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ObjectivesThe MRCPCH clinical examination is career critical for UK paediatricians. Data from the RCPCH website shows consistent disparity in attainments between the International medical graduates (IMG) and UK trained counterparts, the former having worse outcomes in the clinical exams (e.g., 52.2% vs 92.0% at the February 2023 diet).Preparatory materials and support for the clinical exam vary across deaneries and may be less accessible to International Medical Graduates (IMGs) either in training or non-training UK posts or abroad.The Clinical Pearls group was created to address these inequalities, to boost confidence of IMG candidates and improve outcome for IMGs in the clinical exams. This has been done by creating safe online spaces for these candidates to hone their skills in preparation for the clinical exams.MethodsFrom June, 2022 till October, 2023, the faculty which consists of IMG paediatric trainees have moderated 4 diets of exam preparation.Each diet spanned a 6–week period with online sessions tailor-made to address specific needs.Each diet consisted of week long introductory sessions that explained the different components of the clinical exam.Each session was two hours long and moderated by faculty members that had passed the MRCPCH Clinical exam.Mock exams were conducted after each 6–week epoch and they were designed similar to the RCPCH standards. Anonymised feedbacks were collated to assess candidate experiences.The Mock exams consisted of six (6) exam stations and simulated using examiner and role player model. Feedback for mock exams were given using the RCPCH Anchor Statements.ResultsResults:There were 75 candidates enrolled into the program over the 4 exam diets.96%( n=72) rated the sessions extremely useful.The objectives were clear to all candidates 100% (n=75) and 96% (n=72) of them found the mocks extremely useful.65.3% (n=49) of the candidates have passed the MRCPCH clinical exams.Consistent comments gotten from candidate feedback were ‘ excellent organisation of sessions and mocks’, ‘thorough systematic sessions’ and ‘encouraged critical thinking for candidates’.ConclusionThis project has clearly demonstrated the benefit of targeted support for IMGs preparing for the MRCPCH clinical exam.Focused support sessions for IMGs at regional and national levels enhance success rates in the MRCPCH clinical exams.We hope to include one-on one mentoring as our capacity increases to help cater to the needs of candidates who struggle with learning in large traditional settings.

ObjectivesWe set out to improve an existing in-situ neonatal simulation programme in a District General Hospital setting. The paediatric department had a weekly 30 minute slot dedicated to Registrar facilitated neonatal simulation, with the content of sessions determined by the facilitator on the day. These sessions were understood to be poorly attended, often didn’t occur and the educational value was largely unknown due to the lack of formalised curriculum.MethodsTo gauge opinion on the existing programme we sent an anonymised survey to the junior doctor cohort in the paediatric department, this also served to identify reasons for sessions not going ahead and attendance. Using the information collected we then produced a new simulation programme, developing a new curriculum of simulation scenarios with defined learning objectives, designed to be used by a facilitator who may not be simulation trained (including potential discussion points for debriefing). On introducing this new curriculum, we sent the scenario to the assigned facilitator in advance of the session. We also moved the sessions to a time when a consultant could be present to help the facilitator, or to take over if the facilitator is called away. We then gained feedback from these sessions over the following 3 months using another anonymised survey, focussing on participant’s perception of the sessions usefulness to their training (scored out of 5), and how it could be improved.ResultsPrior to introducing the new curriculum, the weekly sessions were only going ahead 60% of the time. Our initial survey revealed that this was primarily due to workload and timing of the sessions. In the 3 months after the changes were implemented, the weekly sessions occurred on 100% of the available weeks. Participants perceptions of the sessions improved, with their ratings increasing from an average of 3.8/5 prior to the new curriculum being introduced, to 4.7/5 after its introduction. Multiple participants commented on how these sessions had increased their confidence in neonatal resuscitation and management, as well as mentioning how productive the debrief and discussion after had been.ConclusionIntroducing a set and defined curriculum of simulation scenarios for a neonatal in-situ simulation programme has shown an improvement in the sessions usefulness for junior doctor’s training, as well as improving confidence in neonatal management within the cohort. We have also shown that by determining and addressing the factors causing teaching sessions not to go ahead, we can improve their occurrence and attendance.

ObjectivesPost-graduate doctors typically apply for speciality training during, or soon after, their Foundation Two Year; however, many of them have very limited exposure to Paediatrics.We therefore provided an ‘Introduction to Paediatrics’ course, aimed at foundation doctors with an interest in Paediatrics training. The aims of the course were to: experience a range of common Paediatric presentations and procedural skills; learn about applying for Paediatrics; and learn about a career in Paediatrics.MethodsThe one-day programme consisted of mixed-methods teaching, designed to expose learners to a broad range of Paediatric-relevant experiences, whilst stimulating enthusiasm for the specialty.The course consisted of: four simulation scenarios of common Paediatric presentations, planned to be challenging but accessible to doctors without any previous Paediatric experience; two procedural skills stations (neonatal life support and umbilical venous catheterisation); and a series of short talks on Paediatric training and the application process. There was a large faculty of Paediatric trainees and consultants, with ample time for learners to ask questions. The course was offered at a minimal cost of £20, to limit financial discrimination.The participants were asked to feedback via online surveys, both immediately after the course, and a year following the course.ResultsThirty-nine doctors have attended the course, over three iterations; 20% of them had previous formal postgraduate experience in Paediatrics, and all of them were considering applying to Paediatric training.Immediately after the day, all the participants stated that they would recommend the course to someone who was considering Paediatric training, and that the day was useful in deciding whether to do Paediatrics training. Using a Likert scale, they rated all the teaching sessions as ‘Good’ or ‘Very good’. When asked to give a star rating out of 5, the mean was 4.9.Seven participants replied to a survey sent 12–18 months after the course. Using a Likert scale, they ranked how much attending the course had influenced (in either direction) how likely they were to apply for Paediatrics, and all chose ‘A lot’ or ‘Quite a lot’. Three of them have applied successfully, and the remaining 4 intend to apply in the future.ConclusionThis one-day low-cost course is an effective way of providing foundation doctors with a ‘taster’ of Paediatrics. Although not a substitute for a foundation programme placement in Paediatrics or a clinical taster day, it provides another opportunity for interested foundation doctors to learn about a specialty.

ObjectivesRegistrar Ready days are aimed at trainees prior to starting the second on-call rota. It is a simulation-based course which aims to help trainees learn in a constructive and safe environment what being the ‘Paediatric Registrar on-call’ may feel like. The scenarios cover a variety of aspects including critical thinking and decision making, dealing with difficult patients, communication and leadership skills. Each candidate will experience leading a scenario, with sufficient time for debrief and self-reflection by a supportive faculty. We aim to build self-confidence and ability, whilst allowing the trainees to experience decision making/team management skills in an encouraging environment.MethodsPrevious Registrar Ready days had been uncoordinated, meaning trainees experience were different depending on where they attended. We wanted to ensure that no matter where the course was delivered, and who the faculty were, the trainees would have an equitable experience.The previous and prospective trainees were surveyed to ensure that we delivered scenarios that were relevant to their level, and of topics that were interesting and based on real-life situations. As part of the process the simulations were re-written with sufficient information, so that the days could be run even without the organisers!ResultsFeedback from both paediatric trainees and faculty from the course was excellent. Self-ratings for confidence relating to different situations showed an improvement following the day. Trainees commented on a supportive atmosphere, useful scenarios and detailed feedback discussion as being the best aspects of the course.The revitalised course is now into it’s second year and has already been expanded to capture those stepping up half-way through the year. Industrial action has had an impact on the most recent courses, but we will be looking to replicate and improve on the results of feedback in the next iteration of the course.ConclusionStandardising the simulation day has meant that paediatric trainees in our region have an equitable experience when attending the course. The new scenarios are relevant to trainees and have proved to improve their confidence when they have to take responsibility for different scenarios.Using the candidates feedback and suggestions we are continuing to develop these days with a bank of scenarios prepared and being added to, ensuring it remains relevant and realistic. Our hope would be to integrate this into regional recommendations as part of the ‘Readiness for Tier 2 Rota’ e-portfolio entry.

ObjectivesChild and adolescent mental health is a key area of paediatrics that requires targeted knowledge and skills to navigate. It is an area with often challenging, emotive and unpredictable scenarios that can benefit greatly from a practitioner that can approach them confidently and competently to ensure the care standards of these children and young people (CYP) matches that of the physically ailed. It is often seen amongst trainees that there is hesitancy and low-confidence in approaching discussions with CYP about mental health (MH) and its treatment. Additionally, MH is now encompassed in the core Progress+ curriculum for paediatric trainees. The East of England ST1–4 simulation teaching committee has aimed to increase trainee confidence and competency in MH scenarios through integration into low-fidelity simulation days both at the start of training, ST1, and in registrar transition, ST2–4.MethodsWorking with a trainee with a special interest in MH (CAMHS GRID) we integrated a MH simulation into two distinct simulation days for trainees – ST1 simulation and ‘Ready for Registrar’ days and assembled an additional focused MH simulation day. These utilise low fidelity, face to face simulation equipment and actors, following a standard simulation model for briefing and debriefing participants. One ‘simulation day’ typically included 6 scenarios of which one was MH focused.ResultsThere was a clear and distinct increase in confidence and competence reported by trainees both participating within scenarios and/or debrief sessions. This was on par with traditional medical scenarios and was valued across all levels of trainee participant. Highlights include an increase in confidence-rating in Paediatric ST1 doctors from 73% stating ‘Not confident’ pre-course, to 64% ‘confident’, 7% ‘very confident’ and 0% ‘not confident’ after completing a MH scenario as part of wider simulation teaching.ConclusionWe propose it is a vital consideration to include MH simulation when planning holistic teaching to improve trainee practice. We recommend the engagement of higher trainees and/or consultants in CAMHS to guide sessions and debrief participants. We demonstrate that both singular scenarios and dedicated MH simulation days can add value to a trainee’s development and progression pathway. We shall continue to collect a robust qualitative dataset in sessions within the 2023/24 trainee calendar year and encourage paediatric educators around the UK to consider MH simulation a vital tool in delivering paediatric training.

ObjectivesThe transition between junior and middle grade roles is daunting for many trainees. Performing procedures independently and leading a team in an emergency were particular areas of anxiety identified by the first author when starting ST3 and when returning to work after time out of training. We hypothesise the transition would have been easier with formal procedures training and the opportunity to practice leading paediatric emergencies through simulation. The aim of this project was to first understand whether this need was felt by other trainees. Once training needs were identified, the objective was to set up and run a pilot course with a view to establishing this training into regular practice.MethodsA training needs survey was circulated to all paediatric trainees in the region. The responses were used to design a one-day training course. The course was advertised to ST1–3 trainees and trainees returning to work after time out of training. Funding was obtained to cover purchase of a lumbar puncture simulator, room hire and catering. The course was free to attend and booked through Eventbrite. Faculty were recruited from paediatric consultants and ST4–8 trainees. Trainees and faculty completed a post-course survey to feed back on their experiences.Results56 trainees (approximately 25% of trainees) responded to the training needs survey. 79% agreed there was a need for additional procedures training, and 93% agreed additional simulation training was needed. Trainees responded that training in lumbar puncture (70%), intraosseous cannulation (86%), mid/long line insertion (95%) and airway skills (68%) would be useful or very useful. Umbilical arterial and venous cannulation were also requested. All 24 places were booked and 17 attended. There were 13 faculty present including four consultants. All procedures other than mid/long line insertion were covered. Trainees rotated in small groups through 4 x 50-minute procedure stations and 4 x 25-minute simulation scenarios. 100% of trainees agreed that all stations were useful or very useful. Feedback revealed there was insufficient time in the airway station and the need for additional faculty.ConclusionThis course was extremely well received by trainees supporting its continuation as regular training in the region. The next course will expand to include trainees from a neighbouring region but has the potential to be standardised and delivered across the country. Trainees should be encouraged to identify and act on areas of training need which can improve training experience for future paediatricians.

ObjectivesOver the last year, there have been multiple periods of strike action by both junior doctors and consultants. These have had a major impact on patient care, leading to over 1 million rescheduled appointments.1 Industrial action has also impacted medical students who often are advised not to attend clinical placement during strike days. For students doing shorter placements, such as paediatrics and child health, this impact may be even more significant.We wanted to understand medical student’s experiences of strike action, the impact these had on their learning, and what meas ures they thought may help to mitigate this. We hoped this knowledge may help us to improve the teaching and support provided to this cohort of students, as they continue their studies, and future students if further strike action is announced.MethodsWe surveyed students who have undertaken Child Health placements over the last 3 months. We asked about experiences of strike action, its impact on students learning and asked about what mitigations they found most helpful. We asked free text questions to gain qualitative data about experiences. Surveys were sent to students via email sent by the university administrative staff. Free text responses were analysed for key emerging themes using a framework analysis approach. Consent was taken from students for their anonymised responses to be shared.ResultsSurveys were sent to 148 medical students; there were 23 responses.100% of respondents reported that their placements had been disrupted due to doctor’s industrial action.Whilst many students wanted to re-iterate their support for junior doctors strikes, 19/23 (83%) students reported that the strikes had a moderate or major (very significant) impact on their learning.The main impacts includedMissed time on placement and clinical exposure: ‘I lost almost two whole weeks of a five week placement in paediatrics.’Reduced opportunities to get key skills signed off: ‘More pressure to get sign-offs which means less freedom to join placement activities that I am interested in or might be very valuable to my learning.’Not feeling part of the team: ‘Difficulty getting to know the team.’Additional stress: ‘This put a lot of pressure on and caused a lot of stress.’The mitigations that students found most helpful were:Extra teaching sessions with a clinical focusReduced expectations for skills sign offsAcknowledgements that strikes are stressful for studentsConclusionIndustrial action has a significant impact on student learning and experiences in child health. Understanding the impacts of the strikes and the mitigations that students find most helpful will be key in supporting current and future students.ReferenceNHS publishes data following junior doctors and consultant strikes NHS England; 2023 [updated 6.10.23. Available from: https://www.england.nhs.uk/2023/10/nhs-publishes-data-following-junior-doctors-and-consultants-strike-2/.

ObjectivesTrainees from our region’s Trainees’ Committee, alongside Training Programme Directors, have supported trainees undertaking RCPCH examinations for many years. This has included face-to-face and online events, alongside a website with online guides and YouTube videos. Our YouTube channel has 376000 subscribers; the most popular video has 3.8 million views. Both website and YouTube channel are free to access and have been used by doctors based across the world.In recent years, the format of the MRCPCH examination has changed. Paediatric training has evolved, including Shape of Training and Progress Plus. While our online course ‘Ace The Clinical’, which takes place with every exam diet, has been updated, the website has not changed since it’s launch 10 years ago. We aimed to evaluate our online content in order to optimise our resources and therefore continue to support MRCPCH examination candidates.MethodsA review of the website including guides, video resources and YouTube channel was conducted. Anonymous feedback was collected from attendees after the most recent ‘Ace the Clinical’ online event. A further anonymous survey was sent out via WhatsApp to trainees from our region who sat the MRCPCH clinical exam recently. The aim was to evaluate the content of the website, and subsequently tailor it based on trainee’s needs.ResultsOur evaluation of the website showed that multiple web links did not work, for example links to other courses. Additionally some of the station information was out of date due to examination format changes.The most recent ‘Ace the Clinical’ teams evening was attended by 32 trainees, 9 trainees filled in feedback. All trainees thought the content of Ace the Clinical was relevant. Qualitative feedback quotes included that the session was ‘well thought through’, contained ‘helpful information’ and had a ‘good mix of teaching styles’. Two people requested additional sessions to help MRCPCH clinical examination revision.A survey sent to all trainees across the region who did the exam recently showed that 8 out of 10 trainees who replied had used the website. In free text feedback, trainees voiced a wish for more lectures about systems, and updated information about recently changed stations (specifically video and development stations).ConclusionOur website and YouTube channel, although based upon previous MRCPCH formats, remains a valuable resource for trainees. We are currently in the process of reinvigorating the website, including updating previous content and adding new content relevant to the current MRCPCH examination format.

ObjectivesSimulation training has become an established part of training programmes in acute paediatric units. A common arrangement is for staff to have internal resuscitation training annually, with senior team members completing externally accredited courses every 4 years.This study investigated the potential to improve specific skills required in paediatric resuscitation. Mastery of resuscitations skills deteriorates within shorter periods than 12 months. Incorporating refresher training into ward simulation programmes may be an efficient method to mitigate skill decay.MethodsThis was a crossover study with the intervention delivered on one ward across the multi-site trust for 3 months, then on the other site for 3 months. The intervention was the inclusion of a resuscitation-based scenario every 3 weeks, as part of the established simulation programme, with refresher training in resuscitation skills using an AW- QCPR Manikin (Laerdal), specifically airway opening skills, bag-valve-mask ventilation and chest compressions.Assessment of the MDT members was completed on both wards before the study period, after the first 3 months and after the second 3 months. Each assessment period was 3 days on each site, where all team members on duty were invited to participate. Nurses, doctors and advanced clinical practitioners all took part.Assessments were completed using the validated RESCAPE tool.1 Anonymous feedback forms were also collected from participants and educators in the training sessions.Results101 individual staff were assessed at least once during the study period, completing a total of 141 assessments. Participant recruitment is shown in figure 1. Data sets were identified to be left skewed since a proportion of participants scored the maximum or close to the maximum RESCAPE score (30), therefore all data is presented as median and non-parametric statistical tests are used.Baseline analysis showed similar skills across the 2 paediatric wards before interventions were delivered. Median RESCAPE baseline scores were 22.5. Scores in the intervention group increased to 28 and this change was significantly more than the median 25 in the control group (Mann-Whitney U p=value <0.001) as shown in figure 2. Median score at follow up 3 months after the intervention was 22.5A descriptive secondary analysis suggested improvement was seen consistently across staff groups, despite limited engagement of some staff groups. Feedback scores from educators and participants were positive regarding the intervention compared to standard simulation training.Abstract 6628 Figure 1Record of aarticiaant recruitment and assessments comaleted. *B eliaib/eAbstract 6628 Figure 2Boxplot (min, 1st quartile, median, 3rd quartile, max) of RESCAPE scores in post-control, post-intervention and follow up groupsConclusionThis study deliberately examined the impact of a realistic intervention and its effect on the resuscitation skills of the team. The relatively low engagement from team members in nursing disciplines, reflects the potential real-life limitations of any simulation programme. Integrating regular resuscitation skills training into existing simulation programmes is valuable even when attendance across the MDT cannot be assured.Delivery of the study combined with positive feedback from the educators and participants demonstrates that the model of integrating resuscitation training regularly with simulation training is viable.ReferenceFaudeux C, et al. Development of reliable and validated tools to evaluate technical resuscitation skills in a pediatric simulation setting: resuscitation and emergency simulation checklist for assessment in pediatrics. J Pediatr. 2017Sep;188:252–257.e6 PMID: 28456389.

ObjectivesWe work in a busy District General Hospital where we very frequently manage critically ill children. A recent case we encountered was escalated to serious incident investigation, where both skill-mix and multidisciplinary team functioning were identified as shortfalls. In response to this, we designed and led a training day. The aim was to develop knowledge and skills in managing critically ill children within the District General Hospital setting, provide hands-on experience in setting up and troubleshooting equipment used in resuscitation, and enhance in-house multidisciplinary team working. We planned to focus simulation scenarios around real life serious incidents, where cases presented with more than one pathology. We recognise that real life cases (as opposed to the algorithmic approach of emergency courses) are messy problems which require lateral thinking and management of more than one presenting complaint/more than one organ system at the same time.MethodsWe devised small group high-fidelity simulation scenarios based on three recently encountered serious incidents. This was run in conjunction with our Trust simulation team in a dedicated simulation suite. We recruited external faculty (Consultant from our retrieval service and Consultant from our network Paediatric intensive care unit) and internal faculty (Consultant Paediatrician and Consultant Anaesthetist) to debrief on scenarios and to deliver tutorials on anaesthetic agents, ventilation and inotropes per pathology.ResultsThe course was attended by A+E and ward nurses, Paediatrics and Anaesthetics doctors from our hospital and other District General Hospitals within our regional network. It received excellent feedback including ‘so good to have interdisciplinary collaboration and learning’ and ‘very practical and easy to follow, relevant to real life practice’. We have now integrated this course into our annual local Paediatrics teaching programme. Feedback from our most recent course this year demonstrated that all candidates felt that the programme had influenced their future practice and had improved their communication and team working skills.ConclusionWe believe in-house simulation days are excellent for understanding and unpicking human factors that exist within the team, in addition to upskilling staff in a safe and unpressured environment. We would like to share our experience with the wider Paediatrics Community across our region and across the UK.