Milestones - the magazine of the Royal College of Paediatrics and Child Health - winter 2020

The magazine of the Royal College of Paediatrics and Child Health ELECTION

MOVING FORWARD Meet your RCPCH Presidential candidates

I N S I DE

WINTER 2020

Page 12

Skin Deep

Improving resources to diagnose skin conditions Page 14

Stepping Up

Easing the transition to consultant roles Page 21

Winter and COVID Members’ views on this exceptional challenge Page 18

Self confidence How to deal with imposter syndrome Page 29

Contents

Contact We’d love to hear from you – get in touch at

Winter 2020

milestones@ rcpch.ac.uk

19

Welcome THIS EDITION REFLECTS the intensity of the period we find ourselves in, with a focus on winter,

20 The Cleft Collective

wellbeing, and the forthcoming

The importance of team work in successful research

elections for the roles of President and Registrar.

I want to thank all of you who

21 Stepping Up

helped with this year’s recruitment

30

campaign. After a tough few years for the specialty we find ourselves in a much healthier position with a considerable increase in applications at ST1 level and an increased number of posts filled across the UK. We now stand at the precipice of a very challenging winter. There’s no doubt that with rising cases and non-COVID winter demand, it will be a difficult period for our patients and all of us who work in the NHS. Our focus will be on supporting you and advocating strongly for the maintenance and protection of child health services throughout the winter.

Thank you for all your efforts in this extraordinary year. Enjoy this edition of Milestones and thanks as usual to everyone who made it happen.

THIS ISSUE

Russell Viner @RCPCHPresident

A programme to help new consultants adjust to their roles

EVERY ISSUE 4

Update RCPCH news, training opportunities, and more

12 Presidential elections We pose a number of questions to the Presidential candidates

11 RCPCH &Us Why #RightsMatter for RCPCH

14 Skin Deep

22 Members

Improving resources to recognise skin disorders in darker skin tones

News and views from members

16 Sustaining ourselves and our teams in Winter Why team work will be crucial

27 International Paediatrics in India

28 Wellbeing

18 Winter with COVID-19

Dealing with imposter syndrome and writing to build resilience

Facing the additional challenges posed by the pandemic

30 A Day in the Life

19 COVID and me

Best wishes,

16

Dr Nikhil Ganjoo, Consultant Paediatrician with Neonatal Interest

What one doctor learnt from firsthand experience of COVID

Copyright of the Royal College of Paediatrics and Child Health. All rights reserved; no part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form by any means – electronic, mechanical, photocopying, recording, or otherwise – without prior permission of the publishers. The views, opinions and policies expressed in Milestones do not necessarily reflect those of the College. While all reasonable efforts have been made to ensure the accuracy of the contents of this publication, no responsibility can be accepted for any error, inconsistency or omission. Products and services advertised in Milestones are also not recommended or endorsed by the College. Readers should exercise their own discretion and, where necessary, obtain appropriate independent advice about their suitability. Royal College of Paediatrics and Child Health is a registered charity in England and Wales (1057744) and in Scotland (SC038299). Registered address: 5-11 Theobalds Road, Holborn, London WC1X 8SH. Head of Design: Simon Goddard Project manager: Lizzie Hufton Publisher: James Houston.

Milestones is published four times per year on behalf of the Royal College of Paediatrics and Child Health by James Pembroke Media, 90 Walcot Street, Bath, BA1 5BG. T: 01225 337777. Advertising: Alex Brown, Head of Corporate Partnerships advertising@rcpch.ac.uk

EDITORIAL Managing editor: Aisling Beecher Dr Hannah Baynes @HLB27 Dr James Dearden KEEP IN TOUCH

@AislingBeecher Editorial board: Dr Seb Gray @drjamesdearden Dr Dita Aswani @DrDita

@RCPCHTweets

@RCPCH

@SebJGray

@RCPCH

milestones@rcpch.ac.uk

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KEEP IN TOUCH We’d love to hear from you, get in touch through our channels

The latest news and views DIVERSITY

If we’re going to be represented, we need to represent RECENT MONTHS HAVE seen a long overdue discussion about race, equality and inclusion.

In line with this, the College published its action plan on improving Dr Kunal Babla representation in ST8 Neonatal volunteer roles. The report Medicine notes “a trend towards King’s College under representation, Hospital particularly in @kunbab Black/Black British” demographics, but notes a paucity of data on members’ protected characteristics, such as ethnicity and gender.

We welcome the open and frank tone of the Dr Ranj Singh report, and applaud many Locum of the recommendations Consultant in Paediatric to equalise representation Emergency in College roles. Only then Medicine can the range of views, @DrRanj problems and solutions be properly heard and addressed. We had two observations on the report.

04

We can all play an active part in improving inclusion

complete training after ST8. The report may make its recommendations, but we as a membership can be more ambitious. How? We need to be the change that we wish to see. If people are to be represented, we have to represent.

That means volunteering and taking up the roles that interest you and being visible.

Change may be slow, but we can hasten it.

We fully believe equitable representation is possible well before the 2030 target, but it won’t happen if we are passive. As we’ve said before, the onus cannot solely be on underrepresented people to step up: support from allies is key, and can provide the strength to battle the systemic inequality that can be so exhausting. So, if you have a colleague that would be a good candidate, encourage and help them take up these opportunities.

Step up and take part

Leading light

Firstly, it states an ambition to make people in voluntary roles representative of the wider membership by 2030. While we acknowledge and accept the scale of work required, this means a new ST1 doctor starting training this year may not experience any net change when they

Secondly, we noticed the report does not recommend a nominated Officer or Lead for Equality, Diversity and Inclusion (EDI).

We commend the Trainees’ Committee for leading by example and appointing

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Twitter @RCPCHTweets Facebook @RCPCH Instagram @RCPCH milestones@rcpch.ac.uk

an EDI Representative: an incredibly important and positive step. These roles exist in other organisations, and serve to ensure accountability, and drive progress.

We strongly support the ethos of creating a culture that makes EDI everybody’s responsibility, but not appointing leaders in this area means that by making it everybody’s problem, we run the risk of making it nobody’s problem.

Ultimately, the aim is to improve the status quo, and we think the EDI report makes a strong start. However, it is up to us as members, especially from underrepresented groups, to drive progress and ensure its success. In the meantime, we strongly encourage members to seek out and apply for the College’s voluntary roles, some of which will be covered in RCPCH member blogs.

We know how beneficial these positions can be for career development and progression. But it’s about more than that now. It’s about levelling the playing field for parity of opportunity. It’s about more than us as individuals, but it starts with each one of us. What are you waiting for? Apply now!

Get involved in College activities: www.rcpch.ac.uk/nominations-college-posts

UPDATE

Building a bank of images The Skin Deep project is building resources for better diagnoses of skin conditions across different skin tones P14

COLLEGE NEWS

AN IMPORTANT YEAR ON EDI

1,330

(APPROX.) MEMBERS VOLUNTEER AT THE COLLEGE

95

COMMITTEES & GROUPS

32

MEMBERS MAKE UP THE TRAINEES’ COMMITTEE

21

COUNCIL MEMBERS

4

VICE PRESIDENTS REPRESENTING HEALTH POLICY, SCIENCE & RESEARCH, EDUCATION & PROFESSIONAL DEVELOPMENT, TRAINING & ASSESSMENT

1

PRESIDENT, PROFESSOR RUSSELL VINER REPRESENTING OVER

19,000 MEMBERS

YOU REMEMBER THE scene from Indiana Jones, where boulders are crashing down around the archaeologist adventurer as he rushes through the canyon to a narrow escape? One of our research team mentioned it recently to describe the sense of events hurtling towards us as we try to run such a Jo Revill RCPCH CEO sizeable programme of work for the whole of @8jorev paediatrics while facing unexpected hurdles.

I’m proud of how much we’ve been able to keep our usual activities running, even if they are less visible than the high-profile work on the COVID response.

On a totally non-pandemic related theme, we’ve begun an important initiative to consider how the College can contribute to combating climate change. The issue was well described by one of our members, Dr Katie Knight, in the last issue of Milestones. Katie and colleagues had brought a motion to our AGM on the subject. This initiative brings together experts to think about how we can develop insight into the College’s current work and performance regarding climate change impact and consider a range of activities and policies.

Finally, I’d like to say a very big thank you to those of you who contributed to our virtual conference in September, both as participants and attendees. We had an audience of over 2,000 attend the special launch event, with 8,000 across 90 countries registered for webinars and talks which took place over the following weeks. All of which have been recorded for you to view online. The RCPCH Gallery also went virtual this year with around 400 ePosters to browse through.

It gives us all hope that so many members can find this time to listen to developments in the field, hear inspiring talks from those who have brought about real change and listen to our RCPCH &Us network talking PROTECT OUR PLANET about how they have experienced care during COVID-19.

The magazine of the Royal College of Paediatrics and Child Health

AUTUMN 2020

THE COLLEGE HAS taken good steps in Equality, Diversity and Inclusion (EDI) and the action plan was the start of work to set clear ambitions. The 2030 target to make our voluntary roles representative of the wider membership seems fair but we could get there sooner given our commitment to regularly review progress.

Our current approach is to ensure everyone recognises and plays their role in EDI – RCPCH Council, Trustees, members, and College staff alike. To ensure that EDI work is embedded and coordinated across members and staff, the three nominated senior leads within the College include me as the trustee representative, Dr Camilla Kingdon as a College Senior Officer, and Robert Okunnu, the College’s Director of Policy and External Affairs, representing staff. A new EDI member reference group has been launched to help shape our work and of course, we wait to hear the learnings from RCPCH’s Trainees Committee, who we’ll be working closely with.

It’s been an important year for the College on EDI – but it is only the Dr Bhanu beginning! Please Williams keep sharing Consultant your ideas and Paediatrician feeding back on Northwick how we are doing.

Park Hospital

Message from the CEO

I N S I DE

DIVERSITY

VOLUNTEERS RCPCH FACTS

REPORT

Practical solutions for a more sustainable way of working Page 14

Working together A message from the College’s CEO Jo Revill Page 4

Vaccinations

Shining a spotlight on essential immunisations Page 12

Race for equality How to address racial discrimination Page 16

Medical students YPHSIG essay competition Page 19

Find out about the College’s work on climate change: www.rcpch.ac.uk/climate-emergency

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UPDATE

Paediatricians tell us what inspired them to #ChoosePaediatrics

CAREERS

#ChoosePaediatrics

Dr Kay Tyerman Paediatric Nephrology Consultant Leeds Children’s Hospital @ kay_tyerman

WE ALL HAVE memorable moments in our professional careers – no matter how long ago they started – from the point we were accepted to medical school, to our first day as a junior doctor and maybe the first time we intubated a premature infant. Do you remember the moment you chose a career in paediatrics?

The College’s careers campaign has asked paediatricians about their experiences and what inspired them to #ChoosePaediatrics and has also captured the essence of why paediatrics is a tough but rewarding career in three videos. There is no doubt that paediatrics is a challenging job and we have all had to change our

practice, innovate, and pull together in our teams over the last few months.

So, there is no better time to reflect on the positives – the impact we can all make, the huge variety in our job and how rewarding paediatrics is as a career.

Contributing to the careers campaign over the last year, we’ve also had help from UKAPS (The UK Aspiring Paediatricians Society) who last winter held a hugely successful conference for medical students and foundation doctors. More recently they helped the College create a series of career focused webinars.

Getting enough experience to decide that paediatrics is the right career choice is challenging, in part due to limited opportunities in the undergraduate curriculum and foundation years. Recruitment at ST1 is not based on paediatric knowledge, but the ability to demonstrate enthusiasm and focus upon the attributes that will make a good paediatrician. Overall, we need to ensure that enthusiastic trainees are encouraged to consider a career in paediatrics and then want to stay in paediatrics and become the consultants of the future.

Find out more: www.rcpch.ac.uk/choose-paediatrics

WORKING PRACTICES

VIRTUAL CONSULTATIONS

Dr Emma Parish General Paediatric and Adolescent Consultant Evelina London Children’s Hospital YPHSIG Secretary @ ejparish

06

WINTER 2020

THE YOUNG PEOPLE’S HEALTH SPECIAL INTEREST GROUP (YPHSIG) is concerned about the unintended but potentially harmful consequences of a slip towards a ‘digital by default’ approach to healthcare consultations. Virtual consultation offers many benefits, but there is a risk that this approach will exacerbate inequalities in access to healthcare services, and affect our ability to really see and hear from young people themselves in a confidential safe space.

Being able to offer ‘something’ during the pandemic felt vital. It is right to embrace the benefits coming from telemedicine and virtual consultation. However, we need to

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hear from young people themselves.

Confidentiality has been raised by children and young people as a key concern, especially around mental health. The YPHSIG recommends a full biopsychosocial history as part of routine health consultations with young people. Best practice, unless developmentally inappropriate, is to speak with a young person alone.

The ability of our members to speak with young people by themselves has reduced since virtual consultations have become the default. There are many reasons for this: confidence; space to ensure confidentiality on both sides of the screen; technical

issues and socioeconomic ones. It is a privilege to have the space, privacy and technology at home to conduct a confidential discussion. Without the ability to ‘see’ young people alone, we risk missing safeguarding concerns, with inadequate safety netting.

The YPHSIG has written a joint statement about virtual consultations with the Association of Young People’s Health (AYPH) and Adolescent Health Group for RCGP, endorsed by RCPCH and RCGP. Visit: www.yphsig.org.uk

CORONA BONUS!

Positive about paeds

Dr Nikhil Ganjoo describes the joy of good team working, working with trainees… and nebulising Shrek!

UPDATE

I got to explore parts of the UK I have never been to before #staycation

P30

Staff Spotlight

Tragically the pandemic has been life changing for many people, but some have found unexpected positives

Magdalena Umerska

Commercial and Digital Product Manager

I JOINED THE COLLEGE in 2018, in the Membership and Development division. My areas of activity span across publications, including our journal Archives of Disease in Childhood, managing digital platforms such as the Child Protection Portal, the digital version of the Personal Child Health Record, and most recently the development of digital growth assessment.

Coming up with an idea for the project, working towards a grand vision, juggling the creative and the analytical, and turning goals in to reality, make my role fulfilling.

My favourite part of the job is working with the cross-functional teams and being surrounded by people with a vast amount of knowledge to ensure that what we do has the potential to transform child health. We are so pleased that our digital child growth assessment project has won the award as the Best Health Tech Solution of the Year. It will revolutionise growth monitoring for better child health moving from print to digital.

When not working, I’m an outdoor enthusiast and I love hiking – it’s meditative and slow but rewarding.

RESOURCES

DIGITAL GROWTH CHARTS LIKE EVERY PAEDIATRICIAN, I love a good growth chart. The crisp card, the dots in pen documenting the steady march of progress up the Dr Simon page. You can sometimes Chapman almost guess the child’s Consultant story just by looking at Paediatrician the ascent and rest of King’s College Hospital the dots. Paper charts @eatyourpeas just don’t cut it anymore.

A variety of third party solutions have appeared, none of which reimagine the chart, few of which are properly validated, all of which are proprietary and expensive.

Earlier this year, the Personal Child Health Record (PCHR) or ‘Red Book’ approached the College to help it ‘go digital’. The College, though, chose

not just to build an app that does growth charts. Instead it embarked on a much bolder project – to build an API (application programme interface). The RCPCHGrowth API is code that wraps around the complex task of calculating a centile against a child’s measurement. Future developers of growth chart software now no longer have to recreate the maths behind the calculation; they need only build an interface which sends measurements to RCPCHGrowth, knowing they will get accurate, dependable and validated results back every time.

They can trust the API because it was built by the same experts that brought you the paper charts.

This is the first time a Royal College has sought to build its own

software, share the code open source for all to use and improve.

Drawing on its expertise across child health, the College could host early warning scores, jaundice calculators, resuscitation drug doses and frailty indices.

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UPDATE

CORONA BONUS! I got to know my neighbours and neighbourhood much better

NEW ROLE

New Officer for Retention IN ADDITION TO my specialist interest in Home Haemodialysis, I have considerable experience in designing and delivering training programmes in Quality Improvement and Clinical Leadership.

I was a faculty member of the NHS Staff College for four years and am a trained Action Learning Set facilitator. Over the years I have held several Dr Daljit Hothi Paediatric leadership roles in clinical care and QI, wellbeing Nephrologist and medical leadership.

Associate Medical As I endeavoured to lead teams for performance Director for Wellbeing, Leadership & I was spending less time supporting colleagues’ Improvement learning and growth. Over the last two years I have GOSH invested time and energy developing expertise @DalHothi_HD_QI in coaching individuals, teams and systems and am an accredited coach, awarded the Associate Certified Coach credential from the International Coach Federation.

This is my first role at the College, but my application, in hindsight, was a forgone conclusion. In the words of Stefan Emunds: “Time is an illusion, timing is an art.” In this respect the timing was perfect.

Improving the life work experiences of members is a priority at the College and the same holds true for my role as a doctor and coach. This post presents a unique opportunity to influence and raise the profile of wellness, fulfilment and belonging at scale, making members feel valued and realise the value of their work.

NEW ROLE

NEW ASSISTANT REGISTRAR PRIOR TO BECOMING Assistant Registrar, I was the Clinical Director for Children and Young People with the Healthy London Partnership working towards making London the healthiest global city.

I am absolutely thrilled to be joining the leadership team at the College in this new role, particularly at such a pivotal moment in our history. We continue Dr Omowunmi Akindolie to play an instrumental and ever increasing role in Consultant terms of shaping the future health of the nation. in Ambulatory Working alongside the incredible Registrar Paediatrics Dr Mike Linney, I will initially lead on RCPCH &Us King’s College Hospital NHS and Invited Reviews, which has gone virtual. I have Foundation Trust been heartened to witness the powerful impact the @MAkindolie College has in amplifying the voice of children and young people, placing them front and centre of all our work. The College is pioneering in so many ways. We have a phenomenal legacy and an even brighter future. I am delighted to be joining the team.

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JOURNAL

ADC JOURNAL UPDATE FOR THIS YEAR’S virtual annual Conference, I put together a talk ironically, called ‘Certainty’. The ‘story’ is couched in a rerun through a few decades of ADC history, papers that came to symbolise their era, each so Nick confident and authoritative when Brown published. All, of course, were important Archives statements, but none ultimately of Disease definitive as there is no such thing as the in Childhood Editor-in-Chief final word. There has always been more @ADC_BMJ to explore, new hypotheses to test and novel ways of approaching problems as witnessed by recurring themes with new angles: group A streptococcal disease, for example, featured in the first ever issue in January 1926 – and in the latest, September 2020. I rest my case.

Despite the obvious analogies with the (disarming) unpredictability of events in 2020, my slant (and it’s an affectionate one) is that, in general, uncertainty is welcome. It keeps us thinking, keeps us interested, in short fuels us as paediatricians, yes, and as people.

JOURNAL

BMJ PAEDIATRICS OPEN THE ADVANTAGE OF BMJ PO publishing protocols for studies is that it enhances transparency and informs the research community of planned research. It also hopefully improves the accuracy of published Imti papers, in that researchers are less Choonara likely to use different outcomes than BMJ originally planned, if the protocol Paediatrics Open is published and available to all Editor-in-Chief (protocols are usually published in @BMJ_PO open access journals). Protocols are both highly read and cited. A planned longitudinal cohort study of children detained in Nauru, while seeking asylum in Australia, has had over 1,500 reads. The protocol for a randomised clinical trial of surgery versus non-operative care for appendicitis has been cited over 20 times.

Additionally, peer review can improve some protocols by suggesting changes as well as being good experience for young researchers in understanding how to write a paper.

UPDATE PAEDIATRIC TWEETS

The National Paediatric Diabetes Audit conference in January

AUDITS

National Audits: moving from measurement to QI Dr Oliver Rackham Neonatal Consultant Glan Clwyd

WHY DO WE DO AUDITS? Three reasons we often hear: For my annual review or appraisal This annoys me and I want to change it It’s easier than if I call it research

Hospital @OliverRackham

Why should we do audits? Alternative answers could be to: Compare practice against standards and / or our peers Identify and share learning from areas of good practice Identify opportunities for quality improvement (QI) activities The College is commissioned to deliver Epilepsy12, the National Neonatal Audit Programme and the National Paediatric Diabetes Audit as part of the National Clinical Audit and Patient Outcomes Programme.

All three audits have demonstrated improvements in processes. The

outcome measures are clinically driven, agreed and revised by multidisciplinary teams. The voices and input of children, young people and families are key.

Reporting continues to improve over time, moving from weighty paper documents to interactive online systems allowing comparison across units and networks.

During COVID it is as important as ever to continue to participate in the national audits. These existing health conditions have not gone away.

As I learned in my very first COVIDinduced webinar, in pandemics more harm comes from “collateral damage” of not treating other conditions, than is caused by the pandemic infections.

Thanks to the team at the College for all their work, and to the three clinical audit leads, Justin Warner, Colin Dunkley and Sam Oddie.

WORKING PRACTICES

QI CENTRAL RELAUNCHED

Dr Megan Peng RCPCH Quality Improvement Manager @RCPCH_ QICentral

SINCE JOINING THE COLLEGE from paediatric specialty training in 2018, and working alongside teams in the Situation Awareness for Everyone programme and national QI collaboratives for diabetes and epilepsy, QI to me has come to symbolise a culture of continuous improvement built on collaboration, teamwork and shared purpose.

Often the most powerful and

meaningful resource is the shared experience of peers. QI Central has been relaunched this autumn as the College’s online sharing hub for quality improvement, showcasing work and resources across the paediatrics community with tools, webinars, blogs, ePosters, projects and the latest QI news and events.

Absolutely fab afternoon at the @RCPCHtweets virtual conference opening, 100% convinced paeds is the path for me! Especially loved the inspiring wellbeing talk by @DrStaceyHarris looking forwards to the specialist symposiums in the coming weeks! @immabeahippo What a lovely idea ending today’s @RCPCHtweets online conference with music!! @ColdSpray4 rock! @virgingi05 Honoured and humbled to find out on the way to work I won best poster presentation at RCPCH virtual conference! Thank you @AssocPEM for a great conference today with fantastic speakers in such a challenge time #paedsrocks @murrellthemedic I feel very privileged to have been nominated 4 @RCPCH_and_Us voice Champion award. It’s a pleasure working with &Us, it give authenticity to @RCPCHIreland work and a clear and present reminder of who we serve. #RCPCH2020 @RayRInet

FEEDBACK Get in touch about the magazine! Tweet @RCPCHtweets using #RCPCHMilestones

Visit us at: qicentral.rcpch.ac.uk

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UPDATE

CORONA BONUS!

Stepping Up We’re closer as a team than we’ve ever been before

A programme to help senior trainees with the transition into their new roles as consultants p21

Online learning with Compass RCPCH Compass Access Compass www.rcpch.ac.uk/Compass

Imaging in Cases of Suspected Physical Abuse in Children (NEW) Being able to recognise suspected physical abuse in children has never been more important. Our eLearning outlines how key professionals can work together to get the high quality images needed for effective investigation.

Pain Management in Children and Young People Build your understanding of acute pain in neonates, children and young people.

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WINTER 2020

NOW THAT WE HAVE successfully completed a season of testing online courses, we are now planning the next batch for 2021. These will be posted on the website as soon as possible. Meanwhile you can still access our qualityassured eLearning courses on Compass.

Cleft Palate: Examination in the newborn This module provides recordings for health professionals for optimal examination of the palate during routine newborn examinations, including detection of congenital anomalies.

Information Sharing Matters Designed for the early years workforce and healthcare professionals to improve information sharing across the sector.

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Vitamin D Deficiency in Children Course This module will explain the biology and metabolism of vitamin D, and help you identify children at risk of vitamin D deficiency.

Professional Witness Report Writing This module will teach you how to write effective reports for professional witness purposes, giving you a better understanding of the role of the report when acting as a professional witness.

RCPCH CONFERENCE SESSIONS AVAILABLE ON DEMAND If you missed any of this year’s RCPCH Conference Online, you can catch up on demand via Compass on the RCPCH website. Don’t miss out on a fantastic array of sessions. Check out the full list www.rcpch.ac.uk/conference-programme

WEBINARS Remote consultations, opportunities and risks for paediatrics Practical tips, opportunities and risks.

Mentoring skills peer support Delegates share experiences as mentors.

Stroke in childhood guidelines: key messages and recommendation Including new diagnostic and interventional pathways.

See more Free and accessible educational updates www.rcpch.ac.uk/webinars

RCPCH &US

There are 54 articles in the United Nations Convention on the Rights of the Child

#RightsMatter to RCPCH

Fun and thought-provoking activities, brought to you by the RCPCH &Us bear RECIPES FOR RIGHTS The 2018 College Members Survey highlighted that members wanted a better understanding of children’s rights, so young people across the UK got thinking… and Recipes for Rights was created! Developed by young people’s groups in each nation, the booklet explains the United Nations Convention on the Rights of the Child which looks at the protection, provision and participation of children and young people in all elements of their life. Five articles have been explored in relation to health services with questions for health workers to consider for their work.

There are a number of recipes which have lots of different games and discussion activities for paediatricians to use with their patients and their teams to be able to provide the best health services possible (article 24) and to involve children and young people in decisions that affect them (article 12).

The rights all make sense – most of them are common sense and should happen anyway RCPCH &Us Young Person

Rights are like pancakes.

Each right is important, but when you layer them up they make something strong which protects all children and young people RCPCH &Us Young Person

Above left: The Recipes for Rights. Above right: Origami dogs to get people talking

There are activities designed for one-to-one discussions, as well as games that will support Quality Improvement work. Recipe 4 helps doctors and health professionals to think about communicating clearly, and how this needs to be adapted for children and young people with different communication preferences or disabilities. Why don’t you have a go at making an origami dog? Once you’ve done it, tweet us your pictures to @RCPCH_and_Us using #RightsMatter We want to say a big thank you to all the children and young people who took part in RCPCH &Us projects to help create the resources: Central Bedfordshire Council Youth Voice, Fitzalan High School Cardiff, Girvan Academy, Knowsley Children in Care Council, NICCY Youth Panel, RCPCH &Us young volunteers, St Mary’s College Derry, VOYPIC, Warrington Children in Care Council and YiPpEe – Young People’s Executive Oxford.

Download your copy from www.rcpch.ac.uk/rightsmatter

ABOUT RCPCH &Us: The Children and Young People’s Engagement Team delivers projects and programmes across the UK to support patients, siblings, families and under 25s, and gives them a voice in shaping services, health policy and practice. RCPCH &Us is a network of young voices who work with the College, providing information and advice on children’s rights and engagement.

KEEP IN TOUCH

@RCPCH_and_Us

@rcpch_and_us

@RCPCHandUs

and_us@rcpch.ac.uk

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FEATURE

Your RCPCH Presidential Candidates GET TO KNOW A BIT MORE ABOUT YOUR CANDIDATES WITH QUESTIONS FROM RCPCH &US MEMBERS AND THE MILESTONES EDITORIAL BOARD

Dr Simon Clark

Dr Camilla Kingdon

Neonatal Consultant Sheffield Teaching Hospitals NHS Foundation Trust

Consultant Neonatologist Evelina London Children’s Hospital

How will you make GPs more

How will you make GPs more

aware of child health issues

aware of child health issues and diseases, such as invisible

and diseases, such as invisible diseases, so that diagnosis and

Investing in them ensures a

diseases, so that diagnosis and

health in everything we do.

referrals to paediatricians are

population of adults who will

referrals to paediatricians are

We also each have a personal

much faster? RCPCH must work

be healthy, well educated, with

much faster? Our GP colleagues

responsibility. This is a core

with RCGP, sharing training

well paid jobs, who pay taxes.

do an amazing job! If we think

role for paediatricians. Each

there are child health issues that

of us must develop the skills to

and education. We also need to

b) Local services in health and

enhance our work with families,

education, joining up providers,

could be addressed faster or

motivate for improved services

so they are empowered to ask

enabling seamless care delivery

better by GPs, I believe the onus

for children in our hospitals,

questions. I believe that the

for children.

is on us to reach out to them to

and above all emphasise the

have a think about how we can

importance of listening to children and their families.

development of the digital child

c) The wider health care team

health record (replacing the Red

ensuring workers are properly

work differently. Paediatricians

Book) will help parents to record

trained and can escalate care

and local GPs working and

symptoms and signs, enabling

as needed.

learning together is a powerful

If you could be a paediatrician

way of improving care.

practising at any time in history

them and healthcare professionals to collaborate and pursue earlier

If you could be a paediatrician

diagnosis in these conditions.

practising at any time in history

Who are your role models in

honestly wouldn’t want to work

when would it be and why?

life and why? I grew up in South

in any other time than now.

Who are your role models in

Future history – about 100 years

Africa in troubling times and so

Regardless of the complexity

life and why? There are so many

from now. I could see whether

it was hard to find role models,

of modern life, I find it exciting

people I wish I could emulate.

any of our hoped-for reduction

especially women. When I came

and energising. I feel very

Stephen Bolsin: The anaesthetist

in child poverty and inequalities

to the UK as a junior doctor,

optimistic about the future and

who raised the problems with

had occurred. Although, I might

I struggled to find my place.

that is fundamentally because

cardiac surgery in Bristol and

worry that I could end up in

As a paediatric SHO I met an

I know how many incredible

changed the approach to clinical

some post-apocalyptic dystopian

incredible woman called Helen

paediatricians there are around

governance in the UK.

nightmare, in which case my

Issler who epitomised what I was

the country. I should also add, as

Stevie Wonder: Survivor of

paediatric skills might be helpful.

looking for. She was a brilliant

a woman, now is the time!

prematurity and did not let

clinician, with a fantastic sense of

blindness due to retinopathy of

Tragically the pandemic has

prematurity stop him becoming a

been irreversibly life changing

superstar.

for many people but some have

How could you stop children

for many people but some have

Florence Nightingale: She

found unexpected positives.

and young people slipping

found unexpected positives.

dramatically changed the outcome

What is your personal corona-

through the cracks and

What is your personal corona-

for wounded soldiers in Crimea, but

bonus? I cherish the time we had

prioritise child health? As a

bonus? Having my girls at

also she was a stellar statistician.

with our three children (ages 17 to

College we have a key role. We

home for that difficult time was

23). It was like living with another

are explicitly not a Royal College

wonderful. Not only did they

How could you stop children and

three adults. We had family

of Paediatricians as all the other

do all the shopping and tedious

young people slipping through

meals, played board games,

specialty colleges are. We are

queueing, they also cooked,

the cracks and prioritise child

watched movies, exercised in the

a Royal College of Paediatrics

and so it was just bliss coming

health? We need to work with:

garden. It was so special seeing

and Child Health. So, we have

home in the evenings to a lovely

a) Governments, reminding

them enjoy each other’s company

an inescapable responsibility to

family dinner! I really treasure

and even ours.

advocate for children and child

that time.

them children are our future.

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when would it be and why? I

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humour; above all she was kind.

Tragically the pandemic has been irreversibly life changing

FEATURE Vote Now Vote now and have your say on the next RCPCH President. Voting is open to UK and Ireland members of RCPCH from 11 November to www.rcpch.ac.uk/election 12pm on 9 December.

Dr Jane Valente

Dr David Vickers

Medical Director & Complex Care Paediatrician Royal Manchester Children’s Hospital

Medical Director & Consultant Paediatrician Cambridgeshire Community Services NHS Trust

How will you make GPs more

How will you make GPs more

aware of child health issues

aware of child health issues and diseases, such as invisible

and diseases, such as invisible diseases, so that diagnosis and

support for issues pertinent to

diseases, so that diagnosis and

Prioritising child health is part of

referrals to paediatricians

those they represent eg Sure Start

referrals to paediatricians

our reason for existing. We must

are much faster? Forming

and free school meals.

are much faster? It is easy

be a voice constantly drawing

to criticise primary care for

attention to the needs of children.

Who are your role models in life

missing diagnoses but they

The NHS has to make difficult

and why? Dr Janet Anderson,

are generalists, so spotting

decisions about priorities. We

General Paediatrician; one of

rare problems can be difficult.

must shout for children.

the best teachers and examiners

Our task is to provide primary

partnerships with GPs by: Establishing educational forums using virtual technology.

Ensuring that GP trainees have appropriate paediatric exposure.

I know, notably for being very

care with tools to help in

If you could be a paediatrician

models with paediatricians

fair with exam candidates.

recognising that something is

practising at any time in

working within primary care.

Prof Andrew Bush, Paediatric

out of the ordinary. We must

history when would it be and

Respiratory Consultant, who

also empower patients and their

why? Being a paediatrician in

children’s clinical advisory groups

taught me years ago. He has

families to access information

2020 as the genomic revolution

to form joint innovative pathways

outstanding listening skills and a

and ensure we have a system

begins to unfold, and children’s

and also alongside primary care

magnificent sense of humour.

that takes this into account

importance in society is becoming

when providing care.

more recognised, especially

Expanding ‘hub and spoke’

Working in forums such as

networks.

Replicating and building on the

as we see the disproportionate

If you could be a paediatrician

communication work done during

practising at any time in

Who are your role models in

impact of COVID on the young

the pandemic.

history when would it be and

life and why? The parents of

and old. If I had to be in the

why? During the 1854 Broad

children with complex needs

past, I would have enjoyed being

How could you stop children and

Street cholera outbreak work

who I have met who never fail to

around when the Platt Report was

young people slipping through the

whereby those drinking water

humble me with their devotion to

published, and we realised the

cracks and prioritise child health?

from a particular pump well

their children and their energy to

damage separation from parents

By raising the profile of CYP via

contracted cholera. Public health

support service improvement.

did to children.

CYP transformation group.

work can save so many lives and

Lucy Watts, a young woman

Making points of contact for

paediatricians can play a key role

living with a life-limiting illness

Tragically the pandemic has

in this.

and a passionate advocate for

been irreversibly life changing

people with disabilities.

for many people but some have

health professionals to interact with social services/health visitors/ social clubs/police by finding

Tragically the pandemic has been

Julie Bailey, who played a key

found unexpected positives.

shared forums reaching the most

irreversibly life changing for

role in exposing the Mid Staffs

What is your personal corona-

vulnerable.

many people but some have found

scandal, she saw something

bonus? Coronavirus is a tragedy

unexpected positives. What is

she thought was wrong,

for those who have died, remain

early help’ programmes and the

your personal corona-bonus?

and persevered in raising

chronically unwell, lost loved

voluntary and community social

COVID has enabled things that

her concerns, resulting in

ones or had their lives disrupted.

enterprise initiatives.

we have tried to make happen for

fundamental changes.

It feels wrong to look for a bonus,

Communication about ‘access to

Establishing educational

but if I have to I will identify the

years just ‘happen’. Significant

‘outlets’ in settings where the most

relationships/skill sets have

How could you stop children

way in which shared adversity

vulnerable attend.

developed between paediatric

and young people slipping

has brought individuals and

and adult services through

through the cracks and

groups together and catalysed

redeployments.

prioritise child health?

innovation in patient care.

Engaging with local and national leaders to highlight and gain

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FEATURE

Skin Deep SKIN DEEP IS A DON’T FORGET THE BUBBLES (DFTB) GLOBAL COLLABORATIVE PROJECT INCREASING THE DIVERSITY OF PAEDIATRIC SKIN IMAGES ONLINE

I

t is remarkable that in 2020, we have the ability to choose from 60 different shades of make-up foundation and yet find no equity Dr Shaarna Shanmugavadivel in skin tone images NIHR Doctoral when we open a Research Fellow medical textbook University of Nottingham or search an online Media/Awareness medical education Lead for Skin Deep resource. @HeadSmartFellow This basic misrepresentation of the society we live in has potentially life-threatening repercussions for the children and young people that we see and treat as healthcare professionals. We know consciously that skin conditions will present differently depending on the skin tone, yet we still default to describing rashes with only light skin tones in mind. Erythema, pallor, cyanosis are all classic descriptors which are harder to recognise in darker skin tones, or may not be present at all. We can all close our eyes and picture a measles rash in a light skin tone, but how many of us can honestly do the same for darker skin tones? Purpura does not look purple on the darkest of skin tones and chances are that we would not notice as quickly as in light skin tones

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when eyeballing the patient unless we are actively looking for it. This unconscious discrimination has occurred mainly due to these descriptions and images being handed down the “generational line” without being noticed or challenged.

Recently, DFTB’s new project Skin Deep, together with Brown Skin Matters and Mind the Gap, have successfully brought this important issue into the spotlight. The GMC has also acknowledged the need for greater diversity within undergraduate and postgraduate medical education.

Free resource Skin Deep is an exciting new global collaboration led by DFTB and the Royal London Hospital (RLH). The aim is to develop a free, open-access bank of photographs of medical conditions in a range of skin tones for use by both the public and healthcare professionals for medical education and as a diagnostic resource. We hope that, with time, this will improve education and recognition of conditions in all skin tones, reducing inequalities and improving patient care by ensuring all children and young people receive a timely and correct diagnosis irrespective of the colour of their skin.

If you haven’t already heard of DFTB, it is one of the largest free open-access medical education resources available

online and the team have strong international collaborative networks.

Skin Deep started in June 2020, but the huge response has led to its launch as a stand-alone project with its own website and social media channels. The project uses a two-pronged approach targeting parents, guardians and carers as well as healthcare professionals to maximise the quality and quantity of images. All the submitted photographs are reviewed by dermatologists to provide the correct diagnoses and clinical terms. Images are only used with consent from parents, and case details are anonymised.

As a team, we are calling on you all as our colleagues to collaborate with us. We have developed a streamlined process to set up the project at individual hospital sites, including the appropriate governance and consent processes to ensure patient confidentiality and secure transfer of photographs. We have 10 UK hospitals on board already and a number of others across Australia and South Africa.

As a result, we are delighted to have over 275 images on our website and invite you all to have a look, learn and use the images in your own teaching.

It is 2020, and no child or young person should be disadvantaged in the care they receive due to the colour of their skin. Let’s make change together!

FEATURE

Spot diagnosis quiz

Children deserve an accurate diagnosis regardless of their skin tone

Rapid picture quiz time. Can you identify these skin conditions? Find the answers on page 26.

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2

I

n order for a project such as ours that is centred around educational diversity to be truly impactful, it has to Dr Kaylita Chantiluke have a global reach.

Paediatric This international Registrar approach ensures Sunshine Hospital, that people of Melbourne @MusingsMedic all backgrounds and ethnicities have the opportunity to contribute to, and benefit from, the Skin Deep project. This has the advantage not only of improving understanding of dermatology presentations in different skin tones, but also the ability to empower patients to become our educators by allowing them to independently submit their photos.

This is especially important in a country such as Australia where there is a seven- to eight-year difference in life

expectancy between the Indigenous and Non-Indigenous population, a proportion of which is due to health inequality.

Reaching out Therefore, the Skin Deep team in Australia is liaising with a wide range of hospitals, including those that serve a large indigenous population. This is so we can encourage photo submissions from a range of skin tones as this will ensure that our photo bank is representative of the diversity present in Australia. Our overarching aim is that these efforts will hopefully lead to improved diagnosis and management of skin conditions in both Indigenous and Non-Indigenous children.

In addition to our work in Australia, Skin Deep is also highly active in a wide range of countries such as Sierra Leone, Kenya, Peru, Italy and South Africa and is centred around creating strong educational links which are beneficial for all involved.

3

Get involved Keep up to date with the activities of the Skin Deep project: www.DFTBSkinDeep.com @DFTBSkinDeep

@DFTBSkinDeep

@DFTBSkinDeep

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FEATURE

We may not always work with just one team, but nurturing team spirit is still important

Sustaining ourselves and our teams through Winter LEAD DOCTOR FOR WELLBEING, DR ANNA BAVERSTOCK, REFLECTS ON THE BEST RECIPE FOR BUILDING AND NURTURING TEAM WORKING

I

WORK AS part of a number of teams. In the very early days of the pandemic, I became part of a very small wellbeing strategy group for our trust. We Dr Anna Baverstock knew each other from Consultant our previous wellbeing Paediatrician and related roles. There were Lead doctor for wellbeing many challenges. Of the Musgrave Park four of us, some were Hospital working from home @ anna_annabav and some on hospital site. We had to learn new virtual ways of communicating and fast. We were meeting at the beginning and end of each day. We all felt under pressure to deliver, needed to make decisions that were timely, but also evidenced based where possible and psychologically safe for our colleagues.

I was reflecting recently on what I had learnt. We now know each other very well.

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“The strength of the team is each individual member. The strength of each member is the team” Phil Jackson We realised that our twice daily calls were unsustainable. We also recognised we weren’t having any lighter moments during the calls.

Now we do have a chat at the beginning of the call and try and end the call with what nice things we are going to do at the end of the day.

We have also shared many emotions – there has been much laughter but also tears and a space to be honest about the challenges we have faced. We understand how each other works and enable space in calls to think as well as talk. We are a true mix of reflectors and activists. We can finish each other’s sentences and smile at the familiarity of each other’s answers.

I am most proud of the brave conversations we have had. We have been clear and kind in our feedback to each other. We can now ask for an opinion from each other and get it. I have learnt so much about myself and my new team. I am grateful to be a part of something that truly feels like a rather special recipe. We each bring a different ingredient that is central to the dish, with careful blending we balance and enable each to play its part.

So, as we move into the next phase, what lessons can I draw from this to share with my clinical teams? Michael West has written and recorded much on this topic. Several themes emerge around how we build and nurture team working especially when things are tricky. These include: Focus on team strengths especially how we work best together. What we change and adapt to enable better coordination.

Check in with each other. Ensure we all feel listened to and supported. We need to prioritise time and energy for this alongside

Left: Anna (centre) at the College’s conference last year Below: Working on team relationships at a FriYAY lunchtime meeting

our busy clinical roles.

C reate a shared team vision – what you want to achieve. This really helps unite teams to focus when working towards a common goal.

O nce you have the vision, setting out steps to achieve this and what to prioritise can help break bigger ideas into clearer objectives.

T hese objectives can then be discussed and shared out with clear lines of responsibility.

Teams who are able to have brave conversations, and give each other clear, honest feedback in a compassionate way, are better able to share ideas and make shared decisions.

Teams where smaller groups fracture off to make decisions, and meetings are followed by sub-meetings, foster mistrust and do much to undermine team function. We need to ensure we talk to colleagues not about them. This helps build trust. We need to have confidence that every member of our team shares the same vision and purpose.

Reducing hierarchy also truly helps with the above. Ensuring that all feel able to contribute and all opinions are valued and heard.

Measuring progress is important to ensure everything’s on the right track and can also hugely aid motivation. This can enable timely review. If things aren’t progressing, a discussion focusing on what is getting in the way and what changes need to be made can help to shift.

If we nurture a compassionate environment, we can reduce conflict. Open conversations where thoughts and feelings are expressed allow concerns to be listened to and responded to.

Amy Edmondson writes about teams in

her book on Teaming. In our current working lives we cannot be expert in everything. Our success depends on being able to rely on multiple sources of expertise. Bringing this expertise together is vital for how organisations learn.

Teaming is the verb that describes a dynamic activity, not a bounded, static entity. It fits well with how we function in many of our teams that come together for a shift. Teaming is largely determined by the mindset and practices of teamwork, not by the design and structure.

Teaming is ‘teamwork on the fly’, an ability to communicate, collaborate and coordinate across boundaries without a stable team structure.

We may well work with one team today and a different team tomorrow. Teaming still relies on trust, coordination and clarifying roles.

There isn’t time however to build a foundation of familiarity. We must rather rely on clear communication, sharing crucial knowledge, asking questions to adjust to the skills and knowledge within the group.

Teams are often stable entities where we get to know each other and develop ways of working over time. They are often a fixed group of colleagues who meet regularly, have role clarity, a shared vision and planned objectives. Teaming recognises that this isn’t always possible. As we work in different shifts with different colleagues we need to think about this. Teaming when successful can be a powerful way to successfully work in an innovative, creative way to find solutions. This success is often dependent on remaining open and curious, ensuring all voices are heard alongside a willingness to experiment and learn along the way. When teaming works it enables a sense of psychological safety for all.

So let’s be brave as we take the next steps forward. While we enjoy and nurture spending time with our teams, let us also consider how we can take a bolder leap towards teaming.

FEATURE

Is anybody there?

By Dr Carrie Furnell Can anybody hear me…

Is anybody there?

I think I’m here… where are you?

I can only see your hair.

Are you on mute? Did you press the button?

No, no not that one, It’s somewhere at the bottom.

There you are, I’m waving, I really think I’ve got it.

I do like your pyjamas, Now how do I stop it?

I’m sharing the agenda, am I meant to be in charge?

Oh dear that’s the wrong picture, Your nostrils do look large.

I’ve dropped my phone again, it’s got stuck down the chair Oops, I’ve gone, I think, Have I? Is anybody there?

Further reading: Teaming: How Organizations Learn, Innovate and Compete in the Knowledge Economy, Amy Edmondson.

Resources to support your wellbeing: www.rcpch.ac.uk/wellbeing-covid-19

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FEATURE WINTER PRESSURES

Winter with COVID-19 Three paediatricians look at a difficult winter ahead Dr Damian Roland Honorary Associate Professor in Paediatric Emergency Medicine Leicester Hospitals and University @damian_roland

C

HILDREN’S ACUTE AND emergency services have faced a massive conundrum during the pandemic. Prior to March 2020 the popular narrative was of ever-increasing presentations and a need to transform pathways so that more minor illness and injury could be seen outside of emergency departments. During the pandemic there was an about-turn and a concern children were not presenting in sufficient numbers.

The start of winter 2020 has brought both a steady increase in presentations, with the normal surge in wheeze, and a need to protect patients and staff from the spread of COVID-19. There had been hope that social distancing and hand washing may stop the rapid spread of viruses as children and young people returned to school. Early evidence suggests this has not been the case; coughs and colds appear to be as ubiquitous in 2020 as ever. Departments that have already struggled with winter pressures are now even more strained as patients are separated into suspected and non-suspected cohorts. Waiting rooms, often already too small, reduced in size to allow distance between families.

Solutions are not immediately apparent.

Some departments, based on the very low prevalence of COVID-19 in admitted children, have stopped streaming patients. Others are joining pilots to see if 111 can be used to divert children safely away prior to presentation.

However currently there is no plan for a national “call before you walk” to be applied to children. It is unlikely schools will be

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closed again so viral chains will continue and bronchiolitis and croup will most likely be as virulent this year as last. It is likely that reducing inflow and maximising outflow will be the biggest contributors to reducing overcrowding and sadly both of these are outside of departments’ control. Solutions within emergency departments will be around maximising processes and early safe discharge.

damage felt by CYP over the past months.

This winter, CC4C will continue to keep citizens at the heart of all we do. We will share our good practice via webinars and look forward to learning from other integrated services around the country.

Dr Ruchi Sinha Consultant Paediatric Intensivist St Mary’s Hospital @PICSociety

Dr Arpana Soni ST7 Paediatric Trainee and Integrated Care Fellow St Mary’s Hospital @CC4CLondon

C

ONNECTING CARE FOR CHILDREN (CC4C), based at St Mary’s hospital, London, has been working to support health professionals within primary and secondary care, to reach children and young people (CYP) with health needs and to continue to deliver joined-up care in a COVID world.

Face-to-face clinics with GPs, paediatricians and multidisciplinary meetings involving all child health professionals have run virtually. CYP and families have continued to receive specialist support alongside their primary care team, with an opportunity for all to continue to learn together.

In addition to changes to healthcare delivery, CC4C has supported families through community engagement. Listening, understanding local needs and co-producing child health interventions has allowed the team to mitigate some of the collateral

P

AEDIATRIC INTENSIVE CARE services (PICU) are not immune to winter pressures – in fact, there is a 25% increase in unplanned PICU admissions each winter. Increased demand for PICU beds has always been difficult, but maintaining patient flow this winter given the additional pressures of COVID-19 will be even more challenging due to the limited number of PICU beds.

Many valuable lessons were learnt including redesigning teams, implementing education and training systems for upskilling staff and embedding wellbeing tools as part of the service. This transformation formed part of a huge national effort involving careful modelling of national audit data and strategic national planning.

Winter planning with the recently established paediatric critical care operational delivery networks will ensure that access to specialist care is consistent, minimising travel and disruption for families where possible. Recent College guidance regarding the management of bronchiolitis and other respiratory tract infections is key to maintaining patient flow this winter.

Resources on winter planning www.rcpch.ac.uk/winter-planning

FEATURE Having recovered from the virus, Dan is pleased to be back at work

COVID-19

COVID and me Musings in the time of paediatrics and pandemics

A

S A NEWLY appointed Clinical Lead, February and March 2020 were some of the busiest weeks I have Dr Dan Magnus ever experienced in our efforts to prepare the Consultant in Paediatric team, the department Emergency Medicine and the hospital for what Bristol Royal Hospital for Children we feared might unfold. @drdanmagnus There was that palpable sense of the ‘tide going out’ that many in the NHS will recall, the preparation was frenetic as the cases started to rise nationally. Clapping in the streets began but so too did reports of healthcare professionals succumbing to coronavirus.

At the end of March my little boy, Elias, had a fever and sore throat as he was prone to get on occasion. Not wanting to take any chances – and in accordance with the advice at the time – I moved into a hotel in order to continue working because there was so much activity at work and I felt that I was needed.

The seven nights I spent in the hotel near the hospital were a blur. I would go to the house and talk to Elias and my wife, Kerri through the front window. We touched hands on either side of the glass and I can remember smiling but fighting to hold back my tears.

At this time, staff testing was in its infancy and many staff were going off sick with symptoms. I soon found myself at home with a fever, isolating too. I did my best to keep my temperature down and to carry on working from home, even appearing on BBC Breakfast one morning during a lull in my fever, with a shirt on for the video interview and nobody the wiser to my pyjama bottoms. But it was

“Who knows what winter has in store, but we are going to need to work hard to protect our patients, our colleagues and each other”

soon clear that I was becoming more unwell.

Kerri borrowed an oxygen saturation probe and, with a reading of 87%, she put me in the car and dropped me off at the emergency department.

First-hand experience My time in hospital feels like a tapestry of interwoven sounds, feelings, memories and dreams. I can remember feeling awful physically and the nights in particular felt long and distressing. It was impossible to control my fever and it was hard to breathe. I was moved to the High Dependency Unit and as my oxygen requirement continued to rise so did an unnerving number of visits from Intensive Care Consultants. The CT scan of my lungs was pretty bad, they said, and the myth that this was a disease that only killed the elderly had been dispelled by then. I felt scared and alone. Nobody was allowed to visit and the human contact I did have with staff in full PPE felt alien. As my body started to recover, I began to improve quite quickly and after eight days in hospital, feeling pretty weak and 5kg lighter, I was able to go home.

So what did I learn? Amidst the joy of returning to my family and work and having now pretty much recovered fully, my main

Being separated from his son Elias was tough for Dan

reflections are threefold: Firstly on the amazing care and compassion I experienced from an inspiring handful of staff. My gratitude to them is immeasurable. Our NHS and its people can be truly magnificent.

Secondly, on the importance of the people around us. I was so touched with the support and love I received from family, friends and colleagues. I can’t thank them enough and don’t ever want to take them for granted.

Finally, on the virus itself. Who knows what the future is going to bring exactly, or what this winter has in store, but we are going to need to work hard together to protect our patients, our colleagues and ourselves. It has never been more important to care for each other at work as well as at home.

In general most of us find uncertainty hard and the pandemic continues to challenge us in this way. But we can be certain about the fact that, despite not knowing what is around the corner, our capacity to work together, to find resilience, to weather the storm and to gain strength from one another is almost limitless.

I see those qualities particularly in colleagues and friends working in paediatrics and child health and it brings me peace.

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FEATURE The Cleft Collective Team at the University of Bristol

RESEARCH

The Cleft Collective Lead applicant for the team who won this year’s RCPCH PIER prize talks about why research is so important

M

Y CAREER IN research started after I had worked for 10 years in a clinical role as a speech and language therapist (SLT). Observing how some children responded well to intervention and others struggled to progress raised questions about why this happens. The evidence base in my specialist area of speech sound disorders was limited to small scale studies and I was keen to identify a way in which I could become involved in research and help create new knowledge which was clinically relevant.

Opportunities to get involved in research as an Allied Health Professional were few and far between at the time. This was the late 1990s – the National Institute of Health Research (NIHR) was not yet in existence and fellowships and research training roles for SLTs were rare. However, back in 1989, the Bristol Speech and Language Therapy Research Unit (BSLTRU) had been established. The purpose of the unit was to carry out research which would have an impact on individuals living with communication impairment and their Dr Yvonne Wren families and friends. A Director of range of research studies Bristol Speech and Language Therapy were being carried out Research Unit at the unit with external Southmead Hospital funding from charitable and government sources. @yvonnewren

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Working as a team Research is often described as a team sport and in that way is similar to the multidisciplinary working we do as clinicians. We need each other and the variety of skills that we bring to be successful at all stages of research – from the initial bidding process through to the publication of findings and implementation into practice.

I am fortunate to work with two teams who make working life both inspiring and fun – two essential elements to a successful research career.

The Cleft Collective team at the University of Bristol includes people in research, clinical, administrative and laboratory roles. All are vital to the successful running of what is now one of the largest studies of children born with cleft lip and palate in the world. With over 9,000 participants, data from biological samples, clinical reports, speech recordings, and participant questionnaires are being collected. At each phase, the input of our Patient Consultation Group, which we run in collaboration with the support organisation, the Cleft Lip and Palate Association (CLAPA), has been integral to the decisions we make regarding collection and use of the data. They are essential in ensuring that what we do will have impact, not just for clinicians and academics, but for people and families with lived experience of cleft as well.

The team at BSLTRU is also diverse, including psychologists, linguists and administrative staff as well as speech and

“I am fortunate to work with people who make working life both inspiring and fun – two essential elements to a research career”

language therapists. Unique amongst UK speech and language therapy research centres in being based at a hospital rather than a university, our remit is to carry out research which will make a difference to those living with communication impairment. But alongside this, we all share a passion to increase awareness of what it is like to have a communication impairment. Unlike other conditions treated by the NHS, our patients struggle to communicate what matters to them. Imagine, for example, what it must be like to experience COVID-19 yet not be able to explain clearly what your symptoms are or fail to understand the clinicians when options for treatment are explained to you.

Communication impairment affects many of those we know and care about; at BSLTRU we are determined to ensure that the next generation is more informed and equipped to work with all those affected.

More details are available at www.bristol.ac.uk/cleft-collective

FEATURE DEVELOPMENT

Stepping Up Supporting the transition of senior trainees as they move up into new consultant roles

I

Kathryn with

FIRST BECAME Stepping Up Champion for INVOLVED with Scotland Dr Stepping Up when Lindsay Ford I saw the challenges facing my friends as the gap by allowing dialogue between new they came to the end of consultants and trainees to help find out Dr Kathryn Cox training and started out what the challenges can be and to share General Paediatrics as consultants. Stepping with an interest in experiences of how to meet them. It is coUp is a programme to help Diabetes ordinated by one or more regional ‘Stepping with the transition from Royal Hospital for Sick Children, Up Champions’ who plan the sessions to fit in registrar to consultant Edinburgh with local factors. Most regions arrange two working. I am really @kathrynjcox to three sessions per year with presentations interested in trainee (topics are often based on suggestions from wellbeing and mentoring, attendees), opportunities for discussion of and it seems obvious that these needs don’t personal experiences, and a social aspect. stop at your CCT date. I have been the As I have gone through my training, I have trainee rep for Stepping Up for the past two come to realise that consultant working is years and hope to continue to be involved collaborative and that there is always someone when I become a consultant. available to talk things through with. For The period from the last couple of years of people moving to a new region it can be hard training to starting out as a consultant can be to make those links for communication. Peer an exciting yet daunting time. Our training support and networking is a key aspect of pathway is predetermined albeit with some Stepping Up, and this allows you to link with variation – in my case a bit of OOPR, mat other people in your situation. leave and LTFT working. While the Progress Curriculum prompts us to build our skills Positive feedback in leadership, management and teaching, Stepping Up started out in two pilot regions the working life of a registrar is still vastly around three years ago, but has now different from that of a consultant, leaving expanded to cover nearly all UK regions. us feeling underprepared. So many tasks Part of this growth was driven by wouldthat are entirely new to recently appointed be participants: as people saw what was consultants – job-planning and appraisal, being offered in neighbouring regions, they building business cases, dealing with asked for Stepping Up to be made complaints and managing available locally. Feedback complex cases – can seem CORONA BONUS! from participants so far has daunting, bewildering, and even frightening.

Stepping Up bridges

My kids can now all make beans on toast

been overwhelmingly positive. The structure

“The period from the last couple of years of training to starting as a consultant can be exciting yet daunting” of the programme, delivered locally with RCPCH support, allows sharing of experience between regions and this has helped to successfully develop the programme.

It can sometimes be hard to make sure that invitations get sent out to the right people (and we can all be guilty of deleting emails without fully reading them). If you are a trainee in ST7 or above, or a new consultant within three years of CCT and have not heard about Stepping Up in your region, then contact your local Champion via the website to be included in future communications.

I am increasingly grateful that Stepping Up gives me a way to think about what the future holds and plan for my life as a consultant. I recently attended my first Stepping Up event in my own region, Scotland (after a slight pandemic delay), and am looking forward to more. I hope that if you are also at this stage in your career you too will be able to take advantage of all that Stepping Up can offer.

Find out more about the programme www.rcpch.ac.uk/steppingup

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KEEP IN TOUCH We’d love to hear from you, get in touch through our channels Twitter @RCPCHTweets Facebook @RCPCH Instagram @RCPCH milestones@rcpch.ac.uk

The latest member news and views Suzanne and her colleagues are some of the trainees involved in the project

TRAINEES

A VIRTUAL START EXPERIENCE

TRAINEES

A simple trainee-led initiative DESPITE OUR BEST efforts, we all know that busy shifts can leave less time for clinical teaching. We also Dr Suzanne know that lack of Milne continuity in shift ST4 Paediatrics Victoria Hospital, patterns can leave Kirkcaldy you wondering whether all those investigations you did actually led to a diagnosis.

Trainees in South East Scotland have been working hard to tackle these challenges in general paediatrics with a simple, low-cost initiative – a weekly educational email bulletin.

We aim to ensure that every member of the team has an opportunity to benefit from interesting cases and clinical teaching, even if they haven’t been at work that day.

Each week, the ‘Learning Points’ are carefully compiled by a small

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group of trainees and distributed to the multidisciplinary team as an email. While the focus is on highlighting recent clinical cases and promoting evidence-based practice, pearls of wisdom from consultants are always included. Important departmental issues and patient safety updates are shared. The emails offer a platform for trainees to highlight their ongoing quality improvement projects and research to the wider team. The Learning Points can also provide evidence for trainees on their portfolios for knowledge attainment, skills and systems discussions; thus enabling active reflection. We encourage contributions from all members of the MDT, in particular our nursing colleagues.

We hope that the project will continue to evolve and grow over the coming years, promoting the ethos of lifelong learning within south east Scotland.

WITH START CANCELLED in April, the College put all its efforts into preparing a virtual assessment. It would include generic competencies with scenarios covering safeguarding, ethics/law/consent, logistics, prescribing, handover and conflict.

For many of us, this assessment felt like it had added pressure given how close it was to our potential completion of training.

The week before D-day we were all invited to attend a Microsoft Teams forum. This was an opportunity to ask questions and get general advice because this was the first virtual START assessment. We met Dr Tushar Vince and Stephen BeglanWitt. Both were incredibly useful, friendly and reassuring. If I was apprehensive before this meeting, I wasn’t afterwards.

Tushar explained that the assessors were experienced, friendly and wanted to get the best out of us, not put us down. Both explained the general principles of online assessments and the critical practicalities of the assessment itself.

On the day, although there were a couple of small hiccups, it seemed to not matter. The overall feeling was one of a series of extended case-based discussions.

It was an opportunity to explain your point of view on a number of realistic, common scenarios with someone listening and genuinely caring about what you had to say.

A thorough, fair and important assessment with the constraints of time and Dr Kunal a worldwide pandemic. My Gadhvi best advice for others about ST8 PICM GRID Trainee to complete a virtual START: Bristol Royal relax, be honest, be yourself Hospital for Children and go for it. @gadhvi_kunal

CORONA BONUS! I’ve spent more time with my other half as he is working from home

MEMBERS A painting positivity project is one initiative to raise smiles during tough times

FOUNDATION DOCTORS

Don't let COVID stop your paediatrics application

Dr Christina Tran Foundation Year 2 Doctor in Renal Adult Medicine Derriford Hospital @ChristinaNT

I AM CURRENTLY an F2 planning on applying for paediatric specialty training whilst taking an ‘F3’ year. Many of the learning opportunities I had arranged to gain more paediatric exposure have been affected

by COVID-19.

The inevitable disruption to our medical training should not compromise our progression. The mainstay message from senior colleagues? Do not worry about the experience you have missed out on.

Instead, consider how you can adapt to these changes and make the most of the situation.

When recruiting specialty trainees, emphasis is placed on qualities that make a good doctor and team member.

The interview panel will be looking Children still need care – so don't let COVID change your paediatric plans

for candidates with potential to make a good paediatrician – not an already experienced one. Demonstrating enthusiasm for clinical development is important. Emphasis will be placed on domains of teamwork, communication, and leadership – skills which are applicable to all different branches of medicine.

There is considerable crossover between the worlds of adult medicine and paediatrics. Continue to make the most out of the training experience you have and look for similarities to paediatrics. Reflect on your clinical encounters. Why not discuss with your current clinical team how you can contribute to service appraisal, by developing a quality improvement project, audit, or local guidelines?

Be reassured that application to specialty training will not be compromised. Adapt, find opportunities to develop in your current rotation, and reflect on experiences applicable to a post in paediatrics.

MORALE

POSITIVITY IN PAEDIATRICS POSITIVITY. COVID-19 has brought with it a huge amount of uncertainty, upheaval and even fear. I believe that a positive mindset is paramount in maintaining wellbeing and morale. If you can spark the match of positivity, then you can enlighten others and encourage them to promote a similar outlook.

During these challenging times, we created a number of positive initiatives to instil hope and help people come together.

It is often the small things which make the biggest differences, and integrating these acts of kindness into our workplace has hugely helped to uplift spirits.

Recently, we’ve taken a number of steps to ensure we promote this, including positivity posts on social media, a weekly ‘Friday Fun Factor’ email to the whole team celebrating those who’ve made a difference, a birthday baking rota and a painting positivity project. Beginning with a rainbow in the paediatric emergency department, and then an NHS Superhero logo, they serve as a reminder to us all to look on the bright side in tough times.

We recognise that there Dr Mumtaz will always be highs and Mooncey lows. Through maintaining Paediatric Trainee a positive outlook and The Whittington supporting one another, Hospital we can continue to shine @mumtazsophia together.

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MEMBERS STARTER FOR TEN

We put 10 questions to a paediatric registrar and a consultant to see what makes them tick Dr Belinda Bateman

Dr Sunil Bhopal

Consultant Community Paediatrician Honorary Senior Clinical Lecturer Northumbria Healthcare NHS Foundation Trust / Newcastle University

NIHR Academic Clinical Lecturer in Population Health Paediatrics, sub-specialty Registrar in Community Paediatrics, Northumbria Healthcare NHS Foundation Trust / Newcastle University @sunilbhop

1) Describe your job in three words.

People, people, people.

2) After a hard day at work, what is your guilty pleasure?

Walking up the hills when out running in the Northumberland countryside.

3) What do you find particularly challenging?

Balancing the routine with idealism and innovation.

4) What is the best part of your working day?

Working with amazing trainees, students, parents and carers.

5) What is the one piece of advice you wish you could impart to yourself as a junior trainee?

Take as many of the opportunities offered to you as you can. Being a paediatrician needs to last your whole working life.

6) Who is the best fictional character of all time, and why?

I’m not sure about ‘of all time’, but I’ve just read Olive Kitteridge by Elizabeth Strout. She was such a lovable grumpy flawed older woman.

7) What three medications would you like with you if you were marooned on a desert island filled with paediatric patients?

If these patients are fully immunised then bacterial infections may not be my main concern. How about contraception for my older patients? I’d like some paracetamol and salbutamol for all ages though!

8) What superpower would you like?

At the stroke of a wand to provide every child with a bike (and a helmet).

9) What is the single, most encouraging thing that one of your colleagues can do to make your day?

Bring me another interesting exciting idea.

10) How can you, your colleagues and current trainees inspire the next generation of paediatricians?

Giving each one insight into the entire experience of child health so they are inspired to make a difference.

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1) Describe your job in three words.

Juggling fun things.

2) After a hard day at work, what is your guilty pleasure?

Guilt not allowed (pleasure: dad-dancing with my children).

3) What do you find particularly challenging?

Straddling organisations with different cultural norms (black humour is very much an NHS thing) and the time spent away from family for my global child health research.

4) What is the best part of your working day?

Research day: sitting at the computer, early morning, coffee in hand (probably still in pyjamas), mind full of plans and possibilities. Clinical day: playing with younger children, and interesting conversations with adolescents in clinic.

5) What is the best advice you have received as a trainee?

Stay in touch with people and don’t burn bridges. “Don’t sweat the small stuff.”

6) Who is the best fictional character of all time, and why?

Woody from Toy Story – an inspirational leader!

7) What three medications would you like with you if you were marooned on a desert island filled with paediatric patients?

ORS probably. What about some naughty combo antibiotic/antimalarial pill?

8) What superpower would you like?

The ability to turn up the sun on Whitley Bay beach. I’m dreaming of it now…

9) What is the single, most encouraging thing that one of your colleagues can do to make your day?

The smallest amount of positive feedback, delivered with sincerity, really goes a long way!

10) How do you think you and your colleagues can inspire the next generation of paediatricians?

By showing how services must change as disease burden shifts, explaining how our work fits with the ‘big picture’ (especially global) and remembering that there aren’t many workplaces where it’s acceptable on a tough day to put on a funny hat, do a dance, or host a pretend tea party.

@RCPCH

milestones@rcpch.ac.uk

CORONA BONUS!

MEMBERS

I like scrubs because they have pockets

FILM

THE PEANUT BUTTER FALCON

Professor Lloyd was instrumental in the creation of RCPCH

TRIBUTE

History Taking: Professor Dame June Lloyd I CANNOT BE the only paediatrician who spends many wonderful evenings staring at the Membership Dr Richard certificate I Daniels received when ST5 Paediatrics/ Neonatology I passed my Barnet Hospital clinical exams. @ccdaniels65 Surely, there are others amongst us who have lovingly mounted their certificate opposite the sofa and wondered “Who is the dapper woman holding the familiar medical emblem, the staff of Aesculapius?”

Well, wonder no more.

The supporter in question is Baroness Lloyd of Highbury – or Professor June Lloyd as she’d have been known during her career. She studied medicine at the University of Bristol where she achieved the Gold Medal. After qualifying, she

worked in Birmingham, where she also had a research post looking at metabolic disease in children, especially diabetes and childhood obesity. How times have changed…

She then worked at GOSH and the Institute of Child Health where she became a professor. However, it was in the national domain after retiring where she left an even bigger mark.

Paediatrics previously came under the Royal College of Physicians with a non-collegiate British Paediatric Association (BPS) as the highest national group. Prof Lloyd headed the BPA and believed that it needed to become a Royal College in its own right. Her lobbying delivered results in 1996, with the creation of the RCPCH. She was influential in the creation of the new MRCPCH exam in 1999, which leads us back to the certificate on my wall.

June Lloyd died in 2006 aged 78 and her legacy is commemorated every time the crest is used.

THE PEANUT BUTTER FALCON is an uplifting and feel-good film that warmed my heart. It showed the nature of the human species and that there is good Maddy in everything. It also Aged 13 showed the dangers of discrimination. This film is a great motivator that you can do anything, no matter what other people tell you.

I THINK The Peanut Butter Falcon was an excellent and raw movie. You could see the chemistry between the actors which made the movie very realistic Valentina and relatable. The story Aged 15 has a big heart and is very emotional, maybe too emotional for my liking. Overall, I really enjoyed it and I'm glad I watched it!

BOOK

MIDNIGHT GANG

by David Walliams

Zachary Aged 9

WHEN I FIRST read The Midnight Gang I really liked it because it was about the hospital and children that are sick. This book also encouraged me to be more like my dad because he is a paediatrician and that could very possibly be my future job. To work in the same hospital too.

The Midnight Gang is one of my favourite books to read.

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MEMBERS Dr Shilpa Shah

Dr Laura Crosby

Consultant Paediatrician Craigavon Area Hospital

by Chris Hanvey

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DEAR NHS: 100 STORIES TO SAY THANK YOU

by Adam Kay

THE AUTHOR CHRIS EXPLAINS that contemporary childhood is an age of plenty, with a general state of health and wellbeing far better than that of their predecessors, 50 years ago.

He showcases the history of children's services in the UK, punctuated by landmark acts and reports that have shaped these very services today.

Despite the successes however, he reminds us of numerous high profile serious case reviews that highlight how these services can lack integration and vulnerable children can fall through these gaps. He states that inconsistency with which health is delivered across regions contributes to significant variations in mortality.

He expounds the true meaning of integration in relation to paediatric services, citing useful local resources and exemplars across Europe aimed at prevention and early intervention.

Chris concludes on a positive note by laying out a detailed proposal of a new, state of the art children's services team offering wraparound care. This book will definitely appeal to all those who believe the proverb, “It takes a village to raise a child.”

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Poole Hospital @fontanellepod

BOOK

SHAPING CHILDREN'S SERVICES

Clinical Fellow in Community Paediatrics

@drlauracrosby

@drshilpashah

BOOK

Caroline Storey

ST5 Paediatrics Great Western Hospital

THIS BOOK IS a compilation of essays telling stories of extraordinary care from the NHS. It is a bit of an emotional rollercoaster.

One is lulled into a false sense of security with a silly story about Louis Theroux’s testicle, then blind-sided by an entry from Jimmy Carr which I had expected to be arch and dry but is instead devastatingly beautiful and sad. It’s not dissimilar to the highs and lows of a day at the office for us (albeit with less celebrities), and this book certainly won’t provide escapism from work, but it’s gorgeous nonetheless.

Over a third of authors talk of times when they were ill as children, or when their own children have been unwell. Proof (if proof were needed) that paediatrics is amongst the most valued specialties. Although there are stories of heroics – of lives saved and of body parts reattached – mostly people talk of kindness. I was reminded of how the cases that are to us entirely unremarkable leave an indelible mark in the memory of patient and families.

At a time of social distancing when hugs are hard to come by, this book felt like giant grateful embrace. I can’t recommend it highly enough, but would also recommend tissues.

PODCAST

FONTANELLE FONTANELLE BEGAN WHEN, as a paediatric registrar, I was driving across the region between hospitals, revising for my clinicals and looking for ways to learn on the go.

I came across some excellent acute adult medicine podcasts, but I was looking for something more paediatric based. I could see that the wealth of knowledge in the consultants around me should be tapped into and made accessible to others. One evening the whole family sat at the kitchen table, brainstorming names, settling on Fontanelle – with an open mind for learning and a soft spot for paediatrics.

Fontanelle has now covered all sorts of general paediatric topics such as D+V, and UTIs, bronchiolitis and abdominal pain. Fontanelle is a great accompaniment to pathways from Healthier Together, our regional clinical resource for clinicians and parents.

Fontanelle has reached doctors, nurses and students in more than 60 countries. As well as bridging the gap between primary and secondary care, Fontanelle is now producing podcasts specifically aimed at parents, with the first one on constipation extremely well received. Do get in touch if you would like to contribute.

Spot diagnosis (p15): Answers 1. Tinea Corporis 2. Measles 3. Pityriasis versicolor

Despite working in a challenging environment, paediatricians in India enjoy a close bond with patients I COMPLETED MY Masters in paediatrics from a Government Medical College and Hospital in a small town, Gwalior. Currently, I am Dr Deepak Ugra practising as a general General paediatrician in a statePaediatrician of-the-art tertiary-level Lilavati Hospital & private hospital in Research Centre Mumbai city.

The majority of the Indian population has very limited access to public health systems.

In India, healthcare comes with a price that only a marginal percentage of the population can afford. Besides, healthcare in the public sector varies widely from excellent to very poor, primarily because the workload on the healthcare personnel in this sector is back-breaking. The private healthcare system also ranges from being mediocre to excellent. Most people in the medical profession here are in for the love of this job.

The healthcare system in the private sector includes both small nursing homes and big corporate hospitals. The small nursing homes often employ semi-qualified staff who may have work experience but do not hold the required medical degree. This is definitely one of the major challenges faced by paediatricians in India on a daily basis.

“Paediatricians in India strike a close bond with the child and the family, so much so that we are often counted as an integral part of the family�

Working with limited resources in most set-ups is quite daunting. Investigations on children, who are not as vocal as adults, cannot be done so freely to back up one’s clinical judgement. Often, paediatricians have no option but to take calculated risks which can be very stressful for us as the outcome cannot be predicted. We also have to deal with parents who come from all kinds of economic strata and literacy levels.

Helping the have-nots Yet another challenge for paediatricians in India is that this is a field in which many other specialties, such as family physicians and general medicine, dabble in and these compete with qualified paediatricians or make the situation very complicated and difficult at times for us with partially treated and thus mismanaged cases. In India, paediatrics is a less well paid field due to the existing social structure and glamour associated with some other fields.

Indian society sees a huge divide between the haves and the have-nots, the latter being a much larger number. Less than optimum nutrition for all-round growth and development is the chief problem the young ones who come from the lower income group of society face. To add to this,

INTERNATIONAL

A paediatrician in India there are limited educational opportunities at their disposal and also limited assistance from less expensive public healthcare systems in cases of chronic ailments or emergencies. This sadly results in unprecedented infant mortality deaths with many children not living beyond five years of age.

Serious problems relating to both physical and mental wellbeing among children exist on the other side of the spectrum too. Viral infections and allergies, obesity, social media addiction, poor physical fitness along with poor selfconfidence and self-esteem that culminates in depression are serious ailments. We have started observing this growing upward trend in children belonging to affluent and higher middle class families.

Paediatricians in India like myself are able to strike a close, loving and genuine bond with the child and the family, so much so that we are often counted as an important and integral part of the family set-up. It is a matter of great pride that, over the years, there have been many public health achievements in the field of paediatrics in India and we hope and pledge to keep this an ongoing process.

Above: Deepak with his colleagues Top: Deepak currently works in a state-of-the-art hospital

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WELLBEING

Wellbeing Support, guidance and reflection

RESILIENCE

A pragmatic guide to writing and resilience Writing is a multi-functional tool to paediatricians, both as a method of developing resilience skills and a hobby to boost your own wellbeing CYRIL CONNOLLY SAID: “There is no more sombre enemy of good art than the pram in the hall.” …which is odd because paediatricians are great writers and our way is constantly blocked by buggies, car seats and XBox consoles. If good writing is being able to put the picture you have Dr Serena Haywood in your head into someone else’s, our ability to Neurodevelopmental handover a clinical story with textured passion Paediatrician and is unparalleled. I run a Balint group with our Guardian of Safe Working Hours trainees and their ability to strip back emotional St George’s layers and run a family’s story rapidly back and University Hospital forth exploring potential futures beats Steven @SerenaHaywood Spielberg hands down. It’s just a small jump into creative storytelling.

I teach resilience in all sorts of places to all sorts of people including to the civil servants in the Treasury Office trying to deliver Brexit. Resilience is all about accepting failure as an inevitability of being human and trusting yourself to find the inner resources to have another go. And the ability to challenge broken systems. And leave if you have to. I use creative writing and work with actors to bring words to life. I can help someone write a oneminute play in 10 minutes and we stage it for them right there. I am a playwright, producer of brand new work and reader for the Finborough Theatre.

Why writing and resilience? First, it’s fun. Writing is a nice way to spend a wet Sunday afternoon either blogging, journaling, writing prose, poems or plays. You make something that wasn’t there before out of your head. It doesn’t have to ‘go anywhere’. It can just be of itself. Or you can share it and then it becomes a social exercise either in a writer’s group, publishing or staging yourself or if you’re lucky, by someone else in a theatre.

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There is an increasing understanding of how the arts can help healthcare professionals with groups such as Performing Medicine bringing forum theatre to work through difficult situations using actors to examine different versions of the same scenario and Breathe Arts Health Research who collaborate with arts, health and science to bring performing arts and training in arts to patients and staff and is recognised by NHS England.

So, how do you bring writing and performing to staff in healthcare?

1. Talk about plays and books; set up clubs and outings.

2. Bring in actors to do warm-up and improv. The physical process of moving in a different way is energising. And embarrassing.

And laughter is good!

3. Go to immersive events such as Secret Cinema where you get to do a tiny bit of performance but not enough to be threatening and really get into the heads of the characters!

4. Join a writing group. They love medical facts and your inbox will feel very loved with such questions as: “How do I kill someone without getting caught?” – “Wait, on stage!”

5. Do a blog or share writing online. Discuss it in a tea, wellbeing session. I have a friend who leaves his poems on the Tube.

Maybe don’t do that.

Doctors have a huge advantage. We’re not precious where we work. We scribble fast and furious in corners of EDs, in binging and beeping hot rooms and whilst having Lego aimed at us. We have writing combat training; so sitting down to write a play is a doddle. Writing is a journey into your mind and that of others.

There’s always time to write. It’ll take you places you never dreamed of!

Listen to Serena’s podcast Unmasked – dramatised stories from COVID-19 in the NHS www.unmasked.org.uk

WELLBEING

CONFIDENCE

Imposter Syndrome Imposter syndrome feels personal, but it is a self-doubt that impacts many of us.

Recognising that it happens to many of us is important

I CONSTANTLY FEEL like I’m about to be found out.

I wonder why I’ve been selected or chosen for a role and why they didn’t choose someone with more Dr Seb Gray expertise, charisma or General Paediatric knowledge. The constant Consultant feeling that I don’t deserve Salisbury NHS Foundation Trust to be where I am is Milestones Editorial draining. Being grateful Board that I got lucky to get where @SebGray I am is outweighed by that tiny voice shouting in my head, “You’re not good enough!”

I know I’m not alone (as demonstrated on twitter – see right). The consciousness of becoming aware of how much I don’t know is like walking around the edge of ravine with a snowstorm worsening. The more I do, the faster it feels like I’m going and the worse the fall is going to be.

It could be argued that the feeling of being inadequate and unknowledgeable is what drives us to be better. Complacency can result in negligence and missing finer details but it’s not a character trait common amongst healthcare professionals working in paediatrics.

Self-doubt, however, is rife. Even in those who appear the most confident, you don’t see beyond the facade and the exhaustion caused by keeping it up.

Impostor syndrome is one of many factors that contribute to burnout. But how do we keep the drive for bettering ourselves without constantly feeling we are not good enough?

The learning from excellence movement and switch from safety-I to safety-II are positive steps. Moving away from the ingrained culture of honing in on mistakes is not a switch that can just be flicked. The NHS can move from blame to acclaim but it will take time.

For me it started at medical school. You go from being a high achiever to an average medical student overnight. I didn’t like this status update and used my new-found independence to avoid it by skipping lectures.

Failing the first year was a reality check. To succeed I needed to acknowledge that I wasn’t the best – I was going to have to work harder than ever before to just be average. My impostor syndrome was born.

If you think of the last time you compared yourself to someone, I’d bet you came off worse. We only fleetingly think of those we outshine and focus on those that magnify our inadequacies. We need to reinstate self-care and a positive self-image. Kindness is difficult to fight against and spreads joy. By focusing on positivity regularly, the less active it becomes.

Passive positivity is like a ray of sunshine when you thought it would never stop raining.

Ross Fisher summed it up perfectly at the DFTBLive conference in August: “We don’t need to be better to be valued or loved. You should be proud of who you are right now.”

Image extracted from The Boy, the Mole, the Fox and the Horse

by Charlie Mackesy (Ebury Press, £16.99).

Look out for a review of the book in the next issue of Milestones

PAEDIATRIC TWEETS Imposter syndrome The more I learn about a subject, the less I think I know about it. #MedEd @kunbab Medicine is cool because you can feel like ur a genius one minute and then 80 seconds later you wonder why you are probably the dumbest person in the hospital @samsfeelinggood

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Nikhil says that team working is key in neonatology

A DAY IN THE LIFE

“The best part is the thrill of being hands on” Dr Nikhil Ganjoo

Consultant Paediatrician with Neonatal Interest , Peterborough City Hospital @DrGanjoo

I became a paediatrician after convincing a young child to have his salbutamol nebulisation by first nebulising his Shrek toy.

That moment I knew it had to be paediatrics for me! What can be more satisfying than adapting how you work than to pull out a grape from a nostril of a giggling child!

My typical working day at NICU while ‘on call’ starts with a catch-up with the obstetric team about likely admissions and high risk patients, it is all about team working.

Then, being greeted onto NICU by the sounds of the monitors/ ventilators and some blue phototherapy lights. To someone who likes working with neonates this is the scene set for working our magic. Ward rounds are a team effort with trainees, ANNPs, nurses and parents to decide on the best plan of action for our little miracles. This is doubled up with teaching on the rounds for the team on setting up equipment, interpreting blood gases and learning from each other on the latest evidence.

Then comes the Special Care Baby Unit rounds. There are the fruits of the labour of our dedicated NICU nurses plus the love and positivity of their parents. By this stage of their admission, they are like family.

The next destination is Transitional Care, where the aim is to address concerns of suspected sepsis, feeding or jaundice, giving them as much focus as we would for the tiny preterm neonate.

Every baby counts! All credit to our amazing Transitional Care team at Peterborough.

The most difficult part of my job is when deliveries do not

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@RCPCH

go as planned and parents are left to deal with unexpected circumstances. This is heart breaking for families and our difficult role is to comfort them, while at times stabilising them for transfer to Level 3 units with the support of our outstanding Acute Neonatal Transport Service (ANTS). It feels unnatural to transfer our neonates elsewhere but we know it is right for them at that time and know that we would take over their care again in the future.

When I finish work I like to... drive back home listening to loud music.

To relax, I value my warm cup of coffee

The best part of the job is the thrill of being hands on. By sharing our passion, we shape the future SPIN or GRID neonatal trainees. We also build valued relationships with families who we then follow up in our ‘Baby Clinic’. Team working is the key in neonatology!

and quality time with my family. I recognise how lucky I am to have people who care for me. In my free time, I enjoy photography. I also engage with social

My most memorable moment was on holiday, when a lady approached me with a huge smile.

She was the mother of extremely unwell premature twins whose care I was extensively involved with as a trainee. These boys were now doing well, and I saw them running around the park. This gave me a great sense of satisfaction and pride to be part of our network, where we support the dreams of such families.

@RCPCH

milestones@rcpch.ac.uk

media sharing and retweeting medical updates. To keep healthy, I incorporate some exercise into my routine, this helps to bring that balance.