Domain 3

Procedures

HK Doctors Core Competences mapped to this domain:

Clinical procedures - Medical graduates should be able to master a range of basic clinical procedures independently (more advanced skills are expected of a paediatric trainee

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Basic Training

Learning Outcomes
  • Carry out clinical examinations with appropriate adaptations for CYP of different growth and developmental stages.
  • Carry out basic clinical procedures with appropriate adaptation and troubleshooting for CYP under a range of situations.
Key Capabilities
  1. Perform basic and advanced paediatric life support and neonatal resuscitation.
  2. Recognize and take prompt and appropriate procedures when the child's well-being, safety, dignity or comfort is being compromised.
  3. Perform developmental assessment of CYP and appreciate normal variations in growth and development.
  4. Perform the following essential procedures:
    • Infection control measure
    • Aseptic technique
    • Administration of sedation
    • Blood taking techniques, including heel prick
    • Various injection techniques
    • Peripheral venous cannulation
    • Peripheral Arterial cannulation
    • Umbilical venous cannulation
    • Umbilical arterial cannulation
    • Intraosseous needle insertion
    • Lumbar puncture
    • Measuring peak flow rate
    • Advanced airway support, including tracheal intubation, replacing tracheostomy tube and bagging
    • Microbiological study specimen collection
    • Bladder catheterization
    • ECG performance and interpretation
    • Use of Epinephrine auto-injector
    • Chest tap and chest tube insertion
    • Nasogastric tube insertion
    • Use of Automated external defibrillator
Illustrations
  1. Complete the training of the necessary skills of a basic trainee.
  2. Take care to ensure the dignity and comfort of CYP when performing clinical procedures.
  3. Take prompt and appropriate actions when the CYP’s well-being, safety, dignity or comfort is being compromised.
  4. Explain the indication, side effect and possible complications of common procedures to the CYP and family.

 

Higher Training

Learning Outcomes
  1. Supervise and assess junior staff undertaking clinical procedures, and manage complications arising from the procedures.
  2. Demonstrate competence in performing independently a wider range of advanced procedural skills that are required in the practice of paediatrics and their chosen subspecialties.
  3. Recognize the situation that requires the advanced or specialized skills of other health professionals and to employ their skills.
Key Capabilities

Perform the following essential procedures during higher training:

  • Exchange transfusion
  • Point-of-care ultrasound (e.g. head ultrasound examination, ultrasound guided vascular cannulation) – the use of ultrasound as a modality of examination or guidance of clinical procedure instead of the specific ultrasound procedure.
Illustrations
  • Supervise junior staff in essential clinical procedures with appropriate guidance and teaching.
  • Decide alternative strategy when the procedures are contraindicated or refused.

 

Opinion Recieved by the Working Group for Curriculum Review

Opinions
To include Point -of-care Ultrasound skills in key capabilities, e.g. Basic echocardiogram for assessing left ventricular function (M mode), appreciating poor contractility, diagnosing pneumothorax, ultrasound guided blood vessel catheter insertion. (Dr Lawrence Chan, 27 Jan 2022)
  • Working Group Replies (16 Feb 2022): Thanks, Lawrence! The Group agrees that ultrasound usage is becoming an essential skill for paediatricians. In the backbone of a curriculum statement, we think it is appropriate to state a generic requirement of POCUS but without specifying the region and the usage. We think the specific skills e.g. detecting pericardial effusion can be listed in the syllabus of the relevant subspecialty. A trainee may acquire these skills according to their scope of training.
To change the following key capabilities to a new "Optional" category and to be listed in the illustration section (Dr Eric Lee, Dr Sabrina Tsao, Dr NC Fong and Dr SP Wu, 5 March 2022):​
  • Basic Training - Peripheral arterial catheterization (reason: it is considered a skill that is nice to have, but not absolutely mandatory for all paediatricians.)​
  • Higher training - Exchange transfusion. (reason: this procedure is increasingly rare)

To accept simulation training as an alternative to real patient training in the following key capabilities (Dr Eric Lee, Dr Sabrina Tsao, Dr NC Fong and Dr SP Wu, 5 March 2022):

  • Basic Training - Advanced airway management, including tracheal intubation​
  • Basic Training - Intraosseous need insertion
  • Basic Training - Use of epinephrine auto-injector
  • Basic Training - Chest drain and chest tube insertion, including needle thoracocentesis
  • Basic Training - Use of Automated External Defibrillators

To specify performing blood culture instead of "Microbiological specimen collection" to be more specific (Dr Eric Lee, Dr Sabrina Tsao, Dr NC Fong and Dr SP Wu, 5 March 2022)

Inclusion of reduction of pulled elbow and removal of foreign body from oropharynx with Magill forceps under Domain 3 (Dr Philip Sham)

Upon the drafting of syllabus, the Working Group agreed that red reflex examination is a mandatory skill during basic training. This applies to the newborns and young children for the detection of cataract and intraocular mass. (WGCR 29 Sept 2022)

Adding the word "holistic" in the Learning outcome of Domain 1 to emphasize the importance of whole person care (WGCR 29 November 2022)

Adding 'Physical and mental health" in key capability of Domain 4 to emphasize that emergency and serious conditions does not only refer to physical body, but also the mind (WGCR 29 November 2022)

Refine the scope of advocacy in the domains. Focus on injury prevention. The difference between "Illness Prevention" and "Disease Prevention"of domain 5 (Dr CB Chow, 7 March 2023)

Responses
 Reply from Dr SP Wu (7 March 2023)​
(1) The eleven domains are the same as the ones of the Progress Curriculum of RCPCH. The wordings originated from the GMC. We tried to map the domains to the "HK Doctors" document issued by the MCHK. In the latter document, the wording was "disease prevention" and not "illness prevention". The meaning of the word was taken loosely and we do not intend for a stringent literal distinction between illness and disease. I suppose illness is broader in a sense, although this is only my take on the word.
(2) I agree that injury prevention was only tangentially alluded to in the Safeguarding domain. I will bring this to the attention of the Working Group.
(3) "Taking the interest and welfare of children as the first and most important consideration" is a learning outcome in Professional values and behavior, although the word "advocacy" appears only in the syllabuses of "Adolescent Health" and "Community Paediatrics". I will discuss with the Working group if the advocacy should be included as a learning outcome.

 

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