APPENDIX 5 MBCHB CURRENT LEARNING OBJECTIVES. Appendix 5 166

Transcription

1 APPENDIX 5 MBCHB CURRENT LEARNING OBJECTIVES Appendix 5 166

2 CORE CURRICULUM IN CHILD HEALTH This document is a guide for undergraduates, and summarises the key knowledge, skills and attitudes that it is expected that a student will acquire by the time he or she qualifies as a doctor Some of this core curriculum is covered in the earlier years during P.B.L. sessions, specially teaching sessions in Years 1-3. Other parts may be covered during the period spent in General Practice. Appendix 5 167

3 GENERAL OBJECTIVES By the end of year 5 students should be equipped with knowledge about the health and diseases of children, clinical skills to apply this, and attitudes relevant to their care. Students should be able to: demonstrate their ability to identify the main causes of the common and important presentations of illness, considering physical, psychological and social aspects, and use clinical reasoning to reach an appropriate provisional diagnosis, in infants, children and adolescents by taking a history: from carers about a newborn baby, an infant, a toddler from an older child and/or his or her parent from an adolescent take a history appropriate to acute and chronic illness and developmental and behavioural problems take an appropriate family history have a sound knowledge of normal child and adolescent development, including psychological, social, emotional and sexual development recognise the seriously ill infant, child and adolescent and know how to take immediate action elicit normal and abnormal physical signs to make a diagnosis use investigations appropriately to confirm a diagnosis recognise the possibility of genetic disease be aware of the effect of carer s beliefs and attitudes on the presentation have a general knowledge of normal variations in child and adolescent behaviour formulate a management plan, if necessary using information sources, appraise evidence and apply the conclusions for the care of infants, children and adolescents appreciate the team approach to child health in community, school and hospital give advice to parents about normal infant care Appendix 5 168

4 SPECIFIC OBJECTIVES: by the end of the course the student should be able to Epidemiology & Community Child Health define infant, perinatal, neonatal and childhood mortality have a general knowledge of the childhood origins of adult disease explain to parents the benefits and schedule of immunisation and describe its scientific basis give advice to parents about injury prevention participate in health education available to children know about the legal framework for child protection in Scotland debate the general principles of screening and their application in paediatrics have a general knowledge of the common causes of childhood and adolescent illness and mortality in Scotland understand the nature of socioeconomic patterning of child health 1.2 Nutrition and Feeding know the advantages of breastfeeding and how to overcome common difficulties make-up and give a bottle feed give advice to parents about infant weaning understand fluid and electrolyte requirements of the ill neonate and child recognise and assess obesity know how to choose between enteral and parenteral nutritional support of the chronically sick child Appendix 5 169

5 1.3 Investigations relevant to Diseases in Childhood recognise the basic radiological features in childhood of: hyaline membrane disease pneumothorax pneumonia pleural effusion intestinal obstruction - dilated bowel loops fractures and relate them to the underlying pathology know the value and use of ultrasound and CT in diagnosis of intracranial disease (hydrocephalus) and renal tract disease measure height, weight and head circumference, plot these on appropriate charts and interpret the results 1.4 Neonatal Problems carry out a routine examination of a newborn baby and identify variations from normal know the principles of gestational assessment recognise neonatal jaundice, describe the underlying biochemical disturbances and appropriate management recognise cyanosis and outline the causes and management to parents feed and change a baby recognise the common cause of failure to establish feeding and delay in passing meconium recognise respiratory distress, assess severity and refer appropriately Appendix 5 170

6 1.5 Congenital Abnormalities recognise and explain to parents the principles of management of the commoner congenital abnormalities obtain the information necessary to provide genetic counselling know the principal environmental and genetic causes of birth defects 1.6 Growth and Developmental Child Health recognise failure to thrive, its common causes and initiate investigation make a developmental assessment of the infant and toddler recognise delay in speech and in walking examine a child for hearing loss, including distraction testing examine a child for reduced visual acuity and squint recognise the normal pattern of infantile, childhood and pubertal growth outline to parents the facilities available for children with mobility difficulties recognise short stature and refer appropriately recognise early and delayed puberty and discuss the causes and investigation with patients and parents 1.7 Child and Adolescent Psychiatric Disorders recognise the common presentations of psychiatric disorder in children and adolescents and distinguish the common causes recognise the interaction between child and family upon the psychological disorders of childhood discuss attachment theory recognise the common disorders of childhood and adolescent psychological development recognise the impact on children of physical/mental illness in a parent recognise the psychological aspects of chronic physical illness in children and adolescents recognise the social and emotional issues in adolescence with chronic illness discuss problem of school attendance with a child and its parents Appendix 5 171

7 1.8 Respiratory Disease recognise the common causes of breathlessness at different ages diagnose asthma in the school age child measure peak flow rate and instruct the older child in the technique manage asthma in childhood according to BTS guidelines discuss with parents and older children the causes and management of asthma instruct parents and children in the use of appropriate inhaler devices give advice to parents on the management of upper respiratory tract infections recognise acute and chronic stridor and refer appropriately recognise the likelihood of lower respiratory infection recognise the presentations of cystic fibrosis in infancy, childhood and adolescence 1.9 Cardiovascular Disease measure the blood pressure in infancy, childhood and adolescence recognise the possibility of cyanotic and acyanotic cardiac disease at different ages recognise congestive cardiac failure understand the principle modalities used to investigate congenital heart disease 1.10 Gastrointestinal Disease recognise the common causes of vomiting in infancy, childhood and adolescence and initiate management recognise the common causes of acute and chronic diarrhoea in infancy, childhood and adolescence and initiate management recognise the common causes of constipation in infancy, childhood and adolescence and initiate management give advice to parents on gastroenteritis, including oral rehydration therapy make an initial assessment of a child with acute abdominal pain and refer appropriately recognise the common causes of acute, chronic and recurrent abdominal pain recognise the common causes of abdominal mass in infancy, childhood and adolescen Appendix 5 172

8 1.11 Renal and Genitourinary Disease recognise oedema in infancy, childhood and adolescence, discuss its causes and management with parents recognise a history of haematuria, and initiate investigations recognise polyuria, initiate investigations and know principles of treatment of urinary tract infection identify the commoner causes of bedwetting and give advice to parents examine the inguinal and scrotal regions and distinguish between a hernia and hydrocele understand the normal development of the foreskin and labia/vulva, recognise abnormalities and initiate treatment of balanitis and dysuria have knowledge of normal descent of the testis, recognise abnormalities and know management of retractile and undescended testis fit a urine bag, obtain a specimen for testing explain suprapubic aspiration to parents recognise and interpret the urine abnormalities in urinary infections 1.12 Central Nervous System Diseases take a history of febrile convulsions recognise epilepsy in infancy, childhood and adolescence outline to parents the nature, treatment and prevention of febrile convulsions and epilepsy examine a floppy baby and discuss the nature of the problem with parents recognise the possibility of meningitis and initiate management recognise and interpret the CSF abnormalities of meningitis recognise the common causes of abnormalities in gait in infancy, childhood and adolescence know the common causes of delayed development in early life appreciate the contribution of physiotherapist, dietician, occupational therapist, social worker and community paediatrician to the care of the child with cerebral palsy know the causes and recognise the signs of raised intracranial pressure in infancy and childhood recognise spina bifida and its associated problems Appendix 5 173

9 1.13 Haematological Disorders assess anaemia in infancy and childhood assess a child with bruising recognise Lymphadenopathy 1.14 Metabolic Disease diagnose and assess diabetes mellitus outline to parents and child the management of childhood diabetes give dietary advice and the principles of insulin treatment perform ward-based blood and urine tests and interpret the results understand the principles of screening for, and dietary management of phenylketonuria recognise and investigate hypothyroidism 1.15 Skin Disease recognise the common skin conditions in infancy, childhood and adolescence 1.16 Trauma in Children recognise the common fractures that occur in children know the main potential complications of common childhood fractures know the principles of safe splintage assess the significance and sequelae of head injury in infancy and childhood be aware of non-accidental injuries (including sexual abuse) and know the outline strategy for handling them know the principles underlying management of thermal injury (burns), and chest/abdominal injury 1.17 Limping Child examine the child with a painful hip or knee outline treatment to the child and family recognise the child who needs immediate hospital admission know the main features of chronic and septic joint diseases initiate appropriate investigations, in particular which X-rays are required Appendix 5 174

10 1.18 Infectious Disease and Immunology recognise the early signs of meningococcal disease know when to suspect immunodeficiency know the symptoms and signs of the common exanthematous diseases of childhood 1.19 Diseases of Ear, Nose and Throat use an auroscope to examine the ear drum examine the nose and throat of a child differentiate serous otitis media from acute otitis media differentiate viral sore throat from tonsillitis diagnose sensory neural deafness in infancy and childhood Portfolio cases that are principally concerned with child health (from the GU Master List of Clinical Presentations) 1.1 A sick neonate 1.2 An infant with failure to thrive 1.3 An injured child 1.4 A hyperactive child 1.5 A dysmorphic infant 1.6 A child with constipation 1.7 A wheezing child 1.8 A child with bed-wetting 1.9 A child with a fever 1.10 An infant with delayed development 1.11 A child with a fit, faint or funny turn 1.12 A collapsed child 1.13 A child with abdominal pain and vomiting Appendix 5 175