Shadowing is an arrangement where a prospective FY1 (Foundation Year 1) doctor observes an existing FY1  doctor undertaking the usual activities required of their role before taking over the role themselves.

It helps incoming FY1 doctors become more familiar with working practices and hospital systems. It also helps them gain confidence and professional skills and helps to improve patient care.

It can also be an opportunity for incoming FY1 doctors to develop working relationships with the clinical and educational supervisors they may work with in the future.

What happens during shadowing

Shadowing should take place as close to the start of your FY1 as possible. Typically, it will occur on the four working days before the start of your FY1 post (first Wednesday in August).

Your employer should contact you to inform you of the dates. If this has not happened, you should contact them directly.

You can expect to:

• observe the doctor you are shadowing and learn how the department and hospital work and what your responsibilities as an FY1 will be when you begin your post
• become familiar with all local processes and learn to be able to recognise tasks where closer supervision is necessary
• be informed in advance of the specific learning objectives associated with the programme
• begin 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.

Introducing yourself to patients during the shadowing period

If the doctor you are shadowing has not already introduced you to the patients, we advise you to tell patients that you are a newly qualified doctor undertaking a period of shadowing.

Adjustment for personal circumstances

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.

We would advise you to contact your employer's medical staffing unit to request any adjustments to accommodate your personal circumstances.

What to do if you have any concerns 

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. If after this you still have concerns, you should contact the relevant member of staff from the foundation school.

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.

Your pay and contract

Your pay

All new FY1s across the UK should receive at least four days of paid shadowing at the basic F1 annual salary rate. 

Following discussions between national negotiating parties, it has been agreed between the BMA, NHSE and HEE to pursue the following calculation:

• A day’s pay under this specific arrangement should be calculated as the F1 basic salary divided by 261 working days.

We recognise that many employers across England believe that this payment should be calculated by taking the monthly FY1 basic salary and dividing this by the total number of days in the month, including non-working days. This was in line with NHSE guidance previously.

We are pleased that NHSE have changed their position on this and would highlight and encourage any doctor not being offered these terms whilst on a shadowing contract to contact the BMA for support, and to note to their employer the guidance from NHSE.

If you believe your employer is not paying you according to the calculation method we recommend, please contact us.

It is especially important that you contact the BMA if your new employer says they will not be paying you for shadowing, or you believe the hourly rate you are being paid is less than the national minimum wage.

Your contract 

There is no nationally agreed contract in England for the pre-FY1 shadowing period.

The BMA believes that the best approach is for FY1s to sign a full employment contract before starting shadowing. This would allow new FY1s to engage fully in clinical activity whilst shadowing. 

In England, the 2016 terms and conditions of service clearly state that the contract should not be used for the period of shadowing and that separate arrangements should be made.

However, a copy of the 2016 TCS with this clause removed can be used for this purpose for the FY1 shadowing period. This is a practice that many employers follow.