Alison Skippen is a Paediatric Neurology Registrar, who is undertaking her GRID post in Oxford. Alison undertook her Level 1 and 2 Paediatric Specialist Training in the East of England, including posts in Cambridge, Southend & Basildon. She also spent 1 year working in Great Ormond Street Hospital in Paediatric Neurology.
Having previously completed a BSc and PhD in Biochemistry before graduating Medicine, her decision to pursue Paediatrics and then subspecialise in Neurology were driven by her experiences in the hospital & a drive to care and support children & families.
What is GRID?
GRID describes the sub-specialty training which a paediatric trainee can enter once at Level 3 (ST6-8) of their training. There are 16 sub-specialities, which are listed on the RCPCH website.
How / When do you apply?
Previously, you would apply in ST5 for GRID training that started in ST6 and then would last 3 years; however, with Progress+, the new 7-year paediatric specialty training programme being rolled out in August 2023, you will now apply in ST4 (in October-November), with interviews in the following January / February, then you will start your GRID post at the beginning of ST5.
What does the application process involve?
An overview of the application timeline can be found on the RCPCH website: https://www.rcpch.ac.uk/resources/paediatric-sub-specialty-training-application-guidance#timeline
The application process involves completing an application form on Oriel (an online platform), on which you will be scored to be shortlisted for an interview, which will happen in January/February. The interviews are now virtual and are standardised.
After shortlisting, your interview performance and score will decide your ranking and whether you are appointable as there is a minimum score required for success. In the past, the interview was worth 75% and the application form score counted for 25%, but since 2021/2022, the score is 100% determined by the interview. As mentioned above, you will need to reach a certain threshold percentage in your interview to be appointable. Based on your interview score / ranking, and the ranking you gave for job choices, this will determine which offers you receive. Personal circumstances are not taken into account for determining GRID posts/allocations, so having settled in one area of the country for >5 years, hard choices are often placed on trainees at what is a crucial point in their training. It can be challenging to make such big choices which affect not only the trainee but their wider families and children.
How can I put forward a competitive application?
The best thing to do is start thinking about it early, during ST1-3, and decide whether there is any particular paediatric sub-specialty you’re interested in.
During this time, you can undertake audits and projects to build up your CV and get more points. For example, you may choose to undertake an online post graduate certificate in medical education, which would take 2-years of part time work (16 hours a week). You may also get education points from being a local or regional teaching lead. Leadership and management roles are also important ways to gain points and being a regional or local hospital Paediatric trainee representative can be useful. It is better to do this early (in ST1-2), as you will have less time to do so in ST3/4.
Many people may choose to take a year out, perhaps after ST3, to gain more experience or undertake some research to build up your CV, before coming back into training and applying. In fact, there is almost a sort of push / encouragement to do this now with progress+ now shortening training by 12 months.
Any advice for the interviews?
Practise! The Soft Landing website has lots of interview skills-based webinars for GRID and also for general interviews (link at bottom). They have been inspirational in my journey, as I was unsuccessful for GRID the first time I applied.
I also used a question book (by iscMedical – link at the bottom), as well as questions shared between people I knew. I had approximately 7 mock interviews and this was with both non-medical family members as well as Medical Registrars and Consultants who were willing to perform a mock interview for me. A lot can be gained from just asking others to critique your performance and it also gives you time to practice the questions on the spot in a structured way.
The interview is very structured as it has been standardised deliberately to reduce bias. There is no conversation as such so be prepared, as you will do most of the talking. The interview panel consists of four Paediatric Consultants from the speciality you are applying. There will be a lay member of the panel who is usually present but you won’t be able to see them (camera switched off). There is also a college representative, but again you won’t be able to see them as their cameras will be switched off.
The format is a 25 min panel interview, with 4 questions, each covering a specific domain: 1) your motivation, 2) clinical question, 3) audit, QI or research, and 4) multidisciplinary teamworking.
In the answers, it can be helpful to bring in examples of real-life experiences you have of teaching, leading projects, QI, audit and research. This is particularly applicable in the answers to questions 3 & 4. For example, you could describe when you worked in a team, including when things went well and also when they didn’t go well, and what you did to resolve them and the outcomes.
CHEERI as given many trainees in the east of England the chance to lead on projects but also be with others that have an interest in Paediatric research. This has invariably been a useful experience which they have been able to use in their GRID applications. I would advocate for medical students and Paediatric trainees to try and get involved in a local research network such as CHEERI. In areas of the UK, where there isn’t such a research network at present, such as the Thames Valley Deanery where I am now working, there might even be opportunities to set up one.
Being a member of CHEERI, I have been able to write a critical appraisal for DFTB website. I also have been able to help set up a regional research day at NPEG with other colleagues. I was involved with helping to obtain speakers for the virtual teaching day and I was also able to be a co-chair, ensuring speakers were introduced and they knew their timings. I was able to field questions appropriately. Use of technology in the form of presentations, video, sound and Microsoft teams were critical for the day to run smoothly.
What if I don’t succeed in my application?
You’re technically allowed to have multiple attempts at the GRID application, but it actually works out to be a maximum of 2 application rounds, as you can only count one year retrospectively. For example, if you apply in ST4 to start a neonatal GRID post in ST5, but you’re unsuccessful, your hospital may keep you in neonatal posts for the coming year (as an ST5); and then, the following year, you apply for the second time for GRID, you can retrospectively count the past year (as an ST5) as if it were your first year on a GRID post. And then, hopefully successful the second time around, you then begin your ST6 (as if your second year of GRID post).
This happened to me, when I was unsuccessful for my first GRID application, and then I was able to stay for a further year in Paediatric Neurology posts. My Training Programme Director was able to support me to stay in Paediatric Neurology posts for 6 months in Cambridge and 6 months at GOSH.
Finally, if you are not successful in your GRID interview or you are appointable but unable to take up your post, due to geographical or family reasons, there are always alternative ways to achieve subspeciality in your area of interest. Indeed, many subspeciality Paediatric Consultants might not have done GRID training, so it is useful to ask them what their journey was to success. If this is what you might need to do, it is best to discuss with the subspeciality CSAC as earlier as possible, as they will be able to advise you of the options. You can apply for Clinical fellow posts after your CCT to gain an equivalent training but these need to be approved with the CSAC. Most importantly, don’t give up your dream. There are lots of ways to achieve success and this looks different for everyone.
How do I know which subspecialties to apply for?
You can apply for a maximum of two specialties (for more information, please see the RCPCH website).
I applied for Paediatric Neurology because I really enjoyed working in the field of epilepsy whilst in a local district general hospital as a Paediatric SHO. This interest led to me requesting a placement in Paediatric Neurology in Cambridge during my ST2 year. This placement was both interesting and challenging, with some very difficult cases. I was given independence to lead on projects and take part in MDT discussions in the weekly neuro-rehab meetings. The Paediatric Neurology team I joined in Cambridge were inspiring and it was a time I cherished most notably as I felt supported in my clinical work but also because I was able to see how I could make a difference to children and their families with neurological problems. Genetics was just starting to really come into clinical practice. I also wrote up cases which got accepted for both oral and poster presentations in conferences such as the British Paediatric Neurology Association (BPNA). I really wanted to be a part of the team and the wider Paediatric Neurology community. During this placement I made some big decisions about what I wanted from my career and I knew that neurology needed to part of my future in some form. Of course, most Paediatricians (about 70%) don’t undergo subspecialty training, and there are many benefits to being a General Paediatrician, which can provide a wide range of opportunities, such as in teaching, training, and research. Many General Paediatricians will develop a special interest such as in Allergy, Cardiology or Epilepsy. As a Paediatric Neurologist you are able to work closely with colleagues in all specialities.
Interview book (Amazon): https://www.amazon.co.uk/Medical-Interviews-Comprehensive-Registrar-Techniques/dp/1905812310
SoftLanding events (incl. interview webinars and workshops): https://www.soft-landing.org/upcoming-events
HEEoE website, with further details about GRID: https://heeoe.hee.nhs.uk/paediatrics/home-paediatrics/educational-opportunities/grid-training
Queries can be directed to: Email: [email protected], Phone: 020 7092 6139