Rcpch Generic Curriculum

RCPCH Generic Curriculum The duties of a doctor • Roles and responsibilities of paediatricians (1) o understand the duties and responsibilities of a paediatrician in the safeguarding of babies, children and young people o LEVEL 1 • Have read the introduction to MRCPCH master-course including the duties of a paediatrician • Attended ST1 Regional Training 22/6/11 on “Safeguarding Children: rights, responsibilities, consent and confidentiality” • Had child protection training as part of neonatal induction at UHCW • Completed West midlands Deanery E-induction including module on child protection • Have attended level 3 child protection training • Have been involved in safeguarding medicals while working in Coventry community and have attended a child protection peer review meeting o LEVEL 2 • See also entries into Level 2 Safeguarding area of curriculum Good clinical care & Maintaining good medical practice • Response to challenge, complexity and stress in paediatrics (2) o in complex difficult communication situations with children and families show awareness and have begun to develop strategies to respond • Advanced neonatal and paediatric life support skills (3) o be able to respond appropriately to cardiac arrest o be able to provide advanced neonatal and acute life support as demonstrated by successful o o • Consultation and examination (4) o the need to anticipate and respond sensitively to children and young people who are o o o o o o • completion of and assessment by recognised course, be able to carry out resuscitation using bag, mask ventilation and cardiac compressions be able to intubate term babies and have had supervised experience of intubating pre-term babies suggesting unease or unwillingness about a physical examination and begin to develop appropriate strategies to reassure be able to take a history accurately and sensitively that routinely includes biological, psychological, educational and social factors in the child and family have begun to develop skills and strategies to manage consultations effectively with babies, young children, adolescents and their families be able to examine children and young people accurately and sensitively in appropriate settings understand the need to conduct a consultation in such a way that a child or young person and their family may feel able to talk about difficult or emotional issues have begun to develop skills to involve both the child and parents or carers when both are present in consultations know about and begin to develop skills to prevent disruptive or antisocial behaviour in children, families and adolescents in clinical settings and to respond to them if they occur Effective paediatric assessment (5) o recognise case histories which suggest serious or unusual pathology in children o recognise the diseases and host characteristics which make certain presentations lifethreatening in children and know when to ask for help o Recognise presentations of common disorders in children, assess symptoms and signs accurately • formulating an appropriate differential diagnosis (6) o begin to develop analytic and informed clinical reasoning skill o be able to formulate a differential diagnosis • • management of acute and chronic conditions (7) o understand the importance of effective strategies for the management of pain o be able to assess and initiate management of patients appropriately o understand the importance of negotiated management plans for individual patients and o o o • behavioural, emotional and psychosocial aspects of illness in children and families (8) o know about normal emotional and behavioural development and how it may affect the child o o o o o o o o o o o o • families, including self-care strategies, understand and have the ability to recognise Acute Kidney Injury in acutely ill children and young people begin to make common decisions in the care of patients understand the factors which influence children, young people and parents or carers in their approach to following prescribed management and treatment plans begin to develop strategies to help children, young people and their families to follow management/treatment plans and family at different stages be able to look at behaviour as a form of communication and to take this into account when interviewing, examining and assessing children has begun to develop an approach to the assessment of behaviour problems that uses observation as well as history-taking have begun to develop strategies and skills to support and engage parents of children with emotional or mental health difficulties know about the effects of developmental difficulties and physical diseases on behaviour and vice versa know about the multi-disciplinary nature of the Child and Adolescent Mental Health Services, Recognise the effects of school and other social settings on childhood illness and vice versa, know the principles of managing common behaviour problems such as temper tantrums, sleep problems, the crying baby, feeding difficulties, oppositional behaviour, enuresis and encopresis, school refusal know about the initial assessment and management of common causes of admission to hospital due to psychological distress such as self-harm, somatic symptoms of distress know about the signs and symptoms that indicate serious conditions such as ADHD, autistic spectrum disorders, depression, psychosis know about the effects of substance abuse Recognise the mental health components of paediatric illness Be able to assess the mental state of children and young people Written communications (10) o have understood the need for careful record-keeping and report-writing o keep accurate, legible and relevant medical records o begun to develop effective written communications with patients and their families, with o o colleagues and with other professional organisations be able to use information technology effectively in clinical practice and audit ensure that written communications summarise accurately discussions with young people and parents or carers, and, to avoid confusion and anxiety, do not include info that was not part of the original discussion • Investigations in paediatrics (11) o be able to explain the investigation results to parents and/or the child o demonstrate safe practice in the timely and appropriate requests for investigations o be able to initiate appropriate investigations, be able to interpret results of investigations requested and respond appropriately o be able to record results and document procedures legibly and accurately, be able to give o o o o o • Safe prescribing in paediatrics (12) o know and understand the pharmacological basis for treatments o be able to prescribe safely for the newborn and for children of all ages o know the approved indications and justification for prescribing drugs in common paediatric o o o o o o o o o o o o o o o o o o o o o o • appropriate medical information when requesting investigations know that results should be requested clearly and retrieved promptly understand common age appropriate normal ranges and appearances be receptive to feedback form patients and parents/carers on the effects of medication/treatment, be aware of the role of complex investigations e.g. CT and MRI scans and their diagnostic potential and complications know when to seek advice regarding further investigations of a child or interpretation of an abnormal result problems know the pharmacokinetics and pharmodynamics of commonly prescribed drugs know about the drug interactions of commonly used drugs be aware of possible drug interactions of commonly used drugs where more than one drug is prescribed Know how to report adverse affect Recognise serious drug reactions for example Stevens-Johnson Syndrome. Know the risks of prescribing in the child-bearing years, in pregnancy and breast feeding mothers understand the principles of prescribing for newborn babies and breast feeding mothers Understand the principles of prescribing in children with renal function Know about the roles of the regulatory agencies involved in drug use, monitoring and licensing Know about the licensing of medicines for paediatric patients and unlicensed and off-label use Be able to calculate drugs accurately according to specific does for weight or age/weight range or on a specific dose/specific area basis know how to find out information necessary for safe prescribing through the use of paediatric formularies and pharmacy liaison know how to use the local and national guidelines for the relief of pain in children be aware of procedures for obtaining consent in children and young people for the administration of drugs be aware of and follow local policies for intrathecal cytotoxic therapy understand the rationale for prescribing common antimicrobials know the indications for antimicrobial prophylaxis understand the mechanism of drug resistance know the complications and management of paracetamol poisoning be able to apply the national and local guidelines on prescribing paediatric intravenous fluid be able to make reliable and accurate mathematical calculations required in clinical practice e.g. drug and fluid prescriptions be able to prescribe safely and write legible prescriptions, using appropriate medications in correct doses Safeguarding in paediatrics (13) o understand the effects of family composition, socio-economic factors and poverty on child health o be aware of the effect of the media on public perception of health care issues, o be aware of the effect of non health policies on child health, be aware of child health exploitation issues including child prostitution, child labour and children in combat, be aware of the effects of armed conflict on child health o Know the principles of the UN Convention on the Rights of the Child, apply these in their own practice and work for the protection of these rights o be aware of the World Health Organisation and UNICEF o o o o o o o o o o o o o o o o o o o o be aware of the implications of sustainable development in low income countries be able to recognise increased needs in children who are fostered, adopted or in residential care, be able to recognise and outline the management of children in need of protection know about the resources that may be available from health and other agencies, including the voluntary sector and the roles of allied health professionals to support children and their families have a basic understanding of local interagency structures for joint planning of services have an understanding of how different disciplines and agencies collaborate locally with respect to looked after children, children with disabilities and over child protection issues understand concepts and factors underpinning child protection work, recognise features in presentation, where child protection may be in an issue for example where there are patterns of injury, delay in presentation, inconsistencies in the history, recognise where families are distressed and need help to prevent child abuse be familiar with the different categories of abuse and recognise that they may occur together: physical, emotional, sexual, neglect, fabrication or falsification/induction of illness in a child understand the emotional impact of abuse on the child, family and on professionals know the local guidelines and national guidance and follow the procedures for cases where child abuse is suspected keep accurate records of all findings and communications with the child, family members and all other professionals, to be able to record clearly the results of an examination of a baby, child or adolescent using body charts recognise the importance of noting all observations of the child's demeanour and interactions with parents and carers understand the need to initiate a safe response where abuse is suspected, whilst treating the family with respect and courtesy at all times begin to understand the ways in which their own beliefs, experience and attitudes might influence professional involvement in child protection work begin to understand the principles and practice of common legal processes and legislation relating to safeguarding children and the vulnerable know how to access the Child Protection Register be able to contribute under supervision to written reports for the police or social service Understand what is required when asked to give oral or written reports in strategy meetings and case conferences have attended child protection awareness training Understand what is required when asked to give evidence in court as a witness of fact • knowledge of the science base (14) o Know and be able to apply the scientific base relevant to clinical practice in paediatrics o Know the aetiology and pathophysiology of common and serious childhood conditions • knowledge of common and serious paediatric conditions (15) o understand the promotion of health and the management of ill-health in babies children and adolescents o o o understand the specific health issues, diseases and disorders related to the stages of growth and development recognise the mental health components of all paediatric illness recognise the effects that school and other social settings may have on childhood illness and vice versa Growth, development, health and wellbeing (16) • Development o understand the variations in relationship between physical, emotional, intellectual and social factors and their influence on development and health o be familiar with the patterns of normal development from birth to adulthood o understand the need for further assessment and investigation of delayed development and how to access this o know and understand the principles of screening and monitoring o understand the specific health issues, diseases and disorders related to the stages of growth and development o be able to assess and monitor development using appropriate tools o know the causes of neurodisability, how disability might affect clinical o examination and assessment and understand the need for a multi-disciplinary approach to management o recognise deviations from normal patterns of development o recognise that child neglect or abuse might affect a child's development o be able to identify abnormal patterns of development • • Emotional Development o know the factors which influence healthy emotional development o understand the emotional impact of illness and hospitalisation on children and their families o understand a child's need for opportunities to play and learn at different ages o understand the emotional dimensions of eating disorders o understand and recognise somatisation disorders o be able to assess parenting skills and recognise indications of unsatisfactory or unsafe parenting o recognise and know the principles of managing common behavioural problems o recognise the need for specialised input in cases of serious emotional distress or mental illness o recognise pointers to fabricated and induced illnesses and know how to seek help • • Social development o know the factors that influence social development o understand the impact of autistic spectrum disorders on social development • Educational development o know the factors which influence intellectual development o understand the vulnerability of a child with learning difficulties o understand the impact of learning difficulties on social and emotional behaviour o know about the process of formal statutory assessment of children with possible special educational needs and other educational strategies to support learning and development • • Growth and Nutrition o understand the effects of fetal growth restriction on long-term health o understand the importance of emotional factors in feeding and nutrition, in particular in non-organic failure to thrive o be able to monitor growth using appropriate tools o o understand the basic physiology of breast feeding o recognise common breast feeding problems and refer appropriately o Be able to advise a mother about the benefits and risks associated with infant feeding o be able to advise a mother about appropriate complementary feeding o understand the role of nutritional support team, specialist nurses, dieticians, psychologists, pharmacists, speech and language therapists in managing feeding and nutrition in paediatrics o be able to describe a child's nutritional status in terms of balance, body composition and function o understand the relevance of nutritional requirements for healthy and sick children o understand the relationship between nutritional status and disease o know about the principles and methods of dietary supplementation o recognise cultural and religious issues related to nutrition o understand the effects of obesity on long term health o understand interventional strategies involved in weight reduction o understand the range of factors, biological, psychological and social which influence normal growth and puberty o be able to indentify a family needing nutritional support or advice o understand the effects of malnutrition on clinical outcomes • Adolescence o understand the variations in relationship between physical, emotional, intellectual and social factors and their influence on adolescent development o understand the different specific and changing health needs of adolescents as inpatients and outpatients o understand normal and abnormal pubertal development and its relationship to growth o understand and respond appropriately to episodes of self-harm in adolescents o know about national policies for reduction of teenage pregnancy o know about contraceptive and sexual health issues and where appropriate advice might be sought o know about the issues around transition from paediatric to adult care in adolescents with chronic conditions o be aware of issues relating to gender and sexual identity o recognise risk-taking behaviours, particularly those which pose a threat to chronic disease management Health promotion and public health issues in paediatrics (17) INFORMATION • Screening and Surveillance o Know about screening and surveillance programmes o Know about the conditions currently screened for o Understand the ethical dilemmas posted by screening o Be able to explain specific screening to parents o Be able to conduct developmental examinations at different ages • Health promotion o Understand the importance of evidence to support health promotion activities o Know the role of health promotion programmes for example to prevent dental decay, smoking, accidents, obesity, sudden infant death o Be able to advise parents of avoiding risks for children • • • Have completed RCPCH part 1a and 1b exams Have read a number of paediatric texts for revision including RCPCH master-course, Practical Paediatric Problems, Essential Paediatrics and Essential Neonatal Medicine Have completed looked after children’s medicals for teenagers, including providing information and advice about smoking, drinking and sexual health • Public health and epidemiology o know about population statistics and know how they might be used in service development o understand the role of public health doctors in commissioning NHS services o Understand good study design o know the principles of how to conduct population studies o Be able to evaluate evidence • Injury Prevention o Understand the epidemiology of injuries in children and young people o Know about the sequelae of injury o Know about rehabilitation o Be able to recognise when injury may be non-accidental o Be able to recognise and treat accidental ingestion and deliberate self-poisoning o Be able to advise parents on injury prevention • Immunisation o understand passive and active immunisation o understand the principles and the rationale behind the national immunisation policy for children in Britain o know the indications, contraindications and complications of routine and specific childhood immunisations o be able to advise parents Evidence-based approach to paediatric practice (18) INFORMATION o know how Cochrane systematic reviews are developed and the principles of meta analysis o ensure that they are up to date in their practice and endeavour to promote evidence-based medicine where possible o be able to give an evidence based presentation Clinical governance activities and audit in paediatric practice (19) o know how clinical guidelines are produced and how they might be used appropriately within the context of clinical practice o familiar with and follow the local and national clinical guidelines and protocols o understand the principles of evaluation, audit, research, development and standard setting in improving quality o participate in clinical governance activities, risk management and audit o be able to use ICT effectively in clinical practice and audit o know how to access clinical databases and where to find web-based information A reflective approach to improvement of professional practice as a paediatrician (20) o begun to develop a reflective approach to their practice and a commitment to learning and improving their practice through reflection Equality and diversity in paediatric practice (21) o understand the importance of cultural diversity and the difficulties where religious and cultural beliefs that parents might hold about the treatment of their children are in conflict o o o o with good medical practice ( and know where to find legal and ethical guidelines to support their work) begin to understand that young people may have or may develop health care beliefs which are in conflict with those of parents or professionals,( and know where to find legal and ethical guidelines to support their work) when to seek support and where to find legal and ethical guidelines to support their work have an open minded approach to equality and diversity understand the national and contribute to local initiatives aimed at reducing inequalities in child health and well-being Knowledge of the law regarding paediatric practice (22) o know the law with regard to consent and confidentiality, in children, young people and adolescents and follow the relevant legal principles in practice o understand the importance of post-mortem investigations Teaching and training, appraising and assessing • Teaching in Paediatrics (23) o begin to develop a sound understanding and a commitment to the principles and practice of effective teaching and learning in clinical contexts • A positive approach to mentoring and educational supervision (24) o understand the importance of a positive and constructive approach to mentoring and supervision o show a commitment to their continuing professional development and respond positively to requests for enquiries or critical incident reports and to outcomes of reviews, assessments and appraisals of their performance o show honesty and integrity when contributing to peer reviews of colleagues in teaching and research o LEVEL 2 • Have been actively supporting junior colleagues with offering opportunities for work place based assessments Research in paediatrics (25) o o o o o o o an understanding of the need for an ethical and rigorous approach to research in paediatrics understand their responsibilities to conduct research with honesty and integrity, seeking ethical approval where appropriate and safeguarding the interests of patients begin to understand basic concepts in research design and methodology including the difference types of research studies understand the difference between research and audit understand the steps involved in planning a research project understand when to use simple statistical tests and their interpretation begin to develop critical appraisal skills and to apply to their reading of the literature, including systematic reviews of their own teaching and the teaching of others Relationships with patients • Communication and interpersonal skills with children of all ages (26) o have understood the need for and begun to develop effective communication skills specific to their work with babies, children, young people and their families o know where to find assistance in the case where a child or family member may not speak English o have understood the need to respond to babies, disabled children or young people who may not be able to express themselves verbally and who might be in pain or distress o understand the need to develop strategies for careful and appropriate use of language in difficult and challenging circumstances o have strong communication and interpersonal skills to enable them to work effectively with patients and their families, and colleagues in multi-professional and multi-discipline teams o be able to demonstrate courtesy to families, colleagues and members of the multidisciplinary team at all times o experience of how to communicate diagnosis and prognosis effectively to children , where appropriate, young people and their families o have begun to develop appropriate responses and empathy for children, young people and their families experiencing difficulty and distress, for example, in the case of a child who is dying o be able to discuss the indications, benefits and adverse events of a procedure to patients, relatives and carers that will allow informed consent for procedure which the doctor is competent themselves to perform o have experience of how to communicate a diagnosis and prognosis effectively to children, where appropriate, young people and their families • Empathy and sensitivity and skills in engaging the trust of and consent from children and their families (27) o understand the need for compassion, empathy and respect for children, young people and their families o know the national and local guidance for obtaining consent for post-mortem o understand the different factors that have an influence on the patient's journey o understand the factors that affect a child's level of anxiety about illness, treatment or examination o have begun to develop strategies to manage a child's anxieties and personal anxieties o recognise the impact on parents and the rest of the family of acute or chronic illness, hospitalisation or the death of a child • Listening skills and basic skills in giving information and advice to young people and their families (28) o have begun to develop active listening skills with children and young people and understood the need to respect their views o show patience and sensitivity in their communications with children and their families and a particular ability to explore their individual perspectives of a problem o know about agencies both statutory and voluntary that can provide support to children and their families in coping with. Working with colleagues • Communication and interpersonal skills with colleagues (29) o understand the need to engage effectively with professionals in other disciplines and agencies from the voluntary sector o understand the need for open and non-discriminatory professional working relationships with colleagues o recognise the needs for timely senior support in serious clinical situations and be effective in requesting this • Professional respect for the contribution of colleagues in a range of roles in paediatric practice (30) o Demonstrate the ability to work effectively in multi-disciplinary teams and with colleagues from a wide range of groups o Have the ability to take on differing and complementary roles within the different communities of practice within which they work, in hospitals, general practice and in the community, in social services and schools o Understand the importance of effective team work with colleagues in multi-disciplinary teams to ensure consistency and continuity and a holistic approach to the treatment and care of children and young people • Management and leadership skills (31) INFORMATION o Have effective time management skills in their professional roles o be able to prioritise tasks in personal and professional contexts for example in medical emergencies • • Handover, referral and discharge (32) INFORMATION o Ensure effective hand-over procedures and clear communications with colleagues to ensure the continuing good medical care of patients o Ensure the effective discharge procedures to their family, community, social and primary care services • Effects of local, national and international policies on their work and on the health of children (33) o understand how national and local policy initiatives impact on medical practice and social health and well being o begin to develop an understanding of national service frameworks and managed clinical networks within paediatrics, the role if NICE, the role of RCPCH, PMETB and the GMC in professional life and professional regulation o be aware of shared care protocols and the role of outreach clinics o have some familiarity with the roles of allied health professionals and other agencies in the support of children and families o be aware of the impact of the European Union on child health and healthcare systems Professional Behaviour • Ethical personal and professional practice (34) o understand the limitations of their competence, in their clinical practice and in their relationships with patients and know where and when to ask for help, support and supervision o Understand the need for honesty and know the procedures to follow where there is concern about the professional conduct of a colleague who might be putting the health of a patient at risk o demonstrate probity in personal and professional life o be aware of the ways in which their personal experiences, values and attitudes might affect their professional practice and know when to refer to another doctor • responsibility and accessibility to patients, families and colleagues (35) o demonstrate a commitment to the highest standards of care and ethical and professional behaviour within their speciality and with the medical profession as a whole o • Approach to personal health, stress and well-being (36) o take responsibility for their own obligation for health and well-being, safety and welfare issues o show an understanding of the importance of ensuring the healthy balance between professional and domestic priorities o demonstrate a responsibility for their own health in so far as it might affect the welfare of safety of patients o