Dealing with disappointment
Authors: Emma Sedgwick
Publication date: 27 Jul 2012
Emma Sedgwick advises on how to bounce back if you did not receive your first choice of training post
If you have set your heart on a particular training post and believe that you are the ideal candidate, it can be demoralising to discover that the people who assessed you had other ideas.
You won’t be alone—in 2012, there were 16 635 applications for just 7499 positions—but knowing that doesn’t make it any easier.
This may be the first time you have encountered failure. The nature of the medical profession is that many doctors are academic high fliers at school and are tipped early for success.
In an ideal world, this setback would simply make you more determined to achieve your goal, but some doctors find that they are unable to recover from the disappointment and become so fixated on what might have been that it saps their confidence and even starts to affect their performance and prospects.
Although you are unlikely to question your decision to pursue a medical career, the success of such a career demands that you come to terms with what has happened and move on. The following do’s and don’ts might help.
Do give yourself the opportunity to wallow, but set a time limit
If it was a shock to miss out on your first choice, there is no point in pretending otherwise. This was important to you, so acknowledge the disappointment, rather than brushing it off.
Follow your natural instinct to lick your wounds and work your way through a box set of DVDs to switch off, but say to yourself that on such and such a day you will do something practical to move on, such as speaking to your educational supervisor or taking another look at the UK offers website. In other words, set a deadline for any wallowing and stick to it.
Don’t take it personally
Given the number of applications, selection panels are in the happy position of being able to pick and choose from a strong field. They are obliged to make a swift decision about your suitability for a particular post on the basis of your application form and your performance at interview or in the selection centre, against their own criteria. It’s possible that on another day they might have come to a different decision, and it certainly doesn’t mean that other interview panels will reach the same conclusion.
Do take pride in your achievements
Remember how you have got this far. Make a list of five successes on which you look back with pleasure, and remember how you felt the day you achieved them, whether it’s your diagnosis of subacute bacterial endocarditis during your foundation year 1 placement or the publication of your article in Student BMJ. This exercise should help restore your self confidence and remind you that you have come too far to be foiled by one rejection.
Don’t write off the experience
You may not want to think about your rejection (or you may think about little else), but don’t assume that there’s nothing you can gain from it. Deaneries can provide information about your score, the number of applicants, and the score necessary to get an interview or to receive an offer. In addition, you can obtain anonymised copies of your interview score sheets to find out your strengths and areas for improvement. It is also worth seeking feedback on your application form from your educational supervisor or mentor, if you have one, who can highlight the information that would strengthen your case next time.
Do think about what motivates you
Go back to basics. See this as an opportunity to analyse what you have found most fulfilling or inspiring during your work placements as a foundation doctor, whether that’s the level of competition, the variety of presentations, the problem solving, or the practical, hands-on work. Think about what you want from your career—a good work-life balance; the chance to see results quickly or to care for patients over a longer period; being part of a team or working more independently; plenty of managerial responsibility or more hands-on doctoring.
Then ask yourself which area of medicine is the best fit for you and plays to your strengths as a doctor, rather than try to contort yourself into a specialty that sounds seductive but may leave you frustrated or unhappy.
Don’t rely only on advice from parents and friends
The great thing about those close to you is that they want to offer you help and support. The disadvantage is that they are often tempted to tell you what they think you want to hear. And because they are understandably proud of you, they may not be sufficiently objective or independent to be the ideal careers counsellor.
Many young doctors’ career choices have been influenced by the advice of others, and quite a few have struggled because the advice has not been right for them (see box). For example, a doctor may have started training as a general practitioner to follow in a parent’s footsteps or applied for a paediatric post because friends believe that he or she has an excellent rapport with children.
Of course, it’s great to have someone to boost your morale when you’ve had a career setback, but it’s also in your best interests to find someone who can help you think things through for yourself, rather than point you in a particular direction.
Dr A, a foundation year 2 doctor, had always loved science and was routinely at the top of his class. After achieving excellent results in his GCSEs, he decided on a medical career; and with the encouragement of his teachers and parents (who were both general practitioners), he applied for and won a place at medical school, which he secured with three A* grades in his A levels.
Dr A had thrived at medical school, and, inspired by the experience of observing a challenging ruptured aortic aneurysm operation, he initially set his heart on becoming a surgeon. He completed his foundation year 1 placements with positive feedback from his supervisors and applied for core surgical training, giving his preferences as the London, Kent, Surrey and Sussex, and Oxford deaneries. Against the advice of his educational supervisor, he would not countenance applying for any other specialty.
Despite feeling that he had performed well in his interviews, Dr A was devastated to find that he had been unsuccessful in his applications, while nearly all his contemporaries had been offered their first or second choice posts.
He confided to friends that he now believed that the whole process had been a waste of time and that he had blown his chance. Nervous of his parents’ warning about being left behind, he quickly applied for a training post in general practice with a deanery in another part of the country. Although he was successful this time and relocated to take the job, it was not long before Dr A became frustrated by the limited opportunities to carry out clinical procedures, and he felt unable to settle. Questions were raised about his sickness record and negative attitude, and after disastrous results in his first set of assessments he was summoned to see the deanery programme director, who told him he was in danger of being asked to leave.
Dr A admitted that he wasn’t motivated and was having second thoughts about the specialty but did not know what else he could do. He was warned that it might be difficult to change at this stage, but, undaunted, he consulted a careers coach, who suggested that he think about what he most enjoyed during his foundation training placements and ask himself whether another area of medicine would be better suited to his personality and allow him to pursue his career goals.
Recognising that he had loved the camaraderie of working as part of a team and had been exhilarated by the challenge of working in the emergency department, Dr A decided to resign from his current post and take up a locum position until the next round of training applications, when he successfully applied for an acute care common stem training post.
*This is a composite case and not about a single doctor.
Do make use of the resources available
Ask for advice from your educational supervisor, from your mentor, or from colleagues whom you trust. Your deanery will also have a confidential career or support service for doctors in your position. If you are considering other specialties, try to find a senior doctor who can spare an hour to talk to you about their work or even let you shadow them for a week. The NHS medical careers website ( [Link] ) also has useful tools for postgraduate medics, including interviews with senior doctors in different specialties and advice on career planning. Or you can get help from a specialist medical careers coach.
Don’t jump into something else on the rebound
In the same way that it’s rarely a good idea to start another relationship straight after being dumped, don’t panic and choose another specialty just because you think it will be straightforward to get a training post. Some young doctors are so desperate not to be left behind that they quickly grab at the opportunity to pursue a different specialty, only to regret it later. This is not good for them or for their colleagues and patients.
It is now harder for trainee doctors to explore a number of alternative specialties, but if you are stuck it is worth considering a standalone position while you take time to investigate the options. Bear in mind that in your early 20s you are less than a third of the way through your medical career. Invest the time now so that you won’t look back in anger at your retirement party.
Do be flexible and have a back-up plan
You may well have already discovered the hard way, but the competitive nature of specialty training means that it’s essential to have a back-up plan. It may be a training post with a deanery in a different area; training abroad (although it’s important to check whether this is accredited); or working for a charity. Remember, your valuable skills will always be in demand somewhere, but to take advantage you need to do your research and be prepared.
Competing interests: ES is director of the professional development specialists Healthcare Performance and has been coaching doctors for six years.
Emma Sedgwick director
Healthcare Performance, Kent, UK