Shape of training - frequently asked questions

This page aims to provide you with the all-important answers to some of the questions we are sure you have in relation to Shape of training.
Last modified
27 April 2021

This is not an exhaustive list, and if you think there are areas that we have not covered or answered please do get in touch with us on shape-of-training@rcpch.ac.uk. We will add your questions and our answer below. 

For additional context, you can also refer to the further information available from our Shape of training page.

Overview

Key changes to the revised training programme

  • The structure will change from a three-level ST1-ST8 programme to a two-level ST1-ST7 programme ('ST' means 'specialty trainee').
  • The positioning of the exams will move so that only the theory exams need to be completed by the end of ST3, before a trainee can take on tier 2 (middle grade) rota responsibilities. The clinical exam will need to be completed by the end of ST4.
  • There is a less prescriptive approach to placement requirements, allowing some flexibility to reflect local needs and trainees’ career intentions
  • Where requested and feasible, a trainee can incorporate up to one year of Out of Programme (OOP) time to develop more experience. This can happen midway through the training programme and before selecting a sub-specialty. This will ensure paediatrics is a more attractive option for those foundation doctors concerned about the contracts of a seven-year programme.
  • Trainees will be able to commence sub-specialty training from ST5 and consequently apply from ST4 onwards providing they have enough indicative time at the start of sub-specialty programme to complete prior to CCT (Certificate of Completion of Training).
  • Trainees will move to undertake START (Specialty Trainee Assessment of Readiness for Training) in ST6.
  • There will be better facilitation of trainees moving to a different sub-specialty training pathway within paediatrics after making their initial selection, in response to changing demands (workforce needs, career intention, lifestyle requirements).
  • The programme will be underpinned by 11 new training principles to articulate the standard that all programmes should be meeting, promote enhanced flexibility and encourage a greater focus on integrated care and efficient multi-disciplinary working. These training principles are introduced in our Paediatrician of the Future document.

Why should we change?

We need more flexibility in training, for both our patients and our trainees. Removing the middle level simplifies the pathway, allowing trainees to move into a chosen subspecialty sooner and also provides a more natural break point for out-of-programme experience.

There will be some flexibility at ST6 to change sub-specialty pathway. The pathway is capability-based. Trainees can move through the pathway faster – for example, if you have prior capabilities. The Progress+ curriculum places less emphasis on specific placements, allowing more flexibility for differing routes through the pathway.

The aim is to allow the training experience to better match final career; we don’t expect paediatricians to have identical skill sets.

How can we train paediatricians in only seven years?

We aim to improve efficiency of training by removing the current level 2 (minimum of six months each in general, community and neonatology) – accepting that trainees will no longer undertake the current core middle grade years, but will gain a core set of generic capabilities.

In addition, trainees gain specialty-specific capabilities (eg general paediatrics, paediatric oncology and paediatric neurodisability) depending on the chosen pathway.

What about the quality of training?

Our Paediatrician of the Future document sets out how to improve quality, giving primacy to maximising learning opportunities through good supervision. This will be a challenge; the document won’t improve quality in itself, but it does clearly set out the agenda and direction.

When will we know what is happening for sure?

The Progress+ pathway, including the transition plans and workforce implications, was submitted to the GMC (General Medical Council) in April 2021 (see news story).

Upon approval, we can then publish more specific and granular details, but we are anticipating the transition during summer 2023.

Curriculum

What is the difference between Progress and Progress+?  Is this a completely new curriculum?

Progress+ is not a new curriculum. The + signifies the changes we are making to the Progress curriculum (subject to approval by GMC, to be rolled out at implementation) and the accompanying syllabi to convert training from three levels to two levels.

With the introduction of Progress + and a shorter training programme, will there still be opportunities to fast track through training?

The short answer to this is yes. But, there have always been opportunities to fast track as the curriculum is capability-based and not time-based; as long as you have met the requirements of the curriculum at each level you can progress through your training.

I am an academic trainee. How will Progress+ affect me?

In short, the introduction of the new paediatric training programme will not affect academic trainees. If anything, the changes to Level 1 and Level 2 into a new core training level now complement the academic training pathway as it currently stands.

Transition

How will you implement this change?

We are anticipating the transition during summer 2023. A simplified summary is that new and junior trainees (ST1-3) will move over to core paediatrics, senior trainees (ST6-8) will move into specialty paediatrics (as the curricula are essentially unchanged), and there will be some element of choice for current level 2 trainees (ST4-5) about whether they transition in the first year or whether they wait a further training year before transitioning.

What training requirements at current level 2 or tier 2 rota (middle grade) will be required to be eligible for sub-specialty training?

Current level 2 capabilities have been reviewed so that they are aligned with core training. Trainees commencing ST5 at the start of Progress+ need to have been placed in rotations across general paediatrics, neonates and community paediatrics at ST4 to meet their training needs and ensure they able to move to specialty training both for general paediatrics and sub-specialty training at ST5.

Also see FAQs about sub-specialty training below

If the move to Progress+ happens at the start of my ST5 training year, when will I complete my level 2 capabilities? 

Current level 2 key capabilities have been reviewed so that they are aligned with core training. At this stage you will work with your Educational Supervisor to agree whether you progress into specialty training or remain in core training. You will then work towards the syllabi at that level ensuring you complete any remaining gaps in your capabilities.

Will I need to have completed 18 months WTE across general paediatrics/ neonates and community paediatrics at ST4 to be eligible to apply for sub-specialty training in the following year's recruitment round?

Current level 2 capabilities will be reviewed so that they are aligned with core training. Trainees commencing ST5 at the start of Progress+ will be placed in rotations across general paediatrics, neonates and community paediatrics at ST4 by their local TPD (Training Programme Director) to meet their training needs and ensure they are able to move to specialty training both for general paediatrics and sub-specialty training at ST5.

As an employing trust we are concerned that the move to allow all ST3s on to the Tier 2 rota before completing their MRCPCH will have pay implications and therefore an impact on budgets – can the RCPCH provide some assurance on this?

We can reassure you that the pay you receive as a trainee is not linked to the rota you are on and so this change to the training programme will not affect trusts.

Examinations

In the new training pathway when do I need to have passed my MRCPCH theory and clinical exams?

You will need to have completed MRCPCH theory exams by the end of ST3 to allow progress to ST4 and tier 2 rota (middle grade), and MRCPCH Clinical by the end of ST4 before progressing from core to specialty training.

Sub-specialty training

When will I be able to apply for sub-specialty training in the new training programme?

You will be able to apply for sub-specialty training (also known as 'Grid') from the start of ST4 training year to commence sub-specialty training from ST5. 

To be eligible to apply for sub-specialty training, you will need to have completed your MRCPCH Clinical by end of ST4 and on a satisfactory ARCP (Annual Review of Competence Progression) outcome. You will also need to have enough indicative time at the start of sub-specialty programme for you to complete prior to CCT date.

What happens if my first application to sub-specialty training is unsuccessful and I do not have enough indicative time to complete sub-specialty training from the start of ST6? 

From 2021-22, there is no limit to the number of times you can apply for sub-specialty training, providing you have enough indicative time to complete training prior to your CCT.

If you are applying for a 3 / 3.5 year indicative time sub-specialty programme, you will need to request that your TPD place you in a suitable training post in ST5 that can count towards training, and get this agreed by the CSAC (College Specialty Advisory Committee) Chair prior to submitting your sub-specialty application as suitable to be counted towards sub-specialty training.

I'm worried that I will not have enough experience to competitively apply for sub-specialty training in my ST4 year. Will I be disadvantaged compared to more experienced trainees who have completed 24 months WTE at level 2 prior to move to Progress+? 

CSAC teams are aware that some trainees will have less exposure to their chosen sub-specialty when they apply for sub-specialty training following the move to Progress+. They will take this into account when reviewing sub-specialty applications.

RCPCH and CSAC teams encourage trainees to explore all avenues of information about their chosen -specialty prior to their sub-specialty application to make sure they are both the right fit for the chosen sub-specialty and the sub-specialty is the right fit for them.

As a trainee if I opt to remain in Core training as proposed, how will this affect my pay?

If you decide to remain in Core training, your pay will not be affected by this decision.

START

START means Specialty Trainee Assessment of Readiness for Tenure, and it guides trainees as they prepare for completion of training and practice as a new consultant paediatrician.

When can I apply for START following the commencement of Progress+? 

You will be able to apply for START in your ST6 year. The College will ensure there are additional places available to manage any increased volume of applications during the transition phase.

Workforce

I am concerned that the changes to the paediatric training programme will further exacerbate the rota gap issues that we are already having to deal with.  How are the RCPCH proposing that this is managed? 

The College's Workforce team has been working on different modelling options so that we can anticipate the risks to service with the new training programme.

We plan to work with service leads to identify the impact and possible mitigations, as well as focus on the opportunities that Shape of training presents. Please do look out for further updates on the Shape of training page.

How will we cope with only seven years’ worth of trainees?

Firstly, it is not a given that there will be fewer trainees. The number should be determined by service need, not set by the pathway.

Even if we recruit no more as currently at ST1, there would be a transient bulge in those gaining CCT, followed by a fall in trainee numbers, but matched by the increase in CCT holders. Employers need to anticipate this when planning how to resource their service.

What about middle grade rotas?

Progress+ will rebalance the junior/middle grade ratios by supporting more junior trainees moving to tier 2 rotas during ST3. All core trainees should be on tier 2 during ST4. The requirement for MRCPCH will move to the end of ST4, and thus before progression to specialty paediatrics.

Flexibility

I understand that there is a new Out of Programme designation that will allow me to pause my training. How does this work, and will this really increase flexibility?

The ability to pause your training is a relatively new option currently available in England only. Health Education England developed the programme, Out of Programme Pause (OOPP), which is currently being piloted to evaluate opportunities for doctors in training who wish to ‘pause’ their training to undertake an NHS non-training post, gain further experience, take stock of their training, work in another related specialty, etc. This will not only include clinical patient facing roles but also non-clinical activities such as leadership, management and informatics. OOPP differs from OOPE in that experiences or capabilities gained while out of programme are likely to be counted toward CCT if they are demonstrated and assessed once back in training.

Whether it increases flexibility remains to be seen. But, it is hoped that giving trainees this opportunity to pause their training will at the very least stop them from potentially leaving training and medicine altogether.

Further details about OOPP and flexibility in training can be found in the Academy of Medical Royal Colleges' document, Guidance for flexibility in postgraduate training and changing specialties.