Paediatrics specialty training

My experience of paediatrics is limited to 4 months stint as a foundation doctor. I hated every minute of it. Rota was horrendous and I was completely unsupported. I was put on the SHO rota and expected to turn up to deliveries with no NLFS or any sort of proper training beyond and instruction how to dry and bag and mask a newborn. Later to be heavily criticised for not intubating a meconium aspiration and bag and masking instead. Just one of many examples of completely unrealistic expectations from the consultants. Just 4 months left me broken and sick with anxiety.

As for pros and cons in terms of choosing paediatrics training as a career:
Con's for some people include the intensity of the acute work. I think the pace and workload can be equivalent to that experienced in A&E, and that's not for everyone. Also the length of the training programme and the fact that it's run-through can be off putting for some, however it is competency based, meaning you can progress through it more slowly or more quickly depending on how you are doing with exams or competencies. This means you can do the programme in between 5.5 and 8 years full time (more if you take OOP years or go LTFT, though if you work at 80% of full time, it is possible to progress at 100% rate).
Another thing that is a con for some is the safeguarding work. Fortunately it's a very small part of my job, but a really important one to be an advocate for a child in those situations.
A massive pro for me is the variety. As a trainee you work in general paediatrics, neonatal medicine, community paediatrics, and every sub-specialty of adult medicine you can think of also exists as a specialty to rotate through including paeds surgery, PICU, and paeds A&E. I really like that even several years into specialty training I still feel very much the generalist and get to work across so many different environments. It also means I get to mix the pace of the acute work with the more clinic-based community work and don't have to choose which of these to sub-specialise in until the very end of my training, or as a consultant I can choose to still do a bit of both.
Paeds is also great if you like procedures. I don't need an anaesthetist to intubate a baby, a radiologist to put in a chest drain, or ITU to put in a central line for me, all of these things I am trained for in my training programme, and it's a really great feeling to know you have all of those skills under your belt should you need them.
I really like that I get to work in a huge team of people. We have more doctors and nurses around in a ratio to patients than many other hospital environments, and paeds tends to attract friendly people that you end up being friends with as well as colleagues. You also get to work with lots of other specialties and allied health professions and that means good teamwork is the norm.
The fact that the average length of stay for a paediatric inpatient is <24hrs means it is impossible to get bored and it's really rewarding to see kids get better so quickly. Their parents are always really grateful, we get lots of cards and chocolate!
We don't have the same funding problems as adult services so you wont find paediatric patients waiting days or weeks as medically fit waiting for a residential home placement or package of care. We don't have the same problems with outliers on other wards or bed pressures as much and I really don't miss that side of working with adults!
The paediatrics training programme is flexible and I am already on my second OOP year doing a teaching fellowship (had a year out between ST1 and ST2 to do a leadership fellowship), and there are lots of opportunities to do research, global health, public health, service improvement, teaching, etc.
Very happy to answer any specific questions about paediatric training but in terms of my happiness as a trainee? No question I think I have the best job in the world. Get on twitter and look up the hashtag #paedsrocks to see the thoughts of other paeds trainees around the UK. I'd say in general we are a very happy bunch!

As for pros and cons in terms of choosing paediatrics training as a career:
Con's for some people include the intensity of the acute work. I think the pace and workload can be equivalent to that experienced in A&E, and that's not for everyone. Also the length of the training programme and the fact that it's run-through can be off putting for some, however it is competency based, meaning you can progress through it more slowly or more quickly depending on how you are doing with exams or competencies. This means you can do the programme in between 5.5 and 8 years full time (more if you take OOP years or go LTFT, though if you work at 80% of full time, it is possible to progress at 100% rate).
Another thing that is a con for some is the safeguarding work. Fortunately it's a very small part of my job, but a really important one to be an advocate for a child in those situations.
A massive pro for me is the variety. As a trainee you work in general paediatrics, neonatal medicine, community paediatrics, and every sub-specialty of adult medicine you can think of also exists as a specialty to rotate through including paeds surgery, PICU, and paeds A&E. I really like that even several years into specialty training I still feel very much the generalist and get to work across so many different environments. It also means I get to mix the pace of the acute work with the more clinic-based community work and don't have to choose which of these to sub-specialise in until the very end of my training, or as a consultant I can choose to still do a bit of both.
Paeds is also great if you like procedures. I don't need an anaesthetist to intubate a baby, a radiologist to put in a chest drain, or ITU to put in a central line for me, all of these things I am trained for in my training programme, and it's a really great feeling to know you have all of those skills under your belt should you need them.
I really like that I get to work in a huge team of people. We have more doctors and nurses around in a ratio to patients than many other hospital environments, and paeds tends to attract friendly people that you end up being friends with as well as colleagues. You also get to work with lots of other specialties and allied health professions and that means good teamwork is the norm.
The fact that the average length of stay for a paediatric inpatient is <24hrs means it is impossible to get bored and it's really rewarding to see kids get better so quickly. Their parents are always really grateful, we get lots of cards and chocolate!
We don't have the same funding problems as adult services so you wont find paediatric patients waiting days or weeks as medically fit waiting for a residential home placement or package of care. We don't have the same problems with outliers on other wards or bed pressures as much and I really don't miss that side of working with adults!
The paediatrics training programme is flexible and I am already on my second OOP year doing a teaching fellowship (had a year out between ST1 and ST2 to do a leadership fellowship), and there are lots of opportunities to do research, global health, public health, service improvement, teaching, etc.
Very happy to answer any specific questions about paediatric training but in terms of my happiness as a trainee? No question I think I have the best job in the world. Get on twitter and look up the hashtag #paedsrocks to see the thoughts of other paeds trainees around the UK. I'd say in general we are a very happy bunch!

My experience in foundation put me off. There were some aspects that I enjoyed but a lot that I didn't. I have opted for a child and adolescent psychiatry in the end, which has a lot of overlap with community paediatrics (complex developmental issues, learning disability, ASD, ADHD etc) and some with acute paediatrics ( we work alongside inpatient paediatricians a lot with acute self-harm, overdoses and eating disorders). The out of hours workload is minimal though and no neonates, which I absolutely hated.

I think the experience that you get varies a lot depending on where you train. Even within the same deanery, there are great hospitals and dire ones. It is a bit of a lottery. I would listen carefully to the negatives and positives and make your own balance. If your heart is in it you may be able to put up with a lot of things that would be potential deal breakers for others.

Thanks for your reply. I’m sorry to hear you were put off but glad to see you’ve found a career you’re happy in yeah I know what you mean about the hospital lottery situation- it’s worrying me in case I get a bad hospital for paeds and it puts me off!

Can I ask- what was it that you hated about neonates? And you mentioned that there were parts of the career you loved- would you mind talking a bit about those? Thanks

Sticking needles into tiny, tiny babies is just not my thing. There are few things that I find difficult emotionally in medicine but this is definitely one of them. It often felt like we spend weeks subjecting the babies to all sorts of torture and they died in the end anyway. The staff were not very nice, which I think compounded on my strong dislike. It was also very busy with relentless rota and limited support as reg was pulled in all sorts of directions often living me feeling totally out of my depth with nurses barking at me to do this or that when I did not feel comfortable. The only thing worse was being allocated to postnatal ward and dealing with midwives demanding baby checks non-stop.

I did enjoy the community side of paediatrics but I only had minimal exposure to it as we were largely kept on the wards as clerking/discharge letter writing machines with limited opportunities to go to clinics. I also enjoyed the interactions with parents and kids, particularly older kids and teenagers. I also liked that most children in the hospital got better very quickly. I do miss that instant gratification in CAMHS sometimes. I need to wait months to see positive results.

Neonatal medicine is quite different to other areas of paeds training and more analogous to other intensive care environments. The experience also really depends on whether you work in a level 3 NICU where they take the most premature and unwell babies, or whether you are working in a more high dependency/special care environment.
The pros and cons are different to general paeds. The pros are the excitement of deliveries, the reward when the babies heart rate races up as you give inflation breaths, the joy of handing a healthy baby to new parents, seeing lots of healthy babies and happy parents when doing baby checks, the long term relationships you develop with the parents of prems, seeing them leave hospital and getting cards from ex nicu families every birthday, Christmas etc. I also really like some aspects of the clinical work which requires lots of attention to detail, tweaking ventilators and IV fluid regimes but that's not for everyone.
Intensive care means lots more nurses and doctors than other environments so it's great fun. Consultants are very involved and have been really great at teaching and training where I have worked, I also like the teamwork with obstetrics and anaesthetics. Again there are lots of procedures if you like that kind of thing.
Cons are, the workload can be high if you have lots of ICU tasks and the delivery bleep won't stop, midwives are not known for being easy to work with, putting needles in babies is not nice (but you do get good at it), there are more deaths and poor outcomes than other areas of paeds, but some brilliant examples of holistic and palliative care too, it can sometimes be stressful and emotionally draining when the babies are really sick.
I really enjoyed my neonates too but it's quite niche and even as a paeds trainee if you've never done neonates before there is a lot to learn.

I did my foundation post (FY2) in NICU last year , and felt put off instantly afterwards. I always wanted to be involved in treating children, so it really put me off and meant I lost career direction, as suddenly the one thing I wanted to do was not something I could see myself doing as a consultant.
The pros and cons for me were:

Pros:
-Going to deliveries - The joy of helping a newborn come into this world- second to none, to hand that baby over to their parents and see that joy
-Acute neonatal resus - Loved that bit
-Playing with babies on post-natal ward
-Sense of satisfaction when you get babies healthy and send them home or tell parents they're well to be handed over.
-A Noble job honestly.
-Forming relationships with families, some of whom have been there for a very long time.

Cons:
-Never ending baby checks
-Neonatal consultant never went home. Consultant life just seemed life really bad work/life balance
-2 ST1s quit in front of me - That was very off-putting!
-Lack of autonomy as a junior (Understandably! But I found it bothering a bit, as I felt quite independent in all my other jobs)
-Horrendous Rota. Felt tired after almost every single shift.
-Multiple responsibilities due to staff shortages.
-Low morale through out the unit. I don't know if it was just my unit, but trainees just did not seem happy at all whatsoever.

-As an Fy2 I was on the rota with the STs. There were days I had to cover as the only SHO on NICU + Cover post-natal ward for any reviews they needed and do my own post natal ward round of babies who were staying. It was a lot of responsibility as an FY2, and frankly as much as I grew into that role with a very steep learning curve, I could not see myself doing a lifetime of it.
-Doing LTFT is probably the best if you can manage the financial pressures that brings - It keeps you sane + you get to do paeds. And that is what many paeds trainees I know of have done.

I hate saying this but I wish Paeds training was more supported, and they were better staffed and the job was actually designed to train you up to be the physician you always wanted to be. I had always imagined myself as a paediatrician, but seeing this made me think real hard about what I actually want, and work/life balance, and doing something that satisfies me (Still finding this mysterious speciality!)

P.S. My experience may be very skewed and I may just have become a very cynical person in life.

My experience of paediatrics is limited to 4 months stint as a foundation doctor. I hated every minute of it. Rota was horrendous and I was completely unsupported. I was put on the SHO rota and expected to turn up to deliveries with no NLFS or any sort of proper training beyond and instruction how to dry and bag and mask a newborn. Later to be heavily criticised for not intubating a meconium aspiration and bag and masking instead. Just one of many examples of completely unrealistic expectations from the consultants. Just 4 months left me broken and sick with anxiety.

Why did the STs quite? Can you elaborate, please, if you get the time?

Also, when you say the rota was horrendous, do you mean the actual rota (i.e. a bazillion long days/nights) or do you mean, the rota was fine, but the shifts were difficult? Would you be able to post your rota template with non-identifiable info? Really considering paediatrics.



Hi, that sounds AWFUL. Would you be able to provide a bit more detail though? Sounds like a few of your consultants should have been fired if they literally left an FY2 with no paediatric experience like this!

Hey,
Yes, I can tell you more about it, but have rota copies anymore.
By rotas being horrendous - I mean because 2 STs quit they were left quite short. We were on the brink of an illegal rota. Lots of long days and night shifts. And the long days were bad sometimes as I was running between NICU, labour wards and theatres and also doing postnatal ward reviews sometimes(Bear in mind this was as an FY2 as well!..I think I coped well looking back!)

Wouldn't want to put you off paeds though - And bear in mind this was NICU! Only certain people really enjoy NICU!

I decided long term I might not be able to tackle this constantly.
But I still have nice memories of some moments in Paeds which I treasure!

I am now thinking of Paeds Anaesthetics - Glory of children + Acute stuff + Good life - Think about it if its your thing!