This is not any easy decision to make. Limited exposure at medical school, few posts included in the foundation programme and the tertiary nature of the specialty can make paediatric surgical experience difficult to attain. A typical GP workload does not include many paediatric surgery conditions and it is far removed from adult surgery in many aspects. So how do you find out if it is for you? And how do you get into the speciality if it is?
A small specialty with a broad range of conditions.
Paediatric surgery is often thought of as the cross over between paediatrics and general surgery. In truth, it is quite different from both in terms of the breadth of practice, philosophy and personalities involved. Paediatric surgery has been described as the “last true bastion of general surgery”. While adult general surgery has become increasingly subspecialized (e.g. upper GI, HPB, Colorectal, Vascular, Breast), general paediatric surgical practice still covers aspects of head and neck, thoracic, abdominal and gynaecological surgery and includes preterm neonates right through to adolescents. Although oncology, urology and hepatobiliary surgery are now subspecialty areas, these surgeons often still cover the general emergency take. This means that, while most adult surgeons will do a limited number of surgeries in their elective practice and refer on the emergency “take” to their speciality colleagues, most paediatric surgeons cover a huge plethora of anatomical regions, operations and age groups. In any given week on-call, a paediatric surgeon may perform a laparotomy for necrotising enterocolitis on a <1kg premature neonate, repair a congenital malformation such as oesophageal atresia, deal with infant conditions such as intussusception or volvulus, and manage teenagers with appendicitis or traumatic injuries. The rare is the norm in paediatric surgery.
Paediatric Surgery Curriculum:
Paediatric surgery requires strong interpersonal and communication skills. It is unique in that the interactions are frequently with the parent or caregiver rather than the patient themselves. A paediatric surgeon must be able to communicate with anxious new parents, expert parents of children with chronic disease, young children, teenagers, and everyone in between.
The small size of the speciality can make getting adequate exposure difficult. There are relatively few available jobs in limited centres. This does however provide a platform for collaboration. The small size has also created an intimate specialty with a great community feel with most people knowing each other at all the major meetings and training days.
How to find out more?
Medical School and Foundation Training
Although some medical schools and foundation training programmes do include placements in paediatric surgery, these are few and far between. However, most medical schools do offer student selected components, or projects, in a field of interest so this may be a good avenue to explore. A medical school elective also provides a great opportunity to gain paediatric surgical experience either in the United Kingdom or overseas.
Taster weeks (leave for these is provided during foundation training) can also be arranged with your local paediatric surgery unit and most units would have several projects available to those that show an interest. Many university surgical societies organise career events and TRiPS are always happy to support these.
Core Surgery Trainees
There are some paediatric surgery themed core training posts available including London, Oxford, Southampton, Norwich and Bristol. There are normally only one or two posts per region so these can be relatively competitive. Ideally, these should be allied to at least 12 months of adult general surgery. However, do not worry if your core surgical training does not include paediatric surgery, surgical exposure through adult general surgery is the most important experience and you can still approach your nearest paediatric surgery unit as described above. Furthermore, many district general surgeons have a paediatric interest.
We advertise courses through the BAPS, ASiT and RCS websites and circulate these through the TRiPS mailing list (email [email protected] to be included). The ASiT conference includes a (now virtual) paediatric surgery pre-conference course and specialty village, organised by TRiPS. There is also (again, currently virtual) a Preparing for ST3 (P4ST3) course run by ASiT and the RCS with paediatric surgery breakout sessions. We are, of course, happy to field questions via our email or twitter accounts too.
Paediatric Surgery Shape of Training
Following completion of core surgical training, recruitment is at ST3 level through the National Selection process. Run-through training (with ST1 level recruitment) is being piloted in the Birmingham/Bristol/Cardiff, North West and Scotland consortia in 2021.
The training deaneries (consortia) are set up differently, and cover wider geographical areas, than other specialities. The map shows the consortia and how many numbered training posts there are in each centre. During the 6 years of training, each trainee rotates through a number (usually between 3 and 6) centres, gaining a breadth of experience including general surgery of childhood, oncology, urology, thoracic, upper and lower gastrointestinal surgery. This often entails significantly more movement around the country between centres when compared to other surgical specialties.
It is worth mentioning that not all consortia have available training numbers each year, so a certain degree of flexibility regarding location may be required. Interdeanery transfers are possible but there are strict eligibility criteria.
Similar to the Foundation and Core Surgical Training Programmes, trainees are assessed regularly through workplace based assessments and an Annual Review of Competency Progression (ARCP). Compulsory courses and publication requirements are due to be removed from the Certificate of Completion of Training (CCT) requirements. Currently, the recommendation is for trainees to sit the FRCS once they have received a favourable ST6 outcome and are signed off for the exam by 2 consultants. For more information on the exam see https://www.baps.org.uk/education/exam-guide/ and https://www.jcie.org.uk/content/content.aspx?ID=18
National Training Representative 2018-2020
National Training Representative 2020-2022