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ROADS to Success Choosing your specialty Dr Caroline Elton

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www.careerplanningfordoctorsanddentists.com ROADS to Success Choosing your specialty Dr Caroline Elton
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Page 1: ROADS to Success Choosing your specialty Dr Caroline Elton

www.careerplanningfordoctorsanddentists.com

ROADS to Success – Choosing your specialty

Dr Caroline Elton

Page 2: ROADS to Success Choosing your specialty Dr Caroline Elton

www.careerplanningfordoctorsanddentists.com

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

Page 3: ROADS to Success Choosing your specialty Dr Caroline Elton

www.careerplanningfordoctorsanddentists.com

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).

Page 4: ROADS to Success Choosing your specialty Dr Caroline Elton

www.careerplanningfordoctorsanddentists.com

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

Page 5: ROADS to Success Choosing your specialty Dr Caroline Elton

www.careerplanningfordoctorsanddentists.com

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

Page 6: ROADS to Success Choosing your specialty Dr Caroline Elton

www.careerplanningfordoctorsanddentists.com

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

Page 7: ROADS to Success Choosing your specialty Dr Caroline Elton

www.careerplanningfordoctorsanddentists.com

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

Page 8: ROADS to Success Choosing your specialty Dr Caroline Elton

www.careerplanningfordoctorsanddentists.com

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

Page 9: ROADS to Success Choosing your specialty Dr Caroline Elton

www.careerplanningfordoctorsanddentists.com

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).

Page 10: ROADS to Success Choosing your specialty Dr Caroline Elton

www.careerplanningfordoctorsanddentists.com

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?

Page 11: ROADS to Success Choosing your specialty Dr Caroline Elton

www.careerplanningfordoctorsanddentists.com

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

Page 12: ROADS to Success Choosing your specialty Dr Caroline Elton

www.careerplanningfordoctorsanddentists.com

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?

Page 13: ROADS to Success Choosing your specialty Dr Caroline Elton

www.careerplanningfordoctorsanddentists.com

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

Page 14: ROADS to Success Choosing your specialty Dr Caroline Elton

www.careerplanningfordoctorsanddentists.com

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

Page 15: ROADS to Success Choosing your specialty Dr Caroline Elton

www.careerplanningfordoctorsanddentists.com

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?

Page 16: ROADS to Success Choosing your specialty Dr Caroline Elton

www.careerplanningfordoctorsanddentists.com

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

Page 17: ROADS to Success Choosing your specialty Dr Caroline Elton

www.careerplanningfordoctorsanddentists.com

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.

Page 18: ROADS to Success Choosing your specialty Dr Caroline Elton

www.careerplanningfordoctorsanddentists.com

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)

Page 19: ROADS to Success Choosing your specialty Dr Caroline Elton

www.careerplanningfordoctorsanddentists.com

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

Page 20: ROADS to Success Choosing your specialty Dr Caroline Elton

www.careerplanningfordoctorsanddentists.com

Opportunities: The Spinach effect:

Page 21: ROADS to Success Choosing your specialty Dr Caroline Elton

www.careerplanningfordoctorsanddentists.com

Chance only favours the prepared

mind

Page 22: ROADS to Success Choosing your specialty Dr Caroline Elton

www.careerplanningfordoctorsanddentists.com

Page 23: ROADS to Success Choosing your specialty Dr Caroline Elton

www.careerplanningfordoctorsanddentists.com

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).

Page 24: ROADS to Success Choosing your specialty Dr Caroline Elton

www.careerplanningfordoctorsanddentists.com

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?

Page 25: ROADS to Success Choosing your specialty Dr Caroline Elton

www.careerplanningfordoctorsanddentists.com

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).

Page 26: ROADS to Success Choosing your specialty Dr Caroline Elton

www.careerplanningfordoctorsanddentists.com

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?

Page 27: ROADS to Success Choosing your specialty Dr Caroline Elton

www.careerplanningfordoctorsanddentists.com

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).

Page 28: ROADS to Success Choosing your specialty Dr Caroline Elton

www.careerplanningfordoctorsanddentists.com

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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