Applying to Paediatrics

On the one hand, you wear a Disney lanyard, with a pocket stuffed with stickers, on the other, you are dealing with what is internationally referred to as the most precious of lives. Child medicine requires the silly and light-heartedness in parallel with the calm and intense – if that appeals to you, you’re already halfway there.

Why choose paediatrics?

  • A fun specialty, with fun patients. Your inner child is welcomed in your day-to-day practice without judgement.
  • You think on your feet constantly, with each patient being a personal challenge – gaining their trust to perform simple tasks like physical examination is a skill requiring adaptability and compromise.
  • Massive team environment, you are never alone in paediatrics. Senior led specialty with support, encouragement and supervision.
  • Huge MDT effort, from SALT or Play Therapists to Schools and Social Services – paediatrics is a very holistic specialty. 
  • Paediatrics is a specialty of communication – with patients of every developmental age, you learn to say things in 100 different ways, sometimes with no words at all. If you enjoy the communication and language aspect of medicine, paediatrics will satisfy this.
  • Core skills – heel pricks, cannulas, LP, intubation, long lines, umbilical lines, cerebral function monitoring (CFM) / amplitude integrated EEG (aEEG), catheters – lots of hands-on practical skills in the day-to-day job. Very well supported, and fun to learn.
    • For anyone reading this thinking it’s just impossible to perform practical skills on children/babies- it’s possible, it’s learnable, it’s achievable and actually, it’s kinda fun. The fear of it almost stopped me from applying – let me reassure you – that’s not a reason.
  • If you are a “generalist”, paediatrics will be perfect for you. However, there is scope to sub-specialise in any area of medicine – very broad with ample opportunity, will keep you stimulated and never bored.
  • Run through training – guaranteed training number until consultancy. Dreamy.
  • Easy to enter into less than full-time training, and take time out to gain experience in personal areas of interest that the program does not satisfy.
  • Full of stickers, bubbles and paint!
Why did I pick the job?
It was probably the moment I heard my consultant impatiently clear his throat, looking down at me rather perplexed as I crouched by a 4 year-old, medical clerking notes crumpled under one arm, drawing a smiley face on an inflated glove, that I thought ‘hmmm…adult medicine isn’t the one’.

Despite paediatrics being on my no-go list of specialties (‘it’s too sad’) I had done every paeds-related society at university because ‘I’ll never get the chance again’, even did a paediatric taster week to ‘get it out of my system’. Queue my A&E rotation, where I quickly became the paeds-ED SHO, and then my GP rotation paired with an ex-ST5 paeds reg who sent all the kids my way, because those were the only consultations I presented with any enthusiasm. I didn’t know who I thought I was fooling.

Pick the job with patients you look forward to seeing, with patients you genuinely care for. I didn’t always feel joy seeing the adult patients – I always had something to moan about, but with the kids, each patient felt like my patient. This is ironic considering how senior-led the specialty is. I also realise it wasn’t just the ‘too sad’ assumption I had made – the idea of needing to perform core skills on children actually terrified me, but let me re-assure you, it’s possible, it’s learnable, it’s achievable and actually, its kinda fun.

Paediatrics is a specialty of communication. You speak with every developmental age, you explain medicine to parents at their most vulnerable who believe they know best (and sometimes they do), you liaise with every specialty and work in a massive MDT (with meetings you don’t dread), you ask the questions that might just stop a child from ever being hurt again, you explain to a first-time parent how to hold their child. In paediatrics you talk a lot, and you learn to say things in one hundred ways, sometimes without any words at all. With all this in mind, a kid once told me to ‘shut up’ during my clearly poor attempts at distraction while a colleague took bloods – should have used bubbles in retrospect. That’s another thing about paediatrics – your patients will always surprise you.

Things to bear in mind:

  • You will be often be dealing with three patients instead of one: the child and the parents.
  • Consultants are very present in paediatrics – an important consideration in long-term career planning.
  • People often relate the specialty to being ‘too sad’ or ‘too heartbreaking’, but it really is a fantastic specialty and you should give it chance without letting the stereotype sway you. Paediatricians are very good at supporting each other. Although there will always be difficult cases, this does not form the majority, and the job is very rewarding.

Things you can do before applying for experience/ portfolio building:

Show commitment to specialty – through paediatric related: society involvement, audits, posters, conferences, teaching sessions.

You don’t have to sit any exams before applying – if you do want to, the Foundation of Practice (FOP) and Theory and Science (TAS) would be the ones to do. TAS is often known as the hardest of the exams – very nitty-gritty. Exam question banks (especially PASTEST) are very helpful to revise for these.

They do not expect you to have any paediatric experience when applying, so if you don’t have a rotation in FY1/2, that will not impact your application in any way.

There is a limit of 24 months of paediatric experience when applying for ST1. So if you have more experience than this (excluding FY1/FY2 jobs) you cannot apply for ST1 and should consider applying for ST3!

Suggestions:

University
– Teddy bear hospital – a great beginning to learning the skills of communicating ‘medical’ topics with young children.
– Heart start (in association with The British Heart Foundation) – teaching CPR to children.
– PaedSoc – shows ‘commitment to specialty’ and gets you networking early.
– Elective in a paediatric specialty.
FY1/2
Taster week – try to get a mix of ward/A&E.
FY3 and beyond
Plenty of locum opportunities and trust grade jobs. Note neonates is very different to general paediatrics – so try to get some exposure to both babies and children to help you get a more realistic taste of the specialty.

The application process

The application process changes regularly so review the recruitment website for the most up to date guidance. There are two elements:

  • 30% weighting: Application form (white-space questions):
    • Covers Past achievements, Clinical experience, Career motivation, Transferable Skills and Reflection
    • Marked by two assessors with a possible maximum score of 60.
  • 70% weighting: 45-minute virtual interview
    • Two panel members. Possible maximum score of 160. Need to score minimum 88 out of 160 for interviews to be offered a job.
    • Stations:
      • Communication: (like an OSCE communication station). Examples of this could be: explaining to a parent their child has received an overdose of gentamicin, or a parent tells you they want to self discharge and their child is on oxygen with viral induced wheeze or bronchiolitis.
      • Career motivation: (portfolio station: why you chose paediatrics and why you are well suited).
      • Reflective practice: (set questions, should be prepped in advance: “Briefly describe a significant event where things went particularly well or not well and outline your role in it. How did you reflect on this event? How has this developed your practice as a result, and how would you deal with a similar situation in the future?”
      • Paediatric clinical reasoning: Candidate will be asked about a case based scenario and are expected to describe how they would manage the situation. This is not a test of clinical paediatrics knowledge. This is to test your clinical reasoning and to make sure you are likely to act safely. Always say you will escalate to seniors and ask for help early.

Once you start training

  • The paediatric training programme has changed in 2023/2024 to “Progress Plus” which means it is now meant to be a competency based training programme rather than a training programme based on length of time in training. This makes it easier to accelerate through training if you have some prior experience and are competent with clinical skills. It also means you no longer have to do tertiary neonates or community paediatrics as a registrar.
  • ST1-3: SHO years
    • Generally consists of jobs in general paediatrics in a DGH, a tertiary neonatal job and jobs in a tertiary paediatric hospital. (Although this varies deanery to deanery). In some deaneries 6 months of your ST3 will be as an SHO and 6 months as a registrar.
    • Need to complete the FOP/TAS/AKP written exams. Clinical exam is generally done between ST3 -ST4 although can be done earlier. You cannot progress past ST4 without passing your clinicals.
    • There is some portfolio required which involves reflective pieces, mini-CEX, CBD and at least one MSF and an audit/ QIP in ST1-3.
  • ST4-7: Registrar years (With the advent of “progress plus” paediatric training has reduced to 7 from 8 years.

Extras:

  • ST5-7: You can do SPIN: ‘specialist interest’ in a particular specialty or GRID training which is a formal sub-specialisation recognised on the GMC register (requires application, competitive).
  • ST2-6: OOPs: Out Of Program training opportunities: you can request time out to gain experience in areas of interest, and this can be done abroad.
  • It has recently become a lot easier to work in paediatrics as less than full time. This can be 80% or 60%. The college have become quite flexible with this (which they have had to do to retain trainees!)
Screenshot 2024 02 16 at 19.20.04

Useful Resources 

  1. RCPCH Website
  2. RCPCH Application process guidance
  3. RCPCH ST1 Application Guidance
  4. This blog post discusses the pre-covid application style) and has a great breakdown of the way they assess each station, to help prepare for the interview.

Written by Dr Sarah Al-Rawi (Paediatrics ST1)

Edited and updated by Dr Bex Evans Paediatric Registrar Feb 2024

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4 thoughts on “Applying to Paediatrics”

  1. Hi, I don’t think the MSRA exam is now involved in the recruitment process anymore. This is the information I have got. Please let me know if I am mistaken. Thanks. (HK – YR5 MBChB)

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