Making use of the university careers serviceBMJ 1996; 313 doi: https://doi.org/10.1136/bmj.313.7050.2 (Published 20 July 1996) Cite this as: BMJ 1996;313:S2-7050
Careers services aren't just for students - graduates can use them as well. Pritpal S Tamber, the student editor of the Student BMJ investigates
Careers advice is the one big omission from medical education. At present, once a specialty has been chosen, a third of doctors change their minds, some more than once. School leavers are often propelled into medical education without sufficient guidance about the realities of being a doctor. Medical students defer career choices because of the length of training and the broad range of specialties yet to be experienced. In fact, seeking advice is seen as a weakness and trainees are often discouraged from doing so. There is no formal provision of careers advice, too much emphasis on establishing good relationships with consultants, and sexism, homophobia, and racial discrimination are ever present.
The first step is to work out what you want to do. This is not as easy as it sounds. The ideal is to do what you enjoy, but matching your interests with employment is rare. It is probably the hardest step but there are three computer programs that are able help. “Prospect” is designed to increase your awareness of your expressed interests, skills, and motivations, broaden your knowledge of occupations, and explore the connections between them. It's a form of self evaluation and, although it takes a long time, if done properly it can help both those without career ideas as well as those who want information on entry strategies and application methods. “Gradscope” only takes an hour. It contains a wider range of available jobs, two thirds of which are open to graduates of any discipline. The programme is specifically for those who have an idea of what they want to do and are looking for new ideas to explore. “Scan” is specifically about employers. The programme matches your preferred occupation, type of employer, location, and subject of study to a database of about two thousand employers across the country. This is generally for those in the final stages of their job search and is often used in conjunction with the information on employers found in the careers centre.
Careers counselling is a one to one interview with a careers adviser. The idea is to help the interviewee understand his or her strengths and weaknesses and to formulate a plan of action. This type of counselling can be done before or after time spent on the computers as the idea is to respond to current circumstances. Those with little idea about careers often begin with counselling as a conversation is more inviting than sitting behind a computer. It's another form of self evaluation - something that careers advisers are trained in helping people to do. Other services include the “quick query desk” where an adviser will provide careers guidance - a more directive and advisory role than counselling, used to help individuals find appropriate sources of information. The centres also have information on funding, pay structures, and whether the profession is over or under-subscribed - effectively the chances of promotion.
With all this in mind, and feeling disheartened by medical education, I went to arrange a careers interview at my university, the University of Birmingham.
“What faculty are you with?” “Medicine.” “Oh. Are you thinking of leaving medicine?” “Um. I don't really know.” “The thing is you can't have an interview about medicine because the medical faculty doesn't fund the careers service.”
It turns out that this is true of many university careers centres - they can only help with careers outside the medical profession. I was allowed to have an interview as long as it wasn't about medicine. So where do medical students go when they're looking for advice about medical specialties? “They have their own library at the medical school. Most of them seem to know where they're going anyway.” Unfortunately this isn't true. Many careers centres assume that medical students are able to find out about careers from within the profession but the reality is that they are not encouraged to seek careers advice and most have no idea where to start. While students of other faculties spend an appreciable amount of time in careers centres medical students, and indeed doctors, are expected to decide between more than 50 specialties with specific training requirements, pay structures, and possibilities for promotion without any guidance. Also the three computer programs do not contain information on medical specialties. In the hope of getting some benefit from the software, some medical students try the programs and then extrapolate the suggestions to the medical profession. For instance if the program suggests primary school teaching it's tempting to think of it as suggesting paediatrics. However, such extrapolations are dubious and obviously limited.
Thankfully some careers services have faculty advisers - a member of staff specialising in careers relevant to that faculty. The medical advisers primarily help students but at a push may help doctors as long as the doctor recognises the constraints on his or her time. Again, this is simply because it isn't possible to see everyone.
Recently the British Medical Association revised its booklet entitled Guidelines for the provision of careers services for doctors highlighting the lack of careers services for medical students and doctors. This, together with the booklet Medical careers: a general guide, has motivated University College London to set up a panel of consultants trained in giving careers advice. The consultants are being taught how to encourage medical students to weigh up the pros and cons of a particular career. Helping students to make their own decisions is a rare skill in the medical profession as traditionally consultants tend to be both directive and domineering.
Medical students in their fourth year will be invited to approach a consultant in the specialty they're interested in. As well as representing a specialty the consultants also represent a specific background - perhaps a part time doctor or a member of an ethnic minority for example. Those students who are undecided will be able to see a general adviser to discuss the different specialties as well as the possibility of leaving the profession.
The panel, one of the first of its kind, is certainly the way forward for careers advice but is not available under the mutual aid scheme, again because they simply wouldn't be able to cope with the demand.
Inadequate careers services can mean that doctors remain ignorant of the options available to them, don't fulfil their potential, spend too much time in posts that are ultimately irrelevant, and may even be lost to the profession. There is also a good argument to suggest that they may even compromise patient care.
Obviously it would be expensive to provide comprehensive careers advice to all medical students and doctors but such expense may be justified in the face of losing more doctors from the profession.
New schemes such as the panel of consultants (the scheme is as yet untitled) and initiatives such as the British Medical Association's Guidelines for the provision of careers services for doctors will help the future generation of doctors. For now the “old school tie” regime remains but things do appear to be changing. University careers centres are the first place to start looking, and even if they are unable to help directly they should be able to point you in the right direction. Hopefully one day I will be able to phone a medical school, ask for the careers adviser, and not have to hear; “We just train doctors here, so there aren't any other careers to consider.”
Medical careers: a general guide is available from local BMA offices or from the BMA's Medical Education department, free to members and £10 to non members from BMJ Bookshop, 1 Burton Street, London WC1H 9JR. Tel: 0171 383 6662 The Careers Service Unit web page has information about most of the university career services in Britain.http://www.prospects.csu.man.ac.uk/