Objectives of Training Manual for Paediatric Emergency Medicine

Program Overview

Welcome to the Paediatric Emergency Medicine Fellowship Training Program

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Goal

To prepare trainees for a career in paediatric emergency medicine.

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Duration

3 years including compulsory and elective rotations with overseas training.

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Requirement

Paediatrician and/or Emergency Physician with minimum 2 years' working experience after gazettement.

Program Objectives

2.1 To train and develop physicians to obtain exceptional clinical skills in managing paediatric patients in emergency setting.
2.2 To strengthen evidence-based medical practice in patient care.
2.3 To develop this field through research and teaching.
2.4 To ensure competency and professionalism in administration.

Overall Learning Outcomes

All trainees are expected to meet these outcomes throughout their training period:

5.1.1 Able to recognize, assess and manage the full range of paediatric emergency conditions.

5.1.2 Undertakes the role of paediatric emergency team leader and assumes responsibility for this domain of service.

5.1.3 Executes high-level clinical and technical skills and procedures in the paediatric emergency setting.

5.1.4 Liaises effectively with pre-hospital, hospital and other specialist counterparts.

5.1.5 Coordinates and manages patient flow, staffing, safety and quality in paediatric emergency department.

5.1.6 Able to make pragmatic and rapid decisions across a broad range of paediatric emergencies.

Program Leadership

Program Coordinator

Dr Suhaimi Mahmud

Head of Subspecialty Program

Deputy Coordinator

Dr Abd Kursi bin Abdul Latif

Document Compiled by:

Dr Kiran Nesarajah

First Year & Second Year Rotations

Core rotations to build foundational knowledge and skills

4 Months

General Paediatrics

3 Months

NICU

1 Month

Prehospital/Retrieval

1 Month

Paediatric Trauma

2 Months

Paediatric Anaesthesia

1 Month

Paediatric Surgery

1 Month

Paediatric Orthopaedics

4 Months

PICU

1 Month

Electives

6 Months
PEM Core

Neonatal Intensive Care

3 Months

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Recognized Training Centres

Hospital Tunku Azizah, Kuala Lumpur
Hospital Tuanku Ja'afar, Seremban
Hospital Raja Permaisuri Bainun, Ipoh

Foundations of Neonatal Care

Knowledge

Learn to assess, diagnose, and manage common presentations of illnesses affecting the neonate population
Learn the importance of nutrition and support of the infant
Learn of the outcome of premature/ill neonatal patients and possible impact on their health throughout childhood

Skills

Stabilization of acutely ill premature neonates
Perform procedures including umbilical arterial catheterization, umbilical vein catheterization, and endotracheal intubation
Acquire skills in managing ventilation of neonate patients

Paediatric Anaesthesia

2 Months

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Recognized Training Centre

Hospital Tunku Azizah, Kuala Lumpur

Principles of Paediatric Airway and Ventilation Management

Knowledge

Augment knowledge in the intubation of the paediatric airway
Be introduced to management of the non-intubated paralyzed paediatric patient
Augment knowledge of neuromuscular blockade, including reversal in children
Augment knowledge of temperature homeostasis in cold environment
Learn documentation of anaesthesiology intraoperative medical record
Learn pre-operative and post-operative evaluation of paediatric patient undergoing anaesthesia

Skills

Augment skill in the intubation of the paediatric airway
Administer neuromuscular blockade to paediatric patient
Perform documentation of anaesthesiology intraoperative medical record

Paediatric Surgery

1 Month

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Recognized Training Centre

Hospital Tunku Azizah, Kuala Lumpur

Principle of Paediatric Surgical Care

Knowledge

Learn common surgical problems
Learn appropriate use of radiological imaging in evaluation of surgical problems
Learn to consult surgical appropriately and timely in the ED

Skills

Assess and manage common acute surgical problems
Appreciate the practice style of surgical colleagues

Paediatric Orthopaedics

1 Month

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Recognized Training Centre

Hospital Tunku Azizah, Kuala Lumpur

Principle of Paediatric Orthopaedic Care

Knowledge

Learn common acute orthopaedic problems
Learn appropriate use of radiographic imaging in evaluation of orthopaedic problems
Learn to interpret orthopaedic radiographs
Learn to consult orthopaedic appropriately and timely in the ED

Skills

Assess and manage common acute orthopaedic problems
Appreciate the practice style of orthopaedic colleagues

Paediatric Intensive Care

4 Months

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Recognized Training Centres

Hospital Tunku Azizah, Kuala Lumpur
Hospital Umum Sarawak, Kuching
Hospital Pulau Pinang, Pulau Pinang

Foundation of Paediatric Acute Critical Care

Knowledge

Augment knowledge in airway management
Augment management of critically ill patients in Paediatric Intensive Care
Augment knowledge of advanced resuscitation and advanced procedural skills

Skills

Augment skill in airway management
Gain experience in managing critically ill patients in PICU
Augment advanced resuscitation and procedural skills
Participating in clinical rounds
Take up supervisory role as clinical fellow under Paediatric Intensivist supervision

Rotation Electives

1 Month

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Recognized Training Centres

Any recognized training centre subject to prior approval by program coordinator which would be able to facilitate the following attachments:

Paediatric Intensive Care (PICU)
Paediatric Retrieval
Paediatric Subspeciality (Medical or Surgical based)

Learning Objectives

Gain experience in aspects of PEM not offered in the regular curriculum
Study particular areas of PEM in greater depth
Explore areas of interest
To facilitate minimum requirements for overseas attachment

Paediatric Emergency Medicine Core Training

6 Months of focused PEM training - The core of your fellowship

What is Paediatric Emergency Medicine?

Paediatric Emergency Medicine is a branch of medicine concerned with providing highly specialised acute health care to children of all ages and developmental levels, which includes triage, stabilisation, diagnosis, treatment, and appropriate follow-up care.

PEM sub-specialists provide patient and family centred care in a compassionate fashion and with respect for the individual and the family. They are committed to the advancement of the field through education at the undergraduate and postgraduate level, and through continuing education to physicians and other health care professionals.

PEM Training Schedule

Hospital Tuanku Ja'afar, Seremban 1 Month (Year 1)

Hospital Tunku Azizah, Kuala Lumpur 3 Months (Year 2)

Hospital Tuanku Ja'afar, Seremban 2 Months (Year 2)

PEM Physician Competencies

The seven roles that define an excellent PEM Physician

Medical Expert

Communicator

Collaborator

Manager

Health Advocate

Scholar

Professional

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Medical Expert

Central physician role in the PEM framework

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As Medical Experts, PEM Physicians integrate all PEM Physician Roles, applying medical knowledge, clinical skills, and professional values in their provision of patient-centred care.

Key Competencies:

Function effectively as consultants providing optimal, ethical, patient-centred care
Establish and maintain clinical knowledge, skills, and behaviours
Perform complete and appropriate patient assessments
Use preventive and therapeutic interventions effectively
Demonstrate proficient use of diagnostic and therapeutic procedural skills
Seek appropriate consultation recognizing limits of expertise

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Communicator

Facilitating dynamic doctor-patient exchanges

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As Communicators, PEM Physicians facilitate the doctor-patient relationship and dynamic exchanges before, during, and after the medical encounter.

Key Competencies:

Develop rapport, trust, and ethical therapeutic relationships with patients and families
Respect patient privacy, confidentiality, and autonomy in high-risk environment
Accurately elicit and synthesize relevant information
Convey relevant information and explanations accurately
Develop common understanding with patients, families, and professionals
Convey oral, written, and electronic information effectively
Communicate effectively as team leader during resuscitation

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Collaborator

Working effectively within health care teams

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As Collaborators, PEM Physicians effectively work within a health care team to achieve optimal patient care.

Key Competencies:

Participate effectively in interprofessional health care team
Recognize and respect diverse roles of other professionals
Function effectively in the unique ED environment
Demonstrate leadership of health care team as appropriate
Work to prevent, negotiate, and resolve interprofessional conflict

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Manager

Contributing to health care organization effectiveness

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As Managers, PEM Physicians are integral participants in health care organizations, organizing sustainable practices, making decisions about resource allocation, and contributing to system effectiveness.

Key Competencies:

Participate in activities contributing to organizational effectiveness
Describe structure and function of health care system
Describe principles of health care financing and budgeting
Manage practice and career effectively
Allocate finite health care resources appropriately
Serve in administration and leadership roles

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Health Advocate

Advancing health and well-being responsibly

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As Health Advocates, PEM Physicians use their expertise and influence responsibly to advance the health and well-being of individual patients, communities, and populations.

Key Competencies:

Respond to individual patient health needs as part of care
Identify opportunities for advocacy, health promotion, and disease prevention
Respond to health needs of communities served
Identify determinants of health for populations served
Promote health of individual patients, communities, and populations

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Scholar

Lifelong learning and knowledge creation

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As Scholars, PEM Physicians demonstrate a lifelong commitment to reflective learning and the creation, dissemination, application, and translation of medical knowledge.

Key Competencies:

Maintain and enhance professional activities through ongoing learning
Critically evaluate medical information and apply to practice
Integrate critical appraisal conclusions into clinical care
Facilitate learning of patients, families, students, and others
Contribute to development and dissemination of new knowledge
Complete scholarly project related to PEM

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Professional

Ethical practice and high personal standards

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As Professionals, PEM Physicians are committed to the health and well-being of individuals and society through ethical practice, profession-led regulation, and high personal standards of behaviour.

Key Competencies:

Demonstrate commitment through ethical practice
Demonstrate consultant level knowledge of legal issues in care of children
Demonstrate commitment to delivering highest quality care
Recognize and respond appropriately to ethical issues
Maintain appropriate boundaries with patients
Demonstrate commitment to physician health and sustainable practice

Third Year - Overseas Attachment

1 year of international training experience

Duration

1 Year

Training Centres

Any overseas recognized training centre subject to prior approval by program coordinator and Bahagian Pengurusan Latihan, Kementerian Kesihatan Malaysia

Approved KKM Overseas Training Nations

Asia Pacific

Australia
New Zealand
Singapura
Hong Kong
Jepun
Korea Selatan
Taiwan
Thailand
Filipina
Indonesia
Brunei
China
India
Bangladesh
Pakistan
Sri Lanka

Europe

United Kingdom
Ireland
German
Perancis
Sepanyol
Itali
Belgium
Netherlands
Austria
Switzerland
Denmark
Norway
Sweden
Finland
Republik Of Czech
Rusia dan Ukraine

Americas

Amerika Syarikat
Canada

Middle East & Africa

Turki
Jordan
Iraq
Syria
Republik Of Yeman
Mesir
Libya
Maghribi
Sudan
Afrika Selatan

Learning Objectives

Gain experience in aspects of PEM not offered in the Malaysian setting
To be able to function as competent PEM Physician upon return to Malaysia
Explore areas of interest in overseas training centre
To complete objectives and targets assigned by overseas training institution

Continuous Evaluation & Assessments

How your progress will be monitored throughout the program

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Supervisor Assignment

Each trainee will be allocated a supervisor to discuss personal and curriculum learning objectives.

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Initial Meeting

Should occur within the first few days of starting the sub-specialty training post.

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Personal Logbook

Each trainee should maintain a personal logbook documenting clinical experience in each rotation.

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Rotation Feedback

Trainees are required to obtain feedback from rotation supervisor with regards to achieved outcomes.

Assessment Timeline

Year 1

End of Year Assessment

Trainees are required to pass assessment

Year 2

End of Year Assessment

Trainees are required to pass assessment

Year 3

End of Year Assessment

Trainees are required to pass assessment

Exit Viva

Final Assessment

Conducted by head of program and supervisor once trainee has completed all rotations

Key Points

The supervisor will closely monitor trainee performance and give feedback to the Program Coordinator if expected performance is not met
Any documentation of assessment during rotation should be included with the formal feedback form
Trainees are required to pass all three end-of-year assessments
Exit viva is conducted at the end of the final rotation

Program Overview

Goal

Duration

Requirement

Program Objectives

Overall Learning Outcomes

Program Leadership

First Year & Second Year Rotations

General Paediatrics

Recognized Training Centres

Fundamentals of Paediatric Care

Knowledge

Skills

Child Life

Knowledge

Skills

Neonatal Intensive Care

Recognized Training Centres

Foundations of Neonatal Care

Knowledge

Skills

Prehospital Care / Retrieval

Recognized Training Centres

Introduction

Out of Hospital Paediatric Care & Safe Transport

Knowledge

Skills

Paediatric Trauma

Recognized Training Centre

Paediatric Trauma Care

Knowledge

Skills

Paediatric Anaesthesia

Recognized Training Centre

Principles of Paediatric Airway and Ventilation Management

Knowledge

Skills

Paediatric Surgery

Recognized Training Centre

Principle of Paediatric Surgical Care

Knowledge

Skills

Paediatric Orthopaedics

Recognized Training Centre

Principle of Paediatric Orthopaedic Care

Knowledge

Skills

Paediatric Intensive Care

Recognized Training Centres

Foundation of Paediatric Acute Critical Care

Knowledge

Skills

Rotation Electives

Recognized Training Centres

Learning Objectives

Paediatric Emergency Medicine Core Training

What is Paediatric Emergency Medicine?

PEM Training Schedule

Clinical Knowledge Areas

2.1 Resuscitation

Recognize and Manage:

Demonstrate Consultant Level Knowledge of:

2.2 Trauma

Recognize and Manage:

2.3 Allergy

Demonstrate Consultant Level Knowledge of:

2.3 Cardiology

Recognize and Manage:

Demonstrate Consultant Level Knowledge of:

2.4 Dental and Oral Emergencies

Recognize and Manage:

2.5 Dermatology

Recognize and Manage:

2.6 Diagnostic Imaging

Demonstrate Consultant Level Knowledge (indications, limitations, interpretation):

2.7 Endocrinology

Demonstrate Consultant Level Knowledge of:

2.8 Environmental Exposures

Demonstrate Consultant Level Knowledge of:

2.9 Gastroenterology