Training

Training in PEM - RCPCH route

This page is suitable for paediatric (RCPCH) trainees who are interested in a career in Paediatric Emergency Medicine

Paediatric trainees undertaking training in Paediatric Emergency Medicine follow a two year subspecialty GRID training programme during their Level 3 RCPCH training programme, after completing their core level 2 training (ST4 and ST5). There is an annual round of applications to the GRID which is a competitive matching system between applicants and posts available, run by the Royal College of Paediatrics and Child Health. This is a national process – there are often between 15-20 posts available across the UK in each round.

Click  for RCPCH Sub-specialty training (NTN GRID scheme): https://www.rcpch.ac.uk/resources/sub-specialty-training-ntn-grid-application-guidance

The 2 year PEM GRID training consists of a combination of 12 months in a tertiary level paediatric emergency department, a minimum of three months (usually six months) in paediatric intensive care/anaesthetics and three months each of surgical paediatrics and orthopaedics (sometimes combined as a ‘specialty block’ where trainees develop their own timetable to meet their needs).

RCPCH trainees have two opportunities to apply for Subspecialty GRID training and are eligible to apply if they have completed level 2 training, or will have completed level 2 training by the coming September, and still have 2 years whole-time equivalent before CCT.

Who is suited to a career in Paediatric Emergency Medicine?

If you enjoy lots of areas of paediatrics and have the attention span of a small toddler, then paediatric emergency medicine is the perfect career for you. From the coughs and colds to major trauma, you never know what you’ll be dealing with from one minute to the next. The EM paediatrician is at the front line of paediatrics, combining adrenaline-fuelled resuscitations with that happy feeling of explaining simple things to children and their parents. It’s a great team-based speciality, with opportunities in research, teaching, practical procedures, HDU, trauma, you name it, we do it.

One of the key decisions in this process is deciding whether you like acute Paeds or whether you like PEM. Whilst you may love being referred the complex patients as a Paeds SpR/SHO in resus, rushing to emergencies on the ward or seeing rapid improvements over 48 hours on PAU, this is not what most of PEM is about. It’s about seeing ALL of paediatrics – every undifferentiated child who comes through the door. They may be sick, they may be well - it’s up to you to spot the sick/potentially sick ones, manage them appropriately and move on to the next. PEM draws on many different skills compared to acute paeds – much of the time it is about finely honing your decision-making skills, analytically assessing the level of risk for each patient you’re discharging and being confident with the injuries, surgical presentations and major trauma we rarely see as general paediatricians. Sprinkle in the magic of handing out lots of stickers, blowing up lots of glove balloons and bringing a a paediatrician’s innately holistic approach to the front-line of child health in the UK, and you’ve got the chance to see something different, learn something new and make a unique difference every single shift.

Following a career in Paediatric Emergency Medicine from a paediatric versus an EM background

If you plan to train in Paediatric Emergency Medicine in the UK you will have to decide in your Foundation Programme whether you want to approach this from the Emergency Medicine (EM) route or the Paediatric route.

If you plan to train in Paediatric Emergency Medicine in the UK you will have to decide in your Foundation Programme whether you want to approach this from the Emergency Medicine (EM) route or the Paediatric route.

If you choose to take the EM route, this currently means applying during Foundation Year 2 to enter the 2-year Acute Care Common Stem (ACCS) training (CT1 and CT2). In the next CT3 year all EM trainees spend the year based in an Emergency Department with a large proportion of time dedicated to PEM. Once you enter Higher Specialist Training (ST4-6) trainees can spend an additional year acquiring the competencies required to have PEM registered as a Sub-Speciality on the UK Specialist Register as a consultant. The training consists of 6 months in a PEM training ED, and 6 months based on the wards, in clinics and in Paediatric Intensive Care. As a consultant, you could work in a pure paediatric emergency department, or combine your workload with adult emergency medicine.

If you choose to take the Paediatric route, at ST4-5 level Higher Specialist Trainees in Paediatrics can apply to spend 2 years of their senior training on the PEM GRID, acquiring the competencies required to have PEM registered as a Sub-Speciality on the UK Specialist Register as a consultant. This PEM training is undertaken during ST6, 7 or 8 and does not prolong your CCT date. As a consultant, you could work in a pure paediatric emergency department, in HDU settings or as a general paediatric consultant with an interest in emergency medicine. Or a combination of the three!

 

Tailoring your CV for GRID applications

As application to the PEM Grid is competitive, you need to think about what you can do, or have done, to show your interest in PEM. This includes:

  • EM related courses and conferences you have attended
  • Audits relevant to PEM (and be specific - what was it on, what were your responsibilities in the audit – did you lead it, design it, data collect, where was it presented, has the audit cycle been closed?)
  • Guidelines and Protocols relevant to PEM (what was your involvement?)
  • Abstracts and Posters presented at local, national or international meetings
  • Publications (from case reports to Best Bets)
  • Research experience (from undergraduate dissertations through literature reviews or applications to ethics committees to involvement in a large-scale research project)
  • Management experience (have you done anything, or could you do anything, for your local ED, have you been on any management courses?)
  • Teaching and training within your paediatric and EM departments
  • What have you done to augment your clinical skills, relevant to PEM?

How the GRID application is scored

All application forms are scored by a minimum of 3 people against a standardised scoring matrix. The results are averaged to give a final score for each application form; this both guides short-listing and forms part of the overall interview score for those candidates who go forward. The idea of the scoring matrix is to make assessment of the application forms as objective as possible and there is little room for those scoring to make allowances for a poorly completed form. For example, if in the section on audit a candidate fails to mention an important piece of audit work, but refers to it later under presentations, they will not receive recognition for the achievement in the audit section. It is therefore vital that trainees take time to answer the questions posed in as much detail as word count constraints allow.

The shortlisting matrix is available on the RCPCH website (see the link at the top of this page). It is split down into the following domains, each with a number of anchor statements which define how many points you’re allocated in each domain:

  • Clinical Experience
  • Quality Improvement/Audit
  • Management experience
  • Research achievements
  • Publications/presentations/posters
  • Education – involvement in teaching
  • Statement to support application (basically your motivation for applying)

If you’re thinking of applying – consider the domains above and look at the formal matrix on the RCPCH website. Use the time you have before the application to bolster any domain you’re slightly less experienced in and feel free to email anyone below for any advice.

Who to contact if you are interested in applying for PEM Grid training

Dr Tina Newton, Consultant in PEM, Birmingham Children’s Hospital, RCPCH CSAC for PEM Grid
Tina.Newton@bch.nhs.uk

Dr Ami Parikh, Consultant in PEM, Royal London Hospital, RCPCH CSAC PEM Grid Training Advisor
Ami.parikh@bartshealth.nhs.uk

Dr Mark Lyttle, Consultant in PEM, Bristol Royal Hospital for Children, RCPCH CSAC PEM Grid Training Advisor
mark.lyttle@uhbristol.nhs.uk

Dr Robin Marlow, PEM Consultant in Bristol, RCPCH CSAC PEM Grid Trainee Representative
robin.marlow@gmail.com

Dr Alexandra Pelivan, PEM GRID trainee, PEMISAC Trainee Representative
PEMtrainingUK@gmail.com

Dr Michael Malley, PEM GRID trainee, APEM RCPCH trainee representative, Bristol Royal Hospital for Children, michaelkmalley@gmail.com

Who to contact if you are interested in applying for PEM Grid training

Dr Tina Newton, Consultant in PEM, Birmingham Children’s Hospital, RCPCH CSAC for PEM Grid
Tina.Newton@bch.nhs.uk

Dr Ami Parikh, Consultant in PEM, Royal London Hospital, RCPCH CSAC PEM Grid Training Advisor
Ami.parikh@bartshealth.nhs.uk

Dr Mark Lyttle, Consultant in PEM, Bristol Royal Hospital for Children, RCPCH CSAC PEM Grid Training Advisor
mark.lyttle@uhbristol.nhs.uk

Dr Robin Marlow, PEM Consultant in Bristol, RCPCH CSAC PEM Grid Trainee Representative
robin.marlow@gmail.com

Dr Alexandra Pelivan, PEM GRID trainee, PEMISAC Trainee Representative
PEMtrainingUK@gmail.com

Dr Michael Malley, PEM GRID trainee, APEM RCPCH trainee representative, Bristol Royal Hospital for Children, michaelkmalley@gmail.com