Intended for healthcare professionals


How can I smoothly transition from trainee to consultant?

BMJ 2020; 370 doi: (Published 28 September 2020) Cite this as: BMJ 2020;370:m3677
  1. Abi Rimmer
  1. The BMJ

The move from training into a consultant position can be daunting. Abi Rimmer speaks to four experts about how to make the transition

“Don’t rush into it”

Rebecca Caulfield, specialty trainee year 8 in community paediatrics, Mersey Deanery, says, “Moving into year eight after 10 years of postgraduate training was daunting. I started the #TipsForCCT hashtag on Twitter to invite colleagues to give their advice. This is what I learnt.

“Ask about opportunities, attend consultant meetings, and remind people that you’re nearly finished with your training. Identify your dream job and then ask for it—if you don’t ask, you won’t get. Be prepared to defend your own worth.

“Before you start looking at job adverts, learn what direct clinical care and supporting professional activities mean and how the consultant contract works. Know how many patients you can see in a four hour ward round.

“There’s no need to rush into your long term role. The experience you can gain in a locum or fixed term post will come in handy and you may find yourself trying something new that you continue.

“Being a consultant involves some management so it might help to read a business plan or try courses for new consultants on medical education and management. You’ll be transforming services so knowing how to speak to managers and what pressures they face is helpful.

“Don’t forget to think about your work-life balance—pick a job that fits your lifestyle. Look at the team you’ll be working with before accepting a post—they will be important. If you can visualise yourself working, laughing, and crying with them, that’s your team. Then use your first year to build relationships. Don’t be in a rush. It’s a very long job.

“Finally, brush up on your organisational skills—make a habit of reading, dealing with, and filing your emails into subfolders and deleting regularly. Make sure you have a system for completing assessments.”

“Pick your role with care”

Andrew Tabner, emergency department consultant, Royal Derby Hospital, says, “Don’t be afraid to take a little time off before you start your consultant role. You’ve been working hard for many years to get to this point, and it may be the last time for a while that it’s this easy to take a month or two—or more—off in a row. You can always do a few locum shifts to make ends meet.

“Pick your department and your colleagues with care. The culture is likely different from place to place, and while it’s not immutable it takes huge effort to change. Equally, while colleagues will change over time, it’s much simpler to start with a team you enjoy working with than to hope one develops around you.

“Think about your job plan early. What special experience, interest, or skills do you bring, and what do you want to do with your time beyond your basic clinical commitment? Everyone says to ‘say no’ to things early in a job, and it’s true that your diary will soon fill, but it’s never too soon to have a passion project.

“Don’t forget to think about finances. Pensions and taxes are complex, and pay rises and promotions will come at a time where you are already at a high risk of incurring an unexpected tax bill. Get a good financial advisor if you don’t have one already; it’s likely too late once the bill has arrived.

“Finally, don’t worry. It’s natural to be nervous at the step up, but neither the patients nor their illnesses have changed. You’ve got this.”

“Foster relationships”

Nikola Henderson, consultant surgeon, NHS Tayside, says, “Your reputation takes a while to build. Being polite, kind to patients and staff, and remembering that no job is beneath you is a good place to start. You will get more done and effect more change if you have built relationships and have allies.

“The other people who matter are trainees. Being a trainer is good fun. I try hard to complete the various forms and assessments that trainees need as it shows respect. In hindsight, I wish I’d gained some experience in coaching skills and reflection before becoming a trainer so if this is available to you make the most of it.

“Administration is job planned as a session of my time, but the reality is that it is part of everyday life. Having my NHS laptop means I can do a lot from home. Having my email on my phone is essential—if an email only takes a few seconds to respond to then it is worth dealing with instantly. I also use the calendar on my phone to protect any scheduled non-working time as otherwise the temptation is to agree to do something.

“Going from being a less than full time surgical registrar to a full time consultant has meant a reduction in the length of each day. I am no longer tied to the hospital from 8 am to 6 pm and this freedom has been wonderful. I can take my children to school and then drive to the hospital: the overall improvement in my work-life balance has been considerable.”

“It’s a gradual process”

Sarah Muldoon, consultant anaesthetist and Royal College of Anaesthetists council member for anaesthetists in training, says, “I’ve been an anaesthetic consultant for six weeks and recently a registrar asked how I prepared for the change in role and responsibility. The advice I gave was to seek opportunities to think and act like a consultant before the transition.

“This might be as simple as a mental exercise when dealing with an individual patient, or a formal arrangement to do solo lists, clinics, or ward rounds with distant support. I was able to ‘act up’ on the consultant rota in my final months as an anaesthetic specialty trainee year 7.

“In the first weeks of being a consultant, I felt awkward answering ‘that’s me’ when someone asked for the anaesthetist in charge. I wasn’t sure I had the experience to manage complex cases or the diplomacy to deal with political disputes. Being in a supportive department where I knew the team well helped.

“I knew the role was part of my training, and other consultants would expect me to have questions and doubts—that gave me a bit of psychological safety. In fact, I found I didn’t ask for as much help or advice as I expected, which reassured me that all my training had paid off.

“Seeking more independent experience may also help you prepare for job applications. I read job descriptions and person specifications and knew I was already fulfilling the roles described. Being able to tick the “desirable” box of “experience at consultant level” gave me more confidence to pursue the post I wanted.

“Getting as much independent experience as possible, whether through acting up or other opportunities, will help prove to yourself that you can do the job. I’m still comfortable asking fellow consultants for advice, as I now see the change from senior trainee to consultant is a gradual process, and I’ve been fortunate to get a head start.”