Without the voices of our trainees, the story would be incomplete. Some older people believe they have already known what the youngsters think. Some even believe that the youngsters do not know how to think and they know what is best for them. To a certain extent, I also agree that young people may not tell you the truth even if you ask, but I wished to ask.
In March 2009, two investigators (VW and KY) independently generated a list of basic trainees in our department who have taken or passed the MRCP exam and expressed interest in joining a specialty. A standard set of open questions was sent by e-mail. For confidentiality reasons, the identity of trainees and the exact specialties would not be revealed. Overall, eight of nine trainees responded (response rate 89%).
The median number of specialties the trainees had seriously considered was 3 (range 2 to 4). Six trainees made the final decision after the MRCP exam and one made the decision during internship. One notable exception was a trainee who determined to join a specialty even before entering the medical school. That trainee continued to pursue the dream despite failing to enter the medical school at the first attempt. He/she is now generally agreed to be one of the most responsible and competent colleagues in our department. Based on this touching story, I am ready to help all youngsters to develop their careers.
Factors affecting the decision
Not surprisingly, five trainees stated interest as their main reason of choosing a specialty. Five also considered the team spirit and the behavior of other team members important. Three respondents considered future prospects (one stated promotion, one stated the likelihood of staying in the team after the completion of training, and one reported the prospect in the private market). Three trainees also thought the leadership of team heads was important. On the other hand, only one trainee wished to join a team for research and challenge. One trainee said that the decision was affected by what the other trainees chose.
One interesting phenomenon recently is that specialties with more trainees and fellows continue to attract the biggest number of new recruits. Some people have questioned this behavior on the ground that the promotion and training opportunities may be adversely affected. When we asked the same questions, three trainees thought that the number of existing members in a specialty was unimportant in their decision process. Three other trainees believed that bigger teams were more attractive because they would get more support and have better exchange of ideas. Only two respondents were worried about the prospect and said that specialties with more existing trainees were less attractive.
Pro-choice or Pro-life?
Under the current system, most trainees can enter their first-choice specialties. When we asked about their view on the possibility of job assignment by the department according to service need, four trainees stated that they would seek training posts in other hospitals and one would negotiate with the department. Two trainees would accept the offer if they could join their other favorite specialties, but would still leave us if the team was not what they wanted. None of these seven trainees believed they could excel in specialties they did not like. Only one respondent agreed to accept any offer and try the work first.