From the classroom to the ward round – what’s it like being a doctor after medical school?

University graduate Dr Alex Gordon explains the step up from medical school to his first year of foundation training.
Doctor
Dr Alex Gordon
Commissioned by the GMC, the University of Plymouth recently led research into how well medical schools prepare their graduates for careers in medicine. 


Here, Dr Alex Gordon, currently in the first year of his foundation training (F1) at Torbay and South Devon NHS Foundation Trust, after graduating from the University, reflects on his experience and what the research tells us.

During medical school I always felt very comfortable with what the job of an F1 would entail, at least during the daytime, due to the amount of exposure we were given to ward life.
The basic mechanisms of being a foundation doctor seemed obvious; writing discharge summaries, scribing ward rounds, making jobs lists, prescribing, requesting scans, and referring to other specialties did not seem like a big step up. 
But being an F1 (in the first of your two foundation years) is certainly not as simple as all that, as the GMC’s new research into preparedness demonstrates.
Out-of-hours decision making is undoubtedly the biggest step up from student to doctor. It is often complex and riddled with uncertainty, especially in acute and pressured situations.
In medical school, you are taught about protocols for escalating situations like cardiac arrests, severe asthma attacks, or anaphylaxis. Yet the reality is that you are often dealing with patients too frail to survive an intensive care admission, and so there are limitations to where you can go with treatment. 
I felt the biggest step from student to doctor was communicating with colleagues, patients, and families that active treatment may not be the right thing to do, and when prioritising comfort over treating conditions is the kindest course of action. 
Small gestures of kindness go a long way - closeup shot of two unidentifiable people holding hands in comfort. Credit: PeopleImages.
The challenge of working within a multidisciplinary team (MDT) is something I would also echo from the research. For example, I don’t think I fully realised before I started work how vital social care and therapy teams are to the experience patients have.
As an F1, you very much bridge the gap between your seniors’ medical decisions and the therapy teams, nursing teams and social care, as well as patients themselves and their families.
Communication between all of these in an effective manner allows the patient to have the best quality of life within and outside the hospital. I have found that working with the MDT can allow you to empower patients and their families to decide what the best next steps are for them, as they recover from illness outside the hospital as well as within it. 
Based on my experience, and reflecting on the research, my advice to current undergraduates would be:
  • Try to get as involved as possible in your clinical placements, and work with your clinical teams to try to take on individual responsibility for patient care in a supervised fashion. This will push you out of your comfort zone but make you much more familiar with what being an F1 entails than passive shadowing.
  • Work with allied health colleagues to understand the scope of their roles. This will make you a more effective F1 and allow you to significantly improve patient care. Understanding the scope of the MDT will also give you a perspective on what is a reasonable treatment goal and enable you to start making more complex clinical decisions.
  • Try to attend as many out-of-hours shifts as you can to see the type of decision making that happens at those times. It will be helpful to gain an appreciation for the decision-making processes overnight. 
What this research highlights above all is that being an F1 cannot be taught in a didactic fashion. I hope it will push more medical schools towards an ‘assistantship’ model of education, like I had at Plymouth, where medical students are able to be much more engaged within clinical teams, and with supervised responsibility within them.
The research, Preparedness of recent medical graduates to meet anticipated healthcare needs, conducted by the University of Plymouth on behalf of the GMC, is available online.
Dr Michael Marsh, Medical Director for NHS England and NHS Improvement South West, added: 
“The experiences Alex describes are balanced and helpful, and it was really interesting to read that junior doctors face similar challenges to the ones I faced 36 years ago when I started as a ‘House Surgeon’, as it was called then. Of course, there is much more support available for our trainees than in my era, and the General Medical Council has done a huge amount of work to support the transition from a student to a professional. 
“Thank you to Alex for sharing his experiences which will hopefully help other junior doctors and those considering a career in medicine.”

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