5 Simple Rules for a Successful Transition from Trainee to Early Career Psychiatrist

RULE #1: EMBRACE FAILURES – IF AT FIRST YOU DON'T SUCCEED, THEN DUST YOURSELF OFF AND TRY AGAIN.

At various times in our training, we failed (e.g., training interviews, psychotherapy long case, essay-style examination).

Each failure was difficult, and we struggled to get over it. In retrospect, however, the hardest thing to get over was our own expectations.

In other words, we found it difficult to get over ourselves and get over the narcissistic injury. We have found ourselves resorting to more primitive (or immature) coping methods, using defence mechanisms like denial (surely, they must’ve got the candidate number wrong) and distortion (maybe, the College needed to fail everyone to make them look better).

It was not difficult getting stuck in the paranoid-schizoid position. Over the years, however, we learnt that a healthier way of getting over ourselves was to embrace failures. We learnt to take the mickey out of ourselves (humour), try to be altruistic (how could my experience help other trainees?), and thrive to sublime (anger and disappointment get transformed into articles like this one). Once you get your ticket, nobody cares about which assessment you failed during your training anyway.

What you do get out of these failures is the reassurance that:

1. You will fail again, and then again, even as a consultant, but
2. You will overcome the failure again, then again, like that Aaliyah song. “The secret of life”, as written in The Alchemist, “is to fall seven times and get up eight times”. How you get up is more important than how you fall.

RULE #2: TAKE BREAKS – A LOT OF IT, FREQUENTLY.

Taking a break is not something we are good at. There seems to be a part of us that worries that it is selfish or inconsiderate to take breaks.

As many habits are difficult to implement, we suggest that you build your environment, so it is hard not to force the habit. For example, when you finish your training, take a couple of weeks off before starting your first consultant job.

Plan leave in advance – one of the most precious pieces of advice we were ever given went something like this:

Build in a series of short breaks into your year, every six to eight weeks. Even if it is two to three days of professional development leave, you need to have a regular and frequent opportunity to rest.

Unlike training, where the race’s objective is to sprint through the five years, being a consultant is more like pacing for an ultra-marathon. You can’t keep running the whole race. We also recommend being generous with taking time off work for family events like your children’s sports day.

To borrow the title of a best-selling book: it’s just 18 summers before your children grow up. Your career may last for more than double the number. So taking breaks day in and day out is also important. This means ensuring that you do not have access to your work email on your phone (if you take one thing from this article, this should be it).

Dedicate a block of time for rewinding – this may be binging on the West Wing episodes with your spouse or going for a slow jog by yourself in the dark. Regular and frequent breaks will prevent you from having a prolonged breakdown.

RULE #3: BUILD YOUR CIRCLE OF SAFETY.

We wrote about this in our article about trainee welfare [Kim et al., 2019] and a previous blog post on the hub. [Suetani 2019]

We borrowed the idea of the circle of safety from Simon Sinek’s bestselling book Leaders Eat Last. However, we believe this is so important during the transition to a consultant that it’s worth re-emphasising here.

In essence, the circle of safety is an environment you create for yourself. As a result, you feel confident that you have the support you need to overcome the challenges you may face as a newly minted psychiatrist. We recommend you build the circle by working on three distinct peer networks.

1. Vertical Peer Network

• People above you and below you professionally form your vertical peer network. Your line managers and service directors fall into this category. As a new fellow, it is critical to continue to have supervisors and mentors you can keep in touch with.
• It may be worthwhile making the arrangement a little more formal (i.e. booking in a regular meeting every three months rather than catching up for casual coffee when you can). Being an early career psychiatrist also provides a unique window of time to pay it forward. You are still young enough to vividly remember the content and the pain of exams and assessments, but you’ve got the ticket to say that you’re now competent.
• Your words of wisdom and practical advice would be appreciated by many trainees struggling to cruise through the fellowship.

2. Horizontal Peer Network

• Your colleagues around you form your horizontal peer network.
• There may be a group of consultants finishing around the same time as you, or you may want to call someone who finished a year or two above you.
• Upon starting your first consultant job, you will quickly realise that you are far from prepared to be a consultant despite achieving the “junior consultant” standard in all your assessments. To reduce the inevitable feeling of being an imposter, it is useful to have a group of colleagues you can share your insecurities with.
• A peer review group is an obvious way of doing this (and this is also a College CPD requirement), but something much more casual like a WhatsApp/Signal/Telegram group may also be effective.

3. External Peer Network :

• Work hard on maintaining your relationships with the people who matter most. This is what could be termed your external peer network. This is your friends, family, and you may also consider adding your therapist. This network allows you to keep things in perspective.
• We do not necessarily feel that everyone needs formal psychotherapy but have met more and more psychiatrists who report tremendous benefit from this.

Combining these three peer networks – vertical, horizontal, and external – you have your circle of safety. Of course, it would help if you continued working hard on building and maintaining this circle throughout your career. The idea is that within this circle, you will feel comfortable enough to practice being a competent psychiatrist that you have now become.

RULE #4: BE PROMISCUOUS (PROFESSIONALLY).

Be promiscuous professionally, especially at the start of your career. Your first job should not be your last. Every three to five years, consider trying a different position, working with different people, and experience new professional challenges.

In the ultra-marathon of being a psychiatrist, taking the “scenic route” maybe both refreshing and necessary. You may want to locum for a bit, consider working part-time, you may even need or want to take some time off medicine completely.

Come to think of it, life as a consultant may be more like a hike rather than a race. The temptation to compare trails is still there but is faulty. You are not taking the same trail as anyone else, and it is not about speed or distance.

Consequently, as a fellow, it is harder to set clear goals/career destinations. Your growth looks more like a lava lamp – in all directions at different times rather than it being a linear line.

To misquote Soren Kierkegaard:

Your career can only be understood backwards; but it must be lived forwards.

Continuing with the theme of being promiscuous, we also suggest you keep a wandering eye towards good books. Now that you’ve finished your training, you can actually read for fun. We recommend anything written by Cal Newport or Michael Lewis.

Catch-22 by Joseph Heller remains most relevant to this day. Barbara Kingsolver writes novels like poems, and Margaret Atwood takes you to a different dimension.

As a senior psychiatrist once said to us:

The beauty of psychiatry is that you learn your art with every book you read, every film you watch, and every song you sing.

The art of psychiatry is not usually found in textbooks. Instead, practice it by reading books, watching films, and singing songs.

RULE #5: “BREAK ANY OF THESE RULES SOONER THAN SAY ANYTHING OUTRIGHT BARBAROUS”.

We want to finish by borrowing George Orwell’s final rule of writing from Politics and the English Language.

The rules we’ve put together are not written in stone. They are just the main things that came to our minds when we thought about things we wish we had known or considered before we finished training. They do not always apply to everyone all the time.

Take what is helpful and reject what is not.

It is a bit like the scene from Alice in Wonderland:

One day Alice came to a fork in the road and saw a Cheshire cat in a tree. “Which road do I take?” she asked. “Where do you want to go?” was his response. “I don’t know,” Alice answered. ‘Then,’ said the cat, ‘it doesn’t matter.”

We are sure you will find your own way of struggling through the transition period between a trainee and a fellow – but we hope at least some of what we have put down is helpful for you.

Onwards and upwards.