Career guidance for doctors
BMJ 1998; 316 doi: https://doi.org/10.1136/bmj.316.7124.75 (Published 03 January 1998) Cite this as: BMJ 1998;316:75
RCSE is doing much to help surgical trainees and medical students
- R W Porter, Director of education and traininga
- a Royal College of Surgeons of Edinburgh, Edinburgh EH8 9DW
- b Standing Committee on Postgraduate Medical and Dental Education, 1 Park Square West, London NW1 4LJ
Editor—Carnall says that career advice for doctors can be hard to come by.1 He may be correct, but I can assure him that the situation is improving.
It is unusual to find surgical trainees disillusioned, but many are confused about the changes in training, and they are often uncertain about how they should proceed. The Royal College of Surgeons of Edinburgh has taken the need for career advice seriously. For final year medical students we have written and distributed the booklet “Becoming a Surgeon,” which describes the pathways to becoming a trained surgeon. We exhibit at the medical school career fairs and have developed a career advisory service, which responds to the needs of medical students as well as surgical trainees. Each year more than 1000 surgical senior house officers receive a brochure from the college describing the new training. Those who register with us receive not only advice and help on structured learning but have the opportunity to correspond with and visit the college for help. Our booklet “Choosing a Surgical Specialty,” which explains the higher surgical specialty options, also assures our trainees that a departure from the traditional career path is not a disadvantage and that interview committees appreciate candidates with diverse range of talents.
Carnall is correct that not all consultants are skilled in appraisal or in counselling. Our course “Educating consultants” is designed to help trainers improve these qualities. All our fellows in the United Kingdom recently received literature on how they can make the most of their training opportunities. We say that one of the motivations for a lifetime of enjoyable surgery is to see confidence grow in young doctors as skills develop and a career begins to blossom. We try to make sure that career information is accessible where it is needed. It is available on the internet (http://www/.rcsed.ac.uk) and also by post.
References
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Career counselling has to be part of appraisal
- Barbara Clayton, Chairb
- a Royal College of Surgeons of Edinburgh, Edinburgh EH8 9DW
- b Standing Committee on Postgraduate Medical and Dental Education, 1 Park Square West, London NW1 4LJ
Editor—Carnall's editorial on career guidance and recent letters in response to Smith's editorial on problem doctors show the wide range of advice and support that doctors currently need.1 2 3 4 As part of this support, the Standing Committee on Postgraduate Medical and Dental Education has recommended the introduction of appraisal for doctors and dentists in training. Its 1996 working paper for consultation clarified the purposes of, and distinctions between, appraisal, assessment, and performance review.5 There is still tremendous confusion about the meaning of these terms and unhelpful variability in their use.
In the standing committee's view, supported by the vast majority of those responding to the consultation, appraisal for doctors and dentists in training should be primarily educational, totally confidential except in defined eventualities, and designed to help the trainee to progress. In contrast, assessments, which are also an important part of postgraduate education, are needed to inform the regulatory process about career progress. They should be objective and open and subject to appeal. Both appraisal and assessment contain elements of performance review, but they need to be kept separate. This presents challenges to hard pressed consultants and trainees, who must find protected time to carry them out.
Unlike Smith,4 the Standing Committee on Postgraduate Medical and Dental Education considers that career counselling has to be part of appraisal because appraisal is a tool to help career development. Appraisal should therefore not just be confined to feedback on performance in a particular post. Doctors will draw on many inputs when making decisions about their careers and professional lives, a process that the committee has termed continuing professional development. This and other forms of support, including mentoring, are the subject of inquiries by the standing committee, and reports will be submitted shortly to the secretary of state for health.