Foundation rotations in medical training: is it love at first sight?

Purpose of studyFactors influencing physician specialty choice is a prominent topic given the recruitment challenges faced by various specialties. We aimed to assess whether specialty exposure in the first foundation year was a positive predictive factor for permanent career choice.Study designA questionnaire-based study was distributed online using a survey tool. Questions recorded the foundation rotations of participants as well as their chosen medical specialty.Results1181 responses were included in the analysis. 23% of respondents had undertaken a Foundation Year 1 (F1) rotation in their career specialty. Having undertaken a foundation rotation in anaesthetics, cardiology, emergency medicine, endocrinology, gastroenterology, genito-urinary medicine, intensive care, obstetrics and gynaecology, oncology, paediatrics, palliative care, psychiatry, radiology, respiratory and rheumatology was found to be statistically significantly linked to choosing that specialty as a career (p<0.01). There was a significant correlation between the second foundation rotation and career choice (p=0.02).ConclusionsFor many specialties, direct experience within foundation training has a positive effect on later career choice.

Effect of Anticipated Lifestyle and Income on Medical Students' Decision to Pursue a Primary Care Career in Saudi Arabia

Background: This study examines factors that influence Saudi Arabian medical school students in their selection of primary care as their career specialty. We focused on the two main factors identified to influence medical students generally in consideration of career specialty: lifestyle and income. We surveyed all fourth- and fifth-year students at 10 medical schools in the Riyad region using a questionnaire regarding factors influencing their intended specialty choice; 1005 (64%) completed the questionnaire. Results: The clear majority (77% of students) considered lifestyle characteristics to be a significant influence in their career decision to enter a specialty versus primary care (P<0.05). There was also significant relationship (p < 0.005) between students’ specialty choices and importance attached to anticipated income. Conclusion: Lifestyle and income consideration are important influences on specialty selection among 4th and 5th year Saudi Arabian medical students. These results are in consistent with findings of previous studies conducted in many nations around the world.

Junior doctors’ aspirations for careers in ophthalmology: 40 years of surveys of UK medical graduates

Objective Using data from 40 years of national surveys of UK medical graduates, we report on ophthalmology as a career choice. Design, setting, and participants Self-administered questionnaire surveys of all graduates from all UK medical schools in selected years of qualification between 1974 and 2015. Main outcome measures Career specialty preferences of doctors one, three, and five years after graduation; career specialty destinations 10 years after graduation. Results One year after graduation, ophthalmology was the first career preference of 1.6% of the qualifiers of 1974–83, 2.2% of 1993–2002, and 1.8% of 2005–15. The corresponding percentages three years after graduation were 1.5, 1.8, and 1.2%. Men were more likely than women to choose ophthalmology: among graduates of 2005–15, 2.4% of men and 1.4% of women did so at one year, as did 1.7% of men and 0.7% of women at five years. Seventy per cent of doctors practising as ophthalmologists 10 years after qualification had told us in their first post-qualification year that ophthalmology was their first choice of career. Conclusions There has been no systematic change in recent years in the proportion of recent medical graduates intending to have a career in ophthalmology when surveyed one year after graduation. However, the proportion at three and five years after graduation was lower than that at year 1. Suggestions for maintaining interest in the specialty include improved career advice, greater early clinical exposure to ophthalmology, and improved access to flexible training. Most practising ophthalmologists had made early decisions that this was their intended career.

Career choices for obstetrics and gynaecology: recent updates from 40 years of national surveys of UK medical graduates

Summary Objective To report doctors' early career choices for obstetrics and gynaecology, their eventual career destinations and factors influencing their career pathways. Design Multi-cohort multi-purpose national questionnaire surveys of medical graduates in selected graduation years between 1974 and 2015. Setting UK. Participants UK-trained medical graduates. Main outcome measures Career specialty choices; certainty about specialty choice; factors which influenced doctors' career choices; career specialty destinations 10 years after graduation. Results Obstetrics and Gynaecology was the first choice of career for 5.7% of post-2002 graduates in year 1, 4.3% in year 3 and 3.8% in year 5. A much higher percentage of women than men specified Obstetrics and Gynaecology as their first choice: in year 1, 7.7% of women and 2.3% of men did so. The gender gap has widened since the 1970s and 1980s. In recent years, of those who specified Obstetrics and Gynaecology as their first choice in year 1 after graduation, 48% were working in Obstetrics and Gynaecology in year 10 (63% of men, 45% of women). Looking backwards from career destinations, 85% of doctors working in Obstetrics and Gynaecology in year 10 had specified Obstetrics and Gynaecology as a first, second or third choice of preferred career in year 1. Conclusions Interest in Obstetrics and Gynaecology among UK graduates appears to be exceeding the demand for new specialists. Policy needs to address risks of over-production of trainees and ensure that some graduates interested in Obstetrics and Gynaecology consider alternative careers. The large gender imbalance should encourage consideration of the reasons for men choosing Obstetrics and Gynaecology in falling numbers.

Views of UK doctors in training on the timing of choosing a clinical specialty: quantitative and qualitative analysis of surveys 3 years after graduation

BackgroundWorkforce studies show a declining proportion of UK junior doctors proceeding directly to specialist training, with many taking career breaks. Doctors may be choosing to delay this important career decision.AimTo assess doctors’ views on the timing of choosing a clinical specialty.MethodsSurveys of two cohorts of UK-trained doctors 3 years after qualification, in 2011 and 2015.ResultsPresented with the statement ‘I had to choose my career specialty too soon after qualification’, 61% agreed (27% strongly) and 22% disagreed (3% strongly disagreed). Doctors least certain about their choice of specialty were most likely to agree (81%), compared with those who were more confident (72%) or were definite regarding their choice of long-term specialty (54%). Doctors not in higher specialist training were more likely to agree with this statement than those who were (72% vs 59%). Graduate medical school entrants (ie, those who had completed prior degrees) were less likely to agree than non-graduates (56% vs 62%). Qualitative analysis of free text comments identified three themes as reasons why doctors felt rushed into choosing their future career: insufficient exposure to a wide range of specialties; a desire for a greater breadth of experience of medicine in general; and inadequate career advice.ConclusionsMost UK-trained doctors feel rushed into choosing their long-term career specialty. Doctors find this difficult because they lack sufficient medical experience and adequate career advice to make sound choices. Workforce trainers and planners should enable greater flexibility in training pathways and should further improve existing career guidance.

Being a doctor

This chapter explores what is involved in being a doctor. It includes details of the Foundation Programme and how to apply, the curriculum and assessment, healthcare in the UK, starting life as an F1, what to do before you start, your first day, occupational health, what to carry, organization and efficiency, patient-centred care, communication and conduct, breaking bad news, cross-cultural communication, outside agencies, quality and ethics, clinical governance/quality, medical ethics, patient confidentiality, capacity, consent, what to do when things go wrong, medical errors, complaints, incident reporting, colleagues and problems, hating your job, relaxation, causes of stress, pay and contracts, making more money, debt, NHS entitlements, career, specialty training applications, options, and competition, career structure, choosing a job, specialties in medicine, your curriculum vitae, post-Foundation Programme CV, interviews, membership exams, continuing your education, audit, presentations and teaching, teaching medical students, and research and academia.

Career choices for nephrology and factors influencing them: surveys of UK medical graduates

Objectives To study early and eventual career choices for nephrology among UK medical graduates and investigate factors which influenced career preferences. Design Self-completed survey questionnaires mailed to medical graduates 1, 3, 5 and 10 years after graduation. Setting United Kingdom. Participants UK medical graduates in 15 year-of-qualification cohorts between 1974 and 2015. Main outcome measures Early career specialty choices, career specialty destinations at 10 years and ratings of factors affecting career choices. Results Around 0.4%–1.1% of these junior doctors expressed a career preference for nephrology, varying by year of qualification and years after qualification. Among all graduates of 1993–2002 combined, 0.4% expressed a career preference for nephrology 1 year after qualification rising to 1.0% in year 5. Among graduates of 2005–2008, the corresponding figures were 1.0% in year 1 falling to 0.7% in year 5. Only 18% of doctors who chose nephrology in year 1 eventually became nephrologists. Of doctors who were practising as nephrologists for 10 years and more after qualification, 74% of the women and 56% of the men had decided to pursue a career in nephrology by year 5 after qualification. ‘Enthusiasm/commitment’ had a great deal of influence on those who chose nephrology, for all cohorts and all years studied. Conclusions The most recent data suggest that the proportion of young doctors who sustain an interest in nephrology through the early postgraduate training years may be lower than among their predecessors. Efforts are needed to reverse the declining trend and increase interest in nephrology.