There is an ever-increasing demand for out-of-hours expert opinion in paediatric radiology, which cannot be delivered in all hospitals. This study was designed to ascertain whether paediatricians, paediatric surgeons and radiologists are satisfied with the current situation; and to investigate the extent to which diagnostic errors are made while on-call with either residents, general or paediatric radiologists reporting on paediatric examinations.

Two surveys were compiled and dispatched. The first, is to paediatricians, paediatric surgeons and paediatric radiologists questioning their satisfaction with the current on-call paediatric radiology services in their hospitals. The second, is to paediatric radiologists inviting them to retrospectively score the accuracy of the reporting on consecutive paediatric radiology examinations performed during on-call hours in their hospitals.

The first survey revealed that 40/49 (82%) paediatric physicians were satisfied with the paediatric radiology service during office hours, decreasing to 33% during on-call hours. In the second survey, a total of 464 on-call paediatric radiology examinations were analysed, demonstrating 20.2% misdiagnoses. General radiologists had more misdiagnoses and were slower in providing a report than residents.

The current service with a lack of on-call paediatric radiologists, is associated with increased misdiagnoses and dissatisfaction among physicians and requires improvement.

This study shows that it may be a struggle to organise the 24-h availability of an expert paediatric radiologist, yet this might avoid 20% of misdiagnoses, half of which have direct clinical consequences.

The current organisation of paediatric radiology on-call rotas is unsatisfactory for many clinicians. A substantial amount of on-call paediatric radiology reports contain misdiagnoses, and these may have significant clinical consequences. Hospitals should reconfigure out-of-hours paediatric radiology covers.

The use of abdominal ultrasound is becoming a necessity, rather than an option, for pediatricians. Incorporating abdominal ultrasound training into resident training programs for pediatricians provides a direct pathway for physicians to effectively utilize point-of-care ultrasound (POCUS) in their clinical practice after board certification. This study proposed a detailed system to support this initiative by establishing 22 standard views of pediatric abdominal ultrasound and emphasizing a structured training regimen with repeated practice to achieve proficiency. This approach offers a streamlined method for trainees to become experts rapidly. After board certification, this foundational training serves as the basis for advanced learning, allowing clinicians to tailor POCUS techniques according to their specific areas of practice.

Despite being an essential specialty, pediatrics in South Korea faces the threat of collapse. While the declining birth rate is an important contributor to the decrease in the pediatric population, a more critical issue lies in the dysfunctional healthcare system. Primary care pediatricians are troubled by the lack of patients, whereas tertiary care specialists are concerned about the shortage of doctors. Although the absolute number of pediatric specialists is not small, there is a scarcity of doctors willing to specialize in pediatrics. Recently, pediatric abdominal ultrasonography has been conducted in tertiary hospitals. However, there is an argument that this responsibility should be shifted to primary care pediatricians. As someone who has been performing pediatric abdominal ultrasound examinations for years, I am committed to educating pediatric specialists in this field. My aim is to contribute, albeit modestly, to improving the South Korean healthcare system.

Healthcare has become highly specialized. Specialists, in medicine as well as in nursing, determine much of the high quality of current health care. But healthcare has also become increasingly fragmented, with professionals trained in separate postgraduate silos, with boundaries often difficult to cross. While a century ago, generalists dominated patient care provision, now specialists prevail and risk becoming alienated from each other, losing the ability to adapt to neighboring professional domains. Current health care requires a flexible workforce, ready to serve in multiple contexts, as the COVID-19 crisis has shown.The new concept of transdisciplinary entrustable professional activities, EPAs applicable in more than one specialty, was recently conceived to enhance collaboration and transfer between educational programs in postgraduate nursing in the Netherlands.In this paper, we reflect on our experiences so far, and on practical and conceptual issues concerning transdisciplinary EPAs, such as: who should define, train, assess, and register transdisciplinary EPAs? How can different prior education prepare for similar EPAs? And how do transdisciplinary EPAs affect professional identity?We believe that transdisciplinary EPAs can contribute to creating more flexible curricula and hence to a more coherent, collaborative healthcare workforce, less determined by the boundaries of traditional specialties.

Healthcare transitions, including from paediatric to adult services, can be disruptive and cause a lack of continuity in care. Existing research on the paediatric-adult healthcare transition often uses a simple age cut-off to assign transition status. This risks misclassification bias, reducing observed changes at transition (adults are included in the paediatric group and vice versa) possibly to differing extents between groups that transition at different ages.

To develop and assess methods for estimating the transition point from paediatric to adult healthcare from routine healthcare records.

A retrospective cohort of young people (12 to 23 years) with long term conditions was constructed from linked primary and secondary care data in England. Inpatient and outpatient records were classified as paediatric or adult based on treatment and clinician specialities. Transition point was estimated using three methods based on record classification (First Adult: the date of first adult record; Last Paediatric: date of last paediatric record; Fitted: a date determined by statistical fitting). Estimated transition age was compared between methods. A simulation explored impacts of estimation approaches compared to a simple age cut-off when assessing associations between transition status and healthcare events.

Simulations showed using an age-based cut-off at 16 or 18 years as transition point, common in research on transition, may underestimate transition-associated changes. Many health records for those aged <14 years were classified as adult, limiting utility of the First Adult approach. The Last Paediatric approach is least sensitive to this possible misclassification and may best reflect experience of the transition.

Estimating transition point from routine healthcare data is possible and offers advantages over a simple age cut-off. These methods, adapted as necessary for data from other countries, should be used to reduce risk of misclassification bias in studies of transition in nationally representative data.