RCPCH news Royal College of Paediatrics and Child Health
Leading the way in children’s health
SPRING 2008
Finlay Scott of the GMC on Child Protection 6
College response 7
4 Medicines for Children Research Network 8-9 Recertification – what does it mean for you? 10 Mastercourse update
Editorials Spring 2008
In the news 4 The Medicines for Children Research Network Media update 6 GMC on Child Protection 7 Commentary on the GMC article Do you and your team enjoy teaching medical stidents 8&9 Recertification 10 Mastercourse to membership The effect of cancer treatment on reproductive functions 12 SASG news Cairo event 13 Tackling childhood obesity with HENRY and the Glugs 14 Trainees column 15 Meetings Advocacy guide Going carbon neutral
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From the Treasurer As our Registrar Hilary Cass moves to pastures new and different challenges, we all wish her well in her future endeavours and thank her for her vision and commitment to the College. Not only will her presence, wit and humour be missed, but more importantly we had to find someone who was going to write the Registrar’s Column in this Newsletter! On my graduation from Medical School the quotation in the Year Book was: “Sue has 3 ambitions. 1) To get married 2) To be a Paediatrician and 3) To write a gossip column in the BMJ!” Is this now my big chance?! Writing the column is a hard act to follow. I asked the Publications team what they wished me to write about. “Finance and the new building” was the reply. Our President, in her column in the Winter Newsletter, has spoken of our vision for the new building and hopes and aspirations for the future. There will continue to be a lot in the Newsletter, President’s email bulletin and on the College website about our impending move. I was a “new girl” as Regional Representative on Council when we moved from St Andrew’s Place to Hallam Street. I was in awe of the then Honorary Treasurer John Osborne that he had undertaken such a mammoth task, never thinking that in years to come it would be my turn. That move at the time seemed a huge leap in our “growing up”. This second move, as the college enters adolescence, is another amazing step in the direction of our future. With growth comes the challenge of being a business in every sense of the word: dynamic, innovative, responsive, professional are just a few adjectives that come to mind. It is the opportunity for our staff and members to put their considerable talents together to produce a College that is second to none in its productivity and delivery of service. The open-plan offices will foster the cohesion between departments and there is plenty of light modern space for members and fellows to meet, debate, and discuss issues in comfortable surroundings. Finance has been a major and very important aspect of this purchase. There has been a lot of hard work reviewing facts and figures going on behind the scenes from many of the College staff and Officers. The hours committed to the project to ensure this was a viable and affordable proposition cannot be underestimated. We are lucky to have a hard working dedicated Finance Team
led by Mike Poole, Director of Internal Services; and yes, our belts will have to be tightened but with good financial management and prioritisation of work, business will proceed as usual. So what else does a College Treasurer do apart from buy new buildings? A “Day in the life of ...” or “All you ever wanted to know but were afraid to ask” comes to mind. I chair many internal committees such as Finance, Membership and IT Strategy. As a member of other committees - SASGs, Publications, Council and EC - I contribute from the perspective of being a District General Hospital Paediatrician. I work closely with the Finance and Membership departments on a day-by-day basis supporting the delivery of good financial governance. I chair several external committees such as BNFC Publications Board and ADC Management Committee, and meet regularly with other Royal College and Faculty Treasurers. I attend RCN meetings and use my “day job experience” to input into discussions with our nursing colleagues and continue to use my workforce experience in meetings regarding configurations of services. As Senior Officers, I and my colleagues support our President in delivering the College’s Strategy. The work is divided so we attend different internal and external meetings such as with Ministers, DoH, Colleges and Education to name a few and complete allotted tasks. It is a team effort and on your behalf we represent your views and concerns to produce policy and solutions. Yes, it is busy as I also have my day job, but very rewarding. In these financiallychallenged times in the NHS, Trusts are not recognising the invaluable work you all do for the College and hence the greater good of the NHS. It is important this does not stand in the way of College work and with a new building and work ethos this input will be even more necessary. So with all the hard work, let’s raise a cheer for the new building, and drink a toast (Bucks Fizz from the local supermarket!) to the College and a great future.
Dr Sue Hobbins RCPCH HONORARY TREASURER
RCPCH news
Editorials From the President Regular readers of this column may remember Sven the gardener, a Nordic god who periodically descends from Valhalla (or at least the Battersea branch thereof) to prune the trees and generally tame my garden. I recently realised that the house was becoming as unkempt as the garden and called for the builders and decorators. To my great delight the painter’s name is Raphael. Whilst my Victorian terraced house does not really run to the space for it, I nevertheless have fantasies of returning home to find a Madonna or a Transfiguration painted on the ceiling. (Yes, I do know it’s Michelangelo who does ceilings, but he’s busy in Lambeth). Raphael comes from Poland. We are seeing an influx of eastern European doctors (and patients) and at the same time a reduction in the numbers of non-EU international medical graduates (IMGs). We have agonised over the latter – many of whom have played such an important part in delivering paediatric services in many parts of the UK – but who, overall, were contributing to an imbalance in the numbers of available posts and the number of applicants. We felt inevitably there must be change but also that we must be fair to those who have worked so hard. The outlook for IMGs is still undecided but the dilemma has made the training department here at the College start work on senior fellowships that could give several years’ training at a senior level for those IMGs who plan to go back to their own countries after a fixed training period. There is a serious problem for paediatrics here too. Whilst over-subscribed specialties such as surgery were unable to provide enough posts for aspiring UK graduate surgeons, we in paediatrics are struggling to fill unexpected vacancies in posts above ST1. We are hearing from regional advisers and from clinical directors that we seem to have exhausted the pool of doctors looking to fill these posts. The “Hutton” numbers and other extra unplanned allocations have seen to that, and along with the departure of many IMGs – and a fall in PLAB registrants - there are few prospects of suitable applicants. There have been, of course, many applicants from the EU but there are concerns about communication skills and difficulties in assessing competence. There are lots of opportunities in Europe to try to set standards for training and assessment that
will help new accession (and indeed older) countries to have confidence that they can apply and be judged fairly for jobs across Europe. The old CESP (Confederation of European Specialists in Paediatrics) is still the paediatric branch of UEMS (Union of European Medical Specialties) but is aiming to expand into a European Academy of Paediatrics - a bit like the American Academy. It already has a syllabus defined as the “Common Trunk” but it is not really a curriculum or competence framework as yet. It also is only equivalent to our first 5 years, i.e. up to the end of core higher specialist training – 2 years after the exam. There is an opportunity here for us to offer the Mastercourse leaning package and parts of our exam – especially the part 2 written – as a model for Europe. There is interest in this, but the wheels in Brussels grind very slow and new sprouts are rarer than you might think. We persevere. Do look at the article on the Mastercourse in this newsletter (page 10) – even better, buy a copy or persuade your trainees to do so. You get not only an imaginative textbook but also a brilliant DVD and a fantastic interactive website which gives inexhaustible information and assessment tools which you can complete and put in your portfolio. The Darzi children’s clinical pathway groups are beginning to report as I write this. London is on a different timescale but all the groups are identifying similar themes. Inequality, difficult access, need for joined up commissioning and regulation. There are also other Darzi work streams and I am also involved in the one on Leadership. This came about because I chair the steering group of a project called Enhancing Engagement in Medical Leadership. This is run under the joint banners of the Academy of Medical Royal Colleges and the National Institute for Innovation and Improvement. The aim is to promote the concept that elements of management and leadership are core to delivery of services and as essential to good patient care as are pharmacology and physiology. As a doctor you cannot deliver best service to your patient without these essential skills. We are producing a coherent curriculum for undergraduates, postgraduates and the newly qualified consultant (or SASG doctor) up to the first 5 years post specialist registration. We want to get away from the idea that management and
clinical leadership are only for those who want to “go over to the dark side”, but rather that they are essential for all. Like any aspect of medicine some may wish to specialise later, and we hope that many will and that there will be a larger and better trained pool of people who want to do this. The team has done a lot of work with reference groups and interviews with undergraduate and postgraduate deans and chief executives to try to get understanding and acceptance of this curriculum. We know that the overall curriculum is already overcrowded and we have tried to keep it simple and clinically relevant – so that it is taught alongside clinical cases or problem based learning. Assessment is of course the next step and multisource feedback is an obvious tool that could be used. This is really all part of professionalism and we hope that starting it early will help to deflect the cynicism of the recently qualified but overburdened consultant. We hope it will grow the leaders of the future – and encourage women into these roles. You will see from our Honorary Treasurer’s column opposite that this is a real challenge for the College. More information about the Medical Leadership Competency Framework and the project may be found at www.institute.nhs.uk/medicalleadership. Finally child death review teams are causing concern amongst paediatricians who are uncertain as to how we can possibly implement the duties set out in Working Together. We have taken up these issues with the Departments of Health (DH) and Children, Schools and Families (DCSF). We have said that whilst we support the general concept we are unable to participate in the rapid response teams without proper training and a clear understanding of what is expected of us at each stage of the process. This will require resources as teams are already stretched to breaking point. We believe our concerns have been heard and I hope that by the time you read this we will have news about those resources and also we shall have published our guidance for paediatricians.
Dr Patricia Hamilton RCPCH PRESIDENT
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News The Medicines for Children Research Network – the infrastructure support for clinical studies in England Following on from the commentaries that appeared in this newsletter last year, this article sets out to describe one of the primary functions of the Medicines for Children Research Network (MCRN), the provision of effective infrastructure support for clinical studies. Six Local Research Networks (LRN) were appointed following an open, competitive process, in January 2006, and are the primary vehicle for providing this support. The LRNs cover 60% of England and have access to approximately 6 million children. The MCRN liaises closely with the equivalent groups within the devolved nations (Scottish Medicines for Children Network, Northern Ireland Clinical Research Network – Children, and the Welsh Children’s Research Network) to ensure that the medicines for children research agenda is addressed and delivered across the entire UK.
RCPCH news Media Update
Each LRN is led by one or more Directors, supported by a full time manager and a team of research and administrative staff. LRN staff are available to support studies in the MCRN Portfolio in a number of key ways; reducing the administrative burden by assisting with local approvals; publicising studies and disseminating results; facilitating recruitment of children to studies; and reducing study set up time. This support will ensure that studies complete within time and to budget, thereby reducing the need for extension grant applications to funding bodies. The LRNs are working on a growing portfolio, which currently includes 58 studies covering a wide range of topics from large, multinational neonatal trials, to smaller qualitative studies. The MCRN Study Adoption Committee (SAC) meet every other month and view between eight to ten studies per meeting, so the size of the portfolio is rapidly expanding. Studies eligible for adoption must be fully resourced and funded following open competition with peer review. Both Industry-sponsored and non-commercial studies can be supported and the role of the SAC is to assess the feasibility of running each study through the network, and to ensure that the appropriate level of support is available. The diverse nature of the MCRN portfolio is providing the LRNs with an exciting, if somewhat challenging, selection of studies on which to focus their support. We are holding a MCRN Symposium at the RCPCH Spring Meeting on 17 April 2008, and our 2nd Annual Conference will take place the following day, also in York. Registration for the MCRN Conference is free, see the MCRN website www.mcrn.org.uk for more information. All are welcome to attend both events to learn more about the MCRN.
Back in November, a study published in Archives of Disease in Childhood led to medical experts suggesting children should be vaccinated against chickenpox at the same time as receiving the MMR vaccine, which received wide coverage in the media. The Food Standards Agency and the Department of Health also set out stricter controls for the advertising, promotion and labelling of infant and follow-on formulas. The College welcomed these changes, and released a statement to the media which whilst encouraging breastfeeding, recognised the need for parents to be better informed about the healthiest ways to feed their babies. On 4 December, a prominent paediatrician was struck-off the medical register having been found guilty of serious professional misconduct by the GMC. In a statement to the press, Patricia Hamilton said the College was “saddened and disappointed to learn of this judgement” and recognised his contribution to child health during his career. The Guardian, Times, Independent, Mirror and BBC News website used her quote. The President also appeared on Channel 4 News to express her concern about the impact of the ruling on the future of child protection work. Rosalyn Proops, Child Protection Officer, talked to the Times about College initiatives in child protection. Also in December, the National Audit Office published a report on neonatal services in England. Reporting looked at the current level of neonatal care within the NHS. The report revealed that many neonatal units were not meeting British Association of Perinatal Medicine’s (BAPM) guideline ratio of one nurse to every four babies and was therefore compromising the overall outcome for vulnerable babies. At the beginning 2008, Patricia Hamilton contributed to the BMJ review of 2007, in which she hoped for improvement in the selection and training of junior doctors. The BMA and Royal College of Pathologists raised concern over the illegal transport of children’s bodies due to a shortage of paediatric pathologists too. The College shares these concerns as the recommendations made by a working group from the RCPCH and Royal College of Pathologists in 2004 called for any pathologist examining the body of child to be trained in child deaths. Towards the end of January, Terence Stephenson, Vice-President for Science and Research spoke to Children and Young People Now about prescribing medication for children. And finally, the College raised concerns – which were quoted not only in the UK but even on a US radio show in connection with Channel 4’s ‘Bringing up baby’ programme. To keep up-to-date with news articles that mention or quote the RCPCH, or to stay informed about what is going on within paediatrics and child health, visit the website for a regular summary of articles – www.rcpch.ac.uk
Dr Vanessa Poustie ASSISTANT DIRECTOR, MCRN
Claire Brunert HEAD OF MEDIA
Locations of MCRN Local Research Networks Cheshire, Merseyside & North Wales LRN (cmnw@mcrn.org.uk) Greater Manchester, Lancashire and South Cumbria LRN (gmlc@mcrn.org.uk) London - South East, North, Central and East (SENCE) LRN (sence@mcrn.org.uk) South West LRN (swest@mcrn.org.uk) Trent LRN (trent@mcrn.org.uk) West Midlands LRN (wmids@mcrn.org.uk)
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“Rotarix provides early protection from rotavirus gastroenteritis, pass it on.”
Winner of the UK Prix Galien 2006
Medal engraved by Albert de Jaeger
Only two ORAL doses1 Provides highly effective protection from rotavirus gastroenteritis2 Has a good tolerability profile1 ®
rotavirus vaccine Rotarix is not currently part of the routine UK childhood immunisation programme Rotarix is available direct from GlaxoSmithKline - Call the dedicated Customer Contact Centre on 0808 100 9997 Prescribing information (Please refer to the full SPC before prescribing) ROTARIX® Live attenuated human rotavirus oral vaccine. Composition: Each 1 ml dose contains not less than 106.0 CCID50 human rotavirus RIX4414 strain (live attenuated). Uses: Active immunisation of infants from 6 weeks of age against gastroenteritis due to rotavirus infection. Dosage and administration: Two oral doses. First dose can be administered from 6 weeks of age. Minimum interval of 4 weeks between doses. Vaccination course must be completed by 24 weeks of age. Rotarix should under no circumstances be injected. Contraindications: Hypersensitivity to the active substance or any of the excipients, or after previous administration of rotavirus vaccines. Previous history of intussusception or uncorrected congenital malformation of the gastrointestinal tract that would predispose for intussusception. Known or suspected immunodeficiency. Asymptomatic HIV infection is not expected to affect the safety or efficacy of Rotarix. However, in the absence of sufficient data, administration to asymptomatic HIV subjects is not recommended. Administration should be postponed in subjects with acute severe febrile illness, diarrhoea or vomiting. Presence
of a minor infection is not a contra-indication for immunisation. Precautions: Administer with caution to individuals with gastrointestinal illness, growth retardation, and individuals with immunodeficient close contacts. FOR ORAL USE ONLY. Interactions: No interactions with co-administered paediatric vaccines. Pregnancy and Lactation: Not intended for use in adults. Breastfeeding may be continued during the vaccination schedule. Adverse reactions: Irritability, loss of appetite, diarrhoea, vomiting, flatulence, abdominal pain, regurgitation of food, fever, fatigue. Legal category: POM. MA number: EU/1/05/330/001-004. Presentation and basic NHS cost: 1 dose powder in a vial; 1ml of solvent in glass container; oral applicator; transfer adapter for reconstitution. NHS Cost £41.38 MA holder: GlaxoSmithKline Biologicals s.a., Rue de l’Institut 89 1330 Rixensart, Belgium. Further information is available from: Customer Contact Centre, GlaxoSmithKline, Stockley Park West, Uxbridge, Middlesex UB11 1BT; customercontactuk@gsk.com; Freephone 0808 100 9997. Date of preparation of PI: December 2006 Rotarix® is a registered trademark of the GlaxoSmithKline Group of companies ROT/PRI/06/27986/2
GlaxoSmithKline encourages healthcare professionals to report adverse events, pregnancy, overdose and unexpected benefits to the company on 0808 100 9997. Information about adverse event reporting can also be found at www.yellowcard.gov.uk References 1. Rotarix Summary of Product Characteristics 2. Vesikari T, Karvonen A, Prymula R et al. Human rotavirus vaccine RotarixTM (RIX4414) is highly efficacious in Europe. 24th European Society for Paediatric Infectious Diseases (ESPID), Basel, May 2006 © GlaxoSmithKline group of companies ROT/FPA/08/35005/1 - Feb 2008
News The GMC on Child Protection In the light of recent discussion about the GMC’s role in dealing with the issues around Child Protection, Finlay Scott, the GMC’s Chief Executive, has contributed the article below. On the facing page can be found a commentary on the article by the College’s Child Protection Officer, Dr Rosalyn Proops. Letters responding to both are welcome at newsletter@rcpch.ac.uk . It is being suggested in some quarters that the GMC’s fitness to practise procedures are unfair to paediatricians engaged in child protection work. It is most important that the facts are understood. Paediatricians attract complaints like other doctors. But it is untrue that large or disproportionate numbers of paediatricians are represented in our fitness to practise procedures. Between April 2006 and December 2007, we received 8,400 enquiries or complaints about doctors of all specialities. Of those, eight were about paediatricians connected with child protection work. In the course of investigation, one of the eight doctors entered into voluntary undertakings related to their health, without the need for referral to a fitness to practise panel. The other seven cases were also concluded without referral to a fitness to practise panel and with no effect on the doctor’s registration. It is extremely rare for a paediatrician to appear before a panel in connection with child protection work. Since 2004, panels have considered more than 600 cases. Only two could reasonably be said to have been about paediatricians involved in child protection. In a third case, Sir Roy Meadow was an expert witness in a criminal court. It has been suggested that the GMC does not understand the special nature of the work of paediatricians. This reflects a misunderstanding. When we are investigating a complaint, we can – and do – take advice from specialists where appropriate. The material available, including expert opinion where appropriate, is considered by two case examiners – one medical and one lay – who will decide whether to refer the case on for adjudication. It has also been suggested that fitness to practise panels are not qualified to judge cases involving paediatricians because they don’t include specialists in child protection work. As it happens, this line of argument about the composition of panels was considered and rejected by the High Court in 2006 ([2006] EWHC 2468 (Admin)). But, more importantly, it would be potentially unfair to the doctor if expert opinion was given in private by a specialist panel member. The key point is that expert opinion should be given in open session so that it can be tested by both sides. This is what happens in the courts. We are committed to processes and procedures that are fair, objective, transparent and free from discrimination. And the facts suggest that, in general, we live up to that challenge. But this is not to claim that everything works perfectly. We recognise that the investigation of some complaints can take too long before a decision is taken. Even where the doctor is not referred to a fitness to practise panel, a protracted investigation, and the associated uncertainty, undoubtedly cause stress and strain We have worked hard to reduce delays but we face particular problems in securing transcripts from the Family Courts. We will continue to press for improvement. Meanwhile, it is far from helpful when pressure groups – claiming to speak for doctors or patients – paint an inaccurate picture of our work. Doctors can be confident that we view each complaint or enquiry on its merits, without fear or favour. The motives of the complainant do not influence the decisions taken; and our guideline and rules are in the public domain. The figures demonstrate that our processes and procedures are capable of distinguishing where there is a real problem. Of course we understand that it cannot be in anyone’s interest if paediatricians are deterred from undertaking vitally important child protection work. Equally, it cannot be in the public, or the profession’s, interest, if the GMC does not act when doctors practise incompetently or inappropriately. Our critics are trying to create the impression that the GMC is intent on unfairly persecuting paediatricians involved in child protection work. Nothing could be further from the truth; and, by painting a misleading picture our critics risk creating, or adding to, the very problem they say they wish to resolve. Finlay Scott Chief Executive, GMC Page 6
News
RCPCH news
Commentary on GMC article Child protection is still everyone’s business It has always been a difficult area to work in – and so it should be. The morbidity and mortality for the children is high and the price paid by parents can be the most profound loss to family life as their child is removed from them by the state. Finding the right path between returning the abused child home and removing a child from an innocent family must be one of the most difficult decisions we contribute to as part of the Safeguarding team. We should not be surprised if this generates so much upset, distress and attention.
What is it that most of us are worried about? Making the wrong decision? Being quizzed in court? Receiving a complaint? Being reported to the GMC? Seeing our name in the local or national media? The effects on our families? Probably all of these at some time, and now even more than ever the anxiety looms very large and feels very real.
Parts of the media paint a distorted picture We can do something about this by taking the initiative and take any opportunities that arise to offer balanced evidenced based stories. But there will always be some parts of the media which we cannot influence. Bad news stories make better copy and we find it hard to persuade the press to publish articles that support doctors.
What are the risks of being reported to the GMC? Please read the article from the GMC, and let’s carefully consider this and our own complaints survey from 2004. The GMC letter tells us that of 8,400 complaints about doctors in all specialties only 8 related to paediatricians and child protection work. All 8 of these were closed without referral to a fitness to practise panel with 1 agreeing to voluntary undertakings without referral to a panel. The RCPCH survey asked paediatricians (3879) if they had ever (over their whole careers) been the subject of a complaint related to child protection. 533 doctors reported 786 complaints. 79% were dealt with locally, of which 9% received publicity and 3% were upheld. 71 doctors (86 complaints) were referred to the GMC. At the time of the report 59% were found unproven, 20% were ongoing and none were upheld.
So, what does this mean in reality? The risk of receiving a complaint that is reported to the GMC is low and the risk of any further investigation or sanction on the part of the GMC is extremely small. The distress and anxiety however is very significant. The process for those very few caught up in it, takes far too long and the style of communication from the GMC is quite daunting. We have been meeting with the GMC for some time and we welcome this article and the facts which they lay out for us. We are asking for more information and will pass this on to you as soon as it is available. We have successfully addressed some of our other concerns. The GMC have accepted our nominations of 10 paediatricians to act as advisors and experts at any part of the proceedings. Rosalyn Proops and Terence Stephenson met with the 12 GMC case examiners in January 2008 to talk about the specific problems associated with child protection. Case examiners are the people who review the complaints in detail, obtain further expert advice, and decide if the complaint requires further action. This was a useful meeting from which both sides gained. Whilst there are no paediatricians in the case examiner group, five of them have direct experience of child protection, three as general practitioners, one as a barrister and one as a social worker. We need to move on and focus on good and competent practice in the clinical environment as well as in the courtroom. Our College training courses, guidelines and evidence-based publications will help us to practise in a way which not only keeps children and families safe – but keeps us safe too. Dr Rosalyn Proops OFFICER FOR CHILD PROTECTION
Do you and your team enjoy teaching medical students? If so we are looking for two-week residency placements in local district general hospitals for Imperial College students. We currently have 20 hospitals all over the country and our students enjoy these attachments immensely as they are in small groups of two or three and can receive very personalised tuition and experience. The aim for these residences is for the students to consolidate their knowledge and experience learnt back at the teaching hospital bases, and for them to feel part of the local team. They will be required to be resident and therefore can help current staff with appropriate duties on call out of hours. We are currently recruiting for the next academic year starting Autumn 2008 . The current reimbursement for students is approximately £500 per student per attachment to include appropriate hospital accommodation. Please discuss with your team and housing departments and contact me by telephone or e-mail to obtain further details before the end of April. Dr Mitch Blair PAEDIATRICS COURSE DIRECTOR IMPERIAL COLLEGE LONDON Tel: 0208 8693330 Email: m.blair@imperial.ac.uk
Annual General Meeting 2008 In accordance with Bye Law 8 (ii) the College wishes to serve notice to the membership that the next Annual General Meeting of the College will be held on Wednesday 16 April 2008 at 6.15pm at the University of York, during the College’s Spring Meeting.
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Revalidation
Recertification Dr Alistair Thomson, RCPCH CPD OFFICER, Dr Hilary Cass, RCPCH REGISTRAR Revalidation will comprise renewal of a doctor’s licence to practise (relicensing) and renewal of a specialist’s accreditation (recertification). It arouses mixed responses. Patient pressure groups believe it is long overdue and will weed out medical “rotten apples”. Health professionals are wary of unpiloted and unproven systems which might consume time better spent seeing patients. Many patients believe that doctors are tested regularly in some way. Doctors tend to regard recertification as a bogeyman that is wheeled out at intervals to frighten and worry them, but they suspect it does not exist. However, just in case it does, senior doctors are keeping an eye on their retirement date and younger consultants keep looking over their shoulders. To what extent are these perceptions and expectations fulfilled? Background The system of revalidation was first proposed in 2006 by the Chief Medical Officer (1). This system was refined by the publication of Trust, Assurance, Safety in February 2007 (2). It is a proposal for a regulation of all the healthcare professions, not just doctors. What is Recertification? Recertification will require a doctor to demonstrate that they meet specialty-specific standards – i.e. being a paediatrician and having specialist expertise. It will also relate to specific skills on the register – such as endoscopy or being lead consultant for diabetes. The process will be undertaken at 5-year intervals, coinciding with relicensing in order to reduce the burden for individuals and organisations. The GMC recognises that the evidence provided will vary between specialties and subspecialties and will be drawn from a number of sources. The publication Your GMC (3) suggests that the evidence required might include appraisal, audit of clinical outcomes, patient feedback, CPD, observation of practice, simulator tests and knowledge tests. The last three are likely to be particularly challenging to the profession and may not be applicable to all branches of paediatrics - for example, simulator tests would be difficult to apply to community child health.
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Implications for the RCPCH Recertification will be a statutory duty for the College to undertake. It will be a major challenge. It must be a fair and transparent process for all paediatric specialists and sub-specialists, and career-level, specialist-recognised SASG doctors, whether members of RCPCH or not. There are 3000-3500 such paediatricians and the number is expanding. It will be tempting to invent a process that is complex and unwieldy, but recertification must be both effective and feasible. The major implication for the RCPCH is that the College may have to recommend whether specialist paediatricians – i.e. those with CCT - are fit to practise as specialists for the next 5 years through the process of recertification. This may be done locally but in any case will be assessed against standards and evidence set by the RCPCH. There was initially ambiguity about SASG doctors, who may not be on the specialist register, but it was recently emphasised that the recertification system will be applicable to all doctors who have completed training, whether they have CCT or not, The criteria applied to those who do not have CCT cannot be the same as the criteria applied to those who do. Each College or Faculty needs to design and implement a recertification system that will command the confidence of the public, the GMC and the doctors who participate. There is unfortunately little evidence about what the components of a scheme might be, which would both identify doctors who are fit-to-practise at specialist level in the UK and select out those who are not. A combination of validated assessment tools and other evidence is likely to prove the most informative. Development of Schemes The Academy of Medical Royal Colleges (AoMRC) and GMC are leading on development of recertification. Work is focusing on CPD, e-learning and multi-source feedback (MSF), for each Specialty Group. There will be lay representation on all groups. There may be other work-streams. There will need to be work on the issues raised by doctors who are not Members or Fellows of a College and also work on other components of recertification.
There are of course many other interested parties - for example BMA, NCAS, BAMM, etc - whose views will be taken into account, but the GMC will be the final arbiter. Shape of Recertification for Paediatricians There is as yet no generally accepted or implemented model for recertification. The recommendations are under debate, but it is anticipated that recertification will require at a minimum: 1. 50 appropriate credits per annum of CPD; 2. Multi-Source Feedback (MSF) on specialist practise (to complement that on generic practice that will be required for re-licensing); 3. Outcome data (possible in paediatrics only if a paediatrician is in a sub-specialty where outcomes are easily measurable, e.g. neonatology); 4. Evidence of clinical audit activity by the specialist; 5. Other evidence as determined by the specialty or sub-specialty. How this evidence is gathered and who will assess it are not clear. What criteria are to be used to reach decisions and who will be responsible for the recommendation on whether to recertify or not will need careful consideration. An appeals mechanism will be needed. Principles for Development of Recertification The recertification scheme for paediatric specialists: a) Must conform to the guidance set out in the documents cited above. b) Should change minimally after introduction, in order for continuity and consistency: otherwise confidence could be lost by all stakeholders. c) Should maintain continuity with the current CPD Scheme. Not only because the CPD Scheme has proved so far ‘fit-for purpose’ (notwithstanding some compliance problems – see below - which are to do with implementation) but also because paediatricians have been documenting and using CPD points for appraisal over the last quinquennium (i.e. the period to be covered by revalidation).
RCPCH news
Revalidation
RCPCH Recertification Road Map - Draft Cons 5
Portfolio and trainers reports
ST6
MSF (annually CBD (external validation) SAIL SHEFFPAT
Structured Assessment?
ST8 ST7
CPD Portfolio (inc. Reflective Notes)
Components for Recertification for Paediatricians Continuing Professional Development will remain the basis of revalidation – in fact it has been recognised that CPD is important both for relicensing and recertification. The RCPCH CPD scheme has stood the test of time as a framework within which paediatricians can collect CPD credits. These can now be notified to the College online. Evidence of CPD is supposed to be presented and inspected at appraisal. But in the latest complete audit (2004), <80% of the 5% sample of paediatricians surveyed could produce evidence of > 25 external CPD points; and < 40% could produce evidence of > 25 internal CPD points. The criteria used for the acceptance of evidence for the CPD audit are not stringent enough to satisfy recertification standards and need review. This will reduce still further the percentage of returns that are acceptable and increase the risk of an individual failing recertification (which could lead to the GMC’s Fitness to Practise procedures). There is an AoMRC research project underway on the ‘Effectiveness of CPD’. This is funded via the GMC, led by the College of Emergency Medicine and is being conducted over the next 2 years. A recent comparison of all College CPD schemes by the Directors of CPD (DoCPD) showed that they are broadly similar, probably because they adhere to the 10 principles of CPD (4). Classification into clinical, academic and professional categories and internal, external and personal was reaffirmed (RCPCH does not use ‘personal’, but reflective notes are similar). Another part of the problem is that stringent attention may not be paid to CPD at appraisal. Some paediatricians still do not have regular appraisal. Rigour at appraisal will assist revalidation and appraisal is being reviewed. MSF will be a major component of recertification, a good test of performance in practice. The generic MSF tool for re-licensing is ready: around 100 members and fellows of the RCPCH have participated in the AoMRC 360 Appraisal/MSF study. This MSF is generic and a specialist MSF will be needed. The RCPCH could use SPRAT for recertification, but it would need validation in this context. There are other components of recertification which are shown in the draft roadmap (see figure).
MSF x2 (annually?) CBD (external validation) PCAT SHEFFPAT (Others: SAIL, etc)
DOPS as required
Cons 1
Structural Paediatric Assessment
Version 2 Assessment of performance
Annual Appraisals
Cons 2
Clinical Audit
Cons 3
Outcome data
Cons 4
Assessment of competence Clinical Governance info.
d) Should maintain continuity with the Training and Assessment Department’s guidance on trainee assessment. e) Should outline what other evidence of performance will be acceptable. f) Must resemble the recertification systems of other Colleges.
Figure: The possible shape of revalidation. There is continuity with Postgraduate Medical Education and with current CPD and Appraisal.
Current RCPCH Work Towards Revalidation There are many strands of work which have been set off to cover the ground. These are not funded by membership, but are subject of a bid to the Academy of Medical Royal Colleges, which has funding from the Department of Health. The initiatives include consultation with membership by telephone interviews with targeted groups, (generalists and subspecialists), and focus groups of invited members. These will be aimed at development of CPD recording and recognition systems, the generation of a self-assessment/self-mapping tool and guidance to assist paediatricians in planning the components of their recertification submission. Work also needs to be undertaken on development of MSF and development of clinical assessment processes for recertification. Fortunately the RCPCH already has tools available which have been used for assessment in postgraduate medical education, which could be adapted. These include SHEFFPAT (Sheffield Patient Assessment Tool) and PCAT (Peer Consultation Assessment Tool). Studies of
the validity and reliability of these tools in the context of recertification are being considered. The Pilot ST7 Assessment which is being explored might be extended into recertification. It will not be just individual doctors who are affected; departments of paediatrics may need help with revalidation of their members. Certainly, a department will not be able to function unless all the members are currently revalidated and collecting information that will allow them to revalidate again in the future. Development of departmental quality assurance processes (to ensure a fit environment for revalidation) and compilation of a list of standards for use by paediatric departments will become necessary. This early work will need to be followed by a pilot study of a sample. Other components of the quality assurance system will be needed, for example, recruitment and training of local (hospital) revalidation coordinators. There will need to be an evaluation of the College revalidation process as it proceeds. The College will also require new full-time staff to administer revalidation.
Summary Recertification is a five-yearly process which will have to be undertaken by consultants and SASG doctors, who will have to prove their performance is satisfactory and justifies their licence to practise as a specialist continuing for a further five years. There will be a strengthened appraisal process. Documentation for recertification will be in the form of evidence from CPD records, audit, multisource feedback and other components of assessment which are still under development. Paediatricians should collect and retain as much information as possible and having this stringently reviewed at appraisal in order to lay the groundwork for recertification. Ultimately, the system of recertification should assist in identifying doctors who may need support and help to practise, should identify those very few doctors whose practice is potentially dangerous and should support the majority who practise safely by interfering with their work as little as possible. We must not lose sight of the aim of revalidation - the benefit of our patients. Acknowledgements There are many people who have contributed to this paper through background work, discussion and comments. I am most grateful for their input, direct and indirect, over the last months and years; in particular, Pat Hamilton, Hilary Cass, Colin Campbell, Chris Verity and the members of the RCPCH CPD Sub-Committee. However, any errors are ours alone. References 1. Good doctors, safer patients. Chief Medical Officer’s report, London 2006 2. Trust, Assurance and Safety – The Regulation of Health Professionals in the 21st Century. White Paper, London 2007. 3. Your GMC. GMC, London. 4. The Ten Principles of CPD. Academy of Medical Royal Colleges, revised 2007.
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RCPCH news
News
Mastercourse to membership
During his Presidency of the College, Sir David Hall decided to commission a learning package for the MRCPCH examination. He was concerned that no books existed at that time that were written specifically for membership candidates. He was also worried that the scientific basis of paediatric practice was not understood by many membership candidates. That was in 2002, and by June 2007 the resulting package, MasterCourse, was
published. It has sold over 1,000 copies in its first six months, probably suggesting that it is seen by candidates as giving them an advantage in passing the examination and in improving their practice. MasterCourse is a multi-media learning package comprising two books, a DVD and access to an interactive website for 3 years. Volume 1 is a tool-kit for paediatricians in training which covers child development (physical and emotional), nutrition, pharmacology, research methods, ethics, public health and community paediatrics. It is designed to help those intending to take only MRCPCH Part 1A as well as career paediatricians. Volume 2 deals with hospitalbased paediatrics. Both volumes are written in a problem-orientated manner underpinned by basic science. The DVDs contain over 80 video clips demonstrating clinical signs, examination skills and developmental landmarks. Both books are extensively linked to external websites so that candidates can extend their knowledge beyond the published material by assessing relevant links. The website development makes this project unique and offers another dimension in publishing as the site is updated every month with new material, case presentations, reviews
The effects of cancer treatment on reproductive functions New guidance produced by the Royal College of Physicians, The Royal College of Radiologists and the Royal College of Obstetricians and Gynaecologists. Remarkable advances have taken place in the management of cancer in recent years, with a marked increase in cure rates. This rapid progress, though, has not been matched by a proper evaluation of the gonadal toxicity of the many new drugs now in routine use. This new guidance, written by a multidisciplinary expert group, sets out the
effects of a range of cancer treatments on reproductive functions, and provides clear standards for management. Approximately 11,000 adults in the 15â&#x20AC;&#x201C;40 age group are diagnosed with cancer each year, and for many of these younger cancer patients fertility is or will become extremely important. The report makes the case for comprehensive provision and funding of fertility services nationwide. The working party stresses the need for full discussion with patients before their treatment about its possible effects on fertility,
Managing editor: Graham Sleight
RCPCH news
Editor: Joanne Ball Email: newsletter@rcpch.ac.uk
Copy deadline for next issue:
Editorial services: Chamberlain Dunn Associates
1 May 2008
Advertisements: British Medical Journal
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and a website of the month feature. Users can thereby follow the field of paediatrics and child health between editions in a limitless manner. The website also contains a very clever self-assessment area which allows the candidates to calibrate their learning against the list of College competencies. A traffic light system allows the candidate to see their gradual progression from red (failure to achieve that competency) through amber to green (competency achieved). MasterCourse is a project between the College, which holds the copyright, and the publishers (Elsevier) as well as a large number of individual paediatricians who have contributed to its development over the last 5 years. Preliminary feedback from purchasers has been very encouraging and we hope that MasterCourse will grow organically through the website until the need for a second edition.
Professor Malcolm Levene EDITOR-IN-CHIEF, MASTERCOURSE
and provides clear patient information for men and women. This guidance is essential reading for all clinicians, health professionals and clinical services managers involved in cancer care, fertility specialists, service commissioners, and research funders. It will be useful to general practices, primary care trusts, government health advisors and cancer charities. The language used has made technical information as accessible as possible to cancer patients and their families. For more information and to purchase a copy, please call 020 8935 1174 ext 358 or visit www.rcplondon.ac.uk/pubs/brochure.aspx?e=238 Jason Plysi ROYAL COLLEGE OF PHYSICIANS, LONDON
Published by the Royal College of Paediatrics and Child Health, 5-11 Theobalds Road, London WC1X 8SH. Tel: 020 7092 6000, Fax: 020 7092 6001 Website: www.rcpch.ac.uk Email: enquiries@rcpch.ac.uk The College is a registered charity: no. 1057744 Š 2008 Royal College of Paediatrics and Child Health. The views expressed in this newsletter do not necessarily reflect the official positions of the RCPCH.
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News SASG news As a SASG committee we are looking at ways to ensure the work we do is informed by the views of all the SASG paediatricians. We are planning several strands of work to capture your views. We want to meet with you face to face so there are a couple of dates you may want to put in your diary. The first is Wednesday 16th April 2008 our SASG business lunch at the RCPCH meeting in York. We hope to use this meeting to hear about the issues that are currently important to you in order to influence the agenda of work for the SASG committee for the next 12 months. The other is our SASG information day on Friday 14th November 2008 in London. This is where we try and arrange a variety of speakers to respond to the topics you have raised in April. We are aware that not everyone is able to use their study leave to attend these events so we are trying to organise a census to capture your views. Next we want to try and make our SASG regional representative network more effective. So we are starting a piece of work that aims to ensure that each region has a SASG regional rep, that all the SASG
Exams in Egypt
The last week of January saw an event of triple significance take place in Cairo. The first ever RCPCH course for candidates preparing for the MRCPCH Clinical examination was held. Running alongside this was training for potential local examiners to familiarise themselves with the examination for when it is launched later this year. The week concluded with the inaugural meeting of the Egyptian Members Association of the RCPCH (EMA-RCPCH). Overseas candidate in the MRCPCH tends to perform less well in those section of the examination that focus on candidate approach to, and interaction with, patients and parents.
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paediatricians in that region know who it is and how to contact them. Once this is in place we intend to support the regional reps by meeting with them annually, having a rota for them to attend SASG committee meetings, email contact and sending them copies of the SASG committee minutes. The next piece of the jigsaw is to ensure we involve Senior Officers of the College in supporting the SASG agenda. We are very fortunate that some of the Senior Officers regularly attend SASG meetings. We also have a voice at Council by SASG doctors occupying the Associate seats at the Council of the RCPCH. Those of you who are Associate Members of our College should have received a letter from me encouraging nominations for one of the Associate seats on Council. It is disappointing that this seat has now been vacant for over 18 months. Council is the governing body of the College. An Associate Member on Council can contribute to all the discussions in Council meetings reflecting how the issues affect Associate Members. They have full voting rights. I hope by the time you are reading this there will have been a good response to my letter and this seat will soon be occupied. However we recognise that many SASG
paediatricians have full College membership and are therefore ineligible to apply. We hope to resolve this by converting one of the two seats on Council restricted to Associate Members to become one for all Staff Grade and Associate Specialist Grade doctors (with the remaining seat representing Associate Members). This will be discussed at our AGM in York in April. Finally we recognise that all the Colleges support their SASG doctors in different ways, so we are organising an Intercollegiate SASG meeting, which will allow us to learn from the good practice of the other Colleges (and so they can learn from our good practice). I hope you will see that we are working at a lot of different levels to capture and respond to your view. At the point of writing, the one issue most SASG doctors are talking about is the proposal for our new contract – the reason I haven’t dwelled on this issue is that by the time you are reading this the ballot may have already been completed. I will be very interested to hear what is decided and I hope it is something we all feel happy about.
In order to improve the skills of trainees in these areas we have developed short, examiner-led courses to help. The emphasis with these courses is not “This is how you pass the MRCPCH...” it is about giving trainees an understanding of how they can improve their skills to make them better in their day to day work. Our colleagues in Egypt have turned to the MRCPCH in order to be able to assess the competence of their own trainees. Egyptians work across the Middle East and Persian Gulf region and, as our examinations there are oversubscribed, it makes sense to incorporate Egypt as a centre. A lot of preparatory work has to be undertaken to ensure an equivalence of standards between any MRCPCH centre, whether the centre is in Cairo or London, the standards are the same. In order to get the locals conversant with these standards they observed the UK-based team putting on the course. The venue for the course was the Children’s Cancer Hospital, often referred to as 57357. This refers to the account number given to the hospital which has been financed entirely from charitable donations from across the globe. It has a truly remarkable history given that approval to establish the hospital was given only six years ago, now the monies have been raised, the hospital is built, and is nearly full functional. It is, I am told, one of the largest oncology centres in the world. EMA-RCPCH has been established to become
the umbrella organisation for paediatrics in Egypt. It aims to act as a focal point for the development of paediatric and child health practice and for leading education and training development. Its first president is Dr Abla El Alfy from Benha Children’s Hospital. Abla has been a driving force behind establishing links between the College and Egypt. All involved agreed that the week’s work had been hugely successful. Course participants gave us glowing feedback on what they had learned, our potential local examiners felt it was a very important piece of professional development for them, and the launch of EMARCPCH was attended by many, many paediatricians from across many centres in Egypt. The team from the UK consisted of Dr Janet Anderson, Dr Roy Harris, Dr Majeed Jawad and myself. I cannot thank them enough for their hard work in advance of the trip and for their efforts whilst in Egypt. My final thanks goes to all those in Egypt who did so much to ensure the event’s success, there are too many to mention. We hope that this week signals the start of a very useful collaboration between the College and colleagues in Egypt.
Dr Nataile Lyth CHAIR OF THE RCPCH SASG COMMITTEE
Graeme Muir HEAD OF ASSESSMENT
RCPCH news
News
Tackling childhood obesity with HENRY and the Glugs
In 2004 a multidisciplinary group was drawn together by the College to explore its role in supporting research into childhood obesity. As no funding was attached, there was a good deal of scepticism about what could be achieved. As it turns out, a process was set in motion that has resulted in the creation of HENRY with £370,000 granted to the College to date, and a further £350,000 to Warwick and Leeds Universities to trial EMPOWER, its academic arm. The impetus for HENRY was a systematic review published in the BMJ showing that infant weight gain was predictive of obesity later in life - rapid weight gain even in the first weeks was associated with increased risk1. As efforts are almost universally focused on school-age children, the review was a wakeup call that “stable doors were being shut after horses had bolted”. This information pointed to urgent need for action in the very early years, especially given the evidence that obesity is already a problem by school entry, that many toddlers’ lifestyles are unhealthy and that children as young as five years already have early signs of atherogenesis. We started with an exploration of what was needed to help young families tackle obesity. Interviews with mothers of obese preschoolers and focus groups of health visitors2 indicated that there was a clear need for training. Health visitors felt they did not have skills or time, and admitted their discomfort about raising the issue of obesity at all. Mothers mirrored their concerns and felt that their needs had not been met. The Group decided to tackle the problem through developing HENRY as an intervention for practitioners working in Sure Start Children’s Centres and beyond. Its approach focuses on enhancing emotional literacy when working with parents around the sensitive issue of obesity and is underpinned by the Family Partnership Approach3. Key components involve improving eating patterns, nutrition, activity and parenting skills. The training is enlivened by the Glugs4, a
group of animals who live on an isolated island and get up to all sorts of escapades as they develop and grow. Among the Glugs are Eartha, the wise earthworm, and Snappy, a crocodile-cum-dragon who cooks for the crew by flambéing food with his fiery breath. Baby Henry is cared for by the whole family and is introduced to healthy living in a fun way. Together with the Glugs team, and with a grant from the Child Growth Foundation, the HENRY team has developed an imaginative toolkit of resources for professionals and parents. In 2007 the Department of Health launched HENRY with a generous grant to the College, closely followed by a further grant from the Department of Children, Schools and Families. Our challenge is to work with staff of Children’s Centres and other early years practitioners to strengthen their work through HENRY training. This is already well under way in Oxfordshire and is moving to Harrow and Leeds later this year. To make the training more widely available an online training programme is also being developed and is due to be piloted with 200 Children’s Centres from April. Alongside HENRY, the EMPOWER HENRY Professional Accreditation Short courses addressing: l Advanced practitioner skills l PCT managerial responsibility l Competence to monitor obesity and targets l Quality monitoring of Henry l Supervision of team HENRY Licence Level 2 l Intensive staff training l Long term support for centre l Parent education programme HENRY Licence Level 1 l Provision of toolkit l On line training
feasibility trial of an intensive health visitor intervention for at risk babies is under way in Leeds and Birmingham. We have hopes that further funding for a second year for HENRY will be made available by the DH. The HENRY Foundation, HENRY’s charitable arm, is being set up to encourage other funding sources. HENRY is ambitious. It aims to address the pyramid of obesity risk at all levels (see diagram). Its strength lies in the strong evidence base that underpins the development of the intervention, along with the academic rigour of the group (already under way in evaluating EMPOWER). Our intention is to seek research funding in due course to evaluate the effectiveness of HENRY as a complex intervention. Professor Mala Rao, Director of Workforce Planning at the Department of Health, expressed her confidence that “HENRY is the answer to turning around the epidemic of obesity”. Let’s hope we can match her expectations! Professor Mary Rudolf Candida Hunt Email: HENRY@rcpch.ac.uk
Very high risk babies & preschoolers
EMPOWER
Children’s Centres in most disadvantaged areas
Glugs HENRY
Population attending Children’s Centres
The whole preschool population
THE PYRAMID OF OBESITY RISK AND HENRY’S PLANS TO TACKLE IT The RCPCH Obesity Research Group Professor Mary Rudolf Paediatrics, Leeds Candida Hunt HENRY Programme Director Prof Jane Barlow EMPOWER lead, Warwick Dr Mitch Blair Paediatrics, Northwick Park Dr Kati Hajibagheiri SpR paediatrics, Imperial Coll. Prof Carolyn Summerbell Nutrition, Teeside University
Dr Penny Gibson Prof Sarah Cowley Prof Tim Cole Professor Hilton Davis Dr Pinki Sahota Prof Sarah Stewart-Brown
RCPCH Advisor on obesity Health visiting, KCL Biomedical statistician, ICH Psychologist, KCL Dietetics, Leeds Met Warwick University
1
Baird J, Fisher D et al. Being big or growing fast: systematic review of size and growth in infancy and later obesity BMJ 2005; 331: 929-31 Edmunds L, Mulley B, Rudolf MCJ. How should we tackle obesity in the really young Archives of Disease in Childhood 2007; 92 (suppl 1) A75 Davis, H., Day, C. & Bidmead, C. Working in Partnership with Parents: the Parent Adviser Model 2002. Harcourt Assessment 4 www.theglugs.com © Haberman LLP 2 3
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Trainees Trainees’ column Spring Meeting 2008
MMC
This is one of the most important events in the College Calendar. It runs from 14th-17th April. The Spring Meeting is the College's main forum for the presentation of basic and clinical science, together with updates in clinical practice in both general and subspecialty paediatrics. As well as being an educational forum, York provides an excellent background and friendly atmosphere for trainees from around the country to meet. As usual we will be holding the Trainee’s meeting on Wednesday 16th April at lunchtime. This is the ideal opportunity for trainees to voice their opinion about any issues that they have in training. Last year the transition into MMC was nothing short of volatile. Many issues have been successfully addressed. Several remain. It is vital that trainees provide us with their views so that we can effectively deal with the current problems and identify new areas that need to be worked on. Senior members of the College have always been present at this meeting to answer your questions. Please keep an eye out for exact times in the registration pack. Lunch will be available on request.
Recruitment into Specialties is underway. Recruitment into Paediatrics as with the majority of specialties will operate locally, based upon national principles. Trainees are encouraged to regularly check the MMC website for updates. Trainees are expected to accept or decline offers with 48 hours of receipt. There are ongoing discussions regarding the introduction of new methods of recruitment into ST1 for 2009 and pilot schemes are being formulated to identify suitable specialty specific methods of recruitment. In addition, work is underway to formulate a new system for national recruitment in England and Wales.
Trainee Social Event: Spring meeting 2008 This year we are organising a Trainee Social Event on the Wednesday evening on the York Campus. After a busy day at the York meeting, this is the ideal opportunity to meet with friends and colleagues. There will be food available for a small price and we have invited one of the Senior members of the College to give a presentation.
Academia Interviews have now taken place for Academic Clinical Fellow (ACF) posts and appointments are being made. Following the first round of appointments, the remaining posts will be advertised locally. I would encourage trainees who are interested in Academic Paediatrics to seriously consider one of these posts. The ACF’s provide a solid base to gaining experience in both clinical medicine and research. During these posts, trainees will prepare for establishing a significant research project to obtain the degree of MD or PhD.
PMETB Over the Christmas period, The Postgraduate Medical Education and Training Board issued a consultation regarding the fees for CCT and CESR (Article 14). PMETB have stated that they intend to increase the CESR fees by approximately 50% to £1250, with other fees rising with the rate of inflation. This has been on the background
The Royal College of Paediatrics and Child Health is moving! After Easter 2008, our address will be: 5-11 Theobalds Road, London WC1X 8SH Our new telephone numbers are: Tel: 020 7092 6000 Fax: 020 7092 6001 There will also be individual direct dial numbers, which we shall let you have as soon as we can.
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of discussions with the Royal Colleges based upon the limited funding that the Colleges have previously received for processing CESR applications. The Trainees Committee through the Academy of the Medical Royal Colleges Trainees Group has strongly opposed this move following discussions with regional trainees. Whilst we understand the pressing need for the RCPCH to receive extra funding for processing CESR applications, we feel that the burden of this considerable levy should not rest solely with trainees. The Trainees Survey issued by PMETB has now closed. The results of the survey should be available by the middle of this year. In addition, the Trainers survey has now commenced. PMETB have released a booklet for Trainees describing their role, responsibilities and remit. PMETB have also included a trainee’s directory section which can point readers in the right direction for further information around their training. Trainee stakeholders have had a significant input into the development of this guide. I would encourage trainees who are interested in education and training to download this from the PMETB website.
Trainee Section on the RCPCH Website This is now well established. Profiles of your regional representatives and their deputies should be available shortly with their details. I would encourage to trainees to contact their regional representatives regarding issues they have with training.
Dr Paul Dimitri pauldimitri@hotmail.com
RCPCH news
Meetings RCPCH meetings UK meetings and courses
2008 14-17 April RCPCH 12th Spring Meeting University of York Registration is now open at: www.rcpch.ac.uk/Education/Events/ RCPCH-Annual-Spring-Meeting You will need your membership number (this appears in the Handbook) and an email address. On completion of your registration, you will receive confirmation by email. To keep costs down, payment is by debit (preferred) or credit card (excluding American Express) in advance. Registration help is available from:
14-18 April Developmental Paediatrics and Special Needs Venue: Warwick Medical School, Coventry Contact: Annette Finn Tel: 024 7652 2035 Email: cpdenquiries@warwick.ac.uk 22 April Childhood illnesses-where paediatrics meets child mental health Venue: Liberty Stadium, Swansea Contact: Andrea Torok Tel: 020 7290 2986 Email: paediatrics@rsm.ac.uk Website: www.rsm.ac.uk/academ/pde105.php 29 April Autism and Aspergers Syndrome (RSM) Venue: Birmingham Contact: Chloe Waite Tel: 020 7290 3844 Email: chloe.waite@rsm.ac.uk Website: www.rsm.ac.uk/academ/ autismbham.php 30 April 2008 - 1 May Accredited Course in Child Protection Training Venue: City Hospital, Birmingham Tel: 0121 333 8710 Email: d.reay@bham.ac.uk
Website: www.rcpch.ac.uk Email: Saheeda.rahman@rcpch.ac.uk or Aaron.barham@rcpch.ac.uk Telephone: 020 7307 5632 or 020 7307 5633
Advocacy
30 April Why Children Die Venue: British Library, London Contact: Nicola Cogdell Tel: 020 7467 3219 Email: nicola.cogdell@cemach.org.uk Website: www.cemach.org.uk
Dr Tony Waterston CHAIR OF ADVOCACY COMMITTEE
Advocacy guide Please look in the publications section of the College website under A for Advocacy. There you will find an updated version of ‘Advocating for Children’, the guide for paediatricians on how to be an effective advocate. Bursting full of information on methods and techniques, using the media, writing to decision makers and the all-important ‘levers for change’, this is essential reading for all paediatricians – and particularly trainees – at a time when services are under threat, and children remain the most vulnerable members of the community. Concerned about child protection, school based services, bullied children or the problems of asylum seeker families? This guide will help you to lobby and to speak out effectively for children and their families. Make sure this guide is on your hard drive and available to you at all times as for sure, children need your support.
13-14 May Court Skills in Child Protection (England and Wales) Venue: RCPCH, London Contact: Aaron Barham Tel: 020 7307 5633 Email: aaron.barham@rcpch.ac.uk Website: www.rcpch.ac.uk/Education/ Education-Courses-and-Programmes/ Court-Skills-in-Child-Protection 12-16 May Diploma in Paediatric Nutrition 5-day College Diploma Course Venue: Chilworth Manor Hotel, Southampton Contact: Education Projects Administrator Tel: 020 7307 5644 Website: www.rcpch.ac.uk/Education/ Education-Courses-and-Programmes/ Diploma-in-Paediatric-Nutrition 15 May Developmental origins of health and disease Venue: The Royal Society of Medicine, London Contact: Nicole Leida Tel: 0207 290 3946 Email: nicole.leida@rsm.ac.uk Website: www.rsm.ac.uk/academ/ dohdisease.php 3 June 7th Dermatology for Paediatricians Course Venue: Birmingham Heartlands Hospital Contact: Dr Helen Goodyear Email: helen.goodyear@heartofengland.nhs.uk
Going carbon neutral With this newsletter you will find a flyer advertising a conference to be held in the new College building, on Monday 30th June 2008. Be sure that someone from your Trust comes to this meeting as you will learn how to reduce your hospital’s carbon footprint and follow the RCPCH down the route to becoming carbon neutral. Sometimes it seems the NHS is the last one to recognise the threat to our environment from global warming, but there are good examples about and they will be presented on the 30th June. The meeting is jointly organised with the BMJ and Faculty of Public Health and will include ideas on carbon free conferencing, the myths and reality of offsetting, and how to save a trust thousands of pounds in waste, which could go towards expansion of children’s services. Using the experience gained in tackling its own carbon footprint, the RCPCH is in the lead in tackling the number one public health threat in the new millennium. Make sure you are there.
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