There is considerable variation in the duration, location and content of paediatric attachments for medical students in the United Kingdom. Paediatricians involved in undergraduate education are under pressure to establish paediatric competencies within a shorter timeframe and medical students report uncertainty about where the emphasis should lie during attachments in child health. This is the basis for the development of a common syllabus for child health training.
The background to this was the publication of the Kennedy report which raised two important issues. Firstly, it highlighted the importance of children within healthcare. More than a third of all healthcare consultations involve children. However, most medical schools have seen reductions in child health training over the last decade. In some instances, training has been moved from acute into primary care settings. However, there was clear evidence that teaching overall in child health was being reduced.
Secondly, and crucially, the Kennedy report discussed ‘the elephant in the room’ regarding teaching child health in primary care as over half of general practitioners have no training in child health as postgraduates. These shortcomings in postgraduate training continue throughout the country, with general practice training schemes unable to offer paediatric rotations to a significant proportion of trainees. This has been compounded recently by publications by Ingrid Wolfe et al about the poor health outcomes for children in the UK compared to the rest of Europe.
Late in 2010 the idea of a single, national undergraduate curriculum was originally mooted to me by the then Paediatric Education Special Interest Group (PEdSIG) convenor Will Carroll and that we should be spearheading its establishment through our organisation. We knew of other specialities such as Obstetrics and Gynaecology as well as Psychiatry who had developed and completed such initiatives. I organised a meeting in 2011 inviting all the UK key paediatric undergraduate leads. We had a considerable turnout that was truly representative of all UK medical schools. We clearly proved that there was a general whittling away of the paediatric curriculum and all participants were keen to join forces. Additionally we proved that medical schools where there was a high percentage of applicants to paediatric specialist postgraduate training had delivered at least eight weeks of undergraduate paediatric training. Using the categories of tomorrow’s doctors, I amalgamated the findings of the meeting day and produced a draft mission statement with the following rationale which was to ensure that the guideline:
– Shared goals across UK paediatric undergraduate training
– That competencies are well defined and able to be assessed
– Paediatrics remains a core and focused part of the undergraduate training
– That all UK graduates will have the skills to appropriately manage paediatric patients
I sent this round to all participants for their comments and corrections and I secured meetings with the most important stakeholders (RCPCH, GMC, Academic Paediatrics Association and Medical Schools Council) so we could get top level buy-in. I was then successful in a bid to support a trainee to undertake the first UCL educational Academic Clinical Fellowship and I have mentored and supervised Hannah Jacob in that role since. She has presented locally, regionally, nationally and internationally and is in the process of final data collection using a Delphi approach. This process was devised by discussing with senior educationalists in the UK, those presenting at international conferences and review of the literature.
Our study comprised three rounds. During Round 1, a range of clinicians involved in child health were asked what should be included in the child health curriculum. In Round 2, participants ranked each of the suggestions using a Likert scale (1-5). In Round 3, these pooled results were shared with participants, who were then invited to re-rank the items, using the Delphi methodology.
Results showed what participants felt must be in the curriculum and what could be excluded. These results are to be used to form the basis for the national undergraduate curriculum in child health and the items were generated by a wide range of clinicians, academics and students and involved all UK medical schools.
The most important outcome of this piece of work would be that our ‘one national paediatric undergraduate curriculum’ guide (expected late 2015) would be integral to curriculum revision at every UK medical school. We have tried hard to ensure this happens by involving as many stakeholders as possible and keeping everyone updated with regular bulletins and meetings. Throughout I have led on this strategic work
Getting it right for children and young people: Overcoming cultural barriers in the NHS so as to meet their needs. 16 September 2010. Department of Health; A review by Professor Sir Ian Kennedy.
Ingrid Wolfe, Hilary Cass, Matthew J Thompson et al. (2011) Improving child health services in the UK: insights from Europe and their implications for the NHS reforms. BMJ;342:90-04.
Meredith E. Giuliani, Caitlin Gillan, Robin A. Milne et al (2014) Determining an Imaging Literacy Curriculum for Radiation Oncologists: An International Delphi Study. Int J Radiation OncolBiol Phys;88(4):961-966
J Doshi, J McDonald. Determining the content of an educational ENTwebsite using the Delphi technique (2012) J Laryngol Otol;126(4):402-6
Naomi Low-Beer, Martin Lupton, Jenny Higham (2010) A novel method of defining the core objectives of a specialty undergraduate curriculum. Med Educ;44(11):1120