The way I see it

My specialist training application

Authors: Helen Macdonald 

Publication date:  10 Dec 2008

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Helen MacDonald went through the process last year but turned down her scheme to work at the BMJ. This year she is reapplying, and here she shares her tips on getting through the process

Droning on about the recent disasters of medical training and recruitment does not get you a training post. And I like to think junior doctors are above all that. I enjoy nothing more than the thought of our cohort battling the system and emerging with their top training post and dignity intact.

I was a 2008 victor but turned down my scheme to work at the BMJ. As I prepare to reapply (you could defer only for a masters degree), I remember how it felt last year and share some thoughts about approaching it again in 2008/9.

This time last year I was an average foundation year 2 doctor: going through the standard acute, general practice, and specialist rotations; juggling shift and social life; ploughing through foundation assessments; and experiencing periodic waves of unease when specialist training was mentioned.

Approaching the applications for 2007-8 was daunting. Bad press and horror stories can play on your mind. But preconceptions put aside, it was not as horrendous as I imagined. Three factors are needed to beat the system.

(1) Know what you want

This is easier said than decided on. I found it the most time consuming and agonising part of last year.

By clever foundation application, and luck of the computer’s draw, I had experienced the two specialties I applied for before the applications started—general practice and psychiatry.

If you have not decided what you want, think and act now. For some specialties you need to list your experience as a marker of commitment to them. Your educational or clinical supervisor or your foundation school director should be able to advise you on this and point you in the direction of careers advice.

Location is a consideration. The last time I uprooted was to go to medical school, when my choices were flippantly based on an imaginary two hour journey circle that I drew around my parents’ house to ensure a safe distance. Many people are tied to other people or places.

Have a note of the goal and a bottom line. Last year the goal was my BMJ job, then a remote possibility. But I would have accepted either of the training schemes I applied for.

(2) Organisation

If you are reading this then you have probably started to tap into good resources already: the deaneries, royal colleges, and national recruitment programme websites; seniors; last year’s applicants; and peers.

If you do nothing else, read the applicants’ guide from the Modernising Medical Careers website. It is not inspirational, but it states the rules of the game.

It is worth understanding the 48 hour accepting rule early to avoid agonising dilemmas later. Essentially, if you accept a job you have to abandon all other applications.

The ideal scenario is to hear from your chosen places in order of preference. But if you hear from a lower preference first, you cannot keep it in reserve, and you might not get another offer. My Grandma says a bird in the hand is worth two in the bush. I think not, but this is why you need to set your bottom line. Coldly reported geographical and specialty odds on the Modernising Medical Careers website may help. I held my nerve and gambled last year by applying to only one deanery.

The form

Once applications open you have little time to apply. So plan for predictable questions, and show your form to at least one person for advice.

Contact your referees early—otherwise you will end up chasing them around the hospital, as I did last year. A copy of your end of placement appraisal with them makes it easier.

Constant vigilance

The application system is inhuman. It speaks via emails, and they should be read urgently. If you are disorientated on nights or on holiday, make sure you have a trusted reserve reader.

The portfolio

It is easy to enter a certificate war. But as illustrated at my psychiatry interview (where a GP reject was incensed about failing his communication exercise, despite having a certificate of communication competency), certificates and courses may not always represent talent.

On the other hand, my surgical housemate swore by her courses in acute life support, advanced trauma life support, and basic surgical skills. So ask around and make sure any courses are the best use of personal time and finances—we had no study leave or funding for courses.

Know your portfolio. I found it helpful to consider life under the General Medical Council’s seven principles to ensure there was enough in each section. If possible try to personalise the folder intellectually—beyond plastic wallets and glitter pens.

The interview and assessments

These crop up with only days’ notice, but the rough dates will be put up online in advance. Avoid holidaying and give your hospital as much notice as possible, because cover will be thin.

The questions and scenarios posed at interview are largely about being a junior doctor. So I will concentrate on best foundation year 2 practice, rather than clinical management stretching beyond that remit.

Read your application before the interview. I will save mine in a more memorable place this year. I advise getting into the BBC Radio 4 Today programme, because unlike a newspaper it forces you to take in news you might not choose to read and might have to discuss at interview. Find a relevant research paper to talk about. Think about communication, predictable ethical situations (such as a colleague drinking), and how you prioritise your clinical workload.

The GP process is different. The exam is broad and lengthy. I found signing up for practice questions the most helpful preparation.

If you make it to the assessment centre, make sure you have evidence of your foundation competency or a signed letter predicting you will pass. It felt similar to an objective structure clinical exam (OSCE), which I found more familiar than a probing interview. The group discussion is painful and stilted—be prepared to be listened to and agreed with more actively than ever before.

(3) Perspective, perseverance, humour, and friends

I mention these last but they are sanity preserving, helping you to avoid panic, dejection, and crises in self confidence.

The system is imperfect, rigid, and at times unfair. General practice left me jobless but deemed me “trainable.” They said my written work was a possible area of weakness—ironic given my current employment (I challenged it). It worked out well for me because I was able to go to my psychiatry interview. And eventually I had a choice between psychiatry and general practice training in the area I wanted.

There were tough moments for everyone. But juniors are in this together and are the best source of support. Talking about the applications to non-medics is a helpful comparison. I am thankful that at least this year is similar to last year. If that does not inspire confidence, at least be thankful that we are not junior financiers.

Competing interests: None declared.

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Helen Macdonald BMJ editorial registrar London

 hmacdonald@bmj.com