Domain 7

Patient Safety, including Safe Prescribing

As an overarching principle, HK Doctors document stated:

"It is the duty of the Medical Council to protect, promote and maintain the health and safety of the public by ensuring the professional standard of registered medical practitioners. A high standard of medical education is required to meet the needs of the public. Patient safety must be the overriding priority at all stages of medical education and training. A doctor practising safe medicine must also be an ethical doctor."

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Basic Training

Learning Outcomes
  1. Understand the importance of patient safety and apply its principles in child safety, namely sedation and procedural safety and injury prevention.
  2. Select and prescribe common medications safely and appropriately for CYP.
Key Capabilities
  1. Apply the prevailing guidelines in drug prescription.
  2. Educate CYP on the safe use of medicine and their side effects.
Illustrations
  1. Prescribe appropriate fluid therapy for newborns to young adults.
  2. Prescribing antibiotics rationally and understand antibiotics stewardship programme.
  3. Prescribing sedatives, analgesics and opioids safely.
  4. Practice measures to reduce prescription and medication errors (e.g. writing legibly, avoid unconventional abbreviations).
  5. Be knowledgeable of drug interactions of commonly used drugs.
  6. Uses therapeutic drug monitoring to adjust dosing schedules.
  7. Familiarize the common side effects of common prescribed drugs.
  8. Prescribe medications to CYP with an understanding of the pharmacokinetics, pharmacogenetics, dose calculation and dosage adjustment in renal and liver impairment.
  9. Understand the effect of maternal drugs on infants receiving breast milk.
  10. Safely prescribe parenteral nutrition.

 

Higher Training

Learning Outcomes

Identify, report, investigate and mitigate actual and potential risks in clinical management.

Key Capabilities
  1. Perform risk reporting and participate in the investigation and mitigation using the existing mechanisms.
  2. Counsel CYP and the family on the safety implications of drug compliance and handle complicated compliance issues.
Illustrations
  1. Demonstrates a working knowledge of risk assessment and its application.
  2. Applies local policies for risk reporting.
  3. Effectively manages a complaint and learns from clinical errors.
  4. Discussion with CYP & family (especially chronic disease on medications) the importance of compliance, common side effects, and way for communication once problem encountered.
  5. Understand idiosyncratic drug reactions like exanthematous drug eruption associated with antiepileptic drugs and antimicrobials.
  6. Carry out investigations of medication errors.

 

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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