I approached respiratory grid training having previously completed one hectic year in London in this exciting specialty. I was somewhat apprehensive to be the Eastern region’s inaugural grid trainee, but pleased to returning to the region where I spent the first eight years of my medical training.

The training program is split over Norfolk and Norwich, Cambridge PICU and Cambridge Respiratory. While the rotation does not offer some of the rarer optional modules such infant lung function and lung transplantation that one may experience at GOS/RBH, the Eastern region provides a combination of general paediatric and respiratory training which is not catered for in the London centres, rendering the trainee eligible for both tertiary and special interest respiratory consultant posts.

SpR 3 entry		SpR 4 entry*	*may change
12 months PRM	Norwich	6 months PRM	Norwich
6 months PICU	Cambridge	6 months PICU	Cambridge
18 months PRM	Cambridge	12 months PRM	Cambridge

The candidate entering in year four is likely to have prior paediatric respiratory medicine (PRM) experience and may benefit from earlier access to the Cambridge environment, as they may already possess some of the grounding provided by the Norwich post.

Norwich provides an excellent grounding in paediatric PRM as well as access to adult bronchoscopy lists and training under the guidance of the adult physicians. There is facility for chronic lung disease home visits, as well as access to respiratory, general and CF clinics. There is cross-cover of tertiary neonates at night and general paediatrics forms a significant part of the daily commitment.

The PICU stint is a highlight of the rotation, with access to longterm ventilation, tracheostomy, non-invasive ventilation, neuromuscular disease, advanced ventilatory strategies and applied respiratory physiology. There is opportunity to witness and perform chest drain, femoral line and PICC line insertion, as well as the occasional bronchoscopy, skills which are invaluable throughout a career in paediatric respiratory medicine. Moving from NNUH to PICU and thence back to a general paediatric setting in the same hospital gives a special perspective into the importance and consequences of different techniques of pre-ICU stabilisation of the sick child.

The Cambridge Respiratory section of the program allows access to chronic lung disease, allergy, congenital lung lesion, cystic fibrosis, empyema, bronchiectasis and paediatric lung function, sleep medicine, with regular x-ray meetings, teaching. There are three consultants with different interests and backgrounds, and each brings complementary aspects to the grid training experience. In future years this section of the rotation is expected to be more exclusively respiratory which will enhance access to the respiratory curriculum.

There is potential for access to the Papworth adult lung transplantation service and to respiratory research through the interests of Drs Iles, Ross-Russell, as well as the adult physicians and the Papworth research team and I am actively investigating these.

The teaching program is shared with the London ‘Lung in Childhood’ seminar series and local sessions (Eastern Paediatric Respiratory Training group), as well as in house sessions run by the consultants and the radiology meeting. There is scope for the trainee to develop this further.

I have enjoyed my training so far and look forward to workforce changes that will enhance access to the respiratory curriculum.