Medicine alumnus Masood Tabibi recently completed his Foundation Year 3 (known as the F3 year)* as a Clinical Fellow in Critical Care based in North Wales. He spoke to us about what to expect as an F3 doctor, why he would recommend an F3 placement and how the experience has helped him develop key skills for his future career.
Masood says, “During Foundation Years 1 and 2, both placements were based in North Wales, which was helpful as I had great rapport with the staff there beforehand.
“My daily role consisted of doing a systematic review of Intensive Care Unit (ITU) patients, including relevant microbiology. Following this, a consultant-led ward round would take place where we presented our patients using the ‘SBAR’ (Situation-Background-Assessment-Recommendation) technique.
“Other jobs would usually include inserting central venous catheters, vascular catheters, arterial lines, semi-elective Rapid sequence intubations (RSIs) and, most importantly, family discussions.”
“During normal working hours, the team of junior doctors would take turns holding the ‘ITU bleep’ Holding this bleep meant attending medical emergency calls, cardiac arrest calls, trauma calls, paediatric emergency calls, help with vascular access and reviewing patients referred to the ITU for potential admission.”
“After hours and at night, the bleep was held by the ITU doctor on call. This was quite frightening initially, but there were always two airway competent anaesthetists on site covering general and obstetric theatres. All the ITU consultants were more than happy to be called at any time for assistance and they would not hesitate to come in at night if needed. This F3 role made me feel significantly more confident calling a consultant at 4am about an unwell patient”.
The Covid-19 pandemic struck during Masood's F3 placement, causing major changes to everyday practice. Masood says, “Visitors were not allowed into our unit. This became an opportunity for me to build my communication skills as the reviewing doctor would usually give daily updates to family members and address any questions or concerns they have.”
“I built great relationships with my colleagues and I made quite a few lifelong friends”
Masood explains that the role and specialism had many rewarding and challenging aspects. “The biggest reward about doing an F3 year was the fact that I gained an immense amount of experience in a speciality that I was interested in without the pressure of committing to a fixed term training post. It gave me a lot more insight into the speciality than the taster week I did during my foundation years (although taster weeks are still highly recommended).”
“As I was posted in the same department for a whole year, I built great relationships with my colleagues and I made quite a few lifelong friends. One of the worst feelings as a training doctor is when you finally get comfortable with a team or ward but you move onto your next rotation and start all over again.”
“By building this solid rapport, I felt a lot more comfortable learning new advanced procedures. My seniors got to know me a lot better and they felt a lot more comfortable supervising me. I was able to record a lot more procedures in my logbook because of this trust between us.”
“If you’re interested in critical care, it can be quite scary initially given the acuity of the patients. I feel that I’m in a much stronger position to now start my training post in ICU/Anaesthetics as I have already (at least partially) overcome these fears during my F3 year.”
“One of the challenges of an F3 year is having to maintain a high level of self-discipline to keep your portfolio competitive for future applications.”
“I’m sure any foundation year doctor would also love a full year of not having to chase people up to sign paperwork for work-based assessments. I still maintained my portfolio during this year but it was at my own pace and discretion. Audits and quality improvement projects were a lot easier to complete as I didn’t have deadlines for other assessments as you would in a training post.”
“However, this can also pose some challenges. As my portfolio was updated according to my own pace and commitment, at times I felt less motivated and then my portfolio suffered accordingly.”
“One of the challenges of an F3 year is having to maintain a high level of self-discipline to keep your portfolio competitive for future applications. It is all down to how much you do, there are no mandatory educational supervisor meetings to ensure your portfolio is up to date.”
"You may also have to pass up on certain procedures if a trainee doctor also needs to get signed off for it. Understandably, the trainee doctors will have a higher priority for certain procedures. However, in my hospital this was hardly ever an issue as training and non-training doctors all had many opportunities for procedures and audits.”
“Sometimes rotating to another speciality or department can be a good thing if you didn’t enjoy a certain rotation as much as others. As an F3, you can feel like you’re just there for service provision and there isn’t a new rotation to look forward to, but remember that this year can also be quite flexible and you can decide to leave earlier as long as you give the sufficient amount of notice.”
“I would highly recommend an F3 year. It was a nice break from all the assessments and mandatory learning one has to complete as a trainee doctor. It was pure clinical work which, for some, may be a lot more fun.
“Many doctors may be unsure of what they want to specialise in, and the year helps you gain great insight into specialities you’re interested in without the pressure of any major commitments. You also have the chance to form some great work relationships and friendships as you’ll be spending a lot more time in one department compared to the usual 4 or 6 month rotations.”
I feel that I’ve got a head start with some of the advanced procedures included in the training programme.”
Masood explains that the F3 year allowed him to build his confidence and says, “I felt like I was thrown in the deep end initially, but I feel that I’ve now got a head start with some of the advanced procedures included in the training programme.”
During His F3 Year, Masood successfully applied for an Acute Care Common Stem (ACCS) Anaesthetics training post starting in August 2020. Following advice from colleagues he met during his F3 year, he plans to take on a post as a paediatric intensive care fellow before his speciality training. Masood says, “I would like to complete dual training in both Intensive Care Medicine and Anaesthetics with a possible special interest in Paediatric Intensive Care.”
“I worked alongside Anaesthetic core trainees daily who gave relatable advice."
“My F3 year helped me focus solely on applying for a core training post throughout the year with continuous consultant support. I built closer relationships with the consultants in my F3 year which helped as I applied for a training post in the same speciality. This closer relationship also helped with completing audits.”
“I had never worked with Anaesthetic core trainees before, but during my F3 year, I worked alongside Anaesthetic core trainees daily who gave relatable advice and it was great that they had just come out of the application process I was about to start.”
“My F3 year gave me the opportunity to work using a multi-disciplinary approach on a daily basis. I had not worked in a speciality prior to this which had weekly Multidiciplinary Team meetings with nurses, physiotherapists, pharmacists, microbiologists and dieticians. My previous daily practice felt very one-dimensional, but this was not the case by the end of my F3 year.”
* An F3 year is an informal label used to describe a junior doctor who has chosen not to transition into a further formal training programme immediately after the successful completion of the UK foundation programme.