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FY1 Job in Paediatrics
Dr Katie Warnock - FY1 (Greater Glasgow & Clyde deanery)
April 2022 Blog
Hi everyone, my name is Katie and I am currently an FY1 training in Glasgow. I recently completed a block in paediatric surgery at the Royal Hospital for Children and thought I would give you an insight into my experience in paediatrics so far.
Having only worked in paediatrics for 4 months, my experience is limited but if any of you are hoping to work in paediatrics during your foundation years, I thought it might be helpful to share my experience so far and what I wish I had known at the start of my job.
In my induction for this job, we were told by everyone that “children are not small adults”, which I couldn’t agree more with. Children often present differently and it can take a lot of patience and questioning to figure out what’s going on. Coming into hospital can be a scary and stressful experience for both the child and their carer, so remember to be compassionate and understanding of their situation.
A different approach is often needed to paediatric patients, simple tasks like bloods and cannulas often require a bit more time and explanation than in adult patients.
My top tips for working in paediatrics:
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Brush up on your kids tv shows/movies/what’s popular now - the best way to build rapport with the patients is to be able to chat with them about what they are watching (Paw Patrol and Enchanto are the favourites at the minute).
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Remember to speak to the child when taking a history/explaining the results of a test and not just the carer - don’t ignore them!
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Be patient with the kids and their carer - everyone is very tense and they just want to make sure their child is healthy and safe.
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Take advice from your colleagues who have greater experience in paediatrics e.g. nurses, play therapists, pharmacists, senior doctors
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If you’re unsure or worried about anything - just ask!
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Enjoy it! Children are hilarious and some of the best conversations you’ll have during the day will come from them.
I hope this helps and enjoy!
Feel free to get in touch if you have any questions or I can help at all.
‘Twice as likely’
Caitlyn Scott
August 2021 Blog
“Infants are more than twice as likely to die in England and Wales if they are born into a poor family rather than a wealthy one, and the gap is widening.”
A harrowing statement from Professor Russell Viner, President of the Royal College of Paediatrics and Child Health (RCPCH). [1]
“Infant mortality rates in the most deprived areas in Scotland are over 50% higher than those in the least deprived areas.”
A similarly haunting statistic from NHS Scotland. [2] So why is it that the UK, the 5th wealthiest nation in the world, has such high rates of infant mortality?
Health inequalities are defined as preventable and unjust disparities in health status between different populations. You may be familiar with “the Glasgow effect”, a term used to describe the city’s strikingly low life expectancy. To put it into perspective, expected years lived in good health in the most affluent areas of Scotland is around 23 years greater than in the most deprived. [3] 23 years of additional, healthy life, provided you are born into a richer neighbourhood. It is an uncomfortable thought to sit with, but despite an overall decrease in communicable diseases within the UK, we cannot ignore the rising rates of chronic illness, and the fact that those living in the poorest quintiles of the country are being disproportionately impacted by them. The 4.1 million children living in poverty are essentially being left behind.
Research has shown that babies born into areas of the lowest socioeconomic status are on average 200g lighter than those born into the highest. [4] Children growing up in over-crowded or poor-quality housing are more prone to respiratory infections and developing asthma. [5] Prevalence of mental illness and chronic stress is highest amongst young people residing in the poorest quintiles. [6] The list sadly goes on, and these inequalities have only been exacerbated by the Covid-19 pandemic. Reliance on foodbanks has soared, and for the first time ever since its founding in 1946, the charity UNICEF has been forced to step in to provide food aid to hungry UK families.
I am personally interested in the field of Paediatrics because evidence shows that a child’s earliest years of life largely determine their future outcomes. I may only be a first-year medical student, but alongside my peers, I can use my voice to draw attention to the rampant health inequalities that are impacting UK children. We must continue to move away from placing individual blame and instead consider the multitude of factors, largely beyond a parent or child’s control, which contribute to poverty and ill health. Throughout our careers, we will hold the responsibility of advocating for our most vulnerable patients and even encouraging policy change at a national level. SNP’s Baby Box scheme [7], amongst other interventions, are a positive start. But more must be done. Nobody chooses where they are born, but every child has the right to lead a healthy and prosperous life.
References
1. Viner R. Infant mortality rates “extremely worrying” [Internet]. 2019 [cited 2021 March 06]. Available from: Infant mortality rates “extremely worrying” | RCPCH
2. NHS Health Scotland. Child poverty in Scotland: Health impact and health inequalities [Internet]. 2018 [cited 2021 March 06]. Available from: Child Poverty in Scotland: health impact and health inequalities (healthscotland.scot)
3. Public Health Scotland. What are health inequalities? [Internet]. 2021 [cited 2021 March 07]. Available from: What are health inequalities? - Health inequalities - Public Health Scotland
4. Tucker J. The impact of poverty on child health [Internet]. 2018 [cited 2021 March 05]. Available from: The impact of poverty on child health | RCPCH
5. Cumella A, Haque A. On the edge: How inequality affects people with asthma [Internet]. 2018 [cited 2021 March 05]. Available from: auk-health-inequalities-final.pdf (asthma.org.uk)
6. Pearce A, Dundas R, Whitehead M, Taylor-Robinson D. Pathways to inequalities in child health. Arch Dis Child [Internet]. 2019 Feb 23 [cited 2021 March 07]; 104: 998-1003. DOI:10.1136/archdischild-2018-314808
7. SNP. What are the details for the SNP Scottish Government’s baby box scheme? [Internet]. [cited 2021 March 07]. Available from: What are the details for the SNP Scottish Government’s baby box scheme? — Scottish National Party
Additional resource links
What can health professionals do? – RCPCH – State of Child Health
FY1 Job in Paediatrics:
The Good, the Bad, and the Cute and Cuddly!
Dr Mairi Buchan - Foundation Year 1 (Thames Valley/Oxford Deanery)
July 2021 Blog
Following the stressful process of UKFPO Foundation programme applications, alongside my other two rotations, I was thrilled to secure an FY1 post in Paediatrics. In writing this blog post, I’m hoping to shed some light on what working as a very junior member of the Paediatrics team was like and (hopefully) encourage more people to seek out this experience.
Preconceptions of the Job:
Initially, I was terrified that this would be my first job, having completed my last Paediatrics placement in medical school a few years ago. During medical school, our Paediatrics exposure was limited because the curriculum was changing and the placement was being moved from Year 6 to Year 5. The classroom tutorials had been excellent but our hands-on experience was limited due to the large numbers of medical students floating around wards and clinics. I had never taken blood from - never mind cannulated - a child of any age; hadn’t held a baby in quite a while; and my knowledge of immunisation schedules, paediatric jaundice, and causes of abdominal pain in children was a little hazy to say the least.
In my mind, I was going to have to do a lot of catching up in order to be a good junior doctor. I imagined having to deal with sick children with limited senior support and being quizzed on ward rounds about niche causes of genetic conditions. Fortunately, what happened in reality was quite the opposite!
The Job Itself :
As an FY1, I was supernumerary (a valued member of the team but really an extra pair of hands to supplement the work of the SHOs, Registrars, and Consultants). The day started at 0830 with a morning handover where all of the ward patients were discussed and any overnight issues highlighted. We then moved onto a Consultant-led ward round, which depending on the number of patients, could last from one to three or four hours. After this, a team jobs list would be written with tasks generated from the ward round and we would all pitch in to work our way through this. Examples of jobs would include writing discharge letters, prescribing, practical skills (venepuncture or heelprick bloods, cannulation, sometimes a lumbar puncture), and afternoon reviews. This went on until 1700 when there would be an evening handover to discuss the day’s patients and again highlight any issues to be passed on to the night team at 2200. There was time scheduled into the rota to attend clinics and we were also scheduled shifts in Paediatric A&E. As an FY1, I did not work any night shifts and only worked the occasional rota’d long day and a weekend once per month.
👍The Positives:
There were so many positives to this job, it’s difficult to know where to begin! To put it into perspective, I had never considered Paediatrics as a career option prior to my FY1 job in the field but I loved it so much it’s now one of my top choices. Firstly, as a Paediatrics FY1 I was very sheltered. The department was very senior-led, meaning there was always at least a Registrar around to ask for help and allowed me to feel well supported. Everyone on my team was very friendly and encouraging, allowing me to develop confidence in reviewing children and my paediatric skills. Perhaps it was the time of year I worked in Paediatrics, but there was a lot of time for Quality Improvement projects, getting involved in teaching medical students, and online learning, which also helped to develop my confidence in other aspects of foundation training. I also had time to shadow on the Neonatal Unit (usually not included in FY1 jobs), which allowed me to do some career exploration by experiencing a different aspect of Paediatrics (one which makes up a large proportion of Paediatrics specialty training).
👎The Negatives:
There weren’t a massive number of negatives in this job. As I’ve mentioned, I appreciated being relatively sheltered as this was my first job as a qualified doctor. However, having now worked in another department in which I’ve experienced much more independence (particularly because of staffing issues and crazy Covid rotas), I could see this as being frustrating if the job was my second or third placement of FY1. Apart from that, I can’t come up with any other “bad” points.
Summary – The Cute and Cuddly
As you can (hopefully) tell by my infinitely longer number of positives than negatives, I loved my FY1 job in Paediatrics. I would implore everyone to try to include this job somewhere within their foundation training – not only does it broaden your experience of patients across the lifespan but it allows you to develop extremely useful skills for other jobs (such as cannulating tiny babies – useful for elderly patients with thready veins; knowing how to do capillary gases – useful if you’re struggling for access for VBG or ABG on the ward and need a quick lactate; and reviewing children, something you will come across in General Surgery, Anaesthetics, and General Practice to name but a few). Not only do you develop these new skills, you meet some fantastic patients and members of the MDT and, if you’re not busy at all, there are always lovely babies who need fed and cuddled :D
Child Healthcare Inequalities in Scotland - Patrick Corbett
June 2021 Blog
Social determinants are known to have a large effect on children’s health with economic, social and environmental factors all playing a large part. As far back as the Black Report in 1980, there has been increasing understanding that improving the health of the population relies on addressing these ‘upstream’ factors rather than trying to blame one’s health purely on their behaviour (1). This is particularly true for children, many of whom are born in disadvantaged areas in which they are statistically much more likely to have poorer health (2). This is caused by inequalities that systemically affect certain populations due to underlying socio-economic structures. This is well displayed by a study on childhood asthma admission rates across different post-codes with varying levels of socio-economic deprivation. The deprivation score was calculated based on average household income, neighbourhood education, unemployment rates and population density among other factors. Rates of asthma admission were 88 times higher in the most deprived quintile of neighbourhoods compared to the least deprived, proving that the morbidity of diseases such as child asthma is shared unequally across populations due to factors out of the child’s control (3).
Inequalities affect child morbidity and mortality in both high and low income countries (2). Despite Scotland being a wealthy country, levels of child poverty are relatively high compared to other developed countries with 24% of children living below the poverty line (4). This is reflected by large health inequalities. The 2020 State of Child Health report validates this, showing levels of child poverty increasing and the number of young carers in Scotland nearly doubling since 2017 (5). There is no surprise therefore that child and adolescent mortality has increased over this period as well as a number of other health indicators such as levels of learning disability and suicide. The report also displays a clear widening gap in health between children from advantaged and disadvantaged backgrounds. It would appear these inequalities are being amplified in the pandemic with children from disadvantaged backgrounds facing increasing problems from unemployment and income insecurity in the household (6).
The social determinants causing these inequalities are a knock on effect from social and political actions which are out of the hands of parents and doctors (7). Therefore it is logical that action has to be taken at policy level to address healthcare inequalities affecting children in this country. The SOCH 2020 report implores the Scottish government to fully resource all the measures in the Child Poverty act in order to achieve their 2030 childhood poverty and obesity targets (5).
References
1. Macintyre S. The black report and beyond what are the issues?. Social science & medicine. 1997 Mar 1;44(6):723-45.
2. Marmot, M., 2020. Health equity in England: the Marmot review 10 years on. Bmj, 368.
3. Beck, A.F., Moncrief, T., Huang, B., Simmons, J.M., Sauers, H., Chen, C. and Kahn, R.S., 2013. Inequalities in neighborhood child asthma admission rates and underlying community characteristics in one US county. The Journal of pediatrics, 163(2), pp.574-580.
4. Spencer N. The social determinants of child health. Paediatrics and Child Health. 2018 Mar 1;28(3):138-43.
5. Royal College of Paediatrics and Child health. State of child health report 2020. 2020 March. Scotland. https://stateofchildhealth.rcpch.ac.uk/evidence/nations/scotland/
6. Bopall, Broster, Viner. Impact of the COVID-19 pandemic on global child health - joint statement. Royal college of Paediatrics and healthcare. 08/2020. Accessed 05/01/2020. https://www.rcpch.ac.uk/resources/impact-covid-19-pandemic-global-child-health-joint-statement
7. Hagell A, Shah R. Highlighting the health inequalities faced by young people in the UK. 2020 February. The Health Foundation. Accessed 09/12/20 https://www.health.org.uk/news-and-comment/blogs/highlighting-the-health-inequalities-faced-by-young-people-in-the-uk#:~:text=Health%20inequalities%20are%20already%20apparent%20in%20adolescence&text=The%20gap%20between%20obesity%20levels,13.5%25%20in%202017%2F18.
When past losses become new inspirations - Amy Cui
May 2021 Blog
To most people without any background in medicine or health science, the term “palliative care” is either unheard of or misunderstood. It is often perceived as a synonym for end of life care. Upon initial encounters, whenever others ask me what my Ph.D. is about, “that’s so depressing,” “I don’t know how you do it,” and “that’s really impressive” would be the most common responses I would get. As I elaborate further that my research is specifically on paediatric palliative care, most people would express that they have no idea how I can handle the emotional distress attached to it. To most practitioners and researchers in the field of medicine, being able to accept death is perceived as one of the most significant challenges to overcome. Our first ever experience of patient death is often one of the most memorable and hardest ones to overcome.
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When past losses become new inspirations - Amy Cui
May 2021 Blog
To most people without any background in medicine or health science, the term “palliative care” is either unheard of or misunderstood. It is often perceived as a synonym for end of life care. Upon initial encounters, whenever others ask me what my Ph.D. is about, “that’s so depressing,” “I don’t know how you do it,” and “that’s really impressive” would be the most common responses I would get. As I elaborate further that my research is specifically on paediatric palliative care, most people would express that they have no idea how I can handle the emotional distress attached to it. To most practitioners and researchers in the field of medicine, being able to accept death is perceived as one of the most significant challenges to overcome. Our first ever experience of patient death is often one of the most memorable and hardest ones to overcome.
Dissimilar from most medical researchers and clinicians, my first ever patient who passed away happened to be a four-year-old child instead of someone who has had the opportunity to live their life to the fullest. Although she turned just four years old only a month before she passed away, she was, in fact, the child with the most impressive vocabulary I have ever encountered. During that time, she has already lost all of her hair due to the aggressiveness of her chemotherapy treatment; the countless number of bruises on her limbs made her appear extremely fragile. “I used to have long strawberry blonde hair, I used to be really pretty” was one of the first things she said to me during our first ever encounter. Then I immediately realised that she wants others to look beyond her condition and know her as the child she was before her diagnosis instead of simply labelling her as a cancer patient. Afterward, I attempted to earn her trust by asking questions about her life back home. Such as: who her best friends are, what her favourite TV shows are. She then opened up to me immediately and voluntarily told me all of her experiences and feelings from when she first received her diagnosis and adapting to hospital life. It then became apparent to me that it is much more likely to earn a child’s trust if more considerable effort is put into understanding who they are as children.
Before our first meeting, when I first saw the three letters A-M-L on her patient information sheet, I couldn’t help but feel sorry for the child’s family. Leukaemia represents the most common type of paediatric malignancy. Acute lymphoblastic
leukaemia (ALL) and acute myelogenous leukaemia (AML) are the two most common types of leukaemia found within children. Compared to ALL, which has a 5-year survival rate of 95%, the survival rate for AML patients is only~65%. As much as I assumed how tragic the life of that child’s family would be, I was in fact extremely impressed by the outgoing and expressive personality of the child during the process of invasive procedures.
After her death, I became familiar with the term “palliative care” and understood that one of its main goals is to help patients preserve their dignity even until the end of life. Meeting her made me realize that paediatric cancer is not the identity of children with cancer, although it may have tremendously invaded their lives. Instead, it is essential to separate their condition from them and understand who they actually are as children. Her death will never be forgotten, but she will continue to become my inspiration to promote dignity in patients with life-limiting illnesses. This is what happens when the past loss becomes a new inspiration.
Dr Paula de Sousa - Paediatric Trainee
April 2021 Blog
Hello! I’m Paula, I’m a paediatric trainee currently in my 5th year, which means I have 3 years to go! I’m training to be a general paediatrician but there is also an option to sub-specialise within paediatrics and this is called GRID training. You can also do SPIN modules which allow you to be a general paediatrician with a specific interest. That’s the beauty of Paediatrics, there are loads of choices!
What led you to choose your specialty?
I love working with children, young people and their carers. Paediatrics goes beyond treating a child’s illness. We advocate for the child as a whole, it’s a privilege that as doctors we try to ensure that a child can live their best childhood.
Describe a typical day in your life.
There is no typical day in Paediatrics! It can either be busy, calm, or calm but with very sick children. We rotate through various departments so every week is different.
Favourite things about your specialty?
The staff I work with. Doctors, nurses, HCAs, support staff and hospitality staff that work in Paediatrics are always so caring and passionate. Every single thing we do for children matters.
Highlights of your career?
Having the opportunity to get involved in Global Child Health. Using my spare time to focus on projects that make the world a fairer place for all children has been so rewarding.
Anything you wish you'd known before starting your career journey?
There is flexibility in our training! It often feels like we’re on a treadmill straight from school to medical school to F1/2 to Specialty training and then to Consultant! Along the way, stop, take a break, do something different. It will make you happy and turn you into an even better Paediatrician. As someone wise once said, 20 years from now you won’t regret the things you did do but the ones you didn’t!
What do you like to do outside of work?
Eat. I love food and trying different cuisines. Our holidays are based around food. I like most things except coriander. It’s awful.
Any advice for medical students?
Join a society! There are some amazing societies that do great things such as Students for Global Health. You often get sucked into revision, lectures and hospital placements. I wish I had gained experience in organising teaching, conferences and advocacy at an earlier stage in my career.
What attributes are best suited to your specialty?
You either want to do Paediatrics or not. It’s a tough job with long hours, you have to love it otherwise it becomes even tougher. If you’re unsure, try to organise a taster or elective in it and try to pick it as part of your foundation jobs.
If anyone is thinking of doing Paediatrics please feel free to email me: paula.desousa@nhs.net
Dr Abi Buckle - ST1 Paediatrics
March 2021 Blog
Paediatrics is the best speciality in the world! I’m obviously biased as a paediatrics trainee. Not only is it holistic but it covers a very large range of presentations. My first patient could be a vomiting baby and my next a 16 year old with a chronic condition. We work closely with various members of the MDT including nursing staff, physiotherapists, occupational therapists, pharmacists and ward clerks to name a few. It’s a very sociable job in my hospital with large teams. People who work in paediatrics love it and there are always friendly smiles awaiting you in the handover room.
What led you to choose your specialty?
I always knew that I wanted to work with children but initially thought that I wanted to be a teacher. I took a very convoluted route to medicine starting with a sport sciences degree (with the intention of becoming a PE teacher). Following this I took some time out to travel the world and volunteer abroad before returning to the UK once I had a place at medical school. I have been lucky enough to be able to volunteer in medical clinics in India, Canada, Peru and Ecuador. It was always the young patients that inspired me. I can sing my favourite Disney songs and instead of laughing at me like me friends do, children join in. They bounce back quickly, like playing games and you get to be imaginative when examining the child that doesn’t want to be examined. I know I chose the right career because I wake up every morning wanting to go to work. I also now have an excuse to watch Disney movies.
Anything you wish you'd known before starting your career journey?
When applying for a training post consider not only where you want to live but also what training opportunities are available in that area. For example if you have a particular interest in cardiology, explore the cardiology training in the area. It is also useful to discuss with current trainees regarding the training in a particular area to help decide whether it will suit you. If you want to work less than full time or take time out to do research find a deanery that will be flexible in regards to this. I used the Messly website when looking at jobs to see reviews of jobs that I was interested in and explore others that I wanted more information about.
What do you like to do outside of work?
I travel. Or I did until the pandemic hit. I like to explore different places and cultures and volunteer as I do this. More locally I like to walk with my pupster, who is not a puppy but thinks he is. It’s a bit like having a child really, except he doesn’t cry and is just like an excited ball of fluff! I like to keep active by playing hockey, skiing and hiking. To be honest I’ll try any sport.
Any advice for medical students?
Join your local paediatrics society and get involved in it. Apply for committee positions, attend teddy bear hospital events, try to find a local “Save a Baby’s/Child’s Life” workshop (my university ran these and we organised an instructors course so we could teach them also). Bedside play is a great way to get involved and get used to seeing children in a medical setting.
As a foundation doctors try to get a paediatrics job. If you don’t manage this, don’t be disheartened. Apply for a taster session where you can spend 1-2 weeks in paediatrics as part of the team learning how things work and what interests you.
Attend paediatric conferences – especially at the moment as a lot of them are free due to being virtual.
Start watching kids movies that you want to watch and don’t feel bad about it. Consider it as ‘research’ for your future potential job. It makes it so much easier to connect with children when you know Elsa, Anna and Sven by name!
What attributes are best suited to your specialty?
Be fun and smiley. Children generally respond much better to someone who is smiley, happy and engages with them. A playful nature never seems to go a miss either. For a child that won’t talk to you, try to find an interest of that child. For example complimenting their Peppa Pig top or asking where George is?
Who is your biggest inspiration?
David Attenborough is definitely up there. As a child he allowed me to see and learn about all of these beautiful animals that I had never seen and as an adult has challenged the thoughts of myself and many other people and the ways we live our lives. Whatever you do in life, be it paediatrics or not, find something that inspires you.
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