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• Shape of Training and Integrated Child Health
  Robert E Klaber
  Published on: 1 April 2015
• A response to 'Shape of Training: the right people with the right skills in the right place'
  Graeme M. Denman
  Published on: 3 March 2015

• Published on: 1 April 2015

  Shape of Training and Integrated Child Health

  • Robert E Klaber, Consultant Paediatrician
  • Other Contributors:
    • Daniel E Lumsden, Camilla Kingdon

  Thank you for your response to our article on Shape of Training, and for sharing your interesting and innovative programme for GP registrars in Northumbria, UK.

  We know of a number of different innovative 'integrated child health' programmes that are emerging across the UK and would encourage clinicians and educators innovating in this area to continue to evaluate programmes and to share learning. Your experienc...

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  Thank you for your response to our article on Shape of Training, and for sharing your interesting and innovative programme for GP registrars in Northumbria, UK.

  We know of a number of different innovative 'integrated child health' programmes that are emerging across the UK and would encourage clinicians and educators innovating in this area to continue to evaluate programmes and to share learning. Your experience is an interesting challenge to the idea that hospital-based 6 month placements are the only possible way to train GP trainees in paediatrics and child health. While we would be very supportive of the expansion of the GP training programmes so that all trainees experience placements in paediatrics and child health, we would encourage this to be done in a way that supports the progression of a much more integrated approach to paediatrics and child health.

  If we are to produce the best child health work force possible, it is crucial that the training experience of all doctors on non-paediatric training programmes (e.g. GP, Anaesthetics, Emergency Medicine etc) in paediatric placements is thoughtfully catered to their specific training needs. This requires adaptability in rota design, and care and attention from the clinicians and educators who supervise and support these trainees.

  Conflict of Interest:

  Competing interests as per the original article

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  Conflict of Interest:
  None declared.

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• Published on: 3 March 2015

  A response to 'Shape of Training: the right people with the right skills in the right place'

  • Graeme M. Denman, GP Registrar
  • Other Contributors:
    • Professor Helen Foster, Dr. Karen Thompson and Dr. Sharmila Jandial

  We welcome Kalber et al's article on the 'Shape of Training', particularly in relation to the needs of primary care clinicians and wish to share with the authors our experience of innovative primary care training.

  Paediatric rheumatology is an exemplar of a paediatric subspecialty focussed on the management of specific diseases, such as Juvenile Idiopathic Arthritis, by multidisciplinary care. One of the challe...

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  We welcome Kalber et al's article on the 'Shape of Training', particularly in relation to the needs of primary care clinicians and wish to share with the authors our experience of innovative primary care training.

  Paediatric rheumatology is an exemplar of a paediatric subspecialty focussed on the management of specific diseases, such as Juvenile Idiopathic Arthritis, by multidisciplinary care. One of the challenges faced by our specialty is identification of appropriate patients requiring our care, amongst the many children who may present to primary care. Musculoskeletal complaints are common; the busy primary care doctor requires skills and knowledge in order to identify which children require on-going referral and those who can be managed in primary care.

  Paediatric training is not mandatory in primary care training, and paediatric subspecialty training may not be viewed as useful. However, we were fortunate to be involved with the Northumbria GP vocational training scheme and piloted an integrated training programme (ITP) involving paediatric rheumatology. ITPs offer registrars within the Northumbria GP vocational training scheme the opportunity to spend half their working week in general practice, and the remaining time in a hospital or community specialty. The placement, for one year, also offers a place on the Certificate of Clinical Education programme run by Newcastle University, with formal tutoring on the principles and practice of teaching, regular opportunities to teach medical student in the paediatric setting with feedback from experienced physicians, as well as teaching and assessment of students when in primary care. Three years later this scheme is still in place and has been of enormous benefit to all involved: the GP registrar, the GP trainers and training practice, the paediatric rheumatology multidisciplinary team (MDT) and patient care.

  Our approach to GP registrars based with us in paediatric rheumatology has been in keeping with the ethos of this article; the 'themed area' that trainees are exposed to is that of chronic disease in childhood, how this affects the child and family unit, and how the MDT operates to support the child and family. The learning experience within paediatric rheumatology offers many transferable messages to paediatrics as a whole - clinical assessment, approach to investigations, managing children with chronic disease, MDT working, safeguarding and transitional care. In addition, in new patient clinics, the GP registrar is encouraged to reflect on the referral process and how this can be improved, including training and feedback to referrers where appropriate. We believe that this opens channels of communication between the primary care and hospital based care interface that can only benefit patient care. The scheme has been of great benefit to the hospital team, learning about the challenges of assessing children from the primary care perspective and how to optimise our communication with the health care providers in the community to support families.

  The GP registrars report improved confidence in assessing children with musculoskeletal presentations, as well as recognising red flags of when to be concerned, knowledge of the referral process and when to consider referral to orthopaedic or rheumatology, and identifying those children who can be managed through community-based occupational or physiotherapy. Furthermore the knowledge and skills gained by the GP registrar are shared with primary care colleagues in clinical and supervisory meetings, thus cascading knowledge at a local level, improving awareness of musculoskeletal presentations and how to manage them. GP trainers report increasing confidence amongst GP registrars with regard to patient assessment in primary care and communication at the primary / hospital care interface. Overall, the scheme has been a successful exemplar of a novel approach to training for primary care registrars with mutual benefit to all concerned; this echoes the views of the authors on integrated primary care and paediatric training posts as a way forward to improve the care of children.

  Conflict of Interest:

  None declared

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  Conflict of Interest:
  None declared.

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