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if you are interested in in what when I started was probably not a very kind of well established specialty, So it's great to see more and more people are interested in it. Um, so I think probably by this time of the day, you're absolutely exhausted and looking down the list of electricity you've had, you've had loads and loads of interesting topics, and you've also talked about some of the subspecialties as well. So you're probably getting to the saturated point, so I'll keep it nice and simple. Um, if anyone's got any questions as they go along, you can put them in the chat, and then Chloe will give me a shout and let me know what you've asked or yeah, that's probably the best way to do it so we don't get kind of background interference, but I'm happy to answer questions all the way through. So just give me a shout and let me know whatever you need to know. Whatever your question is, then I'll do my best to answer it. Um, so in pediatrics, you have loads of choices when it comes to subspecialties, and I'm sure other people might have mentioned these as well. So currently there are 17. I suppose about college. May may well, add more. But emergency medicine is one of one of the many which are on that list. So instead of being too technical in my talk and and and going into all the details about the training program, what I thought is I'll give you an overview about, um my training and what I've done to to end up where I am at the moment in P d. D. Grid, Um, to give you an idea of the kind of things you can expect if if you're working within one of those grid posts, um, I think definitely, for a lot of people know exactly what they want to do when they come into pediatrics, and they even know what subspecialty they want to do from the very beginning. Um, I definitely wasn't like that. And what I would say is, really don't worry, because the whole point of your general pediatric training is to give you experience of all those different subspecialties, um, and you'll find as you go through. There are things that you enjoy more and things which you perhaps enjoy less and you will find your way in the end. Um, but then again, if you are someone who does know exactly what they want to do and you're already thinking about what Subspecialty. It's never too late to sort of get some experience and sort of a man your your your various projects in the right direction. So that will. It will stand you in good stead when you do come to apply to that good specialty, if that's the way you're thinking. Um, so the training program is changing, and I'm sure you've you've had talks on this. But when I started, it was an eight year training program, and it's now moving into progress plus, which is going to be seven years. So that's just a general kind of overgrew of the overview of the training program, which I'm sure you've already seen. Um, not a lot of us follow that. To be honest, we tend to most of us tend to start out full time and progressing along nicely. And then life gets in the way, really, and you kind of find a way to make your career fit around your life. So that's definitely what happened to me. So I've been, um I qualified in 2009, so I've been working for quite a few years so far. Um, and I dipped out and became a less than full time training when I had my first child and I stayed as a less than full time training throughout. I also took an out of program year, and that was in P. D. D. And that was really when I started to to really, really enjoy the specialty and become a lot more decided that that's what I wanted to do. Um, and then, uh, two and a bit nearly three years ago. Now I joined the Pizza Medicine Medicine Grid program and hopefully, at some stage, I'll be nearing the end. Um, so in terms of what actually, is PDD good training? So it's a two year program at the moment, and I don't think there's any plans for that to change a lot of us. It takes us a bit longer than two years because we'll we'll work less than full time. So I work at 60% less than full time. Um, it's made up of 26 months blocks and 1 12 month block and the 12 months is E. D. As you'd expect, because that's the thing, which which you're training in, and the other two lots of six months are to develop those other skills with the specialties we work with. So one of them is what we call PSA common. So during that you you're relatively self directed in terms of where you want to gain experience and where you think your strength and your weaknesses are. So most people will spend time with the anesthetists practicing intubations and things like that with the people, surgeons with orthopedics, and that might be going to fracture clinics and going to the trauma meetings and finding out how. Actually, they manage all these minor injuries, which you you haven't really in your general pediatric training had any exposure to, um, spend time with the birds and plastics teams and then other teams as well. So pediatric gynecology, allergy specialists and all of the general pediatric specialist, which we we work with on a day to day basis. Then you get six months in Children's intensive care. Um, and that's sort of the practical procedures, um, side of intensive care. So airways and intubations thinking about invasive ventilation, getting experience about central lines. And I inotropes not necessarily because you might be the one putting them in in a any but because you're going to be able to help those teams facilitate doing that. You're going to know why they are indicated and and how to all collectively work together as a team to help that patient, um, in intensive care. You get a bit of exposure to those chronic illnesses those Children who keep coming back again, Um, and sort of talking about plans of care and, uh, in terms of perhaps withdrawal of care if it's going that way. So you do get some a lot of learning in that. And there's also the transport teams in the intensive care transport teams. You can have a chance to work with them as well. So that's the sort of program that you go through. Um, and there will be there's lots of information on that on the Royal College website, and you can ask people who who are doing the specialty if you want to know more specifics about that, um, what I wanted to do with the kind of 20 minutes we've had really is is go through the reasons that that I do what I do. Um I don't think there's any particular personality who does pediatric e d. I certainly work with lots of people who are very, very different. Um, and I'm sure if you ask different people, the reasons they do it may be different. The reason I thought I'd do it like this is if someone had told me these three things these these 10 things and over time I said, you know, you like doing this, this and this and actually all these things fit in pediatric emergency medicine, I think I probably would have picked it as a specialty a lot before I did. So if any of these resonate with you, um, or reasons why you you know, you feel you like the pediatric job you're gonna do. Then there's definitely something to think about early on. So the number one really is the variety. Um, so I think as soon as you pick a a specialty, you start General like you start narrowing down the field of Children you're looking after so many units is an obvious example. Neonate, you're looking after me and you're not gonna have a 17 year old child who comes into your neonatal clinic. So in my job, child covers a huge spectrum and and actually that's recently extended as well. So, um, we always used to in my department and in many and he's across the country. We would look after Children from when they were born. If they happen to be born in 82 when they when they had their 16th birthday and at that stage, then they they would be seen in the adult ent Department Cove. It has changed that a bit because there's been such a burden on adult services. So certainly in my department and then a lot of eighties up and down the country, they have now moved to looking after Children until they're 18th birthday. So, um, and that is the day where you can apply for your first mortgage. Um, some of the patients I see have Children of their own. Um, so it's I do see the odd 17 year old who who might have a one year old. So, um, it's a huge spectrum of of age groups to see and you flip between them all the time. So you may well have a pre term baby born in the E d. Um, in the morning and then the afternoon, you're you're looking after a 17.5 year old, so it's that it's that variety I really enjoy And that variety is also true when it comes to illness and injury. So anything we see can be the the, you know, very, very minor, um, end of the spectrum to the point where you're really struggling to understand why, why they ended up in any in the first place to those those huge trauma calls or that child who's Perry arrest in your department. And again, it's that it's that variety of of having those because every time, you know, if if we just saw resuscitation all the time, um, that for me would be would be quite draining both physically and emotionally, and so I really like the variety of of seeing the child with something stuck up their nose immediately after I've I've dealt with someone who's really poorly, and it's that moving between them, that's something that keeps me on my toes, and it makes me enjoy it. the next thing is is instant. So I'm perhaps not the most patient person in the world. Uh, I really, really enjoy the fact that with my job, I see a poorly child. I give them a medicine and the majority of them get better, Really, really quickly. And I get to see that change in E. D. And I get to enjoy it with them. So, um, it is not uncommon for Children to look quite unwell when they come into the department and a few hours later be be sending them home because they've had that acute treatment that they need. And actually, the vast majority of Children we see go home within a within a number of hours. So 91% of the Children we see in E. D will go home, and we only have a 9% of mission rate. So that's quite small. Um, in terms of percentages, if you're thinking all those other Children you're seeing, you're making better. So although it is very, very busy, um and certainly are I work in Leicester Children's Emergency Department, which is very, very busy. We might see 5000 Children in a month, so around 200 a day, so there's still a fair proportion of them being a still 9% of those 200 being admitted. But actually, the numbers you're sending home is huge. The next thing I like is that my job is really, really practical. So injuries are about a third of the workload. An illness makes up two thirds. Injuries are really satisfying to treat, and I don't think you really discover them as a general pediatric trainee until you come to work in E. D. So, um, kids coming in with pulled elbows, minor fractures, little wounds that you can glue things stuck in their ears and their nose is all things that you can see. You can sort out and you can send them home. They go straight back to the park or they go straight back on the trampoline and do all those fun kid things that they were doing before. So I find that incredibly satisfying part of my work. The other thing that I I really like that is that my job is so hands on. So in terms of jobs where you're using practical skills, I think you'd be hard push to find something that has the variety that e. D has. So all of these things, we will do very regularly daily, most of them. And And the thing that's unique with that with P Z D is I don't think that particularly changes when you become a consultant. So um, yes, the consultants might be taking more of a leadership role in the department, but that doesn't mean that they don't cannulate the Il neonate when they come in. Um, and it doesn't mean that they don't glue the wound when everyone else is busy. And, uh and uh so those skills are something you maintain and you don't lose as you go through your training and there's a few things on there which I just kind of explain what they are. So procedural sedation in my department will do ketamine sedation, for the most common reason for doing that would be fractures that need manipulating. But they think if they manipulate it well, with orthopedics, they might get away with not having to go to theater. Um, airway management do a lot in E. D. Whether that's formal intubation, which tends to be more the anesthetic side of things but actually having all those skills and being able to manage the airway of that child who comes in in status or something like that when you you have to do those emergency measures, Um, and and of course, as you get more senior, um, develop those skills. You become that team leader in those situations. So you lied resources and you lied traumas, and you'll lead the department as well. Uh, and and sort of delegate all those rolls to the various people with the appropriate skills. The next thing I like is that a D is very unfiltered. So I used to find it quite frustrating going to do a war drowned and having that patient in front of me, but having to find the notes having to find the trolley, um, reading what everyone had written the day before and finding the other volume of notes so I could understand why certain antibiotic was stopped few days ago. Um, the thing I like is in E. D. A lot of those barriers to actually getting on and assessing that patients are are just not there in the first place. So, um, anyone can walk in any time and you start with literally a clean sheet of paper to take their history and do the examination and and make your plan. Now that's not to say we don't read all those other things. And with electronic systems being better now, I can find out what their X ray looked like when they were discharged on the you could go over what their discharge letter said, or what their clinic letters say, and I can build more of a picture with the information the parents are giving me. But I do like that, that initial sort of barrier to seeing them. None of that is there, and I can I can start with a very simplified assessment of them and and document that down. This is where I work. So this is Lester Children's E. D, which is about four years old now. I think so. It is all quite quite nice and modern, Um, but it is a rare condition and it's big and it's ready. So I remember as a as a junior pizza trainee, you get called towards in the middle of the night and it was someone was fitting, but it was dark and they couldn't find a cannula. It had to be quiet because otherwise I woke up everyone else on the ward and then I had to call everyone else to come down. And no one was really ready for that situation to happen. Whereas where I work and the space is ready all the time. So we're currently, you know, all the time we're expecting anything could happen. And with that comes a lot of preparation. So the lights were always on the base. Always start with the appropriate equipment. And I can call for help from lots of people very, very quickly. So I find that very safe feeling for a place for me to work. And this is just an example of one of the rooms. And this is when they were showing everyone around when we first opened the department. So, um, the environment I work in as well is is really suited to the patients we see. So, yes, we have the resource base and they're all stocked with the appropriate equipment we need. This is one of the base which we tend to use for Children with comp needs, maybe sensory issues. So it has a projector which we put on the wall. It has the sensory pads, so that's really kind of specialized, adapted to what they need. And it can mean that that experience is just that much more positive for the patient. The other room we have is a room where we will put Children where we have kind of acute mental health concerns, and that has a barrier which will go down over all the machines and things that the back or anything that they can potentially hurt themselves with. The next thing is the the impacts. Now this slide is true of any pediatric job, really in that if you save someone's life, um, it's not just a few years you could give someone an entire lifetime. Now I'm definitely not saying that that happens every day in in Children Z D Um, but it does happen, and it's a It's a specialty where it's potentially more likely to happen than others. And when you do make that difference, when you when you do have that day and you think Oh, actually you know, we really, really did did say that person's life. It's an incredible feeling and it's well worth all the hard work. The other thing is you do see as one of my consultants is you see the very best and the very worst of all people. And with working in the EU, you really are that person who can make such a difference. Even if you can't make things better, you can really support Children and their families, uh, through those incredibly difficult times, and I think that that makes you feel very, very valuable as a clinician. The other thing we see and particularly since we're seeing more of the older Children as well, is we have a very active role in child safeguarding. So that's not just spotting that that young child who's, um, who's been subject to physical abuse as a baby or something like that. It's the older Children and I think in either you can. You can make a real difference in working effectively together with the teams caring for those Children. So social services and the Children's mental health team to try and bring forward that positive change in in this group of Children, which are often called sort of the the forgotten Tribe by the Royal College so you can make a real differences there and work with those teams to try and bring about positive change. Have alluded to this one before, but it's the balance of the job I really enjoy. So anytime you see something, something sad or you've had something, um, something's happened and you've dealt with a really, really unwell child or you've been in a situation which has has made you feel a little bit a little bit down. There's the next child waiting in line who's who's done something quite minor. And it's that flipping between them and those stories which those Children tell you, which is what keeps you going. And, uh and that's why I love the specialty so much. The next thing is the learning. So E. D is very, very handle in terms of learning. So R e. D as well as a lot of e ds up and down the country have really proactive education team. So this was a really large multidisciplinary team simulation we ran. That's not a real person in the background there with a critically ill child, so those opportunities because you're in E. D. Because we can't take 30 people away and give them a lecture in the seminar room. We make all of that learning interactive when we do that on the E D shop floor. So we'll have practical sessions and simulation sessions running any D most of the time, really to keep people skills up to date and get them interacting with their learning. The next thing is, it's a really good place to teach. So teaching is one of my main passions, and there's definitely no shortage to teach the people we work with new skills. So this is a session we ran recently looking at teaching people how to access Hickman lines and port a cath for for kids who come into E. D. Uh, so there's loads and loads of opportunities to teach both medical students on Just add hot basis when you're when you're in the department and also more structured sessions, which we which we do in our This is our education room, which is just on the side of our emergency department nearing the end now. But the thing one of the other things is the opportunities that he has. So Peru Key is the pediatric emergency research for the UK and Ireland, and there's always quite a few studies running, so you can have a look on the website. There's there's lots of things going. But because pediatric E. D is a relatively new sub specialty, uh, there's always room for lots and lots of research. So in our department at the time, we often have a couple of research studies ongoing, and it's easy to get involved in recruiting patients. For those you can work with the critical care transport teams and calm. It is our local one where I work in Leicester. But as a P D. D trainee, you have some of the skills which they require for that. And, um, I went and spent a little bit of time with them learning more about what they do, and that's definitely a really useful and and also fun thing to do. And then there's other skills in terms of imaging. So the point of care ultrasound is coming into its own, and only the other day. Actually, I did this course, which is teaching clinicians how to to use long ultrasound and a simple point of care. Cardiac ultrasound, abdomen, ultrasound help you with the acute care of those patients and when you put that all together. Really? Um, what you have is a very busy job demanding job, but also something that's really, really fun. And when you do come home to your Children as you get older and they say to you, You know, you haven't been here for two nights because you've been on your night shift. So what have you done? You really do have the best stories. And you get that satisfaction at the end of the shift when you you can physically see how many people you've helped in terms of who you sent home and where they've gone. And you get that feeling of the department being very different from when you started. So hopefully that's the truth about my job. I showed my husband this presentation last night, and he said, But you haven't had any of the bad bits about the specialty. Um, so I did have a I think, and I did try. I think you know, what are the bad habits? And it's not that there aren't bad bits. I just don't think they're particularly any worse than any other specialty. So, um, it is busy. It isn't. You do nights and we do what's called late Shift. So we work until midnight all my shifts or 10 hours, though, so they're not very long like you do as a general pediatric registrar, where you might be doing long days, which is 13 14 hours long. So everything where I work is limited to 10 hours. It is physically demanding because there's lots of hands on practical procedures and the department is busy. But again, I don't think that's any different to being a award based shr registrar who's clocking up all their their steps running up and down the stairs and running between wars. So I don't really think that's very different. Um, so So hopefully that has been useful. Um, hopefully, some of you are pulling this face. I don't know, I can't tell. But if it has sparked an interest in you and as I go through that went through those things, you thought well, actually, that is that is a bit of my job. I do enjoy. Then do you consider PT D and it may just be for you in terms of investigating it further. Well, you can always arrange a taste today in your local pediatric emergency department. You can find out who's in charge when it comes to education. So there'll be a consultant who's the name lead for Education Department and just ask them if you could come along and you could always use one of your study leave days to go and do that to just get a feel for it, cause I think unless you're in an environment, you don't really get a feel for it. I would recommend everyone does a pizza. Cute job. I think different Diener ease. It varies, but certainly in my diary in East Midland scenery, you don't automatically rotate through pediatric E d. And I think that's a shame, because you don't get that exposure and you don't learn what it's like. And certainly I've worked with registrars who who have come through P d. D. As a general piece training, and they've done it at ST five S t six level, and I have really, really enjoyed it when they thought they wouldn't, uh and actually have said, I wish I would have thought about this as a career sooner, because it actually when I did it was something I really enjoyed. You can get involved in local projects, and there's always some up and running. And if you know any of the PDD, Reg is in the department. You work, you're working. Always ask them because we've always got lots and we're always happy to get other people involved, to help and in terms of useful resources. I think these are the Big Three, really? So I've got to put teach me pediatrics down there because it's awesome, because I help with that as well. And that's probably the one I know the best. There's also E M three, which locally is our East Midlands education website, and that's got loads and loads of really useful stuff on it. And then don't forget the bubbles, which is is quite well internationally known. So I think that's my time up. I've taken up nearly 30 minutes of your time. Uh, that's my email on the bottom. I just put the teacher in pediatrics, but please email me about anything If you have any questions, Um, and I'll just let Khloe tell me if there's anything in the chat or anything else I can help with High. Yeah, that's great, thank you. And we have a couple of questions, if that's okay, So the first one is someone's asked. Do you know if it's possible to do a train? For example? Do a few days in the ward as a general pediatrician and a few days in A and A uh So I don't know how that will change with the progress curriculum, but what I would say is, I think some of that depends on where you work. So where I work, I just work in the P d D. However, other places as a P. D. D. Read, you may well help cover the pediatric ward at night. As a registrar, I don't know how that would change as a as a consultant, but it might be that it might vary where you work, because at the moment, the way the training program is I you automatically If you do grid you, you do a We'll sort of qualify. So I will see CT in general pediatrics, hopefully and pediatric emergency medicine when I get there. So in theory, I could work in a general pediatric role because I do have a c c t. In that. So I think that would it might just depend how things change with progress, because general pediatrics is becoming more of a specialty in its own right. Okay, um, the next question is, um is the consultant Rhoda any different or better than the registrar, Rhoda, or is it all made up of shift work? And do you have any sort of say in your shift patterns? Yeah. So, um so the consultant wrote it is very different. So as a registrar, whatever specialty you do, if you're doing an acute specialty, you do on calls and night shifts and things like that. So the consultants don't don't do night shifts in my hospital, but they will work until one o'clock in the morning. So they they work shifts as we do. So they work a day shift, which is eight till six. They were, or they work a late shift, which for them is, uh, one o'clock until 10 o'clock or they might work. And evening, which is six. Pm till 1 a.m. But they definitely they don't work over overnight time. And in my hospital, they're not on call from home either because it's the adult. Any consultant who is who is on call from home, but again, I think some of that will depend on on where you work. But I don't know of any areas in the UK where pediatric easy consultants are doing resident on call so they they're not in the hospital overnight. Um, in terms of as a registrar, Do you have a saying your shift? Well, I think that's that's again, probably the same for everything else. We all work on rotors, and the junior doctor administrators do their best to try and accommodate our choices. But yes, we do work on voters, and you always have to adapt your life slightly to work around that, um, another question just leaving on from that. Um, would you say most of the trainees or consultants, a pediatric background or an emergency medicine background? So that's a good question. And I meant to mention that in my talk to, and I completely forgot to be reminded me. So, um, if you're a pediatrician and you do pediatric emergency medicine, you will just work in the pediatric emergency department. There's no no one can call me to go and help in adults because I I do not look after adult patients. Having said that, you will see consultants who are working in the Children's emergency department, who are A and the doctors by background. And that's because people can come at Children's emergency department from two angles. You can either come into it from the pediatric training pathway, which is which is what I'm doing. Or you can come at it from the the adult and the and the the generic and the training pathway. So when you if you're registrar in in emergency medicine, you can choose to spend a year of your training to get a subspecialty in pediatric emergency medicine. Now those consultants aren't there all the time, but what it means is sometimes they will pick up a shift in the Children's E d, and they will be the consultant in charge. And they they're normally working adults. But they do work in Children as well, and there's quite a lot to be gained from that as well, because they often come up things with a slightly different viewpoint as well. And they also have a much better understanding of how the rest of V D works as a whole and how we feed into that. So, yes, you will see, You will see a little bit of you will see people from both sides and the same with the trainees as well. So there'll be registrars who are doing their year as part of their generic a Andy training in Children. And you will see a pediatric emergency medicine trainees as well, as well as general pediatric trainees who are who are doing some time in, uh, in Children z d, too. Thank you. Just a couple more. Sorry. Another question is, do you have to do a PM rotation during your pediatric training in order to get into PM So So No, you don't have to. It helps if you can. And what I would say is, if you, when you are when you get to that so stage, if you're thinking about wanting to that, you would want to apply for whatever good specialty is having worked in that is really, really helpful. So letting your your educational supervisor in your training program directors know early that that's what your career intention is hopefully going to be. I mean, they can they can place you in the right the right job. We have sort of preference forms that we would we would put into rotations what we wanted to do, and they would try their best to accommodate it. Um, what I would say is that if you if you think you want to do that specialty and you've only maybe had a brief stint there or we didn't get quite the rotation you want, so you didn't get quite what you wanted out of it. There's definitely opportunities to pick that up elsewhere. So, you know, going on course is to show you interested in in a particular topic, doing you know, listening to things like this are going and doing any learning modules and things like that are all just it's all just showing that interesting and that commitment to the specialty. Thanks. And another question. Just do you have any clinics during your time as a registrar slash consultant? So if once you working in the pediatric emergency department, then know so I don't do any clinics, I would either be clinical or on admin time. So as a consultant, that at one time would be, um, is management. So, um, depends on what your interests are, but you might be doing guidelines or education or helping out with, you know, sorting out staffing or whatever your your special area was. But no, we don't we don't run any clinics. Perfect. Thank you. And the last question. And do trainees have to work at a tertiary center? So when you do pizza, emergency medicine yes, it will be a tertiary center that you would work at for your grid. Yes, you would be. You would be placed in a in a tertiary center that had a separate Children's emergency department and the number of places that advertised jobs each year when it comes to grid. And by then you're thinking, you know ST Far s t four s, t five So quite a long way down the line. But and the number of jobs and the places of the jobs vary every year for the grid suspect training. And that's saying for every every specialty, because it might be that they can only have three grid trainings, and they've still got two left over from who haven't quite finished their training. Or they might have recently expanded their department and now the advertising for jobs. Or they might have opened their own Children's emergency department and have someone who's a pen trainer. So then they're they're happy to start having pen training. So I think I wouldn't in terms of kind of geographical areas. If you're living in a certain area and thinking, Well, I really don't want to do pen grip because I'm gonna have to travel somewhere else and that's quite a long way for me. I wouldn't worry about that so much at the moment because I think things are changing and over the number of years it's going to take you to get to that place. There may well be, uh, in that area. They may well be taking pen trainees because it is really is an expanding specialty, Thank you. And just one more question. And then that will be always time. For, um, a question is, as a consultant, would you feel less useful? Slash needed at a d G H if with the pediatric medicine background. So I think it's, uh, I think it depends really. So there's there's nothing to stop you going and working in a District General hospital and and I know some of them will have say, quite a small Children's A and the so they will only have a bay. But actually everyone is different. So if some people would would find it really satisfying to finish their pen training and actually say, I'm gonna I'm gonna be the person who's going to take responsibility of that area. And I'm going to develop their their pediatric emergency department and, you know, and take that on as a as a project and sort of a commitment that that's what you want to do and you want to target your efforts there. And other people would say, I've done pen grip because I want to work in a really big Children's A. Any department, which has lots of other consultants who do the same thing as me and I want to be a part of a big team of them. So I think everyone is different, and I think, like any specialty, really, you can. You can channel it into what you you want to do. Thank you. And that's all over questions. Thank you very much for speaking. That was really helpful. Great. Well, like I said, if anyone does have any questions, just please please email me because I'm always happy to help. Amazing. Thank you. Can everyone head over to the main stage now just for the F three talk? Thank you.