How to get into Pediatrics

Well presented, not too long CV. (the paper used to be of good quality. photocopies always can be easily distinguished and can be picked out easily. It is advisable to use a folder and white envelopes to make the CV well `sent’.
A systematic but well categorized CV. for eg. Separate pages for personal details, work experience, information about each job previously done, including the non-paediatric bits, hobbies and aims.
More stress on the paediatric experience in UK. If post graduation done abroad, to mention only basic experience. (Over-experience can be a negative point for a training post)
Be precise and short in writing about job experience, if possible in point form.
Be sure to mention any distinctions, prizes and special academic/ non-academic performances, for eg. Participation in inter college/ state / national level activities.
References should be ideally from UK. Can be from the guide under whom you have done the post graduation. Always mention the address, phone and fax no for the panel to get in touch with the referees as easily as possible. (Most candidates are short listed prior to interview after the references are received.)
Previous experience:

For a MBBS graduate with no paediatrics done before, it is advisable to do at least a clinical attachment in UK. This helps in knowing the system well and to improve communication skills. This is especially useful in the field of neonatology.

For postgraduates (MD/DCH) it would be good to have a clinical attachment in UK on the CV. it is easier for you to get subspecialties than a fresh graduate. So if you desire experience in a particular field like endocrine, and you have already worked in it for a considerable period it would be a positive point

Clinical attachments:

A clinical observer post is a non-paid post and is recommended to do it in hospitals recognized by the royal college. There are many options but it is becoming increasingly difficult to get these posts and hence I would not be too fussy about the place. An attachment in a teaching hospital looks good on the CV and the referees may be more familiar. Also there can be a chance to do research / audit / presentation as an observer. However getting the job in a teaching hospital is more difficult especially if it is your first job.

The observer post in a district general hospital is easier and better in terms of getting the experience of common conditions and has a better job prospects. As a first time employee it is always better to start in a DGH for 6 months and then go on to rotations (which includes teaching hospitals) but it is not impossible to get rotations straight away as well. As I do know many overseas colleagues who have been lucky.

I found it useful and encouraging to do as many presentations as possible as an observer. This boosts your communication skills and helps your reading. Sometimes you are assigned topics and sometimes you have to make an active effort to express your wish to do so. This helps your references as well.

Audit s is an important part of training in UK and a SHO in his posting is expected to participate in at least I in 6 months.

Research and publications are strong points to get a job but more useful for registrar/ jobs in teaching hospitals, but not having them is not harmful and I think it is a matter of luck and time to do one before you get into employment.


It is advisable to have MRCPCH1 before applying for the job. It is easier to finish this exam as soon as passing PLAB or when you are a clinical observer.

Having a MD / DCH need not be a negative point always and some jobs advertised actually prefer candidates with reasonable experience.


The general appearance of the candidate is very important and the panel does make judgments about the personality from the body language and the confidence in answering questions.

It is not necessary to know / read paediatrics before the interview as many of the candidates may be house officers and doing their 1st paediatric posting. The interview is always in a very informal manner and the panel always try to make the candidate at home as much as possible. Its better to be honest in answering about topics especially if you do not know rather than building up stories. The level of knowledge expected is nothing more than a MBBS graduates and importance is given to how much of senior help you would take in clinical scenarios. You are never expected to make major decisions and it is good assurance to the panel if you prefer to call your senior in the slightest doubt rather than handling things yourself.

Commonly asked questions include details about the CV, the job experience, exams, carrier goals and the favourite … why you have chosen this field. Most of us practice these answers and it is good to come out with practical reasons like I like this filed because I had an experience and that taught me/ I think it is challenging rather than I want to serve this community and so on.

The other questions are on audits, clinical governance, some clinical scenarios (especially dealing with social problems/ emergencies) and finally where do you see yourself in 10 years time. You will also be asked about preference in specialties and honestly I think it is good to be neutral at the 1-st interview in answering that question. Also you will be asked your negative and positive points and why you think you should get this job. I think this really decides your final impression and it is extremely important to be positive and confidant but avoiding miraculous assumptions.

Courses to attend

MRCPCH 1 is a criterion for. The courses are conducted by hospitals but are expensive and you will have to pay if you are not employed in that hospital. For this exam it is important to concentrate on solving as many questions as possible rather than reading big textbooks diabetes from page 1. The mcq books need not be purchased and is easily available at hospital libraries. The result depends on the total percentage of the candidates to be passed in than exam and hence it is difficult to predict the lowest passing score.

APLS / PALS these are paediatric life support courses and are not the requirements for a job and they cost a lot. It is advisable to do these once you are employed, but if you get an opportunity to do it give s you an extra point on your CV.

Is compression ultrasound sufficient for diagnosing deep vein thromboses in the outpatient arena?

Clinical Bottom Lines:

1. Ultrasound with a follow-up study between 5 and 7 days, after the initial test, makes a bad outcome in patients with potential DVTs very unlikely. Much of this risk relates to the prevalence of the condition.

2. If there is high suspicion of a clot as a result of known predisposing factors then the diagnosis needs to be pursued with more vigor.

The Method/Evidence:

Consecutive outpatients were determined to have a normal or abnormal scan.

If abnormal the patients had a venogram, and if this was not done, they were started on heparin.

If the scan was normal, it was repeated 5 to 7 days later.

End points were death, or thromboembolic event.

Exclusions: if compression ultrasonography could not be done or there were technical limitations, follow-up was not assured, the patient had received therapeutic doses of heparin for more than 24 hours, or if the patient was pregnant.

Patients were followed up to 3 months after initial contact.

The negative likelihood ratio of no bad outcome after two negative tests is 2/6 divided by 333/397=0.397


1. Although this article did not address sensitivities and specificities, since a gold standard was not used for all patients, it did address a more important issue. What is the chance of having a bad event if your scans are negative? The answer looks like it’s very low. The reason it’s low is that the prevalence is low. This is why although the numbers look impressive the calculated likelihood ratios are not that impressive.

2. The researchers intentionally did not include a gold standard for negative tests because they wanted to see what the long term results would be if the patients were not treated. If they had obtained a venogram which showed clot it probably would have been unethical to withhold treatment. Unfortunately it is difficult to know if patients did well because the chances of a bad outcome were so low to start or for another reason.

3. The study probably needed more patients so that there were more events.

4. Although I would feel comfortable withholding heparin for a normal person, if your suspicion for clot is high secondary to known predisposing factors, eg cancer, lupus…, then you probably need to pursue the diagnosis more.

5. The study is actually good, but it depends on the prevalence of the disease.


Birdwell BG, Raskob GE, Whitsett TL, Durica SS, Comp PC, George JN, Tytle TL and McKee PA. The Clinical Validity of Normal Compression Ultrasonography in Outpatients Suspected of Having Deep Venous Thrombosis. Annals of Internal Medicine 1998: 128:1 1-7.