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Careers consultant Laura Brammar explores how to understand your own motivations and preferences, to help you make the important decision of what specialty to pursue.

There’s no magic wand

When it comes to making a decision about which medical specialism to pursue, there really is no crystal ball that can instantly tell you which choice is right for you.

Sometimes we treat certain sources of information or advice, such as the opinion of a trusted colleague or the results of a personality questionnaire, as though they are like magic wands, in some way capable of providing us with a definitive answer which will put us out of our decision-making misery!

In reality, it is often far more helpful to remember that these are as useful tools to help you with the personal process of discovering which speciality feels most appropriate to you. Below is an outline of a simple process which can help clarify your choice of specialty, and aid your understanding of the reasons behind that choice.

Specialty choice: an ongoing process, not a one-off decision

Choosing which specialty training route to pursue is a significant decision. Nevertheless, always remember that it will not be the only important choice you need to make about your medical career. There will be future important choices, such as your sub-specialisation, and by understanding the process now, you will be making an investment for similar decisions in the future.

Like making a clinical diagnosis, making a career decision is best approached as a sequence of stages, rather than just by a gut reaction or instinct alone. That is not to say you should discount your hunches or instincts, but rather that you should be able to analyse them in context and from a range of perspectives.

Four stages of your choice

By moving through the following four stages you will be able to reflect on your choice comprehensively, and therefore move more smoothly into the next stage of your medical training:

  1. Self-exploration
  2. Option generation
  3. Decision making
  4. Implementation

Self-exploration: know yourself

For any career decision, there are likely to be a host of influencing factors that can make the choice difficult. These influencing factors can both inform our decisions and sometimes distract us from what we really want from our work, and what we feel most suited to.

Influencing factors can range from aspects of the job itself, such as the level of clinical autonomy or the clinical environment, to more personal factors, such as a need for flexibility or preferred length of training. It can be helpful to spend some time reflecting on what might be the vocational and personal factors which are influencing your decision. This activity is not about criticising or praising any influencing factors, but rather identifying what is important to you.

Here are some sample influencing factors you may want to reflect on:

Vocational factors:

  • Use of specific skills, clinical or non-clinical
  • Variety of patients/clinical work
  • Extent of team working

Personal factors:

  • Personality preferences
  • Significant others (e.g. family, partners)
  • Need for control over working patterns

It can also be very useful to have an honest self-audit of what you see as your skills, interests and preferences. Remember, you may be skilled at many things, but only enjoy a few. Some people can find personality questionnaires such as the Myers-Briggs Type Indicator (MBTI) or psychometric tools such as Sci-59 helpful. How might you answer the following?

  • What am I good at?
  • What am I not so good at?
  • What’s important to me?
  • What bores me?
  • What do I enjoy?
  • What do I avoid?
  • Where do I see myself working well?

Option exploration: how much do you really know?

Once you are armed with a clearer understanding of yourself, you can now apply the same analysis skills to the various options available to you. Medicine is an incredibly varied profession and the likelihood of you finding your niche somewhere is very high.

Often, trainee doctors will admit that they have written off a range of specialities of which they have very little understanding. Obviously, we are all influenced by past experiences. But only you will know if you are dismissing a viable (and potentially rewarding) specialty because of, say, a rather unpleasant consultant during your years at medical school, or (perhaps worse) through ignorance of what that specialty actually has to offer. Equally, it may be that your first choice specialty is essentially the one you know best, and that you haven’t fully researched the potential challenges of other areas.  Either way, you have nothing to lose by finding out more about a range of specialty options:

  • What are your top three specialties at the moment? Why?
  • Which specialities have you already totally dismissed? Why?
  • Could you identify three more specialities that you will explore in further detail?

There is a wealth of information available that can help you learn more about your options, including the additional web resources at the end of this article. You may also want to think about information interviewing, rather than networking, as a way of talking to colleagues about their career choices and experiences. They may be able to answer specific questions you have about the specialty.

Decision making: make your choice

Now you know more about what you want and what is available you will be ready to make your decision. Whether you tend to make decisions quickly or slowly, give yourself time to appraise your choice from different directions. Remember to keep your influencing factors in perspective and assess whether the specialty will meet your expectations and preferences. Sometimes engaging in individual careers counselling, such as with your educational supervisor or a careers adviser, can help you through this process:

  • How have you made similar decisions in the past?
  • Do you rush in? Do you procrastinate?
  • Would a SWOT analysis (strengths, weaknesses, opportunities, threats) be helpful?

Implementation: make it happen

Once you’ve reflected, researched and decided, it is then time to get that training post! To do this you need to maximise your chances.

All the effort you put into making your choice can now be used to demonstrate understanding of, commitment to, and enthusiasm for the specialty which will be assessed through your CV, application form and eventual interview for a training post. Again, some medics find individual CV and interview skills coaching can be helpful in improving their applications.

  • Start collecting evidence of your interest in the specialty e.g. audits, rotations, attachments, research projects, electives etc.
  • Research any Royal College events, conferences, prizes which might be useful
  • Emphasise both competence and enthusiasm in your applications

Magic wand no longer required!

In summary

To choose the best specialty for you, move through the following stages:

  • Be self-aware
  • Explore your options
  • Make a clear and comprehensive decision
  • Utilise any additional support available
  • Apply effectively

Additional web resources

NHS HEE Specialty Training

NHS Health Careers

BMJ Careers

BMA Career Advice

Laura Brammar has worked as a careers consultant for more than 10 years, including work with The Careers Group, University of London and University College, London.