Master of Philosophy in Paediatric Gastroenterology

Purpose

The purpose of this qualification is to equip the learner with the necessary skills and knowledge to manage all aspects of clinical paediatric gastroenterology. At the end of the coursework component, the learner will be able to diagnose and evaluate patients with gastroenterological diseases, liver diseases and disorders of nutrition and will be able to manage and investigate patients appropriately and to determine a therapeutic strategy.

In addition to managing children with complex paediatric gastroenterology conditions, the graduate would be expected to be able to:

• Undertake research in paediatric gastroenterology.
• Develop and manage treatment protocols.
• Plan and manage gastroenterology services.
• Educate nursing and medical staff.
• Undertake and interpret procedures and investigations relevant to paediatric gastroenterology.

Rationale

Diseases of the gastrointestinal tract and liver and disorders of nutrition are important causes of morbidity and mortality in infancy and childhood, particularly in developing countries such as South Africa. Optimal management of these conditions requires specialised knowledge of the specific disease processes and treatment options available, as well as diagnostic and interventional skills. Paediatricians trained in the discipline of gastroenterology, hepatology and nutrition can make an important contribution to specialised care of these children.

Due to the growing knowledge in the field and specialised management options, it is important to define the sub-specialty in a way that will be appropriate to the relevant setting whilst remaining equivalent in status to other established subspecialty programmes. The discipline encompasses all aspects of congenital and acquired diseases of the intestine, liver and pancreas, incorporating an emphasis on nutritional requirements, diseases and nutritional support of infants and children. The care of children with gastrointestinal and liver disease differs from that of adults. From birth through infancy and adolescence into adulthood, dramatic physiological and anatomical changes occur. These involve every aspect of intestinal, liver and pancreatic function as well as changing nutritional requirements to ensure adequate growth and development. As a result, children not only present with a different spectrum of disease, but respond differently to illness and treatment.

Training in South Africa also needs to take into account the specific disease profile seen here, as well as the limitations of the health service in a developing economy. The spectrum of diseases is that of both economically developed and developing countries. Diseases common to developed countries such as inflammatory bowel disease, coeliac disease, cystic fibrosis and biliary atresia are frequently encountered. In addition there is an enormous burden of disease related to infectious diseases, including HIV and TB and malnutrition related to poverty.

There is an obligation not only to manage these challenges optimally but also to provide leadership in the research of these diseases.

Learners undertaking studies for this qualification must

• Comply with the requirements for Registration as a Medical Practitioner as prescribed by the Medical, Dental and Supplementary Health Services Act.
• Be registered as a specialist Paediatrician in terms of the Act.
• Be appointed against a HPCSA-approved training number.

Recognition of Prior Learning

Admission this Master's Degree could be granted to learners not in possession of the specified Degree that meets the admission requirements at the discretion of the Institution and in accordance with the relevant legislation.

Access to the Qualification

Prior to commencing with education and training in the relevant sub-speciality, learners must be able to provide proof of:

• Compliance with all the requirements for registration as a specialist in one of the primary specialities listed against the relevant sub-speciality.
• Registration as a specialist in that field.
• Appointment as a learner by the HPCSA.

Qualification Rules

This qualification comprises two compulsory parts, viz., Paediatric Gastroenterology theory and prescribed practical procedures - 120 Credits and a dissertation not exceeding 20 000 words - 60 Credits. All the Credits are at NQF Level 9. Total required credits for the qualification: 180.

Modules

• Anatomy of the gastrointestinal tract, liver and pancreas.
• Histology of the gastrointestinal tract, liver and pancreas.
• Molecular Biology of the gastrointestinal tract, liver and pancreas.
• Embryology of the gastrointestinal tract, liver and pancreas.
• Physiology and Pathophysiology of the gastrointestinal tract, liver and pancreas.

Dissertation

The research topic/problem is selected in consultation with the supervisor.

The work involves

• The preparation of a research proposal.
• A literature review.
• Data collection.
• Analysis of finding/s.
• Drawing of conclusions.
• Recommendations.
• The preparation of the dissertation of not more than 20 000 words in length.

Exit Level Outcomes

1. Demonstrate skills in taking a medical history, performing a physical examination, formulating a differential diagnosis and developing an appropriate diagnostic and management plan.
2. Demonstrate a comprehensive and systematic knowledge base of the epidemiology of the principal diseases in paediatric gastroenterology and hepatology with emphasis on the differences between developed and developing countries and the specific circumstances pertaining to South Africa.
3. Demonstrate a coherent and critical understanding of the theory, research methodologies and techniques relevant to the physiology, pathophysiology, pathology, diagnosis and treatment of important nutritional, intestinal and liver diseases in infancy, childhood and adolescence.
4. Carry out a research project in paediatric gastroenterology, produce the required dissertation within the allocated timeframe and submit a paper on the subject that meets the standards for publication in a peer review journal.

Critical Cross-Field Outcomes

All the Critical Cross-Field Outcomes are addressed in the qualification.

Associated Assessment Criteria for Exit Level Outcome

• Awareness of the bioethics involved in the clinical management of patients is clearly demonstrated.
• Ethics and a professional approach are clearly demonstrated at all times, whether dealing directly with patients and/or their significant others or in the pursuit of research and the production of an original dissertation.
• Acquisition of competence in the performance of specific diagnostic and therapeutic procedures, the interpretation of findings with the related complications, indications and contraindications is clearly demonstrated.

Range of diagnostic and therapeutic procedures

> Upper GI endoscopy (performance of at least 100).

> Colonoscopy (performance of at least 50).

> Endoscopic procedures (polypectomy, removal of foreign bodies, sclerotherapy).

> Oesophageal, gastric and small intestinal biopsy.

> Rectal biopsy.

> Liver biopsy (performance of at least 20).

> Performing and interpretation of oesophageal pH-metry and manometry.

> Performing and interpretation of anorectal manometry.

> Endoscopic retrograde cholangiopancreatography.

> Transit studies.

> Pancreatic function testing (screening tests, faecal elastase and intubation tests).

> Radio-nucleotide scans.

> Barium studies.

- Knowledge of and skills in managing nutrition in children are clearly demonstrated through the following

> Assessment of nutritional status of all patients examined.

> Dietary requirements of children.

> Pathophysiology of malnutrition.

> Theory, techniques and practical application of enteral and parenteral nutrition support.

> Working in nutritional support teams by cooperating with other specialists and multidisciplinary health care professionals, such as psychologists, dieticians, speech therapists, surgeons, pathologists and laboratory scientists.

- Managerial, academic and clinical skills are clearly demonstrated in the

> Conducting of a clinical audit.

> Organising and delivering formal and informal under- and postgraduate teaching programmes.

> Application of knowledge and understanding of the health priorities of South Africa in teaching programmes and clinical situations.

- Research skills are clearly demonstrated in the following

> Critical evaluation of clinical results from audits, papers and literature reviews.

> Application of the principles of clinical study design and protocol development.

> Application of the data collection process (including collation, database development).

> Data analysis and interpretation including medical statistics and data presentation.

> Application of research methods, techniques and technologies appropriate to an area of specialisation; an ability to undertake a research project and write up a research dissertation under supervision.

> The publication of at least one article in a peer-reviewed journal.

Integrated Assessment

Formative assessment

This takes the form of three monthly assessments of learners made by the consultant gastroenterologists involved in the training programme relating to:

• Required acquisition of technical procedures.
• Clinical and basic science knowledge relating paediatric gastroenterology, hepatology and nutrition.
• Formal review of progress in the research project being submitted, and the keeping of a logbook recording all procedures is mandatory and is verified by the head of the training unit.

The level of competency in performing the procedures is verified by the training supervisor or head of the unit at the end of the training period.

Summative Assessment

This comprises

• A written examination (two three-hour papers).
• An oral/OSCE/OSPE/clinical component (Duration maximum 3 hours).
• A dissertation on an approved topic embodying advanced research under the guidance of a supervisor appointed by Senate.

This comprises a dissertation on an approved topic embodying advanced research under the guidance of a supervisor appointed by Senate.