The Final(s) Hurdle: A Guide to Year 6

A warm congratulations to making it past the beast that is 5th year – the marathon is over, now for the final sprint before you get to go around calling yourself Doctor so-and-so 👀

There is a lot going on in final year, and one can broadly split the year into the following areas:

  • Job applications
  • AFP
  • SJT
  • Firms
  • End of year exams
  • Electives (saving the best for last!)

So, without any further ado, let’s begin…

ApplicationsLocation, Location, Location 📍

The second biggest decision that you will make in final year (after deciding where to go on elective!) is how to rank your deaneries. There are a lot of rumours that go around, and one that was causing the most anxiety for my year was that training in London will look better on your CV/ grant you greater future career prospects. Ultimately, you must remember that your core/specialty trainee applications are, like the FY applications, objectively assessed using a points-based system for which your location of training does not give you a greater score. As such, it follows that training in a particular prestigious hospital for your FY years is going to give as you as much benefit for your next application as studying at Imperial is giving you for this application. So, all things considered, what actually matters?

Just ask yourself: “Where do I want to live for the next two years?”

Don’t get too bogged down in delving into the theoretical pros and cons of working within big city deaneries vs more rural deaneries. Everyone ultimately gets a very similar F1/F2 experience no matter what deanery they choose.

In terms of making the decision, my advice would be to consider the following:

Any commitments e.g. to family
If these are exceptional, bear in mind that it is possible to apply for special circumstances.

Where your family and friends are 👨‍👩‍👧‍👦
Foundation years can get very busy and it’s nice to have a support network around you when you need to unwind.

Finances 💸
Simply put, living at home is the cheapest. If you choose to live out, then weigh up the pay being more in London vs the fact that cost of living is much cheaper the more north you go of London. Do the number crunching now- the future you will thank the you of tomorrow. And please make sure to help your parents out with the bills if you do end up staying at home!

If you’re still stuck after all this between two deaneries, one thing to bear in mind is that you are less likely to get your first choice of jobs in the deanery which is more competitive – and as such if you apply to a less competitive deanery you’ll increase your chances of getting the jobs you want (I got my first choice jobs at my first choice hospital in EBH because of this – had I put London top and scraped in that certainly wouldn’t have been the case!).

After you apply for your deanery it is then time to apply for your jobs/hospitals. In terms of choosing one hospital over another, again the most important thing is location

If you know that you want to pursue a particular speciality (especially if it’s a run through specialty), then I’d also advise that you rank your jobs accordingly to increase your chance of getting a job in that field within your F1 or F2 (ideally in one of your first 2 jobs in F2 before the applications for training posts open as you’ll get a better experience as an SHO and will be able to talk more about the job at an interview).

If the training post you want to go for is super competitive, and you fear of not getting a foundation year job in that speciality – fear not! You can always do taster weeks to show your commitment and attend conferences/ be involved in research in the field etc.

When making the decision about ranking rotations, it is also worth trying to talk to current FYs in the different hospitals you are considering about their experience as some hospitals are known to support their FYs better than others e.g. being rota’d with more senior support on the ward etc. (although bear in mind that they may be biased one way or the other!). The same also goes for when choosing which rotations to do within a hospital.

Some final words of advice on this subject would be firstly to remember that some jobs in F1/F2 will be supernumerary i.e. 9-5 weekdays only e.g. O&G as an F1. These have pros in that you’re chilling, but cons in that you get paid less (which you can make up by locumming –  but bear in mind if you have a supernumerary job as your first job in F1 it might be difficult to locum in medicine or surgery as you won’t have yet done a medical/surgical job). Secondly, some trusts (apparently) have policies that state to locum in acute medicine/A&E you have to have done an acute/emergency job in F2 – so if you plan to locum during F2 or during an F3 then remember that a lot of the locum shifts will be in these departments so do some research and try to get an F2 job in these fields if it’s the case where you are!

AFP To AFP, or not to AFP: the not so big question 🤔

To AFP or not to AFP?...

Everyone always has loads of questions about the AFP. In short, to allay the major concerns, you can still get involved in research if you don’t get onto an AFP programme. And getting onto an AFP programme in and of itself isn’t probably that impressive on an application – it’s more the fact that it gives you a solid 4-month block in F2 to purely dedicate to research/teaching which will look good on your CV. If you don’t get an AFP or if you don’t wish to pursue one, then you can still tick off these boxes – just bear in mind it will be harder to do as you won’t have dedicated time in order to do this so will have to be dedicating your evenings/weekends (i.e. your recovery time) to these endeavours.

One of the biggest unintended benefits of AFP is the fact that your SJT has no bearing on which deanery/hospital you’ll end up in- so it takes away a lot of uncertainty especially for people who want to apply to a competitive deanery and are worried their SJT might let them down. One of the biggest unintended harms of the AFP is the fact that the rotation will usually be supernumerary. So, as I alluded to earlier, this means chill 9-5 weekdays only, but also means less pay (however, you can usually locum alongside to counteract this).

If you’re unsure then I’d advise you just apply as there’s no real harm in doing so. Even if you don’t get an offer it’s all useful experience that will come in handy for future job applications e.g. writing personal statements, attending interviews etc. and you can always change your mind and drop out even after receiving an offer. If you are sure you don’t want to apply, then don’t bother and save yourself some time and stress in your last year before you become employed!

Once you have your AFP offer, you have to accept or reject it before you get your SJT result/FPAS offer, so if you get an AFP offer in your second place deanery you’ll have to make that difficult call as to whether to reject the offer and back your SJT to get you into your first place deanery, or stick with what you have.

SJT The Deal breaker🔨

This is what really determines whether you’ll get into your top deanery or not! Some people who are bottom of the deciles smash out high 40s, some high achievers get mid 30s; some people who got close to full marks on the mocks bombed the real one, and some people who got bombed the mocks did really well on the real paper – it’s all pretty random.

My advice would be to prepare well, nonetheless. Professor Meeran runs some good mock papers which can be used in conjunction with the two official online papers. The way that I did these was that I did one paper a day for about 2 or 3 weeks preceding the SJT until I’d done all the papers three times each. I found that if I did a paper more than 3 times, I’d actually start to do worse and second guess myself, and if I did a paper more frequently than once a day, I’d start remembering the answers which is pointless.

Please remember that understanding the explanations for the answers and the underlying principles when practising is more important that getting a high score (just don’t get frustrated when you find answer explanations contradicting each other! 😭)

FirmsFake it ‘til you make it 💁‍♀️💁‍♂️

Final year firms, done right, can put you in a really good position to start F1. Final year firms, done wrong, can be a complete waste of time. Aside from the necessary sign-offs that allow you to sit your exams and become a doctor – firms are useful for the following:

Playing doctor 👩‍⚕️👨‍⚕️
In A&E and GP in particular, your placements will allow you to autonomously consult patients, form differential diagnoses, and suggest initial management plans which your supervisor will either agree with or tweak.

By the end of these placements, you can get really good at taking succinct histories, performing examinations, forming sensible differentials, and coming up with the proper initial management of a whole range of medical conditions which will put you in really good stead for when you’re clerking-in new patients from the acute assessment unit as an F1. There’ll be no training for these shifts when you start, so getting at good at it now will save you whole lot of stress next year!

Sign-hunting 🛑
For the rest of your placements, use your time at firms to get really hot at picking up signs. Looking for respiratory signs, but on a colorectal senior surgery placement? No worries, the Imperial hospitals are your playground! Use the times that you don’t need to be on the ward (i.e. whenever you’re not expected at a consultant ward round/teaching) to go to different wards (or even different hospitals!) and take ownership of the experience and see the patients that you need to see.

For example, what I did was to pick a sign each day, go to each ward of the hospital and ask the F1 if they had any patients with that sign. After I was confident that I could pick it up (normally after hearing/seeing/feeling it on around three different patients) I’d then go home and pick another sign to do the next day – after a few weeks you’ll be a pro! I’d advise doing the bulk of this earlier in the year (ideally pre-Christmas break) and have one or two refresher days closer to exams. This is because after the Finals revision course, the wards will be packed with other students doing the same thing, and the patients with good signs will be much less likely to let you examine them as they’ll have been examined by 10 students before you!

Clinical skills 💉
Aside from being confident at picking up signs and being slick at taking histories, the other main thing that will really help you in F1 is being good at bloods/cannulas/ABGs. When you start work, your patients will be your responsibility, and your colleagues won’t take kindly to you asking them for help with venepuncture or cannulas unless the patient has genuinely very difficult veins. So, get good at this now, lest you become known as the incompetent F1!

End of year exams – The storm before the calm ⛈🌪

I personally found finals much more taxing than fifth year exams (although I think I was in the minority!), so don’t feel disheartened if you’re feeling that way too.

The written papers I thought were genuinely very difficult, so prep well using Passmed. I was averaging just over 60% in Passmed and got 69% in the actual paper, so it’s pretty representative. The GetAhead books I personally found way too easy vs. the actual paper and were closer to third year exams than finals.

Finals PACES was far easier than fifth year PACES in the sense that the examiners were all SUPER nice (at Northwick Park at least), and really wanted you to pass.

Alasdair Scott’s notes and Cases for PACES is an excellent resource that, when learnt well, will allow you to breeze the vivas. For those that find it difficult to learn from very abbreviated notes and prefer a more short sentence style approach, I made some notes which can be found here – these notes served me really well for finals and I had no problem answering any of the viva questions they threw it at me.  

The only thing to cover on the topic of PACES is the issue of presenting. You’ll be told loads of different things by different people: should I present the whole examinations or just the pertinent findings? Shall I offer investigations/management myself or shall I wait until asked? 

What I personally did was a succinct presentation with key positive and negative findings, and then went on to then offer differentials, investigations, and management of my most likely differential. I found that this allowed me to not spend too long on just presenting findings (which can be very boring and tedious!) and also meant that I could spend most of the three or four minutes after the examination monologuing about what I wanted to talk about and demonstrating my clinical knowledge rather than answering any niche questions in a viva.

The PSA doesn’t require too much work (I personally only spent a few days on it). The main key with this exam is to be able to navigate Medicines Complete/the BNF online app quickly. Barts had some really good practice presentations which were very representative, and the PSA have official papers in their online portals which you’ll get logins to at some point in final year. I personally didn’t find the Pass the PSA book very useful or representative, but nonetheless I’ve included the pdf with the Barts presentations in my Google Drive.

ElectivesThe calm before the storm 🌥🌞

The calm before the storm 😍

This is your last chance to properly chill (or do some cool medicine) abroad before starting the madness which is F1, so make the most of this time! And remember that you can claim back hotel costs and travel (from hotel to placement, not flights 😢) on the NHS using the same claim-back forms as your placement travel expenses – so look into that before you book and get the nicest place you can for the allowance they give 😏! Some hospitals require you to book quite far in advance so bear this in mind and apply early. Personally, I’d hesitate about paying large sums of money to these elective companies: it’s often much cheaper to arrange it with the hospital yourself! Also bear in mind that Imperial sort out travel insurance for you for your elective and any holiday that follows within the same location – so check this before duped by these companies advertising elective insurance!

Anddd…..That’s a wrap! If you got this far, I commend you 👏!

Wishing you all the best in your future endeavours,

Athif Ilyas
Foundation Year 1 Doctor – Luton & Dunstable Hospital

Just some FAQs…

1) Shall I get a new stethoscope?
I personally did, as I was going to get one for FY1 anyway so thought why not get it a bit early so I could use it for finals too. I got the Littman Cardio IV and personally found that I could actually pick up murmurs in final year compared to third year with my Classic 2.0 when I’d just pretend to be able to hear them, but that may be just because I used it more so got better at auscultating…. Result: inconclusive. Definitely not mandatory.

2) Are these courses/mocks worth the money?
I attended the MM surgical PACES weekend, MM medicine PACES weekend, MM mock, and ChelWest mock. I personally found these events to be excellent – they prepped me more than enough for finals and some/most of them were even free! As I didn’t attend any of the other courses, I’m not in a position to comment on their value for money, but definitely don’t feel like you have to splash the cash to pass or even do really well…

How many people fail?
I’m not sure on the stats, but almost everyone I knew of passed everything first time around, compared to every other year in medical school where a good chunk of the people that I knew would be resitting. So you have nothing to worry about!

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