UKFPO Bulletin – June

Cervical Screening Awareness Week – 17-23 June 

Men’s Health Week 12-18 June 

Other national campaigns this month 

Action for happiness calendar – Joyful June 

Introduction

Welcome to the June bulletin!

I’m due to retire this month and so this will be my last bulletin for the UKFPO, and I have decided to use it to talk about careers. I thought a little reflection on a working life that has been mostly enjoyable and mostly satisfying might help some of those who are anxious about their own careers. 

The first thing to say is that my career path has been largely serendipitous. I realise things are a bit different now but it’s fair to say that I didn’t get either of the house jobs I wanted (we didn’t have F1s in 1989). I was nearly unemployed afterwards because I couldn’t get a medical rotation (it was pre-IMT) and took a last-minute post in ED (A&E then) at St George’s. This is where I discovered paediatrics, which became my chosen clinical career. I did get the paediatric job I wanted after this but then didn’t get the subsequent rotation I applied for. I thus moved around a lot and got a very wide experience. My greatest triumph in training (aside from the relief of passing my college exams) was a year’s fellowship in Western Australia, and I would recommend working somewhere else to anyone.

(Learning Point 1). The point of saying all this is that medical training happens all over the place and everywhere you go there are committed senior doctors who are willing to support and teach you, whether this is in regional centres or DGHs. They’re also there in rural practices, inner city health centres, hospices and mental health trusts. I strongly believe that seeing a wide variety of medicine is very beneficial to being a consultant or a GP (general practitioner), where you will suddenly find yourself confronted by patients who haven’t read the textbooks and turn up with all kinds of puzzling symptoms that don’t fit any known pattern. For those of you who are UK citizens and graduates, I would recommend the benefits of experiencing a different healthcare system. (As an IMG once pointed out when I was running a careers session, to him the NHS was a different healthcare system).

Until this point, some ten years into being a consultant, it all seemed to follow naturally, however, my next step was strategic. I applied for the Foundation School Director role in the West Midlands. This was a first step beyond my hospital into a much wider world of education. It also involved significant changes in my job plan with a reduction in clinical work. However, by then, I felt I had consolidated myself in the role of consultant and was comfortable to do this despite warnings that if I wanted to come back to full time clinical practice, that might not be possible.

(Learning Point 2). You spend a lot of your life in a consultant/GP post. Choose wisely. It’s not just about the job, of course: lifestyle, the cost of housing, family etc. all need consideration.  

At this point, it is fair to say that getting the dream job in a part of the country you like with a comfortable home, decent school for the kids (we had two by this stage) and a garden (my wife and I both wanted a garden) is only the first step. (I should comment that, having brought our children up in a rural idyll, they have both moved back to the city and the garden is still a work in progress). 

Away from the clinical side, I soon realised I was interested in medical education, and this was given a boost by taking part in the newly arrived PALS (Paediatric Advanced Life Support) course. RCUK courses weren’t mandatory then. As well as giving me a lot of clinical confidence, the instructor course opened my eyes to the ‘science’ of medical education, and this became a second strand to my career.  Teaching on PALS helped me to get the consultant job too. 

One of the joys of being a consultant is that you get some control over your work, and I was thus able to take the initiative and offer to take responsibility for our departmental undergraduate training. This allowed me to undertake a PGCert in Medical Education. From here, I progressed to ‘college tutor’ and then applied for the deputy PG clinical tutor post – which I didn’t get. I reapplied a year later and did get it, then went on to become PG Clinical Tutor and subsequently Director of Medical Education in my trust. 

(Learning Point 3). There are lots of opportunities out there. Explore them. I could have gone into management, and I have done some purely management roles too but have always found education more interesting. Personally (I know some of my colleagues will be horrified), I’ve never found conducting research particularly interesting, but everyone is different, and we all have our own drivers and interests, so explore opportunities in what interests you (and don’t be too influenced by what interests others).  

Until this point, some ten years into being a consultant, it all seemed to follow naturally, however, my next step was strategic. I applied for the Foundation School Director role in the West Midlands. This was a first step beyond my hospital into a much wider world of education. It also involved significant changes in my job plan with a reduction in clinical work. However, by then, I felt I had consolidated myself in the role of consultant and was comfortable to do this despite warnings that if I wanted to come back to full time clinical practice, that might not be possible.

(Learning Point 4). I’m slightly embarrassed to say this to a generation of people who are certainly going to want portfolio careers but take chances to explore what you want to do. There are all kinds of fellowship posts out there for less senior doctors in all kinds of different areas (for example, education, sustainable healthcare, management and so on) just as there are all kinds of jobs for consultants, GPs and other career grade doctors including clinical director posts, leads for patient safety, quality, appraisal, audit, advisors to the local ICB (Integrated Care Board), tutors, heads of school, lecturerships; the list goes on.

On reflection, things went a bit wrong after this. I was very comfortable as a Foundation School Director and stayed in this role too long. When I did apply for the next step and didn’t get it there wasn’t much of a plan B. (I did my PGCert with a very senior national figure and can’t help feeling that I wasn’t strategic enough.) It was disappointing at the time, but I have no regrets and other opportunities arose.

(Learning Point 5). When a job becomes too easy, it’s time to move on. I could say this about my clinical work too. I wouldn’t say that clinical work ever becomes mundane but even for a generalist it can be a little repetitive – hence the need to look for other challenges. I suppose, I am someone who likes challenges and when I did later drop back into the role of ‘back-bench’ consultant I soon felt bored and irritable. Fortunately, the department needed an interim clinical director…

Fortunately, having failed to get the deputy dean post, I was offered the opportunity to chair the Academy of Medical Royal Colleges Foundation Programme Committee (AFPC) and develop the next iteration of the Foundation curriculum. This was a lot of work, but it felt like an achievement and an opportunity to use my experience to guide future medical training – what better use for a generalist with a background in education? So, for those of you struggling with the curriculum, it’s my fault but I think, at this moment in time, it points in the direction it needs to and when it doesn’t someone else will move it on.

One of the joys of writing the curriculum was that I got to meet an incredibly wide variety of people, senior and junior, medical and lay people from a wide variety of backgrounds. Almost all of them gave me their thoughts and advice. Some of the advice was helpful and some of it wasn’t, and I think this brings me to my final learning point. 

(Learning Point 6). You can’t know everything. Find people who inspire you and whom you trust and seek their counsel. Get a mentor or, ideally, series of mentors. I therefore cite (and thank) for their continued support and/or random acts of kindness:

Peter Rhodes: my second SHO who showed me the ropes, gave me multiple opportunities and let me make decisions in my medical house job and ensured I ate regularly.

Azhar Manzoor: consultant paediatrician in Burton, who looked after me as a new consultant, was a role model and always gave honest and supportive feedback – some of which I listened to.

Manjit Obhra: associate PG Dean from West Midlands, for believing in me and giving a swift kick when I wasn’t pushing myself (and giving me a superb fish and chip supper in the process).

Dame Jane Dacre: past president of the RCP (Royal College of Physicians) who summoned me to her office, gave me lunch and taught me to navigate the corridors of the AoMRC.

However, most of all, I would like to acknowledge Mr Don Bandula Wijetunge: A&E consultant from St George’s, who taught me the importance of caring for your team.  

Best wishes 
Tony Choules, Operational Advisor to the UKFPO