Enhancing perceptions of paediatrics and stimulating specialty recruitment using simulation

Introduction

Paediatrics, like many specialties within the UK and Ireland, is experiencing a decline in applications for specialty training.¹ Reasons include perceptions of poor flexibility, an arduous training programme and lack of adequate career guidance and support.²

In the UK, the transition between foundation-level training and specialty training is an uncertain and stressful time.³ In fact, in recent years applications to specialty training are decreasing despite the number of training posts increasing. In 2016, only 50% of foundation 2 doctors reported that they would enter directly into specialty training.⁴

The Royal College of Paediatrics and Child Health (RCPCH) suggests strategies to increase recruitment should include exposure to educational opportunities.² There is currently no evidence on the use of simulation as a tool to enhance specialty recruitment.

We believe that allowing access to simulation training allows us to showcase our specialty as an acute, stimulating and exciting career. It permits us to challenge the misconception of paediatrics as a ‘soft speciality’. We can address trainees’ concerns regarding the recognition of the sick child. Furthermore, it affords the trainees an opportunity to enhance their curriculum vitae prior to specialty application and interviews.

Methods

We designed, delivered and evaluated ‘A Foundation in Acute Paediatrics Simulation’ (FAPS) course aimed at offering foundation doctors an introduction into the specialty and the management of common paediatric conditions.

This initiative was approved by the Foundation Programme Director of the Northern Ireland Medical & Dental Training Agency (NIMDTA). This course was specially designed to run in the weeks prior to the opening of the national specialty application process.

The programme included the following:

• An introductory promotional video, created by the RCPCH, highlighting the benefits of a career in paediatrics.

• Access to a highly experienced interprofessional faculty who provided an insight into a career in paediatrics, including their personal career perspectives.

• Opportunity for group discussion and tailored career advice.

• Simulated scenarios on recognition and management of the acutely sick child (figure 1).

• Hands-on practice with simulation neonatal and paediatric models.

• Tutorials on airway management, paediatric sepsis and basic life support.

Figure 1.

Multiprofessional simulated scenario highlighting team approach to acutely unwell child.

Clinically relevant interactive simulation scenarios offered the candidates the opportunity to work alongside colleagues and encounter common paediatric conditions, developing their clinical acumen and enhancing non-technical skills such as leadership, teamwork and communication.

We evaluated this course by gathering presession and postsession feedback as part of our department’s ongoing educational service development programme. The questionnaire used a 5-point Likert scale and open-ended questions.

Results

Sixteen candidates took part in the pilot FAPS course. Of these, 8 (50%) had no other opportunities to experience paediatrics during the foundation programme. Prior to the course, 11 (69%) of 16 candidates were unsure whether they intended to apply for paediatrics. Following the course all 11 of the ‘unsure’ candidates indicated that that they were more likely to apply (mean score 2.9 before vs 4.0 after; 1—very unlikely, 3—undecided, 5—very likely to apply).

All 16 (100%) candidates felt more confident in the assessment of the unwell child following the course, and all would recommend this course to peers.

Analysis of the free-text comments revealed two common themes.

The first theme was recognition of the sick child: “Importance of critical language”, “sepsis 6 adaptation for children”, “confidence in recognition of an unwell child” and “early senior help”.

The second theme was enhancing perceptions of the specialty: “hands on”, “very interesting and useful”, “developed my confidence”, “useful information about a career in paediatrics” and “I have not had any paediatrics since fourth year medical school so great introduction to speciality”.

A follow-up survey at 6 months revealed 9 (57%) candidates had applied or are considering applying to a career in paediatrics, and all referenced the FAPS course as an integral stimulus to their application.

Discussion

This is the first reported use of simulation to enhance specialty recruitment. This course affords an opportunity to gain access to motivated clinicians while experiencing common paediatric conditions in a safe, simulated learning environment.

It was extremely well received by the candidates, the faculty and the regional training agency (NIMDTA). Although the numbers are small, the results demonstrate that the candidates were subsequently more likely to apply to paediatric training. We were able to display that paediatrics is an acute, dynamic and stimulating specialty. It afforded candidates the opportunity for practical experience in basic and advanced paediatric resuscitation skills, and the results revealed an increase in confidence.

One limitation of this project is that those who attended the course may have had a pre-existing interest in paediatrics; however, this was not reflected in the presurvey assessment, which revealed that most candidates were undecided on a specific career pathway.

Our initiative is an ideal adjunct in actively helping to address the current plight of low trainee recruitment in paediatrics. We believe simulation is a unique and underutilised tool that should be used to stimulate interest and enhance recruitment to the specialty and could be easily replicated in other areas.