Some emergency medicine trainees find that they would like to gain further skills in paediatric emergency medicine, and choose to dual accredit – earning Certificate of Completion of Training (CCTs) in emergency medicine (EM) and in paediatric emergency medicine (PEM) at the end of training. The PEM subspecialty training consists of an extra year (often taken between ST4 and ST5) which comprises six months in a paediatric ED, three months on a general paediatric ward, and three months in paediatric intensive care unit (ICU). The entry is competitive and does not require previous paediatric experience, although demonstration of interest in the subspecialty is advantageous.
The centre accredited for this subspecialty training in Wales is the University Hospital of Wales, Cardiff, where over 34,000 children are seen each year and there are currently six PEM consultants and two EM Consultants with dedicated sessions to help support education and supervision. The paediatric emergency department operates 24 hours a day, seven days a week and is situated adjacent to the adult ED with a well established paediatric nursing workforce, including play specialist. Within the on-site Children's Hospital for Wales, there are many learning opportunities, including an acute assessment unit for all GP expected patients, a large secondary in and out-patient general paediatric service, including critical and high dependency care, and a wide array of tertiary paediatric medical and surgical services.
The time spent within general paediatrics encompasses the acute assessment and management of patients within the assessment unit and on the wards, with access to general and subspecialty clinics. Trainees will keep in touch with their EM supervisor throughout. If the trainee has prior experience as a paediatric SHO, they may be able to work at registrar level.
The paediatric critical care service based at the University Hospital of Wales (UHW) is a regional service for south Wales. It is a 15 bedded paediatric critical care unit (PICU and HDU combined) with a combined throughput of over 700 patients per year.
There is a weekly teaching programme within each of the departments consisting of simulation and practical skills-based teaching, with management opportunities by way of attendance and participation in the monthly Q&S and joint PICU feedback meetings and weekly multidisciplinary safeguarding meetings. There is an expectation for trainees to be involved in audit, clinical guideline and service development. All trainees are expected to work towards presenting work at one of the annual national meetings and are fully supported in this. Participation in local and national research is actively undertaken within the department.
Successful trainees will be involved in the teaching and supervision of medical students, junior colleagues and nursing staff. There are many opportunities for teaching, both undergraduate and postgraduate, both locally and regionally and with close links to Cardiff University, trainees are actively encouraged to assist with the running of the paediatric module on the emergency medicine BSc. Management experience includes the handling of critical incidents and complaints, rota responsibility, lead roles and project management.
Paediatricians can also get dual accreditation (in paediatrics and in paediatric emergency medicine) by completing a two year training programme which also includes surgical specialties and anaesthetics. Posts for this grid training post are also available in UHW, Cardiff.
For further information on the curriculum and assessment requirements set by the College of Emergency Medicine, please see the PEM subspecialty section on its website.