Infectious Disease

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 Infectious Disease Fellowship Programme

Overview

The Infectious Disease (ID) service at KK Women’s and Children’s Hospital receives referrals and consultations both locally and internationally. We have a sizeable bone marrow transplant programme and a large population of immunocompromised patients, a large birth cohort and neonatal level 2 to 3 unit, as well as a moderately large paediatric intensive care unit with air ambulance transport service, and hence our consultations span the whole range of conditions both in the immunocompromised as well as the immunocompetent host, and both local and foreign/travel-related illnesses.

This is a one-year fellowship programme in paediatric infectious disease. We have dedicated clinics such as MycoB and BBV clinics, which see patients with mycobacterial and blood-borne virus infections (e.g. HIV, HBV and HCV), and we also do vaccination of immunocompromised hosts, see patients with congenital and chronic infections (e.g. bone, joint and cerebral infections), as well as offer pre- and post-travel vaccination advice in our clinics.

Aim of Programme

• The aim of the Paediatric Infectious Disease Fellowship Programme is to offer a broad-based exposure and training in the spectrum of infectious disease conditions seen in both immunocompetent and immunocompromised children, as well as to offer training in infection control, antimicrobial stewardship and vaccine adverse event surveillance.
  

Duration of Programme

12 months

Learning Outcomes

After completing the programme, Fellows will be able to:

• attend to requests for inpatient consultations – perform initial history and physical examination, present to staff on rounds and write consult notes;
• provide clinical care for patients in supervised outpatient clinics, including the MycoB and BBV clinics – perform history and physical examination, arrange laboratory testing etc.;
• attend all sub-specialty activities including infection control rounds, NICU and CICU antibiotic rounds, quarterly HIV Clinico-Psychosocial Rounds, quarterly Hospital Infection Rates Meetings and yearly Antibiogram Meetings;
• attend to infection control (particularly sharps injuries consultations) and antimicrobial stewardship approvals;
• complete ID service online register (KK Infectious Disease System, KIDS) of all inpatient and new outpatient cases on a weekly basis;
• present lectures on an ID topic at least once in 3 months during the rotation;
• present active inpatient cases during ID Teaching Rounds/Journal Club;
• attend the paediatric clinic at the TB control Unit (Tan Tock Seng Hospital);
• attend monthly Vaccine Adverse Event (VAE) Surveillance Meetings and possibly, quarterly MOH Severe Illnesses & Deaths Possibly of Infectious Causes (SIDPIC) meetings;
• be exposed to and participate in research projects in the programme, including vaccine and drug trials, as this will provide a comprehensive understanding of research methodology, and scientific writing skills.
  

Content Areas

The programme covers the following areas:

1. Antimicrobial Therapy: Principles and Practice

• Fellows need to know the principles of antimicrobial therapy and principles of prescribing, duration of therapy and prophylaxis.
• Fellows need to be aware of outpatient intravenous antimicrobial therapy and the logistical implementation.

2. Infectious Disease Syndromes

• Fellows need to be able to diagnose and manage common ID syndromes, e.g. upper and lower respiratory tract infections, urinary tract infections, endocarditis, gastroenteritis, intra-abdominal infections, hepatic/biliary infections, ocular infections, lymphadenitis, bacteremia, meningitis, skin and soft tissue infections, septic arthritis, osteomyelitis, reproductive system infections/sexually transmitted diseases, tuberculosis, dengue, hand, foot and mouth disease, and Salmonella infections (both typhoidal and non-typhoidal).
• Fellows need to appreciate the causes and presentation of infections in immunocompromised hosts such as Cytomegalovirus (CMV) infection, invasive Aspergillosis, Pneumocystis jiroveci and respiratory viral infections. Fellows need to be able to diagnose and manage these conditions in the highrisk immunocompromised host.
• Fellows need to be familiar with the investigation and management of Pyrexia of unknown origin.
• Fellows need to be able to diagnose device-associated infections including central venous catheter infections, ventilator-associated pneumonia, ventriculo-peritoneal shunt infection, urine catheter-related infections and, surgical and traumatic wound infections.
• Fellows need to be aware of the prevention of human immunodeficiency virus (HIV) transmission from mother-to-child. Be aware of the different manifestations of HIV infection. Fellows need to be able to diagnose and plan initial management of children with HIV.
• Fellows need to be aware of less common infections, e.g. intrauterine infections, malaria, typhus, melioidosis, Chikungunya fever, encephalitis (of various causes), meningococcaemia, cat scratch disease, BCG lymphadenitis and non-tuberculous Mycobacteria (NTM) infections.

3. Infectious Control/Antimicrobial Stewardship

• Fellows need to be familiar with various modes of transmission and the prevention of transmission.
• Fellows need to know how to distinguish between colonisation and infection.
• Fellows need to learn about various multi-drug resistant organisms, e.g. Methicillin-resistant Staphylococcus aureus, extended spectrum beta-lactamase Gram negative bacteria, vancomycinresistant enterococcus, carbapenam-resistant Gram negative bacteria and the prevention of transmission.
• Fellows need to be familiar with antibiotic stewardship.
• Fellows need to be aware of employee health and the prevention of vaccine-preventable infections, post-exposure prophylaxis for HIV, prevention and post-exposure management of sharps injuries.

4. Vaccinations

• Fellows need to know the routine childhood immunisation schedule and vaccinations.
• Fellows need to be aware of the optional vaccinations in childhood including travel vaccines.
• Fellows need to be aware of the contraindications and administration of vaccines.
  

Training Methods

Tentative monthly rotation schedule:

For the 3rd and 4th ID1 blocks, electives may be considered if desired and available (e.g. adult ID rotation, STD clinics rotation; may require additional arrangements). Please refer to the schedule for further information.

Please be informed that a post-fellowship offer can be considered after completion of research paper for journal submission and publication.

Team of Experts

The Paediatric Infectious Disease Fellowship Programme is managed by the following experts.

II Assessment and Evaluation

Aims of Assessment

Fellows are required to continually demonstrate the following six competencies throughout the programme:

(A) Patient Care

• Fellows must provide effective, family-centred patient care applying current evidence-based principles, while being fully aware of the balance between risks, cost and benefit to the patient concerned.

(B) Medical Knowledge

• Fellows must demonstrate an ability to acquire, critically interpret and apply new knowledge so as to improve patient care.

(C) Practice-Based Learning and Improvement

• Fellows must demonstrate their ability to identify standardised guidelines for the diagnosis and treatment of conditions common to paediatric ID and adapt them to the specific needs of individuals and their families.

(D) Interpersonal and Communication Skills

• Fellows must demonstrate interpersonal and communication skills and their ability to:

  • provide effective patient education for conditions (including reassurance) common to paediatric ID;
  • communicate effectively with physicians and other health care professionals including microbiologists, laboratory technologists, nurses, pharmacists and social workers to facilitate information exchange and teamwork so as to improve patient care.

(E) Professionalism

• Fellows must demonstrate personal accountability to the well-being of patients and a commitment to carrying out professional responsibilities, adhering to ethical and legal principles at all times.

(F) Systems-Based Practice

• Fellows must demonstrate their ability to be sensitive to the costs of clinical care in ID, taking steps to minimise costs without compromising quality, always striving to recognise early families who may be in need of social-financial assistance.
• Fellows must demonstrate their ability to learn to collaborate with other health-care providers’ (e.g. nursing, pharmacists and social workers) to optimise patient care. 
  

Assessment Approaches

The assessment mode for the programme is as shown in the table below.

Medical Knowledge

• Fellows are assessed on their ID knowledge through question-and-answer sessions with the faculty during the rotation.
• A summative written test in the form of multiple choice questions and a clinical interactive interview (discussions of clinical scenarios) will be conducted to assess overall ID knowledge.
• Case-based discussions and/or mini-CEX (Clinical Examination) assessments will also be utilised to complement the written test in a formative manner.

Readings/Self-study

• Each Fellow must read around the clinical cases and topics for discussion.

Feedback

• A 360-degree feedback evaluation will be conducted by the faculty and ancillary ID staff, including infection control nurses.
• All Fellows will be required to meet with the programme director at the beginning of their fellowship programme and on a 3-monthly basis to discuss their clinical progress to date.
• This will also be an opportunity for the Fellow to provide feedback about their training and the programme, as well as for the programme director to discuss with the Fellow on their performance to date. Fellows are required to attain a 75% percentage pass for this programme.

Please note that Fellows on rotation will be fully supervised by consultant ID specialists, even when the Fellow is the assigned physician in the outpatient clinic. Inpatient referrals and consultations will be supervised by the ID specialist on call.

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 knowledge, skills and performance that Fellows must demonstrate throughout the programme.

*Fellows who have attained a USP grade are given options to extend their fellowship programme. This will depend on the faculty's evaluation on the Fellow's clinical skills and professional attitude.

If the Fellow wishes to terminate his/her training, he/she will be required to give a 1-month’s written notice to the ID department and to the HR department of his/her intention. Rare exceptions may be allowed for pending discussions between the Fellow and the programme director.

The hospital/ID department reserves the right to terminate the training programme in the event of unsatisfactory performance of the temporarily registered doctor (as reflected in the assessment reports to the Singapore Medical Council). 

III Target Audience and Eligibility Requirements

Target Audience

Paediatricians who aspire to sub-specialise in paediatric ID.

Pre-requisite/Eligibility Requirement(s)

Candidates must:

• be medical graduates from recognised medical schools as determined by the Singapore Medical Council or a degree that can be registered by the Singapore Medical Council;
• have completed or is undergoing a training or residency programme in paediatrics.

Success of the fellowship application is also contingent on approval by the Singapore Medical Council for a temporary medical practising license.

IV Other Information

Number of Training Places

1 Fellow at any one time

Course Fees

Course fee will be determined upon application.

Funding

Candidates should obtain their own funding to cover expenses during the training period.

Certification

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