There’s no road map… My journey building a Paediatric Portfolio

By Dr Beth Tremain - F1

From applications, to throughout medical school and thereafter one of the questions I received the most was which speciality I wanted to go into. At the start of medical school, I was really interested in surgery, especially orthopaedics but this changed throughout medical school until I did a Paediatric Emergency Medicine (PEM) additional module. 

I’d been interested in Paediatrics but hadn’t had much exposure pre-clinically. I had done the odd clinic in GP where a few of the patients were children but that was it. I had enjoyed seeing doctors change their approach with children and it was something which caught me by surprise... slowly Paediatrics moved up the ranks of which speciality I wanted to do.

Why I like Paediatrics and PEM

• Being perceptive and adaptable – neonates require a different set of skills to young children; you have to have strong foundations in clinical examination and tailor history taking. From relying on collateral histories in younger patients, reassuring anxious first-time parents, to making an examination a game to stop the child from crying every child and their needs are different.

  • The physiology also changes as children grow and I found that fascinating!

• Strong MDT work – Paediatric doctors work within a large MDT – from nurses and play specialists to social workers and midwives. In Paediatrics there is so much variety. You can be a generalist or choose to sub-specialise even within Paediatrics. 

• Varied clinical workload – Being a generalist in hospital with varied presentations is something which kept me interested... from acute scenarios in resus to the baby with bronchiolitis or the 7-year-old who’s broken his wrist playing football to the toddler with a foreign body every shift is so varied.

This module allowed me to develop my knowledge, clinical and communication skills and observe Paediatricians dealing with different clinical scenarios. I also felt so included within the team, as a medical student, I felt listened to and welcomed. Let’s be honest... there are far and few grumpy paediatricians(!) and I felt drawn to the specialty.

These were just some of the things I admired and started to consolidate my love for Paeds.

But where to start with the portfolio?

There is a lot of anxiety about building a portfolio, especially in the context of training bottlenecks. I have felt it at times, but I’d say start early if you can, but don’t fall into common pitfalls.

Advice for Medical School

Applicants and pre-clinical students:

• First of all, adjusting to medical school is a big change and I encourage you to embrace getting to grips with lectures, meeting friends, building support networks and smashing your first few years.

• The speciality you want to do will likely change - that’s ok! Get involved where you can and find what makes you tick. 

Clinical phase students:

• Congratulations to making it to clinical phase – this is a big achievement! Talk to doctors at various stages about how they find the job – what is the work/life balance like, what does their day to day look like and what do they find interesting about the job?

• Remember, placements vary but there can be a lot to fit in! If you are passionate maybe see if you can get involved in an audit- although this is not at all essential and you will have the chance to do this in foundation years. 

• Are there special modules your university offers to get more time in a speciality?

• Get involved in societies!

• Electives – these like modules are a great way to get more exposure in a specialty. These can be within the UK or abroad and may allow you to see how different health care systems operate.

Remember, even if you change your mind there are transferrable skills to each portfolio – leadership, teaching, skills and audits/ research.

My Experience

1. I did an elective in Paediatrics – spent time on the wards, got to help with medical students and carry out my own research.

2. I did a project on Children’s hearing loss and have submitted it to the RCPCH conference, this has been accepted to present as a poster this year. 

3. Networks I built here also led me to locally present my research to consultants within the field.

4. Unrelated to Paediatrics but transferrable audit work – On my first F1 rotation – I noticed some things clinically which I wanted to audit and have just finished data collection for my first audit with the support of one of my registrars. 

   • I have just submitted this to two conferences with the hope it will be accepted. 

5. Getting involved in societies – I worked for two years within the Paediatric society ‘Juniors’ and one of the years as President – I helped organise and run a national conference and ran a teaching series with good feedback. 

   • I was then invited back in F1 to speak about the Paediatric portfolio! Which was fabulous to support those undecided or passionate about Paediatrics like me. 

6. Courses – as part of medical school I did PILS and then as an F1 - NILS

   • These allow MDT work, developing clinical skills with a focus on acute scenarios and further allowed me to develop commitment to speciality. 

7. Volunteering and mentoring - I am starting to volunteer at my local Brownies group which I am thoroughly looking forward to. I also have mentored prospective medical students with widening participation charities. One of which has just received a full-time tuition fee scholarship. It has been amazing to give this back and become who I wanted to be when I applied.

8. Find your passions – I am massively passionate about widening participation and Paediatrics and have endeavoured to take as many opportunities as I can.

   • I have won the RCPCH Foundation Doctor award – this was something I found within my Foundation School – this enables me to attend the RCPCH conference this year and have a certificate presented to me by college faculty.

   • I recently met my local MP – as a widening participation student myself I am passionate about advocating for these students – from reduced funding in final year, hidden costs to build a portfolio and well-being as a doctor. 

9. Charity work

   • Within one of the societies, I worked with at university – We created boxes to send to underprivileged children overseas. It was incredible as we had a sizeable number of donations!

   • I am also about to complete a charity swim for Great Ormond Street Hospital. 

Cost Effective Career Building

As I am passionate about these hidden costs associated with in medicine, I am a big advocate of doing what you can for free and then what you need to spend money on you can. 

1. My elective was done within one of my local hospitals and so incurred no cost

2. RCPCH Foundation doctor prize means I get a free ticket to attend the RCPCH conference. 

3. Charity and volunteer work – good way to show commitment without spending money. 

4. Look for bursaries/ MAKE USE OF YOUR STUDY BUDGET!

5. Utilise placement and additional modules – PILS I managed to do within university and offered internally which meant it had no cost. 

6. RCPCH grand round – free webinars for CPD points and to gain further information about the speciality. 

7. Look for medical student/ student led conferences/ local audit presentations – these may allow you to present research and either have no or minimal cost incurred. 

Most importantly, look on college websites to see what you need to secure an interview. 

The Journey

Slow and steady wins the race – I look at my portfolio now and there have been many bumps along the way and times I felt defeated– audits fail, consultants don’t respond, you may need to chase seniors to get a response. Don’t get disheartened. It’s all part of the process. 

Always think about transferrable skills and make sure to not over fill your plate. What are you going to get out of this process? Remember it’s all well and good doing an audit but it needs to be meaningful, and the end goal is getting a certificate and name on the project. 

I am excited to see where my career takes me, and I know Paediatrics is where I belong. I will continue to keep building my portfolio and hopefully be successful in the next application cycle and, like getting into medicine, I wouldn’t be where I am without help from various mentors.