Careers Management for Junior Doctors

1
Careers Management for Junior Doctors 17th May
2007
Dr Helen Goodyear Lead Associate Dean for
careers Mrs Witty Sandle Careers Adviser Warwick
University Dr Elizabeth Cottrell Foundation Year
One Doctor Dr Rebecca Chubb Foundation Year One
Doctor
2
What do you hope to get out of this workshop?
3
Outline

• Need for careers management
• Deanery website new careers section
• Educational supervisors checklists and Careers
  Timelines for the Foundation Schools
• Sci 59 as a careers planning tool
• Careers advice and careers guidance how do they
  differ?
• Scenarios in small groups
• Group feedback

4
Working document Career management an approach
for medical schools, deaneries, royal colleges
and trusts 14-item action plan
5
Careers information sources

• Websites WMD, MMC, PMETB, MTAS
• Competition ratios
• Bi-monthly WMD careers bulletin
• The Medical Students Handbook - given to all 4th
  and 5th year medical students and Foundation year
  one doctors
• Careers Fairs and Forum

6
Careers Questionnaire

• All 841 Foundation doctors in WMD January 2006
• 17 item questionnaire
• Sources and quality of previous careers advice
• Knowledge of MMC
• Specialties interested in
• Views on careers fairs
• Demographic data
• Free text comments
• 60 (508/841) response

7
Sources of careers advice

• No Mean score of quality of advice
• Other sources 3 3.88
• Informal 93 3.74
• Ed supervisor 67 3.65
• Postgrad clin tutor 55 3.48
• National careers body 43 3.29
• Careers fair 27 3.19
• Books/leaflets 45 3.18
• Medical school 51 3.08
• Royal college tutors 22 3.06
• MMC Deans 22 3.03

8
Themes about careers

• Clear information on MMC
• Definite answers as to what will be implemented
  between now and 2007
• I wish someone knew something about MMC
• Trainees wished to have specialty information
• For those of us who have a specific career in
  mind it would be useful to have specific session
  in paediatrics, psychiatry, GP, surgery, medicine
  and to identify a doctor who could act as a
  career mentor

9
Themes about careers

• Foundation doctors were concerned about their
  future
• If we knew where we may be in a years time as
  F2 doctors it could help us to plan ahead, but at
  the moment most of us dont even know if we could
  be employed at other hospital next year as a
  likely option
• Advice on how to deal with the uncertainties of
  MMC
• How it will affect me in my training. What
  changes will come about compared to the present
  system. What jobs will be available and when

10
Conclusions

• Trainees seek careers advice from a variety of
  sources
• Differences by gender in a trainees specialty
  choice
• Medicine MF 31, Surgery and anaesthesia MF 21
  whereas Paediatrics and Obstetrics and
  Gynaecology MF 13
• Career aspirations differ between F1 and F2
• Website resources are not used by some trainees
• Targeted careers advice is needed for trainees to
  complement the wealth of information available
  from a variety of other sources

11
One stop web portal for career advice,
information and resources

• Dr E Cottrell
• Foundation Year 1 Doctor

12
Background

• Wealth of career information available
• Distributed among a huge variety of sources
• Not always adequately signposted
• Medical students and doctors are busy
• Convenient
• Relevant information easily accessible
• Easy to navigate
• West Midlands Workforce Deanery creating a
  one-stop portal for career information, tools and
  resources
• Free of charge nationally

13
Target Users

• Individuals considering a career in medicine
• Medical students
• Foundation years 1 and 2 doctors
• Doctors in higher training programmes
• Doctors changing a career choice
• Doctors considering career diversity and
  enrichment
• Professionals providing career support
• Clinical tutors
• Educational supervisors
• GP trainers
• Deans

14
Development

• Pulling together existing resources from
• Deaneries
• Foundation schools
• Medical schools
• Career advisors
• Books
• Journals
• Websites
• Creating new resources
• Liaising with other online career projects
• USA website for career advice

15
Layout

• Clearly categorised for easy access to relevant
  information
• Content provided includes
• Hyperlinks to useful websites
• Downloadable resources and toolkits
• Details of relevant books and articles
• Opportunity for feedback
• Identify useful and popular tools
• Inform further development of the site
• Publish comments on the site to assist future
  users

16
Look out for informationavailable at end of July
2007
17
Sci59

• What is it?

18
Sci 59

• An online psychometric tool
• Designed by the Open University
• Based on a 130 item questionnaire
• Outcome- Specialties most suited to respondent
  clustered around 12 dimensions

19
How does it work?

• Questions start with I want to work in a
  specialty where followed by a skill,
  attribute, attitude or behaviour.
• Answer with 4 point scale from strongly agree to
  strongly disagree. Can skip.

20
How developed?

• Based on interviews with 60 consultants to elicit
  characteristics of jobs and attributes of
  successful and unsuccessful trainees.
• Further 350 consultants were then asked to rate
  the resulting 80 attributes for importance to
  their specialty add anything new.
• Further factor analysis, discriminant function
  analysis so on.
• Questions tested on 500 SHOs.

21
The 12 Dimensions

• Action Orientation
• Academic Orientation
• Minor Specialty
• Detail is Crucial
• Working in Teams
• Working with Children

• Educating Patients
• Coping with Uncertainty
• Independent Specialty
• Need for Assertiveness
• Routine Working  
• Out-of-hours Working

22
Results

• Top/Bottom Ten
• Full Listing- rank ordered
• Comparative Results - listing of matches with
  indications of the dimensions showing closest fit
• Graph - representation of personal profile score
  in each of the 12 dimensions

23
Warwick Medical School Survey Results

• Survey undertaken in March 07
• Response rate of 30.6 (n48/157)

24
Final year students results
Questions Yes No Dont know
Did you complete the Sci59? 54.2 45.8 0
Did the Sci59 results confirm your own views of the career path in which you are interested? 19.2 76.9 3.8
Did the results give you new ideas to consider? 26.9 69.2 3.8
Did the results make you think again about your chosen career path? 19.2 76.9 3.8
Did you take any direct action after completing the Sci59? (e.g. research top 10 suggestions, book appointment with Witty Sandle) 8 92 0
Do you think the time it took to complete all the questions was too long? 46.5 18.6 34.9
Did you save the results from the questionnaire somewhere other than on the Sci59 site? 15.4 80.8 3.8
Would you recommend this questionnaire to other students? 34.1 31.8 34.1

25
Results from 1st year who had attended a career
planning workshop
No Questions Results of Sci59 Yes No Dont know
1 Did you complete the Sci59? If No please go to question number 7 X
2 Did the Sci59 results confirm your own views of the career path in which you are interested? X
3 Did the results give you new ideas to consider? X
4 Did the results make you think again about your chosen career path? X
5 Did you save the results from the questionnaire somewhere other than on the Sci59 site? X
6 Did you take any direct action after completing the Sci59? (e.g. research top 10 suggestions, book appointment with Witty Sandle) X
26
If you did not complete Sci59 please tell us why.

• 
  
  
• Largely irrelevant to choosing career at this
  point in my studies
  
  
  
• Already have a career plan
  
  
  
• Because I know what I want to do
  
  
  
• Said I should be respiratory physician can't
  imagine anything worse
  
  
  
  
  
  
  
• Started questionnaire gave up as all the answers
  seemed to the same and it was taking ages
  
  
• Experience of other similar questionnaires that
  were not really useful - I already have ideas of
  what I enjoy what careers I would like to
  pursue questionnaire would not change this
  
  
  
  
• Don't think I needed it
  
  
  
  
• Lack of time
  
  
  
  
  
  
  
  
• These things are always pointless you need to go
  to work first before you'll know what you like
  
  
  
  
  
  
  
  
  
  

27
Usefulness?

• Needs to be completed with an open mind
• Helpful to understand how it works!
• Encourages self reflection
• Good as a starting point for research
• Useful to confirm or trigger new ideas
• Aid to discussion
• Most effective when mediated in some way
• (personal opinion!)

28
Sci59 user questionnaire
Dr E Cottrell Foundation Year 1 Doctor
29
Sci59 user questionnaire

• Online questionnaire
• Keele, Birmingham and Warwick final year medical
  students and Foundation year 1 students sent the
  link
• 10 responses
• ?not done Sci59
• ?no time to complete questionnaire
• ?email deleted as junk
• 9/10 responses from FY1 doctors
• 2/10 had used Sci59 once before
• 1 got similar answers
• 1 got different answers

30
Sci59 user questionnaire

• Has Sci59 made any users pursue careers they had
  not previously considered?
• NO!
• 2/8 had specialties they were considering in
  their bottom 10 but were not put off by this
• 1/8 had specialties in their bottom 10 that
  they had been advised to undertake
• 5/8 already knew the specialties in their bottom
  10 were not for them

31
Sci59 user questionnaire

• Was Sci59 useful?
• 2/9 yes
• 6/9 no
• 1/9 dont know
• Free text comments - positive
• reinforced what already wanted to do
• good mix of questions and if anything they get
  you to think more about a future career
• I thought no way to psychiatric specialties
  before, but now I will apply to psychiatry if I
  do not get onto a GP training programme
• Useful for anyone with absolutely no idea
• Useful in considering other aspects of the job
  e.g. out of hours workload

32
Sci59 user questionnaire

• Free text comments negative
• I have no interest whatsoeverspecialties
  suggested in the top 10
• I am clearly not suited to the career
  specialtiessuggested
• Questions too generic
• Totally useless
• I would much prefer having an interview with a
  career advisor
• I would strongly advise on providing alternative
  careers advice
• Large number of questions large amount of
  time
• Typical pointless untested psychological
  nonsenseat best tells us what we already know

33
Sci59 user questionnaire

• Difficult to draw conclusions
• Poor response - ?low interest ?lack of time
• ?Negatives be reduced with appropriate support of
  users following Sci59
• Discussion of results
• Support in considering different career paths
• Suggestions
• Further evaluation needed
• Supported use of Sci59
• Sparing use of Sci59 for those who need it

34
Sci59 questionnaire to educational supervisors

• Aim of questionnaire was to assess the views and
  knowledge of Sci59 online carers planning tool of
  educational supervisors of foundation trainees
• 11 item questionnaire
• Likert questions rated from 1 strongly disagree
  to 6 strongly agree
• First 50 responses analysed

35
Sci59 questionnaire to educational supervisors

• 2 (4) had been online and used Sci 59
• 8 (16) had discussed Sci59 with their F1 or F2
  trainee
• Sci59 cannot replace a 11 career discussion
  (5.47)
• I would trust Sci59 to decide my career (1.15)
• Gender difference
• Sci59 is a waste of resources MF 4.72.5
• Sci59 is reliable MF 1.73.5

36
Sci59 questionnaire to educational supervisors

• Free text comments
• Lack of knowledge of Sci59
• Never heard of it Im afraid

37
Sci59 questionnaire to educational supervisors

• Need to train educational supervisors in the use
  of Sci59
• Trainee needs to be able to discuss results with
  educational supervisor
• Without educational supervisor training, little
  impact is likely to be seen from use of Sci59

38
Educational supervisors checklist for F1 and F2
trainees

• Gives reminder of key items to be discussed at 0,
  2 and 4 months

39
Career timelines

• Follows a 4 stage process to career management as
  described by Caroline Elton of KSS Deanery has
  been adopted into Foundation programmes
• Self assessment
• Career exploration
• Decision making
• Implementation
• Have been modified slightly for each Foundation
  school

40
CAREER SUPPORT FROM THE FOUNDATION TRAINEE
PERSPECTIVE

• Dr Elizabeth Cottrell and Dr Rebecca Chubb
• Foundation Year 1 Doctors
• University Hospital of North Staffordshire NHS
  Trust

41
Importance of Career Guidance at This Stage

• MMC resulted in shorter, trainee led postgraduate
  training programmes
• Career decisions need to be made earlier
• Little flexibility for change once embarked on
  higher training programme

42
What Career Guidance are Foundation Trainees
Getting

• Problems with giving foundation trainees career
  guidance
• Variable needs
• Variable resources
• Educational supervisors should support trainees
  through their professional development and key
  career decisions
• Appraisals
• Portfolio development
• Accessing experience to inform choices

43
Career Guidance from Educational Supervisors from
the Trainees Perspective

• Audit University Hospital of North
  Staffordshire
• Questionnaire to FY1 and FY2 trainees
• Career support
• Good medical practice
• Appraisals
• Asked about educational supervisor from first
  post
• Undertaken from week beginning 15th January 2007
• 6wk after end of first post
• Advent of higher training and FY2 applications
• Response rate 45 (46/103)
• 57 FY1 (26/46)
• 35 FY2 (20/57)

44
Outcome of Audit

• Have you talked through your options for
  FY2/higher training with your educational
  supervisor?

45
Outcome of Audit

• Have you talked through your long term options
  for your career with your educational supervisor?

46
Outcome of Audit

• Did your educational supervisor support the
  development of your portfolio?

47
Outcome of Audit

• FY2 doctors only Did your educational
  supervisor give you advice on taster experiences?

48
Conclusions

• 1/3 trainees reported receiving helpful career
  advice for immediate and long-term career choices
• Positive responses FY2gtFY1
• FY2 feel greater urgency of decisions at this
  stage
• Increased familiarity of educational supervisor
  roles
• Need for engaging FY1 and earlier in career
  advice, reflection and consideration
• Missed opportunities and potential for
  ill-informed career decisions

49
Suggestions

• Qualities of good career support
• Concise
• Specific to need, experience and grade
• Easily accessible
• Importance must be made obvious
• Not just advice but resources and information to
  facilitate finding of own answers
• Options one size does not fit all
• From well informed source

50
Suggestions

• Conduits through which career advice for
  Foundation Trainees could be improved
• Educational supervisor checklist
• Varied and easily accessible career information
  and training for educational supervisors e.g.
  online modules
• Encourage consideration and development of career
  decision skills as early as possible e.g. early
  in medical school
• Further areas to explore
• Educational supervisors views on their career
  support role
• Repeat the audit once changes are less frequent

51
Understanding Careers Advice and Guidance

• What is Advice and Guidance? Are they the same or
  different? In what ways are they the same or
  different? Where does counselling fit in?

52
Some definitions
Definition of Advice- providing an immediate
response to the needs of clients who present an
enquiry or reveal a need that requires a
straightforward information response. ..usually
limited to helping with the interpretation of
information and with meeting needs already
clearly understood by the client..
Definition of Guidance- an in-depth interview or
other activity conducted by a trained adviser
which helps clients to explore a range of
options, to relate information to their own needs
and circumstances and to make decisions about
their career..
53
More definitions
ADVICE- a brief consultation to provide someone
with appropriate and accurate information and
give suggestions about how to act upon that
information

• GUIDANCE- extended consultation or series of
  consultations to assist someone to explore
  concerns, provide appropriate and accurate
  information, give suggestions and support about
  how to act upon that information

54
Think differential diagnosis!

• A systematic method of diagnosing a disorder
  (e.g., headache) that lacks unique symptoms or
  signs

• A systematic process of assessing and evaluating
  a career related issue that lacks unique symptoms
  or signs.

55
Guidance? (The Open University)

• Process of clarifying options using the seven
  activities of guidance

• Informing, advising, assessing, enabling,
  advocating, feeding back, the use of counselling
  skills (UDACE)

• Informed by five principles

User-centredness, confidentiality, impartiality,
equality of opportunity, accessibility
56
Information-Advice-Guidance

• A Continuum?
• INFORMATION..ADVICE..GUIDANCE.COUNSELLING
• Or overlapping activities?

Use of counselling skills
Information
Advice
Guidance
Counselling
Information Advice
Advice Guidance
Guidance Counselling
57
Doctors as Careers Advisers

• Directive vs non directive
• Questioning and enabling reflection
• Signposting and referring

58
Example of questioning non-directive style

• F1 Im thinking of psychiatry but wondered if
  you thought I would be suitable?
• Doctor Based on what Ive seen and know about
  you, I think you would make a great
  psychiatrist
• Doctor as Careers Adviser
• Tell me what appeals to you about
  psychiatry?
• What do you know about psychiatry?
• Why do you think you would suit psychiatry?

59
Why might you refer?

• The Careers Adviser can help foundation doctors-
• Reflect on their strengths, skills, abilities and
  values
• Explore their options and alternatives
• Signpost to relevant sources of information and
  help make sense of that information as it applies
  to them
• Reflect on their work and/or study experiences to
  identify what they have learnt
• Enable them to recognise and apply transferable
  skills
• Teach them career management skills eg decision
  making strategies
• Advise on content and layout of CVs, applications
  forms, covering letters, personal statements and
  interviews
• Help form a plan of action including contingencies

Asking Questions
60
Scenarios
61

• Foundation doctor who has not performed
  particularly well in a rotation is starting to
  express concerns about his/her suitability for a
  medical career.
• How tackle?
• Referral to.?

62

• F1 wants to know more about the new MTAS process
  for applying for run through training?
• How tackle?
• A straightforward request for information?
• Referral to ?

63

• F2 cannot decide between specialty A or B as a
  future career.
• How tackle?
• What might be the issue here?
• Referral to?

64

• F2 wants some help with their application form
  for specialty training and asks you to take a
  look and check their answers
• How tackle?
• Referral to .?

65
Careers advice pathway

• Careers information sources
• Websites
• Fairs/forums
• Handbooks
• WMD careers bulletin

Trainee
Educational supervisor
Specialty tutors/Careers leads for postgraduate
schools
Postgraduate Clinical tutor
Taster sessions
Foundation Dean

• Specialist career planning tools
• Sci59
• Scheins career anchors and force field analysis

Deanery Careers manager/ Careers advisor (Warwick)
Deanery careers team
66
Summary

• Need to have clarity between careers advice and
  guidance
• Essential role of educational supervisors
• Career planning tools eg Sci59 cannot be used in
  isolation
• Website new resource for careers information