Choosing a medical specialty requires a deep, structured self-reflection process using frameworks and tools, rather than relying on superficial methods or external opinions, to align personal values and life goals with career realities.
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choosing a medical specialty is so much
more than what do you find interesting
or what's your passion and it's
definitely a lot more nuanced than
taking a buzzfeed quiz or i think once i
even saw an instagram filter that said
that it will help you choose your
medical specialty [Music]
[Music]
hi everyone my name is catherine and i'm
a junior doctor and a gp trainee working
in london united kingdom four months ago
i made my first video which was a vlog
on a day in the life of a gp trainee and
to be honest i was super happy when it
hit a thousand views but the views kept
going up and up and i think at the
moment it's that 26 000 views which
absolutely boggles my mind thank you so
much to everyone who watched it and i'm
glad you found it useful today i thought
i'd sit down to make another video which
was actually inspired by one of the
comments from the vlog and this comic
comes from a user named ym and ym asks
can you do a video on reasons for going
into gp or how to make the most of
medical school in choosing your specialty
specialty
so great question wyan thank you for
your comment i thought about this
question for a while now and i've
decided to approach it in a slightly
different way so i'm not going to be
talking about why i chose general
practice in this video but rather i'm
going to speak through some frameworks
and tools which i found useful and
perhaps you can consider using in
choosing your own medical specialty the
reason for this is that choosing a
specialty has a huge impact on your
career which in turn makes up anything
between 20 60 of your meaningful adult
hours which in turn has a huge impact on
your day-to-day life for up to 30 years
i found it a lot more useful approaching
this problem from first principles and
self-reflection and self-inquiry rather
than listening to someone else speak
about their own specialty which
inevitably will have a roasted bias to
it or might end up in them trying to
convince you to go into their own
specialty but for a decision of the
scale you shouldn't be relying on
convincing i also found that i didn't
really get very good or impartial career
advice in medical school or even in
foundation training yes i would have a
passing conversation with a senior or
consultant but every time i felt like
the conversation always ended up in them
saying something like well obviously my
specialty is the best you should really
consider doing it oh what you want to be
a gp you're way too good for that or
once when i was considering going into
psychiatry a consultant even said what
you want to work with crazy people all
the time which needless to say is very
unhelpful extremely rude and
stigmatizing as with any big decision or
dilemma in life or even a medicine i
think it's really essential to approach
the problem with a framework this is in
order to provide some sense and clarity
in your decision making and also to
guide you in what further research you
need to do to fill in the gaps i don't
expect you to come to a decision on what
specialty to go into by the end of this
video this is a process that might take
weeks months even years
and it's not a static process either
it's a continual process of
research reviewing assessing and
re-evaluating so first off you have to
know what choices you have what medical
specialties are there a good place to
start is the hee or the higher education
england list of specialties which i will
link down below in the description box
and also i'll put a screenshot up up
here you might find that going through
this list you might actually come across
specialties that you've not heard about
and within this website they also put in
the person specifications for each one
of the specialties which essentially is
the eligibility criteria for each one
now i'm just going to start off with
seven questions to ask yourself and
these are sort of screening questions to
start you off on the brainstorming
journey so number one is where do you
want to work do you see yourself working
in a busy hospital ward in the community
on a busy shop floor in a e do you
prefer a mix of community and inpatient
do you see yourself working in theaters
or in a lab try and imagine the setting
that you feel you would enjoy working in
number two
who do you want to be working with are
you someone who would be okay working
independently or would you rather work
in a team and bounce off each other
question number three is a very
important question to ask yourself and
requires a bit of self-reflection and
the question is how do you work what are
your strengths so is it communication is
it data interpretation analytical
thinking are you someone who likes
juggling multiple patients and multiple
problems at the same time or are you
someone who likes to focus on one
patient and one task in front of you do
you enjoy a fast-paced pressured
environment where you have to make lots
of decisions quickly or do you prefer a
slower pace environment where you're
able to have some time to think about a
problem think about medical emergencies
do you enjoy them can you stay calm or
do they just stress you out no matter
how much experience you have do you
enjoy complexity uncertainty unpredictability
unpredictability
are you someone who wants to know what
you're going to be doing each working
day and think of the actual working
environment are you someone who wouldn't
mind working in a noisy environment or
do you prefer peace and quiet
are you a morning person would you be
able to wake up at 6am and go in to do a
surgical list or are you sort of more of
a night owl if you completely clash with
the culture of the specialty ask
yourself why and ask yourself if it's
possible for you to go through the
training if you don't really agree with
perhaps the core essence of the
specialty question number four what will
you do are you someone who enjoys
practical procedures are you someone who
enjoys working with research and data do
you like having every single
investigation possible on your
fingertips are you someone who enjoys
teaching and what opportunities are
there for that do you like working with
the bigger pictures of things like
healthcare policy and management how
would you compare being a specialist and
expert on a certain topic compared to
being a generalist and knowing a bit
about lots of different topics and
finally how much administrative work do
you want to do are you someone who would
be okay doing all of your own letters
and your referrals or would you prefer a
large team of juniors doing all your
discharge summaries and so on for you
and question number five who will be
your patients so think about if there's
a particular group of patients that you
enjoy working with in terms of age in
terms of disease variety in terms of
acute or chronic diseases do you want a
range in variety of pathology how much
patient contact do you want and what
sort of therapeutic relationship do you
want to build
is continuity of care and follow-up
important to you question number six
this is a question that i feel quite
strongly about because it's helped me
provide a lot of direction in my own
process how will you get there so how
long is the training path that you're
intending on taking will it involve a
lot of on-calls weekends and
out-of-hours commitments is it a
run-through program or is it a core
program followed by a re-application for
more specialist registrar training so do
as much research as possible on the
actual training program and speak to the
trainees are they happy do they have
much supervision or teaching time is
this time protected do they get much
feedback what exams will you have to
take would you prefer more of a
one-to-one apprenticeship style training
approach or do you mind sort of being
thrown into the deep end if you'd like
to train less than full-time is this
possible and how easy is it is there a
specific location you'd like to stay in
because of family friends caring needs
health needs would you be expected to
uproot and move around the country often
for different jobs are you okay with the
long commute if you wanted to stay in a
particular place and importantly what
does a job market look like at the end
of your training are there many
consultant posts available in the
location that you want to practice in
and tied to this think about how
competitive each training program is
again he published their competition
ratios every year on the website and
i'll link that down below and put a
screenshot here are you willing to wait
a year or even multiple years if you
don't manage to get into the training
path the first time though you'll hear a
lot of people say focus on the job that
you'll be doing as a consultant because
that's what you'll be spending 30 to 40
years doing which is completely true but
also are you willing to go through up to
10 year process in your late 20s and
early 30s
when a lot of other things may be going
on in your life having to constantly
juggle different commitments number
seven what else do you want to achieve
with your life and this could be other
hobbies side hustles family travel
overseas opportunities etc how much
autonomy and flexibility do you have
within the training program and as a
consultant to pursue these things and
another really important thing to
mention is well-being medicine is a
difficult and stressful job what do you
need around you to support you is it
friends and family in a particular
location is it a particular hobby that
you can only really pursue in certain
areas of the country are there
opportunities to work abroad look for
examples in the trainees and the seniors
ask yourself are they happy after
answering all those questions i've just
thrown at you you might have a clear
idea of what you want to do but i find
that the real interesting and juicy bit
is in doing some mental exercises so the
first exercise is a list of seven
questions and this is taken from a
document that was shared with me when i
reached out to the professional support
unit at hee and i would highly recommend
reaching out to the psu because i had a
really fruitful one-to-one careers
coaching slash counseling session with
someone and they shared with me this
document which is sort of a
brainstorming tapping into your
subconscious exercise and the questions
are i believe something is worth doing
if i'm someone who is good at i'm
passionate about i can spend hours i
want to interact with people who i work
best when i need an environment where so
here you can see that you're approaching
the careers decision making through
first principles so you're asking
yourself what do i want and then
hopefully finding a career direction or
specialty which fits in with that and i
think in the top of the sheet it
actually suggests that you should write
at least 30 statements so you can either
aim for a numerical number of statements
you want to write down or you can give
yourself 20 to 30 minutes to really deep
dive and reflect on
what it is that you want from your
career the second exercise is taken from
a website called wait but why which is a
blog written by a guy called tim urban
and he writes on a variety of different
topics ranging from how to name your
baby to why do procrastinators
procrastinate to a i think a six-part
series on elon musk but the article i'm
referring to is called how to pick a
career brackets that actually fits you
and it's quite a long read it's about a
25 to 30 minute read i think
but it has such a high return on
investment it actually changed the way
that i think about careers completely
i'm just going to sum up the points of
the article which i found the most
useful so this article refers to
choosing a career but i feel like it's
so applicable to choosing a specialty as
well so i'm just going to use these two
terms interchangeably
so he starts off the article talking
about how when we pick a career we have
to find the intersection between a want
pool and a reality pool and in order to
assess what we want in the want pool he
uses a framework called the yearning
octopus which is not actually an octopus
it's got five tentacles so it's a
pentapus i guess um but anyway it looks
like an octopus in some sense and on
each tentacle there is a different want
so there's social moral practical
lifestyle and personal and these
tentacles often don't get along with
each other complicating this even
further is that within each tentacle
there may be differing wants and fears
which are in direct conflict with each
other so an example of this that i can
think of medicine is that one would
think that going into medicine would
fulfill the moral tentacle if your whole
life was dedicated to work and
alleviating suffering of others to the
detriment of the well-being of your
loved ones then your moral tentacle
would be quite unhappy and it's not as
simple as looking at the urine octopus
saying you know i want these tentacles
and i don't want these ones it's an
exercise where you have to really ask
yourself why do i want this and i must
caveat this by saying that being able to
be completely selfish does assume a
level of privilege so it assumes that
you don't have any disabilities for
example or any dependents or you don't
have to care for anyone so on the
article he gives an example of someone
who fantasizes of making 1.2 million
dollars a year and on the surface each
one of the five tentacles has a desire
for wealth for one reason or another but
on unpacking this this person realizes
that it's actually a sense of security
that they're after but this is not basic
security which the practical tentacle
would like but rather a certain level of
fanciness that is given by a rich
lifestyle so it's actually the lifestyle
and social tentacle that wants this or
perhaps the impulse is driven by the
emotional well-being section of the
lifestyle tentacle to alleviate
compulsive financial stress that this
person was grown up to forever feel and
as we go through this exercise of the
yearning octopus there will emerge a
hierarchy of yearnings which is almost
as important as the yearnings themselves
so he uses this illustration of five
different categories five different
categories are the non-negotiable bowl
the top shelf the middle shelf the
bottom shelf and then the trash can
shelf placement is as much about deep
prioritizing as it is about prioritizing
as you're choosing which parts of you
are the most important to make you happy
you're also choosing which parts of you
you intentionally want to leave
inevitably through going through this exercise
exercise
not all yearnings are going to be happy
there's going to be clashes there's
going to be arguments and some fears
will come up he then mentions this
concept called the interrogation room
which is essentially a mental exercise
to figure out whether each of these
yearnings are authentically you
so obviously as we go through life we're
going to hear different bits of advice
and be influenced by different people
but there's a difference between being
given a piece of advice
thinking about it yourself and deciding
to embrace it and take it on
versus having other people masquerading
as you and making your own decisions
this could be your seven-year-old self
your parents your friends your
colleagues what society thinks so using
these frameworks and applying it to
choosing a specialty within medicine
look at your responses at the initial
seven screening questions the first
mental exercise and your yearning
octopus put your wants in a hierarchy
and as you do this ask yourself are
these once actually truly authentically
mine then use this framework to find
your ideal specialty every single
specialty has its pros and cons and the
aim here is to try and find a balance of
the compromises that you're willing to
make going through these mental
exercises they're not easy it's a
massive process of trying to get to know
yourself and there might be a
differentiation between your actual
self-knowledge and your perceived
self-knowledge in this wonderful graph
that he puts up in the article and i
want to bring up another concept here
which is along the way going through
this process you might encounter what
are called cognitive biases and there's
a whole list of these but some that i
want to pick out are firstly
confirmation bias and this is when you
only pay attention to pieces of
information that confirm preconceived
beliefs that you already have about a
certain specialty secondly is authority
bias which is when you put increased
weight in an option because someone that
you like or someone that you respect
told you to go for it the third one is
framing bias which is when you're
influenced by how the specialty was
presented to you rather than actual
content of the presentation and finally
the bias which i find most interesting
is the escalation of commitment bias
which is when one remains committed to
previous behaviors especially if they
were performed publicly even though they
don't have desirable outcomes in other
words it's sort of saying i have got too
much to lose because i've put so much
effort and time into this decision or
process already and even though i feel
like it's not going the right way i'm
just going to continue going on and i
feel like this fear is related to
thinking that our careers are tunnels
which adds to the fear of making the
wrong decision or changing root i think
that this is especially pertinent within
medicine especially in uk
where medicine is an undergraduate
degree so we decide when we're sort of
16 17 years old and some people even
younger that we're going to go to
medical school when we don't really have
an idea or even have a capability to
think about what else do we want in life
and therefore we're definitely in danger
of being increasingly disillusioned and
increasingly unhappy with the decision
that our 16 year old self made for us
this is especially paralyzing for
perfectionistic types which medicine
inevitably attracts but actually what's
mentioned at the end of the weight but
why article is that today's career
landscape is not a series of tunnels but
rather it's a long series of science
experiments our career decisions they're
rarely fixed we should be constantly
auditing and evaluating what is it that
we want and staying true to ourselves
the best justice that you can do for
yourself is to provide yourself with the
right preparation resources and
information necessary to make the right
decision at that particular time in your
life and once we move from point a to
point b and we re-evaluate and think
actually i don't like the direction i'm
heading that's completely fine and at
risk of sounding pretentious but i love
this quote so much it's by a danish
philosopher called soren kyoku guard i'm
not sure if i'm pronouncing that right
and the quote is life can only be
understood backwards but it must be
lived forwards so after this video which
is a lot longer than i intended it to be
my voice is a bit sort of dry now um
going back to ym's comment how do i make
the most out of medical school in
choosing a specialty essentially have
these frameworks in your mind as you go
through each placement use medical
school as a time to evaluate and assess
what you want from your life in your
career give yourself the best chance
possible expose yourself in as many
opportunities as you can volunteer to go
into different settings different
clinics because after medical school
it's actually quite difficult to have
such a wide variety of different
specialties that you're exposed to so
that wraps up the video thank you so
much for everyone who stuck it out to
the end as you can probably tell this is
a topic that i've thought a lot about
and i really hope that you'll take away
these frameworks and tools to your own
careers whether you're with a medicine
or you're not within medicine to give
you some clarity for this very important
decision that you'll be making so i do
plan on making more videos in the future
but there will not be any sort of
regularity to it i must say because i'm
on quite a busy on call rota at the
moment and i prefer to focus on the
quality of the videos rather than the
quantity so if you've got any feedback
on this video or any other videos you
feel you want me to do in the future
then please comment down below and i
read all the comments so thanks for
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