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CESR Specialty Specific Guidance for Paediatrics

• March 31, 2021

This Blog post aims to help Doctors who are applying for entry onto the Specialist Register via CESR in Paediatrics. Here we outline the types of evidence you can use and how to organize your evidence.

One of the most important things to acknowledge, if you’re considering CESR, is that the process is very lengthy and requires huge amounts of documentation/evidence. It is vital that you continually collect your documentation over time whilst you are working in your home country and/or overseas, in order to give yourself the best head-start at producing your portfolio when in the UK.

Types of Possible Evidence:

There are a variety of documents that you can supply to evidence each of the 11 curriculum Domains. The following list is not exhaustive, and you may have alternative evidence. You also do not necessarily have to supply every type of evidence listed, but you must submit sufficient evidence to address each of the required learning outcomes and the associated key capabilities.

• Workplace Appraisals
• Multisource Feedback
• Case Notes and Medical Reports
• Clinical Letters to Patients and Colleagues
• Child Protection reports and/or witness statements
• Skills Logs
• Development Logs
• CPD attendance record and training certificates
• Reflective Notes
• Assessment and appraisal of trainees and colleagues
• Audit Reports and Presentations
• Quality Improvement Projects, draft protocols, guidance
• Incident Reports and examples of Risk management
• Participation in clinical governance meetings
• Responses to Complaints
• Child Protection training
• Team Meetings or Case discussions
• APLS/NLS certifications
• Teaching schedules
   

Organising your evidence: the 11 curriculum learning outcomes

The Paediatrics curriculum is divided into 11 curriculum learning outcomes mapping to the GMC’s Generic Professional Capabilities domains. You will need to ensure that the different types of evidence you provide cover all 11 learning outcomes and the key capabilities within them:

1. Professional Values and behaviours and professional knowledge

Within this section, you will need to demonstrate your knowledge of current legislation related to children and families/ carers in your clinical practice (eg, adoption and safeguarding).

Within this section, you will be specifically expected to provide anonymised court reports, witness statements, reflective notes, development logs, appraisals, revalidation (if in the UK), Certificates of Good Standing, CPD attendance records and training certificates relating to developing independence practice.
 

The Key Capabilities that you must be able to reference through your evidence are as follows:

• Applies knowledge of current legislation related to children and families
• Practices independently in a safe manner

 

2.  Professional Skills: Communication

Within this section, you will need to demonstrate working in an unsupervised role within multidisciplinary teams and apply communication skills with children, young people and families in a range of environments and challenging situations. Communications skills should be demonstrable across the range of paediatric healthcare settings and all levels of complexity.

The RCPCH expect to see examples of MDT meeting notes, Referral Letters, Workplace based assessment, reflective notes, testimonials from patients/carers and Multisource Feedbacks.

The Key Capabilities that you must be able to reference within this sector through your evidence are as follows:

• Models and teaches effective active listening skills in consultation with children and young people (CYP).
• Demonstrates to others how to manage an effective consultation, including communicating a diagnosis and prognosis effectively to children, young people and families.
• Leads MDTs and applies communication skills in a range of environments and situations with children, young people and families, including in challenging circumstances

3. Professional Skills: Procedures

Within this section, you will need to demonstrate that you’re capable of performing all clinical skills that are required in paediatrics with CYP and can confidently teach these to junior colleagues and staff.

The RCPCH expect to see examples of APLS, NLS, EPALS, Directly Observed Procedural Skills, Procedure Logs, Skills Logs, Evidence of Simulation Training and Reflective Practice on Performing procedures.

The Key Capabilities that you must be able to reference within this sector through your evidence are as follows:

• Demonstrates advanced life support skills.
• Undertakes key procedures including the following:
  o Peripheral venous cannula o Lumbar puncture
  o Advanced airway support, including tracheal intubation
  o Umbilical venous cannulation.
• Supervises and assesses junior staff undertaking clinical procedures.
• Responds to and leads emergency situations and performs advanced life support.

 

4. Professional Skills: Patient Management

Within this section, you will need to demonstrate your expertise in a wide range of paediatric conditions in a variety of settings. You will need to show that you can practise independently demonstrating proficient management of children and young people.

The RCPCH expect to see examples of anonymized patient logs, medical reports, case notes, reflective notes on difficult or complex cases, cased base discussions, case histories of communicating with children and young people and families in the event of a death, reflective notes on breaking bad news, development logs and reflective notes on resuscitation activity.

The Key Capabilities that you must be able to reference within this sector through your evidence are as follows:

• Diagnoses and supervises treatment in the common pathologies seen in babies and CYP.

• Encourages CYP to participate in their individual care, using expert resources appropriately.

• Supervises colleagues in the assessment and management of cases which are complex, nuanced or perplexing.

• Models colleagues a flexible, holistic, reflective, evidence-based approach to practice.

• Anticipates the need for transition to another service or can work jointly alongside another service to care for a patient.

• Collaborates flexibly across local health systems to lead in care quality.

5. Professional Skills: Patient Management

Within this section, you will need to demonstrate considering health promotion, illness prevention and public health from a leadership perspective. You should be able to demonstrate considering these concepts from the perspective of the individual child and family plus from a strategic service perspective.

The RCPCH expect to see examples of reflective notes, evidence of contributing to local, national and international initiatives to tackle inequalities, CPD certificates, anonymized patient records of illnesses in child travelers and recent migrants, evidence of communication in the context of cultural differences and ethnic origin and evidence of practical engagement in Public Health issues during clinical encounters.

The Key Capabilities that you must be able to reference within this sector through your evidence are as follows:

• Demonstrates understanding of the systems that enable clinicians to analyse data relating to the patients under their care.
• Applies health information data to a wider community, whether this be regional, national or international.
• Evaluates the way that patients and families use the health system and adapts practice to encourage self-management and early intervention

6. Leadership and Team Working

Within this section, you will need to demonstrate leadership within paediatric settings covering all areas of interest and promote a strong teamworking ethos.

The RCPCH expect to see examples of workplace based assessments of LEADER, Handover Tool and Acute Care Assessment Tools, assessment of looked-after children, letters for schools, charities or other healthcare organizations, involvement of organizing staffing rotas, development logs, records of team meetings, records of chairing team meetings, managing colleagues, reflective notes and case histories.

The Key Capabilities that you must be able to reference within this sector through your evidence are as follows:

• Engages effectively with stakeholders such as patients, families, charities and other healthcare organisations to create and/or sustain a patient-centred service.
• Meets patient need through working with non-clinical or managerial colleagues to develop the skills pertinent to the effective running of a paediatric department.
• Leads in multidisciplinary team working.
• Addresses challenging behaviour within the team.

7. Patient Safety (including safe prescribing)

Within this section, you will need to demonstrate considering all aspects of patient safety and prescribing in an unsupervised capacity, acting as a role model to other members of staff

The RCPCH expect to see examples of safe prescribing in a range of Paediatric settings, anonymized medical reports, case notes, case histories, referral letters, CPD in infection control, reflective notes, actions taken when there has been an identified threat to patient safety, management and responding to complaints.

The Key Capabilities that you must be able to reference within this sector through your evidence are as follows:

• Advises children, young people and their families about the importance of concordance, and about medications and their side effects.
• Takes account in their practice of risks to themselves and others, including those related to personal interactions and biohazards.
• Participates in investigating, reporting and resolving serious incidents, including through communication with patients and families or carers.
• Applies the principles of the Duty of Candour.

8. Quality Improvement

Within this section, you will need to demonstrate considering all aspects of patient safety and prescribing in an unsupervised capacity, acting as a role model to other members of staff.

The RCPCH expect to see examples of participation in clinical governance meetings, reflective notes on service development, audits, draft protocols, guidance, service improvement based evidence, initiation and leading of QI projects demonstrating improved patient safety.

The Key Capabilities that you must be able to reference within this sector through your evidence are as follows:

• Responds appropriately to health service targets and participates in the development of services.
• Employs the principles of evaluation, audit, research and development in standard settings to improve quality.
• Applies understanding of national and local regulatory bodies, particularly those involved in standards of professional behaviour, clinical practice and education, training and assessment.
   

9. Safeguarding

Within this section, you will need to demonstrate proficiency in safeguarding being able to advise others about their area of practice.

The RCPCH expect to see examples of anonymized medical reports, witness statements, police correspondences, workplace based assessments, reflective notes of involvement in multi-agency abuse cases, involvement in safeguarding meetings, child protection reports, correspondences from social services, certification of training in level 3 child protection.

The Key Capabilities that you must be able to reference within this sector through your evidence are as follows:

• Assesses the role of the paediatrician as it relates to those of other agencies in the management of children in need and those in need of protection and ensures suitable follow-up.
• Accesses the health lead for sudden unexpected death in infants and children (SUDIC), including the rapid response teams when the death of a child is sudden and unexpected. Recognises the urgency of this when abuse is suspected.
• Instigates appropriate medical investigations and initiates and contributes to multi-agency involvement in all forms of abuse

 

10. Education and Training

Within this section, you will need to demonstrate the knowledge, skills and attitudes of a highly effective teaching, evaluating impact and feedback from your teaching and adjusting accordingly.

The RCPCH expect to see examples of teaching schedules, presentations, feedback from attendees, involvement in specialty trainee formal education programmes, reflective notes, development logs, certificates of participation, assessments of non-clinical skills of trainees/colleagues and engagement with other healthcare professionals using feedback to improve teaching.

The Key Capabilities that you must be able to reference within this sector through your evidence are as follows:

• Evaluates teaching practice in a range of contexts using a variety of methods. • Effectively uses structured learning events (SLEs) to facilitate learning.
• Teaches patients, families, junior colleagues and other healthcare professionals about a range of general paediatric conditions.

 

11. Research

Within this section, you will need to demonstrate capabilities in using evidence-based practice to support patient care, as well as developing guidelines, protocols and procedures.

The RCPCH expect to see examples of critical appraisals, integration of evidence-based medicine into clinical practice, contribution to department research activity and journals, development logs and skills logs.

The Key Capabilities that you must be able to reference within this sector through your evidence are as follows:

• Practises evidence-based medicine and critically analysing its limits.
• Leads in the development and revision of local guidelines and procedures to improve service delivery
   

BDI Resourcing’s 7 Top Tips for you!

1. Understand the time and effort that is required to make a successful application. You are asked to provide evidence that you have fulfilled all the learning outcomes defined in the curriculum. Doctors who have gone through the formal training programme will normally have taken around eight years to gain these outcomes, so it is not something you can gather overnight.
2. Recognise that you will need others to support you in the application process. Think about who can help, explain to them what help you need and ask if they can support you
3. CESR places most emphasis on evidence gathered in the last five years. If you are providing evidence from before this time, think about what you can do now to show that you still have these capabilities. For example, if you still have contacts in that unit you could ask if they would be prepared for you to go back and have some workplace-based assessments in that area. The Trust would probably want you to have an honorary contract for this.
4. Choose the referees for your structured reports carefully. The GMC provides guidance on who should give structured reports, but you should also think about who values you enough to put in the time and effort to ensure that their report provides the information you need.
5. Make sure you understand which evidence needs to be verified and that you follow the correct verification procedure, to ensure that all your evidence is accepted and does not need to be resubmitted. If in doubt, the GMC can advise on what needs to be verified and what types of verification can be accepted
6. Take care to arrange your evidence following the order it is set out in this guidance, so it is easier for assessors to find the evidence they need for each of the sections.
7. Finally: keep going and don’t lose heart! There will probably be a point in the middle where the task feels huge. When this happens, allow yourself a couple of weeks off CESR then look at it afresh.