THE ESSENTIAL GUIDE TO BECOMING A DOCTOR

Life at university, although hard work, can begreat fun and this can continue in your future career.. Southampton University Hospitals NHS TrustChristine Bowman Consultant Physician, Gen

The Essential Guide to

Becoming a Doctor

S E C O N D E D I T I O N

Adrian Blundell

BMedSci, BM, BS, MRCP

Specialist Registrar

Health Care of the Elderly and General Medicine

Nottingham University Hospital NHS Trust, UK

© 2004 BMJ Publishing Group

© 2007 Adrian Blundell, Benjamin Turney and Richard Harrison

Published by Blackwell Publishing

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Contents

Preface to the First Edition, vPreface to the Second Edition, viAcknowledgements, vii

1 A challenging career, 1

2 The application procedure, 8

3 Admission tests, 27

4 The year out, 31

5 Choosing a medical school, 39

6 Applying to Oxbridge, 58

7 The interview process, 65

8 Over 21s, 75

9 Life at medical school, 82

10 The medical course – early years, 94

11 The medical course – later years, 106

12 The intercalated degree, 118

13 The elective, 123

14 Finances, 129

15 House dog to top dog, 138

16 Working patterns and wages, 149

17 Life as a doctor, 160

18 Career options, 172

iv Contents

19 Training as a general practitioner, 189

20 Training in the medical field (becoming a physician), 197

21 Training in the surgical field, 208

22 Working abroad, 221

Appendix, 228

Index, 237

Preface to the First Edition

So you want to be a doctor? Have you asked yourself why?

Doctors have a highly privileged role Medics are involved in people’s livesfrom facilitating their conception to dignifying their death Medicine can be arewarding career despite constant concerns regarding hours, pay and workingconditions Consequently, competition for places at medical school is high and

on the increase

Deciding to choose medicine is a decision that has lifelong and lifestyleimplications Do you know that you will have to spend 5 years at universityand then up to 15 years before reaching the top of your profession? Do youknow what being on call means? Even more importantly do you have anyidea what life at university and a career as a doctor will be like?

Look no further because help is at hand Here is the completely unbiased,honest and unadulterated guide to telling you everything you ever wanted toknow about being a doctor – and a lot more From the initial applicationright through to training in your chosen speciality – it’s all here

We have written this book to help you make a decision about a career inmedicine We hope that you find it helpful Personally we had little or no ideawhat we were letting ourselves in for Lucky for us it was the right decisionand we love it Sadly for some it isn’t Careful thought early on should pre-vent this; remember there are other rewarding careers

Life at university is fantastic, no arguments Life as a doctor has greatmoments, but be under no illusion, it is hard work, at times routine and itcan be stressful Read this book and embark on your career with your eyesand ears open Work hard but more importantly remember to take time toplay hard

Please remember that courses and application procedures change, as canworking patterns and practices It is advisable to check the latest informationbefore applying

Good luck!Adrian BlundellRichard HarrisonBenjamin Turney

Preface to the Second Edition

The NHS and medical school education are going through the biggestreforms, possibly of their lives Often a second edition just requires a littletweaking of information and updating However, due to the major changes,this second edition is in many ways a complete rewrite Even then, there isstill much uncertainty and continuing change The NHS is scrutinised insome form or other, practically on a daily basis in the news In general thereports are negative and it is easy to become disheartened Morale is also lowwith regard to the financial climate, and many healthcare professionals findthemselves without job security Although there have been few actual con-sultant and GP redundancies, some posts are not being filled followingretirement The expansion in the number of medical school places hasincreased the chance of gaining a place, but there appears to be a reduction inthe number of training posts for doctors, which could lead to greater compe-tition and unemployment amongst trainees

Being a doctor remains rewarding and continually challenging Our originalreasons for writing this book continue to remain the same – too many schoolleavers go to medical school, only to regret their decision in later life This ismainly due to lack of research into what a career as a doctor would really belike From a personal point, our knowledge of our future career was limitedand the reality is extremely different to our expectations All three of us arepleased with our choice of career, although have gone through moments ofuncertainty, which continue The purpose of this book is neither to convinceyou, nor put you off a career in medicine, but instead to portray the reality oftraining and working as a doctor Life at university, although hard work, can begreat fun and this can continue in your future career Work experience in dif-ferent environments is essential, as is talking to students and healthcare profes-sionals If unsure then consider the options of a gap year, or even graduateentry at a later stage Try to keep abreast of developments even during the earlystages of your career and try not to be disillusioned by inaccurate televisionhospital dramas and the continuous doctor bashing in the press

Good luck!

AB, RH, BT

Southampton University Hospitals NHS TrustChristine Bowman Consultant Physician, Genitourinary Medicine

Sheffield Teaching Hospitals NHS FoundationTrust

Tim Brabants Senior House Officer in Emergency Medicine

(Locum)Torquil Duncan-Brown General Practitioner

NottinghamMarcus Hatch Final Year Graduate Entry Medical Student

Nottingham University Bryony Elliott Foundation Year 2 Doctor

Sherwood Hospitals NHS TrustJohn Findlay Final Year Medical Student

Nottingham UniversityRebecca Herbertson Medical Oncology

Weston Park Hospital, SheffieldJames Hopkinson General Practitioner

NottinghamJohn MacFarlane Consultant Physician and Professor of

Respiratory MedicineNottingham University Hospitals NHS Trust

Sir Peter Morris Former President of the Royal College of

Surgeons of EnglandDavid Powis Assistant Dean and Director of Teaching and

LearningUniversity of Newcastle, AustraliaZudin Puthucheary Specialist Registrar in Respiratory Medicine

Southwestern DeaneryGemma Wilkinson General Practitioner

NottinghamSpecial thanks also to Gemma for writing Chapter 19, Rebecca for the bril-liant cartoons and to our family, friends and colleagues for supporting usthroughout this project

viii Acknowledgements

Chapter 1 A challenging career

The decision to study medicine at university should not be made without agreat deal of thought At the age of 17 years it is difficult to know whether youwant to go to university at all, let alone study for at least 5 years It should bediscussed with family and friends but must be an individual decision Thosearound you are likely to have differing views; parents and teachers may feel thatmedicine is a respected profession and possibly encourage you to take this pathbut some doctors may try to dissuade you Whilst listening to this generaladvice, you must try and ignore these opinions and pressures and try to make

up your own mind Without experiencing life as a doctor, it is difficult to knowwhat it will really be like We all know friends who have avoided medicine fol-lowing their personal experience with one or both parents as doctors In com-parison many students, after experiencing their own family life, do decide tofollow in their parents’ footsteps Although relatively common, do not be per-suaded or coerced into studying medicine by your family – it is YOUR decisionand YOUR career for the rest of your life

University is only the tip of the medical career iceberg; the remaining 40years of medicine can be very different Whilst this career can be challenging,rewarding and exciting, it can also be hard work, stressful, tiring and, at times,mundane Have you the right personality, not just for the university days butalso the longer term? The majority of sixth form students have no idea whatuniversity and a career in medicine will be like, and embark on this journeyblinkered by this lack of insight However, knowledge can be gained by talking

to current medical students, career advisors, GPs, hospital doctors, and by ing books on the topic of studying medicine and perusing medical journals It

read-is also essential to spend time in and around a hospital or GP surgery, known

as work experience or voluntary work

Students have differing motivations for choosing a medical career: familytradition has been discussed, others have experienced medicine as a patient,some have an interest in science, a minority have wanted to become a doctorsince the dawn of time and many just feel that they want to help people It isimportant to realise that there are other jobs and university courses that would

1

fulfil many of the reasons that students often state for studying medicine; a lifefollowing one of these different paths could be just as rewarding Rememberthat there are a number of wrong reasons for pursuing medicine as a career.Once you are sure of your future career, you should check that you havethe right attributes and qualities Although academic excellence does notalways equate to good clinical skills as a doctor, there are minimum require-ments for entry into medical school If you are not likely to get high grades at

A level, it is unlikely that you will be offered a place to study medicine, asthere is great competition for places Apart from academic pursuits, it isimportant that applicants demonstrate other interests and abilities Manypotential candidates will have a history of sporting or musical interests and

2 The essential guide to becoming a doctor

The decision to study medicine at university should not be made without a great deal

of thought

Possible advantages to a career in medicine

• Five years at university

• Almost guaranteed a job following qualification

• Reasonable salary

• Diverse range of specialities

• Respected profession

• A job for life

• Opportunity to work in a team

• Sociable work environment

• Structured career

• Opportunity to work abroad

these attributes can be important However, we do not recommend mencing a new hobby for the sake of it, immediately prior to applying!Whilst deciding upon a medical career, it is important not to be disillusioned

com-by the negative media publicity or the drama depicted in television grammes; these are two ends of an extensive spectrum and the majority ofthe work of a doctor can be routine In terms of adverse publicity: doctorshave not just started to make mistakes; doctors probably make fewer mis-takes now than ever before; the difference is in the expectation and knowl-edge of the general public Mistakes are now less tolerated and with theadvent of the Internet, patients are more aware of their diseases and alsotreatment options

pro-A challenging career 3

Possible disadvantages to a career in medicine

• Five years at university

• Possible job insecurity

• Lack of flexibility in training

• Litigation (being sued)

Some colleagues may well know that it is their destiny to become a brain geon but the odds are that these people will change their minds over theforthcoming years The idea of a speciality is different to the reality For manythe final decision to study medicine will be made shortly before sending offthe UCAS (University and College Admission Service) form This decisionshould be made only after careful thought and research about the careerahead As previously mentioned, academic success is important but do not

sur-be disillusioned if your predicted A level grades are lower than necessary.Remember that these are a prediction following one set of exams Once thedecision to study medicine has been made, then follow through by complet-ing the application process It is still possible to be invited for interview and

gain an offer of a place Once this has been achieved, now is the time to studyhard to gain the grades required (usually a combination of A and B grades).

If a candidate is unsuccessful in obtaining an offer then it is still important toconcentrate on gaining good A level grades Once the results are published inAugust it may be possible to find a place at university through the clearingprocess This is unusual in the case of medicine but certainly not impossible

A different degree course could be chosen and it may then be possible to change

to medicine at a later date Alternatively it is now possible to apply to a uate entry course following a first degree The final option would be toembark on a year off (gap year) and reapply to your chosen universities withyour A level grades known

grad-4 The essential guide to becoming a doctor

The job of a doctor can be challenging, rewarding, exciting

but also hard work, stressful, boring and routine

The decision to study medicine is just the beginning Now it is necessary todecide which university and, for some students, which country It is likely youwill have a great time whichever institution you end up studying at.Remember that not all universities are the same and at some the workloadcould be greater and the social life less This is why research before applyingcould save heartache later Once at medical school, the majority of those stu-dents who wish to become doctors do eventually make it through Somedecide that medicine is not the career for them and either leave or change toanother degree Likewise some students embark on other science degrees andfind that medicine would be more suitable so make the change then If youare unsure about your future career, then a possible option might be to study

at a medical school offering intercalated degrees as part of the course Forexample, at Nottingham, the preclinical work leads to the degree of Bachelor

of Medical Science (BMedSci), followed by a research project in the thirdyear After this a student could leave the medical school and pursue an alter-native career with a degree under their belt

to study medicine One interesting aspect is that with the increased number

of places at medical school and the reduction in the number of trainingposts, we will no doubt see unemployed doctors for the first time The days

of being guaranteed a job following graduation could be over and there will

be greater competition for employment especially in more sought after tions Modernising medical careers (MMC) is a government-led initiativewhich has been introduced to make training at all levels more formalised.Following medical school, newly qualified doctors now join a 2-yearFoundation programme rather than the traditional 1-year Pre-registrationHouse Officer (previously known as the Junior House Officer year) Moreinformation about the current and future training can be found in laterchapters Our recommendation would be to keep up to date with the changes

loca-by viewing the British Medical Association and Modernising Medical Careerswebsites (see Appendix)

A challenging career 5