Beware the Trojan Horse: hidden anxieties at the end of specialty training


Dr Brendan McCann reflects upon emotions surrounding finishing specialty training

It is about this time of year when many of the Royal College Final Fellowship or exit exams occur. If successful, it provides a truly momentous occasion that deserves celebration and adulation for all involved.

The timing of these awards often go hand in hand with the final chapter for all trainees alike before travelling to the prophetic land of consultancy.  Soon after the page turns on the heroic achievements over the last decade or so of medical training, it is not uncommon to unearth emotions and anxieties that have been stored up and pushed aside over the years.

The tale of the Trojan horse is a startling parallel for many who enter into their final year.  After ten years of a long siege (sound familiar?) on the city of Troy the Greeks feigned withdrawal and left the infamous wooden horse as a gift to the Trojans.  Unbeknown to the citizens of Troy the horse was laden with Greek soldiers and after the revelry and festivity settled down the horse was opened and the city sacked.

A tad dramatic, and I’m not sure anyone will ever write an Iliad to the training labours of a career in medicine.  Years of exams, work based assessments and projects to buff up the CV provide a worthy distraction to the emotional toll of dealing with death, imposter syndrome and the hovering sword of failure at every turn.  For some, the final year of training should feel like a victory parade – but instead the Trojan horse opens up, with anxiety, depression and burnout released.  The tying up of loose ends, getting those journal articles written, regrets about not doing a PhD or a fellowship and all whilst sailing towards being a consultant – a promised land indeed, but one with the trepidation of weight of responsibility and a foggy outlook as to what your final destination truly looks like.

When all of this happened to me it came as shock. I was meant to be delighted, taking the pats on the back and answering the question “when do you finish and do you know what you’ll be specialising in?” on an almost daily basis.  Instead of realising how unwell I was, I doubled down – see more patients at clinic, be more helpful to my centre, do more activities in my personal life, start acting up as a consultant. Months of anxiety and burnout finally cumulated in time off, visits to the GP,  counsellors and antidepressants.

The final year of training in any speciality can be especially daunting, and it is not uncommon to feel overwhelmed. The first step of dealing with it is acknowledgement and seeking help. Remind yourself that you’re doing a very difficult job and you’ve done well to get where you are.  Try not to do too much, only do what is necessary and throw overboard the responsibilities and tasks that are not needed as a consultant.

Like the Trojans at the end of their story, I took some time to settle and get back to a normal state.   I had huge help from my colleagues at work and support from family and friends, but found out over time that my story – although untold – was far from uncommon.

Dr Brendan McCann is a Clinical Oncologist who worked and trained in Glasgow and completed his training in early 2020. He currently lives in Melbourne, Australia where he is undertaking a Radiation Oncology Fellowship in Skin Cancer.  He wanted to share his story to let others know that it’s ok to not feel ok and there is a future beyond burnout.



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