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Working as a paediatric registrar

Working-as-a-paediatic-registrarDr Richard Fulton, ST8 specialty trainee in paediatrics, shares an insight into this ‘marmite’ specialty

I’m in my final year as a paediatric registrar, and in my current post my typical day starts with a consultant-led handover. This is followed by a ward round, which usually lasts a couple of hours. I may then have an outpatient clinic in the afternoon, or I may be managing patients on the ward, NICU or paediatric A&E depending on the rota.

On most days there is some form of teaching activity, eg, journal club, X-ray meeting or dedicated registrar teaching, or I might be leading the teaching. One of the most enjoyable things about my job is that no two days are the same.

Choosing paediatrics

I chose paediatrics because I personally enjoy the challenges of being a generalist.

Communication skills are extremely important in paediatrics and I thrive on the relationships that are formed with patients and their families and also the challenges that communication with worried parents/carers can present. It’s really satisfying when parents thank you for explaining something clearly, or sorting something out for them.

Training

Paediatrics has eight years of training (ST1-ST8), which is one year longer than most specialties. ST1-ST3 trainees tend to work on SHO rotas. The first of five registrar years is ST4. During ST1-ST3 trainees are expected to pass the MRCPCH exam, which comprises Part 1a, 1b and Part 2 written exams.

The final exam is clinical, which is an OSCE style exam with ten stations. In order to progress from year to year, trainees must complete an ARCP (annual review of competencies). Progression is competency based and therefore it is possible to reduce the time taken to complete training as long as competencies are reached.

Most paediatric trainees complete ST1-3, with ST1-2 normally in district general hospitals and ST3 in teaching hospitals. These three years include general paediatric training, neonatology experience (usually at least 6 months in a tertiary neonatal unit) and subspecialty training. Trainees are usually given several options of available specialties during ST2 level to choose for ST3.

Out-of-hours workload is variable (often busy), but it is usually the best environment for gaining experience, developing leadership and responsibility and can be exciting/ rewarding/ scary in equal measures

ST4-5 are ‘core registrar’ years, which include one year of general paediatrics, six months of neonatology and six months of community paediatrics. During ST5 trainees are given the option to apply for national grid subspecialty training for ST6-8. Some of the subspecialties that currently have grid training available are neonatology, community paediatrics, PICU, gastroenterology, hepatology, metabolic, nephrology, respiratory, infectious diseases and neurology, leading to dual certification on the specialist register for paediatrics and the subspecialty.

Trainees that do not choose/get into grid training can develop specialty interests and will ultimately become general paediatricians with one or two specialty interests. Neonatal or Paediatric Intensive Care trainees will also participate in the transportation of sick children, which for some trainees is the best part of the job.

Competition

Popularity of paediatrics varies from deanery to deanery. In the more popular deaneries there are normally three to four applications per post. The application process takes place through an online form followed by an interview. The applications are submitted in January each year and interviews usually take place in February or March. ST1 jobs start in September and the changeover dates for jobs are the first weeks of September and March each year.

Like obstetrics and gynaecology, paediatric departments are smaller and have fewer trainees than their adult counterparts. In most training jobs, trainees work a full shift rota. There is normally a significant amount of out-of-hours cover in paediatrics. Out-of-hours workload is variable (often busy), but it is usually the best environment for gaining experience, developing leadership and responsibility and can be exciting/rewarding/scary in equal measures.

Rewards

Paediatrics is an incredibly rewarding specialty. Children are amazingly resilient and often recover from life-threatening acute conditions extremely quickly, or deal with their conditions remarkably well. Unlike (some) adult patients, children don’t have much to gain from being ill or confined to bed/hospital. They usually want to be fed, be active and they want to play.

Children are amazingly resilient and often recover from life-threatening acute conditions extremely quickly, or deal with their conditions remarkably well

Paediatric nurses tend to be extremely hard-working and caring individuals. The paediatric multidisciplinary teams work closely together and there is a culture of always striving to improve the services that we give to children, and putting children right at the heart of the way our services are delivered. The full range of medicine is encompassed within paediatrics, from general paediatrics to niche specialties and you can therefore choose something interesting and fulfilling regardless of whether you eventually see yourself working in a city, town or rural environment, since there are children’s services in acute trusts and in the community across the whole country.

Children are amazingly resilient and often recover from life-threatening acute conditions extremely quickly, or deal with their conditions remarkably well

Challenges

Conversely paediatrics can be an emotionally difficult specialty. Unsurprisingly some trainees find it challenging to deal with sick and dying children, and dealing with (some) parents can be equally demanding. Communication skills are usually strong in paediatricians as a result. Paediatrics is a predominantly consultant-led specialty, with bedside teaching and supervision a predominant feature. This has pros and cons. Paediatric consultants are generally very supportive and keen to train juniors. However, it may be that before too long paediatric consultants will be resident in hospital during nights and weekends.

Marmite specialty

One of my colleagues described paediatrics as a ‘marmite’ specialty. You might love it or hate it, but you won’t know until you’ve tried it. General paediatrics is one of the few specialties that still allows you to be a true generalist and if you work in an intensive care specialty (NICU/ PICU) you will develop procedural skills. Alternatively the subspecialties are seeing significant advances in the care of children. There are plenty of opportunities for trainees to pursue academic careers.

Most paediatricians are friendly, diligent and hardworking. There is usually a positive culture of support and education as well as a strong commitment to the patients. If you want to find out more about a career in paediatrics have a look on the Royal College website which has plenty of useful information and links to the different deaneries and subspecialties.
You might love it or hate it, but you won’t know until you’ve tried it