A Doctor's life. Part 2: Specialty training explained

In the first part of this blog, I talked about the length and various steps involved in professional training after graduation. But what does this training really entails? I’ve tried to lay down a few facts about what the major career challenges are for junior doctors.

The first challenge in your path to becoming a specialist is to obtain a position as an intern. As the number of medical graduates increases and that of training positions doesn’t, securing that first doctor job (especially in the city) can be increasingly challenging. You will need good grades, a solid portfolio with good references from your hospital placements and perhaps even a research publication or volunteering experience. It goes without saying that building a solid resume, which ticks all of these boxes takes time and must be planned for early on during medical school.  

During your intern year, you will go through an average of 4 rotations, each in a different field and it is important that you research the training capabilities of the hospital you apply to in each one of these, especially if one of these is the specialty you aim to go into later. Infrastructures, likelihood of interesting cases coming through, quality of teaching and availability of seminars and training aids should all be considered. Bear in mind that many hospitals are quite loyal to their interns and will give them priority for jobs in following years. As a result, it can be important to obtain an intern position in a hospital that has the capabilities for delivering appropriate training in your field of choice later on. For instance, if you plan on specialising in Emergency, it is not a good bet to take a job in a small hospital that does not have an ICU, as ICU exposure will be required in your training later on.

Intern year can be overwhelming to some, as for the first since entering the medical environment, you will be expected to take responsibility for the diagnosis and treatment of your own patients. However, beware that in retrospect, most doctors consider their intern year to have been quite easy in comparison to what is to come. It is therefore a good time to try and build up your resume as much as possible: use your leave and days off to take training courses, volunteer, do research or attend seminars, you will need that edge to secure jobs later.

During your intern year, your rotations will be assessed and if your performance is satisfactory, you can apply to a job as a resident, or HMO. The HMO year also consists of several assessed rotations (usually 4). Some HMO positions advertise the specific rotations that will be undertaken, while others assign these rotations after candidates have been selected (some hospitals may also allow doctors to swap rotations amongst themselves). When applying for jobs, be careful to consider what rotations you need in order to gain admission in your college of choice. If you are offered an HMO position with 4 psych rotations, you may find yourself in a spot of trouble when it comes to applying for admission to a college of surgery… Individual specialties have different prerequisites for the number and type of rotations that must be completed as HMOs, which means that in order to gain entry into some colleges, you may have to complete 2 HMO years. For instance, most people can gain entry into the Emergency college after 1 year and completion of rotations such as Gen Med, Geriatrics, Emergency, GP and obstetrics; however, many more rotations are required for admission into Anaesthesiology and 2 or more HMO years are usually necessary. As an HMO, you will have more responsibilities and independence than as an intern, which means that the work will also be more intense and you will be expected to see more patients. In other words, work will become more rewarding, but also a lot more taxing.

The real big change in your level of responsibilities comes, however, when you start as a registrar. At the end of your HMO year, you must apply to the college that will be in charge of your training. Some colleges are more competitive than others, and you will need recommendations from a supervising doctor who is also a member of that college. It is therefore important to cultivate relationships with senior doctors in your field of choice early on and make sure they know who you are and are satisfied with your performance. Also don’t wait for 4 months after finishing a rotation to ask a supervisor for a reference, there’s a fair chance he or she will have forgotten who you are at that stage. Of course, that is also valid advice with regards to job applications, as you will be asked to provide professional references for these every year. Yup, you got it, impressing your bosses is not optional in this field, so make sure you do well and also that people notice it!

Once you have gained admission into a college, you can apply for a job as a junior registrar in your field of choice. These awful rotations where you find little job interest are finally over! I know more than a few male doctors who breathe a sigh of relief at that point, as they know they will never have to do 20 awkward gyne exams a day ever again! This also marks the beginning of an exciting time where you are finally learning almost exclusively about your field of interest. A significant downer amongst all that excitement, is the need to study for your primary exams.

Although you may have had to study sporadically to improve your practical, on-the-job knowledge since starting as an intern, this will probably be the first time you have to cram any significant amount of theoretical information since you graduated. Needless to say, this can be very challenging, both because you are out of practice at studying and because you have to combine these studies with a somehow gruelling work schedule. Primaries run twice a year, in August and in March and usually include 4 subjects, with a written and an oral exam for each. The syllabus content of primary exams varies according to the specialties but includes clinical, pharmacological and basic scientific content. You thought you could forget all about basic biochemistry and cell biology after your 2nd year as a med student? Think again… Many find it a struggle to study for these more theoretical subjects, as that knowledge is never tested on the job and it can be hard to stay motivated to learn what seems like pointless information. That’s why it is important to select a hospital with a good teaching program: make sure your hospital organises teaching and study groups and most importantly, that it rosters days off for junior registrars on teaching days.

The passing rate for primary exams varies according to the specialty, and many have to take the exams multiple times. Some even adopt the strategies of taking only half of the subjects in a given year, and the remainder on the following.  Once you have passed your primary exams, you may apply for a position as a senior registrar in a training program. This is extremely competitive, but if you are accepted, you are more or less guaranteed a job until the end of your training. This is a major career landmark, as if you have made it to this point, you would have overcome most of the hurdles and successfully negotiated the main bottlenecks in the medical training.

Having said that, training to become a consultant is hard work and the amount of pressure and responsibility you have to shoulder as a senior reg will have increased exponentially. The consultant exam is considerably more challenging than the primaries and is usually attempted multiple times by trainees. Once you finally qualify as a consultant, and depending on your specialty, you may either set up your own private practice, or apply for work at one or more hospital (private or public). Hospital consultancies are competitive, so in order to get full-time work in the city, you will need to have built a pretty solid resume.

For tips on how to succeed as a junior doctor, stay tuned for the upcoming part 3 of our post-graduation series, “Tips for early-career doctors”.