So You’re Considering A Career In Paediatrics?

First Published: 15 August 2020

Let’s talk about what the postgraduate training pathway in Paediatrics looks like. The first thing to say is that the training programme doesn’t rely on you having any previous postgraduate experience of paediatrics (abbreviated to paeds in this article). So you don’t need to have done a foundation post or clinical fellow post in paeds in order to prepare a competitive application to paediatrics, or to be a great paediatric trainee. The application and interview process is specifically designed not to disadvantage those without previous postgraduate experience. 

How is the training programme structured? 

Paediatrics is a run-through training programme. That means you don’t have to reapply at any point between getting your ST1 post and your CCT (Certificate of Completion of Training -the qualification that means you can apply for consultant posts). However, that’s not to say you have to commit to the whole 7 years off the bat. As well as recruiting at ST1, the Paediatrics training pathway also has entry points at ST3 and ST4, so if you want to step away from training at some point down the line, there are points that you can come back in to the pathway later. 

The training structure outlined below is still awaiting final sign off from the GMC (General Medical Council), but if you apply to Paediatrics this year, it’s highly likely your training pathway will look something like this.

Although this template shows a pathway over 7 specialty training years, progression in Paediatrics is competency based rather than time based, meaning it’s possible to complete the training programme in a shorter period than 7 years. Fundamentally it’s a 2 level training programme, with a core of generic experience in general paediatrics, neonatal medicine and community paediatrics, including opportunities to experience integrated care, public health and mental health as well as sub-specialties. Trainees then choose whether they want to become a general paediatrician or a sub-specialty paediatrician (with about 70% of trainees going on to general paeds and 30% becoming sub-specialties). Trainees opting for general paediatrics also have the option to develop an additional special interest through SPIN (SPecial INterest) modules. 

Paediatric training involves 4 exams in total, 3 theory exams and an OSCE-style clinical exam. You’ll need to complete all 3 theory exams before progressing to ST4 and to have completed the clinical exam before moving from core to specialty level training. 

So when can you work as a “registrar” or on a middle grade rota as a paediatric trainee? You’ll need to have completed all 3 theory exams, but if you complete these before the end of ST3 and you’re progressing well with portfolio capabilities, then you could progress to middle grade during your ST3 year. It’s expected that all trainees will complete at least 12 months working at middle grade before progressing from core to specialty training. 

How much flexibility is there in the training pathway? 

By now hopefully it’s becoming clear that the Paediatrics training programme aims to accommodate flexibility in training, recognising that the traditional treadmill-style approach is a big turn-off for junior doctors, but it gets better! Paediatrics is one of only 3 specialties to have access to category 3 less-than-full-time (LTFT) training. This means you can drop your working hours without needing a specific reason for wanting to do so. Typically, category 3 choose to work at 80%. And with the competency-based nature of paediatric training, this doesn’t necessarily need to extend your training time, as long as you’re keeping up with progression with portfolio capabilities. And of course paediatrics accommodates category 1 and 2 LTFT trainees who want to work at varying % of full time. 

What about location and rotating through different hospitals? Practice varies a little by region, but most paediatric trainees rotate hospital roughly every 12 months, with LTFT doctors usually staying in the same hospital for their whole time equivalent time. It’s also possible to inter-deanery transfer between regions if you have a reason you need to move as per the national inter-deanery transfer policy, but it’s also possible to leave the training programme after your first few years and re-enter in another region at ST3 or 4 if you apply again. I’m ST6 and have already moved deaneries twice and worked in a fourth deanery for an Out of Programme post! 

There’s also various ways to take a break in training without the need to step outside of the training programme or resign your training number, great if you’re looking for flexibility in your career with the security of not needing to re-apply. This can be to undertake another post within the NHS like a teaching, leadership or QI fellowship, outside of the NHS to work abroad or volunteer, for research, or just to take a career break.

To finish, I’d like to leave you with this short video of some paediatricians reflecting on their careers 


More resources: 

  • For more information from the Royal College of Paediatrics and Child Health, click here:

  • Youtube videos about application process to paediatrics: 

Careers in paediatrics online workshop: recruitment into specialty training – 3 June 2020

  • And why not join the Royal College of Paediatrics and Child Health as a medical student or foundation member, it’s free!

About the Author 

Emma Coombe is an ST6 paediatric trainee, and the RCPCH trainee representative for recruitment.  

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Elliot is a St George’s graduate currently working as an F1 Doctor in East London. As the first in his family to apply to university, Elliot is well aware of the barriers that can be faced in trying to get to medical school. He is passionate about widening access to medicine for underrepresented groups.
 He was the representative for St George’s on the BMA Medical Students Committee, and has done lots of work with local schools and colleges to raise awareness of medicine as a career, as well as working on admissions policies with the widening participation team St George’s. Elliot is part of the @BecomingaDr outreach team and National Health Careers Conference Team.