1. Introduction to the Career Support Role 23 rd February 2009

2. Aims To understand the bigger picture of medical careers To share understanding of career lead role and its place in the Wales Career strategy To recognise what kind of career support is needed along the pathway To develop understanding and skills to promote good career help To identify next steps – and where we need your help

3. Then… …and now Shift from a recognisable career pathway to a less predictable journey, requiring frequent regeneration

4. Discuss: Who you are, your career lead role What you find most rewarding about your role in the career development of Foundation doctors/specialty trainees What do you find most worrying or challenging?

5. The context we work in Reality of medical careers means: More UK medical graduates No patronage / bias in selection NHS will train the workforce it requires Unpredictable applicant tactics Feminisation of workforce Work-life balance more important for all Medical Unemployment Historically poor retention in Wales

6. UK careers developments Tooke, Darzi Career pathways changing Recruitment processes evolving Improving access to LTFT training UK careers group formalised Workforce Planning MEE – exploring future change

7. UKFPO Careers workstream established UK scoping exercise Careers questions in PMETB survey Feedback from medical students forum New Curriculum and reference Guide Careers skills in curriculum Guidance on tasters in F1 and F2

8. Workforce Planning More Academic posts in early years Experience assists decision making Careers in research and/or medical education promoted More entering academic medicine

9. Wales Career Strategy Approved May 2008 Twice yearly Steering group meetings Membership: Swansea & Cardiff UG Careers and Curriculum leads, BMA representatives, Workforce Planning, Med. Ed. And E-learning, PGOs Identifies actions needed and implementation projects Career Lead role defined & embedded in the Strategy

10. Emerging themes – July 2008 1.Provision of careers information; undergraduate and postgraduate 2.Integrating career support with learning 3.Methods of support: fairs, events, services 4.Systemic issues e.g. workforce planning, geography

11. Early tasks Promoting specialties through careers fairs/events (BMJ, MCID,URDD) Improving links between Undergraduate and Foundation competencies (MCAN, UKFPO) Embedding careers education (F1/2, SpR, Educational Supervisors, e- learning) Improving access to information (hard and online resources, web development)

12. Foundation – embedded modules F1 start – Career Planning (298) F1 end – Making Decisions (c70) F2 start – Specialty Applications (300+)

13. Current issues...discuss

14. Early thoughts – student mindsets

15. Challenges for medical students 76% increase 1996-2006 Two thirds now female Careers advice at school – medicine a safe bet for an A* student ( from F2 workshop – Morriston ) Choices start to fluctuate early ( 60% by Semester 3 - Manchester ) Reduction in Foundation programme headroom FtP – not enough just to get the exams, must demonstrate employability ( ASME June 08)

16. Cardiff medical student soundbites: I think we dont know enough about the system to be energised to learn about it The future is blur as to what happens after F2…theres so may different routes to get to a particular specialty but what happens in the interim, nobody really knows Theres a lot of things changing at the moment, a lot, and more than half of us dont know what the hells going on Ive heard so much about FP1/2/ST…but I can honestly say if someone said what is the form, how do you fill it in, when is the due day…I feels like no-ones actually sat us down as a year group and have been like, youve got to apply for jobs I do admit that Ive just kind of bumbled along…perhaps it would be useful for future years to put some early thought in

17. Into Foundation and beyond…

18. At its simplest… The reality?

20. Wales F1 soundbites – confidence crisis I dont think we get long enough to decide and thats the thing thats bothering me now All of our consultants know that were not going to be as good as they are…as theyll all probably have double the experience that we have The problem with the selection process…is how you look on a piece of paper

21. Challenges for Foundation doctors MMC needs early decisions Still changing; challenge for local helpers First experience of competitive selection 48 hour rule for decisions May not get first choice – no guarantees Some get no offers Future ratio of CCT holders to trainees Future of consultant role/posts

22. Foundation doctors: Largely undecided at the outset about future choice Feel rushed into specialty applications Perceive the system as inflexible Perception of failure – poor coping strategies/Plan B Feel information from their educational supervisors is uncertain or inconsistent Are influencing our medical students!

23. Myths about specialty choice You only get one chance a year to apply for specialty training Working in a fixed term specialty post will count against me in the future Once in a specialty it is well nigh impossible to change Applications to change specialty will be unfavourably viewed If I apply to more than one Deanery/specialty the others will find out If a consultant expresses a view on a career route it is the absolute truth

24. Messages we need to get out there The choice is yours There is plenty of opportunity in Wales and its a sellers market in some specialties There are options where you can explore choices further if you need more time There is some flexibility within the system but aim to do the groundwork early Things change all the time!

25. Challenges for ST/CT and above Health / disability Life events and changing WLB needs Training / career not progressing Wrong speciality choice Academic interests Desire for overseas experience Wrong location Wrong career??!!

26. Common themes we encounter Early Foundation – is this right for me? Flawed decisions when originally applying for specialty MTAS effect feeding into ST3+ thinking Later change of pathway (or even career) Academic posts stimulating thoughts of change Worklife balance, changing circumstances and priorities Im finding it just harder than I thought Core trainees – future options Sudden or planned resignation

27. NICEC Research findings Around half of all work-based career discussions are not part of a formal process Many are spontaneous and unplanned But the best conversations are structured and involve preparation and reflection. A common framework is a predictor of effectiveness NICEC/CIPD Research findings

28. ROADS safety check: To what extent: Is your goal Realistic? Have you considered all Opportunities? Have you built in the Anchors that will provide personal support in the background to your career? Will your choice Develop your potential? Can you work with or minimise the Stress factors in your career choice?

29. Four stages to encourage: Self assessment (taking a history) Exploring career values, motivators, preferences, personal strengths, limitations Career exploration (investigations) Establishing options, alternatives and plan Bs, information gathering, networking, reality checking Decision making (diagnosis) Evaluating options, mapping skills and attributes against actual roles, considering preferred work environments, clarifying personal factors Plan implementation (treatment plan) Applicant research, CV update and applications, preparing for assessments

30. This model is featured in: Deanery Careers website www.cardiff.ac.uk/pgmde/careersandrecruitment National Careers website www.medicalcareers@nhs.uk Other Deanery Careers Services Foundation Year 1 resources (they have the book) F1/F2 curriculum based careers sessions

31. Step 1 - Work Values Work Values – 4 dimensions Sort pieces of paper under the headings Try to rank the very important Any surprises? Any which might be very important in 10 years time? Will you find outlet for all the v important in your current career choices?

32. Self-assessment Psychometric tools: e.g.MBTI – can be remotely administered but only by qualified practitioner. Feedback essential. More general open access self- assessment tools e.g. www.windmillsonline.co.uk, www.teamtechnology.co.uk www.windmillsonline.co.uk www.teamtechnology.co.uk

33. SCI59 On line self assessment tool Improves self awareness if questions considered Gives 10 specialities most likely to enjoy Gives 10 specialities which will be a challenge Take it with a pinch of salt – hazard warning!!! Free to BMA members via their website http://www.bma.org.uk/careers/careers_service/ Careersguidance.jsp http://www.bma.org.uk/careers/careers_service/ Careersguidance.jsp

34. Sources of Careers Information 1.Peers 2.Professional network contacts 3.University – tutors, careers services 4.Web based – MMC, Deaneries, Royal Colleges, BMJ, social network sites 5.Local NHS – Ed. Supvrs, College tutors, PGO, HR 6.Deaneries 7.Libraries (see PG Centre) 8.Careers fairs 9.Independent sources

35. Web based information www.medicalcareers.nhs.uk A one stop shop single site for use by students, trainees and supporters New Deanery Careers pages now live! www.cardiff/ac/uk/pgmde/careersandrecruitment

37. www.medicalcareers.nhs.uk

38. Information for Postgraduate Doctors

39. Specialty Pages

40. External sources of information www.mmc.nhs.uk : person specifications and specialty recruitment info www.mmc.nhs.uk www.bma.org.uk : guidance on recruitment rounds and current procedures www.bma.org.uk www.nhscareers.nhs.uk : for outlines of specialities, pay www.nhscareers.nhs.uk careerfocus.bmj.com/ : details of UK and other job vacancies, career advice, FAQ careerfocus.bmj.com/

42. On-line Resources www.doctorstrainingwales.tv 1100 – 1500 viewers a month since December 2008 Lots of non-UK visitors Promotional information cards for trainees/applicants New chapters being added

43. Decisions, decisions…

44. Influences on career decisions Time - earlier decisions are now required! Generation (Boomers, X and Y) Choice left to individual – (UK norm) Prior exposure to a speciality helps inform choice Peer influence (what others think) Role models Positive and negative experiences (horn and halo) Life style and work life balance Doctors need to take an evidence-based approach!

45. Typical decision dilemmas Which round am I aiming for? What are my main specialty options and preferences? What about any dual career issues? Core vs run-through programme implications What evidence do I have ? Where should I apply? What is my 1 st, 2 nd, 3 rd choice? What is my Plan B? Should I go abroad?

46. Information – for specialty choices Skills and competencies required Experience needed Pathways and progression Competition ratios Number and type of posts Local and UK variation Qualifications and training needed Must be up to date information!

47. Wales competition ratios 2009 SpecialtyGradeVacanciesApplicationsRatio Anaesthetics / ACCS CT1321264 CardiologyST325025 Clinical RadiologyST1722432 CMT and ACCSCT1802923.5 Core PsychiatryCT1271295 Core SurgicalCT1742253 Em Med + ACCSCT148922 OphthalmologyST14113 OphthalmologyST355511 ENTST323718 T+OST3317558 General Practice*ST11362461.8 Paediatrics*ST112554.5 O+G*ST15459

48. Speciality Competition Ratios Powerful set of information Many interpretations No UK agreed format May distort application process year on year Guidance on interpretation

49. Useful models Egan – 3 stages (now, next, how?) Schein – Career anchors More of/less of analysis Kitbags – what to take, what to leave Force fields – push and pull Decision timeline 5- and 10-year plans

50. Supporting applications Cardiff Uni Careers support for Year 5 FP applications Downloadable handouts on Applications, CVs and Interviews F2 workshop on Applying for Specialty Training – F2F and online Practice interview sessions at PGCs Generic Curriculum module on applying for consultant posts

51. Selection for Specialty DVD To help prepare for specialty recruitment PGCs have a copy F2 doctors 2008/9 have a copy Now streamed on PLATO as an online learning resource

52. So what makes a good career helper?

53. Who helped you? Think a career conversation with someone which had a memorable effect on your career? What did they do that helped? How did their behaviour reinforce the positive impact they had on your thinking? How did this conversation make you feel?

54. Career help can include: Information giving and signposting Advice about specific options Guidance about broader direction Coaching Counselling Mentoring Outplacement support Some of these require specialist training and experience – but some skills are transferable

55. What it isnt Telling someone what is or isnt good for them Telling them how awful the system is and best of luck with it, mate The If I were you approach (youre not!) A gatekeeper role (I can make or break your prospects…) Selective – everyone needs help at some stage Knowing all the answers – you just need to ask the right questions

56. Components of a good career conversation Where you are at now How you are doing Values and drivers Potential and aspirations Options (local and wider) Processes and politics Pros and cons of choices Next steps

57. Effective and ineffective behaviours Showing real interest in the person, and insight Being positive and enthusiastic Offering constructive challenge and advice Using facilitative interpersonal skills Giving information Giving honest feedback on skills and potential Sharing networks Managing the session Appearing uninterested or failing to show empathy with their situation Misunderstanding the issue by failing to listen or check with the individual Jumping in with a career suggestion without preparing the ground first Toeing the party line rather than being frank and open Airing your own career/system baggage Promising to do something and then failing to follow it up.

58. Encourage doctors to help you by: Being proactive about seeking help from you and others Thinking about themselves, their options and how they match Being willing to share and disclose career thoughts and concerns Being open minded and open to feedback Prompting discussions well before a job move and being flexible on timings and tactics Being willing to face reality and to adapt the plan if necessary Taking ownership and following up actions

59. Help for the Helpers Supporting Doctors with their Careers 2 hour session for Educational Supervisors Carries 2 CPD points from RCP Opportunity for interaction, reflection, discussion We can run – or so can you! On-line module based on London Deanery materials Coming soon – Being an Effective Mentor Aligns with PMETB domains for Educational Supervisors

60. Role Models Inspirational role models can influence careers decisions Observed behaviours will be noted and shared by students and trainees We are all role models Trainers can discuss working lives with students and PG trainees, as well as teach clinical material. Improves forward thinking on what a role will involve in the future Foundation trainees are role models for students

61. On role models in Wales: I think you get more influenced if you see someone youre impressed by You might think that it is really interesting but if youve got a consultant who…just shouts at you all the time or takes an instant dislike to you…then you just dont like it I had a horrible consultant, just completely humiliated you and you get completely put off, youre scared of the subject and you dont want to do it… whereas I had a placement where I absolutely loved it, it was brilliant and I had a really encouraging consultant and that is kind of what I want to do I liked everything that goes into [this specialty} but sitting there with this consultant, I just sat there for the entire time going I do not want to be like you. You are the antichrist of doctors

62. The joys of a medical career! You get to work with talented people You get to meet and understand all kinds of people (patients, teams) The work is interesting, varied, never dull Specialties are evolving and changing Lots of opportunity to specialise and diversify It is pretty recession-proof Its a journey, not a race, a forced choice or a competition Its unique – no right or wrong career, just your career

63. And finally…

64. Future Career Lead agenda Specialty information in Wales for BMJ Careers 2010 Developing on-line resources Evaluating and co-delivering F1/2 workshops Medical careers fair on 16 th October 2010 Promoting, organising and co-delivering training for Education Supervisors Promoting mentor training and CAMEO

65. Development options Follow up day, annual events Involvement in Career Strategy Group meetings UK and Deanery website sections - resources for career helpers Mentor training/CAMEO Coaching Skills Online PDE module PG Certificate in Managing Medical Careers

66. The role of the career lead… …say no to career Sat-Nav!