The Foundation interim Year 1 (FiY1) doctor was a unique role created during the coronavirus (COVID-19) pandemic for eligible final year medical students – what lessons can we learn from its introduction?  

Dr Bryan Burford – Lead researcher, Newcastle University

The changes to healthcare driven by the coronavirus pandemic are far-reaching and have had a huge impact on the medical profession. In many areas, especially those affecting the workforce, it’s required the healthcare system to find ‘out of the box’ solutions to maintain levels of staffing and continue to deliver the crucial care needed.

One way to tackle this was through the creation of ‘interim’ Foundation Programme posts, open to new graduates ahead of the start of their planned Foundation Programme in August. Medical schools developed ways to graduate students so they could apply for Foundation interim Year 1 (FiY1) posts, months ahead of when they would have normally been expecting to start work. Foundation schools and the GMC worked closely together to adapt processes, checks and safeguards, so that these doctors were able to enter the workforce and contribute to the COVID-19 response whilst being able to work safely, protected and properly supervised.   

Along with seven colleagues at universities in Newcastle, Exeter, Plymouth and Belfast, I’ve been leading a GMC-funded research project that explores how FiY1 posts have affected these new doctors, and the impact it’s had on their work, wellbeing, and perceptions of practice.

We’re examining the value and risks inherent in such a novel approach. As well as providing an evaluation of the current intervention, we also expect our research to help better understand the perennial question of how prepared final year medical students are for the transition to clinical practice. This can inform the response to any future crises, but also any changes to normal practice.

All the areas that we’re looking at will have a story to tell, and some early findings on the work done by FiY1s, and their preparedness and wellbeing, have been described in the just published report into The state of medical education and practice in the UK.

Another interesting angle we’ve explored is how these students see their identity as doctors. We already know that final year medical students tend to perceive themselves ‘as doctors’, but we wanted to see if that image persists when they find themselves ‘unexpectedly’ in this role with a provisional licence to practice, and able to carry out a greater range of work.

Also related to wellbeing, we wanted to look at FiY1s’ ‘tolerance of ambiguity’, a recognised phenomenon related to how well doctors respond to uncertainty in clinical practice. An initial look at our data appears to reinforce earlier suggestions that tolerance of ambiguity is associated with better wellbeing.

The research is split into three phases. The first was a questionnaire that went out to doctors taking up the FiY1 posts, between May and July. The second involved a similar questionnaire that went to all Foundation Year 1 doctors in August and September. Of the 4,662 doctors that were in FiY1 posts, we’ve had over a thousand contributing to the study, plus nearly 500 other F1s.

The third phase – currently in progress – involves Zoom interviews with a sample of those who had responded to the earlier questionnaires. Most were FiY1s, but we are also interviewing a few who did not do an FiY1 post, to elaborate on the reasons why they did not, and how their transition to F1 compared.

We felt it was essential to get data as early as possible in the spring, and managed to get our first questionnaire out just over a month after the first FiY1s started in their posts. Some of this speed was because we were keen to avoid just collecting retrospective data and wanted to capture the ‘in the moment’ experience. That said, the current qualitative work is throwing up some interesting contrasts and thoughts on the differences between how they were working in the spring and where they are now. 

This research will help not only in understanding and evaluating the response to the pandemic from such a singular perspective, but will also bring benefits by what it can tell us about the ‘normal’ transition into practice of new doctors, and just how well final year medical students are prepared. Our final report, which we’ll be completing early in 2021, will add to understanding of new doctors’ experiences of starting work in such unusual circumstances. Through evaluating the positive and negative effects of the FiY1 initiative we will provide useful pointers on how to address the challenges that affect new doctors and give us a clearer idea of what support will help them as they take up their new posts.

More information about the project is available at the project blog: https://blogs.ncl.ac.uk/2020medicalgraduates/

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