Introduction to the Career Support Role

23rd February 2009

AimsTo understand the bigger picture of medical

careers

To share understanding of career lead role and its place in the Wales Career strategy

To recognise what kind of career support is needed along the pathway

To develop understanding and skills to promote “good career help”

To identify next steps – and where we need your help

Then… …and now

Shift from a recognisable career pathway to a less predictable

journey, requiring frequent regeneration

Discuss:

Who you are, your career lead role

What you find most rewarding about your role in the career development of Foundation doctors/specialty trainees

What do you find most worrying or challenging?

The context we work inReality of medical careers means:

More UK medical graduatesNo patronage / bias in selectionNHS will train the workforce it requiresUnpredictable applicant tacticsFeminisation of workforceWork-life balance more important for all Medical UnemploymentHistorically poor retention in Wales

UK careers developments

Tooke , Darzi Career pathways changingRecruitment processes evolvingImproving access to LTFT trainingUK careers group formalisedWorkforce PlanningMEE – exploring future change

UKFPO

Careers workstream establishedUK scoping exerciseCareers questions in PMETB surveyFeedback from medical students forumNew Curriculum and reference GuideCareers skills in curriculum Guidance on

tasters in F1 and F2

Workforce Planning

More Academic posts in early years

Experience assists decision making

Careers in research and/or medical education promoted

More entering academic medicine

Wales Career Strategy

Approved May 2008Twice yearly Steering group meetingsMembership: Swansea & Cardiff UG Careers

and Curriculum leads, BMA representatives, Workforce Planning, Med. Ed. And E-learning, PGOs

Identifies actions needed and implementation projects

Career Lead role defined & embedded in the Strategy

Emerging themes – July 2008

1. Provision of careers information; undergraduate and postgraduate

2. Integrating career support with learning

3. Methods of support: fairs, events, services

4. Systemic issues e.g. workforce planning, geography

Early tasks

Promoting specialties through careers fairs/events (BMJ, MCID,URDD)

Improving links between Undergraduate and Foundation competencies (MCAN, UKFPO)

Embedding careers education (F1/2, SpR, Educational Supervisors, e-learning)

Improving access to information (hard and online resources, web development)

Foundation – embedded modules

F1 start – Career Planning (298)

F1 end – Making Decisions (c70)

F2 start – Specialty Applications (300+)

Current issues...discuss

Early thoughts – student mindsets

Challenges for medical students76% increase 1996-2006Two thirds now femaleCareers advice at school – medicine a “safe bet”

for an A* student (from F2 workshop – Morriston)Choices start to fluctuate early (60% by Semester 3

- Manchester)Reduction in Foundation programme headroomFtP – not enough just to get the exams, must

demonstrate employability (ASME June 08)

Cardiff medical student soundbites:“I think we don’t know enough about the system to be energised to

learn about it”

“The future is blur as to what happens after F2…there’s so may different routes to get to a particular specialty but what happens in the interim, nobody really knows”

“There’s a lot of things changing at the moment, a lot, and more than half of us don’t know what the hells going on”

“I’ve heard so much about FP1/2/ST…but I can honestly say if someone said what is the form, how do you fill it in, when is the due day…I feels like no-ones actually sat us down as a year group and have been like, you’ve got to apply for jobs”

“I do admit that I’ve just kind of bumbled along…perhaps it would be useful for future years to put some early thought in”

Into Foundation and beyond…

At its simplest…

The reality?

Wales F1 soundbites – confidence crisis

“I don’t think we get long enough to decide and that’s the thing that’s bothering me now”

“All of our consultants know that we’re not going to be as good as they are…as they’ll all probably have double the experience that we have”

“The problem with the selection process…is how you look on a piece of paper”

Challenges for Foundation doctors

MMC needs early decisionsStill changing; challenge for local helpersFirst experience of competitive selection 48 hour rule for decisions May not get first choice – no guaranteesSome get no offersFuture ratio of CCT holders to traineesFuture of consultant role/posts

Foundation doctors:

Largely undecided at the outset about future choice

Feel rushed into specialty applicationsPerceive the system as inflexiblePerception of “failure” – poor coping

strategies/Plan BFeel information from their educational

supervisors is uncertain or inconsistentAre influencing our medical students!

Myths about specialty choiceYou only get one chance a year to apply for

specialty trainingWorking in a fixed term specialty post will count

against me in the futureOnce in a specialty it is well nigh impossible to

changeApplications to change specialty will be

unfavourably viewedIf I apply to more than one Deanery/specialty the

others will find outIf a consultant expresses a view on a career

route it is the absolute truth

Messages we need to get out there

The choice is yours There is plenty of opportunity in Wales and

it’s a sellers market in some specialtiesThere are options where you can explore

choices further if you need more timeThere is some flexibility within the system

but aim to do the groundwork earlyThings change all the time!

Challenges for ST/CT and above

Health / disabilityLife events and changing WLB needsTraining / career not progressingWrong speciality choiceAcademic interestsDesire for overseas experienceWrong locationWrong career??!!

Common themes we encounterEarly Foundation – is this right for me?Flawed decisions when originally applying for

specialtyMTAS effect feeding into ST3+ thinking Later change of pathway (or even career)Academic posts stimulating thoughts of changeWorklife balance, changing circumstances and

priorities“I’m finding it just harder than I thought”Core trainees – future optionsSudden or planned resignation

NICEC Research findingsAround half of all work-based career

discussions are not part of a formal processMany are spontaneous and unplanned

But the best conversations are structured and involve preparation and reflection. A common

framework is a predictor of effectiveness

NICEC/CIPD Research findings

ROADS safety check:

To what extent:Is your goal Realistic?Have you considered all Opportunities?Have you built in the Anchors that will provide

personal support in the background to your career?

Will your choice Develop your potential?Can you work with or minimise the Stress

factors in your career choice?

Four stages to encourage:

Self assessment (taking a history) Exploring career values, motivators, preferences,

personal strengths, limitationsCareer exploration (investigations) Establishing options, alternatives and plan B’s,

information gathering, networking, reality checkingDecision making (diagnosis) Evaluating options, mapping skills and attributes against

actual roles, considering preferred work environments, clarifying personal factors

Plan implementation (treatment plan) Applicant research, CV update and applications,

preparing for assessments

This model is featured in:

Deanery Careers websitewww.cardiff.ac.uk/pgmde/careersandrecruitment

National Careers websitewww.medicalcareers@nhs.uk

Other Deanery Careers ServicesFoundation Year 1 resources (they have

the book)F1/F2 curriculum based careers sessions

Step 1 - Work Values

Work Values – 4 dimensionsSort pieces of paper under the headingsTry to rank the “very important”Any surprises?Any which might be very important in 10 years

time?Will you find outlet for all the v important in your

current career choices?

Self-assessment

Psychometric tools: e.g.MBTI – can be remotely administered but only by qualified practitioner. Feedback essential.

More general open access self-assessment tools e.g. www.windmillsonline.co.uk, www.teamtechnology.co.uk

SCI59

On line self assessment tool Improves self awareness if questions consideredGives 10 specialities most likely to enjoyGives 10 specialities which will be a challenge

Take it with a pinch of salt – hazard warning!!!

Free to BMA members via their websitehttp://www.bma.org.uk/careers/

careers_service/Careersguidance.jsp

Sources of Careers Information

1. Peers2. Professional network contacts3. University – tutors, careers services4. Web based – MMC, Deaneries, Royal Colleges,

BMJ, social network sites5. Local NHS – Ed. Supvrs, College tutors, PGO,

HR6. Deaneries7. Libraries (see PG Centre)8. Careers fairs9. Independent sources

Web based information

www.medicalcareers.nhs.uk

A one stop shop single site for use by students, trainees and supporters

New Deanery Careers pages now live!

www.cardiff/ac/uk/pgmde/careersandrecruitment

www.medicalcareers.nhs.uk

Information for Postgraduate Doctors

Specialty Pages

External sources of information

www.mmc.nhs.uk : person specifications and specialty recruitment info

www.bma.org.uk : guidance on recruitment rounds and current procedures

www.nhscareers.nhs.uk : for outlines of specialities, pay

careerfocus.bmj.com/ : details of UK and other job vacancies, career advice, FAQ

On-line Resources

www.doctorstrainingwales.tv 1100 – 1500 viewers a month since

December 2008Lots of non-UK visitorsPromotional information cards for

trainees/applicantsNew chapters being added

Decisions, decisions…

Influences on career decisions

Time - earlier decisions are now required! Generation (Boomers, X and Y) Choice left to individual – (UK norm) Prior exposure to a speciality helps inform

choice Peer influence (what others think) Role models Positive and negative experiences (“horn

and halo”) Life style and work life balance

Doctors need to take an evidence-based approach!

Typical decision dilemmasWhich round am I aiming for?What are my main specialty options and preferences?What about any dual career issues?Core vs run-through programme implicationsWhat evidence do I have ?Where should I apply?What is my 1st, 2nd, 3rd choice?What is my Plan B?Should I go abroad?

Information – for specialty choices

Skills and competencies requiredExperience neededPathways and progressionCompetition ratiosNumber and type of postsLocal and UK variationQualifications and training neededMust be up to date information!

Wales competition ratios 2009

Specialty Grade Vacancies Applications Ratio

Anaesthetics / ACCS

CT1 32 126 4

Cardiology ST3 2 50 25

Clinical Radiology ST1 7 224 32

CMT and ACCS CT1 80 292 3.5

Core Psychiatry CT1 27 129 5

Core Surgical CT1 74 225 3

Em Med + ACCS CT1 4 89 22

Ophthalmology ST1 4 11 3

Ophthalmology ST3 5 55 11

ENT ST3 2 37 18

T+O ST3 3 175 58

General Practice* ST1 136 246 1.8

Paediatrics* ST1 12 55 4.5

O+G* ST1 5 45 9

Speciality Competition Ratios

Powerful set of information

Many interpretationsNo UK agreed format May distort

application process year on year

Guidance on interpretation

Useful models

Egan – 3 stages (now, next, how?)Schein – Career anchorsMore of/less of analysisKitbags – what to take, what to leaveForce fields – push and pullDecision timeline5- and 10-year plans

Supporting applicationsCardiff Uni Careers support for Year 5 FP

applicationsDownloadable handouts on Applications,

CVs and InterviewsF2 workshop on Applying for Specialty

Training – F2F and onlinePractice interview sessions at PGCsGeneric Curriculum module on applying

for consultant posts

Selection for Specialty DVD

To help prepare for specialty recruitment

PGCs have a copy F2 doctors 2008/9 have a copyNow streamed on PLATO as an

online learning resource

So what makes a good career helper?

Who helped you?

Think a career conversation with someone which had a memorable effect on your career?

What did they do that helped?

How did their behaviour reinforce the positive impact they had on your thinking?

How did this conversation make you feel?

Career help can include:

Information giving and signpostingAdvice about specific optionsGuidance about broader directionCoachingCounsellingMentoringOutplacement support

Some of these require specialist training and experience – but some skills are transferable

What it isn’t

Telling someone what is or isn’t good for them

Telling them how awful the system is and best of luck with it, mate

The “If I were you” approach (you’re not!)

A gatekeeper role (I can make or break your prospects…)

Selective – everyone needs help at some stage

Knowing all the answers – you just need to ask the right questions

Components of a good career conversation

Where you are at nowHow you are doingValues and driversPotential and aspirationsOptions (local and wider)Processes and politics Pros and cons of choicesNext steps

Effective and ineffective behavioursShowing real interest in the person, and insightBeing positive and enthusiasticOffering constructive challenge and adviceUsing facilitative interpersonal skillsGiving informationGiving honest feedback on skills and potentialSharing networksManaging the session

Appearing uninterested or failing to show empathy with their situationMisunderstanding the issue by failing to listen or check with the individualJumping in with a career suggestion without preparing the ground first“Toeing the party line” rather than being frank and openAiring your own career/system baggagePromising to do something and then failing to follow it up.

Encourage doctors to help you by:Being proactive about seeking help from you and othersThinking about themselves, their options and how they matchBeing willing to share and disclose career thoughts and concernsBeing open minded and open to feedbackPrompting discussions well before a job move and being flexible on timings and tacticsBeing willing to face reality and to adapt the plan if necessaryTaking ownership and following up actions

Help for the Helpers

“Supporting Doctors with their Careers”2 hour session for Educational SupervisorsCarries 2 CPD points from RCPOpportunity for interaction, reflection, discussionWe can run – or so can you!On-line module based on London Deanery

materialsComing soon – “Being an Effective Mentor”Aligns with PMETB domains for Educational

Supervisors

Role ModelsInspirational role models can influence careers

decisionsObserved behaviours will be noted and shared by

students and traineesWe are all role modelsTrainers can discuss working lives with students and

PG trainees, as well as teach clinical material.Improves forward thinking on what a role will involve

in the futureFoundation trainees are role models for students

On role models in Wales:“ I think you get more influenced if you see someone you’re impressed

by”

“You might think that it is really interesting but if you’ve got a consultant who…just shouts at you all the time or takes an instant dislike to you…then you just don’t like it”

“I had a horrible consultant, just completely humiliated you and you get completely put off, you’re scared of the subject and you don’t want to do it… whereas I had a placement where I absolutely loved it, it was brilliant and I had a really encouraging consultant and that is kind of what I want to do”

“I liked everything that goes into [this specialty} but sitting there with this consultant, I just sat there for the entire time going ‘I do not want to be like you. You are the antichrist of doctors’ ”

The joys of a medical career!

You get to work with talented peopleYou get to meet and understand all kinds of

people (patients, teams)The work is interesting, varied, never dullSpecialties are evolving and changingLots of opportunity to specialise and diversifyIt is pretty recession-proofIt’s a journey, not a race, a forced choice or a

competitionIt’s unique – no right or wrong career, just your

career

And finally…

Future Career Lead agenda

Specialty information in Wales for BMJ Careers 2010

Developing on-line resourcesEvaluating and co-delivering F1/2

workshopsMedical careers fair on 16th October 2010Promoting, organising and co-delivering

training for Education SupervisorsPromoting mentor training and CAMEO

Development optionsFollow up day, annual eventsInvolvement in Career Strategy Group

meetingsUK and Deanery website sections -

resources for career helpersMentor training/CAMEOCoaching SkillsOnline PDE modulePG Certificate in Managing Medical

Careers

The role of the career lead…

…say “no” to career Sat-Nav!