Looking forwards

This week I submitted my medical portfolio for review to determine whether I have met the competencies required to pass my first year as a junior doctor and gain full registration with the General Medical Council. By the end of foundation year one training we are expected have completed three four-month rotations and to have undertaken a multitude of assessments along the way. However, due to COVID, doctors around the UK did not rotate in April. Instead, we will spend a total of eight months on our second rotation.

Several of the portfolio tasks involved reflection to demonstrate evidence of career planning. This has brought into focus my career aspirations for the coming years. During medical school I thought that becoming a doctor was the end goal, however the further into my career I advance, the more I realise that becoming a doctor was just the start. In November, applications open for speciality/residency training in the UK. By then I will be expected to have chosen a speciality and be ready to commit my time and focus towards that endeavour. I now find myself at a crossroads, choosing between various options. Do I want to pursue a career in medicine or surgery? Or perhaps a career in one of the few specialities that fall in between such as intensive care, anaesthetics or radiology? Even after deciding between medicine and surgery there are tens of subspecialties to chose from in each. It is a difficult choice picking a lifelong speciality having had only two junior doctor rotations.

Where to from here?

I have known for several years that I might be suited towards a career in surgery given my love of design, sewing and woodwork. I have always enjoyed craft; making things with my own two hands is incredibly satisfying. In his book, Nobel prize winner for Economics Daniel Kahneman discusses the concept of “flow”. Flow is a state of effortless concentration where a sense of time becomes forgotten. It is the state where one becomes so engaged in their task that they lose awareness of the world around them for extended periods. This almost meditative state is what I experience when I design and create. I can often skip lunch and dinner and sew for six or seven hours at a time without noticing. Surgery allows me to experience this state of flow whilst at work.

However, surgery is a tough career and is not without its difficulties. It is physically and emotionally demanding. There are long hours involved to develop the skills and techniques required to become a surgeon. These long hours mean missed weekends, dinners and family events. A career in surgery can involve frequent moves to new parts of the country to develop skills, which can mean asking partners and children to move jobs and schools every few years. An understanding and flexible family is required to develop a surgeon. Interestingly, surgeons have modest divorce rates (~21%) compared to other professions indicating that a balance between professional and personal life is achievable in surgery.

I am a forward-thinking person with lofty goals. I set a high bar for myself and I meticulously plan how to achieve my objectives. The pressure that I have put myself under in the past decade has pushed me to work hard, undertaking four summer internships whilst at medical school, including several months at the World Health Organisation headquarters in Geneva. I am proud of my experiences. I have enjoyed and benefited from them hugely. These experiences have served as a platform to meet interesting and inspiring individuals, learn new skills and become increasingly adaptable. They have been the platform for discussion at academic interviews and have helped me to obtain a job as an academic foundation doctor.

Presenting my work to a panel of experts at WHO in Geneva

Continually setting personal objectives for several years into the future has meant that I have tended to focus on the destination more than the the journey. The goal I set several years ago to enter surgical training is a perfect example of this. The output-driven system that I have created for myself has been psychologically burdensome. I have continually set higher bars for myself to jump over without appreciating what has already been realised. I have struggled with anxiety and burnout related to the high expectations and goals I set for myself.

So how can I continue to set high standards for myself whilst maintaining good mental and physical health? Well, in the past several months I have realigned the expectations that I place on myself. I have reduced the self-imposed expectations to be constantly advancing my career and juggling multiple research projects. My long term aspirations and goals have not changed, however I have reframed these goals over an extended time period to build in time for rest and recuperation, something that I have been severely lacking in recent years. Continual intense pressure will burn out an individual – I can attest to this.

I have gotten a huge amount of joy from learning new skills and meeting inspirational people since starting medical school. The hard work, internships and research, which I saw as a means to developing a standout CV and obtaining competitive jobs, have enabled me to have a rich body of experiences from which I have genuinely found meaning. However along the way I have become so focused on my goals that I have lost sight of enjoying the journey of self-development. Whilst the journey to becoming a surgeon is full of trepidation, blood and sweat, it is the journey of development and continual improvement that is the uniquely engaging for me.

So we come back to the question: what are my career aspirations? Go out there and train as a surgeon, but take my time and enjoy the ride.

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