Download Standards for Speciality Training in Paediatrics

Paediatric Guidance Checklist
These standards were derived to assist in the assessment of the
paediatric training standards of in your deanery
Specialty:
Gastroenterology and Hepatology
The Programme (which may consist of several posts) should
provide:
1. Supervision - For both gastroenterology and hepatology
/
1.1 An educational supervisor who is a Consultant paediatric
gastroenterologist or Consultant paediatric hepatologist trained in
assessment and appraisal
1.2 An educational supervisor who provides average 4 hours (1PA) per
week of educational supervision
1.3 Evidence that the assessment strategy is being delivered
1.4 Trainers receive appropriate training on the delivery of the assessment
strategy
1.5 appropriate supervision to ensure patient safety
2. Other Personnel
For both gastroenterology and hepatology
2.1 A minimum of 2 consultants in specialty to support & supervise
2.2 More than one ST4 -8 in the children’s department
2.3 A minimum of one wte nurse specialist, and one wte paediatric
dietician
2.4 A minimum of 0.5 wte pharmacist with experience in prescribing PN
and specialty specific drugs (eg tacrolimus, infliximab)
2.4 A minimum of one paediatric surgeon with specialty interest in
gastroenterological and hepatological surgical problems
For hepatology only
2.5 A minimum of one wte transplant co-ordinator
2.6 A minimum of one wte transplant surgeon
3. Service requirements and facilities - For both gastroenterology
and hepatology
3.1 Specialty specific requirements of subspecialty department:
Telephone support for out-patients (i.e. a direct line)
Endoscopy suite staffed for a minimum of one list per week
3.2 Specialty specific requirements of service departments
relevant to delivery of curriculum
Laboratory services including microbiology and pathology,
Paediatric radiology
Access to specialised feed unit (or feeding team) to provide accurate
formulation of feeds and/or teaching of parents
3.3 Specialty specific requirements of clinical networks:
Outreach clinics with other paediatric depts and transition clinics per year
3.4 Specialty specific requirements of related clinical departments
that are involved in delivery of the curriculum:
A minimum of one consultant in metabolic medicine who can visit and
advise on in and out patient management
A minimum of one consultant in immunology who can visit and advise on
in and out patient management
Paediatric Guidance Checklist Gatroenterology and Hepatology
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3.5 Specialty specific requirements of related clinical departments
that are involved in delivery of the curriculum:
For HEPATOLOGY ONLY
Paediatric Intensive Care
Interventional radiology
Paediatric oncology
Paediatric respiratory physicians (esp Cystic fibrosis)
Paediatric cardiology
Anaesthesia for hepato-biliary surgery and minor procedures such as liver
biopsy, endoscopic banding of oesophageal varices
4. Educational activities and training - For both gastroenterology
and hepatology
4.1 Specialty specific clinical exposure required to provide
sufficient learning opportunities(NB if giving workload data ensure it is explicit
whether this is number per annum or number trainee would be expected to be exposed to over entire
programme):
technique of endoscopy
teaching from dieticians, nutritional nurse specialist,
pharmacist and senior colleagues re modes of nutritional
support

training in anthropometrics

evaluation of patients referred by other teams with
gastroenterological or hepatological symptoms
4.2 Specialty specific requirements for structured training
opportunities to include courses:
Attendance of at least one winter meeting in 2 years of the British Society
of paediatric gastroenterology, hepatology and nutrition (BSPGHAN)
Attendance at the regional specialty trainee day (held once a year)
4.3 Specialty specific requirements for other experiential
learning(excluding clinics and ward rounds):
observe practice and receive teaching from specialist staff (for example
nutritional care nurses, pharmacist, dieticians, endoscopy nurses and
radiographers) in the following:

passing and programming an oesophageal pH probe,

aseptic technique used in changing the parenteral nutrition
bag in a patient on intravenous nutrition,

prescribing parenteral nutrition

preparation of a specialised enteral feed,

cleansing and sterilising of an endoscope,

performance of an abdominal ultrasound
4.4 Specialty specific requirements for other experiential learning
Gastroenterology only:

familiarity with changing a gastrostomy tube

understanding of indications and limitations of manometry


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5. Working patterns - For both gastroenterology and hepatology
5.1 Safe cover arrangements for paediatric department out of hours in
line with RCPCH guidance
5.2 Evidence of compliance with existing employment working time
5.3 Working intensity and pattern that is appropriate for learning
5.4 It is unlikely that sufficient access to the sub-specialty will be given if
more than 1/3 of hours are spent outside specialty
5.5 the post forms part of a complete paediatric training programme which
provides a minimum of 5 years acute clinical experience, including out of
hours duties
6. Specific Post requirements
6.1 Gastroenterology only
For Specialist Registrars - 30 months in gastroenterology and 6 months of
hepatology. 12 months of gastroenterology training may be taken as
research provided that the project is agreed in advance, and is related to
gastroenterology, and that the training standards in curriculum and skills
and procedures are accomplished in the 18 months remaining of
gastroenterology training.
For Specialty Training – minimum of 24 months clinical training to include
6 months hepatology. In a 3 year programme a further 12 months maybe
clinical or research in appropriate settings
6.2 Hepatology only
For Specialist Registrars - 30 months in hepatology and 6 months in
gastroenterology. 12 months of hepatology training may be taken as
research provided that the project is agreed in advance, and is related to
hepatology, and that the training standards in curriculum and skills and
procedures are accomplished in the 18 months remaining of hepatology
training.
For Specialty Training - minimum of 24 months clinical training to include
6 months gastroenterology. In a 3 year programme a further 12 months
maybe clinical or research in appropriate settings
7. Enabled to learn new skills, necessary skills and curriculum
coverage (speciality specific)
7.1 GASTROENTEROLOGY Specialty specific marker conditions
trainee should be exposed to:
Minimum of 50 cases of inflammatory bowel disease per year (25 new
cases and 25 follow up cases)
10 children with intestinal failure per year (of which 5 are new cases)
7.2 Specialty specific skills/procedures trainee needs to complete
in gastroenterology only: for the whole training programme
100 upper GI endoscopies and
75 colonoscopies to be completed by trainee
7.3 HEPATOLOGY Specialty specific marker conditions trainee
should be exposed to:
30 new neonatal jaundice patients per year
8 patients with acute liver failure per year
7.4 Specialty specific skills/procedures trainee needs to complete
in hepatology only: for the whole training programme
100 upper GI endoscopies (half with portal hypertension)
75 liver biopsies (50 supervised liver biopsies and 25 unsupervised)
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8. Access to clinics and ward rounds & long term care of patients
8.1 GASTROENTEROLOGY Specialty specific numbers and types of
clinics expected to attend::
1 gastroenterology outpatient clinic per week
400 outpatient episodes in 2 years
8.2 Specialty specific combined clinics gastroenterology trainee is
expected to attend:
3 combined specialties clinic per year (eg with: endocrinology, hepatology,
paediatric surgery)
3 clinics where home PN patients are reviewed per year
8.3 Specialty specific ward rounds – gastroenterology:
4 ward rounds per week (1 should be a consultant led MDT meeting and at
least 2 ward rounds should be conducted independently by trainee)
8.4 Specialty specific involvement in transitional care gastroenterology:
Management of IBD in transitional care
At least 2 transition clinics per year
8.5 HEPATOLOGY Specialty specific numbers and types of clinics
expected to attend including outreach clinics:
1 liver outpatient clinic per week (to include cases of viral hepatitis)
1 related medical disorders affecting the liver clinic per month (eg
metabolic liver disease)
250 outpatient episodes in 2 years for recipients of liver transplants
150 outpatient episodes in 2 years for other forms of liver disease
(patients will include those with neonatal hepatitis, autoimmune hepatitis,
viral hepatitis, post Kasai portoenterostomy)
8.6 Specialty specific combined clinics hepatology trainee is
expected to attend:
3 combined specialties clinic per year (eg with: gastroenterology, cystic
fibrosis, metabolic medicine)
8.7 Specialty specific ward rounds – hepatology:
4 ward rounds per week (1 should be a consultant led MDT meeting and at
least 2 ward rounds should be conducted independently by trainee)
8.8 Specialty specific involvement in transitional care hepatology:
Management of liver transplant recipients and autoimmune liver disease in
transitional care
At least 2 transition clinics per year
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9. Meetings
9.1 GASTROENTEROLOGY - Specialty specific number and types of
MDT meetings expected to be exposed to:
meetings on the management of IBD (in ward round)
meetings with paediatric surgeon especially neonatal surgical cases (either
in ward round or separate review)
meetings on the management of intestinal failure (with pharmacist
present)
9.2 Specialty specific multi-professional meetings trainee is
expected to be exposed to:
Gastrointestinal disorders affecting the liver e.g. short gut, intestinal
failure associated liver disease – 3-6 cases, one or more meetings per year
9.3 Speciality specific other meetings:
at least 2 specialist conferences per month (e.g. in radiology and
pathology) with opportunity to present clinical cases at PG meetings
including clinico-pathological conferences
9.4 HEPATOLOGY Specialty specific number and types of MDT
meetings expected to be exposed to:
weekly meetings on the suitability of patients for liver transplantation (and
present at least 10 candidates for liver transplantation per year)
9.5 Specialty specific multi-professional meetings trainee is
expected to be exposed to:
Malignancy affecting the liver – protocols for evaluation and stages of
treatment – 3-6 cases per year (one or more meetings)
Intravenous nutrition; complications which involve the liver – 3-6 cases
per year (one or more meetings)
9.6 Speciality specific other meetings:
at least 2 specialist conferences per month (eg in radiology and
pathology) with opportunity to present clinical cases at PG meetings
including clinico-pathological conferences
10. Clinical audit
For both gastroenterology and hepatology
10.1 Evidence of trainees participation in clinical governance (at least 1
full audit/year and attendance at critical incident meetings)
10.2 Evidence of trainees participation in clinical guideline development
10.3 Specialty specific audit requirements e.g. participation in BSPGHAN
national audit programmes (i.e. IBD registry and British Intestinal Failure
Registry)
11. Teaching appraising and assessing
For both gastroenterology and hepatology
11.1 Opportunities for formal and informal teaching
11.2 For senior trainees: opportunities for involvement of assessment of
others
11.3 For senior trainees: opportunity to be involved in the appraisal of
others
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12. Research
For both gastroenterology and hepatology
12.1 Provide formal teaching on research ethics and research
methodology
12.2 Provide opportunities to be involved in clinical research
12.3 Support for trainee to submit an abstract to a scientific meeting
12.4 Support for trainee to publish a case report/series
13. Management
For both gastroenterology and hepatology
13.1 Opportunities to be involved in management e.g. participation in
management meetings and projects including attendance at specialty
business meetings
13.2 Specialty specific requirements
participation in Trainees group, opportunity to stand or vote for trainee’s
representative in PGHAN CSAC, BSPGHAN and organise post-graduate and
associate members day at BSPGHAN winter meeting
Xref
Comments
This check list was reviewed by the PGHAN CSAC committee
Dr H Jenkins, Dr S Beath, Dr A Thomas, Dr S Protheroe and
Dr J Puntis, Dr R Srinivasan (Trainee rep).
Dr P McKiernan also kindly advised on the hepatological
aspects on behalf of the Liver Steering Group (BSPGHAN).
12 September 2008
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