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As a medical student approaching the end of your journey, the Prescribing Safety Assessment (PSA) looms as a significant milestone. This comprehensive exam is designed to ensure that newly qualified doctors are equipped with the necessary skills to prescribe medications safely and effectively. In this post, I'll share my experience and strategies that helped me achieve a score of over 90% in the PSA, hoping to provide valuable insights for those preparing to take this crucial exam. What is the PSA? The Prescribing Safety Assessment is an online examination developed by the British Pharmacological Society and the Medical Schools Council. It's designed to assess the prescribing competencies of final-year medical students and overseas graduates who intend to practice as Foundation Year 1 (FY1) doctors in the UK National Health Service (NHS). Who Can Take the PSA? The PSA is primarily taken by: Final-year medical students in UK medical schools Overseas medical graduates seeking to work as FY1 doctors in the UK Foundation doctors who need to retake the exam Why is the PSA Important? The importance of the PSA cannot be overstated. Here's why: Mandatory Requirement: Passing the PSA is a prerequisite for completing Foundation Year 1 training in the UK. Patient Safety: It ensures that new doctors can safely prescribe medicines, which is crucial for patient care and safety in the NHS. Alignment with GMC Standards: The exam aligns with the General Medical Council's "Outcomes for Graduates," ensuring that new doctors meet the required standards for safe prescribing. Practical Skill Development: It helps students transition from theoretical knowledge to practical application in prescribing. Confidence Building: Success in the PSA can boost a new doctor's confidence in their prescribing abilities. Exam Structure and Content The PSA is a 2-hour online examination consisting of 8 sections, with a total of 200 marks. Understanding the structure is crucial for effective preparation and time management during the exam. The 8 Sections of the PSA Prescribing (PWS): Writing prescriptions for common conditions. Prescription Review (REV): Reviewing and correcting existing prescriptions. Planning Management (MAN): Formulating treatment plans for given clinical scenarios. Providing Information about Medicines (COM): Explaining medication details to patients or colleagues. Calculation Skills (CAL): Performing drug calculations and dosage adjustments. Adverse Drug Reactions (ADR): Identifying and managing medication side effects. Drug Monitoring (TDM): Interpreting drug levels and adjusting therapy accordingly. Data Interpretation (DAT): Analyzing clinical data to make prescribing decisions. Each section tests different aspects of prescribing knowledge and skills, reflecting the multifaceted nature of medication management in clinical practice. Strategies for Scoring >90% in the PSA Achieving a high score in the PSA requires a combination of thorough preparation, strategic approach, and effective exam techniques. Here are detailed strategies that helped me score over 90%: 1. Master the British National Formulary (BNF) The BNF is your bible for the PSA. It's not just about memorizing information, but understanding how to navigate and utilize this resource effectively. Practice Daily: Spend time each day looking up drugs, indications, contraindications, and dosages. Understand Structure: Familiarize yourself with the BNF's layout to quickly find information during the exam. Focus on Common Drugs: Pay special attention to medications frequently prescribed in primary and secondary care settings. Learn Drug Classes: Understanding drug classes can help you make educated guesses when faced with unfamiliar medications. 2. Hone Your Calculation Skills Calculation questions can be a significant source of marks, and mastering them can set you apart. Practice Various Types: Work on different calculation types - dosage adjustments, infusion rates, weight-based dosing, etc. Use Real-World Scenarios: Practice calculations in the context of clinical scenarios to better understand their application. Double-Check Your Work: Develop the habit of reviewing your calculations to catch any errors. Learn Shortcuts: While understanding the full process is crucial, learn time-saving techniques for common calculations. 3. Develop a Deep Understanding of Common Prescribing Scenarios Focus on conditions and drugs that F1 doctors frequently encounter. Create Disease-Specific Checklists: For common conditions, develop mental checklists covering diagnosis, treatment, monitoring, and patient counseling. Understand Guidelines: Familiarize yourself with NICE guidelines and local protocols for managing common conditions. Practice Decision-Making: Work through case scenarios, justifying each step of your management plan. Learn from Mistakes: Analyze incorrect answers in practice questions to understand the rationale behind correct prescribing decisions. 4. Adopt a Systematic Approach for Each Question Type Developing a structured approach for each section of the exam can improve both speed and accuracy. For Prescribing (PWS) questions: Identify the condition and any complicating factors Consider patient-specific details (age, weight, comorbidities) Choose the appropriate drug and formulation Determine the correct dose, frequency, and duration Add relevant additional instructions or warnings For Prescription Review (REV) questions: Check patient details and allergies Verify drug choice against the indication Confirm dosage, frequency, and duration Look for potential drug interactions or contraindications Ensure all necessary monitoring instructions are included 5. Master Time Management With only 2 hours for 200 marks, efficient time use is crucial. Allocate Time Wisely: Spend roughly 1 minute per mark, but be flexible. Answer Easy Questions First: Quickly complete questions you're confident about, then return to more challenging ones. Use Flagging Feature: Mark difficult questions for review if time permits. Practice Timed Sessions: Regularly complete mock exams under timed conditions to improve your pacing. 6. Utilize a Variety of Practice Resources Diverse practice materials can broaden your preparation and expose you to different question styles. Official PSA Practice Papers: These provide the most accurate representation of the exam format and difficulty. Medical School Resources: Many schools offer PSA-specific practice materials. Online Question Banks: Platforms like Pastest or OnExamination offer extensive PSA question banks. Textbooks and Apps: Use prescribing-focused textbooks and mobile apps for on-the-go learning. 7. Prioritize Patient Safety in Decision-Making The PSA is fundamentally about safe prescribing. Always consider the safety implications of your decisions. Think Beyond the Immediate: Consider long-term effects and potential complications of treatments. Recognize Red Flags: Be alert to signs that might indicate a more serious underlying condition. Consider Non-Pharmacological Options: Remember that prescribing medication isn't always the first or best option. Emphasize Monitoring: Always consider what follow-up or monitoring might be necessary. 8. Stay Updated with Current Guidelines and Practices Medicine is an ever-evolving field, and staying current is crucial. Follow Medical Journals: Regularly read summaries of key articles in major medical journals. Attend Prescribing Lectures: Take advantage of any PSA-focused lectures or seminars offered by your medical school. Join Study Groups: Collaborate with peers to discuss recent updates and share resources. Use Social Media Wisely: Follow reputable medical education accounts on platforms like Twitter for quick updates. 9. Develop a Strong Understanding of Drug Interactions Drug interactions can be complex, but understanding common and serious ones is crucial. Focus on High-Risk Combinations: Pay special attention to interactions involving anticoagulants, antiplatelets, and drugs with a narrow therapeutic index. Understand Mechanisms: Learn the basic mechanisms of drug interactions (e.g., enzyme induction/inhibition, altered absorption). Use Interaction Checkers: Familiarize yourself with online drug interaction checkers, but also understand their limitations. Consider Polypharmacy: Be especially vigilant for interactions in scenarios involving multiple medications. 10. Practice Providing Clear Patient Information Effective communication about medications is a key skill tested in the PSA. Use Layman's Terms: Practice explaining medical concepts without jargon. Structure Your Explanations: Develop a systematic approach to cover key points (e.g., purpose, dosage, side effects, monitoring). Address Common Concerns: Anticipate and prepare answers for frequently asked patient questions about medications. Incorporate Visual Aids: When possible, use diagrams or written instructions to supplement verbal explanations. Final Thoughts Preparing for and excelling in the Prescribing Safety Assessment requires dedication, strategic studying, and a genuine commitment to understanding safe prescribing practices. Remember, the goal isn't just to pass the exam, but to develop skills that will make you a safer and more effective doctor. By following these strategies and maintaining a consistent study routine, you can aim for that >90% score. However, the true measure of success is not just in the number, but in the confidence and competence you develop in prescribing safely and effectively. As you prepare, keep in mind that this exam is a stepping stone in your medical career. The knowledge and skills you gain through this process will serve you well beyond the exam, forming the foundation of your practice as a safe and effective prescriber. Good luck with your preparation, and remember that every hour of study is an investment in your future patients' safety and well-being. Resources Here's a list of resources for the Prescribing Safety Assessment (PSA) exam: PSA Prep: A collection of free eLearning sessions for medical students, provided by BPSA 1 . Official PSA website: Offers information about the exam structure and content 2 . Geeky Medics PSA Question Bank: Contains over 500 questions designed to reflect the PSA format 3 . BPSA Prescribing Practice Papers: Three practice papers with 120 questions based on the PSA blueprint 5 . Medibuddy PSA resources: Provides information and guidance on the PSA exam structure 6 . MedCourse PSA Guide: Offers a comprehensive overview of the PSA exam and its components 7 . British National Formulary (BNF): An essential resource available online during the exam 7 9 .

The 12 Week Year by Brian P. Moran and Michael Lennington proposes a revolutionary approach to goal-setting and achievement by redefining a "year" as 12 weeks instead of 12 months. This method creates a sense of urgency and focus, allowing individuals and organizations to accomplish more in less time by breaking down long-term goals into shorter, more manageable periods. The book provides a comprehensive system for planning, execution, and accountability that can dramatically improve productivity and results across various aspects of life and business. Who should read this book: Entrepreneurs and business leaders looking to accelerate growth and improve organizational performance Individuals struggling with procrastination or feeling overwhelmed by long-term goals Professionals seeking to enhance their productivity and achieve better work-life balance 3 main takeaways from the book: 1) Redefining the Year: The Power of Urgency and Focus The core premise of The 12 Week Year is the redefinition of a "year" from 12 months to 12 weeks. This shift in perspective creates a profound change in how we approach goal-setting and execution. By compressing the timeframe, we naturally create a sense of urgency that is often lacking in traditional annual planning. When we think in terms of a 12-month year, it's easy to fall into the trap of believing we have plenty of time to achieve our goals. This leads to procrastination and a lack of focus, often resulting in a mad rush towards the end of the year to meet objectives. The 12 Week Year eliminates this problem by making every week count.The authors argue that this approach leverages the power of deadlines and our natural tendency to perform better under pressure. By treating each week as if it were a month in a traditional year, we become more intentional about our actions and more aware of the passage of time. This heightened awareness leads to better decision-making and more efficient use of our resources. Moreover, the 12 Week Year system allows for more frequent course corrections. Instead of waiting for an annual review to assess progress and make adjustments, this method encourages regular evaluation and refinement of strategies. This agility is particularly valuable in today's fast-paced business environment, where market conditions and personal circumstances can change rapidly. The concept also aligns well with the psychological principle of chunking, where breaking larger tasks into smaller, more manageable pieces makes them feel less overwhelming and more achievable. By focusing on a 12-week horizon, we can set more specific, actionable goals that feel within reach, leading to increased motivation and follow-through 2) The Execution System: Eight Elements for High Performance The 12 Week Year isn't just about shortening the planning cycle; it provides a comprehensive execution system built on eight fundamental elements. These elements are divided into five disciplines (vision, planning, process control, measurement, and time use) and three principles (accountability, commitment, and greatness in the moment). Vision serves as the foundation of the system. It's about creating a clear, compelling picture of what you want to achieve, not just in the next 12 weeks, but in the long term. This vision acts as a north star, guiding your actions and providing motivation when faced with challenges. Planning involves translating your vision into specific, actionable goals for the 12-week period. Unlike traditional annual planning, this approach allows for more detailed and realistic goal-setting. The authors emphasize the importance of limiting your focus to a few key objectives to avoid spreading yourself too thin. Process control is about establishing routines and systems to ensure consistent execution of your plan. This might involve creating checklists, setting up reminders, or developing habits that support your goals. Measurement is crucial for tracking progress and maintaining motivation. The book recommends scoring your performance weekly, which provides immediate feedback and allows for quick adjustments. Time use is perhaps one of the most critical elements. The authors advocate for time-blocking, where you schedule your most important activities first, ensuring that crucial tasks aren't left to chance. The principles of accountability, commitment, and greatness in the moment complement these disciplines. Accountability is about taking ownership of your results, regardless of circumstances. Commitment involves making conscious choices to act in ways that support your goals, even when it's uncomfortable. Greatness in the moment emphasizes the importance of bringing your best self to each task, recognizing that success is built through consistent, high-quality actions 3) Overcoming Resistance and Embracing Change One of the most valuable aspects of The 12 Week Year is its recognition that implementing this system – or any significant change – isn't always easy. The authors dedicate considerable attention to the psychological aspects of change and provide strategies for overcoming resistance. They introduce the concept of the "Emotional Cycle of Change," which describes the stages people typically go through when adopting new behaviors. These stages include uninformed optimism, informed pessimism, the valley of despair, informed optimism, and finally, success and fulfillment. Understanding this cycle can help individuals persist through the challenging middle stages where many people give up. The book emphasizes that discomfort is a natural part of growth and achievement. It encourages readers to embrace this discomfort rather than avoid it, recognizing that the most important actions are often the most uncomfortable ones. This mindset shift is crucial for pushing through barriers and achieving breakthrough results. To support this process, the authors provide practical strategies for building new habits and maintaining momentum. They suggest starting with a focus on foundational practices in the first four weeks, such as consistent planning and scoring. As these habits become ingrained, individuals can then build on this foundation in subsequent weeks. The 12 Week Year also addresses common pitfalls that can derail progress, such as the need for immediate gratification or the tendency to fall back into old habits. By anticipating these challenges, readers can prepare strategies to overcome them. Perhaps most importantly, the book emphasizes the power of small, consistent actions. It argues that greatness is achieved not in a single moment of triumph, but in the accumulation of daily choices and actions. This perspective can be incredibly empowering, as it puts success within reach of anyone willing to commit to the process 2 best quotes from the book: On the power of focus: "Intentionality is your secret weapon in your war on mediocrity." This quote encapsulates the book's emphasis on deliberate action and conscious choice in achieving exceptional results. It suggests that by being intentional about our goals and actions, we can overcome the inertia of average performance and reach new heights of achievement. On the importance of consistent action: "To be truly effective, your daily activity must align with your long-term vision, strategies, and tactics." This quote highlights the critical connection between day-to-day actions and long-term success. It underscores the idea that achieving significant goals isn't about sporadic bursts of effort, but rather about consistently aligning our daily activities with our broader objectives. 1 action point to take away from the book: Implement a weekly review and scoring system. At the end of each week, take time to assess your progress on your 12-week goals. Score yourself based on the completion of your planned tasks and reflect on what worked well and what needs improvement. This practice will help you stay accountable, identify areas for growth, and maintain focus on your most important objectives. Chapter summaries Chapter 1: The Challenge The authors introduce the concept of two lives: the one you're currently living and the one you’re capable of living (where you've fully engaged your unique skills and talents). The main obstacle to achieving your potential is the lack of a structured plan to accomplish your goals. Knowledge without action is just a collection of ideas; real change comes from execution. Consistent execution of knowledge is what separates average achievers from top performers. "It's not what you know; it's not even who you know; it's what you implement that counts.” The book promises to help readers get more done in less time by implementing the 12 Week Year concept and ‘close the execution gap’. Chapter 2: Redefining the Year The chapter critiques "annualised thinking," where goals are set for the end of the year, creating a false sense of having plenty of time. This approach often leads to procrastination and a last-minute rush to meet deadlines. The authors introduce the concept of periodization: restructuring long-term goals into focused 12-week periods through focus, concentration and overload on a specific skill or discipline. This shorter timeframe creates a sense of urgency and helps maintain high productivity throughout the year. In the long run, your actions are always congruent with your underlying thinking and your results are ultimately a manifestation of your thinking. The 12 Week Year approach promises to help achieve more in 12 weeks than most do in 12 months. Chapter 3: The Emotional Connection The chapter emphasizes the importance of having a compelling vision for your future to drive execution. A significant vision is crucial because the process of executing at a higher level is simple but not easy. The authors discuss how changing behavior is uncomfortable and often triggers the brain's fight-or-flight response. They introduce four stages of belief in your vision: Impossible, Possible, Probable, and Given. The chapter guides readers on creating a vision for different aspects of life, including spiritual, personal, professional, financial, and relational areas. Chapter 4: Throw Out the Annual Plan The authors advocate for replacing annual planning with the 12 Week Year approach. They discuss the benefits of working from a plan, including reduced mistakes, saved time, and increased focus. The chapter explains why 12 weeks is an ideal timeframe for planning and execution. It emphasizes the importance of having specific and measurable goals for each 12-week period. The authors provide guidance on creating a balanced 12 Week plan that includes both immediate results and future capacity building. Chapter 5: One Week at a Time This chapter focuses on the importance of weekly planning within the 12 Week Year framework. It emphasizes that while results are important, you have more control over your actions than outcomes. The authors recommend reviewing progress at the beginning of each week and creating a plan for the coming week. They stress the importance of daily check-ins with your plan to ensure you're focused on the right tasks. The chapter introduces the concept of lead and lag indicators for measuring progress. Chapter 6: Confronting the Truth The chapter discusses the importance of scorekeeping and measurement in achieving goals. It introduces two types of indicators: lead (measuring activities that lead to results) and lag (measuring the results themselves). The authors emphasize the importance of execution measures to determine if lack of results is due to poor planning or poor execution. They recommend aiming for 85% task completion each week and not getting discouraged by occasional misses. The chapter discusses how productive tension can lead to either quitting or increased motivation. Chapter 7: Intentionality This chapter focuses on the importance of intentional time management. It introduces the concept of time-blocking, including strategic blocks (3 hours of uninterrupted work), buffer blocks (for low-value activities), and breakout blocks (time away from work). The authors emphasize the importance of creating routines and an "ideal week" structure. They discuss how intentional time use can significantly increase productivity and goal achievement. The chapter provides practical tips for implementing these time management strategies. Chapter 8: Accountability as Ownership The authors redefine accountability as personal ownership rather than external consequences. They emphasize that true accountability comes from recognizing that all actions are choices. The chapter discusses how this mindset shift can lead to increased empowerment and better results. It challenges readers to take ownership of their actions and results, regardless of circumstances. The authors provide strategies for developing a stronger sense of personal accountability. Chapter 9: Interest versus Commitment This chapter explores the difference between being interested in achieving a goal and being committed to it. The authors define commitment as a conscious choice to act in order to create a desired result. They introduce four keys to successful commitments: strong desire, keystone actions, counting the costs, and acting on commitments rather than feelings. The chapter emphasizes the importance of keeping commitments to oneself and others for building trust and character. It provides strategies for strengthening one's ability to make and keep commitments. Chapter 10: Greatness in the Moment The authors discuss the importance of being present and fully engaged in the current moment. They argue that greatness is achieved through consistent, high-quality actions rather than a single moment of triumph. The chapter critiques multitasking and encourages focusing on one task at a time for better results. It emphasizes that success is built through daily choices and actions, not just end results. The authors provide strategies for cultivating presence and making the most of each moment. Chapter 11: Intentional Imbalance The authors challenge the traditional concept of life balance, suggesting it's not about equal time allocation. They propose "intentional imbalance" - focusing on specific life aspects based on current priorities. The 12 Week Year process supports this approach by allowing focused improvement in key areas every 12 weeks. This method encourages aligning energy and effort with one's current purpose, which may change over time. The chapter emphasizes the importance of intentional choices in time and energy allocation. Chapter 12: The Execution System The authors introduce an execution system comprising eight elements: three principles and five disciplines. The three principles are Accountability, Commitment, and Greatness in the Moment. The five disciplines include Vision, Planning, Process Control, Measurement, and Time Use. This system is designed to facilitate high performance and achievement. The chapter emphasizes the interconnected nature of these elements in driving execution. Chapter 13: Establish Your Vision The authors stress the importance of creating a compelling, long-term vision. They suggest a thought process progression: from impossible to possible, probable, and given. The chapter outlines three time horizons for vision: long-term aspirations (5-15 years), mid-term goals (3 years), and 12-week goals. It emphasizes the need for specificity and detail, especially in mid-term goals. The authors acknowledge the significant jump from 3-year to 12-week planning but justify it as part of their approach. Chapter 14: Develop Your 12 Week Plan This chapter focuses on creating an effective 12-week plan: The plan should have specific, measurable goals to drive results in the current 12 weeks. It's crucial to balance immediate results with building future capacity. Criteria for writing goals and tactics include: Make them specific and measurable State them positively Ensure they are a realistic stretch Assign accountability Be time-bound Define high-priority daily and weekly actions for each goal 6 . Chapter 15: Installing Process Control This chapter discusses implementing systems to ensure consistent execution: Process control helps you work your plan even when faced with challenges. It provides structural and environmental support to supplement willpower. Tools and events create support structures to maintain focus and follow-through. Chapter 16: Keeping Score This chapter emphasizes the importance of measurement: The 12 Week Year system involves shorter, more frequently measured goals. It distinguishes between execution measures and results measures. Measurement is not an accountability tool but a feedback mechanism. Chapter 17: Take Back Control of Your Day This chapter focuses on effective time management: It introduces the concept of Performance Time with three components: Strategic blocks (3 hours of uninterrupted work) Buffer blocks (for low-value activities) Breakout blocks (time away from work) It emphasizes creating a Model Work Week to ensure important tasks are prioritized. The chapter warns against "busy procrastination" like mindless email checking Chapter 18: Taking Ownership The chapter emphasizes the importance of personal accountability and ownership. It defines accountability as a willingness to own actions and results, regardless of circumstances. The authors argue that taking ownership empowers individuals to change their situations. They suggest shifting focus from making excuses to finding solutions and taking action. The chapter provides practical actions for creating accountability. Chapter 19: 12 Week Commitments The authors define commitment as a conscious decision to take specific action for a desired result. They discuss personal commitments and the challenges of keeping them. The chapter introduces the concept of "iceberg of intentions," where conscious and subconscious intentions may conflict. It suggests two ways to succeed: strengthening conscious intentions or reconciling conflicts. The authors provide strategies for making and keeping effective commitments. Chapter 20: Your First 12 Weeks This chapter prepares readers for implementing their first 12 Week Year. It warns of potential challenges, including resistance, need for immediate gratification, and falling back into old habits. The authors suggest breaking the 12 weeks into three four-week periods with specific focus areas. Weeks 1-4 focus on foundational practices like planning, scoring, and time-blocking. Weeks 5-8 involve continued execution with necessary corrections. Weeks 9-12 emphasize finishing strong and evaluating what worked. The 13th week is for celebration, review, and planning the next cycle.

“What do you want to specialise in?” “What kind of doctor are you planning to be?” “Do you want to be insert specialty of the doctor asking ?”  Since starting my foundation training as a resident doctor in the UK, I am asked these questions on an almost daily basis, by my seniors, my peers and my non-medic friends. And, well, honestly, I’m not quite sure what especially I want to do, but here’s what I’ve realised 4 months into being a doctor: Choosing a medical specialty is a complex and multifaceted decision that shapes a doctor's entire career. Recent data from the Association of American Medical Colleges highlights that personal interest and content of specialty are the most influential factors for medical students when selecting their career path 1 . This aligns with my own experiences and reflections as I navigate through my foundation training. Being a doctor is not my whole life Although being a doctor is a big part of my life and identity, working as a doctor has made me realise how easy it is to make this profession into your whole identity. Excelling professionally is exciting and I have many ambitious career aspirations, but I have equally many aspirations outside of my working life.  Whilst I enjoy a challenge and I’m not afraid of hard work, I’ve come to see that no amount of respectability or external recognition is worth sacrificing personal well-being, family time, and the ability to pursue interests outside of medicine. Specialties that allow flexibility in working hours and provide a sustainable career path have become much more appealing to me now. This realization aligns with a growing trend in the medical profession. Work-life balance is increasingly recognized as crucial for physician well-being and career satisfaction. Specialties such as Family Medicine, Dermatology, and Psychiatry are often cited as offering better work-life balance 2 . This shift in perspective is vital for maintaining long-term career satisfaction and preventing burnout. Less ward time I am one of the few medics (it seems) that enjoys ward rounds and clinics, however I don’t see myself enjoying them for the rest of my career if they are a daily occurrence. I’ve realised that I would like to pursue a specialty that doesn’t rely too heavy on long, repetitive ward rounds and inpatient care, but rather offers a balance of ward and clinic time, with a large emphasis on non-clinical duties.  This preference for varied clinical experiences is common among many junior doctors. Specialties like Dermatology, Radiology, and certain surgical subspecialties often provide a mix of clinical duties, balancing ward rounds with outpatient clinics and procedural work 2 .This diversity can lead to greater job satisfaction and prevent monotony in daily practice. Examples of specialties with... Lots of ward time: Internal Medicine, General Surgery, Cardiology, Respiratory Medicine Some ward time: Dermatology, Obstetrics and Gynaecology, Emergency Medicine Minimal ward time: Radiology, Pathology, Microbiology/Infectious Diseases No ward time: Nuclear Medicine, Pharmaceutical Medicine Teaching and education I’ve found a lot of satisfaction in mentoring and teaching med students, educating patients, and engaging in developing educational materials. I’m gravitating toward specialties that provide ample opportunities for academic involvement and where education and research are integral parts of the specialty, alongside clinical work. The field of medical education is expanding, with increasing opportunities for doctors to incorporate teaching into their careers. Many medical schools and healthcare institutions are developing dedicated pathways that combine clinical practice with educational responsibilities 3 . This trend recognizes the critical role of teaching in advancing medical knowledge and improving patient care. Looking at my future I’ve found that looking at senior doctors (particularly registrars and consultants) in a particular specialty is the best way to gather an idea of whether I would enjoy it. Actually seeing what their day-to-day looks like and whether they are fulfilled and have a good balance has been incredibly enlightening. There are certain groups of doctors that seem to always be stressed and over-worked, despite loving certain aspects of the job. If I don’t see myself doing what they do daily, I won’t be following in their footsteps.  This approach of observing and learning from senior colleagues is supported by research. Role model influence is consistently ranked as one of the top three factors influencing specialty choice among medical graduates 1 . It provides valuable insights into the long-term career trajectory and lifestyle associated with different specialties. Clinical-Academic Career  The boundaries between pure clinical work and academic research are becoming increasingly blurred. Many modern medical careers offer integrated pathways that allow simultaneous progression in clinical skills and research capabilities. I need to love both clinical work and research in order to sustain a fulfilling and impactful career. If one area doesn’t excite me as much as the other, it’s unlikely I’ll thrive in a role that demands both in equal measure. So I’m on a mission for the specialty that combines the 2 for me!  The integration of clinical practice and research is becoming increasingly common in modern medical careers. Many specialties now offer integrated pathways that allow simultaneous progression in clinical skills and research capabilities 4 . This trend is particularly evident in fields like Immunology, Pathology, and certain subspecialties of Internal Medicine. Examples of specialties that typically have… Heavy focus on academia: Clinical Pharmacology and Therapeutics, Immunology, Medical Oncology, Endocrinology Some focus on academia: Cardiology, Neurology, Respiratory Medicine Minimal focus on academia: Emergency Medicine, General Practice, Anaesthetics Emerging Trends in Healthcare Specialties The medical landscape is rapidly changing, influenced by technological innovations, demographic shifts, and evolving healthcare needs. Specialties that demonstrate adaptability and embrace interdisciplinary approaches are likely to offer the most dynamic and fulfilling career opportunities. Other considerations Opportunities for private practice, potential for innovation and technological advancements in the field, and the ability to make a significant impact on patient outcomes are also factors I'm considering. Additionally, I'm thinking about the long-term career prospects and how different specialties might evolve with changes in healthcare delivery and technology. These considerations reflect the complex decision-making process involved in choosing a medical specialty. Factors such as income expectations, future family plans, and the competitiveness of specialties also play significant roles for many medical graduates 1 .The evolving healthcare landscape, influenced by technological innovations and changing patient needs, adds another layer of complexity to this decision. Specific specialties + my thoughts Urology What attracts me : Urology is an interesting field that combines surgical skills with medical knowledge. It offers a variety of procedures and the opportunity to work with cutting-edge technology. The potential for innovation in minimally invasive surgeries is exciting Drawbacks : The surgical lifestyle can be demanding, and there's potential for a toxic work environment in some settings. The on-call schedule might be challenging for maintaining work-life balance. Endocrinology What attracts me : Endocrinology is intellectually stimulating with its complex hormonal systems. It offers diverse sub-specialties like fertility, general endocrinology, obesity, diabetes, and lipid metabolism. There's good potential for private practice and a mix of both acute and chronic patient care. Drawbacks : The prospect of being a medical registrar is daunting, given the intense workload and responsibility. The specialty might involve less procedural work compared to surgical fields. Rheumatology What attracts me : Rheumatology offers interesting cases and the opportunity to manage complex, chronic conditions. There's potential for private practice and a good balance of clinic and ward work. The field is evolving with new biological therapies, offering exciting research opportunities. Drawbacks : Similar to endocrinology, it requires medical registrar training, which can be challenging. Some conditions can be frustrating to treat due to their chronic nature. General Practice What attracts me : GP offers excellent work-life balance and the opportunity to build long-term relationships with patients. It provides a varied caseload and the flexibility to pursue special interests within primary care. Drawbacks : There might be less opportunity for complex procedures or hospital-based work. The high patient volume and time constraints per consultation could be challenging. Obstetrics and Gynaecology What attracts me : This specialty offers a unique blend of medicine and surgery, along with the joy of being involved in childbirth. It provides opportunities for both acute and elective work, and there's potential for subspecialization. Drawbacks : The on-call schedule can be demanding, and the medicolegal risks are high. Achieving work-life balance might be challenging, especially in the early years of training. Dermatology What attracts me : Dermatology offers a good work-life balance and interesting cases. There's significant potential for private practice and aesthetic work. The visual nature of the specialty appeals to me, and there are opportunities for procedural work. Drawbacks : It's highly competitive to enter, and the training pathway can be lengthy. There might be less variety in day-to-day work compared to some other specialties. Immunology/Pathology What attracts me : These fields offer strong research opportunities and less ward-based work. They're at the forefront of medical advancements and provide a deep understanding of disease processes. Drawbacks : There's less patient contact, which might not suit my interest in teaching and patient education. The work can be isolating compared to more clinical specialties. Although I've only completed my first rotation of F1, the learning and reflection has been EXPONENTIAL and is helping me so much in deciding my next steps. I've realized that my preferences align with several key factors identified in research on specialty choice among UK medical students References: https://www.ama-assn.org/medical-students/specialty-profiles/11-factors-influence-med-student-specialty-choice https://www.practicematch.com/physicians/articles/best-physician-medical-specialties-for-career-happiness-work-life-balance.cfm https://www.healthcareers.nhs.uk/explore-roles/doctors/career-opportunities-doctors/alternative-roles-doctors/medical-education https://bmcmededuc.biomedcentral.com/articles/10.1186/s12909-021-02539-5 https://www.dr-bill.ca/blog/practice-management/10-happiest-doctor-specialities-that-offer-the-best-lifestyle