Hello listeners and readers, and welcome back for another solo episode. My name is Linda (she/her) and I am working as a junior doctor. I started this podcast in the summer of 2020 while I was a medical student, and it covers all things not covered in medical school. I normally focus on health and illness, but it is important to consider those who try to improve health as well – i.e. doctors and healthcare professionals!

This is an episode with tips for new junior doctors/FY1/F1 doctors in the UK! Listen to the episode below, but be sure to scroll down and read more about the different topics and find useful links.

I am creating this blog post and episode as a resource to new doctors, having only graduated from Medical School myself in July 2021.

I will be covering two broad areas: life at work, and life around work – things practical to working on the wards (such as tips for night shifts and day to day ward work), but also all other aspects of the job to consider (such as pay, working on your portfolio and maintaining your own physical and mental health). I will pop the time stamps in the episode description, so you can jump to areas you are most interested in listening to.

As always, this is a podcast for educational and entertainment purposes only and should not be taken as individual medical or other advice. Find me and stay in touch on socials @widlims on Instagram and Twitter. If you have any questions or feedback, do message me! Thanks to Marianne from Marrianne does medicine, who is starting as an FY1 this year, for helping me out with some suggested questions and topics 🙂

Okay, let’s get started!

Part One

Part One will be all about preparing for FY1 and stuff around your actual working day.

We will cover:

• Feelings around starting work (fears, imposter syndrome)
• Making the most of shadowing
• As a senior, what do you expect from an F1?
• Resources
• Your rights
  • Pay and pay slips
  • Contract
  • Rotas
• Working on your portfolio
• When/how to ask for help
• Taking care of your health during F1
• Taking care of others during F1/what to do if you see someone else struggling

Imposter syndrome and nerves

First of all, congratulations and well done for securing such a special job! Being a doctor is a privilege and the good moments are exceptionally good. However, the lows are also low, and unfortunately right now is a difficult time to be joining the NHS workforce. I will do my best to give you some tips and comforting words to navigate your first year as a doctor. Bearing in mind, I am only just finishing my own first year of work! Sometimes I feel like I have learnt absolutely nothing, and other times I look back at myself and feel so proud.

My favourite thing about this year has been getting to work with some wonderful colleagues, and the feeling of working as part of a team. I know I have made some friends for life 🙂 I have also had many rewarding moments one to one with patients and family members, and I love being able to help and know that I am actually making a difference to somebody, no matter how small it may feel.

I think it is very normal to feel terrified and unprepared for starting work. If you are feeling like it has all gone terribly wrong, and that you’re not supposed to be where you are – don’t worry! You have made it this far for a reason, and that reason is that you are safe to start working as a junior doctor. Nothing can fully prepare you for work, you will learn on the job and I am personally definitely learning myself every day. Imposter syndrome is real, and I think you just have to go for it and start doing things. When you look back at your progress over the next weeks and months, you will definitely notice that some has been made! I myself definitely sometimes have pinch me moments, and I don’t think it completely has sunk in yet that I am working as a doctor – but I am! And so will you be, and it will be petrifying but exciting and you will make such rapid progress in the space of 12 months.

I think what helps with dealing with imposter syndrome is reflecting on what you have learnt, and also talking about it with colleagues. I guarantee you most of the new junior doctors feel the same. So talk it out, but know that you have earned the right to be here through your hard work and dedication.

It can also be helpful to voice your fears and worries or to write them down if you like journalling. For example, you might be very scared of making mistakes, and in particular of making fatal mistakes. Mistakes can and will happen. There are things you can do to help mitigate them, such as always practicing within your remit, ensuring you feel comfortable with tasks you have, and talking through them with a senior. As long as you are doing that, and acting in the patient’s best interests, and documenting conversations and thought processes, you are being safe. Everybody makes mistakes, especially when stretched thin and stressed and tired. You simply have to accept that, and do your best to prevent such circumstances to arise, and like I said double check prescriptions, talk through management with a senior if you’re not sure and so on – sorry for being a bit vague, but this is just general advice.

In summary: yes, it is scary but you can and will do it! And you are worthy of the title of doctor of medicine, you have put a lot of work into coming here and it isn’t an accident in the slightest.

Making the most of your shadowing

By the time I release this blog post/episode recording, it is probably going to be too late for this year’s cohort, as shadowing is pretty much over. But essentially, my main point about shadowing is that it really isn’t going to prepare you completely. It is very useful, but if you are still feeling nervous and unprepared, that is normal! Medical school doesn’t prepare you for work as a junior doctor, but it does equip you with the basic skills and thought processes that you can then use and build on.

Use shadowing to familiarise yourself with the ward, ward staff and IT systems. Learn where you put your things, where to get changed, where the microwave is, the mess and so on. Make sure you know how to request investigations, how switchboard works, how referrals are made. How you bleep people. And how to put out a medical emergency/cardiac arrest call.

A few days of shadowing are not going to turn you into a competent doctor, but they will help you get used to your new environment and get started!

What is expected from an FY1 doctor?

Trust me, everybody knows that the new doctors are starting. People know that you are fresh out of medical school and only just starting. They should be happy to help and guide you, and if anybody is rude to you or demeaning, that is not okay.

What is expected from you is that you are willing to learn, that you do pick up new skills and knowledge, and that you help the ward function. You will be supporting seniors on ward rounds, or maybe even doing your own, ordering and reviewing blood tests and scans, doing procedures such as venepuncture, cannulation, catheterisation, having conversations with patients and relatives, and reviewing sick patients and escalating appropriately to seniors. Personally, I double checked stuff a lot when I started, and I still do. I mean, like when it came to prescribing paracetamol and ibuprofen, I still double checked with the BNF the first few times… it’s okay!

Some things you will not be able to or expected to do as an F1. For example, writing certain prescriptions of controlled or regulated drugs and signing DNACPR forms. You might be expected to initiate certain difficult conversations, but you should not be the one breaking bad news as a completely fresh FY1. If you feel uncomfortable – and this goes for anything – it probably is because you should be, so double check it is okay.

Resources

Speaking of the BNF, that is the British National Formulary. There are some resources that will be useful to you on and off the ward. I will link them in the podcast episode description, and in the body of this text here.

Apps to have for day to day use:

• Induction: for phone numbers and bleeps in your hospital
• BNF: for prescribing
• Microguide: for your local hospital specialty and antibiotic guidelines
• iResus: not one I use day to day, but useful algorhithms to look at and learn
• BMJ best practice: for more information about conditions, investigations and management with great treatment algorhithms
• UptoDate: search good quality evidence for lots of different types of conditions and drugs

There also are good resources for learning about medicine, which would be your notes from medical school and textbooks.

There also are lots of good resources for learning about FY1 and beyond, such as the free platform Mind the bleep. I am in no way sponsored, but I think they create a lot of good content, including educational lectures but also blog posts covering things like understanding your payslip, your rights, and general tips and tricks for working on the wards and within different specialties. If you’re into twitter, there’s #medtwitter and lots of helpful people on there – but also some not so helpful discussions being had. There are also many doctor instagrammers, youtubers and bloggers who put out content – I suppose I could be counted as one of them.

Help and further information is out there.

Your rights and obligations

Okay, so – this one is so important! It is crucial that you know what you are expected to do but also what you are not expected to do, and what you are owed.

I am not going to go too much in depth into this, because the BMA has great info online as does mind the bleep which I mentioned earlier. Just google “junior doctor uk payslip” or “junior doctor uk rota” and you will find more info. The BMA is the union for doctors in the UK, the British Medical Association. You can often join for free at the start of FY1. BMA advisers are available online and via the phone and can help you out. They also set up webinars and provide education.

But, some quick tips anyway. Learn more about your rights here, and here is a quick summary of your rights under the new junior doctor contract in terms of rest breaks and rota.

• you should receive your rotas 6 weeks in advance
• your rotas must be compliant with certain regulations, such as you being entitled to a certain amount of rest after night shifts, and not working more than a certain number of hours in a certain number of days. the BMA has a handy rota checker you can use.
• the BMA also has a free contract checking service for members.
• your rota should correspond to your work schedule, which your pay is based on.
• you should be paid the same as your colleagues if you are doing the same job – compare payslips (with other people’s permission). More about payslips here and here as per the BMA.

In return, you also need to do certain things, such as requesting leave at least six weeks in advance. Remember that for bank holidays, you are owed days off in lieu. Unless you are working a job such as GP or psychiatry, this usually means that you will get as many extra days off as there are bank holidays to take off in addition to your annual leave. Even if you have a zero day on a bank holiday!

You will have to do a bunch of quite dull mandatory training – try to do this at work if you have some downtime at any point, as you are not meant to be doing it in your free time, or if you have self development time built into your rota you can do this then.

On that note, be sure to take all your allocated leave – nobody will thank you for not doing so.

And make sure that you register with a defense organisation of your choosing.

Working on your portfolio

During the year, you will not have to sit an exam – yay! But to pass FY1, you need to complete a Portfolio. I work in England which uses the Horus Portfolio, I believe in Scotland it’s called Turas. The principles are the same, though. Throughout the rotation, you will have to get seniors to sign you off to prove that you are learning and doing skills. There are different types of things you can get signed off. The most up to date information can be found on the UK foundation programme organisation website.

I won’t go into detail about the specifics here, but definitely work on your portfolio as you go along. It’s what I did, and it made such a difference.

Be proactive in asking for sign-offs. Everybody knows you have to do them. Establish a rapport with senior doctors, and ask if they would mind supervising you for a mini-CEX or DOPS. Or, if you discussed a management plan for a patient with a registrar or consultant, that could make up a CBD. Write up cases on the same day or soon after you discuss with a senior and send them the ticket. If you aren’t going to be able to do it anytime soon, write down a little draft/bullet points of what you want to include on your phone as you will forget otherwise. Don’t chase someone too much about a sign off, give them some time before sending them reminders. Remember you can get senior nurses and allied healthcare professionals to sign you off as well!

When it comes to reflections, they can be good to use if you have encountered a situation which genuinely made you think and impacted you in some way. I reflected on bad days a few times, or situations where I felt I could have done better, but also on good things that happened.

Attend teaching and log it in your portfolio. Sometimes you can do online catch-up teaching.

Basically, there are many components to the portfolio, and it can feel quite overwhelming and stressful. Read up on what is required of you early on, so you know what you need to achieve in what time frame, and set aside a couple of hours every week or every other week to just work on your portfolio.

Asking for help

I ask for help a lot – at work. How about asking for help outside of work? For struggling with health or finances? As a rule of thumb, nothing bad is going to happen if you ask for help. In fact, only good can come of it: if you are not coping, you need adjustments, and it is not sustainable to push yourself through work. Some people may experience a few bad days here and there, but many doctors and other healthcare professionals deal with poor mental health and conditions such as depression. Help is available, please don’t suffer in silence. There are a few people you can rely on, depending on your circumstances and place of work:

• support network of friends and family
• your own doctor/healthcare professionals you are in touch with: GP, therapist, psychologist, psychiatrist
• your clinical supervisor on placement
• your educational supervisor for the year
• staff wellbeing/mental health support persons or service
• your foundation year co-ordinator/that one person who is always sending you emails about various things, should be able to direct you in the direction of something
• phone helplines or web chats/forums
  • BMA wellbeing and support services directory
  • BMA 24/7 counselling 0330 123 1245
  • Samaritans 116 123
  • NHS directory of resources for mental health crisis
• in an emergency, please phone the appropriate services!

If you see somebody else struggling, reach out to them and offer them help and signpost to where they can find more support.

Looking after yourself as a junior doctor

So congrats, you made it to Foundation Year 1! But you have got many years to go, and it is important to remember that work is not everything and you are a human being who needs to function, and ideally thrive outside of work. Everybody’s situation is different, but there definitely are some modifiable lifestyle factors that I want to empower you to influence so that you feel better equipped to take on your job, and life outside of work. On my podcast, and website, I have several episodes and posts about the principles of lifestyle medicine, and recipes! I have an entire episode on sleep and night shift working that you should definitely also check out, here.

• Food
  • Eating well outside of work, including eating less nutritious foods for the pleasure and sociable aspect, is very important to nourish your body.
  • Meal prep if you can, batch cooking things that you can either eat cold like sandwiches, wraps and salads, or bring food to heat up during your lunch break. I would recommend getting an insulated lunch box and an ice pack which will work as a mini fridge. Stock up on snack bars, fruits, dried fruit and nuts as well as treats like chocolate.
  • Focus on increasing your whole foods, i.e. whole grains, fruits, vegetables, pulses, nuts and seeds.
  • Don’t overdose on caffeine… if you can, try to not rely on it too much.
• Exercise
  • Move your body in a way you enjoy. Try to incorporate some resistance training.
  • Go for walks, to parks and green areas if you can!
  • Try to work around your shifts – I personally don’t usually have the energy to get up early, or work out after work but everybody is different
• Sleep
  • so important to sleep well, especially if you are having to get up early to drive, as it can be life threatening to drive while sleep deprived
  • basically, starting to prioritise sleep can make a massive difference to your life
• Stress management
  • you need to have a few things you can do to rely on when things get tough
  • meditation, yoga, walks in nature
  • talking with colleagues, friends, family
  • if you are struggling, reach out to GP or mental health services
• Fun
  • F1 is also a fun time! Some people move to a new place and meet new people
  • Join socials, clubs etc – but don’t let FOMO take over, and don’t feel bad about having a quiet night in to replenish yourself
  • be careful with risky substances such as alcohol

And that’s it for my section on preparing for FY1 and life outside of work. Now, onto…

Part Two

This is all about tips and tricks for actually working as an FY1. I will cover:

• What does a typical day look like?
• Tips for getting your job done
  • organisation
  • jobs lists
  • resources
• Working within teams
  • Tips for teamwork, communications with colleagues, splitting up tasks specifically with juniors
• Working with seniors
• Tips for on calls and nights
• When/how to ask for help
• Breaks, working late and exception reporting
• Difficult situations
  • Death and dying
  • Difficult patients and relatives
  • Bullying and harrassment

What does a typical day look like?

This will vary hugely depending on what hospital and ward you are working on. Shadowing is a good time to get the lowdown on this, and you can always ask colleagues working on different wards for a better idea when you are rotating onto a new specialty. In general, on a medical or surgical ward, you can expect to be updating your patient/ward list, chase and review imaging and blood test results, support seniors during ward rounds or do your own ward rounds, have conversations with patients and relatives, and review sick patients. You will also be helping with patient flow through the hospital and ensuring they are discharged with the right paperwork and medication, and also communicating with the multi-disciplinary team (MDT): pharmacists, physiotherapists, occupation therapists, specialist nurses, healthcare assistants, dieticians, porters, site managers, radiographers… and the list goes on.

While you are working on the take/clerking new patients, you will be seeing new patients in A&E or ambulatory care, taking a history and examining them, initiate basic management, discussing with your seniors and presenting to seniors and helping with the post take ward round.

Tips for on-call and night shifts

After the main hours, i.e. out of hours, there usually is reduced staffing and some people refer to this as being “on call”. For example, in my care of the elderly job, I was expected to cover all the geriatric wards after 17:00 until the night team takes over. During this time, I would review unwell patients, chase urgent investigations, and answer bleeps from nurses.

At night, you generally will be covering the entire hospital with reduced staffing and things are a bit different. You should not be completely on your own as an F1 doctor: there is usually at least an SHO and a registrar about. If you need help urgently, put out a medical emergency call via switchboard. Similar to the on-call you will be answering nurses’ bleeps with requests to review patients or prescribe drugs. Not everything you are asked to do is urgent and needs to be done: you will get better at figuring this out with experience, I would often do things that maybe weren’t necessary just to be nice which I wouldn’t always advise.

On call, stick to your A-E framework when assessing patients and if you feel unsure, either chat things through with a senior such as the medical or surgical registrar, or if the situation is urgent escalate to a medical emergency/peri-arrest call etc. as appropriate. The critical care outreach team can be super helpful at night as well.

When it comes to managing sleep and rest and eating on a night shift, once again I redirect you to my episode with consultant sleep specialist Dr Farquhar here. You may also want to have a browse of this BMA information page here.

Staying organised

Some people may wonder if they need to get any particular equipment for work. I think you just need to have scrubs or clothes with good pockets, or you could have a bumbag if that’s your vibe. Make sure you carry plenty of pens and some A4 sheets of paper folded in half/quarters to write on, or a small notebook. Have a water bottle on hand and snacks.

Stay on top of what you need to do, whether it be during a normal ward day or on-call or nights, with a good jobs list! I like to make sure I have the patient name, number and location down and next to that I will write a few words about them so I know what is going on if relevant, or just the jobs. Normally I will write for example “chase CT report” or “CXR” with an empty square next to it. I then fill half of this in across the diagonal when the job has been started/partway done, and colour it in fully when it is completed.

It is very important to write down jobs as soon as you can, at the time they are generated during the ward round. It is worth asking your senior to slow down if you haven’t had the time to note everything down because at the end of the day, it affects you both if the relevant things aren’t done. More about ward rounds and how to deal with them here.

Working within teams

Part of why being a doctor is fun, is working with other people! There is the MDT which I mentioned earlier, and then there are your doctor colleagues.

It is very important to respect everybody’s role in the MDT, and also to know what people can do. For example, what which nurses are able to do to help you (can they cannulate? take bloods? can they do female catheters but not male?), and what the role of the pharmacist is (some can prescribe and help do discharge summary medications). Be kind, courteous and helpful to your colleagues. Offer to help when appropriate, within your own role. For example, in my trust nurses can do referrals to dieticians, so it would not be appropriate or a good use of my time to offer to do that. Nurses are amazing, and charge nurses run a ward, so building good relationships is important. We are all part of a team and every MDT member contributes and matters.

In terms of working with your other junior doctor colleagues, you need to find your own balance which works. It depends on the job, the ward, and the workload. Essentially, you should be working a similar amount, and help each other out. If somebody is drowning in work, and you have done your jobs, help out! Some people like to do a shared jobs list. Ask people “what can I help with to make you leave on time?” and they should ask it back to you when you’re the one who’s overwhelmed.

If you learn something new, share it, for example if you find out something that might be useful about the process of ordering a scan, or where things are kept on the ward that you didn’t know existed.

Working with seniors

This is something I was asked by an incoming F1 doctor. I assume the person meant how do you maintain good relationships with consultants, or more senior doctors. I think it is important to be courteous and helpful, but ultimately, you should not be treated badly or be given a hard time by anyone no matter what their grade is. If you find that you are struggling with a senior colleague, and you are doing your best, is that because of something they are doing rather than you?

Bullying and harassment is never okay.

So my tip is just to do your job well, show some interest, but if you feel that someone is being difficult with your or mean, something else might be going on. Solve it locally or discuss with your colleagues, or your clinical or educational supervisor.

Asking for help

If you need help, it is always right to ask for it. Either discuss things with your F1 colleagues or an SHO, next in line would be registrar then consultant on call. In an emergency, a medical emergency is appropriate. If you are on your own and just need more people quickly, again a medical emergency call is appropriate. Sometimes things can wait and you just need advice or a senior review but not imminently. Be clear when asking for help. If you have phoned someone, tell them “I am phoning you for advice because I am worried about this patient” or “I would like you to come and review this patient”. Ask for what you need, then it is up to the other person to take things from there. Trust your gut.

Don’t feel like you need to know everything or that you have anything to prove. You are here to learn!

Breaks, working late and exception reporting

One thing that you will learn is to take your breaks. There will always be more things to do, so at some point you need to take a break. Ideally, you should do more urgent jobs before taking a break, or initiate jobs that you know may take a few hours to complete earlier on. You are entitled to a 30 minute break every day, two 30 minute breaks for shifts over 9 hours, and three 30 minute break for shifts over 12 hours! Read more about junior doctor contract entitlements here.

Don’t stay late! Nobody will thank you for going above and beyond. Of course sometimes you will find yourself in a situation where nobody is there for you to hand over to, or you are dealing with an emergency or something that cannot wait, but in reality most things can wait. The hospital is a 24-hour service, and you should be able to hand over and go home on time.

If for any reason you are not taking your entitled breaks, and you are not leaving on time, it is important that you exception report. This not only highlights to the department that there may be staffing issues for example, which then serves as proof when the trust seeks funding for more junior doctor posts, but it also means you get paid for overtime. Specify that you would like to get paid instead of time off in lieu (as that is often difficult to get if we’re being realistic). If you are being intimidated or bullied, or feel awkward about your placement clinical supervisor knowing about the exception report, you can just send the exception report so it notifies your educational supervisor. Either way, it is nothing that should be discouraged or shamed. More about exception reporting here.

Don’t spend your free time working over, and if you do, don’t do it for free!

Difficult situations

A few difficult situations you may not have thought about, that are worth mentioning are coming up here.

First of all: you will deal with death and dying patients, and you have to verify deaths. This can feel scary and creepy if you have never had to deal with it before. Take your time, speak to a senior colleague if you feel scared.

Secondly, you might encounter patients, or relatives who are difficult. They might be unfairly rude or criticise you as a person. They might call you a bad doctor, and be verbally or even physically aggressive or abusive. Know when to leave a situation, and debrief with a senior if it affects you.

Thirdly, you may encounter colleagues that others might describe as “difficult” or as having interesting “personalities”. Please do not tolerate bullying, harassment and undermining. Don’t take things personally. Escalate and get help if needed and things aren’t getting better!

Wrapping it up…

So that was a bit of an overview of different areas where I felt I had some wisdom to impart. I definitely have a lot left to learn myself, but I think I have become more confident in who I am and my value in the system, and what my role is. I would be happy to produce more content if there is a demand for it, in terms of tips for medical students and junior doctors.

I would love to hear your thoughts and feedback.

As always, find me @widlims on Instagram and Twitter. I look forward to speaking to you soon!

Linda