The “medicine on track” checklist

Authors: Caroline Elton 

Publication date:  30 Sep 2009

Caroline Elton, head of careers advice and planning at the London Deanery, looks at giving your medical career an “MOT”

Four years ago, while I was immersed in the task of devising a career support strategy for the Kent, Surrey, and Sussex deanery, I heard Wendy Hirsh speak at a conference. Professor Hirsh, one of the United Kingdom’s leading researchers on career development, had previously studied the quality and quantity of career support available to doctors,[1] but on this occasion she wasn’t talking about the medical profession but was instead describing the findings of a large scale study that she had done in conjunction with the Chartered Institute of Personnel and Development.[2] This study had focused on work based career discussions (for example, between a line manager and a more junior employee), and one of the key findings was that if the providers and recipients of career support shared a common framework, the recipients found the career support to be more effective.

This result makes intuitive sense: when a senior and a junior person are sitting down to review the junior person’s career, if neither party has any sense of what to focus on or what the conversation is aiming to achieve, the conversation is likely to drift all over the place. Hearing Professor Hirsh speak at the conference was a bit of a “light bulb moment” for me, and this notion of both parties having a shared framework has informed all the subsequent work that I have done in medical career planning.

The four stage approach—a model with a 100 year history

After the conference, the next task was to identify what that shared framework should be, and it quickly became apparent that the four stage approach to career planning could form an appropriate model (box 1).

Box 1: Four stage approach to career planning

  • Stage 1: self assessment

  • Stage 2: career exploration

  • Stage 3: decision making

  • Stage 4: plan implementation

This four stage approach is the one that is commonly used in higher education careers support—both within and beyond medicine. In a medical context, the Association of American Medical Colleges’ online career planning tool (Careers in Medicine), which formed the starting point for the UK’s new national medical careers website ( [Link] ), was based on the four stage approach. Other medical careers services in the UK have also adopted this model—for example, Witty Sandle, from the Warwick Medical School, created the acronym MEDI (Me; Exploration; Decision making; and Implementation) based on the same four stages, and a recent career leaflet produced by the United Kingdom Foundation Programme Office is also structured around the four stage approach.

It is also worth noting that although this approach has been applied to medicine only relatively recently, the idea that career planning entails a series of stages has been around a long time. In fact, the origin of this approach lies in the seminal work of Frank Parsons, whose key text Choosing a Vocation was published 100 years ago this year.[3] Box 2 shows the three “broad factors” that Parsons identified as underpinning a “wise choice of vocation.”

Box 2: Factors underpinning vocational choice[3]

  • A clear understanding of yourself, your aptitudes, abilities, interests, ambitions, resources, limitations, and their causes

  • A knowledge of the requirements and conditions of success, advantages and disadvantages, compensation, opportunities, and prospects in different lines of work

  • True reasoning of the relations of these two groups of facts

Admittedly Parsons identified only three of the four stages. This is not surprising given that a century ago, structured recruitment and selection approaches involving processes such as competency based application forms or assessment centres had not yet been devised. So Parsons didn’t include a stage that maps on to the current stage 4—that is, plan implementation.

Parsons also came up with a list of the personal attributes of a doctor (box 3). With the exception of the final point, they have a surprisingly contemporary feel to them.

Box 3: Personal attributes of a doctor[3]

  • Skill in diagnosis, which depends on knowledge of the body, symptoms, diseases, and so on

  • Powers of observation and analysis

  • Constructive reasoning, or putting all the facts together to make a valid working hypothesis or rational conclusion on the whole case

  • Skill in treatment; delicate adaptation to the individual case

  • Caution, resource, knowledge of remedies

  • Memory for volume of facts

  • Sympathy—a pleasing address

  • Eyesight

  • Mechanical ability

  • Attractive personality/fine character

  • Inventiveness

  • Health

  • Love of the work

  • Resources to buy a practice or live while building one

Four stages in practice

Although the four stage model makes intuitive sense, people actually faced with a critical career decision tend to rush through stages 1-3 and focus all their attention on stage 4 (plan implementation). Ideally people should start thinking about their career well before they have to make a critical decision so they have time for rigorous self assessment (stage 1) followed by detailed career exploration (stage 2), and they are then able to use the results of these two stages to inform their career decision making (stage 3). Instead, all too frequently career planning is left to the last minute and people rush through the first three stages and focus their concern on the details of the application process—CVs, application forms, interviews, and so on (that is, stage 4). Having worked as a career counsellor (both within and beyond medicine) for 20 years, I am constantly reminded how difficult people find it when they feel uncertain about a particular career decision and how often they fail to carry out detailed self assessment or career exploration, but instead rush to make a decision and implement their career plans.

Thankfully a number of useful resources are now available to assist medical students and foundation and specialty trainees with the task of career planning. Within London and Kent, Surrey, and Sussex deaneries, all foundation trainees receive a copy of the career support handbook The Roads to Success, which I wrote with my colleague, Joan Reid.[4] Other deaneries are using the Windmills resources ( [Link] ), and all students and trainees have access to the national medical careers website ( [Link] ), which provides detailed self assessment exercises and careers information, again linked to each of the four stages.

Giving your career an “MOT”: the medicine on track checklist

The medicine on track checklist, which can be downloaded from the Sharing Good Practice section of the United Kingdom Foundation Programme Office website ( [Link] ), should not be used in isolation. Instead, it should be used in conjunction with the sort of career support resources listed above. But I developed it for two reasons. First (and most topically), as a tool to be used in the London BMJ Careers Fair, which is taking place at the Business Design Centre in Islington on 2 and 3 October 2009.

One of the things on offer at the Careers Fair is a 15 minute confidential rapid review with an experienced medical careers adviser. For these 15 minute sessions to be maximally effective, I thought it would be useful to develop a quick checklist which the trainees could fill out in advance and then discuss with the careers adviser during the actual session. For example, if the trainee has not yet carried out adequate self assessment, then that task should be their first priority, and during the review session the adviser can direct the trainee to suitable self assessment resources (as well as relevant seminars taking place at the Careers Fair). Other trainees may have spent a considerable amount of time on self assessment and also on career exploration but feel uncertain about how to match these two stages together to reach a decision. For these trainees the rapid review would focus on stage 3 (career decision making).

The second potential use of the checklist is in career discussions between educational supervisors and trainees. It is clear from national guidelines on the role of the educational supervisor (both within the foundation progamme and also post-foundation) that the educational supervisor should discuss the trainee’s developing career plans during their regular educational appraisal sessions. In the relevant London Deanery training courses for educational supervisors (and also in the faculty development e-learning materials on career support available at [Link] ), the need for educational supervisors to use the four stage approach is stressed.

Educational supervisors are also advised to make full use of the trainee’s educational portfolio as an essential resource. So, for example, if it becomes clear (from the medicine on track checklist) that the trainee has carried out little self assessment, as a starting point the educational supervisor could use the trainee’s portfolio as a way of helping the trainee clarify what seem to be some of their key skills and interests. The supervisor could then move on (but still with reference to the portfolio) to discuss areas of work that the trainee seems to struggle with or to find less engaging.

When training consultants in career support I often draw a parallel between the four stage model and approaches to clinical consultation. When a clinician is faced with a new patient, after they have introduced themselves and put the patient at ease, they will progress through four stages during the clinical consultation (history taking; examination/investigations; diagnosis; and treatment plan). Of course there may be to-ing and fro-ing between the four stages of clinical consultation (and actually this often happens when working one’s way through the four stages of career support with a trainee), but it simply wouldn’t make sense in the context of a clinical consultation with a new patient to start with the treatment plan, then formulate a diagnosis, then carry out a clinical examination, and only at the end take a clinical history.

Although the parallel between the four stages of career planning and the four stages of clinical consultation has its limitations (an issue that is discussed more fully in The Roads to Success [4]) it is useful to bear in mind when providing careers support to an invidual that some tasks come before others. The medicine on track checklist was devised as a simple reminder of this fact, and when used in conjunction with the trainee’s portfolio, as well as with other more detailed careers resources, it is hoped that it will prove a useful additional tool.

Competing interests: None declared.

Caroline Elton will be speaking at the BMJ Careers Fair in London, 2-3 October 2009, at the Business Design Centre in Islington


  1. Jackson C, Ball JE, Hirsh W, Kidd JM. Informing choices: the need for career advice in medical training  . London: BMA Health Policy and Economic Research Unit, 2003.
  2. Hirsh W, Jackson C, Kidd JM. Straight talking: effective career discussions at work  . Cambridge: National Institute for Careers Education and Counselling (NICEC), 2001.
  3. Parsons F. Choosing a vocation  . 1909. Reprint of the original edition. [Link]
  4. Elton C, Reid J. The roads to success: a practical approach to career planning for medical students, foundation trainees (and their supervisors).   2007. [Link] .

Caroline Elton head of careers advice and planning London deanery

Cite this as BMJ Careers ; doi: