In March 2020, I set off for my medical elective in New York. I was so excited for the two months ahead of me and felt like it was the greatest reward for having made it to my final year of medical school. However, two weeks later, due to the COVID-19 pandemic, I was on a plane home.

I had a whole mixture of emotions: disappointment to have missed out on the trip of a lifetime, relief to have made it back home to friends and family and very quickly, uncertainty about what lay ahead. With returning to medical school no longer an option, just two weeks after arriving home, I was faced with the option to graduate early and to start work in the NHS. Although this was a daunting prospect, I was sure that it was what I wanted to do. I instinctively wanted to help those that were more vulnerable than myself and with the skills that I had gained from medical school – this was the best way to do that.

Stepping straight into FiY1

Fast forward a few weeks of filling out forms, reading through contracts, throwing homemade mortarboards in the air and moving back down to the south-west (where I would be starting my FiY1 placement), I stepped onto the wards for the first time as a doctor.

Having now come to the end of my interim placement, I can look back and say what a valuable, eye opening and humbling experience it was. I was so fortunate to join the NHS at a time where team spirit and public support were evident. I used my skills to help those in a true time of need which was undoubtedly satisfying and in return I gained confidence and experience that will be a great help as I start my first year of foundation training.

However, it was challenging, and I hadn’t appreciated how significant the step up in responsibility would feel. I also hadn’t anticipated how different working life would be during the pandemic and how much I would have to adapt what I had learned. Personally, I found the most significant change was working in a mask.

Masks and communication challenges

In the hospital, we wore masks all day, every day. With patients, in our ward offices and as we walked around the hospital. Our patients were also in masks, to reduce the transmission of the COVID-19 virus. It is so important but before being in that environment myself, I was totally naïve about the impact that it would have. 

One of the earliest and most fundamental aspects of medical school training was about communication, as it is an essential part of our role and of patient care. We were taught to read our patient’s expressions, body language and emotions; we were taught to use our own expressions to aid communication; and we were taught to empathetically and effectively break bad news, update relatives and converse with the wider multidisciplinary team.

While wearing a mask, what had become second nature in my training was immediately challenged as I started work. Behind my mask, patients couldn’t see the empathy that I was expressing or the fear on my face during my first few days of work. And, behind their masks, I couldn’t see the colour in my patients’ faces as I approached their beds or the tears running down their cheeks as they recalled recent events.

Adapting skills to a new working environment

I had to adapt so many of my essential skills in order to develop relationships with my patients, to build their trust in me and to get to know them well enough, to deliver optimal and personalised care. To achieve this, as always, I learnt and took inspiration from those around me. I observed as my colleagues took extra time to introduce themselves to new patients; I used friends, family and mirrors to rehearse expressing myself with visible parts of my face and I took inspiration from clinicians around the world with their creations such as photos of themselves on their scrubs.

Over time, I adapted what I knew to this new way of work and felt as though I could deliver equally good care. I hope the skills that I have learned will be useful as our healthcare environment adapts in the future and I am certain that my appreciation for the importance of non-verbal communication will stay with me during my development as a doctor.

Despite the challenges, I now feel ready to start work as an FY1 doctor and I am prepared for the challenges that will come working during the pandemic. I have learned how to work with uncertainty, I have learned the importance of working in a team, I have developed the confidence to ask questions, I have learned how to adapt my skills to a changing environment and I have learned how rewarding a career in medicine can be. All that I have learned as an interim foundation doctor will be so valuable at the start of my career and I am so looking forward to getting started.