Searching for the true attrition rate of UK paediatric trainees.

OBJECTIVE: To quantitatively analyse the number of doctors leaving the paediatric specialty training (ST) programme in the UK, to assist with evidence-based workforce planning. DESIGN: Data were sought on those leaving the UK paediatrics training programme between 2014 and 2019 from Heads of Schools of Paediatrics and Freedom of Information Act requests. SETTING: Retrospective data analysis. OUTCOME MEASURES: Overall attrition rate, attrition rate across level of training, attrition rate across geographical area, recorded reason for leaving. RESULTS: All results must be interpreted with caution due to limitations in record keeping and analysis. The annual attrition rate across all ST levels between 2014 and 2019 is estimated at 3.7%-4.2% (ie, 749-845 trainees may have left the paediatric training programme over 2014-2019). No reason for leaving was recorded for three-quarters of individuals, around 630 doctors. Of those leaving paediatrics, significantly more (χ², p=0.015) did so at ST3 (20.3%) versus the next highest training year, ST2 (13.6%). CONCLUSIONS: This project seems to demonstrate worryingly poor record-keeping of the true attrition rate of paediatric trainees by organisations responsible for workforce planning, including Health Education England, the Royal College of Paediatrics and Child Health and individual paediatric schools across the UK. To allow evidence-based workforce planning for the benefit of UK children, it is vital that accurate records on trainees who leave the training programme are kept and shared across the UK.

Completion of paediatric training: trends across 2011-2017 cohorts.

OBJECTIVE: To determine trends in the demographics and destinations of doctors who have recently completed paediatric training in the UK. DESIGN: A survey was sent to all new paediatric certificate holders 1 year on from completing specialty training every year from 2011 to 2017. SETTING: Retrospective survey. OUTCOME MEASURES: Demographics, career destinations, time to complete training, working patterns, subspecialty registration, numbers of job applications, and use of the period of grace are reported. RESULTS: 1262 people who gained their paediatric certificate in the UK between 2011 and 2017 completed the survey (60.6% response rate). 58.5% (n=738) of respondents were female, and 32.4% (n=224) of women work less than full time, compared with 4.6% (n=23) of men. 85.9% (n=1056) of respondents were in a UK consultant post. 7.6% (n=94) were working overseas. 65.1% (n=722) remained in the region they trained in. 64.8% (n=1348) were registered for general paediatrics, whereas 35.2% (n=733) had subspecialised.Respondents who held a non-UK medical degree (47.5%, n=501) made more job applications on average (mean=2.2; 95% CI 2.0 to 2.5) than those with a UK degree (52.5%, n=554) (mean=1.1; 95% CI 1.0 to 1.2) (p<0.001). Average training time increased from 9.8 years (95% CI 9.4 to 10.2) to 11.3 years (95% CI 11.1 to 11.6) (p<0.001). Respondents' use of their grace period reduced from 42.7% (n=47) to 20.6% (n=29) (p<0.001). CONCLUSIONS: The data reflect the diverse paediatric workforce and doctors' working patterns following the completion of paediatric training in the UK. The trends demonstrated are vital to consider for evidence-based workforce planning.

Maximum likelihood conjoint measurement of lightness and chroma.

Color varies along dimensions of lightness, hue, and chroma. We used maximum likelihood conjoint measurement to investigate how lightness and chroma influence color judgments. Observers judged lightness and chroma of stimuli that varied in both dimensions in a paired-comparison task. We modeled how changes in one dimension influenced judgment of the other. An additive model best fit the data in all conditions except for judgment of red chroma where there was a small but significant interaction. Lightness negatively contributed to perception of chroma for red, blue, and green hues but not for yellow. The method permits quantification of lightness and chroma contributions to color appearance.

Fecal calprotectin: a selection tool for small bowel capsule endoscopy in suspected IBD with prior negative bi-directional endoscopy.

BACKGROUND AND AIM: Fecal calprotectin (FC) is a non-invasive marker of gastrointestinal inflammation with advocated diagnostic precision in distinguishing inflammatory bowel disease (IBD) from non-IBD diagnoses. FC correlates with abnormalities seen on small bowel barium radiology, but little data exist in relation with small bowel capsule endoscopy (SBCE). To investigate the value of FC as a selection tool for further investigation of the small bowel with SBCE, in a cohort of patients who had negative bi-directional endoscopies, but with continuing clinical suspicion of Crohn's disease (CD). METHODS: We retrospectively correlated the findings of SBCE with FC levels in patients referred with clinical suspicion of CD and negative bi-directional endoscopies. Only patients with FC results prior to the SBCE test were included; in cases of multiple FC determinations, the value closest to the SBCE date was selected. Medications history including usage of aspirin or non-steroidal anti-inflammatory drugs (NSAIDs) was made available for all patients. SBCE findings were analyzed against final diagnosis and FC values. RESULTS: Seventy adult patients were studied (53 females, 17 males). Three cases were excluded, due to capsule retention in the stomach. Median time from FC measurement to SBCE was 62 days. Twenty-three patients had normal FC (≤ 50 µg/g) and in all those the SBCE was normal. Forty-four patients had FC >50 µg/g; in this group, nine patients had FC between 51 and 100 µg/g and all had a normal SBCE. Thirty-five patients had FC levels >100 µg/g; of those, 15 (42.85%) had SBCE findings compatible with CD and mean FC levels 326 µg/g (range 116-1430 µg/g). A definitive clinical diagnosis of CD, based on subsequent follow-up, was made in 10/35 (28.5%) of patients. These 10 patients were within the subgroup of 15 patients with positive SBCE findings and had median FC levels 368 µg/g (range 235-1430 µg/g). CONCLUSIONS: Measurement of FC levels prior to referral for SBCE is a useful tool to select patients with possible small bowel CD. A FC >100 µg/g is good predictor of positive SBCE findings, while FC >200 µg/g was associated with higher SBCE yield (65%) and confirmed CD in 50% of cases. Patients with FC between 50 and 100 µg/g had normal SBCE, despite symptoms suggestive of IBD. In all patients with clinical suspicion of CD and negative bi-directional endoscopies, FC assessment should be carried out prior to their referral for SBCE. Where FC is <100 µg/g (NPV 1.0), SBCE is not indicated.