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Worried about starting F1

Hi,

I'm starting to get really worried about starting F1 and just hoped some people here could give me some advice.

I really didn't think I was going to pass finals, and while I am over the moon and delighted and still cannot quite believe it, I was not at all prepared for starting F1 in August. I know I shouldn't have but I prepared myself for failing finals and failing resits and thus having to redo the year. I had a really bad last placement with an F1 who I just didn't click with and whilst I did my best to get on with him he completely knocked my confidence and I think this is partly why I felt so bad. Every time we did a mock examination or he asked me questions the way he made me feel was like I was a 1st year with no idea what to do. Maybe that was right, I was coming up to finals and very stressed, I probably didn't show myself off to the best when I just wanted to get home to revise, but he has put that doubt in my mind that I didn't deserve to pass.

So much is going through my head. Am I ready to be an F1, do I know enough, if my confidence could get knocked by an F1 am I strong enough to get through what is going to be such a stressful 2 years...

Along with all of that I didn't get my first choice UoA or job, far from it. I am stuck somewhere further from home when I wanted to stay nearby and not even getting to do the jobs I was really keen for. Part of me thinks I should take a year out, apply again (with a decile score now much better thanks to finals) and hope I get my first choice. But then I think what happens if I mess up SJT (as I assume I would need to redo it, I might end up in a worse position than now....)

Alongside all this I really want to be a doctor, I can't wait to start helping, learning new things, actually being able to do stuff and make decisions, however small. I know I have good qualities about me, feedback has always been that I have a lovely manner with patients and relatives. I get on well with people, I want to help, I will work incredibly hard, but I don't know if I know enough. I am just so scared I am not up to it, will make the wrong choices, cause harm to someone by mistake.

Has anyone here ever taken a year out between finals and F1? How does it work? Or should I just get on with it, stop worrying and man up a bit.

I've always been less confident in my abilty, but now I'm actually here, I'm starting to wonder if I really can be a good doctor... I think it's just nerves but I just want some advice, or maybe someone to tell me they felt like this too.

Sorry for the long post, it just all came out, and in a way has helped a bit already. Hope someone can give me a bit of advice :smile:

Reply 1

girl_in_black

16

You describe exactly how I felt this time last year, OP. Like you, I was preparing myself to fail my final exams and was almost disappointed when I passed because I just did not feel ready to start working. For various reasons, I always felt less confident than the other students in my year, so my entire summer was spent worrying about how I would cope and thinking that I just wasn't good enough to be a doctor. It has taken me a whole year and a lot of positive feedback and reassurance from seniors to realise that I am doing OK and do deserve to be here.

My biggest advice for you at this point would be to try and increase your confidence. The fact that you got through 5-6 years of medical school (having had good feedback and done well in your finals, by the sounds of things) is a good indicator of your ability! I'm sorry you had such a bad experience on your last placement... But sometimes people just don't click for whatever reason, and the fact that the F1 as making you feel that way was probably more a reflection of him, or his working environment, than you. Try and put this behind you and focus on the fact that you have passed your exams and all the reasons why you will be a good doctor! :smile:

It's a shame you didn't get the jobs you wanted, however you might actually find that you enjoy them a lot more than you think. My favourite job (and one I got the most out of) turned out to be the one I was looking forward to the least. As for declining a job this year and replying, I have never heard of anyone doing that, but maybe someone else will be able to advise on whether this is possible.

Ultimately, whether they admit it or not, the vast majority of people are worried about starting FY1. It's a huge transition, and regardless of how much time you spent on the wards as a student, you will not appreciate what it's like being a junior doctor until you start working. You will be tired, and stressed, and you will make mistakes, however there will always be someone more senior around to ask for help, and you should never be scared of doing so. People will expect you to be unsure of what to do, and will be more than happy to help, especially in the first few months. Make the most of your shadowing weak - learn what the paperwork looks like, where to find local guidelines, where equipment is kept, how to order bloods, scans etc., and this will make you first day of work slightly less stressful. Make friends with the nurses and make sure they know it's your first job, and this will also make life a bit easier.

It's normal to be worried and I am sure you will be absolutely fine :smile:

If you have any questions or anything specific you would like advice on, feel free to message me and I will do my best to answer.

Reply 2

Anonymous #1

OP

Original post by girl_in_black

You describe exactly how I felt this time last year, OP. Like you, I was preparing myself to fail my final exams and was almost disappointed when I passed because I just did not feel ready to start working. For various reasons, I always felt less confident than the other students in my year, so my entire summer was spent worrying about how I would cope and thinking that I just wasn't good enough to be a doctor. It has taken me a whole year and a lot of positive feedback and reassurance from seniors to realise that I am doing OK and do deserve to be here.

My biggest advice for you at this point would be to try and increase your confidence. The fact that you got through 5-6 years of medical school (having had good feedback and done well in your finals, by the sounds of things) is a good indicator of your ability! I'm sorry you had such a bad experience on your last placement... But sometimes people just don't click for whatever reason, and the fact that the F1 as making you feel that way was probably more a reflection of him, or his working environment, than you. Try and put this behind you and focus on the fact that you have passed your exams and all the reasons why you will be a good doctor! :smile:

It's a shame you didn't get the jobs you wanted, however you might actually find that you enjoy them a lot more than you think. My favourite job (and one I got the most out of) turned out to be the one I was looking forward to the least. As for declining a job this year and replying, I have never heard of anyone doing that, but maybe someone else will be able to advise on whether this is possible.

Ultimately, whether they admit it or not, the vast majority of people are worried about starting FY1. It's a huge transition, and regardless of how much time you spent on the wards as a student, you will not appreciate what it's like being a junior doctor until you start working. You will be tired, and stressed, and you will make mistakes, however there will always be someone more senior around to ask for help, and you should never be scared of doing so. People will expect you to be unsure of what to do, and will be more than happy to help, especially in the first few months. Make the most of your shadowing weak - learn what the paperwork looks like, where to find local guidelines, where equipment is kept, how to order bloods, scans etc., and this will make you first day of work slightly less stressful. Make friends with the nurses and make sure they know it's your first job, and this will also make life a bit easier.

It's normal to be worried and I am sure you will be absolutely fine :smile:

If you have any questions or anything specific you would like advice on, feel free to message me and I will do my best to answer.

Thank you so much for this reply. I can't explain how much it has helped.I felt so alone, everyone of my friends/peers seemed so confident about passing, looking forward to F1, I didn't prepare for any of it because of how sure I was of failing.

It is so good to hear that you enjoyed your jobs, I am going to go into it with an open mind, and I do have one I'm really looking forward to. I have heard from others doctors on placement that F1 is a leveller, no matter if you are top or bottom, no one knows where the blood forms are, or how to order an x-ray at first, so it helps to have you saying the same!

I'm just worried at I don't know enough to manage things and will start annoying my seniors by asking too many questions. How did you deal with that? Because I want to make decisions myself but if I'm not sure I'd rather ask than guess, just wondering how long I can get away with that for.

Have you enjoyed your F1? I really appreciate you answering, just to know someone felt like me and got through helps!

Reply 3

TheRabbit

17

Maybe I'm wrong but I think pretty much everyone is terrified about starting FY1, and even if they don't show it/admit it find the first few months very stressful, feel like they are a bit of a phony. There is a degree of (wo)man-up and just do it, survive it and learn from it.

I suffer a lot from self doubt, and I think its actually pretty common amongst my colleagues too, its just not the done thing to discuss it - I only ever speak about it with my best friends from med school who seem pretty stressed about the whole thing too. Its difficult to explain, but basically it all comes out alright in the end. That little doubt at the back of your mind means you ask for help, initially you will ask for help all the time and that is expected - they want to know if someone is sick, or has funny blood results or whatever - gradually you realise you can manage this or that and ask less, the doubt decreases and you feel more confident.

I recently did my ALS with a mixed group of people, and it was actually pretty reassuring seeing more senior colleagues getting as stressed about things as we were, and hearing other FY1s say 'well in real life I would be on the phone to my reg right now!' at the same things I was worrying about.

Ultimately a lot of FY1 is admin and knowing when to ask for help. The admin stuff is boring, the sick people stressful, the workload tiring and stressful - but organisation skills grow over the year (and the ability to decide that actually my lunch is more important than that IDL or whatever), and with sick people it comes down to ABCDE (consider bloods/ECG/CXR+/-blood gas) and look for help if very sick or unsure.

It does depend where you work but FY1 can be quite sociable at work and you should feel supported (though you might not have any time off to enjoy with colleagues!). My first job was horrendous but my FY1 colleagues were an awesome group and we all kept each other going - we had limited senior support but had a policy that we would just discuss any problems we were worried about and trouble shoot with each other. I then probably had too much fun on my medical job with great senior support, and on the current surgical job there is a lot of working together to get jobs done and cover all bases but also good social element at work too with cups of tea, lunch break etc and banter with the registrars.

Hmm this is a bit of a post-nights ramble, I am just trying to explain that I think a lot of people have this feeling of wanting to delay starting work, but at some point you just have to bite the bullet and do it, and it turns out okay.

Reply 4

girl_in_black

16

Original post by Anonymous

Thank you so much for this reply. I can't explain how much it has helped.I felt so alone, everyone of my friends/peers seemed so confident about passing, looking forward to F1, I didn't prepare for any of it because of how sure I was of failing.

It is so good to hear that you enjoyed your jobs, I am going to go into it with an open mind, and I do have one I'm really looking forward to. I have heard from others doctors on placement that F1 is a leveller, no matter if you are top or bottom, no one knows where the blood forms are, or how to order an x-ray at first, so it helps to have you saying the same!

I'm just worried at I don't know enough to manage things and will start annoying my seniors by asking too many questions. How did you deal with that? Because I want to make decisions myself but if I'm not sure I'd rather ask than guess, just wondering how long I can get away with that for.

Have you enjoyed your F1? I really appreciate you answering, just to know someone felt like me and got through helps!

I was looking forward to F1 right up until the last few weeks before final exams, at which point the panic set in and I realised I did not feel ready at all to be graduating. But it did work out OK and yes, for the most part, I have enjoyed F1, although there have been plenty of times where I've felt stressed and out of my depth.

As TheRabbit has pointed out, a lot of F1 is admin stuff - requesting scans, chasing scans, doing discharge letters... If you are asked to see a sick patient, don't panic straight away - think ABC (not OMG :wink:

) and assess the situation. It will be quite scary initially, but even if you are not confident about what the problem is, you can still do an assessment and go to someone more senior with that information. And do try to see sick patients on your own first as it is a very good way of learning. Similarly, speaking to families - it's a very useful skill to learn early on, but very tempting to leave to someone more senior to deal with because it's 'scary' (or that's certainly how I saw it!).

If you haven't already got a copy, I would highly recommend the Oxford Handbook for the Foundation Programme. Another useful tool I've found is the "Asked to see patient re:..." guide by the North Western Deanery (not sure if we are allowed to post links here, but it it's on google), which is very good overview of the more common things you will be asked to see as an F1, and what to do in each situation.

With regards to asking questions, to be honest, I never had a problem with this. I ran everything I wasn't sure about past a reg in my first few weeks, and they were perfectly nice about it (there were no middle graders on the ward so even the little things went to the registrars - even things like how fast to give fluids to a patient with an AKI). It will be expected, so don't worry about it! :smile:

. And you will learn a lot, so will need to ask fewer questions as time goes on. Decision-making-wise, most of the decisions you will get to make will be out of hours, and even then, there will always be someone on-call available for advice, even in a DGH, and if someone is really sick, you would not be expected to manage them on your own.

My confidence has definitely grown a lot since starting as an F1. There is definitely an element of 'man up', and for me, it turned out to be a natural step when I started working, simply because things had to get done regardless of how I felt about them. From what I remember, the anticipation of waiting for the job to start was the worst, actually being on the wards was enjoyable for the most part, despite my first job being very busy and stressful.

(edited 7 years ago)

Reply 5

Anonymous #1

OP

Original post by TheRabbit

-

Original post by girl_in_black

-

Thank you both so much, sorry, I have just seen your post TheRabbit. Just hearing from both of you has stopped me worrying quite as much. And it is silly to think about putting it off because I have wanted this for so long and even if I did take a year out I'm eventually going to have to do it, so no time like the present! You are both right about just remebering ABC and that I'm not going to be making the massive decisions, I just need to try and keep on top of things, know the patients and know when to get senior help.

I'm going to make the most of this month off, and try to be more positive about things. I know it's going to be difficult and stressful so at least I am prepared for that, but to know that other people felt the way I do and survived is a great relief!

Thank you both again :smile:

Reply 6

nexttime

22

Original post by Anonymous

I'm starting to get really worried about starting F1

So normal then.

(with a decile score now much better thanks to finals)

So not only did you pass finals, you did well in them? That should give you confidence.

Has anyone here ever taken a year out between finals and F1? How does it work? Or should I just get on with it, stop worrying and man up a bit.

Very not recommended. You will forget stuff quickly. If you think you're unprepared now, taking a year out is going to make things 10x worse.

Along with all of that I didn't get my first choice UoA or job, far from it.

I wonder whether this is a bigger part of the issue than you let on. Ultimately no one gets their perfect job and most people have to make significant sacrifices. This is true now and will be true throughout training, and is just something you have to deal with until the powers that be stop using such a stupid system I'm afraid.

Most of being an FY1 is admin. Like, 95% of it. And for the 5% you can always call a senior, especially at first when they expect you to be new and nervous. Seniors are very used to it - remember that its not just FY1s that are new. Imagine being me 2 months ago starting a gynae job a full 2.5 years after doing any gynaecology whatsoever in med school. Or a GP trainee even more years down the line for that matter. Lots of people need help at first, and that's fine.

Reply 7

Anonymous #1

OP

Original post by nexttime

So normal then.

So not only did you pass finals, you did well in them? That should give you confidence.

Very not recommended. You will forget stuff quickly. If you think you're unprepared now, taking a year out is going to make things 10x worse.

I wonder whether this is a bigger part of the issue than you let on. Ultimately no one gets their perfect job and most people have to make significant sacrifices. This is true now and will be true throughout training, and is just something you have to deal with until the powers that be stop using such a stupid system I'm afraid.

Most of being an FY1 is admin. Like, 95% of it. And for the 5% you can always call a senior, especially at first when they expect you to be new and nervous. Seniors are very used to it - remember that its not just FY1s that are new. Imagine being me 2 months ago starting a gynae job a full 2.5 years after doing any gynaecology whatsoever in med school. Or a GP trainee even more years down the line for that matter. Lots of people need help at first, and that's fine.

Thanks for your reply. Yes I did pass well compared to how I have done previously but I don't think many people in my year would consider it a good pass. I did move from 9th to 6th decile though, so maybe you are right, I should have more confidence. And you are right about the year out, it was just something that I thought about, but realistically it will make things worse and I'm going to have to start at some point!

I'm trying to think about the positives of my new jobs now rather than keep thinking how I wish I was somewhere else. I'm sure it will be a nice hospital and being near home wouldn't make any difference realistically. It's just I think not preparing myself for passing meant I hadn't prepared myself to leave family and friends, hadn't looked into finding somewhere to stay, hadn't thought much money wise how to afford moving and now it's all happening!

Reminding me that I'm not going to be the only one whos new helps! I know it's obvious but sometimes you forget that those more senior are starting in a new job and don't always feel prepared. Really appreciate you taking the time to reply, it is starting to put my mind at ease that other people feel like me too!

Reply 8

MonteCristo

14

On my first day as an FY1, I couldn't cannulate, take blood, or read an ECG. As nexttime said, your day job is to write discharge summaries, take blood (other FY1s +/- your seniors will help when you struggle), and scribble down everything your boss says in the notes. If a patient is unwell and you don't know why, call your SHO/SpR for help. If they become suddenly unwell and there isn't time to pick up the telephone, pull the red cord and help will come very quickly indeed.

You don't learn medicine at medical school - it's all on the job training. There are occasional moments of panic but they are few and far between. You will be a great FY1 if you arrive early, have a "can do" attitude, don't race for the door at 5pm, and are nice to the nurses/patients. If you happen to have some useful medical knowledge on day 1 then everyone will be surprised... it's absolutely not expected or required.

Reply 9

inthevale

6

"Decision-making-wise, most of the decisions you will get to make will be out of hours, and even then, there will always be someone on-call available for advice, even in a DGH, and if someone is really sick, you would not be expected to manage them on your own."

Thanks - as another F1 starting in August this was helpful. Although I'm concerned that in the hospital i'm at there is no nights for F1s, does that mean I will have fewer learning opportunities?

(edited 7 years ago)

Reply 10

TheRabbit

17

Original post by inthevale

"Decision-making-wise, most of the decisions you will get to make will be out of hours, and even then, there will always be someone on-call available for advice, even in a DGH, and if someone is really sick, you would not be expected to manage them on your own."

Thanks - as another F1 starting in August this was helpful. Although I'm concerned that in the hospital i'm at there is no nights for F1s, does that mean I will have fewer learning opportunities?

I guess it means you will probably have different learning opportunities, not necessarily fewer - especially as it means you'll be doing more daytime hours. Nights are kind of good for letting you do your own thing a bit, but on surgery that sort of happens during the day too thinking about it...
At the end of the foundation programme we have to be at roughly the same place, wherever we trained, so over the 2 years it is unlikely to make that big a difference.

Reply 11

girl_in_black

16

Original post by inthevale

"Decision-making-wise, most of the decisions you will get to make will be out of hours, and even then, there will always be someone on-call available for advice, even in a DGH, and if someone is really sick, you would not be expected to manage them on your own."

Thanks - as another F1 starting in August this was helpful. Although I'm concerned that in the hospital i'm at there is no nights for F1s, does that mean I will have fewer learning opportunities?

I agree with TheRabbit, there will be different learning opportunities. If you will be working in a bigger hospital, there will be a lot more senior input so more opportunities to learn medicine. If it's a smaller hospital, you may be the only doctor on the ward for large periods of time (especially if it's a surgical ward), so you will get to do the 'on-call' kind of things such as dealing with sepsis, chest pain, fluid reviews etc during the day. Usually, F1 jobs have a mix of quieter and busier rotations, so I wouldn't worry too much as you will get the opportunity to do some medicine and not just admin stuff during the year!

Reply 12

girl_in_black

16

Also, just to point out - although nights are good for letting you do your own thing, in some ways they can be very frustrating and anxiety-provoking as you don't get feedback about whether what you've done is right or wrong. If it's a quieter set of nights, you can go back the next night and check what the day team have done, but very often you will not have the time do that that. I sometimes find on-calls quite frustrating from that point of view. But is can be very rewarding to see patients on your own and see their EWS score drop once you've started appropriate management.

Reply 13

MedicZd

9

Starting F1 soon too and I am really nervous about it so this thread is encouraging. I'm more worried about being on call and night shifts.

Reply 14

angela_ecco

4

Thank you so much for this message! I'm about to start a fixed-term post as an FY1 in trauma for four months... And I'm very nervous about it. I'm a EU graduate and I don't really know the system so well. It took several months for me to arrange all the papers needed (IELTS...) And that's why I'm starting in April even though I graduated last June.

I feel like I forgot so much stuff and I don't know where to start to revise... In my country doctors don't need to do cannulations or similar procedures... So I don't have too much experience with that.. Mainly I trained on plastic models. I also feel that I need to refresh my ECG and basically everything in general! Don't know where to start, this is a bit overwhelming.

Thank you so much for all your answers, they are so very helpful :smile:

Original post by MonteCristo

On my first day as an FY1, I couldn't cannulate, take blood, or read an ECG. As nexttime said, your day job is to write discharge summaries, take blood (other FY1s +/- your seniors will help when you struggle), and scribble down everything your boss says in the notes. If a patient is unwell and you don't know why, call your SHO/SpR for help. If they become suddenly unwell and there isn't time to pick up the telephone, pull the red cord and help will come very quickly indeed.

You don't learn medicine at medical school - it's all on the job training. There are occasional moments of panic but they are few and far between. You will be a great FY1 if you arrive early, have a "can do" attitude, don't race for the door at 5pm, and are nice to the nurses/patients. If you happen to have some useful medical knowledge on day 1 then everyone will be surprised... it's absolutely not expected or required.

Worried about starting F1

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