Starting FY1 - What I Wish I Knew

Coming to the end of FY1 feels crazy to me, and I’m sure to lots of other trainees out there. It’s like you put your head down last July and not lifted it until now, like you’ve blinked and a whole year has gone, like Uni was a whole different lifetime. Don’t get me wrong, it’s been TOUGH. I’ve cried, laughed, all the emotional stuff in-between, made friends, made an idiot of myself, made myself proud. It really is a journey, and one that can be made a lot easier by hand me down advice, so I’m going to give you my two-pence on what I wish I knew before starting:

1. No-one knows what they’re doing straight away - This was a huge realization for me, I struggled a lot with the step up from med school, not so much about theoretical knowledge but in how things actually worked in practice; getting scans done, escalating to seniors, prioritizing patients. There are points where you will doubt yourself, feel slow, make mistakes and feel out of your depth. THIS IS NORMAL. It’s easy to look around at your colleagues and think they know everything and feel super confident every day - but it’s likely they are going through the same emotions as you. All that matters is you act within your ability, and try to get a bit better each week. 

2. Ask questions early, but remember the answers - You absolutely should ask as many questions as you need. People would rather you ask and get it right than feel unsure and get it wrong. In my experience, asking genuine, thought out questions was nearly always  met with a good response, and when it’s not it’s likely the person you are asking is stressed/tired/burnt out or all of the above (so just ask someone else!). You have to remember this is a training post - you are not expected to know everything and won’t learn as much if you don’t ask. That being said, be wary of asking something before trying to work it out yourself - I would often blurt out a question before checking through the notes/handbook then realise the info was in front of me which can be met with frustration.  I started keeping a little record on my phone of bits and bobs I’d picked up along the way which helped me consolidate what I’d learnt. Striking a healthy balance between being humble enough to acknowledge where you need help, and making the effort to try and work it out yourself first is key. 

4. Use all available resources - Know the handbooks for each block inside out - I can’t speak for other hospitals but I know for ours there would always be a handbook passed down through previous trainees that would go through the logistics of doing the job ie how to refer to different services, how to request certain imaging, who to email about x,y,z. Most jobs in FY1 require lots of admin and grunt work and this can seem overwhelming if you don’t understand the basics of how the hospital systems run. The Foundation App (summaries of symptoms, investigations, management), BNF (meds, routes, doses, contraindications), Eolas (microguide - for antibiotic guidance), and local hospital guidelines, are an absolute lifeline. It’s easy to think you have to remember everything off the top of your head to be a good doctor, but in reality using information aids makes you safer and more confident. 

   
   

5. Organisation is key -  developing your own little system for keeping things organised is such an important part of FY1. Whether thats a jobs list on paper, or word document, google doc, whatever works - there’s often so much going on that it’s impossible to keep it all in your head even if you’re convinced you’ll remember it all. Outsourcing to a physical list really helped me for ward jobs - I’d just divide paper up into however many patients I was looking after and do little tick boxes for the jobs with a star next to the urgent ones, and reminders for things to do before the ned of the day like putting bloods out for tomorrow. This is particularly important on on-calls, where you’re likely to be flitting between lots of different patients on lots of different wards - I would create a paper list or word document with bleep numbers, patient details, jobs and progress so that I could keep track of what’s going on and what needs to be handed over.  The little bit of time taken to organise yourself saves so much stress later on.

5. On calls are savage - YOU CAN ONLY DO WHAT YOU ARE CAPABLE OF DOING - this was another big one for me, the first on call can be quite a smack in the face if your normal job is well supported. It felt like having the carpet pulled from under my feet, being given 5 times as many patients as usual and expecting myself to find it easy. You often have lots of bleeps coming in for patients you don’t know about, and be expected to make decisions that would normally be being made by someone much more senior if it wasn’t out of hours. There will be points where there is physically too much to do for the time you have - you have to  accept you can only do what your abilities and workload allow. What’s important is to have a system where you can quickly prioritise what’s urgent, and keep track of other bits that you can do when it calms down . Essentially, do what you can, the rest will be handed over. Within this, escalation is such an important one, even if staffing is stretched, if you think someone is unwell and it’s outside of your capacity, you have to ask for help. It is their job to respond to escalation just as it’s your job to raise them. Do what you can first and have the basic bloods/ obs/ imaging ready for when they get there. Do not be afraid to ask for help - that’s what seniors are there for. 

6. Make good use of your teammates! There are so many teams involved with patient care, and knowing who they are and what they do is so important. It seems to be a bit overlooked at uni, but so much of the job is liaising with other teams, checking with pharmacists, working with nurses, physios, dieticians. Make an effort to get to know people, not only because it’s important to be kind but also it makes things so much easier when things get tough and you need help. It is also important to know what you can expect from different teams and what is or is not in their remit. This can help you set boundaries and stand firm if people push back on doing jobs (in my experience most people are super helpful but we did butt head with some nursing staff who would say they can't do bloods etc or escalate before trying themselves). That being said, it’s important to nurture the doctor/nurse relationship; help where you can but set boundaries when you are busy.   Pharmacy are also amazing, at correcting mistakes, giving advice on prescriptions, and most will be happy to answer queries about meds especially when you are starting out (this is not you being a bad doctor it's drawing on teams with the most knowledge of certain aspects of care ie meds) Ultimately, treat everyone with respect, and you’ll be treated with respect in return. 

7. Medicine is not an exact science - This one really threw me off, after 5 years of rope learning signs symptoms and management, I expected to be able to absorb and re-produce the practice of my seniors. I quickly found out that doctors often do things differently, especially at more senior levels, and there is quite a lot left to personal experience and preference. With basic stuff like fluids, antibiotics, analgesia, laxatives there may be more than one correct answer, and with more complex decisions consultants will have very different approaches whihc can be confusing. Though guidleines are your friend as an FY1 and should be followed, bare in mind you will likely have to become flexible in your application of this knowledge as every patient is so different. Understanding the ‘’how’  ie how do certain meds or imaging techniques work, can help you understand the ‘why’ behind decisions and help you build confidence in your practice. (side note - this doesn't come instantly, but you'll be amazed how much more confident you feel after one year)

8. Be kind to yourself - this is the most important one of all. FY1 is hard, there’s no avoiding it. Some people will look like they’re breezing through and it’s easy to feel your behind - the truth is everyone is at least a bit nervous and most people find blind confidence more concerning anyway. You also have to remember your cohort will be a smart bunch, it’s how they all got to where they are, and also how you got here. If you made it through med school you are just as capable and deserving of this job as anyone else, it  might just take a bit longer to feel comfortable in the transition. 

Overall, this is an incredible, at points ridiculous, terrifying, inspiring job that will test you, but also remind you of what all the hard work was for. You will be absolutely fine, and if you’re not, know that it genuinely gets better. Next year you’ll be sat as I am, reflecting on a crazy year’s passed and think to yourself, bloody hell, I made it, and I’m so proud. 

Dr Jess Beresford