Master of Philosophy in Paediatric Rheumatology

Purpose

The purpose of the Master of Philosophy in Paediatric Rheumatology is to train specialist paediatricians to be competent in the management of the sub-speciality of Paediatric Rheumatic Diseases. The qualification will provide clearly defined standards of paediatric rheumatology practice in terms of knowledge, skills, and capabilities at an advanced level of achievement. Learners will be provided with skills knowledge and capabilities to use a wide range of appropriate diagnostic and therapeutic procedures, including joint and soft tissue injection and aspiration, and synovial fluid examination.

Upon completion of this qualification, qualifying learners will be able to

• Demonstrate specialist knowledge of the epidemiology and socio-economic impact of paediatric rheumatic disorders to enable engagement with and critique of current research or practice.
• Illustrate a command of basic and applied medical sciences relevant to paediatric rheumatic disorders, including morbid anatomy, pathophysiology, chemical pathology, immunology, and microbiology.
• Apply a wide range of specialised skills in the classification, clinical features, laboratory findings, pathophysiology, physical, and psychosocial impact of rheumatic disorders.
• Apply appropriate research techniques, statistical methods, and critical evaluation of the medical literature.
• Promote research in rheumatology by supporting or participating in research activities.
• Contribute to the education of colleagues, junior medical officers, learners, other healthcare workers, and the public.

Rationale

This qualification is aligned to the College of Medicine of South Africa's requirements to be registered by the Health Professions Council of South Africa as a registered paediatric rheumatologist. The College of Medicine of South Africa provides a clear indication of the knowledge, skills and attitudes required for skilled learners in this field. It is expected that South African paediatric rheumatologists will practice their skills and apply their expertise within the framework of a specialised tertiary care unit, division, department, hospital, outpatient departments and outreach clinics. Furthermore, such specialists will commit to train general paediatricians, paediatricians with an interest in paediatric rheumatology, paediatric rheumatologist trainees and specialist paediatric rheumatologists.

This qualification aims to promote clearly defined standards of paediatric rheumatology practice in terms of knowledge, skills, and capabilities at an advanced level of achievement and foster the development of a South African network of competent tertiary care centres in paediatric rheumatology. This qualification will provide learners with skills and knowledge to improve the care of children and adolescents within Southern Africa with chronic as well as acute rheumatic disorders. The qualification will enhance the African contribution to international scientific progress in the field of paediatric rheumatology, with special emphasis on disease patterns relevant to practice in developing countries.

This qualification is aligned with the College of Medicine of South Africa's requirements to be registered by the Health Professions Council of South Africa as a registered paediatric rheumatologist.

This qualification aims to address the need to properly train clinicians with a thorough understanding of and experience in clinical research in the field of paediatric rheumatology. Similar to all the subspecialty qualifications in paediatrics, learners will be qualified paediatricians who have obtained their MMed (Paed) or FC Paed (SA) degrees.

The institution has an approved Recognition of Prior Learning (RPL) policy applicable to equivalent qualifications for admission into the qualification. RPL will be applied to accommodate applicants who qualify. RPL thus provides alternative access and admission to qualifications, as well as advancement within qualifications.

RPL for access

• Learners who do not meet the minimum entrance requirements or the required qualification that is at the same NQF level as the qualification required for admission may be considered for admission through RPL.
• To be considered for admission in the qualification based on RPL, applicants should provide evidence in the form of a portfolio that demonstrates that they have acquired the relevant knowledge, skills, and competencies through formal, non-formal and/or informal learning to cope with the qualification expectations.

RPL for exemption of modules

• Learners may apply for RPL to be exempted from modules that form part of the qualification. For a learner to be exempted from a module, the learner needs to provide sufficient evidence in the form of a portfolio that demonstrates that competency was achieved for the learning outcomes that are equivalent to the learning outcomes of the module.

RPL for credit

• Learners may also apply for RPL for credit for or towards the qualification, in which they must provide evidence in the form of a portfolio that demonstrates prior learning through formal, non-formal and/or informal learning to obtain credits towards the qualification.
• Credit shall be appropriate to the context in which it is awarded and accepted.

Entry Requirements

The minimum entry requirement for this qualification is

• Bachelor of Medical Science Honours, NQF Level 8.

Or

• Bachelor of Medicine and Bachelor of Surgery, NQF Level 8.

And

• Registration with the Health Professions Council of South Africa (HPCSA).

This qualification consists of the following compulsory modules at National Qualifications Framework Level 8 totalling 180 Credits.

Compulsory modules, Level 8, 180 Credits

• Paediatric Rheumatology Research Project, 45 Credits.
• Clinical Paediatric Rheumatology, 135 Credits.

1. Critically appraise paediatric rheumatic disorders' epidemiology and socio-economic impact, enabling them to deconstruct and defend current research and practice within the field.
2. Master and deploy advanced knowledge of basic and applied medical sciences relevant to paediatric rheumatology, including morbid anatomy, pathophysiology, chemical pathology, immunology, and microbiology, for complex clinical analysis and problem-solving.
3. Strategically select and apply specialised skills to independently evaluate, diagnose, and manage the classification, clinical features, laboratory findings, pathophysiology, and physical and psychosocial impact of rheumatic disorders in children.
4. Design and justify comprehensive, holistic assessment and management plans for children with rheumatic disorders, incorporating cognitive, behavioural, and bio-psychosocial components, demonstrating sound clinical judgment.
5. Independently prescribe and critically evaluate pharmacotherapy for rheumatic disorders, including analgesic, steroidal and non-steroidal anti-inflammatory, conventional and biologic disease-modifying and immunosuppressive drugs, accounting for potential adverse effects and implementing appropriate toxicity monitoring procedures.
6. Execute with precision and competence a wide range of advanced diagnostic and therapeutic procedures, including joint and soft tissue injection, aspiration, and synovial fluid examination, demonstrating mastery of technical skills and sound clinical decision-making.
7. Conduct original research utilizing appropriate techniques and advanced statistical methods, and critically analyse and interpret the medical literature relevant to paediatric rheumatology, drawing independent conclusions and proposing future research directions.
8. Champion and contribute to research advancements in rheumatology through active participation in innovative and impactful research projects or by providing expert support and collaboration.
9. Disseminate knowledge by educating colleagues, junior medical officers, students, other healthcare workers, and the public on paediatric rheumatology and related topics, tailoring content and delivery to diverse audiences and demonstrating practical communication skills.
10. Remain at the forefront of the field by pursuing continuous professional development (CPD) opportunities and actively engaging in quality assurance initiatives, demonstrating a commitment to professional excellence and lifelong learning.

Associated Assessment Criteria for Exit Level Outcome 1

• Accurately analyse and correctly interpret research data on the prevalence, incidence, and risk factors of specific rheumatic disorders in children.
• Develop and justify written and oral arguments that critically evaluate the impact of rheumatic disorders on individual patients, families, and healthcare systems, considering economic, social, and psychological factors.
• Accurately compare and efficiently contrast different research methodologies used to study paediatric rheumatic disorders' epidemiology and socio-economic impact.
• Correctly identify strengths and weaknesses of existing research and propose avenues for future research directions.

Associated Assessment Criteria for Exit Level Outcome 2

• Correctly and accurately explain the mechanisms and presentations of specific paediatric rheumatic disorders by correctly applying advanced knowledge of relevant medical sciences (morbid anatomy, pathophysiology, etc.).
• Accurately differentiate between different types of rheumatic disorders based on clinical features (symptoms and signs), laboratory findings, and imaging studies.
• Propose appropriate treatment plans based on a sound understanding of disease pathophysiology and pharmacological mechanisms of action.
• Critically evaluate new scientific developments and their potential impact on diagnosing and managing pediatric rheumatic disorders.

Associated Assessment Criteria for Exit Level Outcome 3

• Independently assess patients with suspected rheumatic disorders, incorporating detailed history, physical examination, and relevant investigations (routine and specialised tests) accurately and thoroughly.
• Formulate accurate differential diagnoses considering various clinical presentations and underlying pathophysiology.
• Apply a range of specialised skills like joint aspiration, synovial fluid analysis, and interpretation of imaging studies to confirm diagnosis and monitor disease activity.
• Select and implement appropriate management strategies for different types of paediatric rheumatic disorders, tailoring options to individual patient needs.

Associated Assessment Criteria for Exit Level Outcome 4

• Develop appropriate holistic assessment and management plans that address the physical, cognitive, behavioural, and psychosocial aspects of each patient's condition.
• Collaborate effectively and respectfully with other multi-disciplinary healthcare team professionals (physiotherapists, occupational therapists, social workers, dieticians, ophthalmologists, psychologists, etc.) to provide integrated holistic care.
• Justify treatment decisions by considering evidence-based guidelines, individual patient characteristics, and potential risks and benefits, both verbally and in written form.
• Accurately monitor and appropriately adapt care plans based on clinical response and evolving patient needs.

Associated Assessment Criteria for Exit Level Outcome 5

• Accurately and correctly discuss the pharmacology, indications, and potential adverse effects of different medications used in paediatric rheumatology with various audiences, including fellow medical practitioners and guardians of patients.
• Correctly prescribe medications independently, considering individual patient factors and potential interactions.
• Accurately monitor patients for medication side effects and adjust dosages or switch medications as needed.
• Understand the impact of medication on the growing child and adolescent: growth and development, tailor in the need family planning counselling and appropriate use of contraceptives, acknowledge the risk of teratogenicity in unplanned pregnancies and acquire fertility preservation knowledge.
• Critically evaluate new drug efficacy and safety research, applying findings to inform evidence-based prescribing practices.

Associated Assessment Criteria for Exit Level Outcome 6

• Accurately perform a range of advanced diagnostic and therapeutic procedures (joint injections, aspirations with accuracy, safety, and adherence to sterile technique.
• Correctly interpret results of procedures and integrate findings into the overall patient assessment and management plan.
• Clearly communicate and accurately explain procedures to patients and families, obtaining informed consent before proceeding.
• Maintain clear, concise, and accurate records of procedures and outcomes.

Associated Assessment Criteria for Exit Level Outcome 7

• Thoroughly design and conduct relevant research projects using appropriate methodologies and statistical techniques relevant to paediatric rheumatology.
• Conduct a thorough literature review, critically evaluating existing research and identifying gaps in knowledge.
• Accurately analyse and interpret research findings objectively, drawing conclusions and identifying limitations.
• Accurately disseminate research findings through presentations, publications, or other scholarly activities.

Associated Assessment Criteria for Exit Level Outcome 8

• Actively participate in research projects, demonstrating initiative and commitment to advancing knowledge in paediatric rheumatology.
• Collaborate effectively with research teams and contribute meaningfully to data collection, analysis, and interpretation.
• Provide appropriate arguments to be used to advocate for research initiatives and secure funding opportunities to support further investigation in the field.

Associated Assessment Criteria for Exit Level Outcome 9

• Develop clear, concise, and engaging presentations tailored to diverse audiences (colleagues, patients, families, public).
• Effectively communicate complex medical information using appropriate technology.
• Appropriately adapt language and content used for communication purposes to the needs and understanding of different audience groups.

Associated Assessment Criteria for Exit Level Outcome 10

• Proactively engage in continuous professional development opportunities to stay updated on the latest advancements in paediatric rheumatology.
• Critically and accurately evaluate new evidence and guidelines, incorporating them into clinical practice where appropriate.
• Actively participate in quality assurance initiatives and contribute to improving patient care standards in the field.

INTEGRATED ASSESSMENT

Formative Assessments

Formative assessments are performed continuously. Monitoring of learning is performed formally via a three-monthly discussion between the candidate and the qualification coordinator and her team, where the following issues are discussed:

• Objectives for the period under review.
• Candidate's self-assessment of the learning experience.
• Qualification coordinator's assessment of the learning experience.
• Progress with the research project.

This process assists in identifying areas for development before engaging in the summative assessment process. Learners will be required to complete the portfolio of evidence (learning portfolio). The format for this portfolio will align with the requirements outlined by the College of Medicine of South Africa (CMSA), as the portfolio is also used as evidence of the knowledge and skills required.

The purpose of the portfolio is to serve as a record of the candidate's training and encourage the reflective and evaluation skills of learners.

When the candidate applies to sit for the Cert Rheumatology (SA) examination, the Portfolio and the logbook will be reviewed and signed by the Head of Department, who will supply a letter to the College of Medicine of South Africa (CMSA) certifying that the portfolio has been satisfactorily completed and that the candidate is now eligible to sit for the final exit exam.

Content of the portfolio

• Work Rotations.
• Syllabus for the Cert Rheumatology (SA) Paed.
• Formative and Summative assessment.
• Formal training.
• Presentations at departmental meetings and conferences.
• Logbook.
• Research.
• Declaration on Completion of Training.

Summative Assessment

The summative assessment of a learner is performed by a process of formal internal and external examination of the two qualification modules.

• Clinical Paediatric Rheumatology: Clinical competency is evaluated by a formal national written and oral examination, set, marked, and assessed by the Colleges of Medicine of South Africa (CMSA).

Structure of the Examination.

The Certificate examination has two components

• A written component
• An oral or OSCE/OSPE or clinical component.

Each of the two components contributes 50% to the overall mark.

The pass mark for the overall exam is 50%.

A sub-minimum pass mark of 50% is expected for each of the two (written and the oral/OSCE or clinical)

Components of the examination.

There are no sub-minima for individual papers, questions, or sub-sections of the OSCE/ or oral or clinical examination.