physician training

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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A million different people.

I’ll be finished internship soon.  The year will be marked by general (instead of provisional) registration which I’m told is something that gives you freedom.  It’s been a hard year.  I told a family their mother had gone.  For the first time.  And then I did it again and again.  I watched really young people die and felt helpless.  I saved a guys life in my 23rd hour of being awake (probably the only life saved directly by me this year 😉 ).  I cried a lot.  I felt stupid and inferior even more than I cried.  I learned how to numb a hand.  Irrigate a bladder.  Three different kinds of stitches.  I did a million blood gases.  I made dumb mistakes.  I got someone (who deserved it) put in jail.  I made new friends.  Even got good feedback a few times.  Worked countless hours of overtime.  Realised I needed a cleaner and that eating out most of the time was probably okay.  Lost a few kilos from stress then gained them back again when I made a further realisation that eating chocolate every day is perfectly okay when you’re running up 5 stories every day inumerable times.  I can probably put a cannula in with my eyes shut.  I can write up bags of electrolytes and plenty of drugs without having to look up the dosages.

But I don’t feel so much like a doctor yet.  Maybe in brief moments.  Mostly I feel like I can do stuff.  And organise stuff and do a lot of paperwork.  Lately I’ve been realising that I want to be better.  I want to start thinking, educating myself and my patients.  Working out how to get them better again.  I’ve been thinking about doing physician training again even though it feels like I’m paralysed just contemplating it.  Am I that person?

For those who don’t know, physician training is one of the most academic, detail oriented, high pressure areas of medicine.  I’m a big picture person.  Who procrastinates.  And while I’ve never failed an exam in medicine so far, 40% of the people who sit that exam fail it.  In spite of that, I want to be better.  I want to know more.  I want to have the answers for my patients.  I want to fix them.  And if I can’t, I want to treat them.  And if I can’t, I want to be there with them and as much as I can, get them and their families to the end well.

Am I that person?  There are clever, clear minded people who are constantly told they are physician material by consultants and those around them.  No one has ever said that to me. I suppose if I tried, at least there’d be no one to let down.

I’m not sure I’ve ever felt like this before.  Like I really really want something, but almost convinced I can’t do it.  I wonder where the self-belief comes from.