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Critical care of children at risk because UK medical training has not kept pace

July 18, 2003

The critical care of children in the UK is under threat because medical training has not kept pace with developments. And the numbers of junior doctors in paediatrics are being cut, contends a children’s intensive care specialist in Archives of Disease in Childhood.

Dr David Stewart was lead clinician for training and clinical development at Manchester Children’s Hospital before taking up a sabbatical at Los Angeles Children’s Hospital and as a professor at the University of Southern California.

He argues that public expectation has continued to rise while shortened training, a reduction in junior doctors’ hours, and the centralisation of children’s intensive care services are all conspiring to threaten the acquisition of expertise required for dealing with seriously ill children.

Taking into account working hours restrictions and changes in training grade, the actual time allowed for postgraduate medical training has halved over the past decade, he says. Yet the knowledge required has significantly increased as technology has rapidly advanced.

There is still a heavy reliance on one to one teaching at the bedside, supplemented by lectures and tutorials. But the introduction of shift systems, the moves towards consultant based, rather than consultant led care, plus the requirements for continuing professional development for consultants are putting the squeeze on available training time, says Dr Stewart. This is especially problematic in acute and critical care.

The UK is in danger of adopting the US training pattern, where specialist training lasts just three years, he says. There, doctors know a lot, but have had very little experience of actually treating patients. But in the US they have at least recognised the problem and restrict inexperienced doctors’ practice with the adoption of a junior consultant grade, known as “junior attending.”

Regionalisation of paediatric critical care services in the UK also means that doctors in training are exposed to less of the critical illness they need to see in order to gain sufficient practical expertise. Courses in resuscitation are now more widespread, but are not an adequate substitute for the real thing, contends Dr Stewart.

He calls for mandatory spells in paediatric intensive care units as part of medical training and the use of hi-tech “simulation centres” to offset these trends and safeguard doctors’ competence, and ultimately, patient care.

British Medical Journal (BMJ)

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