Stage 3: Helping your trainee with career decision making
The next two stages are more relevant to trainee doctors than medical students, as the latter group are not immediately faced with making major career decisions. But they will be useful for anyone involved in the supervision of a student or colleague faced with a difficult decision.
There are two related ways in which you can help a trainee with their career decision making. First, it can be useful to encourage them to think about how they have made critical decisions in the past, i.e. you may want to spend a bit of time exploring the process of career decision making.
Second, you need to help your trainee with an in-depth exploration of the actual content of their career decision making, i.e. what it is they have actually decided to apply for next.
The process of career decision making
The simplest way to explore this with your trainee is to ask them about any previous important decision that they feel, in retrospect, worked out well. It doesn’t necessarily need to be a career decision. Ask them about what made it a good decision, and how they went about reaching that particular decision.
You can then do the opposite, and see if they can identify a decision that they now think didn’t work out so well. What can they learn from this example about how not to make an important decision in future? You might wonder about the sorts of issue that emerge from asking these questions. Typical answers might be that they rushed through the decision, that they let themselves be unduly influenced by key people in their lives, that they ignored a strong gut feeling, etc. Insights like these can be useful to highlight, as they can form the basis of personal guidelines on how best to approach a career decision in future.
Crux time: making the decision
The ROADS acronym (Elton and Reid, 2007) can be used to structure a discussion about the robustness of a career decision. Specifically, you can ask your trainee the following questions.
- Realistic: are you being realistic about yourself and about the demands of the job?
- Opportunities: have you given serious consideration to all the opportunities available?
- Anchors: have you built in the things that provide support in your life?
- Development: do your choices fully develop your potential?
- Stress: have you considered those aspects of work that create particular stresses for you?
When discussing the ROADS criteria with your trainee, it is helpful if you not only draw on the self-assessment (Stage 1) exercises, but more generally that you ask them to show you evidence from their learning portfolio that demonstrates the robustness of their career planning.
A plan and a back-up
Borges et al. (2004) in a study of medical specialty choice concluded:
Early in their training medical students should be disabused of the idea that there is one perfect specialty choice for each person. Instead, they should be helped to understand how they could use different specialties to construct satisfying and successful careers.
It is therefore sound practice to encourage your trainees to have a back-up plan (preferably in a less competitive specialty) that they would be happy to pursue if they are not successful with their first-choice option. It is often worth reminding students/trainees that the notion they will only be happy in one specialty is not borne out by the psychological literature on medical specialty choice.
And the trainee who is seriously considering leaving medicine
In your role of educational supervisor, your first task is to explore whether there are some educational difficulties in the student or trainee's current placement or current mental or physical health issues that are contributing to the situation. In both of these situations you should liaise with the local training programme director in the first place.
If it seems that lack of educational support or health issues are not the issue, then you would be well advised to suggest that your trainee seeks specialist career support. This could be ‘third-tier’ support (see Tiers of support), or it could be provided by a suitably qualified private career specialist. The resources at the end of the module offer suggestions on how to access private career support.