Francesca Birch – Foundation Year 1 Doctor at the Royal Devon and Exeter Hospital


My application process was different to most as I applied for the academic foundation programme (now re-named to specialised foundation programme). Applications for this programme are different as you can only apply for 2 foundation schools, and you have some extra hoops to jump through such as interviews. Luckily, I managed to get the job I wanted at the foundation school I wanted, and so far, I am extremely happy with my choice.

Starting out

One of the many changes that have appeared following COVID is the introduction of a voluntary (but paid) 2 week shadowing period for new starting F1s. I, like most of the other new starters, gladly accepted this opportunity. This meant that my first few days of being a doctor were much, much more manageable as the tedious tasks such as getting logins sorted and getting to know the layout of the hospital were already done.

I started work with one week of normal days (9-5) followed by the second weekend on-call (Friday 9am until 9.30pm, Saturday and Sunday 8.30am until 9.00pm). Looking back, I don’t think my first few weeks as a doctor could have gone smoother, and that is mostly down to the support I received from the people around me. All the hospital staff that I encountered were compellingly compassionate, understanding, and patient with me. One of the most striking differences compared to being on a ward as a medical student was way I truly felt part of a team, allowing fellow doctors on my ward to quickly become friends.


Now to discuss the challenges. I struggled more than anticipated at switching off after a long shift, day or night. I know most my F1 colleagues felt the same way, and I think this is because the new responsibility that weigh on our shoulders takes some getting used to. Another challenge has been getting my head around the new foundation curriculum. Unlike what we had experienced in medical school, there were no set number of forms we needed signing off, instead we must use a range of evidence to show we have met the outcomes of the year. Because this changed for the F2s as well, it meant we were all slightly confused by what we needed to do at the start.

On-call shifts

I admit this is rather rouge, but I have always enjoyed the prospect of on-call shifts more than normal ward work, which made having to do a lot of them in the first few weeks much easier. A few other things that made on-call shifts easier was having confidence to ask for help. One scenario sticks in my mind – I was tasked to clerk a patient on the cardiology ward, but on my arrival, the nurses told me she was having runs of arrhythmia. I rang the medical registrar and the F2 immediately as I knew this was beyond my capabilities. This turned out to be the best decision I could have made as 5 minutes later the patient arrested. I think this highlights the importance of being able to recognise when you feel out of your depth and being able to ask for help – two things that I struggled with throughout my final year at medical school.

My first set of night shifts were in my 3rd week as a doctor. These lived up to the expectations I had from being a medical student – hectic. Yet, once again, made significantly less hectic by having a supportive SHO and an understanding medical registrar. The hardest part of these shifts was having to make the political decisions such as what needed to be done during my shift and what could wait until the morning.

General advice

Make socialising a priority in the first month. This will give you a much-needed support network as well as having a contact in specialities across the hospital, so when you have a trivial question that you don’t want to bother with a senior with you can simply ask you friend. And remember, you don’t have to study!

Get active. Work is tiring and exercising can become a chore – I would strongly encourage you to join a sports club of some sort so that you have that extra bit of motivation.

Don’t leave understanding the e-portfolio and curriculum until the end of the rotation. Talk to your colleagues in the year above and gain an understanding of what is required of you early. For example, note that you must attend a certain amount of core teaching per year, so try and prioritise that.

Final note

No one will say that starting as a doctor is easy, but most will say that they enjoyed it. Don’t be disheartened by the difficult days, be a nice person, and have fun!