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Induction, shadowing and student assistantships

What you need to know

Induction

Shadowing

All you need to know about shadowing

What is shadowing?

Shadowing is an arrangement where a prospective doctor observes an existing Foundation Year 1 doctor (FY1) undertaking the usual activities required of their role before taking over the role themselves. It helps forthcoming FY1 doctors become more familiar with working practices and hospital systems.

This helps new doctors gain confidence and professional skills and helps to improve patient care.

It can also provide a chance for students to develop working relationships with the clinical and educational supervisors they may work with in the future.

 

What should take place during shadowing?

Ideally you should be able to accompany the FY1, whose post you will be filling in August, whilst they go about their daily duties so that you can observe and learn how the department and hospital work and what your responsibilities as an FY1 will be when you begin your substantive post.

You should be able to become familiar with all local processes and learn to be able to recognise tasks where closer supervision is necessary. You should be informed in advance of the specific learning objectives associated with the programme.

Your shadowing should include a period of induction where you will learn about your employer's local policies and practices. This should include information about issues such as sick leave, fire evacuation procedures and access arrangements for disabled staff.

Find out more about induction

 

What should I expect to do during a shadowing placement?

When you begin your shadowing placement you should receive an introduction to the programme, including a description of what you will be expected to do during the time, and be introduced to relevant staff at the hospital and foundation school. If you have any concerns over what you are asked to do, you should raise this with the doctor you are shadowing in the first instance. If after this you still have concerns, you should contact the relevant member of staff from the foundation school.

You may be encouraged to have some clinical responsibility during your period of shadowing and be asked to undertake clinical tasks, under the close supervision of the current FY1 and senior doctor. If you have concerns about being asked to do something you are not comfortable with, you should inform the doctor who is supervising you as soon as possible.

The content of the programme is largely governed by the postgraduate tutors at the hospital where you will be shadowing. You should not be actually doing the work of the FY1 doctor or tasks that should legally form part of induction.

Inappropriate tasks include:
Holding the on-call bleep
Breaking bad news
Covering for FY1 doctors without the agreement of the clinical supervisor
Any process which should be part of induction (e.g. health and safety training, etc.)

 

Will I be paid for shadowing?

All new FY1s across the UK should receive at least four days paid shadowing at the basic F1 salary rate (£22,636 annually).

If your new employer says they will not be paying you for shadowing, despite the agreement, please call the BMA on 0300 123 1233 or email support@bma.org.uk.

The BMA and NHS Employers recognise that some medical students may already have made alternative arrangements for the shadowing period. Where it is not possible to change these you should discuss the situation with the hospital. For further advice, please call the BMA on 0300 123 1233.

 

I have been asked to attend shadowing and induction for two weeks; will this be paid?

Some employers organise longer periods of shadowing for new F1s, but at least four days of this must now be paid. We recommend that students take part in a shadowing programme if it is available.

However, unless it has been agreed in advance or is a condition of your graduation from medical school, periods of shadowing lasting more than 4 days cannot be a compulsory requirement for students.

We would expect that employers who make attendance at shadowing a condition of continuing employment should pay students for the whole period. Students must make their own decision about whether to attend for unpaid periods.

 

How has shadowing been implemented across the UK?

In both Scotland and Wales arrangements have been made to bring the start of the FY1 contract forward to cover the shadowing period. The BMA believes that this is a sensible solution and endorses this approach.

Read more about the Scotland arrangements for shadowing

There are no nationally agreed contractual arrangements in England for the employment of doctors undertaking FY1 shadowing. Trusts make payments for shadowing in three main ways:

  • extension of the current FY1 contract (early start date);
  • stand alone contract; and
  • contract for training.

We believe that the best approach is for the FY1 contract to be extended, as is the case in Scotland and Wales, as this allows new FY1s to engage fully in clinical activity whilst shadowing. Furthermore we understand that this is the approach being adopted by more than half of trusts.

Research carried out by NHS Employers found that in 2013, 57% of trusts extended the FY1 contract.

If you have any concerns about a contract for shadowing please contact support@bma.org.uk.

Read more about the England arrangements for shadowing

The government of Northern Ireland has now confirmed that new FY1s will receive four days' paid shadowing

Read more about the Northern Ireland arrangements for shadowing

 

Will I have to sign a contract for shadowing?

You should be required to sign a contract before starting shadowing to ensure that both you and the employer are properly protected.

 

Who is ultimately responsible for my supervision during shadowing?

This may differ from placement to placement. Managerial arrangements should be explained to you on the first day of the shadowing period.

 

I have already completed a shadowing placement as part of my final year, do I still need to attend another one at my new place of employment?

A key purpose of pre-employment shadowing is to introduce you to your place of employment in advance of starting work.

It is unlikely that your shadowing placement in final year will be in exactly the same place where you will work as an F1, so we would urge you to participate fully in shadowing in July.

 

When does shadowing start?

Shadowing should take place as close to the start of work as possible.

 

How will I find out when I am expected to start my shadowing period?

Your employer should already have contacted you to inform you of the dates. If this has not happened, you should contact them directly as soon as possible.

 

Am I indemnified for the work that I am undertaking?

New doctors employed under an extended FY1 contract will receive the same protections as other NHS employees.

The BMA has sought assurances from the NHS Litigation Authority (NHSLA) that prospective FY1s employed under other contracts will also be protected by the NHS Indemnity. The NHSLA has confirmed that a prospective junior doctor who is participating in shadowing will be covered by the NHS indemnity, whether or not they are actually employed, provided that any clinical work that they undertake is supervised by a doctor.

 

What will happen about the four days of shadowing if I am due to start work on a less than full-time basis?

We would advise you to contact your employer's medical staffing unit to request flexible arrangements. We would expect that arrangements should be made to ensure you do not miss the key elements of the shadowing and induction programme, and this may involve continuing the programme into August. 

 

Should I get a proper entitlement to breaks?

Yes, we would advise that you take breaks with the F1 doctor you are shadowing.

 

Will my employer let me move into the hospital accommodation that I have booked for F1 in time to start shadowing?

You will need to check this with your employer. There may be issues with capacity because existing F1 doctors may be living in the accommodation until they move posts in August. We hope employers and students will be prepared to be flexible.

 

How should I introduce myself to patients during the shadowing period? Am I considered to be a doctor?

If the doctor you are shadowing has not already introduced you to the patients, then before you take over your full clinical responsibilities we advise you to tell patients that you are a newly qualified doctor undertaking a period of shadowing.

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NHS indemnity during shadowing

Newly qualified doctors will be covered by NHS indemnity when they take part in shadowing before their first jobs.

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