Sunday, 29 January 2012

Love the skin you're in

This week, I have been thinking about what it means to help my team develop as individuals. The circumstances in which I work with house officers and SHOs can be challenging: junior doctors often rotate after a very short time, they are often away from the wards doing on-calls, and they join the team I work on from other teams, which may have demonstrated to them ways of working that are different to the way that we do things. On top of this, is the need for them to satisfy us enough that they are competent for us to assess them favourably as part of their training programmes.

What then is the best way to help them develop?

The temptation is to try to portray the specialty that one works in as the best one to do, and to treat the time junior doctors have with you as a prolonged sales pitch. Another approach is to try to embed in them your way of doing this. It is very easy to begin to believe that the way that you practice medicine is the way that everyone should practice medicine, but it does not take a long period of reflection to realise that even if we all implement the current best practice, that there is significant scope for individual preferences and styles.

What I have recently recognised is that junior doctors are asked to develop some idea of what they would like to specialise in very early in their careers, which is a new kind of pressure that I never really had to deal with: when I was an SHO, it was usual to either get a training rotation in the relevant field, or to cast around for a specialty that suited by taking on short term contracts in different specialties. The beauty of this system was that it allowed different people to either go quickly or slowly in their chosen direction, on the basis of their own aspirations and experiences. These days, junior doctors are asked to have some idea of what they would like to do, when they do not necessarily have the experience they need.

The risk, therefore, is that young doctors hedge their bets, and go for specialties that they are poorly suited for, and will not thrive in. However, I have been wondering recently, how real this risk is. One issue in medicine that I have written about before is the problems associated with socialisation of junior doctors and medical students, so that they mimic the behaviours of senior doctors, and a certain pattern of behaviour becomes embedded in the way that particular specialties conduct their business.

I suspect that for most specialties, there is the scope for a range of different approaches and character types, and perhaps the distinctions we traditionally make about the types of people who become surgeons or physicians or paediatricians are in fact arbitrary. If we break down the stereotype then maybe the whole of medicine would reap the benefits of new approaches.

Of course, I imagine when doctors think about what specialty to apply for, they look at the people who do it now, and make some form of assessment of affinity. So it may be that the new pressure to choose early will actually entrench old fashioned stereotypes, but what if our young doctors are choosing specialties before they have had a chance to know what kind of doctor they will be in the future? This is a process of discovery that we all have to go through, and it is true for me, and therefore I suspect others, that I have turned out differently to how I both hoped and expected. Asking doctors to make career choices early may, therefore, result in the erosion of traditional stereotypes, if and where they still exist.

If my arguments here feel a little forced, then hopefully what it has persuaded me of will not, for it occurred to me, that what is important for junior doctors is not necessarily what specialty they choose, but rather how they approach it. It is perhaps plausible that any doctor could be happy and successful in any specialty: medicine is a sizeable place, and there should be scope to accommodate all sorts of different character types within its walls.

It is crucial for doctors to recognise that both they, and the people they work with, have particular preferences about the way that they go about things, and that these preferences are not universal and equally shared: some people are really focused on the details, others on the broader strategic aspects: some like practical procedures while others prefer to specialise in the decision making required to know when to do what. We all have a slightly different pattern of preferences, and while it is important to recognise what appeals to you, it is also important to recognise how the people you work with view the world.

Every doctor that I work with brings with them certain strengths (things they are simply good at) and areas that need a bit of work. With junior doctors, the temptation is to spend the most time working on the things that they need to improve, but my recent realisation is that where they have strengths, then we ought to spend some time developing them, and putting them to the best use of the team.

By emphasising the positives that all team members bring to work, you foster an atmosphere of collaboration and also of learning. By first defining colleagues by their talents, they are immediately valued team members, and not just trainees. This shift in emphasis makes the point that there is no one ‘right way’ to practice, and acknowledges from the start that there is no expectation that a trainee on my firm should work in a particular way. Done well, this approach would mean that every new job a trainee goes to is a chance to both shine, and develop, by adapting their approaches to a new arena.

And that is what I have been mulling over this week.

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