COVID – Head of School Update 4/4/20

Update on training, progression and working during these times

I can’t believe that the last update I penned was over 2 weeks ago. Many apologies. In the intervening time there have been a number of policy directions that have come and gone, many things that have become clearer but some that still are not. So here is an update that I hope will be of use to you at work and in training.

The General Situation in Paediatrics and elsewhere
As has been found elsewhere, the health needs have been predominantly in the adult and elderly population. Children get it, of course, and pass covid on to adults, or staff as they are called in a hospital! However, not all children are mild, with a small number developing ARDS and an oxygen requirement. This video from a seminar at SMH covers the paediatric spectrum of disease, and a good use of 45 mins if you want something different from Trump, BoJo or Matt Hancock at 6pm.
https://drive.google.com/open?id=1X0_hrlPG7c7n0XHB-X1gNrIms2Sl0xv4

Trusts have seen increasing demand on beds and ICU beds, but not at the catastrophic levels anticipated/feared. Consequently, and rightly, children’s staff from medical and nursing teams have been working in Covid areas. Of all people you guys deserve to hear the applause at 8pm on thursdays.

The latest modelling suggests that we will see a flatter, but longer peak of this illness. Therefore there has been thought about how we focus not just on capacity for those requiring oxygen and ventilation, but also on non-covid problems. Apparently more people died in the Ebola affected areas from not being able to access healthcare for a non-Ebola problem than from Ebola itself. Its a real danger and we have picked up stories of late and severe presentations in children, then care being hampered by poor skillmix and numbers. There is also more thought about how we can manage sub-acute issues that simply can’t be deferred for 6 months, both in theatre and in clinic. 

Its a difficult situation to manage for sure.

Super Trainees
All those working for the school have been humbled and inspired by the many contacts and stories of how paediatric trainees are responding to this crisis. Most notable are those returning from OOP to work clinically. Others have continued working when they should have been on leave. Most have been placed already and some will be going to the Nightingale. So impressed. For those not doing OOP or research, It should also be highlighted just how flexible many have been, both in their location of work and their shift patterns. Thanks to you all.
There has also been a lot of inventiveness coming out of it all. Nick and Ajay have got an online teaching programme up and running pan-London. The live link to the programme is here: https://docs.google.com/spreadsheets/d/e/2PACX-1vST-EAcpU79iSimVuR5MSQpEF413R-Ucw9Ah0uJ8Jn3j3zR-5RQtWXd66lDguvL-wY9DUrZDKnGdMxn/pubhtml

OOP
The OOP process has continued for the september start and has now been completed. Some were disappointed, I’m sorry, but this was not to do with Covid, all to do with the regulations of the programme. The school tries to do what it can within programme guidance to make training as person-specific and flexible as possible, but this is not always possible to do what everyone would like. If you want to discuss OOP further, please feel free to book into a ‘support’ meeting (badly needs a rename!). 

OOP for september is a little up in the air. We were asked to ‘provisionally’ approve OOPs, which we have done. Whether they will be allowed depends on things way out of my control or influence. Looking ahead it is going to be a challenging year placing people as so many things will be in flux. It may be that we end up with too many going out of programme in september as those who have just come off OOP for Covid go off again. How does this get managed? Not sure at the mo, but we will try to do this as fairly as possible when the situation is clearer. 

ARCP

This will be going ahead – online, virtually, with as much adherence to the normal processes as possible. The RCPCH has put out some helpful guidance from the ever-cheerful David Evans https://www.rcpch.ac.uk/resources/covid-19-rcpch-trainee-progression-uk-through-2020 which is worth a read to see what the direction is. Essentially, continue to put things in your portfolio as much as possible, tagging them to curriculum domains. These may need to be more inventive than normal, but many things that you could learn in an adult covid ward could count as non-clinical learning. Add lots of reflections too. Most important is the ESTR and MSF for all trainees.
Some trainees have been on contact wondering who should be their ES if they have been posted to adult settings. Most important is that you have contact with an ES, and it is most appropriate that this is a paediatrician. The default would be the last ES, and use the adult consultants as Clinical supervisors. This will be impossible to organise centrally, but at this time people seem to be super busy, but also super accommodating. Bottom line – you need an ESTR, and you need someone to help make some sort of training sense out of this all.

For those transitioning between levels, or at the end of training, there is no change in the requirements. So please ensure you have done what you can in relation to these.  It will probably not have escaped your attention that there is no START or MRCPCH examination happening at the moment. This could raise problems for those attempting to CCT or move to ST4. 
The college is working out how to run a START in the autumn and will address this issue. This is likely to cause a delay in CCT for the (few) affected trainees. I don’t know more than that at the moment. Similarly without MRCPCH exams running, trainees moving from ST2 to 3 and 4 will be affected. Again, the college is looking at how this can be addressed, but as these progression points (and START too) are hard-wired into training regulations, they can’t simply be ignored. More information to follow as it emerges. 
I would say that these are substantial problems for those affected, but professional life is long, and this sort of thing can usually be compensated for in the longer term.

And finally…
A huge thank you to all those working in so many trusts, to the TPDs, to the HEE staff and the trainees doing so much to keep the show on the road, and to look after each other.