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    I'm a final year medical student, sitting finals this spring.

    I'm really starting to think that I am not cut out for medicine. I do well academically and get good feedback on placements so I should be fine. But the whole thing makes me so tired and anxious. A few months after the start of clinical years I had to take a year out because I wasn't coping. Since then I have not been overly engaged (e.g. bare minimum amount of time spent on the wards) because I feel tired and anxious all the time. I feel so much dread when Monday comes around and get next to no sleep which compounds things. I realise that as a student I have no responsibility yet here I am still struggling.

    I thought maybe I had depression / anxiety, but it is purely situational. For example I had most of last month off for revision, and while friends of mine were stressed and getting no sleep I felt like a weight had been lifted. I started sleeping through the night, felt so much happier doing revision in my own time, and did really well in the exams.

    Then placement started again on monday. I got no sleep on sunday night because I was dreading the next day, but got through the day thinking it would be better after I had slept. Then last night I again got no sleep despite being exhausted. I emailed my consultant at 6am to say I wouldnt be in. I feel awful from 2 nights of no sleep - and am honestly not exaggerating. I now also feel anxious about what everyone will think of me being absent on day 2.

    I still love learning medicine, and in certain situations which dont provoke my anxiety I love seeing patients. But I think everything - the responsibility, the long hours, the commute, the night shifts, the frequent changeover of jobs, the pressure to progress - will be too much for me. My Dad was also diagnosed with terminal cancer in October and has perhaps a year to live. He is so proud of me doing medicine and I feel like I have to try for him.

    As I enjoy medicine and the academic side I wondered about a job at the medical school. I feel I would be so happy in the clinical skills department teaching histories and examinations and clinical procedures. But the chances of a job coming up in that tiny department are small and all I can offer is a medical degree and some informal peer teaching experience.

    Sorry that was so long. Just wondering if anyone had any advice.
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    I'm sorry you're feeling like this. I don't think it is particularly uncommon actually. Would you consider trying the job after graduating? You'll have a bit of a break before it starts?

    Or have you thought about going into academics and teaching as a doctor instead of through clinical skills?

    It's a long road and it is not surprised you're tired of it at the end. Perhaps take a break?
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    Most medical schools are crying out for teaching fellows, group learning facilitators, or whatever they are taught at any given institution. Warwick Medical School is currently advertising for someone to lead their pre-clinical course - that person must hold an MBChB and have previous experience as some kind of teaching fellow. The salary range is £50-70k. This to me suggests that there is a formal teaching career structure emerging within some medical schools for clinical teachers.

    I personally think that you will be in a much stronger position to develop this as your career direction if you finished FY1/FY2 +/- completed one of the professional diplomas (e.g. MRCS or MRCP). This is definitely the case if you want to build a career teaching clinical skills as you really need some clinical legitimacy to develop this into a full career. If you were willing to develop in some other direction, e.g. as an anatomist doing a bit of research but mostly responsible for the anatomy curriculum, then this would be useful but probably not quite as essential. You could easily develop an education career into doing some education research (MSc/MD/PhD), taking on a heavy teaching load, and becoming the Associate Dean for Education or something similar instead of developing as clinical role as a consultant. There are also many international opportunities for clinical teachers with some UK training.
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    (Original post by clusters)
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    Sorry you're finding it tough at the moment. It sounds like you have a lot on your plate with finals and your dad's ill health.

    For the moment, try not to focus too much on whether or not you will cope as an F1. You don't know until you try it! With a supportive team of colleagues, living in the right place to minimise the commute, getting used to the night shifts, getting used to your jobs (four months is a lot longer than most student placements in each department - it doesn't go too quickly), etc, you may find that it's quite manageable, especially with some purposeful job-picking - i.e. starting with something unbanded and senior-heavy to allow you to ease into it. However, it sounds like you need some support before you get to F1.

    Try not to worry about what other people think about you taking time off - take as much time as you need. When you are on placement, you need to be fit to be there, not completely exhausted. Have you spoken to your tutor at uni about how you're feeling? Or your GP? What support did you get when you had your year off, and did that help? It might be useful to revisit that. Have you had any contact with your university occupational health department?

    I'm an F2 who's been off for the majority of this current rotation with stress, and I can empathise with what you're saying about difficulty sleeping, worrying about what others think, and wondering how to cope with future steps up in responsibility. Medicine is stressful, especially when you're dealing with stressful situations at home as well like you are. If people around you, like your uni tutor, GP, etc, know what's going on, then they can help. They might be able to direct you to support services that can help you deal with the anxiety and other symptoms you're feeling so that they're not such an issue when August comes round. When you start F1, the medical school passes on information to your deanery, so that they can continue to support you at work. You can take up to four weeks sick leave as an F1 if you need a break, without it compromising your ability to progress, and if you run over that then deaneries are usually really good about 'borrowing' annual leave etc to ensure you complete F1 on time.

    You mention that you enjoy spending time with patients, and love learning medicine, which are the important things - I don't think changing your career plans because you're worried about your ability to cope with something you haven't experienced fully yet, whilst going through a difficult time regarding family members, is the most sensible thing. See how much support your uni etc can provide to get you through these last student placements and finals, and use your time after finals to find some coping strategies before August, and see how things go, but take the time you need to get to where you want to be - there's an awful lot of working years ahead and there's no point rushing to get to them if more time out to prepare would be more helpful. i'm sure your dad would rather see you happy and taking time to focus on yourself than with a medical degree but unwell.

    Hope things improve for you.
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    Thanks everyone for your replies.

    The day when I posted was a particularly bad day after 2 nights of no sleep. Some days I feel fine - usually when I have someone specific to report to or to shadow on the wards. For the past 3 weeks I have been on placement in a hospital local to my family to spend some time at home. It has probably made things a bit worse as it was quite informally arranged so I didn't have anyone to report to, or any particular timetable - I know I should be mature enough when left to my own devices to get on with things, but if I don't have anywhere specific to be then my anxiety about being there tends to override everything else and I go home. This is counterproductive as I then feel anxious about not being there, I am getting signed off on Friday and worry that the consultant will grill me about what I have been up to. I have been in almost every day, some days for most of the day (and one day I did a long on call day) but most other days only for half a day and then doing book work for the other half.

    I did some research into clinical skills jobs and you are all correct in that I would need a lot more clinical experience to apply for those roles. I got the idea into my head because we have academic F2s who teach at the clinical skills department during their academic post.

    I have spoken to my tutor and the administrative head of year about my family situation, they offered me to take a year off which I declined, and that is the extent of it really. I tried counselling with a university counsellor last year, but found it really wasn't for me. I haven't spoken to anyone about my anxiety about the course because I don't know what they can practically do - I can't have someone to hold my hand every day on placement.

    It doesn't help that our finals include an OSCE. I am not someone who performs well in that situation and although it sounds stupid the nerves about that almost paralyse me into doing nothing to prepare for it? Even though I know that is the opposite of what I should be doing. I don't really have a friendship group on my course since I dropped down a year (I sound more hopeless by the minute...) so I don't have a group to practice with.

    I have a question which I have tried to research but can't find an answer to. If I take a break before F1, how many years do I have before I have to do F1? I thought I heard somewhere that F1 has to be completed within 3 years from graduation. If it is not completed in 3 years, what happens then, is my medical degree no longer eligible to apply for foundation posts?

    Thanks everyone.
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    (Original post by clusters)
    I have a question which I have tried to research but can't find an answer to. If I take a break before F1, how many years do I have before I have to do F1? I thought I heard somewhere that F1 has to be completed within 3 years from graduation. If it is not completed in 3 years, what happens then, is my medical degree no longer eligible to apply for foundation posts?
    Is there actually one currently? This document seems to propose it and it's under consultation. http://www.gmc-uk.org/31___Regulatio...f_58721619.pdf

    Seems like 3 years is the going figure to complete FY1. Not quite the same as a time limit to enter but I would imagine it'd be similar?
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    I'm sorry you've had it so tough. Everything is probably compounded by your father's health. I was in a similar situation and although I didn't realise my parent's diagnosis had an effect on me, in hindsight all my anxiety problems arose from that one thing!! Sometimes you don't realise until afterwards.

    If this is a new phenomenon, maybe it's because you feel so guilty being away from your father (or that may play a small part)?

    If you've always felt like this, then maybe a less acute speciality (psychiatry, GP) is more-suited to you? I know a few medics who are very shy and have anxiety issues. Not everyone in medicine is outgoing or extroverted.

    You love medicine and seeing patients. It sounds like you'd love the GP life (training may involve less moving around? And less commuting (once you're settled)? I don't know much about GP training so cannot comment, sorry. But don't quit! You love this. Your father would never want you to quit what you loved. Maybe take a year out to spend time with him? Live with no regrets. Ultimately, family >>>>>> medical school, so do what is best for you *hugs*

    EDIT: Just read your response. You don't sound hopeless at all! Maybe confide in someone? Confiding won't fix your problems, but may make it easier to handle if you feel like you have some support. It's not hand-holding. Asking for support is sometimes the best thing you can do.

    Also, prepare for the OSCE! I completely understand you, but don't live with regrets. Try your best in the short-term, I think it'll make things worse if you go for a retake/retake the year!
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    I know there is a limit for how long after commencing F1 you can have before you are required to have completed F1. However if you don't actually formally start F1 in the first place then I'm not personally aware of any impediments.
 
 
 
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