Opinions Received
on Syllabus Proposals

Thank you very much for your suggestions and opinions

They are listed below for your perusal.

The Working Group will discuss in our future meetings.

Comments are welcome!

Delivering Package

Cardiology  (Dr KS Lun)

Dr Lun has sent the WGCR a document listing the specific competences in Paediatric Cardiology for General Paediatric trainees. The scope is almost the same as our proposal.

Desirable skills - trainees are given orientation on Holter reporting, treadmill exercise test, ECMO, cardiac coding. The WGCR has to consider if these shold be added to the desirable skills. We have to bear in mind that observing is not the same as knowing.

Neurology (Dr Sheila Wong)

Suggested to add stereotypies and tics to the list of common movement disorders in basic training.

Suggested to list out the signs and symptoms of common inheritable metabolic condition  - encephalopathy, epilepsy, movement disorders, weakness and neurodevelopmental regression.

Intensive Care (Dr Janice Chow)

(1) Training in ECMO is optional - but need to learn about risk assessment and indications fo referral 

(2) Post-operative care - General surgery, Neurosurgery, Orthopaedic surgery. Cardiac surgery is optional (should we keep it generic?)

(3) ICU management of airway is important (covered in Domain 3 Procedural skills)

(4) Trauma - burn management

Emergency Paediatrics (Dr Janice Chow)

Wound management including irrigation and simple suturing - how and where should a trainee acquire the skills?

Does College of EM or surgeons including these training as well?

Neonatology (Dr Chee Yuet Yee)

Suggest adding

(1) Metabolic disorders - manage the process of screening for an investigation of IEM

(2) Fluid Balanace and renal disorders 

Recognize the causes of electrolyte disturbances (hyper and hyponatraemia, hyper and hypokalaemia)

Anticipates and manage acute renal failure in the neonate, including considering and referring for renal replacement therapy

Manage antenatally diagnosed renal tract disorders following birth (sic)

Recognizes the indication for appropriate nephro-urology referrals for complicated or urgent renal tract disorder

(3) Cardiorespiratory disorders

Applies knowledge of the indications for ECMO and the referral process

Diagnosis and manage critical duct-dependent cardiac conditions

(4) Genetic disorder

Diagnose and manage common chromosomal disorders

Counsel prents when a genetic disorder is suspected and obtain consent for genetic testing

Investigates and manage babies with multiple congenital abnormalities

Manage appropriate multidissciplinary referrals in babies with MCA

(5) Haematological disorders

Identify and manage polycythaemia and hyperviscosity disorders

Manage severe haemolytic disease of newborn, including major blood group incompatibility and rhesus disease

Investigate and manage severe and persistent neonatal thrombocytopaenia

Diagnose and manage major coagulation disorders, including the appropriate use of blood products and coagulation factors

 

Mental health (Dr Dorothy Chan)

Community Paediatrics (Dr Dorothy Chan)

Developemental - Behavioral Paediatrics (Dr Dorothy Chan)

Rheumatology  (Dr Winnie Chan for HK Society of Paediatric Rheumatology)

Feedback from Dr KP Lee

The curriculum is written in great details and inclusive. The content of some subspecialties has covered major topics of subspecialty textbook. Are we expecting our trainees to learn/manage that much during the 6 years of training? Wonder whether it can simple like what RCPCH syllabus? Another suggestion is whether College can give some flexibility on mandatory courses. Fully agree NRP/PALS/sedation course should strongly recommended to take during the basic training. Wonder flexibility say 6 months can be given for mop up if a trainee is eligible for elevation to Member in terms of training and examination except mandatory course requirement.

Palliative Care - HK Society of Children's Palliative Care 

Gastroenterology, Hepatology & Nutrition - HKCH PGI team (Dr Stephen Lui, Dr Rosanna Wong)

Add to Basic training: "Differentiating functional gastrointestinal problems from organic diseases, with appropriate interpretation and follow up investigations to red flags"

Add to Higher trainig: " Appropriate investigation and management approach to acute and chronic pancreatitis"

Nephrology - Hong Kong Paediatric Neprhology Society

Metabolic Medicine - HK Society of Inborn Errors of Metabolism

Endocrinology - PE Specialists 

Intensive Care - Dr Karen Leung

The following points were suggested:

Basic training

1)  Respiratory intensive care

- Airway assessment prior to intubation

- Recognition of difficult airway and when to call for support

- Indication and preparation for intubation

- Indication and management of patient with a tracheostomy

2) Neurological intensive care

- Recognition and basic management of raised intracranial pressure

Higher training

1) Resuscitation

- Initiate and lead resuscitation according to the PALS guidelines

- Post resuscitation care

2) Cardiology intensive care

- Recognition and initial stabilization of patient with congenital cyanotic heart disease

- Management of arrhythmia as per PALS guidelines

- ECMO indication and referral criteria of patient with cardiac failure

3) Respiratory intensive care

- ECMO indication and referral criteria of patient with respiratory failure

4) Haematology and oncology intensive care

Basic understanding and management of mediastinal mass syndrome

5) Transport of PICU patient

- Preparation and stabilization of patient during intrahospital and interhospital transport

6) Monitoring of critically ill patients 

Essential skills

- Central venous access - Understanding of how to select a central venous catheter and how to perform central venous access

Genetics & Genomics - Dr HM Luk

Points suggested:

(1) Patterns of inheritance

Common AD, AR, X-linked diseases

(2) Genetic variants

Different types of mutations: nonsense, missense, frameshift, splice site variants
Understand loss-of-function, gain-of-function variants, dominant negative mechanisms

(3) Non-invasive prenatal screening and invasive diagnostic techniques, applications and limitations

(4) Basic principles of genetic testing

(5) Understand the application and limitations of karyotyping, FISH and array comparative genomic hybridization, quantitative fluorescent polymerase chain reaction.

(6) Patterns of inheritance - please delete partial chromosome deletion

(7) Genetic counseling - understand the need of pre-test / post-test counselling and informed consent process.

Intensive Care (Particularly Critical care Nephrology) - Dr Alvin Hui

1) The syllabus appears to me like training of a subspecialist instead of a general paediatrician. While there are lots of areas to cover within the scope of intensive care, it may be easier for trainees to understand the expectation if the requirement are listed out more specifically (for both basic and higher)

- e.g. Some items are very broad like "Liver failure", "Transverse myelitis", which will make it difficult to distinguish between training of a general paediatrician vs subspecialists. Please consider to make it more specific like "recognition and initial workup of acute liver failure" for basic trainee and "initial management and stabilization of patients with acute liver failure including timing to initiate liver transplant evaluation" for higher trainee 

- Sedation and pain control are important elements in ICU management and will be good to be included 

2) Bronchoscopy, POCT ultrasound, CRRT, plasmapheresis may be more suitable for subspecialist training instead for a general paediatrician?

3) Critical care nephrology

A) Acute kidney injury (AKI) and fluid overload 

Basic trainee

- Recognition of patients having high risk of AKI in critical care setting with early initiation of appropriate monitoring and preventive strategy 

- Recognition of types of acute kidney injury (AKI) and use of standard diagnostic criteria for diagnosis / documentation

- Understand how to assess fluid status and quantify fluid overload in critical setting 

- Understand how to perform relevant investigations for patients with AKI

- Understand basic management of patients with AKI - Avoidance and rational use of nephrotoxic drugs and contrast media for imaging, fluid management including rational use of different types of diuretics, electrolytes and blood pressure management (see below) 

Higher trainee

- Understand the common indications of kidney replacement therapy (KRT) and the timing to initiate referral for KRT

- Understand the pros and cons and potential complication of different modalities of KRT

- Understand the long term sequelae of children with severe AKI and formulate plan of follow up 

B) Electrolyte disturbances 

Basic trainee

- Understand the potential complications of electrolytes and acid-base disturbances (Na, K, Ca, PO4, Mg, Acid-base)

- Acute management of various electrolytes disturbances esp hypoNa, HypoK, hypoCa, Hyper Na, Hyper K, HypoMg, acidosis and alkalosis

Higher trainee

- Initiate workup for potential causes of electrolyte disturbances, especially those with multiple electrolyte disturbances suggestive of tubular dysfunction or underlying pathology such as diabetes insipidus 

- Management of tumour lysis syndrome and understand when to initiate KRT

C) Hypertensive emergency and crisis

Basic trainee 

- Understand the difference between hypertensive urgency, emergency and crisis 

- Understand the pharmacology of various medications used to control blood pressures 

- Understand how to monitor patients with high BP at diagnosis and during intensive care treatment 

Higher trainee

- Workup for patients with hypertensive emergency / crisis or malignant hypertension 

- Understand the initial management of patients with hypertensive emergency / crisis or malignant hypertension in critical care setting

Optional 

D) Extracorporeal blood purification (EBP) techniques including plasmapheresis

Basic trainee and higher trainee

- Understand the indications of EBP in various conditions (e.g. decompensation of inherited metabolic disease, sepsis, liver support, rhabdomyolysis, drug intoxication, neurological conditions etc)

- Brief understanding of the various modalities of EBP devices

Dermatology - Dr David Luk

1.  "Atopic eczema" could be renamed as "Atopic dermatitis"
2.  Include "Understand the College Guideline on the Management of Atopic Dermatitis"
3.  For basic trainees, I would suggest a basic understanding on these relatively common conditions including nevus, birthmarks, warts, genetic skin diseases (Cafe au lait macules, ashleaf macules, etc), quality of life issues in dermatology, scar, and skin scrappings for fungal culture.