roads to success choosing your specialty dr caroline elton
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ROADS to Success – Choosing your specialty
Dr Caroline Elton
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Brief Introduction
• Chartered psychologist (with dual accreditation in occupational and counselling psychology)
• Specialise in complex career counselling
• 1998-2008 Education Adviser with KSS Deanery
• 2008-Feb 2014 Head of Careers Unit, London Deanery
• Feb 2014 – Set up CPD
• Dec 2015-July 2017 – Writing a book, to be published by Penguin/Random House
in January 2018
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Why do UK doctors need help choosing their specialty?
Modernising Medical Careers reforms introduced in 2005
Pre MMC
Many junior doctors had not made their mind about specialty choice 15 months after leaving medical school (ref, UK Medical Careers Research Group)
Implementation of MMC
Cohort surveys of foundation doctors who graduated from med school in 2005 found that half changed their career intentions during their FY1 year and a little less than half in their FY2 year
(BMA, surveys of 2008 and 2009).
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But more recently…….
“Post MMC graduates were less likely to change their career choice and more likely to be motivated by personal factors and self assessment of their suitability to a particular area of work” Svirko E, Lambert TW and Goldacre MJ (2015) J.R Soc of Medicine. Jan 108(1), p12-27
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Role Models
A study of medical students’ specialty-choice pathways: trying on possible selves The process of specialty choice can be described usefully as a socially constructed process of ‘trying on possible selves’……..This may explain role models’ exceptional influence in disproving negative stereotypes. Burack et al, 1997. Academic Medicine. 72(6) pp534-41
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Experience of the specialty
What factors influence British medical students’ career intentions? This study shows the career intentions of British medical students are influenced by their undergraduate experience Medical Teacher 2014
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Work-Life Balance
Attitudes of medical students toward careers in general surgery The 2 most common disincentives (ie for not choosing a career in general surgery) were family considerations and the sacrifice of personal time Tambyraja et al (2008). World J Surg 32 (6) pp960-3
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An important parallel
(ref Elton and Borges, 2013 in T.Swanwick, Understanding
Medical Education)
Clinical Decision Making
Taking a History
Examination/Investigations
Diagnosis
Treatment Plan
Career Decision Making
Self Assessment
Option Exploration
Decision
Plan Implementation
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So - when you want to rush to sort out your application form without doing the earlier tasks – remember that it makes as much sense as working out the treatment plan before taking a history or examining the patient).
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The ROADS checklist:
Realistic: Are you being realistic
about yourself and about the
demands of the job?
Opportunities: Have you given
serious consideration to all the
opportunities available?
Anchors: Have you built in the things
that provide support in your life?
Development: How does your
decision adequately develop your
potential?
Stress: Have you minimised those
aspects of work that you find
particularly stressful?
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Realism: Which criteria?
Vocational Preference and Person-Occupation fit: Reflections on Holland’s theory of vocational choice:
(Applied Psychology and International Review, 2001 (50), p5-29)
Adrian Furnham
3 sorts of data you need to consider in self assessment:
Ability
Interests,
Personality
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Realism: Ability/Skills
What did you most enjoy learning at medical school? And currently?
For which skills do you tend to get the most positive feedback?
Think of a specific work achievement which made you feel really proud. What skills were you using?
What do your answers tell you about your key skills and abilities?
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Realism: Holland’s Vocational
Interests • Realistic – Practical, physical, hands-
on, tool-oriented
• Investigative – analytical, intellectual, scientifc, explorative
• Artistic – creative, original, independent, chaotic
• Social – co-operative, supporting, helping, healing/nurturing
• Enterprising – competitive environments, leadership, persuading
• Conventional – detail-oriented, organizing, clerical
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Holland’s Theory applied to Medical Specialty Choice
N.J Borges et al, 2004
Journal of Career assessment 12(2), pp188-206
83% - I as 1st or 2nd Code
31.7% I-S
17.7% S-I
15.6% I-R
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Realism: Interests
• What optional modules did you choose at medical school?
• When you pick up a medical journal – what sort of articles do you read?
• What out of work activities do you enjoy doing?
• What do your answers to the above questions tell you about your key interests?
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Realism: Personality: Five Factor
Models Extroversion The degree to which a person needs attention and social interaction Agreeableness The degree to which a person needs pleasant and harmonious relations with others Openness The degree to which a person needs intellectual stimulation, change and variety Conscientiousness The degree to which a person is willing to comply with conventional rules, norms and standards Neuroticism The degree to which a person experiences the world as threatening and beyond their control
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Personality and Medical Specialty Choice: A literature review and integration
Borges N and Savickas M. (2002) Journal of Career Assessment, 10(3), pp362-380
There is more variation within medical specialties than between them
All personality types appear in all specialties and more than one specialty fits the personality of any particular medical student
Personalities should be considered as one of the many factors that students consider when choosing a specialty
Jobs consist of two components – task and context. Possible that personality relates more to context than task.
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Realism: Work Values
ROADS has a values card sort –
Sort 36 aspects of work into 4
categories
Very Important: Quite Important:
Not Important: Important Not Present
Advantage of doing this exercise as a
card sort is that you can then pose
questions to yourself such as:
How might my core values change in
5-10 years?
“Values in relation to work
represent the degree to which a
person regards his or her work as
worthwhile. This ‘worthwhileness’
includes the amount of power,
autonomy, creativity, learning,
altruism, security, status and
money which are sought in work”.
Nathan and Hill (2006)
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Careers Days!
Thinking about your own experience of a specialty (but bearing in mind that your experience of a given
specialty as a student or a junior trainee doesn’t necessarily tally with that of a consultant).
Taster Weeks
Talking to other clinical colleagues – whilst also realising people often have a tendency to assume that
what they love (or hate) applies more generally.
Keeping your eyes (and mind) open.
Opportunities
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Opportunities: The Spinach effect:
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Chance only favours the prepared
mind
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need ‘anchors’ Why might trainees need ‘anchors’?20s and
30s?
Relationships and marriages forming (and
sometimes, sadly, breaking up)
Doctors may be moving to a part of the country
or abroad where they have no links.
Couples where both are doctors may find it
particularly difficult to get training places in their
first choice specialty and first choice location.
Parents may be getting older, sicker – and
eventually dying.
There may be pregnancies (planned or
unplanned), failed attempts at getting pregnant –
and also babies/young children
Postgraduate exams to pass (or to fail).
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Think about times when, (from a psychological
point of view) – you bring your work home. What
helps you unwind? Spending time with your
partner? Going for a run? baking a cake? Talking to
close family/friends?
What experience have you had of moving far away
from friends and family? How did it work out?
Bear in mind that stresses are not the same as 25
years ago: the length of the working day is shorter
but (at least in the UK context)
decline of ‘the firm’
most doctors are not living in the mess
with a feminized workforce, some doctors will
be pregnant, or looking after young children
at home.
What structure of support would you need to put in
place to make a successful move into a part of the
country or a different country where you had no
prior links?
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Development
Get feedback from senior colleagues whom you really
rate. Ask them what career pathway they think might
suit you. (But again – this is only tentative. Data
gathering rather than career diagnosis).
Review the points of your career which you have
enjoyed the most? Was that at times that you felt
particularly challenged?
What sort of work-life balance would you like now?
And in the next 5-10 years. (But if people say that
certain specialties are incompatible with young
families – check it out. Don’t assume one person’s
experience is universal).
How ambitious are you? Is it important that you work
in a leading university teaching hospital and have a
research profile?
What sort of challenges are you are likely to be drawn
to in future (bearing in mind that your experience of a
given specialty as a trainee may not neatly map on to
that of a consultant).
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Stress
Thinking back to your career trajectory from
medical school onwards – were there any
times that you felt particularly stressed?
What were some of the specific
circumstances that you found most
stressful?
Was the source of the stress particular
patient groups? Or patients’ families? Or
the organisational context?
What are the implications of these for your
current and future career choices?
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This is THE MOST IMPORTANT SLIDE!!!!
Career decision making is not an exclusively
rational practice….reason, intuition and
occupational engagement contribute mutually to
adaptive career decision making
As for the basic mechanism by which rationality and
intuition become richer – it is experience acquired
via engagement
We would do well to teach people to think and feel
about experiential information in a more intentional
way (T Krieshok et al, 2009 – Journal of Vocational Behavior).
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Tentative Conclusions
Medical school is the time for gathering data about yourself, and about different
career options – not for making ‘set-in-stone’ specialty decisions. To make final
decisions, you need to have some experience working as a doctor
The literature does not support the notion that each person is only suited to one
specialty.
There is no simple mapping of one factor (eg personality) onto a particular
specialty – good decisions require you to consider a number of factors
Reflection on the day to day stuff of actual experience enhances the quality of
career decision making
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