It was 9pm on a cold train station platform in Tokyo, Japan, when I opened my exam results.
I had passed my final exams.
I was to become a doctor.
I had been on my elective block during my fifth and final year of medical school (also my eighth year of university), and for a good two weeks after sitting my final UKMLA exams, I had given myself the luxury of forgetting all about the results. The day had started as usual, with me shadowing the orthopaedics team in theatres and exploring the city of Tokyo in the evening.
We all knew it was results day, but the great thing about being on the other side of the world was being able to fill my day with distracting tourist activities before the expected email reached my inbox.
I still remember the moment.
I locked eyes with a friend, and we both shared that feeling, a mutual understanding that this was the result that would determine not only how the rest of our elective would go, but also how life would never be the same again.
Heart racing and fingers shaking, I opened my results.
And there it was… a single capital “P” that changed the course of my life.
I had passed.
I was a doctor.
Over the next few days, I still felt a numbness to the reality. Over the following months, that happiness and relief became overrun with a dawning sense of fear.
I was Dr Umer now, but was I ready to answer the call?
I think this version of imposter syndrome is something that many FY1s experience at some point. It’s not enough to have passed every exam in your life and earned the title. It is when you pass and then realise that your real education is only just beginning.
In truth, this may seem very scary and often overwhelming to hear when you are approaching the end of medical school. You may still feel uncertain about your ability to survive as a medical professional. Perhaps an element of burnout creeps in, as it did with me.
Yet, the most refreshing part of this unique feeling is when you realise that you can finally make a difference in the way you always wanted.
What most students fail to understand is that medicine is not just about understanding guidelines and performing well in exams.
It is the art of implementation that makes a good doctor a great one.
Simply put, it is all in your hands.
You get to choose how much time you spend with a patient. You get to prioritise tasks. You decide how often you smile.
The question is: what matters most, and how can I make sure I optimise that development?
That is why I’m writing this article, to alleviate some of the common fears I held as I transitioned into a first-year doctor.
You will make mistakes.
I was often left paralysed by fear before sitting my exams. Thoughts of “what if I choose the wrong option?” and “what if I fail?” and that chronic overthinking translated into “what if I make a mistake?” just before my first medicine on-call shift.
I know that I’m not alone in this because once you begin to open up and speak to other doctors, you will realise that almost everyone, including consultants have this fear of doing something wrong.
I am not sure what the statistics say but I am certain the years of intense medical school experiences on placements and exams contributes to this mindset. However, during my shadowing period, one of the outgoing FY1 doctors told me something that changed my perspective. When I told her “I’m scared I will make a mistake”, she simply responded with:
“And you will…but that’s the point.”
It was never about being perfect. It was about learning from the mistakes and making sure you don’t make the same one twice.
Becoming an FY1 doctor is a big step from being a medical student, but this is a year where you learn. It’s about slowly using your experience to build up your real-world knowledge and ask questions when you feel like you are out of your depth.
That tolerance for uncertainty is understandably shallow in the first few months of FY1, but your resilience grows in ways that are difficult to put into words.
You make mistakes, you learn, and then you find new ones to make.
And one day, you wake up and realise you’re making fewer.
This journey was best summarised in a conversation with a respiratory consultant:
- “In your first year, you will learn.
- In your second year, you will master.
- By the third year, you will become bored.”
The constant exposure to new and more complex situations, one at a time, should be used as data similar to how you revise for your exams. You do not need to be perfect, you just need to keep learning until you master your response in uncertainty. In the end, it this the challenges on this journey which make it worthwhile.
Your tone matters more than speaking perfect words
I realised very quickly as a doctor that it was not about responding to a patients question in an OSCE style manner. If that was the case, then the words of Google and ChatGPT would suffice better than you or me. Patients often just want to be heard and feel understood.
Yes, clinical knowledge is vital and the communication of medical information is essential to make sure you safety net and inform your patients appropriately. However, it is the manner in which you adjust your tone and tailor your communication which matters as much.
It is genuinely okay to say “I’m sorry but I don’t know the answer to this…” but finishing the conversation with “…but I will find out for you.” is the best way to showcase your honesty at your junior level but also your commitment to care to a patient.
Often this is tested with various counselling and communication stations during OSCEs. I never understood why we were given such unique vignettes and patient actors who felt like they were performing to win a BAFTA. That was until I was deep into daily family discussions and understood that my medical school was preparing me for real life questions someone can ask.
Not everyone has the access or resources to understand medicine in the way we do, especially in the underprivileged and working class community that I have grown up in. It is therefore our responsibility as doctors to communicate complex medical decisions and treatment options in a simplified and comprehensive manner that also empowers our patients to make a decision that best suits them.
The feeling of responsibility grew further as I ‘accidentally’ became indispensable at work because of my ability to speak 3 languages. I would regularly translate for my consultants to my patients and vice versa, only to find myself in situations where I established rapport far quicker than I had ever imagined.
Language matters and equally important is the tone. The best consultants I have worked with often spend time recalling the events that brought the patient into hospital but from a deeply personal standpoint that made the patient felt heard. If a time came when they had to deliver difficult news, the patient already felt listened to and therefore receive information in a far better way.
Most complaints I have heard of originate from miscommunication and feeling aggrieved but in my opinion this can be avoided if you are able to connect on a deeper level.
Patients want to feel represented and language is one aspect of it. Yet, we can all connect with the human experience and life’s challenges.
It is taking the time to express empathy and share your own experiences that allows for the construction of a truly powerful and productive doctor-patient relationship.
Treat the patient, not the disease.
The principle of holistic medicine is captured perfectly in the words of William Osler:
“Treat the patient, not the disease.”
I first read this in the Oxford Handbook for Clinical Medicine during my earliest placements.
So you can imagine my surprise when, during my elective in Tokyo, I saw a Japanese saying on a hospital wall that translated to the exact same phrase.
It was the first time I truly reflected on its meaning.
As medical students, we focus heavily on memorisation and pattern recognition, skills that help us pass exams like the UKMLA. I remember peers working through hundreds of questions a day, testing niche facts about medical conditions.
But the real world is not that simple.
The application of medical knowledge is nuanced.
Just because we can do something, doesn’t mean we should.
Treating symptoms in isolation or relying solely on data like blood tests is not always enough.
As an FY1, you begin to develop what I call a “Sepsis Sense” - a gut feeling that something is wrong, even when observations appear normal.
There will be times when a patient’s presentation simply doesn’t add up.
Maybe it’s subtle. Maybe something hasn’t declared itself yet.
Whatever it is, you learn through exposure, what a truly unwell patient looks like.
And the most important thing is this: don’t ignore that instinct.
As an FY1, you are often the first to assess a patient. It is your responsibility to escalate concerns.
No one will criticise you for raising the alarm if you believe a patient is deteriorating.
At the start, it can feel uncomfortable and almost embarrassing, not to know what to do.
But medicine is not about always having the answer.
I have seen consultants seek second opinions. Doctors collaborate constantly. Nurses and pharmacists provide invaluable insight.
Medicine is a team effort.
There is no single “correct” approach for every patient.
Every individual deserves care tailored to them and that comes with experience, confidence, and the willingness to advocate for them.
If you take one thing from this, let it be this:
It is never just about the numbers on a chart or what the guidelines say. Sometimes, it is about trusting the instinct that your training has built within you.
Final thoughts
The transition from medical student to Doctor is one of the most challenging and rewarding, experiences you will ever go through.
It will push you to your limits.
But it will also shape you in ways you never expected.
It is easy to let fear of the unknown take over. But I hope that by reading this, you find some comfort in knowing that you can thrive in the environment you have worked so hard to enter.
Be kind to yourself. Give yourself time to adjust.
This is your coming-of-age moment.
It will give you memories for a lifetime and a deep sense of fulfilment after years of delayed gratification.
Trust the process.
And most importantly, trust yourself to become the doctor you are meant to be.
Dr. Muhammad Umer MBBS BSc (Hons) AKC
FY1 Resident Doctor
Choosing a specialty as a Doctor