So, you’re a Doctor: Now what? How to survive FY1...
Dr Natasha Holmes,
Locum Paediatric Doctor & ‘You Okay, Doc?’ Ambassador
The transition from medical student to doctor is often a turbulent time. On the surface, it seems to split soon-to-be-doctors into two camps. In one camp are the ones who are chomping at the bit to get started and put their knowledge into practice, stepping into their newfound identity as doctors. In the other are those who are terrified about the unknown territory they’re venturing into, with all its incumbent responsibility.
Often, what little separates these two groups is how they deal with times of change, or transition periods. How we interpret the thoughts and bodily signals that arise during this time can lead us to view those butterflies in our stomach as an adrenaline-rush of excitement, or as anxious dread. Others may find themselves somewhere in the middle of this spectrum, with their new doctor title inspiring equal measures of excitement and bewilderment.
Whether you find yourself in one of these two groups, or somewhere in the middle, read on for some advice on how to get through this challenging time.
Transition & Handover
The process of transitioning from medical student to doctor can be thought of as a handover process, much like the one used in medical handovers to share pertinent information about patients between shifts. You, as a medical student, are metaphorically being handed over from university to hospital. In an ideal medical education system, this handover would be seamless. Medical students would be perfectly seasoned after their experiences on the wards, in Accident & Emergency, in clinics and GP settings and would glide into their new roles without a hitch.
Things continue to improve in the medical education system with this aim in mind. New doctors get longer shadowing periods with their predecessors before stepping into their new role. Many universities and organisations offer FY1 preparation courses. Despite these changes, the process remains imperfect. In fact, it’s hard for any education system to get it 100% right. Why? Because there is simply no substitute for the experience of being a doctor.
There is a common misconception amongst the public and medical students alike that the medical system turns out doctors who are “combat-ready”, sufficiently equipped during their 4 to 6 years of training with the skills and knowledge they will need (both medical and systems-based) to perfectly perform their jobs. In reality, this is only the very beginning of your journey into becoming a doctor. It’s only once we really step into that role and assume that identity and the responsibility that comes with it that we begin to mould into the doctors we will eventually become.
Impostor syndrome & “Faking it till you make it”
To deal with this experience gap, fledgling doctors are often given advice like “fake it till you make it”. This is not particularly comforting advice for those who might already be experiencing impostor syndrome, where we fear (despite our evident competence) that we are not as competent as others perceive us to be, and that we could be caught out as “impostors” at any moment.
Here’s the thing - whilst you are definitely not an impostor - you also don’t know everything you need to know just yet to be a fully seasoned doctor. That’s why FY1s have a provisional registration with a licence to practise and spend a year working under these conditions before they get a full registration with a licence to practice. This is in recognition of the fact that it takes time to learn how to apply everything you’ve learnt in practice, whilst also learning new skills. These include practical skills like how to work the hospital system, communication skills like how to refer and handover properly and team-based working skills.
It’s important to remember this when you’re getting started. Doctors often exhibit perfectionism. Some might argue that “it’s a feature, not a bug”, an adaptive mechanism that ensures we double and triple check ourselves to prevent errors and ensure high standards. However, it can also lead us to expect far too much of ourselves far too early.
My advice? You cannot be an impostor if you’re not forcing yourself to pretend to be something you are not.
Lean in to your new role
Ditch “faking it till you make it” in favour of acknowledging your own limitations and realising that you are still learning. Lean in to your new role. Ask lots of questions so you understand the reasoning behind clinical decisions. Continue to read up on the conditions you come across on a daily basis. Do this even if it means reading the Oxford handbook for the foundation programme on your commute home, or reading evidence-based information online for a few minutes when you arrive. Track your learning systematically in your e-portfolio, a little at a time. Make sure you attend all your mandatory teaching sessions, and don’t be afraid to speak up if your service provision expectations are stopping you from attending. Raise concerns if you feel your supervision is inadequate. No one should be asked to perform duties outside of their competence or limitations without adequate guidance.
Guidance and mentorship
In order to facilitate your transition and help shape your future identity as a doctor, try to find a guide and a mentor early on.
Your guide should be a friendly junior - someone who has recently been through the process of FY1 and can help guide you through those initial stages and how to navigate your current hospital.
Your mentor should be more aspirational - a registrar, fellow, or consultant who works in your specialty of interest. Don’t just pick someone based on their credentials - consider their whole identity as a doctor. This includes their demeanour and bedside manner. Is this the kind of doctor you want to be? Do you find yourself emulating their behaviours? That’s the kind of person you want to be working with. Makes these connections early. Some hospitals even offer mentorship schemes.
Not sure what specialty pathway you want to go down? Wondering whether a medical career is even for you? You can still benefit from a mentor. Seek medics who have done FY3s or years out of training, worked abroad, taken on locuming jobs, or moved into an alternative career. You can even consider working with a specialist career coach like the Disillusioned Medic who specialises in coaching medics who want to leave the profession.
Embrace all of your identities
We all have multiple aspects to our identity that make us who we are e.g. sibling, artist, runner etc. However, in our efforts to adjust to our new job and embody our new doctor identity, it’s easy for new doctors to forget their other identities.
When we ignore other facets of our identity in favour of just one - like our doctor identity - we can start to feel off kilter. This kind of thing doesn’t happen overnight. It’s a gradual process of attrition where our medical work encroaches on the other parts of our lives. You just wake up one day and think “When was the last time I did that thing I love?” This isn’t surprising given how much time we spend at work, or studying outside of work to maintain our competencies, or for some of us - the time we spend thinking about work when we aren’t there!
The only way to maintain balance is to nourish all parts of yourself - including the non-medic parts. Remember that you are more than your work. Embrace everything that makes you, you. Try to do these things even if it’s only in drips and drabs. It will keep you safe and act as a mental health cushion.
Self-care
Ok, so all you need to do is to simultaneously:
keep expanding your knowledge
learn all the new skills needed to navigate working a medical job in the real world
keep up to date with your e-portfolio
find a guide and a mentor
find the time to do everything else you love
Are you following so far?
OH AND don’t forget to take care of yourself too whilst you do all that!
If this sounds like a lot, it’s probably because it is. This is often where new doctors fall down in their first few months on the job. The learning curve is steep, the rotas are hard and the exhaustion - physical and mental - is real. During this time new doctors often prioritise other things over looking after themselves and they become increasingly run-down. This isn’t good for you and it isn’t good for your patients either! You won’t be performing at your best if you don’t look after yourself.
Self-care might sound trite but it’s one of the things that will actually protect you during this transition period. So… Bubble baths all round? Not quite, although you can do that if you want to!
Self-care in its purest form simply means caring for yourself. It includes things like:
Physical self-care (taking breaks on shift, preparing and eating nourishing meals, getting enough sleep, doing some regular exercise, taking sick leave if you need it)
Emotional self-care (checking in with yourself, reflecting on your experiences, discussing psychological health with trusted people or professionals if you want to, taking mental health leave if you need it)
Social self-care (talking to and spending time with loved ones like friends or family, using your support systems, asking for help when you need it)
Spiritual self-care (religious or secular, meditation, time alone, spending time in nature, journalling)
Personal self-care (engaging in hobbies, expressing your personal identity)
These are just some ideas. No one expects you to run marathons and meditate twice a day whilst you juggle getting your full registration. Still, it’s a good idea to find some small ways you can practice self-care during this time.
Normalise struggle
Even if you do everything right, you are likely to struggle at some point. Anecdotally speaking, in my 6 and a half years of being a doctor, I don’t know a single foundation year doctor who hasn’t struggled - at least a little - at some point. Some have struggled more than others. If this happens to you, please know that you are not alone.
You might have heard the metaphor about the butterfly emerging from its chrysalis and that it has to struggle to complete this transition, before it can emerge as a beautiful butterfly. The moral of the story is that some degree of struggle is a natural part of change.
But did you know that if a butterfly is struggling to get out, butterfly experts can help this process along by making gentle incisions into the chrysalis? That’s science for you.
Know when and how to get help
Just like struggling butterflies, sometimes new doctors might need a little help to get going too.
It’s important to check in with yourself regularly to make sure you are coping. There is a fine line between some degree of struggle, which is natural, and struggle that starts to affect your mental health and wellbeing. Mental health problems are actually pretty common amongst doctors as a whole. This is more likely to happen during times of intense pressure or stress, including during times of transition.
The job of a doctor is hard, so there’s no point expecting it to be easy and pretending that we are ok if we aren’t. We must learn to lean into our vulnerability and to communicate with each other when we are struggling.
If you find yourself struggling, please know that help is available. Apart from speaking to loved and trusted ones you could consider the following sources of support:
> Your GP
> You Okay, Doc? (the doctors’ mental health & wellbeing charity)
Text YOD to 85258 for free, confidential, 24/7 mental health SMS support from trained mental health support professionals.
Join us at The Huddle - a peer support group for doctors and medical students held via Zoom on Wednesdays at 8pm (British Time). This is hosted by the charity’s highly-experienced resident psychotherapist, Chris Cherry. Here, you can chat informally and confidentially with other doctors about life as a medic. This is a SAFE SPACE for doctors to chat in a private group about things that are not often freely talked-about elsewhere:
Talk about what challenges you are facing
Get advice and tips from other doctors
Do you wonder if you could have handled a case or situation differently? (patient anonymity maintained)
Chat about the effects of being a doctor on your home life and general well-being.
For free, confidential, emotional support:
Call 0300 303 4434 from 8am to 8pm, 7 days a week, for trauma and bereavement support from Just B
Text FRONTLINE to 85258
Or call 0800 069 6222 from 7am to 11pm if you’re in England, or 116 123 any time or if you’re elsewhere in the UK, to talk to Samaritans
All in confidence with trained volunteers
> BMA Counselling and peer support services
Free and confidential 24/7 counselling and peer support services open to all doctors and medical students (regardless of BMA membership), plus their partners and dependents, on 0330 123 1245.
this is a FREE, confidential NHS mental health service with expertise in treating healthcare professionals.
Eligible professional include Doctors and Dentists in England & Scotland
The service can help with depression, anxiety & OCD. They also see professionals with bipolar affective disorder, personality disorders, psychosis & addiction issues.
The service is provided by a multidisciplinary team including GPs, psychiatrists, nurses & therapists.
Frontline19 is a FREE independent, confidential, UK-based nationwide service delivering psychological support to people working on the frontline
This service is provided by fully qualified, experienced psychotherapists, counsellors and psychologists who have volunteered their time, skills and expertise for free to support frontline workers.
Body & Soul is a UK based charity. They are currently offering a confidential crisis counselling support service called Brave NHS Support for frontline key workers AND close family members affected by the COVID-19 pandemic.
This is an opportunity for frontline workers to discuss absolutely anything that’s currently making their life stressful or difficult - it doesn’t have to relate to work or COVID directly.
For more information on how to navigate life as a doctor whilst preserving your mental health, including practical advice and worksheets for FY1s, check out my blog above or follow me on Instagram and twitter @thewell_doctor
If you are interested in coaching you can email me at thewelldoctoruk@gmail.com
This is not an exhaustive list!
For a full list of resources click here.
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To all the new starters reading this: Best of luck, stay well and remember – even the worst day only lasts 24 hours!