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1. What makes a gastroenterology, hepatology and nutrition paediatrician?

A paediatric gastroenterologist is a clinician who provides tertiary services for the diagnosis and long-term management of rare disorders and complex cases of more common disorders that affect the gastrointestinal tract. Gastroenterologists provide nutritional support for patients, including those with temporary or permanent intestinal failure, and manage services for home parenteral nutrition.

Paediatric hepatologists provide both tertiary and national hepatology services in designated centres. They diagnose and manage paediatric liver diseases, such as acute and chronic liver failure, and are co-located with transplant services to provide care for liver and small bowel transplantation patients.

Paediatric gastroenterologists and hepatologists often provide specialist advice in a model of shared care. They are co-located in regional units with key services such as paediatric surgery and paediatric intensive care. They understand the indications, benefits and risks of procedures for diagnostic evaluation and possess specialised skills in performing and interpreting the results of tests, such as gastrointestinal endoscopy and liver biopsy.

2. A day in the life of a paediatrician working in gastroenterology, hepatology and nutrition

By Anthony Wiskin, Consultant Paediatric Gastroenterologist in Bristol

"'On service' days typically start with a ward round of gastro inpatients including education opportunities for trainees as patients are reviewed. Other teams may request GI/nutrition reviews of their own inpatients and there may be questions to answer about inpatients in local hospitals that will also need support or transfer. For some long-stay patients, there will be discharge planning meetings to support or lead. The multi-faceted nature of PGHAN means that there are many multi-disciplinary meetings/interactions to attend. There may be inpatients requiring urgent endoscopy. Out of hours work is similar, dealing with urgent clinical enquiries such as acute colitis or GI bleeding which may require endoscopy. 

"'Off service' days include elective activities such as outpatient clinics and endoscopy lists. Some specialist clinics may involve dietitians, clinical nurse specialists, psychologists, and pharmacists depending on the nature of the clinic. Examples of specialist clinics include those for patients with Inflammatory Bowel Disease, Coeliac disease, Intestinal Failure and transition to adult services. A significant amount of time is required for patient admin – planning investigations/ admissions, actioning results, triaging referrals, etc."

3. How and where to experience paediatric gastroenterology, hepatology and nutrition in your early medical career

Consider doing a project with your nearest PGHAN centre. This could be as part of the relevant training curriculum or as an extra activity. Completing an audit cycle or doing a quality improvement project is good for the CV but also develops links with the team and provides opportunities for shadowing an endoscopy list, clinic or ward round. Good projects could be submitted to the British Society of Paediatric Gastroenterology, Hepatology and Nutrition (BSPGHAN) annual conference or other national meetings which, if accepted, can strengthen a sub-specialty application.  

Talk to your training advisor about getting a job that includes PGHAN in the rotation. Some foundations and most specialty training programs have access to PGHAN job allocation.

Use study leave to spend a day with your local PGHAN team to see ward rounds, attend multi-disciplinary meetings, endoscopy lists and specialist clinics to see if you like these aspects of the job.

Find out whether there are outreach PGHAN clinics in your local hospital and find out if you can sit in on the clinic. You might need to do some rota swaps or use study leave to do this.

Consider joining BSPGHAN. There are a number of meetings each year often including one for trainees who may be interested in a PGHAN career, you could even attend the annual national conference. BSPGHAN arrange free weekly virtual education sessions. You can also listen to some PGHAN podcasts such as “Bowel Sounds”.

4. Applying to a paediatric gastroenterology, hepatology and nutrition programme

Successful candidates to the programme will be able to show a clear interest in PGHAN and a good knowledge of what the job involves, linking to experiences they have had. Keep a record of interesting PGHAN cases that you have seen, why they were interesting and what your involvement was, as well as what you learnt. You may want to refer back to these cases when doing your application. You don’t need to have done a PGHAN job to get PGHAN experience.

PGHAN is a specialty involving teamwork. To give good care to patients, clinicians need to work collaboratively with the whole of the multi-disciplinary team and at times other agencies such as education and social care. Trainees particularly suited to PGHAN will be able to demonstrate how they can lead an MDT but of equal importance, they will be able to demonstrate the ability to follow directions from other team members who have their own skills.

Children with complex “functional GI disorders” contribute significantly to the caseload of a consultant in PGHAN and may be managed with support from CAMHS, psychologists and occasionally alternative practitioners. Candidates need to be able to demonstrate skills needed for managing this patient group including a holistic and empathic attitude to children and families and excellent communication skills.

Get some experience in research so that you understand the process of how to do research. This doesn’t have to be a first author publication in a lead journal or a PhD. Talk with your local research nurses to understand how research happens in your hospital and find tasks on the delegation log that you could do for a study.

5. Information for paediatric gastroenterology, hepatology and nutrition trainees

The PGHAN CSAC have put together an induction pack to help PGHAN sub-specialty trainees as they enter the training programme, which you can find below in the Downloads section. This explains how PGHAN training will work, sources of support, ePortfolio requirements and educational opportunities. 

The best place to find more information if you are a PGHAN trainee is the BSPGHAN website (see External links below) or contact the CSAC.

External links

To find out more about paediatric gastroenterology, hepatology and nutrition, the CSAC recommend the following website as a useful resource: