Applying for specialty training: top tips

Establish your goal and the bottom line

First you have to decide what you want. This can be very difficult, especially if you haven’t experienced one of your chosen specialties.

Speak to your peers and supervisors, and try to consider what experiences might help you to decide. You may be able to arrange taster sessions, courses, or speak to doctors in different specialties.

Location is a consideration. Remember that some deaneries cover large geographical areas. You may not be placed in the town or county that you want, and you cannot specify precise locations or hospitals at the outset. You should also expect to work in more than one area, unless you are applying for GP training schemes.

It is helpful to look at the competition ratios between specialties and deaneries, and to keep these in mind when applying. Also look at interview dates. It may be worth trying to secure an interview in a deanery that interviews early. Questions are very similar, or identical, within specialties.

Keep in mind, however, that when offers arrive it is easy to get confused or feel swayed into accepting the first offer, particularly as worries about competition escalate. If you plan to keep your options open by submitting multiple applications, try to ensure that you establish a goal, or at least a bottom line, based on specialty and location. Remember that you will have to work for several years in the location and specialty you accept, and swapping inside schemes is very tricky.

Organise your form

Talk to peers, seniors, and last year’s applicants. They are good sources of information and are likely to direct you to more online resources, such as the deanery, royal college, and national recruitment programme websites. Make sure you are as informed as possible about the process of training and the reality of working in your chosen specialty.

Read the applicants’ guide from Modernising Medical Careers (www.mmc.nhs.uk). Last year’s document was not an inspiring read, but it explains the rules, and understanding the most upsetting ones—such as non-negotiable, narrow acceptance windows—will help prepare you for tough decisions ahead.

When application forms are out you will have little time to apply. Think in advance about how you will answer questions, and ensure that you have covered all the basics that might crop up on the form, such as audit and teaching. Sort out your certificates and job details so that you are ready to enter precise dates and grades onto the form.

Before you submit your form, show it to at least one person who will give you honest advice, perhaps a senior colleague in the specialty to which you are applying. Remember that each box on the form can be graded by a different person, so do not write in a way that assumes the marker has read your form sequentially, or in full.

I have always aimed, but never managed, to submit the application much ahead of the deadline. In the final hours, the sites crashing has been a problem, and this can cause stress. If you do leave it to the last minute, my experience has been that traffic to the sites is lighter at the beginning and end of the day.

From the day your application is submitted until the moment you accept the offer, it is important to be hypervigilant to communication from application computers. In 2009 some specialties texted applicants to warn them of emails. For simplicity, ensure all communication goes to one email address—ideally you should be able to access it from hospital and home. You must check it once a day, or ask others to if you take leave.

Prepare your portfolio

When your application is in, start priming your portfolio. I say this with some frustration: my portfolio was a paper one, and with the exception of one psychiatry interview in 2008, to the best of my knowledge nobody opened it. Knowing its contents helps, however, because most specialties ask something about portfolios—except the GP process. Also ensure that you have something filed under each of the General Medical Council’s seven principles.

Make sure that there is some evidence in the portfolio of commitment to the specialty you are applying for. Going to a conference or a course is an easy way of adding to evidence. You could add and remove content according to the interview that you are attending.

Ensure you have done at least one audit. It is helpful to do this in an area relevant to your chosen specialty. But if you are not sure, there are generic topics and processes that can be relevant to a variety of settings. It is best if you can complete the audit cycle, or at least comment on plans to do so.

There is conflicting advice about whether membership exams help. Colleagues applying for surgery seemed most keen to have them.

Most interviews are conducted in objective structured clinical examination style and candidates move between examiners. The questions and scenarios posed at interview are largely about being a junior doctor. The only exception I found to this was an academic GP interview, where scenarios were posed as if you were working as a GP and touched on the department’s research interest.

The GP application process is very different. The exam covers a wide range of presentations and ethical and professional dilemmas. Signing up for practice questions was the most helpful preparation I did—this will familiarise you with the question style, and the dilemma questions are odd to begin with. Remember to book your exam location when prompted or you may be left with a venue at the wrong end of the country.

In the GP assessment centre, the patient interview is straightforward. Make sure you answer something of all of the questions in the written station, and leave time to reflect. Most people find the group discussion is painful and stilted, particularly if other candidates have practised set phrases or statements to add. Be prepared to be listened to and agreed with more actively than ever before. Take a watch because someone will have to keep an eye on the time to make sure you get through the scenarios.

Gather supporting documents

Supporting documents are of equal importance to the portfolio. Read the lists of interview documents carefully. Gather them well in advance of hearing about the interview, in case there are hiccups, such as referees being on holiday, or incomplete foundation documentation.

You must have evidence of actual or predicted foundation competency. Ensure that you establish and then get your references early. If you are applying to more than one specialty, be aware that the reference forms are different and that certain specialties will not accept another specialty’s forms. Take the originals to interview, where you often have to hand them in. Be sure to get the references stamped with the appropriate logos. Make a copy of each reference just in case.

Keep perspective

Perspective, humour, and friends are needed to preserve your sanity. Applying from a year out can be harder because you miss the support of your peers.

The system is rigid, but it is slowly developing. You have to be ready to make difficult decisions. It is possible that you will not get an offer straight away. It is possible that you will not get offered anything at all in round one. I found it helpful to talk to non-medics about the number of application forms and rejections they face to get a job.

Other options are available if your application does not work out. Generally, supervisors are very supportive and have helped candidates in similar situations before. You may want to apply in round two, which could still mean getting your first choice job after others have rejected it. You may, however, decide to take a year out and develop your portfolio for next year.