DEFINITION:Pediatrics
is that branch of medicine concerned with the study of infants, children
and adolescents in health and disease, their growth and development, and
their opportunity to achieve full potential as adults.
GENERAL
OBJECTIVES:A
pediatrician is a specialist trained in the diagnosis and treatment of a
broad range of diseases involving children based on a sound knowledge of
normal growth and development and of the wide range of clinical
conditions encountered in infants, children, and adolescents. On
completion of the educational program, the graduate physician will be
competent to function as a consultant pediatrician in the essential
roles and key competencies of pediatricians, that is — medical
expert/clinical decision-maker, communicator, collaborator, manager,
health advocate, scholar and professional. The resident will have
acquired a degree of independent responsibility for clinical decisions
and an understanding of the nature of the relationships between a
referring physician and a consultant clinical pediatrician. Following
certification in Pediatrics, the resident will be prepared for
independent practice.
General Content of
Core Training
The resident will have had
an adequate experience in both the in-hospital services and the
ambulatory facilities of a children's hospital or of the pediatric
department of a general hospital. A portion of the training must include
experience and study in the comprehensive care of children with physical
and psychosocial challenges. The resident will learn the skills to work
collaboratively with and to provide consultation to other medical and
health disciplines dealing with infants and children, especially with
psychiatry, surgery and obstetrics. The resident will acquire the
professional attitudes to work with other health disciplines in a
variety of health care service models. The resident will develop the
skills of a self-directed, life-long learner. The resident will learn
the skills to critically appraise both his/her practice as well as the
practice of pediatrics.
Specific Content
The resident will have been
registered in an accredited pediatric postgraduate residency program.
The resident will have had experiences in core general pediatrics and in
the various pediatric subspecialties, in both in-patient and ambulatory
settings. Core pediatric training must include rotations in critical
care pediatrics, emergency pediatrics and neonatology. The resident will
learn to set his/her own educational goals and will have had
opportunities for elective experiences outside of the core training
program, the essential feature being that these must be arranged with
the understanding and approval of the postgraduate program director.
General Educational Objectives for Pediatrics
A broad educational
experience in Pediatrics is essential if residents are to understand
infants, children and adolescents in health and in sickness, and if they
are to deal effectively with their physical, mental, emotional and
social problems.
The resident will
demonstrate a variety of personal attributes which are relevant to the
broad range of clinical work with pediatric patients and their families.
These important attributes which apply in all pediatric settings are
described below and are not repeated for each special area. For certain
clinical fields, specific additional points regarding attitudes are
incorporated within the appropriate section.
Essential Roles and Key Competencies
- Medical
Expert / Clinical Decision-Maker
Pediatricians
possess a defined body of knowledge and procedural skills which are used
to collect and interpret data, make appropriate clinical decisions and
carry out diagnostic and therapeutic procedures within the boundaries of
their discipline and expertise. Their care is characterized by
up-to-date ethical, and cost-effective clinical practice and effective
communication in partnership with patients, other health care
professionals, and the community. The role of medical expert/clinical
decision-maker is central to the function of pediatricians and draws
upon the competencies included in the roles of scholar, communicator,
health advocate, manager, collaborator, and professional. In this role,
the resident will demonstrate diagnostic and therapeutic skills for
ethical and effective patient care.
1.1.
Knowledge of normal body structure and function as expressed in a
biopsychosocial model of human development. The resident will understand
the normal human anatomy, physiology and psychology with emphasis on
physiological and psychological changes during growth and development.
1.2.
Knowledge of disturbed body structure and function
The resident will understand the pathophysiological and psychological
processes underlying departures from normal.
The
resident should therefore be able to recognize, diagnose and manage;
- the
normal healthy state
- the
natural course of pediatric problems, variations in and
deviations from the normal
1.3.
Knowledge of promotion and maintenance of optimal functioning in
biological and psychological aspects. This will include knowledge of
therapy in its broadest sense, to include life-style, dietary,
nutritional, physical and drug therapies. The resident will demonstrate
the ability to access and apply relevant information to clinical
practice.
1.4.
Interviewing and communication skills
The
resident will be able to establish a
professional relationship
and to interact with the patient (infant, child or adolescent) and
parent, guardian or other care giver in order to obtain a history, to
conduct a physical examination and to provide ongoing care. The
pediatric resident will establish an atmosphere of open communication
appropriate to the situation and will convey interest, sensitivity,
empathy and support.
1.5. History
taking skills
The resident will be able to obtain and record a complete history
including:
- identifying
data and date of contact
- reasons
the patient was brought for or sought medical help (chief
complaint)
- the
important symptoms in sufficient detail to provide a clear picture
of the clinical problem(s) - history of present illness
- all
other important information from the past history, perinatal
history, developmental history, medications, allergies, review of
systems, family history, and social history
1.6. Physical
examination skills
The resident will carry out an efficient, orderly physical examination,
demonstrating sensitivity to the patient's needs, modified according to
the patient's age, gender and problem, and record this information by
regions or systems.
1.7. Problem
Solving and Decision Making
The
resident should demonstrate the ability to correlate, evaluate, priorize
and synthesize information, including the relevant ethical issues,
acquired by interview, history taking and physical examination. The
resident should recognize and define problems (formulation) and generate
a differential diagnosis and problem list.
The
resident will be able to demonstrate the ability to manage problems by:
- appropriate
application of knowledge derived from critical appraisal of the
literature
- formulation
of a problem oriented plan of management
- generating
a rational plan of diagnostic and therapeutic measures with use of
information on cost benefit ratios
- interpretation
and modification of a plan of management with explanation and
ongoing communication with parents and child
- participating
suitably in multi-disciplinary group discussion, initiating or
facilitating as required
- maintaining
confidential information as appropriate
- evaluating
and modifying management plans by periodic reassessment of the
patient's progress
- ensuring
proper recording of care and its effectiveness
- participating
in medical quality assurance activities to review quality of care
issues in provision of health care.
1.8.
The resident should demonstrate effective consultation skills in
presenting well-documented assessments and recommendations in written
and/or verbal form in response to a request from another health care
provider, with respect to patient care, education and legal opinions.
1.9.
The resident should recognize personal limitations and demonstrate a
willingness to call upon others with special expertise and make
referrals where appropriate.
1.10.Technical
Skills
The
resident must demonstrate knowledge and skills required for the safe and
efficient practice of the following procedures.
- intravenous
access and blood-drawing
- umbilical
venous and umbilical arterial catheterization
- arterial
puncture
- suture
of a one layer laceration, simple wound closure
- cardiopulmonary
resuscitation (newborn and child)
- tracheal
intubation (newborn and child)
- lumbar
puncture
- bladder
catheterization and/or suprapubic aspiration
- gastric
tube placement (oro or nasogastric)
- intraosseous
insertion, chest tube placement and thoracentesis as demonstrated
in either a patient or model
The
resident should also have knowledge and proficiency of the specific
technical skills.
- Communicator
To
provide humane high quality care, pediatricians establish effective
relationships with patients, other physicians and other health care
professionals. Communication skills are essential for the functioning of
a pediatrician and are necessary for obtaining information from,
conveying information to patients and their families and establishing
therapeutic relationships with patients and families. Furthermore these
abilities are critical in eliciting patients' and/or families' beliefs,
concerns and expectations about their illnesses, and for assessing key
factors impacting upon patients' health.
2.1. Communication
Skills
The resident will be able to demonstrate the ability to:
- listen
effectively and obtain and synthesize relevant history from
patients, families and communities
- communicate
effectively and discuss appropriate information with patients and
families and all members of the interdisciplinary health care team
- educate
patients, families and health care professionals in formal and
informal educational settings
- present
the patient's problem(s) clearly, concisely and correctly, in the
following ways:
- verbally,
in the clinical setting or formal presentation
- in
a written medical record (in standard or problem oriented
form) or consultation report
2.2.
The resident will demonstrate caring and empathy for patients and
their families, and especially for those individuals who are vulnerable.
2.3.
The resident will give close attention to the impact of such factors as
age, gender, disability, ethnocultural background, social support, and
emotional influences on a patient's illness.
2.4.
The resident will demonstrate respect for individual patients,
families, colleagues and for their value systems which may be different
from the resident's own values.
2.5.
The resident will demonstrate an appreciation of the parents'
perspective of and concerns for a child's health and the impact of a
child's illness on family relationships.
2.6.
The resident will demonstrate a willingness to communicate
effectively with patients and families and all members of the
interdisciplinary team.
2.7.
The resident will demonstrate an ability to support and counsel a child
(and his/her family) with chronic illness and/or impending death and
provide bereavement counselling.
- Collaborator
Pediatricians
work in partnership with others who are appropriately involved in the
care of children and adolescents. It is therefore essential for
pediatricians to be able to collaborate effectively with patients, their
families and a multidisciplinary team of expert health professionals for
provision of optimal patient care, education, and research.
3.1.
The resident will demonstrate a capacity to establish and maintain a
productive and responsible relationship with young patients and
families, and a capacity to establish and maintain cooperative
interpersonal relationships with a multi-disciplinary team and thus
contribute effectively to other interdisciplinary team activities.
- Manager
Pediatricians
function as managers when they make every day practice decisions
involving resources, co-workers, tasks, policies, and their personal
lives. They do this in the setting of individual patient care, practice
organizations and in the broader context of the health care system. Thus
pediatricians require the abilities to priorize and effectively execute
tasks through teamwork with colleagues, and make systematic decisions
when allocating finite health care resources. As managers, pediatricians
take on positions of leadership within the context of professional
organizations and dynamic health care system.
4.1.
Provision of Health Care
The
resident will be able to demonstrate the knowledge of various forms of
health care provision and to work effectively and efficiently in a
health care organization, including the following:
- an
understanding of the importance of the families' (parents' and
child's) involvement in the provision of health care to the child
- the
role of a pediatrician in the provision of preventive and
therapeutic health care, based on sound scientific evidence
- the
importance of shared responsibility for health care provision in a
multidisciplinary setting
- the
advantages, disadvantages and relative costs of preventive and
therapeutic health care programs
- the
advantages, disadvantages and relative costs of care in different
settings, including an appreciation of the various forms of health
care provision, including hospitals, ambulatory clinics, private
offices, home
- care,
chronic care and rehabilitation facilities
- the
avoidance of unnecessary investigation and/or hospitalization
The
resident should exhibit knowledge of the relative advantages and
disadvantages and the impact on the child and the family of such forms
of care.
4.2.
Quality Assurance
- knowledge
of the definitions and role of audits, quality improvement, risk
management, occurrence / incident reporting, and complaint
management in a hospital and ambulatory setting.
- knowledge
of cost/benefit ratios of diagnostic and therapeutic
interventions, cost-containment and efficacy, effectiveness and
efficiency as they relate to quality assurance.
4.3.
The resident will demonstrate an awareness of the need to
continually balance professional, personal, institutional and social
commitments.
4.4.
The resident will demonstrate open-mindedness to the consideration
of alternative health care practices.
4.5.
The resident will demonstrate an awareness of cost and
cost-effectiveness of various forms of pediatric care, and the ability
to utilize resources effectively and to allocate finite health care
resources widely.
- a
willingness to participate in cost-containment and quality
assurance programs.
4.6.
The resident will demonstrate an awareness of the social, societal
and governmental aspects of health care provision as applied to the
pediatric age group.
4.7.
The resident will demonstrate an ability to utilize information
technology to optimize patient care, life-long learning and other
activities.
- Health
Advocate
Pediatricians
recognize the importance of advocacy activities in responding to the
challenges represented by those social, environmental, and biological
factors that determine the health of children and adolescents within
society. They recognize advocacy as an essential and fundamental
component of health promotion that occurs at the level of the individual
patient, the pediatric population, and the broader community. Health
advocacy is appropriately expressed both by the individual and
collective responses of specialist physicians in influencing public
health and policy.
5.1.
The resident will demonstrate an appreciation that the health care
needs of children are distinct from those of adults.
5.2.
The resident will encourage promotion of active family involvement
in decision-making and continuing management of the child.
5.3.
The resident will demonstrate the ability to contribute effectively to
improved health of patients and communities.
5.4.
The resident will identify the important determinants of health that
affect children and adolescents. This includes the ability to recognize,
assess, and respond to the psychosocial, economic, societal and biologic
factors influencing the health of those served.
- Scholar
Pediatricians
engage in a lifelong pursuit of mastery of Pediatrics. They recognize
the need to be continually learning and model this for others. Through
their scholarly activities, they contribute to the appraisal,
collection, and understanding of health care knowledge, and facilitate
the education of their students / housestaff, patients, and other health
professionals.
6.1.
The resident will recognize the importance of self-assessment of
professional competence and acceptance of the responsibility for
self-directed learning as a life long goal, to develop, implement and
monitor a personal continuing education strategy. Learning should
incorporate critical appraisal and evaluation of medical and other
relevant literature.
6.2.
The resident will maintain a questioning and inquisitive attitude
towards medical information and an appreciation of the necessity for
ongoing research to develop new knowledge.
6.3.
The resident will facilitate the education of patients, housestaff/students
and other health care professionals and contribute to development of new
knowledge.
- Professional
Pediatricians
have a unique societal role as professionals dedicated to improving the
health and well-being of children and adolescents. Pediatricians are
committed to the highest standards of excellence in clinical care and
ethical conduct, and to continually perfecting mastery of their
discipline. Pediatricians are committed to delivering highest quality
care with integrity, honesty and compassion.
7.1.
The resident will demonstrate knowledge of Medical Ethics
- basic
knowledge of the principles of medical ethics including:
"best interest" of the child, autonomy, beneficence and
non-maleficence, confidentiality, truth-telling, justice, respect
for persons, conflict of
- interest,
advanced directives and end-of-life care, and resource allocation
- knowledge
of and ability to obtain informed consent
- knowledge
of ethical decision-making process
- knowledge
of required communication skills
- knowledge
of child development and family theory that is applicable to
pediatric medical ethics
- knowledge
of the legal and ethical codes of professional behaviour and the
obligations of a physician that apply to pediatrics including:
notification of coroner, reporting of suspected child or sexual
abuse, public health issues with respect to infections
7.2.
The resident will demonstrate tolerance for ambiguity and
uncertainty and the possibility of error in ethical decision-making;
flexibility and willingness to adjust appropriately to changing
circumstances.
7.3.
The resident will demonstrate trustworthiness (honesty,
confidentiality) with respect to patients, families and colleagues.
7.4.
The resident will demonstrate recognition of personal limitations
and a willingness to call upon others with special expertise.
7.5.
The resident will demonstrate a willingness to accept peer and
supervisor reviews of professional competence.
7.6.
The resident will demonstrate an appreciation of the moral and
ethical implications of various forms of patient care and research.
Systems-Based Educational Objectives In the
Core Program in Pediatrics
These
objectives are based on the major systems and classifications of
pediatric illness. They are not subspecialty-based objectives.
Objectives are listed once in the most appropriate
category, rather than repeated under each relevant section.
Knowledge of
embryology, anatomy and pathophysiology refers to that which is relevant
to common pediatric disorders.
- ACUTE
CARE (Critical Care / Emergency Pediatrics)
1.1. KNOWLEDGE
- pathophysiology
of altered consciousness, shock, respiratory failure and
principles of mechanical ventilation
- pathophysiology
of cardiorespiratory arrest
- role
of nutrition and fluid management in the critically ill patient
- principles,
techniques and limitations of invasive and non-invasive
cardiorespiratory monitoring
- principles,
role, and logistics of interhospital transport of critically ill
infants and children
- determination
of brain death and principles of organ donation
- management
of the child with special needs / technology dependence.
1.2. SKILLS
- recognition
of the critically ill child and stabilization and / or transfer of
the critically ill child
- airway
management and cardiorespiratory resuscitation
- access
and care for indwelling catheters
- manage
a child with a tracheotomy tube including replacement of the tube.
- management
of unexpected death
The
following technical procedures, in addition to those listed in Essential
Roles 1.10.:
- foreign
body removal - eye / nose
- perform
and interpret oximetry
- assess
the traumatized eye
- c-spine
immobilization
- immobilization
of acute injury including fractures
- gastric
lavage
- eye
irrigation, and the use of dilating drops, topical fluorescein,
topical anesthetics
1.3. PROBLEMS
- cardiorespiratory
arrest
- foreign
body
- shock
- acute
vomiting
- respiratory
failure
- acute
dehydration
- status
epilepticus
- sepsis
- coma
- electrolyte
imbalance
- multiple
trauma
- burn
management
- head
injury
- near
drowning
- apparent
life-threatening events (ALTEs)
- poisonings
and drug overdoses
-
child abuse
- ADOLESCENT
HEALTH CARE
2.1. KNOWLEDGE
- normal
development: cognitive, psychological, peer relations,
parent-adolescent relations
- adolescents
and society: influencing factors, heterogeneity, sub-cultures
- health
needs and health problems
- normal
adolescent behaviour
- intervention
principles
- laws
and resources in adolescence
- normal
adolescent gynecology
2.2. SKILLS
- gynecological
and pelvic examination and specimen procurement
- breast
examination
2.3.
PROBLEMS
- eating
disorders: anorexia nervosa, bulimia
- behavioural
problems: risk taking, delinquency
- gynecological
problems and disorders of menstruation
- pregnancy
issues, contraception, sexually transmitted diseases
- alcohol,
drug, tobacco and other substance use and abuse
- sexual
abuse
- chronic
diseases and compliance to therapeutic regimen
- sexuality:
male / female issues
- ALLERGY
AND IMMUNOLOGY
3.1. KNOWLEDGE
- the
normal host defenses and immune response
- variations
in normal immune response with age
- pathophysiology
of immunodeficiency states and autoimmune disease
- basic
diagnostic laboratory techniques involving the immune system
- pathophysiology
of allergic disorders
- pharmacologic
and immunologic therapy of allergic disorders
- indications
for and limitations of skin testing, RAST testing and challenge
testing
3.2
SKILLS (included in other sections)
3.3. PROBLEMS
- recurrent
infections and immunodeficiency syndromes
- seasonal
and non-seasonal rhinitis
- anaphylactic
shock
- insect
stings
- urticaria/angioedema
- serum
sickness
- drug
allergy
- food
allergy
- CARDIOVASCULAR
SYSTEM
4.1. KNOWLEDGE
- the
anatomy, hemodynamics and electrophysiology of the normal heart
and the common congenital and acquired pediatric heart diseases
- the
fetal circulation and changes in circulation at birth
- indications
for, limitations, benefits, costs and hazards of:
- electrocardiogram
- chest
x-ray
- echocardiogram
and doppler
- diagnostic
and interventional cardiac catheterization and angiography
- radionuclide
studies
- exercise
ECG
- holter
monitor
- pre-
and post-operative needs of the pediatric heart patient, and
long-term complications
- the
incidence and recurrence risk for congenital heart disease
- appropriate
use of medications commonly used in the treatment of heart disease
4.2. SKILLS
- record
and interpret reliably an electrocardiogram in all age groups
- interpret
a chest X-ray with respect to heart size, contour and pulmonary
vascularity
4.3.
PROBLEMS
- common
forms of cyanotic and acyanotic congenital heart disease
- cardiac
murmurs
- congestive
heart failure
- syncope
- cardiac
arrhythmia
- chest
pain
- cor
pulmonale
- endocarditis,
myocarditis, and pericarditis
- Kawasaki
disease
- rheumatic
fever
- CLINICAL
PHARMACOLOGY
5.1.
KNOWLEDGE
- mechanisms
of action of drugs in relation to their ability to correct a
pathophysiologic state
- pharmacokinetics
in infants and children
- placental
transfer and breast milk excretion of drugs
- drug
interactions
- modifications
of drug dosage required in altered pathophysiologic states (renal
failure, liver failure)
- therapeutic
drug monitoring
- the
cost of commonly used drugs; choice of drugs with respect to
availability of drug plans; issues related to compliance
5.2.
SKILLS (included in other sections)
5.3.
PROBLEMS
- adverse
drug reactions
- drug
toxicity
- management
of acute and chronic pain
- drug
withdrawal
- DEVELOPMENT
AND BEHAVIOUR
6.1.
KNOWLEDGE
- normal
and abnormal development - gross motor, fine motor language,
personal-social and behavioural
- biological
and psychosocial factors affecting development and behaviour
- understanding
of and interpreting psychological and education testing
6.2.
SKILLS
- assessment
of psychomotor development
- counselling
parents on normal growth, development and behaviour with provision
of anticipatory guidance
- counselling
of parents regarding developmental and behavioural concerns with
attention to available community support and resources
6.3.
PROBLEMS
- developmental
delay and mental retardation
- pervasive
developmental disorders/autism spectrum disorders
- common
behavioural problems
- crying
infant, infantile colic, sleep disorders, nightmares and night
terrors
- learning
disabilities
- attention
deficit hyperactivity disorders
- school
avoidance
- ENDOCRINOLOGY
AND METABOLISM
7.1.
KNOWLEDGE
- the
normal anatomy, and embryology and physiology of the endocrine
glands
- normal
physical growth
- physiology
of normal and abnormal puberty
- disorders
affecting the endocrine gland, producing underactivity or
overactivity
- indications
and interpretation of endocrine tests
- pharmacology
of commonly used drugs and hormones
7.2.
SKILLS
- bedside
measurement of glucose
- orchidometry
7.3.
PROBLEMS
- growth
retardation/short stature
- hypoglycemia
- ambiguous
genitalia
- early/late
sexual development
- thyroid
disease
- pituitary
disorders
- diabetes
mellitus, diabetic ketoacidosis
- diabetes
insipidus
- inappropriate
ADH secretion
- adrenal
disease
- hypo-/hypercalcemia
- hyperlipidemias
- GASTROINTESTINAL,
HEPATIC AND BILIARY SYSTEMS
8.1.
KNOWLEDGE
- normal
and abnormal development of the gastrointestinal tract, liver and
pancreas
- physiology
and function of the gastrointestinal tract including liver,
biliary tract and pancreas, in normal and abnormal states
- pathophysiology
of liver failure
- indications
for diagnostic procedures including: endoscopy, plain abdominal
- x-rays,
upper gastrointestinal and small bowel x-rays, contrast enema,
abdominal ultrasound and CT scan, radionuclide scan
- indications
for and interpretation of liver function tests
8.2. SKILLS
- interpretation
of abdominal X-rays
8.3.
PROBLEMS
- vomiting
and regurgitation
- abdominal
pain (acute/chronic)
- diarrhea
(acute/chronic)
- inflammatory
bowel disease
- malabsorption
- constipation
/ encopresis
- intestinal
bleeding
- jaundice
- enlargement
of liver
- liver
dysfunction/failure
- abdominal
masses
- dysphagia
- GENETICS
AND TERATOLOGY
9.1.
KNOWLEDGE
- modes
and molecular basis of inheritance
- application
of cytogenetics
- indications
and limitations of prenatal diagnosis
- indications
and limitations of screening programs for genetic disease
- principles
of assessment of dysmorphology and syndrome identification
- application
of molecular diagnosis
- common
presentations of inborn errors of metabolism
- embryological
basis of malformation
- environmental
factors in fetal development
9.2.
SKILLS
- construction
and interpretation of a pedigree
- ability
to provide genetic counselling to a family / individual with a
known genetic or inherited disorder, or referral to appropriate
source
9.3.
PROBLEMS
- the
dysmorphic child
- exposure
to a possible teratogen
- approaches
to and initial investigations of suspected inherited metabolic
diseases
- common
genetic syndromes (e.g. Down syndrome, Turner syndrome, Fragile-X)
- RENAL
and GENITOURINARY SYSTEM
10.1.
KNOWLEDGE
- normal
and abnormal development of the genitourinary tract including the
external genitalia
- clinical
presentation of acute and chronic glomerular diseases and tubular
disorders
- indications
for, advantages and risks of investigative techniques: IVP,
voiding cystourethrograms, renal scan, renal ultrasound,
urodynamics, renal angiography, renin studies and renal biopsy
- pathophysiology
of renal failure
- indications
and complications of dialysis and renal transplantation
- renal
transplantation
- fluid
and electrolyte requirements in normal and abnormal states
- normal
mechanisms of acid-base balance
- indications
for and interpretations of renal function tests
10.2.
SKILLS
- interpret
common abnormalities seen on urine microscopy
10.3.
PROBLEMS
-
enuresis
-
incontinence
-
disorders
of the male and female external genitalia
-
pathophysiology
of alterations in morphology or quantity of formed elements in the
blood
-
principles
underlying transfusion and hypertransfusion of blood and blood
products
-
pathophysiology
of neoplasms including the acute leukemias
-
characteristics
and principles of investigation of the acute leukemias and common
tumours of childhood
-
social,
familial and personal effects of childhood cancer
-
techniques
for safe administration of chemotherapy
-
common
side effects of chemotherapy and radiotherapy and their management
-
management
of the immunocompromised oncology patient
-
late
effects of cancer therapy
-
principles
of palliative care
-
indications
for and interpretation of common hematological tests
11.2.
SKILLS
- counselling
families faced with life-threatening illness/chronic childhood
illness
11.3.
PROBLEMS
- pallor
/ anemia
- bleeding
- purpura
and petechiae
- lymphadenopathy
- cytopenia
- hepatosplenomegaly
- indications
and complications of splenectomy
- acute
complications of hemoglobinopathies and red cell disorders
- INFECTIOUS
DISEASES
12.1.
KNOWLEDGE
- characteristics,
epidemiology and pathogenicity of common infectious agents and
conditions
- mechanisms
of infection and host defense
- pharmacology
of anti-microbial agents and interpretation of sensitivity tests
for antibiotics
- antimicrobial
resistance
- control
of communicable diseases, including: prevention and immunization
- prevention
of congenital and perinatal infections
- nosocomial
infections and infection control
12.2.
SKILLS
- tuberculin
skin testing - perform and interpret
- procurement
of appropriate specimens for diagnosis of infections
12.3.
PROBLEMS
- common
infectious diseases (viral bacterial, fungal, parasitic, protozoan
infections)
- infection
in the immunocompromised host
- fever
without focus
- fever
of unknown origin
- perinatal
/ congenital infections
- HIV
Infection
- occult
bacteremia
- life-threatening
infection
- infectious
issues relating to travel and immigration
- NEONATAL
/ PERINATAL MEDICINE
13.1.
KNOWLEDGE
- fetal
growth, development and physiology including the role of the
placenta
- aspects
of pregnancy, labour and delivery which affect the neonate
- effect
of maternal systemic disease on the fetus and newborn
- demographic,
medical and psychosocial factors which influence perinatal
mortality and morbidity (the high-risk pregnancy)
- process
of neonatal adaptation to extrauterine life
- neonatal
growth, nutrition, metabolic problems, feeding problems
- aspects
of drug therapy unique to the newborn
- general
principles of care of the newborn: skin, warmth, feeding
- problems
encountered in the follow-up of the high-risk neonate
- newborn
screening
13.2.
SKILLS
- neonatal
resuscitation and stabilization of critically ill newborn
- initial
assessment of the newborn, including APGAR score and gestational
age
- recognition
of the seriously ill newborn
- management
of conventional mechanical ventilation and its complications
13.3.
PROBLEMS
- respiratory
distress
- prematurity
- cyanosis
- bronchopulmonary
dysplasia
- jaundice
- retinopathy
of prematurity
- intrauterine
growth retardation
- seizures
- asphyxia
- floppy
infant
- sepsis
- feeding
difficulties / vomiting
- metabolic
abnormalities including: hypoglycemia, hypo / hypercalcemia
- intraventricular
hemorrhage
- surgical
problems of the newborn
- anemia,
hypovolemia, polycythemia
- bleeding
- apnea
- drug
withdrawal
- congenital
anomalies
- NEUROMUSCULAR
SYSTEM
14.1.
KNOWLEDGE
- basic
embryology, neuroanatomy and neurophysiology of the central
nervous system, congenital malformations and common pediatric
neurologic problems
- indications
for, appropriate use of, and risks/complications of the following
investigations:
- Lumbar
puncture
- EEG
- Evoked
potentials
- nerve
conduction studies and electromyography
- skull
and spine x-rays
- ultrasound
scan of the head and spine
- CT
scan
- MRI
- Radionuclide
scan of the head and spine
- interpretation
of CSF anaylsis
- pharmacology
of drugs used in neurologic and neuromuscular problems
14.2
SKILLS (included in other sections)
14.3.
PROBLEMS
- congenital
malformations of the nervous system including the skull
- neurocutaneous
syndromes
- developmental
regression
- cerebral
palsy
- seizures
and sudden loss of consciousness
- breath-holding
spells
- headaches
- raised
intracranial pressure
- head
trauma and sequelae
- cerebrovascular
diseases including intracranial hemorrhage and strokes
- weakness
and paralysis
- parasthesias
- disorders
of peripheral nerves
- tics
- nystagmus,
dizziness and vertigo
- ataxia
- NUTRITION
15.1.
KNOWLEDGE
- recommended
nutritional requirements during infancy, childhood and adolescence
- effect
of disease states on nutritional requirements
- infant
feeding
- health
implications of restricted diets, fad diets, diets determined by
custom or socioeconomic situation
- indications
for, physiological basis of and complications of parenteral and
enteral nutrition
15.2.
SKILLS
- prescribe
and manage parenteral and enteral nutrition
15.3.
PROBLEMS
- failure
to thrive
- feeding
disorders
- obesity
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