Top TipThings to consider when choosing a deanery (or LETB) include the following.
Specialist units. If you are thinking of subspecialising within paediatrics then it is worth considering which deaneries contain hospitals which provide that particular service. Subspecialty training is applied for through a competitive national application process which takes place at level 3 in the training programme (see Box 11.1 for the structure of paediatrics training in the UK). In order to increase your chances of success, it is useful to get some experience in your chosen subspecialty during your earlier training years. This will only be possible if you apply to a deanery where there is a unit which provides these services, some of which will only take place at tertiary referral centres.
Trainee satisfaction. It is possible to look back at the results of previous national trainee surveys on the GMC website (www.gmc-uk.org/education/surveys), to find out what current paediatric trainees think about different aspects of their training in that deanery. You can look at feedback from trainees about many aspects of working in that deanery such as workload, level of senior support and quality of teaching.
Personal reasons. Where do you actually want to be living for the next 8 years of your life? Your personal life can change enormously within the space of 8 years so try to think through the possibilities of what might be happening and what might be important to you then as well as now. This is obviously very difficult to predict but talking things through with important people in your life can help you to work out some of what matters to you (and them) now and your collective best guesses for what you might want in the future.
Population. Who is the population you will be serving? Affluence, ethnic and cultural diversity vary widely between different areas of the UK. Different populations have different disease sets and bring with them their own unique challenges in terms of providing their healthcare.
Number of other trainees. If you have applied to a deanery where there are only a handful of new paediatric training posts each year, you will very quickly get to know everyone. For some people this is a welcome prospect whilst for others it may feel too claustrophobic. Information can be found on the RCPCH website about the number of training posts advertised over the past few years in each region and the number of people who applied (http://www.rcpch.ac.uk).
Think really long term. Although your training years are really important as an experience in themselves, you also need to consider that you will spend the majority of your career as a consultant. Think about what you might like to be doing once you’re a consultant and how different training schemes in different regions might help you to get there. It might also be worth considering the number of available consultant posts in the area of your choice and how many trainees from that area are able to find consultant jobs in the same region.
Extra opportunities. What else does that deanery offer in addition to the normal training? Are there lots of opportunities to become involved in teaching, for example through out-of-programme fellowship schemes? Does the deanery focus on involving their trainees in research? Does it have established leadership and innovation schemes? Each will have a slightly different focus and working out which fits best with your personality and your long-term plans is important. Visit the websites for the different deaneries, talk to people who already work there if possible and attend conferences or careers events at the deaneries you are thinking of applying to. These sorts of things can give you vital clues about the values and aspirations of a particular region and which appeals to you most.
Once you have been accepted onto a paediatric training programme, you become a specialist trainee (ST) and must register as a junior member of the Royal College of Paediatrics and Child Health (which is responsible for overseeing all paediatric training in the UK and ensuring it is of high quality). See Box 11.1 for an overview of the structure of paediatric training in the UK.
Opportunities for research
Academic training programme
It is possible to pursue an academic route alongside your specialist training. This pathway is offered by academic clinical fellowship posts or (at a more senior level) academic clinical lectureships, which provide you with the opportunity to split your time between academic and clinical work. You may be able to apply at any level between ST1 and ST4 for an academic clinical fellowship, depending on posts available, and you do not have to have completed an academic foundation programme in order to apply (although this may help). The aim of your academic clinical fellowship is to gain research experience, skills and training, and to secure funding for completion of a higher degree, usually a PhD.
After completion of an academic clinical fellowship, it is expected that many people will go on to complete PhDs and apply for academic clinical lectureships with a view to becoming a consultant with joint academic and clinical responsibilities after they have finished their specialist training. However, it is possible to decide after completion of an academic clinical fellowship that you wish to return to the clinical training pathway instead.
A detailed guide full of valuable practical information about academic training (and written by trainees who have completed academic training themselves) is available on the RCPCH website (RCPCH 2013) (www.rcpch.ac.uk).
For more information about academic clinical fellowships you can also visit the website for the National Institute for Health Research Trainees Co-ordinating Centre (www.nihrtcc.nhs.uk) and also look at the websites for the deaneries to which you are thinking of applying. There is more about the academic medicine pathway available on the medical careers website at www.medicalcareers.nhs.uk.
Out-of-programme research (OOPR)
It is worth noting that you do not have to be an academic clinic fellow in order to conduct research and this can be done as time out of programme instead if you pursue the conventional training programme. For more information see the Out of Programme section under ‘CV building for specialist trainees’ above.
Completing research projects alongside regular training
Taking part in research is useful and important for all trainees as it can give you a greater understanding of how to interpret literature and trial data in order to take a more evidence-based approach to patient management. Smaller projects can certainly be done alongside your regular clinical training if you are dedicated. Approach consultants in your department (or those who conduct research in an area that interests you) to see if they have any research projects you can get involved with.
College exams
In order to become a member of the Royal College of Paediatrics and Child Health (MRCPCH), you must pass several exams. You must pass all the separate parts of the MRCPCH or ‘MEMBERSHIP’ exams in order to progress to working as a registrar (which starts in ST4 year; see Box 11.1). This can sometimes cause problems as the average time taken by candidates to pass all parts of the MRCPCH is currently 3.5 years but there are only 3 years of specialist training before you are expected to progress to registrar level. This means that some trainees have to delay their progression to working as a registrar whilst attempting to pass the necessary exams. For this reason, amongst others, many people decide to sit some parts of the exam whilst they are a Foundation trainee (more about this below).
The names of the exams and the order in which they can be attempted have recently changed (although the purpose and content of the exams remain more or less the same). It is now possible to sit the written exams in any order you choose (and even sit them all at the same time if you want to), but all written papers must be passed before you can sit the clinical exam.
There are four parts to the MRCPCH: three written papers and one clinical exam.
Written papers
Foundation of Practice (formerly Part 1a). This exam consists of one written paper with extended matching, best of five and true or false questions. It aims to test your basic clinical knowledge of paediatrics. Completing a short placement working in paediatrics (even as a Foundation trainee) can be helpful for passing this exam but is by no means essential for success.
Scientific Knowledge and Theory of Practice (formerly Part 1b). This exam consists of one written paper with extended matching, best of five and true or false questions. It aims to test your understanding of the science which underpins paediatrics. People often find this the most difficult and historically it has the lowest pass rate of all the written papers. Make sure that you prepare thoroughly for this exam and do plenty of practice questions and background reading.
Applied Knowledge in Practice (Clinical Decision and Management) (formerly Part 2 written). This exam is made up of two separate papers, both of which are taken on the same day. These papers focuses primarily on clinical scenarios and your ability to make the correct diagnosis based on a description of history and examination findings, to correctly interpret investigations and to select an appropriate management plan and involvement of colleagues. This exam requires you to have experience working in paediatrics in order to have sufficient clinical knowledge to pass.
Clinical exam
The clinical exam follows an OSCE-style format which you may be familiar with from medical school. You move between different stations all designed to test an aspect of your clinical knowledge and skills.
For more detailed information about the different aspects of the MRCPCH exams, the syllabus and practice papers, visit the Royal College website (www.rcpch.ac.uk). A ‘guide for newcomers’ can be downloaded from the website with lots of information about each of the exams.
Things to consider when thinking about exams include the following.
Sitting a written paper as a Foundation trainee. The Royal College of Paediatrics and Child Health doesn’t officially endorse sitting specialist exams during Foundation years and the Foundation programme actively discourages it (by not giving any study leave for exams, meaning that it all has to come out of your annual leave allowance). However, some people do choose to sit one, or sometimes two, of the written papers during their Foundation training. This shows your commitment to the specialty, which helps to improve your chances of gaining a place on a specialist paediatrics training programme. Passing at least one of the written papers as a Foundation trainee can really take off some of the pressure as a paediatric SHO. This not only helps the whole process to feel more relaxed but will also give you more freedom to take up other opportunities.
Finding time for all the exams as a specialist trainee. It is perfectly possible to fit all the exams into the first 3 years of training as long as you start early enough and don’t have to take too many resits. There are three sittings of each exam every year, meaning that it is possible to have many separate attempts within a short space of time. Sitting exams as a specialist trainee means that you can apply for study leave in order to prepare for the exam and may have some financial support for attending revision courses.
Rotations and rotas. Rotations which are less demanding in terms of night and weekend shifts can be useful when studying for written exams as you will have more free time to do book work. Busy rotations at big general paediatric or tertiary paediatric units can be really useful when preparing for clinical exams as you will have the opportunity to see lots of children and work on your examination skills and see some rare pathology. If you have not yet applied for specialist training, it may be worth considering how you plan to fit in your exams when you are choosing which rotations you would like to do and at which stage.
Finances. Sitting exams is expensive, particularly if you have to sit some of the papers more than once. Try to budget for this when considering big expenses for the year. Given the financial as well as time implications, you should take each attempt seriously. Plan ahead, give yourself plenty of time to prepare and do lots of practice questions and any available practice papers.
Talk to people who have recently passed the exams. Talking to people who have passed recently can be really helpful in terms of taking their advice about how they prepared. It can also potentially save you a lot of money if they are willing to lend you the books that they used. If not, then trying the hospital library for books could also save you from shelling out extra money for these.
Don’t be disheartened. The pass rate for professional postgraduate exams is much lower than for most medical school exams. Do not be disheartened if you do have to resit some of the papers and take the opportunity to learn from what happened. You will receive a breakdown of your marks for each of the topics on the paper so you can identify any problem areas and focus on those before your next attempt.
Invest in practice questions. There are lots of different versions available online and in book form. Practice questions are a great way of getting used to the style of questions and strategies in approaching the answer. They are also a great way of identifying topics which you need to do more reading on.
Start with the hard bits. The temptation with revision can be to start with topics you feel comfortable with and avoid the topics you don’t like. Chances are, the topics you don’t like are the ones you know least about and disciplining yourself to start with these can mean that you have plenty of time to learn and improve your knowledge in these areas.
Do practice cases with senior colleagues. When it comes to revising for your clinical exams, it is really important to get some feedback from your senior colleagues. Practising solely with your peers watching you can mean that you miss out on valuable feedback; they will not only have much less experience to offer but are also likely to be less critical, meaning that you miss out on the opportunity to improve. Find out if any of the consultants at your hospital are current clinical examiners and ask them if they would mind assessing you on some cases. You will be sent to a hospital outside your area for the clinical exam so these consultants will not be examining you on the day and their feedback can be enormously valuable in helping you to pass the exam.
How to boost your CV
Regardless of where you are in your career, there are some golden rules about making your CV look more impressive and setting yourself apart from the crowd.
Finish things. This can be easier said than done but so many people start pieces of work or projects which they don’t finish. This is such a waste of your time and energy and may give you little or nothing to show for your efforts.
Don’t overcommit. Think about how much time you have available before agreeing to take part in new things. Taking on too many projects at the same time means you are much less likely to finish any of them or to do them to a high standard. In order to avoid missing out on future opportunities, say yes but negotiate that the person asking does something for you in return, or agree to take on only a smaller portion of what they have asked for. If you do have to say no, make sure to tell them that you will do it another time but you are too busy at the moment.
Work with other people. Working on projects with colleagues means you can get through large volumes of work much more quickly and you all gain from the end result. It can also improve your team-working skills, which are highly sought after and should be mentioned at interviews.
Do what interests you. One way to ensure that your projects get finished and that you do them to a high standard is to choose something which interests you. Don’t do something just because you think it will look good on your CV if the thought of doing it fills you with dread or boredom. Taking part in things which you find interesting or that you think are important will give you far more motivation to finish than scoring points alone.
Find people who inspire you. Inspiring and enthusiastic senior colleagues can help enormously, not just by offering you opportunities but with motivating you to take on new challenges and push yourself.
Update your CV. Whilst for many of the specialist programmes, you will need to fill in a generic application form, some deaneries may ask you to take a copy of your CV to interview with you and you may need to send it to people when other opportunities arise. Make sure you keep it up to date and keep it short. Previous achievements which were once significant will become less important as you progress so remember to go through and remove things as well as adding new achievements in. Keep the formatting clear and professional looking.
As well as this general advice on CV building, there are some specific things which you can do at different stages to set you apart from your peers and increase your chances of success.
CV building for medical students
This is an early stage to start thinking about your career but chances are, if you’re reading this book, you’re already pretty interested in a career in paediatrics. There are lots of things which you can do to find out more about the specialty to make sure it is the right choice for you. Also, because you have more time and energy than once you start working, this is a great time to complete projects which will look impressive later on.
Apply for Foundation posts in paediatrics
There are relatively few paediatric Foundation training jobs so this is not essential for being able to apply for paediatrics but it is certainly useful. This is a great time for you to test out how you feel about the actual job (which can sometimes be quite a different experience from doing a placement as a student) and will also help you to gain valuable insight for interview and lots of additional opportunities such as audits, improvement projects and teaching relevant to paediatrics. Think about the timing of the paediatric rotation so that you will have a chance to gain some experience prior to your applications for specialist training (which happen in the first rotation of FY2). If you don’t manage to get a rotation in paediatrics as part of your Foundation years, you can always apply to do a taster week at a paediatric unit instead (see the CV Building for Foundation Trainees section below for more details). There is also now an attempt nationally to offer more rotations to Foundation trainees that involve working in the community setting or in psychiatry so try to get a rotation in community paediatrics or child and adolescent psychiatry if you can.
Special study modules and electives
Completing additional rotations in paediatrics as part of a special study module or during your medical elective can allow you to gain additional experience of paediatrics and help to demonstrate your interest in the specialty. There may even be an opportunity for you to take part in a small project or audit as part of the special study module which could be useful later on. Medical electives are a great time to gain an international perspective on child health and the challenges of high mortality rates in the under-5s in developing countries.
Prizes
There are numerous prizes available to medical students for accounts of interesting cases or essays on various subjects. For example, the Royal College of Paediatrics and Child Health runs a prize uniquely for medical students in addition to several prizes for which junior doctors and medical students are both eligible. These can look impressive on your CV and often also involve a financial reward.
Volunteer
Volunteering can be a hugely rewarding experience and a great way for you to learn new skills. There are so many different opportunities: helping with a play group for disabled children, working at a children’s hospice or teaching sex education in schools. Look out for local and national children’s charities which you can help with. The website www.do-it.org.uk allows you to search for volunteering opportunities in your local area by topic. Also, find out about any student initiatives at your university. Some of the following initiatives now have groups in medical schools. If there isn’t one at your medical school already then contact them for help in setting up a local branch.
Play4all. This is a social enterprise set up by a medical student which aims to provide out-of-hours play facilities for children who are in hospital through medical students volunteering their time and skills (www.play4all.org.uk).
Sexpression. Medical students volunteer to provide informal sex and relationship sessions for young people to empower them to make informed decisions about their sexual health (www.sexpression.org.uk).
Teddy Bear Hospital. Medical students go into schools to teach young children about their health and about doctors and hospitals through play. The idea is to promote healthy lifestyles and also to prepare children so that visits to the doctor and hospital become less frightening.
Join or set up a paediatric society
Find out if your university already has a paediatric society and how to get involved. If there isn’t one already, could you set one up yourself?
Attend a conference
There are national paediatric conferences held by undergraduates for undergraduates which you can attend. There are also student conferences in global health organised by Medsin, which include presentations and workshops on international child health (www.medsin.org). Medsin also oversee the international children’s charity SKIP (Students for Kids International Projects) which supports child welfare in communities throughout the developing world. See the website www.skipkids.org.uk for details of how to get involved.
Become a medical student affiliate member of the RCPCH
You can become an affiliate member of the RCPCH as a medical student. It is free to become an affiliate member as a medical student but you can also choose to pay a (heavily subsidised) annual subscription for the journal Archives of Disease in Childhood. As an affiliate member you will get regular email updates from the Royal College, careers advice and access to members-only areas of the website and online publications. Go to www.rcpch.ac.uk/member-services to apply.
Additional qualifications
Many medical schools offer you the opportunity to complete an additional qualification such as a BSc. Consider choosing a BSc which is relevant to paediatrics, for example through the research project or essay topics which you choose.
CV building for Foundation trainees
Taster weeks
Don’t worry if you have only recently considered paediatrics and don’t have any Foundation jobs in the specialty; there are still opportunities to gain experience. During your Foundation training you can arrange a ‘taster week’ in a paediatric unit in order to learn more about the specialty and talk to paediatric trainees. Even if you have a Foundation job in paediatrics, you can apply to spend a taster week in community paediatrics or with the child and adolescent mental health team to gain further experience.
Careers events
The RCPCH runs careers events for Foundation doctors. Check the website for details or become a Foundation doctor affiliate member of the RCPCH to get regular updates about events.
Conferences
Attend paediatric conferences such as the RCPCH conference (which is an international conference) or your local paediatric deanery conference. This is a great way of learning about the latest developments in the specialty and hearing experts present their work. Try submitting an abstract of an audit or improvement project you have been involved in, as poster presentations at conferences look impressive on your CV.
Audits
Completing an audit is a compulsory part of Foundation training but you can make yourself stand out by going further than the basic requirements. Taking part in regular audits, leading audits yourself and completing the audit cycle (i.e. re-auditing after making a change) all help to highlight your motivation and ability to see a task through to completion. Presenting your findings at a regional or national meeting (as well as locally) looks impressive and gives you an opportunity to share your ideas with a wider audience. You can also submit an abstract of your audit findings to a conference or journal to gain credit by way of a poster or publication.
Exams
Sitting one of the paediatric MRCPCH exams during your Foundation years shows that you are committed to the specialty and can be useful when applying for specialist training.
Improvement projects
These can be challenging but rewarding to be involved in. Completion of an improvement project is also now a compulsory part of Foundation training so to stand out, you need to do more than the basics. Presenting your work at various patient safety or quality and improvement conferences is one way of helping to set you apart. There are also several places where you can try to get your work published such as Casebook (www.the-network.org.uk) and BMJ Quality and Safety Journal.
Life support training
Completion of a paediatric life support course can provide you with clinical skills for use during clinical placements (not just in paediatrics but in the emergency department or general practice). Completion of these courses also helps to set you apart from others by showing your commitment to pursuing a career in paediatrics.
Teaching and training in teaching
Teaching should be a standard part of all doctors’ day-to-day work. Taking the initiative and setting up your own teaching programme to suit students’ needs is impressive and if you can organise this regionally or across the entire medical school, this looks even better. Collecting feedback is important, as is being able to show how you’ve changed your teaching based on the feedback you’ve received from students. You may also find it useful to complete a training course in medical education. Many of these courses are available locally, sometimes free of charge for doctors working in teaching hospitals. Find out what is available at your trust and sign up early as they tend to be very popular.
CV building for specialist trainees
Subspecialties
You may already have an idea about whether or not you would like to subspecialise within paediatrics. If you do think that you may apply for subspecialty training through the ‘grid’ process, it is worth trying to gain relevant experience to show your interest in the specialty. Try to get involved in audits or research in that area, apply for rotations in the earlier stages of your training which include time at a unit which specialises in your area of interest. Also, even if you know that you want to pursue the general paediatrics route, it is worth remembering that you can qualify as a general paediatrician with a specialist interest. This means that you have more opportunity to pursue areas which interest you without having to commit solely to that subspecialty. It can also be helpful when applying for consultant jobs to have a specialist interest which you can add to the department.
Out of programme (OOP)
It is possible to take time ‘out of programme’ for a variety of different reasons. Each of these needs approval from the Royal College and your deanery to go ahead and the national guidance on OOP time is outlined in the ‘Gold Guide’ (the postgraduate training guide produced by Modernising Medical Careers). The different OOP opportunities are as follows.
Out of Programme Clinical Training (OOPT). You can apply to the General Medical Council for approval of pursuing training abroad for a year, which will contribute towards your overall training (i.e. you will still progress a year within the training programme).
Out of Programme Experience (OOPE). This is for cases which do not receive approval from the GMC as a training post. This means that you can pursue training abroad but the year will not count towards your specialist training and when you return, you will continue training at the same point as you left.
Out of Programme Research (OOPR). This allows time to pursue research and it is possible to have the time approved by the GMC so that it counts towards your specialty training. This research is usually undertaken as part of a higher qualification such as a PhD or MSc.
Out of Programme Career Break (OOPC). This can be time out for maternity leave or childcare responsibilities or because of your own or a family member’s ill health.
Most people use the term ‘ooo-pee’ (OOPE) when referring to any of the above four variations of time out of programme. For more information look at the ‘Gold Guide’ which can be downloaded from www.mmc.nhs.uk.
Further qualifications
You don’t necessarily have to take time out of programme to study for postgraduate qualifications. There are flexible Master’s and diploma courses which can be completed over an extended period of time rather than as a full-time year-long course. You could consider pursuing an additional qualification in medical education or a Master’s in international child health. There are lots of different courses available.
Clinical governance – more than just audit
It is important to undertake audits to make sure that the care we provide for patients lives up to the expected standards. Sadly, audit is frequently treated as a tick box exercise rather than something which can have a positive impact on patient care. This is partly because many junior doctors just complete audits which their senior colleagues have told them to do and have no interest in the subject themselves. This can mean that they take on something too big for them to realistically complete and the audit feels like a tedious task which drags on for an extended period of time. As a consequence, many people start audits which they don’t subsequently finish and therefore waste a lot of time and energy on work which they receive no credit for and the patients receive no benefit from.
If you are going to complete an audit then try to pick the topic yourself and choose something small which you can realistically complete. Remember that audits are only useful if something changes as a result of what you have found out. Many people do the data collection and analysis bit, present a list of recommendations and then think that the audit is done. But if you want to have any impact on patient care then you need to make sure that these recommendations become real-life changes. Also, if you manage to put some changes in place then there is an opportunity to re-audit and see if there has been any improvement following your intervention. This is what people mean when they refer to ‘closing the loop’ with an audit. Not only is this far more satisfying as you can see a change in practice resulting from your interventions but it will also gain you far more credit when it comes to building an impressive CV for job applications. Doctors who have taken part in a complete audit cycle (i.e. audit, change something, re-audit) are rare and this can really make you stand out at interview.
