Developing a community child health service for the 21st century
A report on a review of the community child health service in Scotland.
Results of the Paediatric Trainee Questionnaire
1. Background of trainees
Of the 55 who replied:
- 67% of responders were female (current ST1 entry across the UK is 76% female)
- 24% were flexible trainees
- 84% were aged between 25 and 35 (16% 36 and over)
- 73% attended medical schools in Scotland; 18% outside the UK and 9% trained in England.
- Duration and overall satisfaction
The majority have spent (or expect to spend) 6-9 months in CCH. (11% expected to or had spent 2 or more years in CCH). Responders were almost equally divided across training years 1-7 giving a good spread across the training period. 75% felt that their training was adequate given their choice of career but 24% said no or were uncertain. 7 responders (13%) had either not done any training or were not sure how long they had trained in CCH .
- Rating of elements of training
In terms of the elements of CCH training there was a high level of satisfaction with some elements of training. Trainees rated their experience highly in child protection; learning disability; motor disorders and communication disorders with more than 40% responders scoring these topics 8 or more on a 10-point scale . Public health topics and research training scored poorly with very few good/excellent ratings. Overall, 80% of trainees rated 10 out of 17 CCH topics listed at >5/10.
Author's Note: Availability of Supervision in CCH Clinics
RCPCH guidance suggests dual consulting (simultaneous presence of consultant at trainee clinic) is available for supervision of trainees. In the Health Board survey 21% (3) HBs in Scotland indicated that all their clinics allow this but 29% (4) indicate less than 50% of their clinics allow dual-consulting. This finding may mean that trainees are not supervised adequately in some areas.
Trainees rating of training by CCH topic (10 point scale)
3. Current Duties of Trainees
The vast majority of participants are combining daytime community placement with acute hospital work (82%) and 84% felt this was helpful for their training.
71% are working night "on-call" cover and a further 27% are working both "day and night cover". For those undertaking acute on call, 74% respondents are on the same rota as hospital based trainees. 5% respondents report they are on fixed night work.
20% of participants were undertaking child protection on call but 65% were not.
11% were providing "full cover" and 15% were acting as an "observer only".
Comment: If trainees are actually undertaking " full" child protection cover, then questions need to be asked about their supervision in this very difficult area of work.
4. Study and research
The majority of participants (95%) have access to a PC and the internet at home and at work (96%). 84% felt there were appropriate clinical training facilities in hospitals versus 62% satisfied with training facilities in the community. 84% believed there were adequate library facilities with relevant books and journals but only 62% believed there were adequate library facilities with relevant CCH books.
5. Future career choices
Most trainees (62%) were looking for a consultant post in acute general paediatrics with acute on-call. Several noted other sub-speciality roles eg paediatric emergency medicine; respiratory paediatrics; academic paediatrics; paediatrics with an interest in Diabetes/Endocrinology and paediatric intensive care. When asked if they wished to undertake out of hours/on-call duties as a consultant, 87% answered yes but only 9% of these wished to undertake child protection on call. 40% thought that "social paediatrics" would be an essential ingredient of a future job. 65% thought interagency working/public health/management and planning as essential or desirable in a future job.
Significant numbers rated neonatal on call duties as "undesirable" in a future post with18% stating they wished a job as a general paediatrician with acute and neonatal on-call. 16% wanted a general paediatric post which included child protection on call. 11% wanted to be a community paediatrician with acute on call. 9% wanted to be a community paediatrician with child protection on-call. A majority wished a special interest clinic.
- Mary Sloan firstname.lastname@example.org
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