Bridging the Gap – Foundation Training
Much as in life, a doctor’s first 1,000 days are formative. For many, their experiences during foundation training heavily influence one major life decision- their choice of specialty. With the UKFPO’s new Preference Informed Allocation system leaving many aspiring paediatricians without a paediatrics rotation, some feel their choice is less informed than ever1. The risk is a gap in engagement between medical school, where child health is increasingly integrated into undergraduate teaching, and ever more inclusive specialty training2, 3. Supporting foundation trainees disadvantaged by a random ballot should be a priority for all who care about the future of paediatrics.
Children aren’t just small adults
From safeguarding to genetic counselling, working in paediatrics is tangibly different from adult medicine. Understanding these nuances is crucial and requires more than just a taster week. While primary care and emergency medicine jobs offer opportunities to work closely with children, trainees should be encouraged to seek relevant learning experiences in all rotations. For instance, in a recent rheumatology job, I saw the value of dedicated transitional services in meeting the complex needs of young adults with Behçet's disease. The Royal College of Obstetricians and Gynaecologists encourages foundation doctors interested in women’s health to gain experience through a two-tiered curriculum for O&G vs other rotations4. A similar programme, developed by the RCPCH, would allow future paediatricians to show commitment while building their portfolios for specialty applications.
Exploring an interest
It is a fact of foundation training that doctors spend relatively little time in specialties they are interested in pursuing. For any specialty, maximising engagement with aspiring trainees across these two years is crucial. At a national level, the RCPCH has created the infrastructure to reward those showing early enthusiasm for paediatrics. Free College membership and subsidised conference attendance remove any financial penalty for commitment, while competitions like this encourage deeper thinking about paediatrics.
What some foundation doctors find is a lack of local support networks, with many having little involvement with their hospital’s paediatric department. In many areas, such as quality improvement, collaboration is in everyone’s interest. A requirement for both foundation doctors and departments, audits allow doctors to conduct work of clinical importance while gaining useful outcomes such as conference presentations. The same is true of research, although opportunities are often restricted to larger academic departments and doctors on specialised foundation programmes. The RCPCH should be commended for democratising early exposure to academia through its Trainee Research Network5. Programmes like this also offer invaluable mentorship for those lacking a paediatrics job or facing structural barriers to career progression.
Despite these efforts, foundation doctors without a paediatrics rotation may still need more experience before they commit to the specialty. Perhaps the final piece of the puzzle is to continue normalising time out of training, with ‘F3’ years giving doctors the chance to explore paediatrics in all its wonderful forms. By nurturing young talent, and allowing it to flourish in its own time, the future of the paediatric workforce will be secured for years to come.
References:
Bharmal A, Sharma I, Majeed A, Pinder R J. Foundation job allocation in the UK BMJ 2024; 385 : q1191 doi:10.1136/bmj.q1191
"Medical Licensing Assessment: Content Map." General Medical Council, 2021. Accessed 09/01/2025. https://www.gmc-uk.org/education/medical-licensing-assessment/mla-content-map
Dhugga L, Ludman S.1401 More or less than full time? A new era for flexible training in paediatrics.Archives of Disease in Childhood 2022; 107:A508 A509.
"Guide to Foundation Training in Women's Health Care." Royal College of Obstetricians and Gynaecologists, 2014. Accessed 08/01/2025 , https://www.rcog.org.uk/media/x5kp45o3/guide_to_foundation_training3.pdf
"RCPCH Trainee Research Network." Royal College of Paediatrics and Child Health, Accessed 08/01/2025, https://www.rcpch.ac.uk/resources/rcpch-trainee-research-network
