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Doctors at Work Podcast.

Episode #63

How to succeed in your first F1 job

Mat Daniel


Starting work as a doctor much be one of the most stressful career transitions. In this episode, Ellen advises others to be ready for the significant jump in responsibility, and to recognise that they have a large body of knowledge to call on. Self-care is important too, both for short term stress management as well as for long term career longevity. And whilst the focus may be on the clinical job, doctors also need to remember the importance of learning, portfolio building, and longer term career planning.

Dr Ellen Nelson-Rowe is a junior doctor on a specialised foundation programme for Medical Education based in East Midlands. Her career passions are surgery, medical education and leadership which her dream is to combine all in a portfolio career. She also has a keen interest in communications and continues to balance leadership roles alongside her foundation training. Some of the organisations she is currently involved with include The Healthcare Leadership Academy, Melanin Medics and SFO ENT UK. She is passionate about her faith and ensures to prioritise church and life around the demands of F1.


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Podcast Transcript

Mat: [00:00:00] Welcome to Doctors at Work. My name is Mat Daniel, and this podcast is about doctors’ careers. Today, I’m having a conversation with Ellen Nelson and we’re talking about how to succeed in your first foundation job. Ellen has just completed hers. Now starting work as a doctor Doctor must be 1 of the most stressful career transitions.

And in this episode, Ellen advises others to be ready for the significant jumping responsibility and also to recognize that actually they do have a large body of knowledge to call on. Self care is important too, both for short term stress management as well as for long term about longevity. And whilst the focus may be on your clinical job, doctors also need to remember the importance of learning, portfolio building, and longer term career planning. Welcome, Ellen. Tell me a little bit about yourself.

Ellen: Hello. So I’m Ellen. I’m an f 1 doctor in the East Midlands. Um, I studied at Cardiff University. [00:01:00] Uh, graduated last July.

Um, a bit more about myself. Um, I’m really interested in surgery. That’s what I wanna do for my future career. I have to put EMT as well, actually. And I’m also, uh, I’d like to have, like, a portfolio career, so I’m involved a lot of leadership.

Um, I’m on the academic program for medical education, um, and I like to keep myself busy outside of work.

Mat: And I invited you to talk about how to succeed in your first f 1 post because you’ve just completed your first f 1 post. So Yes. Tell me, what was it like?

Ellen: Wow It was a bit of a whirlwind. So I started on general surgery, which I think is very well known that general surgery is probably 1 of the busiest jobs to start on, um, as an f 1. Um, but I’m really glad I did start on it because I think it propels you, uh, just to really just learn on the job. Everyone always talks about the jump between medical and f 1. And until you go through it yourself, it’s hard to really understand, like, the big jump.

And I think The main reasons for that is, [00:02:00] I think, first of all, the responsibility. Because a medical student, often, he can say, oh, I’ve got teaching and just leave off early. But, actually, You the patients truly do become your priorities. If it’s 5 PM and and a patient is sick, you can’t just go all the time. Sometimes you do have to stay.

Um, I think the The length, the duration of the shift as well is quite a big shift because we didn’t really do many on calls or, like, long 12 hour shifts in med school and actually Just even getting accustomed to, like, eating and breaks, um, that has been really hard. Um, but also just In terms of what you’re experiencing, you know, when it comes to, for example, end of life care or acutely unwell patients, um, there’s only so much simulation you can do in med school. But until you’re actually thrown deep end, um, and actually, you know, teach you know, doing it yourself on the board, um, I think there’s a lot to learn. I think my first few weeks, I think the first time experiences lots of things kinda panics you, and after a while, you just become so accustomed to it. Um, but [00:03:00] I’ve I realized that as I progressed Through the rotation.

So at first, I was really nervous because I’m sure. Um, and then as you start getting that confidence and experience, By the end of it, even though I finished on night shift, because I, um, built so much experience just from the past 3 months, it’s just amazing the steep learning curve that you go through. So you have to, you You know, when they have that graph where you kinda learn and then get that sort of graph, it really is like that.

Mat: Let’s let’s go back to to Maybe when you finish medical school, I’m interested in this idea of how much of a jump it is. I mean, what what were you expecting before you started?

Ellen: Good question. Um, I think when you start out as a final year math student, I think you just expect that you’re doing quite a lot of the admin work. So the discharge letters, some of the blurts, um, you you know, kind of scribing a ward round. Um, I don’t think I actually had fully, um, anticipated how much you you start off on. Uh, what I mean by that is say if, you know, you’re on [00:04:00] call or, um, You know, you’re on night shift.

You know, if you’re you’re usually are the first person who is called unless it is serious, like, for acute or well patient. And, actually, although, you know, you do escalate for help, the fact that you are the first point of call and you sort of have to know what is the right thing to initiate, I think, Can be quite nerving. I I don’t think I anticipated how much of a responsibility that actually is. Um, and I think what else did I expect? Um, I think I expected less responsibility, Actually, I think to contradict myself, I did not expect to be able to do as much as you get to do as an f 1 or Just knowing where your limitations are, actually, you know, you really are thrown in and you you are still respected as a doctor.

Because in my head, I thought, okay. I’m an f 1, so they’re still gonna sort Treat me like a baby doctor, but actually, no. You’re a you’re a doctor regardless. And then, obviously, there’s only certain things within your limitation depending on your your specialty [00:05:00] of trading as well.

Mat: So certainly, there there’s something there, you know, we can all ask for help, isn’t it?

Even even as consultants, we ask for help. Yeah? So, you know, that that’s not unique, um, to Foundation Doctor, but but it’s it sounds like that there’s a real big difference in that, you know, 1 day you’re a student and the next day you’re a doctor, and you have all of these responsibilities, uh, as well as privileges and and duties.

Ellen: Yeah. It was a big jump for me because we I graduated on the seventeenth of July, and, um, our induction was on the 20 fourth of July.

So I didn’t really have much time to just, like, really just Kinda just relax into it. It was just straight into it. How how

Mat: did, um, how did your friends deal with that All of a sudden, you have all of this responsibility. What what was everybody else saying?

Ellen: The girl cried a lot.

Um, and I I don’t mean that jovially. I I know. I’ve definitely cried a lot more in the, like, in the first months than I I do now. Um, but I think those are [00:06:00] sort of Tears are sort of just overwhelmed. It’s quite overwhelming, um, and tears of frustration as well because I think I know myself.

Uh, I’m quite a perfectionist. I like being I like being good at what I do. So when I feel like I’m not in control of a situation or I don’t have Being that you’re not fully equipped to deal with something, I find that really frustrating. Um, so I think a lot of people, if anything, found it quite overwhelming, particularly, You know, your first crash call or your first, um, you know, kind of desk confirmation when it’s you signing, like, the death certificates, like, when you feel that that When you when you really particularly those, like, quote and quote life or death sort of scenarios until you so is that for the first time and your name is being signed on as the doctor. I think you really that’s when I really really set in for me.

Mat: And how how did you deal with those kind of how how emotionally, how did you deal with that?

Ellen: I think debriefing is so important. Uh, I, uh, I I think I was saying to you, uh, earlier [00:07:00] that so I’ve moved closer to home Now, uh, before I used to live, um, 4 hours away from home because of the uni, and now home is only half an hour, which is really great. There were just some times I just went home for the weekends just to really just unwind and move myself just from the environment, um, calling my friends who in the same scenario, starting f 1. It’s really important to talk about it because you it’s very hard to leave the job at work.

You think about stuff at home a lot, but actually processing people is so important and also making sure that you’re debriefing it with your seniors. So, um, I remember my first, uh, Crash call was probably, like, 4 days into be starting f 1. And and I know it sounds very silly, but I just wasn’t expecting it. And, of course, you’re never expecting it. But, you know, when you just thought, okay.

That’s gonna come a bit later on. Um, and I I was just I was just like a deer in the headlights. I was just really just Overwhelmed by it. Um, and, actually, I was really grateful for the consultant registrar to sit down with me and talk it through. And, um, it it was it’s really comforting [00:08:00] as well.

I’ve I’ve also heard of, uh, not my hospital, but I know my other friends. Um, they actually have regular, like, group therapy. They actually have other stuff as well, which is really great as well. Nelson. Yeah.

Mat: Mhmm. And in terms of, um, preparing people for, um, what f 1 is like, what what What advice or what tips would you have for somebody who’s finishing medical school?

Ellen: So I think there’s 2 folds to it. So I think There’s the experience and there’s the portfolio bit. So, um, I don’t think people understand the portfolio Requirements to f 1 as well because the requirements have been a lot more relaxed.

So, uh, we use a system called Horace in England where we upload all of our Kinda, um, mini taxes, CBDs, uh, those sort of kind of statutory requirements. Previously, there was a certain number you had to achieve per rotation, Um, but now they sort of removed that. So [00:09:00] you it’s it’s down to you. You have to set your own goals of what you’d like to achieve each rotation. Um, and I think if you’re not an goal oriented person.

That’d be quite difficult because you’re not quite sure how much you’re meant to do. And, also, you you have to self motivate yourself to keep your portfolio up to date. Um, personally, I don’t think they explain the portfolio very well. So I think it’s really important that people starting f 1, To get access to those sort of portfolios is really going through the websites, going through the help information, and listening to videos just Just so you understand what are the different types of, um, skills and cases that you can get signed up that support for your portfolio, The importance of writing reflections is really good as well, um, and tracking your teaching and learning because I think what will happen is when we get to ARCP time, a A lot of people, if you’re not staying on top of it and then all of a sudden you’re trying to backdate everything till the year, it it’s very difficult to do. So actually how important it is to regularly Stay on top of your portfolio.

Um, and I think we’re we’re sort of [00:10:00] trained to do that through med school. Like, every single rotation in med school is just and you get the sign off, you need to get signed off. And I don’t think people realize it that’s just the beginning. You you there’s constantly more things you have to get signed off, you know, beyond, uh, medical. So I think people don’t realize the extent of that.

And then the the second part in here is preparing for the experience. Um, I think actually just listening, uh, I know it’s not silly, but I listened to quite a few, um, YouTube videos of kinda f 1 kind of, Uh, blogs and vlogs that people just share their experiences. And I think that was quite useful because I really had some firsthand experiences knowing what to expect. So usually you get the, um, when you sign up for the MDU, we get the Oxford handbooks for foundation training. That was really useful just to read over as well because All although you’ve been studying for finals, um, I mean, at my uni, we did finals in fourth year.

So, actually, my knowledge wasn’t as on point as those who do their finals and final year. So actually making sure you’ve [00:11:00] just got a basic general line of, uh, information is important. And that’s even more particularly important because although I started on general surgery, as the f 1, you have to deal with all the medical stuff. Um, so So the registrar therapy was just a surgery, but when it comes to high blood sugars, that’s your responsibility. So you need to make sure you’ve got a bit of baseline, um, across the whole thing.

Oh, yeah. That’s some things there.

Mat: It it’s interesting because there’s so many competing things. And, certainly, if I think of that blood sugar, You know, that I I very much understand that because if I think the patients that I see, if there’s anything that is that is not pediatric airway related. I know very, very little about it here.

And and you’re right because because, you know, because we we totally rely on, you know, the foundation doctors or the core trainees to have that to have that general medical knowledge. Mhmm. Um, and and also, You know, yeah, you know much more about high blood sugars than I do. I might be the consultant. Yeah.

And you know you know much more about high blood sugars than I do. So so [00:12:00] and and it’s really interesting that that jump in responsibility that that perhaps peep people people actually people don’t realize how much they know and that and that Often, they do know more than the consultant. Um, cert certainly for some of the kind of general, um, medical stuff, you know, if you work with consultants that that that are, um, specialized. But you you’ve got all of these competing priorities because you’ve got to turn up and do the job because, you know, that’s where you’re paid. You’re paid to do the job.

Then you also you’ve got to learn somewhere along the line, and you’ve got to demonstrate that you’re progressing your careers with the portfolio and ARCPs. And by the way, that carries on for the rest of existence also. Yeah. So

Ellen: I’ve heard.

Mat: Completely echo that that tip about get keeping your portfolio going because even as a consultant, you still have to do all of that here.

Um, so so, um, so definitely suggest that. Um, and then you’ve got to progress your career as well because, you know, because you’ve got to then build your CV in order to apply for for for, um, for the next step of your career. [00:13:00] So so many competing priorities. I mean, how how do you balance all of those things?

Ellen: I think it depends on the type of person you are.

So I’m very much a forward thinker. I almost think Tear is in advance all the time. So, uh, the moment that I got my special explanation program job, I was always I was already thinking, okay. So after this job, what am I doing after this? So, um, I’m already in my mind trying to decide, am I gonna do an or am I just gonna apply for core surgical training, which I think I will just try and apply and see because it’s very competitive.

Um, but already, you have to think, well, if If I went to apply for core surgical training, that’s something I have to do for months into me starting f 2. So actually, not only do I need to f 1 is all about figuring out how to be a foundation doctor. It’s also about preparing for the next step to apply for the next step, um, which actually, I think and and it’s com it’s perfectly okay if you don’t know what you don’t if you don’t know what you want to do. [00:14:00] Um, but I think If you do know what you want to do, being prepared is so important, and actually, uh, having some sort of credit landmarks and goals setting Well, the future is really important. Um, we I mean, because I’m quite interested with leadership, I’m all about 5 year plans and 2 year plans.

I’m naturally inclined that way, so I know not many people are like that. Um, but you you have to think ahead to know what your priorities are And also be flexible to know that things will come up, um, and, you know, so know what your prioritize priorities are, whether that is family, whether is that your career, or That is a bit of both or just enjoying life and knowing what your values are and knowing when to say no. I think as someone who’s quite busy like myself, and I I say yes to lots of things, but as I’m getting older and I’m realizing how important rest is actually, I’ve been able to block off your time. So I’m very strict with my time. So before, I would do meetings on Sundays.

Um, and as I got older and I shoved into my faith as well, like, I’m not going [00:15:00] to Do meetings when I have church or if I’ve got church responsibilities because that’s my priority. Um, or if I’ve, you know, if my family is ill, My my priority is going to be with my family. So it’s it’s being adaptable, but having a long term goal in mind and breaking those down to the short term goals, I think, is really important.

Mat: I hope you’re enjoying the show. Please click subscribe so you’ll be notified when new episodes become available.

This Podcast is part of my mission to help doctors create successful and meaningful careers. You can be part of that mission too by forwarding this show to 1 person who you think might benefit from listening. Thank you. Now on with the show. If if I go back to the people that don’t know what, um, they want to do, I mean, what what advice would you give to somebody who says, I I really have no idea what I’m going to do.

Ellen: I think it’s important to broaden your base if you don’t know what you want to do because for all sorts of things, [00:16:00] there’s There’s always generic things that is applicable to whatever career you’re going into. So for most careers, you’re going to have to share involvement In audits or, um, involvements, for example, in teaching, you can still do generic Audits and get involved and support a medical student just to build a generic baseline so you’ve got something. And then when And then try to get experience in different specialties. So use your make the most of your actual foundation rotations to know if it’s what you want to do. So I’m really glad that I chose to do my surgery rotation first, um, because although I knew I knew I wanted to do surgery since medical school, A part of me was still like, okay.

This is my blanket cushion to decide if I don’t want to do surgery, this is it, because then I’ve got the rest of everyone to sort of change my mind. In f 1, you also have the opportunity to do taster weeks as well. So I’m trying to organize mine at the moment, um, to make the most of those opportunities. You also get self [00:17:00] development time as well to make the most of those. Although you can use them to be at home, they should be for career and self development opportunities.

Make Make the opportunity to go and do that as well and just explore and just talk to people, um, ahead of you. Go in a mess and ask people what they’re doing. So

Mat: yeah. So there’s sort of 2 2 2 overarching things there for me. You know, 1 is about, okay, you don’t know what to do.

How are you gonna find out? So to how how are you gonna make that decision? How are you gonna find out? You know? And and that’s I don’t know what to do now, but what’s my plan to making that decision?

So That’s number 1. And then number 2 is that that that at some stage, you’re gonna be having to apply, and you’re gonna need a portfolio and a good CV. So the fact that you don’t know what to do, that that Doesn’t stop you building a really, really good portfolio with with some rock solid, you know, projects, um, or or

Ellen: whatever. Yeah. Yeah.

So I always try to aim, Um, try and do, like, an audit. Her rotation, I think, is very doable. Uh, there’s always opportunities to get involved with kind of just your Department audits [00:18:00] anyway, um, and then try and seek other opportunities. So, um, because I’m doing the the specialized foundation program in MedEd, I don’t actually have ENT as part of 1 of my foundation rotations, so I’m making sure that I’m going out to find opportunities, like, Outside of that so that I’m still inclined with what I want to do and stay staying on top of it. There’s always a way if you’re determined.

Yeah. Um,

Mat: you talked in the beginning about the the the long shifts, uh, and sort of in how I I mean, I’m guessing maybe both physically and emotionally child. That is, you know, so tell tell me about, you know, this jump from, you know, sitting in a lecture for 3 hours or an hour and a half to all of a sudden having to be on your feet for 12 hours. It’s

Ellen: it’s it’s a big jump. I I think You you know, it’s quite interesting because before you start f 1, everyone’s like, make sure you take breaks.

Make sure you take breaks. Until you’re actually doing those shifts, you realize how easy it is to go about having a break. And I remember at the start of f 1, I was going through 12 [00:19:00] hour shifts. I’m only having 15 minute breaks. Or what I was doing, I was eating in front of a computer and continuing to write discharge letters, and it got to a point where I was just so exhausted, particularly when you have the Monday to Thursdays, 8 to late Thursday Consecutively, um, go home, sleep, repeat.

I just felt like I was in just in a rut, and I wasn’t able to make the most of my evenings. And Although, sometimes you’re just so tired, you just have to sleep. Um, I wasn’t looking after myself well-being, so some advice I always do is actually try to make sure you Go away to have your lunch because actually just have a break from the environment that you’re in. Um, whether that is just going to the mess or just going to sit in Costa. Like, it’s really important, um, Because it’s very easy not to take a break, and, uh, it’s actually very scary how easy it is to do that.

Um, I think lots of water. I know it’s Kind of basic, but it’s so easy to go so long without drinking any water. Um, I’m I’m over having snacks. I always have, like, a tub of grapes or, like, an apple in my [00:20:00] bag because You actually need it to keep on going because it was really hard going. And because it was quite a quick turnaround of patient, particularly when you’re on call And you’re walking all over the hospital.

I’m easily doing over 10000 steps every time I’m on call. You you need to, like, keep your energy up because it’s it is exhausting. And that is why going to the gym and doing activity outside of the work is really important as well just to keep your overall strength and help off help off anyway.

Mat: I guess people would say, oh, I’m busy. I’ve got all of this to do.

I haven’t got time to eat. Um, you know, what what would you say to that?

Ellen: Batch cooking. Um, if you’re doing batch cooking in uni, you have to batch cook now. Um, I’ve I’ve kept that going.

Um, I’ve I’ve tried not to pull I mean, Where I work, we have Subway, 1 minute walk on the mess, which is probably the most particularly placed Subway ever. Oh, I know there have been times I’m like, oh, I’d I wouldn’t mind the subway. Actually, bringing your own food and batch cooking It’s really good. So in [00:21:00] the weekends, what I do, I kinda iron my scurbs, do all my batch cooking for the week. And it you may you feel so much better for actually and also just saving money because I think that’s something foundation doctors aren’t good at is actually prioritizing this money that you suddenly have because you had no money in medical, and now you do.

Mat: It’s It’s interesting, actually. I wish I’d known that because am I for for me, from when I started medical school to kind of halfway through my registrar years, I put on weight 40 kilos. Wow. Starting. I mean, I’ve I’ve I’ve lost it and kept it on, but but it’s actually re really, really interesting sort of how, For me personally, how how unhealthy

Ellen: Yeah.

Sort of I I I think also that environment of, you know, oh, let me just buy Just Costa. Oh, I don’t really want a Costa. Just those even just those tapping your card on those machines and it piles up and you you don’t realize actually What you’re putting into your body actually isn’t helping you, and I I found that I put on a lot of weight in my first rotation as well just because I was snacking so much because I was so hungry, but also just Kind of comfort eating when I get [00:22:00] home. I don’t really know what to do myself. So you you really do have to find that balance.

Mat: There’s something for me there about, um, a mindset that asked what what’s the consequences? You know? Okay. So I’m I’m I’m eating rubbish. I’m not resting.

I’m not taking breaks. You know, what what’s the consequences? And I sort of guess, certainly, if I think, you know, for me personally, the consequences are, you know, I’m techy, I’m bad tempered, Sort of, you know, I get resentful, burnout. So, you know, that that’s the consequences. And and it’s very easy to say, oh, today, I’m gonna work hard.

Today, I’m gonna go without a break. Today, I’m gonna go without food. Well, you know, that that’s okay today, but that’s not a strategy

Ellen: No. The next 15 minutes. It has a secondary impact On your friendships, on your family.

Um, I made an intentional decision sort of not to kinda planned stuff kinda 2 months since me started. I gave my first love my first kinda a month and a half to 2 months, Not planning things just to give myself time to adjust. You know? It’s [00:23:00] a new city. It’s a new job.

It’s a new church. There’s a lot of change at once. It’s quite overwhelming. So So actually having to commit to kinda events and activities and feeling really guilty you can’t attend. I don’t wanna put the added pressure on myself.

Just wanted to see what it was like and then find the balance. Um, but, actually, sometimes when you’re so exhausted, I mean, you know, you would do would you would like to go out and see your friend, And you feel really guilty that you can’t because you’re so tired. That’s okay. But you you you do have to find that balance. I I I think I realized almost after a month then, Um, so I’m taking ownership of my time here.

I’m not gonna let my job be the the sole thing what I do. The job is just a job, and I I have a life as well. And I think people need to remember that this is not you need to have that distinguishment between what is you and what is the job. Um, otherwise, you you probably will get quite suffocated with it. Mhmm.

Mat: So let’s, um, let’s wrap this up then. So what would be your top tips for doctors at work? [00:24:00]

Ellen: So I think my first Tip is prioritize your well-being. Um, make sure you’ve got a support network to debrief about the things that you’re encountering, Uh, making sure that you make these with your supervisors and really escalate if you do have concern. Uh, my second tip, also well-being related, is make sure you eat well, plan your food, Um, and really just look after you by the day.

If you don’t have time to go to the gym or go for walks, do it. Uh, first tip is being staying and preparing, um, is really important. So portfolio, set aside some time, maybe once every 2 weeks or so, just making sure that you’re staying on top of your learning and tracking your teaching and your cases as well. Uh, set goals of what you want to achieve, and your rotation is really important. Uh, my fourth tip, um, would be, um, I think just all about making the most of your colleagues as well.

Um, you really have to work collaboratively when you’re starting an f 1 and relying on others and helping each other out. Make the inte make the intentional effort to get to know [00:25:00] your colleagues. So you you like, you might be a bit of an introvert, but actually make the effort to maybe go to 1 f 1 social or Organize a team dinner, which I did, and I found that I really helped with the dynamics of the team people you’re working with. And I think that’s really important because you want to build the networks. And then my final fifth tip, um, would just be just to say you’re not alone.

And what I mean by that is that you Really do ask for help. Um, I’ve I found that when I first started, I always felt a bit embarrassed to ask for help. But, actually, I learned so much by asking Questions and people expect you to ask for help. And in fact, if you’re not asking for help, that’s sort of concern you’re not to say, uh, make sure you do.

Mat: Wonderful.

Thank you very much, Ellen.

Ellen: Thank you.

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