Criteria Paediatrics

Criteria for Registering as Paediatrician in Malaysia Any doctor can request to be registered as a paediatrician if he/she fulfils ALL the following requirements: 1

A recognised basic medical degree

1.1 2

2.1. 2.2. 2.3 2.4 2.5 2.6 2.7

A basic medical degree recognized by the Malaysian Medical Council A recognised postgraduate qualification One of the following paediatric postgraduate degrees recognized by the Malaysian Paediatric Specialty Committee: M.Med (Paed) awarded by Universiti Malaya, Universiti Kebangsaan Malaysia or Universiti Sains Malaysia MRCP (UK) up to year 2000 MRCPCH by Royal College of Child Health UK MRCPI (Ireland) FRACP M.Med in Paediatrics (Singapore) Any other equivalent paediatric postgraduate degree recognised by the Malaysian Paediatric Specialty Committee on a case to case basis

3 3.1

Completed postgraduate training in recognised centres Minimum duration of training

3.1.1

Completion of a minimum of 4 years of paediatric training in centres which fulfilled the criteria stipulated by the Malaysian Specialty Committee (refer to Appendix A) and under the supervision of trainers who fulfilled the criteria stipulated by the Malaysian Specialty Committee This period of training does not include the time the applicant spent during his/her housemanship period.

3.1.2

The period of training received by the applicant can be either before or after acquisition of the above postgraduate degrees.

3.2

Evidence of satisfactory postgraduate training as supported by:

3.2.1

Log book of core procedures (refer to Appendix B)

3.2.2

Portfolio, if any

3.2.3

Satisfactory supervisors’ reports on Clinical Core Competency (referred to Appendix C) and core procedures (Appendix B)

3.3

For those practicing full time in the field of paediatrics and who obtained their post graduate paediatric qualification as listed above at 1st September 2006 or earlier, their application will be considered without the need for submission of log book and supervisors’ report stipulated in 3.2.1 and 3.2.3if they fulfill ONE of the following criteria:

3.3.1 Have been gazetted as a paediatricians by the Ministry of Health of Malaysia. They are to submit a copy of the gazettement letter. 3.3.2 Have been registered as a paediatrician in the Specialist Register of the Academy of Medicine of Malaysia

3.3.3. Have at least 4 years of supervised training in Paediatrics. References from two credentialed paediatricians are required. 3.3.4. Have practised paediatrics full time for at least 5 years with certificate of good standing from MMC. References from two credentialed paediatricians are required.

Appendix A

Criteria of a centre where training in Paediatrics is recognised by the Malaysian Paediatric Specialty Committee (NB: This applies to applicants who were trained in overseas centres. For applicants trained in Malaysia, please refer to the list of centres accredited for training by the Paediatric Subspecialty Committee.)

A. HOSPITAL Work load and services 1. Name of Hospital ________________________________________ (If you have been trained at a purpose built Children’s Hospital, omit items 2-5) 2. Total number of beds in the hospital (minimum 500)

_________ beds

3. Occupancy rate of beds in the hospital (occupancy rate >60%)

__________%

4. Total number of in-patients in the hospital per year (Minimum 20,000)

_________ per yr

5. Total number of out-patients seen at the hospital per year (Minimum 100,000)

__________ per yr

6. Does the hospital have the following clinical and supporting departments: (Please tick) Medicine Yes [ ] No [ ] Surgery Yes [ ] No [ ] O&G Yes [ ] No [ ] Orthopaedics Yes [ ] No [ ] A&E Yes [ ] No [ ] Blood bank Yes [ ] No [ ] Pathology lab Yes [ ] No [ ] Microbiology lab Yes [ ] No [ ] Radiology department with ultrasound Yes [ ] No [ ] and contrast study facilities (These represent the minimum supporting departments that must be available) 7. Total number of accredited specialists/consultants in each of the following specialty in the hospital (At least one in each department) Consultants Physicians (Internal Medicine) Orthopaedic Surgeons Pathologists Anaesthesiologists

Number

8. Number of hospital clinical meetings (At least once a month)

Consultants Obstetricians/Gynaecologists General Surgeons Radiologists Microbiologists

_____ per month

Number

9. Does the hospital have a) night duty rooms for doctors Yes [ ] No [ ] Comments ______________________________________________________ ______________________________________________________ b) medical library Yes [ ] No [ ] Comments _______________________________________________________ _______________________________________________________ c) meeting room with audio-visual aids Yes [ ] No [ ] Comments _______________________________________________________ _______________________________________________________ B. Criteria of the PAEDIATRIC DEPARTMENT or CHILDREN’S/MATERNITY HOSPITAL 1. Total number of general paediatric beds _____ beds (Minimum 30 occupied beds daily. This includes HDU, ICU, day care & surgical beds PROVIDED the paediatric unit is actively involved in daily care) 2. Total number of neonatal beds (Minimum 15 occupied daily beds)

______beds

3. Does the hospital have Level III neonatal care Yes [ ] No [ ] Comments ___________________________________________________________ ___________________________________________________________ 6. Number of ventilators in the neonatal intensive care unit (Minimum 3 in use)

_____ ventilators

7. Total number of out-patients (general paediatric & neonates) per year ________per yr (Minimum 5,000/yr) 8. Number of service medical officers in Paediatrics unit (Minimum 2, excluding Master of Medicine candidates) 9. How many days per week does a Paediatrician visit each ward? (Minimum 5/week)

______ _____ days/wk

10. Total number of outpatient clinics per week _______ per wk (Minimum 4, including 2 subspecialty clinics) Please furnish a copy of the current weekly clinic schedule and call roster for the department 11. Departmental teaching activities Please furnish a copy of the department’s current weekly or monthly teaching activities a) Number of Journal club per month ______ per month (Minimum once/mth) Comments_____________________________________________________

_____________________________________________________ b) Number of clinical audit per month _______per month (Minimum once/mth) Comments _____________________________________________________ _____________________________________________________ c) Number of grand ward round per month ______ per month (Minimum once/week) Comments _____________________________________________________ _____________________________________________________ d) Number of department clinical conference per month ______ per month (Minimum once/fortnight) Comments _____________________________________________________ ____________________________________________________ e) Other teaching activities (please indicate type and frequency per month): 12. An accredited trainer/supervisor for training of paediatricians in Malaysia is one who has fulfilled all the criteria for registering as a Paediatric Specialist with the Malaysian Specialist Register( In future, this will be changed to one who has registered with the Malaysian Specialist Register) and has been practicing for at least 2 years in one of the Hospitals which fulfilled the criteria stipulated above. A trainer can only have 2 trainees at any one time.

Appendix B

Core procedural skills acquired by a specialist upon completion of training in Paediatrics Skills in resuscitation of newborn infants, as supported by a valid Certificate of successful training in Neonatal Resuscitation (NRP certificate) or its equivalent. Skills in resuscitation of children (a Valid Certificate of Paediatric Advanced Life Support is desirable) Core Procedure Skills on Completion of Specialist Training in Paediatrics Procedure

Completed

Signature of supervisors/designation

1

Lumbar Puncture

2

Chest tube insertion

3

Suprapubic aspiration of urine

4

Basic ventilation indication, set up Conventional CPAP

5

Surfactant administration

6

Endotracheal intubation

7

Central venous/long line insertion Femoral Jugular

8

Arterial puncture/cannulation

9

Bone marrow aspiration and trephine biopsy

10

Intraosseous cannulation

11

DC cardioversion/defibrillation

12

Peritoneal dialysis

13

Umblical artery and vein cannulation

14

Ultrasound brain Basic ECHO for LV function

15

Neonatal resuscitation NRP certified Pals certified

16

Exchange transfusion

17

Vaccination BCG IM injection SC injection Mantoux Test

Appendix C

Post Module Assessment Summary (To be completed after each module and a copy sent to the Credentialing Committee) Name of trainee: ………………………………………………….. Duration of Training: From …../…../………. till …../…../……… Assessment Summary 1 Poor 1

Clinical competence

a)

Inquiry skills

b)

Diagnostic ability

c)

Patient management

d)

Technical skills

2

Knowledge

3

Professional characteristics

4

Personal learning & assignments

5

Conduct & communication skills

6

Record keeping

7

Participation in Teaching-learning activities

a)

Ward round

b)

Clinic

c)

Case presentation

d)

Tutorial

e)

X’ray/CPC/Audit, Mortality conference etc

f)

Journal club

g)

Teaching ability

2 3 Borderline Satisfactory

4 Good

5 Excellent

8. Research and publication 8.1: Title of project:…………………………………………………… Initiated In progress Presented Published 8.2 Title of project:…………………………………………………… Initiated In progress Presented Published Comments

Overall Assessment: Fail / Repeat module / Pass / Satisfactory / Excellent

…………………………………….. Name & Signature of Trainer

………………….. Date

DEFINITIONS OF CORE COMPETENCY ASSESSMENT Please mark the box in the post-module assessment summary which corresponds with your observations in each category. Please judge according to the criteria outlined below and not according to your experience with other trainees under your supervision. The category “excellent” is the “gold standard” by which the student should be judged.

1. Clinical Competence a) Inquiry skills (obtaining data/information from history, physical examination and investigations ) Excellent:

Consistently elicits problem-related data from patient and other relevant sources, stresses important points, well organized approach. Consistently elicits and interprets correctly all signs, technical and organizational approach consistently good. Consistently plans and interprets investigations appropriate to the problem with attention to specificity, reliability, patient safety and comfort, cost and explains reasons for and nature of investigations to patient.

Good:

As above but less consistently.

Satisfactory:

As above, but sometimes concentrate on data not related to the problem, sometimes omits to consult other sources, occasionally misses important signs. Occasionally request investigations not appropriate to the problem and / or without attention to specificity, reliability, etc, sometimes miss important data.

Borderline:

Approach not well organized, not always problem related, frequently misses important data. Approach technically imperfect and not very systematic, frequently misses important physical signs. Frequently request investigations not appropriate to the problem and/ or without attention to specificity, reliability, patient safety, misses important data.

Paed-criteria/8/6/2007

Poor:

Approach not organized, frequently problem related, important data missed on most occasions. Approach technically unacceptable and not systematic, important signs missed on most occasions. Consistently makes inappropriate decisions in ordering investigations, consistently misinterprets and/ or misses important data.

b) Problem solving and decision- making skills Diagnostic ability Excellent:

Consistently makes careful reasoned deductions from available data (history, physical examination, investigations) to arrive at the appropriate decision.

Good:

As above, but less consistently.

Satisfactory:

As above, but occasionally makes incorrect deductions. Most times able to give correct provisional diagnosis but not all relevant differential diagnoses.

Borderline:

Frequently does not follow a logical approach to deduction from the available data, frequently gives incorrect provisional diagnosis.

Poor:

Illogical reasoning and deductions. Frequently makes incorrect diagnosis.

Patient Management Excellent:

Consistently suggests appropriate management, exhibits awareness of the role and possible complications of the proposed intervention (e.g adverse drug reaction, treatment morbidity), self-reliant and conscientious in approach, involves patient and family in management decisions.

Good:

As above, but less consistently.

Satisfactory:

As above, but occasionally suggests inappropriate management.

Paed-criteria/8/6/2007

Borderline:

Shows some lack of awareness of role of proposed interventions and their possible complications, is unsure/not conscientious in implementing management.

Poor:

Frequently makes inappropriate management decisions.

Technical skills Excellent:

Good:

Consistently carries out procedures and operative tasks with an appropriate level of technical skill and with due consideration for the patient. As above, but less consistently

Satisfactory:

As above, but is not equally skilled in all procedures

Borderline:

Not skilled in most procedures, occasionally exhibits lack of consideration and/or care and attention to detail.

Poor:

Serious lack of skill in a number of procedures, frequently exhibits lack of care and attention to detail, not considerate to patients.

2. Knowledge Excellent:

Consistently applies appropriate knowledge of basic and clinical sciences to the solution of patient problems. Demonstrates maturity and initiative for self-directed learning in problem solving.

Good:

As above, but less consistently

Satisfactory:

As above, but occasional gaps in knowledge and/or difficulty in application to patient problems. However makes effort to seek information.

Borderline:

Inadequate knowledge and/or difficulty in application to patient problems. Sometimes make effort to seek information.

Paed-criteria/8/6/2007

Poor:

As in borderline but lacks initiative in seeking information.

3. Professional Characteristics Excellent:

Shows evidence of professional qualities: accepting responsibility, being caring, thorough, reliable, available, punctual, trustworthy and respecting confidentiality

Good:

As above, but less consistently or as effectively.

Satisfactory:

As above, but with occasional deficiencies in professional qualities as defined above.

Borderline:

Frequently deficient in areas defined above.

Weak:

Consistently deficient in areas defined above.

4. Personal Learning and Assignments. Excellent:

Consistently manages own learning by asking questions and searching for the answer in journals, books and consultation, improves progress as a learner and as a future physician by seeking feedback and acting on the latter, willing to teach others, conscientious in completing assignments : case write ups, audits, log book, dissertation.

Good:

As above, but less consistently or as effectively

Satisfactory:

As above, but with occasional deficiencies in self directed learning, self monitoring

Borderline:

Frequently deficient in areas defined above.

Poor: Consistently deficient in areas defined above. 5. Conduct and communication skills Excellent:

Paed-criteria/8/6/2007

Consistently in communication with patients, listens and is sensitive to the needs of the patient; comforts the patients; gives equal priority to the person and the illness; establishes and maintains an open but objective relationship with the patient; recognizes

that the patient’s attitude to the doctor affects patient’s reactions/behaviour; provides clearly understood information. Consistently communicating/working with other professionals, is courteous, sensitive to needs of others; fulfils role in the team appropriately by collaborating readily with others; provides clear information, instruction/advice to others; readily accepts reasonable advice/criticism from others. Good:

As above, but less consistently or as effectively

Satisfactory:

As above, but with occasional deficiencies in communicating skills outlined above.

Borderline:

Frequently deficient in communicating skills outlined above.

Poor:

Consistently deficient in communicating skills outlined above.

6. Record Keeping Excellent:

Consistently records legibly, updates accurately patient’s problems and management progress, with emphasis on own observations, and provides regular informative summary of progress.

Good:

As above, but less consistently.

Satisfactory:

As above, but occasionally one or more aspects of record keeping inadequate.

Borderline:

Records are frequently illegible, not up-to-date, inaccurate, and poorly organized.

Poor:

Records are consistently inadequate according to above criteria.

7. Participation in Teaching-learning Activities.

Paed-criteria/8/6/2007