Forensic Paediatrics A Report by the Short Life Working Group

Chapter 3 Training and Skills for Paediatricians

1. The RCPCH oversees the training of all paediatricians. There are 3 stages of training to become a Consultant:-

• Basic Specialist Training in Paediatrics - which provides competencies on recognition and basic assessment of a child in need of protection. This is the level expected of a junior paediatric trainee;
• Core higher specialist training in paediatrics - which provides competencies on management of a child in need of protection. This is the level expected of a senior trainee who has gained a wider experience of working with children;
• Post-core higher specialist training - which provides competencies to know when an expert genital examination is needed and the role of colposcopy as part of that. This is the level expected of a trainee who is ready to take up a consultant post (i.e. has a CCT in general paediatrics or CCH).

Above this level additional competencies to develop specialist interests are provided by RCPCH. This would allow training in the conduct of sexual abuse examinations including the use of the colposcope. This does not necessarily confer expert status on the doctor.

2. The normal programme of training takes eight years until a paediatrician receives a CCT before they are deemed competent to apply for a consultant post. In child protection, there are specific levels of competency from level 1 to 6 described in the Intercollegiate document "Safeguarding Competencies" published in 2010. All trainees at ST 6-8 should obtain level 3 competencies before the end of their training and all consultants presently working as general paediatricians should aim to have level 3 Safeguarding Competencies or equivalent. After the CCT a consultant can gain additional competencies e.g. level 4,5 and 6.

3. There is no mandatory requirement for further qualifications for consultants with a special interest in child protection. However RCPCH has recommended that specialists performing examinations for CSA should be required to gain further qualifications such as the Diploma in Forensic and Clinical Aspects of Sexual Assault.There is also a recognised need for ongoing training, at a range of levels, to complement qualifications.

4. At present the training courses of those involved in forensic paediatric examinations is made up of national, accredited courses and local courses. Local training is not subject to accreditation and, while there is an appreciation of the need for flexibility and independence to create appropriate training courses, this needs to be balanced by a requirement to ensure training is adequate and appropriate.

5. It is recommended that paediatricians are required to see and undertake 10 examinations a year to maintain competencies. RCPCH recently recommended a minimum of 4 peer review sessions a year.

6. Training for paediatricians and forensic physicians on evidence gathering, report writing and giving evidence in court in cases of child sexual abuse has been arranged in the past by the RCPCH and Faculty of Advocates with appropriate input from COPFS, but these are not regularly held.