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Explaining the need

With the introduction of the UK Foundation Programme in August 2005, junior doctors were required to make major career decisions 18 months after finishing their undergraduate training. Yet prior to the introduction of Modernising Medical Careers (MMC), the majority of junior doctors still did not regard their career choices as definitive three years after leaving medical school (Goldacre et al., 2004).

Currently it is unclear what changes will be implemented in light of the recent inquiry into MMC. However, the recommendations highlighted the need for accurate information about the competitiveness of different specialties and also for greater access to career advice at undergraduate level. This accords with earlier studies that demonstrated that medical students and junior doctors tend to view the quantity and quality of career support they receive as inadequate (e.g. Lambert et al., 2000; Jackson et al., 2003; Lambert and Goldacre, 2007).

Who should provide support?

A study of medical students and junior doctors carried out in 2003 found that the most frequent source of career advice was senior doctors (Jackson et al., 2003). Prior to MMC, there was minimal training available for clinicians in how to provide career support. Since the inception of MMC, training initiatives have begun to be provided for educational supervisors, and more comprehensive courses are on offer for clinical tutors and other designated faculty members. Qualified careers advisors have also been appointed in many regions. So the next question to consider is ‘Who does what?’

Tiers of support

The notion of tiers of support can be helpful.

Tiers of career support

With this model all educational supervisors should have access to some basic training in providing career support (such as this module). Trust-based clinical staff with additional educational responsibilities can take referrals from educational supervisors and this will be sufficient for the majority of trainees. But those trainees who need specialist career support can be referred to the deanery or university careers service.

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