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Nervous about starting FY1

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    Hey guys, I'm a final year student (passed finals) who will be starting FY1 in August and can't help but feel worried/anxious about it. I've always been an average/below average medical student throughout med school and a big part of what's worrying me is that I did quite well on my SJT and managed to get into my first choice deanery which is a highly competitive one. I put it as my first choice as it's quite close to home but never thought I'd actually be able to meet the FPAS points required because my EPM wasn't great and the SJT was always a gamble.

    Anyway, I did manage to get in and even though a big part of me is happy about this the other part of me can't help but think I am going to be so **** compared to the other juniors in this deanery, in terms of knowledge, practical skills and general ward experience. I was never the type of student who would hang around on wards to help out when I didn't need to be there, I hated ward rounds and would completely zone out a lot of the time when I wasn't actively a part of it and as you can imagine I don't have a great amount of practical experience (I'm not great at bloods/cannulas, sometimes unable to get them at all and go back empty handed). I know it's my own fault and I accept that but the idea of how bad I'll be for the first few weeks makes me feel anxious.

    I do have a student assistantship coming up at my med school (different deanery to FY1) but don't know which ward I'll be on yet and I plan on making the most of it but it's not long at all and even if I get some more practical experience and learn some of the ins and outs of the way the ward works I still don't think I'll be anywhere near the level of my colleagues, and that's not even in terms of my knowledge levels.

    Just wondering if anyone else felt the same way before they started and how it all turned out. I'm guessing it's going to be a very steep learning curve for me when I start :afraid:

    IMO your SJT/EPM scores mean very little when it comes to FY1, same for your academic performance. All that really matters is being sensible, ABC assessments, keeping calm under pressure and practical skills. Also being quick, anticipating the needs of others (butlering, basically..) and learning where everything is!!

    Nobody is going to be asking you academic questions. Nobody is going to be asking SJT questions. My experience is that F1 is something different entirely.

    It's normal to be anxious and also normal (I think!) to feel crap sometimes unless you're very cocky. All the hours colleagues may have spent on the wards doing cannulas etc are levelled out in the first day when you suddenly have to do loads and you just become good at them suddenly! When the buck stops with you, you'll be able to do them. You have to! I was also very unconfident with cannulas and bloods and I became confident within a few days. Also the idea that EPM and SJT scores will make your colleagues better F1s - honestly I don't think it makes much difference at all.

    Basically - you'll be fine! Or as fine as anybody actually can be under the circumstances. Hopefully you've got a more supportive job to start off with.

    I wasn't particularly good at cannulas when I started, and it did take me a few months before I was half decent at them. Even having a general "idea" is a start.

    It will be ok. F1 is a good leveller, you aren't expected to know everything and it is important to ask for help. Hopefully your hospital will be supportive. And remember you are not alone! Talk to other F1s.

    You're feeling pretty much the same as at least, like, 20%* of the soon-to-be-FY1 cohort.

    *yes, number plucked from sphincterous origins, but the point I'm making is that you're very, very far from alone. Even with your specific worries.

    I don't think there is anyone who has no anxiety before they start FY1. No one.

    Personally I feel the best thing to observe in preparation for FY1 is shadowing an FY1/2 on medical weekend ward cover. I found it one of the few times when I actually had to use medical knowledge as an FY1 (most of the ward stuff is purely secretarial work) and it will give you an insight into the practical solutions you need to get through those shifts.

    Get some more bloods/cannula practice if you need it as well - you've still plenty of time.

    Fy1 is pretty levelling. I mean some people are definitely better than others, but the vast majority are sitting at the same level.

    Bloods and cannulas just keep trying and it will come. I still have my **** days for cannulas when I have to go red faced to get a colleague help.

    If you just turn up to the ward, introduce yourself and ask there is usually bloods needing to be done somewhere. The Fy1s love it when there are med students around to do the morning bloods at my hospital as we don't have phlebs (well we have a shocking service), and especially on medicine it makes a big difference if we can get all the bloods down first thing.

    Just know your A-E assessment. Don't be afraid to ask for help, and when you're with a sick patient, get extra hands as soon as possible.

    Cannulas come with practice, which you will get plenty of.

    The list and your bleep own you now. Stay organised, plan your route/jobs. Sick patients first, then scans, then discharges, then everything else. With time, you will be able to anticipate what needs doing, and by the time you're told to do it, you'll have already done it.

    There is always time for lunch and nobody will tell you to go for break and people will actively take advantage of you if you let them. Sometimes that "Oh, before you go to lunch, can you just do this?" job can take half an hour (especially when you have 5 different nurses giving you the "oh its only a 30 second job" spiel). When you're going for lunch, go for lunch. You don't have protected breaks like nurses do.

    And above all, be kind. For the love of god, just be kind. The hospital is a scary place. Never forget that.

    I don't recall feeling anxious before FY1 but I was pretty rubbish. The day job is actually quite mundane... writing in notes on the ward round, updating the patient list, writing discharge summaries, etc. The real "fun" begins on call when you are inundated with jobs, don't have very much support, and are the first person called to see patients that are deteriorating. I would absolutely advise giving up some weekends, evenings, and nights to shadowing a ward cover FY1/SHO before you do this yourself as it will make your first few on calls less stressful. My top tips:

    1. Learn how to do little things (prescribe warfarin, set up a sliding scale, spot ischaemic changes on an ECG, write up maintenance fluids, assess a patient that has fallen on the ward, etc) that might have passed you by at medical school. You will see all these things again and again with the on call FY1/SHO.

    2. Carry a list of people you can call for help... your SHO, your SpR, the medical SpR, the critical care outreach team, etc. I found the critical care outreach team were a great support when I was an FY1... you can usually get hold of them easily by asking the ward nurses to call "outreach". They often have skills beyond the ward staff (cannulae, ABGs), are used to assessing sick patients, and will sometimes be followed by ITU doctors if the outreach team are worried enough. This is great if you are struggling to persuade other docs (e.g. the medical SpR) to actually join you at the bedside.

    3. Be nice to everyone but sometimes you will have to be assertive, such as when a patient is deteriorating and you need help but the nurses are desperate to finish their drug round... This is a skill that will come with time.

    4. Plan to stay late. My most rewarding jobs have always been those in which I wasn't clock watching... it's actually quite nice to know your patients well, meet their relatives during visiting hours, and have a good reputation with your consultant for being a hard worker. You probably won't sustain this for a whole career but I think it's a worthwhile approach for your first 4-8 months as an FY1 as it will accelerate your journey up the learning curve. I've never received as many "thank you" letters as I did during my first two FY1 jobs.

    5. Try to learn safe short cuts... a patient who feels absolutely well but is a little tachycardic just needs to drink a jug of orange squash... isolated pyrexia (particularly 1-3 days post-op) should similarly be ignored... as should asymptomatic low BPs, particularly in the elderly at night. Your on calls will be a lot less stressful if you focus on the things that need to be done and don't get tied up over-managing patients that are perfectly well. Again this is an intuition that will come with time... but that's the point of the foundation programme.

    Have fun !!

    Awesome advice from all the doctors above.

    OP, I wouldn't worry about it. You've made it this far with just being "average/below average" (can't tell if you're just being modest though) - so you must be doing something right. I'm the same as you with regards to ward rounds/exam performance and I couldn't even pass medical school. So rather than feeling anxious, I think you should use this next chapter in your professional life as motivation for you to succeed further. I don't really know the ins and outs of being an FY1 as I haven't made it that far yet, but take everything in your stride and don't hesitate to ask for support - in the same way you would if it was any other job. Make friends with the nurses and use every patient as an opportunity to practise your cannulae/venepuncture rather than worrying about whether you'll get the vein or not. From what people have said above, it sounds to me like it's more about finding your feet, using the appropriate support available and learning how to handle a position of responsibility rather than memorising loads of medical knowledge. I'm sure your consultants will only test you on the basic facts. Even if you don't pay attention to the ward round, just remember to listen to your consultant and you'll be fine. Hope it all goes well.
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