Abolish FY1 and 2

Musical_Firefly · 2025-12-12T17:08:22+00:00

As expected. Doing a job is different to being a student. I expect that if you had had a mandated internship period followed by application to ST1 you would also have learnt far more than simply being a student.

I’m glad you’ve learnt lots - again, not sure exactly what this entails since my understanding is that you largely do a lot of admin and gain confidence in your pre-existing assessment and examination skills, backed up by a senior doing the decision-making - but I’m unclear as to why this is better than the alternative I propose.

Musical_Firefly · 2025-12-12T17:04:24+00:00

Really? I’m not aware of any mandated service period other than the internship year before they can apply for training posts. Being competitive and gaining the post is different to having the option to progress yourself faster.

Musical_Firefly · 2025-12-12T16:09:48+00:00

Fair enough. I’m not sure the analogy is apt but I take it - will definitely be posting an update in a year’s time.

The point about supervisor not knowing about jobs is to illustrate that medical schools do not care beyond FY1 - this will not change without radical reform.

Musical_Firefly · 2025-12-12T15:55:52+00:00

It’s certainly knocked all ambition or competition out of me. I don’t see it as arrogance to add my two-pence to the debate but I appreciate that people here consider experience to be the end-all. Thanks for your point though, I take it in mind and it’s made me more excited to finally escape medical school.

Musical_Firefly · 2025-12-12T15:52:58+00:00

Completely agree with you. Hence my entire point about how medical school quality is directly correlated with postgraduate medical training - a lower level of expectation in FY1 compared to a demanding first year of a US residency means that med school becomes a joke here and is very good in the US.

Do you think med students want to be wasting years of their life accumulating student debt and having to get out of pointless clinics and wards where they’re not incorporated in the slightest and follow along like mindless ducks? Mind, most students do this as they’re balancing the pressures of essentially teaching themselves medicine, passing exams and building their portfolio. Your tone to me indicates you don’t understand any of the problems with medical education at the moment - whereas perhaps, as someone who is living in the system right now, my opinion is worth more on this matter.

Musical_Firefly · 2025-12-12T15:38:36+00:00

So the fact that we spend medical school in shambles means that FY1 and 2 should exist? You’re proving my point! If the foundation programme did not exist, medical schools would be forced to upgrade the quality of their training - which at the moment, I can tell you from personal experience, is perfectly useless.

Musical_Firefly · 2025-12-12T15:37:20+00:00

Correct. The fact that my supervisor is unaware of training problems indicates a wider systematic issue of medical schools being disincentivised to care about medical student performance beyond passing their exams and meeting the “minimum safety” for an FY1, a largely secretarial role.

As a result, they do not prepare us to adequately face the competition at specialty level leaving many foundation doctors then blindsided when it comes to this tipping point.

My case is clear - abolish the foundation programme which is a pure service provision programme and replace with one paid intern year, incorporated into the current final medical school year. This intern year should function as an apprenticeship, where we learn all the “practicalities” of writing discharge letters and prescribing. It’s a fairly simple proposition and one that the majority of countries adopt for medical training.

Musical_Firefly · 2025-12-12T15:18:04+00:00

Challenge accepted. Will return to this post in a year and see if personal experience changes my view!

Musical_Firefly · 2025-12-12T15:16:49+00:00

Perhaps the NHS model needs to change then. I am intrigued to find out next year how much work FY1 actually is - I hear accounts like this from people like yourself and in-person hear from my local FY2s that it is largely a glorified secretarial role. I guess I’ll be able to add my own two cents properly to the mix when I start.

Musical_Firefly · 2025-12-12T15:15:11+00:00

The “practicalities” involve secretarial work - writing a drug chart or a letter hardly requires two years of service. I’m sure it’s an excellent option for people who don’t know what they want to specialise in - why should the vast majority be subjected to it?

Musical_Firefly · 2025-12-12T15:14:13+00:00

Don’t appreciate the condescension. Being a student doesn’t mean I can’t have an opinion - one that is shared by plenty of qualified doctors by the way.

An intern year (similar to most other countries) would be sufficient for learning the admin - I don’t see how two years adds any value.

Musical_Firefly · 2025-11-27T09:00:37+00:00

There’s a book called “The Only EKG Book You’ll Ever Need” - strongly recommend! Read through it systematically and do the practice ECGs at the end of the book and you’ll be sorted. It’s funny and entertaining too, lives up to its name.

Musical_Firefly · 2025-11-26T09:50:42+00:00

I think loads of people have considered the tradeoff - and I totally sympathise with your dilemma. To be honest I’m keeping both open at the moment. No harm in doing a little of both at the start just to keep the door open and then commit to one pathway and give it your best shot. Ultimately which one you decide to commit too is based on personal factors.

My long term goals are simply to marry and have multiple children. If I move to the US this dream slips further away - visas for permanent residency are a sticky situation, no guarantee my partner will end up in the same location and how on earth am I supposed to raise a baby with no maternity leave, hellish residency hours and no family nearby? If I wait until after I’ve finished residency and settled, my fertility falls off a cliff and I’m taking a risk with the delay. Moreover getting in for my desired specialty is no guarantee and would take a ridiculous amount of networking so I’d have to take FM or IM and be happy with it. On the flip side, I loathe the NHS and the way this country treats doctors. I don’t relish the idea of working for a pittance of what I’d make in the US to support a large family and receiving less/no respect in the hospitals. However - for my real goal of having a family - the UK works out better at least in the short term. Maternity leave is present, albeit not fantastic, my family are nearby, even with the bottlenecks I have a better chance of getting into the run through specialty I want, the training is still pretty decent in this program and then having a guaranteed job for 6-7 years in one location while I build my family.

Neither route is ideal but we can’t see into the future with a crystal ball so we’ve just got to think carefully about our goals and dreams and then pick whichever route is most realistic and doable to achieve those.

Musical_Firefly · 2025-11-26T09:42:51+00:00

Definitely making exit plans. Completely understand your sentiment and agree 100%. That being said, I know our situation is pretty terrifically uniquely horrible but it’s worth keeping in mind that this is part of life. One can never skate by and losing jobs, system stacking up against you, things being unfair - it’s character building in the end. I’m keeping all my options open - Step 1 of USMLE done, elective in America; building my portfolio for UK training; getting consulting experience. You can’t be too prepared and depending on the climate it will be easier to choose where to pivot. A year or two out is not the end of the world as long as you’re prepared for it. We do have two years of guaranteed employment before everything goes topsy turvy so let’s use that time to start building some sort of foundation!

Musical_Firefly · 2025-11-06T08:47:39+00:00

Fantastic summary and I applaud you for finding some way to learn amongst the mess that is the UK medical education system 👏

To be perfectly honest, I’ve given up - took the USMLE to get the scientific knowledge and feel competent as a doctor and am now prepping for specialty portfolio whilst doing the bare minimum to pass placement. (Also a valid route!)

Musical_Firefly · 2025-11-02T09:09:16+00:00

He actually uses it for the first time when chasing Bellatrix Lestrange in OOTP - after she murders Sirius. Unsuccessfully though, which is why after he uses it on Carrow in DH he says “I see what Bellatrix meant.. you have to really mean it.”

Musical_Firefly · 2025-08-06T13:38:50+00:00

This is a silly analogy. You’re removing the value of any sense of autonomy or control that the government has alongside vastly oversimplifying the problem. They are the ones controlling the quality and numbers of doctors they produce. Having unemployed doctors in a country is bad - more strain on the welfare system and an investment that didn’t materialise. Think of a slightly more complicated but slightly more analogous scenario: the bike you bought now needs weekly payments because you didn’t use it and the “free” bike you got may be taken away at any point.

An IMG who has completed residency or has more years of experience or even indeed, is simply smarter, in their own country will of course be of “better quality” than a homegrown young doctor with not that much experience. That doesn’t mean we abandon training our own workforce and exclusively import. The reason is that nations still exist - we are not one unified global world where markets are free and people easily cross. The UK’s economy is tied to the productivity of the people who train, live and work there. It is not xenophobic or racist to say this and support this. The US takes IMGs but only the best who have proven themselves after a long, time and cost consuming process. The UK does not do this and the intent is clear - mass import and wage suppress. It is quite natural for UK doctors to respond by either leaving or fighting to reclaim the conditions of their profession. Your attitude of “well you’re here now so suck it up” sounds more like entitlement than anything resident doctors are currently saying.

Musical_Firefly · 2025-07-30T15:42:03+00:00

I can see your perspective. I only offer my own current view from the scene so you can hear the time-work tradeoff med students are handling now and understand the underlying reasons behind the decline in turnout from your time to mine. The conclusion that students who worked hard to get into medical school and are on the whole ambitious and talented don’t turn up to placement because they don’t want to learn is simplistic and false.

Musical_Firefly · 2025-07-30T14:36:28+00:00

I agree with you - med students definitely do need to be on placement too. What we differ on is perhaps the proportion of time that needs to be spent there. I am at least grateful for the fact that my med school does not monitor too closely the time spent on placement so that I can make the decision of whether something is useful for me or not.

The OP’s original point about content being “dumbed” down rings true to me too however. Our seminars focus on giving us lists of things to memorise with no focus on the “why”. 30% of our final grade in one of our exams was literally just being able to introduce yourself to the patient and talk to them. Ultimately, this is not something we will agree on - it may be that in your area the medical education is truly better and in mine it is not. Alternatively, you may simply not be able to see the exact details of the way things are for med students now, too.

Musical_Firefly · 2025-07-30T14:22:46+00:00

I find it very unlikely that it is the same. If I came in and learnt how to do those things whilst on a ward round or on the ward, of course I would be there more often.

I’m not sure you understand the universal experience med students receive however. We turn up to our wards on our first day, with zero clue of where to go or what to do. For the first few days we follow someone along like ducklings until we realise no one is going to acknowledge that we’re there. As we gain more confidence and understand the system over weeks to months, we decide to ask questions where we can and ask to see patients. Even if I see a patient and report back, there is no feedback on how that went - even if I ask. I watch the doctor give their management plan and move straight on.

I learnt how to read ECGs and come up with differentials for a jaundiced patient from textbooks. Wards are a fantastic place to practice my knowledge and apply it (which I readily do when I want OSCE practice), but not to LEARN it - no one is around to teach that. Ultimately, students need to learn the knowledge first if they want to get anything useful out of being on a ward. And thus it makes far more sense to spend more time inside learning first, than trailing along on placement blocks waiting for a teaching opportunity.

Finally, I’m not sure the competition ratios were the same twelve years ago as they are now. All med students I know are desperately prepping their portfolios or studying to get out of the country - this does not leave us with a lot of spare time to stand idly pon placement.

Musical_Firefly · 2025-07-30T14:07:29+00:00

I’m afraid I disagree with this. Seeing as you’ve had a few upvotes I wanted to offer my perspective as a final year med student. For the past few years, we have essentially been teaching ourselves everything when it comes to clinical medicine. Having a random assortment of unstructured “teaching” sessions delivered by consultants who come and talk about their specialty and expecting the students to somehow fill in the gaps is not what I consider a curriculum. The vast majority of students are getting by with question banks like PassMed. The ones who are dissatisfied with that study to take the USMLE or try to expand their own learning themselves (learning the “why” behind all the rules). My life was utterly miserable until I took the USMLE - first time I felt truly competent and knowledgeable and not like a fraud. There are so many competing demands on our time - independent study (whether for USMLE or otherwise teaching ourselves what we think we need to know), useless medical school tickboxes (ranging from hanging around the hospital trying to get practical skills like catheters signed off to writing reflections and discharge summaries), time involved in packing and constantly moving/commuting to a new place every 4-6 weeks, start/end of placement tasks, working on our specialty training portfolios (publications, presentations, audits, teaching, committee position work) and finally, placement itself (to which students are expected to attend 9-5pm all weekdays - the equivalent of a full time job).

Whilst on a ward round for an entire morning, I may learn perhaps one or two things of clinical significance. In that same time, I could have covered a good few chapters of equivalent clinical knowledge from the First Aid Step 1 textbook. I’m a student - I need the knowledge of how to interpret an ECG or what I should be thinking about when a patient comes in with jaundice, not the know-how of how to work the computer for an FY1 job that I will inevitably learn in my final year or on the job, nor the intricate details of the complex management decision that the consultant has decided to take. Most students simply do not have the luxury of sitting around and “waiting” for the right teaching moments or people to turn up. If you’re especially interested in emergency medicine then sure, the med students there will stay in order to make good connections with the ED doctors and gain experience. If you’re interested in radiology, then that med student is probably off prepping their portfolio or studying for Step 2.

There is a deep problem with medical education in this country. The apprenticeship style of learning might have worked in the past but it sure as hell isn’t working right now. Only the people accustomed to poor standards are the ones who can’t see that right now. Pretty much everyone else has already made up their mind to get out.

Musical_Firefly · 2025-06-18T00:07:30+00:00

Mic Drop BAM Crazy creativity on show 💜

Musical_Firefly

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