What nobody told me about starting ST3
Article by: Dr Nashwah Ismail
Dr Nashwah Ismail, a clinical oncology resident at The Christie NHS Foundation Trust, shares the lessons she learned from her year as an ST3 and the advice she wishes she'd received before starting.
What surprised you most in your first few months as an ST3?
It definitely felt very different from the medicine I’d practiced before. Other than, of course, the radiotherapy and SACT regimens being completely new to me, transitioning from inpatient to mostly outpatient medicine took some adjustment.
While working in inpatient medicine previously, it was often possible to offer an intervention and see its outcome immediately or even in short days. However, working in an outpatient setting meant dealing with a new kind of uncertainty, and having to have trust in my decision-making and safety-netting advice.
The breadth of the role also surprised me. On any given day I could be in clinic, reviewing patients on the chemotherapy unit or in the radiotherapy department, taking calls from paramedics or other hospitals and managing our inpatients. Initially, balancing those responsibilities while learning what felt like a completely new language was daunting. Looking back now though, that variety is one of the aspects of oncology I value the most, as every day brings new challenges and opportunities to learn.
Was there a moment early on when it really hit you that you were now an ST3 – and what happened?
There wasn't a single defining moment, but my first few on-call shifts were when it really sank in that I was now an ST3. I had moved from gathering information to being the person expected to formulate a management plan. Taking referrals and advising other specialties felt like a significant step up, even though consultant support was always just a phone call away.
Alongside this came a new leadership responsibility within the team, which included supporting resident doctors, coordinating the workload and knowing when to escalate. Initially, I found myself wanting to check every decision, either again with myself, with other residents or the on-call consultant. One of the most rewarding developments over the year has been realising that I'm now able to formulate and justify management plans that would have seemed daunting only a few months earlier.
What change in responsibility feels like the biggest step up at ST3, but isn’t really talked about beforehand?
There’s a lot more self-directed time as an ST3 compared to earlier in training. There is also a lot more to balance, including clinic admin, contouring, research opportunities and exam revision, as well as greater expectations to manage that time well. Admin has an ability to expand to fill whatever time it can, and some of the best advice I received was to try finish all the clinic admin within the clinic itself. Learning how to organise my time and develop different strategies to do that really helped me with this adjustment. There are so many opportunities for development, and I learnt that I needed to carve out and protect my time to enable me to make the most of all of them.
What do you wish someone had told you before you started ST3?
Before ST3 I was fortunate to have had great mentorship from oncology residents and consultants, but if I’d known how much that mentorship and support would expand once I become an oncology resident, it definitely would have eased some of my nerves.
My fellow residents are a huge source of day-to-day support, and I couldn’t have done without the invaluable advice from the lived experiences of the senior residents. There was always a listening ear whenever I needed one and many a kind word.
I couldn’t be more grateful for the mentorship and time invested in me by my consultants, from developing my clinical judgement and radiotherapy skills to encouraging my academic interests and supporting my future career goals.
What expectations did you have about ST3 that turned out not to be true?
Starting ST3, there was a lot of self-pressure to hit the ground running and to continue working with the same ease that had been developed after years as an IMT. However, it was really reassuring to discover that I wasn’t expected to know everything (or very much at all) about the ins and outs of a specialty that was new to me. I felt supported by my teams in finding my feet and being trained in what I needed to know.
What three pieces of advice would you give to someone about to step into ST3?
Ask a thousand questions, and then some more! No one expects you to be proficient in a specialty you haven’t done before, and your team is there to support you. I found asking questions to be the best way to learn and asking for opportunities to be the best way to find them.
Leave enough time to prepare for the FRCR Part 1 exam. It will come around quicker than you think.
Enjoy it. It’s a steep learning curve, but you’ll be surprised at how much you know at the end of even one year, and day in, day out it’s an incredibly rewarding job.