Any doctors out there? Career advice needed for terrified grad…

[Ilovechurrosalldaylong]

My DD has just completed her 5 year medicine degree and in a tearful phone conversation has disclosed to us that she is absolutely terrified of starting her F1 to the point where she is thinking about not starting.

The reasons are along the lines of that she might make a mistake etc. Of course we have tried reassuring her but she said that she only scraped some of her exams over the years and feels she won’t remember knowledge needed to be an F1 and that there have even been some F1s on her placements that have been declared not competent and are not allowed to make decisions and this is also terrifying her.

I’m assuming this is very common at this stage and I tried to reassure her but obviously nothing I say is going to help. She’s talking about getting a corporate job instead and I advised not to make any decisions until she has started and tried it for a while and then see if she is coping with it.

Any advice would be welcome!

My dd has also just graduated, but is not concerned about this at all, as she knows from friends in years above her that they are not expected to know everything/anything and the teaching process continues. Does your daughter know anyone in years above her who could reassure her?
Tbh her anxiety sounds unusually high, and I would focus on helping her to manage this. I don’t think her fears have any basis in reality .

@KittytheHare I think that’s part of the problem. She doesn’t know a lot of older students. At least not well enough to discuss her worries. I asked her if she wanted me to put her in touch with someone I know a few years ahead but she’s too self-conscious to discuss her fears with a stranger.

I’m a doctor and a medical educator. Some new graduates do feel the pressure, especially during the weeks between passing finals and starting work. The gap between relatively theoretical knowledge and the upcoming practical realities affects some young people quite badly. There is lots of good support available, either through her medical school, the BMA and also on some of the F1 Reddit forums, where people coming to the end of their foundation training pass on good advice for the new starters. Her comments about wanting to work in a corporate job might reflect some bigger anxieties about a career in medicine in the UK at the moment. Your advice to give it a good go first, before making any decisions, is great.

It sounds like her anxiety is quite debilitating for her at the moment. I’m not sure how the system works in the UK (am in Ireland) but surely there will be some sort of mentor or even peer support for her when she starts work?
Has she ever thought about some counselling to help her with coping strategies? The very fact that she has successfully passed her exams should be a source of confidence for her, rather than overthinking on one or two she struggled with (this is completely common in med school, as I’m sure you know). If you think this is a more deep rooted issue for her than simple pre-placement or work nerves, then I would definitely be seeking outside support.

@JollyLacrosseSticks thank you that is reassuring. I will point her towards those sources for support. And yes, I think the idea that she will have no/little control over days off and working nights etc for the next few years is adding to the doom and gloom!

I think this is really common not medical but I spend a lot of time in hospital and august is so funny to be In hospital. I remember over hearing a group of junior drs around August time saying to each other I haven't got a clue what I'm doing an the others where all saying me neither. I also remember another time I was in a&e and every question I asked he just said let me go check with the consultant the poor lad must of walked back and forth 5 or 6 times. During ward round it's usually just a group of them following the consultant around. Honestly tell her not to worry they expect them to make mistakes, consultants still make mistakes everyone is human. Tell your daughter good luck she will be fine

Ah bless her, of course she's nervous, to be honest I'd be more worried about the ones that think it's going to be a breeze as they already know it all after medical school. A healthy cautiousness and realism about her own capabilities is a far more likely indicator of success! As per a PP said while of course F1 year is hard work, stressful, a huge adjustment from medical school, all of that is absolutely true, she will also still be very highly supervised and protected, the kinds of decisions she'll be making as an F1 are quite limited and if she is mindful of her limits and isn't afraid to ask for help when she needs it she'll be grand. I do think medicine are a terrible profession for feeling as though you need to be excelling at everything all the time, any mistake is career ending and simply passing an exam or doing a job is not enough, everyone must be above average at all times (not possible of course).

If it was my DD I think I'd be encouraging her to give it a go, I know it doesn't seem like it to her but 2 years is no time really in the scheme of her whole life and she'll have a much better idea if medicine is really for her after doing the foundation programme than now (and of course if she truly hates it and knows sooner it isn't for her she can always drop out midway through). After completing f2 is a more natural time to take a break than between med school and f1, lots of docs do a 'gap year' then and do some locumming or a spell abroad or a non medical job before entering specialist training. There's loads of directions you can go in as a qualified doctor outside the traditional treadmill of hospital medicine or GP, but it would be a shame to cut all that of for some nebulous corporate job she doesn't really want (different of course if she's really sure medicine as a whole isn't for her and her interests lie elsewhere but it doesn't sound like that's the case).

We have had a few finished students Shadowing the current F1 few weeks before actually officially starting.

She should seek counseling and the sooner the better. Yes, she will be talking about her innermost self to a complete stranger.

She needs to understand that she will be a complete stranger to her patients one day, and they will be expected to reveal their own innermost selves and most personal health issues to her. In order to be a good doctor, it would be a very good idea for her have the experience of standing in their shoes.

What she needs to focus on in counseling is impostor syndrome, anxiety, perfectionism, and shame. She needs to learn to reach out for help and support. She will need that ability and a mindset free from perfectionism amd its adjacent unhealthy hangers on (anxiety, isolation, shame, and fear) in her toolkit as she advances through her medical training and career.

That sounds like a great idea. Unfortunately it doesn’t happen at her uni.

It’s a very normal feeling. It sounds like she has insight. Which in time will make her a better doctor. Oh, and I’ve never seen any particular correlation between performance in medical school exams and how good a doctor you become.

It's not arranged through uni, just some individual doctors contacted the department they are planning to start in. I don't know if it happens in other departments. We are a teaching hospital.

https://www.bma.org.uk/advice-and-support/career-progression/training/shadowing-for-resident-doctors

There is some info in the link here about shadowing. It isn’t something organised by the medical school. Your DD would need to speak to the HR department and ask for this. In the hospitals I’ve worked at, it’s been offered in the week of starting, just a day or two of shadowing before the job itself starts off, but it sounds as if shadowing for a few days now might be really helpful.

I’m a hospital consultant. Please reassure her that the FY years are heavily supervised and she will never be alone to struggle with decisions. Her SHO and Registrar team will be close by, and consultants typically round most days now. The ward nurses will know the job and patients well, as will the ward pharmacist. Ringing and asking to pop in and shadow is a good idea but in many/most areas the FY1 team start a week early to overlap with the current FY1. She’ll be absolutely fine. Tell her to carry lip balm and keep a water bottle on the ward!

Mother of a doc a lot further down the line here. There may be a buddy system at the hospital to support foundation doctors. There was a nationwide one a while back.... might not exist now. I think funding was a prob. Can she talk to the final year tutor at her med school about her worries?

I'm a geriatric registrar, I don't think it's a sign of too much anxiety. It's been quite few years since I was an F1 but honestly remember feeling the same. Definitely scraped many exams in med school - even had to resit a bunch in my second year. Not to blow my own trumpet but I'm good at my job now - I 100% still need advice / to chat it through with a colleague but I don't think that ever stops! We're treating individual people so no 2 cases are identical and if you become complacent I think then that's when you're a risk.
The vast majority of mistakes you can make at F1 level will be picked up or just in paperwork - nurses will guide you, pharmacists check your prescriptions + mostly you're following direct instructions from a senior.
For sick people there's often critical care outreach or acute response teams that are senior nurses extremely used to the August cluelessness of most people - lots of people are new to the computer systems + layout of the hospital as well as to their role.
The support is 100% there if you ask for it - as the med reg on call I turn up on surgical wards often because the juniors are stuck + their seniors are in theatres - not necessarily the correct route but if you keep asking someone will help if it's a poorly patient or even just to answer a question that's niggling.
We had a shadowing week as juniors which was really useful + it is common, so if she knows where she's starting + the hospital don't officially offer it, I have no doubt she'd be allowed to shadow. All my colleagues I met when shadowing were also fairly clueless when presented with a sick person (I went with 2 other F1s to see our first 'sicky' we walked in decided they looked very sick + called the reg to come whilst we were doing the basic tests!) Which now as a reg is 100% what I expect the first few months from August - all the theory does click in surprisingly quickly though + by Christmas I'm sure she'll be fully in the swing of it.
She'll be given a clinical supervisor + can ask for a peer support person if it's not automatically given in her trust.

Tell her we need more doctors and everyone starts like this you learn as you go it’s understandable to be anxious. if she doesn’t give it a chance she will never know and might regret wasting all them years studying. They must get support from more experienced staff before doing anything major I hope she goes through with it she is obviously capable just thinking the worst possible outcome. Is there no groups she can speak to a lot of graduates must get scared to begin with.

When ur worried it shows your humble, conscientious and care a lot about getting it right...I'd say good person to be a Dr.
I'm not a Dr but I'm sure she will be brilliant. Just as others say, always ask ask ask when she has questions and confidence will grow with competence and experience.
Its a steep learning curve she's on and it's totally normal to be worried id say.
She sounds like she will be a lovely caring Dr.
Just take one step at a time.

Thank you, we really appreciate all the replies and different perspectives. It hard because she’s also at the other end of the country although thank goodness she is carrying on in the same deanery so at least will have friends there.
we have had some more chats and it seems it’s made worse by ICU being her first rotation and worrying about being in charge on her own there as well as not being able to find accommodation yet which is adding to the stress but she’s much better than she was when I wrote the OP so thank you everyone, I’ve passed it all on.

She’ll never be ‘in charge’ of ICU as an F1, I promise. She’ll have even less autonomy there then she might have on more general wards, but it’s a really interesting place and she’ll be able to learn a lot from the specialist nurses.
From my experience (almost 20 years ago, yikes!) there wasn’t a huge correlation between those who got good exam results and those who coped best with the early hospital years. A lot of it is common sense, conscientiousness and good people skills.

I am a hospital consultant and an educator. My Dd is starting FY1 this summer as well.
She will be supervised closely and will not be in charge of anything alone. ICU will always have CT, Registrars and consultants. All decisions will be made by her seniors and I think it up is probably one of the best places to start - you will have plenty of support and will be exposed to the sickest of the patients in the hospital.
Her main job would be to do what her seniors ask her to do, chase results, request investigation and learn as she goes along. Make sure she talks to her ES and CS, it’s completely understandable to feel how she feels. She sounds brilliant OP.

Ah yes, if she's worried about being on her own ICU actually one of the best places to start as there will be 24/7 senior doctor cover as well as very highly trained and specialist nurses and other support staff. Very little chance of her ever getting to make any clinical decisions alone TBH unlike if she's covering regular wards at night.

She'll be doing more admin, paperwork, writing stuff up, chasing up requests and acting as general dogsbody for the SHOs and regs, but lots of opportunity to observe and learn...

I was going to say that ICU is probably THE best place to start - always lots of people around, small patient numbers, stellar nurses who know everything, and a chance to gain confidence in simple clinical skills in a very supportive environment. I suspect your daughter will really enjoy it and be much more confident at the end of it.

Oh, if she's got ITU first she's going to be absolutely fine. ITU consultants are absolutely lovely, but control freaks. She is going to be incredibly heavily supported and supervised. Probably one of the most supportive specialities it's possible to start in.

No experience but I’d prefer a cautious junior dr then a overly confident doctor