Postgraduate Diploma in Clinical Paediatric Critical Care

Purpose

The purpose of this qualification is to allow practising doctors to develop foundational skills in paediatric critical care to ensure development of this service where not established and continued safe practice in this field.

Qualified doctors are therefore trained in the discipline to strengthen and deepen their knowledge in the field of caring for children with critical illness, thereby building capacity to improve child health in Africa. This enables and empowers these working professionals to undertake advanced reflection and development in this sub-area of their practice by means of training which is targeted at current thinking, practice and research methods in the area of paediatric critical care including injury, and allows these skilled workers to use their knowledge gained to lobby for improving child health.

Rationale

The Department of Paediatrics has been training general practitioners from other African countries in terms of the African Paediatric Fellowship Programme (APFP) for some years. These trainees benefit from greater support and resources whereby they are able to demonstrate that they have acquired a recognised qualification. However, previously these trainees were not awarded any certification, thus the process needed to be structure so that the trainees leave with a measurable and certified outcome. It is envisaged that the qualification may also be useful to South African doctors in resource-challenged health care settings, and that even paediatricians-who are not necessarily exposed to these skills and techniques-would also find the training helpful.

Those doctors who wish to and qualify for admission to a speciality or sub-speciality training programme (of 4 and 2 years respectively) may apply for admission to such qualifications. It has been noted that many doctors and specialists cannot leave their jobs in the public health care sector in their home countries for extended periods of time, and furthermore they have no desire to specialise or do research, however, there is a critical need for doctors in Africa-particularly those in resource-poor areas to gain skills in diagnosing and managing (often through referral) the most acute paediatric diseases. This Diploma aims to help address that need.

The trainees require skills in the management of children who have suffered a life threatening injury or illness or who need to recover from major surgical procedures and require high care or intensive care. This training is unique because of the centralisation of paediatric critical care services meaning that learners are exposed to an extraordinarily large spectrum of disease and illness/injury.

Recognition of Prior Learning (RPL)

RPL will be possible whereby specific existing knowledge and skills will be assessed in one or more of the modules, against the Exit Level Outcomes of the qualification and in line with the assessment procedures of the qualification.

Entry Requirements

For admission to this qualification, a learner must be

• Qualified with a Bachelor in medicine (MBBS, MBChB/equivalent qualification).
• Have experience working in paediatrics.
• Registered with the HPCSA.

This qualification consists of 2 compulsory modules at NQF Level 8, totalling 120 Credits.

• Clinical Management in Paediatric Critical Care, 90 Credits.
• Essay: Transition and Translation of Knowledge, 30 Credits.

1. Understand the prevalence of children requiring critical care and the organisational structures required to be accommodated for critical care.
2. Demonstrate ability to translate knowledge and implement skills to their home country.
3. Interpret clinical case studies of children requiring critical care for a variety of conditions covering the clinical presentation, procedures and investigations required as well as management challenges and the co-morbidities identified.

Associated Assessment Criteria for Exit Level Outcome 1

• A critically ill child is assessed and is stabilised according to the APLS system of ABC(Airway, Breathing, Circulation).
• Knowledge of intubation and ventilation including indications for High Flow oxygen, CPAP, Conventional and Oscillatory forms of ventilation are understood and applied.
• Techniques relevant for basic resuscitation including intubation and resuscitation are applied.
• Basic management of a critically ill or injured child in terms of all main organ systems involved is demonstrated.
• In log book the number of types of patients managed as well as procedures performed or witnessed is recorded and monitored.
• Organisational structures allowing for care of group of children with critical illness or injury including medical, nursing and allied practitioners including pharmacy issues and infection control are understood.
• Different causes resulting in patients requiring paediatric critical care are evaluated.
• The use of different forms of invasive procedures is understood.

Associated Assessment Criteria for Exit Level Outcome 2

• A basic understanding of the current definitions of shock and critical care is demonstrated.
• Current recommended international guidelines relevant to practice in the field is understood and applied.
• Knowledge of paediatric critical care is integrated and is translated to own practice.
• Being mindful of context within which practice takes place, in this case, African context is demonstrated.
• Use of clinical discourse to relate to understandable approaches for the management of paediatric critical care patients including high care patients is communicated.

Associated Assessment Criteria for Exit Level Outcome 3

• Appropriate first line management of a critically ill child followed by appropriate investigations and procedures required to aid in diagnosis is applied.
• Investigations followed by management plans for patients including involvement of multi-disciplinary teams are interpreted.
• Organisational structures allowing for care of group of children with critical illness or injury including medical, nursing and allied practitioners including pharmacy issues and infection control are understood and applied.
• Information in the literature on paediatric critical care is independently gathered, validated and evaluated.

Integrated Assessment

Assessment is both formative and summative. Formative assessment is built on continuous feedback on both knowledge and clinical competence. Knowledge is then applied and such application assessed in an extended essay. In addition students are required to maintain a logbook of clinical procedures.