Post-graduate School of Paediatrics Midlands Workforce Deanery Post-graduate School of Paediatrics...

West Midlands Workforce Deanery

Post-graduate School of Paediatrics

Prioritised areas of learning for paediatric trainees - [regional / local educational provider (LEP) / self-directed]

mapped to RCPCH Curriculum

for General Paediatric training [September 2010]

Updated - September 2012 1

Contents

Definition of contexts – (RCPCH) training goals and (West Midlands) learning opportunities. . . Advice for trainees and trainers - How to use this document? . . . . . . . . . . . . . . . . . . . . Page 3 List of contributors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Page 4

Summary sheets of prioritised areas of learning

Level 1 training

(Pages 6-14 & 15-27)

Level 2 training

(Pages 6-14 & 28-40)

Level 3 training

(Pages 6-14 & 41-53)

General competences 6-14 General competences 6-14 General competences 6-14

Neonatology 16 Neonatology 29 Neonatology 42

Community Paediatrics; Palliative care 17 Community Paediatrics; Palliative care 31 Community Paediatrics; Palliative care 44

Cardiology; Respiratory medicine & ENT

19 Cardiology; Respiratory medicine & ENT

32 Cardiology; Respiratory medicine & ENT

45

Dermatology; Infection, Immunity and Allergy; Musculo-skeletal medicine

20 Dermatology; Infection, Immunity and Allergy; Musculo-skeletal medicine

33 Dermatology; Infection, Immunity and Allergy; Musculo-skeletal medicine

46

Diabetes & Endocrinology 21 Diabetes & Endocrinology 34 Diabetes & Endocrinology 47

Gastro-enterology (nutrition); Hepatology; Metabolic medicine

22 Gastro-enterology (nutrition); Hepatology; Metabolic medicine

35 Gastro-enterology (nutrition); Hepatology; Metabolic medicine

48

Haematology & Oncology 24 Haematology & Oncology 37 Haematology & Oncology 50

Nephro-urology 25 Nephro-urology 38 Nephro-urology 51

Neurology & neuro-disability; Ophthalmology; Genetics & dysmorphology

26 Neurology & neuro-disability; Ophthalmology; Genetics & dysmorphology

39 Neurology & neuro-disability; Ophthalmology; Genetics & dysmorphology

52


Definition of contexts – (RCPCH) training goals and (West Midlands) learning opportunities

Level 1 training [ST 1-3 years] - to facilitate acquisition of fundamental knowledge base,

acquisition of clinical examination / assessment skills & application of these in clinical practice

Level 2 training [ST 4-5 years] & Level 3 training [ST 6-8 years]

- to facilitate acquisition of knowledge base to provide appropriate clinical care, analysis of clinical findings to derive appropriate differential diagnosis and management plan

& initial explanation of these to children and families

Learning opportunities

Regional sessions – 2-year cycle – monthly study days x 20; each study day x 5-7 themes @ 30-45 min each

Local (LEP) sessions – Planned – 6 or 12-month cycle – weekly session x 40-50 /yr @ 1 theme /week for 45-60 min; Additional learning opportunities may include other clinical contexts – examples of

- Unplanned – learning during ward rounds; outpatient clinics; meetings - handover / x-ray / MDT

Priority areas for self-directed learning – will include any area not attended / not covered in planned sessions


Advice for trainees and trainers - How to use this document? Trainees

This document should be read along with the RCPCH curriculum for General Paediatrics [September 2010 version]. It allows you to use your time and effort more efficiently - by focussing initially on relatively more important

components of your curriculum using these prioritised areas of learning relevant for each level of your training. It is laid out in 4 sections – General Competences (pages 6-14) & sub-specialty competences for 3 levels of training

o Each sub-specialty section has 10 summary sheets for various speciality areas (13 pages for each level) o Each summary sheet identifies clinical / professional themes that can be delivered through regional study days or

local hospital (LEP) teaching programmes; it also highlights areas for self-directed learning o It identifies suitable themes / methods that can be used to assess competence in speciality themes o Page number(s) in brackets adjacent to each theme refer(s) to RCPCH Curriculum for General Paediatrics (2010)

Overall this document sets the expectations about various learning opportunities in our region.

You may find this document useful throughout your clinical posting – o Evolving your personal development plan (initial appraisal meeting) o Helping to shape your local hospital teaching programme relevant to the cohort of trainees o Identifying themes for your CbDs and other WBAs - to gather evidence of your competence o Clarifying if you have learnt all the prioritised themes in each speciality (final appraisal meeting)

Trainers This document should be used as a reference

o to guide trainees to maximise the learning opportunities in your hospital / unit o to identify areas of learning in different speciality themes that can be delivered during unplanned sessions o to deliver /contribute to planned teaching sessions at various levels – regional or local hospital

Programme organisers This document should be used as a reference

o to organise / deliver regional study days for trainees in various levels o to organise / deliver local hospital (LEP) teaching - can be varied to suit the needs of trainee cohort


List of contributors

Dr V Ganesan Joint-Lead for Quality - PG School of Paediatrics

[Conceived and developed the concept; planned & executed the project; refined & collated summary sheets]

Dr Helen Goodyear Head & Joint-Lead for Quality - PG School of Paediatrics

[Approved and supported the project]

Focus groups [Prioritised areas of learning based on the RCPCH curriculum document – completed the summary sheets]

General Paediatrics – Level 1 General Paediatrics – Level 2 General Paediatrics – Level 3 Dr Helen Roper Heartlands Hospital

Birmingham Dr Mandy Goldstein

Children’s Hospital, Birmingham

Dr Penny Dison Royal Wolverhampton Hospital

Dr Anthony Choules

Alexandra Hospital, Burton

Dr P Ramesh University Hospital of North Staffordshire, Stoke-on-Trent

Dr Gyan Sinha Manor Hospital, Walsall

Dr Julie Vickers Hereford Dr Kim Neuling University Hospital of Coventry & Warwickshire

Dr Nick Makwana City & Sandwell Hospital, Birmingham

Neonatology Community Paediatrics – Level 1 Community Paediatrics – Level 2 & 3 Dr Tariq Ahmad University Hospital,

Coventry & Warwickshire

Dr David Lewis Worcestershire Community Trust, Worcester

Dr Annie Callaghan

Coventry & Warwickshire Community Trust

Dr Kate Palmer University Hospital, Stoke-on-Trent

Dr Jane Armstrong B’ham Community Healthcare NHS Trust

Dr Orlaith Byrne B’ham Community Healthcare NHS Trust

Dr Alyson Skinner Royal Wolver-hampton Hospital

Dr Manju Shenoy Walsall Community Trust

Dr Ayesha Qureshi

B’ham Community Healthcare NHS Trust

Dr Alex Philpott Neonatal Transport Service, Birmingham Women’s Hospital


List of contributors

Cardiology; Respiratory medicine & ENT Diabetes & Endocrinology Dermatology ; Infections, Immunology & Allergy; Musculo-skeletal medicine;

Dr Ari Kannivelu Royal Shrewsbury Hospital

Dr Melanie Kershaw

[George Elliot Hospital, Nuneaton] Children’s Hospital

Dr Helen Goodyear

Heartlands Hospital Birmingham

Dr Satish Rao Children’s Hospital, Birmingham

Dr Jeremy Kirk


Dr Nick Makwana City & Sandwell Hospital, Birmingham

Dr Ali Akbar City & Sandwell Hospital, Birmingham

Dr Swati Karandikar

Heartlands Hospital Birmingham

Dr Clive Ryder Children’s Hospital, Birmingham

Dr Penny Davis Children’s Hospital, Birmingham

Gastro-enterology (nutrition); Hepatology; Metabolic medicine

Haematology & Oncology Nephro-urology

Dr Subramanian Mahadevan

Russells Hall Hospital, Dudley

Dr Jayashree Motwani


Dr V Ganesan City & Sandwell Hospital, Birmingham

Dr Patrick McKiernon


Dr Baylon Kamalarajan

Royal Worcestershire Hospital, Worcester

Dr David Milford Children’s Hospital, Birmingham

Dr Vijay Suresh


Dr Aswath Kumar

University Hospital, Stoke-on-Trent

Dr Nigel Coad University Hospital, Coventry & W’shire

Neurology & neuro-disability; Ophthalmology; Genetics & dysmorphology

Dr Katie Banerjee B’ham Community Healthcare NHS Trust

Prof Rajat Gupta Children’s Hospital, Birmingham

Dr Shakti Agrawal Children’s Hospital, Birmingham


West Midlands Workforce Deanery Post-graduate School of Paediatrics

Prioritised areas for learning mapped to RCPCH Curriculum for General Paediatrics [Sept 2010]

Summary sheet – General competences (p 15 - 85)

Page number(s) in brackets adjacent to each learning theme refer(s) to those in the RCPCH document

Theme [Assessment] Level 1 trainees [ST 1-3] Level 2 trainees [ST 4-5] Level 3 trainees [ST 6-8]

Duties of a doctor [Knowledge, skills and performance]

1] Roles and responsibilities of a paediatrician [17] [MSF]

An understanding

A commitment in their practice

A commitment to advocate for the individual child in his/her

particular context

Good clinical care [Knowledge, skills, performance, communication, partnership and teamwork]

2] Response to challenge, complexity and stress in Paediatrics [20] [MSF, MRCPCH, CbD, MiniCEX, portfolio]

Effective

Increasing credibility and

independence

Responsibility for an effective

response

3] Advanced paediatric and neonatal life support skills [21] [APLS / NLS, MSF, DOPS, CbD]

Basic skills

Leadership skills

Effective response to life threatening situations and

unpredictability in paediatric clinical situations

4] Skills in consultation and examination [22] [CbD, MiniCEX, MRCPCH]

Effective skills in 3-way consultation

Responsibility for conducting

effective paediatric assessment and interpreting finding appropriately

Commitment to focussed and

analytic assessment of common and complex

clinical problems in paediatrics







Good clinical care [Knowledge, skills, performance, communication, partnership and teamwork] 5] Skills in paediatric assessment [23] [MRCPCH, CbD, MiniCEX]

Effective skills

Responsibility for conducting

effective paediatric assessment and interpreting finding appropriately

Commitment to focussed and analytic assessment of common and complex

clinical problems in paediatrics

6] Formulating an appropriate differential diagnosis in paediatrics [24] [MRCPCH, MSF, CbD, MiniCEX]

Basic skills

Improving skills

Effective skills in making safe

decisions about the most likely diagnosis in paediatrics

7] Management of clinical conditions in paediatrics seeking additional advice and opinion as appropriate [25-26] [MRCPCH, MSF, CbD, MiniCEX]

Effective initial management of ill-health and conditions

Responsibility for the effective

management of the common acute and chronic conditions

Leadership skills in the

management of common and complex conditions in paediatrics

and paediatric sub-specialities

8] Behavioural, emotional and psychosocial aspects of illness in children and families [27-28] [MRCPCH, MSF, CbD]

Knowledge, understanding and recognition of common issues

Effective skills in recognising and

responding to these needs

Effective skills in ensuring the management of these needs

9] Practical skills in paediatrics [29-30] [MSF, DOPS, Portfolio]

Safe practice

Effective skills in performing and supervising common practical procedures in paediatrics ensuring patient safety

Expertise in a range of practical procedures in paediatrics specific to general and sub-specialty training







Good clinical care [Knowledge, skills, performance, communication, partnership and teamwork]

10] Record keeping and report writing [31-32] [MSF, CbD]

Clear record-keeping and

Report writing skills

Improving skills in written

communication for a range of audience

Effective skills in written

communication for a range of audience – children, families, colleagues and organisations

11] Investigations in paediatrics [33-34] [MSF, CbD]

Reliable responses to

investigations in paediatrics

Effective leadership skills in

undertaking initial investigations in children, based on the

understanding of risks and benefits

Effective collaboration with other

specialities in using and interpreting complex investigations undertaken in children

12] Safe prescribing [35-37] [MRCPCH, CbD]

Knowledge and skills in safe

prescribing of common drugs in paediatrics

Improving safe prescribing in

paediatrics and advising others appropriately

Responsibility for safe prescribing

in common and complex situations and for the supervision of others

13] Safeguarding and vulnerability in paediatrics [38-41] [MRCPCH, CbD, SAIL, portfolio]

Basic understanding

Effective skills in the assessment

of cases and in contributing to their management

Effective skills in advising other agencies in safeguarding cases







Maintaining good medical practice [Knowledge, skills, performance] 14] Science-base of paediatrics [44] [MRCPCH, CbD]

Basic knowledge

Sound knowledge

Detailed up-to-date knowledge of the science base for paediatrics

or a paediatric sub-speciality

15] Knowledge of common and serious paediatric conditions and their management [45] [MRCPCH, CbD]

Basic knowledge

Extended knowledge

Detailed knowledge of …

in paediatrics or a paediatric sub-speciality

16] Growth, development, health and well-being in paediatrics [46-51] [MRCPCH, CbD]

Basic understanding

Effective skills in assessment and management of children and young people with normal and abnormal

growth and development

Effective skills in recognising and responding effectively to disordered

growth and development of any kind in paediatrics

17] Health promotion [52-55] [MRCPCH, Portfolio]

An understanding of health promotion and public health issues

in paediatrics

A commitment to health promotion activities for children

and their families

Involvement in health promotion activities specific to general paediatrics

or a paediatric sub-speciality

18] Evidence-based clinical paediatrics [56] [MRCPCH, MSF, CbD, Portfolio]

An understanding of an evidence

based approach to paediatric practice

Development and refinement of evidence-based clinical paediatrics

Independent thinking to enable

them to challenge guidelines and procedures in paediatrics

where appropriate







Maintaining good medical practice [Knowledge, skills, performance] 19] Clinical governance and audits in paediatric practice [57.58] [MRCPCH, MSF, CbD, portfolio]

An understanding

Participation in these activities

An application of risk assessment

strategy through involvement in the development, evaluation and implementation of policy and

clinical governance activities in paediatric practice

20] Reflective practice [59] [MSF, portfolio]

A reflective approach to

improvement of professional practice as a paediatrician

A commitment to reflective practice

and continuing improvement of practice as a paediatrician

Effective skills to maintain and develop knowledge and clinical skills required of a specialist in

paediatrics

21] Equality and diversity [60] [MRCPCH, CbD, portfolio]

An understanding of E&D in

paediatric practice

A commitment to an open minded approach to equality and diversity

in their role as a paediatrician

Responsibility to ensuring an open-minded approach to equality and diversity in the paediatric team

22] Knowledge of law [61-62] [MRCPCH, CbD, Portfolio]

Knowledge of law regarding

paediatric practice

Knowledge of law regarding death, data protection, confidentiality and

consent in paediatrics

Detailed knowledge of law

regarding death, data protection, confidentiality and consent

in paediatrics







Teaching, training, assessing and appraising [Communication, partnership and teamwork, knowledge, skills, performance, safety and quality]

23] Effective teaching in paediatrics [64] [MRCPCH, MSF, portfolio]

An understanding

Skills in effective teaching in paediatrics

A commitment to effective teaching and training of colleagues who are working in different contexts in the care of children and young people

24] Mentoring and educational supervision [65] [MSF, portfolio]

A positive approach to

receiving mentoring and educational supervision

A commitment to providing

positive experience of mentoring and supervision

Effective skills in the training,

supervision and assessment of a wide range of colleagues working

in the care of children and young people

25] Research in paediatrics [66-67] [MRCPCH, MSF, portfolio]

An understanding of the need for an

ethical and rigorous approach to research in paediatrics

An understanding of research

methods and methodology & an involvement in research activities

and publications

An understanding and application of complex

methodological approaches in research in paediatrics







Relationship with patients [Communication, partnership and teamwork]

26] Communication and interpersonal skills [69-71] [MRCPCH, MSF, MiniCEX]

An understanding of effective

communication and interpersonal skills with children of all ages

A commitment to effective

communication and interpersonal skills with children of all ages

Effective strategies to engage children in consultation and

in the management of their care

27] Engaging children and families [72] [MRCPCH, MSF, MiniCEX]

Empathy and sensitivity; skills in

engaging the trust and consent from children and their families

Improving skills in building relationships of trust with children and their families

Effective skills in conveying and discussing difficult information

(including death and bereavement) with young people and their families

28] Giving information [73] [MRCPCH, MSF, MiniCEX]

An understanding of listening

skills and basic skills in giving information and advice to young people and their families

Increasing confidence in giving

advice to young people and their families

Effective skills in giving information and advice

to young people and their families in common and complex cases







Working with colleagues [Communication, partnership and teamwork, safety and quality, knowledge, skills and performance] 29] Communication with colleagues [75] [MSF, mini-CEX]

Effective communication and

interpersonal skills with colleagues

Skills in ensuring effective

relationships between colleagues

Positive and constructive

relationships from a wide range of professional contexts

30] Team working skills [76] [MSF, mini-CEX]

Professional respect for the contribution of colleagues in a

range of roles in paediatric practice

Increasing confidence in teamwork and the ability to collaborate with a

range of external agencies about the needs of children

A commitment to effective multi-agency and multi-disciplinary team

working for the care of children

31] Management skills [77-78] [MSF, mini-CEX]

Effective time management skills

Effective leadership and

management skills in clinical and non-clinical setting

Effective managerial skills in taking

on a positive managerial role to support effective service provision

32] Handover [79] [SAIL, Portfolio]

Effective handover, referral and discharge procedures in paediatrics

Effective skills in ensuring handover, referral and discharge

procedures in paediatrics

Effective leadership skills in organisation of paediatric team working and effective handover

33] Health policy – local, national and international [80-81] [MRCPCH, MSF, CbD, Portfolio]

An understanding of the effect of local, national and international

policies on their work and on the health of children

Experience and understanding of working within local, national and international legal structures and

organisations involved in the care of children

Effective skills in promoting clinical practice through engagement with

local, national and international organisations involved in the care of children







Probity [Maintaining trust, safety and quality]

34] Ethical practice [83] [MRCPCH, MSF, MiniCEX, portfolio]

Ethical personal and professional practice

in providing safe clinical care

Sound ethical personal and

professional practice in providing safe clinical care

Exemplary professional conduct so as to acts as a role model to others

in providing safe clinical care

35] Reliability and accessibility [84] [MSF, Portfolio]

Reliability and responsibility in ensuring their accessibility

to colleagues, patients and their families

Continued responsibility

and accessibility to colleagues,

patients and their families

Responsibility for ensuring their

own reliability and accessibility and that of others in their team

36] Personal health and well-being [85]

An understanding of the importance

of self-awareness and a responsible approach to personal

health, stress and well-being

A consistent approach to

personal health, stress and well-being

Effective skills in ensuring their own

responsible approach to personal health, stress and well-being

and that of others





Level 1 training [ST 1-3 years] - to facilitate acquisition of fundamental knowledge base,

acquisition of clinical examination / assessment skills & application of these in clinical practice





Page numbers in brackets adjacent to specialities and themes refer to those in RCPCH Curriculum [Sept 2010]



Prioritised areas for regional / LEP / self-directed learning mapped to RCPCH Curriculum for General Paediatrics [2010]

Summary sheet – Sub-speciality – Neonatology (p 107 - 113)

Page number(s) in brackets adjacent to specialities and each learning theme refer(s) to those in the RCPCH document

Clinical/ professional themes that can be delivered through

Priority areas for

self-directed learning Suitable method

to assess competence

Regional teaching Local hospital teaching Area of knowledge / skill Area of knowledge / skill Day 1 - Cardio-respiratory & Infection

1) Respiratory problems in term infants (109)

2) Neonatal ventilation (109) 3) Chronic lung disease (109) 4) Approach to a blue baby (109,

113) 5) PDA (109) ; 6) Hypotension (109) 7) Infections (111)

Day 2 – Neurology & Gastrointestinal

8) Breast feeding (112) 9) Feeding problems & management

of growth in term infants (110) 10) Nutritional management of

preterm infant (110) 11) NEC (110) 12) Neonatal seizures (110) 13) Neonatal encephalopathy (108) 14) Intracranial haemorrhages & post-

haemorrhagic hydrocephalus (110)

1) Surfactant guideline (109) 3) Parenteral nutrition (110) 4) Abnormal coagulation (110) 5) Use of blood products (110) 6) Infant of diabetic mother (112) 7) Dev dysplasia of hip (113) 8) Common abnormalities on routine examination (107, 113) 9) Neonatal jaundice (112) 10) Neonatal counselling (Downs syndrome; congenital abnormalities) (111, 113) 11) Sodium & water in neonates (110) 12) The Floppy Infant (110) 13) Withholding & withdrawing care; care of the dying baby (111) 14) Genetics for neonatologists (107, 111, 113) 15) Congenital malformations (107, 111, 113) 16) Impact of fetal medicine on neonatal care (111)

1) Neonatal blood spot screening (113) 2) Neonatal hearing screening (113) 3) Retinopathy of prematurity (107, 113)

e-CbDs 1] Respiratory problems 2] Neonatal ventilation 3] Blue baby 4] Initial evaluation and management of an ill baby (suspected sepsis) 5] jaundiced infant 6] prolonged neonatal jaundice 7] baby with poor growth 8] floppy infant DOPS Many practical skills




Summary sheet – Sub-speciality – Community Paediatrics (including safeguarding and palliative care)

(p 27-28; 48; 52-55; 76, 117-119; 121-4 ) (p 38-41; 131-132) (p 127) Page number(s) in brackets adjacent to specialities and each learning theme refer(s) to those in the RCPCH document


Priority areas for



Regional teaching Local hospital teaching Area of knowledge / skill Area of knowledge / skill

Part 1 (one morning session to cover) [52-55] 1.Key determinants of child health [52] 2.Child Health care, social care and education [52] 3. Child in need [39] 4. Understand how health care relates to National and local education/ social services [52] 5. Principles of health promotion [53] 6) Principles of public health assessment [52]

All these topics may be covered locally in a variety of ways which may be clinic or lecture based or delivered by other professionals 1) To look at behaviour as a form of communication [27] 2) Approach to assessment of behaviour using observation and history [27] 3) Develop strategies to support parents of children with mental health problems [27] 4) Principles of common behaviour problems [27] 5) Multidisciplinary nature of CAMHS [27]

Self directed Understand poverty and child health [38] Media and child health [38] Non health policies and child health [38] Child exploitation [38] Armed conflict [38] UN [38] WHO [38] Millennium dev goals Sustainable development and low income countries [38] Understand how their own beliefs may influence child protection work [40] Understand infection outbreak [52]

Observation of history taking ,

management strategies in clinic

Child protection case history taking, management and

decision making – observation only

Awareness of Common Assessment Framework


Part 2 ( one afternoon session to cover) – [38-41] 1) recognition of child abuse [39] 2) concepts of child protection work [39-40] 3) Needs of children who are fostered and in residential care [38] 4. effects of substance abuse [28] Part 3 ( next session am ) 1) normal emotional and behavioural development [46-48] 2) ADHD/ ASD [28] Part 4 ( next session pm ) [127] 1) the dying child - symptom control, ethics etc [127] 2). Be aware of the guidelines on management of sudden death [127] 3) Be aware of National and local guidelines on withdrawing and with holding treatment [127] 4. Withdrawing of life support [127] 5. Know importance of seeking advice when treatment may not be in the best interest of child [127] 6.. Understand the need for respecting the wishes of the child when these are different from those of the family or professional [127]

6) Basic understanding of local interagency services [39] 7) Local multidisciplinary working in childhood disability [39] 8) Recognise families in distress and child protection [39] 9) Understand impact of child abuse [39] 10) Local guidelines for child protection [40] 11) Accurate record keeping and documentation [40] 12 ) Use of body charts [40] 13) Importance of observation of parent child interaction [40] 14) Safe response to child protection while treating family with respect [40] 15) Access child protection register [40] 16) Multi professional working in palliative care [127] 17) Know about local opportunities in respite care [127] 18) Recognise loss and grief and effects on child and family [127] 19) Be aware of local bereavement services [127]




Summary sheet – Sub-speciality – Cardiology; Respiratory medicine & ENT

(p 87-88) (p 128 - 130) Page number(s) in brackets adjacent to specialities and each learning theme refer(s) to those in the RCPCH document


Priority areas for




1: Asthma (chronic/severe) (130) 2: Cyanosis (cardiac/non-cardiac) (87) 3: Heart Murmur (88) 4: Heart Failure/Shock (87) 5: Recurrent/chronic Chestiness (130) 6: Cystic Fibrosis (130) 7: Chronic Stridor (130) 8. Obstructive sleep apnoea (128) 9: Syncope (88) 10: Palpitations/Arrhythmias (88)

1: Acute Asthma (129) 2: Acute Stridor (129) 3: Lower respiratory tract infection (129) 4: Cervical Lymphadenopathy (129) 5. Cardiological investigations – indications (87) 6. CF – principles of treatment/ MDT(130)

1: Infective Endocarditis (88) 2: Snoring (128) 3: Sore throat/mouth (128) 4: Nose bleeds (128) 5: Earache (128) 6: Hypertension (88) – covered in Nephrology 7. Aetiological factors of congenital heart disease (87) 8. Cardiac complications of other system disorders (87)

MiniCEX: Wheeze (129)/Inhaler technique(130); Stridor (129) Heart Murmur/Femoral pulses(88) CBDs: Asthma (age appropriate treatment) (130); Acute LRTI (129) ; Heart Failure/Shock (87) DOPS: ECG ; Cap/Blood gases Peak Flow (130) Blood Pressure measurement (88) MRCPCH: CF (130); Chronic Chestiness 130) APLS - Emergency / Resuscitation (129,87,88) Reflective Notes




Summary sheet – Dermatology; Infection, Immunology and Allergy & Musculo-skeletal medicine (p 89-90) (p 102-103) (p 105-106)


Priority areas for




Infectious disease and immunology Allergies, food intolerance and anaphylaxis (103) TB, HIV, Malaria (102) Recurrent infections and vulnerability including primary and secondary immunodeficiency (102, 103) Musculoskeletal History and examination of muscuolskeletal system including limb pains and swelling (105) (E-learning a prior requisite) Association of uveitis with JIA (105) Dermatology Investigation and management of common skin disorders including principles of therapy (89,90) Basic principles of emergency management of skin disorders (89,90)

Infectious disease and immunology Fever of Unknown Origin (103) Use of antibiotics (102) Disease notification (102) Septic Shock (including meningococcal disease) – as part of APLS scenario (102) Infection control principles (102)

Shock – septic from reading APLS manual (102) Common infections including Kawasaki’s disease (102) Epidemiology of worldwide disease (102) Indications, contraindications and complications of routine immunisations (103) Classification of infectious agents (102) E-learning for the differential diagnosis and initial investigation of joint pain and swelling (105,106)

MRCPCH APLS NICE guidelines eg for eczema, UTI, fever etc The Green Book CbD / mini-CEX Eg. meningococcal disease CbD – skin infection / principles of treatment Mini-CEXs 1] eczema management and treatment 2] musculoskeletal examination - eg leg / back pain




Summary sheet – Sub-speciality – Diabetes & Endocrinology (p 91 - 93)



Priority areas for




1) Diabetes and pathophysiology [91] 2) Diabetic ketoacidosis [91] 3) General endocrine disorders- thyroid/adrenal/pituitary dysfunction to include changes in insulin and steroid doses peri -operatively/ during illness. [91] 4) Obesity [93] 5) Short and Tall stature/abnormal growth and growth hormone therapy [92] 6) Delayed and Early puberty [92] 7) Neonatal endocrine disorders-ambiguous genitalia/neonatal thyrotoxicosis [92, 93]

1) Investigation and management of hypoglycaemia [92] 2) Recognition and Management of DKA [91] 3) Managing new diagnosis of Diabetes, different insulin regimes [91] 4) Growth and puberty, how to stage puberty [91] 5) Approach to polydipsia [93]

1) Acute and chronic complications of type 1 diabetes inc NICE guidelines and DKA 2) National screening programme-congenital hypothyroidism 3) Accurate measurement and plotting of growth parameters 4) Know causes of short and tall stature and treatments 5) Tanner staging 6) NICE/RCPCH obesity guidelines-understand the causes, identifying serious pathology. Weight reduction and type 2 diabetes

CbDs: 1] neonatal hypoglycaemia / young child with hypoglycaemia 2] short stature

Mini- CEXs 1] on measurement, and BMI/weight/ MPH and interpretation

2] pubertal staging- Tanner




Summary sheet – Sub-speciality – Gastroenterology & Hepatology (including nutrition) (p 94 - 97)



Priority areas for




1] Acute abdominal pain and Abdominal distension and congenital anomalies – TOF, malrotation - recognition & surgical referral (94)

Acute diarrhoea – symptoms, management and ORS - isolation practise and public health information (94) NICE GUIDELINE Resuscitation and Fluid management in acute severe diarrhoea (94) GOR – common presentation in well babies and management (95) Chronic constipation – approach and NICE guidelines (96) WHO-UK Growth chart

NICE guidelines – diarrhoea in children <5 yrs (94) ORS – composition WHO & low osmolar solution (94) Iron deficiency anaemia – causes, predisposition factors, diet rich in Iron (97)

CbDs : 1] Recurrent abdominal pain – History, approach, psychological factors, Mgt (96) 2] Abdominal distension in neonates – history and investigations, when to refer to surgeon (95) 3] Lower GI bleeding - IBD and infectious diarrhoea (94) 4] WHO-UK Growth chart 5] Growth faltering and FTT – (97) 6] Prolonged neonatal Jaundice causes, investigations, management , referral to liver unit (94)

2] Approach to Jaundice - causes in neonate and children (94) 3] Recurrent abdominal pain (94) – abdominal migraine, food intolerance related

4] Chronic constipation (96) NICE CG

5] Chronic diarrhoea / Malabsorption – coeliac, intolerance (96)

6] GORD – symptoms associated with oesophagitis (95)

7] Acute Liver failure – paracetamol poisoning – recognise need to discuss with liver unit (95)

8] Upper and Lower GI bleeding – aetiology and assess severity (94) – IBD and Polyp

9] Dysphagia in children (96)

10] Malnutrition – FTT/growth faltering (97)




Summary sheet – Sub-speciality – Metabolic Medicine (p 104)



Priority areas for self-directed learning

Suitable method to assess competence

Regional teaching

Local hospital teaching

Area of knowledge / skill


1 Common presentations of metabolic illness in children, when to investigate, basic management (104)

Metabolic bone disease Rickets including Vitamin D resistant (104) Neonatal heel prick test (104)

Acid base balance (104) Genetic presentation of metabolic illnesses (104) Genetic clinic or combined specialist clinic (104)

History taking, evaluation, management plan of suspected child with metabolic illness – Mini CEX (104) CbDs : 1] How to approach a case of metabolic problem (104) 2] Case presentation of acute metabolic illness in neonate (104)

2 How to approach acute metabolic illness presentations – hypoglycaemia, acidosis, hyperammonimia (104)

3 How to evaluate metabolic aspect in a child with visceromegaly – when to suspect metabolic problem (104)

4 Educational and social implication of metabolic disease (104)




Summary sheet – Sub-speciality – Haematology and Oncology (p 99 - 101)





Regional teaching




1) Evaluation of anaemia- common causes and management (99) 2) Febrile neutropenia (100) 3) Evaluation of bruises- what and when to be concerned (100) 4)Haemoglobinopathy screening (99) 5) Sickle cell crisis (99) 6) Leukaemia-common clinical presentation (100) 7) Evaluation of abdominal mass (101) 8) Coagulation disorders- initial assessment(100) 9) Late effects of chemotherapy (99) 10) Short talks on paediatric cancers. (99,101) 11) end of life care (99)

1) Iron def anaemia- assessment and management, dietary advice (99) 2) leukaemia initial management-(40) 3) sickle cell anaemia- physiology and common complications (99) 4) ITP- advise to the parents (100) 5) polycythemia – neonatal (99) 6) Wilms tumour (101) 7) neonatal haemostasis (100) 8) use of blood products in clinical setting (101)

1) leukaemia treatment guidelines (100)

2) febrile neutropenia guidelines (100) 3) Haemolytic anaemia (99) 4) hereditary spherocytosis (99) 5) haemophilia (100) 6) blood transfusion local policy (99) 7)exchange transfusion (99) 8) investigations of lymphadenopathy (101)

CbDs : 1] Iron def anaemia- history , evaluation and management

2] ITP

3] Febrile neutropenia-

4] HSP




Summary sheet – Sub-speciality – Nephro-urology (p 114 - 116)





Regional teaching




Nephrology themes 1) Role of different techniques for imaging urinary tract [114] 2) Fluid balance [114]+ tubular disorders [116] 3) Acute nephritis [114] + Hypertension [115] 4) Acute kidney injury [114] + recognition of CKD [116] 5) Nephrotic syndrome [114] 6) UTI + VUR [115] - controversies 7) Haematuria & proteinuria [116] Urology themes 1) Acute scrotal pain [115] 2) urogenital abnormalities [116] 3) Antenatal renal anomalies [115] 4) Voiding disorders [115] 5) Urinary tract stones [115]

1) Recognise presenting features of serious or significant nephro-urology problems [114] 2) Assessment and initial management of nephro-urology problems in acute and OP setting [114] 3) Accurate assessment of fluid status & initial management [114] 4) UTI – acute presentation and out-patient management [115] 5) Antenatal renal anomalies + postnatal presentations [115] 6) Voiding disorders [115]

1) UTI NICE & local guidelines 2) Principles of prescribing in renal disease [114] including steroid therapy – complications [114] 3) Impact of CKD in childhood and later adult life – on children & families [116]

CbDs : 1] Complex UTI – recurrent / underlying abnormality / abnormal renal imaging results 2] Nephrotic syndrome 3] Acute nephritis




Summary sheet – Sub-speciality – Neurology & Neurodisability ; Ophthalmology; Genetics & Dysmorphology (p 117 - 124) (p 125 – 126) (p 98)



Priority areas for



Regional teaching




1. Basics of disordered development and regression. Common causes of disabilities (physical, behavioural, cognitive and sensory impairments) (117)(122) 2. Chromosomal disorders/common syndromes/ modes of inheritance / interpreting patterns / constructing family trees/ common dysmorphic features (incl. environmental causes) (98) 3. Knowledge and understanding of pathophysiology of common disorders affecting the nervous system. Appropriate history and examination

1. Sensory impairments Hearing and vision – history and examination. Local and National support for sensory impairments (educational support) (125,126) 2. Basics of genetic counselling (non-directive, culturally sensitive), pre-natal screening, ethical dilemmas, observing interviews (98) 3. Assessment of acute neurological conditions and initiating diagnostic tests, management and explanation to parents(117)(119)

1. Molecular genetics and dysmorphology (98) 2. Genotype-phenotype correlation (98) 3. Coma guidelines 4. NICE guidelines of febrile child / Acute CNS infections 5. APLS guidelines of management of status epilepticus and raised ICP 6. IHSS classification of headaches

CbDs 1] Developmental delay 2] Headaches and sensory impairments 3] Genetics and pre-natal screening


of nervous system to elicit symptoms and signs. (117) (121) 4. Basic principles of neuro-radiological imaging and neuro-physiological tests (117)(119) 5. Fits/faints and funny turns (119)Epilepsy syndromes/treatments/long term implications 6. Meningism, head injury and other causes of raised ICP (to include concerning features of headaches) (117) (123) 7. Care of the disabled child, presentations of acute illness and injury (including safeguarding) (117) 8. Floppy infant / neuropathies, myopathies (117)(120) Recognition and knowledge of investigations 9. Ataxia, clumsiness, abnormal movements including dystonia and spasticity. (117) (120)

4. Conscious level, status epilepticus, meningitis, encephalitis, acute focal neurological signs (120) 5. Neurological history and examination including head circumference parameters (119) and abnormal eye movements (125) Communication with parents (121) 6. Neuro-developmental assessment (117). Understand implications and management for regression (121) 7. Concepts of disability and impacts on child and family. Working in MDT’s, local services and interagency working (117) (121). Be aware of/ be able to assess for common medical conditions in disabled children (121) 8. Awareness of traumatic brain injury and possibilities for rehabilitation (121)

7. Features of common syndromes including neural tube defects (98)

Mini-CEXs 1] Neurological and developmental examinations 2] Ophthalmology – eye examinations 3] Communication skills with disabled children, families and other professionals





Level 2 training [ST 4-5 years]

- to facilitate acquisition of knowledge base to provide appropriate clinical care, analysis of clinical findings to derive appropriate differential diagnosis and management plan

& initial explanation of these to children and families









Summary sheet – Sub-speciality – Neonatology (p 107 – 113; 30, 104)



Priority areas for




1) Know the criteria for diagnosis of perinatal asphyxia (108) Physiological effects of HIE (108) Long term implications of HIE (108) and its treatment 2) Principles and complications of differing ventilation techniques (109) Aware of indications for ECMO and NO therapies (109) Pathophysiological and management of CLD (109) 3) Common presentations of congenital cardiac disease and which need urgent action (111) Management of the cyanotic baby PPHN – pathophysiology and Tx (109) Seen ECHO diagnosis of PDA (109)

1) Statistics of outcomes of birth depression (108) 2) common causes of respiratory distress and the relevant investigations (109) 3) Images needed and safe positions for arterial and venous lines (108) 4) importance of Fluid requirements of preterm, sick & growth restricted babies (107, 110) 5) Coagulation and blood products (110)

Recap on level 1 knowledge and catch up on any sessions in either regional or local teaching not attended

CbDs 1] Communicating bad news 2] Management of withdrawal of care 3] Acute management of the cyanotic baby 4] Birth Asphyxia 5] Initial stabilisation and management of the extremely premature infant Mini- CEXs 1] Developmental examination (107) 2] Neurological examination (107)


3) Principles of nutrition in sick babies (107, 110) Principles of TPN (107, 110) Risk factors for NEC (110) Signs, symptoms & complications of NEC (110) 4) Seizures – causes and effects (110) Stages of PVL (110) Management of post haemorrhagic hydrocephalus (110) 5) Causes of abnormal tone (110) Aetiology & prognosis of abnormal neurological status (108, 110) 6) Management of surgical conditions – initial stabilisation and timely referral (111) 7) Role of fetal medicine and interventions that are available (111) Ethical principles in withdrawing of withholding care (111) 8) ) Range of screening tests (113) including Newborn Hearing Screening Know about cataract and ROP (113) Management of developmental dysplasia of the hip (113)

6) Impact on parents of birth of baby with serious congenital abnormalities etc (111) 7) Terminal care and bereavement counselling (111) 8) Jaundice (whole section) (112) 9) local policies on feeding (112) 10) Knows when infant of diabetic baby should be admitted to NNU (112) 11) Minor Congenital abnormalities – common diagnosis and likely prognosis (112) 12) Sepsis, its origin, presentation and treatment (111) 13) Metabolic disease – its presentation, diagnosis and initial management (104)

Mandatory DOPS 1] Preterm intubation (30, 107) 2] Neonatal resuscitation (108) 3] Insertion of UAC and UVC (108) 4] Insertion of a long line (108) 5] Basic cranial ultrasound (108) Supplementary DOPS 6] Exchange transfusion – knowledge and skill (30, 112) 7] Chest drain insertion (30) (if the opportunity arises)





(p 27-28; 48; 52-55; 76, 117-119; 121-4 ) (p 38-41; 131-132) (p 127)


Priority areas for



Regional teaching Local hospital teaching Area of knowledge / skill Area of knowledge / skill Behavioural paediatrics (27-28; 119; 132) 1) Common Problems. 2) Major ASD/ADHD. 3) Emotional issues / CAMHS. 4) Palliative care (127) _________________________ Child protection and children in special circumstances (131-132) 1) Categories of abuse 2) Modes of presentation of abuse a)Acute b)Non acute 3) Child Protection report writing / witness statements/court reports 4) Child in special circumstances. a) looked after children (LAC) and those for adoption b) special medical needs /safeguarding issues / multi-agency working

Community sessions covering examples of:- 1) Neuro-developmental / neuro-behavioural (117, 121) 2) Awareness of multidisciplinary and Multi agency working (131-132; 76) 3) Child and adolescent mental health issues (Acute presentation assessment and appropriate referral) (27) 4) LAC (Looked after Children-health assessments particular needs and multi-agency working) (38, 117) 5) SEN (Special Educational Needs) (48, 118) 6) Attending clinics. 7) Attend case conference & strategy meeting (40)

1) Legal process with respect to safeguarding p34 2) Understanding of current Government guidance documents on safeguarding e.g. Laming report/serious case reviews p33 3) Global issues relating to child health p33 4)Child Public Health p38 5) Attend peer review meetings for child protection. 6) Attend case conferencep34 7)Report writing for child protection and special educational needs p34 and p38

SAIL : 1) Assessment of Child protection reports by supervisor and assessment tools if appropriate such as assessment of letters. 2)Reflective notes and Critical Incidents writing Mini Cex / CBD : Neuro-behavioural / Neuro-developmental / Child protection Local child protection training at appropriate level e.g. via trust/local safeguarding board




Summary sheet – Sub-speciality – Cardiology (p 87-88); Respiratory medicine & ENT (p 128-130)



Priority areas for




1: Difficult Asthma – Modify management plan and emergency treatment out of hospital (130) 2: Cyanosis – initial management and discussion with cardiologists (87) 3: Common ECG abnormalities (87) 4: Arrhythmias (SVT) – emergency Rx (88) 5: Recurrent /Chronic Chestiness/ role for specialist investigations (130) 6: Syncope/seizures (88) 7: Obstructive Sleep Apnoeas – referral to ENT (128) 8: Lung Function Test/ Spirometry (130)

1: Acute Stridor management/ENT(129) 2: Acute LRTI –management of, including complications (129) 3: Acute severe asthma – lead treatment/ongoing treatment (129) 4: Acute respiratory failure – assisted ventilation, HDU/PICU transfer (129) 5: Advise families on effect of heart disease at school (88) 6: CF – diagnostic tests (130) 7: Respiratory problems in neurological conditions (130)

1: Infective Endocarditis (recognition) (88) 2: Sore throat – serious pathology/Earache (128) 3: Nose bleeds – underlying pathology (128)

CbDs: 1] Complicated LRTI (129) 2] Respiratory / Cardiac failure – transfer to PICU (129) 3] Syncope (88) 4] Cyanosis – emergency management/discussion (87) 5] Chronic asthma management / modify treatment (130) 6] Recurrent Chestiness / CF (investigations and treatment (130) MiniCEX: 1] Severe asthma/Respiratory Failure (129) 2] Arrhythmias/ SVT (88) DOPS - Lung Function Test/Spirometry (130) Reflective Notes: Severe ENT problems – underlying (serious) pathology (128) Sleep apnoea referral (128) Long term management of chronic respiratory problem (128)






Priority areas for




Dermatology Hair loss and hypertrichosis (89) Serious nature of some skin disorders including impact of severe dermatological disorders – skin camouflage and advanced skin failure (90) Eczema - Infected eczema and eczema herpeticum (89); understanding topical steroids and their side effects (89) Infection, Immunology and Allergy Institute effective management of immunocompromised child including febrile neutropenia (102) Distinguishing allergy (IgE v non-IgE) and food intolerance (103) Musculoskeletal medicine Multidisciplinary team management and referral including tests of children with musculoskeletal pain or joint swelling (105) Vasculitis and connective tissue disorders (105) Idiopathic pain syndromes including chronic fatigue (105)

Infection, immunology and Allergy Recap on anaphylaxis and management (103) Antibiotic policies and prescription (102) Stabilisation and transfer of shocked patients (102)

e-learning package on rheumatology 1) Limping child (105,106) 2) Limb pains (105,106) 3) Neck pain (105,106) APLS and shock Management of infection in immunodeficiency (102) Anything trainee “missed out” or did not cover in level 1

CbDs- 1] PUO, 2] recurrent infection, 3] allergy, 4] immunodeficiency, 5] eczema, 6] musculoskeletal pain Mini-CEX- 1] PUO, 2] Epipen use, 3] PICU transfer, 4] septic child APLS scenarios







Priority areas for




1) Hypoglycaemia causes and complications, Ix and Mx including rare causes [92]. 2) Recognising endocrine causes of hypoglycaemia- hypo adrenalism and pituitary dysfunction [92] 3) Other forms of diabetes- Type 2, CF, MODY/ syndromes [91] 4) Ambiguous genitalia- neonatal emergency!, causes, managing, communication with families [92] 5) Knowledge - Pituitary disorders presentation + function testing [92] 6) Non diabetic polyuria – differential diagnosis and assessment [93]

1) Treatment and monitoring of DKA [91] 2) Recognition and management of cerebral oedema [91] 3) Management of acute diabetic problems /common telephone advice calls [91] 4) Tall and Short stature – red flags [92] 5) Management of congenital and acquired hypothyroidism and understand the associated autoimmune diseases and Trisomy 21 [93]

1) Be able to apply BSPED guidance on DKA in practice 2) NICE guidance + multidisciplinary team in diabetes care 3) Treatment of hypoglycaemia 4) Congenital hypothyroidism guidelines 5) Investigation of delayed and precocious puberty- 6) Pituitary hormone deficiencies.

CbDs: 1] Managing DKA +CO 2] Ix and Mx of hypoglycaemia 3] Short/Tall stature - Ix and management 4] Assessment of delayed puberty 5] Assessment of precocious puberty. 6] hypothyroidism-congenital / juvenile







Priority areas for




1] Abdominal pain, distension and congenital anomalies – when to refer to surgeon, recognition of bowel distension & mgt (94-95)

Abdominal pain – surgical causes – Recognition of intussusception (94) Hirschprung, appendicitis and bowel distension in young children (95) Chronic diarrhoea – aetiology, differential diagnosis, mgt (96) Difficult cases of chronic constipation – when to refer to CAMHS (96) Failure to thrive – approach (96-7) GORD – when to refer to specialist (95)

NICE guidelines – Acute Diarrhoea and Chronic constipation ORS solution – principles of oral rehydration Coeliac disease – BSPGHAN guidelines (96) Lower GI bleeding – IBD and management – use of steroids and biologics Management of Iron deficiency anaemia – nutritional advice (97)

CbDs : 1] Diarrhoea and PR bleeding – (HUS, related to public health – when to add antibiotics) 2] Recurrent abdominal pain – psychological and child protection issues 3] Nutritional aspects of failure to thrive & metabolic cause CbD, mini CEX, counselling Lower GI bleed – IBD, Polyps Mini CEX 1] Counselling children with constipation and soiling 2] Coeliac disease – counselling and referral to specialist

2] Chronic diarrhoea / Malabsorption - Investigations - Coeliac, IBD, intolerance, CF short gut - (96-97)

3] Nutritional assessment and dietary management of Malnutrition / Malabsorption & intolerance (96-97)

4] Jaundice in children – presentation as ALF and approach – liaison to Liver unit (AIH, Wilson, Infection) (94)

5] GI bleeding – Recognition of serious pathology and referral to specialist (94)

6] Assessment of malnutrition – nutritional assessment - FTT and role of dietician (97)

7] Dysphagia in children – role of SALT – organic cause and Aware of anorexia and bulimia (96)

8] Recurrent abdominal pain – management and when to suspect child protection / refer (96)

9] Approach to Hepatosplenomegaly (95)







Priority areas for



Regional teaching




1) Further investigation and interpretation of metabolic investigations (104) 2) How to investigate appropriately acute metabolic illness presentations, hypoglycaemia, acidosis, hyper ammonaemia and visceromegaly, (104) 3) Dietary and medical management including supplementation in metabolic disorder (104) 4) Approach and evaluation of neurodisability related to metabolic disorder (104) 5) Common clinical presentation of metabolic illnesses.(104) 6) Acute metabolic investigations in neonate and children (104) 7) Which are the appropriate samples to be sent to lab in case of suspected metabolic problems (104)

Metabolic bone disease and management of vitamin D deficiency (104)

Appropriate screening investigations for metabolic disorder (104) Acute porphyria – a rare cause of acute abdominal pain (104) Educational and social implications of metabolic diseases (104) Genetic clinic – inheritance pattern of metabolic disease (104)

Mini CEXs 1] History taking, evaluation, management plan of child with metabolic illness (104) 2] Neonatal screening and discussion with parents about the abnormal results (104)







Priority areas for



Regional teaching




1) Evaluation of anaemia- investigation and management (99) 2) Febrile neutropenia-why urgency and current guidelines (100) 3) Evaluation of bruises- what and when to investigate (100) 4)Haemoglobinopathy screening- implication on the family, long term management (99) 5) Sickle cell crisis- management (99) 6) Leukaemia- initial assessment and investigations (100) 7) Evaluation of abdominal mass- approach (101) 8) Coagulation disorders-clinical evaluation and investigations (100) 9) Late effects of chemotherapy (99) 10) Paediatric cancers (101) 11) end of life care (99)

1) Thalassemia- iron toxicity (99) 2) Blood product transfusions-guidelines (101) 3) haemorrhagic disease of the newborn (100) 4) Evaluation of lymphadenopathy (101) 5)Auto immune haemolytic anaemia (99) 6) HSP (100) 7) evaluation of non –iron deficiency anaemia (99) 8) DGH management of new diagnosis of cancer (99)

1) blood transfusion side effects-(101) 2) Thalassemia and sickle cell disease –national guidelines.(99) 3) Management of acute bleeding in haemophilia and VWD- local guidelines.(100) 4) BMT (99) 5) Radiotherapy (99) 6) tumour lysis syndrome(99) 7) exchange transfusion (99) 8) use of specialised blood products (101) 9] Common solid tumours – Neuroblastoma, Wilms Tumour

CbDs 1] Sickle cell crisis 2] Leukaemia new diagnosis 3] Febrile neutropenia







Priority areas for



Regional teaching Local hospital teaching Area of knowledge / skill Area of knowledge / skill Nephrology themes 1) UTI + VUR [115] – challenges - renal scar + renal insufficiency - IP & OP management 2) CKD – growth & nutritional problems; basics of dialysis and transplantation [116] + impact on families [116] 3) Nephrotic syndrome – acute mgmt; long term treatment & complications [114] 4) Acute nephritis – treatment + prognosis + immunosuppressive therapy [114] 5) Hypertension – initial mgmt, identify complications; liaise with specialists [115] 6) AKI – initial assessment & fluid mgmt + hyperkalaemia [114] + tubular disorders [116] 7) Haematuria & proteinuria [116] 8) Renal imaging techniques – recognise common abnormalities [114] Urology themes 1) Urology mgmt - Voiding disorders [115] 2) Urinary tract stones [115] 3) Management of antenatal anomalies [115] & urogenital abnormalities [116] eg. hypospadias, ambiguous genitalia

1) Recognise and assess serious and significant pathology (‘red flags’) – presenting as nephro-urology problems [114] 2) Ability to interpret blood biochemistry in relation to age and body size [114] 3) renal imaging techniques – recognise common abnormalities [114] 4) Antenatal renal anomaly – antenatal counselling of parents, OP mgmt [115] 5) Urogenital anomalies [115] counselling parents

1) Prescribing in children with renal insufficiency / failure; immunosuppression [114] 2) Impact of CKD on families [116] 3) Acute scrotal pain [115]

CbDs: 1] Acute kidney injury – acute presentation and inpatient management - 2] Antenatal renal anomalies – outpatient management 3] Voiding disorders







Priority areas for




1. Long term implications of epilepsy / SUDEP (119) 2. Neonatal seizures and epilepsy in infancy (119) 3. Neurophysiological /radiological investigations and interpretation of results (EEG,NCS,VEP,ERG,EMG) (119) 4. Ethical principles and management decisions in Neural tube defects.(121) 5. Pre-natal screening and genetic counselling, genetics and dysmorphology – local protocols/recognising common patterns of syndromes (98)

1. Differential diagnosis of headaches/investigations and treatment (123) 2. Acute focal neurological signs assessment and management of early presentations of meningism (120), blocked shunts (121) Elicit and interpret abnormalities in tone (120) 3. Speech and language delay (including hearing loss and ASD) (122) 4. Audiology (Sensorineural and conductive hearing loss) Testing and management(122) (124)

1. Headaches (causes – biological and psychosocial factors) (123) 2. Causes of neurodevelopmental regression (121)

CbDs 1] Differential diagnosis of Ataxias 2] Headaches 3] Infantile spasms 4] Epilepsy syndromes 5] Neurodevelopmental regression 6] Focal neurological signs SAIL Report writing


6. Neurodevelopmental regression (121) 7. Disordered development. Recognising common disorders, support groups, equipment use (118) to include abnormal head shape and size. (123) 8. Recognise and refer appropriately for neurodevelopmental regression (121). 9. Neuromuscular pattern of weakness (123) 10. Management of peripheral nervous system trauma (121)

5. Disabled children- work on specific cases with MDT’s and other agencies including safeguarding.(117) Accessing further help for acute complications (121) 6. Specific Learning difficulties and special schools/ SEN and statementing/ report writing(118) (124) 7. Starting anti-convulsants, safety advice to parents (119) 8. Visual impairment. To undertake visual acuity testing (125) / developmental patterns (126). Further assessments needed in squint and ptosis (125) 9. Genetic counselling and presenting a diagnosis to parents (Down syndrome) (98)





Level 3 training [ST 6-8 years] - to facilitate acquisition of knowledge base to provide appropriate clinical care,

analysis of clinical findings to derive appropriate differential diagnosis and management plan & initial explanation of these to children and families









Summary sheet – Sub-speciality – Neonatology (p 107 – 113; 30, 104)



Priority areas for




1) Chronic lung disease – steroids, drugs, long term follow up and outcomes (109) 2) Management of a cyanosed infant and congenital heart disease (109) 3) Neurology – current trials and research e.g. cooling (108) 4) Organisation of Care – BAPM standards, network, DOH docs (107,108) 5) Post NEC, surgical interventions and aftercare, liver disease (108)

Recap on level 2 knowledge and catch up on any sessions in either regional or local teaching not attended

CBD + reflective notes

Complicated cases Communication/counselling

DOPS

Insertion of a chest drain [61] Catch up on any other procedures not assessed


6) Gut infections and trials/research, probiotics (110) 7) Communication with parents on clinical updates, prognosis (108) 8) Counselling on end of life issues (107, 111) 9) Criteria for ECMO (109) 10) Initial management and stabilisation (independently ) of an extremely premature infant (107) 11) Acute management of surgical problems e.g. congenital diaphragmatic hernia (111) 12) Neurology, role of imaging – cranial USS, MRI, role and relation to progress (110)





(p 27-28; 48; 52-55; 76, 117-119; 121-4 ) (p 38-41; 131-132) (p 127) Page number(s) in brackets adjacent to specialities and each learning theme refer(s) to those in the RCPCH document


Priority areas for




Community Local Teaching. Sessions covering examples of:- Building on skills acquired at level 2. 1) Behavioural Paediatrics 2) Multidisciplinary working This can be done by a) Attending clinics. b) Attend case conference & strategy meetings c) Multidisciplinary meetings 3) Screening and Surveillance and discussion of results. Understanding of false positive/false negative results. Self directed reading and educational meetings such as

Building on previous competencies as in level 2 1 )Initial management of sudden unexpected death in infancy and childhood. Be able to put local procedures into action p79 Read regional policy 2) Understand the behavioural aspects of progressive CNS disease e.g attendance at neurology clinic and self directed reading p36 3) Able to manage Vulvo-vaginitis and vaginal discharge appropriately p36 (attend OPD clinics) 4)Understand Immunisation programme and reasons for immunisation failure-self directed learning (green book)

1) Attendance at local child death response training/shadow a senior if possible 2)Reflective notes and Critical Incidents writing 3) Further assessment tools would include : Mini Cex CbD (Neurobehavioural/ Neurodevelopmental/ Child protection) 4) Local child protection training at appropriate level e.g. via trust/local safeguarding board


journal club



Summary sheet – Sub-speciality – Cardiology; Respiratory medicine & ENT

(p 87-88) (p 128 - 130) Page number(s) in brackets adjacent to specialities and each learning theme refer(s) to those in the RCPCH document





1: Oxymetry and Sleep studies (128) 2: Predisposing conditions for recurrent/chronic chestiness (130) 3: Chronic Recurrent Chestiness specialist investigations eg bronchoscopy) – (130) 4: Non-Invasive ventilation for chronic respiratory failure (129)

1: Specialist Clinics Asthma/CF (130) 2: Long term management of overall health and development needs of a child with chronic problem such as congenital heart disease (87)

ECG abnormalities (87)

CBDs: Difficult to control Asthma (130) Respiratory problems in Neurology/Immune compromised patients (82) Reflective Notes: Debriefing after resuscitation Attending MDT meetings – child with chronic respiratory problem/multisystem problems including heart disease (130, 87)










Musculoskeletal medicine Understand the association of musculoskeletal presentations with common chronic diseases (105) Masterclass of musculoskeletal cases Vitamin D deficiency and rickets (106) Infection, Immunology and Allergy How to treat food allergy including dietetic management (103) Dermatology Adherence to treatment, why treatment fails including understanding steroid potencies (89) When to consult other specialities eg eye, ENT, dermatology (89, 90)

Musculoskeletal medicine Rickets (106)

Anything missed out Congenital skeletal dysplasias (105)

APLS CbD – skin infection/ infestations Mini-CEX- allergy CbD – musculoskeletal presentations and chronic disease; vitamin D deficiency and antibiotic prophylaxis










Thyrotoxicosis Height velocity and charts Initial management of adrenal insufficiency- HC/fludro doses. DM: Initiation of treatment in a well newly diagnosed diabetic Insulin management Carb counting – dietician Introduction to Pump therapy

1) Making Every Young Person with Diabetes Matter 2) Dietary and insulin Mx to include carb counting and insulin adjustment 7) Diabetes Associated disorders 8) Diabetes Complications inc screening and Mx 9) Auto immune polyendocrine disease MEN

MiniCex: new diagnosis of diabetes- Advice and information sharing with parents CBD/ mini CEX-ambiguous genitalia- counselling parents mini Cex- Hypocortisolism- advice CBD: Obese child CBD: Safe management of DKA acc to BSPED guidelines CBD: telephone advice / diabetes calls CBD Polydipsia










1) Surgical abdominal problems – how to recognise and transfer for surgical care (94) 2) Upper GI bleeding and bleeding varix – management and stabilisation – (94) 3) Acute Liver failure and jaundice– role of transplantation and immunosuppressant monitoring (95) 4) Chronic abdominal pain & Lower GI bleeding - IBD – shared care and problems in adolescent group (94) 5) Intestinal failure - Nutritional management and Role of TPN and small bowel transplantation (96) 6) MDT approach to dysphagia and feeding problems in complex and disabled children (97) 7) Adolescent issues in chronic GI and Liver problems and shared care protocols 8) Fatty Liver disease and management

GORD – In disabled children and Eosinophilic esophagitis (96) Upper GI bleeding – approach and management (94) Abdominal pain in toddlers – recognition of appendicitis and surgical problems (94) Management o f Malnutrition and FTT (97)

Presentation of other conditions Acute diarrhoea and complications – HUS (94) Acute and chronic abdominal pain – when to recognise surgical problem in infants and child protection issues (96) Chronic diarrhoea & malabsorptive conditions – investigations & to refer to specialist (96)

Neonatal surgical conditions (CbD and counselling) (94) Chronic constipation – when to involve multi disciplinary input and referral to specialist – CbD (96) GOR – medical treatment failure – when to refer to surgeon – mini CEX (96) Chronic diarrhoea – when to investigate more – (CbD) (96)









Regional teaching




Management of Acid Base and electrolyte abnormalities (104) Management of metabolic diseases including FTT, visceromegaly, Encephalopathy in neonates (104) Management of metabolic diseases including FTT, visceromegaly, Encephalopathy in children (104)

Consider porphyria as a cause of abdominal pain (104) Learning disability and metabolic problems (104) Genetic clinic or combined specialist clinic (104)

Appropriate samples for metabolic investigations and liaison with specialist care – Mini CEX To lead and provide overview of overall care of children with metabolic problems – Mini CEX Breaking the bad news – abnormal results and appropriate liaison with specialist – Mini CEX









Regional teaching




1) Leukaemia – update on current management (100) 2) Tumour lysis syndrome 3) lymphoma –current staging and management (101) 4) Long term effects of children received chemo and radiotherapy (99) 5) congenital anaemia’s- investigation and management

1) intrathecal policy (99) 2) HSP (100) 3) febrile neutropenia – network guidelines (100) 4) fanconis anemia (99) 5) management of haemophilia with inhibitors (100) 6) Acute presentation of brain tumours – seizures / raised ICP

CbDs 1] Tumour lysis syndrome 2] Relapsed leukemia










1) Recognise and assess serious and significant pathology (‘red flags’) – presenting as nephro-urology problems [115] 2) Develop on knowledge and clinical competencies acquired during Level 2 training – focussing on - OP management / long-term management - counselling - recognition of complications

1) Hypertension [115] – acute presentation; initial investigation and management; recognition of complications. 2) Voiding disorders [115] – long term management 3) Haematuria / Proteinuira – OP management [116]

1] Haematuria and proteinuria – OP mgmt - CbD 2] Hypertension – IP & OP mgmt – CbD 3] HSP – OP management










1. Demyelinating diseases (not included in RCPCH curriculum) 2. Differential diagnosis of neuropathies and myopathies, initiating appropriate tests (120) 3. Coma, withholding and withdrawing intensive care. Principles of palliative care. 4. Pharmacological and non-pharmacological treatment of epilepsy. Behaviour, SUDEP, long term implications for child and family (118)

1. Local services involvement 2. CDC teams including education, special schooling provision, awareness of SEN assessments and disability allowances, accessing support groups / short breaks (118) 3. Practical audiology / ophthalmology clinics (125) including cochlear implantations and implications of nystagmus (125) 4. Seizures and CNS infections/lead care and share difficult information

1. Acquired brain injury (120) 2. Neurometabolic diseases and investigations (not in RCPCH curriculum)

CbD CNS infections ePaed MSF / 360 degree assessments for MDT working and communication skills Mini CEX Communication end of life plans, counselling children, young people and families


5. Recognising features of acute neurological disorders (raised ICP/status epilepticus/tumours) (118) Signs of acute/chronic blocked shunts (121) 6. Recognition of non-organic causes for headache, worrying signs, appropriate investigations and on-going management (123) 7. Principles of neuro-rehabilitation acute and on-going management (MDT’s) 8. Distinguishing developmental delay from developmental disorders, appropriate referrals and support (118)

with parents (119) Long term sequelae and follow up (120) 5. MDT management of children with VP shunts(121) 6. Initiate and interpret test results of tonal abnormalities (120) 7. Genetics, working with fetal medicine, neonatologists and paediatric surgeons. Taking a lead in presenting a diagnosis to parents and planning transitional care (98)

Post-graduate School of Paediatrics Midlands Workforce Deanery Post-graduate School of Paediatrics...

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