"Welcome to the Wales deanery..."

This is what I read that very day our placements were released. I thought it was a mistake. Wales was my 12th choice. I was upset to say the least. 

The next step was to rank all the jobs in the whole of Wales. I quickly realised that Wales is a country, not like small deanery in England. It's huge. Being from London, logic told me to rank the South Wales jobs first then north Wales jobs last. That’s is the way to do it if you have a location preference. If you are looking for a particular job, then rank your job in order of your preference. There are about 360 jobs to rank. It is a tedious job and may take a couple of days to get completely right. It helps to colour code the various health boards and mark their location on the map of Wales.

After all that, I received the email that told me where I would be.... Withybush General Hospital in Haverfordwest. 

I had never heard of this place. I Google mapped it and saw I was closer to Ireland than England. It was the most southwest region of Wales. 

Through this process I learnt that it is not guaranteed you will be placed in your top five options. Be prepared for the worst. Always remember, no matter what deanery you get, you are not alone. 

My hospital/medical experience so far...

The hospital is very small and quaint. From my very first day I was welcomed by all staff....porters, nurses, doctors, pharmacists, the WHSmith shopkeeper, canteen staff, postgrad girls and many more. 

The hospital is extremely friendly. Because it was so small, it felt like a community.

My jobs as an F1 were general medicine (4 months gastro, 4 months stroke/care of elderly) and then general surgery (4months colorectal surgery). I specifically chose general jobs for F1 to develop my broad based knowledge. I knew I would apply for more specialised posts for F2. 

In Wales, you apply for you F2 jobs in Oct/Nov time. You rank your top 8 jobs. Your application is like a CV with a personal statement. It is not based on academic performance.

You will get an email to inform you have one of your top 8 choice, or not. If you are not successful you will enter round 2 of applications and will have to reapply to the jobs available. 

Miraculously, I got my first choice of rotations; Paediatrics, A&E and Ophthalmology at Royal Glamorgan hospital. I am currently on my paediatric placement. Most F1s get one of their top 8 choices.

In withybush they practice team based care. This means when your consultant is on-call all patients get admitted under that same consultant (irrespective of their presenting complaint/diagnosis) and the patient continues under their care. It's great for patients because they see that one consultant throughout their stay. This minimises conflicting treatment plans with different consultants and improves continuity of care. I saw a wide range of conditions under every specialty. Another advantage of team based care. 

The only downside is because it is not ward based care, you end walking around the whole hospital on the ward round. 

The team comprises of a Consultant (the Boss), Registrar (2nd in Command, but your "go to"), an SHO (your partner in crime) and an F1. 

I quickly learned that being a know-it-all was not half as important as being diligent, organised and a hard worker. As an F1 doctor you the person that makes the plans come to life. 

The most important thing is, if you don't know...ask. You are well supported and help is usually close by. 

A smaller hospital means that services are limited. Withybush was the very definition of that. Referrals were frequently made to specialties in other hospitals. This meant we would have to wait some time before a patient is seen/reviewed. Scans are not always done on the same day, which is also frustrating. It is a small DGH where resources are no comparison to a large tertiary centre.

There is opportunity to learn and do things you wouldn't be able to do in other hospitals. In withybush, the trainee doctors allow you to do specialised procedures under supervision if you feel confident to do so. For example; lumbar punctures, ascitic taps/drains, pleural taps/drains, femoral stabs and assist in theatre. If you are hands on eager, there is plenty of opportunity to develop these skills.

The teaching programme is well established in Withybush. 

There is Grand round, F1 teaching and medical department teaching once weekly. Surgical teaching is twice weekly. As an F1 you will be expected to teach during each of your rotations. 

Living and socialising...

As mentioned before, I lived for FREE in hospital accommodation. This is offered to all F1 doctors working in Wales. The accommodation was not very appealing. It is very old, with communal showers and kitchens. There is a cleaner who comes once a week to clean the rooms, kitchens and bathrooms. There are no bills apart from £10 a month for wifi. Might is add the wifi was terrible. It was slow to connect, sometimes taking up to 45 minutes to get a connection. It was very difficult to complain when you are not paying rent or bills, so you just get on with it. If you are not happy with your accommodation, you can of course find elsewhere to live.

Haverfordwest lacks social activities. There is no shopping centre, a few restaurants, one cinema with two screens (I heard) and one club that everyone goes to. You are not really spoilt for choice when it comes to fun. 

Haverfordwest is more of a holiday destination. In the summer there are plenty of holidaymakers. You will see them in hospital too. 

When the weather is good the place is stunning with ample things to do. There are two go karting tracks, theme parks, the beaches are fantastic for surfing, sunning and bbq's. There are also coastal paths for walking, running and cycling. In general the place comes alive in the summer. Most activities are free which is an added bonus. 

To summarise:

• Be prepared for the worst in terms of deanery

• Try to make what seems a bad situation into a positive one. I dreaded moving to Wales and now I can say it has been the best 1 year.

• Being an F1 is the same wherever you go. Some places are more high pressured than others.

• The key to being a good F1 is being organised, proficient and knowing how to prioritise.

• Accommodation is FREE!!

• Withybush is a wonderful place to work and meet great people

• Social activities are lacking in Haverfordwest, you have to be inventive and create activities. 

N. Uchendu 

FY2