INTRODUCTION
When I graduated I started work in a 950-plus bed then district general hospital, which subsequently became the flagship teaching hospital of the UK, that is the first private funding initiative hospital to be built.Not only was it chaotic to move an entire hospital from one building to another several miles down the road, but I was thrown in at the deep end clinically, to say the least. In my second week as a house officer I was scheduled to do nights, which meant looking after all the medical in-patients alone. In cases of emergency I could call the medical senior house officer (SHO) from the medical assessment unit. It was a case of sink or swim and swim hard I did. The Hands-on Guide for House Officers1 and the Oxford Handbook of Clinical Medicine2 (Cheese and Onion) became my best friends, but I could not help but notice that there were certain things in the day-to-day tasks that I had not learnt at medical
school and were not in the books. There are some skills that medical students are expected to learn by ‘osmosis’ while on placement and under the guidance of junior doctors. These skills are never officially taught or examined in medical school. They are, however, a fundamental part of being a safe, good and efficient doctor.
I found that as a junior theoretically simple tasks when put into practice take a long time and are frustrating to organise and complete.When I was a pre-registration house officer (PRHO) there were normally other staff around that I could ask, but they always seemed so busy and I wanted a guide on hand.When I asked around, my colleagues and I were all in the same boat.We had the knowledge (the map) and we thought we knew how to be doctors (we had been to medical school and therefore could read a map), but there was a missing link (the map was in a different language)!
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