5th Years PED

5th Years PED


Welcome to your paediatric placement here in Walsall. Over the next five weeks, we aim to help you gain the necessary knowledge & skills to enable you to competently take a history from the parent(s) and/or child, to perform a competent clinical examination on a child, to understand common conditions of childhood as well as less common but important ones and to understand growth and development and how they can be affected by illness.

All doctors will encounter children and families in their work and it is essential that newly qualified doctors can competently interact with, assess and care for children and young people. Working closely with the Birmingham medical School we will strive to help train the very best doctors who are safe, competent, good communicators and well placed to meet the demands of a changing National Health Service.

As your Senior Academy Tutor, I will be meeting you on a regular basis over the next five weeks and my colleagues and I look forward to teaching you

 BJ

Dr B. Muhammed
Consultant Paediatrician
Senior Academy Tutor 

 

Overview of Paediatrics Department

Key Staff

Overview of Placement

Resuscitation Council UK PILS Course

Paediatric Simulated Teaching Sessions

Lecture and Web Based Teaching Programme

History Taking in Children

Clinical Examination in Children

Raising Concerns about Patient Safety 

 

Key Staff

  BJ            Blank          Phil_Jevon                   Blank
        Dr Muhammed                   Professor Gatrad                     Phil Jevon                                 Emma Hughes   
 Consultant Paediatrician                                                 Multi Professional Medical        RSCN Academy Tutor/Advanced     Senior Academy Tutor                                                 Education Skills Manager        Clinical Practitioner (Paediatrics)                                       

 

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Overview of Placement

Academic in-days (AIDs)

  • Week 1: Monday - Birmingham Children’s Hospital: paediatric basic life support
  • Week 2: Monday - Birmingham Children’s Hospital: Paediatric Examination Skills (how to examine the cardiovascular system, how to assess infant neurology & how to assess the respiratory system
  • Week 3: Monday - Birmingham Children’s Hospital

NB if the AID is due to fall on a Bank Holiday Monday – will move to Tuesday

Themed weeks

  • Week 1: Normal Children and Young People Growth and Development
  • (incorporating Neonatology)
  • Week 2: Acutely ill children and young people (incorporating Nutrition)
  • Week 3: Children and young people with Chronic Illness (1)
  • Week 4: Children and young people with Special Needs
  • (incorporating Genetics)
  • Week 5: Children and young people with Chronic Illness (2)

Course textbook

The course textbook is Lissauer T Clayden G (2011) Illustrated Textbook of Paediatrics 4th Edition, Elsevier, London. There are sufficient copies in our Library for one each. Please don’t forget to return the textbook at the end of the placement 

 

        Book

 

Paediatric Basic Life Support

Competency in Paediatric Basic Life Support is a requirement of this placement. This will be assessed in the Academic In-day programme at Birmingham Children’s Hospital. You are expected to be familiar with the Resuscitation Council (UK) Guidelines 2015 Paediatric Basic Life Support  

https://www.resus.org.uk/resuscitation-guidelines/paediatric-basic-life-support/

Problem Based Learning (PBL) case scenarios

  • We have scheduled a weekly seminar during your placement for the problem based learning case scenarios 
  • We expect you to consider the clinical problems in advance to include basic science(s) of underlying disease, management of disease, population perspective, psychological and sociological aspects, communications for clinical practice & future developments
  • You will need to be able to justify the use of any investigations, the results of which you can negotiate from the tutor in the seminar.

The timetable for themes is as follows:

  • Week 1 Theme: Growth & development
  • Week 2 Theme Acutely ill children & young people
  • Week 3 Theme Children & young people with chronic disease
  • Week 4 Theme: Children & young people with special needs
  • Week 5 Theme: Children & young people with chronic disease

Consultant Assessment of Professional Behaviour & Attitudes (PBA)

  • To be undertaken by your SAT towards the end of your clinical attachment.
  • Please obtain a carbonated form Medical Education in MLCC & arrange for your SAT to complete it and discuss its contents with you
  • Top copy: return to Medical Education  
  • Bottom copy: keep for your files.

Talking to/examining children on the wards

  • On arrival on the ward, please introduce yourself to the nurse in charge.
  • Before going to see any patients, identify suitable patients to examine with the nurse in charge
  • Introduce yourself to the child’s named nurse carer and ask her/him to introduce you to the parent(s).
  • Prior to talking to a child: obtain the parent(s) consent (if parent(s) are not available, ask the named nurse carer)
  • Prior to undertaking a physical examination: obtain the parent(s) consent & check with the nursing staff as to whether a chaperone is required.

Teaching/learning opportunities at Walsall  

  • Paediatric assessment unit (PAU) & paediatric ward: ward rounds, history taking, clinical examinations etc
  • Ward rounds
  • Emergency Department: opportunities to go with paediatric on-call team to review children 
  • Paediatric Grand Round – on Friday mornings in MLCC
  • Resuscitation Council (UK) PILS course
  • Paediatrics themed simulated teaching sessions
  • On-call experience

 

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Resuscitation Council UK PILS Course

During your second week on placement, we will be running the Resuscitation Council (UK) Paediatric Immediate Life Support (PILS) course for you. This course is designed for healthcare professionals e.g., yourselves, who may have to act as first responders and treat seriously ill children or children in cardiac arrest until the arrival of the paediatric cardiac arrest team

The course will teach you the knowledge and skills to:

  • Understand the structured ABCDE approach that facilitates rapid recognition of seriously ill children;
  • Provide appropriate initial treatment interventions to prevent cardiorespiratory arrest;
  • Treat children in respiratory or cardiorespiratory arrest until the arrival of a resuscitation team or more experienced assistance;
  • Promote active  membership of a paediatric resuscitation team.

Assessment is continuous and is guided by the assessment forms provided for each core skill.  

You will receive the PILS Course manual on your induction, together with the PILS course assessment sheets. On successful completion, you will receive a nationally recognised Resuscitation Council UK PILS certificate which is valid for one year.

 

                  Manual_PILS_2010

 

 

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Paediatric Simulated Teaching Sessions

We run paediatric themed simulated teaching sessions (STSs) towards the end of your placement:

  • Clinical examination
  • Child development
  • ABCDE assessment of the acutely ill child
  • Safeguarding children
  • Data interpretation  
  • Clinical procedures

These sessions will provide you with feedback on how well you are doing and any areas of improvement that may be required.

 

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Lecture and Web Based Teaching Programme

  • Child Protection Definitions, incidence, causation, physical signs, bruising, burns, fractures, sexual abuse, what to do
  • Acutely Ill Children Recognition of acutely ill children
  • Infection Immunisation, fever, exanthema, meningococcal disease, Kawasaki meningitis, tropical infections, HIV
  • Adolescence Adolescent development, confidentiality, transition to adult services, adolescent health care
  • Nutrition Nutritional requirements, breast feeding, bottle feeding, content of formula milks, weaning, baby foods, vitamin supplementation, nutrient deficiency and excess
  • Disability Disclosure, cerebral palsy management, abnormal gait, multi-disciplinary care, CDC, autistic spectrum disorder
  • Surgery Common surgical conditions in childhood, presentation & management
  • Gastroenterology Recurrent abdominal pain, constipation, acute and chronic diarrhoea, GI bleeding, inflammatory bowel disease, celiac disease, reflux, jaundice
  • Cardiology Fetal circulation, presentation of common congenital heart lesions, cyanotic conditions, cardiac failure, arrhythmias
  • Respiratory Asthma guidelines, cystic fibrosis, bronchiolitis, pneumonia
  • Rheumatology Musculoskeletal symptoms, differential diagnosis of inflammatory, septic, mechanical disorders, joints in systemic disease, hip pain, growing pains
  • ENT Deafness, causes, detection and management, otitis media, stridor, cervical lymphadenopathy
  • Neurology Seizures and movement disorders, causes & investigation of developmental delay, dysmorphic syndromes
  • Dermatology Eczema, acne, psoriasis, skin infections, reactive erythemas, genordermatoses, autoimmune conditions
  • Oncology Epidemiology, presentation and management of common childhood cancers
  • Diabetes Type I and II diabetes
  • Haematology Iron deficiency, leukaemia, bleeding disorders
  • Nephrology Urinary tract infection, vesico-ureteric reflux, proteinuria, haematuria, renal failure

 

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History Taking in Children

Presenting complaint: relate to child/young person and families’ presenting concerns

General enquiry: appetite, general health, behaviour/personality changes, sleeping, rashes, cough/ SOB/ wheeze, bowel frequency and consistency, D&V, dysuria, frequency, headaches, seizures

Pregnancy and obstetric history

Neonatal history: birth weight, gestation, delivery, neonatal problems

Medical history: regular GP attendances, admissions, operations, outpatients, accidents, trauma

Immunisations

Developmental history: vision, hearing & language, understanding, gross motor, fine motor, social; if adolescent, consider pubertal status including menarche in girls

School & nursery: bullying, academic progress, days missed at school

Medication: drug allergies, allergens

Family History: family tree, FH of similar problems, consanguinity

Social History: occupations, housing, relationships, friends, smoking; is the child/young person happy at home?; recent overseas travel

For adolescents, consider HEADSSS psychosocial screening tool:

H – Home

E – Education, Exercise

A – Activities

D – Drugs

S – Sleep

S – Safety

S – Suicide

 

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Clinical Examination in Children

Cardio-Vascular System

  • As with adult examination
  • JVP unhelpful in younger children
  • Cardiac border percussion unhelpful
  • Hepatomegaly important sign of cardiac failure in infants
  • Must feel femoral pulses

Respiratory System

  • As with adult examination
  • Observation more important than percussion or auscultation
  • Respiratory rate is age dependent
  • Tracheal examination usually not done – disliked by children
  • Percussion seldom useful <5y

Abdominal System

  • As for adult examination
  • Rectal examination not liked and not routine
  • Genital examination routine under 1y
  • Liver edge and spleen tip may be palpable in babies

Neurological System

  • Different techniques required for different age groups

Musculo-skeletal system

  • Quick screening examination essential in every child/young person (see pGALS

Ear, Nose & Throat

  • Essential in most young children

Skin

  • Are the skin, hair and nails grossly normal
  • Look for eczema in the flexures
  • Any unusual birthmarks
  • Bruises, burns etc 

 

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Raising Concerns about Patient Safety 

        Promoting_excellence
Click on the cover above to read more about Promoting Excellence

We take patient safety very seriously. In line with the GMC’s Promoting excellence: standards for medical education & training (GMC, 2015), we strive to create a culture of promoting patient safety. We will endeavour to ensure that your education & training takes place where patients are safe, the care & experience of patients is good & education and training is valued.  

We strive to demonstrate a culture that allows learners & educators to raise concerns about patient safety, and the standard of care or of education and training, openly and safely without fear of adverse consequences. Should you have any concerns while on placement here in Walsall please speak to an appropriate member of Trust Staff as soon as possible.  

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