Clinical Fellowship in General Paediatric Surgery

I About The Programme
II Assessment and Evaluation
III Target Audience and Eligibility Requirements
IV Other Information

I About The Programme

Name of Programme

Clinical Fellowship in General Paediatric Surgery

Overview

A key gap in the advancement of paediatric surgical outcomes is the lack of skilled professionals in geographical areas where the needs are most pronounced. Low- and middle-income countries (LMIC) see a disproportionate volume of paediatric and congenital neonatal surgical conditions. This programme aims to address this gap by training the paediatric surgeons that is required to advance the care of general paediatric surgery in LMICs.

The programme builds on the Department’s past general paediatric surgery cum paediatric urology programme which has trained clinical fellows and observers from Southeast Asia since 2013. In a similar vein, doctors who complete the training will return to their home countries with the newly gained expertise and experience to contribute towards enhancing their countries’ clinical and research capabilities.

For more information on the services provided by the Department of Paediatric Surgery, click here.

Aim of Programme

The aim of this clinical fellowship is to provide general paediatric surgery training to junior paediatric surgeons, particularly those coming from resource-challenged settings.

Duration of Programme

This is a 6- to 12-month programme. The 12-month programme is strongly recommended to better achieve training objectives.

Number of Training Places

One trainee will be accepted into this programme per year.

Main intake is in July. Entry into the programme at other times is subject to availability.

Learning Outcomes

On completion of the programme, the clinical fellow should:

• be proficient with the management of common elective and emergency paediatric and neonatal surgical conditions. This includes:
  a) competence in clinical decision making;
  b) judicious diagnostic workup;
  c) operative technical competence;
  d) competence in postoperative care and follow up.
• acquire academic skills such as critical appraisal of medical literature and/or research.

Content Areas

The training content is as outlined below:

1. Clinical training

• Patient care
  The fellow will participate in the clinical management of patients with general paediatric and neonatal surgery at KK Hospital. Specifically, for the fellow to gain a good appreciation of preoperative evaluation and pre-surgical optimisation, postoperative assessment and follow-up, and performance of operative procedures under supervision. This includes elective and emergency, outpatient and inpatient cases.
  
  
• Participation in call duties may be required where appropriate.
  
  
• Procedural skills
  The fellow will be familiarised with the operative management of common paediatric and neonatal operations, including cystoscopy, laparoscopy and thoracoscopy
  
  
• Infection control
  Sessions with Infection Control nurse to learn about infection control systems and audit will be arranged.
  
  

2. Education

The fellow is expected to actively participate by attending and presenting at educational meetings. These include:

• weekly mortality and morbidity rounds;
• weekly journal club meeting;
• monthly combined x-ray rounds;
• bi-monthly anomalies vascular malformation meeting;
• quarterly combined urology-nephrology meeting;
• quarterly combined clinico-pathological rounds;
• quarterly trauma conference.

3. Research

• Research project
  The fellow is strongly encouraged to complete a research project with the aim of (i) submission of abstract and presentation at a scientific meeting, and (ii) completion of manuscript on research project for publication, under the guidance and mentorship of senior staff of the department.

Training Methods

The fellow will be equipped with up-do-date clinical and practical skills via didactic and bedside teaching, as well as practical clinical work in the wards, clinics and operating theatres. The fellow will also participate in active academic discussion, journal clubs, publications, workshops, conferences and research.

The training location will be the Department of Paediatric Surgery, KK Hospital. Rotation to different surgical teams (with special interest in Urology, Hepatobiliary, Oncology or Minimally Invasive Surgery) can be arranged based on the fellow's area of interest, where possible. In addition, short external rotations to the Neonatology Intensive Care Unit or other services can be arranged if specific areas of interest or needs are identified.

Past and Present Fellows

The Department of Paediatric Surgery at KKH has had a prior track record of training clinical fellows and observers in general paediatric surgery and paediatric urology. Under the past programme, the Department has trained 8 clinical fellows and clinical observers from 2013 to 2015.

Clinical fellows and clinical observers trained at the Department of Paediatric Surgery, KKH, from 2013 to 2015:

Team of Experts

The General Paediatric Surgery Fellowship Programme is managed by the following experts:

II Assessment and Evaluation

Aims of Assessment

Fellows are required to continually demonstrate their proficiency levels based on the following competencies:

(A) Patient Care

• Fellows must provide patient care that is compassionate, appropriate and effective, including the treatment of paediatric surgical and oncologic conditions and their associated complications. They need to be familiar with and have a good understanding of management protocols and principles of treatment in paediatric surgical diseases. 
  
  Inpatient Ward Rounds
• To actively participate in rounds in surgical wards and other subspecialty wards where appropriate
• To present and discuss clinical problems effectively during ward rounds, accurately interpret laboratory results and outline subsequent management plans
  
  Outpatient Clinics
• To run weekly general paediatric surgery clinics under supervision of senior staff
• To assist in paediatric surgical subspecialty clinics where appropriate
  
  Procedures
• To assist and perform (under supervision) relevant surgical procedures
  

(B) Medical Knowledge

• Fellows must demonstrate knowledge of established and evolving aspects of general surgical practice in children.
  

(C) Practice-Based Learning and Improvement

• Fellows must demonstrate their ability to investigate and evaluate evidence, both in appraisal and assimilation of scientific evidence required for patient care in current and evolving practice settings, including diagnosing and treating health problems and promotion of health.
• Fellows must demonstrate life-long learning skills and continuous self-assessment based on reflection and feedback required for patient care in current and evolving health care settings.
• Fellows should demonstrate teaching and learning skills, and perform research to contribute to medical education of health professionals.
  

(D) Interpersonal and Communication Skills

• Fellows must demonstrate interpersonal and communication skills necessary for effective exchange of information and demonstrate the ability to collaborate with patients, their families and health professionals to provide quality patient care.
  

(E) Professionalism

• Fellows must demonstrate commitment and professional attributes adhering to ethical principles including:
• compassion and empathy;
• honour and integrity;
• accountability and responsibility;
• duty and service;
• respect;
• humility;
• excellence and scholarship;
• social responsibility.
  

(F) Systems-Based Practice

• Fellows must demonstrate an awareness and responsiveness to the larger context and system of health care and demonstrate effective use of resources in the system to provide optimal health care for patients.
  

Assessment Approaches

The clinical fellow will be assessed periodically and will receive an end of fellowship report and certificate. Clinical fellows must remain under Level 1 supervision for the entire duration of their training. They will be assessed (using SMC Form T3) during the following time points:

• 3rd month;
• 6-monthly intervals;
• end of term.

Clinical fellows must maintain a logbook of cases.

Evaluation Process

General overall grading system

The general overall grading system evaluates the fellow’s performance upon completion of the fellowship programme. All fellows will be given a general overall grading status at the end of the fellowship programme based on the grading criteria requirements. These requirements incorporate the six competencies that fellows must demonstrate throughout the programme.

The fellow will be terminated from the programme if he/she receives poor interim assessment reviews, or continually unsatisfactory performance assessment reviews during the programme. Such early termination will be recorded in the stipulated SMC assessment form and all relevant parties notified.

III Target Audience and Eligibility Requirements

Target Audience

This fellowship programme aims to provide general paediatric surgery training to junior paediatric surgeons, particularly those coming from resource-challenged settings. The candidate who will benefit most from this programme will be a junior surgeon working in a children’s hospital, and should have completed post-graduate training in paediatric surgery in his/her country of origin, and may have some experience working as a junior paediatric surgeon in his/her hospital.

Pre-requisite/Eligibility Requirement(s)

Candidates must:

• be recommended by their respective Head of Department OR at least two referees chosen by the applicant;
• have a good general knowledge of English;
• provide a letter of good standing from own country’s licensing authority;
• return to their parent hospital in their country upon completion of the fellowship, with the aim of imparting the new skills and knowledge learnt, for the good of their community.

IV Other Information

Course Fees

There is no separate course fee.

Funding

Candidates should be self-funded or have funding from external sources/institutions.

Certification

Certificate of fellowship will be awarded after completion at the end of the attachment.