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BackgroundTired doctors make mistakes and excessive workload is a key driver to burnout, creating exhausted, cynical and ineffective individuals. The RCPCH, RCEM and BMA recognised this, having designed a framework for managing fatigue and stipulated rest break entitlements according to hours worked.But how does this translate to the realities of a busy emergency department (ED)? Despite written and verbal encouragement about break entitlements, doctors reported challenges to the timely access to all entitled breaks. With additional pressures of a global pandemic, we recognized the importance of having a well-rested workforce. We therefore set out to identify and address challenges our ED staff were facing in taking breaks.ObjectivesTo introduce a break-system that ensures doctors have a 30-minute break for every 4 hours worked in a Children’s Hospital ED.MethodsWe undertook a 36-week project using plan-do-study-act (PDSA) cycles. Each intervention was evaluated to assess reported percentage of time breaks were taken and time required to coordinate breaks. Qualitative data was collected to inform interventions and subsequent cycles. PDSA Cycles P Survey designed: quantitative questions to identify baseline; qualitative questions to identify barriers, ideal time to take breaks, and staff suggestionsD Staff surveyedS Results analysedA Intervention 1: Introduction of the ‘breaks board,’ which facilitated allocation of break slot(s) at start of shift. Launch accompanied by creation of guideline for use and staff education. Details incorporated into induction program to make it the usual practice for new starters.P Design of resurvey to evaluate interventionD Staff surveyedS Results analysedA Intervention 2: printing of permanent boards for both COVID and non-COVID sides of ED; staff education; incorporating breaks allocation into template of daily board round/huddle.ResultsIntroducing a formalised breaks system via a break(s) allocation board resulted in a greater percentage of time staff reported taking both their first and second break, and reduced the time required to coordinate each break (see table 2). It did however demonstrate that the taking of a 2nd break in a 10-hour shift is still a challenge, requiring further attention.Abstract 1387 Table 1 Reported average: Percent of time 1st break taken Percentage of time 2nd break taken Time taken to coordinate each break Pre-Initiative 90% 32% 4.5 min Post-Initiative 97% 51% 2.2 min Improvement 7% 19% 2.3min 88% of people reported the breaks board helped them coordinate and take breaks. Staff reported that it ‘has been an excellent initiative’ ensuring ‘the team are proactive about everyone having their break.’ Our future work will focus on ensuring the longevity of the change, by creating a culture change in order to get the ‘whole team to fully adopt it.’ For the next cycle we plan to do this by introducing break champions or seniors who encourage ‘everyone to put their times at huddles/handovers. ConclusionsThe Breaks Board initiative reduces time required for staff to coordinate their breaks, increases people taking their breaks, and is felt by the majority to be a helpful breaks system.

ObjectivesThe attrition rate during the early years of paediatric training in the UK remains a significant concern. Thus, it is important to ensure ST1 doctors are sufficiently supported from the outset of their training. The West Midlands Paediatric Trainees’ Committee have developed a ‘Welcome to Paediatrics’ day for new paediatric ST1 doctors, one day before their official start of training. The ‘Welcome to Paediatrics’ day aims to improve the confidence of ST1 doctors before commencing their first paediatric training post and to cultivate a sense of wellbeing.MethodsNewly recruited ST1 doctors in the region were invited to attend a ‘Welcome to Paediatrics’ face-to-face induction event. The training day consisted of a series of talks and workshops with topics such as portfolio, examinations and an open faculty-led conversation about challenges in paediatrics. Pre and post-event surveys were conducted before and after the event to evaluate the main concerns and to assess the impact of the event. The surveys consisted of open-ended questions with a Likert scale assessing confidence.ResultsThere were 28 and 17 responses for the pre and post-event survey respectively; all responses were anonymous. Braun’s framework was used to conduct a thematic analysis of the responses. The primary concerns of new ST1 doctors identified in the pre-session survey were broadly divided into six categories: portfolio, knowledge and skills expected, neonates, work-life balance, work environment and exams. In the post-event survey attendees focussed on the positive environment in which the event was conducted, with a particular focus on the benefit of honest reflections and discussions centered around wellbeing. The themes that attendees found most useful in the post-event survey included: wellbeing, portfolio, less than full time working and peer networking. Following the event there was a marked increase in confidence with 94% of attendees feeling ‘confident’ or ‘very confident’ after the event, compared to only 44% before the event.ConclusionsThe ‘Welcome to Paediatrics’ day increased the confidence of ST1 doctors starting paediatric training in the West Midlands. ST1 doctors appreciated the two-pronged approach, which provided both practical information as well as an emphasis on wellbeing. A similar day could be arranged in different deaneries and for different specialties.

AimsPassing the MRCPCH Clinical exam is an important milestone in paediatric training, marking the transition of paediatric trainees from junior to senior training. Support for candidates varies by hospital, depending on the availability of tutors and the workload of each department.The COVID-19 pandemic led to redeployment of staff, increased workloads, and changes in the format of the MRCPCH clinical exam, switching from in-person to virtual examination. Candidates had to adapt to all these challenges simultaneously. We identified that providing additional support to candidates was critical to their preparation, maintaining their confidence, and ensuring their success, whilst also improving their welfare during this difficult period.MethodsWe designed the 5-week West Midlands Paediatrics (WMP) exam preparation programme which included these core elements:• Weekly consultant-led communication teaching• Weekly buddy group teaching and peer mentorship• Online resources: specialty lectures by Grid trainees available via YouTube• IMG focused workshops and seminarsTo improve accessibility, all sessions were conducted online via Zoom or Microsoft TeaAll mentors were provided with a bank of cases and questions based on a weekly theme to reduce the preparation time required to facilitate sessions.ResultsFollowing the initial implementation of the programme, feedback was collated from 24 traineesConsultant Teaching• 88% of candidates found the consultant teaching useful.• Candidates appreciated getting feedback from consultants who are also clinical examiners and the opportunity to practice the exam in real time.• Most candidates said having more sessions would ensure each candidate gets individual feedback following the practice sessions.Buddy Group Teaching• 80% of candidates found the buddy group teaching useful• Candidates found that this provided another platform to practice and gain feedback and learn from different candidates in the groups.• Candidates felt it could be improved by providing more support with issues such as work-life balance and well-being.• Some trainees also reported difficulties accessing the buddy group sessions due to conflicting schedules.Teaching strategy• 92% of candidates said they would like more specialty and case-based teaching• 38% of candidates would like more lecture-based teachingCandidates found the following resources most helpful:• Consultant Teaching• Buddy group and mentorship• YouTube lectures and Video resourcesPass Rate66% of candidates passed the MRCPCH Clinical exam following the programme.Mentor Recruitment88% of candidates said they would be happy to become mentors after passing their clinical exam.Candidates recommended hospital-based mentoring and mock exams as other ways to improve the preparation programme.ConclusionThe WMP exam preparation programme is a useful and valuable aid to revision for candidates preparing for their exaAs the MRCPCH clinical examinations move back to in-person sittings, adaptations may have to be made to the programme to ensure that it continues to provide support for our post-graduate learners.

BackgroundAfter the onset of the COVID-19 pandemic, the government issued national lockdown restrictions. This was soon after the March 2020 changeover, meaning many paediatric trainees were working in new, unfamiliar hospitals with strict social distancing rules. This impaired the normal development of workplace relationships at a time where peer-support was pivotal.The risk of poor mental health and moral distress is well recognised in healthcare professionals. With isolation and restricted peer-support, this was likely to increase. The regional Trainee Support Network launched a series of pan-regional virtual Quiz Nights to combat this.ObjectivesTo organise virtual quiz nights that provide a safe environment for paediatric trainees, consultants and the wider deanery ‘paediatric family’ to see each other and have fun, in order to improve workplace relationships and boost staff morale.MethodsA 32-week project using plan-do-study-act (PDSA) cycles was completed (table 1). We evaluated interventions via mixed quantitative and qualitative questionnaires assessing whether people would attend again, would recommend the quiz to friends, and whether attendees reported improvement in workplace relationships and morale.A total of 6 virtual quiz nights were hosted across an 8-month period from May to December 2020.Abstract 1301 Table 1 PDSA Cycles 1 Launch of Quiz Night. Variety of questions, including region specific (‘Name the Hospital’ and ‘Guess the Consultant’ childhood photo rounds) and general rounds. 2 Further promotion, including a regional twitter hashtag. Addition of attendee requested rounds (continuing mixture of deanery specific and general rounds) 3 Head of School and TPDs invited to guest host rounds and addition of further innovative (COVID face mask) photo rounds 4 Quiz Night held in conjunction with regional PAFTAS award ceremony evening 5 Special edition quizzes (Back to School, Christmas Quiz) ResultsThe quiz was attended by a mixture of clinical, non-clinical, senior and junior paediatric staff and their families. Attendance ranged from 20–40 per quiz, peaking during lockdown. We received a total of 39 responses to our questionnaire.100% (n = 39) reported they would attend again and would recommend the quiz to a friend or colleague. 97% (n = 38) reported they agree or strongly agree that the quiz boosts staff morale. 92% (n = 36) reported it improved workplace relationships. When asked whether they preferred the quiz to be only trainee or consultant based, 100% (n = 39) reported they wanted it to be open to all.Attendees reported that it was a ‘great initiative’ that allowed people to ‘connect with colleagues’ at a time where this was ‘not possible in groups outside of work due to COVID.’ They ‘loved the banter’ and the ‘imaginative rounds.’ Thematic analysis demonstrated that what people valued most was the ‘chance to see friends’ from ‘around the region,’ ‘getting everyone together,’ and the ‘community feel’ created by these events through the ‘light-hearted entertainment.’ ConclusionsThrough innovative photo rounds, guest hosts, and friendly competition, the quiz was a ‘wonderful way to get trainees and consultants of the region together,’ improving staff morale and workplace relationships. Hopefully one day we can ‘do it in a pub.’