Developing Careers Support for Undergraduate Medical Students A Case Study from University of Liverpool Christine Waddelove Senior Careers Adviser School of Medical Education

A Day in the Life?

Why the need to develop careers support? Changes in postgraduate medicine training e.g. Modernising Medical Careers agenda (2005) Research shows dissatisfaction of junior doctors with lack of careers advice* Increased Diversity and flexibility of students entering medicine e.g. ‘feminisation’ Changes in society – growth in number of speciality areas Retention International doctors – restrictions? *Jackson C, Ball JE, Hirsh W, Kidd JM. Informing choices: the need for career advice in medical training  . London: BMA Health Policy and Economic Research Unit, 2003.

Application Process pre- and post- MMC Before PRHO - SHO (lost tribe) Specialist Registrar Applications all year round Multiple applications required Potential for perceived favouritism/nepotism Now F1 and F2 Specialty Trainee National timeline UK-wide online application system National scoring guidance Fair and open competitive process

Specialty Training post MMC www.mmc.nhs.uk

Helped by government reports.... 2005 Career Management: an approach for medical schools, deaneries, royal colleges and trusts, put together by the (MMC) working group for career management states: ‘ an effective career management system must span the totality of undergraduate and postgraduate medical training, including recruitment of students into medical school.’ 2007 Recommendation 17 in the Tooke report emphasised the need for medical schools to play a greater role in providing careers information and advice: ‘Career aspirations and choices should be informed by accurate data. Medical schools should play a greater role in careers advice.’ 2008 This recommendation has subsequently been fully accepted by the Secretary of State for Health: ‘I am pleased that Sir John has acknowledged the role that medical schools have to play in providing careers advice. I look forward to hearing more about their plans in this area shortly.’ 2009 Tomorrow’s Doctors ‘Schools must have a carers guidance strategy. Generic resources should include an outline of career paths in medicine and the postgraduate specialties, as well as guidance on application forms and process. Specific guidance should be provided for personalised career planning.’  

So why specifically careers support at undergraduate level? Doctors will have to choose which speciality to enter 16 months after graduation during early part Foundation year 2 Decisions made in medical school can help or hinder choices Useful to develop career management skills early because doctors will need these skills during their career

Some of their choices Extra curricular activities Positions of responsibility Work experience / voluntary work Student societies Elective Special Study Modules (SSCs in some institutions) Intercalate Publish Articles Undertake audits Teaching Prizes/Awards

In the next 3 minutes in groups of 2/3 write down as many medical specialties as you can

Medical Specialties Anaesthesia Chemical Pathology Clinical Radiology General Practice Histopathology Medical Microbiology Medical Virology Medicine (sub specialties) Acute medicine Allergy Audiological medicine Cardiology Clinical genetics Clinical neurophysiology Clinical oncology Clinical pharmacology & therapeutics Dermatology Endocrinology & diabetes Gastroenterology General internal medicine/acute medicine Genito-urinary medicine Geriatric medicine Haematology Immunology Infectious diseases Metabolic medicine Medical oncology Medical ophthalmology Neurology Nuclear medicine Occupational medicine Paediatric cardiology Palliative medicine Pharmaceutical medicine Rehabilitation medicine Renal medicine Respiratory medicine Rheumatology Sports & exercise medicine Stroke Medicine Tropical medicine Emergency Medicine Neurosurgery Obstetrics and gynaecology Ophthalmology Paediatrics Psychiatry – general Public Health Surgery (sub specialties) Cardiothoracic surgery General surgery Oral and maxillo f acial surgery Orthopaedic Otolaryngology (ENT) Paediatric surgery Plastic surgery Trauma and orthopaedic surgery Urology

Some Issues

UK Medical School Intake www.foundation.nhs.uk

2009 ST1 Level Posts & Applications of (source) www 2009 ST1 Level Posts & Applications of (source) www.foundationprogramme.nhs.uk

Issues Need to work on expectations of prospective medical graduates and medical graduates In 2009 40% of the available specialty posts were in GP and yet only 13% of foundation doctors applied for GP. Core surgery represented 8% of the available posts with 20% of foundation doctors applying for them (see figure 2). By 2012 60% of specialty posts will be in GP Geography – some areas short doctors others massively oversubscribed

Development Strategies Involved ‘taster days’ with 6th formers Developed relevant careers information –leaflets and website Career readiness tools e.g. Sci59 Used technology – VLE /email guidance/ voice-over presentations Developed career management skills workshops within curriculum - Customising ‘Destinations Fairs- “balloon” debate, Year3 and Year5 trust fairs Training the trainers - consultants Work conjunction with post graduate deanery Research

Example of recent SSM titles – 3rd year ‘’Undergraduate and postgraduate experiences as factors affecting speciality choice’’. “A critical evaluation of the careers management advice suggested for junior doctors since the implementation of the modernising medical careers agenda”. “General Practice as a career over the last two decades”. “What factors determine junior doctors and medical students decision to pursue a career in primary care specialties and how has this changed over the recent decade?”

History and examination Stage approach to Career Planning– Elton, C. and Reid, J. (2007) The roads to success. A practical approach to career planning for medical students, foundation trainees (and their supervisors), London: Postgraduate Deanery for Kent, Surrey, and Sussex) History and examination Self Awareness or Assessment Investigations exploration Career Diagnosis making Decision Implementation Treatment Plan 17

What have medical students said: “Awareness that MBChB degree is only the start of the process of being a doctor, it will be followed by at least 5 and maybe up to 12 years of study - I am sure I was told this but I certainly didn’t think about it!” “The sheer number of specialties available and that I wasn’t just training as a ‘general doctor’.” “It’s a long slog – consider having a gap year before you come to university as once you are on the ‘training route’ it can be hard to decide when you should take time off and you need it!” “Unlike other undergraduates who may leave the university after 3 years you will be in the same place for 5 years and then most students will undertake their foundation 2 years in that region – so think carefully about where you want to be.”

Contd.. “Make the most of your first few years at med school and take the opportunity to mix with students from different departments, it gets much harder after 3 rd year because of time and a lot of the other students have gone, it’s all to easy just to mix with medics.” “You are not going to cure everyone – very few specialties cure – maybe orthopaedics – be realistic otherwise you will become disillusioned.” “Beware of the shock when you go on the wards for the first time – at times you are bound to question whether this is the career for you.”

Key Learning Points Medical students are typically “Generation Y” Delivery of career management and employability must optimise interest and need Students are most motivated when content and topic align with real-life career needs Only interested when right thing at right time

Useful Resources Resource to help you plan your career in medicine http://www.medicalcareers.nhs.uk/Pages/default.aspx Lots of information on specialties, competitiveness etc http://www.mmc.nhs.uk/ Lots of Information on the Foundation programme http://www.foundationprogramme.nhs.uk/pages/home Information on medical specialties etc. http://www.nhscareers.nhs.uk/medical_training.shtml Useful Book- The Medical Student Career Handbook edited by Elizabeth Cottrell