(A Rough Guide to the Paediatric ST1 Application Process) – updated 2022
Dr Sophie Croft, Dr Will Creasy, Dr Seb Gray
So you’re thinking of applying for the best specialty in medicine. Great! We can’t wait to work with you. So, here’s some advice to help you over the little hurdle of the application process.
- Reading this article isn’t an alternative to properly preparing for the application process. Anyone serious about applying for a ST1 post should carefully thumb their way through the official RCPCH Applicant Guidanceon the RCPCH website.
- This article is based on the 2022/23 application process and finer details may change slightly from year to year. For the most accurate information please see the RCPCH website.
Application Numbers & Competition Ratios
According to RCPCH stats, there were 1,075 ST1 applicants for a total of 458 posts for the 2022 application year. This gives a competition ratio of 1 : 2.35, a rate that has gradually increased over the past few years (in 2018 the ratio was 1 : 1.3). The exact reasoning behind this surge in applications is unclear, however COVID-19 preventing international travel and hindering FY3 years has likely had a significant role. It is important to note that many applicants will apply to more than one specialty, and some decide against specialty training all together after applying.
Like the Foundation Program application, the country is split into regions which each have about 15-40 training posts with the exception of London – which has a whopping 100 jobs split into three sub-sections. Unlike the Foundation Program application, you can specify regions as “not wanted”. This means you can avoid being allocated somewhere you don’t want to go. But, the flip side of only ranking your favourite regions means that if you do not manage to score highly enough in the interview, you will not be offered a job at all.
After the offers are released, applicants have the option to ‘upgrade’. This means that if other applicants do not accept an offer that you have ranked highly, your offer may be ‘upgraded’ to this higher option. You are also able to re-rank your jobs after the initial offers are released in time for the ‘upgrading’, as the RCPCH are aware that sometimes plans will change between the initial ranking and when the offers are released.
Application Window and Important Dates
The application window opens at the start of November and closes at the start of December. So if you’re planning to start training after FY2 you need to have your application ready by the end of your first F2 rotation.
- Start of November – applications open
- Start of December – applications close
- End of January to Beginning of March – interview window
- End of March – offers released
Supporting Information (“white space” section)
The Supporting Information section of the application is essentially your CV in written form, and is used by the RCPCH to decide who is shortlisted for the interview stages. Consisting of eight disciplines, each section is like a mini personal statement, where you can display all the fantastic things you have achieved and why you would be such a great paediatric trainee.
The various sections (which are fairly consistent with any job application in medicine) and their respective marks are:
- Additional qualifications (mark out of 2)
- Transferable Clinical Skills (out of 4)
- Transferable Clinical experience and reflection (out of 4)
- Quality improvement project (QIP)/Audit (out of 3)
- Leadership/management experience (out of 3)
- Academic achievements (out of 4)
- Teaching experience (out of 4)
- Suitability for a career in paediatrics (out of 6)
Total score for application form white-space answers = 30. This will be marked by 2 different assessors, giving a cumulative score of 60.
You can find the full scoring frame-work on the RCPCH website, which you should read thoroughly, here – Paediatrics – Level 1 for ST1 and ST2 entry | Medical Education Hub (hee.nhs.uk)
This part of the application is essential and inevitably most time-consuming. Try to start it as early as possible as it will need to be finished by the beginning of December. Use the frame-work to help with your answers, they have specified exactly what they want to read here; quality and relevance is much more important than quantity!
Once finished, it is submitted online via the Oriel system. Get people to read it, and read it again! It helps to ask several people at different levels of experience – maybe a registrar, a consultant and a colleague at your level. They will all pick up on different things.
The final document which is worthwhile is the ‘Person Specification’. This document has by-and-large the same details in as the ‘Shortlisting Framework’. However, it also includes some extra nuggets that look good on your CV.
The important ones demonstrate further achievements that the RCPCH considers desirable, for example:
- Successful completion of training in a Paediatric Life Support course e.g. PILS, APLS, EPALS etc
- Other relevant courses, certificates, degrees/diplomas e.g. Level 2 or 3 child safeguarding training.
- Evidence of altruistic behaviour e.g. voluntary work
- Evidence of organisational skills (not necessarily in medicine) e.g. organisation of a university club, sports section, etc.
Commonly Asked Questions
Q: Would you recommend doing the first parts of the MRCPCH exams for my application?
A: Hmmm, not really…
You might have noticed that there’s no mention of the word ‘exam’ on the Shortlisting Framework or the Person Specification. This means NO direct points are available for exam certificates (for ST1). Revising for the exams will take up considerable amounts of your free time, which you could be using to rack up points in the various categories mentioned above. That being said, if your CV is already sparkling and you enjoy exams (ha ha), go for it. There are lots of people who opt to take the exams early for various different reasons but whether you do or don’t, it won’t impact on getting a Paediatric ST1 place.
Q: Does it matter that I don’t have a paediatric job for F1 or F2?
A: Emphatically NO, it doesn’t matter at all.
The RCPCH is totally aware that the FPAS Application process doesn’t always reflect how good a paediatrician you are going to be, thus it doesn’t discriminate against people who do not have paeds jobs in FY1 or FY2. The RCPCH is more focused on your commitment to the speciality, and wants to see you doing tasters and attending paediatric themed study days or being involved in paediatric audits etc. Most foundation year training posts will likely contain either GP or ED, and with enough planning and polite emailing it should be relatively easy to arrange a taster week using study leave. Regardless, there are PLENTY of opportunities to gain experience in looking after children and being inspired by other fantastic paediatric doctors. which you can reflect on in your interview.
The interview is undoubtedly the trickiest section of the application, however with a little bit of consideration you can prepare yourself pretty well for the big day.
There are four parts to the interview: three conventional interview stations where you will be interviewed by two/three RCPCH members and a communication station with an actor. Each station is 10 minutes long and worth 40 marks (total marks 160). You must score at least 88 marks to be eligible to accept a training position.
Since the Covid-19 pandemic, the paediatric interviews have been virtual, and this is continuing for the 2023 applications.
The whole point of the interview is to show the panel why you think you would make a good paediatrician and highlight the things about you as an individual that will make you a great trainee.
The interview is nationally ranked – your answers will be independently scored against a mark scheme. As a result, the interview panels are given set questions to ask, and have less flexibility in their questioning. The panel are unlikely to ask you to expand on your given answers, nor ask many other follow up questions, so if you answer your questions succinctly, don’t be concerned if your station finishes early! This also means that the interview can be well prepared for, as the RCPCH guidelines highlight exactly to expect. They’re not trying to catch you out, so if you prepare well there shouldn’t be any surprises!
And a final bit of advice for this interview, particularly in the career motivation and reflective practice sections, is to be honest! It is better to speak patiently about why YOU want to do paediatrics instead of reciting a formulaic answer half remembered from an interview textbook.The panel will likely recognise if you’re saying what you think they want you to say, rather than how you actually feel. If one of the main reasons you want to do paediatrics is because you love talking about Paw Patrol and debating which dinosaur is the best with children to make them feel at ease, then let the interview know this.
Make sure you inform your rota coordinator about the interview as soon as you know the date!
1) Communication Station – 10 minutes, 40 marks
Do you remember your paeds OSCE at med school with warmth and fondness? If so, then this is certainly the station for you! You will be given a scenario to read 5 minutes before the start of the interview and then have a 10 minute consultation with an actor, masquerading as a teenage patient or parent/carer. This will involve an explanation of a clinical condition, or reasons for an intervention or transfer.
Although the scenarios are paediatric themed, they are purposely designed NOT to disadvantage those who have not had a paediatric training post.
They will undoubtedly have some qualm or question, so listen carefully and try to offer solutions as sensitively as possible. Use the core skills of communication you’ve developed during foundation training and medical student days.
- Ask the patient/parent what is wrong – the information sheet will not necessarily tell you all the issues.
- Try and get the patient/parent to do as much talking as possible in the first part of the conversation. Remember the golden minute!
- Do not act above your station and DO NOT ‘blag’ it – if you don’t know an answer to a question then say you will ask your senior and come back later (i.e. how long am I going to be in hospital for?).
- Always search for hidden concerns– once you have established a rapport with the patient/parent they may have be willing to unveil further worries that they were uncomfortable to mention at the Sensitively explore whether there is anything else you can help with.
- Summarise where possible – If appropriate make a clear, simple plan with the patient. Check that they can retain and understand it at the end of the conversation.
2) Career motivation – 10 minutes, 40 marks
This section should be used to highlight the salient points of your “Supporting information” white space application. You will be required to demonstrate the following:
- “Demonstrate commitment to a career in paediatrics.”
- “Demonstrate understanding of the specialty.”
- “Demonstrate how their personal attributes and career so far will help to make them a good Paediatrician.”
The panel will not have access to your “Supporting Information” application (which has already been marked by this point), and so you should use the most important things you wrote about in the white spaces to demonstrate the three points above.
It is important that you can talk about the things you are proudest of on your CV and how it will consequently make you a good paediatrician. For example, talking about your experiences of taster day will allow you to discuss all of the above points. Not only will carrying out the taster demonstrate a commitment to paediatrics, it will also give you an opportunity to demonstrate understanding of the specialty, Furthermore, talking about a consultant you met during this taster will give you a platform to discuss all the personal attributes that make a good paediatrician and have you ALSO share these same traits. Anything discussed in this section should be linked back to why the interviewer should pick you to join paediatrics.
Try not to overload the panel with a list of your achievements. It is much more important to give quality answers that show understanding and ability to reflect. It may, therefore, be helpful to pick a handful of things to talk about and then reflect on, rather than getting to the interview and stumbling over listing everything (which we’ve all done in some interview or another!).
Finally, be prepared to answer the ‘big questions’ in this section – i.e. “Why do you want to be a paediatrician?” or “What are the characteristics of a good paediatrician?”
3) Reflective Practice – 10 minutes total, 40 marks
The guidance for this section is very clear and highlights two specific questions that will be asked:
- “Please could you briefly describe a significant clinical event you were involved in or observed and discuss your learning from it?”
- “How do you use similar reflective practice in your daily work?”
In this section it is important to not spend too long explaining the exact minutiae of the scenario in length and instead focus your time on your learning points and how it has changed your practice. Practice concisely summarising the scenario instead of using the entire ten minutes reciting the patients blood results and never talking about what the learning points of the case were.
This is a station that can be well prepared for, so have a good think about something that has happened during your clinical career that may have changed your practice for the future. Remember, this does not necessarily have to be a clinical change to your practice; it could be organisational, how to manage work-place relationships or even self-care/wellbeing related.
In summary, use an event at work, explain what your involvement was, and how the learning points from this experience will make you a good paediatric trainee. Don’t be afraid to talk about a negative experience here. A challenging situation usually provides lots of learning points and you can then show awareness of the developmental goals you need to achieve in order to be an excellent paediatrician.
Given this is a reflective practice station, do not leave without saying the following phrases:
- “I discussed this with my clinical/education supervisor…”
- “I made entry in me e-portfolio”
- “I reflected on this…”
4) Paediatric Clinical Thinking – 10 minutes, 40 marks
You will be given a short clinical scenario to evaluate and talk through, similar to the case based discussions you’ve done throughout your foundation training. Expect a paediatric themed case designed with the intention of not disadvantaging those without prior paeds experience.
The clinical scenarios will include a brief history, and possibly the child’s observations with some basic clinical findings. You will be asked to explain what you would do in this scenario. Expect conditions with an urgent/ emergency aspect such as: sepsis, asthma, head injury, suspected cancer etc.
These scenarios can be practiced easily with a senior or colleague, so practice, practice and practice some more! Please remember that you are attending an interview for an ST1 job – not a consultant post – so you are expected to perform to the level of a competent new ST1. You need to demonstrate that you can think clearly, spot an unwell child, escalate this to a senior and start a basic management plan until they arrive.
- Talk through the scenario logically – ABCDE, history, examination, tests, plan.
- State the obvious!“This child is sick” or “Those observations are abnormal”. You can’t be given marks if you don’t say what you’re thinking
- If the child is sick (which is almost inevitable) mention that you would ask for help from your registrar / consultantor put out a 2222 in a peri-arrest situation.
- Be aware of what department you are in and what type of hospital it is – do you have seniors within earshot or will you need to bleep them? Are you in a fancy tertiary centre or a small district general which will not have access to specialist services such as neurosurgery? Will the child need a retrieval team to transfer them to a PICU? Being aware of ‘next steps’ is important here.
- One of the most important things in this station is to know your limitations. Don’t guess the answer/management, don’t suggest you would do anything beyond your clinical ability. Always state you would check guidelines and call for senior help if you are unsure! There is no longer a paediatric prescribing task in the ST1 interviews. HORAAAAYYY!
Paediatric training has recently had a re-vamp, and the new changes are all part of something called ‘Progress +’. The main things to note are that training is now to be 7 years, split into two levels (ST1-ST4 and ST5-ST7), and is largely competency based. You can find more information about these training programme changes on the RCPCH website, which will be important to understand before you apply.
As paediatric training is largely competency based, you are also now able to apply for ‘fast-tracking’ when joining the programme. Simply, this means if you have more than 12 months experience in paediatrics (excluding foundation years) you can apply to be considered to go through paediatric training at a faster rate. You are still required to do your ST1 year, but beyond this you may be able to skip parts of your training, provided you have all of your competencies.
Fast-tracking and missing any years out of your training is a big decision to make, so read the applicant guidance carefully and think about having a chat with a senior at work to decide whether it is the right decision for you.
The paediatric application takes a substantial amount of time and mental effort, however most candidates would agree that it’s a reasonable and fair process. The competition ratios are increasing but manageable, the application is focused on your positives traits rather than areas of development and you can expect the interview panel to be friendly and encouraging (paediatricians are lovely). If you have any questions, buy a paediatric trainee a coffee at work and ask them for their experiences in the application.
Good luck, and we look forward to you joining the team!
- Read the Applicant Guidance. Read it cover to cover. Everything included is there for a reason.
- Prepare for the interview, and use the guidelines. They are not trying to trick you! So if they say they are going to ask specific questions, believe them!
- In your supporting information and interview, demonstrate why you would be a brilliant paediatrician and that you have the right core values to flourish as a paeds trainee. Have a think about a great reg or consultant that you work with or have met on a taster. What are their best attributes? What makes them particularly impressive?
Dr Will Creasy, Paediatric ST1; Dr Seb Gray, Consultant Paediatrician; Dr Sophie Croft, Paediatric ST1