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Three generations of paediatric training
  1. Lionel P Balfour-Lynn1,
  2. Rosie E Balfour-Lynn2,
  3. Ian M Balfour-Lynn3
  1. 1 Retired, London, UK
  2. 2 Department of Paediatrics, Whipps Cross University Hospital NHS Trust, London, UK
  3. 3 Department of Paediatric Respiratory Medicine, Royal Brompton Hospital, London, UK
  1. Correspondence to Dr Ian M Balfour-Lynn, Royal Brompton Hospital, Sydney Street, London SW3 6NP, UK; i.balfourlynn{at}

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In the UK, the life of a paediatric trainee has undoubtedly changed over three generations, spanning the last 70 years. LPB-L, who is retired, started training in the mid-1950s; his nephew IMB-L, a consultant, started in the mid-1980s; and his daughter REB-L, is a first-year trainee in the 2020s. It has certainly changed, but is it always for the better?

Medical school

Paediatric education starts at medical school and has not changed appreciably in the UK. It still plays second fiddle to adult medicine and surgery, placements generally being for 2 months only out of 3 clinical years, sometimes with optional extra time available in electives. In the 1950s, the huge majority of students were male, in 1980 60% were male, but currently 43% of the intake are male.1 2

Training structure


Paediatric training was not formalised, one applied for jobs at a junior level, and then after a few years applied for a more senior post, until eventually becoming a consultant. One could apply for a post as soon as the next one came up if unsuccessful at a previous interview. Patronage from the consultant was most important, and references were critical, especially the phone call from your boss. The ‘old boy network’ was definitely in play. Training was essentially an apprenticeship learning on the job, formal teaching did not exist aside from the hospital grand rounds. Experience gained was huge due to the extremely long hours spent at work, although often unsupervised by a senior paediatrician; consequently, trainees were more confident and experienced sooner in their careers for decision-making. There was no concept of appraisals or assessments. Learning …

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  • Contributors All three authors contributed equally to the content of the paper. IMB-L wrote it with the other two authors editing.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Author note Dedicated to the first Dr Balfour-Lynn – Stanley. Brother, father and grandfather. An inspiration to us all.