Postgraduate Diploma in Clinical Paediatric Cardiology

Purpose

The purpose of this qualification is to train General Practitioners to be able to diagnose, resuscitate, triage and manage children with congenital and acquired heart disease safely and effectively. It does not aim to train the candidate to become a paediatric cardiologist, but rather to be able to practice safely and effectively in resource limited areas without the immediate supervision of a paediatric cardiologist.

The emphasis of the qualification is on core diagnostic skills that are required at the point of first contact with health care facilities in resource-limited areas. The qualification will enable general practitioners to determine the clinical status of the patient and to be able to make an informed referral to tertiary services. This would optimise patient referral patterns for severe cases and reduce needless referrals for less severe conditions.

Upon qualifying the candidate will be able to

• Conduct routine management of new patients, including the initiation of appropriate acute treatment and long-term management plans.
• Provide long-term follow-up of post-operative patients by understanding their potential complications (not immediate post-op ICU care).
• Understand Echocardiography (ECG), defibrillation and cardioversion; pericardiocentesis.

Rationale

The Department of Paediatrics at the University has been training General Practitioners from other African countries in terms of the African Paediatric Fellowship Programme (APFP) for some years. Although these trainees, on their return to their home institution, have benefitted from the support and resources they have received but they are unable to demonstrate that they have acquired a recognised qualification. Thus the institution has decided to structure the process so that the trainees will be able to attain a measurable and certified outcome, which is a recognised qualification.

It is also envisaged that the qualification may be useful to South African doctors as there is a critical need for doctors in resource-poor areas to gain skills in diagnosing and managing (often through referral) the most acute paediatric diseases. Also it may benefit paediatricians who are not exposed to these skills and techniques.

Recognition of Prior Learning (RPL)

The University's official Policy for the Assessment and Recognition of Prior Learning (RPL) will be rigorously followed. Applicants who do not meet the admission criteria as stipulated, but who can demonstrate experiential or work-based learning at an equivalent level may be considered for RPL provided a proper assessment of the prior learning has been conducted. The process will be implemented in strict adherence to the relevant University's RPL Policy.

The Recognition of Prior Learning (RPL) can also be used where applicable to grant credits to the qualification.

Entry Requirements

Applicants must

• Have a Bachelor in Medicine (MB BS, MB ChB, or equivalent qualification).
• Be registered with the Health Professions Council of South Africa (SA).

The qualification comprises compulsory modules at NQF Level 8, totalling 120 Credits

• Clinical Management in Paediatric Cardiology, 40 Credits.
• Echocardiography, 40 Credits.
• Essay: Transition and Translation of Knowledge, 40 Credits.

1. Understand the physics of and demonstrate the use of echocardiography (ECG).
2. Conduct accurate assessments of the anatomy of normal and diseased hearts in order to inform management decisions.
3. Integrate and implement the knowledge of paediatric cardiology to conduct routine management of patients.

Associated Assessment Criteria for Exit Level Outcomes 1

• Knowledge of basic routine, normal and typical diagnostic ECGs of heart disease is demonstrated.
• Principles of ultrasonology, the technical capabilities and limitations of echocardiography is understood.
• A sound knowledge and application of the various routine echocardiographic views of the heart and related structures, and relevant ancillary techniques (e.g. bubblegrams) is demonstrated.
• Knowledge of the pathology and physiology of congenital cardiac lesions, and normal developmental physiology in infants as it applies to paediatric echocardiography is demonstrated.
• Special views used in paediatric echocardiography, particularly the sub-xiphoid and right and left parasternal views are understood.

Associated Assessment Criteria for Exit Level Outcomes 2

• Life-threatening arrhythmias are recognised and an urgent management plan is developed.
• In a tertiary Paediatric Echocardiography the examination of patients with congenital heart disease is conducted under supervised training.
• Appropriate understanding of cardiac anatomy is shown in the interpretation of echocardiographic images.
• Paediatric echocardiographic studies (at least 400 with congenital or acquired heart disease) in conjunction with and under the supervision of a paediatric cardiologist are assessed.

Associated Assessment Criteria for Exit Level Outcomes 3

• Different theories of paediatric cardiology are evaluated.
• Techniques relevant to the practice of paediatric cardiology are applied.
• Routine management of new patients, including the initiation of appropriate acute treatment and long-term management plans are executed.
• A wide variety of sources is used to gather information on Paediatric Cardiology which is critiqued for own use.
• Clinical discourse is engaged with to relate and communicate different approaches and techniques in the care of children with heart disease.
• Complicated problems in the area of paediatric cardiology are solved.
• The epidemiology of the centres at which healthcare is practiced is analysed and the healthcare needs of the region are planned.
• Emergency management and resuscitation; selection and triage for tertiary referral is conducted.
• Post-operative care; long-term follow-up of post-operative patients and their potential complications (not immediate post-
• Emergency management and resuscitation plans are developed to assist children in need.
• Children who need tertiary (crucial) referral are selected and triaged.
• Patient interaction and care are conducted according to ethical and professional standards.
• The nature of the heart disease, it's possible/probable cause, its management and prognosis is communicated to parents of children and counselling are provided.

Integrated Assessment

This qualification will administer both formative and summative assessments. Formative assessments will be used to provide continuous feedback to learners regarding both knowledge and clinical competence. Knowledge is then applied and such application is assessed in an essay. In addition learners are required to maintain a logbook of clinical procedures, and the completion of this is a Developmental Programme requirement for the final assessment to be undertaken. An exit examination will be externally moderated.

Formative Assessment will include

• Case-based orals; corrective action will be introduced where progress is unsatisfactory.
• Logbook links skills training and theoretical knowledge to application in clinical practice.
• Long essay.

Summative Assessment will include

• Examination will consist of a Multiple Choice Questions (MCQ) for Clinical Medicine and Surgery and a case-based oral assessment.
• An essay whereby the learners applied competencies will be assessed.