Postgraduate Diploma in Clinical Paediatric Pulmonology

Purpose

The purpose of this qualification is to train suitable learners to practice clinical paediatric pulmonology to enable effective care in resource limited areas without the immediate supervision of a paediatric pulmonologist.

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 structured 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 emphasis in the diploma would be on core diagnostic skills required at the point of first contact with health care facilities in resource-limited areas. It would help inform the general practitioner of the clinical status of the patient and assist him/her in making an informed referral to tertiary services.

Paediatric respiratory diseases are the major cause of childhood morbidity and mortality in Africa. There is an urgent need for training and upskilling of health care professionals in paediatric pulmonology to improve care, develop local training programmes and promote child lung health. The Paediatric Pulmonology Division wants to partner with institutions that have an interest in developing paediatric pulmonology through training of suitable candidates. This would apply to most major centres in South Africa and Africa where there is a university-based department of paediatrics.

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 Pulmonology, 90 Credits.
• Essay: Transition and Translation of Knowledge, 30 Credits.

1. Demonstrate Knowledge of embryology, anatomy and physiology of respiratory tract and system and respiratory pathophysiology.
2. Interpretation of routine investigations related to pulmonary diseases.
3. Comprehensive knowledge and insight (aetiology, pathology, pathophysiology, presentation, complications, diagnosis and management, prevention) of common paediatric respiratory conditions.

Associated Assessment Criteria for Exit Level Outcome 1

• Knowledge of paediatric respiratory diseases are integrated and evidence based practices is translated into care.
• The structure and function of the respiratory system is correlated.
• The development of the respiratory tract and how this relates to common developmental anomalies is outlined.
• The mechanics of the process of respiration, using anatomical and physiological principles of muscle action, flow, pressure etc. are explained.
• The common pathologies of the respiratory tract in terms of disordered anatomy and physiology is discussed.
• Simple clinical cases involving the respiratory system (including tumours, serious infections, fractures, pneumothorax, pleural effusions, haemothorax and flail chest) in terms of disordered anatomy and physiology is interpreted.

Associated Assessment Criteria for Exit Level Outcome 2

• Clinical history and elicitation (with interpretation) of the physical signs of the respiratory system is interpreted.
• Systematic approach to common childhood respiratory symptoms is diagnosed.
• Acting ethically and professionally in context of children with paediatric respiratory diseases is displayed.

Associated Assessment Criteria for Exit Level Outcome 3

• Comprehensive knowledge and insight (aetiology, pathology, pathophysiology, presentation, complications, diagnosis and management, prevention) of common paediatric respiratory conditions is displayed.
• Congenital malformations and lesions of the respiratory tract, interstitial lung diseases and pulmonary haemorrhage syndromes, pulmonary hypertension, cystic fibrosis, lung diseases in the immunocompromised host, lleural effusions and pneumothorax, lntrathoracic tumours and other mass lesions if the chest, ARDS and acute lung injury, acute and chronic respiratory failure, respiratory disease in neuromuscular weakness and chest wall deformity is diagnosed and managed.
• Essential skills and procedures of comprehensive physical examination, Spirometry, Tracheostomy care and change, Pleural aspiration, Insertion and care of intercostal chest drains are conducted.
• Techniques relevant to practice for appropriate management are applied.
• Problem solving in the area of specialisation of Paediatric Pulmonology is displayed.

Integrated Assessment

Learners will be assessed continuously throughout the coursework. Regular meetings with the programme convenor or mentor will be held and formal feedback provided at least three times in a month. Logbook completion will be monitored. An exit examination will consist of a 1 hour oral examination that will evaluate clinical skills, knowledge and interpretation of specific investigations. Each learner will be mentored to enable them to produce a long essay or report.