Developing career resilience in medicine

Authors: Helen Grote, Mazn Raouf, Caroline Elton 

Publication date:  17 May 2012

---

The insecurity inherent in working in a rapidly changing workplace, together with personal demands such as caring for children, coping with illness, and moving to new parts of the country, require trainees to develop “career resilience” or “self reliance” to cope. Helen Grote (together with Mazn Raouf and Caroline Elton) explores what this means in practice

The ongoing changes in the structure of medical training, requirements for the certificate of completion of training (CCT), and the NHS reforms all mean that job security has changed and a career in medicine can no longer be considered a career for life. In an increasingly competitive marketplace where competition ratios for some training jobs can be as high as 25 to 1,[1] employers are looking for “value added” doctors who have a portfolio of skills as well as clinical acumen and a good bedside manner.

Career resilience is “the ability to adapt to changing circumstances, even when the circumstances are discouraging or disruptive.”[2] The Latin derivative, “resiliens,” refers to the pliant or elastic quality of a substance, implying a capacity to absorb negative conditions, integrate them in meaningful ways, and move forward. As such, resilience can be seen as a process as much as an outcome. It needs to be ongoing, needs continuous effort, and is not a one-off event.[3]

The concept of a job for life is a myth not only in medicine but in other careers too. Mechanisation has rendered many jobs obsolete, such as telegraph operators, lamplighters, and pinsetters (employed to reset the pins at bowling alleys). There are new jobs, too—20 years ago who knew of social media strategists, green funeral directors, and carbon offset traders? In medicine, advances in interventional technology have enabled some patients with coronary artery disease to be treated by stenting, rather than with open heart bypass, while new specialties, such as community sexual health, allergy, and audiological medicine have been emerging as distinct fields in response to the medical needs of the population.

Changes in the way healthcare is delivered will also affect the way doctors work. NHS reforms look set to shift about 60% of funded medical posts, particularly for chronic conditions such as diabetes and heart failure, into the community, where they might have previously been managed in a hospital outpatient setting.

Personal resilience

Change can also happen at the individual level, sometimes with profound personal and professional implications. The vast majority of postgraduate medical trainees are in their late 20s and 30s, a time of life when personal changes are extremely common and when personal demands such as marriage, starting a family, and caring for relatives coincide with the professional demands of postgraduate exams, annual reviews of competence progression, and looking for jobs after receiving their CCT.

In some cases, change is a planned, chosen, and, hopefully, positive experience. Trainees may also choose to move abroad to gain more experience in a particular field, or take time out (“out of programme” experience) during training for research, to do further degrees, or perhaps even to hone exceptional sporting talents for the 2012 Olympics.

Unfortunately, not all change is chosen or welcome. Life threatening illness, loss of mobility after an injury, mental health conditions, latex allergies, a positive HIV test, or a hand tremor can all have a devastating effect on a person’s chosen career. Seeking help early in such circumstances, and exploring different options with a trained medical career counsellor, is essential to identify sources of support and, where appropriate, adaptations to the current job or even an alternative career pathway.

The attitude of an individual trainee in response to his or her changing circumstances has a great influence on the ability to become career resilient. Several psychological studies have examined in detail what it means to be career resilient and have identified key personal attributes associated with increased career resilience (box 1).

Case study: career resilience

Since its inception in September 2008 the London Deanery Careers Unit has provided careers support to more than 400 doctors in training. Many of these doctors approach the unit for help with relatively straightforward career dilemmas, such as choosing a specialty, whether or not to follow an academic training pathway, or whether to apply for an out of programme career break. Other trainees have more challenging personal and professional situations. I (HG) asked one trainee, Mazn Raouf, to describe what happened to him, and then asked Caroline Elton of the Careers Unit to describe the aspects of Mazn’s story that demonstrate the factors associated with career resilience (box 2). Shortly after his support from the Careers Unit, Mazn wrote to Caroline to thank her for her input and asked her if there was anything he could do to support the work of the unit. Following his suggestion, Caroline organised a seminar at the BMJ Careers Fair on the subject of career resilience, at which Mazn and I spoke.

Enhancing career resilience in medicine

For most doctors in training, the challenge to career resilience comes not so much from personal circumstances, as Mazn experienced, but from the more common experiences of coping with night shifts, exams, and annual reviews of competence progression and negotiating the hurdles of specialty training applications.

Each year many doctors find that the seemingly smooth transition through medical school and the foundation programme may be followed by the unexpected shock of failing to obtain a desired training post or of finding that there are no posts for their chosen specialty in a particular area. Equally, applying to specialty training can all go horribly wrong, quite unexpectedly. Every year the London Deanery withdraws around 100 applications at the longlisting stage, many from excellent trainees, simply because relevant exams or experience haven’t been listed on the application form. I should know—I was one of them this year.

I submitted an application for an academic training post well in advance of the deadline and received the standardised email confirming that my application “was being considered at shortlisting.” I didn’t hear about an interview. After several emails and phone calls, I eventually discovered, less than 48 hours before the scheduled interviews, that my application had actually been withdrawn by the deanery’s recruitment team because of my failure to list “MRCP Part 1” in the professional qualifications section. It didn’t matter that I had just acquired full membership of the Royal College of Physicians (MRCP) or that I had an undergraduate degree and a DPhil from Oxford, had completed 18 months as a visiting academic in Melbourne and then completed clinical training in Cambridge, or that I was currently a core trainee year 2 at a prestigious London teaching hospital. My application had been withdrawn, and an appeal was refused.

I have completed all my current training and research against a background of a profound congenital hearing loss; this has helped hone some degree of resilience, for which I am thankful. Despite being really quite angry about my unsuccessful application for specialty training, I concluded that a forced year out could be something of an opportunity. I’ve had the benefit of some excellent friends and colleagues to whom I’ve talked about my disappointment over coffee. I’ve discussed career options and ways of using a year out with senior colleagues, friends, and family. I’ve revisited my CV and identified how to improve it in advance of specialty training applications next year. I’ve identified options for constructive employment in a year off the training escalator.

Dealing with the fallout and disappointment of unsuccessful application for specialty training is very difficult. You may be an excellent trainee with the exams, the experience, and postgraduate degrees but no training post to go to. What to do? Whether to move to a different area, consider training in a different specialty, or take a year out is a personal decision, but there are always options that will enhance your CV (box 3). And remember, reaching the end of training isn’t a race, it’s a journey, and broadening your experience and networks now may well expand your future career options and employability in the future.

Helen Grote core medical trainee year 2  National Hospital for Neurology and Neurosurgery, Queen Square, London, UK
Mazn Raouf GP specialty trainee year 1  St Peter’s Hospital, Chertsey, Surrey, UK
Caroline Elton head of careers advice and planning  London Deanery, London

 helengrote@cantab.net