Bristol Royal Hospital for Children
The Bristol Royal Hospital for Children opened in 2001 and is part of the University Hospitals Bristol NHS Foundation Trust. It provides paediatric services to Bristol and surrounding area and is a tertiary referral centre for the whole South West region. The haematology department provides care for children with a wide variety of malignant and non-malignant conditions. There are approximately 40 news cases of leukaemia per year and 75 new benign referrals seen in the Bristol clinic, as well as significant numbers seen in peripheral clinics or as ward referrals. There are approximately 30 children with sickle cell syndromes on active follow-up, and 6 children at present with transfusion dependent anaemias. We share a ward, day bed unit and clinic rooms with the paediatric oncology service, and also have 7 beds on the bone marrow transplant unit. There are 3 consultant haematologists, 2 clinical nurse specialists, 2 registrars (one adult and one paediatric trainee), 1 senior house officer who also covers oncology, and a large multidisciplinary team.
The Registrar Posts
The paediatric registrar spends 2 - 2.5 years in the department where as adult trainees occupy a 3-month slot. Paediatric trainees are therefore afforded extensive experience with a solid grounding in paediatric haematology and opportunity for increased responsibility within the team. They participate in the haematology / oncology on-call rota 1 in 7.
To begin with, adult trainees work in a supernumerary capacity so initial paediatric exposure is very well supported. By the end of the post, they should be confident to work more independently, having gained experience in managing most of the common (and some less common) paediatric haematological conditions. At present there is no on-call but funding is being sought to rectify this, and would be as part of the adult middle grade rota for the AHU.
Trainees will gain experience in day-to-day running of a busy ward, assessment of new / emergency admissions, twice weekly outpatient clinics (one for benign haematology, one for malignant disease), and involvement in regular multi-disciplinary and integrated care meetings.
Registrars receive training in chemotherapy prescription and practical procedures including bone marrow aspirates, trephines, harvests and administration of intrathecal chemotherapy. Having been trained, they will sometimes be called upon to assist with the weekly procedures list.
Laboratory Sessions & Formal Teaching
There are twice weekly morphology sessions in the laboratory with the consultants. Registrars will be instructed in reporting of blood films and bone marrows reviewed at these sessions.
A departmental academic meeting takes place every Monday afternoon and there are tutorials on Thursday mornings which cover topics in both haematology and oncology. The consultants are enthusiastic about teaching so additional tutorials often occur.
Audit and Review of Clinical Processes
There is opportunity for one or both of the above. Such activities are encouraged as they are of general benefit to all.
Overall, paediatric haematology at the BRHC provides exposure to a wide range of disorders, excellent teaching and plenty of support within a friendly, approachable team. The differing needs of paediatric and adult trainees are sensibly addressed with paediatric registrars enjoying a lengthier training period and adult trainees gaining enlightenment regarding the paediatric approach.