Foundation interim year 1 (FiY1) – success or failure?
Richard Phillips is an Academic FY1 Doctor in Birmingham interested in helping to bridge the gap between pre-clinical and clinical medicine.
Having recently been a member of the cohort of 2020 graduating medics I have experienced firsthand the FiY1 programme (henceforth referred to as “interim”). This hastily concocted programme was a UK Foundation Programme Office (UKFPO) initiative primarily in response to the fears of NHS staff sickness during the COVID-19 pandemic.
With the cancellation or modification of medical finals up all across the country, March, April and May saw the early (and rather unceremonious) graduation of ~8,500 new doctors. However, with the formal FY1 programme not set to start until 5th August 2020 there remained 8,500 fresh-faced doctors who couldn't be deployed. The interim programme allowed these new doctors the opportunity to commence work early in either: 1) a hospital linked to their medical school deanery; 2) a hospital linked to the deanery that they were assigned for FY1. In my case, I elected to start work in Birmingham, where I now work as an FY1.
Admittedly the process had a huge number of positives. For me, the biggest plus was earning the right to join the workforce as an NHS doctor. To be granted this title during one of the most significant periods of our generation was something very special. I felt privileged to be able to help out and perhaps the largest contribution that myself and the fellow interims may have made was providing the existing junior doctors a chance to finally take some (much-needed) annual leave.
In return for this contribution, I found myself allocated to a well-staffed firm, with experienced juniors who could provide a supportive and educational environment for us newly qualified doctors. In any other year, the start date of FY1would have signaled the rotation of the other junior grade doctors (e.g. FY2 upwards) meaning I would have joined a ward where everyone is new to the department. However, with interim the lessons I learned from these juniors prepared me excellently for life as an FY1. I was introduced to the daily functioning of the ward, how to hone my practical skills (e.g. cannulation) and also how to begin working on my Horus portfolio. Whilst these may have been experiences that I would have learned during FY1, in interim they were shared with me in a gentler environment (sans on-calls, short staffing and the full responsibility expected of an FY1).
Inconsistencies and inequalities
So, was interim a flawless masterpiece of unparalleled success? I would argue no. Firstly, and most importantly, not everyone who wanted to start could start. There was somewhat (understandably) a postcode lottery of where you applied, however this must have been very distressing for those who felt like their colleagues were advancing in a programme they were being denied.
I also found the variability in start dates very jarring. Some started in mid-late April, whilst others (myself included) not until June. This stole that moment of comradery that I had been anticipating when initially we would all have started in August, a day eerily known as “Black Wednesday”. Furthermore, it meant that my peers and I were all experiencing our “first …” at different times, be it a cannula, a TTO or a rejected radiology request. For me, not being able to share these moments with my friends who were already 6 weeks into their jobs felt incredibly isolating. Anything that I had experienced had likely already been experienced by them.
In addition to this, I could not help but feel that despite the consistent pay for each interim, the levels of responsibility differed exceptionally. Some interims were shoe-horned into the existing rotas to alleviate staff shortages, whilst others found themselves (perhaps correctly) in supernumerary, shadowing roles that allowed them to be immersed ever-so gently into the world of work during such a stressful time. I found it vexing to hear colleagues who were given afternoons off to “get ahead” on their Horus e-portfolios, whilst I was expected to stay late if required. This is not a complaint of the latter, rather a comment that the programme should have been consistent for all.
So did the interim work? Ultimately, yes. It is one thing the country got right in this pandemic, ensuring that the health system did not collapse from mass worker sickness by ensuring that a back-up reserve of new doctors were on hand to help out. Not only this, but the additional experience has meant that the majority of the FY1 intake is also better equipped to deal with the second wave we are currently facing.
On a personal note, it definitely eased the start of being a doctor. Omission of on-calls, nights and weekends certainly meant I could just focus on getting to grips with the world of work. However, on the day before “Black Wednesday” I mentioned to a colleague that the interim experience had taken away the story that every doctor has about their first day as an FY1. Maybe I tempted fate as the very next day (through staff illness) I was left to manage an entire ward on my own! Whoops
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I hope you are still doing well for the NHS with those case numbers; note I have worked as both SR and, 12 years later, Consultant Surgeon in NHS some years back. In NSW, about 250 FiYs worked across the second half of 2020 - these 'assistants-in-medicine' worked and completed their medical final year as NSW Health pushed on with the program even though Aust has done "well". 85 were from WesternSydneyUniversity where I now work. There are several evaluations in progress. Our medical school view was how to keep the workers, and those 35 remaining as students in parallel, so we could be sure about completion, to be well-prepared to be real interns in 2021. They all had dedicated prep training in advance, orientation into hospitals metro & urban, and we used EPAs on smartphone app to keep track. Extra teaching was provided and final checkpoint OSCEs deleted. Instead, structured interview around 2 EPAs was performed, with some later workshop and further interviews for six. Regarding the jobs, there was variation as you described but largely it worked. There were also excellent performances in paeds, O+G, and mental health AIM jobs, these being areas not usually commenced until PGY 2 or later. We saw interesting allegiances to the work place as the workplace came to replace the medical school - the tandem arrangements certainly allowed transition. We will report all of this in the first half of 2021.
Best wishes going forward
Prof Stephen Tobin WSU school of Medicine, Sydney
Dear Prof. Tobin,
Thanks for taking the time to read. It’s good to hear that this strategy was employed in other healthcare systems and that overall you seem to think it was beneficial. 6 months on since I originally drafted this blog and I still maintain these opinions. I remain grateful for the opportunity and am confident that it shaped me into a well prepared FY1 doctor.
Sending regards to NSW.