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!
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 should 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
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.
Genetics and Genomics - Dr HM Luk
Suggest to remove partial chromosomal deletion from the Pattern of Inheritance of Higher training as there are more aberrations possible for chromosomes e.g. duplication, inversion. (Clarification by Dr S P Wu has been made that the syllabus need not be exhaustive and the three topics in this category are referring to specific conditions like Angelman syndrome, Williams syndrome, Mosaic Turner or Down syndrome)
DBP - Dr Florence Lee
Intensive Care - Dr Cheung Hon Ming
Specifying Paracetamol overdose as a topic in basic toxicology
Immunology, Allergy and Infectious Diseases - Dr Mike Kwan (14 February 2023)
Neonatology - Professor Simon Lam and Neonatologists (7 March 2023)
In the original syllabus, part of the problem was that prematurity is not a single topic, which made things a little confusing for some colleagues. The other main issues was the conflict between having content in Higher Training, but some trainees not having the opportunity to go through Higher Training in neonatology. Thus, an asterisk was added to Higher Training indicating that it is not a mandatory part of the general paediatrics training, but that the syllabus serves as a guide to those Higher Trainees who do rotate through Neonatology again. I have deleted the specific advanced modes of ventilatory support and haemodynamic monitoring.
Mental Health - Dr KW Tsui
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Under the common mental health conditions of CYP, Anxiety Disorders should be included in this category as it is even more prevalent than depression. Adjustment Disorders and Obsessive-Compulsive Disorders should also be added since they are also commonly encountered in paediatric settings.
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I suggest creating a separate category on the recognition and prompt referral of severe mental illnesses, such as schizophrenia and other psychotic disorders, bipolar disorders, and major depressive disorder. It is not ideal to group psychosis under common mental health conditions. Trainees are also expected to have knowledge and skills in handling these patients who become violent or delirious in paediatric settings.
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Recognizing and managing organic disorders in patients with psychiatric presentations is also important and it should be added to the syllabus.
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For the desirable skills of basic trainees, I suggest removing "offering reassurance" to avoid misunderstanding as many mental health conditions require other forms of treatment. Instead, I suggest replacing it with "Psychoeducation and basic counseling skills" in this category.
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In terms of terminology, it is preferable to use proper wordings, such as "Attention-Deficit/Hyperactivity Disorder" for ADHD, “Autism Spectrum Disorder” for ASD and "Oppositional Defiant Disorder" for ODD, with reference to DSM-5.