ROADS to Success Choosing your specialty Dr Caroline Elton

ROADS to Success Choosing your specialty Dr Caroline Elton

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

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).

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

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

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

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

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

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).

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?

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

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?

Realism: Holland s Vocational Interests Realistic Practical, physical, handson, 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

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 1 st or 2 nd Code 31.7% I-S 17.7% S-I 15.6% I-R

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?

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

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.

Values in relation to work represent the degree to which a Realism: Work Values person regards his or her work as worthwhile. This worthwhileness includes the amount of power, autonomy, creativity, learning, altruism, security, status and ROADS has a values card sort money which are sought in work. Nathan and Hill (2006) 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?

Opportunities 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: The Spinach effect:

Chance only favours the prepared mind

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).

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?

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).

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?

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).

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