Medicine is one of those professions which inspired me right from childhood.

Humanistic values and social

reputation that physician enjoys has motivated many in their tender age to cherish a dream to become doctor.

I was surely one among them. I successfully become first doctor in my family in India in 2002. During my early
years in medical school I was most influenced by surgeons as they not only have reasoning and decision-making
skills and artistic skills to alleviate sufferings of fellow human beings. Most medical student choose interesting
and challenging specialities and procedure-oriented specialities which with better renumeration are obvious
choices. Competitive and social factors in Indian training environment landed me in orthopaedic academic
residency training which I finished in 2006. The completion of Master of surgery in Orthopaedic surgery as part
of the residency training started my career as orthopaedic doctor in India.

which I am an orthopaedic surgeon from Cyprus. I wanted to become a doctor since I was kid when by experience
I realized how musculoskeletal injuries can affected patients’ quality of life. Thus, getting to be an orthopaedic
surgeon was a one-way road for me, because I wanted to influence with my actions the outcomes of injured
people. As a result, during my training, I developed a special interest in trauma. However, after attending a
course about Shoulder and Elbow pathologies I got fascinated with this particular anatomic area of the body and
decided to try fulfilling my goal in becoming a Shoulder and Elbow consultant.

Upper limb function not only is very important in accomplishing daily life activities but also defines who we are.
It is the creative tool that helps us express ourselves. Without proper upper limb function, a wide spectrum of
activities is affected. The patient becomes dependant, or not efficient, at least, to perform even simple daily
tasks. Imagine a young woman with frozen elbow incapable to move her shoulder more than a few degrees
without pain. It would be difficult even to pick up her clothes from the closet with her affected limb. Not only
her work would be compromised, but also her leisure activities, and ultimately her psycho-social status. So, early
in my training, I decided to get involved with shoulder and elbow lesions. However, basic orthopaedic training
in Cyprus did not provide me with the skills to address these pathologies effectively. Thus, I decided to move to
the UK because NHS priorities coincided with mine. We both believe that in order to meet the needs of patients,
all health care practitioners have the duty not only to maintain but also update the knowledge, skills and,
competence required for their professional practice. I also believed that NHS could enable professionals to
expand and fulfil their potential.

An orthopaedic surgeon in the UK, in order to work as a consultant, has to complete his/her training, have FRCS
or an analogous higher orthopaedic surgical qualification and be fully registered in GMC’s specialist list. But entry
in GMC’s specialist list is not sufficient. Consultation is a request made to another clinician to give his or her
opinion on the diagnosis or management of a particular patient. Thus, consultant is the most senior member of
clinical staff in a hospital, communicating his/her opinion on the diagnosis or management of a particular
patient. It is obvious that clinical expertise and effective communication are the foundation underlying the art
of medical consultation. Clinical experience in assessing and managing a wide variety of elective/traumatic
shoulder and elbow pathologies is essential. Besides, a shoulder and elbow consultant should be capable of
independently performing shoulder and elbow surgery, supervise Specialist Registrars and CTs in the operating
theatre and preferentially have fellowship experience in Shoulder Surgery. However, apart from an appropriate
knowledge base, also ability to apply sound clinical judgment to problems is needed, as well as awareness of
constraints, risks and potential complications of management. Moreover, good communication with patients,
relatives, peers, and other multi-disciplinary teams is paramount. A good communicator in medical practice
firstly has to be a good listener, empathising and understanding different cultures, styles and views. He/she has
to be caring, sensitive and concise, clear and informative in the delivery of information to the patients and
colleagues. Notes taking and gestures-body language are appreciated tools in efficient communication as well
capability in the delivery of bad news and conflict resolution.

In modern medical systems, however, it has been realised that for accomplishing safe practice, efficiency and
improvement in health care expertise and communication are not enough (Henwood and Booth , 2016) . First
of all, health practitioners are part of a team where everyone has to work collectively in achieving a common
goal (Silverman , 2013). Thus, every team member must know the aims, objectives, and mission of team; must
have respect for one another; collaborate with others sharing ideas, skills and practices; and eventually, assume
the role of a leader. This is more evident for a consultant who leads a team, whether it is a team of doctors or a
multidisciplinary team including nurses and other health professionals. In doing this effectively, a consultant has
to be enthusiastic, self-confident, persistent, hard worker, able to work under pressure and manage stress
(Henwood and Booth , 2016;Silverman , 2013;Ford , 2010). He/she should not only be able to take initiatives and
provide solutions but also challenge practice, being visionary, innovative and driving change when necessary
(Price and Miller , 2010). In addition, a consultant should inspire by example, demonstrating expertise,
professionalism and clear and rational thinking. Furthermore, good self-managing and organisational skills are
mandatory. Moreover, a consultant should exhibit constant self-motivation and career progression, seizing
opportunities, realising potential and promoting self. Efficient rejection management and negotiation -
persuasion skills are also very important (Henwood and Booth , 2016) . It is also imperial to understand the
financial influence of practice, as well as the principles of clinical governance and audit. Finally, Knowledge of
NHS/Trust policies in the care of the patients within the hospital, the ratification of protocols and involvement
in risk management are desired.

In addition, academic skills, such as teaching and involvement in research are very important. Indeed,
commitment to demonstrating, explaining and teaching undergraduates, postgraduates, trainees and other
hospital staff is essential for safe practice and improvement of the quality of delivering medical art. In this
content, it is very important for the consultant involved in teaching to be able to identify those factors which
facilitate and influence clinical learning of training stuff, including learning theories, intervention planning,
design, delivery, implementation, assessment and evaluation. Moreover, experience in delivering knowledge to
bigger audiences, willingness to develop new approaches to teaching as well as attendance of appropriate
courses in the delivery of surgical education or even post-graduate qualification in medical education are
appreciated qualities although not essential. Finally, the ideal teacher should also be enthusiastic, being able to
involve others in learning and inspire them.

On the other hand, in order to validate the quality of service and drive change, a consultant should be able to
design and conduct original research studies, including data collection and analysis. On the one hand, producing
a clearly written, coherently argued and accurately presented research project report mandates mastery of
Academic writing using relevant methodologies and bibliographic databases. On the other hand, research
necessitates critical knowledge of biostatistics as well as IT skills, such as ability to use web browser, excel, word
and statistical programs. Research publication in peer-reviewed journals on subjects relevant to the shoulder
and elbow sub-speciality, and ability to appraise research critically are desired. Post graduate qualification is also
an invaluable asset to guide critical thinking and familiarisation with research strategies.

In order to improve personal performance and enhance career progression it is imperial not only identify our
desired career role, but also analyse our present knowledge skills and abilities/learning in comparison with those
required by our future projection and conceptualise a development plan based on our learning needs (Hatcher
and Bringle , 1997;Elmore , 2002;du Boulay , 2000) . Actually, I have full GMC registration with entry on the GMC
Specialist Register via CCT after completing my specialist training in Cyprus. During my specialisation, I had the
opportunity to work with a team of consultants and specialist trainees and gain experience within the
orthopaedic speciality, including basic trauma, total knee and hip arthroplasties and basic foot and ankle
procedures. I developed excellent communication skills with patients and relatives and self-awareness of
constraints, risks and potential complications of management. In addition, I became a very good team player,
starting to recognise the value of respect for one another; of collaboration; and of understanding the objectives
and mission of a team. I also acquired good ability in taking accurate medical notes. Furthermore, I attended
and conducted regular interfaculty presentations, in hospital teaching of medical/nurse staff as well as
presentations of interesting cases in regional meetings. Moreover, I participated in several courses and
instructional lessons regarding trauma, foot and ankle and shoulder and elbow pathology. What’s more, my love
for trauma led the local trauma committee to proposed me as an ATLS instructor, having the opportunity to
teach and evaluate health practitioners on trauma management. As a result, I obtained good teaching skills,
always trying to explain, demonstrate and teach trainees and other hospital staff in my working environment. I
also undertook courses of delivering knowledge to others during ATLS instructor course, during which I was
announced as the ideal instructor for being enthusiastic, persistent, hard worker, visionary, innovative, eager to
learn and enjoying myself in doing so. Finally, the last year of my training I commenced a Master’s course in
Orthopaedic Science and Rehabilitation coming in touch with biostatistics and academic writing by preparing a
Thesis using principles of scientific and research method. I am interested to continue research and in this
content, I undertook lessons in Academic writing and wrote an article which is going to be published in a peer-
reviewed journal.

By comparing my actual status and the requirements of my desired role I understand that I have limited NHS
experience and little practice in assessing and managing elective/traumatic upper limb pathologies. The same is
true for more complex general trauma. My lack of experience makes me incapable of independently performing
shoulder and elbow surgery, as I need a larger number of basic operations as first surgeon to acquire more
confidence. Thus, it is obvious that I am not ready yet to supervise other training doctors as I still need guidance
from a more senior surgeon to correct possible mistakes and perfect my practice in basic procedures. In order
to fill my learning gap, I have to continue gaining experience in NHS as it will help me get well acquainted with
UK’s hospital policies, guidelines and culture (Parker , 2006). I also need to gain more clinical experience in
shoulder and elbow pathologies by working under the supervision of a Shoulder and Elbow consultant. Indeed,
by observing more senior surgeons in their clinics, by taking active role in examining patients under the
supervision of a consultant I will be able to identify those aspects of my practice that need development and
which can be improved by reflective practice and by reading relevant books/attending courses and seminars. I
could also subscribe to online virtual study plans which, by providing daily topics by email and monthly
evaluation tests, help doctors in training get in touch with a wide variety of pathologies and identify their
strengths and deficiencies. I should also participate in as many theatres as possible to familiarise with upper limb
theatre setup, draping, tools and do gradually more steps in Upper limb surgery with the scope in 2 years’ time
perform independently many upper limb procedures. Finally, my plan is to do a fellowship in a major trauma
centre for more exposure to complex shoulder and elbow trauma surgery and do a fellowship in upper
limb/Shoulder and Elbow Surgery after a year to observe and practice under supervision of an expert in this field
and finally become efficient in independently performing as a shoulder and elbow consultant (Daniels and
DiGiovanni , 2014) .

I am highly motivated, trying to seize opportunities and realise potential, but I am more sensitive that needed
and I get influenced by negative critic. In this regard, I will try to use criticism productively by self-reflective
practice and by reading relative books/articles (Weisinger , 1995). Attending stress management courses also
helps to control a person's reaction to negative feelings, thus improving everyday functioning (Schultz and
 Schultz , 2015). In addition, my daily practice could improve by regularly participating in clinical governance
meetings and performing one audit every 6 months. Having moved to the UK from Cyprus, I have little
experience with clinical governance and no record of audit work (Manzouri, Flanagan and Hingorani , 2012).
Attending Wolverhampton’s University Clinical Medicine Master’s Module on clinical Governance would also
prepare me for the task of improving the quality of patient care through familiarisation with clinical governance
and patient safety initiatives and help me engage more effectively with the factors that fundamentally affect the
provision of safe, effective and compassionate healthcare for patients. Furthermore, choosing the leadership
pathway in the same Master’s course would help me not only improve as a leader and overcome my difficulty
in guiding other people by providing me insights on how to improve my skills, behaviours and competencies in
the same area; it could also help me contribute in guiding change and healthcare practice improvement by
getting in touch with theories on contemporary management challenges and organisational environments in the
context of the nature and effectiveness of organisational transformation.

Improvement in healthcare practice can also derive by skilled and competent workforce. There is recognition
that this can be accomplished by the provision of excellence in education and training (Mannion and Brotherton
, 2014). Teaching and research is an integral responsibility of all doctors since the age of Hippocrates (Lowry ,
1993) . I have a good teaching experience as an ATLS instructor and I undertook some courses in the same area,
but I dot fully understand and incorporate into practice learning theories. I still trying to adapt teaching to
audience characteristics and I need more development on design and delivery of teaching to incorporate
purpose fulfilling. I am willing o get involved in the teaching of undergraduate and postgraduate students but I
don’t have a Ph.D. I am planning to continue participating in ATLS as an instructor, get more actively involved in
teaching junior doctors and attend more courses in the delivery of education, probably starting a Ph.D in medical
teaching as receiving instruction in Clinical Teaching improves competency and efficiency (Wachtel, et al , 2013).
As far as my involvement in research is concerned, I have some experience in designing and conducting original
research studies, including data collection and analysis but it is limited. I still have some difficulty in appraising
research critically and I have not published any research article in peer-reviewed. I have completed a module in
Biostatics in the Master in Orthopaedic science but I would like to attend also Wolverhampton’s University
Clinical Medicine Master’s Modules on Advanced Research Skills and Research Dissertation as I will get a
thorough knowledge of the research process and I will acquire practical skills for the design and conduct of
research studies.

By materializing the above plan, I hope to start working as a consultant by 2022

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Medical specialty considerations by

medical students early in their clinical
experience
 Charles WeissmanEmail author,
 Rachel Yaffa Zisk-Rony,
 Josh E Schroeder,
 Yoram G Weiss,
 Alex Avidan,
 Uriel Elchalal and
 Howard Tandeter

Israel Journal of Health Policy Research20121:13

https://doi.org/10.1186/2045-4015-1-13
© Weissman et al; licensee BioMed Central Ltd. 2012