1. Careers Advice For Foundation Trainers M Venkataraman Ex-Clinical Tutor GEH Careers advisor West Midlands Deanery

2. Careers Advice: Why? MMC Increased numbers of medical graduates Dynamic Work force planning Mismatch between expectations/abilities/aspirations and ultimate career pathway Unemployment

3. Training? Most of us have intuitive skills that we are not aware of Listening Analysing Groups of trainers generally concur on the skills and “bent” of a trainee Formalising that process Research shows the “best” way.....

4. Requirements of a trainer? Approachable Credible Analytical Good listener Knowledgeable Focussed

5. UK Medical School Intake

6. Risk of long term undersupply of GPs www.mmc.nhs.uk

7. Risk of long term oversupply of CCT holders www.mmc.nhs.uk

8. LIKELY CHANGES TO MEDICAL WORK-FORCE BASED ON RECOMMENDATIONS FROM CWFI Recommendations Our specialty recommendations have four elements: changes to the number of NTNs, and therefore the future estimated number of entry level posts1 for recruitment, the proposed transition period for any increase or reduction, recommendations on geographical allocation and a date for the next review. An explanation for our recommendations, and the detail for each specialty, can be found in each specialty fact sheet and summary sheet available at: http://www.cfwi.org.uk/intelligence/projects/medical-shape-2011

9. 11 Increases An increase in General Practice (GP) training posts of 450 to reach a stable number of 3250 by 2014, resulting in an overall increase of 283 entry-level specialty training posts. An overall increase in trainee stock of 544 full time equivalent (FTE) as a result of the GP increase Decreases An overall decrease of 167 entry-level training posts for hospital-based specialties. An overall reduction in hospital specialties trainee stock of 1106 FTE. Estimates By 2014 the average number of entry-level posts for specialty training will be around 6511. This is above the system wide agreed and expected level of 6500 and so further work is needed to look at where further reductions can effectively be made. By 2020 England will be producing around 5898 FTE Certificate of Completion of Training (CCT) holders of which 3132 will be in GP and 2766 will be in the remaining specialties

10. Training 2011 Uncoupled CT1/2, ST3/4/5 etc Core medical training, leading to competitive entry to medical specialties Core surgical training, leading to competitive entry to surgical specialties Psychiatry Anaesthetics Emergency medicine Run-through ST1 to 7 (for e.g.) General practice Paediatrics and child health Obstetrics and gynaecology Public health Histopathology Clinical radiology Ophthalmology Chemical pathology Clinical neurosurgery Medical microbiology Academic clinical fellowship

11. Context and competition Competition Ratios 2009 14,000 applicants, 44,000 applications, 8,500 posts Competition ratio overall nearly 2:1 Cardiothoracic Surgery around 14:1 Trauma & Orthopaedics around 41:1 Core Medical Trainingaround 3:1 www.mmc.nhs.uk

12. Stages of career planning Self Assessment : Windmills, E-tab, reflection, ?Sci-59 Career Exploration: Careers days, networking, actively seeking information, online careers resources, tasters Decision Making Plan Implementation: Preparing CV, additional “brownie points”, commitment to specialty, interview practice.

13. Essential reads http://www.medicalcareers.nhs.uk/ www.mmc.nhs.uk

14. Key points for a 1:1 meeting with your trainee doctor: Discussing your trainee’s career plans at each meeting Look at their e-portfolio specially the careers section Try to ensure they do not leave career planning to the last minute In your first session, review the overall four-stage career-planning model Help your trainee doctor to lay the groundwork by spending sufficient time on Stages 1 and 2 If you are concerned that the trainee doctor is being unrealistic, focus on challenging questions rather than directive advice At the end of each meeting, ask your trainee doctor to specify which career-planning tasks they will carry out, and within which specified time- scale If necessary suggest that they talk through their career plans with a colleague. Before this meeting, provide your colleague with a brief report that outlines your concerns

15. Your F2 has had placements in General Practice, Psychiatry and Obstetrics and Gynaecology. He enjoyed all three of these placements and is finding it really hard to say what his preference is. He is now beginning to feel no closer to deciding on a career pathway for his post foundation Training. He has arranged a meeting with you, his Educational Supervisor to seek advice regarding his career. What do you say to him?

16. Use the stages of career planning Self assessment Career exploration Decision making Plan implementation

17. What would you do/say? Your F2 comes to you for career advice saying that they want to apply for basic specialist training in surgery, with a long-term goal of training in a particularly competitive surgical specialty. Yet in their F1 assessments they were graded as ‘borderline for F1 completion’ on some of the assessment tools, and in particular, their performance seemed highly variable on some of the DOPS (Direct Observation of Procedural Skills) assessments.

18. Unrealistic aims? Who decides? You are faced with a trainee doctor who wants to pursue a career plan that you feel is completely unrealistic – your first task is to provide a balance of support and challenge. In other words, you want to discuss where you see their key strengths as lying and the possible career implications of these. You also want to challenge them with probing questions that clearly set out your concerns about their chosen career plans. Don’t say...if I were you I would......Why not? Emphasize strengths. Get F2 to think and decide for themselves

19. Your F1 is very good at his work when he’s there! You ask him why he takes unplanned leave so often. He takes time to open up, but it transpires that his partner has MS, which is unlikely to improve and he is juggling work with care of his partner and his baby boy. What do you discuss? What are his options?

20. LTFT What is LTFT Who can apply? Are there any rules? Associate dean for LTFT...Helen Goodyear.

21. Total number of LTFT trainees is 3544-Nov 2010

24. Tasters A total of 10 days in specialties the trainee is thinking of applying for May be structured according to trainee’s and department’s convenience We suggest 5 days in last block of F1 and 5 days in 1 st block of F2 Conditions to be met

25. My usual advice to trainees

26. Applying Know yourself Prepare Then choose wisely Have a Plan A, Plan B and Plan C

27. About the Choice Be realistic about your skills but don’t undersell yourself Do you know your skills? (Sci 59, Windmills) Check competition ratios but don’t rely only on them Read the person specs again and again Read the job descriptions Try to match your skills, personality and aptitude to your choices Look at progression within the specialty...how many years, how many exams, how many posts? Have a plan A, plan B and plan C

28. About Yourself What are your skills? What would you like to do? Now....in 5 years....in 15 years? What would you NOT like to do? Have you got the skills and personality suited to your job? Identify 3 key matches for all your choices

29. Preparing yourself Tasters Audits E-portfolio “Real” experience of specialty Read up Some hard, honest, thinking Extra “credits” (like BSS, ATLS, exams etc.) (NOT recommended by UKFPO)

30. Remember, you are much more likely to stay in your chosen field for the rest of your life than with your spouse/partner!!!!!

31. Careers summary Allow time Ask questions Use the careers cycle Guide trainee into asking the right questions of himself and others Use knowledge from cwfi, mmc, medical careers Tasters, Careers Fairs, LTFT Make trainee responsible....facilitate

32. Useful resources www.mmc.nhs.uk www.medicalcareers.nhs.uk www.gprecruitment.org.uk Recruitment for Academic Clinical Fellowships in medicine and dentistry in England: www.nihrtcc.nhs.uk/intetacatrain www.mmc.scot.nhs.uk http://specialty.walesdeanery.org www.nimdta.gov.uk Useful documents on www.mmc.nhs.uk The main Applicant Guide to specialty training recruitment 2012 (available from October) A Reference Guide for Postgraduate Specialty Training in the UK (The Gold Guide, Fourth Edition, June 2010

33. Any questions?

34. Thank you