Diary of an FY1: How to be an FY1

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In his latest edition, Oscar reflects on the challenges of FY1 and how best to overcome them.

In less than a month, I will be an F2. Though there are dear thoughts of the achievements of surviving the year, they are equally trumped by thoughts that I really ought to sort out where I’m living next year. These thoughts are probably shared by many of my dear readers of this column, and I am happy to have been able to share my journey with you, from initial fears, overcoming them and the slow onward march of progress. And I suppose it is at this point that I should bequeath my own knowledge to those that are about to take my place running around completing venflons and IDLs.

The most important thing I suppose is understanding that you will be about to have the double edged sword of responsibility for the lives of others in your two hands. This is the fundamental step that each FY1 must either accept or flounder on. The worst FY1s are the ones that fail to step up to this. What you must fundamentally accept that you can do more harm to yourself and then consequently to others.

There are two kinds of bad FY1s. The first kind is obvious. Work shy and lazy, these FY1s fail to do their jobs and don’t assess patients properly. It is a fundamental contempt of their own roles and a failure to realise that they have a responsibility for their patients. These FY1s should clearly not be doing the job they are doing because they fundamentally don’t care about what they’re doing. And when this involves people that can die, that matters.

However, the second type of terrible FY1s are at the opposite end of the scale: the ones that care too much. Paralysed by the thought that with any act they could cause harm, they are excessively slow, doubting every decision they make. These FY1s also unfortunately tend to be the high flyers at university scoring well in exams and carrying forward the same anal attitude to multiple choice questions to real life. These FY1s are hugely inefficient, taking hours to make decisions, by which point patients often will have declined due to inaction. They also stay late at work doing tasks that could easily have been done during the day because of this. If you’re an FY1 that ends up staying late consistently for a reason other than seriously ill patients, you need to realise you are not being a hard worker, you’re being incompetent.

Fundamentally, the most important skill as an FY1 is to be pragmatic, accepting that there are shades of grey and that what is most important thing is to realise that something needs to be done and who is the best person to make that decision. Patients rarely go from straight from well one minute to NEWS 12 the next. There is time to respond and correct ways to respond.

Of course, it is only after the first few weeks that many FY1s will know which camp they are in. To begin with, everyone is slow at doing cannulas and taking blood. Medical school only equips us with the basic skills to begin, but these quickly become fine honed over weeks. You also need to accept that medical school gives you theory but FY1 is the practice. Saying ‘I don’t know’ is perfectly acceptable and indeed a sign of wisdom. Remember that the nurses around you have been doing the job for years, they will likely know what you don’t. They will have basic doses for drugs that they give out every day. Also remember also that your SHOs have done it all before even if they look light years better than you. Ask them questions for how to manage things and what needs to be done. They will have seen it all before, and when they haven’t, they know who to make the referral to.

It is also likely that for the first time in your life as an FY1 you will experience the effects of serious stress and fatigue in your life. The hours are long and arduous and learning to achieve a balance is difficult. One thing to realise is that you are becoming stressed. You will end up emotionally labile from stress hormones but the important thing is to realise this. It is important to take a step back and realise that our mental states are affected by our environment. So when you snap at the nurse when they ask you to do something, remember that it might have been a little unreasonable no matter how annoyed you were at the time.

The other end of the scale fatigue also causes its own issues. Most likely when you fail to do 3 cannulas in a row. The important thing again is to not take this as a representation of you being a bad FY1. You are allowed bad days where you can’t do things. It’s learning that fatigue affects us at work and can affect our own capacity to do things.

FY1 is a scary personal journey for all of us. But it teaches us what we value as people and how we can begin to become the doctors that we want to be. Always remember that you have your team to support you when you need them and that you are not alone. Realise that you are an important vital member of the team and then you do make a difference. You are the next generation of doctors.

 

Good luck.

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