Every August, newly qualified doctors start work filled with nerves and anticipation. An increasing number of FY1s admit when they start foundation training, that they feel anxious and unprepared. It’s a pattern Dr Clare van Hamel, associate postgraduate dean and director of Severn Foundation School, says she’s observed through research she’s undertaken for over 10 years. 

However, follow up surveys conducted with newly qualified doctors after only three months in post reveal this anxiety almost certainly reduces.

Her research highlights how valuable exposure to clinical practice is to reducing anxiety associated with being an FY1 doctor. Not only are new doctors able to gain new stills, competencies and experience, its helping them feel prepared and reduce anxiety. As Clare says: “It’s normal to feel anxious. That anxiety will reduce as you become more confident in your own competence.”

How shadowing has evolved

Mandatory induction for foundation year 1 (FY1) was introduced in 2012 to help ease the transition from student to doctor. In 2021, due to the unprecedented disruption in students training, all FY1s are being offer an extended paid shadowing period. The UK Foundation says “this additional paid commitment is to help compensate for some of the disrupted learning and experiences arising from Covid-related impacts.”

In 2020, final year students were offered the opportunity to graduate and start work much sooner than anticipated in a new role called foundation interim year 1 (FiY1). To qualify for the FiY1 role, students needed provisional GMC registration and to have graduated. Foundation schools were responsible for the training of FiY1s and the early graduates should have had an induction, full supervision, and a ‘buddy’ foundation doctor.

In fact, research led by Clare also suggests newly qualified doctors who undertook the FiY1 roles were more prepared, based on a self-assessment of preparedness and had less anxiety than those who did not undertake the interim post. “It demonstrates that a few extra weeks of being in a clinical environment can really help in terms of how prepared you feel,” says Clare.

Why do new doctors feel unprepared?

New doctors will have lots of concerns when they start practising – which hopefully the induction period will help to address. Sometimes the concerns are simple to resolve. For example, asking questions when you’re unsure, shadowing your FY1, getting access to IT systems and having a tour of the hospital can go a long way to making you feel better prepared.

Prescribing seems to be an area that some new doctors are particularly concerned about. According to Clare, “Prescribing is an area that can be difficult to put into practice because of legal requirements but is an area that really should be focused on to help prepare you for the FY1 role.” Clare notes that prescribing confidence varies with many factors – for example, people are more confident prescribing paracetamol than insulin. Students who complete the PSA are also more likely to have improved confidence. 

Clare also notes that despite greater emphasis on mental health awareness in medical school and in the curriculum, confidence in prescribing for acute and chronic mental health was lower than critical illness.