Column

Doctors and the “C” word

Authors: Caroline Elton 

Publication date:  29 Nov 2012

I know I should be more careful about how I present myself, but sometimes the “C” word slips out. When this happens it never works out well, particularly if I am teaching consultants. The shift in tone in the room can be palpable, with the audience looking slightly askance and simultaneously disengaging from what I am saying.

The C word in question—“Careers”—almost inevitably causes a degree of heart sink among the medical profession, especially when it is followed by “advice” or “guidance.” And I know well the curse of the C word, because if instead of introducing myself as the head of careers at London Deanery I say that I am an occupational psychologist, the response is entirely different.

I used to take it quite personally, but then I found out from other C word colleagues that they experienced the same thing. And earlier this year when I was presenting at an American medical education conference, I discovered that it is no different on the other side of the Atlantic. Despite the fact that my cofacilitators included a leading medical education researcher, an educationalist working for the Association of American Medical Colleges, and a professor in psychiatry, turn-out at our session on career planning was dismal.

So why is careers support positioned in this way within medical education? I think it relates partly to the quality of careers support that people had at school. In fact, when I am teaching groups of doctors I often start by asking how many of them had useful careers support at school. Typically, in a group of 30 only one or two individuals will raise their hands. These low expectations about the value of careers support are then projected into the medical school or postgraduate context.

I am not saying this to belittle the teaching profession (before I trained as a psychologist I worked as a secondary school teacher). Instead, I want to draw attention to the ways in which careers education is often a low priority within secondary schools. Teachers may be passed the careers mantle not because they have any relevant knowledge, interest, or skills, but rather because they have a free period on Wednesday afternoon when the year 10s are timetabled to cover the careers curriculum. That is what happened when I was a pupil and when I was teacher, and anecdotally, it may still be happening (because my daughter, who read philosophy at university and specialises in religious education, has now been landed with teaching careers as well).

Does any of this matter? In the grand scale of things, the fact that careers professionals working within medical education can be marginalised probably isn’t that important (although I can think of poorly supported colleagues in other deaneries who left their jobs, ground down by institutional lack of engagement with what they were trying to achieve). But in the post-Modernising Medical Careers world, where junior doctors have to make important career decisions earlier on in their postgraduate training, the separation of medical careers policy from the wider field of occupational psychology matters greatly.

To cite just one example, the 2010 Collins report that evaluated the foundation programme recommended: “All of the appropriate organisations must work together to define good practice in the provision of careers information and advice. Such information must be easily accessible, simple to understand and contain transparent data on each specialty, including competition ratios and a potential applicant’s ‘likelihood of success.’”

Sensible sounding stuff, but actually this recommendation is out of kilter with evidence based careers support because it fundamentally overemphasises the role of information and directive advice in career decision making. (If one draws a parallel with health behaviour, most people are aware that smoking causes cancer, but some will continue to smoke.) So helping trainees to make robust career decisions is not simply a question of providing accessible and comprehensible careers information (although that is important); it is also the much tougher issue of enabling trainees to take on board the notion that the information actually applies to them.

For this to happen, trainees need to develop fundamental career management skills, such as the ability to engage in an honest self assessment of their abilities, interests, work values, and vulnerabilities. The broader field of occupational psychology has much to stay about how best to help people accomplish these different (and sometimes difficult) tasks. But as long as the careers field is positioned as the Cinderella (to use another C word) of medical education, medical careers support may continue to be as lacklustre as the earlier careers interventions that people endured at school.

Competing interests: CE is an occupational psychologist and head of the C****** Unit at London Deanery.

Caroline Elton chartered psychologist and head of Careers Unit London Deanery, London, UK

 caroline.elton@londondeanery.ac.uk