Starting in A&E as an FY1 doctor

Starting your first job as a doctor can be both exhilarating and overwhelming - especially when that first step lands you in the fast-paced world of A&E.

We know how important it is to hear from those who’ve recently walked the path you’re about to take. That’s why we’ve invited Charlie, an FY1 doctor currently working in Brighton, to share their honest reflections and practical advice on transitioning into A&E.

Transitioning from medical school to being a doctor can feel daunting, especially when it comes to working in acute settings like A&E. The fast pace, intensity, and high stakes can naturally cause apprehension.

My first rotation was in psychiatry, but I frequently worked weekends in A&E, which offered a first-hand glimpse into its challenges and rewards. I hope sharing my experiences can help ease some of the anxieties about starting in this environment.

First impressions

My first weekend in A&E was a blur. I can’t recall the patients or their diagnoses, but I distinctly remember the corridors lined with trolleys and the immediate need to start clerking patients with minimal orientation.

Thankfully, the team was incredibly supportive, guiding me through the processes and systems. It quickly became clear how much urgency defines the A&E environment. Often clashing with systemic inefficiencies - a dynamic that requires adaptability and teamwork.

Key challenges and how to tackle them

• Managing time in a fast-paced environment

Time management is one of the most essential skills as an FY1, especially in A&E. However, it’s not something you master overnight.

Start by keeping a simple task list on a scrap of paper to track jobs for each patient - it’s basic but effective. Looking after multiple patients at once can feel overwhelming, so avoid overloading yourself early on. Focus on managing your workload efficiently and prioritising tasks.

• Dealing with uncertainty

It’s natural to feel uncertain, especially in new environments. At times you might feel like you’re the only one struggling, but the truth is many of your peers will feel the same.

Communication and asking for help early are vital for settling in and building your confidence. Most colleagues, including senior consultants, are supportive and want to see you develop. Use these opportunities to learn and grow.

• Prioritising patient care

When faced with a long jobs list, it’s easy to feel paralyzed by indecision. Start by identifying who is most unwell and focus on jobs that stabilise or diagnose those patients.

Next, think about patients ready for discharge and which tasks can expedite their care. Referrals should also take priority to ensure ongoing management. Don’t forget to keep track of patients waiting the longest to minimise delays.

• Navigating high-pressure situations

A&E is high-pressure, and managing critically unwell patients can be particularly stressful. Staying calm and working methodically through assessments is key, but exposure and experience are the best teachers.

These situations can linger in your mind, so it’s important to have strategies for processing the emotional toll. Debriefs with your team, talking with peers or loved ones and focusing on your emotions rather than just the details can help.

Personally, I find exercise a powerful way to cope - it provides clarity and relief, even when motivation feels hard to find.

Tips for success in A&E

• Familiarise yourself early

Learn the layout and key protocols of the department to feel more prepared.

• Keep learning on the job

Practical knowledge gained in A&E often surpasses what you’ve learned at university.

• Communicate openly

Build confidence by seeking support from your team and sharing concerns when needed.

• Prioritise self-care

Find healthy coping mechanisms, whether that’s exercise, talking to friends or mindfulness.

Final thoughts

Starting in A&E can feel intimidating, but it’s also an invaluable opportunity to develop as a doctor. Clear communication, teamwork and a willingness to learn will form the foundation of your practice. Remember, you’re never alone - ask for help and embrace each challenge as a chance to grow.

As you prepare to take your own first steps into clinical practice, remember that growth comes with experience and support is always within reach. Stay curious, stay kind - to your patients and yourself - and know that The Next Step is here to guide you along the way.

Want to hear more real stories from doctors who’ve successfully navigated FY1? Head over to our YouTube playlist to watch interviews and get and practical tips from resident doctors across the UK. It’s a great way to feel more connected, informed, and inspired as you begin your journey.