Some final year medical students are graduating early and starting work as foundation interim year 1 doctors (FiY1). Recent graduate from Manchester University, Sarah Allen tells us what it’s like just before entering practice. For fifth year medical students, graduating and starting work has come much sooner than anticipated with the opportunity to apply for the role as a foundation interim year 1 doctor (FiY1). Medical schools across the UK have brought forward the graduation date for many final year students and the GMC has invited these recent graduates to apply for early provisional registration. For students who wish to help and volunteer – such as students not in final year and not eligible for early provisional registration – the Medical Schools Council (MSC) has set out its expectations for employers, medical schools and students. The statement confirms that medical students who take up posts should not undertake nor be expected to undertake duties beyond their competence. NHS employers are also expected to provide interim foundation year doctors with appropriate induction, training and supervision in their role, including training in the use of personal protective equipment (PPE) where necessary. Medical student members who choose to work as FiY1s do not need to let our membership team know they are doing so. You can also seek our assistance if medico-legal difficulties arise as a result of undertaking this role. Sarah Allen is a recent medical school graduate from Manchester University who takes a particular interest in paediatrics, emergency medicine and mental health, and holds a Bachelor of Science in Global Health. She recently secured a place in South Thames Foundation School where she is looking forward to beginning her career as a junior doctor and pursuing her passions further. Prior to this she has signed up to return to work in Manchester, as one of the hundreds of students who have chosen to apply for a FiY1 post to help fight the COVID-19 pandemic. When asked why she chose to sign up to become a FiY1, Sarah described her motivations as being both a sense of duty, and a chance to put the skills she has spent the past five years acquiring to good use. “Before this there’s never really been the opportunity to actually make a difference…but in this case, it’s the simple jobs that do make a difference…things like taking bloods and giving fluids… it’s nice to know that we will actually be able to help”. Sarah was excited to start work and take on responsibility but also felt a “moral obligation to step in and play your part where you can”. She explained, “all of my friends, other doctors, and everyone involved are pulling together.” The role of a FiY1 explained “The UKFPO (UK Foundation Programme Office) has given recent guidance that details what our role will be in hospital. They seem keen to separate our role as an ‘interim F1’ from the F1s that are working at the moment. So we won’t be assessing acutely unwell patients on our own; it’s more duties such as making clinical entries, ordering investigations, procedures like venesection and IV cannulation, prescribing under supervision, and completing discharge summaries.” The UKFPO document states that students applying for a role as an interim F1 have to have graduated and have a provisional GMC registration. Foundation schools will be responsible for the training of FiY1s and the early graduates should have an induction, full supervision, and a ‘buddy’ foundation doctor. Sarah added “we can drop out at any stage, there’s absolutely no pressure to work if we don’t feel comfortable and that won’t be held against us”. When everyone is busy and stretched, I’m imagining we won’t have as much support from other doctors’ meaning there’s a risk to patient safety if I did slip up and make a mistake. The document suggests the UKFPO is making a conscious effort to make this transition as easy as possible for FiY1s stating that they need “additional support so that they can undertake these new roles safely and without detriment to their short and long-term wellbeing”. They also highlighted some of the benefits of taking up this role such as FiY1 doctors having a unique opportunity to contribute to healthcare during this crisis and the clinical supervisor report can be used as evidence for some Foundation Professional Capabilities (curricular outcomes). Naturally, Sarah has some fears about going into the role. “I’m worried about the fact that everyone seems to be gearing up for a massive influx of patients”, she said. At the time of writing, Manchester was much further behind London in terms of confirmed cases and at the time, Sarah told us she sensed people in Manchester were “getting ready for the worst to happen.” Staying at her family home in Bristol she said “I feel a little bit separate from it here and I’m worried about what it’s going to be like in reality when I actually get to the wards…it’s quite concerning hearing things from other students about care in busy central London hospitals.” “When everyone is busy and stretched, I’m imagining we won’t have as much support from other doctors’ meaning there’s a risk to patient safety if I did slip up and make a mistake.” Sarah was also worried about the fact that she will be starting her career as a doctor having not had the chance to learn certain duties such as discharge and documentation. However, she noted that “they should go through stuff with us in an induction period on our first day which makes me feel a little bit more at ease.” Sarah sharing a meal with her university housemates before the pandemic Patient safety was at the forefront of Sarah’s mind, but her own health, and the health of her friends, was also a concern. "Hearing of doctors dying does make me feel worried. Especially when I think of my friends and for anyone with underlying health problems that could put them at more risk." Uncertainty and sacrifice Waiting in anticipation at her family home in Bristol, Sarah spoke of the uncertainty felt by her and her peers. From her communication with the UKFPO and Manchester medical school Sarah gathered there were differences between different schools and when they could expect to start. Although they have been given some information about what work they will be doing, there’s some uncertainty about when it will start. "My friend at Sheffield’s been told she’s going to be working soon, but I know there are medical schools that are a bit further ahead in that process." Since this interview, Sarah has now returned to Manchester and expects to start working soon. Sarah Allen and a fellow FiY1 in scrubs With guidelines adapting daily to meet the needs of the NHS, the expectations that Sarah originally had of her first week working as a doctor have changed. “We’ve had five years of medical training and we’ve spent a lot of time on the wards practicing jobs and observing doctors, so technically we should be ready, but I think the abruptness of the situation is definitely taken me a bit of time to get my head around. We’ll be missing out on that gradual introductory period we would have had if we’d started at a normal time and we are definitely going to be put in a bit more at the deep end than we originally expected.” Aside from missing out on mental preparation and a week shadowing, FiY1s like Sarah will be sacrificing their well-deserved rest after completing five years of medical school. Rather than spending important restorative time with her family and friends in Bristol, Sarah and her university housemates have all made the decision to return to Manchester and work as FiY1s. “It’s the same for everyone else – we can’t have that nice sunny break we were all hoping for before starting in August but that’s just the sacrifice I guess, and there’s nowhere to go anyway!” Encouragement and support for NHS staff and volunteers Sarah described the “feeling of camaraderie” as an encouragement, with “everybody playing their part and making sacrifices.” She takes comfort in the fact that “there are job roles set out for us and we won’t be too far out of our comfort zone because we’ll be doing things that mostly we’ve practiced.” She has also been uplifted by the public support and gratitude of the NHS saying “the clap for carers has been really nice. I didn’t expect it to be such a big success but it has been really encouraging to hear. Seeing everyone’s videos saying thank you to all of their NHS workers was a really nice support as there’s quite a few in my family.” Rainbows in people’s windows and video calls with friends were amongst other things lifting Sarah’s spirits. With both of her parents working as doctors, I asked Sarah what else her and other medics were doing to support each other. Before returning back to Manchester to begin her new role, she said “I’m cooking for my family every day, so just making lots of meals and trying to look after them as much as I can by doing jobs around the house. We’re doing workouts in the garden with my mum! I guess it’ll be really similar up in Manchester.” Considering the drastic circumstances, Sarah seemed pragmatic and positive in her response to working as a FiY1. Above anything, she was willing and ready to put years of hard work in to practice. She concluded, “I think now I am definitely ready to get started and do some work.” Source
