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Supporting the trainee with unrealistic career plans

Educational supervisors often express concern about how best to support a trainee whose career plans they believe to be unrealistic. The example described below could be regarded as typical of this problem.

A trainee has been graded as ‘borderline for F1 completion’ on some of the DOPS (Direct Observation of Procedural Skills) assessment, and it seems that they struggle with tasks requiring fine motor skills. The educational supervisor is then surprised when the trainee tells them during a supervision session that they want to apply for core surgical training, with a long-term goal of training in a particularly competitive surgical specialty. How should the educational supervisor respond?

The importance of posing challenging questions

In this situation, the educational supervisor should focus on posing the following types of challenging question to the trainee.

  • What does the trainee see as their key strengths?
  • How does this self-assessment of their key strengths tie in with some of the assessment evidence in their portfolio?
  • In which areas have they been assessed as being less strong? Are any of these areas important in terms of demonstrating suitability for surgical training?
  • Is there a match between their areas of personal weakness and areas that are critically important in terms of suitability for surgical training?
  • Have they researched the likely competitiveness for core surgical training?
  • What are their thoughts on the fact that they are interested in a particularly competitive surgical specialty but they have not scored highly on the relevant key competences?

It also needs to be pointed out that suggesting you pose challenging questions to your trainee is not equivalent to suggesting you move into ‘rottweiler’ mode. The content of your questions can be tough, but you need to ensure that there isn’t a breakdown in rapport between you and the trainee. So watch your pacing of questions and your tone of voice and be alert to the effect of your questions on your trainee. It can be helpful if you acknowledge that you understand that discussing these issues is very hard for the trainee, but you do want them to do some serious thinking about their career plans.

The advantages of this approach

Some of the potential benefits of the approach outlined above (i.e. posing challenging questions) as opposed to a more directive approach (i.e. ‘If I were you, I’d ditch surgery’) are as follows.

  • The directive approach absolves the trainee from taking responsibility for their own career decision making.
  • Posing challenging questions rather than providing answers makes it more likely that the discussion will be opened up, and the trainee will start to think critically about their position.
  • With the ‘If I were you’ route, there is the danger that the advice given will be influenced by the supervisor’s own pet likes and dislikes. Quite unconsciously the supervisor may be less likely to suggest career options that they personally disliked, and instead may suggest options that they have previously enjoyed. But the ‘If I were you’ approach has a more basic flaw: the trainee is not you.
  • And perhaps (though it may be unlikely) the educational supervisor could be wrong. For example, perhaps something is going on in the trainee’s private life that means they have been sleeping poorly or been anxious about the assessments and in turn getting poor assessment results, but the trainee knows that at medical school they received highly favourable feedback on their potential for surgical training, and they didn’t have any problems with fine motor control.

See Nathan and Hill (2006) for a fuller discussion of the limitations of directive advice.

If the trainee still persists in wanting to pursue their dream

If you have challenged the trainee in the way outlined above, but they are unwilling to shift their career aspirations, then you should suggest that the trainee has a further discussion, either with a colleague who is in that particular specialty or with somebody else (who could be a clinician or a careers adviser) who has had additional training in career support. You should then prepare a brief summary outlining your specific concerns and give it to the person who will be providing this additional support.

It is also important to realise that while you have to behave responsibly towards the trainee, you are not responsible for their career decisions. So if your trainee wants to ignore clear feedback that they have been given about their below-average performance in their current job, or ignore the facts on how competitive it is to succeed in their chosen pathway, then ultimately that is their decision. Your job is to ensure that you have raised these challenging issues in a clear, yet supportive way. But it is not always possible to stop some people from making poor career decisions.

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