Postgraduate Diploma in Clinical Paediatric Rheumatology

Purpose

There is an urgent need to provide appropriate care for children with rheumatic diseases, regardless of geographic or racial origin. Thus qualification will enable the general practitioner to determine the clinical status of the patient and assist in making an informed referral to tertiary services. Furthermore, they will acquire the necessary skills to be able to engage in meaningful conversations with the specialist/subspecialist at the referral centre. Thus the patient referral patterns for severe cases will be optimised and it will reduce needless referrals for less severe conditions.

Upon qualifying the learner will be able to

• Accurately elicit and synthesise relevant information and perspectives of patients and families, colleagues, and other professionals.
• Develop rapport, trust, and ethical therapeutic relationships with patients and families.
• Seek appropriate consultation from other health professionals recognising the important contributions of the multidisciplinary team members in the care of patients with arthritis related conditions (Registered Nurse, Physiotherapist, Occupational Therapist, Social Work, Dietician and Pharmacist).
• Demonstrate proficient and appropriate use of procedural skills, both diagnostic and therapeutic.
• Use preventive and therapeutic interventions effectively.
• Perform a complete and appropriate assessment of the patient.

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, however, these general practitioners leave the training with no formal qualification. Thus the institution would like to structure the process so that the learners leave with a recognised qualification.

Furthermore it is envisaged that the Diploma may also be useful to South African doctors in resource-challenged health care settings, as well as paediatricians - who are not necessarily exposed to these skills and techniques - would also find the training helpful.

While paediatric rheumatology is a well-established discipline in Australia, Europe and the America's, it is in its infancy in Africa. There is a critical shortage of trained paediatric rheumatologists in South Africa and in the rest of Africa. By training young, enthusiastic learners in Africa and South Africa, we hope to create leaders who will advance the field further in their own countries, making use of the excellent international research links already established in the department of paediatric rheumatology. There are currently no other training opportunities in Africa, so this qualification will be a first for Africa.

Recognition of Prior Learning (RPL)

Each learner will be considered according to the institution's RPL policy and guidelines. The learner will be thoroughly briefed on the mechanism to be used and the appropriate support/guidance will be provided. The process will provide the learner with an opportunity to demonstrate competence in the relevant learning areas/outcomes and will not prevent him/her from taking up the RPL option towards attempting to gain the qualification.

If the learner is able to demonstrate competence in the knowledge, skills, values and attitudes implicit in this qualification the appropriate credits will be assigned to him/her. RPL will be achieved by means of an appropriate integrated assessment method as mentioned above.

This RPL may allow a successful learner

• Accelerated access to further learning at this level on the NQF.
• Obtaining of this qualification in part or in whole.

Entry Requirements

Learners are required to have the following in order to be considered for admission

• Bachelor of Medicine and Bachelor of Surgery (MB BS/MBChB) or an equivalent qualification as a medical doctor and
• Experience working in the field of paediatrics and
• Registered with the Health Professions Council of South Africa (HPCSA).

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

Modules

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

1. Perform a complete and appropriate assessment of the patient.
2. Use preventive and therapeutic interventions effectively.
3. Demonstrate proficient and appropriate use of procedural skills, both diagnostic and therapeutic.
4. Seek appropriate consultation from other health professionals recognising the important contributions of the multidisciplinary team members in the care of patients with arthritis-related conditions (Registered Nurse, Physiotherapist, Occupational Therapist, Social Work, Dietician and Pharmacist).
5. Develop rapport, trust, and ethical therapeutic relationships with patients and families.
6. Accurately elicit and synthesise relevant information and perspectives of patients and families, colleagues, and other professionals.

Associated Assessment Criteria for Exit Level outcome 1

• Issues to be addressed in a patient encounter is effectively identified and explored, including the patient's context and preferences.
• A history that is relevant, concise and accurate to context and preferences for the purposes of prevention and health promotion, diagnosis and/or management is elicited.
• A focused physical examination is performed that is relevant and accurate for the purposes of prevention and health promotion, diagnosis and/or management.
• Medically appropriate investigative methods in a resource-effective and ethical manner are selected.
• Knowledge of the scientific basis, indications/contraindications, limitations and clinical interpretation thereof is demonstrated:

> Specialised immunological and serologic investigations.

> Joint aspiration and synovial fluid analysis.

> Tissue biopsies.

> Electromyography and nerve conduction studies.

> Diagnostic imaging of joint and skeletal diseases.

• Effective clinical problem solving and judgment to address patient problems, including interpreting available data and integrating information to generate differential diagnoses and management plans is displayed.

Associated Assessment Criteria for Exit Level outcome 2

• A management plan is implemented in collaboration with a patient and their family.
• Appropriate and timely application of preventive and therapeutic interventions relevant to the physician's practice is demonstrated:

> Non pharmacological therapy.

> Pharmacologic and biologic therapy [including plasma exchange and Intravenous Immunoglobulin (IVIg)].

> Joint and soft tissue injections.

> Complementary medicine.

• Informed consent is obtained for therapies.

Associated Assessment Criteria for Exit Level outcome 3

• Effective, appropriate, and timely performance of diagnostic and therapeutic procedures is applied that is relevant to Rheumatology including joint and soft tissue aspiration and/or injections and synovial fluid analysis, including accurate use of polarised microscopy for crystal analysis as needed.
• The indications and contraindications for and analgesia as required for specific patients undergoing rheumatologic procedures are explained.
• The process required to ensure that appropriate informed consent is obtained for procedures is applied.
• Information related to procedures performed and their outcomes is documented and disseminated.
• Adequate follow-up is arranged for procedures performed.

Associated Assessment Criteria for Exit Level outcome 4

• Insight into their own limitations of expertise is articulated.
• Effective, appropriate, and timely consultation of another health professional as needed for optimal patient care is displayed.
• Appropriate follow-up care services for a patient and their family is arranged.

Associated Assessment Criteria for Exit Level outcome 5

• Positive therapeutic relationships with patients and their families that are characterised by understanding, trust, respect, honesty and empathy are established.
• Respect patient confidentiality, privacy and autonomy are demonstrated.
• A structured clinical encounter is effectively facilitated.

Associated Assessment Criteria for Exit Level outcome 6

• Information about a disease and about a patient's beliefs, concerns, expectations and illness experience is gathered.
• Relevant information from other sources, such as a patient's family, caregivers and other professionals is sought out and synthesised.

Integrated Assessment

Formative assessment is built on continuous feedback on both knowledge and clinical competence.

The methods of the formative assessment that will be used are

• The completion of the Logbook.
• A final integrated case-based oral exam will be conducted at the end of the qualification.
• In an essay learners will demonstrate the clinical knowledge and skills gained throughout the qualification to the clinical situations of their own work environments by implementing proper research protocols.

Furthermore, and two written formative assessments such as tests, tasks etc. will need to be completed.