Know what makes you tick: the key to specialty selection
Authors: Emma Sedgwick
Publication date: 18 Sep 2012
Choosing a specialty requires a thorough evaluation of your strengths and preferences, says Emma Sedgwick
Faced with a life changing decision—whether to accept a proposal of marriage or buy that dream house—many people seem happy to trust their instincts. When it comes to selecting a specialty, however, relying solely on your gut instinct can leave you with a nasty case of career indigestion.
Doctors who find they are unhappy in their specialty often cite a variety of external influences that pushed them towards a particular career path, such as parental pressure to choose (or reject) a particular specialty. Others admit that they should have sought more guidance but were perhaps too keen to fill out their application forms and begin the next phase of their career. What these doctors generally have in common is that they did not pay enough attention to the first and perhaps most important aspect of career planning: understanding who they are.
The nearest many of us come to examining our own attitudes and behaviour is when we complete the jokey surveys in magazines: “Are you a super mum?” “What fashion tribe are you?”
Of course, a personality test won’t magically lead you to the perfect specialty for your “type.” Psychometric testing is a useful starting point if someone qualified can interpret the results, but research has shown that there is likely to be as much variation in “personality types” within specialties as between them.
A better approach is to carry out a thorough and honest appraisal of your own likes, strengths, and dislikes, which will give you an insight into the areas of medicine that are most likely to suit you.
Try to keep an open mind about your specialty choice at this stage, and don’t be tempted to moderate responses that don’t seem to fit your preference. If you really hate working on your own, for example, don’t pretend this isn’t important because you have always wanted to become a general practitioner.
So, what questions should you ask yourself?
What am I good at?
Look back at your top five achievements, either inside or outside work. It might be a social event that you organised at medical school; an interaction with an elderly patient that received positive feedback from your supervisor; diagnosing a patient’s unusual condition after he or she initially failed to respond to treatment; a charity marathon run; even a decorating project at home.
Analyse and list the skills that made each achievement possible. Was it technically demanding? Did you demonstrate organisational ability; communicate effectively with a vulnerable patient; work well within a team; display problem solving skills; or show attention to detail? It’s also a good idea to talk to your educational supervisor about what he or she considers to be your particular strengths.
You should end up with an inventory of your skills and strengths that you can consider against the person specifications for each specialty provided by the medical specialty training website. This will give you a feel for the specialties that play to your particular strengths and could prove invaluable if you are asked during an interview to give practical examples of why you are suited to a particular specialty.
Voices of experience: Hywel Jones
Hywel Jones is sub-dean of medicine at Gwent Clinical School and associate medical director (education) at Gwent Healthcare NHS Trust. He is a practising anaesthetist at Royal Gwent Hospital and vice president elect of the Royal College of Anaesthetists’ council
Acute medicine always fired my imagination, and I was drawn to anaesthesia through my interest in pharmacology, as well as physiology and anatomy. One has to be a little obsessive about detail in anaesthesia, given the powerful drugs involved and the need to concentrate on a patient’s physiological response and his or her vital signs throughout the surgical procedure.
I love the immediacy of anaesthetics and the variety: as well as providing an anaesthetic service, we get involved in critical care, pain management, obstetric analgesia, and resuscitation services, and we have a growing role in prehospital emergency medicine, treating severely injured trauma patients. Plus the specialty is well represented in education, research, and management.
Some friends joked that I chose anaesthetics because I didn’t want to speak to my patients, but anaesthetists have to be excellent communicators to reassure patients when they are at their most vulnerable. Our role is to humanise what is inevitably a frightening experience, especially for young children, and do our best to ensure it is as stress free and pain free as possible. The responsibility can be stressful, but experience helps, and you are never isolated because you are always working in a team.
I’d advise anyone considering a career in anaesthesia to do their research. Many foundation rotations include four months of anaesthesia and critical care, which are very popular, even for non-anaesthetists, because they deliver further knowledge and skill in looking after critically unwell people. Foundation training also offers periods of attachment (taster weeks) that can help you decide on your future career.
What do I enjoy?
What we enjoy and what we are good at tend to go hand in hand, so it can be helpful to reflect on the areas of medicine that you enjoyed the most during your medical school and foundation years and consider what made them so gratifying. For example, you may have enjoyed emergency medicine because of the adrenaline rush you experienced and the quick results; a research project that you took part in because of the statistical analysis involved; or general practice because of the variety of conditions you saw.
Be careful not to allow your fond memories of the people you were working with or the person supervising you to cloud your judgment. For example, if you felt a connection with people from a certain specialty it’s natural to gravitate towards that specialty, but it doesn’t mean every team or department will be the same.
What makes me unhappy?
Consider what makes you stressed or bored, both inside and outside work. You may hate routine or dislike uncertainty; some doctors instinctively prefer the idea of a run-through specialty, for example, because it means they know where they will be for the next few years. Have there been particular types of patients who have left you demoralised? Were there placements that left you frustrated because you did not know the outcome of patients you treated?
Bear these factors in mind when researching the different specialties. It may seem negative to think about all the reasons why a specialty isn’t for you, but if you disregard this information you could find yourself feeling demotivated a year or so down the line.
Voices of experience: Alice Lomax
Alice Lomax is a specialty trainee year 5 in liaison psychiatry at St Helier Hospital in Carshalton and part of the St George’s higher training scheme in psychiatry. She also chairs the Royal College of Psychiatrists’ trainees committee
There are no quick fixes in psychiatry, but I find it fascinating, rather than frustrating, to delve a bit deeper with patients over multiple appointments and get to know them better.
Unfortunately, there are some common misconceptions about the specialty: for example, that psychiatrists risk losing their medical skills. However, this just doesn’t reflect my experience of general adult psychiatry, where patients’ mental and physical wellbeing always go hand in hand and where my clinical knowledge is regularly put to the test as part of a multidisciplinary team.
My advice to anyone considering
psychiatry is not to base your decision on one or two conversations. There is so much more to the specialty than you might realise, so it’s worth talking to as many people as possible—at core training, registrar, and consultant levels and from different teams—to get a rounded picture. I’d also recommend going on taster weeks and perhaps attending one of the summer schools run by some universities and deaneries. Finally, look at the training rotations of the different deaneries, as some may focus more on the area of psychiatry that most interests you.
What motivates me?
Think about your ambitions. You might want to be a renowned surgeon, be in charge of a department, have the chance to teach, or work overseas.
Your goals don’t have to be entirely work related. For example, it can be difficult for doctors to admit that they are motivated by money, because they often feel expected to be wholly altruistic. But there is no point in pretending otherwise if you are motivated by an expensive lifestyle and want to work in a specialty, such as plastic surgery, where there are more opportunities to practise privately. Equally, spending time with your family may be more important to you than a job with long periods on call.
There are no right or wrong answers here, but you need to know what is important to you. It may just keep you going during that marathon night shift.
Where do I want to be in 15 years?
It’s all very well going for a specialty that inspires you now, but will that still be the case when you have reached consultant level? (And how difficult will it be to find a consultant post?)
Envy may be one of the seven deadly sins, but look at the consultants who inspire you: are they living the life you want to live? If you discover that management tasks take up a large amount of their time, for example, will you see this as an exciting challenge or an unwelcome distraction from clinical practice?
Voices of experience: Andrea Collins
Andrea Collins is a specialty trainee year 7 (currently studying for a PhD) in respiratory medicine at the Mersey Deanery and chairs the specialist trainees advisory group of the British Thoracic Society
I came quite late to respiratory medicine after senior house officer rotations in anaesthesia and intensive care medicine and was particularly inspired by two dual accredited intensive care respiratory consultants who seemed to have really interesting jobs.
I think it helped that I was a decent all rounder. Being a generalist is a great plus in respiratory medicine because there are so many possible causes of respiratory problems: obviously lung and heart disease, but also other factors, including psychological conditions.
Many people seem to believe that respiratory medicine is all sputum, but I’d argue that gastroenterologists in particular have to deal with a lot more bodily fluids than we do. In fact, there’s a lot of variety in respiratory medicine: from acute medical conditions, such as acute pulmonary emboli, to managing chronic conditions such as bronchiectasis and chronic obstructive pulmonary disease, to involvement in palliative care. There are also plenty of opportunities to subspecialise and get involved in research and education.
I’d advise foundation year doctors and specialty trainee years 1 or 2 doctors who are interested in the specialty to talk to some respiratory doctors and try a taster week or even just a few days. The specialty is quite different when you are a registrar and a consultant than it is as a foundation doctor. It’s definitely worth attending the British Thoracic Society’s conferences to enhance your knowledge of the specialty and find out about important new developments.
The information that you have accumulated from these exercises is the ideal starting point to explore the medical careers open to you.
Get as much experience of prospective specialties as possible through the taster weeks on offer at your foundation school, and seize opportunities to meet other trainees and consultants from the specialties you are interested in, because it’s easy to have misconceptions about specialties that you have not experienced at first hand. Don’t allow any worries about giving the wrong impression to stop you from finding out what matters to you. For example, if you want to know about the opportunities to take a career break further down the line in a specialty, then check with your deanery careers service.
If you decide you want to pursue a particular specialty, ask other trainees which consultants are most approachable and find out whether they are prepared to act as your mentor so you have someone to go to for advice and inspiration when you need it. You can also seek help through the royal colleges and specialty medical societies, which are always keen to attract enthusiastic and able recruits.
If you are struggling, it can sometimes help to draw a grid with the things that are most important to you along one axis and the specialties along the other so you can see in black and white whether a particular specialty ticks the right boxes. It’s also worth approaching your deanery careers service or a careers coach if you want to talk things through with an independent third party.
Understanding yourself can help you choose the right specialty, but it doesn’t mean there will be only one perfect fit. Research indicates that you can be equally happy in several specialties, provided of course that you don’t see the alternatives as second best. Be realistic about your options and don’t reject a career path that looks like it might be right for you because it isn’t the one you had dreamt of.
Voices of experience: Steve Mowle
Steve Mowle is a vice chair of the Royal College of General Practitioners’ Council and a general practitioner principal in South London. He’s also a general practitioner trainer with the London Deanery
What sets general practice apart from some hospital specialties is the chance to build long term relationships with patients. As a trainee 80-90% of my patients had made an appointment on the same day, but now most of my consultations are with long term patients who have asked for me, some of whom I have been treating since I joined the practice 12 years ago. I have come to know many of them so well that each appointment almost becomes a chance to continue a conversation with an old friend.
As well as being good communicators, general practitioners need to be able to work independently. This is something some trainees can find difficult because, unlike on the wards, there isn’t always a nurse or registrar on hand.
In my experience, a career in general practice offers variety and flexibility. I can choose to work out of hours shifts; I have been able to develop my interest in treating mental health and addiction; and it’s been possible to achieve the right work-life balance for me, enabling me to fit medical education and politics around my practice.
My advice to foundation doctors who are unsure what path to follow is to think long term. After all, you could be doing this job for 40 years after your training, so you need to be sure.
BMJ Careers Fair
Find out more about choosing a specialty at the BMJ Careers Fair on Friday 19 and Saturday 20 October at the Business Design Centre in Islington, London. Register online at careersfair.bmj.com .
Competing interests: ES is director of the professional development specialists Healthcare Performance Ltd and has been coaching doctors for six years.