Paediatric Term Requirement

1. Introduction

This guidance details the paediatric requirements for a Registrar to be competent to commence training as a general practitioner in Australia (Standard 3.1, Outcome 3.1.2 and Criterion

2. Definitions

GP General Practitioner

RACGP Royal Australian College of General Practitioners

Registrar means a medical practitioner who is enrolled in the Vocational Training Pathway.

3. References

RACGP Vocational Training Standards

Vocational Training Pathway - Requirements for Fellowship Policy

4. Guidance

General practice training is a combination of hospital training and training in general practice and other community specialist settings under supervision. This enables Registrars to have a full understanding of the integration of primary and secondary levels of care.

Hospital rotations are to be undertaken in accredited hospital posts (criterion and be relevant to general practice. The Registrar must be able to provide evidence of a satisfactory level of performance in each rotation as determined by the hospital end of term report.

It is essential that the Registrar has adequate exposure to the discipline of paediatrics in a hospital environment (in addition to medicine, surgery and emergency medicine) sufficient to demonstrate safe practice in this area prior to commencing work as a GP under supervision.

Should exceptional circumstances result in a Registrar not achieving hospital training in paediatrics, requirements may be achieved through RACGP approved alternative means.

This document details the minimal training requirements with respect to acute presentations, rather than the wider range of skills potentially acquired during this period of training. It should be read in conjunction with the Curriculum Statement on Children and Young People’s Health (RACGP Curriculum for Australian General Practice ). Registrars should not lose sight of the overall learning objectives of the curriculum as they progress through training.

4.1 RACGP Vocational paediatric training requirements prior to commencing general practice training

4.1.1 Aims

Registrars require paediatric clinical experience prior to commencement of their General Practice Term 1 (GPT1) to support the development of competence in the detection and management of serious or potentially serious illness through the full spectrum of the neonatal period, infancy, early and middle childhood and also, where relevant, adolescence and young adulthood.

4.1.2 Content of paediatric clinical experience requirements

Clinical paediatric experience must include the recognition, diagnosis and management of the seriously ill child.

The Registrar must demonstrate exposure to and an understanding of the clinical situations listed below:

  1. Recognise and manage children with the following five acute clinical presentations:
    1. The febrile child.
    2. The child with acute abdominal pain.
    3. The vomiting child
    4. The child with breathing difficulties.
    5. The dehydrated child.
  2. Recognise and initiate and/or continue the management of the following severe acute clinical presentations:
    1. The fitting child.
    2. The child with altered consciousness.
    3. The poisoned/bitten child.
    4. The child presenting with trauma and/or burns.
    5. The child at risk of abuse.
  3. Registrars need to be able to:
    1. Manage the sick child in conjunction with the family unit, carers and the extended health care team.
    2. Develop effective and appropriate safety nets with parents and carers to enable them to detect and manage a deteriorating situation in such a way as to prevent any adverse outcomes.
    3. Communicate with children, young people and their families, as well as providing support, advice and follow-up.

If the clinical experiences listed above cannot be confirmed by the hospital report, Registrar’s must provide a selection of the following evidence sources to demonstrate exposure to and an understanding of the clinical situations listed above:

  1. patient presentation log
  2. self-evaluation
  3. education activity.

Rationale for content of paediatric clinical experience requirements

The two groups of acute problems (a and b above) present commonly in both hospital and general practice.

The first five (a) represent the most common, undifferentiated acute health problems.

In both hospital and general practice settings, all thirteen clinical scenarios can vary from mild to severe, with a diversity of symptom complexes and a highly variable threshold of recognition.

In routine general practice the majority of children with these conditions, especially those in the first group, are often able to be managed at home. This means that considerable responsibility rests upon parents and medical advisers to ensure children do not deteriorate to a point where significant morbidity or even mortality ensues.

In the second group the more severe presentations often require hospital admission after initial emergency management. Less severe cases following hospital assessment can be managed in an ambulatory setting after coordinated transfer from emergency departments or hospital to general practice and/or community services, when parents and carers take on a greater role.

Therefore, in addition to the specific skills needed to manage these presentations, some key generic patient management skills need to be developed including co-management with parents, carers and ancillary medical staff.

4.1.3 Paediatric clinical experience training post requirements

Paediatric clinical experience training settings

In a hospital setting, Registrars are most likely to be able to develop skills in the recognition and management of acute, life threatening conditions and those conditions which, without appropriate management, could result in death or cause severe morbidity. This clinical experience should include a high proportion of paediatric emergency attendances with appropriate supervision from paediatricians and/or appropriately experienced general practitioners and/or emergency medicine physicians prior to entering GPT1. Similar supervised prevocational training terms undertaken in a general practice or community setting may also provide some of this experience.

Not all paediatric training during general practice vocational training can or will be achieved during time in hospital-based paediatric posts. The majority of training and learning will occur during training terms based in general practice. Supervised paediatric clinical experience prior to GPT1 is required to provide patient safety experience in the general practice setting.

Requirements of emergency department terms approved for RACGP Vocational training paediatric clinical experience

In order to be approved for RACGP Vocational training paediatric clinical experience, emergency department terms must have a significant paediatric component with a minimum of 20% paediatric presentations. Evidence for this percentage can be supported through hospital administration reports or a personal patient log for a minimum of two weeks.

Paediatric clinical experience training post requirements

Paediatric clinical experience training posts must:

  1. Have general practice Registrars seeing patients as the initial contact doctor
  2. Provide authentic, first point of contact clinical paediatric experience (‘hands on’ experience)
  3. Provide the Registrars with opportunities to follow up patients where practical, during admission and following discharge in order to develop an appreciation of the complete natural history of acute illness
  4. Demonstrate a capacity to fulfil the educational objectives by providing sufficient exposure of the Registrar to an appropriate number and spectrum of acute paediatric presentations
  5. Have direct supervision from accredited supervisors
  6. Provide access for GP Registrars to educational resources. An example of an educational resource is the Sydney Child Health Program.

4.1.4 Paediatric clinical training posts that meet the RACGP paediatric training requirements prior to commencing general practice training

The RACGP paediatric training requirements prior to commencing general practice training requirement may be fulfilled in the following posts that meet the conditions listed above in 4.1.

A complete (10–12 weeks) Paediatric term in an accredited paediatric post.

  1. A half Paediatric term (minimum 6 weeks in length) with an approved full (10–12 week)
    Emergency Department term.
  2. Two approved emergency department terms as defined in 4.1. One term may be undertaken in Post Graduate Year 1 (PGY1) if the other is undertaken in Post Graduate Year 2 (PGY2) or later. In both cases the Registrar needs to be able to demonstrate sufficient experience in assessing and managing paediatric cases and the training provider needs to be satisfied that adequate skills have been gained.
  3. An approved emergency department term as defined in 4.1.3 and a Post Graduate Prevocational Placements Program (PGPPP) term with appropriate supervision and education components. One term may be undertaken in PGY1 year (provided a sufficient number and spread of paediatric cases were seen) if the other is undertaken in PGY2 or later. A PGPPP term does not count as a standalone paediatric requirement.
  4. Completion of the coursework and exam for the Sydney Child Health Program at the Westmead Children's Hospital (formerly the Westmead Diploma in Child Health) or any other RACGP Board of Censors approved course can also count as the paediatric component, as long as the doctor has also had some clinical exposure to children (for example an emergency department term or PGPPP term).

Any other College Board of Censors approved program which adequately addresses the required content in 4.1.2 with appropriate levels of educational content, clinical experience and assessment. All programs in this category seeking to fulfil the paediatric requirement must obtain approval from the Board of Censors.