Disclaimer

The following reflections are entirely my own and do not represent Somerset NHS Foundation Trust, the Upper GI service, or the F1 who mistook potassium for paracetamol that one time. Any resemblance to real persons—living, rotating, or attempting to clerk on pace—is purely coincidental. No F1s were harmed in the making of this blog, although a few were gently emotionally nudged in the direction of resilience.

It’s that magical time of year again—somewhere between “Why is it so dark at 4pm?” and “How many layers can I wear under scrubs before becoming immobile?”—when our first batch of F1s complete their inaugural four months and prepare to migrate to their next habitat.

Every August, the NHS wards are blessed with a fresh crop of brand-new postgraduate doctors. They arrive bright-eyed, hopeful, and clinically pale from the final months of medical school revision. Then their first job as an F1 begins, and the innocence fades quicker than an ED corridor lightbulb.

Rotation One: The ‘Please Don’t Leave Them Unsupervised’ Phase

This is where we, the Upper GI team, cradle them gently into the world of “real medicine.”
They learn:

• Transferable skills
• Basic assessment
• Communicating concisely (eventually)
• How the bleep system can be both a lifeline and a personal attack
• That being reliable is not optional

They also learn that when they start sinking—and they will—there is always someone in Upper GI to throw them a buoy: Specialist Nurses, CT1/2s, registrars, and consultants. And on a very good day, the buoy even works.

Rotation Two: Confidence… and Consequences

Ah yes. The second rotation.
The most dangerous rotation.

This is when they’ve had a few months in the wild and begin to think:
“I’ve cracked medicine. I am unstoppable.”

This confidence manifests in two predictable ways:

1. Attempts at autonomous decision-making
2. Accidental ward-nurse provocation

The latter tends to end swiftly and decisively. A life lesson. A formative experience. The day an F1 realises that upsetting ward nurses is a career-limiting move. It’s beautiful character development.

Rotation Three: Theoretically Competent

By now they’ve survived eight months and three OSCE-levels worth of emotional damage.
In theory, they should be:

• Capable
• Efficient
• Aware of trust policies
• Able to request a CT scan without sweating

Any problems that remain at this stage should already be highlighted in their TABs. Or in their handwriting. Or in their bleeping habits.

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This Year’s Class: The Fantastic Four (+ Banter Upgrade)

This year’s cohort of four F1s arrived, and early on, a leader emerged—swiftly, confidently, and, crucially, competently. Fortunately, this leadership did not manifest as ego but as the kind that involves actually knowing things and getting the job done.

The other three were not far behind. In fact, they were almost annoyingly good.

Naturally, I couldn’t tell them this—otherwise they’d become intolerably big-headed, and Upper GI corridors aren’t wide enough to accommodate expanding skulls.

What I can say is that this year we introduced an additional service line within Upper GI:

Sarcasm & Banter Therapy™

Free of charge. Open 24/7.
Results vary but generally include:

• Rapid resilience building
• Questionable coping mechanisms
• Enhanced team bonding
• And, in one case, accidental or on purpose comparisons to strong 19th-century Germanic leadership (yes, Bismarck made an appearance)

Combine that with a decent grounding in Upper GI knowledge, and these four should survive medicine—an environment known for long ward rounds, even longer notes, and significantly less walking than surgery.

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To the Four of You

You know who you are.
You survived your first four months.
You absorbed the banter.
You tolerated the sarcasm.
You learned the difference between urgent and surgical urgent.
And somewhere along the way, I hope we shaped your early career—just a little.

Good luck on medicine.

May your ward rounds be short, your consultants kind, and your discharge summaries readable.

Go forth.
Rotate proudly.

And remember:
Upper GI made you tougher than you think.