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 ©Copyright
 Published: 29/11/2011

objectives for registrars

Introduction Clinical Assessment Procedures
Interpretation of Laboratory Tests Self-Directed Learning Presentation Skills

TRAINING PROGRAMME: Paediatrics

SPECIALTY: Neonatal Paediatrics

LENGTH OF ROTATION:

TRAINING YEAR:

CONSULTANT/TEAM:

HOSPITAL: National Women’s Health at Auckland City Hospital

Introduction

These educational objectives are intended to highlight areas of experience that you can expect to gain during this run to help better structure, direct and oversee your education.

Your progress and experience should be noted in a logbook that should be reviewed by the consultant team and your director of training at the middle and the end of the rotation.

1.  Clinical Assessment

Objective:

Listed below are some important topics that you will be exposed to on this run. By the end of the run, you should have a thorough understanding of these conditions including epidemiology, pathogenesis, presentation (history and physical examination), investigation and treatment (unless indicated otherwise.). This is not intended as an exclusive list:

  • Prematurity (including outcomes)
  • Adaptation at birth
  • Respiratory Distress Syndrome
  • Meconium Aspiration Syndrome
  • Neonatal sepsis (early and late onset)
  • Patent Ductus Arteriosus
  • Common Congenital Cardiac Lesions
  • Apnoea
  • Birth asphyxia
  • Neonatal seizures
  • Intraventricular haemorrhage
  • Hypoglycaemia
  • Hyperbilirubinaemia
  • Necrotising enterocolitis
  • Presentation of congenital anomalies
  • Common neonatal rashes
  • Neonatal nutrition and feeding

Evaluation:

To formally present babies newly admitted to the nursery on consultant ward rounds, including:

  • detailed maternal and antenatal history,
  • detailed history of the delivery and resuscitation,
  • description of progress of the baby,
  • formulation of a problem list, and
  • formulation of a management plan.

It is expected that there will be a discussion of all aspects of the history, examination, and management. The formulation of a problem list and management plan should be evidence-based.

A formal case presentation, similar to that of the examination long case format (a 10 minute concise presentation of history and examination followed by a 20 minute discussion of patient management with the consultant) may be appropriate for some infants. However, the registrar should seek out such suitable cases and approach the most appropriate consultant.

You should ensure that you have a good understanding of the management of the disorders presented. The names of the cases should be kept in your logbook and any written material should be kept in your learning portfolio.

2.  Procedures

Objectives:

To have observed or performed the following procedures. You should have a good knowledge of the indications, contraindications and precautions for these procedures. This is not intended as an exclusive list.

  • Examination of the newborn
    (including accurate length and head circumference measurement)
  • Orogastric/nasogastric tube insertion
  • IV cannula insertion
  • Arterial ‘stab'
  • Umbilical vein cannulation
  • Umbilical artery cannulation
  • Peripheral artery cannulation
  • Percutaneous CVL (longline) insertion
  • Blood Culture
  • Lumbar puncture
  • Suprapubic bladder aspiration
  • Urinary catheterisation
  • Bag and mask ventilation
  • Application of CPAP
  • Intubation (including securing of tube)
  • Ventilation (including HFOV)
  • Administration of Surfactant
  • Chest drain insertion
  • Transport of a ventilated neonate
  • Exchange transfusion (performed if possible)
  • Head ultrasound scan (observation only)
  • Cardiac ultrasound scan (observation only)

Evaluation:

You should keep a logbook of these procedures and code them as performed (P) or observed (O).

3.  Interpretation of Laboratory Tests

Objectives:

To be able to order the following laboratory or radiological investigations appropriately and to be able to interpret the results of such investigations.

Laboratory

Radiology

  • Full blood count
    • including left shift calculation
  • Blood gas
  • Electrolyte measurement
  • Serum bilirubin 
    • including conjugated fraction
  • Serum calcium, phosphate, and alkaline phosphatase
  • CSF biochemistry and cell counts
  • Therapeutic Drug Monitoring
    • Antibiotic levels
    • Anticonvulsant levels
    • Caffeine levels
  • Chest radiographs
  • Abdominal radiographs
  • Cerebral Ultrasound Scans

Evaluation:

Investigations will be evaluated during ward rounds, x-ray conferences, and the teaching sessions outline above.

4.  Self Directed Learning

Objectives:

To read around cases and to utilise existing resources (textbooks are available in the nursery) and to obtain new reference materials.

To read a wide range of current literature in this specialty.

We suggest that you read important articles from journals that are less than 12 months old. The following journals are recommended:
  • Archives of Disease in Childhood (fetal and neonatal issue)
  • Clinics in Perinatology (review articles)
  • Journal of Paediatrics and Child Health
  • Journal of Pediatrics
  • Pediatrics

A logbook of the names and disorders will be kept of the cases that have formed the basis of further reading. A minimum of 5 cases on a run is expected.

Evaluation:

You will be asked about the articles in the folder or current articles in the listed journals during Ward Rounds, Registrar Teaching and Journal Clubs.

5.  Presentation Skills

Objective:

To present at regular clinical meetings such as Grand Round (1 presentation), Journal Club (1 presentation), Registrar Teaching (1 presentation), and the Perinatal Case Review Meeting (as required).

Click here to see the teaching timetable

Registrars will be expected to use PowerPoint in their Grand Round presentations, and a similar level of presentation may be required at the other meetings .  A laptop computer and data projector are available from the departmental secretary and support with using software can be sought from the specialists and fellows.  If you require digital images of radiographs or ultrasound scans for a PowerPoint presentation, contact Carl Kuschel or David Knight.

Evaluation:

Record such presentations in the logbook or keep a copy in your learning portfolio.

Reviewed by Carl Kuschel, November, 2011