roadstosuccess eworkbook (3rd edition)

7/28/2019 ROADSToSuccess eWorkbook (3rd Edition)

1/55

The ROADS

to Success:Workbook Exercises

Caroline Elton & Joan Reid


2/55

Exercises taken rom the third edition and ormatted or online use 2012

By the Postgraduate Deanery or Kent, Surrey and Sussex

Acknowledgements

This workbook has been produced by the careers specialists in the KSS (Kent, Surrey and

Sussex) and London deaneries. It includes the exercises and task suggestions rom The ROADS

to Success (third edition).

Caroline Elton would like to acknowledge the late Proessor Kath Green, who tragically

died as the frst edition o this book was going to print. Kath was a much valued mentor

and someone with whom it was a privilege to work or many years. Caroline would also

like to thank Howard Cooper and Rob Nathan.Finally, both authors wish to acknowledge the support o their respective Andrews.

Andrew Reid provided helpul technical advice at various points and Andrew Franklin

oered publishing input, as well as introducing us to Judy Horaceks cartoons.

Both Andrews are probably relieved that the end o ROADS has been reached.

Caroline Elton and Joan Reid

July 2010

Copyright: Caroline Elton, Joan Reid and the Postgraduate Deanery for Kent, Surrey & Sussex.

Do not distribute this book without the permission o the copyright holders.


3/55


4/55

4

The Roads to Success

When this workbook might be used

The transition rom medical school to being a qualiied doctor is prettydemanding, and longer term career planning may not seem an immediatepriority at the start o your F1 year. Whilst it clearly makes sense or you to getthrough induction and the early weeks o your irst F1 job beore you startocussing on career planning, we would suggest that you should dip into this

workbook and slowly work your way through it as soon as you eel settled intoyour irst F1 job. You might also want to review some o the exercises as youmove between dierent oundation jobs because your views about yoursel,and about dierent specialties may change.

Perhaps it also needs to be stressed that even though the oundationprogramme lasts two years, you will be completing applications or post-oundation specialty training in the November/December o your F2 year. Sothe time period or making specialty decisions is actually quite tight. What thismeans is that lastminute.com has no place as a career planning strategy.

Some specialty training pathways also require trainees to undertake a post-oundation core training block, beore later embarking on higher specialtytraining. For example, i you want to train in a medical specialty you will irstcomplete two years o core medical training, and then apply or a place on ahigher specialty training programme. With over 25 specialties to choose rom,trainees on core medical training programmes still have substantial specialtychoice decisions to make. The exercises in this workbook can also be used bypost-oundation trainees on programmes such as core medical training, as well

as by doctors who are not currently in a training post, but who want to applyor specialty training in uture.

How to use this workbook

The exercises in this workbook can be used in dierent ways. You can completethem on your own, and then discuss your answers with colleagues, partner,amily and, o course, your educational supervisor. In some trusts the exercises

are also incorporated into structured junior doctor career-planning sessions.But whether you complete the exercises on your own, or as part o a workshop,we strongly advise you not to take a pick and mix approach. Although it istempting (particularly i you have decided on your post-oundation options) toskip Stages 13 and turn straight to Stage 4, this is not the most eective wayto plan your career. Even i you know what you want to do post-oundation,the exercises within Stages 1 and 2, and the thoroughness o your decisionmaking (Stage 3), will give you the raw data that you need to draw on or yourapplication orm and interview. Skipping straight to Stage 4 may reduce yourchances o being successul in implementing your preerred career option.


5/55

5Exercise 1: work values

Introduction to exercise 1Rob Nathan, a leading occupational psychologist and career counsellor,has written an excellent practical guide or career counsellors. In his book(Nathan and Hill, 2006), he has the ollowing to say about work values:

Values in relation to work represent the degree to which a person regardshis or her work as worthwhile. This worthwhileness includes the amounto power, autonomy, creativity, learning, altruism, security, status andmoney which are sought in work.

Clearly worthwhileness is an important component o occupationalsatisaction, and thus it is vital to become clearer on ones underlying

work values.The workbook contains 4 sel-assessment exercises:

i. work valuesii. achievements, skills and interestsiii. stresses and strainsiv. role models.

The inal activity is aimed at supporting you to pull together all the aspects

rom your sel-assessmentWe have also adapted Hopson and Scallys grading criteria, in the lighto a trainees comment that it is important to think about those workvalues that you dont want to be present. (And, in act, this notion thatoccupational decision making also involves thinking about things that youdont want accords with the wider research literature.)

NOTIMPORTANT

QUITEIMPORTANT

IMPORTANT

NOT PRESENT

(i.e. important that youdont have this at work)

VERY

IMPORTANT

Stage 1 Self-Assessment

STAGE 1: SELF ASSESSMENT


6/55

6


If double-side printing you can cut out the previouspage


7/55

7

PLACE OF WORKWorking in a speciic part

o the country

MONEYThe possibility o earning

a higher salary

VARIETYhaving a variety o dierent

responsibilities

COMPETITIVEworking in a specialty to which

entry is highly competitive

INDEPENDENCEBeing able to work on your own

MANAGING

YOUR OWN TIME

Having some lexibility in when you

carry out your dierent responsibilities

FRIENDS

Forming riendships with

colleagues at work

PACE OF WORKA rapid pace o work

RESPECTA high-status job

MANAGING OTHERSthe opportunity to manage

a clinical service

CREATIVITYThinking up new ideas and

ways o doing things

EXCITEMENTWorking in a context where

you take clinical decisions

under pressure



8/55

8


If double-side printing you can cut out the next pageIf double-side printing you can cut out the next page


9/55

9

CONTACT WITH PATIENTS

Working in the context

where you have lots o

contact with patients

TECHNIQUES

Working in a specialty in which you

perorm particular surgical and/or

diagnostic procedures

COMMUNITY SETTING

Working in a

community-based specialty

HOSPITAL-BASED

Working in a

hospital-based specialty

RECOGNITION

Receiving appreciation or

the work you do

JOB SECURITY

Knowing that your work will

always be there or you

CONTROLLABLE LIFESTYLEWorking in a specialty where

you can achieve a satisactory

work/lie balance

PRECISION

Working at tasks which involve

great care and precision

CONTINUITY OF CARE

Working in a specialty where youcan provide continuity o care

or your patients

SUPERVISION

Having responsibility or

supervising others

HELPING PEOPLE

A role in which you help individuals,

groups or society in some way

LEARNING

A rapidly changing role in

which you will continually be

learning new things



10/55

10




11/55

11


BEING EXPERT

Being known as someone with

special knowledge or skills

ORGANISATION

Working in a well-known

hospital or service

PROMOTION

Work in which there is a good

chance o promotion

CHALLENGE

Being stretched and given new

problems to work on

PREDICTABILITY

Having a work routine which

is airly predictable

RESEARCH

Having the opportunity to

carry out research

COMMUNITYWorking in a place where you

can get involved in the

local community

WORK WITH OTHERS

Working in a team alongside others

PHYSICAL CHALLENGEWork that is physically demanding

TEACHINGBeing able to teach others

FLEXIBLE WORKING

A role in which there is the possibility

o working part-time

TYPES OF PATIENTS

Working with a particular

patient group


12/55

12




13/55

13

BEING EXPERT

Being known as someone with

special knowledge or skills

ORGANISATION

Working in a well-known

hospital or service

PROMOTION

Work in which there is a good

chance o promotion

CHALLENGE

Being stretched and given new

problems to work on

PREDICTABILITY

Having a work routine which

is airly predictable

RESEARCH

Having the opportunity to

carry out research

COMMUNITYWorking in a place where you

can get involved in the

local community

WORK WITH OTHERS

Working in a team alongside others

PHYSICAL CHALLENGEWork that is physically demanding

TEACHINGBeing able to teach others

FLEXIBLE WORKING

A role in which there is the possibility

o working part-time

TYPES OF PATIENTS

Working with a particular

patient group



14/55

14




15/55

15Instructions for Exercise 11. Photocopy (or cut out) this exercise. Then, using the photocopies, cut out

the our headings cards:

VeryImportant NotImportant

QuiteImportant ImportantNotPresent

2. Again using the photocopies cut out the individual work values cards

a Then sort the work values cards under the our headings (i.e. pileup those work values that are Very Important to you under theVery Important heading, etc.)

b Try to be a little selective so, or example, dont have more thanseven or eight work values cards under the Very Important heading.

c I there are any work values that are not on the list, but you knowhave a signicant bearing on your career decision-making, thenadd them in on separate pieces o paper. (You can add them inunder any o the our headings.)

d I you can, try to rank-order your Very Important work values.

3. Write down your Very Important work values. (And, i you havemanaged to rank them, write them down in rank order.)

Look at your list and consider the ollowing questions:

a Is there anything that surprises you, or anything that has raisedyour awareness about yoursel rom the list? I so, make a note owhatever it is that has struck you.

b Think about how your work values might change over time. Arethere any values which are not Very Important now but mightbe so in 5-10 years time? (Flexible working may be an obviousone, but there might well be others.) I this is the case, then makesure that you take a note o how you imagine your work values

might change.c Are there any work values which you regard as Very Important

but are unlikely to nd an outlet in any o the options you are

1. _____________________

2. _____________________

3. _____________________

4. _____________________

5. _____________________

6. _____________________

7. _____________________

8. _____________________



16/55

16


considering? (For example, artistic values are very important tosome doctors, but they dont necessarily ind an outlet orthem in their paid role in medicine.) I this is the case, is thereany way that you could ind an outlet or these values outsidework? And i you did, would this be satisactory or you, or

might you still end up eeling unulilled?

Exercise 2: achievements, skills and interests

Introduction to exercise 2In this exercise we ask you to consider three achievements two rom yourwork as a junior doctor/medical student and one rom outside work.

Typically, when we give trainees/students this particular exercise on courses,

some will say that they dont actually have any achievements. But such aresponse is based on a crucial misunderstanding. When we say that wewould like you to consider three achievements, we are not saying thatthey should be o world-shattering importance or enormous, or rare (e.g.a lead paper in a major medical journal). Instead, what we are asking youto identiy is something that you have done that you elt proud about,and ideally, but not essentially, something or which you received positiveeedback rom a patient, colleague or supervisor.

It is also important, given that this exercise is part o the sel-assessmentstage o an overall career-planning model, that your answers are genuine,rather than o the Miss World/Id like to save the planet variety. Thepurpose o the exercise is to think about things that you have done well,and which have given you a genuine sense o satisaction. It is not aboutimpressing others but rather starting to think more clearly about whatmakes you tick, so that you can use this knowledge as the basis orsubsequent career decision making.

Instructions for exercise 2A. Read through your e-portolio and identiy two things that you were

involved with at work which gave you great personal satisaction. Whenhave you elt the glow o satisaction that you did a particular task well?

When have you received positive eedback?

(See i something in your e-portolio jogs your memory about particularachievements. But i it doesnt, choose something that you haventwritten about in your portolio. The vital thing is to choose something

that you did well and you ound personally satisying.)


17/55

17


I you are a medical student, you may have a learning portolio that youcould use or this activity. I you do not have either a medical student ore-portolio, then just choose something rom your memory.

In addition to the work-based example you should also identiysomething that you have been involved with, out o work, that gave

you great satisaction. Possible examples include achievements insports, music, drama, local community action, charities, religiousinstitutions, etc. Sometimes, though, the out o work achievementsare home-based. For example, i you have got through medical schoolwhile simultaneously caring or a young child, then that is a very realachievement and you can use it to demonstrate the possession o awhole range o personal skills such as commitment, organisation, timemanagement, etc.

B. For each achievement, identiy all the skills involved. These could betechnical skills, communication skills, organisational skills, conceptualskills, etc. Tease out all the skills that you used to accomplish each o thelisted achievements. Moreover, dont just list the broad type o skill (e.g.communication skills), but try to analyse your achievements at a moredetailed level. (See the example below.)

C. For each achievement, describe how you (and, i possible, other people)knew the achievement was a success.

Example

A. Achievement:

Successully presenting case at irst multi-disciplinary case conerence.

B. Skills involved:

Summarising complex case notes.

Building eective relationships with the other proessionals present at theconerence, none o whom I had met beore.

Presentation skills presenting my point o view to the other attendees.

Standing irm when my viewpoint was challenged, but not resorting tousing a similarly conrontational approach.

How did I (or other people) know it was a success?

Feedback rom other people attending the case conerence.

Despite initial opposition, the approach that I suggested was acceptedby the team.


18/55

18


D. Finally, look at the lists o skills you have identied. Put a mark next tothose skills that you are most interested in using at work. You can alsonote down the skills that you have not developed yet, but that you wantto develop in the uture.

Repeat the exercise or the other two achievements.

Exercise 3: stresses and strains

Introduction to exercise 3Now switch your ocus to areas in and out o work that you ind diicult.All specialties will contain tasks that you enjoy less; however, good careerdecision making involves identiying what you ind stressul and diicult, andthen choosing a career pathway that minimises these particular stresses.

You might think that people do this automatically, and some do. However,we requently encounter clients who have made choices based on oneactor (e.g. opting or a specialty that has run-through training), withoutadequately considering the way in which this choice will involve otheractors that they ind stressul.

Instructions for exercise 3What we would like you to do in this exercise is to identiy two examples

(one rom your working lie and one rom outside work) in which you eltthat your stress levels were higher than they normally are or you.

Again, it may help you to read through your portolio to jog your memory.For the non-work example, lick through your personal diary, to see i anyexamples come to mind.

Having identiied the two examples (one rom work, and one rom outsidework), then answer the ollowing questions. (Go through them separatelyor each example).

1. Give a brie description o the situation, outlining the background, whatrole you played, and what eelings it engendered in you.

2. Try to identiy what it was about this situation that made you eel theway that you did. For example, or the work-based scenario, was it theeedback rom others, the pace o work, the response o the patients, etc.

3. What can you learn rom this example in terms o actors that you mightwant to minimise at work?

Now repeat the exercise, this time analysing an example rom outside work.(And, o course, you can repeat this exercise, giving more than one workand one outside work example.)


19/55

19


Exercise 4: role models

Probably the most consistent inding in the literature on actors eectingspecialty choice is the inluence o role models. Across a large range odierent specialties, and in studies rom all over the world, doctors cite theinluence o role models as one o the actors that inluenced their choice

o specialty.

Sometimes this inluence is direct trainees report that they have chosena particular specialty because that was the specialty o their role model. Atother times, it is not that they choose the same specialty as their role model but rather that they realise that they want to practice a dierent specialtyin a similar manner as their role model. It is also important to realise thatthis inluence works both ways; positive role models are related to choosinga particular specialty or working in a particular way, whilst negative role

models are correlated with the decision not to ollow a particular careerpath, or to practice medicine in a very dierent manner.

The exercise below aims to help you think about particular role models(both positive and negative) in order to clariy some o the aspects o workthat are most important to you.

Positive Role Models

First, spend a couple o moments identiying a particular doctor whom youconsider to be a positive role model.

Then, with reerence to this particular doctor try to answer the ollowingquestions:

a What was it about this doctor that you particularly admired?(For example, was it the depth o their clinical knowledge;their mastery o particular techniques; their temperament;their enthusiasm; their team leading skills; their manner with

patients, etc etc). You might ind it helpul i you think aboutspeciic examples o this doctor at work in answering thisquestion. And you dont have to limit yoursel to one or twopoints there might be a number o dierent reasons whyyou regard a given doctor as a positive role model.

b Use your answer to question (a) above to identiy aspects owork that are particularly important to you and you need tobe present in order to ind work ulilling.


20/55

20


Negative Role Models

Next, without naming names spend a couple o moments identiying aparticular doctor whom you consider to be a negative role model.

a Then, with reerence to this doctor (but still without naming

them), think about what it was about their approach to theirwork, that you disliked.

b What does you answer to question (a) above tell you about someo the actors that are important to you at work?

Activity 1: Summary o Stage 1

Introduction to summary

It is now time to construct a summary o Stage 1. (Remember that theprocess o carrying out the career exploration tasks in Stage 2 might makeyou reconsider some o your answers to these Stage 1 exercises. Thereoreit is perectly acceptable or you to return to and reine this Stage 1summary at a later date.)

Read through your answers to the Stage 1 exercises that you havecompleted. I you have completed any psychometric instruments, then readthrough the report summaries, as well, at this point. Then record the key

points using the summary headings given below.


21/55

211. The doctor-patient relationship

(Write down any points that have emerged rom the Stage 1 exercisesrelating to the doctor-patient relationship. These might include some orall o the points listed below, but you can also add your own personal

points. The list below is not necessarily exhaustive.)

Do you want to see patients in a community or hospital setting?

Do you enjoy brie encounters with patients, or providing continuity ocare over long periods o time?

Do you want to spend a signiicant portion o your working day havingcontact with patients?

Do you want to work with acutely ill or chronically ill patients?

What about the emotional landscape? (For example, do you ind itrewarding to work with patients who are in a distressed or disturbedemotional state?)

Do you have preerences about the ages o your patients? And do youpreer working with individual patients, or patients and their amilies?

Do you want to contribute directly to the treatment o patients, or wouldyou enjoy working to support the diagnostic process (e.g. in areas such

as diagnostic radiology or pathology)?

Would you enjoy having to consider the whole o the patients body(e.g. GP/paediatrician), or would you enjoy becoming an expert on aspeciic region o the body (e.g. ophthalmology)?

Do you enjoy perorming technical diagnostic or interventionalprocedures?



22/55

22


2. Intellectual matters

(Some o these issues might have emerged in the earlier Stage 1exercises, but it is possible that they have not. I they havent, it doesntmatter just ill out the summary now.)

What areas o academic work have you most enjoyed studying in yourundergraduate and postgraduate training?

What medical journals are you most drawn to reading?

Within the BMJ, what sorts o articles tend to attract your attention?

What subjects have you enjoyed (or might you in uture enjoy) teachingto others?

What subjects have you carried out an audit on (or might you plan to

carry out an audit on in the uture)?

What subjects have you enjoyed (or might you enjoy in uture) carryingout research on?

3. Status

In this section in particular (although it actually applies throughout thewhole o this Stage 1 summary), it is important to ask yoursel whetheryour answers represent your own views, or whether you are being unduly

inluenced by pressure rom signiicant others, such as parents or partner.

How important is it to you that you work in a highly competitive brancho the medical proession?

How important is status to you?

Do you want to ensure that there are opportunities or private practice inyour chosen specialty?

Do you want to go into a branch o medicine where there is the potentialor earning a very high salary?

Is it important to you that you have opportunities or participatingin research?

Are opportunities or travelling abroad with your work important to you?


23/55

234. Quality of life

What sort o worklie balance do you want to have in 510 years time?

What sort o weekly schedule would you like to have in 510 years time?

What, or you, are your core work values, rom which you derive mostsatisaction?

What stressul actors do you want to minimise at work?

Is the length o postgraduate training an issue or you?

5. Relationships with colleagues

Do you want to be able to spend quite a portion o your day working on

your own?Do you want to be able to spend quite a portion o your day workingin teams?

Do you enjoy working in multi-disciplinary teams?

Do you want to be able to develop and manage a clinical service?

Do you want to be able to do quite a lot o teaching?

Do you want to be able to carry out research?

Notes:



24/55

24


Explaining to everyone

Work values

Contact with patients

ExcitementLearning

Teaching

Helping others

Work with others

Hospital

Skills

Applying scienceto uncertainty

Translating symptoms intomedical meaning

Dealing with angryor upset people

InterestsExplaining my clinical thinking/

reasoning to trainees

Working with whats causing

problems or a patient when

others cannot

Explaining complex issuesto patients/carers

Stressors

Practical procedures

Emergency/hyper-acute,

e.g. A&E situationsManagement decisions

Figure 1: Shield and motto from a consultant

An alternative way o summarising Stage 1

Instructions for alternative summarySome people preer diagrams and pictures to words. I you would preer, youcould provide a more visually based summary o Stage 1.

Take a large piece o paper (either A3 or paper rom a lip chart).

Copy out the outline o the shield shown overlea.

Then, in each o the our quadrants, either write bullet points o thekey issues or, i you are so inclined, you can devise symbols to depict the keyissues.

Then, underneath the shield, you could write a brie punchy motto thatencapsulates what it is that is important to you in your work.

The example on the ollowing page, was provided by a consultant in generalgeriatric medicine.


25/55

25

Stage 1 Self-AssessmentStage 1 Self-Assessment

Final comments

Hopeully you have ound these exercises useul. But i you havent, we wouldask you to bear with us.

When you come to apply or jobs, completing the Stage 1 exercises in suicient

detail will help you construct clear, credible answers on your written applicationorms, and also help you prepare how to answer the sorts o questions that willbe posed at interview. This is because the quality o your career decision makingwill be thoroughly scrutinised in the application process, and you need todemonstrate that you have carried out adequate sel-assessment (Stage 1), andthorough career exploration (Stage 2).


26/55

26


This section o the workbook includes advice on how to start your explorationinto possible career options and then includes a speciic exercise on how toresearch options in more depth.

Preliminary research tasksThe sorts o issues that you might want to begin by researching (and in actyou may carry out this more basic desk-bound research or a number odierent options) include the ollowing:

Entry criteria to the specialty: this is clearly laid out in the personspeciications which are available on the MMC website. You can then reviewyour Stage 1 assessments against the person speciication, to see i thereis a close it, or i there are any skills or experiences that you might need toacquire.

I you are not currently on a oundation programme, you need to check thatyou are applying or entry to the correct level. Your educational supervisoror Clinical Tutor should be able to advise you on this. Alternatively you cancontact the careers specialists at your deanery. I you have a very unusualquery, you can also email the MMC help desk: [email protected]

The applicants guide to Specialty Training (available on the MMC website)

contains detailed advice or overseas applicants, and it is important thatall overseas applicants read this inormation careully beore submittingan application. And i you have any queries the careers specialists at yourdeanery or the MMC help desk (see above) should be able to help. Overseasapplicants should check the MMC website regularly, so they keep up to datewith any changes to the law.

The C word (Competition)

In the past it was very diicult to get inormation about the relativecompetitiveness o dierent specialties. One o the deaneries (theWest Midlands) pioneered the production o data on the comparativecompetitiveness o dierent specialties, but these were local rather thannational igures. National data rom the previous round o recruitment arenow available (typically on the MMC website) and it is important that youamiliarise yoursel with this inormation. Inormation about workorceplanning data is available on the national medical careers website

(www.medicalcareers.nhs.uk).You also need to discuss the possible implications o the competitiveness oyour specialty choices with your educational supervisor.

STAGE 2: CAREER EXPLORATION


27/55

27Beyond preliminary research

Some o you may know immediately which options you want to exploreurther. I this applies to you then skip to the next section. But others o youmay be ar less sure.

I you all into this latter category (i.e. you dont know which options toexplore in depth), then the ollowing suggestions might help:

1. Complete a relevant psychometric instrument in order to generate lists ospecialties that might suit you. (Remember, though, that in the previouschapter it was argued in some detail that results rom psychometricinstruments should never be regarded as narrowly diagnostic.)

2. Discuss your Stage 1 summary with your educational supervisor, clinicalsupervisor, the Clinical Tutor/Director o Medical Education or the

Foundation Programme Training Director, to see i they can help you withideas o careers to which you might be suited.

3. Read through one on the specialised medical career handbook books(see urther inormation) and review the specialty inormation providedon the medical careers website (www.medicalcareers.nhs.uk). Fromthese, choose a number o career options that seem, on initial reading,to be interesting.

4. Search through the BMJ Careers website which contain numerous

articles on careers in dierent specialties.

5. Check websites o dierent Deaneries to see what inormation theyprovide about the dierent specialties in their region.

Isnt there another way o identiying suitablecareers?

Perhaps you are surprised that there isnt a more scientiic method thanthe suggestions listed above. But based on our proessional training, andalso on our experience o helping people make good career decisions,we know that this process is as much an art as it is a science. So calledscientiic approaches (particularly the use o psychometric instruments)can be useul in generating ideas, but they dont hold all the answers. Andoten the answers start to emerge through ollowing up the suggestions ocolleagues and supervisors with whom you have worked, coupled with aair smattering o background reading.

And inally i you have done all o the above and nothing grabs yourattention, perhaps you need to ask yoursel whether you actually want toremain in medicine. I this is the case, we strongly recommend that you

Stage 2 Career Exploration


28/55

28


either ask or a reerral to the specialist careers adviser (i your deanery hasone), or you seek out some private career counselling with an appropriatelyqualiied careers counsellor.

How to research options in urther depthHaving decided which options you wish to explore urther, you then needto work out what it is you wish to ind out, and how you will go about doingso.

Oten, the best way to ind out more about a particular career option isto try it out, as one o your oundation programme placements. But i thisis not possible (either because the specialty you are interested in doesntoer oundation placements, or because you werent successul in getting

the placement you wanted), then see i you can arrange a taster weekideally early in your oundation year two. A good place to start would be todiscuss this with your educational supervisor and Foundation ProgrammeTraining Director.

Exercise 1: Inormational interviewing

Look at the summary you constructed at the end o Stage 1. For each othe ive dierent sections, write down a list o speciic questions that you

are going to ask o the person who is (or people who are) currently workingin the options that you are interested in.

You then need to identiy at least one person (and preerably more thanone) working in that specialty, in order to put these questions to them.Ask your educational supervisor or suggestions as to whom you can ask.In addition, you can approach college tutors. It is helpul i you are able totalk to people at dierent levels o seniority, so ask among your riends tosee i they know SpRs or consultants working in your ield o interest.

Finally, set yoursel a suitable timescale in which these interviews will becarried out and arrange to discuss your indings with your educationalsupervisor, or other experienced clinician.


29/55

29Person, phone or email?

Ideally you should talk to people ace to ace. (And some deaneries organisecareers airs where you can talk to people in all sorts o dierent specialties,and the BMJ Careers Fairs are also useul ways o talking to people inparticular specialties.)

Clearly i you are doing a oundation placement in a large teaching hospitalyou will have easier access to a broader range o specialties than i you are ina specialised psychiatric hospital or a smaller District General Hospital. I youcant manage a ace-to-ace interview, then see i you can arrange to talk tosomebody on the phone.

And i all else ails email people, and ask i you can send them a list oquestions.

But whatever your mode o communication, you need to approach the tasko inormational interviewing as an important research project. You are nothaving an aimless chat; instead, you are trying to get answers to some othe questions that have emerged rom the Stage 1 sel-assessment.

(Be aware that some o the responses to questions will be quite subjectiveThereore it is useul to speak to more than one person. Find out what theinterviewee enjoys about their work. Not only is this interesting inormationto elicit, but i they give you a very cynical response, then you know that you

might be getting a somewhat jaded opinion. And while it is clearly importantto get a balanced rather than an overly glossy view o the specialty, you dowant to avoid being turned o a specialty because you have talked to aburnt-out clinician.)

Finally, its worthwhile going back to the library and spending a bit o timewith your nose in the journals. Choose the major journals in your specialty ointerest (i you are unsure about which journals these are, ask the librarian)and spend some time having a good read through some recent issues.

O course, as you havent begun specialist training in these areas, manyo the articles will be too specialised. But, in general, ask yoursel whetheryou are gripped by some o the articles, or whether they leave yousomewhat cold.

In addition to the relevant journals, you can also ask the librarian to directyou to some o the core texts in the ields that you are exploring. And again,pose yoursel the same question. Am I really interested in reading moreabout psychiatry (cardiology, pathology, etc.)? Because i you are, that is agood sign. But i you are not (assuming that you have chosen a textbook atapproximately the right level), then you need to ask yoursel whether youare making a good career decision.

Stage 2 Career Exploration


30/55

30


This section o the workbook guides you through the decision makingprocess.

There are three exercises in this chapter:

i. Constructing a lieline provides you with an opportunity to reviewsignicant decisions that you have in the past.

ii. The decision template is a structured approach or comparing the dierentoptions that you are currently considering.

iii. Using the ROADS acronym this is to check the robustness o your careerdecision.

Exercise 1: constructing a lieline

Instructions for exercise 1Think about how you have made important decisions in the past: orexample, career-related decisions about A-level subjects, applying ormedical school, elective choices, etc., or personal decisions that areunrelated to work, such as taking a gap year between school and university,starting or ending a signiicant personal relationship, etc.

Then, ollow the instructions below. (And see Fig. 2 or an example.)

1. Take a sheet o paper (ideally A3 or fip chart paper. But A4 will worki it is all that is available). Turn it round so that it is landscape ratherthan portrait.

2. Draw a horizontal line across the middle o the paper. Note down yourage at the right-hand end o the line. Then, put in a plus (+) above thehorizontal line (to signiy times that you look back on with pleasure) anda minus (-) below the line (to signiy those times when things were notgoing well).

3. Beore you go any urther, think very careully about the course the linewill take. Where are the high points and the low points? Which parts othe line (i any) are relatively stable?

4. Now mark in the signicant lie events. Include experiences whichinfuenced you, achievements, and both good and bad events that haveoccurred in your lie to date. Allow yoursel sucient space, as includingone event may trigger a memory o another.

5. Connect up the points that you have marked.

6. Identiy a couple o decisions that you have marked on your lieline whichyou eel (in retrospect) have worked out well. What made them gooddecisions? How did you go about making these particular decisions?

STAGE 3: DECISION MAKING


31/55

317. Now, identiy a couple o decisions on your lieline that you eel (inretrospect) didnt work out so well.* What made them poorer decisions?How did you approach these decisions that didnt work out so well?

8. A much-avoured adage o psychologists is that the best predictor outure behaviour is past behaviour. Bearing this in mind, can you use

this analysis o past decisions to throw any light on how you shouldapproach the career choices that you are currently acing?

(One way o doing this is to look at your answers to questions 6 and 7 inorder to identiy the best way or you to approach your current decision,as well as approaches you should avoid. For example, do you seem tobe somebody who makes good decisions when you rely on your guteelings, or are you somebody who has made your best decisions whenyou adopt a more structured approach?)

________________________________________________________________

*When we have used the lifeline exercise in workshops (with both consultantsand trainees), we have often heard the comment that there is no such thing asan entirely bad decision, as good elements can emerge even from decisionsthat didnt turn out at all smoothly. We would both entirely agree with this, andhave examples from our own personal career histories that illustrate the point.Moreover, in our professional practice we often hear clients describe careerdecisions that they regret taking, but which they do realise also allowed them to

develop certain useful skills.

However, in terms of the lifeline exercise, we do think that it is possible to identifydecisions that you have taken that, in retrospect, you feel were not the best ones.These are decisions where, even though you can see that some good things haveemerged from them, you have a sense that a different decision at that point inyour life would probably have been a better option. It is these sorts or decisionsthat we would like you to identify in question 7.

Has anything else struck you rom completing this lieline exercise?

(And in case you dont understand this question, it might help i we give youan example o the sort o insight that can emerge. One o us once ran a two-day career-planning workshop or a housing association that was making alarge number o sta redundant. The sta attending the workshop were,or entirely understandable reasons, angry, de-motivated and anxious aboutthe uture. One particular member o sta was very withdrawn during therst day o the workshop, and was reluctant to contribute to the discussions,or complete any o the activities. Following the ieline exercise, there was a

noticeable shit in his attitude. When the acilitator remarked on this, andenquired what had happened, the member o sta replied that he had eltoverwhelmed by the orthcoming redundancy, and had convinced himsel

Stage 3 Decision Making


32/55

32


that he wouldnt get a new job. But when he reviewed his lieline as a wholehe realised that the current dilemma was just one o a series o obstaclesthat he had aced in his lie and, as he had overcome the previous ones, henow elt more condent that he wouldnt be deeated by the orthcomingredundancy. This is just one example. But it gives a favour o the sort o

insights that sometimes emerge rom the Lieline exercise.)Figure 2: Lifeline example from a consultant

+

_

_ _

_

+

+ +

Diagnosed withchildhood RA

(RheumatoidArthritis)

Accepted forCambridge

Good

d

ecision

Marry, LifetimeFriend

Support

Work innegativeunrealisticexpectation of

specialty-wrongarea, wrong specialty

Appointed asgeriatric trainee.Good decision!

Appointed as consultant

DeaneryPost!

Post too busyReduced support

Pressure toorganise research

Correctcareerchoice!

0 7 26 27 29 34 48 50

Age


33/55

33Exercise 2: The Decision Template - a more structuredapproach to decision making

Instructions for Exercise 2I the results rom the Lieline exercise suggest that you would beneit

rom a more structured approach, then you might ind the exercise belowhelpul.

1. With reerence to the Stage 1 Summary, and using the ve headings(Doctor-PatientRelationship,IntellectualMatters,Status,QualityofLifeand Relationships with Colleagues), write down your answers to thequestions listed in Fig 3.

Then, along the top, write down the particular career options that you

are currently considering. (Ideally, this should not be more than our, asotherwise the decision making becomes rather unwieldy.)

2. With reerence to your Stage 2 research, note down whether a givenactor (e.g. seeing patients in a community setting; continuity opatient care, etc.) is present or absent in the dierent specialties youare considering.

3. Counting the number o ticks in each career option may well bemisleading, because the dierent actors are not necessarily o equal

importance. Instead, we would suggest that initially you eyeball thechart, and see what conclusions you reach. Having done that, we wouldrecommend that you discuss the chart with signicant people in your lie(partner, amily, close riends), and also with your educational supervisor,or another clinician who knows your clinical work.

In this way, the best career decision should become clearer to you.

In this exercise we havent included the precise details o how many

options you have to choose rom at any particular stage (i.e. the detailso application or oundation year 1 or post-oundation training). Wecannot gaze into a crystal ball and predict the precise details o theapplication process into oundation year 1, or into post-oundationtraining that will be in place next year, let alone the year ater. Thus wetook the decision to describe a generic approach to decision makingwhich can be applied to any situation.



34/55

34


Figure 3: Exercise 2 Questions to consider for eachoption

1. Doctor-patient relationship Options(please tick)

1 2 3Do you want to see patients in community or hospitalsetting?

Do you enjoy brie encounters with patients,or providing continuity o care over long periodso time?

Do you want to spend most o your working dayhaving contact with patients?

Do you want to work with acutely ill or chronicallyill patients?

What about the emotional landscape? (For example,do you ind it rewarding working with patients whoare in a distressed or disturbed emotional state?).

Do you have preerences about the ages o yourpatients? And do you preer working with individualpatients, or patients and their amilies?

Do you want to contribute directly to the treatment opatients, or would you enjoy working to support thediagnostic process (e.g. in areas such as diagnosticradiology or pathology)?

Would you enjoy having to consider the whole o thepatients body, (e.g. as a GP/paediatrician), or wouldyou enjoy becoming an expert on a speciic region othe body (e.g. ophthalmology)?

Do you enjoy perorming technical diagnostic orinterventional procedures?


35/55

352. Intellectual matters Options(please tick)

1 2 3

What areas o academic work have you most enjoyedstudying in your undergraduate and postgraduatetraining?

What medical journals are you most drawnto reading?

Within the BMJ, what sorts o articles tend toattract your attention?

What subjects have you enjoyed (or might you inuture enjoy) teaching to others?

What subjects have you enjoyed (or might youenjoy in uture) carrying out research on?

What subjects have you carried out an auditon (or might you plan to carry out an audit onin the uture)?

3. Status Options(please tick)

1 2 3How important is it to you that you work in a highlycompetitive branch o the medical proession?

How important is status to you?

Do you want to ensure that there are opportunitiesor private practice in your chosen specialty?

Do you want to go into a branch o medicine wherethere is the potential or earning a very high salary?

Is it important to you that you have opportunities orparticipating in research?

Are opportunities or travelling abroad with yourwork important to you?



36/55

36


4.Qualityoflife Options(please tick)

1 2 3

What sort o work-lie balance do you want to havein 5-10 years time?

What sort o weekly schedule would like to have in5-10 years time?

What, or you, are your core work values, rom whichyou derive most satisaction?

What stressul actors do you want to minimise atwork?

Is the length o postgraduate training an issue

or you?

5. Relationships with colleagues Options(please tick)

1 2 3

Do you want to be able to spend quite a portion oyour day working on your own?

Do you want to be able to spend quite a portion o

your day working in teams?

Do you enjoy working in multi-disciplinary teams?

Do you want to be able to develop and manage aclinical service?

Do you want to be able to do quite a lot o teaching?

Do you want to be able to carry out research?


37/55

37Exercise 2: crunch time making the decision

From Exercise 2 you should have got some sense o what has helped youto make good decisions in the past (and perhaps too, o actors that havecontributed to you making less successul choices). It is worth bearing inmind Krieshoks indings (mentioned in Chapter 2 o ROADS to Success,

Elton & Reid), that intuition can also be important in career decisionmaking. But it is also necessary to be clear about what Krieshok is sayingwhen he describes intuitive decision making processes. He certainly isnttalking about crystal ball or navel-gazing. Instead he argues that the wayto help people make good career decisions is to encourage them to getstuck in dierent career-related activities and then step back and relect onthe experience. At this point (and not beore) a strong gut eeling that aparticular option is right (or or that matter wrong), may well be o value.

Exercise 3: how robust is your career decision?

The inal task that we would encourage you to carry out is to interrogateyour career decision using the ROADS checklist. Initially we would suggestthat you should do this on your own. But then you should talk throughyour conclusions with the same people listed above. (And, o course, theresults o all three exercises detailed in this chapter could be discussed withthe relevant people on one occasion, or on separate occasions, depending

upon your own particular circumstances.)

Good career decisions: ROADS

Realistic are you being realistic about yoursel AND the demandso the job?

Opportunities have you given serious consideration to all theopportunities available?

Anchors have you built in the things that provide support in your lie?

Development do your choices ully develop your potential?

Stress have you considered those aspects o work that create particularstresses or you?



38/55

38


I you cant make up your mind

There are a number o possible reasons why you might struggle with adecision. (And in act, these reasons are not mutually exclusive.)

1. You are still unclear about your skills, interests, achievements, values, etc.

2. Your career research to date hasnt enabled you to become moreclear about the extent o the match between the work actors thatare most important to you and the dierent career options that youare currently considering.

3. Youve gone through Stages 1 and 2 thoroughly but you still cant makeup your mind (perhaps because you are someone who always struggleswith decisions).

4. You are uncertain whether you wish to remain in medicine at all.

I 1 and/or 2 apply to you, and you havent really devoted much time toworking through the structured exercises outlined in this workbook, then itmight be useul or you to go back and do so. But i 3 applies (i.e. you havecompleted the exercises to the best o your ability, and discussed them withyour educational supervisor, but you still cannot decide) we would adviseyou to ask or a reerral to the deanery careers team.

And i 4 applies, then we would strongly recommend that you seek

proessional help rom an experienced and appropriately qualiied careersproessional. Both o us have experience o working with individualswho all into this category, and as a result we know that the decision toleave medicine is a major one, and that the individuals concerned haveenormously appreciated the input rom people who have a proessionalgrounding in career planning.


39/55

39

Stage 4 Plan Implementation

This section includes some golden rules with regard to job applications andother activities relating to applications and interviews. Finally it includes somepoints to consider with regards to presentations and selection centres.

Some golden rulesMany o the points listed below will seem obvious. But one o us hashad experience scoring applications or oundation programmes (and theother has considerable experience o medical recruitment and selection,particularly at consultant level) and both o us know that a number oapplicants disregard some o these basic points.

1. Preparation, preparation, preparation

Make sure that you understand the practicalities o the applicationprocess.

This involves reading through the whole orm extremely careully. Whenis the deadline? Looking at all the questions, how long might it takeyou to devise really good answers? Will you need to nd additionalinormation that you dont yet have to hand?

You shouldnt start answering any question until you have studied thewhole orm, because an example that you give or one question might

be one that you nd you want to re-use or a subsequent question.

2. Understand what the recruiters are looking forFamiliarise yoursel with the person specication or the training post asshort-listing will take place with reerence to this specication. (Ater all,you might bake the best chocolate chip cookies on the planet, but i therecruiters arent looking or chocolate chip cookie bakers it probably wontdo you any good to say so.) You always have to construct your answersto the questions with the person specication in mind. (But this doesnt

mean a simple reiteration o the person specication on your applicationorm. That approach becomes extremely tiresome or the reader.)

3. Check, check, and then check againMistakes (in spelling or grammar) will make it harder or you to get yourpoints across and can lead to the loss o marks. You might eel that thisis unair as you are applying to work as a doctor, not an English teacher.But we would counter-argue that the dierence between 0.25 and0.025 mg or a particular medication could be a matter o lie and death.Attention to detail matters, and being sloppy on your orm wont helpyou get your message across.

STAGE 4: PLAN IMPLEMENTATION


40/55

40


4. A note about plagiarismThere have been a number o cases recently where applicants have beenreerred to the GMC or plagiarism. So bear in mind the guidance givenin Good Medical Practice that: You must be honest and trustworthywhen writing reports, and when completing or signing orms, reports

and other documents. It also goes on to say that: You must always behonest about your experience, qualications and positions, particularlywhen applying or posts.

Completed application orms will be checked or plagiarism and theanswers on the orm must be your own rather than copied rom theworks o others. Using a commercial service to provide answers or yourorms would not be regarded as compatible with the requirement thatyou write the answers yoursel. And i the commercial services end up

with a number o applicants writing very similar answers, then this is thesort o situation that might be detected by the anti-plagiarism sotware.

The issue o how much help riends/supervisors can responsibly give youis a ar greyer area. We advise consultants to give you general eedbackrather than mentioning specic wording that you should include on theorms.

Activity 1: How to approach the short-answerquestions

There will be a number o questions on the orm that relate to the personspeciication. You could, or example, be asked about your experience oteam-working, leadership, time-management, making diicult decisions, oryour longer term career plans.

Typically, the space to answer these questions is limited to a speciicword count.

Some consultants may be relatively unamiliar with these sorts o questions,and may struggle with giving you the best advice. (Certainly, the advicethat you can dash o any old answer, because these questions arent thatimportant, is not advice that you should ollow.)

1. As a way o preparing to write your answer, you might want to use theSTAR structure. By this we mean you could break down your exampleinto:

Situation/TaskProvide a concise overview o the example you are considering using,ensuring that it is relevant to the question.


41/55

41


ActionsWhat exactly did you do? What was your role and contribution? Whatskills did you use? (This part will probably orm the bulk o your answer.)

Results/RefectionWhat was the outcome? What have you learnt rom it?The STAR acronym is a very useul way o analysing the examples thatyou intend using in the short-answer questions.

However, depending upon the actual wording o the question, youmight not actually include all the dierent parts, or you may want toemphasise one part more than another. So in the actual answer you willhave to tailor the STAR components to the specics o the question. But

STAR is an excellent starting point.2. As mentioned above, gather together all the relevant personal data that

you might need to reer to, in one place, beore you start answering thesequestions. And by this we mean your answers to the exercises in this book,your CV, your learning portolio, inormation on any audits you have doneand, or junior doctors, the assessments that you have carried out.

3. Beore you start writing anything, read through the GMCs guideGood Medical Practice (which can be obtained rom the GMC website).

This will remind you o the qualities and values that the reader will belooking or in your answers. Scoring o the application orm may relateto the elements o good practice outlined in this document.

4. Read the question extremely careully. You need to make sure that youanswer all parts o the question, as each part will be allocated separatemarks. I the question has a number o parts, structure your answer in alogical way so that it matches the dierent parts o the question. In thisway you will make it easier or the short-lister to recognise that you have

ully answered all the parts. In addition, your answers always need to berelevant to the question that has been asked.

(When we are running seminars on application orms we oten say thatyou should imagine that each word you write is ghting or inclusion inyour answer. I it doesnt add value, it shouldnt be there.)

5. When the question asks or examples o achievements, or initiative, orleadership, it is not requiring you to have extraordinary examples. Inother words, the short-listers are not expecting you to have written thelead article in nature, or have climbed to the top o Everest. Instead,they are looking or answers in which you refect intelligently, and withinsight, on the sorts o experiences that you would be expected to have,


42/55

42


at your particular level o training.

6. You will nd it easier to write good answers about generic skills (e.g.time-management, communication skills, teamworking) i you havehad some background training in these issues. I sessions on thesetopics are oered as part o the generic training programme, we would

strongly advise you to attend them. This will give you a basic theoreticalunderpinning that you can use to structure your answer. I thesesessions havent been oered (or i you missed them), then do a bit obackground reading beore lling out the orm.

7. When you are constructing your answers try to think about what anobserver would notice i they had been watching you. For example, i youwere asked to explain how you communicated with an agitated patient,a good answer might describe how you remained calm, and responded

to the specic concerns the patient raised. I the patient had demandedto see the consultant, you would also explain careully to the patient thatthe consultant was not on site, but you would be doing a ward roundthe ollowing morning and take personal responsibility or asking him/her to speak to the patient when s/he was on the ward. An answer likethis demonstrates to the reader that you do in act know what constituteseective communication with an agitated patient. In contrast, an answerwhich said something like I made sure that the way I responded to thepatient diminished their level o agitation doesnt convey to the reader

that you would have the rst clue how to do this in practice.

8. You will probably need to edit your rst attempt at writing these answers.We suggest this because oten the rst drat misses points out, or includesirrelevant detail, but it is dicult to spot this at the time. Instead, i youwrite the rst drat, and then leave it (or at least a ew hours), when youcome back to it, it is ar easier to see what changes need to be made.

9. What you need to avoid is something that reads like a reiteration o theperson specication. In contrast, what you want to aim or is something

that engages the interest o the reader. With the best application ormsnot only is it clear that the candidate has the necessary abilities and skills,but the reader also builds up an initial sense o what the candidate islike as a person. Its a very hard balance to strike because you dont wantto sound too condent or over-amiliar. But you also dont want youranswers to be arid or to sound as i they have come out o a textbook.

In our experience the best way o nding the middle road and writinganswers that engage the interest o the reader (and are, o course, also

highly relevant to the question) is to write about examples that matterto you. With these examples, it is easier to convey your interest andinvolvement, and in turn this helps to engage the reader. But you also


43/55

43


need to allow sucient time or lling in the application orm. I youhave read the question careully, chosen your most appropriate examples,and then ne-tuned your answers through sucient editing, you aremaximising your chances o success.


44/55

44


So how long is long enough?

There are no hard and ast rules on how long it takes to ill in yourapplication orm. But in our experience it usually takes longer than youwould think.

We would certainly advise you not to leave the orms to the last coupleo days beore the deadline. Instead, look at them as soon as the systemgoes live, and approach illing them in in the systematic way that we havedescribed above. It might also be helpul to ask more senior colleagueswho have already completed these orms how long it took.

Portolios and CVs

During both oundation and specialty training you will use a portolio/e-portolio to support your learning, collect together inormation aboutyour assessments and other achievements. Your portolio can help supportyou with career planning and your Personal Development Plan can be usedto help you consider what you need to do to progress your career.

Keeping you portolio up to date is essential as it is used as evidenceto support sign-o as you progress through your training programme(Foundation and Specialty) and can be used to help support your applicationsor specialty training. It is oten reviewed during the selection/interview

process into specialty training. Do ensure your portolio is comprehensive andcontains your relections on your training to date. It should also include a CVwhich is a useul way o organising data about your educational career historyto date.

Long listing and short listing

Once the application deadline has been reached the next stage in the

selection process is long listing. The applications which have beenreceived are checked against the essential eligibility criteria in the personspeciication or the specialty and level applied or. The next stage is shortlisting. For GP recruitment this involves Machine Marked Tests (MMT) inClinical Problem Solving (CPD) and Situational Judgement Tests (SJT) anddetailed explanations o these dierent tests, together with samplequestions, are available on the GP national recruitment website(www.gprecruitment.org.uk). For other specialties short listing is carriedout by consultants in that specialty. Some specialties are reviewing their

selection methodology and is likely that MMTs will be developed andorm an increasing part o the selection process in the uture.


45/55

45


Activity 2: Interviews

IntroductionIt is useul to begin by thinking about the purpose o interviews.

A ormal answer is that the purpose o the interview is to assess each

candidate against the person speciication, and thus identiy whichcandidate (or candidates) is best suited to the position on oer. But it isalso important to realise that you (as the applicant) and the panel membersall share membership o the human race. An interview should not eellike a mechanised process o quality control but, instead, a proessionalconversation in which you build up rapport with the panel.

O course, building up such rapport is easier said than done. And nearlyeverybody is nervous beore an interview particularly when there is a lot

at stake. But it is useul to remember that you want to convey a sense owho you are as a person during the interview. Ater all, the panel will beasking themselves i you are the sort o person whom they would want tohave as a trainee.

I you are very nervous, it is ine to say to the panel that you ind interviewsquite stressul. Similarly, i you are asked an extremely diicult question youcan begin your answer by saying something like Thats a tough one. But Illgive it a go. In these and other ways you can convey something o your

personality to the panel.We oten remind our clients that interviews or jobs are not like policeinterrogations. By this we mean that whereas, i the police wereinterviewing you to ind out i you had committed a crime, you would beunwise to comment that a question was very hard, or that you needed abit o time to prepare an answer, such strategies are entirely appropriatein a job interview. Because, in the latter situation, responding in this wayboth gives a sense o your own personality and also shows that you handlepressure well.

Preparing for an interviewMost interviews will be structured and time-limited. There will almostcertainly be more than one person present. I there is a panel, one memberwill be appointed as Chair, and is the person who is likely to welcomeyou, introduce the other panel members, and outline the structure o theinterview. I the mantra or estate agents is location, location, location,a similar rerain or career counsellors would be preparation, preparation,

preparation. (And this applies, o course, as discussed above, to theapplication orm stage as well as to interviews.)


46/55

46


The reason why this is so important is that many questions can broadlybe predicted in advance. So i you devote adequate time to pre-interviewpreparation, you should be able to improve the quality o your perormanceon the day. (O course, you might still be asked some questions that youhavent considered beore. But i a structured interview process is used, at

least you can reassure yoursel that all the candidates will have been askedthis particular question.)

So how should you prepare?For starters it is helpul to realise that questions which are asked atinterviews are usually divided into three broad areas:

1. Questionsaboutyou.

2. Questionsaboutthejob/specialty.

3. Questionsaboutthewidercontextofhealthcare.

Each o these three categories will be considered in turn.

1. Questions about you

The list below gives examples o the sorts o questions about yoursel thatyou might be asked.

1. Describe some o your key qualities/characteristics.2. Tell me what you have gained rom your training to date?

3. What are your key strengths?

4. What do you think is your greatest achievement to date?

5. Tell me about your approach to working in a team.

6. Describe a situation at work which, in retrospect, you think you couldhave handled better. What did you learn rom the situation?

7. What sort o decisions do you nd it dicult to make?

8. What do you see yoursel doing in ve years time?


47/55

47


General guidance on these questions

It is always ar better to reer to speciic examples than to talk ingeneralities. So, or example, i you are asked about your strengths,mention perhaps two to our points, but link each o them to a speciicexample (which can be rom work or rom out o work). I you just talk in

generalities (Im compassionate, organised, thorough, etc.), a little voicepipes up in the head o the listener saying, Well, you would say that,wouldnt you? But i you supply the examples, the answer as a whole hasmuch more credibility.

(And as an aside: thats why working through the exercises in thisworkbook is important, because they supply you with the sorts o examplesthat you will need to draw on in your application orms and at interview.)

Not only should you have thought out examples o all your positive points,but you should also have planned what examples you will give i you areasked about your mistakes or areas o weakness.

The key thing to consider when you are asked about mistakes or areaso weakness is to choose an appropriate example. Bearing in mind theelements o the GMCs The New Doctor you cannot reer to any examplethat would cause the panel to have doubts about your suitability as adoctor. But, equally, you dont want to reer to anything too trivial, or tobe too clever by sneaking in a positive under the guise o a negative. For

example, i you are asked about your weaknesses, responding by sayingthat you work too hard might be o-putting or the panel. Everybody hasareas o personal weakness, and they should be able to discuss them, withinsight, at an interview.

We would suggest that the best strategy is to choose a middle-o-the-road sort o example, and then whether you are asked or this part ornot tell the panel how you remedied the situation. So, or example, youcould say something such as initially you ound it hard to switch o rom

work, and it was aecting your sleep. But you realised that you had to beable to recharge your batteries at the end o the day, so you started goingor a run, playing the piano, reading a novel, or whatever, and that helpedyou to switch o rom work and get a good nights sleep. (This is only oneexample there are hundreds that you could use. But it illustrates the pointthat you need to pick the everyday sorts o examples that will have actuallyhappened to you as part o your medical school/oundation training, andthen describe to the panel what you did to remedy the situation.)


48/55

48


2. Questions about the job/specialty

Questionsinthiscategorymightincludethefollowing:

1. Why do you want this job?

2. Why have you applied to this particular training programme?

3. Talk us through your CV.

4. What skills will you bring to this specialty?

5. Describe your views on whether less than ull-time training is possible?

6. What do you think it takes to excel in this particular specialty?

7. Whats the most useul course that you have attended in the last12 months?

8. Tell us about a research paper that you have read recently that has hadan impact on your clinical practice.

For questions o this type you will be drawing on your answers to the Stage 1and Stage 2 exercises, including any psychometric instruments that youhave completed. I you have given suicient thought to both these stagesyou should be able to give coherent answers to these sorts o questions.This is because, essentially, most o these questions are assessing the matchbetween your personal qualities and the demands o the job.

Beore you go or an interview you should be amiliar with the personspeciication, and any other basic inormation on training issued by therelevant Royal College. In addition, you should also try to get some sense(either through College literature or through talking to people in post) olikely developments in that specialty, because, with the introduction o newtechnologies, some specialties can expect signiicant changes in the uture.(A well-known example is cardio-thoracic surgery, where the rise in invasivecardiology perormed by medically trained cardiologists, not surgeons

has meant that more procedures are being done through catheters, withearlier intervention in acute myocardial inarction, and thereore less open-chest surgery is required.) So check or likely uture developments in yourspecialty o interest.

As or good ways o answering questions about the specialty, you need todistinguish between questions o dierent sorts. For example, i you areasked why you want to train in a particular specialty, you shouldnt haveto pause or a long time beore you answer. In act, you should expect tobe asked why you are applying or the post, and a good, well-thought-outanswer should be on the tip o your tongue.


49/55

49


However, you might also be asked to discuss some more complex scenariosrelated to your specialty or indeed to the practice o medicine in general.In this situation, you will not be expected to have an answer immediatelyand it is perectly acceptable to pause beore you respond. (More detailedguidance on answering questions o this sort will be given below.)

Questions about the wider context o healthcare

Typical questions in this third category include the ollowing:

1. What do you think about the recommendations o the Tooke Inquiryinto MMC, and the Department o Healths response to theserecommendations?

2. Describe how you think appraisal will help improve the quality o care

that doctors deliver to their patients?

3. What do you think are the main challenges acing the NHS? (These couldinclude Payment by Results, MMC, NHS Direct, Foundation Trusts, etc.)

4. Should patients be involved in decision making about their care?

5. How might the European Working Time Directive aect you?

6. What is audit, and how does it dier rom research?

7. Can you tell me about an audit project that has infuenced your practice?In answering these questions you are not expected to be an expert onhealth policy or have an MBA in healthcare management. However,you are expected to have a basic understanding o the wider healthcarecontext in which you would be training.

As a basic minimum you should look at the ollowing websites:

1. The Department o Health.

2. The relevant Royal College.3. The Deanery/Foundation School to which you are applying.

4. The MMC website

In addition, you might also want to look through the on-line archives oBMJ Careers (to ind recent articles about your specialty), Health ServiceJournal (to get short articles on health service topics) and perhaps eventhe Kings Fund (which has good coverage o relevant NHS policy issuessuch as the establishment o oundation trusts).


50/55

50


I you are very keen on management issues, and see yoursel as somebodywho might want to manage a clinical service in uture, see i you can getto talk to somebody in your Trust (or PCT) who has a senior managementposition. They will be able to give you a eel or how initiatives which youread about (e.g. Payment by Results) are being implemented in practice.

Questions that you cant easily anticipate

You might ind that you are given particular clinical scenarios and asked tocomment on them. Or, alternatively, you might be asked about your viewson tricky ethical dilemmas.

As mentioned above, dont rush into answering questions o this sort,and take a moment or two to gather your thoughts. As regards theclinical scenarios, the panel will be interested in both the content o your

answer and also whether you demonstrate a systematic, well-thought-outapproach to the problem. I there is one act that you are unsure about,then acknowledge this to the panel, but try your best to provide a logical,well-reasoned answer that demonstrates an ability to distinguish betweenessential and non-essential clinical tasks.

In contrast to the clinical scenario, i you are posed a complex ethicaldilemma, you dont necessarily need to give the panel a hard-and-astanswer as to exactly what you would do. Instead, you can say that that is

a very tricky situation, and one that you would hope that you would neverind yoursel in. In eect, you describe the actors that you would takeinto consideration when approaching the situation, rather than necessarilycoming up with something cut and dried.

(I, though, the panel says that you are sitting on the ence, and they needyou to be more explicit in what you would do, then o course you wouldhave to come down on one side o the ence or the other.)

Structuring your answerIn the section above on application orms, it was suggested that you could usethe STAR approach as initial preparation or your application orm answers.

To recap: the STAR approach suggests that you should do the ollowing:

1. Briefy describe the situation or task.

2. Briefy describe your own actions/activities i.e. what you did.

3. Briefy describe the results (and/or your refections).4. The MMC website.


51/55

51


It can be useul interview preparation i you read through your portolio,and the answers to the Stage 1 and 2 exercises, in order to analyse bothpositive and negative examples, using the STAR structure. However, wewould not suggest that you necessarily stick to the STAR structure in howyou word your answer in interview or that you necessarily give equalweight to the dierent components.

You certainly dont want to give the impression that you are parrottingpre-prepared answers, as this is unlikely to build a rapport with the panel.

Instead, by thinking through clear examples (o both positive and negativeaspects o your work) prior to the interview, you can give more succinct andocused answers.

General advice on interview technique

1. I you are being interviewed by a panel you need to make sure that youbuild a rapport with all the panel members. Although you should ocusyour eye contact on the person who has asked you the question, youmight also want to make eye contact rom time to time with the otherpanel members.

2. I you dont understand a question, then in the rst place you can ask or itto be repeated or claried. I you still dont understand ater the repetition/clarication, it is probably best to indicate this in your answer. For example,

you could say something like: I am not sure i this is what you are lookingor in the answer, but I think that the key points here are x, y and z.I there is any possibility that you havent properly understood thequestion, it is better to allude to this in your answer. Giving a completelyo-the-wall answer, without indicating to the panel that you know youmay be way o-track, is potentially ar more damaging to your chances.

3. It is to be hoped that the panel wont be giving you short, closedquestions (except where they need to check out particular actual details,

such as when you would be able to start in post). But i they do, resistthe temptation to give one-word answers, and expand on the answer alittle, regardless o the question.

4. I you dont know the answer to a actual question, dont ramble on inthe hope o divine inspiration arriving mid-answer. In our experience, ittends not to be orthcoming! Instead, it is best to admit that you dontknow the answer, smile, and explain that you have orgotten it, or thatit is something you havent experienced yet. I you can, oer an answerto a more generic situation related to the question, but that doesntrequire you to remember a particular actual detail. (For example, i youare asked about the management o a particular condition in an elderly


52/55

52


patient, and you have orgotten the details, or never knew them, wewould suggest that you admit to your ignorance, and then say somethingabout general approaches to care o the elderly.)

5. Long rambling answers are best avoided. As soon as you realise you havestarted to ramble, pause, gather your thoughts, provide a brie summary,and then nish o your answer.

6. Look through the suggested interview questions listed above and practisegiving succinct answers. We would suggest that you say these answersout loud, rather than running through the points in your head. I youget into the habit o vocalizing your answer to the mirror, it can be lessanxiety-provoking to hear yoursel speaking in the actual interview. Inaddition, you can also practise not rushing through your answers, butusing a slightly slower, clearer, rate o speech.

7. Think about your body language (not only eye contact, but also how youare sitting, whether you appear suciently, but not overly relaxed, etc.).I appropriate, a lightness o touch can go down well but obviously thisdepends upon the situation. So, or example, i you are presented with ascenario involving a very distressing situation, we would not advise you totreat it in a light-hearted manner. But i you are asked about your weakness,you can (ater rst demonstrating insight through an appropriate discussiono a particular weakness) add a comment like:I also have a weakness or chocolate, or Manchester United, or whatever.

But you have to use your proessional judgement as to whether suchcomments would be appropriate or not (just as you use your judgementwith patients as to whether, at a particular moment, a light-heartedcomment would ease the situation, or cause great oence).

When its your turn to ask questions

At the end o the interview you may be asked i you have any questions.(I your interview is only 1015 minutes, this might not happen.)

I they do ask you or your questions, avoid putting a question or the sakeo it. Interviews are tiring or the panel, as well as or the candidates, andinterviewers dont appreciate being asked pointless questions.

I you really havent got a sensible question, say something like: All thequestions that I had planned to ask have been covered in your explanation othe post. This means that you dont end the interview by responding with acurt No.

However, it is a good idea to have a couple o suitable questions up yoursleeve. Possibilities include the ollowing:

1. What impact do you think the changes to medical career pathways will


53/55

53

have on the training in this deanery?

2. Are there any opportunities, at a later date, or sub-specialty training in x, y,or z? (But make sure that the answer to this question is not covered in anyreadily available inormation about the training programme.)

3. What have the trainees who have just nished training in x specialty in this

hospital gone on to do?

Presentations

Prior to the MMC reorms, interviews or entry into a specialist trainingprogramme, or or consultant posts, typically involved you giving a presentation.At present you would probably not be expected to give a presentation duringan interview or entry on to a oundation programme. However, you may beasked to give a presentation during an interview or a basic specialty trainingprogramme. And starting in 2008, some specialties required the applicant todevise the presentation on the day o the interview i.e. they did not supply thetitle o the presentation in advance. We have included guidelines or preparinga presentation in ROADS (Elton and Reid, 2008).

Selection centres

One o the recommendations o the Tooke Inquiry into MMC was or the

need to develop more robust selection systems.

A number o specialties are now using selection centres as part o therecruitment and selection process. This approach is based on the idea that youend up with more robust selection decisions i you present applicants with tasksthat relect the actual activities that they would have to carry out in the job towhich they are applying. So or example, the selection centre that is used inGeneral Practice includes 3 exercises: an encounter with a simulated patient;a group exercise and a written exercise (www.gprecruitment.org.uk). These

activities are observed and assessed by trained assessors.I the specialty to which you are applying is using a selection centre approach,you will be provided with inormation about the selectioncentre as part o the inormation available or applicants. There is otenlittle speciic preparation that you can do or the selection centres abovemaking yoursel amiliar with the person speciication o the post or whichyou are applying. However, you may ind it helpul to look at a DVD producedby the A

roadstosuccess eworkbook (3rd edition)

Documents