Background Leading a ward round is an essential skill for hospital consultants and senior trainees but is rarely assessed during training. Objectives To investigate the key attributes for ward round leadership and to use these results to develop a multisource feedback (MSF) tool to assess the ward round leadership skills of senior specialist trainees. Methods A panel of experts comprising four senior paediatric consultants and two nurse managers were interviewed from May to August 2009. From analysis of the interview transcripts, 10 key themes emerged. A structured questionnaire based on the key themes was designed and sent electronically to paediatric consultants, nurses and trainees at a large university hospital (June–October 2010). Results 81 consultants, nurses and trainees responded to the survey. The internal consistency of this tool was high (Cronbach's α 0.95). Factor analysis showed that five factors accounted for 72% of variance. The five key areas for ward round leadership were communication skills, preparation and organisation, teaching and enthusiasm, team working and punctuality; communication was the most important key theme. A MSF tool for ward round leadership skills was developed with these areas as five domains. Conclusions We believe that this tool will add to the current assessment tools available by providing feedback about ward round leadership skills.

Background A five-domain multisource feedback (MSF) tool was previously developed in 2009-2010 by the authors to assess senior paediatric trainees' ward round leadership skills. Objectives To determine whether this MSF tool is practicable and reliable, whether individuals' feedback varies over time and trainees' views of the tool. Methods The MSF tool was piloted (April-July 2011) and field tested (September 2011-February 2013) with senior paediatric trainees. A focus group held at the end of field testing obtained trainees' views of the tool. Results In field testing, 96/115 (84%) trainees returned 633 individual assessments from three different ward rounds over 18 months. The MSF tool had high reliability (Cronbach's α 0.84, G coefficient 0.8 for three raters). In all five domains, data were shifted to the right with scores of 3 (good) and 4 (excellent). Consultants gave significantly lower scores ( p<0.001), as did trainees for self-assessment ( p<0.001). There was no significant change in MSF scores over 18 months but comments showed that trainees' performance improved. Trainees valued these comments and the MSF tool but had concerns about time taken for feedback and confusion about tool use and the paediatric assessment strategy. Conclusions A five-domain MSF tool was found to be reliable on pilot and field testing, practicable to use and liked by trainees. Comments on performance were more helpful than scores in giving trainees feedback.

SummaryObjectivesTo look at why a regional cohort of UK doctors chose a paediatric career and to ascertain views on their career near the end of training year one.DesignA 20-item questionnaire was sent to all new regional paediatric specialty trainees. Three focus groups were held with trainees near the end of year one to elicit key themes.SettingWest Midlands Deanery, UKParticipantsTwenty-nine new regional paediatric specialty trainees in year one completed the questionnaire. A total of 15 trainees participated in the focus groups near the end of year one training.Main outcome measuresReasons for choosing a paediatric career and factors which further influence career choice for trainees during their first specialty training year.ResultsKey influencing factors for choosing paediatrics were enjoying working with children and positive undergraduate experience of the specialty. All trainees had paediatrics as their first choice specialty and undertook a paediatric Foundation post. Near the end of year one, doubts were cast on career aspirations due to seeing middle grade colleagues struggling with work–life balance and a growing feeling that family came first.ConclusionsSenior trainees need to be aware that they act as powerful role models for their more junior colleagues and therefore have an influential role on how juniors perceive a paediatric career. Family friendly flexible working patterns in paediatrics are vital to retain junior trainees. All paediatric staff are role models and need to be enthusiastic, keen to teach and to promote a positive working environment.

Aim To investigate feasibility of using the Rehabilitation Complexity Scale (RCS) to assess rehabilitation needs in children receiving in-patient neurorehabilitation in a RNSC. Background The RCS is established in adult neurorehabilitation practice for assessing complexity of care and therapy needs in hospital and community settings. Few data exist concerning its use in paediatric neurorehabilitation. Methods Children receiving specialist in-patient neurorehabilitation were scored on the RCS-Extended (RCS-E) by the multi-disciplinary team at weekly neurorehabilitation clinical meetings over 15 months. Patients' functional status was scored simultaneously by King's Outcome Score for Childhood Head Injury (KOSCHI) and Modified Rankin Scale (MRS). Demographic details were obtained from the clinical neurorehabilitation database. Statistical analyses were performed using IBM SPSS Statistics Version 21.Results 180 RCS-E, KOSCHI and MRS assessments were obtained in 34 patients, mean age=7.6 years (range 0.1-17). 43% were male, 57% female. 78% had ABI. There were significant differences between RCS-E, scored on neurorehabilitation admission and hospital discharge, for total RCS-E (admission: mean=12.97, SD=2.48; discharge: mean=9.50, SD=3.70; paired t test, p<0.001) and for care (p<0.001) and therapy subscales (p<0.001). No correlations were found between age and admission or discharge total RCS-Es (both, p>0.05). Admission total RCS-E did not predict neurorehabilitation duration (r=0.26, p=0.10), but there was a relationship between rehabilitation duration and discharge total RCS-E (r=0.40. p=0.005). In ABI patients, correlations were seen between admission and discharge total RCS-Es and contemporaneous KOSCHI (admission, r=À0.60, p<0.001; discharge, r=À0.75, p<0.001) and MRS (admission, r=0.76, p<0.001; discharge r=0.74, p<0.001) scores. Total RCS-E on neurorehabilitation admission did not predict discharge functional status, assessed by KOSCHI (r=0.12, p=0.55) or MRS (r=0.09; p=0.65). Applying adult RCS-E categories, 46% in-patient weeks were classed as high/very high dependency; 52% medium dependency and 2% low dependency. Trajectories of care and therapy needs could be identified. Conclusion The RCS-E is easy to use in in-patient paediatric rehabilitation practice, despite issues around the applicability of definitions of care need. The measure is sensitive to change over time and correlates with functional status. Evidence that>50% total weeks of in-patient neurorehabilitation were classed as medium-level dependency supports provision of an outreach neurorehabilitation service.Aims Menarche can be a challenging time in any girl's life; for girls and young women with severe learning difficulties (SLDs) and their families, the experience can be even more demanding. We aimed to establish the challenges associated with menstruation in this group, the support they receive, and the support they would like to benefit from. Methods We identified all young women with SLDs who had passed the age of menarche in two specialist...