SAUDI BOARD

OF

PEDIATRIC INFECTIOUS DISEASES

TRAINING PROGRAM

The Kingdom of Saudi Arabia is a very rapidly developing country withsignificant improvement of health services. Disorders caused by a variety ofinfectious agents constitute one of the major causes of morbidity and mortality inSaudi children. Furthermore, the field of infectious diseases is one of the verymarkedly progressing subspecialties. Over the past two decades, marked progresshas occurred in diagnostic, preventive as well as therapeutic modalities.Furthermore, the list of newly discovered infectious agents and rapidly changingdisease syndromes, as well as newly introduced antimicrobial agents are ever. .lllcreaslllg.

Based on these, there is a growing demand for a national trallllllg program toprovide pediatricians with all the necessary training towards acquisition of SaudiBoard in Pediatric Infectious Diseases, after which the trainee will be competentin the management of various infectious disease problems in infants, children andadolescents and will acquire a mature understanding of the related socialeconomical and environmental aspects.

The program consists of two years of full-time structured supervised training inPediatric Infectious Diseases. This will involve admission to an approved jointprogram with rotations in hospitals accredited for training in Pediatric InfectiousDiseases.

1. Become competent in the management of infections in infants, childrenand adolescents.

2. Acquire adequate knowledge and ability to interpret data originating fromthe clinical microbiology laboratory.

3. Become self-disciplined, self-dependent learners and to serve asconsultants to other services and be able to provide an educationalenvironment that will promote a high standard of health care.

4. Perform research and emphasize the research-oriented approach to newproblems.

5. Reach an international acceptable standard with appropriate attitude andmedical ethics.

A. Etiology, pathogenesis, natural history, pathology, clinical features andmanagement of the following:

a.l Acute illnesses due to a wide variety of microbial agents includingthe acute communicable diseases occurring in the normal hosts.

a.3 Common tropical and parasitic diseases, particularly malaria,leishmaniasis and schistosomiasis.

a.5 Infections in the irnmunocompromised host including patients withacquired immune deficiency syndrome (AIDS).

a.IO Infections in children with inborn errors of metabolism, geneticand other systemic disorders.

B. The clinical and laboratory approach and differential diagnosis of complexproblems in which infections may playa role, such as:

b.2 acute rapidly progressive illness due to sepsis from an undefinedsite and

C. Principles of epidemiology and public health and their application in theprevention and control of:

c.l infection within the community including knowledge aboutreservoir, transmission, sanitation and vector control, and the role

of public health authorities at local, national and internationallevels; and

c.2 hospital acquired infections including knowledge aboutchemoprophylaxis, disinfection and sterilization and infectiouswaste management.

D. General knowledge and technical skills in all principal areas of diagnosticmicrobiology, virology and parasitology, including knowledge ofappropriate diagnostic material for most diseases or syndromes and abilityto differentiate normal flora from pathogenic organisms.

e.l details of humoral, cell mediated and phagocytic responses tomicrobial colonization and invasion in the normal and abnormalhost;

e.2 pathogenic mechanisms by which immune responses facilitate orprevent disease; and

e.3 principles and practice of immunization techniques together withadverse effects and efficacy of immunizing agents.

G. An appreciation of the infectious diseases literature with the ability tocritically evaluate it.

H. Research experience with both clinical and laboratory investigation andthe expectation that these data will be published in a refereed journal.

I. Educational skills as demonstrated by the ability to teach infectiousdiseases to patients, trainees and colleagues as well as the ability to writeinformative consultation notes.

1. Possess a certificate of the Saudi Board of Pediatrics or an equivalentrecognized degree, or has successfully completed the written componentof the Final Saudi Board of Pediatrics.

3. Provide three letters of recommendation from consultants with whom thecandidate has recently worked with for a minimum period of six months.

4. Provide written permission from the sponsoring institution of thecandidate allowing him to participate, on full time basis, for the entireperiod of the program.

For any hospital to be accredited to participate in the training program in PediatricInfectious Diseases, the following requirements must be fulfilled:

1. Full accreditation for Pediatrics training by the Saudi Council for HealthSpecialties

The fellowship program director should be a Pediatric InfectiousDiseases consultant certified by the Saudi Board of Pediatrics or itsequivalent in general pediatrics and preferably certified or at leasteligible for certification by an international recognized scientificbody in the field of Pediatric Infectious Diseases with a minimumof three years of post training experience and a background inresearch with a record of publications.

b) A minimum of two full-time Pediatric Infectious Diseasesconsultants (including a program director) who have had at leasttwo years of fellowship training in an accredited infectious

1. Adequate number of consultations involving immunocompetentand immunocompromised children (at least 250 consults per year)to ensure adequate exposure to infectious diseases problems invarious hosts. A record of these consultations should bemaintained.

11. In-patients, intensive care (including neonatal intensive care) andambulatory care facilities.

111. Fully equipped, high standard and staffed microbiologicallaboratory facilities with the ability to perform diagnosticbacteriology, parasitology, virology, mycology and specializedserological tests. In addition to a laboratory facility capable ofperforming diagnostic immunologic and molecular tests.

IV. Supportive services such as a diagnostic and interventionalradiology unit and a pathology laboratory.

a. Library facilities with ready access to all major infectious diseasejournals and literature search facilities.

Pediatric Infectious Diseases program is a two year program, during which thetrainee rotates through various rotations. Those rotations include clinical services(14 months, including 2 months in adult services), microbiology(4 months),infection control (1 month), clinical immunology( 1 month), research(1 month)and an elective rotation (1 month). The candidate is eligible for one month annualvacation.

1. acquire a broad overview of basic sciences of infectious diseases(e.g., microbiology, immunology, pathogenesis, pharmacology,etc).

2. have adequate knowledge of common pediatric infectious diseaseproblems.

Consultation Service( minimum)General Microbiology, parasitologyVirology-Molecular, serologyT.B/ MycologyVacation

6 months6 weeks3 weeks3 weeks1 month

The rest of the first year will be left for the program director toassign the fellow to any rotation of the program.

1. acquire a high level of understanding of basic sciences and itsapplication to management of infectious disease problems.

2. learn the approach to investigate and manage complicated and rareinfectious diseases

During this year, the trainee will have a month of training in themicrobiology laboratory (2 weeks bacteriology, 1week virology and aweek in TB/ Mycology). He/She will also complete the rest of rotationsnot done during the first year. The elective rotation may be spent fortropical medicine or other aspects of infectious diseases felt necessary bythe program director.

The program should offer a broad range of clinical experience. In additionto consultations in the general and subspecialty pediatric services, theprogram should also offer consultations to the surgical subspecialties, thePediatric and Neonatal Intensive Care Units and the varioustransplantation programs. Exposure to adult infectious diseases isundertaken through rotations in an Adult Infectious Diseases TrainingProgram or an organized adult, infectious diseases service supervised by aqualified Adult Infectious Disease specialist.

Trainees should have the opportunity to assume responsibility for patientcare over a sufficiently long period to observe the natural history of thedisease and the benefits and complications of therapy.

Organized outpatient clinics should be available for the investigation andtreatment of infections not requiring hospitalization, as well as for follow-up of inpatients after discharge from the hospital.

Trainees are given the opportunity to observe the infection control unitorganization and function. They should actively participate in theHospital Infection Control Program and attend the meetings of theHospital Infection Control Committee. The trainee is expected to learn:

• the role of microbiology laboratory in infection control andsurveillance.

• isolation guidelines and methods of prevention of nosocomialinfections

• epidemiology and laboratory investigations of nosocomialoutbreaks, including biotyping, phage typing, plasmid analysis,etc.

Trainees should spend 4 months full-time in diagnostic microbiology andmolecular techniques under the supervision of a certified microbiologist inan accredited laboratory for training in Medical Microbiology.

• Routine techniques including use of different culture media,specimen collecting and primary inoculation, and various stainingtechniques.

• Bench experience and familiarity with special isolation andidentification techniques related to urine, respiratory, blood, tissue,and body fluid, enteric and anaerobic bacteriology.

• Specimen collection, transport and media for fungi andmycobacteria.

• Rhodamine staining for AFB and antibiotic sensitivity testing formycobacteria.

• Identification of common fungi including candida, aspergillus,cryptococcus; fungal serology and antigen detection.

• Stool examination for ova, trophozites, and larvae; concentrationtechniques; string test; special stains and serology.

• Virus isolation for herpes viruses, respiratory viruses, and entericvIruses

• Chlamydia and mycoplasma isolation and antigen detectionsystems.

• Quantitative bacteriology, rapid diagnostic techniques, ELISA,immunofluorescence, DNA probes, electron microscopy, etc.

Trainees are expected to participate in the research activities of the Section ofPaediatrics Infectious Diseases and by the end of his/her training he/she should:

1. complete one research project2. prepare and submit at least one manuscript to a referreed journal or3. present a paper in a scientific meeting locally or internationally

1. Case presentations and discussions2. Infectious Diseases Grand Rounds3. Microbiology Plate Rounds4. Infectious Diseases Journal Club

5. Didactic lectures in basic science and core topics such as:i. structure of bacteriaii. principle of antimicrobial therapy including pharmacokinetics and

pharmacodynamic.Ill. host response to infection

6. Morbidity and mortality meetinglrounds7. City-wide Infectious Diseases/Microbiology Club Meeting8. National and international symposia/conferences

The fellows should be given the opportunity to develop effective teaching skills.This should be achieved through daily rounds and informal group discussions inaddition to formal teaching sessions and via the written consultation report.

1. Trainees are required to take calls for the Infectious Disease Service witha maximum of two weeks per month including two weekends.

2. Fellows are entitled to four weeks vacation annually and a maximum often days for both Eid holiday and emergency leave.

3. Sick and maternity leave should be compensated for during or at the endof training.

Evaluation of knowledge and performance of trainees through an establishedcommittee using regular written records detailing the progress of each trainee atleast twice per year is required.

1. Knowledge of history taking in infectious diseases and ability toperform a comprehensive and accurate physical examination.

111. Knowledge of basic and clinical aspects of Pediatric InfectiousDiseases.

1. Formal evaluation forms after each rotation.Il. Documentation of attendance and participation in academic

activities.Ill. In-training evaluating examination done at the end of the first year.

To be promoted to the second year, the candidate fellow must have passed his/hergeneral pediatrics clinical examination. By the end of the first year the traineeshould pass the evaluation and examination conducted by the local supervisorycommittee. If failed, the trainee should repeat the first year. Failing the secondattempt the trainee will be dismissed from the program.

I. To be admitted to the final subspecialty examination, the candidate mustbe certified in Pediatrics.

II. Upon the completion of two years of training in Pediatric InfectiousDiseases in an accredited training program, a final certifying examinationwill be conducted by Saudi Council of Health Specialist. The componentsof the final examination will include:

1. written examination2. clinical/oral examination

Upon completion of the training and passing of the final examination thetrainee will be awarded the Certificate of "Saudi Subspecialty Certificatein Pediatric Infectious Diseases".

(i) Textbook of Pediatric Infectious Diseases - Feigin & Cherry(ii) Infectious Diseases of the Fetus and Newborn - Remington &

Klein(iii) Pediatric Infectious Diseases - Moffet(iv) Principle and Practice of Pediatric Infectious Diseases - Long &

Others(v) Principle and Practice of Pediatric Infectious Diseases

(vi) A Practical Approach to Infectious Diseases - Reese & Betts(vii) Principle & Practice of Infectious Diseases -Mandell(viii) Tropical and Geographic Medicine - Warren & Adel Mahmoud(ix) Hunter's - Tropical Disease

(i) Medical Microbiology - Sherris(ii) Medical Microbiology - Mims

(i) Red Book(ii) MWWR - special issues

(i) Seminar in Pediatric Infectious Diseases - 4 issues/year(ii) Advances in Pediatric Infectious Diseases - once/year(iii) Infectious Diseases Clinic ofN.A.(iv) Current Opinion in Infectious Diseases (All issues - August: Ped)(v) Current Opinion in Pediatrics (February)

(i) The Pediatric Infectious Diseases Journal(ii) Clinical Infectious Diseases(iii) The Journal ofInfectious Diseases(iv) The Canadian Journal ofInfectious Diseases(v) New England Journal of Medicine(vi) Journal of Pediatrics(vii) Pediatrics