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:
- Self-exploration
- Option generation
- Decision making
- 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 the BMA’s Specialty Explorer, to be 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?
Example tool: MBTI
One approach to help us understand the idea of personality preferences, and the way we differ from other people, is the Jungian-based instrument, the Myers-Briggs Type Indicator.
Many doctors will already be familiar with this tool, which can be used to identify four prime ways in which people are different (Houghton, 2004, BMJ Careers). These ways are
- how we focus our attention
- the way we like to absorb information
- the sort of information we prioritise in decision making
- our preferred style of working and living our lives.
Remember though, MBTI is only one instrument and it’s important to remember that one of MBTI’s key principles is that all types are valuable.
Only an individual can decide on her/his type, regardless of their responses to the questionnaire used to ascertain that type. Moreover, one’s type is linked to preferred styles rather than abilities; indeed, all of us can learn to use non-preferred behaviours.
So what does this have to do with specialty choice?
Well, the argument is that if you improve your understanding of your personality preferences, you are more likely to appreciate why you make the choices that you do. Furthermore, you will be more satisfied and fulfilled in the work that you do, or the specialty that you choose.
Much has been written about how personality differences between doctors can have implications for their specialty choice (Gilligan et al, 1999, Clack et al, 2004) and how certain personality preferences are perhaps cultivated and rewarded within a changing NHS system (Houghton, 2005).
Equally, some recent research has issued a note of caution about using personality to explain rather than just inform specialty choice (Leong et al 2005, Borges & Savickas 2002), based on evidence of a wide range of personality types within specialities, not just between specialities.
Here though is a brief summary of how the four dimensions of personality highlighted by the MBTI tool can provide an insight into the types of activities and, to a lesser extent, specialties which you may prefer:
Different ways we focus our attention
- Extroverted E (on the outside world)
- Introverted I (on the world inside our heads)
Activities within medicine which require extroversion and introversion
| E | I |
| Seeing lots of patients | Thinking through clinical problems |
| Teaching, presenting | Focusing on individual patients |
| Team working | Examining data, writing reports |
Different ways we prefer to absorb information
- Sensing S (take in information in a factual, step by step fashion)
- Intuition N (take in information by creating meanings and patterns out of that information)
Activities within medicine which require Sensing and Intuition
| S | N |
| Taking structured histories | Generating ideas for research |
| Collecting data for research | Drawing meaning out of histories |
| Following clear care pathways | Developing new ideas to approach issues |
Different kinds of information we prioritise in our decision making
- Thinking T (use logical analysis to weigh up the pros and cons)
- Feeling F (refer to their own values and the consequences of decisions on other people involved)
Activities within medicine which require Thinking and Feeling
| T | F |
| Explaining cause and effect | Talking to patients and relatives |
| Treating according to evidence | Explaining personal consequences |
| Technical work and analysis |
Different way we prefer to work and live our lives
- Judging J (likes to be scheduled and organised)
- Perceiving P (likes to be flexible, energised by last minute pressures)
Activities within medicine which require Judging and Perceiving types
| J | P |
| Organising schedules | Being flexible |
| Making clear decisions | Emergencies |
| Clinics | Gathering information needed for decision making |
No doubt you can see there is a bias towards certain preferences within medicine, particularly the Thinking and Judging preferences across all specialities, with some studies suggesting that a significant majority (85%) of doctors describe themselves as Thinking types (see Gilligan, 1999).
Personality informs rather than explains choice
Clearly, it would be unwise to suggest that only certain specialties require or appeal to certain personality types. Like any other profession, medicine needs all types of personalities, although some specialties may tend to attract some types more than others.
As Houghton (2003) notes, one of the main differences between different specialties can be the tangibility of results and timescales involved. For this reason, those who are of the Sensing preference may find Emergency Medicine and Surgery appealing because of its pace and tangible results. Alternatively, those who are more of the Intuitive preference may find the longer-term and more abstract results of public health or psychiatry more satisfying.
Specialties which require high levels of contact with patients and relatives, ranging from paediatrics to general practice, may be more attractive to those of an Extroverted preference, whilst Introverts may find the lab-based work within Pathology more appealing.
Essentially though, these personality factors are there to help you understand your natural inclinations towards certain specialities and help you interpret what job satisfaction means for you in your work. They are not there to provide a crude formula along the lines of “all anaesthetists are INSPs!”
That said, as we know, most medics describe themselves as having a Thinking preference, so below we will cover an additional tool to help you analyse your speciality choice, and one that should appeal to those Thinkers amongst you!
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.
Example tool: SWOT analysis
Whether your specialty choice is now crystal clear or still rather foggy, applying a structured analysis to your decision could be a useful way of ensuring you have assessed your choice in a thorough and systematic manner.
SWOT analyses (Strengths, Weaknesses, Opportunities, Threats) are used in various industries as a way to compare and contrast options in an objective way. This type of analysis enables you to assess the current appeal of the specialty, but also acknowledge future factors which might influence your choice.
Clearly, how you would complete your individual SWOT analyis would depend on what you regard as your individual strengths and weaknesses and what you regard as positive and negative aspects of that speciality.
Here though are two example outlines of a SWOT analysis for two very different medical specialties:
General practice
Strengths
- Autonomy
- Lots of patient contact
Weaknesses
- Time pressures within consultations
- Responsibilites of partnership, beyond clinical work
Opportunities
- Possibility of part-time work, flexible hours
- Opportunity to develop specialist skills
Threats
- Future unknown for some practices; Darzi review of the NHS, polyclinics
Orthopaedic surgery
Strengths
- Tangible results
- Development of technical skills
Weaknesses
- Significant on-call responsibilities, even at Consultant grade
Opportunities
- Opportunity to hone your specialist surgical skills
Threats
- Highly competitive training route
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
References
Borges, N.J. Savickas, M.L. (2002) Personality and Medical Specialty Choice: A literature Review and Integration, Journal of Career Assessment, 10,3,362-380
Clack GB, Allen J, Cooper, D, Head, JO. Personality differences between doctors and their patients: implications for the teaching of communication skills. Med Educ 2004: 38 (2): 177-186
Gilligan H, Watts C, Welsh F, Treasure T. Square pegs in round holes: has psychometric testing a place in choosing a surgical career. Ann R Coll Surg Engl 1999: 81:73-79
Houghton, A, Understanding your personality type, BMJ Careers, 2004
Houghton, A, The importance of having all types in the work force, BMJ Careers, 2005
Leong, F, Hardin, E., Gaylor, M (2005) Career Specialty Choice: A combined research-intervention project, Journal of Vocational Behavior, 67, 1, 69-86
Article compiled by Laura Brammar and RMBF staff. 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.