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RCPCH Trainee Committee Statement
Inappropriate Tasks for Doctors in Training
The RCPCH has always been committed to ensuring paediatric doctors in training do not spend
significant amounts of time undertaking inappropriate tasks in the work place. With the introduction
of the European Working Time Regulation (EWTR) it is important to ensure that junior doctors in
training are exposed to the greatest training opportunities possible. The RCPCH last issued guidance
on inappropriate tasks for doctors in training in 2002, as guidance for College visits to paediatric
departments. Now the College no longer undertakes such visits the RCPCH Trainee Committee feels
it is important to issue updated guidance. Trainees report that in many units significant time is
currently spent undertaking inappropriate tasks, and it is unclear at present what mechanisms exist
to report such problems.
The Trainee Committee would like to make the following suggestions regarding what could be
considered inappropriate tasks. The Committee note not every task undertaken by a junior doctor
during their working day can have an intrinsic value for training. It is important to remember that it
is often not the task itself which is inappropriate, but rather the frequency and context with which
the task is performed, e.g. routine Newborn Examinations (see below).
1) Inappropriate attendance to the Delivery suite:
Clear local guidance should be in place to indicate which deliveries Paediatric staff should attend,
minimising presence where there is no proven need. Guidelines should be reviewed on a yearly
basis. It is to be expected that there will be some regional variation with this guidance, depending
upon the level of training of midwifery staff and the availability of Advanced Neonatal Nurse
Practitioners. All paediatric staff attending deliveries should be offered appropriate NLS training.
2) Phlebotomy:
Junior doctors should not be used to provide a routine phlebotomy service for the outpatient
department or for General Practitioners. Foundation and ST1 doctors may find phlebotomy clinics an
excellent training opportunity to develop their venepuncture skills, but service delivery should not
be dependent upon trainees.
3) Newborn examinations:
Examination of the newborn is a vital skill for the paediatrician. Paediatric Trainees must be given
sufficient exposure to the well newborn during their training in order to help them recognise the
“sick” child. As such, the Trainee Committee supports the ongoing involvement of junior doctors
with newborn examinations of well infants within normal working hours. Junior doctors should not,
however, be routinely expected to perform examinations of well newborn infants during evening
and night shifts, unless this is clinically indicated. The Trainees Committee believe a newborn
examination within 4-6 hours of birth is an aspiration not a right. Units providing this service must
not rely on junior Doctors for this to occur.
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4) Administration of IV Antibiotics:
Junior doctors should not be asked to routinely administer IV antibiotics. Trainees should, however,
be fully trained in the preparation and administration of IV antibiotics as this may be necessary in an
emergency situation, e.g. a child with meningococcal sepsis
5) Discharge letters:
All paediatric patients admitted to hospital require some form of discharge notification to be sent to
involved professionals, e.g. the families GP. For children admitted for short periods of time with
relatively uncomplicated medical or surgical problems comprehensive discharge summaries are not
necessary. Brief details entered on pharmacy documentation (commonly referred to as TTO or TTA)
should be sufficient in most cases. Children admitted with complex, unusual or difficult problems
require more detailed discharge documents. Clerical support should exist to aid this process.
6) Administrative duties:
Administrative duties including preparation of notes, finding equipment, filing of results within
patient notes and locating and retrieving patient medical records following admission should not
routinely be the responsibility of junior doctors. Junior doctors should assist with these tasks when
appropriate but sufficient clerical support should exist within the department. There is a slight
distinction with the issue of chasing laboratory results. The increased availability of electronic
ordering and reporting systems has reduced the time spent doing this. In the few hospitals without
such systems, sufficient clerical support should be available to prevent trainees spending long
periods of the working day chasing results. Ultimately though, the responsibility for chasing results
lies with the clinical team in charge of the child’s care and should not be deferred to clerical or
secretarial staff
The Trainee Committee welcomes the College’s intention to issue new guidance regarding
inappropriate tasks for paediatric doctors in training. We also recognise, in the absence of regular
visits to units by the college, the need to develop mechanisms to allow the trainee/trainer to
monitor non-educational work load within the workplace. We would strongly support efforts to
develop such mechanisms, as well as encouraging regular audit at the local level of non-educational
tasks.