Clinical Fellowship in Paediatric Neurosurgery and Paediatric Neurosurgical Onco

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 Paediatric Neurosurgery and Paediatric Neurosurgical Oncology

Overview

Around the globe, it is estimated each year there are 180,000 newly diagnosed cases of cancer in children younger than 15. In this group, brain tumours are the most common solid tumours in children. More than 80 percent of these occur in low- and middle-income countries (LMIC). This programme aims to address this gap by training apex subspecialty professionals of the clinical workforce who is required to advance the care of paediatric neurosurgery and neurosurgical oncology in LMICs.

The VIVA-KKH Paediatric Brain and Solid Tumour Programme will be providing sponsorship for this fellowship to selected medical doctors from less developed countries in the region, as part of its education and exchange initiatives to enhance inter-institutional collaboration, reach out to the broader population in Southeast Asia and integrate training and education into our healthcare and research activities. One of the key aims is for the doctors who have completed the fellowship to return to their home countries with newly gained expertise and experience. We hope to contribute towards enhancing their countries’ clinical and research capabilities, particularly in the care of paediatric brain and solid tumours.

Aim of Programme

The aim of this clinical fellowship is to provide Paediatric Neurosurgery experience to junior neurosurgeons, particularly those coming from resource-limited settings, with a special focus on Paediatric Neurooncology.

Duration of Programme

The year-long training programme constitutes a 12-month rotation in paediatric neurosurgery, with a strong focus on Paediatric Neurooncology.

Number of Training Places

One trainee will be accepted into this program per year.

Learning Outcomes

On completion of the programme, the clinical fellow should:

• Acquire an understanding of the holistic management of Paediatric Neurooncology conditions including:
  1. Competence in diagnostic workup, neurosurgical approaches, and support during adjuvant therapy.
  2. Competence in performing neurosurgical procedures, particularly in implementing modern surgical adjuncts.
  3. Competence in the management of symptoms and the role of neurosurgical care in patients with terminal or incurable disorders
• Be proficient with the management of elective and emergency paediatric and neonatal neurosurgical conditions.
• Completed a research project focused on Paediatric Neurooncology suitable for academic publication.

Content Areas

The programme covers the following areas:

1. Clinical training

• Patient care
  The fellow will participate in the clinical management of patients with general paediatric neurosurgery and paediatric neurooncological conditions at KK Women’s and Children’s Hospital. Specifically, for the applicant to gain a good appreciation of preoperative evaluation and pre-surgical optimization, postoperative assessment and follow-up, and performance of operative procedures under supervision. In addition, the fellow will attend to acute referrals for emergent conditions and diagnostic workups for example for newly diagnosed lesions. This may include call duties where appropriate.
  
  
• The fellow will be familiarized with the operative management of the following conditions: Paediatric neurosurgical procedures specific for neurooncology:
  
  • Surgical techniques that involve resection and, or biopsy of brain/ spine lesions. These can be via open or endoscopic or stereotactic approaches.
  • Cerebrospinal fluid diversion methods such as insertion of shunts, drains and endoscopic third ventriculostomy for obstructive hydrocephalus secondary to brain/ spinal tumours.
  • Neuroendoscopic techniques for brain tumours

Other general paediatric neurosurgical procedures: Exposure to elective and emergency paediatric and neonatal neurosurgical conditions.

2. Education

Besides participating in the didactic learning, the fellow is responsible for organizing cases for discussion and presenting at educational meetings. These include departmental meetings based at the National Neuroscience Institute (NNI), whereby the consultant neurosurgeons from KKH are also part of.

• Core educational activities (Compulsory and with no clinical work involved)
  Weekly to 2-weekly:
  
  • NNI Department of Neurosurgery Morbidity and Mortality Meeting
  • NNI Department of Neurosurgery subspeciality academic meetings, consisting of a rotating schedule of X-ray conferences, journal clubs, and educational seminars
    
  Monthly:
  
  • Neuro Paeds Tumour Board
  • Neuroradiology Rounds
    
  • Combined Paeds Neurosurgery Discussion Group
    
  Quarterly:
  
  • Vascular malformations multidisciplinary meeting, clinical pathology meeting, multidisciplinary trauma conference
    
• Supplementary educational activities ((No clinical work involved)
  
  • Malaysia-Singapore Online Brain Tumour Meeting
  • NNI Neurosurgery Residency Teaching
  • NNI Neurosurgery Journal Club

3. Research

• Research project
  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.

Training Methods

The primary training location will be the Neurosurgical Service, KK Hospital. 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, outpatient clinics, and operating theatres. The fellow will also participate in active academic discussion, journal clubs, publications, workshops, conferences, and research.

II Assessment and Evaluation

Aims of Assessment

(A) Patient Care

• Fellows must provide patient care that is compassionate, appropriate, and effective, especially in the treatment of paediatric neurooncological 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 central nervous system (CNS) tumours.
  
  To assist and perform (under supervision) neurosurgical procedures relevant to interventions for patients with paediatric CNS tumours.

(B) Medical Knowledge

• Fellows must demonstrate knowledge of established and evolving aspects of neurosurgical practice, especially in neurooncology.
  

(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 continually 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 (SMC Form T3) during the following time points:

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

Clinical fellows must maintain a logbook of neurosurgical cases.

Clinical fellows must present a research-based topic related to Paediatric Neurooncology each month.

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 sub-specialty Paediatric Neurooncology training to junior paediatric neurosurgeons, particularly those coming from resource-limited settings. The candidate who will benefit most from this programme will be a junior neurosurgeon working in a children’s hospital with Paediatric Neurooncology service support and should have completed post-graduate training in paediatric neurosurgery in his/her country of origin and may have some experience working as a junior paediatric neurosurgeon in his/her hospital.

Pre-requisite/Eligibility Requirement(s)

Candidates must:

• Be recommended by their respective Head of the 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
• Upon completion of the fellowship, return to their parent hospital in their country with the aim of imparting the new skills and knowledge learnt, for the good of their community; and continuous engagement with the global health community for collaborative work in the field of paediatric neurosurgery would be preferred, but not mandatory.

IV Other Information

Course Fees

No separate course fee.

Funding

Candidates should be self-funded or have funding from external sources/institutions. Sponsorship through the VIVA-KKH Paediatric Brain and Solid Tumour Programme will be considered on a case-by-case basis

Certification

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