The paediatrics hospital term is essential for all registrars to develop competence in detecting and managing serious and potentially serious illness throughout childhood: in the neonatal period, infancy, early and middle childhood and, where relevant, adolescence and young adulthood. The accepted patient range is 0 – 17 years inclusive.
In routine general practice most children can be managed at home. This means that considerable responsibility lies with parents and medical advisers to ensure children don’t deteriorate to a point where significant morbidity or even mortality ensues.
In more severe presentations, hospital admission may be required after initial emergency management. Following hospital assessment, less severe cases can be managed in an ambulatory setting after coordinated transfer from an emergency department 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, registrars need to develop patient management skills, including co-management with parents, carers and ancillary medical staff.
You may find it’s not possible to do a specific paediatrics term; however, other options may be adequate alternatives, such as certain emergency terms. Talk to your training coordinator as early as possible if you think you’ll have difficulty completing the paediatrics requirement and they’ll support you to find an alternative. Please note that a hospital rotation located in a general practice does not count as a stand-alone paediatrics term.
An approved emergency department, for the purposes of paediatrics hospital training, must have a minimum 20% paediatric presentations. The registrar must then demonstrate that:
- they saw a minimum of 20% paediatric presentations
- the term provided sufficient experience in assessing and managing paediatric cases
- they gained adequate skills.
Emergency departments accredited for paediatrics by the Australasian College for Emergency Medicine (ACEM) automatically meet this requirement. For more information, visit the Where can I do my training? page on the ACEM website.
Requirements of the post
- Direct supervision by a paediatrician, an appropriately experienced GP, and/or an emergency medicine physician.
- A high proportion of paediatric emergency attendances.
- The opportunity to learn to recognise, diagnose, and manage the seriously ill child.
- The opportunity to see patients as the first point of medical contact (‘hands on’).
- The opportunity to follow up patients, where practical, during admission and after discharge (eg where there is an obligation to notify of an abnormal result received after discharge) to develop an appreciation of the complete natural history of acute illnesses.
- Exposure to a broad spectrum of acute paediatric presentations.
Specific competencies to be covered
You must demonstrate exposure to, and an understanding of, a range of the following clinical situations:
- Recognise and manage children with the following five acute clinical presentations, which represent the most common undifferentiated acute health problems:
- the febrile child
- the child with acute abdominal pain
- the vomiting child
- the child with breathing difficulties
- the dehydrated child.
- Recognise and initiate and/or continue the management of the following severe acute clinical presentations:
- the fitting child
- the child with altered consciousness
- the poisoned/bitten child
- the child presenting with trauma and/or burns
- the child at risk of abuse.
- Manage the sick child together with the family, carers and the extended healthcare team.
- Develop effective and appropriate safety nets with parents and carers to enable them to detect and manage a deteriorating situation and prevent any adverse outcomes.
- Communicate with children, young people and their families, and provide support, advice and follow-up.
Paediatrics evidence requirements
- In addition to providing an end-of-term assessment form and a statement of service from the JMO Manager (or equivalent), including the dates of the rotation, you must provide documentary evidence of completion of one of the following:
- a full paediatrics term (10–12 weeks) in an accredited post, such as general paediatrics or paediatric-only emergency department,
Note: completion of a full paediatrics subspeciality term (10–12 weeks) may not fully meet the RACGP paediatrics term requirements. This includes terms such as NICU, ENT, neurosurgery, surgery, cardiology, and many others. Please discuss this with your training program team, as you may need to complete some additional clinical experience and/or educational activities.
- a half paediatrics term (5–6 weeks) plus an approved full emergency department term (10–12 weeks)
- two terms in an approved emergency department
- the coursework and exam for the Sydney Child Health Program or Graduate Diploma in Child Health or Graduate Certificate in Child Health at the Sydney Children’s Hospital Network provided the registrar has also had adequate clinical exposure to children, such as one of the following:
- an approved emergency department term (10–12 weeks)
- a half paediatrics term (5–6 weeks)
- general practice hospital allocated rotation (10 weeks)
Note: evidence of completion must be provided prior to commencing general practice terms.
- If your paediatrics experience was gained at an approved emergency department, you must provide one of the following supporting documents to demonstrate adequate experience and safe practice in assessing and managing paediatric cases to satisfy the RACGP assessor that you have gained adequate skills:
- a signed RACGP Paediatric experience in a mixed emergency department declaration for each term
- A personal 2-week logbook for each 10-week rotation in a mixed emergency department. The logbook should include patient demographics, a brief summary and reflection and be signed off by a supervisor.
- evidence/de-identified data from the emergency department or hospital administration confirming that you managed a significant paediatric caseload with a minimum of 20% paediatric presentations during the rotation.