In July the GMC published research into the experiences of medical students who graduated early to help meet the challenge of the first wave of COVID-19 in newly created interim Foundation Year 1 (FiY1) posts.
Dom Proctor was one of them. He was nearing the end of his medical studies, and on a placement at a hospital in The Gambia, when news about a new coronavirus emerged. Within weeks he was working on the front line as a doctor in a UK hospital. Here he looks back at the challenges of that time.
From medical student to interim Foundation Year 1 doctor
Between a premature ending to my elective placement in Africa and an expedited virtual graduation, it would be reasonable to say that the final months of medical school had more than their fair share of uncertainty.
The culmination of six years of work, I had anticipated graduation would entail sipping a glass of bubbly surrounded by the family and friends who had unwaveringly supported my academic pursuits over the years. And yet, it would seem that fate had other ideas.
It was in the midst of an idyllic elective that I first took any significant notice of a new virus by the name of ‘COVID-19’. Sat on a white-sand beach in West Africa after a long, warm day in the emergency department of Brikama General Hospital, cold drink in hand watching the sun reflect off a calm sea, my primary concern had been my rapidly depleting stores of factor 50.
At the time, the coverage surrounding the outbreak of this new virus was merely media hysteria in the eyes of many, a scaremongering ploy to gain traction amongst a plethora of journalistic content. If only we had known.
It was not until a week or so later that the gravity of the situation became clear. The grounding of flights and the closure of international borders signifying that this latest outbreak was not to follow the same course as the Ebola and Zika epidemics. This was evolving into something entirely different.
All in all, it was a little over a week between the day of my repatriation flight and the announcement that 5,500 final year medical students would be awarded provisional GMC registration three months sooner than expected.
As cases of the virus surged, and the fabric of the NHS bulged at the seams, an old aphorism about frying pans and fires sprang to mind.
And yet, in all honesty, the transition from medical student to junior doctor felt seamless for the most part, largely due to my experience of my FiY1 post in general surgery at the Royal Devon and Exeter Hospital.
Thrust onto a bustling surgical ward, we worked within a socially-distanced rota composed of three ‘pods’ of doctors at various stages of career progression from consultant surgeon to FiY1 doctor. Each pod completed 15-day cycles, beginning with five days in the hospital, followed by five days off-site but on reserve should a colleague fall ill, and finishing with five days leave.
Despite the obvious excitement associated with entering the world of clinical practice, as with any untested initiative I had some initial reservations about the suitability of the role. Even the most eligible candidate for the FiY1 post would be taking on clinical responsibility having been deprived of several months of valuable training, potentially with deficits in knowledge and confidence that would otherwise have been filled.
Furthermore, while more hands may lighten the workload, if such inexperienced hands were not adequately supervised, or if that supervision is overly time-consuming for supervisors, they would have the potential to detract from the high-quality care delivered across the NHS.
And yet, the organisation of the FiY1 role was such that these concerns rapidly faded into obscurity.
Being afforded the opportunity to begin work in a familiar hospital with an augmented level of supervision contributed in no small part to its success.
The combination of challenging clinical scenarios – busy ward rounds, acutely unwell patients, enacting new communication skills – and an abundance of incredibly supportive colleagues, generated a calibre of learning that only clinical practice can bring. It was undoubtedly the springboard, and confidence-boost, that I needed on entering the daunting world of clinical medicine.
By occupying the niche between medical student and practising clinician the FiY1 doctor position had, to some extent, bridged the sizeable gap that exists in this greyest of areas and in doing so eased the process of entering clinical practice under already trying circumstances.
And yet, for all the positives, reflecting on the past year comes tainted with melancholia. The victims of this pandemic have come from all walks of society and observing its impact on patients and healthcare staff has been challenging to say the least.
While the clinical camaraderie has been unwavering, the past 18 months have presented a barrage of emotional demands for newly-qualified and experienced healthcare workers alike. Day-to-day there are very few observable signs, but below the surface there is on occasion a tangible sense of weariness.
In retrospect the real value of the FiY1 role has been the way in which the additional clinical experience afforded me greater mental capacity to process the psychological obstacles encountered during this highly atypical first year of Foundation Training.
It was the extra first-hand exposure to the hidden curriculum from which I truly benefited, and I have no doubt that the resilience acquired during this time will remain an asset to my fellow FiY1s and I as we continue along and pass beyond the end of the COVID-19 gauntlet.