Stepping into the unknown: reflections on becoming a foundation doctor

Starting foundation training is like standing at the edge of a vast, shifting landscape. The final year of medical school prepares you with knowledge, but it cannot replicate the immediacy of patient care, the hum of the ward, or the responsibility that comes with a bleep in your pocket. Every shift brings a mix of anticipation and uncertainty, and learning to navigate this balance is a process that unfolds gradually, shaped by experience, reflection, and mentorship. 

The first few weeks are dominated by practical challenges: learning local systems, managing handovers, prioritising tasks, and understanding the subtle expectations of each department. I quickly realised that asking questions, clarifying instructions, and seeking feedback are not signs of weakness. They are the cornerstones of safe, effective practice. Simple practices such as pre-ward huddles with the team, documenting learning points after procedures, and shadowing seniors during complex tasks became habits that improved my confidence and competence. 

One strategy that I found invaluable was maintaining a reflective journal. After each shift, I would note moments that challenged me, lessons learned, and interactions that inspired me. For instance, one night I witnessed a senior colleague calmly navigate a sudden clinical deterioration. Observing how they communicated clearly, reassured the patient and family, and delegated tasks efficiently left a lasting impression. I later reflected in my journal not just what happened, but why it worked, the clear communication, situational awareness, and empathy, all aligning with GMC principles of good medical practice. 

Sharing best practice became a natural extension of reflection. Early in my rotation, I noticed discrepancies in how colleagues approached daily ward tasks, from prescribing to patient handovers. I started creating concise tip sheets for myself and studying short visual guides for procedures like safe prescribing checks, escalation pathways, and effective documentation. Sharing these resources with junior colleagues helped standardise good practice locally and fostered a culture of continuous learning. More importantly, it encouraged a mindset of humility and collaboration, acknowledging that learning is ongoing, regardless of grade. 

Medical humanities have been equally vital in maintaining perspective. Sketching, writing short reflective pieces, and even composing small pieces of music provided a creative outlet for processing emotionally intense experiences. One poem I wrote after a particularly difficult day reads: 

“In the quiet hum of monitors, 

Lives intersect in fleeting moments, 

We stumble, learn, and rise, 

Bearing the weight with care and grace.” 

Sharing such creative reflections with peers has fostered empathy, connectedness, and resilience. It reminds us that being a good doctor is not just about clinical skills, but about human connection, compassion, and self-awareness. These moments of reflection help anchor the fast pace of foundation life and highlight that professional development extends beyond technical competence. 

For final-year medical students preparing to step into the Foundation Programme, my advice is to embrace curiosity, seek guidance, and reflect regularly. Observe and learn from seniors, celebrate small achievements, and don’t shy away from mistakes; they are opportunities for growth. Engage with medical humanities as a way of maintaining emotional balance and share knowledge and good practice to strengthen the team around you. 

Initiatives like Humans of the Foundation Programme are invaluable. They provide a platform to share experiences, showcase creativity, and connect across the Foundation community. By highlighting stories, tips, and reflections, we celebrate the diversity of experiences, encourage supportive learning, and reinforce the values enshrined in GMC Good Medical Practice: putting patients first, maintaining trust, and committing to lifelong learning. 

Dr Bishoy Daoud Yassa

F1, London Foundation School 

All previous HOFP articles can be found on our HOFP webpage