Lending a helping hand

newsRCPCH

5David Baum Foundationsponsored walk

6Medicines for childrenresearch network

14Trainees’ column

Lending a helping hand

SPRING 2007

Royal College of Paediatrics and Child Health Leading the way in children’s health

SPECIAL FEATURERCPCH Internationalwork, pages 8-9

Education! Education! Education! Education! Education! Education! pages 12-13

Page 2

Have realised the secret of

dieting is not weighing oneself.

BRIDGET JONES

Regular followers of the Registrar’sColumn will know that I am on amission to improve my health. Herewitha progress report:

Week commencing 1st Jan – followingXmas excesses, New Year’s resolution tolose X stone by end Feb. Criminal towaste last few mince pies …so best tostart tomorrow.

4th Jan – after 48 hours of dietarydiligence, meet with rest of CollegeACCEA Committee to review ACCEAapplications. Our 2005 workforce censusdemonstrated that average contractedPAs for full time paediatricians was 11.5– but we know that a majority ofpaediatricians are working far in excessof this…and shortlisted ACCEAcandidates are working to an even more phenomenal pitch.

Essential to celebrate the achievementsof these individuals - plus the President’sbirthday. Glass of champagne only haslow calorific value… but seems churlishnot to go out for meal afterwards…..

Week commencing 8th Jan – thisweek will be different!! After eating out 3nights last week, resolve to consume onlyfruit and lettuce leaves. Resolve to spendthe evenings at home. Resolve NOT tosend any emails after 11pm.

8th Jan - afternoon at Collegediscussing our workforce dilemmas. Our2005 census reports 2723 consultants inUK (2556 WTEs). To achieve consultantEWTD compliance for current number ofhospitals we would need at least another1200 to 1400 – and that doesn’t includeoption of resident on call. Conversely, we also know that the rate of consultantexpansion has slowed to 4% whilst wehave increased our middle grade traineesby 25%. Modelling from the North Westdemonstrates that any further increase inthe number of trainees entering ourprogrammes will saturate and exceedconsultant vacancies. Service reconfigurationis clearly essential – but will it bepolitically achievable?

Stress of workforce discussions culminatesin trip to pub rather than gym - and thento cinema. Uncomfortable suspicioncreeps over me that crisps and alcoholin pub followed by popcorn in cinemamay not constitute a nutritionallybalanced meal. Maybe I should have hadpeanuts…?? Send first email of the day at11.45pm…

Week commencing 15th Jan – lastweek’s average daily calorie intakeprobably circa 3000. Exercise 0. Decide notto answer any calls from personal trainer.

15th Jan – spend lunchtimediscussing how to involve parents andyoung people in a more proactiveapproach to obesity issues – whilst allconsuming large bowls of pasta.

17th Jan – attend national EWTDmeeting. Colleagues from RCOG and RCPare sanguine about a future which willsee a consultant to trainee ratio of 3 to 1.Am struck by the imperative to thinkbeyond reconfiguration – which will stillresult in a 1:1 ratio of consultants tomiddle grades, and an ongoing heavyreliance on middle grades for service.

We have all talked about ‘consultantdelivered’ services. What will this mean forcareer planning? Will we need to ‘front-load’post-CCT careers to do on call – perhapsresident – up to mid career in order tomove to a less acute role in later life? Howwill we phase 30 year careers as clinicians,academics, educators, and managers?

Meal out in evening with two colleagueswho have just been reduced to 10 PAs perweek. One will now be taking one day offper week, the other will have 17 weeksleave per year. Maybe EWTD is not so bad!!

Week commencing 22nd Jan – off on holiday to Namibia. Summary of last3 weeks - weight up 4lbs. HonoraryTreasurer has refused funding for 2weeks in an exclusive health farm, withNO email access. However, am persuadedof the merits of reviewing work patterns

and changing work-life balance.

Hilary CassRCPCH REGISTRAR

Editorials

From the Registrar

2From the Registrar

3From the President

4-7News

8‘Child in Mind” project update

9Paediatric Evidence Course

12Education! Education!Education!

13A year in 8 hours

14Trainees’ column

15Meetings

In the newsSpring 2007

Page 3

On my way to the MRCPCH examinationceremony, a smartly dressed young manasks me if he is going in the right directionfor the RCP. I say he is and ask if he isgoing to the exam ceremony and dinner.He says he is. I ask if his parents will alsobe there; he says no and looks surprised at the question. Faithful readers of thiscolumn will immediately deduce that Ihave got hold of the wrong end of thestick and am about to run with it. Ihowever have not yet realised this andchat breezily on about how difficult it is towork so many late nights in a row (heagrees) and how difficult it is when peopleare more demanding (he fervently agrees).We part at the door and I resolve to givehim an extra big smile when I see him onthe platform. I do not of course see himthere, but he gives me an extra smilewhen he serves the food and wine at the dinner.

I do not know if the catering industry is fastidious in its observance of theEuropean Working Time Directive, butclearly we don’t have a monopoly onworking late shifts. However the EWTDhas huge repercussions on training and onservice. The EU ruling on equatingpresence in hospital with work has beenunsuccessfully appealed against severaltimes. Should we obey the rules when notall our European counterparts do? Some donot, some are patchy, but others work astrict 48 or even 40 hour week. TheEuropean Commission has now stated thatit will launch legal action against non-compliant countries. Certain EU memberstates have called for a split in thedirective with the aim of resolving the oncall time issues. However others, includingPortugal (who hold the 2007 presidency),are against this so any potential changewill not even begin until 2008.

In any case, what will our trainees sayif we go back to the old hours? Less thanfull-time trainees can now train moreclosely alongside their full-time colleagues.The BMA, the Postgraduate Deans and theAcademy of Medical Royal Colleges allsupport EWTD compliance on Health andSafety grounds. We therefore have toaccept that we must work with it andensure rotas are compliant, are safe, andthat teaching and education find their

place. Is it realistic to expect a doctor tobe “fully trained” as a day 1 consultant? We support specialist registration asindependent practitioners, but do we wanta “buck stops here” ethos or continuedpeer review and life long learning?

Is it right to discontinue local servicesbecause we cannot staff them in 2009? Is it right for patients to be seen by the leastexperienced doctor at the point when theymay be sickest and where the diagnosis is least apparent? Our main problem iscoping with urgent and unplannedpresentations as well as planned orscheduled care. “Hot” consultant weeksgive time in the other weeks for plannedand outpatient care, teaching andassessment, but needs a critical mass of consultants.

How do we handle the increasing loadof children presenting in EmergencyDepartments who were formerly seen inprimary care who may or may not needsecondary or tertiary services? There isevidence that we are falling behind ourEuropean colleagues in the outcomes ofsome conditions – for example earlydiagnosis of tumours. Is this because – as has been suggested – we do not haveprimary care paediatricians? We have toconsider how we cope with primary urgentcare – that is, any child or young personpresenting unscheduled or unreferred in orout of hours. Should we set up jointfacilities with PCT staff on acute hospitalor locality sites to see these children andyoung people?

For any of these models we need morespecialist posts for trained doctors. We needthese posts and we have the trainees to fillthem. We continue to campaign forconsultant expansion – see the workdescribed in the Registrar’s column opposite.

Enough questions! Now some news:Rosalyn Proops has been appointed as ournew Child Protection Officer. She hasextensive child protection experience andhas been developing our Court Skillstraining course which starts in May. We look forward to working with her.

One of the “objects” in our RoyalCharter is to “promote the art and scienceof paediatrics”. We do much for scienceand now we are addressing the art. Joanna

MacGregor, Director of the Bath MusicFestival, invited us to collaborate with theRoyal College of Arts and the GuildhallSchool of Music on “The Edge of Life”- aproject on the balance between life anddeath that is associated with birth. Art andmusic students have visited neonatal unitsand have seen videos of maternity projectsin developing countries by the InternationalPerinatal Care Unit. The result will be seenin an installation of artwork and music atthe Bath Festival on June 2nd interspersedwith some contributions from me and fromProfessor Anthony Costello. Do comealong and support us!

Patricia HamiltonRCPCH PRESIDENT

More details of "The Edge of Life" event can be found

at http://www.bathmusicfest.org.uk/, and bookings

will open in mid-March. Ed.

RCPCH newsEditorials

From the President

Drawing of the President by one of herex-patients, Jasmyn Monroe

News

Honorary editor: Rashmin Tahmne

Managing editor: Graham Sleight

Editor: Joanne Ball

Email: newsletter@rcpch.ac.uk

Editorial services: Chamberlain Dunn Associates

Advertisements: British Medical Journal

Published by the Royal College of Paediatrics andChild Health, 50 Hallam Street, London W1W 6DE Tel: 020 7307 5600, Fax: 020 7307 5601 Website: www.rcpch.ac.uk Email: enquiries@rcpch.ac.ukThe College is a registered charity: no. 1057744

© 2007 Royal College of Paediatrics and Child Health. The views expressed inthis newsletter do not necessarily reflect the official positions of the RCPCH.

RCPCH newsCopy deadline for next issue:

1 May 2007

Page 4

The standards for entry to the specialist registerthrough Article 14 are based on those requiredto enter the specialist register by the CCTroute. One of these standards is ‘a detailedknowledge and understanding of paediatricconditions specific to the sub-speciality.’

We are aware that some candidatesapplying for the specialist register througharticle 14 will not have had the opportunity toundertake a knowledge test such as theMRCPCH and thus will find it challenging toprovide the necessary evidence that they havemet this particular standard. We have thereforedevised an examination that will be will beavailable to those wishing to use it as evidenceof knowledge in paediatrics. It will not be

compulsory, applicants can chose to enter theexamination and if they subsequently do notwish to present their results in the examinationthat is their decision.

The paper will seek to test competence ofknowledge as broadly as possible across therange of paediatrics. The paper will includequestions relating to diagnosis, managementand clinical practice. The remainder of thepaper will consist of questions testingimportant core clinical knowledge, thescience that underpins clinical practice andwill also test a number of the othercompetences such as governance and ethics.

Applicant performance will be comparedagainst a benchmark based upon performance

in this examination by a group of volunteercandidates drawn from a group of HigherSpecialist Trainees and consultantpaediatricians. Individual performances will alsobe compared with performance of the grouptaking this examination, if applicable. Our aimis to provide meaningful feedback that willprovide some guidance as to the level ofknowledge exhibited by those taking the test.

Further details regarding exam dates,application procedures and fees will be releasedshortly after the re-launch of the RCPCH Website.

Graeme MuirHEAD OF EXAMINATIONS

A standardised assessment of knowledgefor certification under Article 14

I have just returned from a glorious weekwalking the snow-covered Cumbrian fells incrisp bright sunshine, to prepare for my firstcollege Council meeting as representative ofsenior members.

The RCPCH presently has over 700 seniormembers, comprising:

• 488 Senior Fellows• 180 Honorary Fellows• 60 Senior MembersWe are growing in number and represent a

valuable and under-utilised resource.Since my election in December last, I have

had helpful meetings with relevant officers andmembers of the secretariat about the ways inwhich we might increase the involvement ofsenior members in College activities.

I have been impressed by their level ofcommitment to the senior members, andjudging by the attendance at the recent seniors’Christmas lunch there is no lack of enthusiasmon the part of senior members either.

My first priority is to improve communicationbetween the seniors and the College throughthe President’s email bulletin, the Newsletter,

and the college Website. We have been offereda page in the members’ section of the newWebsite. I hope to find out what issues concernyou and how you would like to be involvedwith, or to help the College.

For example, are you concerned aboutrevalidation, CPD, or college fees? Would youlike to be invited to Regional college meetings?Should the college organise other events forseniors in addition to those in London and atYork? Are you involved in college activitieslocally or nationally? Would you like to be?

Please let me have your views, ideally byemail to keith@dodd394.fsnet.co.uk or write tome in Derby.

The Seniors’ session in York this year is onthe afternoon of Thursday 29th March. MartinBax and Lewis Rosenbloom will be talkingabout “Ronnie Mac Keith – his career andlegacy.” I hope to see you there.

Dr Keith DoddSENIOR MEMBERS’ REPRESENTATIVE

Involving Senior Members in the College’s workMedicines forParentsThe Parents’ Medicines InformationProject has now officially started. This is a joint RCPCH and Neonataland Paediatric Pharmacists Group(NPPG) project to produce druginformation directed at the specificneeds of parents and children and the conditions/illnesses for which they are prescribed. We hope that this information willdelivered in a variety of formats,initially by leaflets available on theweb. The project will also involve layorganisations such as Contact aFamily and Wellchild.

If you have any suggestions forspecific drugs or groups of drugswhere you think better information is needed or examples of good locallyproduced leaflets please do nothesitate to contact the projectmanager Caroline Higgins.caroline.higgins@rcpch.ac.uk

News RCPCH news

Page 5

Following the success of the walk in Scotland(28th May – 4th June 2005), where participantsraised £30,000 for international child healthtraining programmes, we are announcing a newwalk for the David Baum InternationalFoundation to bring the best of UK training inChild Health to the developing world.

The walk will commence at Windsor Castlewith a send-off by Her Royal Highness

Princess Anne at approx. 2.00pm on FridayJune 29th. The walk will be optionally one ortwo days. On Friday 29th, we will walk alongthe Thames tow-path from Windsor to Staines.This lovely walk will pass Old Windsor Lockand Runnymede along the way. The overnightstay will be in Staines (8 miles from Windsor).On Saturday, we will continue on the tow-pathfor a 14 mile flat walk via Shepperton toHampton Court, where a reception is planned.

This is a wonderful opportunity to join inand make the event match your availabletime, ability and means. Please bring yourfamily and friends and spread the word.

Please register your interest by e-mail toCiara McNulty at ciaramcnulty@btconnect.com

or call her on 0207390 8447 as soon as possible.

Hampton Court

Windsor Castle to...

The Royal Palace to Palace Walk In support of the David BaumInternational Foundation

Send-off from Windsor Castle by HRH The Princess Royal, Princess Anne 29th – 30th June 2007

ClinicalEffectiveness Team Update:Notice of Erratum:An error has occurred in the printedversion of the Decreased ConsciousLevel Guideline Appraisal distributedwith the Autumn 2006 Newsletter. Thefinal sentence on page 4 should read: If more than 40 ml per kg has beengiven with little clinical response,drug treatment to support thecirculation should be considered.NOT: 4.0ml per kg as incorrectly stated. More details and a revised electronicversion of the appraisal document canbe found at the following linkwww.ce.rcpch.ac.uk. We would be happyto provide any further information anamended hard copy of the document.

Clinical GuidelineWorkshop – How toWrite a Good GuidelineWednesday March 28th, 2007 atRCPCH 2007 annual meeting

• Are you planning to develop a guidelinebut are not sure where to start?

• Are you already in the process ofdeveloping a guideline but needsome advice on what to do next?

• Have you produced a guidelinealready but are not sure how to get it endorsed by the College?

The RCPCH Quality of PracticeCommittee (QPC) is holding a one-hourlunchtime workshop to provide guidanceto members on how to develop a goodquality, evidence-based clinical guidelineto College standards. The session willprovide an opportunity to discuss yourproject with experts in guidelinedevelopment as well as provideinformation on how the College cansupport you with guideline development.

If you are interested and would like toknow more or register, please reserveyour place through the Spring meetingregistration (http://www.rcpch.ac.uk/events/rcpch_spring_meeting.html) orby contacting the Clinical EffectivenessTeam (clinical.effectiveness@rcpch.ac.uk)or by phone on 0207 323 7932.Numbers are limited so book early toavoid disappointment!

For more information on the event go to www.dbif.org

For more information on the walk go to www.nationaltrail.co.uk > Thames Path > About this trail > Introduction to Thames Path > Windsor to > Shepperton & Shepperton

to Teddington. Also www.visitthames.co.uk

For more information on the David Baum International Foundation go to the RCPCH websitehttp://www.rcpch.ac.uk , which will also link to the event.

Medicines

Page 6

Many medicines are given each day to childrenwithout an adequate evidence base. It isundesirable both to give treatments ofunproven benefit and harm and also to denychildren potentially valuable therapies.Paediatricians face this challenge every day.

Over a 15 years survey, only 249 randomisedcontrolled trials were published in Archives ofDisease in Childhood, 50% with fewer than 40children. In a survey of the evidence to supportcommunity paediatric practice, 40% of clinicalwork was supported by research evidence.

If evidence for the safety, efficacy andquality of a drug does exist in children, thenthat drug may become a licensed medicine forchildren with specific indications, doserecommendations and warnings regardingrecognised side-effects. For other drugs,prescribing may be unlicensed (e.g. themedicine is given as a liquid formulationwhereas the licence is for a tablet) or outsidethe terms of the licence (off-label) (e.g. in adifferent dose, or for a different disease or agegroup). Forty five percent of medicines used ingeneral paediatric wards, over 90% of thoseused in neonatal intensive care and 11-33% inthe community are unlicensed or off-label.

The RCPCH report Safer and Better

Medicines for Children (May 2004) describedthese disadvantages to children and emphasisedthe need to assist paediatricians to undertakemore and larger studies in children. As aconsequence of lobbying, children’s medicinewas one of the first priorities developed by theUK Clinical Research Collaboration (UKCRC).Best Research for Best Health, the government’shealth research strategy, established the UKCRCto provide networks for studies in a range oftargeted medical fields (e.g. children’s medicines,stroke and diabetes).

Following a national competition, theInstitute of Child Health in Liverpool wasselected as the coordinating centre for the MCRN(Medicines for Children Research Network), ledby Professor Ros Smyth. The key purpose of thisnetwork is to provide a world-class environmentfor clinical trials of medical treatmentsspecifically designed for children. The MCRN hasestablished a young person’s advisory panel –“STAND UP, SPEAK OUT” - to make sure theopinions of children are taken account.

The work of MCRN will be carried out by sixlocal research networks (LRNs). Each LRN willreceive £1.0-1.4 million over the first three yearsto provide research nurses and expertise tosupport multicentre clinical studies addressing

medicines for children. These six LRNs are locatedin a number of regions throughout England &Wales. The LRNs include more than 100 NHSTrusts and PCTs and cover six million children.

The MCRN has also developed ClinicalStudies Groups, inviting paediatricians and othersto suggest research priorities ‘bottom-up’. TheMCRN will also develop training programmesand will help negotiate the sometimes complexlegislation and regulations governing trials.

To paraphrase John Donne, “Nopaediatrician is an island”. Hopefully the MRCNwill help consign the attitudes of “I know best”(i.e. I will not follow evidence based practice)and “We know best” (the hospital or PCT willnot participate in a trial to find the answer) tohistory. In summary, MCRN:1. is good news for UK paediatrics2. is good news for UK children3. is receiving real money of £20m over five years4. will only succeed if busy UK paediatricians

get involved and enter their patients 5. has the strong support of the Royal College

of Paediatrics and Child Health

Professor Terence StephensonVICE-PRESIDENT ELECT FOR RESEARCH & SCIENCE

The simple answer is that if you don’t getinvolved, the MfC Research Network will fail. Itisn’t a research network in which a small numberof paediatricians and others are hoping toundertake a few studies testing children’smedicines used in the UK. It is a new way ofworking together, a new way of gathering muchneeded clinical data, a new way of sharing thiswith others and feeling part of a new nationalapproach to the treatment of sick children.

We have, quite rightly, complained for manyyears that children are frequently ignored and areconsidered as only small adults. Well, the Departmentof Health has listened! It is now concerned thatmany medicines used in the UK do not have alicence for use in children and wants to changethat. It is wonderful news, but success isdependent on everyone playing his or her part.

In what ways can you be part of the MfC

Research Network?Firstly, you may have ideas about which

medicines are important to study. The teamsinvolved in developing and prioritising clinicalstudies are the multidisciplinary Clinical StudiesGroups (CSG’s) which roughly equate to theRCPCH speciality groups. Details of the chairsand members of those CSG’s can be found onthe MCRN website and the appropriatecolleague would be delighted to hear from youabout any research ideas you may have. Youmay wish to become a member of one of theCSG’s as the network develops.

Secondly, you will hear about studies whichwill be taking place and if some of your patientsmight be suitable to participate, it would beexcellent if you could work with the recruitmentofficers to help identify would-be participants.

Thirdly, the MCRN is financed to offerinfrastructure support to deal with the time-consuming parts of research such as LREC andR&D approval, various aspects of recruitmentand consent, but we hope that you will bewilling, as an expert in your field, to becomedirectly involved with patients entering studiesand play an active role in the collection of the

necessary data, following those patientsthrough to the end of the study.

Recognition for your support andinvolvement in research will be acknowledgedwithin the appraisal process and within otherareas of future professional development throughmechanisms within the RCPCH. The flagship forthe new research networks is the National CancerResearch Network which now proudly states that14% of all cancer patients participate in clinicalresearch. We want the same percentage of sickchildren in the country to be taking part in MCRNstudies, but this can only happen with your helpand support. We desperately need children totake part in clinical studies to determine the truescientific benefit of the medicines used now andthose in development. We also need to assesstheir safety and discover new formulations whichare more appropriate for use in specific agegroups. We must not let our children down – wemay never get the same chance again.

Professor Warren Lenney FRCPCH FRCPNETWORK DIRECTOR, WEST MIDLANDS LOCAL

RESEARCH NETWORK

What does the article by TerenceStephenson mean for you and your colleagues?Can you become involved, should you become involved?

The Medicines for Children Research Networka good news story for child health in the UK

News RCPCH news

Page 7

I’m glad to report that the SASG informationday back in December was a great success.Over 60 SASG paediatricians attended from all over the United Kingdom.

We were also joined by Sue Hobbins,Honorary Treasurer of the RCPCH, who offers a great deal of support to the SASG committee.Alistair Thompson, RCPCH CPD officer, joinedus for lunch and answered informal questions.Speakers included Simon Lenton, VicePresident for Health Services, who enlightenedus on Modelling the Future- Key Issues andEmerging Findings. As this work developsfurther it will be important for us a group of

SASGs to understand what we can offer to thenew ways of working. Helen Hammond, Chairof the Child Protection Subcommittee, gave us an interesting update on the Role ofPaediatricians Protecting Children. NedRowlands from Blackpool discussed How toMake a Successful Application to PMETB andencouraged us to read the guidance on thePMETB website several times to ensure wecollect all the evidence needed in the formatneeded. Naeem Ashraf from Hull urged us tosee the SASG role in a positive light and gaveexamples of how we can get the most out ofour roles. Last but not least was Greg Dillaway,

deputy chairman of the SASG committee of theBMA, who gave us an update on where ournew contract is up to. Hopefully the BMA willbe running roadshows early this year to informus about this prior to the ballot on this.

If you have any topics you would like usto cover in our SASG information day in 2007,please let me know.

Dr Natalie Lyth CHAIR OF THE SASG COMMITTEE OF THE RCPCH(NATALIE.LYTH@NYYPCT.NHS.UK)

SASG News

RCPCH news really does travel. PatriciaHamilton’s visit to Oman to meet the Ministry ofHealth and observe their exams at the end of2006 was reported in the Times of Oman. InDecember, Gwyneth Owen, RCPCH Officer forWales, was quoted in the Welsh press aboutthreats to Morriston Hospital's neurosurgery unit.

Into the New Year, the tragic death ofpaediatrician and vice chancellor of PlymouthUniversity, Professor Roland Levinsky, was widelyreported. He died after being hit by a power cablewhile walking his dog in a storrm in Devon. Laterin January, the College was quoted in a Guardianarticle about plans to X-ray young asylum seekers,‘raising concerns that the procedures areinappropriate for determining age’.

Also in January, the College’s Palestiniandoctor training featured in Hospital Doctormagazine after an interview with the programmeleader, Dr Tony Waterston. In February, PatriciaHamilton had the opportunity to talk to HospitalDoctor magazine as well about what she aims todo during her Presidency in a profile piece, sayingthat “Doctors must learn to come out of their silos.We need to get all the colleges working together,and along with nurses and children’s charities. Itwon’t be easy, but it would be fantastic if I feltthat we had contributed something.”

To keep up-to-date with news articles that mention or quote the RCPCH, or to stayinformed about what is going on within paediatricsand child health, visit the new website for a dailysummary of articles – go to www.rcpch.ac.uk

Claire BrunertHEAD OF MEDIA AFFAIRS 020 7307 8004

Media

A Celebration of the Life of

Dr. Stuart H. Green MA FRCPConsultant Paediatric Neurologist and Senior Lecturer in Paediatrics and Child Health

On Sunday 22nd April 2007 at 3.00p.m.At Birmingham Hebrew Congregation, Singers Hill Synagogue, Blucher Street

Birmingham B1 1HL, (adjacent to The Mailbox)

Complimentary tickets with full details are available. Please indicate your intention to be present at this Service by contacting:

Mrs. J. Simmonds, Secretary to Dr. Green, Department of Neurology, Birmingham Children’s Hospital, Steelhouse Lane, Birmingham B4 6NH

Tel: 0121-333-8704 e-mail: janet.simmonds@bch.nhs.uk

New Year Honours 2007The RCPCH offers its congratulations to the following for awards given in the New Year’sHonours List:

Mrs Mary Marsh DBE

(For Services to Families and Children)

Director and Chief Executive, National Society for the Prevention of Cruelty to ChildrenRoswyn Hakesley-Brown CBE(For Services to Healthcare)

President, Royal College of NursingProfessor Sheila Haworth CBE(Services to the NHS)

Professor of Developmental Cardiology; Head, Cardiovascular & Respiratory Sciences, ICHProfessor Malcolm Stuart Tanner CBE(For Services to Medicine)

Emeritus Professor of Paediatrics, Sheffield Children’s HospitalMr David Astley OBE(For Services to the NHS)

Chief Executive, St George’s Healthcare NHS TrustProfessor Elizabeth Molyneux OBE(For Services to Paediatric Healthcare in Malawi)Professor Jonathan Richard Sibert OBE(For Services to Paediatrics and to Child Health)

Lately Paediatrician, Cardiff & Vale NHS Trust & Lately Professor of Child Health, Cardiff University

The International Board directs several activitiesfor the College out with the UK with theprimary role of education and support ofpaediatricians. We are establishing a network ofsustainable postgraduate events across theworld to promote appropriate best practice inthe health of children and adolescents, under

the guidance of our International AssociateDirectors: Steve Allen (East and West Africa);Ezzedin Gouta (Middle East) and Mike Webb(Asia). Through the Newsletter and the newCollege website we will give regular updates tothe members on our programmes. We report ontwo of our current activities in the Middle East

and an exciting new development in East Africawith the International Malnutrition Task Force.

Dr Stephen Greene DAVID BAUM FELLOW; CHAIR OF THE

INTERNATIONAL BOARD

International project update

International

Page 8

Teaching Child Health: RCPCH andJordanian Paediatric Society:Jordan November 2006In November 2006, under thedirection of Mary Rudolf andEzzedin Gouta and supported byChris Verity (RCPCH Vice PresidentEducation) and Dr Ali M El-Halabi,(Jordanian Paediatric Society), the3rd post-graduate course was heldin Amman. During the 5 dayprogramme 31 Iraqi, 12 Palestinianand 15 Jordanian Paediatricians,participated in two parallelprogrammes in Paediatric LifeSupport and Teaching Paediatrics.Both the Iraqi and Palestiniandoctors, all of whom had to makedifficult travelling arrangementsfrom all parts of Iraq and the WestBank, were generous in their praiseof the course, making this ahumbling experience for theTeaching Faculty.

Iraqi and Palestinian doctors in asmall group meeting

Thanks to Professor Al Nouri,President of the Iraqi PaediatricSociety, Bagdhad, Iraq

Chris Verity thanking Dr Ali El-Halabi from the JordanianPaediatric Society

Students from the Course receivingtheir Certificates

Amman Course: Teaching FacultyAlistair Thompson, Mary Rudolf. VivMills, Susie Butt, Steve Greene, SheilaReilly, Chris Verity, Ezzedin Gouta

THE VSO/RCPCH FELLOWSHIPSAre you looking for a satisfying challenging experience, anopportunity to travel and live and build friendships in adifferent culture?

If so, have a look at the RCPCH /VSO Fellowships, but be aware thatyour year in a developing country could change your perspectives andoutlook on life. These Fellowships have been in place since 2000 andare open to all year 3/4 SpRs. The year spent as a VSO volunteer isaccredited for UK training. VSO offers a comprehensive package ofsupport and training prior to departure, while the College organisesUK and in-country based mentors with assessments and evaluation ofyour experiences in the placement. You do not need to provide yourown funding. You will be given responsibilities that trainees in the UKwill never receive, be introduced to a whole new world of tropicaldiseases and pathology, develop your teaching skills and become

involved in local projects, which have often led to presentations atnational and international meetings.

The receiving hospital on the other hand will benefit from yourclinical skills and you will be an encouragement and a boost to themorale of poorly paid and overworked local health staff.

Junior Fellowships are also available. These are for more juniortrainees who have recently gained their MRCPCH. These placementsare not accreditable for training but do receive the VSO package andsupport by College mentors.

Returned Fellows will be giving presentations about theirexperiences at the Annual Meeting in York on Tuesday March 27th2007 at 6.15pm.

Further information is available from Natasha Stein, Volunteer andProgramme Advisor, Health and Social Well-being Goal team, VSO, 317Putney Bridge Rd, London SW15 PN. Tel: 0208 780 7616, e-mailnatasha.stein@vso.org.uk, website: www.vso.org.uk

WARNING: THIS IS A YEAR WHICH COULD CHANGE YOUR LIFE!

International RCPCH news

Page 9

Update on the Palestinian Certificate in Child Health (formerly Gaza Project)Our programme in the West Bank is making great strides despite the difficulties in theMiddle East. By May we had completed the first 3 months of the training programmeaimed at doctors and nurses working in primary care. This initially a pilot but thestudents wished to complete the whole year, so by the generosity of the David BaumInternational Foundation, the next set of modules started in November with Clinicalskills, a highly original and thorough module developed in Leeds by Prof Mary Rudolf.Our nine candidates will then move on to acute illness, child development and newborn care,and later to disability, nutrition, genetics, chronic illness, child protection and health promotion.Tutors will visit four times over this period but the main facilitators of the group work will belocal paediatricians. Successful candidates will be awarded the Palestinian Certificate in ChildHealth. A website will be used for learning, for communication, for evaluation and forassessment. We sincerely hope that our example will be a model for teaching initiatives by the College in other parts of the world.

Dr Tony WaterstonCOURSE DIRECTOR

Paediatric Evidence Week: Dar esSalaam, Tanzania: October 2006Much of the groundwork for the coursewas undertaken by Dr Mike English andDr Jay Berkley at KEMRI/Wellcome Trust,Nairobi and Kilifi, Kenya in partnershipwith representatives from the PaediatricAssociation of Tanzania, the Departmentof Paediatrics Muhimbili College of HealthSciences, and the Ministry of Health IMCI.A total of 52 participants and speakersattended the workshop. We are developing through the contactsmade in this course an excitingpartnership with the InternationalMalnutrition Task Force (Alan Jackson,Tony Williams and Ann Hill). Followingrecent discussions with RCPCH aprogramme for a joint initiative isplanned for 2007, looking forward to asustainable programme of work over the next five to ten years.

Dr Steve AllenRCPCH ASSOCIATE DIRECTOR, AFRICA

Discussions during the break-out groups wereanimated!

Dr. Kath Maitland, KEMRI, Kenya, teaching onrespiratory distress in malaria.

Palestinian CourseOrganisersDr Tareq Hindi(coordinator), Dr SamiaHalileh (Chief Tutor),Tony Waterson, MaryRudolf and Dr ????

Paediatric Evidence CourseDar es Salaam, Tanzania; October 2nd-6th, 2006

This one week course was developed andorganised by Drs. Jay Berkely and MikeEnglish, KEMRI/Wellcome Trust, Nairobi,Kenya working together with Dr RodrickKisenge, President of the PaediatricAssociation of Tanzania, the Ministry of HealthIntegrated Management of Childhood Illness(IMCI) co-ordinator and the Department ofPaediatrics at the Muhimbili College of HealthSciences and National Hospital, Tanzania.Funding was provided by the David BaumInternational Foundation.

The aim was to improve quality of care forchildren. Fifty-two paediatricians fromTanzania, Kenya and Uganda attended and thecourse focussed on the essential content of theWHO IMCI guidelines, the researchbackground to the guidelines, how researchhas informed structured approaches toemergency assessment and care and howknowledge of research findings and modernteaching methods might be used in trainingand implementing the guidelines.

Sessions were chaired by a local seniorpaediatrician and presentations were made byexperts from Tanzania, Kenya, Malawi and theUK. The format was highly interactive. Eachsession ended with a discussion regarding theparticipants’ own situation and problems thatcommonly arose. Much lively discussionoccurred around the assessment andmanagement of shock and dehydration,respiratory distress in malaria, reductiveadaptation to malnutrition, meningitis andlumbar puncture and the new conjugatevaccines. A pre-course quiz assessed existingknowledge and further quizzes during thecourse and a final post-course quiz allowedparticipants to track their learning.

All participants were provided with a CDRom which contained extensive materials ofdirect relevance to clinical management andtraining. The end of course feedbackdemonstrated that the participants had valuedthe teaching highly and there were demands forthe course to be repeated throughout the region.

Dr Rodrick Kisenge, President of the PaediatricAssociation of Tanzania, leading a break-outdiscussion group

“It is astonishing with how little reading adoctor can practise medicine, but it is notastonishing how badly he may do it.” Osler

Hopefully, in the brave new world ofmedical education, no doctor will practisemedicine badly for the want of a littlereading. However the creation of PMETB,the implementation of MMC and the CMO’s

plans for revalidation will continue to makea major impact on our working and learninglives. These changes have already led to ahuge amount of work for all those involvedin planning and directing paediatric training– Regional Advisors, College Tutors andindeed all paediatricians who are responsiblefor teaching.

We now have to make the most of these

changes in the context of reduced workinghours and cuts in study leave budgets. Thatis why the College is committed todeveloping and rolling out innovative andstimulating education packages. The aim is tosupport trainees and career gradepaediatricians by helping them to developcore paediatric skills. Here is a brief overviewof current College education projects.

Education! Education! Education!

Education

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• The Child in Mind ProjectIt is essential that

paediatricians are ableto understand andsupport the mentalhealth of children andtheir families. The

three stages of the Project are alldesigned for trainees new topaediatrics. Stage 1 concentrates oncommunication with and by children,Stage 2 is focussed on theassessment of behavioural problems,Stage 3 deals in the cognitivedevelopment of the newborn and thepromotion of positive relationships inthe neonatal period. AvrilWashington and Quentin Spenderare currently planning a series ofdays, including a new combinedworkshop for stage 1 and 2, fortrainers to ensure that thesematerials become an integral part ofpaediatric education. For furtherinformation and to downloadapplication forms for “Training theTrainers” workshops please see:http://www.rcpch.ac.uk/education

• Safeguarding Children

- Level 1: Recognition & Response in Child Protection This collaboration between RCPCH,NSPCC and ALSG was launched inJanuary 2006 is now well established,with 150 recognised trainers able tosustain 100 training courses each year.To date over 300 trainees haveexperienced the package that includesface to face teaching, a DVD and aReader. The aim is to ensure that newtrainees are competent and confidentto deal with child protection issues atthe appropriate level for theirseniority. Three day trainer courses

and one-day masterclasses areplanned by the ALSG. For furtherinformation contact Neela Shabde,Project Director, or Sue Wieteska,Project Manager, onneela.shabde@nhct.nhs.uk ork.e.kirton@ncl.nhs.uk orneela.shabde@btinternet.comor swieteska@alsg.org

- Level 2: collaboration betweenthe RCPCH and the ALSG This programme is also being ledby Neela Shabde and SueWieteska. It is being developed fortrainees in their core years andeventually for consultants and willconsist mainly of distance-learningmodules plus some face-to-facetraining. In many situations wherethere is excellent existing materialthis is being signposted ratherthan reinvented. The work hasbeen supported by a generousgrant from the Johnson &Johnson Pediatric Institute andprovides a model for futureCollege educational activities. Theaim is to complete this project bythe end of 2007 and we arelooking for potential expertreviewers and facilitators. Morecan be found on the ALSG websitewww.alsg.org/index.php?id=724

• The other important child protectionprojects are a Training Programmein Court Skills being developedjointly with the RSM for a launch on14th-15th May this year and the Mini-Pupillage Scheme that is to designedto offer paediatricians experience ofthe legal process with local Judges.Both of these projects are being ledby Rosalyn Proops who is a memberof the Family Justice Council andwho has just been appointed as theChild Protection Officer for theRCPCH. For further details of theprogramme and registration pleasecontact jennifer.lake@rsm.ac.uk

• Paediatric Educators Programme (PEP)

There has been a dramaticresponse to a call for thoseinterested in education foreducators. Clearly there aremany out there who want tolearn more about thechallenges and rewards ofteaching the special skills

that are required to be a goodpaediatrician. The first PEP course isbeing piloted in June under theguidance of Debbie Murdoch Eaton.Many of you are already involved inthis new development, but if youwant to know more, contactCunniF@gosh.nhs.uk

• The RCPCH Nutrition Course This is already well established, thanks tomembers of the Diploma ManagementPanel who have worked under thechairmanship of Tony Williams. Afterattending the Intercollegiate Course inHuman Nutrition and the RCPCHNutrition course there is the opportunityfor candidates to write a dissertation forexamination, leading to award of theRCPCH Diploma in Paediatric Nutrition.We are working with the Institute ofHuman Nutrition, University ofSouthampton towards an accreditedMaster’s level Certificate in PaediatricNutrition that will be jointly awarded bythe College and University.

• Training in Adolescent MedicineThe Department of Health hascommissioned the RCPCH to take thelead in developing a curriculum andlearning resources in adolescent health.These will be aimed at trainees inpaediatrics at specialist level and willalso be designed to be useful for thosetraining in other professions. Thisexciting new intercollegiate project willbe developed by a group led by RussellViner and more information will becomeavailable on the new RCPCH website.

Education RCPCH news

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What next? When one looks at the above listit is clear that the College has fostered a greatdeal of activity and that key individuals havepoured time and enthusiasm into developingthese diverse projects. It is the responsibilityof the Education Department of the Collegeto ensure that this activity is not wasted andthat these materials are used to educate andsupport both trainees and careerpaediatricians. This task has been greatlyhelped by the appointment of Chris Masonas the Education Projects Leader - a newpost within the Education Department. It isalso clear that without grassroots support forthese educational initiatives they will founder.College Tutors therefore have a key role toplay in directing trainees towards thembecause it is our intention, together with theDepartment of Training and Assessment, thattrainees will acquire competences in thesekey areas and that these competences will beassessed. As the educationalists say –assessment drives learning! I am thereforepleased that Ian Spillman has agreed to takeover tutor support from Janet Anderson inanother new College post – that of SeniorCollege Tutor.

Our intention is that these educationprojects will support paediatricians in theirwork and enrich their working lives – notonly as pupils, but also as active participantsin an invigorating training programme. Ournext task is to develop the College website sothat it provides a platform for the interactivedistance learning that is likely to be animportant part of the all the educationalinitiatives developed by the College in the

future. Please help us to expand the role ofthe College as an important provider ofeducation for all paediatricians.

Dr Chris VerityVICE-PRESIDENT, EDUCATION

Picture: Chris Mason, Education Projects Manager,with Dr Chris Verity, Vice President, Education.

I nearly had to write to myself.

Owing to a very busy year personally and professionally, I was inarrears with filling in my CPD returns. I did not realise how much,until I looked in the first week in January 2007, when I found that Ihad not filed any returns for 2006. Mea culpa. I would have to writean official reminder from the CPD Officer to myself before I fell offthe A list.

I considered the irony of my position. I had registered for the onlineCPD scheme diary data entry but had not yet entered any data for 2006.This is not uncommon: I get letters each year from CPD schememembers citing a variety of reasons for their late completion of returns,either online or quarterly cards.

However, this provided me with the opportunity to quantify the timeneeded to update the CPD scheme diary and personal development plan at a sitting.

Paediatricians can differ in their approach to CPD. I am preachingto the converted - the majority now fill in CPD claims online and areundergoing appraisal, according to the RCPCH annual audit. My ownpractice is to keep an electronic diary on Microsoft Outlook, in whichI tick completed appointments: I print a hard copy for future record.Through the year I add CPD-worthy activities to my folder as theyhappen, so I only have to order these. I also update my portfolio ofeducation/learning, from which I can copy the year’s activities intothe annual appraisal template. I annotate the targets from last year’spersonal development plan (PDP) against the main domains on myjob plan (and my other career strands) and summarise the comingyear’s PDP and targets.

The time taken for each part was:1. Outlook diary hard copy production Checking diary updated 3 hours

Printing out diary (3 hours, but done during other tasks so effective time) 20 minutes

2. Ordering CPD folder 20 minutes3. Online database: Populating CPD database from scratch 2 hours

Updating CV 1 hour4. Transferring material from CV to appraisal document 30 minutes5. Updating PDP 30 minutesTotal: 8 hours approx

This estimate of 8 hours is generous. Time could be saved by notcompleting and printing the electronic diary or an updated CV. In all 4-5hours would be a reasonable estimate for a ‘quick-fix’ approach. Timetaken in 2007 will be less because I have now populated the online CPDdatabase with events that can be reloaded with a couple of keystrokes.If data entry were spread out throughout the year – as it should be toprevent arrears accumulating - then the total might be less still.

Quarterly return cards were still sent out for 2007. Making returnsonline (at www.cpd.rcpch.ac.uk) is not yet compulsory, though themajority of paediatricians now do so. The ‘A-list’ on the College websitelists all career paediatricians who are participating in the CPD scheme(that is, less than a year in arrears with submissions). If your details arenot there when you think they should be, please let the RCPCH CPDoffice know (at 0207 3075600).

As for writing to myself, it was a near thing. But on my PersonalDevelopment Plan it now says “don’t take on too much: learn to say no”.

* Thomson A P J. How to make the RCPCH CPD Guidelines work for you. Arch Dis Child 2005;91:65-67.

Dr Alistair ThomsonCPD OFFICER

A Year in 8 Hours

Trainees

MMCThe SHO and Specialist Registrar era iscoming to a close. We will soon see the newbreed of ‘Specialty Registrars’. Only a fewmonths ago, there were concerns that theapplication system would not be ready intime, but MMC have been successful in itsimplementation. This new process raisesmany questions: Will the selection strategywork? Will people get jobs where they wantthem? Will transition run smoothly?

It remains to be seen how many traineeswill choose paediatrics or whether there will be unfilled posts or unemployment.However, the outcome for paediatrics looks promising.

SHOs are advised to discuss applicationsto the new system with local trainers andregional advisors. It is a good idea to keepup to date with new information bychecking the PMETB and MMC websites.Changes are made sometimes on a daily orweekly basis.

The new training, with its ethos ofcompetency and confidence, creates a much-needed dimension to training. Competencyassessment strategies are close to completion.There will be a number of work-basedassessments that will be electronically loggedthrough the college. The integration of thesework based assessments into regular serviceprovision is still being considered.

Current SpRs have to keep more thanone eye on the changes that are happeningwith MMC. There are a number of reasons for this.• A number of deaneries are moving SpRs

changeover from September to August.This will leave some SpRs one monthshort of training in specific posts. This is aparticular problem for those trainees incore training posts. PMETB has confirmedthat this month will have to be made up.Check your deanery websites as towhat is happening even if you have acontract that says you are working tillSeptember.

• SHOs are often dependant on seniorcolleagues for up to date advice regardingMMC and transition

• A gradual transition of the use of theassessment tools is envisaged to includecurrent SpRs.

PMETB• An important piece of legislation has

come to our attention over recentmonths. In essence, to achieve theaward of a CCT (Certificate ofCompletion of Training) you have tohave completed all your training inapproved posts. If you have undertakenor plan to undertake posts that areunapproved either in the UK or abroad -they must be prospectively approved.Since January 1st 2007, posts cannot beretrospectively approved. Trainees whohave training in unapproved posts mustdeclare this on application to the newsystem. However, these posts will onlybe included in overall training time if therequisite competencies have beenachieved. If unapproved posts areincluded in overall training you mayonly apply to the specialist register viaArticle 14 (CESR – Certificate of Eligibilityto the Specialist Register). Both routesare equivalent and lead to entry onto thespecialist register. This will make youeligible to apply for consultant posts inthe UK.

• Article 14 fees: the proposed increaseshave been opposed by trainees and weare waiting the result of this.

• Trainees’ survey: Overall, trainees aresatisfied with their supervision andtraining. Local details should be availablefrom the deaneries. The survey is beingrepeated later this year.

Education and TrainingA number of RCPCH projects for educatingtrainees have been successfully implemented.The Child in Mind project and SafeguardingChildren courses are now successfullyrunning. The Diploma in Nutrition has beenvery well received and many trainees havesigned up for this course. There is alsofunding available for training in AdolescentMedicine. There are also several mini-pupillage schemes around the country. Theseare designed to provide training in courtskills and legal issues within paediatrics.

Our Committee:• We are holding the Trainees’ forum at

York on Wednesday 28th March. We

hope to see as many people as possiblethere. We also hope that trainees havetaken advantage of the 15 % discountthat we have negotiated for this year.

• We are also holding a Trainees’ dinneron the Tuesday evening. We hope thissocial event will be a fun evening.

• We are still working on the websitewhich is due to be revamped later thisspring. We are open to suggestions as towhat trainees would like to find in theirsection.

• We have vacancies on the committee –do consider joining us. Although it isunpaid work, it is worthwhile.

Trainees’ column

Martha Wyles Marthawyles@nhs.net

Paul Dimitri pauldimitri@hotmail.com

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CommunicationWorks!3 one hour workshops highlightingsome of the issues in communicatingwith young patients and offeringpractical tips and advice from a youngperson’s perspective.

When: Tuesday 27th March from 9.30amWhere: RCPCH Spring Meeting @ YorkWho: Open to all, but places will belimited so please sign up ASAP at thereception desk in Central Hall.

Workshops will be facilitated by:Dr Bob Klaber (St. Mary’s Hospital,London); Dr Bryony Beresford (SeniorResearch Fellow, York University);Miriam Morris (DH Young ExpertPatients Programme) and 2 YoungExpert Patients.For more information please contactsophie.auckland@rcpch.ac.uk

Meetings RCPCH news

UK meetings26 February – 2 March 2007Paediatric Nephrology & Urology WeekVenue: Institute of Child Health, LondonContact: Claire Lister Tel: 020 7905 2232 Email: info@ichevents.comWebsite: http://www.ich.ucl.ac.uk/education/short_courses/courses/2S_44

21 - 23 March 2007Advanced Course in the Management in Unexpected Childhood Deaths Contact: Therese Lepicard - Course Co-ordinatorTel: 024 76 574 263Fax: 024 76 573 959

23 - 24 March 2007Essential Paediatric Echocardiography CourseVenue: Royal Manchester Children's Hospital,Pendlebury. Contact: Ms Debra Broughton Tel: 01619222445Email: debra.broughton@cmmc.nhs.uk

16 - 17 April 20072nd Neonatal & Paediatric Cardiac IntensiveCare CourseVenue: Institute of Child Health, London Contact: Claire ListerTel: 020 7905 2232Email: info@ichevents.comWebsite: http://www.ich.ucl.ac.uk/education/short_courses/courses/2T13

24 April 2007Eating Disorders in Children & Adolescents: A Course for Community CMAHS CliniciansVenue: Institute of Child Health, London Contact: Claire ListerTel: 020 7905 2232Email: info@ichevents.comWebsite: http://www.ich.ucl.ac.uk/education/short_courses/courses/2S_48

5 June 2007Problems and pitfalls ain child protection Venue: The Royal College of Physicians, LondonTel: 020 7594 2150 Email: sympreg@imperial.ac.ukWebsite: www.symposia.org.uk

5 - 7 June 20076th Annual Course Dermatology forPaediatricians Venue: Heartlands Education Centre,Birmingham Heartlands Hospital, BirminghamContact: Megan Wood, Course DevelopmentUnit Co-ordinatorTel: 0121 424 3939Email: megan.wood@heartofengland.nhs.ukWebsite: www.qualityvenues.co.uk > in housecourses & events'

13 - 15 June 2007Update in neuromuscular disorders Venue: The National Heart & Lung Institute, London Tel: 020 7594 2150 Email: sympreg@imperial.ac.ukWebsite: www.symposia.org.uk

14 June 200759th Simpson Smith SymposiumVenue: Institute of Child Health, LondonContact: Claire ListerTel: 020 7905 2232 Email: info@ichevents.comWebsite: http://www.ich.ucl.ac.uk/education/short_courses/courses/2S_58

19 June 2007Managing Comorbidity in DevelopmentalDisorders - common clinical pathways - a life span approachVenue: Royal College of Physicians, London Tel: 020 7594 2150 Email: sympreg@imperial.ac.ukWebsite: www.symposia.org.uk

19 September 2007Nutrition in the critically ill child Venue: The National Heart & Lung Institute, London Tel: 020 7594 2150 Email: sympreg@imperial.ac.ukWebsite: www.symposia.org.uk

4 - 6 October 20074th European Paediatric GI Motility MeetingVenue: Institute of Child Health, LondonContact: Claire ListerTel: 020 7905 2232 Email: info@ichevents.comWebsite: http://www.ich.ucl.ac.uk/education/short_courses/courses/2T-14

8 - 9 November 2007Community Child Health Venue: Cavendish Conference Centre, London Tel: 020 7594 2150 Email: sympreg@imperial.ac.ukWebsite: www.symposia.org.uk

26 - 30 November 2007Neonatal Update 2007 'The Science ofNewborn Care'Celebrating the centenary of Imperial CollegeLondon and the 10th anniversary of the Faculty of MedicineVenue: Imperial College London, London Tel: 020 7594 2150 Email: sympreg@imperial.ac.ukWebsite: www.symposia.org.uk

Worldwide meetings20 – 23 June 20079th International Conference of Baltic ChildNeurology Association (BCNA)Venue: Vilnius, LithuaniaTel: +37052120003Fax: +37052120013Mobile: +37061569888Email: bcna@bcna2007.comWebsite: www.bcna2007.com

9 - 12 September 2007World Congress 2007 - Pedriatic SurgeonsVenue: Hilton Buenos Aires Hotel, ArgentinaTel: + 54 11 4322 5707Email: pedsurg2007@uniline.com.arWebsite: http://www.pedsurg2007.org.ar

6 - 8 November 200748th annual Meeting of the EuropeanSociety for Paediatric ResearchVenue: Prague, Czech RepublicTel: +41 22 908 0488Fax: +41 22 732 2850Email: reg_espr07@kenes.comWebsite: http://www.kenes.com/Paediatric-Research

RCPCH meetings

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