Dr Annabel Greenwood

The SRC was established by the Kaiser Permanente Health Group in Northern California, and has reduced antibiotic use in babies by almost 50%.

It is a tool for calculating the risk of early-onset neonatal sepsis (EONS) in babies ³ 34/40 gestation.  It uses maternal risk factors together with the clinical presentation of the baby to calculate a probability of EONS per 1000 babies. 

The incidence of EONS is 0.5-0.9/1000 live births in babies ³34/40 gestation, with a 3.5% incidence of mortality.  Current guidelines for EONS are not sensitive or specific e.g. the definition of chorioamnionitis can vary, diagnostic tests have poor predictive value for EONS, and 40-50% of cases are not captured by current screening tools.  Furthermore, current guidelines do not take into account the clinical examination of the baby.

We have a duty as clinicians to improve antibiotic stewardship, avoid unnecessary investigations, and shorten duration of stay in hospital.

An initial probability of EONS is calculated based on the population incidence together with risk factors for sepsis including; gestational age, highest maternal antepartum temperature, GBS carriage status, duration of rupture of membranes, and the nature and timing of intrapartum antibiotic administration.  The baseline risk is then modified based on the infant’s clinical examination

The calculator is not currently in use in neonatal units across Wales.  However, following extensive discussion at the Wales Neonatal Network Audit & QI day, the provisional aim is for implementation early next year. 

It has already been implemented in some neonatal units across England (Plymouth, Exeter, Bath, Southampton, Oxford), with a reported 40-70% reduction in antibiotic use (depending on the centre

On reflection, after listening to the discussions at the Wales Neonatal Network Audit & QI day and exploring the topic further, I feel the implementation of a sepsis risk calculator on the neonatal and postnatal units is a positive move towards improving our antibiotic stewardship, protecting babies against unnecessary investigations, whilst at the same time easing the workload of the medical team by reducing unnecessary procedures.  However, let’s not forget that neither the SRC or current guidelines will pick up unwell babies at birth…There is of course no substitute for clinical acumen!

Dr Chris Course

The RCPCH and the NIHR (National Institute for Health Research) held annual joint study day aimed at promoting and de-mystifying academic training careers. This free study day is fairly new on the RCPCH events calendar, having only been held for the past couple of years, but aims to tackle an area of training which is sometimes perceived as difficult to understand and undertake.
 
This was my first trip to RCPCH HQ in London, and it was great to actually see the place where its all run from. Despite not being as grand as the Royal College of Surgeons or GPs, it was a modern building with good meeting facilities. I was also a little worried that, not already been on an academic training pathway, I may be a little “out-of-it” or some of the subject matter may not be useful or attainable for me.
 
Thankfully, I was wrong! There was a really good mix of trainees in attendance with a wide range of backgrounds. Some were already undertaking PhDs, some were nearing the end of their training and looking to build a research career, some were already on an academic training fellowship. Meeting all these colleagues with different backgrounds in the “Networking” session during the morning helped me to put my own current aspirations and difficulties into context and to being finding some solutions to these problems.
 
The speakers for the day were an eminent bunch and gave some really useful and insightful talks. Professor Anne Greenough started the day with a broad introduction to academic career paths, and how the new progress curriculum is building research and academia into the training domains, aiming to improve our exposure to clinical research, as well as encouraging the Deaneries to facilitate more academic opportunities. Dr Chris Gale then gave his personal experience of his path into an academic career, giving a “how-to” guide too framing a research question, finding the supervisors and mentors to help develop your project and then how to find the grant money. It was encouraging to hear how perseverance is the key to obtaining the funding, and giving hope that somebody wold fund your project if you’ve had a good idea! The morning was rounded off by Professor Paul Dimitri trying to de-mystify the NIHR – not an easy task! It seems to be a very complex structure, and I can’t say I understand how they work completely, but I’ve definitely got a better idea of where to find more information now. There was also good formation on how to further an academic career as a trainee and consultant after completing your initial projects.
 
The afternoon included workshops from Dr Lauren Kier from the Wellcome trust, covering tips on grant application writing and how to secure that all-important funding, and balancing clinical and academic priorities through your training grades. Following this, there was a presentation covering developing a career in industry, and leaving clinical medicine. I can’t say this talk filled me with inspiration, but it was a interesting to hear the experiences of life outside of clinical medicine with a medical degree. The day was a rounded off with an entertaining talk from Professor Mike Levin, giving an overview of “A journey into research with no plan”, and how an inquisitive mind and a bit of serendipity can help forge an academic career. I’m not sure if the much more structured and formalised training career we have now, with portfolio and ARCP demands, would still allow such a career path, but it was interesting all the same.
 
I would recommend the Academic Trainees Day to anyone contemplating an academic training path or thinking about taking time out of training to do research. Also highlighted in the day was the RCPCH’s Academic Toolkit www.academictoolkit.org which is another useful resource for anyone wanting to know more about academic careers. The day highlighted the challenges and obstacles  to an academic career, and how to start overcoming them, and was a good networking opportunity to learn of other peoples experiences. The day showed that an academic career can be a challenging one to start and maintain, but can be incredibly rewarding.

Dr Rebecca Broomfield

A summary of a year taken out of program to pursue an interest in clinical leadership.

​Why do it? Is it even important?

Leadership is everyone’s business. As you go through your career you will be but into leadership positions even if you don’t think that you are. Everybody within medicine is a leader in some way and therefore surely it is important to learn the skills to be a good one? We teach other things, procedures, history taking, interpretation of investigations so why not teach leadership? I believe there is some weight in the argument that leaders are born, not made in that some people will naturally gravitate to and thrive in leadership positions. But every leader can improve, and therefore good leadership can be taught. If as trainees we are given an opportunity to learn these skills then this can only be a good thing for the future of health care. ​

The Faculty of Medical Leadership and Management Trainee steering group is a fantastic resource for trainees. (https://www.fmlm.ac.uk/about-us/networks-and-groups/trainee-steering-group). They have just published a toolkit which outlines the importance of clinical leadership more eloquently than I can summate in this paragraph. It offers hints and tips to expand your own leadership styles without having to take a year out like I did. This can be found here: https://www.fmlm.ac.uk/members/resources/leading-as-a-junior-doctor

If you are interested in applying for the Welsh Clinical Leadership Year and want me information please do contact me, I’d be more than happy to chat over coffee. ​