Becoming a doctor requires years of study and clinical placements, so what happens when a newly qualified doctor finally starts their first job? How can they prepare? What do they really need to know? What might be their best experience? In this blog post, two doctors present essential advice on how to make the most of being a newly qualified doctor.
David Fisher and Liora Wittner are the authors of Oxford Clinical Guidelines: Newly Qualified Doctor. David Fisher worked as an FY1 doctor in Hinchingbrooke hospital, Huntingdon in 2015 and Liora Wittner worked as an FY1 doctor at Lister hospital, Stevenage in 2017.
What can I do to prepare for my first rotation?
David: Personally, after cramming for medical finals I arrived at my first FY1 post (part respiratory and part ITU) feeling as though the knowledge I crammed for finals had leaked out of my ears until there was nothing left! If you are like me, I would recommend reading up on the most common diagnoses that you will be experiencing on your first rotation. I am not suggesting that you become an expert in the specialty because nobody is expecting a new consultant to walk through the door on your first day, but enough that you will understand the plans that you are writing.
In terms of on-call shifts, I would similarly refresh your knowledge of managing key emergencies that you might experience on on-call shifts. If you start feeling sweaty and have palpitations as you imagine yourself responding to an emergency, remember that you will not be alone and help will be at hand. By the time you have assessed an unwell patient someone else will probably have arrived to help!
“Being a newly qualified doctor involves a lot of learning on the job, and that’s OK.”
Liora: I think no matter how well you’ve done in your exams, or how much you’ve practiced your clinical skills, or how much reading you’ve done, you will never go in feeling prepared enough! So first of all, accept that you won’t feel ready no matter what. But in reality, you are much more ready than you think! Being newly qualified involves a lot of learning on the job, and that’s OK. No one is expecting you to come in knowing everything, just to be ready to learn. If you can, try to chat to FY2s who did the job last year, it’s a great opportunity to get insider tips.
What can I do if I get a shock or have a bad experience?
David: There is no denying that the job is tough. At its most basic, medicine is a battle between health and disease and a bad experience may occur when disease prevails earlier than we expected. There are of course other bad experiences: mistakes, difficult inter-personal team relationships, and the sheer bodily demand from working long and sometimes antisocial hours are all hard to negotiate. It is important to talk through bad experiences with colleagues and other people who form your emotional support network, whether that is family or friends. Everyone experiences bad experiences sometimes and in medicine it is practically unavoidable. It is important to keep things in perspective and to make sure that you have a way of unwinding from the stresses of the job. Whether that involves exercise, food, socialising, or any other hobby, make time for it because these things will help you to process bad experiences and even be strengthened by them.
“It is important to talk through bad experience with colleagues and people in your emotional support network.”
Liora: Talk to someone. Whether that’s your direct supervisor, your FY1 peers or other doctors on the team, make sure you get a chance to debrief with someone you trust. Chances are one of them will have experienced something similar before and will have some good advice. Remember that you’re not alone. Of course, you can also talk to family and non-medic friends (patient confidentiality permitting!)—sometimes it’s helpful to have an outside perspective. And try to take the time outside of work to relax and refresh yourself, with some great TV, good food, or whatever works for you.
What was your best experience in your first year as a newly qualified doctor?
David: It’s hard to pinpoint my best experience in my first year of working. It felt like living in a whirlwind as there was so much to learn but I couldn’t believe how much more competent I felt by the end of the year. I clearly remember all of the small achievements (which didn’t feel small at the time) such as putting a cannula in independently on the first attempt. At the start of the year I had so many questions and frequently bleeped the registrar during on-call shifts even for relatively minor things, but at the start of the year nothing felt minor. By the end of the year I started to stand on my own feet and I needed less support than I did and that felt great because I felt more useful. I also enjoyed the team mentality that all the FY1s had; we were all in it together, whether we were struggling or celebrating, we grew together and forged friendships.
“As an FY1 who is always on the ward, you have an amazing opportunity to build relationships with patients.”
Liora: Feeling that I had gained the trust of a patient. Unfortunately, some patients spend much longer than they might have hoped in hospital, but as an FY1 who is always on the ward, you often represent continuity of care for the patient. You might be the doctor that they see the most over a period of weeks or months. This means that you have an amazing opportunity to build relationships with the longer-stay patients, to really get to know them and their families. Having the chance to really engage with the patient and gain their trust is a great feeling, and then seeing them finally being happily discharged home is incredibly satisfying.
What do I do if I make a mistake?
David: Everyone makes mistakes and anyone who denies ever making a mistake in medicine is probably lying. Mistakes range from the most minor with no adverse effects to the most serious, which in medicine can result in patient harm. Debrief and identify the contributing factors to the mistake: which of those factors were unavoidable and which can be modified in the future? Mistakes happen, and the question is, “how will you respond?” A positive response is one where lessons are learned and most crucially, when subsequently placed in an almost identical situation, the outcome is different. It is natural to feel low after making a mistake, it shows you care. At the same time, do not eat yourself up but rather pick yourself up and move forward and become a better doctor because of it.
Liora: Don’t stress! Everyone makes mistakes. Things like prescription errors are very common and often picked up by the nurses or ward pharmacist so that you can correct them. Make sure you learn from it for next time. If it’s a bigger mistake, make sure that you have the support of your supervisor to help you fix and apologise for it.
“You are part of a team and all of your seniors are there to support you.”
What would you have told yourself as a new FY1 on your first day?
David: That feeling of being completely overwhelmed will pass and after one year you will feel much more competent. To help along the way, bring a pillow and blanket for your on-calls. You may not use them much but the downtime that you have will be more comfortable.
When you get given a bleep, work out how to check the volume and if it is set to “obnoxiously loud” turn it down because nobody wants a doctor in the middle of night who is experiencing chest pain from being awoken by a loud bleep. At the same time, don’t turn the volume down so much that you don’t hear it; nobody wants a doctor in the middle of the night who doesn’t turn up because they slept through the bleep.
Liora: Don’t panic! You have worked hard to get where you are and you deserve to be there. You are there as part of a team and all of your seniors are there to support you. And most importantly, make a note of every door and cupboard code you get given—you’ll be grateful for it when you suddenly find yourself locked out of a ward or looking for equipment in the middle of the night!
Featured image via Pixabay, public domain