The future of paediatric training - view from a trainee

What should be expected as the national standard for future training, and how do we respond to changing healthcare? Dr Emma Dyer, a trainee paediatrician working in London, introduces our new, collaborative document, which draws on wide experiences to present 11 new training principles and how these can be linked to the curriculum.
Dr Emma Dyer

Some of you may have heard of something called “Shape of training”. This was originally a report commissioned by the Government in 2013, which looked at current training across all specialties and suggested some changes and reforms to training as we know it (you can see more detail about Shape of training on General Medical Council website). 

"Shape of training" came out of a recognition that training needed to be modernised and made more flexible, as well as wanting to see more integration between different specialties. The RCPCH has used this as an opportunity to review the paediatric training programme and work out how it can be modified and improved for trainees. As a result, there are going to be changes coming within paediatric training that will be rolled out in 2023. As we approach this date, there will be plenty of information from the College about what Shape of training is going to look like so I’m not going to dwell on that here, but watch this space!

What I want to talk about is a document that is being released in preparation for these changes in training. It's called Paediatrician of the Future, and it outlines new principles for paediatric training. This is a truly collaborative document drawing together the ideas and experiences of trainees and consultants from all around the UK, as well as the team at RCPCH and, of course, children and young people from RCPCH &Us

The inclusion of child and adolescent mental health and public health capabilities are seen as vital... as well as better interfacing with primary care, mental health services and schools

This is a very aspirational (and I would say also inspirational) document and is definitely worth a read.

Paediatrician of the Future starts by talking about how healthcare is changing, and explains that our training needs to evolve to reflect this. There is an increasing emphasis on integrated care, and the inclusion of child and adolescent mental health and public health capabilities are seen as vital. There is also an increasing need to address the needs of young people beyond our usual age cut-offs – potentially up to 25 years, as well as better interfacing with primary care, mental health services and schools.

The document goes on to talk about the importance of a flexible and adaptable workforce, including increasing the numbers recruited onto our training programme, as well as addressing current challenges around workload and shifting the balance to a healthy distribution between service provision and training. Facilitating less than time training and out of programme (OOP) time is also recognised as important to creating this workforce for the future.

As with workforce, training must be being flexible – and the document discusses moving away from the very rigid set placements and having a more creative approach, which can also be tailored to individual trainees.

The philosophy underlying the training and the curriculum within paediatrics is known as the “Whole Population Approach”. This incorporates six segments as shown below.

Whole population approach - in six segments

There are some nice examples of how you might apply many of these segments in any one case or setting. For example, in a child on PICU with meningococcal sepsis you may need to consider:

  • The “Healthy Child” with prophylaxis in siblings
  • The “Vulnerable child with social needs” as the parent is struggling to provide care for the siblings and be in the hospital at the same time
  • The “Acutely mild to moderately unwell child” for the initial management of the preceding upper respiratory tract infection
  • The “Acutely Severely unwell child” as things escalate to PICU

The core of the document outlines 11 training principles, all of which complement the RCPCH Trainee Charter (also worth a read if you haven’t seen it before). 

These new training principles are outlined below:

  1. Every patient encounter is a learning opportunity
  2. Complex case management provides rich learning opportunities
  3. Clinical reasoning skills are explicitly taught within training
  4. Patients and families are heard
  5. A biopsychosocial approach is applied at all times
  6. Leadership skills are developed and nurtured
  7. Training time and learning opportunities are prioritised within the workplace
  8. Educational supervision is high quality and provides consistency
  9. Morale and job satisfaction are improved
  10. Assessment is used as a learning tool
  11. Progression and length of training are personalised and flexible

On the surface, none of these principles perhaps look particularly new or groundbreaking. However, the document delves into detail about what these should look like in practice, including:

  • Rota designs giving trainees the opportunity to follow the patient journey rather than just getting a snapshot of their care
  • Trainees shadowing a social worker or health visitor doing safeguarding work
  • Trainees working alongside CAMHS (Child and Adolescent Mental Health Services) and spending time within their teams
  • Trainees working with groups of young people to help redesign services
  • Rota design that offers training/education weeks
  • Non-training tasks being delegated away from paediatric trainees
  • Trainees participating in nurse education sessions fostering two-way learning
  • Senior nurses supporting triaging of all paediatric bleeps
  • Resilience, stress management and mindfulness training being available within the Schools
  • Consultants holding specific SLE (supervised learning events) clinics for trainees 
  • Trainees working with schools to help with health promotion programmes.
  • Setting up joint clinics or consultations with GPs
  • Shadowing clinicians that straddle paediatric and adult care such as gynaecologists, surgeons and GPs

To have such progressive and training-focused ideas like these... I think is pretty exciting

The document describes case studies for all of these examples, and helpfully demonstrates how they will link to the Progress curriculum. These all provide great examples of how the curriculum can really be used to guide and enhance trainee’s experiences rather than just being seen as a “tick box” exercise or something quite restrictive.

I know that there are already many pockets of excellent practice in training up and down the country. However, to have such progressive and training-focused ideas like these laid out as what should be expected as the national standard for future training... I think is pretty exciting.

If this is what the future of paediatric training is going to look like, then that’s somewhere that I want to be!