among medics than in any other sphere, except perhaps the church.

Seph : Special Circumstances and FPAS

[Several years on from this post and I have successfully applied for Special Circumstances to stay where I trained. For more up to date information please see www.foundationprogramme.nhs.uk]

Some more on the Foundation Programme! Don't ever say that we're not thorough... Here is another guest post by Seph which looks a little more closely at applying for special circumstances within the application process (specifically, reasons you need to stay in your 'home' - read medical school - deanery to work). Thanks Seph =)

In order to tie in with Flo's series on FPAS, I want to write a little bit about special circumstances. This is a process by which you can try to demonstrate that you have a particular need to have a job in a particular foundation school (and deanery). If you are successful, you are allocated to that school ahead of the general allocation process.

I should mention at this point that I did not get special circumstances, because I didn't apply in time, because I assumed I didn't qualify. I was then advised to apply on the basis that I would be more mentally stable if I didn't have to move across the country. Which I would have been. So: make no assumptions! If you think you might benefit from it and you can think of some justification, apply. At the least, email your med school's pastoral support person (particularly if they know you) and ask them what they think.

So, to qualify for special circumstances you need to a) have children, b) be a carer, c) have a medical condition (physical or psychological) or disability for which local follow up is an absolute requirement. There are also educational special circumstances which we will discuss in a minute.

Obviously point c is the more relevant here, and the one under which I tried to apply. Note that their idea of an absolute requirement varies – it may be that your area has a better speciality service than others, it may be that you are used to a psychiatrist or a therapist and would not benefit from being transferred, it may be that you have a surgeon who is taking an interest in your care. It doesn't matter what the reason is as long as you can justify it and get either an OH doctor, a specialist or (at a pinch) your GP to back you up. They have to write a report explaining about your condition, your ongoing treatment and follow up and – importantly – why said treatment has to be local. If you are going to apply, therefore, you need to discuss this with your chosen doctor well in advance and get them to write the letter well in advance so you've got it to hand in. Get your ducks in a row, as soon as you can. If you can get more than one letter backing you up, so much the better, and do it now. It is also worth noting that you can only do this is if you're applying to remain in your current deanery. You can't claim that you need local follow up somewhere else in the country.

Educational special circumstances is a slightly different deal. If you have special educational needs, your medical school will discuss with you what would be the best environment in which to carry out your foundation training. I should point out that the wording of this part suggests that this also includes an assessment as to whether you can “adapt to the working environment”. Make of that what you will. Anyway, your medical school can then put you forward for pre allocation to a particular foundation school.

Applying for special circumstances requires just a short form and the backup stuff. The form and the relevant guidance can be found on the Foundation Programme website at http://www.foundationprogramme.nhs.uk/pages/home/keydocs. The guidance document is pretty good, written in reasonably plain language and fairly straightforward. As these things go.

Special circs is not a certainty. Your application will be reviewed by a local and a national panel and your score still needs to meet the “national allocation criteria”, whatever that is. It won't guarantee you a job, either. You also can't link applications if you apply this way. However, it doesn't hurt (unless you're planning to link) and you might be eligible even if you don't strictly meet the above criteria. As I said above, if you can think of something that would medically justify your need to remain in your own deanery, give it a go.

Good luck!

Do you have experience of applying for special circumstances for the foundation programme? Would you like to write a guest post about any aspect of disability/chronic illness and medicine? Leave a comment or email disabledmedic[funny at thing]hotmail[dot]co[dot]uk

Foundation Programme : Applying for flexible training

[This post is now several years old. In fact, I am now working as a less than fulltime FY1 on a 50% pro rata basis. The first part of the application process is ranking your preferred foundation schools. When you find out which foundation school you have been matched to, you should contact them about working less than fulltime. They require at least 3 months notice before you would start work. In my foundation school the only official options now for the foundation programme are fulltime or 50%, although I know one doctor working on a supernumerary basis. You can be less than fulltime for reasons of childcare, health or for some professional reasons. I will write more about my experiences now I have the answers to a lot of my questions.]

Again, this is just my understanding, which is not a substitute for actual information being obtained from a proper grown-up, k?

This post has actually been several months in the brewing - that's how hard it is to get any straight answers on this topic. I still have plenty of questions left unanswered, as you'll see.

If you wish / need to complete the foundation programme on a less than fulltime basis, you go through the application process as normal, until you're allocated to a foundation school. Then it gets confusing, because you are then told to contact the Associate Dean for Flexible Training of the relevant deanery, even though you won't know which deanery you'll be in until you've got a job. The first area which needs further clarification.

As far as I understand from conversations with the med school, you wait until you have a job, and then you ask for flexible training. This is good in terms of anti-discrimination-ness, and would be fine if the NHS wasn't as it is. I'm just worried that they won't get anyone extra to cover the rest of 'my' hours, so other juniors will take up the slack, and everyone will hate me. Anyway...

My med school has already had a 'quiet word' with the relevant person in my deanery (with my consent, because it is for his ears only, and so that we can have conversations about the various options early - he is not part of the selection process). This is fine, as long as I get a job in the deanery I want to, otherwise I'll have a frantic few months trying to sort this all out, during my finals.

At this point you have to provide evidence to back up your reason - which are basically health or caring issues (although there are a variety of more unusual circumstances that can qualify). This then goes through the Associate Dean, and then to someone else (hospital, trust...?) who can approve or deny the application. (Apparently my letter of diagnosis from my consultant which the med school has a copy of is enough evidence. I hope this is true.)

That is the sum total of the information that I can find.

Flexible training during other stages is calculated on a pro rata basis (as in, if you're doing 0.6 of a fulltime job, you do 60% of the nights, 60% of the on calls and 60% of the hours. You also, as far as I can tell, get 60% of the pay, and 60% of the annual leave entitlement.), so I imagine this is true for foundation years.

However, there is no information about what would happen for those who cannot work night shifts, or who would need to work half days, for example. I personally need to know if I would be expected to work the same blocks of shifts as other folk (for example 12 days on) with just longer to recover, or if I could work shorter blocks, with more regular breaks.

There is also no information about how the programme works on a LTFT basis. Do I do 4 foundation years? And if so, do I get a 'normal' F1/F2 allocation, and then have to find locum jobs to bring up my hours, or do I get allocated to 4 years worth of job? When in those 4 years do I get my full GMC registration? After year 1, or after I've done a 'normal' 1 year's worth of hours?

There is so little information about this, which is really frustrating. Why should I, as a disabled applicant, have less of an idea of the application process I will go through than a non-disabled applicant? The long and short answer is that so few people do flexible training during foundation years that it's really dealt with on a case-by-case basis. Not helpful.

Yes, we are individuals, and a lot of applicants for flexible training will have different needs, but even a recognition of that would be useful. There is just no indication about how 'flexible' flexible training can be, if needed. This is a real flaw in the one-size-fits-all national application process. Obviously, I haven't been through the system that came before, so I don't know if it was any better...

There seems to be every chance of me pushing my way through the application process, only to get a job and not be able to take it, because the hours will be unworkable. There is also no way to factor in things like travel time or relative accessibility of different wards / hospitals into the process, but that is another conversation entirely.

It just feels very much like disabled applicants haven't been taken into account, or properly catered for at any stage of the planning process.

Does anyone have any more information about flexible training? I've never even met any F1/F2 who aren't training fulltime.

Foundation Programme : FPAS and disability

[This post is now several years old. For up to date information on FPAS, please see www.foundationprogramme.nhs.uk]

Here are some specific things to consider related to FPAS applications as a follow-up to yesterday's post, again with reference to the 2012 applicant's handbook :

- Some with evidence of a good reason they need to be placed in a specific foundation school (for example, school-aged children, staying with a certain healthcare team) can apply to do so. The application and evidence must be submitted by 29 Sept. However, this isn't a guarantee that you will get a job in this foundation school - you still have to have as high a score to be allocated a place as you would otherwise.

- The form does ask if you are disabled or have health problems. This will not affect your allocation to a foundation school (which is based purely on your score), but the foundation school will see it. Bear in mind that it takes time to put adaptations in place so it is probably wise to disclose at the time of application. You can tell them later in the process, but you don't want to give folk any excuse to not adequately deal with your needs.

*Edit : I am investigating this point further, in relation to a comment left below.*

- If you want to link your application to somehow - which may be extra important if, like me, your partner is also your carer to whatever degree - bear in mind two things :

1) You will both be assigned based according to the lower of the two scores

2) Linking applications will limit the number of posts you can apply for, because not all posts have a suitable 'sister' post that will work.

You need to talk this stuff out in advance, to avoid nasty surprises.

- Your referee will be asked if you have any health problems which will have an impact on your work. I think that this is really odd. To be frank, I don't think it is your referee's place to disclose personal information about you. For one, these referees are colleagues/supervisors - and my health, or lack of it, is none of their business to start with. I don't think it's appropriate, but maybe it's a standard questions for employers to ask referees, I don't know.

- The handbook points out that spelling and grammar mistakes can cause you to be marked down in the questions section. I would suggest that if this is likely to be an issue, you ask someone to proofread, which is allowed (and is probably a good idea anyway).

Foundation Programme : FPAS, the basics

[This information is now out of date - please see www.foundationprogramme.nhs.uk]

Hey gang. I'm doing some research about the foundation programme today* because the applications are slowly sneaking up on me, and I need to get some things straight in my head. I'm hoping that Seph's going to help me a little bit, because she's just jumped through all of these particular hoops.

I'm planing to start off with the basics of how applications work (because every time I think I have it straight I end up thinking "but what the hell is a foundation school?"** and that's me back to square one). I'm using the 2012 Foundation Applicant's handbook (available here) for reference. Note, this post should not be considered the final word on anything, this is only a summary of my understanding. Refer to the handbook or other official documentation. Thanks =)

Application Form

You will register on FPAS between 3 and 10 Oct, ready to complete the application form between 10 and 21 Oct. The form consists of :

Personal Information - unscored : includes address etc, but also whether you want to link applications, and if you want to disclose an illness or disability (which I'll discuss tomorrow)

Qualifications - unscored : degrees awarded and such - also what you've been up to if you've not gone straight from med school into F1/F2

Clinical Skills - unscored : a tick list of skills supposedly so that your employer knows what you need to cover during F1/F2. I wonder if anyone actually looks at it?

Equal Opportunities - unscored : for the foundation school to see whether they're getting a good enough mix. Doesn't seem to include sexuality, which is odd as most forms like this seem to.

References - unscored : one doctor who can talk about your clinical skills, and one from someone within the med school (they have from 16 Dec-24 Feb to do it, but basically if you don't have 2 for your employer by August you can't start work). The list of questions they'll be asked is available in the handbook, one is of particular relevance here, which I will discuss tomorrow.

Preferences - unscored : you have to sort every foundation school into order of preference.

Questions - this is the only scored bit : 1) Education Achievements - other degrees, publications etc are scored up to a maximum of 10 points. 2) 5 questions, requiring a 200 word answer, which are related to the "Person Specification", which are worth up to 10 points each. The scoring of these seems to have no rhyme or reason, which will explain why all the people that you think are the best in your year won't get a job in the first round.

Quartiles - as far as I know, these don't go on the form and supplied by your medical school. Basically, you get points out of 40 depending on where you stand within your class, which takes you up to a score out of 100 - you cannot appeal this score. Irritatingly enough for me this will mean that the last assessment which will count towards this is 3rd year exams, which will be more than 2 years ago when I apply. Finals happen after application, and in terms of F1/F2 all that matters is pass/fail.

What next?

If you score high enough to get a place in your favourite foundation school then that's you. Otherwise you move down the list until you end up in your favourite of the foundation schools that you score highly enough to get into. (I believe this is a slightly different system to last year)

By 8 Dec if all goes to plan you will be told you have a place at your favourite foundation school. Otherwise you'll be told that you're on the reserve list, and what will happen next. I don't really understand the explanation of it. Once you have a foundation school, you apply for actual jobs - the system for doing this differs from place to place. Some have interviews, some have to rank every.single.job. in order of preference, some have it easy... You will find out your job on 15 Feb, unless you are on the reserve list, in which case you will find out between May and July.

Apparently, at some point this year we're also supposed to fit in a Situational Judgement Test, as a pilot for next year's applicants. I believe this will be an hour-long written paper. (Will extra time be allowed I wonder?) They're also piloting a new score - the Education Performance Measure - which I think will just involve them doing calculations based on information about us they already have.

*Foundation programme = first two years of postgraduate training out of medical school, aka F1 and F2

**Foundation School = not an actual school - made up of all the med schools, deaneries, hospitals, NHS trusts etc in a given area (Scotland, Wales and N Ireland are all foundation schools, England is split into regions). To be honest, I'm not entirely sure what their role actually is.

Guest post by Seph : how to survive moving house

As you will have noticed, this is a guest post. Assuming Ms Disabled Medic approves it, this will be my first guest post, but I hope to write a few more in time.

So who am I? I'm a medic, although I have now completed my studies and I'm about to start work as a junior doctor or FY1 as it's known. I have just (as in two days ago) moved about a hundred miles, which was, er, interesting.

I do not consider myself disabled, but for a long time I have had an undefined depressive illness. Medical school presented some interesting challenges which I hope to discuss at some point - tips for surviving final exams, special circumstances in MTAS, starting work and so on.
This post talks about moving house, because it's something that medics tend to do a *lot*, and it can use an awful lot of spoons. It's commonly known as one of the most stressful life events to go through. My partner is dyslexic so he and I both tend to get very tired when trying to do certain things. I also have a quite limited capacity for stress and things going wrong before I lose the plot. This post comes from our collective experiences over the past couple of weeks.

1. Know your limits. Figure out what you can do and what you can't. Ask people for help, pace yourself, and if you can, pay removal companies to do some things. If you know you can't shift your worldly possessions up three flights of stairs, don't try. You'll only end up knackered and that doesn't help. Don't feel bad about not doing everything. Everyone has limits.

2. Rest appropriately. If you tend to get fatigued you probably know your limits pretty well anyway, but this can go out of the window when you're trying to get so much done, particularly if you're working alongside someone who has different limits to you. Don't feel guilty if you need to take more breaks. You might feel like you just want to get it over and done with but you know the reality is it will get done faster and better if you're not exhausted.

3. Make a "home" space early. Pick one room – bedroom, living room, whatever you want (although it needs to be comfortable, so maybe not the bathroom!) - and make it as homely as you possibly can as fast as you can. This means unpacking that room first, arranging some of your bits of artwork, photographs, books, cushions, birthday cards or other familiar, homey items, and moving most of the boxes out. This way, even if the rest of the flat is total chaos, you have one area where you can go to rest and relax a little. When you're freaking out because the place is a madhouse and there's loads to do, you can go to your “home” space, take a few deep breaths and feel a bit better. A plant or some flowers might also help, plus your stereo or tv or even just a clock for some friendly noise.

4. Talk. If you have a roommate or a partner, sit down with them well before the move and talk about it. Even if you know each other well, moving will raise unique issues and it is worth going through them. Try to make a rough list of tasks (changing addresses, organising particular rooms, etc) and decide who could do each one. It won't work out exactly that way, and there will always be things you miss, but having a rough plan and a good idea of each others' abilities and limits will help.

The picture shows a variety of cardboard moving boxes taped shut

and stacked up in piles. By skrewtape on flickr.

5. Take your time. Start packing in plenty of time before the move (more than three days. Oops!) and don't expect to have everything sorted out the day after. Be realistic.

6. Figure out what you need. Is your support network largely on the internet? Do you need to have a working phone line for emergencies? Do you need to set up clinic appointments, blood level monitoring or counselling? Whatever it is, make sure you have it in place well before you move. (I suggest looking into these things at least a month in advance because it always takes longer than you expect.)

7. Figure out what you need (part 2). If there are any items you absolutely need - splints, meds, hot water bottle, whale song CD, blanket, cat, whatever - make sure you know where they are and that they're not at the bottom of a huge box (particularly the cat).

8. Arrange food. The last thing you want to do after a day's unpacking is cook, so make sure you have something sorted out. You'll be hungry and tired and you need something good to eat that will give you energy, not just junk food. Make some sandwiches or just put some tupperwares of food where you can find them. This is particularly important if you have a specific diet.

9. Get your prescription. If you take any medication, regular or PRN, make sure you have *at least* three weeks' supply before you move, from your old GP. It might take you a wee while to find a new GP and you don't want to run out. Also make sure that you have a copy of your repeat prescription, any relevant clinic letters, and if necessary (e.g. if you take opiate painkillers or odd doses of things) a letter from your old GP explaining your medication regime. Anything which makes it easier for your new GP to give you your medication is good. Your notes will take a while to come through, so don't rely on the new GP being able to access them.

10. Go outside. Being surrounded by boxes is overwhelming and unpacking creates a lot of dust. Go outside at least twice a day. Explore your new area or just sit outside the house and breathe the fresh air. At the very least, open a window. It will help, I promise.

Moving is hard work and it's stressful, but you'll get there.

Have you moved house recently? Did you find that it presented you with any particular challenges? What tips do you have?

Questions

Over the next few weeks, I'm going to try and find out some answers to the following questions. If you know the answer, or how I might find out, please let me know in the comments. If you'd like to add something else to the list, then leave a comment and I'll do my best.

- What support is available through the BMA for disabled med students
- How to access the BMA chronic illness matching scheme

- What adaptations have been made for people during their final clinical exams, especially those with pain / fatigue issues

- What some other people's experiences are of being a disabled medical student or junior doctor (if you'd like to write a guest post, let me know)
- What some examples of med schools being good at dealing with disabled students are
- What equipment is available for D/deaf and visually impaired/blind medics (I'm curious)

- How less-than-fulltime FY1/FY2 years are structured, other than the basic nights and weekends on a pro rata basis stuff (for example, will I end up doing 4 foundation years? will I have to apply for the last 2 as a locum, or will they be sorted out for me? etc)
- Whether Access to Work or Occupational Health can be any use in providing adaptations for the workplace, considering how short junior posts are