Roads To Success

The ROADS
to Success
A practical approach to career management
for medical students, junior doctors
(and their supervisors).
Caroline Elton & Joan Reid

First published 2007
By the Postgraduate Deanery for Kent, Surrey and Sussex
Second edition published 2008
Third edition published 2010
Third edition formatted for online use 2012
Acknowledgements
This book has been produced by the careers specialists in the KSS (Kent, Surrey and Sussex)
and London deaneries. It started life as a set of resources in A4 ring binders developed to
support the foundation programme run by the South Thames Foundation School. The authors
have received help from people in both organisations, plus a number of others, and would
like to thank the following people: Karen Allman, Professor David Black, Dr Elizabeth Cottrell,
Dr Graeme Dewhurst, Dr Cath Jenson, Dr Arun Kumar, Dr Andrew Long, Dr Melanie Newport,
Professor Zoë Playdon, Dr Pam Shaw, Michael Strevens, Jason Yarrow, Maire Shelly,
Jonathan Nodding, and Dr Melanie Jones, Dr Darshan Sudarshi, Dr Charles Twort,
Dr Jan Welch and Dr Helen Wilson. Dr John Launer from London Deanery gave a
particularly helpful critique of an earlier draft, and we are also extremely grateful to
Professor Chris McManus for his input on the section on psychometric testing.
Our thanks also to Judy Horacek, and to Scribe Publications, for allowing us to reproduce
a selection of cartoons from Make Cakes Not War.
Caroline Elton would like to acknowledge the late Professor Kath Green, who tragically
died as the first edition of this book was going to print. Kath was a much valued mentor
and someone with whom it was a privilege to work for many years. Caroline would also
like to thank Howard Cooper and Rob Nathan.
Finally, both authors wish to acknowledge the support of their respective ‘Andrews’.
Andrew Reid provided helpful technical advice at various points and Andrew Franklin
offered publishing input, as well as introducing us to Judy Horacek’s cartoons.
Both Andrews are probably relieved that the end of ROADS has been reached.
Caroline Elton and Joan Reid

July 2010
The cartoons are the copyright of Judy Horacek, 2006, and are taken from
Make Cakes Not War, published by Scribe Publications.
Copyright: Caroline Elton, Joan Reid and the Postgraduate Deanery for Kent, Surrey & Sussex.
Do not distribute this book without the permission of the copyright holders.
Contents 3
Page No.
I. Introduction:
About the book............................................................ 3
II. Stage 1 of Career Planning:

Self-Assessment............................................................ 9
III. Stage 2 of Career Planning:

Career Exploration...................................................... 33
IV. Stage 3 of Career Planning:

Decision Making.......................................................... 45
V. Stage 4 of Career Planning:

Plan Implementation.................................................. 59
VI. Guidelines for the Educational

Supervisor................................................................ 81
References................................................................. 103
Appendices................................................................ 104
Contents
4
The Roads to Success

5
INTRODUCTION:
ABOUT THE BOOK
6 I. INTRODUCTION
About the book
ROADS to Success
• Is a practical career-planning handbook for all postgraduate doctors
(although medical students can use it as well).
Provides a structured framework to help all postgraduate doctors with their
post-foundation career planning. (It is not just aimed at trainees who are
having difficulty making up their minds.)
• Includes exercises that have been tailor-written for postgraduate doctors
and that have been tried and tested over a number of years.
• Is based on a rigorous review of both the general career-planning
literature and the specific literature on medical specialty choice.
• Aims to help trainees make robust career decisions, and to know how
best to implement their plans.
• Also contains guidance for educational supervisors, on how best to
support trainees with the task of career planning.
How this book is organised

This book uses a structured four-stage approach to career planning:
Stage 1: Self-Assessment
Stage 2: Career Exploration
Stage 3: Decision Making
Stage 4: Plan Implementation
There are numerous reasons why this framework is used, but one vital
benefit of the structured approach is that it helps you approach the task of
career planning in a systematic way. To give you some examples, worrying
about your application forms or interviews (Stage 4 activities) is a waste of
time if you are not clear about Stages 1–3. Similarly, poor decision making
(Stage 3) often rests on inadequate self-assessment or career exploration
(i.e. Stages 1 and 2).
The importance of a structured approach was illustrated by a large-scale
research study of work-based career discussions (Hirsh et al, 2001) which
found that if the providers and recipients of career support shared a
common framework, the recipients found the discussions more useful.

So, in this handbook, while Chapters 2–5 are written for postgraduate 7
doctors, Chapter 6 is for the educational supervisor, enabling both parties
to share such a framework.
(We would also recommend that both parties read the whole book. For
example, Chapter 6 suggests questions, linked to the four stages, that
educational supervisors might want to discuss with their trainees. In order
to get the most out of these meetings, trainees might find it extremely
helpful to look at these suggestions in Chapter 6 in advance, as a way of
preparing for their educational appraisal).
When this book should be read

The transition from medical school to being a qualified doctor is pretty
demanding, and longer term career planning may not seem an immediate
priority at the start of your F1 year. Whilst it clearly makes sense for you to
get through induction and the early weeks of your first F1 job before you
start focussing on career planning, we would suggest that you should dip
into this book and slowly work your way through the chapters as soon as
you feel settled into your first F1 job. You might also want to review some
of the exercises as you move between different foundation jobs because
your views about yourself, and about different specialties may change.
Perhaps it also needs to be stressed that even though the foundation
programme lasts two years, you will be completing applications for post-
foundation specialty training in the December of your F2 year. So the time
period for making specialty decisions is actually quite tight. What this
means is that ‘lastminute.com’ has no place as a career planning strategy.
Some specialty training pathways also require trainees to undertake a post-
foundation ‘core’ training block, before later embarking on higher specialty
training. For example, if you want to train in a medical specialty you will
first complete two years of core medical training, and then apply for a
place on a higher specialty training programme. With over 25 specialties
to choose from, trainees on core medical training programmes still have
substantial specialty choice decisions to make. The exercises in this book
can also be used by post-foundation trainees on programmes such as core
medical training, as well as by doctors who are not currently in a training
post, but who want to apply for specialty training in future.
Introduction – About the book

8 How to use this book
The exercises in this book can be used in different ways. You can
complete them on your own, and then discuss your answers with
colleagues, partner, family and, of course, your educational supervisor.
In some trusts the exercises are also incorporated into structured junior
doctor career-planning sessions.
But whether you complete the exercises on your own, or as part of a
workshop, we strongly advise you not to take a ‘pick and mix’ approach.
Although it is tempting (particularly if you have decided on your post-
foundation options) to skip Stages 1–3 and turn straight to Stage 4, this
is not the most effective way to plan your career. Even if you know what
you want to do post-foundation, the exercises within Stages 1 and 2, and
the thoroughness of your decision making (Stage 3), will give you the raw
data that you need to draw on for your application form and interview.
Skipping straight to Stage 4 may reduce your chances of being successful
in implementing your preferred career option.
About the title

Central to the book is the ROADS checklist. This provides a way of
analysing your career decision, to see if it is robust. Specifically, when you
have made up your mind about your post-foundation career, you should
imagine that somebody is challenging you with the following questions:
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: Does your decision adequately develop your potential?
Stress: Have you minimised those aspects of work that you find
particularly stressful?
And in addition to posing these questions to yourself, we would also advise
that you discuss your answers with your educational supervisor, or another
experienced clinician.

About the authors 9
What experience do we bring to the task of writing this career handbook?
• Between the two of us we have been providing career support to
individuals and groups for over 30 years, working for commercial career
consultancies and in our private practices.
• Both of us are qualified careers professionals and qualified users of
psychometric tests.
• CE completed her Ph.D. in the Department of Academic Psychiatry
at the then Middlesex Hospital and is a chartered psychologist. For
ten years she worked part-time as a deanery education adviser and
spent hundreds of hours observing consultants teach their juniors in
clinical settings. She has also run training workshops for trainees and/
or consultants on career issues within KSS as well as for the Eastern,
London, Oxford, and West Midlands deaneries. Since September 2008
she has been the Head of Careers Advice and Planning at London
Deanery.
• JR is currently working as Head of Careers for the South Thames
Foundation Schools and is course leader for the Postgraduate Certificate
in Managing Medical Careers. She also manages the medical careers
website on behalf of the Department of Health. She has provided career
counselling and coaching to a wide range of professionals at a variety of
stages in their careers.
But neither of us is clinically qualified, so in writing this book we have
worked closely with senior clinicians, and also with medical students and
junior doctors. In this way, we hope that we have produced a practical
handbook that will assist medical students and junior doctors with the
challenging task of planning their careers.
Introduction – About the book

10

11
STAGE 1 OF CAREER
PLANNING:
SELF-ASSESSMENT
12 II. STAGE 1 OF CAREER PLANNING:
Self-Assessment
Overview
In this chapter, after a brief introduction, you will be introduced to four
self-assessment exercises. These exercises cover:
• Work values
• Achievements/skills and interests
• Stresses and strains
• Role Models
There follows a description of different psychometric instruments. If you
do decide that the psychometric approach might help you with your career
decision making, then details of how to get yourself tested are included in
this chapter.
Finally, the chapter ends with two different approaches to summarising the
results of the Stage 1 self-assessment activities.
Introduction: a clinical analogy

Although there are many different models of patient consultation, in
some shape or form they will all cover taking a patient history, examining
the patient, deciding whether further tests are necessary (and if they are,
carrying them out), forming a diagnosis, implementing a treatment plan,
and then reviewing progress.
Furthermore, these tasks have to be carried out in the right order: if an
unknown patient walked through the door of your consulting room you
wouldn’t recommend a specific treatment if you hadn’t taken a history,
examined him or her, perhaps carried out some further investigations,
and formulated a diagnosis.
Models of clinical consultation can serve as a good parallel for a career-
planning framework:
Patient consultation Career planning
Taking patient history Self-assessment
Examining the patient Exploration of particular career options
Formulating a diagnosis Career decision making
Implementing a treatment plan Implementing a career plan

Significantly, in both clinical consultation and career planning, the first 13
two stages are linked. What you have elicited during the patient history
informs the focus of your clinical examination. Similarly, in terms of career
planning, what you find out in Stage 1 (self-assessment) informs not only
which different career options that you explore in greater detail, but also
the specific issues that you research within each career option. For example,
if you have realised that your core work values include great continuity
of patient care and opportunities working in a particular location for
teaching, part of your research would be to find out whether, in the career
options that you are exploring, you would tend to care for patients over a
long timespan and also whether the job market was such that you would
probably be able to stay in a particular part of the country.
In both clinical consultation and career planning there might be a certain
to-ing and fro-ing between the stages. So, for example, a clinical sign
that is seen on examination might mean that you go back and ask further
questions about the patient’s current or past medical history; and while
you are planning your career, something that you find out when you are
researching a particular career option might lead you to go back and
undertake some more self-assessment.
This parallel between clinical consultation and career planning is useful in
that it highlights the importance of approaching both tasks in a systematic
manner, and being guided by an underlying staged framework. However,
we do want to stress that it is not a perfect parallel. In clinical consultation
the aim (although it is not always realised) is to establish a definitive
diagnosis – to provide an answer to the question: ‘What is it that is causing
these symptoms in this patient?’ In terms of career planning, the notion
of a definitive diagnosis can be unhelpful as it might be taken to suggest
that each individual could only be happy in one particular specialty. This
is counter to the wider research literature (discussed later in the chapter),
which strongly suggests that individuals could be satisfied in a number of
different career options.
A further problem with the parallel is that it might unwittingly seem to
imply that there is something wrong with the person (they can’t decide on
their career), and so they need treatment (finding out about themselves and
different options), to make them ‘better’. Instead, as careers professionals
we would argue that not only is it completely ‘normal’ for people to have
difficulty deciding on their career options, but also the four-stage model
that we have used in this book applies equally to people who are having
difficulty deciding and to those who have already decided, but want to
maximise their chances of success.
Stage 1 – Self-Assessment
14 Stage 1: self-assessment
Adequate clinical decision making cannot occur if the doctor has taken a
poor history, performed an examination inadequately or ordered the wrong
clinical investigations. Similarly, in our respective career-counselling practices
it is striking how often it is that clients who are dissatisfied with their
previous career choices had leapt into their chosen lines of work with scant
attention to what they were looking for in a job (self-assessment) and only
cursory research into whether the job they were considering would match
their particular career needs (career exploration).
Starting with self-assessment, there is a whole range of aspects of yourself
that you could investigate, and for each of these there are different possible
ways of carrying out the self-assessment. In this handbook we focus on
four key areas: work values, skills/interests, role models and the stresses/
strains of work. We regard these as the bare minimum in terms of the
range of issues that you need to consider when planning your career.
Personality instruments (such as the Myers-Briggs Type Indicator) or
Interests/Personal Attributes Inventories (such as the Self-Directed Search
or the Sci59 specialty choice inventory) are also being used to help medical
students and trainee doctors with their career decision making. So we also
provide some guidance on when psychometric testing might be appropriate
and how best to interpret the results.
Exercise 1: work values

Introduction to exercise 1
Rob Nathan, a leading occupational psychologist and career counsellor,
has written an excellent practical guide for career counsellors. In his book
(Nathan and Hill, 2006), he has the following to say about work values:
‘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.’
Clearly ‘worthwhileness’ is an important component of occupational
satisfaction, and thus it is vital to become clearer on one’s underlying
work values.
The exercise below is adapted from a generic set of work values (Hobson
and Scally, 2000). Using the experience gained from running workshops
for trainees in four deaneries, we removed work values that participants
felt were not relevant to medicine, and replaced them with values that the
participants felt were missing from the generic list. In addition, there have
been a small number of research studies on doctors’ work values, and we 15
checked the list that we had assembled against this research literature, to
see that there was a reasonable fit.
We have also adapted Hobson and Scally’s grading criteria, in the light
of a trainee’s comment that it is important to think about those work
values that you don’t want to be present. (And, in fact, this notion that
occupational decision making also involves thinking about things that you
don’t want accords with the wider research literature.)
NOT QUITE
IMPORTANT IMPORTANT
IMPORTANT
NOT PRESENT VERY
(i.e. important that you IMPORTANT
don’t have this at work)
PLACE OF WORK MONEY

Working in a specific part The possibility of earning
of the country a higher salary
VARIETY COMPETITIVE
having a variety of different working in a specialty to which
responsibilties entry is highly competitive
16
MANAGING
INDEPENDENCE YOUR OWN TIME
Being able to work on your own Having some flexibility in when you
carry out your different responsibilities
FRIENDS
PACE OF WORK
Forming friendships with
A rapid pace of work
colleagues at work
MANAGING OTHERS
RESPECT
the opportunity to manage
A high-status job
a clinical service
EXCITEMENT
CREATIVITY
Working in a context where
Thinking up new ideas and
you take clinical decisions
ways of doing things
under pressure
CONTACT WITH PATIENTS TECHNIQUES

Working in the context Working in a specialty in which you
where you have lots of perform particular surgical and/or
contact with patients diagnostic procedures
COMMUNITY SETTING HOSPITAL-BASED

Working in a Working in a
community-based specialty hospital-based specialty

17
RECOGNITION JOB SECURITY
Receiving appreciation for Knowing that your work will
the work you do always be there for you
CONTROLLABLE LIFESTYLE
PRECISION
Working in a specialty where
Working at tasks which invoive
you can achieve a satisfactory
great care and precision
work/life balance
CONTINUITY OF CARE
SUPERVISION
Working in a specialty where you
Having responsibility for
can provide continuity of care
supervising others
for your patients
LEARNING
HELPING PEOPLE
A rapidly changing role in
A role which you help individuals,
which you will continually be
groups or society in some way
learning new things
BEING EXPERT ORGANISATION

Being known as someone with Working in a well-known
special knowledge or skills hospital or service
PROMOTION CHALLENGE
Work in which there is a good Being ‘stretched’ and given new
chance of promotion problems to work on
18
PREDICTABILITY RESEARCH
Having a work routine which Having the opportunity to
is fairly predictable carry out research
COMMUNITY
Working in a place where you WORK WITH OTHERS
can get involved in the Working in a team alongside others
local community
PHYSICAL CHALLENGE TEACHING

Work that is physically demanding Being able to teach others
FLEXIBLE WORKING TYPES OF PATIENTS

A role in which there is the possibility Working with a particular
of working part-time patient group

Instructions for Exercise 1 19
1. Photocopy this exercise. Then, using the photocopies, cut out the four
‘headings’ cards:
• Very Important • Not Important
• Quite Important • Important Not Present
2. Again using the photocopies cut out the individual work values cards
a Then sort the work values cards under the four headings (i.e. pile
up those work values that are ‘Very Important’ to you under the
‘Very Important’ heading, etc.)
b Try to be a little selective – so, for example, don’t have more than
seven or eight work values cards under the ‘Very Important’ heading.
c If there are any work values that are not on the list, but you know
have a significant bearing on your career decision-making, then
add them in on separate pieces of paper. (You can add them in
under any of the four headings.)
d If you can, try to rank-order your ‘Very Important’ work values.
3. Write down your ‘Very Important’ work values. (And, if you have
managed to rank them, write them down in rank order.)
1. _____________________ 5. _____________________
2. _____________________ 6. _____________________
3. _____________________ 7. _____________________
4. _____________________ 8. _____________________
Look at your list and consider the following questions:

a Is there anything that surprises you, or anything that has raised
your awareness about yourself from the list? If so, make a note of
whatever it is that has struck you.
b Think about how your work values might change over time. Are
there any values which are not ‘Very Important’ now – but might
be so in 5-10 years’ time? (‘Flexible working’ may be an obvious
one, but there might well be others.) If this is the case, then make
sure that you take a note of how you imagine your work values
might change.
c Are there any work values which you regard as ‘Very Important’
but are unlikely to find an outlet in any of the options you are
20 considering? (For example, artistic values are very important to
some doctors, but they don’t necessarily find an outlet for
them in their paid role in medicine.) If this is the case, is there
any way that you could find an outlet for these values outside
work? And if you did, would this be satisfactory for you, or
might you still end up feeling unfulfilled?
Exercise 2: achievements, skills and interests

In this exercise we ask you to consider three achievements – two from your
work as a junior doctor/medical student and one from outside work.
Typically, when we give trainees/students this particular exercise on courses,
some will say that they don’t actually have any achievements. But such a
response is based on a crucial misunderstanding. When we say that we
would like you to consider three achievements, we are not saying that
they should be of world-shattering importance or enormous, or rare (e.g.
a lead paper in a major medical journal). Instead, what we are asking you
to identify is something that you have done that you felt proud about,
and ideally, but not essentially, something for which you received positive
feedback from a patient, colleague or supervisor.
It is also important, given that this exercise is part of the self-assessment
stage of an overall career-planning model, that your answers are genuine,
rather than of the ‘Miss World/I’d like to save the planet’ variety. The
purpose of the exercise is to think about things that you have done well,
and which have given you a genuine sense of satisfaction. It is not about
impressing others – but rather starting to think more clearly about what
makes you tick, so that you can use this knowledge as the basis for
subsequent career decision making.
Instructions for exercise 2

D. Read through your e-portfolio and identify two things that you were
involved with at work which gave you great personal satisfaction. When
have you felt the glow of satisfaction that you did a particular task well?
When have you received positive feedback?
(See if something in your e-portfolio jogs your memory about particular
achievements. But if it doesn’t, choose something that you haven’t
written about in your portfolio. The vital thing is to choose something
that you did well and you found personally satisfying.)

If you are a medical student, you may have a learning portfolio that you 21
could use for this activity. If you do not have either a medical student or
e-portfolio, then just choose something from your memory.
In addition to the work-based example you should also identify
something that you have been involved with, out of work, that gave
you great satisfaction. Possible examples include achievements in
sports, music, drama, local community action, charities, religious
institutions, etc. Sometimes, though, the ‘out of work’ achievements
are home-based. For example, if you have got through medical school
while simultaneously caring for a young child, then that is a very real
achievement – and you can use it to demonstrate the possession of a
whole range of personal skills such as commitment, organisation, time
management, etc.
B. For each achievement, identify all the skills involved. These could be
technical skills, communication skills, organisational skills, conceptual
skills, etc. Tease out all the skills that you used to accomplish each of the
listed achievements. Moreover, don’t just list the broad type of skill (e.g.
‘communication’ skills), but try to analyse your achievements at a more
detailed level. (See the example below.)
C. For each achievement, describe how you (and, if possible, other people)
knew the achievement was a success.
Example
A. Achievement:
Successfully presenting case at first multi-disciplinary case conference.
B. Skills involved:
Summarising complex case notes.
Building effective relationships with the other professionals present at the
conference, none of whom I had met before.
Presentation skills – presenting my point of view to the other attendees.
Standing firm when my viewpoint was challenged, but not resorting to
using a similarly confrontational approach.
How did I (or other people) know it was a success?
Feedback from other people attending the case conference.
Despite initial opposition, the approach that I suggested was accepted
by the team.
22 D. Finally, look at the lists of skills you have identified. Put a mark next to
those skills that you are most interested in using at work. You can also
note down the skills that you have not developed yet, but that you want
to develop in the future.
Repeat the exercise for the other two achievements.
Exercise 3: stresses and strains

Now switch your focus to areas in and out of work that you find difficult.
All specialties will contain tasks that you enjoy less; however, good career
decision making involves identifying what you find stressful and difficult, and
then choosing a career pathway that minimises these particular stresses.
You might think that people do this automatically, and some do. However,
we frequently encounter clients who have made choices based on one
factor (e.g. opting for a specialty that has ‘run-through’ training), without
adequately considering the way in which this choice will involve other
factors that they find stressful.

What we would like you to do in this exercise is to identify two examples
(one from your working life and one from outside work) in which you felt
that your stress levels were higher than they normally are for you.
Again, it may help you to read through your portfolio to jog your memory.
For the non-work example, flick through your personal diary, to see if any
examples come to mind.
Having identified the two examples (one from work, and one from outside
work), then answer the following questions. (Go through them separately
for each example).
1. Give a brief description of the situation, outlining the background, what
role you played, and what feelings it engendered in you.
2. Try to identify what it was about this situation that made you feel the
way that you did. For example, for the work-based scenario, was it the
feedback from others, the pace of work, the response of the patients, etc.
3. What can you learn from this example in terms of factors that you might
want to minimise at work?
Now repeat the exercise, this time analysing an example from outside work.
(And, of course, you can repeat this exercise, giving more than one work
and one outside work example.)
Exercise 4: role models 23
Probably the most consistent finding in the literature on factors effecting
specialty choice is the influence of role models. Across a large range of
different specialties, and in studies from all over the world, doctors cite the
influence of role models as one of the factors that influenced their choice
of specialty.
Sometimes this influence is direct – trainees report that they have chosen
a particular specialty because that was the specialty of their role model. At
other times, it is not that they choose the same specialty as their role model
– but rather that they realise that they want to practice a different specialty
in a similar manner as their role model. It is also important to realise that
this influence works both ways; positive role models are related to choosing
a particular specialty or working in a particular way, whilst negative role
models are correlated with the decision not to follow a particular career
path, or to practice medicine in a very different manner.
The exercise below aims to help you think about particular role models
(both positive and negative) in order to clarify some of the aspects of work
that are most important to you.
Positive Role Models

First, spend a couple of moments identifying a particular doctor whom you
consider to be a positive role model.
Then, with reference to this particular doctor try to answer the following
questions:
a What was it about this doctor that you particularly admired?
(For example, was it the depth of their clinical knowledge;
their mastery of particular techniques; their temperament;
their enthusiasm; their team leading skills; their manner with
patients, etc etc). You might find it helpful if you think about
specific examples of this doctor at work in answering this
question. And you don’t have to limit yourself to one or two
points – there might be a number of different reasons why
you regard a given doctor as a positive role model.
b Use your answer to question (a) above to identify aspects of
work that are particularly important to you and you need to
be present in order to find work fulfilling.
24 Negative Role Models
Next, without naming names – spend a couple of moments identifying a
particular doctor whom you consider to be a negative role model.
a Then, with reference to this doctor (but still without naming
them), think about what it was about their approach to their
work, that you disliked.
b What does you answer to question (a) above tell you about some
of the factors that are important to you at work?
Psychometric instruments
Psychometric instruments are sometimes used in career counselling to
assess psychological attributes relevant to occupational choice, such as
occupational interests, work values and personality.
What does ‘instrument’ mean in this context?

As doctors, the word ‘instrument’ conjures up images of the specialised
equipment that surgeons use in theatre. But a psychologist uses the word
somewhat differently. For a psychologist there is a difference between a
psychometric test and a psychometric inventory, and therefore the generic
term ‘instrument’ is used to describe something that applies to both tests
and inventories.
To explain this in a bit more depth, for a psychologist, a psychometric ‘test’
refers to measures that assess maximum performance. The underlying
assumption of these is that individuals will attempt to perform at the
top of their form. So, for example, a psychometric assessment of verbal
ability would be classified as a ‘test’, as people who filled it in would
probably want to do as well as they possibly could. This can be contrasted
with psychometric measures of typical response, which are often called
inventories. These are based on self-report, with individuals describing
their likes and dislikes, or how they typically behave.
The most common instruments that are used when career counselling
doctors are measures of personality (such as the Myers-Briggs Type
Indicator), or measures of personal attributes and professional preferences
such as Sci59. These should therefore be called psychometric instruments
or psychometric inventories, not tests, as they do not assess maximum
performance. (See Kidd, 2006.) But we appreciate that using the term
‘instrument’ in this way probably sounds strange to medically qualified
readers.

What makes them psychometric? 25
Next it is important to consider what makes a set of questions
‘psychometric’?
After all, the four exercises given earlier in this chapter also aim to assess
interests, etc work values, and probably also relate to one’s personality.
Without going into excessive detail, the most important point to make is
that with a ‘psychometric’ instrument (as opposed to the sort of exercises
included earlier on in this chapter) data are available on the measurement
properties of the instrument – in particular, on its reliability and validity.
Taking each of these in turn, the reliability of an instrument refers to the
extent to which the instrument produces stable results (assuming that the
underlying psychological construct that the instrument is trying to measure
hasn’t changed).
The validity of the instrument refers to whether the instrument actually
measures what it purports to be measuring, so, for example, a measure of
occupational interests should actually assess that construct and not some
other one.
Both these concepts should be familiar to you from your study of clinical
diagnostic tests, but in a clinical context they may be given different terms.
For example, instead of the term ‘reliability’ you might have seen the terms
‘precision’ or ‘reproducibility’, and instead of the term ‘validity’ you might
be more familiar with the concept of ‘accuracy’.
But despite the conceptual overlap, there are also some subtle differences
between clinical diagnostic measurements and the measurement of
psychological constructs (i.e. psychometrics). In a clinical situation accuracy
can be defined as the relationship between test results and ‘gold standard’
results, where the latter refers to an independent definitive diagnosis of
the presence or absence of disease. In at least some clinical situations, the
‘gold standard’ actually exists, which in turn underpins the measurement of
diagnostic accuracy. Things are never so well defined with psychometrics,
where the ‘gold standard’ (of intelligence, interests, values, etc.) is always
another theoretical construct rather than having the more clear-cut status
of a particular clinical diagnosis. And we think it important to bear this
difference in mind, when you are considering taking a psychometric
instrument to help you with your career decision making.
26 When might psychometric instruments be helpful?
Let’s return to the analogy between clinical consultation and career
decision making made at the beginning of this chapter. While most initial
consultations are likely to include taking a clinical history and clinical
examination, it is not always the case that further clinical investigations
are necessary.
As qualified test users we would suggest that a similar situation applies
to the use of psychometric instruments in helping medical students/junior
doctors with their career decision making. The self-assessment exercises
and strategies for career exploration included in this book will probably
be sufficient for many (perhaps even the majority) of students/trainees,
and they will be able to make career decisions without recourse to
psychometric instruments.
However, some students or trainees get a bit stuck. They struggle with
the self-assessment exercises, or having carried out the self-assessment
exercises don’t know how to translate the results of the exercises into
ideas about which specialties to explore. For these trainees, personality
inventories or measures of occupational interest can, if used appropriately,
be helpful.
But it is really important to introduce some words of caution, and for you
to understand what psychometric instruments can and cannot tell you.
Introducing another analogy might help make the position clearer.
As qualified (or nearly qualified) clinicians, you may well have been irritated
by ill-informed accounts of medical issues that you have read in the
popular press, or heard discussed in social situations. You know about the
importance of an evidence-based approach with representative samples,
appropriate clinical-outcome measures, adequate time-scales to measure
the effects, etc.
Similarly, as experienced careers practitioners, we are often alarmed (and,
if we are honest, sometimes infuriated) by the ill-informed pronouncements
that are made about the role of different psychometric instruments in
helping medical students and trainee doctors with specialty choice. We
know about the importance of examining the psychometric properties of
the instrument (i.e. the reliability and validity), and critically appraising the
evidence that this particular instrument might be an accurate predictor of
future satisfaction in different specialties.
So. What is the evidence?

Personality inventories 27
Personality measures attempt to cast light on our individual temperaments
– to what extent we are for example cautious, adventurous, curious,
gregarious, competitive, independent or sociable. These types of
characteristics may have an impact on the kind of work that we do well
and enjoy and also on the type of work tasks or environments that we
might enjoy less, and find more difficult to carry out.
In terms of evaluating the evidence on the relationship between personality
and medical specialty choice, the picture is complicated by the fact that
different measures of personality have been used with different groups,
thus making comparisons extremely difficult. Furthermore, some of the
studies were carried out 20 or even 30 years ago and there may have
been considerable shifts in the nature of a particular specialty during that
period. And as most of the data comes from the USA rather than the UK,
given that there are differences in the organisation of healthcare in the
two countries, it is possible that the way in which a particular specialty
is practised in the two countries may also differ significantly. So this too
would complicate the picture.
However, the most recent review of the literature (see Borges and Savickas,
2002) concluded the following:
• Although there is a loose relation between a few personality factors and
particular medical specialties, there is more variation in personality traits
within medical specialties than between them.
• All personality types appear in all specialties.
• More than one medical specialty fits the personality of any particular
medical student.
But on the basis of this, the authors do not in fact conclude that personality
testing has no place in career counselling medical students or trainee
doctors. Instead, they recommend that personality instruments should be
used as a way of increasing self-knowledge, rather than as a diagnostic
process that will ‘match’ a particular personality to a particular specialty.
A narrowly diagnostic approach is not supported by the available evidence,
and should be avoided at all costs.
What this means in practice is that if you complete a questionnaire such
as the Myers-Briggs Type Indicator (MBTI), you cannot use it to identify the
specialty to which you would be best suited. But you can use it to find out
a bit more about yourself, and then use that increased self-knowledge (in
addition to the self-knowledge gained from the other activities outlined in
this handbook) to think creatively about specialties that might suit you.
28 Accessing the MBTI
Nowadays it is possible to access the MBTI online, and a quick internet
search will identify a list of organisations that provide this service. However,
as the potential benefit of the psychometric approach resides in the quality
of the feedback discussion, we would not recommend you going down this
route. Instead, Appendix A gives a list of professional bodies that accredit
career counsellors, and the information in Appendix A about the British
Psychological Society explains how you can identify a suitably qualified
individual who would administer the MBTI, provide you with a report,
and discuss the implications of the report with you.
Measures of occupational interests

Holland’s Self-Directed Search is the most widely used measure of
occupational interest. And the conclusion reached above about the
use of personality instruments applies to the use of the Self-Directed
Search. (See Borges et al, 2004.)
In this later paper, Borges et al make the following statement in their
conclusion:
‘Early in their training medical students should be disabused
of the idea that there is one perfect specialty choice for each
person. Instead they should be helped to understand how
they could use different specialties to construct satisfying
and successful careers.’
Given that the MMC changes mean that trainees now need to make career
decisions earlier on in their careers, it may bring a degree of reassurance
for some trainees to realise that there are probably a number of different
specialties that they could enjoy. (And for the cynics among you, it is
perhaps worth stressing that these findings were based on studies in the
USA, so it is not a political coincidence that such data became available
just as the foundation pilots were being devised!)
Sci59 (previously called Sci45)

Finally, there is our own home-grown UK inventory, Sci59 (Gale and Grant,
2002). This instrument was developed to measure personal attributes and
professional preferences of doctors in training and beyond and to match
these to the characteristics needed to prosper in the 59 most common
specialties, including general practice.

As a relatively recent ‘kid on the block’, Sci59 was not included in either 29
of the two studies listed above. However, the basic notion that all
psychometric instruments should be used to suggest career ideas and
increase self-understanding, rather than to ‘diagnose’ what specialty will
suit you, is a basic tenet of sound career-counselling practice, and thus
applies to Sci59.
In addition, it has to be stressed that there are no published predictive
validity data on Sci59 (or on its earlier version, Sci45). What this means is
that there are no published studies that have attempted to correlate Sci45
scores with any measure of occupational satisfaction of people in post.
(And, in fact, while the original list of items was drawn from interviews
with consultants and GP principals, in drawing up the final list of items
Sci45 was actually calibrated using responses from SHOs who had not yet
embarked on their specialty training.)
As for the practicalities, some medical schools and deaneries have made
Sci59 available, while others have not. So if you are interested in taking
Sci59 you need to contact your personal tutor or Foundation Programme
manager, to see if it is on offer locally.
Conclusions
We cannot stress strongly enough that psychometric instruments that are
included as part of a career-planning process need to be regarded as tools
that lead to greater self-awareness rather than as simple quick-fix solutions.
But people like certainty. And if you are in the highly stressful position
of trying to choose your next career move, you might be desperately
seeking answers. So you don’t necessarily want to hear that psychometric
instruments are indicative rather than diagnostic, and can’t actually provide
you with definitive solutions.
Given that you may well be desperate for an answer, feedback should
always be given by people who understand what the test can and cannot
tell you, and know how to use the results to enhance self-understanding.
Ultimately, what you will get out of any additional instruments is highly
dependent upon the skills of the person who is giving you feedback. If
they challenge you to think about the ways in which the results of the
instrument accord (or don’t accord) with your other self-assessment
activities, and if they are all too aware of what the instruments can and
cannot tell you, then it can be useful. If not, then it is at best useless, and,
at worst, misleading.
30 Summary of Stage 1
Introduction to summary
It is now time to construct a summary of Stage 1. (Remember that the
process of carrying out the career exploration tasks in Stage 2 might make
you reconsider some of your answers to these Stage 1 exercises. Therefore
it is perfectly acceptable for you to return to and refine this Stage 1
summary at a later date.)
Read through your answers to the Stage 1 exercises that you have
completed. If you have completed any psychometric instruments, then read
through the report summaries, as well, at this point. Then record the key
points using the summary headings given below.
1. The doctor-patient relationship

(Write down any points that have emerged from the Stage 1 exercises
relating to the doctor-patient relationship. These might include some or
all of the points listed below, but you can also add your own personal
points. The list below is not necessarily exhaustive.)
Do you want to see patients in a community or hospital setting?
Do you enjoy brief encounters with patients, or providing continuity of
care over long periods of time?
Do you want to spend a significant portion of your working day having
contact with patients?
Do you want to work with acutely ill or chronically ill patients?
What about the emotional landscape? (For example, do you find it
rewarding to work with patients who are in a distressed or disturbed
emotional state?)
Do you have preferences about the ages of your patients? And do you
prefer working with individual patients, or patients and their families?
Do you want to contribute directly to the treatment of patients, or would
you enjoy working to support the diagnostic process (e.g. in areas such
as diagnostic radiology or pathology)?
Would you enjoy having to consider the whole of the patient’s body
(e.g. GP/paediatrician), or would you enjoy becoming an expert on a
specific region of the body (e.g. ophthalmology)?
Do you enjoy performing technical diagnostic or interventional
procedures?

2. Intellectual matters 31
(Some of these issues might have emerged in the earlier Stage 1
exercises, but it is possible that they have not. If they haven’t, it doesn’t
matter – just fill out the summary now.)
What areas of academic work have you most enjoyed studying in your
undergraduate and postgraduate training?
What medical journals are you most drawn to reading?
Within the BMJ, what sorts of articles tend to attract your attention?
What subjects have you enjoyed (or might you in future enjoy) teaching
to others?
What subjects have you carried out an audit on (or might you plan to
carry out an audit on in the future)?
What subjects have you enjoyed (or might you enjoy in future) carrying
out research on?
3. Status
In this section in particular (although it actually applies throughout the
whole of this Stage 1 summary), it is important to ask yourself whether
your answers represent your own views, or whether you are being unduly
influenced by pressure from significant others, such as parents or partner.
How important is it to you that you work in a highly competitive branch
of the medical profession?
How important is status to you?
Do you want to ensure that there are opportunities for private practice in
your chosen specialty?
Do you want to go into a branch of medicine where there is the potential
for earning a very high salary?
Is it important to you that you have opportunities for participating
in research?
Are opportunities for travelling abroad with your work important to you?
32 4. Quality of life
What sort of work–life balance do you want to have in 5–10 years’ time?
What sort of weekly schedule would you like to have in 5–10 years’ time?
What, for you, are your core work values, from which you derive most
satisfaction?
What stressful factors do you want to minimise at work?
Is the length of postgraduate training an issue for you?
5. Relationships with colleagues

Do you want to be able to spend quite a portion of your day working on
your own?
Do you want to be able to spend quite a portion of your day working
in teams?
Do you enjoy working in multi-disciplinary teams?
Do you want to be able to develop and manage a clinical service?
Do you want to be able to do quite a lot of teaching?
Do you want to be able to carry out research?
An alternative way of summarising Stage 1

Instructions for alternative summary
Some people prefer diagrams and pictures to words. If you would prefer,
you could provide a more visually based summary of Stage 1.
Take a large piece of paper (either A3 or paper from a flip chart).
Copy out the outline of the shield shown overleaf.
Then, in each of the four quadrants, either write bullet points of the
key issues or, if you are so inclined, you can devise symbols to depict the
key issues.
Then, underneath the shield, you could write a brief punchy motto that
encapsulates what it is that is important to you in your work.
The example on the following page, was provided by a consultant in
general geriatric medicine.

Figure 1: Shield and motto from a consultant 33
Work values Interests
Contact with patients Explaining my clinical thinking/
reasoning to trainees
Excitement Working with what’s causing
Learning
problems for a patient when
Teaching
others cannot
Helping others
Work with others Explaining complex issues
Hospital to patients/carers
Skills Stressors
Applying ‘science’ Practical procedures
to uncertainty Emergency/hyper-acute,
Translating symptoms into e.g. A&E situations
medical meaning
Management decisions
Dealing with angry
or upset people
Explaining to everyone
Final comments
Hopefully you have found these exercises useful. But if you haven’t, we would
ask you to bear with us.
When you come to apply for jobs, completing the Stage 1 exercises in
sufficient detail will help you construct clear, credible answers on your written
application forms, and also help you prepare how to answer the sorts of
questions that will be posed at interview. This is because the quality of your
career decision making will be thoroughly scrutinised in the application
process, and you need to demonstrate that you have carried out adequate
self-assessment (Stage 1), and thorough career exploration (Stage 2).
A final issue to consider is whether career decision making is entirely a
rational process (as is implied by the 4-stage model). Recent occupational
researchers such as Krieshok (2009) argue that intuition also has a vital
role to play in career decision making; specifically he suggests that through
occupational engagement (immersing oneself in one’s work) combined
with in-depth reflection on that engagement – the contribution of intuitive
processes in overall career decision making can be enhanced. But there
again, clinicians such as the surgeon and writer Atul Gawande argue that
intuition also has a role to play in clinical diagnosis – so perhaps the parallel
between career and clinical decision making really is a useful one to bear
in mind.
34

35
STAGE 2 OF CAREER
PLANNING:
CAREER EXPLORATION
36 III. STAGE 2 OF CAREER PLANNING:
CAREER EXPLORATION
Overview
This chapter covers Stage 2, career exploration, in detail. After a brief
explanation of why this stage is so important, the structure of post-
foundation training is outlined. You will then be introduced to preliminary
research tasks that you can carry out for a number of different career
options, and more detailed research tasks that you will carry out on a
smaller subset of options. Advice is also given on how to narrow down
your options, so that you know which options to research in greater depth.
The chapter ends with a ‘reality check’ so that you give sufficient thought
to whether or not your career choices are realistic.
Why Stage 2 matters

The exercises covered in Stage 1 should have given you an opportunity to
develop a clearer idea of what you are looking for in your career.
In Stage 2 you explore different career options, in order to find out
two things:
Firstly, you need to research different options in order to establish which
particular career pathways are most likely to match your own individual
skills, interests, values, personality, etc. Secondly, given the feedback that
you have received from people such as your educational supervisor, clinical
supervisor, the trust Clinical Tutor/Director of Medical Education or the
Foundation Programme Training Director, you need to consider whether
the option (or options) that you are interested in seem to be realistic
career choices.
At the beginning of Stage 2 we want to stress that adequate career
exploration takes time. But it is time well spent. (Both of us have worked
with many clients who never really explored their career options properly,
and then, over a period of time, came to regret their earlier choices.) In
addition, as we described above, spending time exploring different career
options is not only important in terms of making good career decisions, but
will also help you later on at the application form and interview stages.
We also want to emphasise that Stage 2 is not carried out in a vacuum –
but, rather, Stage 2 follows on from Stage 1. This means that as well as
finding out the basic ‘facts’ about a particular career choice (and by this we
mean factors such as typical training pathway, for specialty training, person

specification, competitiveness, etc.), you will also need to research the 37
specific questions that you now realise (on the basis of working through
Stage 1) are important to you.
An easy way of doing this is to use the summary exercise that you
completed at the end of Stage 1 to generate specific issues that you are
going to explore in your specialties of interest.
A couple of other points stem from this idea that Stages 1 and 2 are linked:
Firstly, the clearer you are about what is important to you (Stage 1), the
more targeted and relevant your Stage 2 research is likely to be.
Secondly, a lot of the more personalised information that you need to find
out about is not available in the various medical career handbooks or on
the websites of the different Royal Colleges and deaneries. Instead, in order
to find out what it is ‘really really’ like to work in a particular specialty, you
will need to talk to people who are currently working in that particular
field. Without this sort of research (called ‘informational interviewing’ in the
career-counselling world), it is difficult to ascertain whether the career
is going to match your core work values, skills, interests, etc.
Post-foundation training
Post-foundation, if you wish to pursue training within a particular specialty
(including General Practice) you will need to apply for a specialty training
post. All specialty training programmes lead eventually to a Certificate
of Completion of Training (CCT), assuming satisfactory progress and
achievement of the required competences. A CCT enables you to apply
to the Specialist or General Practitioner register held by the General
Medical Council.
There are two broad types of training programmes in specialty training
– ‘run-through’ training and ‘uncoupled’ training programmes. A ‘run-
through’ programme is one that offers the trainee structured training that
will take them through (assuming satisfactory progress) to the point where
they can be awarded a CCT.
An ‘uncoupled’ training programme is one which offers two years of
core training (three in some specialties, e.g. psychiatry) followed by open
competition to enter higher specialty training programmes leading to CCT.
Securing a core training post in an uncoupled specialty does not guarantee
your progression through to CCT. You will have to go through another
round of competition for posts at the end of your core training. Entry
for posts at this junction between core training and higher specialty
training will be open to all eligible applicants (including those working
Stage 2 – Career Exploration

38 in non-training posts). This means that there may be some opportunities
in future years to enter training at a higher level, for those people who
were not previously successful in securing a core training post. But, again,
in highly competitive specialties, it is likely to be extremely difficult for an
applicant to secure a training post at ST3/4, if they have not previously
been in a core training programme; they will need to demonstrate the
requisite competences.
The following diagram is an overview of the career structure for foundation
and specialty training:
Figure 2
The flowchart below outlines the career structure for foundation and specialty
training. This is an overview only. There may be other points of entry which aren’t
shown here, depending on which vacancies are available at different stages of
training
Run-through posts
ST1, 2, 3, 4, 5, 6, 7 (8)
Under-
graduate
medical
training
F1 F2
CT1, 2, ST3-ST7
(3) (8)
Core specialty Higher specialty

Foundation Training
training training
Competition for Competition for Certificate for

ST1/CT1 post higher specialty completion of
(all specialties) training (uncoupled) training (CCT)
(Diagram adapted from image by David Rice, KSS Deanery, 2008)
Specialties offering run-through training may also offer some fixed-term

specialty appointments (FTSTAs). This will mean that there may be some
opportunities for doctors to develop their training experience so that they
might be successful at a later date in securing a specialty training post. But
it has to be recognised that in many specialties there will be high levels of
competition and taking an FTSTA in a highly competitive specialty won’t in
any way guarantee later success in obtaining a training post at ST2 or ST3.

The application process 39
Applications to specialty training programmes are either through a Royal
College website or the lead deanery website depending on the specialty.
GP recruitment is managed through the national GP recruitment office
(http://www.gprecruitment.org.uk/) and Academic Clinical Fellowships
through the National Institute for Health Research (http://www.nihrtcc.nhs.
uk/intetacatrain/). The Modernising Medical Careers website (www.mmc.
nhs.uk) contains the most up to date picture on the overall process and
timetable for specialty training recruitment.
There are also opportunities for doctors who either do not succeed in
securing a training post or who decide that they want to gain more
experience before choosing a particular specialty. Further information is
available on the medical careers website (http://www.medicalcareers.nhs.
uk/postgraduate_doctors/specialty_doctors.aspx). Job opportunities are
often advertised in NHS jobs and BMJ careers.
Entry for posts at this junction between core training and higher specialty
training will be open to all eligible applicants (including those working in
non-training posts or otherwise not on core training programmes). This
means that there may be some opportunities in future years to enter training
at a higher level, for those people who were not previously successful in
securing a core training post. But again, in highly competitive specialties,
it is likely to be extremely difficult for an applicant to secure a training post
at ST3/4, if they have not previously been in a core training programme.
The description of the recruitment and selection process is correct at the
time of going to press (July, 2010), but it is important that trainees refer
to the MMC and national medical careers website to keep abreast of any
more recent changes.

40 And in future years?
It is not possible to provide details of the recruitment and selection processes
that will be used by particular specialties as they are continuing to evolve.
However it is possible to make some general comments that should stand
the test of time.
1. Keep on top of the system
Post-foundation training continues to develop and change and the only
way you can ensure that you are not disadvantaged by failing to find out
about critical information is to carry out regular checks on six different
types of website:
a The Modernising Medical Careers website (www.mmc.nhs.uk)
which produces key documents, outlining and updating details
of post-foundation training, e.g. applicant handbook and person
specifications for each specialty
b The Medical Careers website (www.medicalcareers.nhs.uk) which
contains information about specialties and a range of career
planning tools and resources
c Deanery websites, of any Deaneries to which you might apply
d Royal College website, of any specialties to which you might apply
e GP recruitment website for opportunities in GP specialty
programmes
f NIHR website for opportunities in academic medicine, e.g.
Academic Clinical Fellowships
2. Begin early
Don’t leave your career exploration to the last minute. This has never been
a wise strategy but in the current system of flux it is particularly unwise.
Instead, from the time you start in your first foundation post you should
be regularly carrying out the self-assessment tasks described in the previous
chapter, and the career exploration tasks described in this chapter.
3. If you are uncertain – ask for help
As a junior doctor you will have an educational supervisor, as well as access
to other senior clinicians with additional educational responsibilities such
as the Director of Medical Education or College Tutor. If you are unsure
about the implication of what you read on these different websites (or in
the medical press), then ask for clarification from one of these people. It
is known that the system is particularly confusing at the moment, and it is
better to seek clarification early on, rather than wait until the point when
everybody is filling in their application forms.
Preliminary research tasks 41
The sorts of issues that you might want to begin by researching (and in fact
you may carry out this more basic desk-bound research for a number of
different options) include the following:
Entry criteria to the specialty: this is clearly laid out in the person
specifications which are available on the MMC website. You can then review
your Stage 1 assessments against the person specification, to see if there
is a close fit, or if there are any skills or experiences that you might need to
acquire.
If you are not currently on a foundation programme, you need to check that
you are applying for entry to the correct level. Your educational supervisor
or Clinical Tutor should be able to advise you on this. Alternatively you can
contact the careers specialists at your deanery. If you have a very unusual
query, you can also email the MMC help desk: [email protected]
The applicant’s guide to Specialty Training (available on the MMC website)
contains detailed advice for overseas applicants, and it is important that
all overseas applicants read this information carefully before submitting
an application. And if you have any queries the careers specialists at your
deanery or the MMC help desk (see above) should be able to help. Overseas
applicants should check the MMC website regularly, so they keep up to date
with any changes to the law.
The C word (Competition)

In the past it was very difficult to get information about the relative
competitiveness of different specialties. One of the deaneries (the
West Midlands) pioneered the production of data on the comparative
competitiveness of different specialties, but these were local rather than
national figures. National data from the previous round of recruitment are
now available (typically on the MMC website) and it is important that you
familiarise yourself with this information. Information about workforce
planning data is available on the national medical careers website
(www.medicalcareers.nhs.uk).
You also need to discuss the possible implications of the competitiveness of
your specialty choices with your educational supervisor.

42 Beyond preliminary research
Some of you may know immediately which options you want to explore
further. If this applies to you then skip to the next section. But others of you
may be far less sure.
If you fall into this latter category (i.e. you don’t know which options to
explore in depth), then the following suggestions might help:
1. Complete a relevant psychometric instrument in order to generate lists of
specialties that might suit you. (Remember, though, that in the previous
chapter it was argued in some detail that results from psychometric
instruments should never be regarded as narrowly diagnostic.)
2. Discuss your Stage 1 summary with your educational supervisor, clinical
supervisor, the Clinical Tutor/Director of Medical Education or the
Foundation Programme Training Director, to see if they can help you with
ideas of careers to which you might be suited.
3. Read through one on the specialised medical career handbook books
mentioned in Appendix B and review the specialty information provided
on the medical careers website (www.medicalcareers.nhs.uk). From
these, choose a number of career options that seem, on initial reading,
to be interesting.
4. Search through the BMJ Careers website which contain numerous
articles on careers in different specialties.
5. Check the website of different Deaneries to see what information they
provide about the different specialties in their region.
Isn’t there another way of identifying suitable

careers?
Perhaps you are surprised that there isn’t a more ‘scientific’ method than
the suggestions listed above. But based on our professional training, and
also on our experience of helping people make good career decisions,
we know that this process is as much an art as it is a science. So called
‘scientific’ approaches (particularly the use of psychometric instruments)
can be useful in generating ideas, but they don’t hold all the answers. And
often the answers start to emerge through following up the suggestions of
colleagues and supervisors with whom you have worked, coupled with a
fair smattering of background reading.
And finally – if you have done all of the above – and nothing grabs your
attention, perhaps you need to ask yourself whether you actually want to
remain in medicine. If this is the case, we strongly recommend that you
either ask for a referral to the specialist careers adviser (if your deanery has 43
one), or you seek out some private career counselling with an appropriately
qualified careers counsellor.
(See Appendix A for a list of organisations that accredit careers
professionals.)
How to research options in further depth

Having decided which options you wish to explore further, you then need
to work out what it is you wish to find out, and how you will go about doing
so.
Often, the best way to find out more about a particular career option is
to try it out, as one of your foundation programme placements. But if this
is not possible (either because the specialty you are interested in doesn’t
offer foundation placements, or because you weren’t successful in getting
the placement you wanted), then see if you can arrange a ‘taster’ week
ideally early in your foundation year two. A good place to start would be to
discuss this with your educational supervisor and Foundation Programme
Training Director.
Informational interviewing
Look at the summary you constructed at the end of Stage 1. For each of
the five different sections, write down a list of specific questions that you
are going to ask of the person who is (or people who are) currently working
in the options that you are interested in.
You then need to identify at least one person (and preferably more than
one) working in that specialty, in order to put these questions to them.
Ask your educational supervisor for suggestions as to whom you can ask.
In addition, you can approach college tutors. It is helpful if you are able to
talk to people at different levels of seniority, so ask among your friends to
see if they know SpRs or consultants working in your field of interest.
Finally, set yourself a suitable timescale in which these interviews will be
carried out and arrange to discuss your findings with your educational
supervisor, or other experienced clinician.

44 Person, phone or email?
Ideally you should talk to people face to face. (And some Deaneries organise
careers fairs where you can talk to people in all sorts of different specialties,
and the BMJ Careers Fairs are also useful ways of talking to people in
particular specialties.)
Clearly if you are doing a foundation placement in a large teaching hospital
you will have easier access to a broader range of specialties than if you are in
a specialised psychiatric hospital or a smaller District General Hospital. If you
can’t manage a face-to-face interview, then see if you can arrange to talk to
somebody on the phone.
And if all else fails – email people, and ask if you can send them a list of
questions.
But whatever your mode of communication, you need to approach the task
of informational interviewing as an important research project. You are not
having an aimless ‘chat’; instead, you are trying to get answers to some of
the questions that have emerged from the Stage 1 self-assessment.
(Be aware that some of the responses to questions will be quite subjective
Therefore it is useful to speak to more than one person. Find out what the
interviewee enjoys about their work. Not only is this interesting information
to elicit, but if they give you a very cynical response, then you know that you
might be getting a somewhat jaded opinion. And while it is clearly important
to get a balanced rather than an overly glossy view of the specialty, you do
want to avoid being turned off a specialty because you have talked to a
burnt-out clinician.)
Finally, it’s worthwhile going back to the library and spending a bit of time
with your nose in the journals. Choose the major journals in your specialty of
interest (if you are unsure about which journals these are, ask the librarian)
and spend some time having a good read through some recent issues.
Of course, as you haven’t begun specialist training in these areas, many
of the articles will be too specialised. But, in general, ask yourself whether
you are gripped by some of the articles, or whether they leave you
somewhat cold.
In addition to the relevant journals, you can also ask the librarian to direct
you to some of the core texts in the fields that you are exploring. And again,
pose yourself the same question. Am I really interested in reading more
about psychiatry (cardiology, pathology, etc.)? Because if you are, that is a
good sign. But if you are not (assuming that you have chosen a textbook at
approximately the right level), then you need to ask yourself whether you
are making a good career decision.

Reality check: is your career decision realistic? 45
This is probably the trickiest issue of all.
During courses for consultants we often get asked about the best ways of
approaching trainees who have ‘an insight by-pass’. And the consultants
then start to give detailed descriptions of trainees with severe dyspraxia who
want to train in micro-surgery.
But, on the other hand, we also often hear from consultants who had been
advised at an earlier stage of their career that ‘they would never make it’ as
a radiologist, gastro-enterologist, etc. And there they are, 15 years into their
careers as consultant radiologists or gastro-enterologists. If they had listened
to the ‘advice’ that had been given to them earlier on, they would have
perhaps denied themselves the chance of succeeding in the career that they
had set their hearts on.
As a trainee, you have to ask your educational supervisor whether they think
that your career plans are realistic. (And if your educational supervisor knows
little about the specialty you are considering, then, having completed some
of the career exploration tasks, you should be able to fill them in with details
of the person specification, training pathway, competition ratios etc.)
Clearly if they feel that your plans are realistic, then there isn’t a particular
problem. (Although in the current climate of flux you should realise that this
support from your educational supervisor doesn’t guarantee that your plans
will be successful.)
But if your educational supervisor thinks that you are not being realistic,
then you are in a stickier position, and you should always try to get as much
information as possible as to the specific nature of their concerns.
If you think that there has been a breakdown of communication with your
educational supervisor and that you have been unfairly judged, then you can
ask to discuss your plans with another consultant, or with the Foundation
Programme Training Director. (In the final chapter, we will recommend to all
clinicians who may be taking part in these sorts of ‘second opinion’ meetings
that they always have a copy of all the previous assessments and also a brief
report from the educational supervisor.) But, by all means, ask if you can have
a ‘second opinion’ from another clinician.
Perhaps you feel that your difficulties in a certain placement were due to
things going on in your personal life, and you are confident that you could
have performed better if circumstances had been different. If at all possible,
discuss this with your educational supervisor or Foundation Programme
Training Director.

46 But, if you feel unable to do so, then this will be something that you take
account of, but is not shared with your supervising consultants.
Ultimately the decision as to what to put down on your application form is
your own. And if you decide that your educational supervisor is being unfair
or unduly pessimistic, then you can of course act against their advice. But
we would urge you, at the very least, to respond to any comments that you
get about not being realistic – by saying to yourself: ‘How do I know that
it is realistic given the feedback that I have received?’ And you should also
ask yourself: ‘How am I going to be able to convince the short-listing panel
and interviewing panel that I am a suitable candidate?’ To avoid challenging
yourself with these two questions is to adopt the ostrich approach. And, as
yet, there aren’t too many ostriches in senior medical positions.

47
STAGE 3 OF CAREER
PLANNING:
DECISION MAKING
48 IV. S
TAGE 3 OF CAREER
PLANNING:
Decision Making
Overview
This chapter guides you through the decision making process.
There are three exercises in this chapter. The first (‘Constructing a Lifeline’)
provides you with an opportunity to review significant decisions that
you have made in the past. The second (‘The Decision Template’) offers
a structured approach for comparing the different options that you are
currently considering.
But whatever method you use, by the end of Stage 3 you will need to
have reached a decision about which option (or options) you will be
applying for next.
The third exercise involves you using the ROADS acronym to check the
robustness of your career decision, and the chapter ends with brief advice
for those of you who are finding it difficult to make up your mind.
Exercise 1: constructing a Lifeline

Think about how you have made important decisions in the past: for
example, career-related decisions about A-level subjects, applying for
medical school, elective choices, etc., or personal decisions that are
unrelated to work, such as taking a gap year between school and university,
starting or ending a significant personal relationship, etc.
Then, follow the instructions below. (And see Fig. 2 for an example.)
1. Take a sheet of paper (ideally A3 or flip chart paper. But A4 will work
if it is all that is available). Turn it round so that it is ‘landscape’ rather
than ‘portrait’.
2. Draw a horizontal line across the middle of the paper. Note down your
age at the right-hand end of the line. Then, put in a ‘plus’ (+) above the
horizontal line (to signify times that you look back on with pleasure) and
a ‘minus’ (-) below the line (to signify those times when things were not
going well).

3. Before you go any further, think very carefully about the course the line 49
will take. Where are the high points and the low points? Which parts of
the line (if any) are relatively stable?
4. Now mark in the significant life events. Include experiences which
influenced you, achievements, and both good and bad events that have
occurred in your life to date. Allow yourself sufficient space, as including
one event may trigger a memory of another.
5. Connect up the points that you have marked.
6. Identify a couple of decisions that you have marked on your Lifeline which
you feel (in retrospect) have worked out well. What made them good
decisions? How did you go about making these particular decisions?
7. Now, identify a couple of decisions on your Lifeline that you feel (in
retrospect) didn’t work out so well.* What made them poorer decisions?
How did you approach these decisions that didn’t work out so well?
8. A much-favoured adage of psychologists is that the best predictor of
future behaviour is past behaviour. Bearing this in mind, can you use
this analysis of past decisions to throw any light on how you should
approach the career choices that you are currently facing?

(One way of doing this is to look at your answers to questions 6 and 7 in
order to identify the best way for you to approach your current decision,
as well as approaches you should avoid. For example, do you seem to
be somebody who makes good decisions when you rely on your ‘gut’
feelings, or are you somebody who has made your best decisions when
you adopt a more structured approach?)
________________________________________________________________
*When we have used the Lifeline exercise in workshops (with both consultants
and trainees), we have often heard the comment that there is no such thing as
an entirely ‘bad’ decision, as good elements can emerge even from decisions
that didn’t turn out at all smoothly. We would both entirely agree with this, and
have examples from our own personal career histories that illustrate the point.
Moreover, in our professional practice we often hear clients describe career
decisions that they regret taking, but which they do realise also allowed them to
develop certain useful skills.
However, in terms of the Lifeline exercise, we do think that it is possible to identify

decisions that you have taken that, in retrospect, you feel were not the best ones.
These are decisions where, even though you can see that some good things have
emerged from them, you have a sense that a different decision at that point in
your life would probably have been a better option. It is these sorts or decisions
that we would like you to identify in question 7.
Stage 3 – Decision Making

50 9. Has anything else struck you from completing this Lifeline exercise?

(And in case you don’t understand this question, it might help if we give
you an example of the sort of insight that can emerge. One of us once
ran a two-day career-planning workshop for a housing association that
was making a large number of staff redundant. The staff attending the
workshop were, for entirely understandable reasons, angry, de-motivated
and anxious about the future. One particular member of staff was very
withdrawn during the first day of the workshop, and was reluctant to
contribute to the discussions, or complete any of the activities. Following
the Lifeline exercise, there was a noticeable shift in his attitude. When
the facilitator remarked on this, and enquired what had happened, the
member of staff replied that he had felt overwhelmed by the forthcoming
redundancy, and had convinced himself that he wouldn’t get a new job.
But when he reviewed his lifeline as a whole he realised that the current
dilemma was just one of a series of obstacles that he had faced in his life
and, as he had overcome the previous ones, he now felt more confident
that he wouldn’t be defeated by the forthcoming redundancy. This is just
one example. But it gives a flavour of the sort of insights that sometimes
emerge from the Lifeline exercise.)
Figure 3 Lifeline Example from a consultant

Friend
Marry, Lifetime
Support Appointed as consultant
+ Appointed as +
od
+ Go
cisio
n geriatric trainee.
Good decision!
Deanery
Post!
de
Accepted for
Cambridge + career
Correct
choice!
Age
0 7 26 27 29 34 48 50
_ Work in
negative
_
_ Diagnosed with unrealistic
expectation of
childhood RA
(Rheumatoid specialty- wrong _ Post too busy
Reduced support
Pressure to
Arthritis) area, wrong specialty
organise research

Exercise 2: a more structured approach to 51
decision making
Instructions for Exercise 2
If the results from the Lifeline exercise suggest that you would benefit
from a more structured approach, then you might find the exercise below
helpful.
1. With reference to the Stage 1 Summary, and using the five headings
(Doctor-Patient Relationship, Intellectual Matters, Status, Quality of Life
and Relationships with Colleagues), write down your answers to the
questions listed in Fig 3.

Then, along the top, write down the particular career options that you
are currently considering. (Ideally, this should not be more than four, as
otherwise the decision making becomes rather unwieldy.)
2. With reference to your Stage 2 research, note down whether a given
factor (e.g. seeing patients in a community setting; continuity of
patient care, etc.) is present or absent in the different specialties you
are considering.
3. Counting the number of ‘ticks’ in each career option may well be
misleading, because the different factors are not necessarily of equal
importance. Instead, we would suggest that initially you ‘eyeball’ the
chart, and see what conclusions you reach. Having done that, we would
recommend that you discuss the chart with significant people in your life
(partner, family, close friends), and also with your educational supervisor,
or another clinician who knows your clinical work.

In this way, the best career decision should become clearer to you.

In this exercise we haven’t included the precise details of how many
options you have to choose from at any particular stage (i.e. the details
of application for foundation year 1 or post-foundation training). We
cannot gaze into a crystal ball and predict the precise details of the
application process into foundation year 1, or into post-foundation
training that will be in place next year, let alone the year after. Thus we
took the decision to describe a generic approach to decision making
which can be applied to any situation.

52 Figure 3: Exercise 2 – Questions to consider for each
option
1. Doctor-patient relationship Options
(please tick)
1 2 3
Do you want to see patients in community or hospital
setting?
Do you enjoy brief encounters with patients,
or providing continuity of care over long periods
of time?
Do you want to spend most of your working day
having contact with patients?
Do you want to work with acutely ill or chronically
ill patients?
What about the emotional landscape? (For example,
do you find it rewarding working with patients who
are in a distressed or disturbed emotional state?).
Do you have preferences about the ages of your
patients? And do you prefer working with individual
patients, or patients and their families?
Do you want to contribute directly to the treatment of
patients, or would you enjoy working to support the
diagnostic process (e.g. in areas such as diagnostic
radiology or pathology)?
Would you enjoy having to consider the whole of the
patient’s body, (e.g. as a GP/paediatrician), or would
you enjoy becoming an expert on a specific region of
the body (e.g. ophthalmology)?
Do you enjoy performing technical diagnostic or
interventional procedures?

2. Intellectual matters Options 53
(please tick)
1 2 3
What areas of academic work have you most enjoyed
studying in your undergraduate and postgraduate
training?
What medical journals are you most drawn
to reading?
Within the BMJ, what sorts of articles tend to
attract your attention?
What subjects have you enjoyed (or might you in
future enjoy) teaching to others?
What subjects have you enjoyed (or might you
enjoy in future) carrying out research on?
What subjects have you carried out an audit
on (or might you plan to carry out an audit on
in the future)?
3. Status Options
(please tick)
1 2 3
How important is it to you that you work in a highly
competitive branch of the medical profession?
How important is status to you?
Do you want to ensure that there are opportunities
for private practice in your chosen specialty?
Do you want to go into a branch of medicine where
there is the potential for earning a very high salary?
Is it important to you that you have opportunities for
participating in research?
Are opportunities for travelling abroad with your
work important to you?

54 4. Quality of life Options
(please tick)
1 2 3
What sort of work-life balance do you want to have
in 5-10 years’ time?
What sort of weekly schedule would like to have in
5-10 years’ time?
What, for you, are your core work values, from which
you derive most satisfaction?
What stressful factors do you want to minimise at
work?
Is the length of post-graduate training an issue
for you?
5. Relationships with colleagues Options

(please tick)
1 2 3
Do you want to be able to spend quite a portion of
your day working on your own?
Do you want to be able to spend quite a portion of
your day working in teams?
Do you enjoy working in multi-disciplinary teams?
Do you want to be able to develop and manage a
clinical service?
Do you want to be able to do quite a lot of teaching?
Do you want to be able to carry out research?

Crunch Time: Making the Decision 55
From Exercise 2 you should have got some sense of what has helped you
to make good decisions in the past (and perhaps too, of factors that have
contributed to you making less successful choices). It is worth bearing in
mind Krieshok’s findings (mentioned in Chapter 2), that intuition can also
be important in career decision making. But it is also necessary to be clear
about what Krieshok is saying when he describes intuitive decision making
processes. He certainly isn’t talking about crystal ball or navel-gazing.
Instead he argues that the way to help people make good career decisions
is to encourage them to get stuck in different career-related activities and
then step back and reflect on the experience. At this point (and not before)
– a strong ‘gut feeling’ that a particular option is right (or for that matter
wrong), may well be of value.
Exercise 3: how robust is your career decision?

The final task that we would encourage you to carry out is to interrogate
your career decision using the ROADS checklist. Initially we would suggest
that you should do this on your own. But then you should talk through
your conclusions with the same people listed above. (And, of course, the
results of all three exercises detailed in this chapter could be discussed with
the relevant people on one occasion, or on separate occasions, depending
upon your own particular circumstances.)
Good career decisions: ROADS

Realistic – are you being realistic about yourself AND the demands
of the job?
Opportunities – have you given serious consideration to all the

Anchors – have you built in the things that provide support in your life?
Development – do your choices fully develop your potential?
Stress – have you considered those aspects of work that create particular
stresses for you?

56 If you can’t make up your mind
There are a number of possible reasons why you might struggle with a
decision. (And in fact, these reasons are not mutually exclusive.)
1. You are still unclear about your skills, interests, achievements, values, etc.
2. Your career research to date hasn’t enabled you to become more
clear about the extent of the ‘match’ between the work factors that
are most important to you and the different career options that you
are currently considering.
3. You’ve gone through Stages 1 and 2 thoroughly but you still can’t make
up your mind (perhaps because you are someone who always struggles
with decisions).
4. You are uncertain whether you wish to remain in medicine at all.
If 1 and/or 2 apply to you, and you haven’t really devoted much time to
working through the structured exercises outlined in this handbook, then it
might be useful for you to go back and do so. But if 3 applies (i.e. you have
completed the exercises to the best of your ability, and discussed them with
your educational supervisor, but you still cannot decide) we would advise
you to ask for a referral to the deanery careers team.
And if 4 applies, then we would strongly recommend that you seek
professional help from an experienced and appropriately qualified careers
professional (see Appendix A). Both of us have experience of working
with individuals who fall into this category, and as a result we know that
the decision to leave medicine is a major one, and that the individuals
concerned have enormously appreciated the input from people who have
a professional grounding in career planning.

Some final thoughts 57
A number of clinical colleagues have given us their insights into the
decisions they made on their specialty choice – see Table 2 below.
Table 2: specialty choice – some reflections from some

consultants and a GP
“I have made a sequence of specialty decisions throughout my career and I
realise that where I am now could have been reached by several different
routes. My decision to go into anaesthesia was because it combined an in-
depth knowledge of physiology with practical skills and I loved the specialty.
The challenge of intensive care took the knowledge and skills combination to
a new level for me with the additional elements of teams working together
in a critical situation and communicating with patients and their families.
Then, when an opportunity to develop my interest in medical education
came along, I jumped at it. Certainly, my career plans have changed with
my circumstances, the system and the opportunities available.”
“I enjoy new challenges; being open to changes and flexible enough to
take advantage of them is important to me… Nothing stands still; my
career has been a fantastic journey – and it still is!”
“My career owes more to serendipity rather than planning, and I

am grateful that medicine has supplied me with so many diverse
opportunities… Advice? Think about what you like doing and
how to engineer change. If you consider that something could be
done better, make constructive suggestions and ask for support
to improve it. Be aware, though, that you will probably end up
running it and more…”
“I have been a consultant anaesthetist for just over 20 years. During that
time my clinical work has changed and evolved giving me the opportunity
to develop and improve services for patients, and participate in training
new entrants to my speciality. My non-clinical work has enabled me to
be involved in postgraduate medical education and NHS management,
as well as contribute to national organisations and specialist societies.

58 Many of the roles I have undertaken have come about because I have
volunteered and got involved in areas not traditionally associated with
my clinical role in a District Hospital in Wales. I have found that if you feel
strongly about a subject, are enthusiastic and demonstrate a willingness to
work hard and implement change, all sorts of things are possible. My career
is always developing and has plenty of challenges – six years ago I was the
President of the Medical Women’s Federation and Flexible Training advisor to
the Royal College of Anaesthetists. Today I am an Associate Dean for Careers
and Less than full-time training in Wales and a Special advisor – Careers to
the UK Foundation Programme Office. I even went back to formal study and
obtained a PG certificate at the age of 53. Who knows what tomorrow may
bring, Finally, my supportive partner and children have certainly helped along
the way.”
“I am a geriatrician. Like most of us, I think I made my decision quite late as
I realised that I liked general medicine and didn’t really want to specialise.
I was also very aware of a work-life balance. I think I would have been
happy in most specialties – most of us enjoy having specialist knowledge
and being able to make a difference.”
“When I commenced my PRHO year, I had been quite determined

to become a surgeon. During my stint in surgery, this interest
strangely ebbed and disappeared, perhaps out of a realisation
that I did not possess the appropriate mindset. I then considered
paediatrics, which I had enjoyed as a medical student, but had
concerns with pursuing, having had little personal experience of
dealing with children. Two weeks as a PRHO in paediatrics proved
sufficient to rekindle this interest and any anxieties were dissipated
by paediatric trainees, who advised me to trust natural paternal
instincts! Twenty-six years on, I have no regrets whatsoever.”
“You may want to use my quote as an example of how not to do it. I applied
for chest medicine in the early 1980s for two reasons. Firstly, I and my
contemporaries were assured that there would be lots of jobs in chest
medicine in the late 1980s, when all the chest physicians appointed shortly
after World War II to sanatoria posts would be retiring, and, secondly,
I thought that my father, who died in my first year at medical school, was
a chest physician and I wanted to follow in his footsteps. The sanatoria
were closed down in the mid-1980s, and so jobs were extremely scarce
in the late 1980s, and it turned out that my father was a cardiologist!”

“I made my specialty choice largely on the basis of work-life balance. 59
I wanted a career that in the future would be flexible enough to fit
around having children and possibly moving around the country
(depending on my husband’s work). This sounds quite old-fashioned and
unambitious, but having subsequently gone on to be involved in running
the GP Flexible Career Scheme, I know it is something a large proportion
of female (and some male) doctors aspire to once the reality of having
children hits home. It is very hard when choosing a career path in your
mid-20s to think ahead to having a family, but I would encourage anyone
who wants to do so (and has a partner with a career) to talk to as many
doctors as they can who have attempted to combine career and family.
I suspect many wish they could work part-time, but have been unable to
do so in hospital specialties. As a GP you maintain ultimate responsibility
for the care of the whole patient and the role has endless variety and
stimulation. It is sometimes possible to negotiate a contract for “school
hours only” for a few years, which is invaluable if you have small children
and a partner who works long hours.”
“There are also many opportunities for outside interests; I have been able
to develop a career as a GP educationalist while my children are still
young, doing much of my work in the evenings when they are in bed
and fitting the rest around school runs, sports days and all the rest of
family life. It was definitely the right choice for me.”

60

61
STAGE 4 OF CAREER
PLANNING:
PLAN IMPLEMENTATION
62 V. STAGE 4 OF CAREER PLANNING:
Plan Implementation
Overview
This chapter covers the nitty-gritty of putting your plan into action.
It begins with a description of the application process, and then includes
detailed advice on how to fill in application forms. In addition, CV
guidelines are included in Appendix C. The chapter then moves on to
explaining preparation you can do in advance of the interview, and also
covers advice on performing well on the day.
Some specialties also require applicants to make a presentation as part of
the interview process and we have included some basic guidelines on giving
an interview presentation in Appendix D.
This chapter ends by referring to some contemporary research on career
planning which highlights the role of luck and chance. In ending the
chapter in this way we are not suggesting that you can rely on striking
it lucky – but at the same time, the research does flag up the almost
inevitable influence of chance factors in lifelong career planning.
Application forms
In recent years there has been an enormous shift in the application
process. Not so many years ago applicants filled in a standard hospital
application form (which was often the same for administrative, clerical
and all healthcare staff), and they also included a CV. In the old system
very little weight was attached to the brief personal statement’ on the
standard application form, and everything went on the CV.
But times have changed, and structured application forms have largely
replaced CVs. One of the difficulties in this change is that some consultants
haven’t quite registered this it. This means that they might not always
provide the most useful advice. It is likely that application forms will
continue to evolve and short-listing will probably still take place on the
basis of some sort of structured form. So thinking about how best to
approach these forms is still a necessary task.

Initial preparation 63
Although in the current system you don’t have to complete the application
in one sitting, it still helps if you are thoroughly prepared for when the
application process goes live.
One useful way of making the task of filling in these forms easier is to
prepare an up-to-date CV in advance (see Appendix C). This means that all
the background data (dates of exams, of electives, of different posts, etc.),
is well organised in advance, and in one place.
In terms of helping you answer the more discursive questions on the forms,
the answers to the exercises that you have completed in this handbook
should provide good raw data. In addition, junior doctors will also need
to refer to their learning portfolios, while some medical students will
have similar collections of reflective writing that they had to fill in for
their undergraduate course. The better organised you are with these
three documents (i.e. your CV, your answers to the ROADS exercises and
your learning portfolio), the easier you will find the task of filling in the
application form.
Overview of the application process

As described in chapter 3, specialty recruitment is either nationally or
deanery led depending on the specialty. What this means is that you have
to familiarise yourself with the deanery, Royal College and MMC websites,
in order to be on top of the process used in the specialties to which you
intend to apply. If you look at these websites you will find out where the
posts are advertised. In addition, you will also find out about the timeline
for applications. These dates are immutable and you want to be aware of
them in advance, so that filling out your application forms doesn’t become
a horrendous last-minute rush. This is particularly important if you intend
to submit a number of different applications.
A detailed applicant’s guide to specialty recruitment, to assist applicants
with the process, is available on the MMC website. You will need to make
sure you have read through this guide and thought about its implications
as soon as it is made available on the MMC website.
Stage 4 – Plan Implementation

64 Figure 4: Overview of the application process for
foundation and specialty training programmes

Some golden rules 65
Many of the points listed below will seem obvious. But one of us has
had experience scoring applications for foundation programmes (and the
other has considerable experience of medical recruitment and selection,
particularly at consultant level) – and both of us know that a number of
applicants disregard some of these basic points.
1. Preparation, preparation, preparation

Make sure that you understand the practicalities of the application
process.
This involves reading through the whole form extremely carefully. When
is the deadline? Looking at all the questions, how long might it take
you to devise really good answers? Will you need to find additional
information that you don’t yet have to hand?
You shouldn’t start answering any question until you have studied the
whole form, because an example that you give for one question might
be one that you find you want to re-use for a subsequent question.
2. Understand what the recruiters are looking for

Familiarise yourself with the person specification for the training post as
short-listing will take place with reference to this specification. (After all,
you might bake the best chocolate chip cookies on the planet, but if the
recruiters aren’t looking for chocolate chip cookie bakers it probably won’t
do you any good to say so.) You always have to construct your answers
to the questions with the person specification in mind. (But this doesn’t
mean a simple reiteration of the person specification on your application
form. That approach becomes extremely tiresome for the reader.)
3. Check, check, and then check again

Mistakes (in spelling or grammar) will make it harder for you to get your
points across and can lead to the loss of marks. You might feel that this
is unfair as you are applying to work as a doctor, not an English teacher.
But we would counter-argue that the difference between 0.25 and
0.025 mg for a particular medication could be a matter of life and death.
Attention to detail matters, and being sloppy on your form won’t help
you get your message across.
4. A note about plagiarism

There have been a number of cases recently where applicants have been
referred to the GMC for plagiarism. So bear in mind the guidance given
in ‘Good Medical Practice’ that: ‘You must be honest and trustworthy
when writing reports, and when completing or signing forms, reports

66 and other documents.’ It also goes on to say that: ‘You must always be
honest about your experience, qualifications and positions, particularly
when applying for posts.’
Completed application forms will be checked for plagiarism and the
answers on the form must be your own rather than copied from the
works of others. Using a commercial service to provide answers for your
forms would not be regarded as compatible with the requirement that
you write the answers yourself. And if the commercial services end up
with a number of applicants writing very similar answers, then this is the
sort of situation that might be detected by the anti-plagiarism software.
The issue of how much help friends/supervisors can responsibly give
you is a far greyer area. But in Chapter 6 (the chapter for educational
supervisors) we advise consultants to give you general feedback rather
than mentioning specific wording that you should include on the forms.
How to approach the short-answer questions

There will be a number of questions on the form that relate to the person
specification. You could, for example, be asked about your experience of
team-working, leadership, time-management, making difficult decisions, or
your longer term career plans.
Typically, the space to answer these questions is limited to a specific
word count.
Some consultants may be relatively unfamiliar with these sorts of questions,
and may struggle with giving you the best advice. (Certainly, the advice
that you can dash off any old answer, because these questions aren’t that
important, is not advice that you should follow.)
1. As a way of preparing to write your answer, you might want to use the
STAR structure. By this we mean you could break down your example
into:

Situation/ Task
Provide a concise overview of the example you are considering using,
ensuring that it is relevant to the question.
Actions
What exactly did you do? What was your role and contribution? What
skills did you use? (This part will probably form the bulk of your answer.)
Results/ Reflection
What was the outcome? What have you learnt from it?
The STAR acronym is a very useful way of analysing the examples that 67
you intend using in the short-answer questions.

However, depending upon the actual wording of the question, you
might not actually include all the different parts, or you may want to
emphasise one part more than another. So in the actual answer you will
have to tailor the STAR components to the specifics of the question. But
STAR is an excellent starting point.
2. As mentioned above, gather together all the relevant personal data that
you might need to refer to, in one place, before you start answering these
questions. And by this we mean your answers to the exercises in this book,
your CV, your learning portfolio, information on any audits you have done
and, for junior doctors, the assessments that you have carried out.
3. Before you start writing anything, read through the GMC’s guide
‘Good Medical Practice’ (which can be obtained from the GMC website).
This will remind you of the qualities and values that the reader will be
looking for in your answers. Scoring of the application form may relate
to the elements of good practice outlined in this document.
4. Read the question extremely carefully. You need to make sure that you
answer all parts of the question, as each part will be allocated separate
marks. If the question has a number of parts, structure your answer in a
logical way so that it matches the different parts of the question. In this
way you will make it easier for the short-lister to recognise that you have
fully answered all the parts. In addition, your answers always need to be
relevant to the question that has been asked.

(When we are running seminars on application forms we often say that
you should imagine that each word you write is fighting for inclusion in
your answer. If it doesn’t ‘add value’, it shouldn’t be there.)
5. When the question asks for examples of achievements, or initiative, or
leadership, it is not requiring you to have extraordinary examples. In
other words, the short-listers are not expecting you to have written the
lead article in Nature, or have climbed to the top of Everest. Instead,
they are looking for answers in which you reflect intelligently, and with
insight, on the sorts of experiences that you would be expected to have,
at your particular level of training.
6. You will find it easier to write good answers about generic skills (e.g.
time-management, communication skills, teamworking) if you have
had some background training in these issues. If sessions on these
topics are offered as part of the generic training programme, we would
strongly advise you to attend them. This will give you a basic theoretical

68 underpinning that you can use to structure your answer. If these
sessions haven’t been offered (or if you missed them), then do a bit of
background reading before filling out the form.
7. When you are constructing your answers try to think about what an
observer would notice if they had been watching you. For example, if you
were asked to explain how you communicated with an agitated patient,
a good answer might describe how you remained calm, and responded
to the specific concerns the patient raised. If the patient had demanded
to see the consultant, you would also explain carefully to the patient that
the consultant was not on site, but you would be doing a ward round
the following morning and take personal responsibility for asking him/
her to speak to the patient when s/he was on the ward. An answer like
this demonstrates to the reader that you do in fact know what constitutes
effective communication with an agitated patient. In contrast, an answer
which said something like ‘I made sure that the way I responded to the
patient diminished their level of agitation’ doesn’t convey to the reader
that you would have the first clue how to do this in practice.
8. You will probably need to edit your first attempt at writing these answers.
We suggest this because often the first draft misses points out, or includes
irrelevant detail, but it is difficult to spot this at the time. Instead, if you
write the first draft, and then leave it (for at least a few hours), when you
come back to it, it is far easier to see what changes need to be made.
9. What you need to avoid is something that reads like a reiteration of the
person specification. In contrast, what you want to aim for is something
that engages the interest of the reader. With the best application forms
not only is it clear that the candidate has the necessary abilities and skills,
but the reader also builds up an initial sense of what the candidate is
like as a person. It’s a very hard balance to strike because you don’t want
to sound too confident or over-familiar. But you also don’t want your
answers to be arid or to sound as if they have come out of a textbook.
In our experience the best way of finding the middle road and writing
answers that engage the interest of the reader (and are, of course, also
highly relevant to the question) is to write about examples that matter
to you. With these examples, it is easier to convey your interest and
involvement, and in turn this helps to engage the reader. But you also
need to allow sufficient time for filling in the application form. If you
have read the question carefully, chosen your most appropriate examples,
and then fine-tuned your answers through sufficient editing, you are
maximising your chances of success.

So how long is long enough? 69
There are no hard and fast rules on how long it takes to fill in your
application form. But in our experience it usually takes longer than you
would think.
We would certainly advise you not to leave the forms to the last couple
of days before the deadline. Instead, look at them as soon as the system
goes live, and approach filling them in in the systematic way that we have
described above. It might also be helpful to ask more senior colleagues
who have already completed these forms how long it took.
Portfolios and CVs

During both foundation and specialty training you will use a portfolio/
e-portfolio to support your learning, collect together information about
your assessments and other achievements. Your portfolio can help support
you with career planning and your Personal Development Plan can be used
to help you consider what you need to do to progress your career.
Keeping you portfolio up to date is essential as it is used as evidence
to support sign-off as you progress through your training programme
(Foundation and Specialty) and can be used to help support your applications
for specialty training. It is often reviewed during the selection/interview
process into specialty training. Do ensure your portfolio is comprehensive and
contains your reflections on your training to date. It should also include a CV
which is a useful way of organising data about your educational career history
to date and we have included some advice on writing CVs in Appendix C.
Long listing and short listing

Once the application deadline has been reached the next stage in the
selection process is long listing. The applications which have been
received are checked against the essential eligibility criteria in the person
specification for the specialty and level applied for. The next stage is short
listing. For GP recruitment this involves Machine Marked Tests (MMT) in
Clinical Problem Solving (CPD) and Situational Judgement (SJT) and
detailed explanations of these different tests, together with sample
questions, are available on the GP national recruitment website
(www.gprecruitment.org.uk). For other specialties short listing is carried
out by consultants in that specialty. Some specialties are reviewing their
selection methodology and it likely that MMTs will be developed and
form an increasing part of the selection process in the future.

70 Interviews
Introduction
It is useful to begin by thinking about the purpose of interviews.
A formal answer is that the purpose of the interview is to assess each
candidate against the person specification, and thus identify which
candidate (or candidates) is best suited to the position on offer. But it is
also important to realise that you (as the applicant) and the panel members
all share membership of the human race. An interview should not feel
like a mechanised process of quality control but, instead, a professional
conversation in which you build up rapport with the panel.
Of course, building up such rapport is easier said than done. And nearly
everybody is nervous before an interview – particularly when there is a lot
at stake. But it is useful to remember that you want to convey a sense of
who you are as a person during the interview. After all, the panel will be
asking themselves if you are the sort of person whom they would want to
have as a trainee.
If you are very nervous, it is fine to say to the panel that you find interviews
quite stressful. Similarly, if you are asked an extremely difficult question you
can begin your answer by saying something like ‘That’s a tough one. But I’ll
give it a go.’ In these – and other ways – you can convey something of your
personality to the panel.
We often remind our clients that interviews for jobs are not like police
interrogations. By this we mean that whereas, if the police were
interviewing you to find out if you had committed a crime, you would be
unwise to comment that a question was very hard, or that you needed a
bit of time to prepare an answer, such strategies are entirely appropriate
in a job interview. Because, in the latter situation, responding in this way
both gives a sense of your own personality and also shows that you handle
pressure well.
Preparing for an interview

Most interviews will be structured and time-limited. There will almost
certainly be more than one person present. If there is a panel, one member
will be appointed as Chair, and is the person who is likely to welcome
you, introduce the other panel members, and outline the structure of the
interview. If the mantra for estate agents is ‘location, location, location’,
a similar refrain for career counsellors would be ‘preparation, preparation,
preparation’. (And this applies, of course, as discussed above, to the
application form stage as well as to interviews.)

The reason why this is so important is that many questions can broadly 71
be predicted in advance. So if you devote adequate time to pre-interview
preparation, you should be able to improve the quality of your performance
on the day. (Of course, you might still be asked some questions that you
haven’t considered before. But if a structured interview process is used, at
least you can reassure yourself that all the candidates will have been asked
this particular question.)
So how should you prepare?

For starters it is helpful to realise that questions which are asked at
interviews are usually divided into three broad areas:
1. Questions about you.
2. Questions about the job/specialty.
3. Questions about the wider context of healthcare.
Each of these three categories will be considered in turn.
1. Questions about you

The list below gives examples of the sorts of questions about yourself that
you might be asked.
1. Describe some of your key qualities/characteristics.
2. Tell me what you have gained from your training to date?
3. What are your key strengths?
4. What do you think is your greatest achievement to date?
5. Tell me about your approach to working in a team.
6. Describe a situation at work which, in retrospect, you think you could
have handled better. What did you learn from the situation?
7. What sort of decisions do you find it difficult to make?
8. What do you see yourself doing in five years’ time?

72 General guidance on these questions
It is always far better to refer to specific examples than to talk in
generalities. So, for example, if you are asked about your strengths,
mention perhaps two to four points, but link each of them to a specific
example (which can be from work or from out of work). If you just talk in
generalities (I’m compassionate, organised, thorough, etc.), a little voice
pipes up in the head of the listener saying, ‘Well, you would say that,
wouldn’t you?’ But if you supply the examples, the answer as a whole has
much more credibility.
(And as an aside: that’s why working through the exercises in this book is
important, because they supply you with the sorts of examples that you will
need to draw on in your application forms and at interview.)
Not only should you have thought out examples of all your positive points,
but you should also have planned what examples you will give if you are
asked about your mistakes or areas of weakness.
The key thing to consider when you are asked about mistakes or areas
of weakness is to choose an appropriate example. Bearing in mind the
elements of the GMC’s ‘The New Doctor’ you cannot refer to any example
that would cause the panel to have doubts about your suitability as a
doctor. But, equally, you don’t want to refer to anything too trivial, or to
be too clever by sneaking in a positive under the guise of a negative. For
example, if you are asked about your weaknesses, responding by saying
that you work too hard might be off-putting for the panel. Everybody has
areas of personal weakness, and they should be able to discuss them, with
insight, at an interview.
We would suggest that the best strategy is to choose a middle-of-the-
road sort of example, and then – whether you are asked for this part or
not – tell the panel how you remedied the situation. So, for example, you
could say something such as initially you found it hard to switch off from
work, and it was affecting your sleep. But you realised that you had to be
able to recharge your batteries at the end of the day, so you started going
for a run, playing the piano, reading a novel, or whatever, and that helped
you to switch off from work and get a good night’s sleep. (This is only one
example – there are hundreds that you could use. But it illustrates the point
that you need to pick the everyday sorts of examples that will have actually
happened to you as part of your medical school/foundation training, and
then describe to the panel what you did to remedy the situation.)

2. Questions about the job/specialty 73
Questions in this category might include the following:
1. Why do you want this job?
2. Why have you applied to this particular training programme?
3. Talk us through your CV.
4. What skills will you bring to this specialty?
5. Describe your views on whether less than full-time training is possible?
6. What do you think it takes to excel in this particular specialty?
7. What’s the most useful course that you have attended in the last
12 months?
8. Tell us about a research paper that you have read recently that has had
an impact on your clinical practice.
For questions of this type you will be drawing on your answers to the Stage 1
and Stage 2 exercises, including any psychometric instruments that you
have completed. If you have given sufficient thought to both these stages
you should be able to give coherent answers to these sorts of questions.
This is because, essentially, most of these questions are assessing the match
between your personal qualities and the demands of the job.
Before you go for an interview you should be familiar with the person
specification, and any other basic information on training issued by the
relevant Royal College. In addition, you should also try to get some sense
(either through College literature or through talking to people in post) of
likely developments in that specialty, because, with the introduction of new
technologies, some specialties can expect significant changes in the future.
(A well-known example is cardio-thoracic surgery, where the rise in invasive
cardiology – performed by medically trained cardiologists, not surgeons –
has meant that more procedures are being done through catheters, with
earlier intervention in acute myocardial infarction, and therefore less open-
chest surgery is required.) So check for likely future developments in your
specialty of interest.
As for good ways of answering questions about the specialty, you need to
distinguish between questions of different sorts. For example, if you are
asked why you want to train in a particular specialty, you shouldn’t have
to pause for a long time before you answer. In fact, you should expect to
be asked why you are applying for the post, and a good, well-thought-out
answer should be on the tip of your tongue.

74 However, you might also be asked to discuss some more complex scenarios
related to your specialty – or indeed to the practice of medicine in general.
In this situation, you will not be expected to have an answer immediately
and it is perfectly acceptable to pause before you respond. (More detailed
guidance on answering questions of this sort will be given below.)
Questions about the wider context of healthcare

Typical questions in this third category include the following:
1. What do you think about the recommendations of the Tooke Inquiry
into MMC, and the Department of Health’s response to these
recommendations?
2. Describe how you think appraisal will help improve the quality of care
that doctors deliver to their patients?
3. What do you think are the main challenges facing the NHS? (These could
include Payment by Results, MMC, NHS Direct, Foundation Trusts, etc.)
4. Should patients be involved in decision making about their care?
5. How might the European Working Time Directive affect you?
6. What is audit, and how does it differ from research?
7. Can you tell me about an audit project that has influenced your practice?
In answering these questions you are not expected to be an expert on
health policy or have an MBA in healthcare management. However,
you are expected to have a basic understanding of the wider healthcare
context in which you would be training.
As a basic minimum you should look at the following websites:
1. The Department of Health.
2. The relevant Royal College.
3. The Deanery/Foundation School to which you are applying.
4. The MMC website
In addition, you might also want to look through the on-line archives of
BMJ Careers (to find recent articles about your specialty), Health Service
Journal (to get short articles on health service topics) and perhaps even
the King’s Fund (which has good coverage of relevant NHS policy issues
such as the establishment of foundation trusts).

If you are very keen on management issues, and see yourself as somebody 75
who might want to manage a clinical service in future, see if you can get
to talk to somebody in your Trust (or PCT) who has a senior management
position. They will be able to give you a feel for how initiatives which you
read about (e.g. Payment by Results) are being implemented in practice.
Questions that you can’t easily anticipate

You might find that you are given particular clinical scenarios and asked to
comment on them. Or, alternatively, you might be asked about your views
on tricky ethical dilemmas.
As mentioned above, don’t rush into answering questions of this sort,
and take a moment or two to gather your thoughts. As regards the
clinical scenarios, the panel will be interested in both the content of your
answer and also whether you demonstrate a systematic, well-thought-out
approach to the problem. If there is one fact that you are unsure about,
then acknowledge this to the panel, but try your best to provide a logical,
well-reasoned answer that demonstrates an ability to distinguish between
essential and non-essential clinical tasks.
In contrast to the clinical scenario, if you are posed a complex ethical
dilemma, you don’t necessarily need to give the panel a hard-and-fast
answer as to exactly what you would do. Instead, you can say that that is
a very tricky situation, and one that you would hope that you would never
find yourself in. In effect, you describe the factors that you would take
into consideration when approaching the situation, rather than necessarily
coming up with something cut and dried.
(If, though, the panel says that you are sitting on the fence, and they need
you to be more explicit in what you would do, then of course you would
have to come down on one side of the fence or the other.)
Structuring your answer

In the section above on application forms, it was suggested that you could use
the STAR approach as initial preparation for your application form answers.
To recap: the STAR approach suggests that you should do the following:
1. Briefly describe the situation or task.
2. Briefly describe your own actions/activities – i.e. what you did.
3. Briefly describe the results (and/or your reflections).
4. The MMC website.
76 It can be useful interview preparation if you read through your portfolio,
and the answers to the Stage 1 and 2 exercises, in order to analyse both
positive and negative examples, using the STAR structure. However, we
would not suggest that you necessarily stick to the STAR structure in how
you word your answer in interview – or that you necessarily give equal
weight to the different components.
You certainly don’t want to give the impression that you are parrotting
pre-prepared answers, as this is unlikely to build a rapport with the panel.
Instead, by thinking through clear examples (of both positive and negative
aspects of your work) prior to the interview, you can give more succinct and
focused answers.
General advice on interview technique

1. If you are being interviewed by a panel you need to make sure that you
build a rapport with all the panel members. Although you should focus
your eye contact on the person who has asked you the question, you
might also want to make eye contact from time to time with the other
panel members.
2. If you don’t understand a question, then in the first place you can ask for it
to be repeated or clarified. If you still don’t understand after the repetition/
clarification, it is probably best to indicate this in your answer. For example,
you could say something like: ‘I am not sure if this is what you are looking
for in the answer, but I think that the key points here are x, y and z.’
If there is any possibility that you haven’t properly understood the
question, it is better to allude to this in your answer. Giving a completely
off-the-wall answer, without indicating to the panel that you know you
may be way off-track, is potentially far more damaging to your chances.
3. It is to be hoped that the panel won’t be giving you short, closed
questions (except where they need to check out particular factual details,
such as when you would be able to start in post). But if they do, resist
the temptation to give one-word answers, and expand on the answer a
little, regardless of the question.
4. If you don’t know the answer to a factual question, don’t ramble on in
the hope of divine inspiration arriving mid-answer. In our experience, it
tends not to be forthcoming! Instead, it is best to admit that you don’t
know the answer, smile, and explain that you have forgotten it, or that
it is something you haven’t experienced yet. If you can, offer an answer
to a more generic situation related to the question, but that doesn’t
require you to remember a particular factual detail. (For example, if
you are asked about the management of a particular condition in an
elderly patient, and you have forgotten the details, or never knew them, 77
we would suggest that you admit to your ignorance, and then say
something about general approaches to care of the elderly.)
5. Long rambling answers are best avoided. As soon as you realise you have
started to ramble, pause, gather your thoughts, provide a brief summary,
and then finish off your answer.
6. Look through the suggested interview questions listed above and
practise giving succinct answers. We would suggest that you say these
answers out loud, rather than running through the points in your head.
If you get into the habit of vocalizing your answer to the mirror, it can be
less anxiety-provoking to hear yourself speaking in the actual interview.
In addition, you can also practise not rushing through your answers, but
using a slightly slower, clearer, rate of speech.
7. Think about your body language (not only eye contact, but also how you
are sitting, whether you appear sufficiently, but not overly relaxed, etc.).
If appropriate, a lightness of touch can go down well – but obviously this
depends upon the situation. So, for example, if you are presented with
a scenario involving a very distressing situation, we would not advise
you to treat it in a light-hearted manner. But if you are asked about
your weakness, you can (after first demonstrating insight through an
appropriate discussion of a particular weakness) add a comment like:
‘I also have a weakness for chocolate’, or Manchester United, or whatever.
But you have to use your professional judgement as to whether such
comments would be appropriate or not (just as you use your judgement
with patients as to whether, at a particular moment, a light-hearted
comment would ease the situation, or cause great offence).
When it’s your turn to ask questions

At the end of the interview you may be asked if you have any questions.
(If your interview is only 10–15 minutes, this might not happen.)
If they do ask you for your questions, avoid putting a question for the sake
of it. Interviews are tiring for the panel, as well as for the candidates, and
interviewers don’t appreciate being asked pointless questions.
If you really haven’t got a sensible question, say something like: ‘All the
questions that I had planned to ask have been covered in your explanation
of the post. ‘This means that you don’t end the interview by responding
with a curt ‘No’.
However, it is a good idea to have a couple of suitable questions up your
sleeve. Possibilities include the following:

78 1. What impact do you think the changes to medical career pathways will
have on the training in this deanery?
2. Are there any opportunities, at a later date, for sub-specialty training in
x, y, or z? (But make sure that the answer to this question is not covered
in any readily available information about the training programme.)
3. What have the trainees who have just finished training in x specialty in
this hospital gone on to do?
Presentations
Prior to the MMC reforms, interviews for entry into a specialist training
programme, or for consultant posts, typically involved you giving a
presentation. At present you would probably not be expected to give a
presentation during an interview for entry on to a foundation programme.
However, you may be asked to give a presentation during an interview for a
basic specialty training programme. And starting in 2008, some specialties
required the applicant to devise the presentation on the day of the interview
– i.e. they did not supply the title of the presentation in advance. We have
included guidelines for preparing a presentation to be given as part of an
interview in Appendix D.
Selection centres
One of the recommendations of the Tooke Inquiry into MMC was for the
need to develop more robust selection systems.
A number of specialties are now using ‘selection centres’ as part of the
recruitment and selection process. This approach is based on the idea that you
end up with more robust selection decisions if you present applicants with
tasks that reflect the actual activities that they would have to carry out in the
job to which they are applying. So for example, the selection centre that is
used in General Practice includes 3 exercises: an encounter with a simulated
patient; a group exercise and a written exercise (www.gprecruitment.org.uk).
These activities are observed and assessed by trained assessors.
If the specialty to which you are applying is using a selection centre
approach, you will be provided with information about the selection
centre as part of the information available for applicants. There is often
little specific preparation that you can do for the selection centres above
making yourself familiar with the person specification of the post for
which you are applying. However, you may find it helpful to look at a DVD
produced by the Association of Graduate Careers Advisory Services entitled
‘Selection Centres for Specialty Training’. Ask the Centre Manager in your
postgraduate education centre, or the careers specialists at your deanery 79
for further information.
Final comments
In writing this chapter, we feel as if we have left you on something of a
cliffhanger. We have given detailed guidance on decision making and plan
implementation – and after that you can’t progress your plans any further
until you have heard the results of the selection process.
If you are successful, we hope that the structured advice given in this
handbook has helped you to make a robust career decision, and that you
are looking forward to getting going with the next stage of your career.
If you are unsuccessful, you might be in a very different state of mind. In
our experience (both personal, and also from our client work), we know
how demoralised and hurt people can feel when they have put a huge
amount of work into an application process which ultimately ends up in
rejection. It’s often a very depressing position to be in.
But, in time, you will have to pick yourself up, dust yourself down, and
work out your next steps.
The first thing to do is to try to get as much information as possible about
your unsuccessful application, because the more information you have, the
better position you are in to review your next step.
After this, we would advise you to go through a brief review of the career-
planning framework, to see if you want to change your choices or not. If you
decide not to, you will then need to concentrate on Stage 4, to see how you
can increase your chances of a subsequent application being successful.
We would also like to add two further observations.
The first is that a myth has been circulating in medical recruitment that for
each doctor there is really only one career option that would suit them. In
part, we think that this is a by-product of the old days when, at interviews
for higher specialist training, you had to demonstrate your undying
devotion to that specialty, and no other.
But this myth doesn’t have psychological validity. Instead, as we described
in Chapter 2, the psychological literature suggests that each doctor could
be well suited to a number of different specialties (although there would
definitely be others that would not suit them well). So we would encourage
you to be flexible in your thinking – in particular about the ‘O’ in the ROADS
acronym, i.e. ‘opportunities’. Go back and see if there are other options that
you hadn’t considered previously to which you might also be suited.

80 The second observation relates to the first, and is that even within
specialties there is enormous variation in the day-to-day details of what
people actually do. For example, a GP in a single-handed rural practice and
a GP in a large multi-partner health centre practice will have some duties in
common, but other aspects of their daily work will differ enormously.
What this means is that even when you have successfully navigated
yourself through the maze of specialty training, the demands of career
decision making are not over. Quite the contrary in fact, as you will have
to make important career decisions throughout your professional life, up
to and including the time you decide to retire. (Examples include whether
you want to do sub-specialty training, become a GP with a Special Interest,
developing teaching or management responsibilities, flexible or part-time
working, etc.)
John Krumboltz, an eminent psychologist at Standford University has
argued that change is an inevitable feature of contemporary careers – and
the real challenge of career planning is learning how to identify a route
through an unpredictable career landscape. Whilst Krumboltz’s research is
based on the American employment situation, and covers the job market
as a whole rather than just medical careers – medical students and doctors
in the UK can probably identify with his conclusion that career pathways
contain an element of unpredictability.
Krumboltz has even coined a term for his preferred approach ‘planned
happenstance’ which he defines as helping people ‘to generate, recognise
and incorporate chance events into career development’. (Mitchell, Levin
and Krumboltz, 1999).
It’s beyond the scope of ROADS to look in detail at how to make the best
of chance events in order to maximise career success – but we will let
Krumboltz have the last word in this chapter because what he says seems
particularly relevant to the challenges currently facing doctors in the UK:
‘Some luck lies in not getting what you thought you wanted but getting
what you have, which, once you have got it, you may be smart enough
to see is what you would have wanted had you known’. (Krumboltz and
Levin, 2007).

81

82

83
GUIDELINES FOR
THE EDUCATIONAL
SUPERVISOR
84 VI. G
UIDELINES FOR THE
EDUCATIONAL SUPERVISOR
Overview
This chapter begins with a brief description of the key players in
postgraduate career support at trust level (namely Clinical Tutor/Director
of Medical Education, the Foundation Programme Training Director and, in
some deaneries, the Faculty Careers Lead). It then moves on to describing
both the broader and career support responsibilities of the educational
supervisor, and looks in detail at the specific concerns that consultants
often express about the career support aspects of their educational
supervisory role. Specific guidelines are given about supporting trainees
whose career plans you believe to be unrealistic as well as supporting
trainees who are contemplating leaving medicine.
The chapter then provides guidance on how to approach a 1:1 career-
planning discussion with your trainee, and gives examples of the sorts
of issues you might discuss in each of the four career-planning stages.
Although the emphasis of the chapter is on the provision of 1:1 support,
the chapter ends with guidance on running group career-planning
workshops. Detailed suggested teaching plans for these workshops are
included in Appendices E and F. (Further electronic resources can be found
on the medical careers website www.medicalcareers.nhs.uk).
Key players in the delivery of career support

It can be helpful to think about tiers of career support.
The first tier of support will typically be provided by educational supervisors
as they are most likely to be able to take a more informed and constructive
role about a particular trainee’s strengths and weaknesses. The second
tier of support is typically provided by the trust Directors of Postgraduate
Medical Education (DMEs), which is the new term for trust Clinical Tutors.
Sitting alongside the DMEs, the Foundation Programme Training Directors
and, if your deanery has them, the Faculty Careers Leads can also be called
upon to provide second-tier support.
The third tier of support is that provided by the deanery-based careers team.
Typical referrals to this team include a trainee who is struggling to make
decisions, someone who is hanging on to plans which all concerned feel
are desperately unrealistic, or a trainee who is seriously considering leaving
medicine.
In addition, senior clinicians within the Foundation School sometimes call 85
upon the deanery careers team when a particular trainee is causing concern
and seems to be finding it hard to settle into their role as a junior doctor.
Ideally, everybody who provides career support should be appropriately
trained for the level of support that they provide. Within many deaneries,
basic training has been provided for educational supervisors on how
best to support trainees with their career planning. Some deaneries
(e.g. N. Western and London) have also produced e-learning resources
for clinicians on this topic. For the second tier, the National Association
of Clinical Tutors (NACT) provides relevant training. As for the third tier,
these are people like us who are qualified careers professionals, so the
task there is continuing professional development rather than basic skills
training. Organisations such as AGCAS (Association of Graduate Careers
Advisory Services) provide professional training that is highly relevant to
staff offering third-tier support and there are also a number of professional
networks for Medical Careers Advisors.
Defining ‘you’
The previous five chapters were written for the junior doctor or medical
student. In contrast, this chapter is written with the educational supervisor in
mind. (In effect the ‘you’ that we have in mind when writing this handbook
has switched. Throughout Chapters 1–5, the ‘you’ has represented the
recipient of career support, while in this chapter the ‘you’ becomes the
educational supervisor.)
Shared framework
We want to return briefly to the first chapter, where reference was
made to a study by Hirsh et al (2001). In this study it was found that
in workplace career discussions, if both participants had a common
framework the recipients found the career discussions more productive.
Bearing this finding in mind, it should be clear that you (the educational
supervisor) should read through and ‘digest’ the contents of the first
five chapters. (And, in fact, you might also want to try out some of the
exercises yourself, as that way you will be in a better position to discuss
them with your trainees.)
Guidelines for the Educational Supervisor

86 The role of the educational supervisor
The guide to specialty training (the ‘Gold Guide’) published in 2008 and
available on the MMC website, outlines the roles of educational and clinical
supervisor. It is clear from this guide that the same person may provide
clinical and educational supervision, although it is also acceptable if the roles
are split, as long as there is appropriate liaison between the two supervisors.
Digressing for a brief moment, it is necessary to refer to some educational
theory, in order to clarify the differences in roles.
If you look at a standard textbook on the theory of assessment (e.g.
Freeman and Lewis, 1998), you will find explanations about the difference
between formative and summative assessment.
Formative assessment aims to provide feedback to the trainee, so that they
are in a position to be able to improve their work. It tends to be provided
during a period of training, rather than simply at the end. Formative
assessment attempts to uncover both the strengths and weaknesses in a
trainee’s work.
In contrast, summative assessment counts towards or constitutes a final
assessment or qualification. It involves making a professional judgement
about the adequacy (or otherwise) of different aspects of the trainee’s work.
Applying these terms to the context of foundation training, within the
operational framework, both educational and clinical supervisors have to be
trained to carry out competence assessments of junior doctors (i.e. summative
assessment). In addition, educational supervisors have to provide educational
appraisals (i.e. formative assessments), to enable the trainee to reflect on their
learning, and then jointly agree on appropriate educational goals.
It is also the task of the educational supervisor to have regular discussions
with their junior doctors about their career plans, and refer them to second-
(or even third-) tier support if necessary.
Educational supervisor as provider of career support

Having run training workshops for consultants in a number of deaneries, we
know that consultants often express concern about the following issues:
1. Their level of expertise across the whole span of medical careers.
2. Can they provide high-quality advice?
3. The trainee with unrealistic career plans.
4. The trainee who is considering leaving medicine.
Each of these will be considered in turn.
You’re not an expert across the whole range of 87
medical careers
On courses when consultants say that they are worried about giving careers
advice because they don’t have sufficient information about all the different
options available, we often draw parallels with our own career-counselling
practices. Currently in our own private practices we are working with
individuals in publishing, medicine, the wine trade, health policy research,
journalism, financial services, veterinary medicine, telecommunications and
production engineering. And while we know quite a lot about some of these
fields, we might know relatively little about other occupations on the list.
But our role is not to be an ‘expert’ in each and every possible occupation
(there are too many of them to achieve this). Instead, we need to know
where our clients can find more information – printed and web-based
(e.g. www.medicalcareers.nhs.uk), and also know how they can gain
access to people who do have expertise in the field of interest.
Using the suggestions outlined in Chapter 3, you should be in a better
position to direct trainees to appropriate resources, so that they can begin
to access the information that they need in order to decide whether that
particular option might suit them. Bear in mind, too, that if the trainee has
worked their way through the Stage 1 exercises, they should be in a better
position to know the sort of information that they want to find out about
when they begin to explore particular options.
Concerns about the quality of careers advice

What about the concern that you might inadvertently give a trainee poor
careers advice? We understand that this is a definite area of concern and
we also know that you – the educational supervisors – are in front-line
positions, in terms of receiving anxious and overwrought requests for help
from your junior doctors. In reality, making decisions is hard enough at
the best of times, and in the current climate of frequent changes in post-
graduate medical training, it can become even harder.
In fact, currently it is extremely challenging to give ‘advice’ as there are
so many unknowns in the new system. However, we would suggest that
advice giving is not your key role – even if the situation was much more
stable. Instead, your role is to provide a ‘route map’ for the trainee through
the rough terrain of career decision making, but it is up to the trainee to
pick the final destination. Or to phrase it rather differently, your role is to
ask challenging, insightful questions – but not to provide the answers.

88 On courses when we introduce this idea of providing a ‘route map’, but
not the final destination, we are frequently challenged by consultants,
who tell us that it is unrealistic. However, having had many heated
discussions with consultants, over a number of years, we feel that much
of the disagreement comes from an understandable confusion between
two different aspects of the educational supervisory role, namely that of
assessor (if you are carrying out a summative, competence assessment)
and careers adviser (when you have a formative developmental discussion
about the trainee’s career plans).
Imagine the following scenario. In your role as clinical supervisor you have
graded a particular trainee as ‘borderline for F1 completion’ on some of the
assessment tools. In particular, their performance seems highly variable on
some DOPS (Direct Observation of Procedural Skills) assessments.
But you are also an educational supervisor to this trainee, and during
their educational appraisal they tell you that they want to apply for
basic specialist training in surgery, with a long-term goal of training in
a particularly competitive surgical specialty. What should you do?
First, if you are both educational and clinical supervisor to a particular
trainee, when you are sitting down to have an appraisal meeting, you
need to think about what hat you are wearing. In terms of your role as
a summative assessor, you cannot (and must not) alter your professional
judgement that your trainee has been ‘borderline’ on these competencies,
just because they have set their heart on a career in surgery. But in terms
of your role as a careers adviser, rather than agonising whether you should
advise the trainee to reconsider their career choices, you should focus on
asking the following sorts of challenging questions.
What does the trainee see as their key strengths?
How does this self-assessment of their key strengths fit in with some of the
assessment evidence in their learning portfolio?
In which areas have they been assessed as being less strong? Are any of these
areas important in terms of demonstrating suitability for surgical training?
Is there a match between their areas of personal weakness and areas which
are critically important in terms of suitability for surgical training?
Have they researched the likely competitiveness for Basic Surgical Training?
What are their thoughts on the fact that competition for entry into Basic
Surgical Training is going to be very tough, but they have not scored highly
on the relevant key competencies?
Have they thought through the robustness of their decision using the
ROADS criteria?
And we could go on and on… 89
Typically consultants then challenge us and say why not ‘call a spade a
spade’, and just tell them that they are not suited for further training in
surgery? We would argue that the challenging questions approach outlined
above is more robust, for the following reasons.
1. The directive approach (i.e. ‘If I were you, I’d ditch surgery’) absolves the
trainee from taking responsibility for their own decision making.
2. Posing challenging questions rather than providing answers makes it
more likely that the discussion will be opened up, and the trainee will
start to think critically about their position.
3. If you go down the ‘If I were you’ route, it is tempting for your own pet
likes and dislikes to influence the advice you give. This means that you
might be more likely to encourage the trainee to reconsider specialties
of interest to you, and to avoid those you particularly disliked at medical
school. But of course, the ‘If I were you’ route has a basic flaw: the
trainee is not you.
4. Your opinion could possibly be wrong. (For example, perhaps something
is going on in the trainee’s private life that means that they have been
sleeping poorly, and in turn getting poor assessment results. But the
trainee knows that at medical school they received highly favourable
feedback on their potential for surgical training.)
We want to reiterate that in suggesting you avoid the ‘If I were you’ advice-
giving approach, we are not advocating that you avoid challenging the
trainee’s career decision making. But we are suggesting that you encourage
the trainee to reflect on the robustness of their career plans by posing
challenging questions, rather than pointing out the answers. And if you go
down this route, any concern about providing poor advice should be much
less acute.
In fact, what you should be concerned about is posing questions that are
insufficiently challenging.

90 The trainee with unrealistic career plans
The lengthy example discussed above is obviously also relevant to the issue
of the ‘unrealistic’ trainee. But it might also be helpful to mention a couple
of other points.
First, if you are faced with a trainee who persists in wanting to pursue a
career plan that you feel is completely unrealistic, we would suggest that
you ask the trainee to go and discuss their plans with another colleague
who is in that particular specialty, or with somebody (either a clinician
or a careers adviser) who has had additional training in career support.
You should then do a brief summary outlining your own concerns about
the robustness of their career plans and give it to the person who will be
providing this additional support.
Secondly, on courses, we often end up discussing the difference between
behaving responsibly ‘to’ but not being responsible ‘for’ the trainee. As
outlined above, we would suggest that part of being responsible ‘to’
the trainee involves the provision of clear, constructive feedback about
how they are performing in their current role; encouraging the trainee to
carry out stages 1–3 of the career-planning process and challenging the
robustness of proposed career plans using the ROADS criteria. All of these
are ways in which you are behaving responsibly ‘to’ the trainee.
But you are not responsible ‘for’ the trainee.
If your trainee wants to ignore clear feedback that you have given them
about their below-average performance in the current job, or ignore the
facts on how competitive it is to succeed in their chosen pathway, or ignore
the fact that they can’t really give a clear and coherent reason as to why
they feel that they are suited to the specialty, then, ultimately, that is the
trainee’s decision.
This distinction might help you feel less anxious if a trainee insists on
following what you feel is an ill-advised career pathway. Because if you have
behaved responsibly ‘to’ the trainee, that is all that is required of you, and it is
not always possible to stop some people from making poor career decisions.
The trainee who is contemplating leaving medicine

Trainees may consider leaving medicine for a variety of reasons. For some,
the notion that they might not be suited to the profession had already
started during their undergraduate training, while for others it is the
demands of being a junior doctor, rather than a medical student, that make
them want to reconsider their plans. And yet others might be influenced
by feeling unsupported in a particular placement.

In addition, while some trainees who are considering leaving the profession 91
experience difficulties with their training, and are perhaps regarded by their
educational supervisors as possibly not being up to the job, others may be
highly regarded by their supervisors.
Working through the structured approach to career planning outlined in
this handbook, should help the trainee start to become clearer about their
career plans. And if it seems that a lack of support in a current placement
is contributing to their dissatisfaction with the profession, you would need
to liaise with the Foundation Programme Training Director in your trust (or
specialty training director, if it is a post-foundation trainee).
However, as both of us are providing individual career counselling to trainees
who are considering leaving medicine, we know from experience that many
of these trainees greatly value specialised career support. We would therefore
suggest that if a trainee comes to you saying that they might want to leave
the profession you begin by using the approach outlined below in this
chapter, to see if it is a temporary issue that can be resolved relatively simply,
or an issue relating to specific difficulties in a particular placement. But if,
after further discussion, it seems that they are seriously considering leaving
medicine, we would suggest that they access the additional third-tier career
support or invest in some private career counselling.
Currently, given the flurry of activity around medical career counselling,
a number of organisations are being set up to offer services. Just as with
other sorts of counselling or psychotherapy, we would strongly recommend
that your trainee checks that the practitioner is adequately accredited by a
suitable professional organisation. A list of appropriate professional bodies
is included in Appendix A.
We would also like to add one further observation. In our experience,
consultants often feel a sense of personal failure when a trainee (particularly
a good one) admits that they are considering leaving the profession. We
would certainly want you, in your role as educational supervisor, to behave
responsibly ‘to’ your trainee, in all the ways detailed above. Thus if they come
to you saying that they are unhappy and might want to leave medicine, we
would want you to provide a supportive, structured response, in order to see
if it is a temporary problem that could be remedied in some way.
But if, after you provide this sort of response, the trainee still persists in
wanting to leave medicine, then you are not responsible ‘for’ this decision,
and it does not represent a personal failing on your part.
What we often point out when this issue is raised in training workshops is
that if selection into medical school was a completely foolproof business,
and if people did not change during their five or six years of undergraduate
training, you would be right to feel that the trainee had, in some crucial
92 way, been let down by the system. But of course selection into medical
school is not completely foolproof, and people change during their
undergraduate training. So for both of these reasons some trainees may
correctly conclude that they don’t want to stay in medicine.
Your responsibility is to ensure that they have thought through the decision
adequately, and where appropriate received specialised career support. But
you shouldn’t automatically regard the exiting trainee as a personal failure.
How to approach a 1:1 career-planning session with

your trainee
One of the responsibilities of the educational supervisor is to have regular
feedback meetings with your trainee. This means that you should devote
some time to discussing your trainee’s career plans at each educational
appraisal meeting. However, depending upon how each particular trainee
is furthering their career plans, you might want to concentrate on career
issues during one session or even arrange a separate time when you
specifically focus on their career plans.
At all costs, what you want to avoid is the trainee failing to engage with
the necessity of identifying their next career move – and then going
into panic mode at the beginning of the second foundation year, when
recruitment for specialty training looms.
Use the four-stage approach

It was argued above that your central role, in terms of supporting career
planning, is to provide your trainee with a ‘route map’ through the career-
planning stages. So in your first session with your F1 trainee we would
suggest that you check their understanding of the overall four-stage career-
planning framework, and then concentrate on Stages 1 and 2.
We cannot emphasise enough that good career decision making rests on
the foundations of adequate self-assessment and career exploration. It is
therefore imperative that you encourage your trainees to spend adequate
time on these first two stages.
In subsequent sections, ways of supporting your trainee through each of
the four career planning stages are described.
Ask your trainees to bring their learning portfolios and (if they have one)
their career-planning folder to all of their meetings. This will help them to
review their work, and also help them develop a systematic approach to
their career planning.

We would also like to emphasise the importance of listening carefully to 93
your trainee in these 1:1 meetings. (And a favourite adage that we often
use on training courses is given that we have been equipped with two ears
and one mouth, we should use them in those proportions.) One helpful
way of monitoring whether you are listening with enough care is to try to
monitor who is doing most of the talking. There might be times in a 1:1
educational appraisal meeting when you (the consultant) should do most
of the talking. But in general, in career-planning sessions, you should be
asking the questions, and contributing your feedback, while the trainee
should be doing most of the talking.
In terms of helping the trainee reflect on their developing career plans,
in the sections below we outline the sorts of questions that you should
be posing to your trainees. But it is important to remember the parallel
with clinical consultations described at the beginning of chapter 2: just as
it is pointless worrying about the details of a treatment regimen until you
have taken a clinical history, examined the patient, and at least formed a
preliminary diagnosis, so too do you have to ensure that the earlier stages
of career planning are in place before you start doling out advice on how
to succeed at the application process.
Your trainee might also find it helpful if you agree on specific career-planning
tasks that they will carry out between the 1:1 meetings, together with
appropriate timescales for their completion.
Weaving in your feedback

In your role of guiding your trainee through a structured framework of
career planning, you also have a vital role in terms of providing them with
feedback on their performance to date.
Using the learning portfolio (and any other relevant data), you need to
weave in your own understanding of how they have been progressing.
If this understanding accords with their self-assessment or developing
career plans, then you need to say so. Equally, when there is a discrepancy
between what they are saying about themselves and your own opinion
– then you need (as described above) to highlight these discrepancies, in
order to discuss them as fully as possible.
While we are advocating that you should encourage your trainee to engage
in rigorous self-assessment, we are not advocating that this should take
place in a vacuum. Instead, it is your task to use your understanding of this
trainee’s performance to confirm, or to pose constructive challenges to,
what the trainee is saying about their career plans.

94 A summary of the key points for a 1:1 meeting with your trainee is included
in Table 3.
Table 3: Summary of key points for a 1:1 meeting

• Spend some time discussing your trainee’s career plans at each
educational appraisal meeting and if necessary arrange an extra
meeting devoted to career planning.
• Encourage your trainee not to leave career planning to the last minute.
• In your first session, review the overall four-stage career-planning model.
• Ask your trainee to bring their learning portfolio and if they have one,
their career-planning folder to all 1:1 meetings.
• Listening is key. Remember! We have two ears and one mouth – to be
used in that proportion.
• Help your trainee to lay the groundwork by spending sufficient time on
Stages 1 and 2.
• At the end of each meeting, ask your trainee to specify which career-
planning tasks they will carry out, and within which specified timescale.
• Ensure you provide them with clear, constructive feedback on their
performance to date.
• Encourage them to use the learning portfolio (and any other relevant
data) to enhance their understanding of how they have been
progressing.
• If you are concerned that the trainee is being unrealistic, focus on
challenging questions rather than directive advice.
• If necessary suggest that they talk through their career plans with a
colleague. Before this meeting, provide your colleague with a brief
report that outlines your concerns.
Helping your trainee with their self-assessments

(Stage 1)
Your task here is to encourage the trainee to conduct a thorough self-
assessment of their work values, skills etc. as well as possibly completing a
psychometric test of interests or personality. You also want to help the trainee
to reflect on the results of these self-assessments, so that they are able to
identify the implications of these exercises for their future career choices.

We would not, however, recommend that the trainee completes these 95
exercises during the 1:1 meeting. Instead, we would suggest that the
trainee should complete the exercises in their own time (or in a career-
planning workshop), and that they should bring the completed exercises to
the 1:1 session for further discussion.
In the table below (see Table 4), we give suggestions for the sorts of
questions that you could helpfully pose to your trainee about the Stage 1
exercises. (These are only suggested questions, so called ‘Starters for 10’.
We are not advocating that you plough through the questions in Table 3
like a semi-structured psychiatric interview, but, rather, that you use the
questions below to get a feel for how you can help your trainee become
clearer about their core values, interests, skills, etc.)
Table 4: Good questions to pose to your trainee about

the Stage 1 exercises
Work values
1. What do you see as your core work values?
2. What are the possible implications of any of your core work values for
the career decisions that you are currently facing?
3. Thinking back to a time when you particularly enjoyed your work,
what links can you see between the reasons for this enjoyment and
your core work values?
4. What about the opposite, i.e. what links can you see between a time
when you were particularly unhappy at work and your core work values?
5. How might your core work values change over time, and how might
you adjust your career plans in order that there is an appropriate match
for these anticipated changes in work values?
Achievements/skills/interests
1. Using the results from the exercise where you examined specific
achievements, what key skills did you identify? Of these, which are you
particularly interested in using at work?
2. Are there any key skills that you aren’t using at work that you would
like to be able to use, in order to find work more satisfying?
3. What key skills did you identify in your non-work example? Are there
any there that you would be interested in using in a work context?
4. What factors contribute to you feeling stressed at work?

96 Psychometric instruments
1. (Before.) What are you hoping to gain from taking this particular
instrument?
2. (After.) What are your thoughts about the results? To what extent do
the results accord with what you already know about yourself? Can
you give specific examples? And to what extent do the results conflict
with what you already know about yourself? (And again, can you give
specific examples?)
Role Models
Thinking about a doctor whom you regard as a positive role model, can
you identify aspects of work that are particularly important to you.
Summary of Stage 1
1. If you were asked to give a summary of the self-assessment exercises
that you carried out as part of Stage 1, what would you say?
2. Can you describe examples from your career to date that illustrate your
individual pattern of values, skills, interests, role models, etc. that you
have included in your summary?
3. If you do not feel at all clear about your key values, skills, interests,
etc., what are you going to do in order to enhance your ability to
complete the Stage 1 exercises in sufficient detail?
Helping your trainee explore different career

options (Stage 2)
The key task for you in this stage is to encourage your trainee to conduct
a systematic exploration of different career options that interest them.
Furthermore, as has been argued throughout, this career exploration does
not involve researching each option in a standardised way, but, instead,
you need to encourage your trainee to construct a personalised list of
queries (derived from the Stage 1 self-assessments) and then apply this
personalised list to the specific careers that they are exploring further.
All the points discussed in the sections above (e.g. good listening combined
with asking challenging questions) also apply to how you should support
your trainee through their Stage 2 activities.
Good questions to pose to your trainee in this stage of the career planning
framework are included in Table 5 (overleaf).
Table 5: Good questions to pose to your trainee about 97
the Stage 2 exercises
1. Have you identified two to four options that you want to explore
further? If yes, then go to question 3, if no, then go to question 2.
2. What specific tasks are you going to carry out in order to be able to
identify a suitable shortlist of possible options? (This might include
going back to redo the Stage 1 exercises in more detail, arranging to
complete a psychometric instrument such as Sci59 or the Myers-Briggs
Type Indicator. Or it might involve getting some additional 1:1 support
such as arranging a session with the Faculty Careers Lead or the Senior
Careers Adviser in your deanery.)
3. (If the educational supervisor has concerns about any of the choices
being explored.) On the basis of what I have seen of your work/
your assessments, it seems as if (name the relevant competence) is
something that you struggle with. Yet this would be seem to be a key
aspect of training in (name the specialty). How do you reconcile these
two facts?
4. Having identified two to four options that you want to explore further,
have you constructed a list of specific questions (linked to the Stage 1
self-assessment activities) that you are going to explore? Having done
this, for each question, have you worked out what you are going to
read/whom you are going to ask? What timescale have you set yourself?
5. Have you identified a ‘backup plan’ in case you are not successful
in achieving your first-choice option? If not, do you think that this
might be a useful strategy? How might you go about choosing your
‘backup plan’?
Helping your trainee make a good career decision

(Stage 3)
Your key task here is to help your trainee make a final decision as to what
they are going to apply for on their application form. You should also help
them interrogate the robustness of this decision using the ROADS criteria.
Good questions to pose to your trainee in this stage of the career-planning
framework are included in Table 6.

98 Table 6: Good questions to pose to your trainee about
Stage 3
1. Looking back at the Lifeline exercise, can you identify a good career
decision that you have made in the past? With reference to this
example, how did you arrive at this decision?
2. What can you learn from this previous decision in terms of how best to
approach your current decision?
3. How would you explain your career decision in terms of the match
between what you now understand about yourself (Stage 1) and what
you have found out about the career options that you wish to pursue
(Stage 2)?
4. Have you reviewed your decision using the ROADS checklist?

Realistic – are you being realistic about yourself AND the demands of
the job?
Opportunities – have you given serious consideration to all the

Anchors – have you built in the things that provide support in

your life?
Development – do your choices fully develop your potential?
Stress – have you considered those aspects of work that pose

particular stresses for you?
5. Have you identified both a plan, and a ‘backup plan’?

(If, as the educational supervisor, you think that the plan and/or the
‘backup’ fail to meet one or more of the ROADS criteria, then you
need to raise this issue with your trainee. If your trainee doesn’t want
to take the questions that you are challenging them with on board,
then you can suggest that they go and discuss their career plans with
the Faculty Careers Lead or the Deanery Careers Adviser.)
Helping your trainee with implementing their plans

(Stage 4)
At this stage you need to discuss the application forms with your trainee,
and also ensure that they are doing adequate interview preparation.

Application forms 99
The issue of how far it is permissible to help your trainees with their
application forms is a vexed one. If you are going to be involved in short-
listing or interviewing, then it is probably advisable if you suggest that your
trainee has a more detailed conversation about their application form or
about the interview with another colleague.
We would suggest that you encourage the trainees to read through the
detailed advice given in the relevant sections of this handbook. In addition
(as long as you are not actually involved in the short-listing or interview
process), you can read through drafts of their answers and make general
comments. For example, it is permissible to make general comments such
as: ‘I don’t think that you have adequately answered the second part of the
question’ or ‘I don’t think that your answer clearly demonstrates that you
have all the necessary skills.’ You should, however, avoid suggesting specific
wording that they should include in the form.
The sorts of questions that you could pose to your trainee at this stage of
the career-planning process are included in Table 7.
Table 7: Good questions to pose to your trainee about

application forms
1. Have you carefully read through Chapter 3 in this handbook?
2. Are you clear that you are going to meet the application deadlines?
3. Have you checked that your answers tally with the specific criteria as
outlined in the person specification? (But, equally, have you made sure
that your answers do not involve simply repeating the wording of the
person specification on your actual application form?)
4. Have you checked and re-checked your spelling and grammar?
Interviews
Using the sample interview questions included in Chapter 3, you can
conduct mock interviews with your trainees. You can either do this on a 1:1
basis, or can incorporate interview training into a group career-planning
workshop (see below). But, again, we would suggest that you don’t run a
mock interview for a trainee (or group of trainees) if you are actually on the
interviewing panel.
In terms of discussing interview preparation during a 1:1 session with your
trainee, the sorts of questions that you might want to ask are included in
Table 8.

100 Table 8: Good questions to pose to your trainee
about interviews
1. Have you thought about the questions that you are highly likely to be
asked, and planned some strong answers? (You can then discuss these.)
2. Have you prepared a small number of examples (taken from your
e-portfolio) that clearly demonstrate your key skills and abilities? Have
you also prepared some suitable examples in case you are asked about
areas in which you are weaker, or about mistakes that you have made
in the past? (And, again, you can discuss these.)
3. What specific concerns do you have about the interview process? How
are you intending to address these concerns? Who else could help you?
Group career-planning workshops

In some regions career-planning workshops have been incorporated into
the generic taught foundation programme.
This is a strategy that we would advocate; not only is it an efficient use of
time, but also the trainees can learn much, and gain encouragement and
support from each other.
The person running the workshop doesn’t need to be a ‘careers expert’,
as all the necessary basic materials have been worked out for you, and are
detailed below. Instead, the role of the person running the workshop is to
act as a facilitator.
Many of the basic guidelines described above about how best to approach
the task of 1:1 careers meetings also apply to the task of group facilitation.
For example, as with a 1:1 meeting, in a group session it is also important to:
1. Outline the overall four-stage career planning framework.
2. Listen carefully to the points that the trainees are making.
3. Pose challenging questions.
But there are a few points that apply specifically to the group situation.
Specifically, we would highlight the following:
Avoid the discussion of highly personal issues (such as whether in future
they might want to have a family) in front of the group. This can be
discussed by setting a task for the whole group, getting the group to
discuss it in smaller groups, and then reconvening when you ask for general
comments. Trainees are much more likely to speak openly to small groups
of their peers than in larger groups, in which the consultant is present.

If you are asking them to reflect on negative issues (what they find stressful, 101
mistakes, etc.), get them to discuss this in pairs, or perhaps to write down
their thoughts on their own. You shouldn’t ask the trainees to discuss what
could be quite painful issues in a small- or large-group context. For these
tasks use paired work, or ask them to work individually.
Provide time at the end of the session for trainees to come and speak
to you in private. If the issue they raise turns out to be quite a complex
one, you might need to arrange an additional time, or suggest a referral
to another source. But, in our experience, at the end of sessions trainees
often come and raise issues in private that they did not feel comfortable
raising in front of the whole group. One advantage of a group context is
that they can learn from each other. So if a trainee asks you a challenging
question, if appropriate pose it back to the group for comments, before
you wade in with your own answer. Often the group will come up with
excellent answers, and the trainees find the support and advice of their
peers particularly helpful.
Final comments
Having run a large number of training workshops for consultants, we know
that some educational supervisors feel distinctly uneasy about their career
support responsibilities.
It is our hope that the structured four-stage model outlined in this chapter
will provide you with a practical framework for approaching the task.
The following figure provides an overview of the activities which need to
be covered.

102 Figure 6: Foundation programme – overview of
activities
Foundation year 1: Run early in F1 Foundation year 2: Run early in F2
Career Trainee doctors Foundation Trainee doctors Foundation
planning programme programme team
stage team
Stage 1 – Interests Run workshop 1 Review Stage Educational
self- for F1 doctors 1 and 2 supervisors to
assessment Values to introduce the assessments in review career
Skills and career-planning order to prepare planning in 1:1
achievements framework and for Stage 3 meetings with
cover Stages 1 trainees
Stresses and and 2 in greater Reflective
strains detail – see Pratice Educational
Appendix E (e-portfolio) supervisors to
Psychometric ensure Personal
tests (optional) Educational Personal development
supervisors to development
Reflective plans
practice review career
(e-portfolio) planning in 1:1 Career
meetings with summary sheets
Personal trainees
development
plans Educational
supervisor to
Career ensure Personal
summary sheets Development
Plans/Career
Role model
Summary sheets
exercise
complete
Stage 2 – Initial search to Run workshop 1 The trainee Educational
career identify possible as above considers their supervisors to
exploration career options career options review in 1:1
Educational in light of any meetings with
F1 Trainee to More focussed supervisors to changes in trainees
set SMART search, review in 1:1 their Stage 1/2
plan after including meetings with activities Educational
workshop interviewing trainees supervisor to
people in the The trainee to ensure Personal
specialities of Educational fully consider development
interest supervisor to plan B plans/career
ensure Personal summary sheets
Attend events, development Arrange tasters complete
including plans/career
careers fairs summary sheets
complete
Arrange tasters
Introduce specialty
training person
specifications

Stage 3 – When ready the Educational The trainee Run workshop 103
decision trainee moves supervisor to considers their 2 for F2 doctors
making to Stage 3 ensure Personal career options to include a brief
development review of the
Emphasise plans/career Decision- career-planning
good decision summary sheets making exercise framework and
making complete ROADS to cover Stages
comes from 3 and 4 – see
carrying Introduce the Carry out
further Appendix F
out Stage 1 importance of
and 2 plan B. Trainee interviewing Educational
to reflect on people in the supervisors to
Stage 2 – career specialties of review career
exploration interest planning in 1:1
The trainee to meetings with
Highlight trainees
timescales fully consider
for specialty plan B Educational
recruitment supervisor to
ensure Personal
development
plans/career
summary sheets
complete
Stage 4 – Reflective Introduce linkage Application Run workshop 2
plan practice of Stages 1, 2 forms as above
implement- (e-portfolio): and 3 on quality
ation applications Interviews Educational
Personal and interview supervisors to
F2 Trainee to development Role of portfolio review career
performance on selection
set SMART plans planning in 1:1
plan after Educational process meetings with
workshop Career supervisor to trainees.
summary sheets Peninsula
ensure Personal Deanery /
development Educational
AGCAS DVD supervisor to
plans/career – selection
summary sheets ensure Personal
centres for development
complete Specialty plans/career
Training summary sheets
complete
Reflective practice
(e-portfolio):
Personal
development
plans
Career summary
sheets

104 Chapter 2 began with a clinical analogy, namely comparing the four-
stage career-planning framework to a model of clinical consultation,
and we would like to return briefly to this parallel, in the final section
of the handbook.
As experienced clinicians, your approach to a clinical consultation will
by now be second nature to you, as it is something that you do without
thinking, day in, day out. But the same isn’t true for your medical students
(and wasn’t true for you when you were a medical student). This therefore
reminds us that learning a complex new skill takes both time and practice.
Putting the framework outlined in this handbook into practice will take a
bit of time to get used to, as there are both information to assimilate and
skills to develop. And you will also need to practise it. But you are starting
from a good vantage point given that you already have a highly developed
set of communication skills that you use in your patient consultations (and
also in teaching and management tasks).
Often at the end of workshops consultants express relief that a task that
they had previously felt was beyond their expertise (namely the provision
of career support) turned out to be much more straightforward than they
had initially envisaged.
We hope that by using this handbook, you will reach a similar conclusion.

References Krieshok, Thomas S.; Black, Michael 105
D.; McKay, Robyn A. Career decision
Borges, N. J. and Savickas, M. L. making: The limits of rationality and the
(2002). ‘Personality and medical abundance of non-conscious processes.
specialty choice: a literature review Journal of Vocational Behavior
and integration’, Journal of Career (0001-8791) Dec, 2009. Vol.75, Iss.3;
Assessment, 10, no. 3, pp. 362–80 pp. 275–290
Borges, N. J., Savickas, M. L. and Jones, Krumboltz and Levin 2007. Luck Is
B. J. (2004). ‘Holland’s theory applied No Accident Making the Most of
to medical specialty choice’, Journal of Happenstance in Your Life and Career
Career Assessment, 12, no. 2, by Krumboltz, John; Levin, Al (2004)
pp.188–206
Mitchell, K E; Levin, A S; Krumboltz,
Freeman, R. and Lewis, R. (1998). J D. Planned happenstance: constructing
Planning and Implementing Assessment. unexpected career opportunities Journal
London: Kogan Page of Counseling and Development
Gale, R. and Grant, J. (2002). ‘Sci45: (0748-9633) Spring 1999. Vol.77, Iss.2;
the development of a specialty choice pp.115–24
inventory’, Medical Education, 36 (7), Nathan, R. and Hill, L. (2006). Career
pp. 659–66 Counselling. 2nd edn. London: Sage
Hirsh, W., Jackson, C. and Kidd, Tooke J. Aspiring to excellence: final
J. M. (2001). Straight Talking: Effective report on the independent inquiry
Career Discussions at Work. Cambridge: into Modernising Medical Careers.
National Institute for Careers Education London: MMC Inquiry, 2008.
and Counselling (NICEC) www.mmcinquiry.org.uk
Kidd, J. M. (2006). Understanding
Career Counselling: Theory, Research
and Practice. London: Sage
Bibliography
106 Appendix A
Career Counsellors: List of Professional Bodies

Within the career-counselling profession the words information, advice and
guidance have specific meanings:
Information – this is the provision of information on learning and work
which can be provided through a wide range of media like websites,
leaflets, etc. and face to face. Within the medical education context
information about specialty training opportunities, competition ratios, etc.
are good examples.
Advice – this is where someone might wish to discuss the information
they have gathered with someone to develop their understanding of it and
find out if there are other sources of information which would be useful to
them. The person giving the advice might propose they need more in-depth
support and this is where guidance comes in.
Guidance – the provision of in-depth support to an individual, often face
to face or by telephone. Increasingly, electronic media are being used to
provide guidance and it’s also often provided in a group setting.
Please note that career counsellors are also often called career advisers,
career guidance professionals, career consultants and career practitioners.
Increasingly, people are also offering career coaching.
Institute of Career Guidance: http://www.icg-uk.org/
The ICG accredits career guidance professional and has a section on its
website to help you find a career adviser.
AGCAS: http://www.agcas.org.uk/
The Association of Graduate Careers Advisory Services is the professional
association of career professionals in Higher Education. University Careers
Services are usually members of AGCAS and your medical school may have
access to the services of the university careers service.
Prospects: http://www.prospects.ac.uk/cms/ShowPage/Home_page/p!eLaXi
This is the UK’s official website for graduates and it is supported by AGCAS.
You can email a careers consultant and also find a career coach if you want
to work with someone on an individual basis. These services are included in
the careers advice section of the website.

NAEGA: http://www.naega.org.uk/ 107
The National Association for Educational Guidance for Adults is a practitioner
organisation run by members for members. The website has links to
guidance providers in its ‘looking for guidance’ section.
British Psychological Society: http://www.bps.org.uk/
The BPS is the representative body for psychology and psychologists in the UK.
You can use their main site to find a chartered psychologist.
The BPS also accredits practitioners in the use of psychometric instruments
and has a separate website for the Psychological Testing Centre:
http://www.psychtesting.org.uk/. The directories section contains details
of qualified testers, and within the directories section you need to search
for a Level B instrument (as personality instruments such as the MBTI are
categorised as Level B).
Coaching
Coaching is an increasingly popular tool which can be used to help support
personal development. It can also be offered as life coaching, career
coaching, personal development coaching, etc. The European Coaching
Institute defines coaching as a ‘simple yet effective form of personal
development where client and coach create an alliance that promotes and
sustains the client’s personal growth and competence’.
At the moment there are no official regulatory standards for coaching
and no governed training standards which need to be attained before
individuals can become a coach. There are though two internationally self-
appointed accreditation bodies that aim to self-regulate the industry and
within the UK CIPD (Chartered Institute of Personnel and Development)
provide advice to HR professionals on coaching and mentoring.
Here are some websites if you would like to find out more:
CIPD: http://www.cipd.co.uk/subjects/lrnanddev/coachmntor/
International Coach Federation: http://www.coachfederation.org/icf/
European Mentoring and Coaching Council: http://www.emccouncil.org/
Appendix A
108 Appendix B
Further Resources for Career Planning

General career planning
Hopson, B. and Scally, M. (2000). Build Your Own Rainbow:Workbook for
Career and Life Management. London: Kogan Page
(This can also be used as a self-help guide by trainees who want more help
with Stage 1.)
Schein, E. H. (1990). Career Anchors: Discovering Your Real Values:
Instrument. USA: Jossey-Bass. Pfiefer
Medical career guides
South West Peninsular and AGCAS DVD –Selection centres for speciality
training. http://www.agcas.org.uk/agcas_resources/37-selection-centres-for-
speciality-training
Chambers, R., Mohanna, K. and Field, S. (2000). Opportunities and Options
in Medical Careers. Oxford: Radcliffe Medical Press
Cottrell, E., Rebora, C. and Williams, M. (2006). The Medical Student
Career Handbook. Oxford: Radcliffe Publishing
Eccles S. and Sanders, S. (2008). So You Want to be a Brain Surgeon?
A medical careers guide. Oxford: Oxford University Press
Hastie, A. and Stephenson A. (2008). Choosing General Practice. Oxford:
Blackwell Publishing
Hill, E. (2008) So you want to be a medical mum? Oxford: Oxford
University Press
Kersley, S. (2005). Prescription for Change. Oxford: Radcliffe Kersley, S.
(2006). ABC of Change for Doctors. Oxford: Radcliffe
Lepnurm, R., Danielson, D. and Dobson, R. (2006). ‘Cornerstones of
career satisfaction in medicine’, Canadian Journal of Psychiatry, 51, no. 8,
pp. 512–22
MacDonald, R. and Hadridge, P. (2003). My Beautiful Career. London: BMJ
Publishing Group
Royal College of Physicians of London (2002). Careers Information
Handbook for Trainees. London: Royal College of Physicians

Careers guidance counselling guides 109
Ali, L. and Graham, B. (1996). The Counselling Approach to Careers
Guidance. London: Taylor and Francis (Routledge)
Cochran, L. (1997). Career Counselling: a Narrative Approach. London: Sage
Kapes, J. T., Mastie, M. M. and Whitfield, E.A. (eds.) (1994). A Counsellor’s
Guide to Career Assessment Instruments. 3rd edn. National Career
Development Association
Reid, H. and Bimrose, J. (eds.) Constructing the Future: Transforming Career
Guidance. Institute of Career Guidance
Watts, A. G., Law, W., Killeen, J., Kidd, J. M. and Hawthorn, R. (1996).
Rethinking Careers Education and Guidance. London: Routledge
Yost, E. B. and Corbishley, M. A. (1987). Career Counselling: a Psychological
Approach. USA: Jossey-Bass. Pfiefer
Coaching guides
Covey, S. (2004). 7 Habits of Highly Effective People. London: Simon and
Schuster
Gallwey, W. T. (2001). The Inner Game of Work. London: Random House
Landsberg, M. (2003). The Tao of Coaching. London: Profile Books
Whitmore, J. (2002). Coaching for Performance: Growing People,
Performance and Purpose. National Book Network
Royal College websites
These sites contain a wide range of information including person specifications,
information about education and training, flexible training, etc.
• Academy of Medical Royal Colleges: http://www.aomrc.org.uk/
• College of Emergency Medicine: http://www.collemergencymed.ac.uk/
CEM/default.asp
• Royal College of Anaesthetists: http://www.rcoa.ac.uk/
• Faculty of Dental Surgery: http://www.rcseng.ac.uk/fds
• Royal College of General Practitioners: http://www.rcgp.org.uk/
• Royal College of Obstetricians and Gynaecology: http://www.rcog.org.uk/
• Faculty of Occupational Medicine: http://www.facoccmed.ac.uk/
• Royal College of Ophthalmologists: http://www.rcophth.ac.uk/
• Royal College of Paediatrics and Child Health: http://www.rcpch.ac.uk/
Appendix B
110 • Royal College of Pathologists: http://www.rcpath.org/
• Faculty of Pharmaceutical Medicine: http://www.fpm.org.uk/
• Royal College of Physicians of Edinburgh: http://www.rcpe.ac.uk/
• Royal College of Physicians of London: http://www.rcplondon.ac.uk/
• Royal College of Physicians and Surgeons of Glasgow: http://www.rcpsg.
ac.uk/Pages/default.aspx
• Royal College of Physicians of Ireland: http://www.rcpi.ie/pages/home.aspx
• Royal College of Psychiatrists: http://www.rcpsych.ac.uk/
• Faculty of Public Health: http://www.fphm.org.uk/
• Royal College of Radiologists: http://www.rcr.ac.uk/
• Royal College of Surgeons of Edinburgh: http://www.rcsed.ac.uk/site/0/
default.aspx
• Royal College of Surgeons of England: http://www.rcseng.ac.uk/
• Royal College of Surgeons in Ireland: http://www.rcsi.ie/
Medical careers websites
• NHS Medical Careers: http://www.medicalcareers.nhs.uk
• NHS careers: http://www.nhscareers.nhs.uk/
• BMJ careers: http://careers.bmj.com/careers/hospital-medical-healthcare-
doctors-jobs.html
• Doctors.net: http://www.doctors.net.uk/
• UK Foundation Programme: http://www.foundationprogramme.nhs.uk/
pages/home
Websites which advertise medical jobs and training opportunities
• National recruitment office for GP training:
• http://www.gprecruitment.org.uk/
• National Institute for Health research advertise jobs in academic
medicine: http://www.nihr.ac.uk/Pages/default.aspx
• NHS jobs: http://www.jobs.nhs.uk/
• BMJ careers: http://careers.bmj.com/careers/hospital-medical-healthcare-
doctors-jobs.html
• Health Service Journal:http://www.hsj.co.uk/
• The Lancet: http://careers.thelancet.com/home/index.cfm?site_id=8802
Essential websites 111
• COPMeD is the Conference on Postgraduate Medical Deans in the UK:
http://www.copmed.org.uk/
• Department of Health: http://www.dh.gov.uk/en/index.htm – can be used
to obtain a copy of the ‘Gold Guide’ which regulates specialty training
• GMC: http://www.dh.gov.uk/en/index.htm – for copies of ‘Good Medical
Practice’ and ‘The New Doctor’ as well information on the regulation of
postgraduate medical education.
• BMA: http://www.bma.org.uk/ – and ensure you have a copy of the
BMA Junior Doctors Handbook.
• Equality and Human Rights Commission: http://www.equalityhumanrights.
com/advice-and-guidance/ – the Disability Discrimination Act (1995)
introduced a number of important provisions for employees: the
guaranteed interview scheme and requiring employers to make reasonable
adjustments for people with disabilities. The Equality and Human Rights
Commission’s website contains useful information and advice.
• British Dyslexia Association: http://www.bdadyslexia.org.uk/ – is a charity
which provides a range of services to employers and employees.
Psychometric tests
Sci45/59. Specialty Choice Inventory.
Available from the Open University Centre for Education in Medicine
Tel. 01908 653776
Available for BMA members from the BMA website. Some deaneries have
also purchased licences for this instrument. Ask the Centre Manager at
your trust Education Centre, or the deanery careers staff.
Appendix B
112 Appendix C
Guidelines for CV Writing

Introduction
There is considerable variability in recommended layouts and we would
suggest that you discuss this matter with your educational supervisor
and your colleagues. But whatever layout you choose, you need to make
sure that the CV matches the person specification of the post to which
you are applying.
To do otherwise can give the impression that you aren’t really that keen on
being offered the post.
The issue of including information that identifies your age is also tricky.
From a legal point of view, you do not need to include such information,
so not only your date of birth but also the dates at which you achieved
different qualifications can be omitted. However, although recruiters cannot
mark you down for omitting this information, they might find it surprising,
as many people would expect to put the dates at which they passed
particular exams on their CV. Again, we would suggest that you get local
advice from your educational supervisor.
The headings below give one possible structure, and it is certainly a useful
starting point for constructing your final CV.
Personal details
Your name, address, telephone number, and email address – these should
be at the top of page one of your CV and could be shown in a header on
subsequent pages.
Career plan
One sentence summarising your career aims, and how the job on offer will
help you achieve them.
Personal information
Include your GMC number and type of registration. You do not need to
include your date of birth, nationality, marital status or sex.
Professional qualifications (from the current time, back to medical school,
i.e. include most recent first).
So if you have completed additional professional qualifications (e.g. MRCP
Part 1), this should go first. Then list your medical school qualifications.
For each qualification list:

– Title of qualification, class of degree (if relevant), awarding body and, if 113
you choose to, the date.
– In addition, bullet-point prizes/distinctions at medical school. You may
also include a bullet point on your elective year, as part of the description
of your undergraduate training.
Education
Details of your school qualifications with name of school and grades and
again, if you choose to, the date. (Again, most recent first.)
Professional expertise
Include job title, locations and dates. For current and previous posts,
beyond listing job title, employing trust and dates, you can also include
a couple of bullet points highlighting the key features of each job that
demonstrate your suitability for the post on offer. If you are a more
experienced applicant who has had a number of previous medical jobs,
then you don’t want to give too much detail on jobs that you did a
considerable time ago, or on jobs in which you basically gained the same
experience. The key point here is that you don’t need to give the same
amount of information on each and every job that you include in your CV;
matching to the person specification is the important task.
Practical skills
Bullet-point specific procedures you are familiar with and where relevant
indicate how many you have performed. For example, ‘performed more
than 20 chest aspirations’.
Additional courses
List ALS or other relevant course.
Research
List your publications, case reports and conference presentations (but be
wary of writing ‘in preparation’ as this can irritate consultants, who know
that such claims often don’t amount to much).
Teaching and audit
Include a couple of examples, and make sure you briefly mention the
outcome of any audit.
Other relevant skills
For example, you can mention foreign languages that you speak, and
particular IT skills.
Appendix C
114 Interests
Bullet-point a couple of your interests that you can talk about at interview
and that add value to your application.
References
Give at least two references. One of the referees should be your current
or most recent educational supervisor. Include accurate contact details for
those referees and remember to let your referee know that you have given
their details as a referee as this avoids unnecessary delays.
If you want more detailed guidance on CV writing, the following two
books are useful:
Adam Poole. How to Get a Job in Medicine. Elsevier Health Sciences. 2005
Sam McErin. Writing a Winning CV: Effective Professional Development.
Edukom. 2004

Appendix D 115
Guidelines for Giving a Presentation at a Job

Interview
For some specialties you may be asked to give a presentation as part of the
selection process. Usually the subject is given to you in advance together
with the maximum time you have to deliver it on the day.
When the topic is given to you in advance
1. Preparation
Start your preparation by researching and gathering your thoughts
on the subject matter of the presentation and what you could cover.
Ask colleagues, friends and others for their views on what should be
included. Do be aware that it might be appropriate to bring in higher level
contextual information, e.g. a new policy on treatment for that particular
specialty.

Once you have an idea of what you think you will cover, organise your
material and start thinking about the best way to present it.
2. PowerPoint
Most people use packages like PowerPoint and that is fine. Do keep
your slides simple, with a clean layout and effective colour scheme. Busy
slides with lots of detail are often difficult to read and flying bullet points
and flashy effects can be very irritating to interviewers. Also ensure you
are familiar with the content as this will help you deliver a more fluent
presentation. Keep the layout of your slides clean and simple. Diagrams
can be effective and help you to make your point. They should be drawn
in such a way that it is clear how they should be read. Keep the number
of bullet points on the slides to no more than five or six and each bullet
should act as a prompt for you to explain the point further.
3. Backup
Technology does sometimes let you down so do take along paper copies
of the material which you can distribute and refer to if the technology
fails. This shows good planning, and that you don’t fall to pieces when
the going gets tough.
4. Beginnings
The presentation is likely to be early in the interview process so make
sure you introduce yourself and the subject matter to the panel before
you start. Take a deep breath and try to enjoy the presentation.
Appendix D
116 5. Positioning
During the presentation be aware of where you are standing and make
sure you don’t obstruct the panel’s view of your slides. You will also need
to maintain eye contact with the panel. The focus of your presentation
is the panel – so look at them and not the computer or the slides on the
wall. If you need prompts for your presentation, prepare a set of notes
which you keep to hand and can refer to. In addition, fluency comes
from being very familiar with the contents of the presentation.

Avoid at all costs turning your back on the interviewers and reading the
points from the slides, and don’t pace up and down! It can make the
interviewing panel nervous.
6. Timing
You will be asked to keep your presentation within a particular time
frame. Make sure you can stick to this, as some panels might stop you
when you come to time, even if you haven’t finished what you wanted
to say.
7. Practice
It is essential to practise your presentation out loud to yourself, and
then ideally to an audience. See if you can find a small willing audience
of friends and family to help you. This will also help you check that it is
within the time limits. Going through it in your head takes a lot less time
than speaking it out loud and will give you a false impression of how
long it will take you on the day. Also, do think about the way your
voice tone and pace might be affected by nerves on the day. You may
speak faster or slower so do bear that in mind when you are checking
your timing.

Taking a deep breath before you start helps get oxygen to your brain.
If at any time during the presentation you feel you are running out of
breath or getting carried away, finish your next point, pause, take a
deep breath and start again.
8. Questions
Once you have completed your presentation the interviewers are likely to
ask you some questions about it. Do think in advance what they might
ask and prepare some suitable answers. There is always a possibility that
one of the interviewers will ask you something which is in an unfamiliar
area. You can’t prepare for this. Take a moment or two to compose
yourself, smile and then try to give the best answer possible.

When the topic is given to you on the day 117
In this situation, you obviously cannot prepare your presentation in advance.
The only constructive preparation that you can do is to talk with friends
and colleagues to think through possible topics that you might be given.
Are there any particularly hot controversies in your specialty of interest? If
there are, you might want to think through a brief summary of your views
on the issue. (And you should do this anyway as a way of preparing for the
questions that you might be asked at interview.)
But beyond thinking about possible topics, the other preparation you can
usefully do is to work out how many ‘bullet points’ you can discuss in the
allocated time. (Typically you will know how long the presentation is prior
to the interview, even if you don’t know the precise topic.) So you might
want to have a dummy run with a topic that you make up yourself – just to
see how much content you can comfortably cover in the given time span.
If the topic is given to you on the day you will be provided with acetates
and pens rather than being expected to do an ‘on-the-spot’ PowerPoint
presentation. Make sure that your writing is clear, that you spell words
correctly, and that you don’t try to stuff too much content onto each acetate.
It is also important that you don’t set yourself impossible standards. If they
give you the topic on the day they are assessing how quickly you can
construct a well ordered coverage of the topic – they are not expecting you
to know every last fact, or have beautifully hand-illustrated acetates. So try to
keep calm, spend most of the preparation time on ordering your argument,
and then in the actual presentation just include a few acetates with a small
number of bullet points on each acetate.
Beyond this points 4, 5 and 7 listed above also apply. (In terms of 7.
‘practice’, you clearly can’t practise the actual presentation, but you can
practise giving a presentation with a topic of your own choice in order
to get used to the sound of your voice, speaking at an appropriate pace
and re-starting if you go blank during the time that you are speaking.)
As mentioned above, this practice can also help you work out how
much content you can comfortably cover in the allocated time.
Appendix D
118 Appendix E
Workshop 1 – Introduction to career-planning

seminar for F1 trainees
Introduction
This workshop has been designed to introduce career planning to
foundation programme trainees and should be held early on in their F1
year. All trainees should be encouraged to attend and will need to bring
along this resource book. For this workshop you should ideally allocate at
least two hours to ensure the material is covered adequately. The timings
given below are for a workshop lasting two and a half hours.
• Purpose of the session and introduction: 15 minutes
• Brief overview of the four stages: 10 minutes;
• Stage 1 self-assessment: 60 minutes;
• Short break: 15 minutes;
• Stage 2 career exploration: 30 minutes;
• Plenary: 20 minutes.
The timings can be amended to cover the material in a two- or
three-hour session by either reducing the break and plenary session
for a two-hour session or increasing the time spent on Stages 1 and
2 for a three-hour session.

Workshop Plan 119
Time Activity Teaching notes Resources
15 mins Explain the Explain the four stages: Trainees to
purpose of have access
the session 1. Self-assessment: work values and skills to this book
and a brief and interests. and bring
introduction 2. Career exploration: research into different their own
career pathways. foundation
portfolios.
3. Decision making.
4. Plan implementation.
Introductory comments:
a. The four-stage framework is one that
applies to career decision making at any
stage of one’s career – it is not restricted
to the current career decisions that the
foundation trainees are facing.
b. This introductory session won’t provide
the trainees with all the answers, i.e.
they won’t be ‘sorted’ by the end of
the session. Instead, the session aims
to provide trainees with a sense of the
questions that they need to ask themselves
over the coming weeks/months, plus ways
of finding answers to these questions –
so that by the Jan/Feb of their F2 year
they are more likely to make a sound
career decision.
c. The session will concentrate on Stages 1
and 2, but will also touch on the other
two stages in more detail in subsequent
sessions.
d. This introductory session is still useful to
those trainees who already feed that they
have made their mind up about their
post-foundation career. Why? First of all,
it is useful to check if their career decision
making is robust. Secondly, Stage 4 (plan
implementation) depends on the previous
stages. If the decision rests on a firm
foundation of self-assessment (Stage 1),
career exploration (Stage 2), and how these
match together (Stage 3), the trainee will
be better equipped to write a convincing
application form and provide good answers
at interview.
Stage 1 self- Run two Stage 1 exercises: work values and Chapter II
assessment skills/achievements
Appendix E
120 30 mins Stage 1 self- Exercise 1: work values Chapter II.
assessment Copy the work
Explain that work values have been found to values cards
be an important predictor of occupational and have
satisfaction. Then explain how to do the scissors and
card sort. envelopes.
Afte the trainees have sorted the cards (on
their own), encourage them to pair up and
talk through the questions.
Reconvene as a group, and ask the trainees
for any comments.
You might also ask them to think about times
at work when thry have been particularly
satisfied (or, for that matter, particularly
dissatisfied), and to see if there is a link
between how they were feeling about their
work at this points and their work values. (the
exercise on stresses and strains has not been
included in the seminar guidelines because
it is probably better to do a more detailed
assessment of difficulties at work in a 1:1
rather than a group setting.)
20 mins Stage 1 self- Exercise 2: skills/achievements Chapter II.
assessment Trainees
See Chapter 2 for instructions. foundation
How many examples? Working in pairs, the portfolio
trainees should analyse one work example and
one non-work example.
10 mins Stage 1 self- Putting the Stage 1 exercises together Chapter II.
assessment
Once the trainees have worked through the
values and skills/achievements exercises,
encourage them to draw out a heraldic shield,
divided into four sections.
Works values/interests
Skills/stressors
Ask the trainees to put a few bullet points in
each of the four quadrants. Refer to example
in the book. They can write a personal motto
in they like.
(And if they want more self-assessment
exercises, direct them, for starters, to the
Hopson and Scally book included in the
resources list in Appendix B.
15 mins 15-minute break

30 mins Stage 2 Introduction to Stage 2 Chapter III 121
in total, career
including exploration The next stage is to explore different career
the options to find out two things:
exercise 1. Which particular career pathways are most
likely to match the trainees’ skills, interest,
values etc.
2. Given feedback from the educational
supervisor and/or Director of Medical
Education, the trainee needs to consider
whether the options(s) they are interested
in seem to be realistic career choices.
Other points to show
• Adequate career exploration takes time
• Stage 2 is not carried out in a vacuum –
rather, Stage 2 follows on from Stage 1.
• So the trainee can use the summary
exercise from Stage 1 to generate a list
of specific issues to be explored in their
specialties of interest.
• The clearer the trainee is about what is
important to them (Stage 1), the more
targeted and relevant the Stage 2 research
can be.
• Trainees will have to augment their reading
about different options with talking to
people – at various levels of seniority –
who are currently working in this specialty.
Without this, it will be difficult to ascertain
whether the career is going to match their
core work values, skills, interests etc.
• There may be some to-ing and fro-ing
between Stages 1 and 2. So, for example,
something that a trainee finds out as part
of their Stage 2 research might cause them
to re-think some aspect of their initial
self-assessment.
Appendix E
122 Stage 2 Exercise 3: what resources are out there? Chapter III
career
exploration 1. The resources list at the end of Chapter III
contains a list of useful books and websites.
2. The MMC website can be used to access
all deanery websites. The COPMeD site has
links to all Royal College websites. Check
these for relevant journals and events which
give the opportunity to find out more about
the specialty.
3. Check the noticeboard in the postgraduate
centre for other useful information and
details of local events.
Activity: identify three career research tasks
which follow on from the Stage 1 self-
assessments that the trainee is going to
undertake. The trainee should write these
down, commit to a date for their completion
and discuss the tasks with a colleague.
20 mins Plenary Recap the purpose of this session has been
to outline a framework (and thus provide
questions rather than answers).
Remind them that there will be further
sessions, as part of the generic programme,
which will look at Stages 3 and 4 (and will also
look at post-F2 training routes in more detail).
Encourage them to spend sufficient time on
their career planning, rather than leaving it all
to the last minute.
Deal with any other questions.

Appendix F 123
Workshop 2 – Introduction to career-planning

seminar for F2 trainees
Introduction
The second workshop is for F2 trainees and should be run early in their F2
year as it covers application forms and interviews. The session should last
three hours to ensure the material is covered adequately The workshop
should be run by a clinician with experience of helping trainees with their
career decision making and who has been involved in recruitment and
selection to posts. An outline session plan is as follows:
• Purpose of the session and introduction: 5 minutes
• Brief review of the four stages: 10 minutes.
• Stage 3 decision making: 30 minutes
• Stage 4 application forms: 45 minutes
• Break: 15 minutes (this can be timed to suit local arrangements)
• Stage 4 interviews: 50 minutes
• Plenary and questions: 25 minutes
Appendix F
124 Workshop plan
Time Activity Teaching notes Resources
15 mins Purpose of the Explain the four stages: Trainees
session and brief to have
overview of the 1. Self-assessment. access to
four stages. 2. Career exploration. this book.
3. Decision making.
4. Plan implementation.
Introductory comments:
a. The four-stage framework is one that
applies to career decision making at any
stage of one’s career – it is not restricted
to the current career decisions that the
foundation trainees are facing.
b. This session builds on the introductory
session they may have had in their F1 year
and specifically focuses on Stages 3 and 4
of the career-planning framework.

It won’t provide the trainees with all the
answers, i.e. they won’t be ‘sorted’ by the
end of the session. Instead, the session
aims to outline the preparatory tasks that
trainees need to carry out prior to filling
in their application forms and before a
selection interview.
c. The session will concentrate on Stages 3
and 4, and will only touch on the other
two stages to set the context.
d. Stage 4 (plan implementation) depends on
the previous stages. If the decision rests
on a firm foundation of selfassessment
(Stage 1), career exploration (Stage 2), and
how these match together (Stage 3), the
trainee will be better equipped to write a
convincing application form and provide
good answers at interview.
Stage 3 Introduction to Stage 3 and an exercise.
decision making

5 mins Stage 3 Introduction to Stage 3 125
decision making
People make decisions in different ways.
Some mull over a decision for a while and
then, on the basis of a gut feeling, become
confident that one pathway is the right one
for them. Others like to be more concrete in
the process and draw up costbenefit tables.
Either approach is valid.
Some points that you might want to raise
include the following.
• Ask them to reflect on past career
decisions in order to identify what helped
them reach a decision. Is this approach
valid for their current career decision?
• If they are considering post-foundation
training in a specialty which is very
competitive, it might be advisable for
them to have a ‘backup’ plan for a less
competitive specialty.
• Advise them to discuss their plan with a
colleague, and also with their educational
supervisor or the Faculty Careers Lead.

Then, introduce them to the idea of the
ROADS criteria.
ROADS – a systematic way of reviewing
career decisions
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 – do your choices fully develop
your potential?
Stress – have you considered those aspects of
work that pose particular stresses for you?
If you have time, take a career decision you
have made in the past and review it with the
group using the ROADS criteria. (it is better
to use the faciliators example than to ask
for examples from previous career decisions
from the trainees, as sometimes this can lead
to quite a personal issue being unwittingly
opened up in front of the group.)
Appendix F
126 15 mins Stage 3 Lifeline exercise Chapter IV.
decision making This exercise can be used with both Blank paper.
individuals and groups and is included in
Chapter 3.
Exercise 1: Lifeline exercise
Ask trainees to complete the Lifeline,
then ask them to split into pairs for the
discussion.
Ask the trainees to get together in pairs and
discuss the following questions:
1. Which changes represented good career
decisions?
2. Use the ROADS criteria to describe the
ways in which they were good career
decisions.
3. Were there any decisions that, in
retrospect, were not so good? If so, use
the ROADS criteria to describe the ways in
which the decision turned out not to be
so favourable.
4. Looking at their Lifeline so far, can they
see a pattern in terms of what helped and
what hindered any decisions that they
have made in the past?
If the trainee has made a decision about
their post-F2 training, then they can analyse
the decision using the ROADS criteria.
10 mins Stage 3 Stage 3 plenary
decision making Ask the trainees if they have any comments.
You might also want to ask the trainees
what they had learnt about themselves, in
terms of how they approach the task of
making decisions.
5 mins Stage 4 plan Introduction to Stage 4 Chapter V
implementation by Stage 4 (which trainees need to reach
well in advance of the time that they will
have to fill out their application forms)
trainees should know what post or specialty
training programme they wish to apply for.
The purpose of this stage is to write
excellent application forms and prepare for
interviews. Some trainees will already know
what they are applying for but others may
be undecided. Either way, they can use the
workshop to practice their techniques.

Application The timings for this session are: Chapter V 127
forms
10 minutes: provide an overview of the
application process
20 minutes: ask the trainees each to draft
an answer to one question taking from
the question bank, and then critique their
answer in pairs.
10 minutes: share hints and tips.
10 mins Application Overview of the application process Chapter V
forms – overview
Chapter 5 contains a flowchart which you
can use to walk through the process. Do
encourage trainees to assemble a CV, so
they have all the information in one place,
and stress the importance of asking their
referees in advance.
Bring out the key points from the
information on initial preparation and
golden rules:
As a way of preparing to write answers for
application forms, trainees might want to
use the STAR structure. By this we mean the
trainee could break down their example into:
Situation/Task
Provide a concise overview of the example
you are considering using, ensuring that it is
relevant to the question.
Actions
What exactly did you do? What were your
role and contribution? What skills did you
use? (This part will probably form the bulk
of your answer).
Results/Reflection
What was the outcome? What have you
learnt about it?
20 mins Application Exercise 2: application forms Chapter V
forms – exercise
Ask the group to split into pairs and to
consider one question from the question
bank detailed below. You will also wish to
add your own suggestions as well.
Trainees should prepare their answer
individually and then working in pairs
critique what they have written. In their
critque they might want to refer to the
STAR acronym.
Appendix F
128 Exercise 2: question bank You may
prefer to
1. Give a recent example of a clinical develop
situation in which you feel teamworking your own
could have been improved. questions.
2. Describe your experience of clinical
audit indicating clearly your own level of
involvement and the clinical relevance of
the audit.
3. Describe a difficult clinical situation you
tackled well.
4. What do you consider the most
challenging aspects of applying the GMC
‘Good Medical Practice’ to your own
career?
5. Describe your experience of clinical
governance and indicate clearly your own
level of involvement?
6. Describe your experience of working in
multi-disciplinary teams, including your
observations on the effectiveness of
teamwork. You may give examples from
both inside and outside medicine.
7. Describe how you deploy time-
management skills in order to optimise
your professional development.
10 mins Application Bring the group back together and ask them Chapter V
forms – group to share their thoughts about the questions
discussion they chose to answer. Try to ensure each pair
contributes their ideas to the discussion.
In this session refer to Chapters 5 and 6, to
draw out the relevant points.
15-minute break
Interviews The purpose of this session is to give you Chapter V
an opportunity to discuss a selection of the
questions foundation trainees might be
asked at interviews.
The timings for the session are as follows:
5 minutes: outline of the exercise
25 minutes: for the exercise in pairs
20 minutes: reassemble as a group to share
best practice.

5 mins Interviews – Some key points about interviews: 129
exercise outline
Most interviews will be structured and time-
limited. There will almost certainly be more
than one person present. If there is a panel,
one member will be appointed as Chair, and
it is the person who is likely to welcome the
trainee, introduce the other panel members,
and outline the structure of the interview.
Preparation is all-important as many
questions can broadly be predicted in
advance. So if trainees devote adequate
time to pre-interview preparation, they
should be able to improve the quality of
their performance on the day. (Of course,
trainees might still be asked some questions
that they haven’t considered before. But if
a structured interview process is used,
then at least trainees can be reassured
that all the candidates will be posed this
particular question.)
So how should trainees prepare?
For starters it is helpful to realise that
questions whixh are asked at interviews are
usuallly divided in three broad areas:
1. Questions about you.
2. Questions about the job/specialty.
3. Questions about the wider context of
health care.
It is far better for trainees to refer to specific
examples than to talk in generalities. The
next exercise aims to give them a chance to
practice structuring specific examples.
25 mins Interviews Exercise 3 Chapter V
exercise
As the group to split into pairs and to
consider at least one question from each of
the three categories in Chapter 5 using the
STAR technique they used for the application
forms exercise.
Check which questions are being covered
so that you can ensure a reasonable range
has been chosen rather than just the first
two in each section. There is a selection of
questions to choose from and you might
wish to add some of your own as well.
Appendix F
130 20 mins Interviews – Bring the group back together and ask them Chapter V
group discussion to share their thoughts about the questions
they chose to answer. Try to ensure each pair
contributes their ideas to the discussion.
In this session aim to draw out some
overall general points and discuss interview
technique.
15 mins Final plenary Recap that the purpose of this session has
been to provide a review of the four-stage
process, and then look in detail at Stage 3
(decision making) and Stage 4 (plan
implementation).
Encourage them to spend sufficient time on
their career planning, rather than leaving it
all to the last minute.
Encourage them to identify one career-
planning task that they will commit to
completing and that has come out of today’s
workshop. Get them to write this down,
with a suitable timescale, and then briefly
to discuss it in pairs.
Deal with any other questions.
Notes

University of London
Postgraduate Deanery for Kent,
Surrey & Sussex

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The ROADS

Caroline Elton & Joan Reid

Caroline Elton and Joan Reid

II. Stage 1 of Career Planning:

III. Stage 2 of Career Planning:

IV. Stage 3 of Career Planning:

V. Stage 4 of Career Planning:

VI. Guidelines for the Educational

The Roads to Success

How this book is organised

The Roads to Success

When this book should be read

Introduction – About the book

About the title

Opportunities: Have you given serious consideration to all the

The Roads to Success

Introduction – About the book

The Roads to Success

Introduction: a clinical analogy

The Roads to Success

Exercise 1: work values

PLACE OF WORK MONEY

CONTACT WITH PATIENTS TECHNIQUES

COMMUNITY SETTING HOSPITAL-BASED

The Roads to Success

BEING EXPERT ORGANISATION

PHYSICAL CHALLENGE TEACHING

FLEXIBLE WORKING TYPES OF PATIENTS

The Roads to Success

Look at your list and consider the following questions:

Exercise 2: achievements, skills and interests

Instructions for exercise 2

The Roads to Success

Exercise 3: stresses and strains

Instructions for exercise 3

Positive Role Models

What does ‘instrument’ mean in this context?

The Roads to Success

The Roads to Success

Measures of occupational interests

Sci59 (previously called Sci45)

The Roads to Success

1. The doctor-patient relationship

The Roads to Success

5. Relationships with colleagues

An alternative way of summarising Stage 1

The Roads to Success

The Roads to Success

Why Stage 2 matters

The Roads to Success

Stage 2 – Career Exploration

Core specialty Higher specialty

Competition for Competition for Certificate for

(Diagram adapted from image by David Rice, KSS Deanery, 2008)

Specialties offering run-through training may also offer some fixed-term

The Roads to Success

Stage 2 – Career Exploration

The C word (Competition)

Stage 2 – Career Exploration

Isn’t there another way of identifying suitable

VI. Guidelines for the Educational

“My career owes more to serendipity rather than planning, and I

“When I commenced my PRHO year, I had been quite determined