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, 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.” 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.
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.
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).
Box 1: Factors associated with career resilience
Internal locus of control (seeing yourself as an agent of your own destiny, rather than a pawn)
Sense of purpose
Courage and determination
Minimising focus on blame or guilt
Capacity for emotional expression (both positive and negative)
Problem solving skills
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.
Box 2: Mazn’s story
I come from Kurdistan in the north of Iraq, and on arriving here in the UK I became involved in the London Deanery refugee doctors’ programme, because I wanted to train as an acute physician. What precipitated my approach to the deanery’s Careers Unit, though, was the fact that I had sustained a serious back injury and had been on sick leave for a number of months. After surgery, my back was slowly improving, but I was unsure whether it would ever recover to the point where I would be able to work as a consultant in acute medicine. I was therefore seriously considering switching my career pathway and applying to train as a general practitioner.
I had been experiencing considerable stress in my personal life for the past few years. The political situation in my home country made it impossible for me to return to see my family. My mother, to whom I am very close, had recently been given a diagnosis of cancer, but I could not visit her. Two other close family members had recently died in politically motivated killings. I had just moved to a new town with my wife and two very young children to start my ST3 training in acute medicine, and we had no friends or family in the vicinity.
I approached my educational supervisor, saying that I needed some help, and was referred to the deanery’s Careers Unit. I saw Caroline Elton, and we discussed in some depth whether I would be suited to a switch to general practice. The session also gave me the opportunity to discuss the various stressors I was facing and to consider ways of ameliorating some aspects of the situation.
I successfully obtained a place to do GP training in the Kent, Surrey, and Sussex Deanery. I am now enjoying working as a GP trainee at St Peter’s Hospital in Chertsey. Despite all the struggles, I have successfully completed my exam for membership of the Royal College of Physicians; I am currently preparing for the membership of the Royal College of General Practitioners exam; and I am looking forward to a career in general practice.
Careers advice from Caroline Elton
Mazn first contacted the Careers Unit to ask for help about a year ago. As his story unfolded, I was struck by just how much this particular trainee was having to manage. (I found my mind going back to my undergraduate psychology lectures on Holmes and Rahe’s life events scale and mentally totting up his total.)
What is striking about Mazn’s career history is just how many of the attributes associated with career resilience (box 1) he had exhibited. Rather than remaining focused on what he had lost (which undoubtedly was considerable), he took active steps to focus on the aspects of his situation that were in his control to alter (internal locus of control). He was willing to consider career options beyond his first choice specialty (flexibility), maintained determination and a sense of purpose, and neither berated his fate (blaming others) or agonised about what he could have done differently (focusing on guilt). During the session he had with me, he talked at length of his sorrow about the fate of different family members (expression of negative emotion) and afterwards emailed me to tell me his good news and to thank me for my quite minimal input (positive emotion).
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.
Box 3: Specialty training application unsuccessful? Tips for enhancing resilience
Talk about disappointments with friends and colleagues—Sometimes you need someone else who can provide a listening ear and remind you of your potential and what you have achieved so far.
Seek opportunities to enhance your CV—Ask for feedback on your application. Find out what you could improve on. Think beyond “spend more money, do more courses.” Need some more teaching experience? Try contacting your postgraduate centre to ask about opportunities to teach medical students and junior doctors. Need some leadership experience? Perhaps your chosen specialty society, college trainees committee, or local BMA junior doctors committee has a vacancy for a rep.
Seek advice—If your deanery has a careers adviser, it might be worth contacting him or her. Equally, consider whom you could approach as a trusted adviser: perhaps a former medical school tutor, a consultant colleague, or college tutor who knows you well. Do you need to consider a different specialty? Or even a different career option? Write down a list of questions you want to cover before you go to a meeting.
Network—Your consultants are a goldmine here. Do they know of any upcoming locum vacancies in your chosen specialty? Perhaps they know of a relevant clinical trial that is looking to recruit a clinical fellow. Do they have links with any research groups that could employ you on a short term basis? Presenting a poster at a conference and attending specialty specific meetings also provide invaluable opportunities to meet people who can give advice and offer opportunities for employment and research.
Seek opportunities for employment—You still need to pay the bills. NHS jobs (www.jobs.nhs.uk) and jobs.ac.uk are two sites worth signing up to. The first of these will have adverts for locum appointments for training or service. If you have any research experience, go to jobs.ac.uk for various research assistant and postdoctoral vacancies. The BMJ advertises vacancies for opportunities such as being an anatomy demonstrator or a teaching fellow as well as various leadership schemes. If you can afford to, consider whether you could demonstrate your commitment to a chosen specialty by working abroad for three or six months in a voluntary capacity, funding this through locum work in the UK. And if you can’t—there’s always Australia and New Zealand.
Be determined—You didn’t get through medical school by accident. That same determination will see you through postgraduate training too and will help you develop the attributes and attitude to enable you to be a successful trained doctor in the future.
- NHS. Medical specialty training (England). Competition information for 2011. http://tinyurl.com/7vsnca3.
- Collard B, Epperheimer JW, Saign D. Career resilience in a changing workplace. (ED 396 191). ERIC Clearinghouse on Adult, Career, and Vocational Education, 1996.
- Borgen WA, Amundsen NE, Reuter J. Using portfolios to enhance career resilience. J Empl Counsel 2004;41:50-9.
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
- MSc in Translational Cardiovascular Medicine
- The GP Cancer Update Course
- Cardiff University Wales Deanery Medical Education Postgraduate Certificate, Diploma and MSc
- UNIVERSITY OF OXFORD Experimental Therapeutics Programme
- De Montfort University Leicester Medical Law and Ethics