Tailor make your training - video
If training is not personalised then trainees may lack interest and attrition rate may be high
Dr Anshoo Dhelaria is East of England LTFT Rep at RCPCH and LTFT TPD in East of England. She talks about the importance of tailoring your training programme and how you can get the best out of your time in training.
Less than full time training (LTFT)
Paediatrics has a large and growing proportion of less than fulltime trainees. In the past, LTFT training was only allowed if you had a specific reason to be LTFT: category 1 referred to people who needed to work LTFT to support their physical or mental health, or had childcare or caring responsibilities. Category 2 LTFT trainees were those who had exceptional opportunities or commitments outside medicine (for example competitive sports, or religious roles within a community). We were one of the early adopters of Category 3 LTFT training – giving postgraduate doctors in training the chance to train LTFT just because they choose to do so. This is proving to be an increasingly popular option, especially as in medicine full time training is often in fact more than full time, and GMC national training surveys are showing ever increasing rates of burnout among trainees. Having that extra little bit of time every week for other interests, rest, recreation, reflection and recharging, can let people connect better with work and training, and thrive rather than just survive.
Some postgraduate doctors in training have jobs in industry, run businesses, or run marathons alongside their training; others enjoy having the breathing space to connect with family or friends. Could Category 3 LTFT training be for you? You don’t need a reason – just the desire to do so! Ask your deanery about applications.
Progress+ allows flexibility in progress along the training pathway, for all doctors, fulltime or less than fulltime. This means that for LTFT trainees, as for their fulltime colleagues, it may be possible to achieve one’s competencies earlier than planned in some circumstances. It is important that both the postgraduate doctor in training and the educational and clinical supervisor understand the curriculum requirements for the trainee. It’s not a race to the finish line, and the aim isn’t to complete one’s training in the shortest possible time, but there should be the opportunity to accelerate progress where it is appropriate and desired.
Out of programme (OOP) training
There are a wide variety of OOP experiences available to paediatric postgraduate doctors in training, that you can apply for, and that work in many different ways. Some of them involve a proportion of clinical work, and may allow you to achieve your clinical competencies and progress through the training years, and others are purely non-clinical, extending training time, which may benefit someone who is planning on applying for sub-specialties, or who fancies something completely different!
There is scope in Progress+ to continue progressing along training while spending a proportion of one’s time working clinically and a proportion acquiring additional competencies, such as in leadership, management, education or research – all skills that will benefit us as future consultants, prepare us for the multitude of roles we will play after the completion of our training (sometimes, otherwise, it can feel like we are training to be registrars rather than consultants!) and of course provide the departments we will work in and the patients we will work for with well rounded, agile and multi-skilled clinicians!
Two paediatric registrars discuss their OOPEs
Oluwadamilola Bamigbade is a ST7 in East Yorkshire, who took up a position as chief registrar alongside clinical work in general paediatrics:
I was very pleased when I got the Chief Registrar post in my Trust (Hull University Teaching Hospitals) in 2020. This was a post that I had applied for with the anticipation of developing my leadership and management skills.
I started the one-year post in September 2020 (as an ST6). My contract was 60% clinical and 40% Chief registrar role. I was given the opportunity to create my own rota to meet this requirement. I decided to take Thursdays and Fridays off every week (with the occasional Wednesday) to concentrate on my projects and leadership roles. I maintained my on-calls in order to meet my clinical competencies.
Overall, the one-year experience was very valuable. Apart from developing my leadership and management skills, I also gained a better understanding of how quality improvement projects (QIP) are done. This was aided by me leading a QIP (‘Stop the Line’), being part of the hospital QIP committee and attending regular teaching sessions organised by the Royal College of Physicians. My knowledge of how my hospital operates also improved over the one year as I was privileged to work with senior managers, attend operational meetings, present ‘patient experience videos’ at the Trust board meeting and write reports for several other committees. As a result of my projects, I was able to present four posters at the HSG Patient Safety Conference in September 2021.
My one year as Chief registrar was recognised as a full training year. I made sure I kept up with my clinical competencies through the year, which I had no difficulty doing. I was able to move to ST7 with no concerns.
I would recommend this post to any trainee looking to develop their leadership and management skills and not wanting to lengthen their training to achieve this.
Alexandra Damazer is a ST7 in East Yorkshire and took a Future Leaders Fellowship for a year, which was purely non clinical. Here she discusses the pros and cons of her experience:
I chose to take a year out of programme for a number of reasons. For me, primarily, it was an opportunity to lead on and complete a regional and national project, focus on leadership and develop new, non-clinical knowledge and skills. I was also a level three trainee who was tired of the system and exhausted by endless on-calls, poorly staffed rotas and long commutes. The OOPE was an opportunity to stop and take stock of my career and my life and really focus on how I wanted to develop going forward.
Being out of programme gave me the time to do this, as well as allowing me to choose to locum in areas and departments I wanted more experience in. It was also an opportunity to develop my CV – in the obvious ways (as a Future Leaders Fellow, I gained skills in leadership, management and advanced communication) but also in the much less obvious ways. I had time to access free careers coaching provided by the deanery, and time to really consider my career options, wishes and plans. I returned to training committed to my chosen SPIN module and with convincing arguments to support my requests for my final placements as a trainee.
I am a general paediatrician at heart, and have never wanted to apply to sub-specialty training – but for those who do an OOPE offers the chance to apply or re-apply with a metaphorical “frozen clock” and time to gain added experience in your chosen area, as well as the significant CV development opportunities.
My OOPE also came with a generous study budget, and for the first time in my career, no fixed guidelines on how to spend it. I was supported to present at multiple conferences (without the worries about rotas and time away from work), complete my MSc, attend courses at the Kings Fund and access numerous regional teaching and training opportunities.
I hadn’t anticipated the difference in approach when out of programme, but I was allowed and encouraged to be an autonomous adult. I planned my own time, was responsible for my own work pattern and was able to work flexibly, both in terms of time and location. The OOPE was a small taste of non-medical working life!
Finally, and most importantly, this week marks exactly a year since I returned to training, and I can hand-on-heart say that I would be a very different trainee without the OOPE experience. Burnout is increasingly common, and I firmly believe I avoided it only by taking the opportunity to stop, re-focus and remember why I became a doctor.
However you approach it, an OOPE is just what it says. It is out of programme and therefore, by it’s very nature, my training has been extended. My CCT date is twelve months later and the assumed benefits of Consultant life are further away.
Returning to runs of nights after a year away was also painful, and I sometimes pine for the autonomy and independence of my year out of training.
Finally, I was initially concerned about the pay cut of an OOPE without on-calls or out of hours work. The ability to locum meant this wasn’t an issue for me, but I suppose I am lucky that there were plenty of locum shifts available when I wanted them.
Overall, the OOPE is the best thing I have done in my career. The opportunities, the personal and career development and the flexibility are unrivalled in any clinical job. An OOPE does come with compromises, but I firmly believe they are massively outweighed by the advantages it gave me at the time, and continues to give me back in training.
Progress+ is live in Summer 2023
Progress+ allows greater personalisation of the content and length of your training; quantitative as well as qualitative changes to how paediatric postgraduate training is going to work. If you're a current trainee, depending on your stage of training and your career intentions, you may have some important decisions to make about how you approach planning your ARCP and your training level over the coming year.
Emma Dyer (paediatric registrar, RCPCH eportfolio and curriculum trainee representative and trainees' committee chair-elect) and Cathryn Chadwick (vice-president for training and assessment) have written a presentation on the changes to the training structure coming as part of Progress+. Please do read through it, whether you're a trainee or a supervisor, and be ready for next summer!
This is particularly vital if you're going to be finishing ST4 next summer, as you need to think about whether you want to transition onto the new, two-level training structure or remain on the old, three-level pathway; whether you want to continue with generalist training or apply for subspecialty paediatrics. Think about how ready you feel; which competencies you already have, or wish to consolidate; what opportunities you want to apply for. Seek feedback and advice from your supervisors; this is a very personal decision!
Dr Maddy Hover is an ST5 Hull University Teaching Hospitals NHS Trust with a special interest in High Dependency Care and is a LTFT rep on the RCPCH Trainee Network. Dr Lauren Dhugga is currently a level 2 trainee and is also a LTFT rep on the RCPCH Trainee Network. Dr Nina Sanghani is an ST2 at Lister Hospital.