In the early stages of the pandemic, the General Medical Council brought forward provisional registration for more than 7,000 final year medical students, allowing them to join the workforce as soon as they graduated.

Hundreds of Newcastle University medical graduates took up this option and were able to begin work as doctors in newly-created roles called interim Foundation Year 1 (FiY1).

Researchers from Newcastle, Exeter and Plymouth Universities have now published research into their experiences, and the impact on their work and wellbeing.

Authentic experience

They found that FiY1 roles provided more authentic experience of medical practice than student placements, easing new doctors’ progression through what researchers called the ‘transitional state’ at the start of their medical careers.

As the new roles were formal and paid, unlike placements, graduates had greater esteem, and their expectations of the role, and those of their workplace colleagues, were higher.

Overall, despite some challenges, researchers found that FiY1 roles were a valuable experience for most graduates, providing an ‘apprenticeship’ in the responsibility of being a doctor, but with fewer of the demands.

Dr Bryan Burford, who co-led the Newcastle University research, said: “Our research gives us important understanding of how starting work as a doctor during the first wave of the pandemic affected a cohort of new graduates.

“It also suggests ways in which their experience of being the first doctors in a brand new transitional role may inform future developments in medical education.”

Researchers used questionnaires, journal entries and interviews to understand participants’ experiences. Their findings included:

• FiY1 roles were attractive – they were perceived as benefiting students’ learning, and many had an altruistic desire to contribute to the NHS in a time of need.
• Work was variable – FiY1s worked across a range of clinical environments, although most were deployed in medical wards. The majority worked with Covid-19 patients.
• The experience made graduates better prepared – those who worked in FiY1 roles felt more prepared for starting their F1 roles.
• There was limited impact on wellbeing – while exposure to acutely ill and dying patients was associated with stress and burnout, there was no difference in wellbeing between those did FiY1 roles and those who did not.
• Graduates were generally well supported – they faced challenging experiences but these were not necessarily negative if accompanied by support from colleagues.

Individual responses from graduates involved in the research revealed both positive and negative experiences. For example, a female doctor in Northern Ireland wrote in her journal that the experience was ‘a positive one in the sense that we are so much better prepared. [A] brilliant opportunity to shadow and learn from current F1s, minimises risks that come from being dropped in [at the] deep end’.

But a journal entry by a female in England recounted a different experience: ‘Often I have felt that I either have too little or too much support. It's either [others] will take all the complicated/interesting patients and you can do the easy jobs in which case I am not learning how to be a doctor. Or we are left to do everything and blamed when things go wrong?’

Researchers found that graduates’ negative experiences were often with other team members, in part because FiY1 roles were new and a change to established team structures. But their experiences with patients were typically positive and rewarding, often because they had more time to spend with them.

Good interim role

The report authors identified features that make a ‘good interim role’. These included that they should be paid, have clear application and appointment processes, have clear duties and responsibilities, avoid antisocial hours, and provide space for both informal and formal support.

Professor Colin Melville, the GMC’s Medical Director and Director of Education and Standards, said: “The creation of FiY1 roles was an innovative response to an unprecedented situation. The challenge of starting work in those circumstances was huge, and so we are grateful to all those graduates who were able to fill these posts and to be part of the NHS response to the pandemic.

“Now we need to consider how to harness the positive features of these interim roles to benefit future medical graduates. This report will help us do that, and it will inform the conversations we have as we continue to shape medical education and training.”

Reference

The full report, 2020 medical graduates: The work and wellbeing of interim Foundation Year 1 doctors during COVID-19, is available here