Intended for healthcare professionals


Covid-19: Looking back at the experiences of graduates and educators during the interim Foundation Year 1

BMJ 2021; 374 doi: (Published 09 July 2021) Cite this as: BMJ 2021;374:n1265
  1. Viktorija Kaminskaite, 2020 Clegg Scholar
  1. Student BMJ
  1. vk252{at}

In March 2020, thousands of final year medical students in the UK graduated early to join the medical workforce as “interim Foundation Year 1” (FiY1) doctors. Viktorija Kaminskaite, BMJ Clegg Scholar, spoke to the administrators, educators, and junior doctors involved in this graduating year.

Redesigning the registration process

As the body responsible for registering and regulating doctors in the UK, the General Medical Council (GMC) processes thousands of applications for provisional registration by new medical graduates each year. In 2020, this process was shifted forwards by several months. Colin Melville, medical director at the GMC, assured students and patients that all graduating students would meet the GMC requirements for new doctors despite their early graduation. “We are immensely grateful for the hard work and willingness that has been shown by this year’s cohort of new doctors,” stated Melville.

Those working in foundation school programmes also faced rapid preparations to allocate interim foundation doctors to job roles and develop robust induction and learning programmes. Helen Johnson, programme director at East Anglia and Essex, Bedfordshire and Hertfordshire (EBH) foundation schools, said that part of the challenge was coping with groups of students who were requiring job placements at different times. “Normally the junior doctors come to us through the national recruitment process, and we know exactly when everybody is going to arrive,” says Johnson.

To prepare the incoming interim doctors, East of England Foundation School distributed a virtual reality simulation licence that included five different acute scenarios as part of the induction process. “There was not a covid-19-specific one, obviously, so we decided to include infection and sepsis instead,” says Johnson. The main concern was how best to support doctors who were not able to complete an interim block. The FY1 administrators worked hard with the East of England Foundation School trusts to improve the access to resources for all of the incoming FY1 doctors whether they had done the interim job or not. Since April, all of incoming trainees were invited to participate in regular teaching and an extended period of shadowing before the start of the formal foundation programme.

Rushed into practice

Many graduates did not think they were fully ready to join the workforce earlier than expected. “Missing out on the last months of medical school, heading into an uncertain environment with many unknowns, I did not feel ready,” says Fabianne Viner, who took an interim post in London. Like many others, Viner heard about the plans to accelerate the graduation of finalists on the news, rather than from her university. “It would have been nice to have had a warning,” quips Viner.

“I don’t think there is such a thing as feeling ready for something like this,” states Izzy Edwards, an interim at the East of England Foundation School. She adds that there are aspects of the job that the medical school cannot fully prepare students for. The uncertain environment and unknown expectations directly affected the perceived preparedness. “I felt quite nervous, because I was not sure what to expect and what the expectations from the other doctors were of me,” says Emily Mills, an interim at the South Thames Foundation School.

Collectively, there was a strong responsibility felt to volunteer for the interim role. “It was the reason why I wanted to do medicine: to help people, help the NHS, and this was an opportunity to demonstrate that,” says Sara Khalid, an interim at South Thames Foundation School.

Worries about missing out key clinical exposure in lockdown was also a motivator. “I felt like I would have forgotten everything by August,” says Edwards. Some were apprehensive about the situation at first. Mills thought that joining the workforce early would make her burn out sooner. However, having an adequate amount of time between finishing medical school early and starting the job made it feasible. “I had the skills, and I had graduated as a doctor, so I felt like it was the right thing to do,” Mills points out.

There were difficulties faced by the interim doctors. “It was hard to get up to speed: getting used to the admin and getting used to how the F1 position works, how the hospital works,” reflects Khalid, describing the interim role as a grey area between being a medical student and a doctor. The ever-changing situation meant that working patterns were subject to change. “Initially we were told we would be working 9-5, and I’ve been working 13-hour shifts including nights, so it was quite a throw in the deep end,” says Khalid.

Overall, however, it was a positive experience. “It has been the best learning experience I have ever had. I’m really grateful for it—it’s like something good has come out of covid-19,” reflects Viner.

Apart from the invaluable learning experience, the situation presented newly graduated doctors with unexpected benefits. With the pandemic adversely affecting the mental health of many people,1 the interim role “gave us the social life that we wouldn’t have had in lockdown” says Mills.

Not left behind

Graduating early did not guarantee medical students an interim job. Chloe Smith, a Nottingham Medical School graduate, applied for an interim role but in the end was not able to start because of oversubscription. “At the time it was horrible not knowing what I was going to do,” says Smith.

After the initial anxiety, Smith has found herself with unexpected opportunities: “I ended up doing an internship with the medical school instead.” This led to a research project looking at the experiences of those without an interim job, with many feeling anxious and not prepared for the start in August. “It was nice to see that I was not alone,” says Smith.

After a few weeks at the start of her FY1, Smith feels that she has settled in well. Thanks to the continued support of her team, it was less of a steep learning curve than she had expected. Smith was sure the apparent difference between trainees’ skills would be short term, but “I don’t think you can overestimate the impact the interim job had on people’s confidence in their abilities.” Returning to practice after a long break was both unnerving and exciting. “I have quite enjoyed returning. I missed it. Being off made me rediscover my love for medicine,” says Smith. Overall, Smith reports that it all worked out well for her: “I fell into quite a few opportunities that happened because of covid-19.”

Interim: a yearly occurrence?

The experiences of newly graduated doctors echo the positive value of the interim job, despite the stressful and unprecedented circumstances. However, some remain sceptical whether it should become a regular occurrence. “If we were going to graduate people earlier, I think they would just end up doing that jump into F1 earlier as it became the norm rather than it being the nice gradation like it has been now,” says Johnson.

A year on, the pandemic is far from over, with doubts over when the new cohort of foundation doctors may begin their new jobs. Yet the interim position, despite being difficult, seems to have had a valuable impact on graduates’ learning experience.


  • Competing interests: None declared.