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The scenario: You want to become an academic paediatrician. You undertake the necessary training and postgraduate examinations, and obtain a National Training Number (NTN). You then obtain a university-funded Clinical Lecturer post, at the end of your Specialist Registrar (SpR) “core training”. Interestingly, there has been a marked 25% reduction in Clinical Lecturer posts in the past five years.1 Despite the attached clinical commitments, the post would hopefully provide valuable laboratory based research, ultimately leading to a higher degree.
First problem: The post is in a different deanery and does not have an attached NTN. Over 15 months later, 69 extended letters (including multiple copies), and marked “external” pressure from both former and current deaneries, you eventually manage to transfer the NTN. The apparent lack of communication between the deaneries, the uncertainty over the NTN transfer, and personal “turmoil” over moving residence and starting in the vastly different world of laboratory science, cause intense personal anxiety. Despite the introduction “Calman” scheme in Paediatrics in 19962 and the potential for inter-deanery transfers, it appears easier to move for personal reasons, such as a partner moving, than for obvious academic reasons.
During the latter stages of your research time, you think about specialising in paediatric intensive care medicine (PICM). The recent introduction of “grid numbers”3 within paediatric specialties has enabled trainees to receive regional subspecialty training, but at the cost of potentially alienating SpRs that joined the Calman scheme prior to its inception, who have already undertaken a substantial proportion of their paediatric training. During this “transition” phase, some SpRs wishing to subspecialise face an uncertain future.
Second problem: With the current deanery wishing to recognise “some” of the research time towards your certificate of completion of specialist training (CCST), you do not have the minimum 24 months necessary to commit to a PICM grid post. You frantically write and speak to everyone involved with PICM training issues locally and nationally, including the Royal College of Paediatrics and Child Health (RCPCH), to resolve the matter. Countless e-mails later, you come to the realisation that you are very much alone in this “fight” to secure an academic subspecialty! The most frustrating aspect is that nobody, including the RCPCH, appears able to support you in your quest to obtain the necessary training, so that as a consultant you have all the necessary skills and experience. An additional problem may be that any clinical experience obtained in the hospital unit may not be recognised by the subspecialty committee to count as recognised training in your chosen specialty. At the end of the day, the deanery and specifically the postgraduate dean alone, dictates the time available for your training. After approximately eight months of uncertainty, I still await an extension to my CCST date. Furthermore, at the prime of my research, I have really questioned the cumbersome bureaucracy that seems to stifle the enthusiasm and aspirations of those who are prepared to make major changes to their own and their family’s lives to achieve their career goals.
Despite the Calman reconstruction of the middle grade staff training to “produce a shorter, more structured and organised training pathway so that independent clinical competence as a consultant can be achieved much earlier than in the past in many disciplines”,4 SpR training has not been shortened.5,6 Indeed, the average time to complete a five year CCST programme is over six years, with 47% of trainees having their CCST date reviewed.5 Postgraduate deans are obviously under “pressure” to implement the UK national directive to increase consultant paediatric numbers substantially over the next 5–10 years, which will require the delivery of suitably trained doctors. The danger is that the system nudges along the less motivated trainees, without necessarily encouraging trainees wishing to “branch out” and pursue interests in their chosen field. One such group that Calman appears to have neglected is academic trainees. The rapid decline in academic trainees and suitable posts in the UK must be of major concern to everyone.7,8 Despite this apparent demise, there appears to be genuine interest in undertaking research among paediatric SpRs, even if they do not have the necessary skills, training, or opportunity to undertake this within their Calman training post.9
What are the possible solutions? Above all, academic trainees need be encouraged and nurtured. Anyone involved in research will become disillusioned and frustrated at some point, but to face endless bureaucracy and time constraints over your paediatric training and CCST, is both unnecessary and pointless. In the end, all that will happen is that trainees with real academic promise will be discouraged even before they start. If deaneries are to continue to manage SpRs with subspecialty and/or academic interests, there needs to be closer links with the RCPCH and in particular the relevant College specialty advisory committees. In addition, at a local level, a “mentoring” system for future academic trainees needs to be established, primarily to encourage research ideas and methodology, but also to provide a support network. If training issues are not addressed, the future of subspecialty and academic paediatrics in this country appears bleak. On a closing note, although I know I am not unique in this situation, I really question whether I would have made the same choices, if I knew the obvious limitations of the current training scheme!