The Left Field Shift: embracing the unexpected opportunities of rural medicine

Moving to Aberystwyth for Foundation Training was quite an unexpected plot twist to say the least. I was hoping to stay in Oxford, but the first year of Preference Informed Allocation found me packing my belongings into a hatchback and driving alone to a Welsh Town I couldn’t pronounce. I found out where I was going in late June because I was a placeholder, so I didn’t even have much time to panic. I knew nothing about what I was heading into and had no-one to ask. In all honesty, I was dreading it. I seriously thought about dropping out and trying again next year.

Eighteen months later and I can’t imagine training anywhere else. There are so many benefits to working somewhere small and rural that I never considered. Everyone in the hospital knows you, which makes referring patients and asking for help much easier. Compared with my colleagues elsewhere, I seem to have been afforded greater clinical exposure and responsibility. It is often easier to gain experience with practical procedures and surgical cases in places with fewer trainees. I did a LIFT programme in obstetrics and gynaecology, assisting in over 100 surgical cases throughout F1.

The work-life balance I have achieved is great. I had free accommodation for F1 and now live in a flat with a balcony over the seafront for less than a third of average London rent. You can get a Sunday roast and a pint of local craft beer for about £14. Everyone says hello to you, and I feel safe enough to run in the dark. I now own an ice axe, a surfboard, and some industrial strength waterproofs. I swim in the sea through all months of the year. Perhaps most importantly, I have made some friends for life. Living and working together in small rural places leads to the development of really special bonds. This is difficult to replicate in larger urban centres with a much higher volume and turnover of trainees.

I am developing a very basic understanding of the language, though had to learn what “dim parcio” means the hard way. The location has certainly presented some unique clinical challenges too. I imagine determining dysphasia from fluent Welsh at 2am and clerking patients who have been “trampled by sheep” are not essential skills for most F1s.

Joking aside, this transition has been difficult for me – clinically and otherwise. We lack many specialties here and the difference in outcomes compared to big tertiary centres is stark. I have found the rural health inequality aspects particularly challenging. My parents live 6hrs drive away and I am also navigating a long-distance relationship from a location with limited transport links. Trains are often cancelled because the tide came in…again!

Much as I have made the most of my Foundation Training, it is not what I chose. Particularly in the early days, I felt unprepared and lacking support. I found myself wishing I’d had more information, and a mentor I could speak to, before arriving. It would have made my decision to give it a try easier and relieved my avoidable anxieties. From research I have conducted, it turns out many Foundation Doctors feel unprepared before moving somewhere new.

In my capacity as a UKFPO Fellow, I have developed The Left Field Shift project. This initiative aims to support Foundation Doctors relocating to remote and rural areas where they may not have any established networks, while celebrating the unique benefits this can offer. We are producing a growing library of “thrival” guides, containing useful information and insights from Foundation Doctor mentors across the UK in the hope that it is helpful for others.

Dr Kaveeta Malhi

F2, Wales Foundation School

April 2026

All previous HOFP articles can be found on our HOFP webpage