Computer generated transcript

Warning!
The following transcript was generated automatically from the content and has not been checked or corrected manually.

Hi, everyone. Welcome to another career talk at mine, the bleak. Today we have Doctor Hannah Brown, who's an f t seven pediatric training, doing talk on community pediatrics. So enjoy, help any questions in the chart, and also make sure to fill in the V back at the end and you'll get your thanks very much for that introduction. Frankie, Um, have a disembodied voice, I think here. But hopefully you will hear me. Okay. And the slides, we'll move on. But Frankie said I think you've had to talk before about general pediatrics. So what I thought I do is talk to you about community child health, which is a sub specialty pediatrics give you a bit of an overview of what that is. Talk about the pros and cons. Um, Andi, how you might want to focus your application in terms of, you know, get those ever important points and any questions at the end. So I, um, training in the Northeast. Um, although I've done most of my training kind of around Yorkshire and up here. So some stuff is, um, region specific, but the specialty is a hold. It is pretty general. So it pediatrics is a whole. Like I say, you may be thinking about pediatrics or it may be something that maybe you've not really considered. I might be biased, but I think it is the best specialty. I think it is one of the last through the emerald specialties, so whatever you're interested in, you can find a niche in pediatrics on. But we are, I think, the most unusual specialty, and that we really do cover everything. So you could be looking after someone right from the very second Airborne all the way up. So adolescence. Unless you decide it's especially in the in eights, in which case you get short of thumb when they're about to. But you really do call for everything. And if there's any specialty that you particularly thinking about in adults, then we'll have it so you can do subspecialty pediatrics in all of the usual things, like neurology, renal, gastro. But we also have our own specialist to subspecialties, which you don't get anywhere else. So I need a little medicine, which is a combination of really fiddly so intensive care and really interesting ethical stuff. We have a quite well trodden route into clinical genetics, which is really interesting specialty in itself. Lots of pediatric training is due to go that route into clinical genetics. And we also have community child health on your disability, which have a little bit of crossover. But they're unique specialties. Really. You don't find anything quite like that in adult medicine, which I think is great. Uh, so this is probably quite out of date, and I think I stole it from Mess. Let me possibly, um so you can see pediatrics is kind of in the middle. So in these kind of like satisfaction surveys with specialties, general practice always seems to be in the top. I think unfortunate. That's changing a little bit, just with everything that's going on, medicine in general. But you can see that generally, in pediatrics, we're fairly happy with our weight clothes. We don't think that it's the least manageable, probably is the most manageable. Are you there? But despite that were pretty high with our satisfaction as well. So you can see that sadly acute internal medicine is right at the bottom. So not saying don't do it. And I'm just saying you could do pediatrics instead. So community child health or sometimes called community pediatrics is, ah, especially like a sign of pediatrics on it, sometimes a little bit unclear what it actually is. Even some pediatrician's sometimes aren't 100%. They think that we just do a child safeguarding or it's just seeing Children with disabilities on. It is actually quite a wide range of things, and I'll talk to you about the different ones. So I think it's brilliant because most of the time Children aren't in hospital, which is where most the pediatricians live, so the clearest in our specialty name. So we're based in the community, so it's a predominately outpatient basis specialty. But we also work into schools we work in two Children centers on, so we often will be doing clinics and special schools. We do school visits if we're getting I'm so off play assessments or assessments and nursery. So you get to see how Children actually spend most of the time and their lived experiences, which is quite different to a lot of pediatrics, where you generally only see them maybe in any when they're poorly or, you know, a very quick snapshot in a really busy general pediatric outpatient clearing pediatrics in general is very multi disciplinary. I think we are a pretty holistic specialty in general, but I think community child health is even more so. So we involve lots and lots of different people, and we really are thinking about how the child is within their family and how we can support the family unit is a whole. There's three main areas to community child health, and I kind of put them in the little boxes here. So a huge part of the job is that we are trying to look after the most vulnerable Children in society, and I think that's so, so important. And it's one of the main reasons that I I'm passionate about this specialty. So we have quite a big role in Children who are looked after. And I don't know how much experience you guys have just in terms of different terms that you might come across. But Children you looked after is, um, another way of saying that Children who were in care so Children who looked after by somebody order than their parents so they might be in a foster placement or in some other form of before we Can we have a big growing Children? You have different developmental impairment or disabilities. So the really amazing thing about community child health is that we often will be referred to the's Children off to when they're babies on. But you will follow them up right up until the point where your transition them to adult care. So until they're sort of 16 17, 18. So you get to have a really pivotal role in these young people's lives. We do a Children. You have complex behavior presentations on. In some areas, they have services which will be looking at things like a D H D. It depends where you work, but a lot of the time you have a role in sort of newer development assessments. In these sorts of presentations, there's a big part off kilter on with life limiting conditions. So we do a lot of the advance care planning we think about palliative care s. So if you're somebody that interested in that sort of area than there's lots of lots of opportunities in community pediatrics on, unfortunately, another big part of the job is looking after Children who are risk off or suspected off being abused. So safeguarding is a big part of community pediatrics. It's not the only part, but we do play a pretty big role in that in some regions, Um, as you probably already know, safeguarding is a a part of all pediatricians roles. But in some areas, community pediatricians will do a lot of comedy routine safeguarding work. So if a child is referred him by social services than in some places, it's a community pediatric rotor. The stuff you assess is that child. We also have some unusual rolls to the rest of pediatrics in that we work a lot with education on do with the local authority in ways that general pediatrician is often don't. So we have started to redo teas, so any child that comes into the care of the local authority has to have a medical assessment. These are often kids that are really vulnerable. They've maybe know, been brought to their appointments. They might have a lot of unmet health needs, so we basically when mot so we do it up to two examination on. We write quite detailed reports on it on the idea is, is that we're trying to see is that opportunity. Teo. Look after these kids that maybe haven't had the opportunity before. And along that vein, we also do adoption medical assessments. So any child that's gonna be adoptive, that's part of our role as well is trying to assess them on. Give us for the picture is possible. To their perspective. Adoptive parents. Just so they kind of know what they might need to anticipate that needs that this child, because it might be quite complicated in terms off a child experiences in the past and how that might impact them on the future. And like I said, we have a big role with education as well. So we have to work quite closely with nurseries with special schools. With SCN say special educational needs teachers in mainstream schools as well on do we provide information and guidance for the medical side of things as to how these Children could be best supported in school and how they can reach the potential from educational point of view and the other area. Community health is quite a lot of is public health research, so if you're a public health, but if you're thinking that that might be something you're interested in that community. Pediatrics is actually great for that because, like I say, our whole role is supposed to be based with kids live on how we can improve things for them. So increasingly, I think the World College of Pediatrics is trying to get more of old and government policy in terms of how we can improve the health of our population in general, by intervening a childhood level. So community pediatrics is having increasing role in planning services. So working with the council, potentially working at a higher governmental level, is well and also do more research. So not necessary lab based research in terms off, you know, looking at genes or very complex metabolic pathways or something that's still really, really important also doing community based research. So what can we do locally that could make an impact right here, right now in these Children's lives? So all of those things, I think a very interesting and exciting this committee. I sex is making my eyes hurt, but you can see the child in the family or in the middle on the Aleve area, people that are involved so we were lots of lots of different professionals on different pediatricians. Different nurses. You often have community nurses who are pediatric nurses by training who work out into the community with these complex Children. We have specialists, dentists. There's a service right at the bond that you can see called Portage. You may not have come across that if you haven't done a pediatric job, but they're amazing their specialist teachers that work with young people even before they go to school. So even before they hit nursery to support parents who have Children with additional needs. So we waited lots and lots of different people. So it's a really great specialty. If you like communicating. If you like lots of collaborative working and thinking about the child in front of you and how they fit in the context of their way to communities, you got a lease. Different people that will help the child will also help you and support you to get the best outcome for this young person. So I was asked to do a bit of ah, typical week, so I'll talk you through. It's not a typical week that I'm out of the minute just because I've been on call this weekend, But for most pediatric trainees, they're usually on the acute. Pediatric rotor is, well, there's a few places around the region where you just do community pediatrics, but for most of us, we do least some acute uncles. So I put my Monday the initial health Assessment clinic. So that's what I was talking about with the Theus ass mints of Children that become looked after by the council. So if you looked after, that is usually because you've been removed from your parents or your current carriers because of concerns about the ability to care for you. So it might be because there's concern to reflect or decidely, it might be more sinister or serious than that in terms of abuse. So you have to be seen usually within a month of being admitted into the care of the local authority is often a bit of a time pressure there, so they're quite long assessments because they're so thorough and list stick medially and so that can take morning. So I put your child to need review meeting, so we have different Children, a different levels of kind of surveillance by the local authority of social services, so depending on how much support the family needs. Then they might be on something called a child in the plan. So that is a family that's needing a more additional support. That isn't quite meeting the threshold for child protection plan. Or, indeed, for the child to be removed from the care of the family so often as a pediatrician. You might have some input into that, because if you're seeing them in clinic, you get an impression of the family and their ability to meet the child's medical needs. Or it might be if you've done, um, assessment from a safeguarding point of view than you, their teeth, that perspective as well. Some days I'll do just a general community pediatric clinic. So that might be, um, people who have been referred with behavioral problems or concerns about their development. There might be Egalite GP that was wondering whether this baby might have cerebral palsy or something like it generates quite a lot of paperwork, So generally the best thing. We have two new doing lots of letters and very true for rules. I might be doing educational health care plans or something like that at least once a week Usually I'll do an acute on call, so I usually finish my clinic about her for and then I go to a any ongoing for the ward's on dyspepsia we care and liveries and 80 until you show up at nine o'clock. I go next day and do a feeding clinic, a special school. So we have lots of Children and young people who have devices like Gastrostomy Zoo or Judge. It feeds lots of young people who have unsafe swallows. It might be on a trial of N G feeds and things like that. So that will be with a dietician with speech language therapist, potentially with specialist teachers. Just try to get a feel for how that child's doing and using all of the expertise and import those different people to come up with a safe plan. Tianshui. That that kid is growing on, be, um, doing a swell as they can do at school. The great thing about community pediatric did is that I have the freedom to kind of do some shadowing, Um, so if there's a particular area that I'm interested in, so say that I want to do some tertiary your disability clinics, then I'm able to arrange that on. I can go to a different hospital if need be on. Do do some clinic where they're just to get that extra experience. If I'm not doing something like that, then I might be doing some teaching. So maybe teaching to medical students or it might be that I'm getting tall. So is pretty regular teaching, usually most pediatric departments on this quiet online as well. Not a little bit about that at the end, when we talk about how to maybe get some experience for your applications. So I mentioned that community pediatricians, or sometimes on the road of a safe garden. So if there's a worry about child's that there's a concern that they may have been so bit to abuse than a social work will make a referral in for a safeguarding medical assessment. So if I'm on the road for that, then I will see a child that's been referred in, so that usually involves on. Usually it's a couple of hours, and that's taking a history, examining the child. So really making a really, really clear on note of any sort of bruises marks on a really clear history from everyone that's involved, and then you have to come up with your your opinion on your plan. So that's your medical opinion. This toe, for example, if it's a bruise, if this is an accidental bruise, or if this could be nonaccidental or inflicted mark, so it it is really important because we are guiding what social services then do. Because if we're saying that we think this is a nonaccidental mark and there's a potential this has been inflicted than that. Social services that have to act on that on detention take steps to safeguard that child, which could involve potentially removing them from their family. So you have to be very clear and very careful in the way that you communicate there. If there aren't any repair was like that. Then I might be doing some guideline. Wasn't ordered it something so off. Quite improvement on then. In the afternoon, I usually do my developmental clinic, so it's probably one of my favorite things, so that is usually preschool. Children have been referred in with different concerns about the development, so it might be his concerns from nursery that this child might have autism or there's been a query about. They don't seem to be walking when they should be good. This be cerebral palsy or something like that. And that usually involves having a a physiotherapist or speech and language therapist. Sometimes o t. Sometimes community nurses' health is it is Portage. So lots of lots of different people, different perspectives just to get a really sort of holistic assessment. The child and I usually do that in our local show Start center on, but it it's really, really good critic. I I learned a lot, and you get to do a really great assessment of the young person because they're just playing while you talk to the parents and you get a bit of play assessment as well, which is wonderful on. But let's see if it's quite nicely with the community child health, because lots of our Children with complex need to have epileptic eso I'm involved in doing the epilepsy clinics. That's new referrals. Is this epilepsy on day follow ups where they're diagnosed and you're trying to manage their blood to his best, you can on again generates a lot of paperwork, and I usually try and have sometimes outside that if need to then, um, teachers or social workers or any of that, how allied health care professionals can get in touch. Because often there are lots of different people involved with these Children, and it's important we will communicate really well. Just those were all on the same page. You know what everybody's doing? This is lots of different, um, young people that we see. These aren't exact cases. I just thought it took a little bit about the kinds of Children that I might see so la ti will call here. But it shows the variety of things that you can do so you can go from doing the acute pediatric stuff. So I was at her resuscitation when she was born. She needed unexpectedly a little bit more help than we thought she works. So she needed a little bit of time in the day to you then. And it was noted that she had lost, uh, dysmorphic features on day when she had her neonatal hearing screening. She was also deaf, So she's got sense from your old Agnes. So now she's got recall bone anchored hearing aid so she doesn't have a genetic diagnosis. A such yet, So we do a lot more genetics than we ever used to. Um, just because that's coming on leaps and bounds, I think that's probably gonna be a huge part of the future of pediatrics in general. But community pediatrics in particular, because we are finding out more and more about Children that previously maybe would never have got a diagnosis. We're now finding my credit, a shins or micro defecation and getting more and more information about so the kinds of concerns of the parents might have it about long term. What were her development be like? And she's the kind of child that we would follow up long term on, disappoint the parents if, on when any additional news developed, it could also be very different. So we have a really excellent um clinic where I work at the moment where the Children who are coming into the country as refugees are referred to by the local authority on it allows us to do a really thorough assessment. But this young man has come from elsewhere, who has a known diagnosis has really complicated near a disability and significant learning disability as well. We don't know how much medical care he's had. We don't know what his prognosis is likely to be if we have no diagnosis. So it's about trying to sort of pragmatically support the family and also potentially restart the diagnostic process for this. Your mom, We still have a still have, you know, people if they've come from settings where maybe there aren't specialist schools or there wasn't the ability to 10 specially schools where they maybe never been in an educational setting on that thing is kind of an argument. Is it? Well, how much do we push for that? Because if the family are taking really excellent care of somebody at home and supporting them and they're doing things that they enjoy, then in some circumstances we say that, you know, in mainstream schools, if no one was, um attending, then that could potentially be a concern from a safeguard, important view. But for this human No, we didn't think so, but it's all about, you know, optimize his quality of life on thinking about the future. So do we need to do an emergency healthcare plan? Do we need to think about seeing a care so thinking a list ically but also trying to pump the future for him. This is a typical kind of pharaoh that we get in the child development clinic. So you man who's going to nursery necessary think that he has some issues with the social communication he likes? Lining cars are like, if you see there doesn't really want to play with other Children doesn't really talk very much. What we're seeing a lot of it a minute is everyone says I was just a lot down baby and there are lots of what time babies. You might have lots of complicated social background things, so it's not unusual for us to have Children who have had quite significant social services involvement. And so then you got a bit of a diagnostic quandary because if there's been any issues with attachment, then that can sometimes present similar Teo conditions that autism. So do you want to rush into a diagnosis that's life long, or do you want to observe for a little bit longer? So sometimes it's about balancing those sorts of things up and trying to solve the problems that are there at the time, So if there's issues with behavior, issues with sleep. What we do pragmatically to help the parents with that. So can they have support from the health visitor? Is it a sensory issue? Can we refer to occupational therapy for some help? With that sleep we sometimes we can help with. So it's leaf might be a support from the health visitor in terms off what is the routine like a hope. But also, sometimes we do think about things like melatonin for these Children, and then it can range all the way for you to teenagers. So again, unfortunately, that uncommon for, um, a teenage girl has been referred for a natural health assessment because she's now looked after by the local authority. So this is a different set of skills, potentially to assessing a child with lots of different dysmorphic features. So this is about being compassionate on Dem Pathetic on. Do you maybe have heard of heads? We talk about it quite a lot of beauty atarax just in terms off trying to explore the different issues that affect teenagers and a sensitive way on trying to meet those health needs. So, unfortunately, we do often have these quite complicated situations where maybe somebody's not going to school so we don't have to work with that. We might have police involved there, especially services on that. We may be in touch with their You might have a dad that suddenly comes back in the seat and says that actually, man was drinking when she was pregnant. So now you'll have social worker asking, What could she have? Fetal alcohol syndrome, which is now called Welchol Spectrum Disorder. Um, so you might have all of that complicating things. So I put about sexual assault there just because there are some community pediatricians that have a specialist expertise in forensic assessment. So that is, Ah, very specialist area. But certainly I have some consultant colleagues that do you do those kinds of assessments? A swell and most important thing in that I think we can do there is to advocate for the child. Listen to them on, just try on D, get a good Adair's we can of what their lived experiences. And if we could do that and we can hopefully see where their needs are being met and get them to the right services. So these the kind of things that are more this off public health and research site of community child health. So I think we're going to see more and more research. That's baseball. So health inequalities are massive for DNA tests in general. But I think particularly for pediatrics, it is honestly shocking how significant poverty is in terms of your health outcomes as a child on day. So there's so much work that can be done there. There's a growing, unfortunately mental health need for Children and young people in the UK, and I'm sure you know that. Unfortunately, the child adolescent mental health services in general are wildly underfunded and understaffed, and this really so, um, lack of service is sometimes these young people, um, your developmental disorder. So you may or may not be aware that we are increasingly diagnosing Children with autism spectrum disorder. So the latest figures that probably that there's least one or 2% of the population the UK has autism, so there's some figures that are higher than that. Generally speaking, they'll be at least one child in every class that has autism. We've also had a recent change in our guidance for resuscitation, so previously we would only advocate resuscitated in the in eights from 23 weeks that the bathroom guidance changed with the last couple years, and we are now able to offer resuscitation from 22 weeks from the in eight nationwide. I think this viable rates for 23 weeker is around. Now. I'm doing is wrong there, but around a third to a year, um, 22 weeks, we don't have enough data yet, but it would seem sensible that we are likely to see even higher numbers off Children who have potentially significant disability from that, just like we have seen a significant number of Children who do have disability from 23 weeks. So that's going to impact on the services that we need to provide. Obesity always gets talked about, but it is a huge problem. Unfortunately, and again, there's so few services available, but we have some good quality research. If we could actually figure out what we can offer that works there, we might be able to fund it. It should be brilliant. That's really exciting novel treatments. I don't know if you heard about in the news. The most think it's still the most expensive drugs of the HS offers, but That's for S M. A spinal muscular atrophy. There's some really, really exciting treatments for particularly certain metabolic conditions and things like that that are developing, which potentially will change the course of them because a lot of these conditions can cause life on disability, then in disability, on needing lifelong care. So what? We may see a big change in some of those conditions. Like I said before, genetics is a huge, um, an expanding field and likely to become even more significant community pediatrics. So what I love about my job is I think Children are brilliant pill areas. I think it does matter. How about the day has been there will always have been one kid that make me laugh or it was just really cute. And that just makes a difference. Sometimes in general, pediatrics is a really supportive and kind of specialty. I have incredibly, rarely found anybody but is unpleasant or difficult to wear with on. But it is really fun training junior colleagues, and it's so lovely when you've got somebody who maybe comes into pediatrics saying that the terrified to Children they know what they're doing. They're scared that he's telling people are going to break, and then four or six months down the line, they were really slick, confident Junior, which is brilliant. Um, pediatrics and general is huge variety. I sort of cover that little bit. But if you do a mixture off pretty and acute, you get some really nice acute, fast paced quick turnaround day and the stuff you get to do some fiddly procedures. Well, as much as I guess, cannulas lumber functions stuff like that, if you find it quickly, you may not. You may be very coordinated on. Then you got the long term stuff. So as a community pediatrician, he said, You could follow someone up for the entire childhood. You might look after them for their entire life. If they've got a life limiting condition, you get to really know the families. And in some ways it's kind of like the it's gone now. But how the GP of model used to operate you. You get to know the families and be part of the community, really, on this, um, really challenging communication, and it's very satisfying to get that right, and that could be in aligned of situations from sort of communicating a diagnosis to talking about genetic counseling to potentially explaining to family why you're doing a mature protection medical on that you've got safeguarding concerns. It's a realistic, um, specialty. We get to every lots of different professions. I get to get their perspective. I learned lots from them. Um, it's just it's really nice not just being very, very medical. I think it's real important because a bang lot about it, but just we get sick after some of the most vulnerable Children in our society on I, I think it's incredibly important that we advocate for them on. Do we try our best to ensure that they get the best care and really the best quality of life possibly come? Um, it's also really good opportunities for teaching, whether that's medical students or junior doctors, or if you get a super specialist interest with increased pediatrics and you might be teaching or the consultant. There's lots of research opportunities and lots of people who are taking time out to do those kinds of things on pediatrics in general. But community pediatrics in particular, are very supportive of less than full time. Um, as a consultant, you confused whether to just do community pediatrics so that would Germany be outpatient based know out of hours? Or you might do what they call a hybrid job, which is what I hope to do when I finish my traded where you do a certain percentage of acute on calls as well, just to keep your handling on Teo kind of have a change of pace. A swell Well, I won't lie to you. There are also things that can be really difficult about pediatrics in general and very specifically about community pediatrics. So, um, emotionally, there are things that could be really hard. So obviously, Joe deaths are are really difficult, Onda. When you're involved in them, it can be very difficult, very hard. Um, I think pediatricians in general are aware of that on your generally very well supported by your colleagues and your consultants about those sorts of things. Safeguarding is difficult times because obviously we don't want to live in a society where people hurt Children will neglect. Um, but unfortunately we do on that is quite hard to deal with sometimes. But again, our role is to calf of the Children that have had this happen to them on, but we can't maybe have stopped what's happened to them, but we can try and help them go forward. There's been so many high profile stuff is well about conflict between parents and cares. You may have seen a case in the news recently about wanting to turn off life support, and you're going to court. There are sometimes cases like that. They're very difficult, even working until District General hospitals. I've come across that and things like that. So sometimes between Cayston challenges satisfying and sometimes they are very difficult there's number, breath call dilemmas in terms off. Well, also spur solve the limits of resuscitated me in eight versus, you know, potentially end of life care a swell so those those can be very difficult. From a practical point of view, the rotors are great. Um, I can't lie. Um, Germany is a middle grade. You do do quite a lot of, um, calls on being a specialist can have its downsides in terms off. If they're, you know, under 16, they somehow become mind to sort out. Um, and as a consultant, it's looking increasingly like it's gonna be a more senior had speciality in terms off potentially more rested consultants, which is you have to think about these kinds of things because it's been more time. It's a consultant. There's the training and I want it. But there is that not everyone enjoys all aspects of the training. So if you are dead set on becoming a neonatologist that, you may know, enjoy the time that you spend in community and vice versa. So we do do a lot of service revision in terms of we spend lots of time in any managing acute pediatric problems, whereas, especially as a whole is probably outpatient based in clinic based. So dislike the adult medical training. Sometimes you have to fight to get your training opportunities. Well, balance. I still think you should join us because pediatrics is great on so thinking about pediatric training and, um, how you would get into it and how you might, um, maximize the chances. So the biggest trading that has changed slightly. Eso variously had a very, very long training program, so I'm still sadly in that so it it's only eight years it's been changed to seven um, so once you are, um, fully qualify in terms of post to you can apply to pediatrics. S o u Conjoined ST one if you've got some pediatric experience. So if you took some time out and did various off trust grade posts or F three or whatever the depending on your experience, you can sometimes joined later on, so sometimes you can join it. Sore vesting to ST three. So during that time, you do your exams s So there are three clinical exams. One. Well, they were not getting any of them easy, but when it's famously quite hard, unfortunately, that's the middle of, um, and you do a clinical assualt, which is similar to the adult medics paces. So it's an asking type exam. Um, your registry, usually from soft ST Do 23, but definitely by S. T four. And then you can choose whether you're going to be a general pediatrician or a some special pediatrician. So if you don't want to be an ologist of any kind, like a neurologist, whatever, then most people stay as a general pediatrician. But they might do a spin, we call it, and that's a special interest. So I'll mention briefly the different ones that you can do on. About a third of us will be sub specialist pediatricians. So you apply competitively to subspecialty pediatrics, which have a subspecialty is that you're interested in on. Then you do usually two or three years of your last bit of training doing that and you come out then as a consultant in whatever sub specialty is. So these are all the different things you can do. There's lots of them, Like I say, some of them, um unique pediatrics, like adolescent health. Um, what else do you that's unique? Um, well, you can do inherited mess about medicine. There's an adult, but I think a lot of the pediatricians the night allergy, your disability so you can do all kinds of specialist interests. And then you come out as a controller pediatrician with a special interest in whatever it is. Do you generally apply in the winter before you're due to start? Um, you have to get an appointed bility score, so there's two parts to that which is the application form on Do the interview. So I had a look at this year's applications. We can't guarantee you will always be like this, but the moment we don't use the MRSA exam I think they have in the past. Don't quote me on that. They're not at the moment. You got white space form. So you talk about your passage IV mints, clinical experience, your motivation for pediatrics. What transferrable skills you've got on some governance. You don't have to have been a pediatric job. Took quite a pediatrics. That's pretty crucial to say on. Then you have an interview. So moment. Still virtual. I don't know if and when they plan to take that back Teo base to face that there will be four main areas s o. They are specific questions. So testing how you communicate so that the communication one, I think they are currently using a role player. Um, in the virtual sessions, Teo, get you to communicate something like, um, the mistake has been made or something that is necessary ahead. Early pediatrics based. So you don't have to have lots of pediatrics knowledge to do. It's just a test of the communication skills. They'll ask you basically, why pediatrics? There trying to reflect on something and the political reasoning again, That's not gonna be, you know, a significant pediatric knowledge required. It's it's gonna be more broad, so you don't have to have extensive pediatric experience. Toe toe. Answer those in terms of things that you could do. So I don't know what level all of you guys are at. But if you are certain medical school and you're thinking that pediatrics might be for you, then you hopefully have something like a pea talk at your medical school. You can become a student member of the Royal College or Pediatrics and Child Health, and that's free. Um, I know what my union. We had the teddy, their hospital, where you go in and teach kids at school that different healthcare activities. That's very nice than just a nice way of showing that you can talk to kids. There's different, often local charities that will do basically have support training for kids. If you haven't yet done your electives and consider um, doing elective somewhere where there's a Children's hospital. Um, do some pediatrics don't necessarily have to do it abroad. There are lots of really excellent Children hospitals in this country as well on most importantly, talk to us. So if you are on your pediatrics placement or if you don't recently. If you even breathe a vague notion your interest in pediatrics will get really excited on. We will try and find you things that might be of use so that there will always be lots of projects and orders that you can get involved with if you're in foundation and beyond. Um, you're thinking pediatrics or specifically, great pediatrics and try and get taste a week because even if you're not thinking about pediatrics, I think until you actually do it, you don't know what we have to offer. And I think I've converted a few people, which is ground, um, you can do things like unless and pediatric intermediate life supports that will get your points on your application. Even if you don't have a pediatrics job, then the chances are that you've probably got some sort of general job like GP or a any to see if you can find an order or project to do that's got a bit of a pediatric focus on that will look good on your application. You can do it exam if you want to, so the first one is foundations of practice, and it's like but you won't get any point to be on your application. So it only do it if you keen. Um, there's lots of online teaching. Um, since Cove it, uh, the other thing you could do, I think you may have to pay, So maybe don't. But you can look at the British Association of Childhood Disability on this. Also, the rich association off being controlled health. So batch on back order. They have journals. They have lots off course is on this online teaching us well. So what? You could check out that some of it is free now, some of it you do have to pay Paul and again talked was so anyone again, who is an f 20. R. Is around doing pediatrics and then says they're interested. We will find you lots of stuff to try and help you with your application on That is my quick run through, um, of pediatrics and community child health. I hope that it's been useful. Thank you for giving up some of your evening to listen to me. If you've got any questions, I'm more than happy to answer them. Thanks so much for another Really, really good, really informative. And I learned quite a lot of Well, I didn't already know about the specialty, but we're so guys, just pop your questions in the chart. If you've got any a toll when I'll ask them to Hannah, um, maybe to give people some food for thought. I'll just ask cooperative our own questions that we are sometimes. So I don't know if you directly covered this. Why was it the you originally picked their specialty? On what? What do you kind of find that you passed me? Enjoy the most about it. Yeah. So I I wasn't always going to pediatrics, so I thought to do a knee that I thought was going to GP. Um and then it was kind of by accident that I did the broad based training program which doesn't exist everywhere anymore. I think it still is going on in Scotland, maybe whales on. But I did pediatrics and got a taste of pediatrics really, really enjoyed it. And I think it should be that he definitely doesn't have to dress be 80 you know, that is fun. Um, you get to be almost like a gp, but just see, kids, because I mean adults, a great but I don't want to spend all my time dealing with them. Um, I think what I get out of it is just that you get to become an expert in a child in their family. It's not just one thing you got to really know them on. Do you get to support them in all sorts of different ways? It's not just about starting medication. It's kind of that holistic idea that I really enjoy. Okay, because someone has just office is very victory. Then you decided to go for over off of specialties. I mean, I don't know if you have anything to add. Um, you kind of just wanted it, but yeah, I mean, I don't know. I conceal actually the Ashlyn. I don't know if that much experience of pediatrics Ashlyn, but, um, you do do a lot of keep pediatrics. Germany is a trainee, which I do enjoy. It's brilliant, but I think in community pediatrics you get to do the thing that you will do as a consultant. So is a training. I get to have a lot more independence and ownership over the patients that I see. It's ah, lot more independent. I find that actually, um, when you're in a any seeing patients. But I think I really like that is so broad and it's working in the community. So it's not just Children that come to a New York just pop in to clinic. You get to make a difference to the experience is just day today in the lives. Nothing that's brilliant. Thanks, Hun uh, on about about is in yourself application process and in your job. Is that what's the biggest challenge you say you would say that you faced like as you go through your training? Um, I think the most challenging stuff is often, um, I guess, the communication side of things and sometimes maybe the emotional response to certain things. But I kind of said that safeguarding is a big part of what we do on. But that can be quite difficult from the point of view of festival communicating to the family that you need to assess the child because this worries essentially might hear that that can be quite difficult. Um, also, when you're doing assessments later on and working with these Children, knowing that they've had the's sometimes really quite awful experience is a young age on D. I guess not. Letting that get you down too much isn't That sounds really flippant, but you can't necessarily change what's happened before, actually, but you can try and give that child the best chance for a good future in the limited way that we can do in terms off the medical support that we can offer. But, yeah, I think that's difficult that, you know, there's so much that we could do if we had the services to offer it. But I think that's not unique to community pediatrics. That's probably the whole of the NHS. There's lots of services that we could do with if we have unlimited money, and that must be quiet and hurrying. Expect. Um, suppose I didn't really think about how much you guys must be involved in all the safeguards off, especially in the community. And, um, so just going back to your portfolio. When was it that you started working on this? And what's all things that do past me? Do I know you gave some advice, but just, you know, from your own experience, what was good thing to do on so I probably didn't start as Evista should have done. So the face I'm gonna pass on, I didn't follow. But that other people should follow is that Try and keep the CV if you come. Um so I was not very good at this. But any job that you do, if you guys are already fo ones or f to make a note of it And if you're doing audits and projects and things like that, put it in a So it's a CD that you're going to apply to a job and it will help you remember all of the problem. Really good things that you've done. Because then when it comes to writing an application for a specialty, even if it isn't pediatrics, I hope to be on. Then you can kind of pull that together. Um, I think the kind of things that I did do in my portfolio, um, I was interested in the safeguarding side of things, so I asked if there was any orders going on. Um Onda I did a project looking how we were doing the assessment. If you do any kind of pediatric project than the Royal College does Ah, big conference every year on But if you've got anything that you can do is a poster, it doesn't have to be a massive, massive project. Then you can usually get that in a decent supposed to or or sometimes even is. A presentation on that looks very good on your application because right away that's a national one. So it definitely advise anything to do pediatric today it try and get into the world College conference, um, of pediatrics. It in general, you like I say, you don't have to have a pizza job, anything that's kind of transferrable. Work s Oh, I did have a piece drops. I was able to talk about some of the stuff that I've done there for the community side of things. I'd already been in pediatrics first or four years that point. So this is after lots of projects and things that you've done. But I guess it's think about what interests you on do see if there's anything available. So, for example, I really like, um, child development, which is appropriate because I do a lot of it that this course is that you can do specifically for that, so you may have come across sort of like, the baby score and stuff like that they're after. Not that expensive, but you can go on those. And that again is good points for you. The application? Um, yeah. I think with any application is mostly just looking at the scoring and seeing what have I got that will fit those boxes. And if I don't have anything, what can I do quickly to try and get some points in that area? And often, if you talk with the people in the area that you're applying to you, they'll be able to give you some tips for quick things that can maybe help you in the sort of less full boxes. Yeah, I think for me when I was a medical shoot and I saw it was a bit lost on a little time to realize what opportunities I could look out for during medical school that might actually benefit. Looks people around me, we're doing different things. And I didn't really understand why I was doing so many extra curricular activities until I saw a call of these applications. Suppose I just wanted Is there any tips in particularly you've got some sort of opportunities to look out early on in medical school that might, you know, you know, good things to do really on rather than bit later. All on a you know what, 80. So not sure if you'll know, but yeah. I mean, I definitely wasn't one of the people that knew exactly what I was gonna do in doing stuff thing to it. I don't know. I mean, I wouldn't assume if it's something you're dead set on a medical school, crack on and do the things that you think related to it. But maybe just seeing what there is because I mean most medical schools, they'll have very different subspecialties societies. It's like I say, you're probably average compete stock or something like that is worth going along to them and just seeing what sorts of things they dio, Um, but also, if they don't stress about it too much, Um, I think there is time and it's like that. You'll change your mind, and I guess it. If if you're one of these people that knows that you want to do neurosurgery or whatever, guess okay. You probably do need to do some publications and stuff, but it doesn't really have to be a medical school. I think it's that, um maybe just to get a bit of an experience of the different things because I think it unless you get to try things out, you don't know if you actually might want to do then this load, especially if we don't get exposure to on depending on your medical school. You might only have, like, a a week or a few weeks on pediatrics. Maybe, you know, in third year, and then you maybe do another couple of weeks that finally air, and then that's it. And that's no, always enough to know that that's what you want to do. But I guess I just talk to the doctors that you're around when you are on those kind of placements on. Be like, Is it always be stuff that you can get involved? But there's always thousands of audits and posters and stuff that needs doing well. Be delighted if you want to do anything like that. Okay, well, thank you very much. Have a I think that's always the question I wanted to ask. No one else has popped any up yet, but I've just put the link to the feedback on the chat. So just make sure you do that, guys, and you get a certificate, then you can use that in your TV in your bank if you have, do apply for pizza, but yeah. Thank you so much, Hannah. I hope that I'm sure you would find it really informative. Yeah, I hope so. I put my email here. Um, if anyone does have any questions or ever does want to get in touch in terms off the pediatric application, I'm more than happy to try and help with them. I'll just write that in the shop for people is lower in case they want off. Any more questions? Okay, then. Well, thanks so much for coming on, but yeah. Thank you, Hannah. Don't think very much for letting me walk along for a bit. Okay. See you later. Take up about