Most often, when a medical student asks for advice about applying for a given specialty (especially the competitive ones), they are told: do research, show your interest and everything else can wait until you’re a doctor. But you have more time as a medical student than a junior doctor. You’re keen and you want more specific advice about how to optimise your time. 

In this article I will show you where to find more concrete advice on the qualities and qualifications you can aim to develop for your specific career goals. Then, I will show you how to plan out the next stage of your training. This is applicable for all stages of training, but the examples are focused on the murky first steps of your career, the junior doctor years.

Surgical training has the most transparent application process and the most information available to guide potential applicants.

In order to get more specific guidance on what you can do, let’s look at some supporting documents: the RACS framework for junior doctors and job descriptions for the posts you eventually want to have. You know that to apply for a surgical programme you will probably do at least one year as an unaccredited registrar, so looking at these job listings actually gives you a lot of information about what kind of person they will be looking for in a few years when you want to apply. 

You can then apply this logic backwards, if you need experience as a senior house officer to become a registrar, what do you need to do to become a senior house officer ad infinitum back to internship. This approach is also applicable to other doctors such as those looking ahead to physician advanced trainee position requirements.

For this example, I have used neurosurgery unaccredited registrar position descriptions, but you can do the same with any other specialty. Comparing the job descriptions for Macquarie University Hospital, Alfred Health, ACT Health, North Adelaide Hospital and St Vincent’s Melbourne found on Seek, Indeed and the Neurosurgical Society of Australia and synthesising the requirements, they consistently want you to: 

• Demonstrate interest and experience in neurosurgery
• Show commitment to teaching
• Some ask for skills as a surgical assistant
• Some ask for post graduate awards and degrees relevant to surgery
• And then the rest are classic key requirements for any medical professional - communicate well with the team and with patients, and be organised.

So the conclusion is, to be a strong applicant for an unaccredited registrar position (PGY-3 or 4), and thus surgical training, your senior medical student years and junior doctor years would focus on developing these characteristics. The same can be said of many applicants applying for any training program. Now I will break down some guidance on how to develop these skills in ways that can be recorded or will be clear to your future referees.

Show interest in your chosen specialty 

The major aspect of your interest would be shown through your work experience, at the point of applying for an unaccredited registrar position (also known as a PHO). You would most likely have completed a few rotations through your chosen department and sampled several others, hopefully leaving you confident about your planned career.

Other ways to show interest include formal degrees such as master’s courses, a growing number of which are delivered online. The topic of these degrees can be guided by your specialty or the selection criteria - for example neurosurgery prioritises degrees in neurosurgery, neurology and neuroscience but also gives points for anatomy, epidemiology, trauma, surgical education, critical care, biomedical science and medical imaging - provided you can show the link to neurosurgery. This means you can hit two birds with one stone by doing a surgical education course to also show your commitment to teaching.

Research degrees are also a strong choice, for the same reasons listed above and giving you a chance to develop a strong one-on-one connection with your project supervisor, is especially helpful if they are a clinician-scientist. Consider the importance of research in your planned career and the expectations placed on the registrars in your specialty.

Show commitment to teaching 

Formal commitment can be shown through taking one of a growing number of degrees in health professional education (Monash, JCU and UWA). Less rigid arrangements are easier to pursue. Often consultants are happy to sign off that you have organised a tutorial series for medical students or other department staff, Medical Education Units will confirm any work you do for intern and resident teaching as you progress. Lecturing and running tutorials for medical students at a medical school is also possible.

Private surgical assisting

Specifically for surgery, this job gives you more experience in theatre and increases your familiarity with common procedures.  It can also provide networking opportunities to meet surgeons you might want to work with, do research collaborations with or simply gain their advice and mentorship. Some people do this as part time work while doing full time research to develop their clinical skills. It helps them maintain contacts and support themselves while researching/studying. 

Some junior doctors find private work locuming or with a longer-term contract, allowing them to develop connections with the specialists in their area on their own terms, as opposed to hoping for a rotation on the whims of your public hospital’s workforce.

Development as a team member and clinician

Focus on the feedback you receive in each rotation and also consider some non-traditional growth areas. You might consider taking on a leadership or communications course (through a university or your hospital employer or teach these skills to medical students. You can be guided as to what level of clinical responsibility you should aim to be comfortable with by the RACS JDOCS Framework, which takes you through PGY-1 to 3 with incremental increases in skills across the RACS surgical competencies. Many of these clinical skills are also applicable to non-surgical doctors and it is a helpful guide with expectations that build year on year.

Choosing your own path

With all of these options, not every candidate will have their fingers in each pie. You might prefer to focus on research and clinical work and not develop your teaching skills as much, or any other combination. If you secure an unaccredited registrar position, you could seek feedback on all of these aspects and find out which parts the department believes you are strongest in and where you can focus your personal development for the duration of your term. 

So, now you have the approach to establish where you want to be in a few years when applying for a training registrar position, it is important to determine the order in which you do things, and set SMART goals over this time period.

SMART goals

If your goals are Specific, Measurable, Achievable, Relevant and Time-bound you are much more likely to achieve them and by planning ahead you can make sure that the work intensive sections of these goals do not coincide avoiding high stress periods.

An approach is to establish several streams on which you will build your career such as education/courses, teaching, research, and clinical skills. Then work backwards from your hopeful date of application, giving yourself ample time to complete each stage. 

This is an example of an ambitious career pathway for a neurosurgical candidate, it’s important to be sensible and honest with yourself about what is a reasonable commitment and time frame (no one finishes a PhD in 1 year, most go over 3).

Based on the surgical selection criteria you can determine how much research and how many courses you want to have completed when you apply. As these can take years from beginning to end, you can backdate how early you should start. For example, if you want to apply in PGY-5 with 2 masters degrees - one in surgical education and one in neuroscience - these would both take approximately 2 years, so starting later than the beginning of intern year is likely to delay when you feel comfortable applying.

Senior Medical School

At this point in time you have more free time and more flexible time than as a doctor but many of the formal degrees/courses available to doctors are not open to you. This doesn’t prevent you from preparing for them. Some postgraduate courses will allow medical students to enrol, especially in the graduate certificates which you can then continue into a diploma or masters once you graduate medical school. 

If you are considering published research timelines, it can take 6-12 months to get a manuscript accepted and published by a journal, so it should be complete by the end of PGY-3. The research work probably needs to start at the beginning of PGY-3 or even during PGY-2. And remember that research builds over time, so starting with a team in senior medical school and working on several projects over the years is more likely to produce larger, more interesting publications. 

Internship (PGY-1)

There is nothing to stop you from sitting GSSE in PGY-1 or 2 and studying for it during your senior medical school years. Some registrars and consultants have commented that it is actually easier as an intern with the breadth of theoretical knowledge from medical school than as a senior house officer when you have focused on a specific surgical specialty. 

If you are keen on surgery, you know you will be completing EMST, CLEAR, CCrISP, ASSET, TIPS, Operating with Respect and Hand Hygiene. Many of the skills courses can be done in Australia, the UK, and Singapore - it is possible to plan ahead and do one or more of these on a trip to the UK or Singapore for a holiday. Eligibility for these courses varies, some can be done in intern year, while EMST is for PGY2+ and CCrISP is for PGY3+, so be sure to check this when planning.

Junior House Officer (PGY-2)

With GSSE out of the way and forming a foundation of knowledge for your practice, this year you can focus on building your clinical, communication and technical skills. You can also begin/continue to complete the RACS courses you haven’t done. With general registration you can now look into alternative options like private assisting and locum work, these may give you more hands-on experience than you could get in your public job.

Senior House Officer (PGY-3)

Like the previous year, you have a lot of balls in the air and if you can keep juggling and keep improving then this year doesn’t require any new goals. 

These are the broad stroke plans for long term goals, but SMART goals can also be utilised for short and medium term goals too, such as the steps of a research project or building specific skills over a term. Most importantly, revisit this process at least once a year. So much can change and so quickly that the goals you write in 2020 may be very off-base in 2022, but it is easier to change course if you already have a roadmap.