A Tale of Two Countries

The words “career guidance” hold different meaning for pathologists from dissimilar backgrounds. Those who are lucky think of mentors who introduced them to new opportunities, structured programs that helped them identify and explore their interests, and a system designed not only to welcome them into the world of pathology, but to help them grow and develop within it. Those less fortunate may have fewer associations with the phrase – or possibly none at all. Imagine the surprise when international medical graduates move to a country with a broad base of support for trainees and early-career pathologists. They begin to understand just how much help good career guidance can provide. It’s an area in which I think many developing healthcare and medical education systems are lacking, and one in which I think we must start learning from one another, if we want to give our aspiring pathologists the tools they need to succeed.

A guiding hand

In Pakistan, medical students look for career guidance from their senior colleagues, friends, and fellow college students – in particular, “house officers” (equivalent to foundation doctors in UK) who have just graduated and started their first jobs. This person-to-person guidance is usually based on individual experience. Unfortunately, a significant proportion of medical students are not personally acquainted with any senior students or early-career doctors, so they often lack the in-depth guidance so necessary to a successful medical career. For instance, those students might choose a specialty based solely on their personal likings – without any familiarity with, or any way of learning about, the details of a career in that specialty (such as working life, hours, exams, nature of the work, length of training, skill and knowledge required) until they are already committed.

Career support and guidance in the UK is very different. It is much more structured, and it begins at a very early stage – in secondary school, in fact. This guidance can take form of apprenticeship opportunities, local careers clubs at school, or nationwide science, technology, engineering and mathematics (STEM) activities offered by the government, charitable organizations, and private employers.

UK medical schools have well-structured career departments, most of which offer guidance on 1:1 (mentee-mentor) basis, as group talks, and even via regular specialty career fairs. Each medical school also has specialty-specific societies known as forums, which help students obtain career-related information and support. These clubs have links with hospital-based trainees and consultants in their relevant specialties who can arrange “career tasters” or “job shadows” for students who want to learn more about a particular field. Students are encouraged to explore various specialties to gain insight into the practical aspects of each one and the differences between them.

Career support in Pakistan

The standard of medical education is very high in Pakistan – it provides a sound knowledge base to use as a jumping-off point. In terms of career support and guidance, though, it all depends on your individual effort – or maybe your luck! My own interest in pathology began to develop very early in my medical schooling. I felt almost immediately that this was something I wanted to do… but, like many of my peers, I did not have access to any kind of career support network; there were no websites related to medical or pathology career options; there was no system in place to arrange a taster week to explore it further or to see the work-pattern of a pathologist.

Soon after my graduation, I moved to the UK. It was only after going through a well-thought-out process of job tasters, aptitude tests and career guidance clubs in my new home that I finally joined pathology. Having such support during my foundation training made a huge contribution to my career decisions, and I finally felt that I was truly making an informed career choice.

Using the UK system

If I could use one word to describe the career guidance system in the UK, it would be: outstanding.

I have found it extremely helpful to discuss my career planning with my supervisor for guidance. The National Health Service (NHS) offers career management workshops free to foundation doctors and medical students, which encourages you to consider the specialties that match your skills, personal abilities and strengths. Those weren’t my only resources, though; in fact, career planning was a mandatory element of my quarterly and annual appraisals. I was encouraged and given protected time to spend time in specialties of my choice to explore them further. I also went to local, regional, and national career fairs, which proved to be extremely useful. They were attended by representatives from each specialty who provided me with information on typical work, practical aspects, work pattern, competition ratios, exams, and essential prerequisites to apply. All extremely useful knowledge to have when selecting a career path to pursue for the rest of my life!

Giving back

After my experiences as a trainee in the UK, I decided that I wanted to help others the same way the system helped me. I took on an active mentoring role. For instance, I’ve developed informative resources like career posters and presentations to be used across the region; I’ve provided one-on-one career guidance to interested medical students; I’ve organized histopathology career stands at local, regional, and national career fairs – and the pathology section of the University of Birmingham’s Virtual Career Fair; I’ve presented exploratory workshops on pathology as a STEM ambassador in local schools. I have also taken on some more formal roles to promote pathology as a career option – as regional lead trainee for careers in pathology and as Public Engagement Regional Coordinator with the Royal College of Pathologists.

Words to the wise

None of the platforms I’ve mentioned exist in Pakistan – and I think it’s likely that other developing countries lack those resources as well, despite huge demand and need. On a recent trip back to Pakistan, I conducted a workshop for careers in histopathology. Feedback and evaluations from the students revealed (unsurprisingly) that none of them had ever experienced a formal career guidance workshop before. Equally unsurprisingly, 100 percent of the participants were keen to have more career guidance in future.

I opted for the workshop format because that’s what I myself found particularly helpful. The workshops in which I participated in the UK gave me a stepwise approach to career decisions:

• self-assessment,
  
• explore your options,
  
• make your decision,
  
• apply and (hopefully) interview.

Our future doctors need a structured career guidance platform. We need to organize career fairs and provide formal career guidance and support (even if only from a distance) to medical students in developing countries so that they can make the same kinds of informed career choices as their peers in other places. This will result in increased job satisfaction, enhanced performance, and – ultimately – better patient care.

My advice to medical students in developing countries is to start their information-seeking journeys at the earliest possible stage of their careers. Without a structured system in place, students may have to seek (or even create) their own guidance by using online resources for self-assessment and contacting specialists themselves to arrange job shadow or career taster sessions. And, once those students have become seasoned doctors with ample experience, I hope that they will turn around and provide future medical students with the opportunity to explore specialties in detail before making career choices.

I have experienced the striking differences between the UK and Pakistani career support systems, and I understand how it feels to practice where resources are limited. Providing guidance and support to our newest colleagues is our responsibility to help future generations of doctors.

Ayesha Azam is a post-fellowship senior registrar in cellular pathology, based in the UK. Her areas of interest include dermatopathology, computational pathology, science communication, and medical education.