Emergency Medicine

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

I About The Programme

Name of Programme

Paediatric Emergency Medicine Fellowship Programme

Overview

The Children’s Emergency provides initial evaluation, stabilisation and treatment to acutely ill or injured infants and children. As the largest pediatric emergency facility in the country, the department sees more than 175,000 paediatric patients a year. We are also a tertiary paediatric trauma centre handling both major and minor trauma. More than 150 procedures are performed monthly in our emergency department, both under local anaesthesia and conscious sedation.

The range of services provided by the Paediatric Emergency Medicine (PEM) team includes:

• Identification, stabilisation and treatment of all acute paediatric emergencies (medical, surgical & trauma)
• Paediatric Injury Surveillance
• Paediatric Trauma Registry
• Child safety patient education
• Monitoring of paediatric poisonings
• Coordination of major incident response in national emergencies
• Paediatric Field Team support in major incident
• Management of victims of non-accidental injury

For more information on Children’s Emergency, click here.

Aim of Programme

The aim of this fellowship programme is to train Fellows from both Paediatrics and Emergency Medicine to competently deliver high quality Paediatric Emergency Care in an A&E setting.independent renal consultation.

Duration of Programme

12 months

Learning Outcomes

After completing the Paediatric Emergency Medicine (PEM) Fellowship Programme, Fellows will be able to:

• Assess and manage acutely ill and injured patients with a range of life threatening to self-limiting pathologies from birth to adolescence
• Assess and manage patients during medical and trauma resuscitations, including performing emergency procedures required in resuscitation
• Perform minor surgical procedures, such as toilet and suturing and manipulation and reduction of fractures
• Make clinical decisions regarding the disposition (admission or discharge) of patients
• Supervise junior staff and direct and co-ordinate care for multiple patients in a busy emergency setting
• Practice system based patient care (coordinate continuity of care between the ED and the various departments within the hospital and with services in the community)
• Act as a co-ordinator in the ED during a Major Incident
• Use team based simulation training to improve resuscitation skills amongst staff
• Use ultrasound techniques (Focused assessment sonography in trauma) to assist in the management of a critically ill or injured child
• Understand the requirements to manage a major incident involving hazardous materials
• Understand the intricacies of managing toxicological ingestions in the paediatric population
• Assess and manage cases of suspected child abuse and understand the different categories of abuse (physical, emotional, sexual, neglect) 
  

Content Areas

The programme covers the following areas:

There are several components to the formal education programme for PEM Fellows. The PEM Fellowship Programme covers the following areas:

• Hands-on consultant supervised clinical experience working in the busy ED
• Monthly Morbidity and Mortality Meetings
• Bi-monthly high fidelity simulation training sessions at the Paediatric Simulation Training Centre
• Journal Clubs and Evidence Based Topic Reviews
• Weekly teaching sessions using a variety of teaching techniques including role play, team based learning, quizzes and case based discussions
• Interactive e-learning modules
• Online collaborative group e-learning with case based discussions
• External training courses and workshops (subject to availability):
• Advanced Paediatric Life Support Singapore – 2 day seminar and workshop
• Basic Simulation Faculty Workshop – 1 day workshop
• Advanced Trauma and Life Support Course – 2 day workshop with hands-on training in procedural skills laboratory
• Hazmat Operator Course, Singapore Civil Defence Academy – 2 day seminar and workshop
• Disaster Medical Responder’s Course – 1 day workshop with simulation training
• Emergency Ultrasound Course – 1 day hands-on workshop
• Paediatric Toxicological Emergencies Simulation Training – Half day high fidelity simulation session
• Lectures by invited speakers
  

Training Methods

The programme covers the following areas:

(a) Fellows will be exposed to the common acute presentations seen in a busy paediatric emergency department such as:

• acute life support and resuscitation
• cardiac emergencies
• respiratory emergencies
• gastroenterology emergencies
• endocrine emergencies
• adolescent and gynaecological emergencies
• haematological and oncological emergencies
• dermatological emergencies
• psychiatric emergencies
• neonatal emergencies
• nephrology emergencies
• neurological emergencies
• the febrile child and infections
• allergic and immunological conditions
• toxicological emergencies
• surgical emergencies including conditions involving orthopaedics, neurosurgery, otorlaryngology, plastic surgery, ophthalmology and dentistry
• non-accidental injury and sexual assault
• trauma and burns

(b) Fellows will be exposed to the following procedures in patients:

• Bag, valve and mask ventilation
• Endotracheal intubation including rapid sequence induction
• Insertion of intraosseous needles
• Foreign body removal from nose, ear and throat
• Incision and drainage of abscesses
• Infiltration of local anaesthetic including digital ring blocks
• Wound repair with glue, adhesive strips and sutures
• Fingertip/ Nail bed injuries
• Fishhook removal
• Immobilization techniques
• Application of arm slings, traction splints for femoral fracture immobilisation, collar and cuff, backslabs
• Manipulation and reduction of fractures and dislocations
• Fluorescein staining and conjunctival irrigation
• Procedural sedation techniques
• Bier’s Block

(c) Fellows will be involved in:

• Paediatric Trauma Control, including acute management of serious and common paediatric trauma cases and the use of FAST (Focused Assessment with Sonography in Trauma) in children.
• Simulation Based Training sessions (participation and facilitation)
• Paediatric disaster preparedness for mass casualty and Hazmat scenarios
• Childhood Injury Surveillance and Prevention

(d) Fellows will participate in at least one Paediatric ED research project in the department and present the paper either in the hospital annual scientific meeting or in regional and international meetings.

Team of Experts

The Paediatric Emergency Medicine Fellowship Programme is managed by the following experts.

II Assessment and Evaluation

Aims of Assessment

Fellows will need to demonstrate their proficiency level based on the following competencies:

(A) Patient Care

• Fellows must provide patient care that is compassionate, appropriate and effective including the treatment of health problems and the promotion of health for children and all stages of illness.
• Fellows must demonstrate competence in diagnosing and treating paediatric emergencies and paediatric ambulatory conditions including performing minor surgical and orthopaedic procedures.

(B) Medical Knowledge

• Fellows must demonstrate medical knowledge of established and evolving biomedical, clinical, epidemiological, social-behavioral sciences and the application of medical knowledge to patient care.
• Fellows must demonstrate and apply their medical knowledge on the following elements.
  • scientific method of problem solving and evidence-based decision making skills.
  • indications for use of screening tests for children presenting acutely at the ED.
  • anatomy, physiology, pharmacology, pathology and molecular biology related to the acutely ill patient.
  • surgical procedures performed in the ED and their complications.

(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 must 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

Assessment mode for the programme:

Fellows are required to attain a 70% percentage pass for this programme.

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 incorporating the six competencies based on knowledge, skills and performance that fellows must demonstrate throughout the programme.

III Target Audience and Eligibility Requirements

Target Audience

The preferred group of fellows to apply for this programme is doctors with post-graduate qualifications in Paediatric Medicine or Emergency Medicine with a special interest in paediatric emergency medicine.

Pre-requisite/Eligibility Requirement(s)

Candidates must be:

• medical graduates from recognised medical schools as determined by the Singapore Medical Council (SMC) or a degree that can be registered by the SMC;
• board-certified by their respective institutions in either paediatric medicine or emergency medicine, or have the equivalent recognition by the relevant national medical bodies.
  

IV Other Information

Course Fees

Course fee will be determined upon application.

Funding

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

Certification

Certificate of PEM fellowship will be awarded upon completion of the fellowship programme.