Starting F1 as an IMG: A Journey of Growth
Starting F1 can only be described as wonderfully terrifying and terrifyingly wonderful. Add to that the experience of being an international medical graduate (IMG), and the fear only grows. A new life, new friends, a new environment, and a new job—enough anxiety for a lifetime. But I promise you, its doable.
I think this section of essays will focus a lot on giving you tips for starting F1 in general, but more than that, I hope this piece gives you the permission to be yourself unapologetically as an IMG working in the UK.
A common fear among IMGs—and I’m sure many of you reading can relate—is feeling inadequate. This fear can come from many places, but let me remind you: it’s not because you lack knowledge or intelligence. You are simply adapting to an environment that others have had years to become accustomed to. Give yourself a break—you’ll get there.
Did I know what 2222 meant when I first started? Absolutely not. But I learned, and so will you. (For those unfamiliar, it’s the number you dial for a medical emergency.) My first tip? Do not be afraid to ask questions—no matter how they make you look.
I vividly remember my first week of Foundation Training, where an overwhelming number of abbreviations were thrown around during a single ward round. I was desperately trying to write things down, but half the time, I had no idea what they actually meant. I found myself scribbling words I didn’t understand, hoping I could piece them together later.
At one point, someone told me a patient was “NEWSing.” I had no clue what that meant. Should I be concerned? Was something seriously wrong? I looked at one of my F1 colleagues, who was more than happy to explain. We dealt with the situation together, and everything was fine.
That moment taught me something important—it’s okay not to know everything immediately. The same thing happened with medication names. Brand names like Laxido and Movicol were being used interchangeably, and I had no clue they were both just macrogol.
Sure enough, after a few days of actively noting down everything that didn’t make sense and asking questions, things started to fall into place. It wasn’t immediate, but I quickly realized that no one expects you to know everything on day one. The key was being proactive in learning and unafraid to ask—because, more often than not, others were just as lost but too afraid to say so.
I’ve had comments made about being an IMG, and it’s important to acknowledge that they do happen. People may comment on your accent, question your credentials, or remind you that you studied somewhere else. Own it. That country, along with your hard work, is the reason you have “Dr” in front of your name. Do not let anyone take that away from you.
You will find those who are interested in what your journey has been like! I had the pleasure of sharing memorable stories from back home and that really made me connect to others. We are fortunate in that we bring a completely unique experience compared to UK medical graduates, and in reality, we should use that to our advantage. Our different training backgrounds, perspectives, and adaptability are strengths—not weaknesses.
Remember, your knowledge is not what’s lacking. At the end of the day, you completed medical school just like everyone else. You have worked just as hard, passed the same rigorous exams, and earned the right to be here. The challenges you face are not a reflection of your abilities but rather the natural process of adapting to a new system.
Another tip: find those who are going through the same experience. F1 is challenging, but having a support system—whether friends, colleagues, or other IMGs—can make a world of difference. Surround yourself with people who uplift you, remind you that you belong here, and understand the journey you’re on.
You are not inadequate. You are simply learning. And just like everyone else, you’ll find your way. Take care 🙂
Dr Elaaf Elmedani
F1, London Foundation School
All previous HOFP articles can be found on on our HOFP webpage