Navigating FY3 And Beyond

How to Navigate the Post-Foundation/Pre-Training Years

As an ‘F8’, I have managed to navigate the years between F2 and a training scheme so far, but it hasn’t been without its ups and downs. 

In terms of my own journey, I completed foundation years 1 and 2 in Wales, applied to IMT, but decided that general medicine wasn’t for me. I then spent F3 between Bristol and Bath in ED and ICU, and applied for ED training starting the following summer, but declined the hospital that offered me a job. I then moved to the north coast of Scotland and worked in NHS Highland before going on an expedition to Nepal on my way to moving to New Zealand. I then worked on Everest and returned as an ED registrar to Cornwall and then subsequently to Bristol. I reapplied for training (GP and ED) in 2024, and whilst I was offered a spot in GP, I declined it again, as I was committed to an expedition to Kyrgyzstan. 

Throughout this journey, I have applied for countless other jobs, including at the British Antarctic Survey, DDRC Dive jobs, ski medic (NZ), and various clinical fellow and training posts (teaching, pre-hospital, trauma, etc.). I have lived all over the UK, been on 5 expeditions, completed 2 diplomas, and made a bunch of mates. But this is just a list of things. And I truly believe that, as medics, we are the worst people for collecting pieces of paper and listing everything we have done. 

Whilst I don’t regret a single day of my F3-8 years, it hasn’t been without its hard work, and until now, I have stood by my rule of either being on a contract or fully unemployed (i.e., no locuming). 

Clinical Fellow Contracts

Applying for contract jobs can be exhausting, and whilst your employer may offer to keep you on, every February/October you can also choose to spend hours, if not day,s scouring the NHS jobs websites and applying for new roles, mainly clinical development fellow (CDF) or Senior Fellow jobs (if you have more experience in a certain specialty).

This often results in interviewing against hundreds of other applicants for very few spots, as the competition is fierce. This path of multiple applications scattered across various specialities in a certain location, because you like the place, or various places for the same speciality, because you want to try the speciality, often leaves you unsettled. It can require you to uproot professional and/or personal relationships, move house, learn specific hospital systems, and generally start all over again every 6 to 12 months.

It can be relentless, but it can also be incredibly rewarding.

Portfolio Maintenance

Regardless of the job you end up pursuing, the most important step in achieving this nomadic wander through the post-graduate non-training years is to maintain a portfolio, and there are various ways of doing this.

Firstly, you could sign up for a portfolio from one of the training colleges, i.e. RCEM and their Kaizen platform. But, coming in at around £400 a year (depending on the college), I decided not to do this as I didn’t know which speciality I eventually wanted to work in, despite my accruing 5 years of ED experience.

Secondly, you could pay for a stand-alone portfolio, such as 14-Fish, as and when you need an appraisal or MSF (multi-source feedback) done. Or thirdly, you could create your own CBD/mCEX/reflection forms (based on your F1/2 ones) and store all of your portfolio pieces on your desktop in a folder for each year, paying for an independent MSF (or getting it for free through your current role) when you need one. This last option is what I did.

What you put in your portfolio is entirely up to you, but if you follow the general structures of the college training requirements you can’t go too far wrong, try and gather together the following.

Type	Definition	Volume
Employment meetings - formal document	Skills, cases, and and clinical practice, signed off by senior colleagues, demonstrating development during a working career.	3 per job (start, middle, end)
mCEX/CBD’s - template	Skills, cases, and clinical practice, signed off by senior colleagues, demonstrating development during a working career.	10+ per year
Reflections - template	Again, any relevant clinical situation, including reflection on positive feedback and complaints.	10+ per year
Skill Lists - Excel sheets	Specific for hands-on specialties where skill level matters i.e. surgery (operation number), ICU (arterial/central lines, intubations), ED (manipulations, sedations) [non-exhaustive list].	As required by future applications
Other	Quality Improvement, Audit and Research projects you are involved in from inception to closure.	1 per year
Courses - certificates	ALS, APLS, ATLS, Burns, Airway Skills, BASICS, any extra course/conference.	1 per year
Feedback - forms	1. Self-assessment 2. Colleague (MSF) 3. Patient	1. One per revalidation cycle 2. Two per revalidation cycle 3. Approx 20 required for revalidation
Other CPD	Examples include e-learning, teaching evidence, rota design, conference attendance, peer review activity, articles you may have written and published, wider reading (journals etc), other projects you may do outside of work that are medical related (or not), volunteering etc.
Medicine Outside NHS	Extracurricular medical activities, keep reports, plans, feedback etc. (see below).

The ‘volume’ column is just a guide; there are no defined requirements, but naturally, the more consistent you can be, and the more you do, the more evidence you will have, demonstrating ‘ongoing professional development’.

Medicine Outside NHS: a key part of the portfolio that is often overlooked and one that is ever more important. A lot of medics do work outside of their day-to-day job, be that in mountain rescue, event cover, expedition medicine, aesthetics etc. These fields are ever-growing and are important aspects to maintain inside the portfolio. Keep records of practice in these fields, reports, feedback, certificates, whatever the format is.

Appraisal and Revalidation

The reason we are keeping this portfolio is that the second thing to consider is your appraisals (traditionally, once a year) and then revalidation (every five years).

However, if you have spent any time out of training or working abroad, i.e. NZ/Aus, with your GMC licence on hold, then the dates can be pushed back by the amount of time you were without a licence on the GMC register (see ‘GMC Registration Options’ below).

Appraisal is simply a way of displaying to an appraising consultant that you are maintaining your practice (as per the table above). My yearly appraisal consists of the aforementioned folder on my desktop of my CPD, a yearly MSF and any activities I feel support my work as a doctor. Five appraisals then make up a revalidation cycle, and whilst I am yet to complete this (due February 2026 and pushed back because of my time in NZ), the only additional factor required to complete the revalidation is to gather around 20 patient feedback forms (see below for GMC templates). 

The pitfall you can fall into with the yearly appraisals is that to perform an appraisal, you need a ‘designated body,’ i.e. trust that you work under. Thus, when you take a contract job or sign a locum contract, you must ensure to update your ‘designated body’ on your GMC profile. You are then entitled to find out who the designated person is in that trust that organises appraisals, email them to get an appraiser allocated to you and then liaise with them to fix an appraisal date. They will not chase you; this is down to you.

GMC Registration Options

This brings us nicely onto the dynamics of the GMC register.

When you get signed off from F1, you are upgraded to ‘full registration to practice’ on the GMC register. So long as you stay in the UK and pay your yearly fee, and without any conditions being applied, then you maintain this full licence. Should you decide to work abroad for an extended period of time or take time out of medicine entirely you can choose to either ‘give up your licence to practice whilst maintaining your name on the register’ at a lower cost per year (these ‘non-practicing’ years are what push your revalidation date back).

Or you can also give up your licence to practice and your registration on the GMC register, but I do not recommend this option as it costs a lot to get back on, and from what I understand, you have to essentially perform as an F1 again to regain a full licence to practice.

See more info on GMC registration options here: https://www.gmc-uk.org/registration-and-licensing/managing-your-registration/changing-your-status-on-the-register/change-status-doctors

CREST Forms

The last pitfall of being in the post-F2, pre-training years is the CREST form. Essentially this form, called the certificate of readiness to enter specialty training (CREST), is to ensure that if you have been out of training for >3.5 years post-F2 by the time you enter training, i.e. you are applying for any form of specialty training through the traditional ORIEL system in your F5 year (regardless of whether you are going to start in February or August of that training year) that you meet the requirements to be a trainee.

This form must be completed and hand-signed by a consultant with whom you have worked for at least 3 months within the last 3.5 years, then scanned and uploaded to your ORIEL application. So, if you are starting a new job in August and applying in November, the dates can be slightly tight. But make sure that you get the form printed, signed, scanned and uploaded onto ORIEL with your application.

They won’t accept it outside of the application (trust me, I found this out the hard way). 

The key here is the timing of ENTRY:

• If you are an F2/3/4 applying for training during those years, you will enter training before you are >3.5 years post finishing F2, i.e. before February in your F5 year.
• If you are applying for training and you expect to start on/after February in your F5 year, then you need a CREST form.

Re-entry to the System

The final hurdle to realise while spending time out of training is whether you ever want to re-enter training.

I am currently operating as a non-training ED registrar. However, my only real options are to re-enter training at ST1, thus taking a significant pay cut, working in ED well below my skill level, repeating ICU and also doing service provision acute medical cover. The only real benefit to me is my Anaesthetics (IAC sign-off), which is incredibly hard to come by outside a formal training scheme.

Alternatively, I could enter at ST4 (DRE-EM), but this is reserved primarily for trainees who have left ST3 for out-of-programme experience (OOPEs); it is more competitive than ST1 and has few spots in focused geographical areas.

Or I could opt for CESR, which is becoming more popular but involves a huge burden of paperwork and self-directed training, and is not for the faint-hearted or poorly organised. 

Whilst there are significant benefits to carving your own path through the non-training years post-foundation, it can be a lot of work. The rewards are countless. You can opt to explore more specialities before picking a training scheme, you can move job/city/country as and when you choose, and you can even take time out to explore other careers, study or generally give yourself a good work-life balance. There are a few hurdles to jump, but you will always find someone around who has ‘been there and done that’ who can show you the ropes. And if and when you want to re-enter the training rigmarole, ORIEL will always be there waiting for your application every November! 

If you have any questions and want to get in touch, please feel free to email me at [email protected]