Paediatric Pain Fellow Training Programme

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 Pain Fellow Training Programme

Overview

KK Women's & Children's Hospital provides pain services for the paediatric patients hospital-wide, through our inpatient Children’s Pain Service and outpatient Children’s Pain Management Clinic.

Our Children’s Pain Service (CPS) is a consultant-led service which manages inpatient perioperative pain, medical pain, complex oncological and palliative pain as well as procedural pain. The service also is heavily involved in complex sedoanalgesic and weaning cases, working hand in hand with the intensive care units. We also work closely with our hospital Child Life therapists, art & music therapists, and nurses through a Pain Link programme.

The CPS has also an ongoing multidisciplinary procedural pain initiative which works to reduce pain and strain for patients undergoing medical procedures e.g. intravenous cannulation, and their parents.

The Children’s Pain Management Clinic is one of Asia’s first true interdisciplinary pediatric pain management clinics, being staffed by a pain physician, pain specialty care nurse, physiotherapist, occupational therapist and psychologist. Each new case is seen by the team as a whole, and patient-centred therapy is proposed. We also work closely with our psychiatry colleagues and the KKH family therapists. Therapy is multimodal and multi-pronged, and may include medication, though it more often involves cognitive behavioural therapy, active and passive physical therapy, goal setting, pacing, scheduling, school liaison and parent/child counselling.

For more information on Paediatric Anaesthesia, click here.

Aim of Programme

The “Paediatric Pain Fellow Training Programme” is initiated with the aim of providing a well-rounded training experience to qualified and practicing paediatric anaesthesiologists or senior anaesthesia trainees from countries which currently lack specialized paediatric pain services or those who intend to sub-specialize in this field.

KKH Paediatric Anaesthesia has taken the lead to promote the standard of Paediatric Anaesthesia in the region and we already have in place the “General Paediatric Anaesthesia Fellow training programme” which has been ongoing since 1988. We hope to continue to lead in our field through this third Fellowship programme.

Duration of Programme

12 months

Number of Training Places

At any one time, only one trainee will be accepted to the Paediatric Pain Fellowship programme.

Learning Outcomes

The Fellow will benefit by learning from our multi-disciplinary paediatric pain team in KKH during daily rounds, operating theatre exposure, clinic sessions, peer-review learning and department teaching sessions. Patient advocacy, education, research and quality improvement concepts are also emphasized in this Fellowship.

Content Areas

Course Content involves recognition and assumption of a pain physician’s role including that of a clinician, communicator, collaborator, scholar, leader, advocate and healthcare professional.

Specific training objectives are found within a separate document.

Training Methods

The fellow will practice in Department of Paediatric Anaesthesia only.

1. Participate in twice daily Children’s Pain Service (CPS) ward rounds
2. Run the Children’s Pain Management Clinic under supervision
3. Contribute to interdisciplinary team updates
4. Contribute to Department and Resident pain-related teachings
5. Shadow / Observe Allied Health sessions with pain patients
6. Attend all relevant teaching sessions within Department of Paediatric Anaesthesia and Hospital Continuing Medical Education (CME)
7. Conduct a supervised pain-related research / quality improvement project with culmination in a poster or publication

Past and Present Fellows

KKH Paediatric Anaesthesia has taken the lead to promote the standard of Paediatric Anaesthesia in the region and we already have in place the “General Paediatric Anaesthesia Fellow training program” which has been ongoing since 1988. We hope to continue to lead in our field through this third Fellowship program.

Team of Experts

The Paediatric Pain Fellow will be supervised by a senior from the Paediatric Anaesthesia Department, KKH at all times.

To enable the supervisor to carry out an adequate level of supervision, the supervisor will be allowed to supervise not more than two clinical fellows within the department or as stipulated in the SMC Supervisory Framework.

II Assessment and Evaluation

Aims of Assessment

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

(A) Patient Care

• Demonstrates comprehensive assessment to reach appropriate diagnosis
• Provides the appropriate ongoing management based on best clinical practice
• Responds appropriately to emergency clinical problems
• Responds appropriately to emergency clinical problems
• Practices within the scope of his/her abilities.

(B) Medical Knowledge

• Demonstrates good basic science knowledge
• Ability to apply knowledge in the clinical
• Demonstrates up-to-date knowledge
• Demonstrates good analytical thinking and problem solving techniques

(C) Practice-Based Learning and Improvement

• Engages in on-going learning
• Facilitates the learning of others
• Understands and integrates concepts of quality improvement into practice
  

(D) Interpersonal and Communication Skills

• Demonstrates care and concern for the patient/family
• Communicates effectively with patient/family
• Communicates and works effectively with other healthcare professionals

(E) Professionalism

• Accepts responsibility and follows through on tasks
• Responds to patient’s unique characteristics and needs equitably
• Demonstrates integrity and ethical behavior

(F) Systems-Based Practice

• Provides cost-conscious medical care
• Works to promote patient safety
• Coordinates care with providers in the larger healthcare community
  
  

The other key competency areas include:

1. Public Sector Ethos:
   Committed to public service and improving patient care in the public sector.
2. Leadership & Motivation:
   Thinks strategically; influences and leads; acts with drive, confidence and commitment.
3. Creativity & Innovation:
   Looks beyond conventional ways; creates new value for patients and patient care.
4. Research Output:
   Participates in research and publications, presents abstracts at conferences.
5. Work Output:
   Contributing and effective member of the team with good work output.

Assessment Approaches

1. Fellow’s log book - A logbook will be issued and this is used to assess the progress of training. It will be reviewed every 3 monthly.
2. One General Physical Examination Assessment (Cardiovascular, Respiratory, Abdominal, Neurological, GALS screen)
3. One Pain-Orientated Sensory Testing Assessment
4. One In-Training Assessments (ITA) every 3 months which assesses both
   1. Clinical skills & Formulation of Problem List
   2. Management Plan
5. One Department level Pain-related Presentation Assessment
6. One Multi-Source Feedback form as filled by at least one Pain Consultant, one Resident and one Pain Specialty Care Nurse. Allied Health input will also be considered and is given weightage based on frequency of clinical encounters.
7. One completed Research / Quality Improvement Project with poster or publication outcome
8. One formal program evaluation discussion will be done at the end of posting using the Program Evaluation Form (Fellow).
9. Completion Report. This 500-word report will need to be submitted to both the Primary Mentor and the Fellow’s supporting department detailing the initial objectives and the achievement of said objectives by the end of the Fellowship.
   
   

Evaluation Process

1. Assessment is based on a scale from 1-9
   1. Superior - All behaviours performed very well (ratings 7, 8, or 9)
   2. Satisfactory - Most behaviours performed acceptably (ratings 4, 5, or 6); satisfactory performance is described below
   3. Unsatisfactory – Most behaviour performed poorly (ratings 1, 2, or 3)
      
2. The minimum pass mark is 4 for Professionalism, Interpersonal & Communication, Medical Knowledge and Patient Care.
3. The minimum pass mark is 3 for the other categories i.e. minimum pass mark is anything higher than the red bar on the scale.

Fellows graded with USP will receive a debrief with his/her Supervisor and the Clinical Director of Children’s Pain Service to understand the deficiencies in performance.

III Target Audience and Eligibility Requirements

Target Audience

Qualified and practicing trainees from countries which currently lack such services. Trainees may be from Anaesthesiology, Rheumatology, or Rehabilitation Medicine backgrounds, or may be from any other relevant field of training which requires exposure to the above-mentioned work.

Applicants whose departments have indicated a need for establishment of pain services will be allocated higher priority. The applicant will have to include the particular field of interest (perioperative, complex, oncological/palliative, procedural, chronic pain) and any relevant information or questions from his/her department that may be answered in a completion report at the end of his/her time with us.

Pre-requisite/Eligibility Requirement(s)

The applicant for the pediatric pain fellowship must be proficient in English language.

He /She will have to meet the following criteria as stated by Singapore Medical Council under the "Framework for Postgraduate Training of Temporarily Registered Doctors from Schools not listed in the Schedule" :

• Basic eligibility requirements for Temporary Registration
• Categories of Temporary Registered Doctors for Postgraduate Training

IV Other Information

Course Fees

Course fees will be determined upon application.

Funding

Fellows must be self-funded or sponsored by their parent country or institution, and are to return home at the end of the training programme.

Certification

A certificate of completion will be presented to each Fellow at the completion of the programme.