Tips for Foundation Doctors interested in applying for Specialty Training in Paediatrics
Considering applying for a paediatric training post? Check out this excellent advice from our Foundation Officer….
Hello, I am Emma, currently an F2 doctor and the Foundation Officer for the Paediatric Educators Special Interest Group. I will be starting my Paediatrics ST1 year at Homerton Hospital as part of an Academic Clinical Fellowship. I had been interested in applying to Paediatrics for a few years but only seriously started thinking about my strengths and weaknesses and how to diversify my portfolio in the summer before I applied.
This is a really exciting time to apply for Paediatrics because there are so many opportunities available. The RCPCH have been doing a brilliant job over the past few years trying to inspire applicants after a few years with lower recruitment numbers, and the last two years have become more competitive. This year, the application form constituted 30% of your total applicant score, with points available in the following areas:
- Additional qualifications (certificates, degrees) – out of 3
- MRCPCH exams (written exams) – out of 3
- Transferable clinical skills – out of 4
- Transferable clinical experience and reflection – out of 4
- Quality improvement projects/audits – out of 4
- Leadership/management – out of 4
- Academic achievements – out of 4
- Teaching experience – out of 4
- Statement to support application – out of 6
The full scoring domain can be found by clicking the link below.
You will notice that to achieve the top scores, you must not only have a diverse range of experiences, but also have reflected well on what you have done.
With this in mind, I hope that sharing some of the opportunities I’ve seen over the years in these areas may be helpful for prospective applicants.
Clinical experience
As you can see above, the RCPCH emphasise the importance of transferable clinical experience. This means you don’t need direct experience in a paediatric setting in order to get a job; you just need experience in an area that will equip you with skills that are relevant to looking after children. If you have jobs in GP or A&E these should give you opportunities to care for children and young people.
Having said that, getting an F1 or F2 post in Paediatrics is a fantastic opportunity to get exposure to the specialty; not just for your application, but to make sure that paediatrics is for you. However, these jobs can be far and few between, especially as many F1s and F2s were redeployed back to adult medicine over the past two years during the COVID surges, and it doesn’t help if you’ve already got your set of jobs allocated for F1/F2.
For me, I did my first F1 post in Paediatrics. I found it to be a wonderful first job – great levels of senior support, and not too many expectations other than to work hard and have fun. If you have the option, an F2 post probably gives a more real experience of the ups and downs of the specialty. Most F2 jobs will have you sharing the Paediatric SHO rota, working night shifts and having higher expectations to prepare you for training.
If you don’t have a placement in F1 or F2, then more and more applicants every year are taking F3s and doing Clinical Fellow jobs in Paediatric A&E, Neonates, and General Paediatrics, as well as other areas. The Foundation Programme and Specialist Training are draining enough, so many people use the F3 year as a chance to have a breakbetween the two without so many portfolio pressures, and to build up their CVs. I have friends who have spent their F3s in paediatric research posts integrated with clinical shifts, and on PICU. You can subscribe to NHS jobs to see these adverts, and also I’ve seen lots of adverts from paediatricians I admire being posted on Twitter. The Evelina London Children’s Hospital, for example, advertised for clinical fellows this year at FY2+ in a range of different specialties-see link below:
Some are advertised quite early (e.g. from January for August starts) so it’s always worth keeping an eye out early on.
The Foundation Programme allows up to five days of study leave for Specialty Taster Weeks which are invaluable if you don’t have an F1/F2 post in paediatrics, or if you want to get exposure to a particular subspecialty e.g. PICU. I personally recommend trying to do these in your own trust, if possible, because this avoids having to go through the mountains of paperwork that come from observing at another trust – plus if you have access to the computer systems you can contribute more meaningfully.
For any medical students reading this, you will know the elective is a brilliant opportunity to spend more time in paediatrics. I was lucky enough to go to The Hospital for Sick Children in Toronto for mine, and really recommend the opportunity to spend time in a dedicated children’s hospital if you can.
Teaching
If you’re interested in applying to paediatrics, then chances are you have picked up more knowledge in paediatrics than the average F1 and F2. One of the most rewarding ways to consolidate this is through teaching others. The easiest way to do this is to connect with paediatricians at your hospital and offer to provide informal teaching or bedside teaching for medical students on placement. I did bedside teaching as a Paediatric F1 with the medical students based on my ward, and after a few sessions I had built up a bank of resources I had made myself which could then be used again and again. At my hospital they also were recruiting doctors to run as actors and examiners for OSCEs, which was lots of fun to get involved with.
You can connect with your local Medical School Paediatrics Society. If you’re not sure where to start, the UK Aspiring Paediatricians Society, UKAPS maintains a network of all associated medical school societies.
UKAPS
Many of these societies organise annual conferences or revision days, and will gladly host a lecture if you want to deliver it in an area of your choice. If you find yourself having to prepare a revision lecture, focusing on common conditions, and integrating your teaching with MCQs (especially interactive apps such as Slido) usually goes down well.
PEdSIG is the Paediatric Educators Special Interest Group and recruits a Foundation Officer and Medical Student Officer, which will be open for recruitment every so often. In these roles you can help with our annual conference and RCPCH session, as well as other ongoing projects to promote paediatric education. We host a number of resources on our website which can help with teaching and are supporters of Paediatric GEMS (Great Education across Medical Schools) which are always on the lookout for new people to get involved.
Audits
Audits and quality improvement projects were as highly valued in the application form this year as academic achievements.
To conduct an audit, first identify an area of potential improvement, and a standard to measure against. Consultants usually have to complete audits every year so may have several already on the go. They will usually be very open to Foundation doctors getting in touch even if you aren’t currently working in Paediatrics, especially if you can collect data remotely, and an already-established audit can be more focused towards departmental needs than starting completely from scratch.
Make sure your audit is registered; this will help you with getting evidence of completion and certificates, and will also mean you can submit your audit to conferences if you have an appropriate registration number. There are plenty of audit and QIP-focused conferences. Audits or QIPs that are appropriately registered can also be published as full papers if appropriate. This means that one project can assist you in multiple different domains on the application form.
Research
A good research project is extremely valuable but for every successful paper there will be many more time-consuming nightmares along the way. Although many of us are desperate to work on papers, I think research can also be a very draining and sometimes unrewarding process, so I think the most important thing to do before taking on lots of extra work on the side is to make sure that doing so will not be detrimental to your own mental health. Doing lots of out of hours work on the side for a paper may not be needed; after all, academic achievements were only rewarded with four points on the ST1 application form this year. I would never take on a research project run by someone else who I hadn’t worked with before, without clearly defining the expectations for your role and whether you will receive authorship in return for your work. Some people worry that asking this question can be difficult, but otherwise you risk doing a lot of work without receiving credit that is sufficiently meaningful to you.
If you do decide you want to take on a research project, in most departments there will be Consultants with ongoing projects who are looking for juniors to get involved with data collection, statistics or writing. It is important to check the team’s track record for completing and publishing their work beforehand. If you have a particular subspecialist area, you can look up academic paediatricians affiliated to your local university and ask if you can get involved.
If you are more interested in running your own project, then the easiest ways to do this within the confines of the F1/F2 rotas is to either publish an audit (see above) or to work on a systematic review. Systematic reviews are easy to do from home since they require searching databases, screening abstracts and extracting data, all of which can be done from home in your free time. They also often allow you to pick your own topic of interest, provided it has not been previously reviewed. Once you have picked your topic, the first step is to register your review protocol on PROSPERO; writing the application form will take you through all the steps of conducting a review that you need to consider and plan beforehand. It can be useful to get in touch with a Consultant or academic in the field of interest and invite them to be a senior author, in case there are any areas in the field that you are not familiar with, and they can help guide your discussion in the final paper. A final project domain to get involved withas a Foundation doctor is through educational projects, or studies involving surveys of Foundation doctors; after all, this is a population group you have easy access to! Finally, before running any project, make sure you have sought appropriate registration – if you have questions you can get in touch with your trust’s Research Ethics Committee or equivalent.
If you are interested in a research career, there is the option of applying for an NIHR Academic Clinical Fellowship in Paediatrics, which provides a funded 9-month period within the ST1-3 years, and is designed to give interested trainees time and experience to prepare an application for funding for a MD or PhD later on. The recruitment for ACFs is around September and involves a more comprehensive scored application form than for standard ST1 and a detailed research-focused interview in December or January.
Exams
RCPCH Membership Exams are not a prerequisite for applying to paediatrics, and were never rewarded with points in the application process until this year, when COVID necessitated some simplification to the application process. This year you could achieve a maximum of three points, one for each of the three written exams, and it is unknown whether they will continue to be awarded points in future years. I would only recommend sitting the exams if you have a rotation which gives you enough free evenings and weekends in which to do it; protecting your mental health is the most important thing before taking on anything extra. If you have time to do it, revising for the exams can help you if you are running teaching sessions.
The first written exam, Foundation of Practice (FOP), is the most accessible; it is also sat by trainees in the UK and around the world who are sitting the Diploma in Child Health. The standard of knowledge required is probably only slightly greater than that taught in some medical schools, and the Sunflower book by Tom Lissauer and Will Carroll (the Illustrated Textbook of Paediatrics) is a good resource for the exam (a new edition is coming out soon). For those who like to study using questions then the accompanying self-assessment book and the RCPCH Clinical Cases series are useful.
Many people find the second written exam, Theory and Science (TAS), the hardest; it requires a deeper understanding of pathophysiology than the other two. The RCPCH host a series of online lectures targeted towards this exam:
These lectures are delivered by some of the question-writers themselves. A valuable resource for this exam is the book The Science of Paediatrics: MRCPCH Mastercourse by Tom Lissauer and Will Carroll; I found it very useful to re-read the chapters on topics I felt most unsure about. Although this book is fairly expensive, the content is fairly constant and no new edition is planned (for now).
The final written exam, Applied Knowledge in Practice (AKP), builds on the knowledge from the first two exams; the question stems tend to be longer and answering them correctly requires a greater integration of knowledge than just remembering facts. A great resource for this exam is Paediatric Exams: A Survival Guide by Paul Gaon, which is now out of print but may be available from libraries or other candidates. It has several short and clear chapters which are useful to re-read on difficult topics.
Finally, it’s also worth mentioning the MSRA (Multi-Specialty Recruitment Assessment) which this year was sat by Paediatrics applicants for the first time and comprised 20% of your total score. It has been used historically in recruitment for GP and some other specialties, and has two components; a situational judgement paper (similar to the SJT sat as part of the Foundation Programme application) and a clinical paper, with a broad syllabus and questions focused on children and (mostly) adults. Revising for this meant several weeks of clicking through MCQs from question banks prior to the test date.
Prizes
The RCPCH Foundation Doctor prize provides a free day at the RCPCH Conference to one trainee from every Foundation School. Each Foundation School will use their own methods to choose their nominated prize-winner (for my deanery you had to write a 500-word statement of interest). There is also an equivalent RCPCH Medical Student prize, with one prize per medical school each year.
The Royal Society of Medicine Paediatrics & Child Health section offer numerous prizes, particularly rewarding case reports, and offer many prizes for juniors who present at their meetings.
Royal Society of Medicine Paediatrics & Child Health…
There are also a number of other conference bursaries or prizes that can be applied for. For example, the King’s John Price Paediatric Respiratory Conference this year offered ten scholarships to early-stage trainees including Foundation doctors.
Other opportunities
Finding a mentor can be invaluable. This year, the UK Aspiring Paediatricians Society (UKAPS) launched a mentorship scheme which paired an aspiring paediatrician with a current paediatrician, to offer advice and a realistic perspective on a career in Paediatrics. They will most likely be doing the same again this year, so keep an eye out for that. A mentor can help in so many ways – such as by providing advice for the application and interviews, putting you in touch with subspecialty colleagues, and in giving honest advice on the pros and cons of the career. If you want to find someone local to you, then get in touch with your hospital Paediatrics department – there are bound to be juniors (and seniors!) with lots of advice to give.
If you are interested in a leadership role, then UKAPS recruit Foundation Reps for every deanery. As a rep you can be a point of contact for promoting opportunities to Foundation doctors in your deaneries and helping with their valuable events including interview preparation sessions, teaching series, and a conference.
The Royal Society of Medicine host study days over the course of each academic year, run by the London School of Paediatrics, which have all been delivered online over the past year.
RSM Study Days
These study days cover the ST4-5 curriculum but are very accessible and interesting, and usually also include a short talk on careers in each sub-specialty.
Volunteering can be an incredibly rewarding way to gain extra experience of working with children (especially outside of the hospital setting). PEdSIG Trainee Officer Dr Amanda Friend has recommended the following charities that she has volunteered for -
Volunteering as a fundraiser or trustee for paediatric or child health charities can be another way to use your time to improve children’s lives.
Imperial College London offer Short Courses with several on paediatric topics offered at different times during the year.
ICL short courses
I attended one this year on Serious Infections and Critical Care in Children which I loved. It ran for one afternoon a week for five weeks, and gave me the opportunity to meet paediatricians, allied health professionals and fellow Foundation doctors interested in paediatrics. It was a great use of the Foundation Doctor study budget.
Finally, life support courses are another valuable way of showing your dedication to paediatrics, and are also mandatory for progression once you enter specialist training. You can sit either APLS (Advanced Paediatric Life Support) or EPALS (European Paediatric Advanced Life Support) which both have two-day face-to-face components and incorporate simulation scenarios for the sick child. There is also NLS (Neonatal Life Support) which is a one day course and will equip you with the skills to attend on-calls as a Neonatal SHO.
I hope this has been helpful! My last reflection is that, no matter how prepared you are, the application process can be extremely draining. It will be months from submitting your application before the interview, and then until offers. Try and find friends and colleagues who are also applying for Paediatrics – I have made some lovely friends this year who were going through the same process, and just being able to rant together and prepare for interviews together made everything much more bearable. Starting early and thinking about areas to improve your application is key, but at the end of the day the interview will make the most difference, and RCPCH value not just your experiences but how you have reflected on them. I recommend the book ‘Medical Interviews (3rd Edition)’ by Olivier Picard for anyone who wants to start thinking about how to summarise what makes you a great candidate.
If anyone has any further questions I could help with then please feel free to email me ([email protected]). Thank you for reading!