🧑‍🎓Medical student ➡️🧑‍⚕️Foundation doctor

View of Kyoto from Grand Gate, Chishakuin Temple, early morning July 2023

This time next week, around 8000 newly qualified medical school graduates will begin their first day at work as foundation doctors all over the UK. Despite extensive training and years of clinical attachments it can be difficult to prepare for the full responsibility that comes with working as a healthcare professional. 

I caught up with Dr Maia Patrick-Smith who is just finishing up her foundation programme in North West London about her work and health learning points on this transition to working life a medic. 

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Shift work

The rota is likely to be much more intense than medical school clinical attachments, without campus days to break up work. Shifts are also much more physically and mentally draining in a doctor vs student capacity when scope is more limited. Unlike student attachments where on site accommodation may be provided, most doctors commute in and out of work at the end of their shift which adds to fatigue. Driving or cycling home can be dangerous without adequate rest. Some hospitals provide post-shift rest facilities for a monthly subscription fee while in other hospitals, there are no adequate places to rest. Finding ways of managing long shifts and day to night to day transitions is key and often impacts on life outside of work more than clinical attachments at med school.

Decision making responsibility 

No matter how much clinical exposure is gained through med school or how realistic sim training and exams try to be, the first few months can feel a huge step up in responsibility. From signing that first prescription, auscultating someone’s chest without double checking with a colleague or starting a peri arrest protocol as the first clinician by the bedside, clinical acumen, decision making and patient safety applied in the ‘live’ environment takes some getting used to. Thankfully, there is always someone to ask for help and knowing when, how and who to ask is an important part of practice. Clinical responsibility and independent decision making naturally increases during training but even on the very first day as a foundation doctor, some tasks will be done independently for the first time, and this can feel like a big step up!

Autonomy

Some colleagues already experience a lack of autonomy in their foundation job allocations and may be working far from their support network. There is often limited choice in where and when to work as a trainee and pay is controlled centrally which can impact living conditions if working somewhere less affordable. Leave authorisation and rota swaps are rarely automated and may not be approved even for important life events. Organising leave and swaps requires administrative overhead on top of an already busy job but are important to action early to have breaks and create space for life outside of work.

Change 

Most foundation doctors change post every 16 weeks. This can mean change as soon as you find your feet, and with the exception of the August changeover day, there may not be ringfenced time for local induction. Getting comfortable with a new role, environment and team overnight can be expected in this high-stakes job, but insight into when to ask for help is key to managing changeover safely. 

Workplace relationships 

The two year foundation programme is a formative experience, and investing in workplace relationships will help cultivate a supportive environment between colleagues. The demands of the role mean it is not uncommon to experience distress or see colleagues distressed at work and making sure you and those around you have the support necessary and are well enough to be at work is essential for patient safety, staff safety and beyond. So much change through a medical career means building up a rich and diverse network- and though people will move on to different posts elsewhere in the UK and abroad, paths do cross again. 

Support

The foundation programme has an in-built senior supervisor function, and using this for more than just a tick-box exercise is helpful. Consultants are so experienced with managing working life and life outside of work, and talking things through with seniors (beyond clinical queries) can be really informative. Finding mentors within your area of interest is a brilliant way to add to your senior support network and can also help build your clinical and other portfolio skills.

What’s next?

Training is the best trodden path to career progression, which can mean preparing for the next career stage while working at the current level. Many doctors take their first postgraduate exams during the foundation programme, and saving up for professional exams and revising on top of a full time job is generally a more complex balancing act compared to med school. Lots of doctors take time out of training to gain more flexibility in how they live and work for a period of time. There are options and reflecting on which components of working life as a medic work for you and why throughout the foundation programme is helpful in thinking through your next career stage. Personal circumstances also evolve and are important to factor in.

Medical school and training can feel like a production line and direct comparisons with peers can be easy to draw. However, thinking about your priorities and what you want from your career and life outside of work in the short to medium term and medium to long term is the best framework for thinking through your next steps. Goals can change and flex and it is important to keep that in mind with the average length of full time postgraduate training to CCT being around a decade! 

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Dr Maia Patrick-Smith will complete the Academic Foundation Programme including a four-month block in the Department of Primary Care and Public Health, Imperial College London this August 2023. Her next step is to take an F3 year, which involves an expedition and wilderness medicine course, locuming as a senior house officer in London and spending some time travelling. She hopes to apply for a training post in Community Sexual and Reproductive Health in the future.