Month: March 2016

How to get a job as a basic physician trainee.

A commenter requested this and I thought I’d write it up because a) it’s helpful to people who want jobs and b) it’s a bit of insight for the non-medical into what you have to do in medicine to become a medical specialist.

First you have to decide what you want.  I went into the program with no idea what I wanted and came out of it completely set on what I wanted.  It’s okay if you don’t know.  I was of the opinion that a year as a medical registrar was good for the resume for pretty much everything else and I stand by that opinion.  Many will disagree and that’s okay.  I’m someone who has always operated on gut feeling and something drew me towards it.  But if you’re defaulting into it for whatever reason, I urge to try a bit harder and do what you really want.  Every year there’s at least one person who pulls out completely traumatised.  Don’t be that person.

Step 2.  Your resume.  You put your name and address, your education details (your degree/s) including extra-curricular stuff and honours, followed by a list of the rotations you’ve done to-date.  That’s page 1.  On page 2 you need the following headings in the following order:

  1. Teaching experience
  2. Quality assurance
  3. Committees and representation
  4. Awards
  5. Professional development
  6. Publications
  7. Referees

This is the order in which the selectors will weight your resume.  1 is self explanatory, 2 is how you have contributing to making sure the hospital achieves a high standard of quality and safety.  Audits are the best way to demonstrate this, and the fastest way to get an audit is to offer to audit the DVT prophylaxis on your ward.  Or do a handwashing audit.  I know it’s doesn’t sound fancy but it doesn’t need to be, it demonstrates you’re committed to safety.  Any morbidity and mortality meetings that you have participated in go here (non-medical people, this is the meeting where the very occasional bad outcome is discussed and everyone makes a plan to make sure it never happens again), and any talks you’ve done to your colleagues on patients with conditions that no one knows a thing about because they never happen.  3 is important, join a committee!  Have opinions!  Pharmaceutical committee, computer systems committee, accreditation committee, RMO association, just join one and show up to their meetings.  Put that on there too.  Professional development is conferences and courses.  Try to get ALS2 done before interviews (not always possible, I didn’t).  Go to some weekend radiology courses, do an online course, it shows you’re committed to studying.

Note that publications is actually pretty low down the list.  I know it’s different for other specialties but for basic training the focus is so heavily on you being safe (because you’re given a LOT of responsibility), and you getting through those rotten exams that at that particular point in time, they’re not as crucial.  (Note for advanced training they can be pretty damn important though).

For referees, try to put 3.  The online system wants two from memory, but medicine is a small world and the selectors DO ask around to get a sense of you.  Secondly when choosing a referee, don’t choose the Professor of Everything Prestigious if they hardly know you and you’re not mates.  They will give you a balanced and fair assessment.  Except no one else is putting up referees who are going to do that.  They are putting up referees who rightly or wrongly are giving them straight excellents and writing stuff like ‘they are amazing at everything all the time’.  So I’m exaggerating – but only a little.   The problem for the selectors is that they KNOW that this goes on, but they can’t justify picking the candidate with the fair and balanced assessment over the one with the straight excellents even if they know it’s untrue.  It’s there on paper and they have a hard time explaining it to admin if anything ever goes wrong.  So choose the referees who like you as a person and you get along really well with even if they’re not the amazing Professor of Everything.

The next step is to tee-up pre-interviews.  You may have strong opinions on these, most people do.  But the truth is, selectors are of the opinion that if some people do it, and you don’t, they are going to go for the people who do because they’ve tried harder than you.  You don’t need to do this for every single hospital.  Do it for your top 5 or 6.  What’s that?  5 or 6?  Yes.  Do not assume your hospital will keep you.  Too many people got burned last year.  Apply widely.  They’re not allowed to ask you what your number one is at interview.  The least terrifying way to organise a pre-interview is to email the MESO (Medical Education Support Officer) and ask them to meet with the DPT or NDPT (Director of Physician Training/Network Director).  They’ll arrange a time to do this.  You go and meet them for ten or fifteen minutes and have a chat about their network.  Read about their network first.  Don’t ask them what the hospitals are.  Don’t ask them anything you could have read yourself.  Ask them things like, ‘what are you looking for in a candidate?’ And ‘where have your candidates gone after BPT’?

After that apply online to everywhere you want to go plus a few places you don’t.  For the selection criteria you must use examples.  Prove you are what you say you are.  Don’t waste 100 words or whatever it is saying how great you are – why should they believe you?  Use clinical examples wherever possible.  Ask around about good networks to go.  Don’t focus solely on pass-rates, nowhere gets 100%.  As long as they’re with or above the national average you should be okay.  Make sure you turn up to the information nights but don’t feel you have to bomb the DPTs/MESOs with questions like everyone else.  If you can manage a ‘it’s nice to see you again after the pre-interview’ or something, that’s great.  If you really really really really want that hospital then sure get in their face.  They take attendance at the info night and they do check that you attended.

Once you get your interview offers do the following.  Do the places you want least first – they make good warm-ups.  Refer to your pre-interview IN the interview and refer to the information night you attended as well.  Ask a few questions at the end.  I can’t comment on the content of the interview, most places ask different questions and they change every year so I recommend asking people currently at those hospitals what they asked the previous year.  Before the interview have a look at the major publications of the DPT and the NDPT, and try to comment on them if you’re interested in that field.

What are the selectors looking for?  They want to know that you’re a safe, nice doctor that they would be comfortable with looking after their husband/wife/mother/grandfather.  They want to know that you’re not going to go blank or crumble under pressure.  That you know how to study for a high stakes exam.  They’re not looking for BPT-level knowledge.  You do get a clinical scenario in the interview but it’s BLS/DETECT level stuff which I recommend reading but don’t go in there thinking you have to prove your knowledge, you wont do that well.  They want competent, caring, focused, and cool.  The knowledge they can teach you.  The other stuff takes a psychologist (which you may want to consider if nerves are a problem for you)!  You can change your preferences after your interviews.  I had my heart set on one hospital but during my interview (and pre-interview actually) for another, I got along with them so famously that I changed my preferences afterwards.  And got that hospital.

That’s really important and probably why pre-interviews ARE a good idea.  They allow you to see beyond a name and a reputation, and work out where YOU click.  Your life will be so much easier if you click with your colleagues and seniors, rather than force yourself into something you’re not for the sake of a name.  Really important.  Go with where you fit in, not to a place where you have to fit yourself to their culture.

I hope that’s helpful, it’s nice to write it all down and I’ll be directing my residents here also.

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That conversation.

My first rotation in my newly chosen specialty (Geriatric Medicine) is on a ward with a policy of not-for-resuscitation.  I really hate that term.  It’s so loaded, so weighted with the implication that we’d just give up.  The context of this current job is that my patient’s have such severe dementia that they’ve forgotten their families, how to use a fork, tie their shoelaces.  If they were to die from natural causes, say a heart attack, our policy is that we should not attempt to restart their heart, or put them on machines that breathe for them, for the simple fact that it wouldn’t cure their heart problem (there is no cure for old age), certainly not cure their dementia, and cause a lot of pain and suffering for an outcome that at best, would give them a few more, horribly painful days of life.  The alternative is if that something catastrophic were to happen, instead of doing things that would achieve nothing but pain and suffering, we would change our goals to prioritising comfort and dignity.

I am at the start of a conversation that will define my career, and one that as a society we are in the process of defining.  I am loathe to go into the mechanics of what happens in these situations.  They’re traumatic enough for trained personnel.  In the movies and television, there’s about a 70% success rate if you get CPR or shocked with the paddles, or go into ICU on a breathing machine.  In reality, it’s about 20%.  If you’re young.  If you’re over the age of 80, it’s close to, if not 0%.  And yet so conditioned by the media are we, that we hold onto the hope that our loved one will be the magic one, the one that proved the doctors wrong.

So even when I have the discussion with the family members of the patient with advanced dementia, a barely functioning heart, and that near-0% success rate, they still tell me to ‘do everything’, to save their loved one.  But I can’t.  I can’t save them.  You can’t cure ageing (yet) and you can’t cure dying of old age.  Sometimes I’m successful in explaining these principles.  The principles of goals of care, of ‘doing everything’ for anything we can absolutely cure, for not ‘doing nothing’ when we can’t.  We never do nothing.  One of my favourite professors once told me that as doctors sometimes we use medicine and surgery to treat problems, sometimes we use morphine and ice-cream.  The opposite of ‘do everything’ is not ‘do nothing’.  It’s ‘do something else’.

Which brings me to ‘comfort and dignity’.  What does that even mean?  I say it a lot at work, because it’s a goal that resonates.  The mechanics of comfort and dignity is that if Something Bad happens, instead of trying to fix the unfixeable in desperation and poor judgment, we fix the symptoms instead.  If the Something Bad causes pain, we give pain relief.  If it causes distress, we give relaxing medication (similar to Valium), if there are other symptoms, there are things we can do.  The end result of going through that sliding door instead of the other, is a loved one, peaceful in bed, in no pain, and sometimes able to talk to their loved ones in their last hours-to-days.  This is in stark contrast to the CPR/breathing machine situation.  Stark contrast.

I want to be clear that this is not euthanasia.  Euthanasia is a complete can of worms which at this point in time is a dogs-breakfast that I don’t wish to visit.  But symptom-relief and subsequent dignity I’m a big fan.  It doesn’t hasten or bring on death, the underlying disease does that all by itself.  But it does make the path there a lot less traumatic for the patient and their loved ones.

I’m so far down the rabbit hole of medicine these days that sometimes I forget that I’m using jargon.  It’s hard to know if I’m losing my patients families when I have this discussion because 99% of the time they’re so polite.  And yes, it’s my job.  There’s a form I have to fill in with a families plan for their loved ones passing.  I don’t want that to come across when I have that conversation.  I’d love to hear some reader’s experiences of death and what was done well and what wasn’t.  This is a conversation I’m going to have a million times over for the rest of my carer and I want to get it right.