I had the good fortune of a very flexible career pathway. This was before the days of specialty training programmes, and so you effectively constructed your own training by applying for a new job every year or two (sometimes less!). This did bring flexibility, but at the price of instability and uncertainty. However, it did mean I could follow a rather non-orthodox pathway, including a research year in Tanzania, six months in genetics and time in child psychiatry.
Fast forward to run-through specialty training in paediatrics and we had the benefits of (generally) well-constructed, coherent, regionally organised training programmes, with the stability and certainty that brought. No more applying for jobs every year! But... the downside was some loss of flexibility - in that individual needs had to be balanced against service needs.
We do want to prioritise flexibility, individuality and personalised training
We now come to the era of Progress+, the shiny new RCPCH training programme starting in 2023. It represents a maturing of the specialty training system, with better preparation for future working, somewhat shorter training (indicative seven years instead of eight), clearer and simpler training (two levels instead of three) and a move away from a granular tick-box approach to a clear vision of capabilities at each level. It aligns us to the GMC’s ‘Shape of Training’ document, and importantly brings in a new level of flexibility.
Training cannot be a ‘sausage machine’. We are all different, with different circumstances, needs and aspirations. Perhaps training should be more like a craft studio, with time, energy and skill being used to bring out the best and the individuality of each piece. And of course that analogy immediately fails because it still suggests the idea of ‘being done to’, and really the best training is a joint project between trainee, trainer and the whole training environment.
Progress+ recognises this. You need to be able to mould your career to suit you, so that it fits your strengths and you can thrive in it. You need to be able to combine your career in paediatrics with all the other things in life that you value, including family, friendships, and other pursuits. For some, that means working less than full time, or a pause in training. Progress+ and other work the College is doing on lifelong careers are all about paediatricians thriving throughout their training and careers - in a system that better accommodates each person’s individuality, and so delivers better care for the children and families we serve.
It can be great to develop special interests or a particular emphasis within paediatrics that makes your work even more rewarding. You can do that through Out of Programme (OOP) experience years, or research, or Leadership Fellowships, or getting involved in the myriad of opportunities that the College and the NHS provide for finding your niche. I had the privilege in recent years of being Convenor of PEdSIG, the Paediatric Educators’ Special Interest Group of the College, and the energy and talent of trainees involved made all the difference.
You need to be able to combine your career with all the other things in life that you value...
So can we promise unlimited flexibility? No, because the best training means being part of delivering high quality services, and that means knowing that we can staff the rotas and roles that make that happen. But we do want to prioritise flexibility, individuality and personalised training. And we believe that with careful planning of our training system, empathetic listening to trainee needs and aspirations and a can do approach, we can deliver high quality NHS services and a training environment in which each trainee thrives.
Dr Jonathan Darling is a general paediatrician based in Leeds