(A Rough Guide to the Paediatric ST1 Application Process)
Dr Will Creasy, Dr Seb Gray
So you’re thinking of applying for the best specialty in medicine. Great! We can’t wait to work with you. So, here’s some advice to help you over the little hurdle of the application process.
- Reading this article isn’t an alternative to properly preparing for the application process. Anyone serious about applying for a ST1 post should carefully thumb their way through the official RCPCH Applicant Guidance on the RCPCH website.
- This article only covers ST1 applications. For information on applying for ST2 see the RCPCH website
- This article is based on the 2017/18 application process and finer details may change slightly from year to year. For the most accurate information please see the RCPCH website
Application Numbers & Competition Ratios
According to RCPCH stats there were 580 ST1 applicants in 2017. 480 of those were invited to interview for 440 posts. This gives a pretty favourable competition ratio of 1:1.33. 80% of applicants make it through to interview, and 90% of those interviewed are subsequently offered a job. The bottom line is, if you’re not too fussy about where you train, you can be pretty confident you will get a paediatric training post.
Like the Foundation Program application, the country is split into regions which each have about 15-40 training posts with the exception of London – which has a whopping 100 jobs split between three sub-sections. Unlike the Foundation Program application, you can specify regions as “not wanted”. This means you can avoid being allocated somewhere you don’t want to go. But, the flip side of only ranking your favourite regions means that if you do not manage to score highly enough in the interview, you will not be offered a job at all.
Application Window and Important Dates
The application window opens at the start of November and closes at the end of November. So if you’re planning to start training after FY2 you need to have your application ready by the end of your first F2 rotation. For those applying during F3 and beyond, don’t forget that (with any luck) you’ll have to be back in the UK at some point to attend an interview!
The interview centres rotate around the UK between the end of December and the end of February, so provided you are happy to travel there is a reasonable amount of flexibility. Please check the RCPCH website for exact dates.
- Start of November – applications open
- End of November – applications close
- End of December to End of February – interview window
- Beginning of March – offers released
When deciding whom to invite to interview, a ‘Shortlisting Framework’ is used to rank candidates. This is pretty standard across applications to all specialties as you are awarded points for your prowess in the variety of predictable disciplines below.
- Clinical Experience
- Academic achievements
- Overall application
A ‘perfect’ candidate could score a grand total of 34 points. Think about the Shortlisting Framework as a ‘mark scheme’ against your CV. How to score points in different categories is quite clear to see (i.e. a local audit gets you 2 points, presenting your local audit gives you 3 points, etc).
The most important point from this section is that you should aim for the low hanging fruit – pick up the easy points rather than those that take years to accumulate.
Be smart about this section – aim to accumulate as many points as possible by bolstering your CV as economically as you can. Ideally plan ahead, giving yourself enough time to score some points in each category.
For example: a PhD looks terribly impressive on your CV, but all those years of hard study will only score you 4 points (and don’t panic – realistically, how many people applying for paediatric ST1 jobs do you think will have a PhD??!)
You can easily get equivalent points by doing much more achievable things – 3 points for designing and running a local teaching session and sneaking an extra management point by acting as a rota co-ordinator.
Have the ‘Shortlisting Framework’ right next to you as you complete the ‘Supporting Information’ section. This is where you convert all those hard earned achievements into wonderful points! Each section is like a mini personal statement, justifying why you would be such a great paediatric trainee. MAKE SURE YOU MAKE THOSE POINTS-WINNING ACHIEVEMENTS OBVIOUS for whoever is scoring your application (they might be reading their twenty-seventh application form in a row, do them a favour!)
The various sections (which are almost identical to the Shortlisting Framework sections) and their respective word counts are:
- Clinical Experience – 250 words
- Clinical Audit – 150 words
- Management – 150 words
- Academic Achievements – 150 words
- Publications – 1000 words
- Presentations – 1000 words
- Teaching Experience – 150 words
- Further Information – 250 words
This part of the application is the most essential and inevitably most time-consuming. Try to start it as early as possible as it will need to be finished by the end of November. Once finished, it is submitted online via the Oriel system. Get people to read it, and read it again! It helps to ask several people at different levels of experience – maybe a registrar, a consultant and a colleague at your level. They will all pick up on different things.
The final document which is worthwhile is the ‘Person Specification’. This document has by-and-large the same details in as the ‘Shortlisting Framework’. However, it also includes some extra nuggets that look good on your CV.
The important ones demonstrate further achievements that the RCPCH considers desirable:
- Successful completion of training in a Paediatric Life Support course e.g. PILS, APLS, EPALS etc
- Evidence of altruistic behaviour e.g. voluntary work
- Evidence of organisational skills (not necessarily in medicine) i.e. organisation of a university club, sports section, etc.
Finally, to apply for ST1 be aware that you are not allowed to have more then 18 months experience in paediatrics (not including your foundation jobs). Any more than this and you will have to apply for ST2.
Commonly Asked Questions
Q: Would you recommend doing the first parts of the MRCPCH exams for my application?
A: Hmmm, not really…
You might have noticed that there’s no mention of the word ‘exam’ on the Shortlisting Framework or the Person Specification. This means NO direct points are available for exam certificates. Revising for the exams will take up loads of your free time, which you could be using to rack up points in the various categories mentioned above. That being said, if your CV is already sparkling and you enjoy exams (ha ha), go for it. There are lots of people who opt to take the exams early for various different reasons but whether you do or don’t, it won’t impact on getting a Paediatric ST1 place.
Q: Does it matter that I don’t have a paediatric job for F1 or F2?
A: Emphatically NO, it doesn’t matter at all.
The RCPCH is totally aware that the FPAS Application process (affectionally known by some as ‘The Job Lottery’) doesn’t always reflect how good a paediatrician you are going to be, thus it doesn’t discriminate against people who do not have paeds jobs. The RCPCH is more focused on your commitment to the speciality, and wants to see you doing tasters and attending paediatric themed study days or being involved in paediatric audits etc. Most foundation year training posts involve either GP or ED, which mean there are PLENTY of opportunities to gain experience in seeing children which you can reflect on in your interview.
The interview is undoubtedly the trickiest section of the application, however with a little bit of consideration you can prepare yourself pretty well for the big day.
There are five parts to the interview: three conventional interview stations where you will be interviewed by two/three RCPCH members, a communication station and a prescribing task. The four ‘talking’ stations are each worth 40 marks, but the prescribing station is only worth 20. Each station is 10 minutes long.
The whole point of the interview is to show the panel why you think you would make a good paediatrician and highlight the things about you as an individual that will make you a great trainee.
The interview is nationally ranked – your answers will be independently scored against a mark scheme. This means that candidates can interview in a centre outside of the region they are applying to, as well as preventing different centres from being ‘harder’ then others.
As a result, the interview panels are given set questions to ask, and have less flexibility in their questioning. The panel are unlikely to ask you to expand on your given answers, so if you answer your questions succinctly, don’t be concerned if your station finishes early!
Finally and most importantly – make sure you inform your rota coordinator about the interview as soon as you know the date!
Communication Station – 10 minutes, 40 marks
Do you remember your paeds OSCE at med school with warmth and fondness? If so, then this is certainly the station for you! You get two minutes to read through a scenario and then have a 10 minute consultation with an actor, masquerading as a patient or parent.
They will undoubtedly have some qualm or question, so listen carefully and try to offer solutions as sensitively as possible. Although the scenarios are paediatric themed, they are purposely designed NOT to disadvantage those who have not had a paediatric training post. Use the core skills of communication you’ve developed during foundation training and medical student days.
- Ask the patient/parent what is wrong – the information sheet will not necessarily tell you all the issues.
- Try and get the patient/parent to do as much talking as possible in the first part of the conversation. Remember the golden minute!
- Do not act above your station and DO NOT ‘blag’ it – if you don’t know an answer to a question then say you will ask your senior and come back later (i.e. how long am I going to be in hospital for?).
- Always search for hidden concerns – once you have established a rapport with the patient/parent they may have be willing to unveil further worries that they were uncomfortable to mention at the Sensitively explore whether there is anything else you can help with.
- Summarise where possible – If appropriate make a clear, simple plan with the patient. Check that they can retain and understand it at the end of the conversation.
Portfolio Station – 10 minutes, 40 marks
You are asked to bring 12 sides of A4 paper which “demonstrate (your) commitment to a career in Paediatrics”. These 12 sheets should be your CV highlights – evidence of all the fantastic things you have achieved.
When assembling your portfolio, it should be concise and look smart (no style points for a handmade Italian leather binder, WHSmith’s will do – but no raggedy dog eared pages!)
Try to include a wide range of contents, ideally featuring something from each section of the Shortlisting Framework / Person Specification.
Things to consider putting in your portfolio could include:
- Careers planning
- Case based discussions
- Audit / quality improvement / patient safety project
- Teaching evidence / feedback
- Prizes or awards
- Patient or colleague feedback
- Exam certificates
- Certificates of attendance at courses / conferences / Resuscitation course certificates
- Anything else you think would make you stand out
Be prepared to talk for a few minutes about anything piece of evidence – i.e. if you include your teaching feedback, talk about what you taught, why it was such a brilliant session, and why it will make you a good paediatric trainee.
Finally, be prepared to answer the ‘big questions’ in this section – i.e. “Why do you want to be a paediatrician?” or “What are the characteristics of a good paediatrician?”
Governance & Reflective Practice (divided into two sections) – 10 minutes total, 40 marks
For the clinical governance section, read around the concepts of clinical governance and its importance in clinical practice. This section will prompt questions about audits, quality improvement and adverse incidents. Practice talking for a few minutes about any of these, ideally with some examples of your personal experience of them.
You may also be asked how you would approach a colleague in difficulty (i.e your fellow SHO turns up smelling of alcohol) so rehearse talking through the process of sensitively challenging someone, offering them support, speaking to their clinical supervisor etc.
The reflective practice component asks candidates to “reflect on a significant event from their career to date and… show their ability to be resilient and use their experiences to help them advance through their career”. This is fairly self-explanatory. Use an event at work, explain what your involvement was, and how the learning points from this experience will make you a good paediatric trainee. Don’t be afraid to talk about a negative experience here. A challenging situation usually provides lots of learning points and you can then show awareness of the developmental goals you need to achieve in order to be an excellent paediatrician.
Essentially, do not leave this station without uttering some clinical governance buzzwords such as:
- “Improving patient safety”
- “I reflected on this”
- “Delivering high quality healthcare”
Paediatric Clinical Thinking – 10 minutes, 40 marks
You will be given a short clinical scenario to evaluate and talk through, similar to the case based discussions you’ve done throughout your foundation training. Expect a paediatric themed case designed with the intention of not disadvantaging those without prior paeds experience.
The clinical scenarios will include a brief history, and possibly the child’s observations with some basic clinical findings. You will be asked to explain what you would do in this scenario. Expect conditions with an urgent/ emergency aspect such as: sepsis, trauma, suspected cancer etc.
These scenarios can be practiced easily with a senior or colleague, so practice, practice and practice some more! Please remember that you are attending an interview for an ST1 job – not a consultant post – so you are expected to perform to the level of a competent new ST1. You need to demonstrate that you can think clearly, spot an unwell child, escalate this to a senior and start a basic management plan until they arrive.
- Talk through the scenario logically – ABCDE, history, examination, tests, plan.
- State the obvious! “This child is sick” or “Those observations are abnormal”. You can’t be given marks if you don’t say what you’re thinking
- If the child is sick (which is almost inevitable) mention that you would ask for help from your registrar / consultant or put out a 2222 in a peri-arrest situation.
- Be aware of what department you are in and what type of hospital it is – do you have seniors within earshot or will you need to bleep them? Are you in a fancy tertiary centre or a small district general which will not have access to specialist services such as neurosurgery? Will the child need a retrieval team to transfer them to a PICU?
Prescribing Task – 10 minutes, 20 marks
Almost there. This is the last station and should be easy to pick up marks, so try not to lose focus!
Here, you get to complete a mock-up drug chart. The chart will be completely blank, so you will need to fill in the usual patient details – name, DoB, allergies, child’s weight etc. THE WEIGHT IS HUGELY IMPORTANT, DO NOT FORGET IT!
You will be told which meds to prescribe (normally only one or two) and yes, you are given a children’s BNF. It is also worthwhile knowing how to prescribe paediatric maintenance fluids – i.e. how much fluid is required over 24 hours and what the hourly rate is. It is unlikely you will be asked to do this, however it is one of those questions that is simple if you know the formula, and impossible if you don’t.
Don’t panic if you don’t completely finish the task, just get as much important information down as possible. INCLUDING THE WEIGHT.
The paediatric application takes a substantial amount of time and mental effort, however most candidates would agree that it’s a reasonable and fair process. The competition ratios are encouraging, the application is focused on your positives traits rather then areas of development and you can expect the interview panel to be friendly and encouraging (paediatricians are lovely).
Good luck, and we look forward to you joining the team!
- Read the Applicant Guidance. Read it cover to cover. Everything included is there for a reason.
- Be economical with your CV preparation – pick up the easy points and ensure you have a good spread of points in different areas. Remember you will need to do all this while managing your clinical duties and maintaining some semblance of a social life.
- In your supporting information and interview, demonstrate why you would be a brilliant paediatrician and that you have the right core values to flourish as a paeds trainee. Have a think about a great reg or consultant that you work with or have met on a taster. What are their best attributes? What makes them particularly impressive?
Dr Will Creasy, Paediatric ST1; Dr Seb Gray, Consultant Paediatrician