On the treatment of the young: Part 1 of 2
I have watched with despair the little-to-no help some cardiothoracic surgical trainees are given when they approach the end of their training and it is time to look for help and guidance to obtain a fellowship and/or employment. Similarly, I have seen the way junior consultants are treated appallingly poorly by more senior consultants and institutions when starting out in practise. It reflects poorly on some in positions of influence in the cardiothoracic surgical community. To use a favorite theme of mine, these behaviours are highly unprofessional. I will discuss these two situations in separate postings.
I believe that it is the responsibility of the staff at teaching institutions to help residents approaching their final years of training to find a consultant's position or an appropriate fellowship. This happens to a lesser or greater degree, sometimes with zeal, but more commonly not at all.
The first step in the process is guidance and counseling. First and foremost, teachers and mentors must be honest about what they believe should be the best path for the resident to choose. Not all residents are researchers or exceptional technicians. They should be counseled accordingly. If there is agreement on the path chosen, teachers should take an active role to help the resident get there. This should not be done informally or inconsistently. It should be part of the commitment taken when training a resident.
For example, if it is agreed by all that, based on abilities and goals, the best thing for the resident is to go into a non-academic, community practice, the resident should not be left alone to seek out a job. Everyone at the training institution should help in the process. Surgeons know what is going on in the job market. Positions opening are not much advertised. This information should be used for the benefit of the resident. In addition, scheduled and regular meetings should be held with the resident, along with the program director or a mentor, to discuss and act upon issues such as lettres of application, CV writing, reference lettres, interviews, advice on salary negotiations, requesting priviledges, licensure, etc. Formal discussions should take place at divisional meetings about the progress of the 'job hunt' and document this in the minutes. All these efforts should be taken well in advance of the end of training and not be an eleventh hour scramble.
The same effort and use of resources should be applied to search for the best fellowship, if that is the path to be chosen.
Sometimes a resident wishes to go into practise right after training, but his mentors may feel he/she should pursue more advanced fellowship training, because of good inherent potential. In the end, the final decision will be made by the trainee. However this should not negate the support given, as described previously. The opposite situation is more problematic. This occurs when a resident wishes to pursue further advanced training, yet his/her mentors feel that the trainee is not the best candidate for this. In fact, this path may not be in the best interest of the resident and the profession as a whole. And even occasionally, it may be felt that the resident would benefit from additional training at their own institution. This is a pedagogical quandary I cannot solve in these pages. All I must insist upon is that the teachers be honest about their impressions as early as possible during the resident's training.
A variant of the circumstances described above occurs when a division is interested in recruiting one of it's residents. The division head should have a formal discussion with the resident. The conversations should detail the direction of the division and how the trainee, as a consultant, can be a part of this vision. It should also detail what the division would want from the resident, specifically related to further clinical and/or research training. If there is agreement in principle, efforts should begin, with the resident, to arrange for fellowship training, as described above. In addition, there should be financial support for the endeavour, and furthermore, lettres of intent exchanged.
I have never seen the degree of support I describe above given to any resident, but I have seen it come close. This has been in the context of getting a fellowship and returning to work at that institution. However, this has been the exception. It strikes me as odd the degree of apathy teachers can have towards their pupils' future, when they have invested so much time and effort in there training.
The overwhelming and unfortunate reality I have seen is that residents receive very little help or guidance to find a job or a fellowship, other than the occasional phone-call. Many go away to do fellowship training with vague and non-committal statements of interest and very little promise of anything at the end of it all. There is a cloak and dagger attitude to recruitment: 'Go away and do your fellowship; keep in touch and we'll see', while backroom and hallway discussions take place. Eventually, last minute offers begin to surface. I find all this very disturbing. It is in no way supportive of new young surgeons and it is certainly no way to treat a future colleague.
One has to invest in the future and this means supporting the young. This includes helping them take the final steps towards a productive professional life. We should strive for them to be better than we are. Their achievements should reflect the investment and care that was taken to train and educate them. In the end, their success is our own.
I would like to acknowledge Drs. André Duranceau and David Sackett, for planting the seeds that led to many of the ideas I discuss above.
I believe that it is the responsibility of the staff at teaching institutions to help residents approaching their final years of training to find a consultant's position or an appropriate fellowship. This happens to a lesser or greater degree, sometimes with zeal, but more commonly not at all.
The first step in the process is guidance and counseling. First and foremost, teachers and mentors must be honest about what they believe should be the best path for the resident to choose. Not all residents are researchers or exceptional technicians. They should be counseled accordingly. If there is agreement on the path chosen, teachers should take an active role to help the resident get there. This should not be done informally or inconsistently. It should be part of the commitment taken when training a resident.
For example, if it is agreed by all that, based on abilities and goals, the best thing for the resident is to go into a non-academic, community practice, the resident should not be left alone to seek out a job. Everyone at the training institution should help in the process. Surgeons know what is going on in the job market. Positions opening are not much advertised. This information should be used for the benefit of the resident. In addition, scheduled and regular meetings should be held with the resident, along with the program director or a mentor, to discuss and act upon issues such as lettres of application, CV writing, reference lettres, interviews, advice on salary negotiations, requesting priviledges, licensure, etc. Formal discussions should take place at divisional meetings about the progress of the 'job hunt' and document this in the minutes. All these efforts should be taken well in advance of the end of training and not be an eleventh hour scramble.
The same effort and use of resources should be applied to search for the best fellowship, if that is the path to be chosen.
Sometimes a resident wishes to go into practise right after training, but his mentors may feel he/she should pursue more advanced fellowship training, because of good inherent potential. In the end, the final decision will be made by the trainee. However this should not negate the support given, as described previously. The opposite situation is more problematic. This occurs when a resident wishes to pursue further advanced training, yet his/her mentors feel that the trainee is not the best candidate for this. In fact, this path may not be in the best interest of the resident and the profession as a whole. And even occasionally, it may be felt that the resident would benefit from additional training at their own institution. This is a pedagogical quandary I cannot solve in these pages. All I must insist upon is that the teachers be honest about their impressions as early as possible during the resident's training.
A variant of the circumstances described above occurs when a division is interested in recruiting one of it's residents. The division head should have a formal discussion with the resident. The conversations should detail the direction of the division and how the trainee, as a consultant, can be a part of this vision. It should also detail what the division would want from the resident, specifically related to further clinical and/or research training. If there is agreement in principle, efforts should begin, with the resident, to arrange for fellowship training, as described above. In addition, there should be financial support for the endeavour, and furthermore, lettres of intent exchanged.
I have never seen the degree of support I describe above given to any resident, but I have seen it come close. This has been in the context of getting a fellowship and returning to work at that institution. However, this has been the exception. It strikes me as odd the degree of apathy teachers can have towards their pupils' future, when they have invested so much time and effort in there training.
The overwhelming and unfortunate reality I have seen is that residents receive very little help or guidance to find a job or a fellowship, other than the occasional phone-call. Many go away to do fellowship training with vague and non-committal statements of interest and very little promise of anything at the end of it all. There is a cloak and dagger attitude to recruitment: 'Go away and do your fellowship; keep in touch and we'll see', while backroom and hallway discussions take place. Eventually, last minute offers begin to surface. I find all this very disturbing. It is in no way supportive of new young surgeons and it is certainly no way to treat a future colleague.
One has to invest in the future and this means supporting the young. This includes helping them take the final steps towards a productive professional life. We should strive for them to be better than we are. Their achievements should reflect the investment and care that was taken to train and educate them. In the end, their success is our own.
I would like to acknowledge Drs. André Duranceau and David Sackett, for planting the seeds that led to many of the ideas I discuss above.
posted by Luis G. Quiñonez, M.D. at
3:24 AM
1 Comments:
I must say, either medical residents and fellows are babies, or you want them to be babied.
While I do agree that it is only in the best interest of everyone if supervisors and mentors be involved in the future directions taken by their understudies (due to all the relevant reasons you duly note), in the end, doesn't acquiring a job ultimately depend on the efforts of residents and fellows who make stuff happen for themselves and not depend on others to make stuff happen for them, and through unofficial discussions regarding potential future opportunities?
More notably, shouldn't a resident or fellow know how to search out and apply for positions, should they not know how to write CVs?!
Further still, not every division head has such control over budgets and administration that they can gurarantee things two to three years down the road. Even if promises are made, I would warn anyone that believes them that they are dealing with institutional time and human bureaucrats who will slice you ear to ear before admitting to anything they've said.
Anyhow, I tend to agree that considering the investments made on trainees, it is somewhat illogical to suddenly cut their leash and see them run around all confused, but really, isn't that more fun than having to find someone a job?
Nonetheless, a relevant critique!
:)
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