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A structure for a careers support session

The four-stage framework describes the sequence of career-planning tasks a trainee needs to complete in order to be able to make robust career decisions at the point when they have to decide on their future career pathway. In other words, progress through the four stages takes place over an extended period of time from medical school, through to the time they have to make definite career decisions. The four stages can also be repeated in miniature each time a trainee is faced with a subsequent career decision.

But how does the four-stage approach map on to the career support that you might be providing in any one session?

The answer to this is that in a given session with a student/trainee you may be spending most of your time on one stage (e.g. Stage 4 activities such as CVs and interview preparation), or you may be moving between a number of stages (e.g. using the results of Stages 1 and 2 to make a career decision, Stage 3). But whichever stage or stages are being discussed, by the end of the session you want the student/trainee to feel that they have moved their career planning forward in some way. This can best be achieved by having an overall structure for each session.

Model of counselling


  • Explaining to the student/trainee how long you have and the purpose of the session.
  • Making sure that the student/trainee feels you are interested in what they are saying.
  • Through discussion, reaching an agreement on which issues to focus on during the session.


  • Helping the student/trainee explore focal issue in greater depth.
  • Renegotiating the focus if another issue emerges as being more pressing.


  • Challenging inconsistencies in what the student/trainee is saying.
  • Helping the student/trainee weigh up the pros and cons of different options.
  • Prioritising between different courses of action.
  • Checking whether you are still keeping to the main focus.

Action planning

  • The student/trainee decides on specific tasks they need to complete within a specified agreed time frame.
  • Reviewing the session.



A trainee comes to you saying that they want to talk about a forthcoming interview and also about whether they might want to train flexibly at a later date. You remind the trainee that you only have 40 minutes in this session, although you could arrange a subsequent session if necessary. You then ask them which issue they feel is more pressing. After a brief discussion they decide that they want to focus on interviews during this session.


You ask them to give you a fuller picture of their specific interview concerns. They give a rather confused answer, so you then ask them to tell you about what happened in the two most recent interviews they attended. From this it becomes clear that they tend to ramble on. (You clock, but don’t at this point comment, that their answers to you in the current session have actually demonstrated the precise problem you have been discussing, namely their answers are long-winded and lacking in focus.) You ask the trainee (while taking care not to sound overly judgemental) about how they previously prepared for interviews. It becomes clear that previously they just turned up on the day and hoped for the best.


You ask the trainee about what ideas they have for improving their interview practice. They say that perhaps they don’t need any help, and they will be fine next time. You gently point out that actually, even during this session, they have tended to give long-winded answers to your questions, and that it does seem to be an issue they need to work on. They then suggest that perhaps they should do some reading on the subject, prepare answers to the sorts of question they might be asked and then have a mock interview session. Or there again, perhaps they should go on a course. You discuss these different options and, as the timescale is tight, the trainee decides that the course option might not be realistic, and anyway, courses often aren’t sufficiently targeted to one’s needs.

Action planning

The trainee decides to prepare for mock interview and you agree a timescale. You reveiw the overall focus of the session, and agree that following this round of interviews you will meet up again to discuss flexible training.

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