PAEDIATRICIANS are often said to be the last of the true generalists in medicine. The specialty encompasses a wide and varied range of practice, from neonatal intensive care to the management of chronic disease and disability in the community. The most common career choice is general paediatric consultant based in hospital or community practice.
Paediatrics was established as a separate area of medical practice in the UK in the nineteenth century and it is thought that Great Ormond Street, founded in 1852, is the oldest children’s hospital in the English-speaking world. There are now more than 4,000 career grade paediatricians working throughout the UK in 276 separate child health services.
Paediatrics takes a holistic approach, focusing on minimising the adverse effects of illness with the aim of allowing the child and family to live as normal a life as possible. The specialty also has a unique dimension whereby the diseases and conditions treated are ever changing due the continued growth and development of the patient.
Among medical careers, paediatrics remains popular though not prohibitively competitive. The rewards of working with children are many and being an advocate for children and the young is considered a privilege among paediatricians. Emotional strength and resilience are essential in this specialty as working with very sick children can be personally stressful and challenging.
Modernising Medical Careers (MMC) replaced the paediatric SHO and registrar grades with a seamless run-through training grade which aims to take doctors from completion of foundation training through to Certificate of Completion of Training (CCT). Training is facilitated through The Royal College of Paediatrics and Child Health (RCPCH) and entry is applied for on a competitive basis.
The RCPCH state the following personal qualities are essential for a career in paediatrics:
• patience, sensitivity, empathy and emotional resilience
• good communication skills
• good team working skills
• comfortable with informality
• good sense of humour
• flexible and opportunistic
• commitment to promoting the welfare of children.
Training takes eight years from ST1-8 grades. The three-part MRCPCH exams should be completed within the first three years, and continual competence and performance assessments are undertaken throughout. ST1- 5 is spent building a good working knowledge of all aspects of child health, involving posts within district hospitals and placements in specialised neonatology, community paediatrics and the sub-specialties. The final three years concentrate on the areas that the trainee wishes to pursue as a career path.
As a specialty, paediatrics is renowned for being very supportive to its trainees and almost 80% of trainees will obtain a consultant post within 12 months of CCT.
The majority of paediatric trainees will pursue general paediatric medicine as their career choice, some with a special interest in a specific area. Others will move into one of the 15 sub-specialties which include oncology, endocrinology, neonatology, respiratory medicine, neurology and community based paediatrics which involves working with long-term problems such as disability and behavioural issues.
Teamwork is very much the ethos: working within a multi-disciplinary team and with the child’s family. This is especially the case when managing chronic illnesses and problems.
Paediatrics is a family oriented specialty and this is reflected in the structure of the training schedule; it has the highest numbers of part- time training grade doctors out of all hospital specialties. It is possible to train flexibly for part or all of your paediatric training and, increasingly, job share posts are also available at consultant level.
As with all branches of medicine there are challenges facing paediatrics in a rapidly evolving NHS. Changes to other areas in the service have a direct effect on the paediatric workforce, i.e. reduction in GP out-of-hours care results in increased attendances of children to A&E departments, and rising expectations of parents and educational providers increase referrals for assessment of perceived learning problems.
Essentially the future of paediatrics is evolving along the same lines as healthcare as a whole with the focus on outpatient units, enhanced local accessibility and fewer inpatient units in hospital settings. It has been well recognised that better linkage between agencies providing children’s services is needed to ensure a coherent and safe service that transcends care levels and ensures a smoother transition into adult care.
For further information contact the RCPCH: www.rcpch.ac.uk
Cherryl Adams is Associate Editor of FYi
Q&A - Dr Damian Roland, paediatrician
• What attracted you most to paediatrics?
I certainly didn’t go to medical school wanting to be a paediatrician (for some reason I can’t adequately explain I had a burning desire to be an orthopod!). Paediatrics is certainly a vocation – you either love it or hate it. I really enjoyed my paediatric attachment and realised I hadn’t actually been that interested in any adult medicine. Having spent time at school teaching youth theatre and sport to primary school pupils I probably should have realised I enjoyed working with children – there is certainly a lot less of the baggage than you get with adults.
• What’s your most memorable experience so far?
I led a resuscitation on a boy with a heart condition who unfortunately subsequently developed a palliative (life-limiting) complication. We discussed with him whether he would want to have CPR performed again. “No” was the very definite reply. However, after a short pause he said if it happened before the World Cup in two weeks’ time he would like to have a chance to watch England play. Very humbling.
• Now that you’re in the job, what do you enjoy most?
I am a paediatrician who specialises in emergency medicine. I enjoy the frantic pace of the emergency department, dealing with a population who get ill and better again in a very short space of time. It’s an observational specialty, and although there are specific practical difficulties, I love the challenge of guessing what is wrong with patients essentially just by looking at them. You have to have a calm temperament and not be frustrated by the belligerent child who won’t let you do anything to them. My personality is suited to handling the large variation in patient acuity you see even on an hourly basis.
• Has anything about the role surprised you?
Rather perversely I enjoy breaking bad news – as long as I do it well. I never thought I would think that when I started the job! Explaining to anxious parents why their child is unwell, how you are treating them and what is going to happen to them is very challenging. It’s very heart warming to hear parents thank you for all you have done for their child when you have done very little practically but simply just kept them up to date and informed.
• Are there any downsides?
It’s a demanding specialty (but it’s difficult to think of a hospital job which isn’t now). The increased media hype regarding child protection makes every consultation potentially difficult, especially when you work in a front-line job like emergency paediatrics. Although it is rare, parents can be extremely rude to you and cruel to their children which is upsetting. However, as a child advocate you can gain a lot of satisfaction from knowing you have done the best from the child’s point of view.
• Do you have any advice for young doctors wishing to pursue a career in paediatrics?
If you can manage four months exposure in your foundation years you can get a real taster. Juniors are very well protected but get a lot of exposure. Paediatricians are the friendliest of all specialists, and we are always keen to promote the subject so ask, ask, ask. If you think you want to do paediatrics as a career ask one of the SpRs if there is an audit project you can help them with – undoubtedly they will say yes and it looks very good on your CV.