Domain 4

Patient Management

HK Doctors Core Competences mapped to this domain:

Clinical skills - Medical graduates should be competent in carrying out a range of clinical skills (e.g. history taking, physical and mental state examination, problem solving skill, making a diagnosis, etc.) independently and to an acceptable standard.

Patient investigation - Medical graduates should be able to demonstrate competence in the general principles of patient investigation and to undertake appropriate investigative procedures by themselves.

Patient management - Medical graduates are expected to have demonstrable knowledge of the important aspects of patient management and to make appropriate referrals

Decision making skills and clinical reasoning and judgment - Medical graduates should be able to develop decision making skills and display clinical reasoning based on medical evidence and humane judgment as basis for their actions.

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Basic Training

Learning Outcomes
  1. Perform comprehensive history taking, physical examination and investigations and give due consideration of personal factors of the CYP.
  2. Devise a safe management plan of common paediatric problems at hospital and community settings based on knowledge and sound clinical reasoning.
  3. Refine differential diagnosis and tailor management plans in response to the patient’s needs and clinical progress.
Key Capabilities
  1. Recognize emergency and serious situations of physical and mental health in CYP and intervene appropriately.
  2. Apply local and international guidelines in the management of common paediatric problems.
  3. Adapt the best evidence-based clinical practice for paediatric problems if guideline is lacking.
Illustrations
  1. Demonstrate the accurate formulation of problems, recognizing the breadth of different presentations of disorders.
  2. Present and discuss patient management in a team to demonstrate understanding of the patient’s situation.
  3. Interpret common laboratory and radiological findings and explain them to the parents.
  4. Diagnose and manage the common important causes of mortality and morbidity in CYP, for instance, common airway and respiratory emergencies, shock, status epilepticus and cardiac arrhythmias.
  5. Recognize maltreatment of children.

 

Higher Training

Learning Outcomes
  1. Recognize, investigate, initiate and continue the management of a wider range of acute and chronic conditions in the outpatient setting when possible.
  2. Consider a wider range of treatment and management options available, including new therapies, relevant to paediatrics and their chosen subspecialties.
  3. Anticipate and determine the need for transition of patient to other specialties or treatment settings, including the transition to adult care, and plan accordingly.
Key Capabilities
  1. Collaborate with other clinicians, specialists, allied health professionals and health-related agencies in patient management in a multidisciplinary setting.
  2. Plan the return of patients with medical complexities to community and home care.
Illustrations
  1. Explain and discuss with patients and families for the process of transition to adult care. Collaborate with adult physicians and concerned health discipline to facilitate the transition.
  2. Recognize rare but important emergency conditions in various subspecialties, especially in the subspecialty of the trainee’s choice.
  3. Explain the rationale to consider escalation of treatment to the family when the need arises
  4. Work with nurses and other professionals in the arrangement of home care of chronic patients.

 

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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