FAST-tracking graduates into specialty training programs could come at a cost as junior doctor’s early specialty preference only translates into a career about half of the time, a study from the UK suggests.

Using data collected from UK doctors who graduated between 1974 and 1996, researchers compared how closely individuals’ choice of specialty at postgraduate year 1, 3 and 5 corresponded to the specialty they were working in 10 years after graduation.

They found half of those surveyed were working in a specialty other than the one they had selected in their first postgraduate year, and a quarter were working in a different specialty to the one selected at the third postgraduate year.

The effect was consistent across five cohorts of junior doctors despite changes in postgraduate training programs; however, differences emerged for different specialities.

The highest match between year 1 choice and destination speciality was seen in general practice, although only half of doctors in general practice had specified it as their year 1 postgraduate preferred option.

“… less than two thirds of doctors who aspired to surgery in year 1 were surgeons in year 10; however; nine out of 10 doctors who were surgeons at year 10 had specified surgery as their first choice in year 1,” the researchers wrote.

Moves to fast-track graduates into training programs, as has occurred in the UK, raise questions about the ideal time for making such significant career choices, the researchers said.

Since eventual career destinations were more likely to match with the specialties chosen three years after graduation than those chosen at year 1, the authors advocate a system of two pathways to specialty training; a fast-track option at the end of the first postgraduate year, and an option for later entry.

“For some specialties, postgraduate experience before final commitment is important because exposure to the specialty in medical school is necessarily limited,” they wrote.

BMJ 2010; 340: c3199 doi: 10.1136/bmj.c3199.
Posted: 12 July, 2010

One thought on “Flexibility needed for timing of specialty training choices

  1. Matthew says:

    Fair and not unexpected results. Early selection is great if you really know what you want from the start. However, fast-tracking carries the risk of narrow sub-specialisation, with ‘single organ doctor’ tendencies emerging. There is value in broad experience early on, even if you have known since in utero that your purpose in life was to become the world authority on the left little toe.

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