Developing career services for studentsBMJ 1996; 313 doi: https://doi.org/10.1136/bmj.313.7058.2 (Published 14 September 1996) Cite this as: BMJ 1996;313:S2-7058
There is some way to go, but career guidance for medical students seems to be improving, writes Kate Thomas, a senior lecturer in general practice in Birmingham I would wholeheartedly echo Pritpal Tamber's challenge to medical schools in these pages recently (20 July). He said that “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’.” Glimmers of light can be seen at the end of what has otherwise been a long dark tunnel of indifference. To be fair, those in positions of influence at medical schools were never involved in a Machiavellian plot to withhold career guidance from their students; it was just that traditionally jobs for doctors were plentiful, most people found something that suited them, and if not there was always general practice.
At the end of the pre-registration house officer year medical graduates are confronted by an enormous choice in their future careers. In theory, at least, there should be something for everyone - from laboratory based subjects, such as microbiology and pathology, to the intensely patient oriented specialties, such as general practice and psychiatry. Between these extremes are all manner of specialties. How is a student to choose which he or she wishes to pursue for up to 40 years? Disillusion with the choice some people make has been shown to make their lives unhappy and is therefore likely to make the medical experiences of some of their patients unhappy too. One way to reduce the incidence of burn out may be to help doctors choose more wisely in the first place. At present there is too little emphasis placed on finding out what an individual student is good at and what his or her aspirations are. This is compounded by the fact that the majority of medical students go through medical school without being known particularly well by anyone. Career guidance is not simply a matter of telling someone “how to become a…”; it must be concerned with suitability of the job for the person and the person for the job.
Survey finds variable provision
In 1992 a colleague and I conducted a survey of all UK medical schools inquiring about their provision of career guidance. I repeated it in October 1995. Our first survey revealed that there were only five of 27 medical schools that could identify someone who was “in charge” of career advice. By 1995, and with, it has to be said, a more robust methodology, 21 such advisers were identified. This in itself may mean nothing, of course, but it might be interpreted by the optimistic as being a sign that there is a growing acknowledgment that medical schools have some role in helping students choose a career that suits their aptitudes and skills and is likely to give them the sort of life they want.
Seventeen of the 21 responding medical schools hold a BMA sponsored careers fair for students, typically during the final year, 15 hold lectures, and nine seminars on careers and career choice. Southampton has student led sessions. Four medical schools have moved from the glimmer of light at the end of the tunnel to become veritable beacons atop hills. Aberdeen, Cambridge, Leeds, and St George's, London offer all students an individual interview to discuss their career development.
This obviously represents a huge amount of effort. Professor Robert Wood, Aberdeen's postgraduate dean, says that “specific career guidance requires one to one contact and the person doing the guiding has to have a full curriculum vitae of the student or young graduate.” One respondent commented that the difficulty some students have in making a choice about a career reflects the difficulties they have in making choices at all, and that we should be focusing on teaching that skill. It may be that the changes in the undergraduate curriculum, with increased emphasis on problem solving and self directed learning, may improve the students' skills in making choices.
When faculties were asked “do you feel that careers guidance currently offered is: too much, adequate, not enough?” 57% of respondents felt that enough advice was available to students compared with 47% in 1992. However, it was also a frequent comment that the students made poor use of the facilities available. Although students may be frustrated by their perception of the paucity of information and help available, their tutors are similarly frustrated by the failure of students to make use of opportunities which do occur. Even the four schools offering individual appointments note that some students fail to attend them.
Problems with informal advice
Five schools commented that the lack of formal provision for career guidance was a problem; particularly opportunities for individual and small group sessions. Six schools mentioned discussion with tutors and clinical staff as the main source of information. This is, of course, the way most of us obtained our information on what a career in a specialty involved and remains the most common method. There is a lot to be said for it. Talking to people training in a field gives the student up to date and “real” advice. The downside is equally apparent. If the trainees like their choice they will give an enthusiastic and biased view of it. If they have just failed an exam, been complained about, split up with their partner, or are just plain disillusioned, the advice may be biased in the opposite direction. Neither junior or senior medical staff are trained to give objective career advice to students and are not, in any case, considering more than one option. As two of the respondents offering individual advice commented: “Specialities sell themselves rather than considering the skills required. No one yet (apart from me) talks to the students about what sort of person they are: their likes, hates and the sort of lifestyle they wish to lead. Too many people involved slightly with it know too little about the options available.”
The influence of role models in career choice in medicine is known to be strong and the charismatic consultant or GP one encounters early in one's career can have a lot to answer for. Even in these days of equal numbers of men and women entrants, encountering a woman who seems to have made it - having both a consultant post and a family - is a powerful motivation for women medical students. Students cannot help but be influenced in this way, but independent advice might help reduce this halo effect - choosing a specialty will not automatically make you become like someone you admire.
It is a vexed question as to whether students should be thinking about careers at all. Some say they are too inexperienced in the realities of work and too focused on qualifying to be able to make cogent decisions on a career. I feel that there are good reasons for making a decision when one knows something of what it is like to be a doctor rather than a student, but I also feel that students need to be using the opportunities available at medical school to access information and advice from a wide variety of sources, and at least start to eliminate careers that they find unattractive.
Action for improvement
One relatively straightforward way in which information for students and junior doctors could be improved is the provision of good written information and a readily accessible list of senior members of each specialty whose responsibility is to give sound impartial advice on a career in that specialty. Such information exists but it is difficult to find and its provision is uncoordinated. Such documents could form part of a “leavers' pack” for all medical graduates.
The major problems in providing good career guidance seem to fall into three categories.
Firstly, there is a lack of good information. This could in part be addressed by better written material, but the problem of not being able to predict the future of the health service is a very real one. The practice of medicine has changed greatly in the past ten years and is likely to continue to change rapidly. Hopefully, the changes in medical education now being introduced will enable today's students to adapt successfully.
Secondly, there is the difficulty of providing advice to such a diverse group. Individual help seems likely to be the most successful, but increasing student numbers make this fraught with logistical
Thirdly, it seems likely that there will always be two schools of thought on whether career guidance should be given to undergraduates and postgraduates or just to postgraduates. There are those who believe it is worth while to offer advice and guidance to students and those who feel that students should not be encouraged to think of making a choice until they are working. It may be that the two camps are not irreconcilable.
By providing students with good quality advice about what specialties involve, added to a discussion regarding what the student wants from life and what his or her interests and skills are, we may be able to help them start to think of suitable options as students, which can be modified or clarified when they become postgraduates.
The 1992 survey was conducted jointly with Dr Caroline Anderson, lecturer in general practice, University of Nottingham. Melanie Cohen, a research associate in the department of general practice at the University of Birmingham, helped with the 1995 survey. The work was funded by a Department of Health grant to the Royal College of General Practitioners' Stress Fellowship. I am grateful to Dr Ruth Chambers, RCGP stress fellow, for her generosity in supporting the research.