The long and winding road (to CCT…)

We are all familiar with that feeling of elation that comes with being appointed to your dream job. Your future is laid out in front of you, your career is mapped out, progress is guaranteed, everything has fallen into place. Back in June 2014, this was exactly how I felt. I’d just been appointed to my NTN, I was heading back to the place where I’d trained as a medical student and the hospital and rotation that felt like ‘home’. I returned to the hospital to find lots of familiar faces, some continuing in training as well as others who had, over the years and for their own reasons, stepped off the treadmill of training.

Unfortunately, as is often the case, things weren’t as rose tinted as they could have been. Exams didn’t go according to plan, personal relationships took a beating, suffice to say things did NOT go to plan. Then came the dreaded ARCP review. I’d had the awful experience of having to turn around and walk back down the steps of Red Lion Square once more, and I knew what was coming… Outcome 4, released from training programme. I had a flurry of meetings and discussions with faculty within the school, making plans on how to progress from here. As medical students and junior ‘postgraduate doctors in training’ to use the new term, we are indoctrinated into the prescribed plan of training programmes and relentless cycle of assessment. Suddenly I was presented with options, the most obvious of which had been staring me in the face since coming back ‘home’. A colleague from the year above me at medical school had worked in the same department and carved himself out his ideal job working as a Specialty Doctor, with a job plan and schedule that suited him and his interests. A few brief corridor chats, and a sit down with the Clinical Director, and suddenly things started to fall into place. A Specialty Doctor role appeared on NHS Jobs and after a hastily submitted application, I was invited for interview and appointed.

Now came a whole new world that had never occurred to me as an StR; job planning, flexi sessions, SPA time, terms you hear as a trainee that have no actual meaning to you, were now concepts I had to grasp and master in weeks. Thankfully, I was supported and guided by other SAS colleagues, senior anaesthetists who had taught me the basics of the speciality when I was a student, now teaching me the basics of the negotiating and balancing acts that the job requires. My job plan came back with a nice balance, I stayed on the senior resident on call rota, and my day time sessions were all flexis. We worked on an annualised job plan and it meant I could spread my time to suit myself: I could work more when I wanted to, but have time to focus on myself and my progression, a luxury not afforded as trainees; and we had time scheduled to do the admin side of the job! SPA time was this holy grail myth that trainees hear about but never get to see, rather than giving up evenings and weekends to complete audit and QI work.

There is no right answer in choosing a career path, but finding something that satisfies you and provides adequate mental stimulation makes such a difference.

The change of pace of work, and the opportunity to refocus my energies during off-time, allowed me to optimise my study time and exam preparation. The FRCA was now not an insurmountable pile of notes and books, but instead an opportunity to show I knew what I was doing in the job. I passed the SOE at the next sitting.

Now came the difficult choice. Do I go back to the training programme, or do I stay in role as an SAS? I worked in a department that was supportive. They had allowed me to negotiate a job plan that worked for me at the time, and provided me with a combination of supervised training opportunities and interesting and stimulating solo work. I worked with a number of senior SAS colleagues who were totally independent and trusted anaesthetists within the department and leaders in the Trust, and others appointed more recently who were developing their own interests and careers outside the traditional training programme. Ultimately, for me, there was still a desire to reach the goal of consultancy. Having been through a rocky training time, I wanted to be in a position to improve the experience for those that came behind, and unfortunately that still requires a place on the Specialist Register. CESR was an option, I had achieved my ILTC and so would only have to show equivalence of the higher and advanced elements of the curriculum (as was). The realities of achieving this, knowing my own lack of skills at paperwork coordination, meant that it would be far more achievable for me to go back into the training programme and achieve CCT via a more established route.

Now three years down the line, I have just received the news that my portfolio has been reviewed and the Trainee Programme Director has approved an Outcome 6. The process of joining the Specialist Register is underway. It hasn’t been an easy run, and returning to training has caused me more stress and frustrations. If the role of a Specialist (the new independent SAS role) had been established and available three years ago, would I have gone back to the training scheme? I’m not so sure. My efforts to reach this point have taken their toll on me, and as I sit writing this, my colleague from medical school works alongside me, developing his own role as a Specialist in anaesthetics. My time working as an SAS has given me insight into the differences faced by trainees and SAS doctors, but also ideas as to how we can help and influence each other’s roles for the better. Simple things that are common for those with a ‘professional activities job plan’ like flexi sessions have now been introduced into trainee rotas locally, providing more autonomy and self-direction for trainees when needed; a small change that can provide a boost for morale, sadly lacking in a post-COVID NHS.

Balancing your career progression and aspirations with your own psychological health can be difficult. As doctors we tend toward the classic type A personality; the recognition that goes alongside status feeds into that and can have an impact on your perceptions of your own wellbeing. There is no right answer in choosing a career path, but finding something that satisfies you and provides adequate mental stimulation makes such a difference.

Ben Hockenhull
ST7 Anaesthetics
Elected Member, Association of Anaesthetists Trainee Committee

Twitter: @ben_hock