Why foundation doctors need a critical friend

Authors: Rita Mildner, Nana Muhammad, Alice Crabtree, Yasmin Rahman 

Publication date:  05 Jul 2016


Despite all the careers advice available, choosing a specialty can be a daunting task. Rita Mildner and colleagues describe how they helped foundation doctors through this process

Many surveys and reports have highlighted the importance of formal career support to foundation doctors planning specialist training.[1] [2] [3] [4] However, despite all the resources available,[5] [6] [7] experience[8] suggests that many foundation trainees are unsure about what specialty training programme to choose.[2] Making that crucial career decision involves the consideration of factors—including lifestyle, location, family, and other interests—which require deep personal reflection.

Our foundation school provides a range of career workshops, one-to-one sessions, specialty-specific talks and presentations. The deanery also runs career fairs and CV and interview sessions. In her role as career adviser, Rita Mildner noticed that an increasing number of trainees were finding it difficult to decide on a specialty. She decided to incorporate the “critical friends” process[9] [10] into small group workshops and see if it could help trainees make a choice.[11]

Who is a “critical friend”?

A critical friend is “a trusted person who asks provocative questions, provides data to be examined through another lens, and offers critiques of a person’s work. A critical friend takes the time to understand the context of the work presented and the outcomes that the person or group is working toward.”[12]

It is somebody who provides a critique in a challenging yet supportive manner and provides you with other perspectives.

The critical friends process

There are three distinct roles in the critical friends process: a facilitator, a presenter, and a discussant (group).[12] [13]

The facilitator introduces the session, sets appropriate time limits, and provides a debrief at the end of the session.

The presenter—in this case the junior unsure of their specialty choice—discusses their problem.

The discussant, or the group, participates in a group discussion about the issue at hand.[13] [14]

Typically, the whole process is made up of six stages as shown in the box.

The six steps of the critical friends process

Facilitator overview

Review process

Set time limits

Presenter overview

Share issue

Provide context

Probing or clarifying questions

Group members ask more questions to learn about the issue

Reminder, this is not a time to give advice or get into a discussion

Discussant’s group discussion

Group discusses issue (both warm and cool)

Presenter is silent, taking notes

Group addresses possible suggestions related to the issue

Presenter response

Presenter responds to group feedback

Debriefing

Facilitator leads discussion, critiquing the process

Taken from [Link]

The workshop

We ran six workshops and recruited three to five trainees for each, giving them some reading before the session. The two hour workshop began with a self assessment, which allowed trainees to go through their work values and decide on what was important or not. In turn, they matched and reflected on the individual outcomes from both the reading and values exercises, and discussed these with the group. Mildner, as facilitator, then explained the critical friends process—emphasising what was expected from a critical friend.

The process began with trainees preparing clear, specific questions that would help them make a specialty choice. They then took turns as presenters and shared their issue(s) with the group. During this time, the group carefully listened and clarified issues raised.

The discussant then talked about the issues while the presenter stayed silent, reflecting on the discussions and taking notes. The discussant then fed back possible solutions to the presenter—although the specialty choice was up to each individual to make. The facilitator ended each process with a debrief. Each trainee spent about 15 minutes as a presenter.

At the end of each workshop, trainees completed an evaluation form designed to critique the process and determine if the workshop had helped them to decided on a specialty choice.

Evaluation

In total, 21 foundation trainees attended the workshops, a total of 15 foundation year 1 doctors and six foundation year 2 doctors.

All (100%) trainees thought that the workshop was pitched at an appropriate level and all (100%) agreed that the amount of content and time given were also appropriate. Overall, 100% of trainees agreed that the session was helpful (81% found it extremely helpful and 19%, very helpful), and all trainees (100%) felt confident in making the decisions necessary for specialty choice (48% felt extremely confident and 52%, very confident).

All trainees agreed that the critical friends process was the most valuable and enjoyable part of the workshop. They said that it was useful to overhear discussions about them in the third person and that the honesty and safety of the environment was invaluable to the success of this activity.

They also found that hearing different perspectives made them understand how their peers and contemporaries viewed them. Learning about others’ issues was also useful. Future evaluation could specifically include a question about whether they had been able to choose a specialty following the workshop.

After the workshop all trainees felt confident in making the decisions necessary for specialty choice but we did not specifically inquire if they had decided on a particular specialty. One participant said they were still undecided.

We think the workshop would be useful for foundation trainees at the end of year one or the beginning of year two. The model could also be used with core surgical or medical trainees in their sub-specialty choices.

Competing interests: None declared

References

  1. Jackson C, Ball JE, Hirsh W, Kidd JM. Informing choices: the need for career advice in medical training. 2003. [Link] .
  2. Tooke J, Ashtiany S, Carter D, et al. Aspiring to excellence: final report of the independent inquiry into modernising medical careers. 2008. [Link] .
  3. Collins J. Foundation for excellence: an evaluation of the foundation programme. 2010. [Link] .
  4. Miller P, Johal K, Shelly M, Barker P. Career support. 2010. [Link] .
  5. Careers H. Health Education England. 2015. [Link] .
  6. Medical and Dental Recruitment and Selection. National Health Service. [Link] .
  7. Choosing a specialty. 2011. [Link] .
  8.  The Foundation Programme. 2016. [Link] .
  9. Mildner R, Muhammad N, Crabtree A, Yasmin R. The use of the critical friends process in choosing specialties. Poster presentation at UKFPO/HENE joint careers conference. 2014 [Link] .
  10. Costa AL, Kallick B. Through the lens of a critical friend. Educ Leadersh  1993;51:2.
  11. Indaba-network. Academia: tips for critical friends. 2010. [Link] .
  12. University of Washington. Critical friends: a process built on reflection. [Link] .
  13. Queensland Government, Department of Education and Training. Principal class performance and development: support materials: critical friend toolkit. 2015. [Link] .
  14. Elton C, Reid J. The Roads to Success.  3rd ed. Scribe publications, 2010.

Rita Mildner consultant physician and medical careers adviser
Nana Muhammad foundation year 1 doctor
Alice Crabtree foundation year 1 doctor
Yasmin Rahman foundation year 1 doctor Alexandra Hospital Redditch, UK

 rita.mildner@nhs.net

Cite this as BMJ Careers ; doi: