’Tis the season to be choosing

Three stories

Rachel was a high flyer with a CV packed full of academic prizes and publications. Like many trainees who are strong across the board and who could turn their hand to many different specialties, she struggled to work out which to choose. She decided, therefore, to limit her choice to run-through specialties, as she didn’t fancy putting herself through an additional competitive recruitment process in two to three years’ time. Rachel successfully applied for radiology training, but just over a year into her training she found that she really missed being responsible for the treatment and longer term care of her patients. We discussed at length whether the sort of patient contact involved in interventional radiology would suffice, but in the end she decided to switch to obstetrics and gynaecology—a specialty where she would have the lead role in the treatment and care of patients. A key principle here is that, when choosing a specialty, it is essential that you think long and hard about the sort of interaction with patients that you find most satisfying. The issues to consider include, for example, whether or not you enjoy having considerable contact; continuity of care; and working with particular sorts of patients.

Vijay’s story was different. His mother was diagnosed with inoperable cancer during his foundation year 1, and his father and siblings looked to him for support at this difficult time. Vijay moved back home, and so his days consisted of looking after sick people at work and then caring for a desperately sick mother at home, so there was little respite from illness and death. It was during this period that he decided to apply for training in public health. At the point he contacted the Careers Unit, his mother had been dead for three years and he was midway through his training in public health. The extent to which he missed contact with patients quickly became apparent in our discussions, and Vijay came to see that choosing a specialty without patients had been an essential survival strategy that allowed him to continue training while playing the major role in caring for his dying mother. What Vijay’s example highlights is the need to consider whether a long term career decision is being unduly influenced by factors that may change in the short to medium term.

My final example is Edward, who came from a family where it was not acceptable to get anything other than full marks. At school, feedback from his parents invariably focused on the subjects in which he hadn’t come top of the class, and this continued throughout his undergraduate training. Not surprisingly, when it came to choosing his specialty he opted for one that would represent the greatest personal challenge—and for him that was radiology. Edward didn’t contact the Careers Unit because he was failing in his training: he had passed all his postgraduate exams and was in the final years of the programme. But he had become increasingly stressed and disillusioned, and he dreaded going in to work each day. In one session Edward mentioned that he had completed some careers related psychometric tests at school. The resulting report, which he brought to the next session, suggested that his verbal, numerical, and abstract reasoning skills were considerably stronger than his ability to interpret data in three dimensions. Yet he had chosen a specialty that drew heavily on this capacity. The point of this story? Build a long term career on natural talents rather than on aspects of work that tend to be more problematic.

General principles

I should emphasise that just because two of these three examples involve radiology I am not implying that exit rates are particularly high from that specialty. (I have seen as many specialty trainees who have opted to switch into radiology as those who have opted out of it.) But I am suggesting that within each of these three stories are some general principles that can underpin robust career decision making.