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Domain 9
Safeguarding
RCPCH Child Protection Portal Front Page stated that:
As child health professionals, child protection plays a role in everything we do. It is about protecting individual children identified as suffering, or likely to suffer, significant harm as a result of abuse or neglect. Safeguarding is a broader issue, and covers how we ensure children grow up in a safe environment.
Basic Training
Learning Outcomes
- Understand and uphold the professional responsibility of safeguarding CYP
- Document any safeguarding concern, alert senior staff of such concern and seek advice and guidance.
- Understand the long term impact of child maltreatment and other adverse childhood experiences.
Key Capabilities
- Recognize presenting features of children where child protection issue may be a concern.
- Recognize vulnerable children and distressed families that need assistance or intervention
- Apply knowledge on how to act in cases of suspected child maltreatment
- Apply knowledge of local multidisciplinary procedures for CYP in need of safeguarding support, including adoption and foster care.
- Document clearly and accurately all examination results, assessment and communication relating to possible safeguarding issues.
- Provide oral or written reports for welfare meetings, multidisciplinary case conferences and produce written reports for the police, social service or court hearings under supervision.
- Participate actively in multidisciplinary conference and welfare meetings.
Illustrations
- Apply knowledge to recognise the diversity of physical signs and symptoms that might indicate or mimic child abuse, including skin injury and genital warts.
- Recognise that frequent emergency department attendance may be a presentation of child abuse and/or neglect.
- Recognise that behaviour changes, including soiling and/or bed wetting, can be a presentation of psychological abuse or neglect.
- Recognise the health indicators of possible neglect, including failure to meet the child’s routine health needs, school absence and severe, untreated dental caries.
- Identify the presenting features of possible abusive head trauma in infants and knows the conditions that might mimic such presentations (e.g. inherited metabolic disorder).
- Recognise the risk factors which contribute to vulnerability, including disability in children, maternal mental illness, parental substance abuse and teenage parents.
- Recognise the risk factors for maltreatment in the unborn child (e.g. maternal substance abuse, maternal mental illness).
- Apply knowledge of the principles and practice of latest local guideline in handling of case of suspected child maltreatment (e.g. Protecting children from maltreatment - procedural guide for multidisciplinary cooperation).
- Employ and interpret investigations in suspected child maltreatment e.g. blood tests, skeletal X ray.
Higher Training
Learning Outcomes
Lead independently the detection, assessment, reporting and decision making in the safeguarding of CYP.
Key Capabilities
- Handle with sensitivity the disclosure and any need to escalate action regarding case with possible safeguarding issue.
- Follow the established guidelines and procedures in the identification, assessment, referral and follow-up of CYP who may have been sexually abused.
- Initiate and take part in the comprehensive multidisciplinary assessment of the developmental, physical and psychological status and the family function of CYP who have been possibly maltreated and draw up a conclusion about the nature of the case.
- Provide oral or written reports for welfare meetings, multidisciplinary case conferences and produce written reports for the police, social service or court hearings independently.
- Assess the role of a Paediatrician as it relates to those of other professionals in the management of children in need of protection and ensure suitable follow-up.
Illustrations
- Obtain valid consent for examination in the case of suspected abuse.
- Identify the risk factors, and physical and behavioural indicators for child sexual abuse (e.g. missing from home or school and presenting with a controlling adult).
- Apply knowledge of the local referral pathways for child sexual abuse
- Respond to the safeguarding needs of the unborn child, including in families with domestic violence, or maternal substance abuse.
- Respond to the safeguarding needs of vulnerable children in high risk family by proper referral for support, comprehensive assessment, risk assessment and welfare planning
- Participate and lead in the management of children in need of protection, and uses local pathways to ensure referral and follow-up.
- Understand the principles of forensic examination and recognize the importance of the chain of evidence.
- Recognise when additional expert advice is needed (e.g. radiology, orthopaedics, neurology and ophthalmology, psychiatry or clinical psychology).
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.
(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.
