Dr Fiona Byrne and Dr Andrew Watson, F2 Trainees, Royal Bolton Hospital
What is the role of an F2?
A foundation 2 (F2) doctor is still a phrase that a lot of nurses and medical staff in the hospital will not understand and essentially you are still thought of as a traditional Senior House officer (SHO).
The role of a F2 is in some ways very similar to that of an F1. However, with F2 jobs in an increasing number of subspecialties such as paediatrics, obstetrics and psychiatry, roles can be wide and varied.
In some jobs there is additional responsibility compared to that of being an F1; being placed on what was once an SHO rota (with more senior, more knowledgeable and more qualified doctors), seeing outpatients in clinics and supervision of F1's and medical students on a day-to-day basis on the wards. In other jobs you are supernumerary and are always fully supervised by senior staff, and therefore can have less direct responsibility than in some F1 jobs.
One thing that is a guaranteed constant is the necessity of 'extra-hospital' work. This is either private study to improve your knowledge base or data collection and analysis as part of an audit or project. This may be based in the area you are working in or an area in which you have career aspirations. Whatever it is that you want to do, you will need to be doing this sort of additional 'portfolio-building' work. In most jobs this must be undertaken outside of normal shift working hours, although if you are organised some may be able to be fitted into 'quiet' moments.
What is the best thing about being an F2?
For most people F2 rotations are in the same hospital as their F1 year, and this allows for continuity, making the change less stressful than starting at an entirely new hospital with new people. Granted, you will generally be working with a different team of people in each job of your foundation rotation, but by remaining in the same hospital with the same group of foundation doctors, you will know some people and there are always friendly faces from previous jobs around. You may even find that you have previously worked with your new colleagues in a different capacity. All this minimises the stress of changing jobs.
In addition to this, a wider range of specialties provide jobs in F2 than previously did to junior SHO's, this is also true of some F1 placements. This allows you to 'sample' an area that may be a possible career for you, perhaps one you are not entirely sure about, before having to take the plunge and select it as one of your specialty training post applications slots. Even if you are sure of the area you want to work in, doing a four month post in an allied area, or in a specialty where previously there were no SHO's, only SpR's, you are able to gain a valuable insight into how this specialty works, which can benefit future working relationships.
What is the worst thing about being an F2?
As many staff members are not entirely sure what an F2 is, you can often fall into a no-man's land. Under the old system you would have been called an SHO, but under the new system you are distinguished from the ST's by your letter and your rotation length, thus linking you more with the F1's, otherwise thought of as house officers. This uncertainty about your position can affect how you see your role and whether you step up to greater responsibilities, as is required under the system of working an old-style SHO position, or whether you shelter under the initial 'F' in your title, an issue that can be magnified in supernumerary roles where your responsibilities are few. The other issue with F2 rotations through areas that did not traditionally have SHO's is whether the department you are working in knows what to do with you or not. There can be a lack of certainty about exactly what your position is, and as such the expectation of you can be either too high or too low.
What is the main thing I learned as an F1?
The main thing you learn as an F1 is to stand on your own two feet. It is surprising that you could turn up on the first day of work and despite being at university for five years a nurse would ask you a question you never learned in medical school, like – when can this patient eat? As a student you are always sheltered by not being qualified and able to defer certain tasks, never being expected to make decisions about even minor treatment issues by yourself. As an F1, even if you don’t start on call, you will have prescriptions to write (and yes it is your signature and you are responsible) and fluids to decide on, as well as bloods and tests to be taken and chased up. All this whilst learning to trust your own clinical judgment and where you fit in the scheme of things, and how to befriend the right people in order to get done that ‘impossible’ request from your Consultant or Registrar, which falls to you as the most junior member of the team. Be organised and keep up-to-date; that is the most important thing to learn as an F1. You are not expected to have every medical answer, but you are expected to have the latest test results available for your patients and to know where they are. The other important thing to learn is your limitations – you learn pretty quickly that your seniors would rather you bothered to ask them a question when you are unsure, than blundered on in ignorance because you don’t want to disturb them.
What surprised me about being an F1?
I am not entirely sure that anything particularly surprised me. The things you fear about starting work are well known lore in medical school – the horror of your first medical night on-call, being on the crash team, having to treat that patient with sepsis, needing to recognise the surgical emergency, and so on. Fear of not knowing anything, screwing up and feeling utterly inadequate as you start as an F1 are pretty much par for the course (I am not entirely convinced that you are human if you aren’t at least a little bit afraid). I suppose that the main surprise that comes is that you can do it, you do know things, and that the day-to-day workings of the ward are soon picked up. In a matter of weeks, you develop some confidence (often after that dreaded first on-call) and a knowledge that extends beyond anything that can ever be taught in medical school; a knowledge that only comes with doing your job - and that is - that you can do your job!