Life After the FFICM

by Dr. Ed Hughes

The Immediate Aftermath

So you've done it, you've sat the FFICM. You may feel you've done well, you might feel there was room for improvement. Either way, it's finished for now.

Over the coming days to weeks there is a process of decompression. Slowly, your normal life will return. The guilt of having spare time, where you do not have to revise, will slowly recede. Emerging from hibernation, the old you will come back, a little bit wiser and more cynical in equal measure. I think to describe the exam as psychological trauma might be melodramatic, but there are parallels in the post event processing that occur. It's normal to think back to the day. It's normal to feel anxious about it. This will all pass.

Results day will come around quicker than you think. The spectre of the exam will creep back and it will be a day of anxiously refreshing emails. The result will be surreptitiously delivered in an understated email like the FFICM Written.

If you open that email and do not get the result you were hoping for, you need to know that this exam does not define you as a person or doctor. Sometimes luck just isn't with you on the day.

If you open that email and see the double pass, congratulations. That moment of happiness and relief belongs entirely to you. Savour it. Equally, I think it’s important to acknowledge that It's normal to feel a little underwhelmed. You spent months working towards a huge goal and it all came down to an email. A bit of an anticlimax. Either way, whether you like it or not, your working life is about to change.

Diplomates Day

A brief note on attending Diplomates Day. This is not just an opportunity for you to celebrate your achievement but for everyone who has supported you along the way.

It's a really grand day where what you’ve accomplished feels genuinely recognised by The College and Faculty. My wife and I went with a 6 week old baby in tow and the event staff were extremely accommodating. It's not for everybody. There are definite similarities with a university graduation. If you can’t decide whether you want to go or not, you can defer your attendance to another year by contacting the events team.

What happens next

In passing the FFICM there are now no significant obstacles between you and a CCT in Intensive Care Medicine. You will not be the only person that knows this. All of a sudden you are officially a prospective consultant and colleagues will explore your post CCT intentions in earnest.

You might have very clear ideas where you want to work. I did not. For the majority of my training CCT seemed so for away as to be incomprehensible. Then, suddenly, all barriers were removed. The end of training was rapidly approaching like an event horizon. I very quickly had to answer the question how do you choose a consultant job?

Choosing where to apply of a consultant post

For some people this decision will come naturally. Personally, I agonised over it for months. It caused me genuine angst that weighed significantly on my mental well-being. There were several places that I could envisage myself working. I felt genuine tension between managing what l thought I wanted against external expectations. Ultimately, the influencing factors that l am able to articulate were:

Who are the people you are going to be working with?

This doesn't just mean are your mates in the department. You can't expect to get along well with everybody. In reality a small amount of grit between individuals is needed for the most productive relationships. It means can you trust everyone to have your back?

From the small things, like will someone swap an or call without too much aggravation, up to the big things if your back is really against the wall? This is a two way street, they have to feel you'll fit too.

Does the post fit with your personal life?

Really think about what is important for you in terms of work life balance. Are you prepared to commute two hours for the perfect job, or are you going uproot your family? How many PA's are you going is be working? What are the expectations for you to work more? Does the geography of where you'll be working match the needs of your family, such as are the schools any good, what are the house prices like? Have a talk with any significant other about what the impact of these things will be.

What is the general ethos / vibe of the trust?

Think not only is the department a fit for me, but how does the department fit in the trust? Is this a trust that is ebbing or flowing? Do you want to be a big fish in a small pond or vice versa. Is this a trust in a secure position or is it facing significant internal or external threats. What is the executive or management team like?

Is private practice an option or significant consideration for you?

You might have picked up on how trusts organise private practice if available. This can have a significant impact on departmental relationships. in a free for all there may be more back stabbing and politicking. Some places have managed to set up a syndicate that seems to smooth many rough edges.

Do you have a niche?

Are you the research guy, the management woman, or POCUS person? Does that niche already exist and someone is retiring, or are you going to carve a new one? Will the department be supportive of you doing so?

These are just some of my considerations. They'll be different for you. Speak to the people in the department. If you're applying out of deanery make sure you visit and talk to the people you'll be working with.

Decide early on what you'll be willing be compromise on. If you truly can't decide think about post CCT fellowships or locum posts. The stigma of changing jobs is reducing, so you don't have to get it right the first time.

When you think you know here you'd like to work, speak to the Clinical Director of that department and say you'd be interested in a job there. Most will be straight with you and set your expectations appropriately. If you are a mutual fit you can discuss when jobs might be released and potentially what the person specification of such jobs would be.

If you know when a job is going to be advertised, you need to begin the next step, preparing your consultant CV.

Preparing your Consultant CV.

This is a job that i guarantee will take you longer than you think. Start early and be strategic.

Ideally, as far out from your consultant application as possible take stock of your CV. Look at everything you've done from the time you have left medical school and filter the activities into different categories. These categories are:

  1. Clinical, Including special skills, logbooks, and courses etc…
  2. Leadership
  3. Research
  4. Education and training.
  5. Audit & quality improvement

These domains of your CV are modifiable in the run up to interviews. Each is an essential domain of consultant practice that you'll be expected to evidence and take about in your interview. If you have any significant deficiency in an area focus your time on achieving quick and easily evidenced wins.

You'll be surprised but your ePortfolio, registrar application portfolio, and CV that you've maintained for ARCP will provide quite good sources of content for your consultant CV. There was a point to all that work after all.

Next, source as many example consultant CV's as possible. Good places to find them are recently appointed friends and colleagues, online (e.g. the BMA website), and in consultant interview reference books. Don't be too dispirited in reading your colleagues CV’s. There are two important things to remember:

  1. These documents are people selling themselves in the most extreme way, where minor achievements can be massively inflated in their stature.
  2. Everyone has taken a different path to arrive at the same point. You will have had opportunities that they have not and vice versa. This will he reflected in the differences between your CV's.

Start with the easiest steps. Create a word document called consultant CV. You're on your way. The next low hanging fruit is your personal details and creating the various section headings. Once you've got the headings throw a few comments under each. It doesn't have to be prose. Just words to jog your thoughts. Slowly but surely, formalise the language and content under each heading and before you know it you'll have a nascent CV.

Invite feedback early and often. Pay close attention to spelling, punctuation, grammar, and formatting. Have a friend proof read it for you.

The real value in writing your CV is forcing you to reflect on your strengths and weakness through the prism of selling yourself. It distills your efforts of the last 10 to 15 years into a single document. This makes it really easy to fill in the NHS job application form. With a well thought out and drafted CV completing the job application becomes a process of transference.

Contact your referees before you submit any application form. You'll end up needing about 10, so the process can become a bit onerous. They don't need to say yes, it's just to alert them that something might land in their inbox.

Once you've completed your CV and submitted your application form, the wait begins. If you have done your due diligence in speaking to the department you should at least expect on interview unless you're going for a particularly competitive job.

ARCP and Administration

In the background, in addition to all the above you must keep an eye on your portfolio and general ARCP progress. This is for 2 reasons.

  1. The first is that your ARCP will come earlier than in a standard year, for me it was in early May rather than the usual late June / July.
  2. The second is that your portfolio will be examined with a fine toothed comb. You'll be forced to rectify any deficiencies before you're signed off.

Your goal is to progress though ARCP with the minimum of aggravation. You’ve done this many times before.

Don’t get caught out, make sure you've collected on appropriate logbook, all your modules are signed off (including non-clinical), and that you've done the usual reflections etc.

Once you've had your ARCP and achieved on outcome 6 you must inform the college / faculty. None of this happens automatically. This is done via several forms that are signed by your TPD/RA for each specialty you are CCT’ing in. Complete these forms ASAP as delays may cause problems with your CCT date and starting a job. Once these forms have been completed The College will contact the GMC advising that you are suitable for CCT. The GMC will contact you asking for about £450 and you'll need to complete another online form. If all goes well you registration status will change overnight on the date that you CCT.

Preparing for your substantive consultant interview.

You thought you were done with stressful spoken exams? Ha. Much like a viva, this is not something you can walk into completely unprepared for. However, there are plenty of resources available.

In order of preference, mine were:

  1. Friends and colleagues. The most reassuring for me was speaking to colleagues who had recently interviewed. They can give you first hand knowledge of the day that makes the whole process less intimidating.
  2. The ISC medical consultant interview course. Hands down the best £400 I spent. Just do it. Book on within a couple of weeks of interview. Don't be a shrinking violet when you attend, get used to selling yourself in this confidential and supportive environment you've paid for. You'll get really useful feedback and resources to move forward with.
  3. Your contacts within the department. Hopefully you've got at least one friendly face that you can rely on for some inside information. This can be minor things from pointing you in the direction of just corporate material, hot local topics, to hints on who might be on your interview panel.

Ask the CD of your department who you should meet in the run up to your interview and book in early. Use your conversations with your colleagues and CD to generate some points to talk about at each meeting. in these meetings with various trust big wigs you'll essentially be told the content of your interview if you read between the lines.

On the day, prepare in much the same way you will have done for your FFICM. Project confidence, wear smart clothes you've worn at least once before etc. You'll hopefully have received some communication about the format of your interview, get in touch with the recruitment team if you haven't. Treat the whole thing like a performance. Use the presentation skills you've worked hard on and mastered.

Hopefully, you'll find out quickly if you've got the job. For me, it was several tense hours. When you receive the job offer, confirm you want it, and begin the laborious process of navigating H.R, occupational health, and resigning your training post.

Sincerely, congratulations. You've achieved something great. Years of hard work have lead you to this point. While it feels like the end of something, it's also the beginning of the rest of your career, and I wish you the best of luck.