Career Snakes and Ladders

How should we spend our time at medical school? Mark Scoote argues that this valuable time is key to increasing our chances in an ever competitive job market.

Medical students in the United Kingdom are led to believe that progression through the various training grades on the ladder is a straightforward process, dependent only on the learning of clinical skills and the passing of postgraduate exams. Unfortunately, competition for training grade jobs, particularly in the transition from senior house officer (SHO) to specialist registrar (SpR) level, has resulted in a bottleneck, with too many doctors competing for too few jobs. A scheme exists where SpRs are given a national training number (NTN), and this number ensures entitlement to a higher specialist training programme.¹ Competition for these jobs is particularly fierce.

Potential hospital trainees should be aware that their future careers are by no means assured by simply achieving the minimum requirements needed for entry into the SpR grade. Furthermore, with continued expansion of medical schools and relatively static availability of NTNs, today's medical students may find competition extremely intense when they reach this stage of their career. With the government promising expansion of NHS consultant posts, more NTNs may be made available in the future to facilitate this. But even if this is the case it will not occur overnight and is unlikely to confer an easier passage up the career ladder. Future NTN candidates should assume that competition will remain intense and while at medical school begin working towards doing everything possible to maximise their future chances of success.

Because of the large numbers of candidates trying to enter the SpR grade, standards are high and only the most well prepared individuals succeed. Such jobs are advertised as requiring only 24 months of SHO experience and possession of the membership of the Royal College of Physicians (or equivalent) in order to be considered. In reality, the true requirements are much higher. Many of the activities needed to enhance your prospects will realistically be carried out once qualified. These include audit projects and case reports that give an indication of your drive, enthusiasm, and ability as a doctor. Furthermore, some experience at SpR or equivalent level already (in a post that does not attract a NTN) is also desirable as it allows the acquisition of additional skills not available to SHOs. Most controversially of all many potential candidates seeking an NTN in one of the popular specialities carry out a higher research degree between the SHO and SpR grades. Although recommendations may still encourage research after entry into higher training,² there is little doubt that candidates feel extreme pressure to go down this route in order to improve their chances of success, a fact that is acknowledged by the royal colleges.³

Having said all that, if you possess a good CV and perform well at interview it is still possible to be competitive with just your achievements and experiences up to SHO level. To this end, your time at medical school should be put to efficient use to maximise your chances of success. Academic performance is one obvious criterion that can set you apart from the crowd. Distinctions in finals, college prizes, and a successful intercalated BSc, perhaps with an associated publication or abstract, will be extremely helpful. Involvement in extracurricular work such as college committees and student union posts demonstrates an enthusiasm that will gain credit, as would a unique and worthwhile elective experience. Non-medical qualifications and experience, particularly in the area of information technology and management, will also help if you have them and never pass over an opportunity to submit a letter or article to college magazines, the studentBMJ and other journals. Obviously, such achievements at medical school will put you in good stead for all your future job applications, whatever the level.

You may feel that minor achievements at medical school carry little sway when applying for more senior jobs as a qualified doctor. There may be some truth in this, but it is a dangerous assumption to disregard them as irrelevant. Owing to the high levels of competition there is often little to choose between potential candidates, and achievements at medical school that set you apart from the rest may be extremely helpful, perhaps making all the difference. There is also a degree of self perpetuating success with regard to career progression that undoubtedly begins with your achievements at medical school. These may help you obtain a good house officer post, which in turn will help you secure a good SHO rotation, and so on, through to SpR level and beyond.

Medical school is a time to enjoy student life while at the same time studying to begin what can still be an enjoyable and rewarding career. Nevertheless you have chosen to enter an extremely competitive career, in which the path to success can be a long and stressful one. It is only once you reach a bottleneck, such as entry to the SpR grade, that you look back at all the missed opportunities, which, if taken earlier, often with minimal effort, could have dramatically improved your CV and chance of success in the job market. Although the medical curriculum continues to evolve, I still believe that not enough emphasis is given towards coaching students for the harsh realities of seeking a job after qualifying. Instead, newly qualified doctors are thrust on to the job market with little or no specific coaching in areas such as CV writing, interview technique, preparing job applications, and planning a career route. The BMA and royal colleges do organise career fairs at least annually and articles published in BMJ Careers also exist to help guide junior doctors through this minefield, but more information and coaching, beginning at medical school, is needed.^4-6

With increasing emphasis on continuous summative assessment in the medical curriculum⁷ students have enough to contend with without worrying about the added stress of seeking jobs after qualifying. If, however, this article has at least made you think about the issues raised and encourages you to pursue some of the merit gaining activities outlined above, it will ensure that you are better prepared than your competitors when applying for that desperately sought after job in the future.

Mark Scoote, clinical research fellow (formerly specialist registrar in cardiology), Imperial College, London
Email: mark.scoote@ic.ac.uk


studentBMJ 2002;10:353-396 October ISSN 0966-6494

1. Department of Health. A guide to specialist registrar training. London: DoH, 1998.
2. Royal College of Physicians. Training in academic medicine: recommendations from the academic medicine committee of the Royal College of Physicians. London: RCP, March 2000. (www.rcplondon.ac.uk/
   
3. Edwards C, Alberti G, Armitage M, Cowan G, MacDermot J, Muir S, et al. Research training for physicians. Statement by the Royal College of Physicians. College Commentary. Royal College of Physicians of London 2002; Jan/Feb:15
4. Black M. Tips on developing a healthy CV. BMJ 2001;323:S3. www.bmj.com/cgi/content/full/323/7304
   /S3-7304? (accessed 29 Aug).
5. Burnett S. How to perform well at interview. BMJ. 2002;324. S69: www.bmj.com/cgi/content/full/324
   /7336/S69? (accessed 29 Aug 2002).
6. Burnett S. How to get shortlisted. BMJ 2002; 324: S3. www.bmj.com/cgi/content/full/324/7328/S3? (accessed 29 Aug 2002).
7. Fowell S, Bligh J. Recent developments in assessing medical students. Postgrad Med J 1998;74:18-24.

   

           

Responses published this month Articles Responses CAREERS Career snakes and ladders       Mark Wilson (October 2002) Danielle Loveday (January 09, 2005) Read this response CAREERS Career snakes and ladders       Mark Wilson (October 2002) Danielle Loveday (January 09, 2005)       PRHO, Sheffield dlovelyday@hotmail.com Thank you! Just fell upon your article while rather desparately seeking some reassurance that, after a week of nights from hell(avec le registrar from hell!!), there is an alternative to the conveyer belt that is mecical/surgical rotation or VTS! It was exactly what i needed to hear to remind me that if you want it to be, medicine can be your passport to the world and an interesting imaginative life. Thank you again.