On completion of the Foundation Programme – What next?

Just a quick blog on what I’m up to. Life has changed gears and its been hard to keep up!

I finished the UK’s Foundation Programme!

August 2020 signified two years since I graduated from King’s College London to start working as a doctor in the South West of England. Two months later and I’m still coming to terms with this and my new reality of not having a ‘real’ job.

I’m sure that more senior doctors might turn up their noses at this achievement. ‘Significant’ milestones are so frequent in a medical career that they dissolve into a long list of exhausting objectives where they remain significant until caught, cast aside and forgotten, while the chase for the next target is started.

But let’s not forget what the Foundation Programme is.

  • For many, it’s a first job.
  • It’s an introduction into long days, short days, working weekend and night shifts.
  • It’s an introduction into eating at unpredictable times, sleeping at odd times and doing or seeing absurd activities to or with other humans at often unexpected times.
  • It’s often a first taste of proper responsibility, navigating seemingly small decisions with large consequences.
  • It’s an insight into the human conditions of health, illness, intervention, recovery and death.

The Foundation Programme is hard.

I think it’s easy to discount the significance of completion of the foundation years. Looking back on the past 24 months, my mind has automatically merged my experiences into one homogenous lump. My gut reaction is that ‘yeah, that was tough at times, but I could do it again’.

As I examine the homogenous lump a little more closely, I see that it is the average of many polarised experiences. Working as a junior doctor can be both deeply satisfying yet dissatisfying, happy and sad, energising and exhausting. The mean emotion is ‘tough’ but the prevailing masochistic attitude of medics likely translates this to ‘ok’.

From a distance, 24 months later, it wasn’t that bad. Up close, on a daily, weekly, monthly basis, it was a roller coaster. I think we all share these experiences. It just depends on how close we’re willing to look.

If we don’t look deeper, the experience would just become a certificate to put into a portfolio. We wouldn’t recognise the time invested, the gain of decision-making capacity and the improvement in application of medical knowledge and practical skills. We might forget all the weird shit, the strange illnesses, the crazy scans, the absurdities of operations. And all the times when someone deteriorates, the discussions with families, end of life decisions, death. A piece of paper pales in comparison to the wealth of experiences hidden somewhere in our minds and memories.

What’s next?

There are a multitude of routes that junior doctors can take, but heading off-piste along the scenic route, away from the path of medical training, is a common option.

Colloquially named ‘Foundation Year 3’, ‘FY3’ or just ‘F3’, a year away provides many appealing opportunities – a chance to build a portfolio, to work flexible hours, to travel, to explore other careers, or just to take some restorative time. Any ad hoc jobs or shifts we take that aren’t in training are described as ‘locum’ jobs.

This is what I’m doing, amongst many others of my friends and colleagues.

What have I been up to?

A little bit of work.

I signed up to work some locum on-call night shifts with the general surgery team. I really like night shifts, especially on surgery. I get to assess and treat sick patients and have the privilege of assisting in the operating theatres too. Staying awake all night while other people are sleeping makes me feel like I’m doing real work. The camaraderie of working in a small group is a great feature of being in the on-call team. All of this is summarised during a team breakfast in the hospital cafeteria to finish a set of nights, a battle between discussing of the cases seen, rolling with the banter and piss-taking and the seeping feeling that with every step your body is sinking further towards exhaustion.

They count as work, but these shifts are a lot of fun.

Lots of play.

Plas Y Brenin Mountain Skills Course

After these night shifts, I drove up to Snowdonia in Wales to join a ‘Mountain Skills’ course at the Plas Y Brenin outdoor education centre. I spent a week with like-minded people, under heavy Coronavirus social distancing precautions, developing the skills needed to better plan and execute walks, hikes and scrambles in the Welsh mountains.

The Plas Y Brenin centre sits next to a lake where they hold their kayaking and outdoor swimming courses. It was special to swim each day with the sunrise or sunset.

After this course had finished, I became feral and started living out of a tent and my car. I had also packed my mountain bike, joining my flatmate for a weekend ride in mid-Wales. Mountain biking is much more exciting in Wales than in Bristol. The elevation, terrain and trail surface make the riding much more variable and hence engaging and dynamic. There are some bloody fast corners, sharp rocks and big drops. I was shit scared.

The Welsh 3000s.

8 days after I had finished my night shifts, I found myself again awake at 0100. I’d been trying to find a place to pitch my tent, hidden from most but discoverable enough to make it easy for my friend to find me as he drove up following a late shift at the hospital. I was quite tired (from exercise) and sleep deprived (camping in the summer) by this point. We had planned to complete a mountain walking challenge called the ‘Welsh 3000s’, bagging 15 peaks greater than 1000 feet across a distance of ~50 kilometres.

We completed the challenge, under the time limit, but with an extra 10km of distance walked and another mountain and ~800m elevation in the bag. This extra distance and elevation wasn’t intended, either. The entire 20 hour challenge became an epic that I’ll have to write about another time.

There we have it. Some work, lots of play and a lot of freedom. Some formal and informal plans simmering away on the back burner.

There will have to be a reality check soon as many important questions about work and life have to be answered, however, I’ll continue to savour the feeling of being able to put them off for a bit longer.

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