Intended for healthcare professionals


Careers guidance for foundation trainees: does it make the grade?

BMJ 2012; 345 doi: (Published 10 July 2012) Cite this as: BMJ 2012;345:e4685
  1. Hannah Williams, foundation year 2 doctor1,
  2. Ella Checkley, foundation career lead2,
  3. Paul Baker, foundation school director2
  1. 1Accident and Emergency Department, Royal Preston Hospital, UK
  2. 2North Western Deanery, Manchester, UK
  1. hannahelizabethwilliams{at}


Hannah Williams and colleagues review the effectiveness of careers guidance for trainee doctors in an ever changing NHS

Careers guidance is an important aspect of foundation doctors’ training, and vital decisions that will affect the future of these doctors have to be made at a very early stage in the foundation programme. The competitiveness of entry to specialty training has resulted in trainees having to make decisions at an earlier point in their career than ever before. Evidence of commitment to a specialty is seen to be advantageous at all stages of the selection process. In an increasingly busy NHS, careers advice has never been more vital.

In 2009 the North Western Deanery did a survey to assess its careers guidance and to highlight areas of weakness, which the foundation school’s careers lead could then rectify. The results and recommendations were published in BMJ Careers.1 The survey identified a number of weaknesses, including difficulty in trainees identifying their career lead: only 18% of trainees were aware that the leads existed, and only 6% were able to name the designated person.1 Poor use of the career resources available to trainees was also identified, with only 6% using the online psychometric instruments Sci 45 and Sci 59 (specialty choice inventories) and 4% using the Medical Forum career planning support website.1 The timing of careers guidance was also scrutinised, and just 7% of foundation year 1 (FY1) doctors had received careers guidance at the time of the survey.1 The survey report made a number of recommendations, including encouraging trusts to provide careers guidance sessions earlier within the FY1 curriculum and the appointment of a career lead in the foundation school.

In 2011 the deanery was keen to revisit the views and comments of its trainees and to see whether the changes made had been effective. Areas of further work were also identified to ensure that the careers guidance provided is progressing in line with the new and ever changing pressures that trainees face.


The North Western Deanery prioritises careers guidance very highly and has appointed a foundation career lead to ensure that trainees receive a service that meets their needs. Consequently a wide range of activities have been implemented (box 1). Activities include the construction of a foundation school careers group that consists of foundation school staff, including the school manager; foundation trainees; specialty trainees; local medical educators; university careers advisers; and deanery careers staff. Members of this group regularly communicate via a virtual learning forum throughout the academic year to allow continual discussion of career related projects and ensure constant progression.

This group then feeds into the career steering committee, which meets annually and consists of the foundation school career lead, the foundation school manager, the foundation school assistant, the school of medicine career lead, general practitioners, staff and associate specialist doctors, specialty trainees, foundation trainees, undergraduate trainees, and lay members. This committee supervises the work of the foundation school careers group, responding to any points highlighted and ensuring that all group activities are appropriate and in line with other activities in the deanery.

Box 1: Current careers guidance work in the North Western Deanery

  • Virtual careers forum—This online forum allows regular contact by all members of the foundation career group throughout the year to allow continual progression and development of ongoing projects.

  • Tri-annual foundation school conference—Training for foundation programme directors and administrators in careers guidance, covering topics such as working abroad, leaving medicine, and interview preparation.

  • Online portfolio—Within the foundation trainee’s portfolio is a specific careers section, which consists of reflective forms to be filled in at certain points of training. This encourages reflection on self assessment, career exploration, decision making, and plan implementation. The foundation career lead can also use the forms to obtain feedback from the trainees, allowing continual development. Each trainee’s portfolio contains a comprehensive list of resources for further careers guidance. The portfolio is currently unique within the United Kingdom, and early evidence shows a good response to careers support activity.

In April 2011 the North Western Deanery did two surveys—one aimed at FY1 trainees and one at FY2 trainees. The two surveys were designed to discover whether trainees were accessing careers guidance, who and what they would access, and when. The results were compared with those of the previous 2009 survey to see whether progress had been made and to highlight where improvement was still needed.

The two surveys were anonymous online surveys available to all foundation trainees. In total, 181 doctors replied: 100 FY1s and 81 FY2s. The FY1s were eight months into their training programme, and the FY2s were about 20 months in.


FY1 responses

FY1 doctors were first asked their opinion about the need for careers guidance:

  • 88% agreed that there was a need for careers guidance.

  • 48% knew how to obtain guidance, but 18% stated that they had no idea where to get advice.

Further questioning investigated the different resources used by trainees:

  • The most popular sources used were specialty trainees (42%) and friends and family (34%).

  • Educational supervisors and clinical supervisors were the next most popular resources (29% and 22%, respectively).

  • 4% said that they spoke to their designated careers lead.

Part of the survey also analysed what formal careers education trainees had received:

  • 64% had received careers guidance lectures, and 26% of people had participated in individual careers sessions.

  • The career resources used independently by trainees were varied. The most common were other specialty doctors, which accounted for 93% of cases. This was followed by specialty and royal college websites (55%).

  • The university career service was hardly used at all (1%).

FY2 responses

Responses were more positive from FY2s:

  • Many (80%) had received structured career lectures within their trust.

  • 60% believed that they had received adequate careers guidance, and 62% believed that this guidance had met their needs.

FY1s and FY2s differed in what they said was the most popular source of careers guidance:

  • The most popular source for FY2s was their educational supervisor (47%).

  • The next most popular resource was specialty trainees (46%), a source favoured by both FY1s and FY2s.

  • Clinical supervisors were also used more by FY2s, with 41% of responders approaching them for some form of guidance.

  • Designated career leads were used slightly more by FY2s—10% of cases.

The internet was the most popular resource accessed (79%), and other resources included the BMA and career resource booklets.

Overall, 76% of responders received offers for their first choice of career, and 78% were happy with the offer they had received.


Although the results are positive (with 78% of FY2 trainees happy with the offer they received), there is still clearly room for improvement.

Specialty trainees were a popular source of advice for both FY1s and FY2s. However, FY2s, unlike FY1s, ranked educational supervisors highest. This may be because FY2 trainees build up a relationship with their educational supervisor over a longer time frame, as they have approximately 12-15 months to get to know and trust them. Eighty per cent of trainees had received careers lectures by the time they reached the second year of their training, which showed that junior doctors are receiving guidance. However, it is clear that this is occurring either at the later part of FY1 or the early part of FY2, which suggests that a great improvement could be achieved simply by altering the timing of the guidance already available.

The results here show that although specialty and trust career leads are used more by second year trainees, they are still a valuable resource that is generally underused.

The internet is clearly a popular resource, which highlights the growing use of and dependence on online information among trainees—a resource that could be maximised in the future. A valuable resource poorly used by trainees, however, is independent careers advice; this could perhaps be tackled by more actively involving university career services and their associated resources.

The future

There is still room for improvement. Particular areas of weakness included lack of awareness of certain services and the timing of the careers guidance.

To deal with these weaknesses the careers forum has begun to put a number of plans in place. Firstly, a careers guidance poster, available to all trusts in the deanery, is being developed. The poster aims to highlight the resources available to all trainees and suggests a time frame for certain actions to be carried out. The poster will also highlight to trainees the availability of a career lead in all trusts and the university careers service—two important resources that are currently underused.

The results of the 2011 survey clearly show a high use of online resources. This needs to be maximised, and the careers forum recognises this. Discussions have been held about the use of social media sites to advertise information. There is, however, much trepidation about the appropriateness and safety of using such sites and concerns about who would be responsible for managing the web page within the social media site; the misuse of people’s identity; and the possibility of inappropriate comments on a public site. Discussions continue, and no formal decision has been made as to whether this option is feasible. With the use of such sites increasing among trainees, however, this is surely a resource not to be disregarded too soon.

Another key weakness that the forum is aiming to tackle is the timing of careers guidance for FY1s. This weakness was highlighted in the first survey and again in 2011. Discussions have been held about bringing career lectures forward in the FY1 curriculum, and again these are ongoing. In the interim, to overcome the problem with timing, it is hoped that the use of the online careers reflection forms and the poster will at the very least prompt trainees to begin to think about their career and signpost them to the people who can help them with their decision early.

In summary, not only will the future activity of the forum (box 2) involve work on the issues highlighted in these surveys, but the forum will also look at new issues that arise as trainees progress. One aspect that future careers guidance must incorporate is the needs of trainees who choose to take a career break. Career breaks happen for various reasons, such as caring responsibilities and to pursue other interests. The foundation school careers group aims to support the development of local resources to help trainees plan for career breaks and those returning to training.

Another aspect that future guidance must also consider is the continual increase in competition for jobs, as highlighted by a survey performed by the UK Foundation Programme Office, which showed that only 70% of FY2 doctors went directly into specialty training in 2011.2 Alongside is the ever growing prospect of medical unemployment within the NHS, because of the financial challenges it is currently facing.

The final aspect that future careers guidance must respond to is the recent proposal by the Department of Health for more break points within training.3 These will allow doctors to leave training to consolidate their experience by providing service at a junior level.3 If these proposals are accepted, foundation trainees and medical students will need good career planning skills to enable them to re-enter training and pursue a career that will fulfil them as well as the needs of their patients.

Box 2: Key future targets of the North Western Deanery’s careers forum

  • Improve the timing of formal careers guidance by arranging earlier teaching sessions in FY1

  • Improve awareness and use of national, deanery, and university resources

  • Develop careers support for new challenges, such as career breaks and medical unemployment

  • Improve training, education, and awareness of careers support for all doctors as part of their role as formal or informal medical educators

It is clear that over the next couple of years the challenge for careers services will be getting trainees and medical educators to recognise that career planning skills and flexibility are going to be essential for trainees to achieve a successful career in medicine.


  • Competing interests: None declared.