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Transcript
SAUDI BOARD OF PEDIATRIC INFECTIOUS DISEASES TRAINING PROGRAM The Kingdom of Saudi Arabia is a very rapidly developing country with significant improvement of health services. Disorders caused by a variety of infectious agents constitute one of the major causes of morbidity and mortality in Saudi children. Furthermore, the field of infectious diseases is one of the very markedly progressing subspecialties. Over the past two decades, marked progress has occurred in diagnostic, preventive as well as therapeutic modalities. Furthermore, the list of newly discovered infectious agents and rapidly changing disease syndromes, as well as newly introduced antimicrobial agents are ever . . lllcreaslllg. Based on these, there is a growing demand for a national trallllllg program to provide pediatricians with all the necessary training towards acquisition of Saudi Board in Pediatric Infectious Diseases, after which the trainee will be competent in the management of various infectious disease problems in infants, children and adolescents and will acquire a mature understanding of the related social economical and environmental aspects. The program consists of two years of full-time structured supervised training in Pediatric Infectious Diseases. This will involve admission to an approved joint program with rotations in hospitals accredited for training in Pediatric Infectious Diseases. 1. Become competent in the management of infections in infants, children and adolescents. 2. Acquire adequate knowledge and ability to interpret data originating from the clinical microbiology laboratory. 3. Become self-disciplined, self-dependent learners and to serve as consultants to other services and be able to provide an educational environment that will promote a high standard of health care. 4. Perform research and emphasize the research-oriented approach to new problems. 5. Reach an international acceptable standard with appropriate attitude and medical ethics. A. B. Etiology, pathogenesis, natural history, pathology, clinical features and management of the following: a.l Acute illnesses due to a wide variety of microbial agents including the acute communicable diseases occurring in the normal hosts. a.3 Common tropical and parasitic diseases, particularly malaria, leishmaniasis and schistosomiasis. a.5 Infections in the irnmunocompromised host including patients with acquired immune deficiency syndrome (AIDS). a.IO Infections in children with inborn errors of metabolism, genetic and other systemic disorders. The clinical and laboratory approach and differential diagnosis of complex problems in which infections may playa role, such as: b.2 C. acute rapidly progressive illness due to sepsis from an undefined site and Principles of epidemiology and public health and their application in the prevention and control of: c.l infection within the community including knowledge about reservoir, transmission, sanitation and vector control, and the role of public health authorities at local, national and international levels; and c.2 D. hospital acquired infections including knowledge about chemoprophylaxis, disinfection and sterilization and infectious waste management. General knowledge and technical skills in all principal areas of diagnostic microbiology, virology and parasitology, including knowledge of appropriate diagnostic material for most diseases or syndromes and ability to differentiate normal flora from pathogenic organisms. e.l details of humoral, cell mediated and phagocytic responses to microbial colonization and invasion in the normal and abnormal host; e.2 pathogenic mechanisms by which immune responses facilitate or prevent disease; and e.3 principles and practice of immunization techniques together with adverse effects and efficacy of immunizing agents. G. An appreciation of the infectious diseases literature with the ability to critically evaluate it. H. Research experience with both clinical and laboratory investigation and the expectation that these data will be published in a refereed journal. I. Educational skills as demonstrated by the ability to teach infectious diseases to patients, trainees and colleagues as well as the ability to write informative consultation notes. 1. Possess a certificate of the Saudi Board of Pediatrics or an equivalent recognized degree, or has successfully completed the written component of the Final Saudi Board of Pediatrics. 3. Provide three letters of recommendation from consultants with whom the candidate has recently worked with for a minimum period of six months. 4. Provide written permission from the sponsoring institution of the candidate allowing him to participate, on full time basis, for the entire period of the program. For any hospital to be accredited to participate in the training program in Pediatric Infectious Diseases, the following requirements must be fulfilled: 1. Full accreditation for Pediatrics training by the Saudi Council for Health Specialties The fellowship program director should be a Pediatric Infectious Diseases consultant certified by the Saudi Board of Pediatrics or its equivalent in general pediatrics and preferably certified or at least eligible for certification by an international recognized scientific body in the field of Pediatric Infectious Diseases with a minimum of three years of post training experience and a background in research with a record of publications. b) A minimum of two full-time Pediatric Infectious Diseases consultants (including a program director) who have had at least two years of fellowship training in an accredited infectious 1. Adequate number of consultations involving immunocompetent and immunocompromised children (at least 250 consults per year) to ensure adequate exposure to infectious diseases problems in various hosts. A record of these consultations should be maintained. 11. In-patients, intensive care (including neonatal intensive care) and ambulatory care facilities. 111. Fully equipped, high standard and staffed microbiological laboratory facilities with the ability to perform diagnostic bacteriology, parasitology, virology, mycology and specialized serological tests. In addition to a laboratory facility capable of performing diagnostic immunologic and molecular tests. IV. Supportive services such as a diagnostic and interventional radiology unit and a pathology laboratory. a. Library facilities with ready access to all major infectious disease journals and literature search facilities. Pediatric Infectious Diseases program is a two year program, during which the trainee rotates through various rotations. Those rotations include clinical services (14 months, including 2 months in adult services), microbiology(4 months), infection control (1 month), clinical immunology( 1 month), research(1 month) and an elective rotation (1 month). The candidate is eligible for one month annual vacation. 1. acquire a broad overview of basic sciences of infectious diseases (e.g., microbiology, immunology, pathogenesis, pharmacology, etc). 2. have adequate knowledge of common pediatric infectious disease problems. Consultation Service( minimum) General Microbiology, parasitology Virology-Molecular, serology T.B/ Mycology Vacation 6 months 6 weeks 3 weeks 3 weeks 1 month The rest of the first year will be left for the program director to assign the fellow to any rotation of the program. 1. acquire a high level of understanding of basic sciences and its application to management of infectious disease problems. 2. learn the approach to investigate and manage complicated and rare infectious diseases During this year, the trainee will have a month of training in the microbiology laboratory (2 weeks bacteriology, 1week virology and a week in TB/ Mycology). He/She will also complete the rest of rotations not done during the first year. The elective rotation may be spent for tropical medicine or other aspects of infectious diseases felt necessary by the program director. The program should offer a broad range of clinical experience. In addition to consultations in the general and subspecialty pediatric services, the program should also offer consultations to the surgical subspecialties, the Pediatric and Neonatal Intensive Care Units and the various transplantation programs. Exposure to adult infectious diseases is undertaken through rotations in an Adult Infectious Diseases Training Program or an organized adult, infectious diseases service supervised by a qualified Adult Infectious Disease specialist. Trainees should have the opportunity to assume responsibility for patient care over a sufficiently long period to observe the natural history of the disease and the benefits and complications of therapy. Organized outpatient clinics should be available for the investigation and treatment of infections not requiring hospitalization, as well as for followup of inpatients after discharge from the hospital. Trainees are given the opportunity to observe the infection control unit organization and function. They should actively participate in the Hospital Infection Control Program and attend the meetings of the Hospital Infection Control Committee. The trainee is expected to learn: • the role of microbiology laboratory in infection control and surveillance. • isolation guidelines and methods of prevention of nosocomial infections • epidemiology and laboratory investigations of nosocomial outbreaks, including biotyping, phage typing, plasmid analysis, etc. Trainees should spend 4 months full-time in diagnostic microbiology and molecular techniques under the supervision of a certified microbiologist in an accredited laboratory for training in Medical Microbiology. • Routine techniques including use of different culture media, specimen collecting and primary inoculation, and various staining techniques. • Bench experience and familiarity with special isolation and identification techniques related to urine, respiratory, blood, tissue, and body fluid, enteric and anaerobic bacteriology. • Specimen collection, transport and media for fungi and mycobacteria. • Rhodamine staining for AFB and antibiotic sensitivity testing for mycobacteria. • Identification of common fungi including candida, aspergillus, cryptococcus; fungal serology and antigen detection. • Stool examination for ova, trophozites, and larvae; concentration techniques; string test; special stains and serology. • Virus isolation for herpes viruses, respiratory viruses, and enteric vIruses • Chlamydia and mycoplasma isolation and antigen detection systems. • Quantitative bacteriology, rapid diagnostic techniques, ELISA, immunofluorescence, DNA probes, electron microscopy, etc. Trainees are expected to participate in the research activities of the Section of Paediatrics Infectious Diseases and by the end of his/her training he/she should: 1. 2. 3. complete one research project prepare and submit at least one manuscript to a referreed journal or present a paper in a scientific meeting locally or internationally 1. 2. 3. 4. Case presentations and discussions Infectious Diseases Grand Rounds Microbiology Plate Rounds Infectious Diseases Journal Club 5. 6. 7. 8. Didactic lectures in basic science and core topics such as: i. structure of bacteria ii. principle of antimicrobial therapy including pharmacokinetics and pharmacodynamic. Ill. host response to infection Morbidity and mortality meetinglrounds City-wide Infectious Diseases/Microbiology Club Meeting National and international symposia/conferences The fellows should be given the opportunity to develop effective teaching skills. This should be achieved through daily rounds and informal group discussions in addition to formal teaching sessions and via the written consultation report. 1. Trainees are required to take calls for the Infectious Disease Service with a maximum of two weeks per month including two weekends. 2. Fellows are entitled to four weeks vacation annually and a maximum of ten days for both Eid holiday and emergency leave. 3. Sick and maternity leave should be compensated for during or at the end of training. Evaluation of knowledge and performance of trainees through an established committee using regular written records detailing the progress of each trainee at least twice per year is required. 1. Knowledge of history taking in infectious diseases and ability to perform a comprehensive and accurate physical examination. 111. Knowledge of basic and clinical aspects of Pediatric Infectious Diseases. 1. Il. Ill. Formal evaluation forms after each rotation. Documentation of attendance and participation in academic activities. In-training evaluating examination done at the end of the first year. To be promoted to the second year, the candidate fellow must have passed his/her general pediatrics clinical examination. By the end of the first year the trainee should pass the evaluation and examination conducted by the local supervisory committee. If failed, the trainee should repeat the first year. Failing the second attempt the trainee will be dismissed from the program. I. To be admitted to the final subspecialty examination, the candidate must be certified in Pediatrics. II. Upon the completion of two years of training in Pediatric Infectious Diseases in an accredited training program, a final certifying examination will be conducted by Saudi Council of Health Specialist. The components of the final examination will include: 1. 2. written examination clinical/oral examination Upon completion of the training and passing of the final examination the trainee will be awarded the Certificate of "Saudi Subspecialty Certificate in Pediatric Infectious Diseases". (i) (ii) (iii) (iv) (v) Textbook of Pediatric Infectious Diseases - Feigin & Cherry Infectious Diseases of the Fetus and Newborn - Remington & Klein Pediatric Infectious Diseases - Moffet Principle and Practice of Pediatric Infectious Diseases - Long & Others Principle and Practice of Pediatric Infectious Diseases (vi) (vii) (viii) (ix) A Practical Approach to Infectious Diseases - Reese & Betts Principle & Practice of Infectious Diseases -Mandell Tropical and Geographic Medicine - Warren & Adel Mahmoud Hunter's - Tropical Disease (i) (ii) Medical Microbiology - Sherris Medical Microbiology - Mims (i) (ii) Red Book MWWR - special issues (i) (ii) (iii) (iv) (v) Seminar in Pediatric Infectious Diseases - 4 issues/year Advances in Pediatric Infectious Diseases - once/year Infectious Diseases Clinic ofN.A. Current Opinion in Infectious Diseases (All issues - August: Ped) Current Opinion in Pediatrics (February) (i) (ii) (iii) (iv) (v) (vi) (vii) The Pediatric Infectious Diseases Journal Clinical Infectious Diseases The Journal ofInfectious Diseases The Canadian Journal ofInfectious Diseases New England Journal of Medicine Journal of Pediatrics Pediatrics