Domain 8

Quality Improvement

This domain can be partially mapped to the following competence of the HK Doctors document:

Roles of doctors within the healthcare system - Medical graduates should understand the healthcare system in Hong Kong and the clinical responsibilities and role of a doctor in the society. They should also appreciate the roles of doctors as researchers, mentors, teachers and managers in the system.

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Basic Training

Learning Outcomes

Understand quality improvement principles.

Key Capabilities
  1. Understand the concept of audit and CQI projects.
  2. Understand the concept and technique in data collection.
Illustrations
  1. Apply and evaluate local and national clinical guidelines and protocols in paediatric practice and public health, and recognize the individual patient needs when using them.
  2. Apply knowledge of how to access clinical databases and find web-based information for quality improvement.
  3. Handle complaints and feedbacks from CYP and families in a constructive manner.

 

Higher Training

Learning Outcomes
  1. Apply knowledge of Quality Improvement to undertake projects and audits to improve clinical effectiveness, patient safety and experience under guidance.
  2. Participate in Quality Improvement projects with other healthcare professionals and facilitates reflective evaluation in relation to QI interventions under guidance.
Key Capabilities

Identify opportunities for quality improvement.

Illustrations
  1. Execute a simple quality improvement project using improvement under guidance.
  2. Understand the process of hospital accreditation.
  3. Understand the key performance indices in clinical practice of the trainee’s institution.

 

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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