Princess of Wales Hospital, Bridgend, Friday 8thJune 2018
Annabel Greenwood Paediatric ST3 Trainee 

Broadly speaking, I feel our exposure to safeguarding training in the early years of paediatric training is limited.  
 
Before you know it, you are the registrar on-call, out of hours, contacted with a complex child protection referral.   As a junior paediatric trainee about to transition to middle-grade training, I will inevitably at some point, be faced with this scenario, and if I’m to be completely honest, the thought has previously caused a slight degree of tachycardia, hyperventilation and perspiration on my part, at the uncertainty of such a situation!  
 
I therefore searched for a way to dispel my fears and came across a child protection simulation course set-up by Dr Emily Payne, ST8 Community Paediatric Trainee in Wales.  This fantastic one-day, multiagency simulation course has certainly enhanced my confidence in the management of child protection cases and I would certainly recommend the day to my fellow trainees.
 
The course facilitates approximately 6-10 trainees, a perfect sized group to allow plenty of opportunity to ask questions and share our experiences with each other.
 
The day began with a couple of short lectures, setting the scene for the day, addressing some key safeguarding principles, including the rights and responsibilities of all doctors, and an outline of the child protection process.  We also discussed the ‘ACE’ (Adverse Child Experiences) Study, which has demonstrated that for every 100 adults in Wales, 47 have suffered at least one ACE during their childhood, and 14 people suffered 4 or more events.  ACE are stressful experiences occurring during childhood that directly harm a child e.g. sexual, physical or emotional abuse, or effect the environment in which they live e.g. domestic violence, mental health, parental separation.  It has been shown that ACE impact across the life course, e.g. affecting neurodevelopment in the early years, potentially causing social, emotional, and cognitive impairment, and perhaps leading to the adoption of high-risk behaviours and crime later on in life.
 
Later in the morning we divided into pairs for 3 workshop sessions focusing on physical, emotional and sexual abuse respectively.  These informal, small-group workshops were based on a clinical scenario and provided an excellent opportunity to voice any queries or concerns we had regarding the different categories of abuse. 
 
In the afternoon, we worked through a number of simulation child protection scenarios with actors playing the role of the child’s parents, making the situation as realistic as possible.  At the end of each scenario we re-grouped to provide feedback and discuss the case in more detail. I felt that this was a completely safe environment to practice leading challenging safeguarding scenarios, and found it extremely useful to receive constructive multiagency feedback, from doctors, social workers and the police.  
 
The day was brought to a close with a simulated strategy meeting, and we all played the role of a different member of the multiagency team.  This provided a fantastic insight into the role of each member of the team, and demonstrated how everyone works together to collate the evidence in order to generate an accurate account of events, to ensure the safety of the child. 
 
I thoroughly enjoyed the course and feel that I will now make the transition to middle-grade training with enhanced knowledge and confidence to manage challenging safeguarding scenarios. 

22nd June 2018, Swansea Marriot Hotel
​Gill Smith, ST4 Paediatrics Trainee, Wales Deanery

The spring 2018 WPS meeting was held in a very sunny Swansea. The sun shone down on the beach next to the Marriot hotel which provided a beautiful view during breaks between some excellent presentations and some very thought-provoking talks. 

The morning presentations were on very varied and interesting topics, which included audits and quality improvement projects from medical students, paediatric trainees and consultants. 
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Presentations from neonatology to general paediatrics meant that there was something for everybody. I particularly enjoyed the presentation by the co-host of the WPS meeting, Dr Carol Sullivan who spoke with enthusiasm and wit about writing a student textbook in paediatrics. It looks like it will be a hit. Just before coffee, we were delighted to see Dr Peter Dale adorned in a bright pink wig and pink cape to highlight and talk about the approaching change to the RCPCH curriculum-progress. He went pink for Progress. Details can be found on the RCPCH website. More fantastic presentations ensued after coffee and the morning session was rounded off with a presentation on the problems encountered by babies born in the late pre-term period. Often thought to be close to term that physiologically they would be similar to those babies born at term. Evidence suggests this is not the case and is certainly gave us food for thought prior to lunch. 

A brilliant and tasty selection of food was available for lunch, finished by coffee and a chance to chat with the exhibitors. The lunch break was also a great opportunity to pop outside and enjoy the glorious sunshine and beautiful views overlooking the mumbles. 

After lunch we were kept from any thoughts of postprandial sleepiness by another set of wonderful and stimulating presentations. The first lecture back, presented by Dr Sheena Durnin was perfectly timed about of the use of paediatric pain relief practices in emergency departments in the UK and Ireland. These practices were evaluated across 40 hospitals in the UK and Ireland. It found a wide variety of practices in terms of analgesia used, timing of analgesia policies, and availability of play specialists to name a few. Dr Durnin earned the award of best presentation. Congratulations!

Next up, another award winning presentation by Dr Rachel Morris who spoke so eloquently and with such passion about the implementation of family integrated care in a tertiary neonatal unit. The results were encouraging in that since the introduction of Family integrated care there had been an increase in breast feeding rates and a reduction in the length of stay and an anecdotal feeling that parents felt more in control and were ready for discharge sooner. Dr Morris won the best trainee award and this was thoroughly deserved.

Following another round of superb presentations, the mid afternoon session was rounded off with an absolute gem of a talk from invited speaker Dr Mark Stacey, consultant anaesthetist and Associate Dean in Cardiff and Vale NHS Trust. The talk entitled ‘A Bakers’ Dozen Resilience Skills’ got us up and thinking. We had to write ourselves thirteen points to aid us in our resilience at work and life and included sleep, meditation and taking care of yourself. Some very important points and recommendations made. This talk left many feeling invigorated and gave us something to talk about during the afternoon tea break over coffee and cake before the late afternoon session.
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Fuelled with caffeine and carrot cake we had a further four short quick fire talks and the day was completed with a guest lecture from Dr Michael Farquhar, Consultant Paediatrician in children’s sleep medicine at Evelina Children’s hospital. His talk entitled “Rounded with a sleep: Why We Need To Talk About Fatigue” discussed the importance of sleep and gave a convincing argument for the need for all of us to sleep well. Night shift workers are encouraged to take power naps as this will improve our senses, judgement skills and general wellbeing. This talk went beautifully well with the Resilience talk and is definitely something we should all try and think about. Driving tired can be as bad as if driving after drinking alcohol.

​We made our way to the beach to enjoy the rest of the sunshine before a delightful dinner with colleagues and friends. A lovely end to a fantastic day.
 
Once again the WPS conference was a great success, showing a very talented bunch of people. It was thought-provoking and inspiring and a great way to meet up with colleagues and brilliant guest speakers. I’m off to get some sleep before the winter meeting (I prescribed it to myself)!

As a Paediatrician I think we play a vitally important role in Public Health, we have the ability to make a significant difference with every contact we have with children and young people, therefore I was excited to attend the Public Health Wales Conference in October. It provided an opportunity to keep up to date with all aspects of Public Health as well as focus in on paediatric specific topics, such as adverse childhood events, the venue was fantastic and with Michael Sheen making a keynote presentation what was not to love?!
 
The start to day 1 was nothing short of inspirational, a montage of pictures detailing the history of Public Health in Wales and significant events in history, such as devolving power over health, was accompanied by a harp and a flashmob choir popping up in the audience culminating in a local school choir taking to the stage, it was breath taking. After an impressive start the audience heard from Rebecca Evans, Minister for Social Services and Public health, who updated us on the progress which Wales had made within Public health. The next speaker Dr Christoph Hamelmann, Head of the World Health Organisation Europe office for Investment in Health and Development, spread the net wider and discussed more global issues and reiterated the importance in looking beyond your own borders in Public Health spheres. I was pleased to learn that the ‘Well being of future generations act” really is leading the way within the WHO.  We wrapped up before lunch with a keynote on Climate change, followed by a discussion panel exploring air pollution and how we can build a sustainable future. 

​​The afternoon sessions on day one were split into ‘Spotlight sessions’ there were many of these going on at the same time and the topics which you could choose from were diverse. I attended one entitled “Mindfulness for wellbeing: Evidence and Practise” The science behind mindfulness was discussed briefly, demonstrating the activation of the pre-frontal cortex when being mindful. Children who are naturally high in mindfulness react less strongly and have better emotional regulation. It was interesting to see demonstrated that by using mindfulness techniques with school aged children you can shift them into individuals with high mindfulness. After the training these children had a significant decrease in the intensity of their reactions to angry faces. Mindfulness has an enormous potential for development within education, as within other areas, but it important that the training is ongoing and children learn to use it within everyday life. Mindfulness, growth mindset and metacognition are surrounding feature of the new curriculum being developed in Wales and has the opportunity to vastly improve the outcomes in mental health for this generation of children.  My spotlight session was fantastic, but I had significant spotlight session envy as a college attended a Lego workshop based on driving improvement through the value chain and got to use LEGO to demonstrate visually resilience and improvements – she got to play with LEGO and call it work! (on a side note you can train to deliver LEGO sessions and this could be your job!)
 
Day 1 ended with a chaired Brexit Debate. The views from the panel were interesting and the uncertainty regarding the exit plans are already causing problems for Public Health initiatives within Wales. The panel presented reasoning that it doesn’t matter what side you were on when voting took place, we need to overcome this and work together to move forward. Wales have already done some of the ground work with how to respond. Brexit is currently overwhelming all of UK politics and other important issues are being neglected because of this focus. But on the other side of the coin, and attempting to be a glass half full type of person, Brexit is a huge opportunity to have ‘No more excuses’ and reduce inequalities. We need to change our mindset on Brexit, accept that it is currently happening and focus on the positives which we can derive from it.
 
Day 2 started by hearing from Dr Frank Atherton who is Chief Medical Officer for Wales and a person I will never get bored of hearing speak. He attended WPS last Autumn and delivered an engaging Keynote there, and as a Welsh Clinical Leadership Fellow we have been in the privileged position to meet him on several occasions. He presented that we should celebrate our Public Health successes (Hepatitis C, Future generations act, reduction in smoking rates) but also recognise that we still have a long way to go. Inequalities still exist and are widening. Moving forward we need to focus on prevention with improved outcomes and ensure sustainability. But because a long term view is not easy to fit into political cycles it is hard to engage managers with this viewpoint. Dr Atherton concluded that we are on the right track and need to continue to engage the public and sustain ongoing developments in Prudent Health Care.
 
Dr Chrissie Pickin followed on from Frank Atherton and presented an engaging talk entitled “Understanding people’s choices and how to influence them”. She started by noting that Health issues are complex and for every complex problem there is a straightforward, easy to implement, wrong solution. Providing education is an obvious solution because the assumption is that people would not deliberately harm themselves but a knowledge gap is rarely the reason behind the behaviour. She gave some top tips to influence people’s choices.

1. Understand the behaviour
2. Motivate not educate – on three levels: individual, peer and social.
3. Change social norms – legislation and policy are key factors in social change, for example drink driving laws, but these are not always the basis for change. Sometimes policy can be socially led and legislation needs to catch up.
4. Manage opportunity – make it easy, or capture people at a significant life event such as becoming a new parent.
5. Build capacity to initiate and sustain change

When looking at a problem find out where the problem lies. Is it a problem with Capacity? Motivation? Opportunity? Or all three? Once you have identified where the problem lies you can target the intervention.
Having learnt about how to influence people’s choices it was fitting that the next speaker, Richard Chataway delivered a talk on Social Marketing and Communication Science. Because we have a better understanding of what drives behaviour change as well as advances in technology social marketing has significantly changed. Richard Chataway presented, amongst other topics, a public health initiate undertaken in Australia, his team wanted to reduce smoking rates. When quitting smoking the motivation is there, the knowledge is there but people need support. He launched My Quit Buddy, an app which provided daily progress tracking, distraction techniques and motivational messages. This was an incredibly successful campaign and the app has had wide uptake. He also explored the use of technology within research into changing behaviours. With the introduction in artificial intelligence it is possible to pre-test communications such as an advertising campaign, to understand it people will find it motivating at a subconscious level this can remove the test and learn element of marketing which will make it more effective, quicker. He again reiterated that in order to find a solution it is important to understand the behaviour and design a solution around it. A panel discussion followed this.
 
After a short break, there were more ‘Spotlight sessions’ with lunch in the middle. There were again many topics to choose from. I attended “Tackling Adverse Childhood Experiences” It is known that if a young person experiences 4 events they are 15x more likely to commit violence, 14x more likely to experience violence and 20x more likely to be in prison than the general population. We need to break the generational cycle and make a social movement for change looking at the root causes and take a psychological approach to tackle these. The impact of breaking the generational cycle is huge, 47% of adults have experience 1 adverse event. The second of my ‘spotlight sessions’, after lunch was “The good, the bad and the social: Two sides of social media” Social media is more addictive than smoking or alcohol, 10 million photos are uploaded to Facebook every hour. It can be both positive and negative the challenge comes with harnessing the positives while mitigating the negatives. Instagram is cited as the most negative with associations to negative body image as well as anxiety and cyber bullying. There was a lot of discussion about where the responsibility lies for managing social media for children and young people. It was felt that this was not just the responsibility of parents, social media itself needs to take some responsibility.
 
The conference closed with Michael Sheen discussing “Building on our cultural strengths: Supporting communities.” As expected Michael Sheen was an engaging and well informed speaker. His message began with the understanding the if you want different outcomes you have to fundamentally change what you do. He outlines inequality as a significant problem, the less you have the more you have to pay for it. If we want families to drive themselves up socially then we need to look at the weight of debt which they have. We have a benefit within Wales as we have a strong community spirit and have held onto our identity and language. As a Public Health team we need to support our communities to be as healthy and sustainable as possible, we need to provide space where communities can come together and shift the power into the grass roots. His concluding statement is worth recognition and highlights a positive to finish a highly engaging conference. “One who has health has hope, and one who has hope, has everything” (Originally a proverb I think!)
 
Once again, I tweeted through the conference and these can be found on my twitter feed from these dates. Public Health is an important topic which is extremely relevant within Paediatrics and the selection of work presented during this conference leaves me in no doubt that Wales really is leading the way. 

This Autumn’s WPS meeting took place in the absolutely stunning location of St Brides Hotel in the picturesque seaside town Saundersfoot.  Nestled in the clifftop, overlooking the breath-taking rugged Welsh coastline, it provided the perfect backdrop for an invigorating day of presentations, discussions and networking.
 
 
 
The day began with the invitation lecture from the esteemed Dr Trevor Brown, Consultant Paediatric Allergist at Ulster Hospital, on cow’s milk allergy (formerly cow’s milk protein allergy).  Ever a diagnostic and management paradox for GPs and general paediatricians, this in-depth discussion covering IgE verus non-IgE mediated reactions, clinical presentation and potential management options was invaluable.
 
The morning session presentations were abundant in variety and interest, including projects and audits from Cardiff University Medical Students, Welsh Paediatric trainees, and Consultants.  Of highlight during this session was the fantastic prize-winning project presented by our very own WREN co-chair Dr Siwan Lloyd on head injury following infant falls on the postnatal ward – a case series.  The variety in the approach to investigation and management of such patients was fascinating, especially given the high rate of CT head abnormalities of those imaged.  The subsequent departmental guideline implemented at UHW will certainly help standardise care and provide more clarity and direction for management.
 
Almost time for lunch, but of course not before the brilliant Guest Lecture from Detective Superintendent Anthony Griffiths, Head of Public Protection, Dyfed Powys Police – ‘Child Protection: The Challenges for Policy and Multi-Agency Working.’  This lecture provided an invaluable insight into the challenges often faced by the police in child protection cases.  The videos and images used were extremely powerful and emphasized the great difficulties in tracking down offenders in today’s society, particularly given the huge smart phone and social media influence.
 
After an action-packed morning of presentations and lectures it was time to refuel with a mouth-watering lunch overlooking the absolutely spectacular scenery.  Coffee could be taken onto the balcony, and what a treat it was to catch up with friends and colleagues with the sound of the waves crashing onto the shore below.  There was also the opportunity during this lunchbreak to visit the exhibitor stands, the main theme being cow’s milk allergy, in-keeping with the invitation lecture earlier in the day, and there were a variety of different formulas to sample at these stands (some of which far more palatable than others!!)
 
The afternoon session was equally interesting and stimulating, including presentations inspiring and empowering trainees, highlighting the importance of blogging, social media and trainee-led initiatives to encourage learning and champion change.
 
The final Guest Lecture of the day was provided by the highly-regarded Dr Julian Forton, Consultant in Paediatric Respiratory Medicine and Cystic Fibrosis, UHW, on ‘the new C21 Curriculum at Cardiff University School of Medicine.’  It was absolutely fascinating to learn how the curriculum and course structure has evolved since my days in medical school! The aim is for a more case-based, small group learning approach with early clinical exposure.  The exam format was also an interesting change, whereby all years take the same end-of-year exam, with the focus being on demonstrating improvement and development each year.

As the sun was setting at the end of a wonderful day, it was time for the evening entertainment in the form of the ‘celebrating trainee event’ followed by the formal evening dinner. This year the Best Trainee prize went to Dr Siwan Lloyd in South Wales (taking a clean sweep of prizes!) and to Dr Stacey Killick in the North.  Best Educational Supervisor went to Dr Zoe Roberts…congratulations to all!
The day was wrapped up with a splendid evening of dinner and dancing (thank goodness for the spa to recover the next morning!)
 
Once again, WPS has delivered an outstanding conference!  It provides an excellent platform to showcase your work, and to become inspired by colleagues and friends.  It also provides the opportunity to learn from lead professionals in their specialised field, and to celebrate the achievements of others.  We certainly are lucky to have such a wonderful paediatric society in Wales! 
 
Now, who’s joining me for the Spring meeting?!....