Developing critical mass and growing our own academics.

Academic paediatrics is an exciting and rewarding career path but is not immune to the problems of recruitment and retention currently affecting most branches of medicine. The Modernising Medical Careers initiative, with its explicit academic training path, offers an unparalleled opportunity to develop novel schemes that promote recruitment and retention. Coordinated action is required to define, publicise and support the new academic training programmes and to attract the best trainees into them.     

Developing critical mass and growing our own academics

Academic paediatrics is an exciting and rewarding career path but is not immune to the problems of recruitment and retention currently affecting most branches of medicine. The Modernising Medical Careers initiative, with its explicit academic training path, offers an unparalleled opportunity to develop novel schemes that promote recruitment and retention. Coordinated action is required to define, publicise and support the new academic training programmes and to attract the best trainees into them.     

Medical students�� views on selecting paediatrics as a career choice

Despite increasing numbers of UK medical students, the number of trainees selecting paediatrics as their specialty choice has decreased. Previous studies show that most students will choose their ultimate career during undergraduate training. We therefore explored the views of students in the final year at Birmingham University about a career in paediatrics. Students completed a 27-item questionnaire during the penultimate week of their paediatric clerkship (PC) and 97% responded (127/131). Prior to the PC, 29% (37/127) of students had considered a career in paediatrics, rising to 50% (63/127) after the PC (p < 0.001). Students felt that paediatricians were enthusiastic and keen on teaching, and the ward working atmosphere was good. However, students perceived paediatrics as a difficult specialty with high competition for training posts. Students felt their paediatric experience was too limited and advice was needed on paediatric careers early in undergraduate training. This study confirmed that focusing on improving the PC is not sufficient if we are to inspire medical students to consider a career in paediatrics. Exposure to the specialty is needed from year 1 of undergraduate training along with career advice to dispel current myths about specialty training. Students would then be able to make more informed career decisions.     

Value of study groups: Why we should stick together

Fellowship examinations are a potentially stressful part of clinical training. While they may feel at the time to be a test of academic fortitude and endurance, they also establish the foundation knowledge essential for a career in paediatrics. We reflect on the important role of the study group in this process, and the far‐reaching benefits of peer support and sticking together, for the exam and beyond.     

A survey of clinical academic staffing in paediatrics and child health in the UK

Background: The state of academic paediatrics in the United Kingdom is a source of anxiety in view of anecdotal reports of loss of identity within medical schools and reductions in staffing levels. Aims: To measure the current numbers and recent changes in clinical academic staff in all university departments of paediatrics in the UK. Methods: A questionnaire was sent to all 24 university departments of paediatrics where undergraduates are taught, and to the postgraduate institute of paediatrics. Results: Full responses were obtained from 24 medical institutions. In the past five years there has been an overall 7.2% decline in clinical academic staff, but among lecturers there has been a 26% reduction. Nine of 24 departments had undergone changes in name with at least some loss of paediatric identity. In 12 of 24 centres it was felt that the research assessment exercise had resulted in some, or severe, detriment. Conclusions: This study confirms the recent loss of academic training positions, leading to a serious concern about the future of academic paediatrics in some UK centres.     

A survey of clinical academic staffing in paediatrics and child health in the UK.

BACKGROUND: The state of academic paediatrics in the United Kingdom is a source of anxiety in view of anecdotal reports of loss of identity within medical schools and reductions in staffing levels. AIMS: To measure the current numbers and recent changes in clinical academic staff in all university departments of paediatrics in the UK. METHODS: A questionnaire was sent to all 24 university departments of paediatrics where undergraduates are taught, and to the postgraduate institute of paediatrics. RESULTS: Full responses were obtained from 24 medical institutions. In the past five years there has been an overall 7.2% decline in clinical academic staff, but among lecturers there has been a 26% reduction. Nine of 24 departments had undergone changes in name with at least some loss of paediatric identity. In 12 of 24 centres it was felt that the research assessment exercise had resulted in some, or severe, detriment. CONCLUSIONS: This study confirms the recent loss of academic training positions, leading to a serious concern about the future of academic paediatrics in some UK centres.     

Postgraduate training in paediatrics: Analysis of deficiencies as perceived by paediatricians

Abstract A listing of all general paediatricians in the country was obtained from the directory of members of the Australian College of Paediatrics. Each of the 287 paediatricians identified was sent a questionnaire requesting information about morbidity patterns of patients seen in their practices and their views regarding paediatric training. The response rate was 80.9%. Half the respondents had been in practice for 10 years or less, while two-thirds practised in a capital city. Respondents rated their training in each of 10 organic specialty areas, on average, as having been appropriate. However, when given a listing of nine areas related to child development and behaviour, chronic disease and counselling, 70% rated training in these areas as having been inadequate; this figure was even higher for recent graduates. Less than one-third had formal training in developmental, behavioural and community paediatrics; the remaining two-thirds of respondents acquired their knowledge by clinical experience, books or journals, professional contacts or meetings. This was despite the fact that almost 80% of respondents felt that practical experience was not an adequate substitute for formal training in developmental and behavioural paediatrics. There was an encouraging trend for paediatricians who had been in practice for 10 years or less to have had training in these areas, although the number was still less than half. Almost 90% of respondents felt that changes were needed in paediatric training to equip trainees for general paediatric practice, while 62% of respondents were of the opinion that the present FRACP training system mitigated against appropriate training for general paediatrics. Ninety-three per cent of respondents agreed that paediatricians had a major role to play in the management of children with problems of development and behaviour. Respondents made a large number of pertinent comments regarding perceived deficiencies in their training. These data are discussed in terms of the need to address imbalances in training. It is suggested that steps need to be taken to address the conflict between hospital service and training needs, that more trainees should be exposed to experiences in ambulatory and community settings, and that it is important to consider the introduction of appropriate curricula in developmental and behavioural paediatrics into Australian training programmes.     

Academic paediatric surgery in Australia and New Zealand: Its governance,drivers, successes and challenges

Traditionally, academic surgeons have been expected to excel in research, administration, teaching and clinical work. For many, to be strong in all of these areas is aspirational rather than a reality – and it may not always be a desirable expectation. It is more likely that future academic surgeons will have exceptional ability in several of these domains, but probably not all. Clinical expertise (even if it is within a narrow field) is critical to gaining credibility with non-academic surgical colleagues; and research leadership and substantial ongoing academic output is critical to maintaining credibility among academic surgical colleagues - and facilitates funding success. The Board of Paediatric Surgery is the specialty training board of the Royal Australasian College of Surgeons (RACS) that is responsible for the training program in paediatric surgery for both Australia and New Zealand. “Scholarship and teaching” is designated as being one of the nine competencies RACS expects of all surgeons. Expertise in the domain of scholarship (and research) occurs at two levels: (1) A working knowledge of scientific method, having a critical and curious mind matched with an ability to formulate a research question and contribute to research studies, and an ability to analyse research data and to use it to inform clinical practice. This is expected of all surgeons; and (2) A career academic surgeon with a formal commitment to research which becomes a major component of their work, with the requisite expertise in scientific method to be able to design, set up and complete research studies. The RACS provides support for academia in surgery to flourish in multiple ways and at various stages in the surgeons’ career, as described in this chapter. Increasingly, the academic surgeon has to forge links and to collaborate with other research groups. At least in Australia and New Zealand, departments should work to ensure that their academic surgeons are not excessively burdened with departmental leadership and governance roles that do not require specific academic expertise. Arguably, future academic paediatric surgeons will expect to have a better balance in their lives than some of their predecessors!     

Fellowships and career development in dysmorphology and clinical genetics.

This article sets forth some guiding principles for the initiation of a productive and satisfying academic career as a clinical researcher in the areas of dysmorphology, teratology, and clinical genetics. It assumes that the fellow in dysmorphology and clinical genetics is genuinely committed to the pursuit of a career in this area, but these general principles are certainly relevant to other medical specialties. It is important for pediatricians to consider careers in this area because the need for dysmorphologists and clinical geneticists will continue to increase during the foreseeable future, and the current opportunities for such training are limited.     

A career in paediatrics? A survey of paediatric senior house officers in England and Wales

A telephone questionnaire was targeted at 189 paediatric senior house officers (SHOs) throughout England and Wales in order to evaluate their attitudes towards paediatrics and gain insight into methods by which recruitment could be improved in future years. A total of 152 senior house officers were interviewed. The group consisted mainly of general practice trainees, but included 51 career paediatricians. The majority were female (57%) and 44% were married. Our assessment revealed a perceived high work-load, but also showed that paediatrics remains a satisfying specialty. Training while in post was perceived as unsatisfactory by 32% of those questioned. Sixty per cent reported a decline in their social life since starting their post. Paediatrics was seen as the busiest of a number of specialties. This perception persisted, and in fact increased, between SHO and consultant grade. It is foreseen that this may lead to further problems in recruitment.     

A career in paediatrics? A survey of paediatric senior house officers in England and Wales.

A telephone questionnaire was targeted at 189 paediatric senior house officers (SHOs) throughout England and Wales in order to evaluate their attitudes towards paediatrics and gain insight into methods by which recruitment could be improved in future years. A total of 152 senior house officers were interviewed. The group consisted mainly of general practice trainees, but included 51 career paediatricians. The majority were female (57%) and 44% were married. Our assessment revealed a perceived high work-load, but also showed that paediatrics remains a satisfying specialty. Training while in post was perceived as unsatisfactory by 32% of those questioned. Sixty per cent reported a decline in their social life since starting their post. Paediatrics was seen as the busiest of a number of specialties. This perception persisted, and in fact increased, between SHO and consultant grade. It is foreseen that this may lead to further problems in recruitment.     

Are the career choices of paediatric residents meeting the needs of academic centres in Canada?

BACKGROUND:

Responsibility for training paediatric medical subspecialists in Canada lies primarily with the 16 academic paediatric departments. There has been no mechanism to assess whether the number of residents in training will meet the needs of currently vacant positions and/or the predicted vacancies to be created by anticipated faculty retirement in the next five years across the different paediatric medical subspecialties.

HYPOTHESIS:

At the present time, the training of the paediatric physician is not linked with the current and future needs of the academic centres where the vast majority of these paediatric subspecialists are employed.

METHODS:

The academic paediatric workforce database of the Paediatric Chairs of Canada (PCC) for the surveys obtained in 2009/2010 were analyzed. Data included the number of physicians working in each subspecialty, the number of physicians 60 years of age or older, as well as the number of residents and their level of training.

RESULTS:

There are some paediatric subspecialties in which the actual number of trainees exceeds the currently predicted need (eg, cardiology, critical care, hematology-oncology, nephrology, neurology, emergency medicine and genetic-metabolic). On the other hand, for other specialties (eg, adolescent medicine, developmental paediatrics, gastroenterology and neonatology), assuming there is no significant change to selection patterns, an important gap will persist or appear between the need and the available human resources.

CONCLUSION:

The present analysis was the first attempt to link the clinical orientation of trainees with the needs of the academic centres where the vast majority of these paediatric subspecialists work.     

European training programme in paediatric haematology and oncology

The European Board of Paediatrics has recommended for all paediatricians a three-year Common Trunk training in basic paediatrics, followed for tertiary care specialists, by three years of training in the relevant specialty. Paediatric Haematology and Oncology is a complex specialty with a broad range of activities, ranging from the care of children with leukaemia and solid tumours including those of the central nervous system, to all types of non-malignant haematologic disorders and laboratory haematology pursuits. A modular training programme has been recommended to provide a broad standard of training across the whole specialty which should last at least 18 months, and a further period of 18 months that may be used flexibly to prepare trainees for their anticipated future careers.     

Gaining and maintaining recognition as a paediatric postgraduate trainer

Consultants who act as Educational or Clinical Supervisors to postgraduate doctors must now be recognised as trainers by the GMC. This is a formal process conducted at employer level using supporting information against domains formulated by the Academy of Medical Educators. Recognition is recommended to Health Education England and reported to the GMC. This article addresses how paediatricians in the UK can gain recognition as a trainer of foundation doctors and specialty trainees in paediatrics and how to maintain that recognition over the 5-year cycle.     

Postgraduate training in paediatrics: analysis of deficiencies as perceived by paediatricians

A listing of all general paediatricians in the country was obtained from the directory of members of the Australian College of Paediatrics. Each of the 287 paediatricians identified was sent a questionnaire requesting information about morbidity patterns of patients seen in their practices and their views regarding paediatric training. The response rate was 80.9%. Half the respondents had been in practice for 10 years or less, while two-thirds practised in a capital city. Respondents rated their training in each of 10 organic specialty areas, on average, as having been appropriate. However, when given a listing of nine areas related to child development and behaviour, chronic disease and counselling, 70% rated training in these areas as having been inadequate; this figure was even higher for recent graduates. Less than one-third had formal training in developmental, behavioural and community paediatrics; the remaining two-thirds of respondents acquired their knowledge by clinical experience, books or journals, professional contacts or meetings. This was despite the fact that almost 80% of respondents felt that practical experience was not an adequate substitute for formal training in developmental and behavioural paediatrics. There was an encouraging trend for paediatricians who had been in practice for 10 years or less to have had training in these areas, although the number was still less than half. Almost 90% of respondents felt that changes were needed in paediatric training to equip trainees for general paediatric practice, while 62% of respondents were of the opinion that the present FRACP training system mitigated against appropriate training for general paediatrics.(ABSTRACT TRUNCATED AT 250 WORDS)     

The training paths and practice patterns of Canadian paediatric residency graduates, 2004–2010

BACKGROUND:The Paediatric Chairs of Canada have been proactive in workforce planning, anticipating paediatric job opportunities in academic centres. To complement this, it is important to characterize the practice profiles of paediatricians exiting training, including those working outside of tertiary care centres.OBJECTIVE:To describe the training paths and the practice patterns of Canadian paediatric residency graduates.METHODS:A survey was completed in 2010 to 2011 by Canadian program directors regarding residents completing core paediatrics training between 2004 and 2010. Data collection included training path after completing core paediatrics training and practice type after graduation.RESULTS:Of 699 residents completing their core training in paediatrics, training path data were available for 685 (98%). Overall, 430 (63%) residents completed subspecialty training while 255 (37%) completed general paediatrics training only. There was a significant increase in subspecialty training, from 59% in earlier graduates (2004 to 2007) to 67% in later graduates (2008 to 2010) (P=0.037). Practice pattern data after completion of training were available for 245 general paediatricians and 205 subspecialists. Sixty-nine percent of general paediatricians were community based while 85% of subspecialists were hospital based in tertiary or quaternary centres. Of all residents currently in practice, only 36 (8%) were working in rural, remote or underserviced areas.CONCLUSIONS:Almost two-thirds of recent Canadian paediatric graduates pursued subspecialty training. There was a significant increase in the frequency of subspecialty training among later-year graduates. Few graduates are practicing in rural or underserviced areas. Further studies are needed to determine whether these trends continue and their impact on the future paediatric workforce in Canada.     

Building Canada��s health research capacity within the framework of the Canadian Institutes of Health Research

The establishment of the Canadian Institutes of Health Research (CIHR) generated considerable excitement about the capacity for health research in Canada. The long term success of the CIHR will be determined, in part, by its ability to recruit, train and retain a cadre of talented researchers. During a workshop to develop the research agenda for one of the proposed institutes within the CIHR, a national, multidisciplinary group of clinical and basic science research trainees were invited to present their views about the challenges that face Canadian researchers of tomorrow. The objective of this paper is to present the challenges associated with recruiting, training and retaining health researchers, and to identify new opportunities provided by the creation of the CIHR. The present paper concludes with suggestions that may improve the success of researchers and, ultimately, the success of the CIHR.     

How are pediatric training programs preparing residents for practice?

The majority of pediatric residents continue to choose a career in practice on completion of their training. Despite knowing residents' career preferences, many training programs have focused on inpatient tertiary care at the expense of primary care. Perhaps this reflects service needs and the significant technology and extensive information resulting in the growth of pediatric subspecialties. To determine the spectrum of didactic and clinical experiences pediatric training programs offer residents to prepare them for managing a practice, we conducted a survey of pediatric training program directors in 1988. Although the majority of residency programs have a practice management curriculum, the number of hours devoted to this area is minimal. In addition, a significant number of residents are not experiencing a community office rotation. This survey indicates the need to develop a practice management curriculum if trainees are to be prepared for choosing the right career and for being competitive in practice.     

Survey on developmental-behavioural training experiences of Australian paediatric advanced trainees

In order to monitor whether paediatric education has adapted to meet modern practice 91 paediatric advanced trainees were surveyed to elicit their satisfaction with developmental-behavioural (DB) training. A response of 69% was obtained to a postal questionnaire. The traditional imbalance persists, with trainees considering themselves significantly better informed in the medical disciplines (P>0.001). Satisfaction with training in the 14 developmental disciplines surveyed is less (P>0.001) and significantly more variable compared with 11 traditional medical disciplines (P>0.01). Formal rotations in DB disciplines had been received by all respondents by the 7th year of training. However, 46–67% consider themselves ill-informed in learning/school problems, attention-deficit hyperactivity disorder, adolescent problems, paediatric rehabilitation and language impairment. Thirty-seven per cent found formal postgraduate instruction unhelpful. Paediatric advanced training gives exposure to, but unsatisfactory formal education, in developmental and behavioural paediatrics. Current initiatives for mandatory DB training have serious implications for achieving adequate resources and standards to meet clinical and training demands.     

Meeting the needs of medical students training in paediatrics and child health

The way education is delivered is changing, and the type of clinical experience in paediatrics available to medical students is changing. Accordingly, the academic departments of Paediatrics and Child Health in Australia and New Zealand are revising both the content and methods of delivery of training in Paediatrics and Child Health. The educational change paradigm and the nature of the changes in training proposed are summarized.