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African Paediatric Fellowship Programme

Paediatric Gastroenterology


Short-term attachment


1 Year Diploma

Masters' Programme

DEPARTMENTAL STAFF

Head of Department:
E Goddard, BSc(Hons) MSc (Med) MBChB PhD MMed (Paed) Cape Town FCPaed, CertPaedGastro SA

Senior Lecturers Full-time:
R de Lacy, MBChB Cape Town FCPaed CertPaedGastro SA

Contact:
Dr  Elizabeth Goddard
Email: liz.goddard@uct.ac.za

See more detail at: http://www.paediatrics.uct.ac.za/scah/clinicalservices/medical/gastroenterology

LOCATION:
Training in paediatric gastroenterology takes place in Ward E2 at the Red Cross War Memorial Children’s Hospital which houses the in-patient ward.  The clinics are in  S27, 1st floor, MOPD.  The service consults on children throughout UCT’s academic hospital complex and children are accepted from, or management is discussed with, referral centres locally and further afield. 

AREA OF TRAINING:
The gastroenterology service sees a spectrum of disease from all over South Africa (inborn errors of metabolism storage diseases, Inflammatory Bowel Disease, biliary atresia, HIV related GIT problems). The training is weighted towards clinical exposure and much of the training is through involvement in patient assessment and care. 

ONSITE EXPECTATIONS:
Trainees participate as full members of the clinical team. Out of hours attendance is optional, but daytime attendance (08.00-17.00) is essential to attain adequate teaching and clinical exposure time.        

ADDITIONAL ACTIVITIES:
The service also offer an endoscopic service which has a slate once a week doing gastroscopy (sclero - Research projects are encouraged and the supervisors will facilitate this. Trainees are encouraged to become involved in the under and postgraduate teaching program providing their own tutorials and teaching sessions for junior doctors, students and other health practitioners.    

TRAINING OPTIONS: 
The encouraged rotation is the 2 years Master’s program, trainees complete with an accredited exit examination and the Master’s. For specific focused training needs there is a 1 year PG Diploma. Short-term observational attachments can be supported but these must have a specific and clear outcome and the involvement of the referring institution is critical.
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MASTERS PROGRAMME

MPHIL SUBSPECIALISATION IN PAEDIATRIC GASTROENTEROLOGY

Convener: Dr E Goddard (Department of Paediatrics & Child Health)

Duration of training
FMC53  Two years of clinical training, one year of research and completion of the dissertation.

Curriculum outline
FMC54 The curriculum outline is as follows:

   NQFcredits  HEQSFlevel
PED7039W -    MPhil Paediatric Gastroenterology Part 1  120  9
PED7040W -    Paediatric Gastroenterology minor dissertation       60  9
                                                                                                Total NQF credits:  180  

NQF credits and HEQSF course levels:
All South African tertiary institutions are required to align their qualifications with the prescriptions of the Higher Education Qualifications Subframework (that forms part of the National Qualifications Framework). Each qualification has an exit level that relates to the skills that may be expected of candidates who have completed a qualification or course at that HEQSF level. Each qualification also has a minimum number of NQF credits at that HEQSF level. One credit equals 10 notional hours of learning.

The NQF requires the following minimum credits per qualification:
•    Postgraduate Diploma (exit level 8): Minimum total credits: 120. Minimum credits at HEQSF level 8: 120.
•    Master’s degree (exit level 9): Minimum total credits: 180. Minimum credits at HEQSF level 9: 120; maximum credits at
     HEQSF level 8: 60 (a full dissertation master’s will be 180 credits at HEQSF level 9). A Professional Master’s degree may
     have a reduced research component of at least 45 credits.

Courses for MPhil subspecialisation in Paediatric Gastroenterology:

PED7039W - MPHIL PAEDIATRIC GASTROENTEROLOGY PART 1
NQF credits: 120 at HEQSF level 9
Convener:  Dr E Goddard
Course entry requirements: None
Course outline: This training programme forms part of the credentialling process of specialist paediatricians to become subspecialists in paediatric gastroenterology. Students follow the relevant curriculum of the College of Paediatricians of South Africa and, on successful completion of the relevant Part 1 examination of the College, are granted credit towards PED7039W. Diseases of the gastrointestinal tract and liver and disorders of nutrition are important causes of morbidity and mortality in infancy and childhood, particularly in developing countries like South Africa. Training includes the development of skills in taking a history, performing a physical examination, formulating a differential diagnosis and an appropriate diagnostic and management plan; knowledge of the epidemiology of the principal diseases in paediatric gastroenterology and hepatology with emphasis on the differences between developed and developing countries and the specific circumstances pertaining to South Africa; an understanding and knowledge of the physiology, pathophysiology, pathology, diagnosis, and treatment of important nutritional, intestinal, and liver diseases in infancy, childhood and adolescence; a range of diagnostic and therapeutic procedures; knowledge and interpretation of tests and scans; knowledge and skills in the nutritional status of children; and research in paediatric gastroenterology, hepatology and nutrition. For the detailed curriculum, see the regulations of the relevant College of Paediatricians at www.collegemedsa.ac.za.

Document Links:
Certificate in Gastroenterology (SA) Paed Portfolio
Certificate in Gastroenterology (SA) Paed Regulations

DP requirements:  At least 18 months as a subspeciality trainee in an accredited subspeciality unit; a written report from the head of the institution/programme; a completed logbook; presentation or acceptance for presentation of an original first-author research poster or paper at a local or international congress, or submission or acceptance for publication of an original first-author or coauthored manuscript in a peer-reviewed journal.
Assessment:  Candidates write the relevant examination of the College of Paediatricians of South Africa. The examination includes a written and an oral component. Each of the two components contributes 50% to the overall mark. A subminimum pass mark of 50% is expected for each of the two (written and the oral) components of the examination.

PED7040W - PAEDIATRIC GASTROENTEROLOGY MINOR DISSERTATION 
NQF credits: 60 at HEQSF level 9
Convener:  Dr E Goddard
Course entry requirements: None.
Course outline:  The minor dissertation, prepared under supervision, is a requirement for those senior registrars who wish to graduate with the MPhil degree. Those who choose not to complete a dissertation may register with the HPCSA as subspecialists after successful completion of the relevant College of Medicine Part 1 examination. The dissertation must be between 15 000 and 20 000 words in length, and must be on a topic in paediatric gastroenterology. It must be based, moreover, on a study the work for which was commenced while the candidate was registered as a postgraduate student. The dissertation should generally be on a clinical topic and of a standard publishable in a peer-reviewed medical journal. Students are trained in statistics, in research methods, in conducting literature reviews, and in designing a research proposal. Having obtained formal ethics approval, where necessary, they analyse the results of their research and write up the dissertation. The candidate may also be required to present the work at a congress and submit the research for publication.
DP requirements:  None
Assessment: External examination of the minor dissertation.
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ONE YEAR POSTGRADUATE DIPLOMA

POSTGRADUATE DIPLOMA IN CLINICAL PAEDIATRIC GASTROENTEROLOGY
Conveners:
  Dr R De Lacy and Dr E Goddard (Department of Paediatrics and Child Health)

This course is intended to train suitable candidates to practise clinical paediatric gastroenterology in order to enable the diagnosis, resuscitation, triage and management of children with disease. It does not aim to train the candidate to become a paediatric gastroenterologist, but rather to practice safely and effectively in resource limited areas without the immediate supervision of a paediatric gastroenterologist

Admission requirements:
FPI1.1
To be eligible for consideration for admission, a candidate

  • shall have a Bachelor of Medicine and Bachelor of Surgery (MBChB) or equivalent qualification as a medical doctor, experience working in the field of paediatrics, and demonstrate an interest in paediatric gastroenterology;
  • if applying via the African Paediatric Fellowship Programme, must be referred by a tertiary African centre allied to the programme and have demonstrated the need for clinical training in this discipline;
  • if a doctor qualified in South Africa, must be practising in an outreach setting;
  • must be registrable with the Health Professions Council of South Africa and registered thus by the time of registration
  • shall submit a letter of support from his/her employer granting the applicant study leave where applicable;
  • shall submit proof that he/she will return back to the home institution to a post in the government/public sector to fulfil a healthcare need;
  • shall have proven proficiency in written and spoken English (this may be tested if necessary); and
  • shall have an acceptable level of computer literacy, and access to a computer and the internet.

Structure and duration of Diploma:
FPI2
The Diploma may be completed over one year full-time or two years part-time. The training is based at the Red Cross War Memorial Children’s Hospital. There are two courses – one clinical and a long essay – and the clinical course consists of lectures, tutorials, case studies and practical workplace experience. During the training period, the student must demonstrate the ability to understand the coursework. The logbook must be completed concurrently with the clinical training. The long essay will be submitted after the clinical course has been completed.

Curriculum
FPI3:  The curriculum outline is as follows:

   NQF credits HSQSF level
PED4038W   -  Clinical Management of Paediatric Gastroenterology    90  8
PED4032W   -  Essay: Transition and Translation Of Knowledge    30  8
                                                                                                                    Total NQF credits:  120  

NQF credits and HEQSF course levels: 
All South African tertiary institutions are required to align their qualifications with the prescriptions of the Higher Education Qualifications Subframework (that forms part of the National Qualifications Framework). Each qualification has an exit level that relates to the skills that may be expected of candidates who have completed a qualification or course at that HEQSF level. Each qualification also has a minimum number of NQF credits at that HEQSF level. One credit equals 10 notional hours of learning.

The NQF requires the following minimum credits per qualification:
•    Postgraduate Diploma (exit level 8): Minimum total credits: 120. Minimum credits at HEQSF level 8: 120.
•    Master’s degree (exit level 9): Minimum total credits: 180. Minimum credits at HEQSF level 9: 120; maximum credits at
     HEQSF level 8: 60 (a full dissertation master’s will be 180 credits at HEQSF level 9). A Professional Master’s degree may
     have a reduced research component of at least 45 credits.

FPI4.1
Each course is made up of individual, discrete modules. Unless indicated otherwise, students must pass each module in order to pass the course.

FPI4.2
Students are required to maintain a logbook of clinical procedures and to submit this by the due date.

FPI4.3
Students are required to submit all supervisors’ reports before the final mark for the relevant course will be released. Should this not be done by the due date, the student will fail the course.

FPI4.4
Students may be permitted to repeat a course they have failed, at the convener’s discretion. No course may be repeated more than once. Where a candidate fails a course twice, or fails three or more courses, a recommendation will be made to the Faculty Examinations Committee to refuse readmission.

FPI4.5
Regular assessments of level of competency achieved throughout the course, undertaken at 3-monthly intervals. Students are required to attend at least 70% of group supervision sessions.

FPI4.6
Students who obtain 45% – 49% for the course may be reassessed before the final mark is submitted for approval to the Faculty Examinations Committee, and/or may be granted a supplementary examination at the discretion of the Faculty Examinations Committee.

Distinction
FPI5
The Diploma may be awarded with distinction (75% – 100% average with not less than 70% for any course.) All courses must be passed at first attempt.

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Courses for Postgraduate Diploma in Clinical Paediatric Gastroenterology:

PED4038W CLINICAL MANAGEMENT IN PAEDIATRIC GASTROENTEROLOGY
NQF credits: 90 at HEQSF level 8
Convener:  Dr E Goddard
Course entry requirements: None
Course outline:   Training in theory and practice includes the following: routine management of new patients including the initiation of appropriate acute treatment and long-term management plans; emergency management and resuscitation (e.g. the critical neonate, the critical child, hematemesis and melaena, acute liver failure, shock secondary to diarrhoea, and selection and triage for tertiary referral); ethics, rational case selection and difficult decisions; and procedural skills. Diagnostic and therapeutic procedures such as upper colonoscopy; endoscopic procedures; and oesophageal, gastric, small intestinal and other biopsies. Knowledge and interpretation of endoscopic retrograde cholangiopancreatography, transit studies, pancreatic function testing (screening tests, faecal elastase, intubation tests), radio-nucleotide scans, and barium studies. Referral and communication. Knowledge and skills in assessment of nutritional status. Working in nutritional support teams. Clinical training takes place via grand rounds, general and speciality meetings, group meetings and interactive sessions, ward rounds, and clinical outpatient interactions and supervisions. Students also partake in supportive multidisciplinary meetings. Key to development of clinical skills is practical work-place experience of one-on-one teaching sessions.
DP requirements: The student will be assessed continuously during the coursework. A formal assessment will be performed after three months to assess initial progress. A student who fails two formative assessments will forego his/her DP and may be required to withdraw from the programme. Logbook completion will be monitored and the logbook must be submitted by the due date.
Assessment:  End-of-training assessment will be a one-hour paper and a one-hour oral examination (to test the interpretation of image-based investigations.)

PED4032W ESSAY: TRANSITION AND TRANSLATION OF KNOWLEDGE
NQF credits: 30 at HEQSF level 8
Convener: Prof David Woods
Course entry requirements: None
Course outline:  This course equips students to apply the knowledge and insights gained during their training to their home settings. Students will analyse the epidemiology of the centres at which they practise healthcare and will analyse the healthcare needs of the region, then plan ways in which to apply the knowledge they have gained in the diploma programme to such settings. 
DP requirements: Full attendance and completion of all coursework requirements by the due dates.
Assessment:  Completion of an essay (100%). This is preceded by ongoing assessment of performance through regular clinical supervision/tutorial sessions and coursework tasks. A pass mark of 50% is required for the long essay, failing which the student will be required to make the necessary corrections or improvements and submit the Assignment for reassessment. The terms of resubmission of the assignment will be at the discretion of the convener.

SHORT-TERM ATTACHMENTS

Short term attachments are accepted in the department but require careful planning. Trainees have gained from periods of observation when they are deciding how to structure a more formal training program (1 or 2 years). Other trainees attend for short attachments to gain insight into how the service is structured to assess which models could be duplicated in their home setting. HPCSA registration is not attained for observation however HPCSA registration can attained for short term attachments and candidates are advised to apply at least 18 months in advance.