COVID response helped graduates prepare for careers in medicine

In spring 2020, in the early stages of the pandemic, the GMC brought forward provisional registration for more than 7,000 final year medical students, allowing them to apply to join the workforce as soon as they graduated. They 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.

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 FiY1 doctor 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.

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.”

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 during their FiY1 posts, 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 while in FiY1 roles. 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 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.’

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.

The full report, 2020 medical graduates: The work and wellbeing of interim Foundation Year 1 doctors during COVID-19, is available via the GMC’s website: www.gmc-uk.org