Making paediatric training work for trainees

There is no doubt that working in paediatrics is highly challenging. But, explains Dr Rupert Ellis, an ST7 in general paediatrics (pictured), it's also a time for optimism as huge efforts are being made to improve the quality of paediatric training and the support available.

Rupert Ellis, ST7 in general paediatrics

The intensity of the work, including high volume and high pressure situations during most shifts, puts a unique burden on trainees and non-trainees alike. There have been many accounts in recent years of the difficulties that doctors face, not least the situation of Dr Hadiza Bawa-Garba. Such a backdrop has caused an inevitable need for reflection among the current workforce and those considering entering paediatric training. Many trainees simultaneously find themselves under huge strain trying to maintain services and complete their training.

It is not surprising, therefore, to note that the first round of paediatric recruitment to ST1 (specialty training 1) for entry to training 2019 showed paediatrics at the bottom of the list, with a fill rate of less than 70%. Add to this the fact that there is a high attrition rate among paediatric trainees, and the problem is potentially quite concerning. Around five percent of paediatric trainees leave training per year and many others are seriously looking elsewhere. There is also a 15% vacancy rate at registrar level which means added pressures for those in training.

However, there are numerous reasons to be optimistic about the future of paediatrics and the opportunities it offers. Meeting and working with a diverse range of children and families can be a very rewarding experience. It is also a specialty in which it is possible to retain true generality, or to become sub-specialised in almost any area under the paediatric umbrella. 

There are numerous reasons to be optimistic about the future of paediatrics and the opportunities it offers

In September last year the College launched its #ChoosePaediatrics campaign with an emphasis on recruitment and retention in paediatrics. It looked to inspire the next generation, while offering resources for those already in the specialty.

In order to get this message across, recruitment events were also developed across the country to offer prospective trainees the chance to find out more. This approach is already beginning to raise the profile of paediatrics. It is an excellent opportunity for current trainees and other members of the paediatric team to get involved and show paediatrics in a positive light. 

In addition, huge efforts have been made in recent years to improve the quality of paediatric training and the support available. The functionality of the training portfolio (RCPCH ePortfolio) is often debated but it is being continually developed with trainees in mind and is a great improvement on the previous iteration. The Trainee Charter, which was introduced in 2019, seeks to put into practice some key basic principles that all trainees should be able to expect, wherever they may be training in the UK. This is a very valuable piece of work which should help to protect trainees and ensure they have the resources they need to work safely and effectively. Paediatrics has also been promoting easier access to less than full time working, which better reflects life in the 21st century.

The Trainee Charter seeks to put into practice some key basic principles that all trainees should be able to expect

Furthermore, significant projects like Paediatrics 2040 are looking in detail at how we are likely to be working in the next few decades. Changes in working practices might include individualised patient care on a genomic level, developing new roles as a consultant throughout one’s career and looking towards providing more paediatric care closer to home rather than in hospital. Development of the training programme is mirroring this move towards adaptability, with the planned change to a new training structure providing an opportunity for trainees to individualise their training.

Huge changes to how we care for children in the UK are likely in the coming years. With the challenges that all those working in paediatrics face, offering more individual choice and career development within and after training is a clear step forward.


Dr Rupert Ellis is an ST7 in general paediatrics and the Mersey representative on our Trainees Committee. As part of his role he organises the annual recruitment event in Liverpool for foundation doctors.