Postgraduate Diploma in Clinical Paediatric Nephrology

Purpose

The purpose of this qualification is to train suitable trainees to practice clinical paediatric nephrology in order to enable them to manage basic and complex paediatric nephrology in children, including those from vulnerable populations affected by diseases of poverty.

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. Thus these trainees, on their return to their home institution, benefit from greater support and resources and also enables them acquire a recognised qualification.

Currently the trainees who are studying for a period of one year exit with no formal qualification. Now the training will be more structured so that the trainees can exit with a measurable and certified outcome and qualification. It is envisaged that the Postgraduate Diploma in Clinical Paediatric Nephrology may also be useful to the general practitioners in South African who work in resource-challenged health care settings, and be also beneficial to paediatricians, who are not necessarily exposed to these skills and techniques, as they will find the training helpful.

Although 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 but, many doctors and specialists cannot leave their jobs in the public health care sector in their home countries for extended periods of time, and they also have no desire to specialise or do research. Furthermore, it must also be pointed out that a full sub-specialisation requires massive investment in infrastructure and this is not possible in some countries.

Thus the APFP, the Red Cross Children's Hospital Paediatric Nephrology Service wants to partner with institutions that have paediatric nephrology units to provide the training. The training of doctors is especially targeted to those who have been identified by their department heads as potential nephrologists for the care of children. Those doctors who wish to apply and qualify for admission to a speciality or sub-speciality training qualification may also apply for admission to such qualifications.

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

Trainees can apply for the Postgraduate Diploma in Clinical Paediatric Nephrology if they meet the following requirements:

• Bachelor of Medicine and Bachelor of Surgery (MBChB or MB BS).

Or

• Equivalent qualification as a medical doctor.
• Have experience working in the field of paediatrics.
• Be registered with the Health Professions Council of South Africa.

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

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

1. Apply techniques relevant to practice for managing complex paediatric nephrology in children, including those from vulnerable populations affected by diseases of poverty.
2. Integrated knowledge of nephrology diseases and care and translation to own practice.

Associated Assessment Criteria for Exit Level Outcome 1

• Acting ethically and professionally in context of sick children is demonstrated.
• Clinical discourse is used to communicate understandable approaches for the care of sick children.
• Clinical history including psychosocial history and elicitation of the physical signs is reviewed and explained.
• Bedside tests, electrolyte and acid-base abnormalities and special investigations related to renal disease such as: Ultrasound, Nuclear medicine studies: Mag-3 studies, renal histology, Urinary tract infection, Nephrotic syndrome are interpreted are outlined.
• Glomerulonephritis including post-infective nephritis as well as other more unusual forms e.g. mesangioproliferative, mesangiocapillary and focal segmental glomerulosclerosis is diagnosed.
• Acute renal failure - related to shock and sepsis including gastro, post-operative cardiac surgery and drug related causes; fluid management is diagnosed.
• Bed-side catheters are inserted and dialysis is instituted.
• Paediatric Hypertension is diagnosed and managed.
• Antenatal abnormalities are followed up and problems are detected.
• Congenital renal abnormalities including paediatric urologic problems - posterior urethral valves, pelvi-ureteric junction obstructions are detected and managed.
• Adolescent paediatric renal disease is diagnosed and treated.
• Paediatric dialysis including peritoneal and haemodialysis.
• Renal support in Paediatric Intensive Care Patients, and in other specialities, e.g. oncology is provided.
• Counselling and information transfer to parents is provided.
• A renal biopsy is performed.

Associated Assessment Criteria for Exit Level Outcome 2

• Basic Science: Embryology, anatomy and physiology of renal and urological system is understood and applied.
• Renal Pathophysiology especially pertaining to fluid and electrolyte balance is detected and regulated.
• Paediatric Vasculitides e.g. PolyarteritisNodosa, Takayasu's Disease is detected.
• Autoimmune conditions such as Systemic Lupus Erythematosis.
• Renal transplantation and fine tuning of immunosuppressive therapies are demonstrated.
• Comprehensive assessment of patients is conducted.
• Radiological and nuclear medicine and renal histology reports are interpreted.
• Basic immunosuppression is used.
• Different theories on the presentation of nephrology complications and diseases are evaluated.
• Problem solving in the area of specialisation of nephrology is demonstrated.
• Information in the literature on nephrological diseases is gathered, independently validated and evaluated.
• Being mindful of context within which practice takes place, in this case, African context is demonstrated.
• A logbook including management of cases and procedures is completed.

Integrated Assessment

The assessments are both formative and summative. Formative assessment is built on continuous feedback on both knowledge and clinical competence. Knowledge is then applied and such application will be assessed in an extended essay. In addition trainees are required to maintain a log-book of clinical procedures. An exit examination will consist of an oral case-based examination.