Career Focus

Career development centres for doctors

BMJ 1998; 316 doi: http://dx.doi.org/10.1136/bmj.316.7135.2 (Published 21 March 1998) Cite this as: BMJ 1998;316:S2-7135
  1. Steve Kisely, Consultant in public health medicine
  1. 213 Hagley Road,Birmingham B16 5RQ.

    When the job for life is dead, reviewing career direction is vital. Steve Kisely was one of a team that piloted a three day course to help NHS doctors to plan their own futures


    Embedded Image

    Assessment and development centres have long been used in industry for the selection and career development of key staff. By contrast, the NHS places little emphasis on the career development of its staff. Although postgraduate deans, training scheme organisers, and trainers have responsibility for giving careers advice to doctors in training grades, this is not accessible to those in career grades, such as consultants, associate specialists, staff grade doctors, general practitioner principals, and community health doctors. In theory, careers advice could form part of continuing professional development (CPD), but it has not formed a prominent feature of college or faculty programmes to date. This article describes experience of a career development centre largely designed for NHS consultants.

    Background

    Historically, attainment of a consultant post has been seen as a career end point. Once appointed, consultants could expect to spend 20-30 years in a stable career structure until retirement. For many, a purely clinical career sufficed, while others sought additional roles in line with their individual interests, participating in education and training, royal college or faculty activities, academic work, or medicopolitics.

    Recently, a number of developments have challenged the assumption of a “job for life.” The advent of shorter, more structured postgraduate training for junior doctors means that many will be appointed as consultants earlier in their clinical career, and they may therefore seek greater diversity of experience in their consultant post. In addition, more doctors are exploring the increasing opportunities to move into medical management with roles such as clinical director, medical director, and chief executive. Finally, greater instability in the jobs market has meant that consultants in some medical specialties and trusts are facing the prospect of compulsory redundancy or retraining, with the consequent need to re-evaluate career choices.

    Consultants may glean informal careers guidance from colleagues, mentors, postgraduate deans, colleges, or faculties, or they may approach private agencies. However, they will rarely find formal programmes of career development within the NHS.

    Career workshops

    The career development workshop described in this paper was organised as a pilot for the NHS Executive by the British Association of Medical Managers (BAMM). Before arriving on the three day intensive residential course, facilitators, organisers, and the 21 participants each submitted a short curriculum vitae, which was shared with the others attending the course. Participants came from a wide variety of backgrounds in public health and clinical and primary care and were of varying seniority, from newly appointed consultants to medical directors and clinical tutors.

    “Settling down”

    On arrival, those attending the workshop were divided into “home groups” of about six members. These groups provided an opportunity to get to know some of the other participants in greater depth and provided a base for support and reflection during the course. Each home group had a facilitator to guide discussion and help members select options from a range of available activities. These initial activities were designed to enable participants to take stock of their current strengths, weaknesses, and motivations.

    Choices included:

    • One to one interviews with workshop facilitators

    • Use of a computer program to identify “core constructs” influencing career choice

    • Questionnaires about life style and psychometric and other tests

    • Facilitated sessions to investigate previous career choices.

    “Why am I where I am?”

    The intention of the next phase was to help people answer the question: “How did I arrive where I am now in my career or in my life?” Variety techniques were used. Working individually or in pairs, participants used a self scoring questionnaire which evaluated personality, used specially designed cards to gain insight into their personal values and skills, and drew their own “biolines,” which involve picturing your life as a series of peaks and troughs and exploring the reasons behind choices made and investigating any recurrent patterns. Some used a computer program to explore which aspect of a job offered them fulfilment. A session on “the balance of our lives” looked at the balance between careers and other aspects of life, assessing how to evaluate and improve satisfaction with each facet.

    Views about medical management and the differences between being a manager and a doctor were investigated. Role analysis exercises provided participants with a framework for analysing professional and managerial roles and enabled them to test their own potential for such careers.

    “Where might I be going?”

    In the third phase participants tested out their new insights with people holding different roles. These included a clinical director, medical director, unit general manager, chief executive, acute trust chairman, clinical tutor, and two people with “portfolio” careers. They were able to test the match of their current skills, competencies, and career paths against those of existing post holders and they could also evaluate these experts' personal experience of potential career alternatives.

    “How do I get there?”

    Participants returned to their home groups for the final part of the workshop, which entailed the facilitated development of an action plan for each individual. This consisted of a realistic career development plan and a series of short term strategies that would form the first steps to fulfilling long term career ambitions. Participants also considered potential sources of help and hindrance, such as superiors, peers, and organisational culture. Personal and organisational resources to implement the action plan were also identified.

    Evaluation

    As a pilot, the workshop was subject to detailed evaluation by a questionnaire completed by participants at the end of the workshop and three months later. One strong message was the frustration that many participants felt at not previously having had the opportunity to look at career development. They found the most useful activities to be the computer aided analysis of career “core constructs,” the opportunity for one to one sessions with experts, and discussions with role models. A discussion of career needs with an outsider is not normally available to consultants, and informal discussions with facilitators, post holders, and colleagues were as important as the formal programme. Participants would also have liked more time to incorporate what they had learnt about their skills, competencies, and ambitions into action plans for career development.

    Three months later, all the participants were making progress with the action plans they developed at the workshop, although some were finding progress slow. Some felt that follow up support would have been useful.

    Unanswered questions

    It is often said that staff are the NHS's greatest asset, but the rhetoric is not currently matched by action to support and develop individuals. Career development workshops offer a way for the organisation to understand doctors' career needs better, as well as offering guidance to individuals. The participants rated the pilot workshop as very worth while, and more are planned.

    However, some questions remain. The first is to decide who should be encouraged to attend. The existing project was targeted at consultants, but clearly other career grades in both hospital and community services could benefit from similar opportunities. Doctors in general practice are also poorly served in terms of career advice and development, despite the current crisis in recruitment and retention. Likewise, formal career development will become increasingly important for junior doctors, and inputs such as this may reduce the worryingly high drop out rate from medical training.

    The second question concerns the provision of ongoing local support to provide follow up and advice on the implementation of agreed action plans. This was not included in the original brief but is very important.

    Finally, residential workshops are expensive to run, with a weekend course costing over £1000. It remains to be seen whether the NHS Executive will support the widespread adoption of such a scheme within the NHS. However, many doctors would benefit from exposure to some of the activities and resources described in this article. Postgraduate deans, training scheme organisers, and personnel departments should consider making these available to the doctors for whom they are responsible.

    Further details about career development workshops can be obtained from the:

    British Association of Medical Managers,

    Barnes Hospital,

    Kingsway,

    Cheadle,

    Cheshire SK8 2NY.

    Acknowledgments

    Acknowledgements

    I thank two fellow workshop participants, Judy Jones and Julia Moore, as well as Mike Garside and Tim Scott, who helped design the workshop, for their help in writing this article.

    View Abstract