Preparing for the consultant paediatrician role: Lived experiences, data and recommended actions

Juggling all the different responsibilities and priorities can feel quite overwhelming. It’s good and important to have early exposure to that type of responsibility.

Dr Nazri Unni1

At the start of my final year of paediatric training I did not feel confident at the prospect of applying for consultant jobs. This was despite completing START [an RCPCH assessment] without issue. My worries were not clinical – seven years as a specialty trainee, experience with patients and exam progression meant I felt confident in dealing with clinical issues, where to go to stay up to date and who and how to ask if I needed help.

My worry was whether I was ready and able to perform the non-clinical aspects of the role. What are these and how could I prepare for them?

Dr Emma Parish2

Background

In 2018, RCPCH conducted a survey of consultants who had qualified the year before. Thirty-seven percent of respondents found the transition from PGDiT, SAS doctor/non-consultant post to consultant very easy or quite easy, 18% found it either quite difficult or very difficult and and the majority found it neither easy nor difficult (45%)3 . This survey did not, however, explore preparedness for consultancy in depth nor interrogate which elements of being a new consultant most impacted their experience.

An older survey of neonatal trainees (2011) found that new consultants felt well prepared when it came to clinical care, communication, teamworking, prioritising tasks, teaching and audit, but not so for management and service delivery, medicolegal issues and complaints, job planning and personal development, supporting doctors in difficulty and chairing meetings 4 . While options for training were available, it was felt that work pressures hindered opportunities for non-clinical training. One quoted, ‘full or partial shift systems make taking additional responsibility very difficult as everything is sacrificed for service provision.’ Another trainee added, ‘there was no structured training for those of us on the Grid [sub-specialty training] programme in my deanery. There should be training in management and extra-clinical issues for the aspiring consultants.’ Our report advocated that both formal and informal avenues should be made available for new consultants to receive support. 

This perceived lack of preparedness for non-clinical work is seemingly reflective of a more general feeling amongst newly-qualified consultants.  A 2012 survey, for example, found that across multiple specialties, consultants who had been in post for less than five years felt less prepared when it came to service planning, staff and resource management and healthcare governance, impacting confidence for both clinical and non-clinical work 5 . 

Similarly, newly-qualified genitourinary consultants felt well-prepared for teaching, training and service development (the latter had previously been a potential cause for concern)6  but had seen considerable improvement thanks to the introduction of QIP 7 . Generally, however, new consultants felt unprepared in terms of managing people, being a supervisor or leader, managing conflict, implementing change, managing finances, understanding system differences between services and managing complaints7 .

Lack of readiness has been linked to consultant burnout alongside the collateral effects of complaints, fitness to practice and safety reviews, all of which have been related to non-clinical components of the work. Overall, formal teaching, such as management training, was considered insufficient when compared to practical experience such as attending meetings and shadowing senior trust individuals.

Exposure was considered key in preparedness and those who had taken some level of responsibility for one or more of the non-clinical tasks listed above felt that they were better able to manage them as a new consultant. Likewise, acting up as a consultant during training lessened the impact of the transition from PGDiT to consultant.

Insights from our workforce CCT survey

In 2025 we conducted a survey among PGDiT approaching CCT qualification and newly qualified consultants within the last five years. You can read its key findings in our full and quick read reports.

Of the 123 PGDiT responding, 68% felt ready to move into their post-training role. This compared to 91% newly-qualified consultants, 83% of whom said that their placements had provided them with the breadth and depth of experience to prepare for their new role.

Just under 20% of PGDiTs had an opportunity to step up as a consultant, compared to 63% of those who were newly-qualified; in both cases this was usually for less than three months. Most respondents had not undertaken preparatory courses and where they had, they were mainly Preparation for Consultant interview followed by Understanding NHS Framework and Consultant role; the same was the case for the newly-qualified consultants.

Formal training in preparation for the consultant role - open in new tab

Both PGDiTs and newly-qualified consultants had undergone training over and above the formal courses. These were largely in leadership, management and educational supervision with less emphasis on administrative duties. In most cases, training was covered by the study leave budget and doable within paid working hours. 

Extra training undertaken in preparation for the consultant role - open in new tab

In both instances, courses were available at the local, regional and national level, but with considerably less offered locally for PGDiTs.

Local and regional course availability - open in new tab

Those who were newly-qualified also rated different aspects of their job plan in terms of the challenge moving from PGDiT to consultant.

How challenging was the transition from PGDiT to consultant role? - open in new tab

Four case studies

PGDiT due to finish training within the next year

A has completed a SPIN (Special Interest) module and is currently working less than full time with a view to continuing this work pattern post-qualification. Although they have no role lined up as yet, they hope to stay in the same trust/NHS region and finalise a role in the remaining months.

With just over a year until CCT (certification of completion of training) qualification, A does not feel ready for a consultant role: on a clinical level “mostly yes though some anxiety”, but on a non-clinical level, “very far off.”

In terms of non-clinical training, A attended a management / leadership module as part of an MSc Research programme but is looking for more training opportunities including career advice, interview and job plan preparation. They have had no formalised mentorship or support network but have informed colleagues that they are coming to the end of their training.

While they have yet to have the opportunity to step up as a consultant, their educational supervisor will arrange for more opportunities to perform consultant duties in the coming months.

PGDiT working as a locum

B is a PGDiT is currently working as a locum in the same region in which they trained. They have completed an Allergy SPIN (Special Interest) module and trained at less than full time (0.8), having changed at Specialty Training 4. But are flexible in terms of continuing this work pattern post-qualification.

B feels ready for a consultant role at both the clinical and non-clinical level having sought out additional training/learning opportunities and having benefitted from a good support network.

B informed their colleagues that they were approaching the end of training and on the non-clinical side attended conflict training and educational supervision courses while being given the opportunity to perform non-clinical tasks including “operational meetings, giving advice to other specialties, consultant meeting.”

They were also given the chance to step up as a consultant. “[It] went very well and gave me confidence that I am prepared. Good support during week – phased approach of going around with consultant on day one and then leading on my own.”

Newly-qualified consultant working in paediatric emergency medicine

C completed sub-specialty paediatric emergency medicine training a year before, in 2024. Their first (and upcoming) roles were/are in London, the same region in which they trained.

“During training I worked 60% mostly, until I reached Specialty Training 7 and then I increased hours as children both in school, so less difficulty with childcare, and also wanted to speed up training.” 

Did they feel ready for their consultancy role at the clinical level?

“No I did not, which is why I opted to do a post CCT fellow year. I had noted during ED (Emergency Department), and PICU (Paediatric Intensive Care Unit) placements that my adult colleagues were much more proficient in managing the departments, and in working with paediatric patients outside the neonatal patient group - be it trauma, airway and cardiovascular emergencies. This I believe is multifactorial; however, the key factor is high volume of very sick patients seen in adult ED resus and adult ICU and also rotating through anaesthetics.

"For this reason I have sought as best as I could to address these gaps that I felt in my training by doing additional PICU (for airway day exposure as there are nearly no SHO anaesthetic posts to be applied for and none I could find without having to move away from home) and retrieval - a total of 12 months additional time.

"I think that paediatricians who have done general paediatrics or ED in the UK direct from F2 (Foundation year 2) with none of anaesthetics, adult ED (in a reg role or at a busy MTC (major trauma centre), adult ICU or cardiology can have full exposure and competence for managing airway/ breathing/ cardiovascularly unstable patients. I spent a lot of time in ED giving breastfeeding advice and managing anxiety due to the high volume of very well patients presenting. I am not a weak trainee, but I was weak due to my lack of exposure of very sick children.

“I felt very disappointed that after eight years of training, I still had to fill in gaps that I do not think were adequately completed with my paediatric training. Not having PICU exposure until ST7 was part of the problem and if I had PICU earlier as an SHO or ST4 that would have helped. Being told I could not go out of programme to adults and that paediatricians should have all the training necessary was frustrating whilst at the same time not having PICU posts available. Neonatal ICU is not relevant for many of the gaps I am highlighting but this is what paediatric trainees get to cover. The opportunity to go out of paediatrics (as per PICM anaesthetic placements) to obtain exposure and competence in adult ICU and adult anaesthetics and adult Trauma EM [would be helpful preparation]."

Did they feel ready for your consultancy role at the non-clinical level?

“Yes. To some extent having sought extensive experience outside of my paediatric departments. Seventy-five percent of this has been in my own time through being a rep for the BMA (British Medical Assocation), chair of the JDF (Junior Doctors Forum) at my hospital, being a director of Soft-Landing IMG support hub, and the Chair of Green at Barts Health Trust staff sustainability group.

"Additional training included Educational Supervisor training, coaching and mentoring as JDF Chair and BMA local negotiating committee training The mentor network system was successful, but this was largely down to the individual sourcing a mentor for themselves.

“I requested my final educational supervisor based on what I had heard about them and their expertise. I don't think being allocated a random supervisor would have supported me getting my CCT as effectively. I was able to find a network for START practice and consultant interviews. The PSU (Professional Support Network) was also helpful.

“I had a poor final placement where the stepping up shifts were mostly very micromanaged in paediatric emergency department with variable buy-in from the different consultants, meaning no real chance to do it enough so as to develop skills and competence.

"The senior nursing staff were not supportive of the reg stepping up unless it was a well-known face who had been in the department for years and they knew well. However ELSE (Extended Supervised Learning Events) were quite useful in getting specific feedback. Regs were not included in many managerial discussions or allowed to join consultant meetings. It may be that I had a bad attitude as I did not feel welcomed or included in my final ST8 placement, and I felt actively undermined by consultants and senior nurses, which was not what I had expected, coming to a department as a very senior trainee.  As a result I went elsewhere for opportunities.”

Newly qualified consultant

“I finished my training in August 2024. I was a full-time trainee till halfway of ST5 till I had my first child. Following this, I returned to work at 60% LTFT till I finished my training. At present as a consultant I am working full time at ten PAs, but I would consider reducing my time to eight or nine PAs to allow me to have a day off in the week for life admin.

“I did not have a job lined up. In our deanery there is a great need of paediatric consultants due to the big workload and five-year waiting lists. But our funding works differently, and there is a lack of this, especially for paediatrics. Most trainees finish the training and are trying to get a short-term locum post, if there is availability. Some can be unemployed for some months. There is also a bottleneck, in my opinion, as most trainees are mums who work part time. But the jobs being advertised are full time, and most will go to a full-time post, as they will have a day off in the week as a lieu for on calls, so it is manageable.

“My first two jobs were covering a consultant’s sick leave for few months. Following this I got a contracted locum post in community paediatrics, as there were no other job opportunities available in my deanery, mainly due to funding issues. If the opportunity arises, I would like to stay in this post, as it is close to home and provides better work / life balance.

“I can’t say I felt ready for my consultant post. As trainees we get trained to become excellent registrars, but not consultants. In my deanery, due to the rota shortages, trainees rarely have the opportunities to attend clinics, meetings etc, as we have to cover the acute work. A consultant though (in most specialties) does mainly outpatient work and overseeing. I literally went from being a registrar on a Tuesday to being a consultant on the Wednesday. So, I had to learn (obviously I am still learning) how to manage and organise my clinic time and how to manage outpatient presentations that we don’t see in the acute setting. In addition, when I was covering acute posts, I had to learn how to manage and oversee my team as a consultant, how best to follow up inpatient cases and results, how to deal with on calls from home.

“There are plenty of things that I still don’t know, such as how the hospital works from a management perspective, what is the process of making changes, how to make business cases, etc. As trainees we don’t get the chance to step up into a consultant role, as most times we are the only registrar on the floor. The deanery provides half day courses on how to manage a team, leadership, supervision, etc. But we learn better by directly observing and doing something under supervision so we can get feedback. I had to seek opportunities myself as a trainee to prepare myself for the consultancy life.

“I think that at least the last six months of training, the trainee should be supernumerary and off the on-call rota to allow them to do consultant only related tasks. A separate portfolio checklist might be helpful as well as a guidance.”

“In my consultant post so far, the consultant team have been very helpful and supportive. They are available to discuss any cases or concerns.

How you can support your transition

Ask about opportunities, attend consultant meetings, and remind people that you’re nearly finished with your training. Identify your dream job and then ask for it - if you don’t ask, you won’t get. Be prepared to defend your own worth.

Identify gaps in experience

• Get feedback from your START and Multisource Feedback
• Engage in reflective learning
• Get feedback from your multidisciplinary team (senior nurses, pharmacy, allied health professionals) to identify MDT-based skills

Get mentoring or supportive conversations 

• These can be between consultants and senior PGDiT
• Gain insight into a day in the life, hints and tips

Seek opportunities on the floor

• Remind people where you are in your training and seek more independent experience 
• Ask for opportunities to act up as a consultant, for example, solo lists, clinics, ward rounds with distant support, attending bed meetings

For example, as a senior registrar you could approach the consultant to carry out the ward round and present your plans at the end of the day...

Focus on your skills

• Address your organisational skills 
• Develop new skills - you will be offered new and exciting opportunities that weren’t available as a trainee
• Develop coaching skills and reflection for training responsibilities, including an educational supervision course

Think about your job plan early. What special experience, interest, or skills do you bring, and what do you want to do with your time beyond your basic clinical commitment?

Seek local opportunities

• Gain experience in non-clinical skills
• Attend consultant meetings 
• Regularly chair senior meetings
• Input to management and service development initiatives
• Draft responses to complaints and medicolegal claim
• Take part in working with doctors needing extra support

Seek opportunities to think and act like a consultant before the transition…This might be as simple as a mental exercise when dealing with an individual patient or a more formal arrangement...

Offer peer support

• Do local registrar teaching, including on non-clinical topics
• Organise local paediatric registrar (small group) training

Job plan

• Think about your job plan early - use our job planning toolkit for consultants (and SAS doctors)
• Learn what direct clinical care and supporting professional activities mean and how the consultant contract works  

Before you start looking at job adverts, learn what direct clinical care and supporting professional activities mean and how the consultant contract works. Know how many patients you can see in a four hour ward round.

Courses and guidance

START

All pre-consultant PGDiT are required to undertake START (Specialty Trainee Assessment for Readiness for Tenure) at RCPCH which assesses clinical decision-making. 

• A three-hour assessment across six domains including scenario-based discussions. 
• Six domains: decision making and prioritising, knowledge, management of complexity, professional approach, safety and risk management and communication. Plus a global rating of overall performance overall 
• For all PGDiTs expecting to attain CCT/Portfolio Pathway ie complete a UK Paediatric Training programme leading to entry on the Specialist Register.
• If in sub-specialty training, START must be in that sub-specialty, if in SPIN START will be in General Paediatrics. Also optional for those in a non-approved training post subject to availability and capacity 

Stepping Up programme

The Stepping Up Programme provides a voluntary support network for senior PGDiT preparing for the transition to consultancy and for those in the early years of a consultant role. 

Consultant readiness for Level 3 trainees 

See Consultant readiness for level 3 trainees with Health Education England (PDF)

This to be used in conjunction with the RCPCH Assessment Guide. It includes: 

Clinical

• Acting up as consultant of the week, attendance at consultant/directorate meeting, rota management
• Safeguarding experience with reports, strategy meeting attendance, SLEs in addition to CPIP modules, involvement in FII if possible or reflection of learning/reading
• Supporting a junior colleague and allied staff
• Further general paediatric experience including more complex cases and outpatient experience with reflection of learning 

Management

• All mandatory courses completed or booked (include intensive communication course, public health, leadership and management, CPIP modules or equivalent learning face to face)
• APLS and NLS up to date
• Leadership and management evidence in day to day practice
• Working within a multidisciplinary (MDT) and multiagency team
• Quality improvement activity or change management activity (which includes completion of audit cycle, clinical governance project)
• Involvement in management of complaints or PALS or root cause analysis with the department
• Evidence of involvement in admin, paperwork, prioritising referrals, eg offer to spend time dealing with a consultant’s admin to demonstrate both initiative and development and competence in effective managerial skills that support effective service provision and time management
• Workplace-based assessment on prescription/prescribing in ST7/8 if not done SCRIPT or any issues raised in START 

• Evidence of advanced communication skills eg breaking bad news, diffusing a difficult situation 
• Management of incidents on call eg bed shortage, staffing issues, absconding patient 
• Dealing with child death (as for CP even if not leading, what you have learned and how you would handle in future) 
• Following completion of START any areas for development to be included into PDP and plan as how will achieve 

Transition to consultant course 

Provided by the London School of Paediatrics, this is a free two-day course and shadowing scheme for paediatric trainees ST7+ to help them prepare for their new role as consultants. The course covers: 

• What to expect from the consultant interview
• How to develop a service
• The structure of the NHS
• Complaints and serious incidents
• Supporting juniors

GMC’s Generic professional capabilities framework

This framework is in place to ensure PGDiT across all specialties are meeting a minimum standard. 

Professional values and behaviours

Demonstrate appropriate personal and professional values and behaviours as per Good medical practice and related professional guidance including duty of care to patients in addition to a wide range of other professional responsibilities

Professional skills

• Practical skills
• Communication and interpersonal skills
• Dealing with complexity and uncertainty
• Clinical skills, including:
  • history taking, diagnosis and medical management
  • consent
  • humane interventions
  • prescribing medicines safely
  • using medical devices safely
  • infection control and communicable disease.

Professional knowledge

• Professional requirements
• National legislative requirements 
• The health service and healthcare system in the four countries

Other available courses

• Royal College of Physicians
• London Leadership, Management and Education

• 1generationleader.co.uk/blog/transitioning-from-registrar-to-consultant-heres-what-to-expect/
• 2londonpaediatrics.co.uk/wp-content/uploads/2020/06/Preparing-to-become-a-Paediatric-Consultant-Madeline-Tyrrell.pdf
• 3www.rcpch.ac.uk/sites/default/files/2019-10/cct_class_of_2017_-_long_report.pdf
• 4pubmed.ncbi.nlm.nih.gov/22193818/
• 5pubmed.ncbi.nlm.nih.gov/22773821/
• 6durham-repository.worktribe.com/output/1508212/are-specialist-registrars-fully-prepared-for-the-role-of-consultant
• 7 a b Flavell S. RA, Dacre, J. The transition to consultant: Identifying gaps in higher specialist training. Clin Med. 2020;20(4):406-11.