O. R. Beesley, A. Hunt, C. Y. Kowa, M. Patel, J. Williamson, Y. Haroon-Mowahed

University College Hospital London, UK


Many children presenting for surgery are managed in general hospitals, rather than specialist paediatric centres. Paediatric surgical patients in such settings can challenge medical and nursing teams less experienced with the unique requirements of paediatric perioperative medicine. While recent improvement initiatives have focused on the care of adults, recent data suggest that rates of adverse outcomes for children undergoing some surgeries are higher(1), highlighting a need to augment training in paediatric perioperative medicine.


Guidance for developing paediatric perioperative services is limited, and training programmes often fail to address the specific needs of children. This contributes to a lack of confidence. The 2022 Training Review In Paediatric Anaesthesia survey, examining national paediatric caseload exposure highlighted significant regional variability(2). Trainees at all stages in London and Scotland reported greater experience, including at lower ages and higher complexity levels. This may suggest geographic discrepancies in competence and confidence.

Strategy for change

We have developed a Massive Online Open Course (MOOC), in partnership with UCL and FutureLearn, following the paediatric perioperative journey. It has been built by a team with prior experience of MOOC development. Content has been developed by a multidisciplinary team of experts from specialist paediatric centres including University College Hospital, Great Ormond Street Hospital, Evelina London Children’s Hospital, Royal Brompton Hospital and the Royal London Hospital.

The course addresses preoperative optimisation, intraoperative management, and postoperative care, including recent advances. It is aimed at all those providing perioperative care for children: anaesthetists, paediatricians, surgeons and perioperative nursing teams. It presents a multidisciplinary model and can guide hospital teams in improving delivery of paediatric perioperative care.

Measure of improvement

Formative assessments are included throughout, as well as objective quizzes at the end of each weekly chapter to reinforce learning points. We encourage active participation in the form of message boards, supported by expert reviewers. Structured feedback is invited on course completion to gauge improvements in participant confidence.

Lessons learnt

The process began with a project proposal to provide an ongoing implementation guide. Subsequently, the team met with digital educators to understand the MOOC process, including the importance of material accessibility and readability, as well as ensuring variety in course activities. A content tracker was used to monitor project progress, and experts sought for content development. Regular team meetings ensured the smooth transfer of this material to the MOOC platform. Our experience highlighted the significant resources required to develop multimedia content, including patient, parent and MDT videos.

Message for others

The course is planned for launch later this year and will be freely accessible worldwide, in keeping with all FutureLearn MOOCs. The incredibly rewarding process of course creation has been worth the significant time investment, and greatly enriched the team’s educational skills.


  1. McMullin JL, Hu QL, Merkow RP, Bilimoria KY, Hu YY, Ko CY, et al. Are Kids More Than Just Little Adults? A Comparison of Surgical Outcomes. The Journal of Surgical Research [Internet]. 2022 Nov 1 [cited 2024 Jan 28];279:586–91. Available from: https://pubmed.ncbi.nlm.nih.gov/35926308/
  2. Chan SM. Training Review In Paediatric Anaesthesia(Trip): An Exposure & Workload Distribution Survey. Pediatric Anesthesia. 2023 Oct 10;33(12):1110–4
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