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Finding your niche

The journey to your subspecialty choice

Factors that determine our choice of specialty are complex and multifactorial. Most doctors do not end up following the path they thought they would when they began medical school, or even after graduation.

The Bland-Meurer model explains that specialty decisions are based on personal and social goals, and on our perception of which subspecialty will achieve these. The problem for trainees is that most of our career decisions need to be made at a young age, when it can be difficult to predict what our future life and social goals may be. In addition, we may have limited exposure to subspecialties so our perception of them may be inaccurate. It is, therefore, of little surprise that subspecialty choices and goals may change over the course of your training time.

Maria Satchi, Specialist Registrar in the Kent, Surrey & Sussex Deanery, takes us through her journey as she decided which urological subspecialty was right for her.

“ ... The journey starts from the day you graduate from medical school, and is one you can never really be prepared for.  We work hard to compete for a core surgical number, and even harder to prove we are deserving of a national training number in urology. Once in urology, we are soon asked "What do you want to do?". For some of us, the answer is crystal clear, for others it can be confusing and daunting. 

"Who do I want to be?" versus "what I think people want me to be" were two questions I was asking myself during my training. I distinctly remember the first registrar teaching day - we were asked our sub-specialist interests.  It was overwhelming, I had just got my NTN! "Pelvic oncology" I blurted out! Yes, I was going to do pelvic oncology. I loved open surgery, the complex cases, the pre-operative planning of technically challenging cases - yes it was obvious, I was going to do pelvic oncology. There was no further discussion after writing my choice on the flip board for all to see, just applause. So, I proceeded with my choice.

I chose jobs based on exposure to pelvic oncology and sought honorary contracts at cancer centres in the region to be able to assist in the big cases - any opportunity to get one step closer. Midway through training however, life changed. I got married and life wasn’t just about me anymore.  I needed to choose a rotation close to home to support a healthy marriage and life outside work. I felt a little lost, still wanting to - or needing to (I am not sure) - do pelvic surgery but maturing slightly to realise that this ultimate career path would limit time spent with things that had suddenly grown in importance – my family.  I was, needless to say, confused.  I confided my fears with consultants I had worked alongside who reassured me that although challenging, maintaining a work-life balance was possible in the world of pelvic oncology. Most of my training was alongside male consultants who I had tremendous respect for, and was reassured that, if they could do it, so could I. 

In my ST5 year, I chose a placement closer to home and, as I rotated into this new job, I found my job plan was different - I was to work mainly for one consultant. I had entered a system of a consultant - registrar partnership/mentorship. My new boss was not a pelvic oncologist but had a specialist interest in andrology. Needless to say, I was worried. I had a glitch in my plan. Despite my initial apprehension, with this new mentorship I became acutely aware of swift personal clinical and surgical progression. We did core urology,  benign open cases, paediatrics and benign andrology. I suddenly found myself enjoying the andrology side of the job most.  

Things changed, and it was as if the seas parted and things became clear. I had found a sub-speciality interest I enjoyed, wanted to know more about, and the best part was working alongside a mentor who supported this enthusiasm. I wanted a sub-speciality interest that was mine, something I could offer and here it was.

 I ultimately decided I needed more time to master and broaden my skills and from that point of realisation, worked extremely hard to secure a fellowship. Finally, I had found my niche, and it was as if a large weight had been lifted. I wasn’t worried about what my family or colleagues wanted me to be, I had found a sub-speciality that I was good at, that I enjoyed and fitted in perfectly with my hierarchical needs. 

What I think helps:

  1. Find something that excites you – pre and post-operatively.
  2. A mentor, who has experience that they are willing to pass on and allow you to grow into your own independent surgeon.
  3. Identify your hierarchy of needs and priorities to identify things important to you – the work life balance. Speak to people dominating the field of your chosen speciality to get insight into the demands of the speciality and how they balance this with family life – if that is your hierarchical need. 
  4. Using the same hierarchy, gauge whether it is a teaching hospital or district general hospital job you ultimately seek – this may help you identify the level to which you wish to develop your sub-speciality interest.
  5. Be open to change in interest, sometimes we are unaware of our strengths until we tap into them or find a surgical mentor who taps into them.
  6. Get an honorary contract with a tertiary centre which leads in your sub-speciality interest. Sit in clinics, scrub in for cases.  It gives great insight into seeing whether it is for you and will help open doors to future opportunities.

Once you reach your goal, remember those who helped you reach this goal when you started climbing, and don’t forget to look back and offer the same helping hand to someone who is starting their climb ... "


How good is my job and what should I be doing?

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JCST quality indicators & the CCT checklist

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Should I do a fellowship?

Further information awaited ...