The review of academic paediatrics by Winyard et al¹ identifies an ongoing crisis in recruitment and retention. They seem cautiously optimistic that the introduction of Modernising Medical Careers (MMC) and its dedicated academic clinical fellowship (ACF) programme will halt this decline. We are concerned that the proposals will not be sufficient in Scotland.

Of the 50 ACF posts dedicated to paediatric/child health specialties in the first round, 40 were within London and South England deaneries. Only 10 cover the remainder of England, with all “general paediatric” ACFs being in the Nottingham area.² The second round has an additional nine paediatric ACFs of which a further three are in London.³ Information on Scottish ACFs is difficult to locate for enquiring trainees but six posts per annum are identified that could be used as ACFs.⁴ Paediatrics is not specifically mentioned or included in the specialties where “national shortage has been identified”. The lack of awareness of the academic strand of MMC is further evidenced by its omission from the teaching material regarding applications provided by NHS Education for Scotland.⁵

The importance of an academic “role model” is highlighted again.⁶ Who will act as inspiration to foundation trainees and those within paediatrics to consider academia as a career choice? We conducted a postal questionnaire survey of west of Scotland specialist registrar (SpR) trainees over 5 years to establish academic contribution at time of appointment to SpR grade. Thirty four of the 35 trainees responded (97%). Presentation at national or international level was recorded for 20 trainees (58%) with a total of 64 presentations, skewed by a single trainee with 22 presentations. Publication was poor. Only 13 (38%) had any publications at time of appointment. The total of 44 publications by these trainees is also skewed by the same single trainee with 16 publications. Trainees indicating a desire for neonatology or a paediatric hospital-based sub-specialty were more likely to have publications or presentations than general or community trainees. If these results are used as a proxy for academic prowess, similar to the Research Assessment Exercise, Scotland is breeding a generation of consultants with limited experience of the vagaries of research. This can only contribute to the “negative attitudes displayed by some non-academic paediatric mentors”.

Academic paediatrics has been declining and Winyard et al rightly point out that MMC may re-invigorate this vital arm of the specialty. The Scottish experience and poor recognition of this aspect of MMC suggest that “North of the Border” this is too little, too late.