A Framework of Competences for Level 3 Special Interest Module in Paediatric Allergy
___________________________________________________________________________________
A Framework of Competences
for the
Special Interest (SPIN) Module in
Paediatric Allergy
October 2013
Version 3
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A Framework of Competences for Level 3 Special Interest Module in Paediatric Allergy
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CONTENTS
Section 1
Introduction
3
Section 2
General Competences
5
Section 3
Specific Clinical Competences
6
General Allergy
6
Anaphylaxis
7
Food Allergy
7
Eczema
8
Uritcaria and Angiodema
8
Rhinoconjunctivitis
9
Venom Allergy
9
Latex Allergy
10
Idiopathic Anaphylaxis
10
Immunology and Infectious Diseases
10
Section 4
Specific practical procedures & investigations
11
in paediatric allergy
Appendix 1
Guidance Checklist for Training
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A Framework of Competences for Level 3 Special Interest Module in Paediatric Allergy
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Section 1 Introduction
Who is this book for?
It is for doctors at Level 3 in their General Paediatric training who wish to
work towards an interest in Paediatric Allergy during Level 3 training. It is
also there to guide tutors and educational supervisors.
Why do I need it?
This book gives you and your tutors’ guidance about the competences you
need to cover in addition to the Framework of Competences for Level 3
Training in General Paediatrics. It gives you a clear picture of what you have
to achieve by the end of this module of training in order to have expertise in
this area.
How do I use the book?
You can sit down with the book on your own and use it to help you identify
areas of practice that you need to work on and those areas in which you feel
fairly confident.
You can talk to your tutor about the balance of your
experiences and look for ways to ensure you cover all areas you need to. It
should be used by Schools and Educational Supervisors to ensure that a
programme of training is developed in Level 3 that will allow the trainees to
achieve these competences.
In setting this programme, liaison with the
relevant CSAC is important. In Appendix 2, there is guidance for training in
the module, which the programme must adhere to.
Progression
Following completion of Level 3 training and the module, the CCT holder
should be competent to take up a post as a General Paediatrician with a
Special Interest in this area. It is expected that there will be a requirement in
paediatric services for consultants with special expertise provided by the
module. Such posts will usually form part of a Regional Specialty Network
including working with accredited sub-specialties in this area.
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It would be expected that a consultant with a specialist interest in Paediatric
Allergy would practice as part of a regional allergy network and should have
mechanisms in place to remain up to date with continuing professional
development. These should include, but are not limited to:

Be a member of an appropriate regional paediatric allergy group for
guideline development, service appraisal, peer review and CPD

Have active links with a regional centre to facilitate referrals,
discussion of patients, further training and support.

Be a member of the British Society for Allergy and Clinical Immunology
(BSACI) +/- the European Academy of Allergy and Clinical
Immunology (EAACI) +/- British Paediatric Allergy Immunology &
Infection Group (BPAIIG).

Remain up to date with national guidelines produced by the BSACI,
European guidelines & position papers produced by EAACI.
A note about the format of this document
This framework sets out the additional competences which should be
achieved by the end of Level 3 training. The trainee also has to achieve all
the competences in the Level 3 General Paediatric Framework
Assessment
The RCPCH Assessment Strategy (PMETB approved) for Level 3 Training
will be used. Trainees working with their educational supervisors should
ensure that the Assessment Strategy is tailored to cover the area of Special
Expertise as well as General Paediatrics and that learning and assessment
are well documented within the e-portfolio.
Pilot
This special expertise module is being introduced as a pilot. The College will
be seeking feedback from the Trainees, Educational Supervisors, Schools of
Paediatrics, CSACs and potentially in future from Employing NHS Trusts and
Regional Networks. This will look at:
1. Need for training in this module
2. Addition or omission of competences unique to the module
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A Framework of Competences for Level 3 Special Interest Module in Paediatric Allergy
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3. Feasibility of delivering the module within Level 3 General Paediatric
training
4. Usefulness of the standards for training for the module.
5. Outcome of trainees undertaking the module
6. Need for revision of the competences
7. Need for further assessment
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Section 2 General Competences in Paediatric Allergy

Have the knowledge and skills to take an allergy-focused history and
initiate management of patients presenting with common allergic
disorders, both in in-patient and out-patient settings.

Be familiar with the genetic, immunological, clinical, epidemiological
and psychosocial aspects of allergic conditions.

Be familiar with the concept and process of transition – from secondary
to primary care services, and from paediatric to adult allergy services.

Be able to describe and explain to children, young people and their
parents or carers the rationale and methods of treatment in terms they
will understand.

Understand the importance, and have experience of participation in a
multidisciplinary team (including specialist nurses and dietitians) and
other professionals involved in the care of children with allergic
disease.

Be aware of, and have experience of the development of local allergy
care guidelines & referral pathways within a clinical network.

Understand the national drivers for allergy care and service delivery.

Understand how audit/quality improvement projects can enhance
service delivery.

Be able to lead an allergy service in a secondary care setting.
Section 3 Specific Competences in Paediatric Allergy
General Allergy

Know the specificity, sensitivities and predictive values of skin‐testing
and in vitro IgE antibody measurements for individual allergens.

Be aware that these values vary with the allergen involved, the
manufacturer the purity of the product and the relative content of the
allergen.

Identify patients who present symptoms mimicking allergy and know
how to refer them to other specialists.
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
Know and be able to recognise the relationship between food allergy,
eczema, failure to thrive, asthma and rhinitis.

Know and understand pet allergy and be able to advise
sympathetically about reducing exposure to animals.
Anaphylaxis

Ensure that guidelines for the management of anaphylaxis are
implemented.

Be able to advise about and interpret investigations performed
immediately following acute allergic reactions.

Be able to identify precipitating causes using ingestion history and
serial tryptase levels, as appropriate
Food Allergy

Know the common and uncommon foods that trigger IgE mediated and
non IgE mediated hypersensitivity reactions

Know the mechanisms of IgE and non‐IgE food hypersensitivity
reactions, including eosinophilic enteropathy and food intolerances due
to pharmacological effects of food or enzyme deficiencies, and be able
to explain this to parents

Be able to recognise multiple presentations of food allergy, be able to
interpret a dietary diary and be able to advise about its management,
including the risks and benefits of avoidance diets, use of alternative
and hypoallergenic milk formulas and a hypoallergenic weaning diet.

Know the indications for food challenges, challenge protocol
procedures and safety precautions.

Be able to use measurement of specific IgE and skin test results to
optimise the timing of food challenges.

Be able to advise about the safe re‐introduction of food following a
negative food challenge.

Know the relationship and cross‐reactivity between food, pollen and
food, and latex and be able to advise children and their families
appropriately.
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
Be able to recognise the distinction between food allergy and oral
allergy syndrome and advise patients appropriately.

Know how to assess future risk of allergic reactions and which children
require the prescription of injectable adrenaline
Eczema

Understand the role of allergen triggers and avoidance in the
pathogenesis and management of eczema and be able to advise
children and their families appropriately.

Know the role of diet in the pathogenesis of eczema and be able to
advise appropriately about dietary modification.

Know the role of exposure to airborne allergens in the pathogenesis
of eczema and be able to advise appropriately about reducing
exposure.

Be able to examine and assess the severity of eczema in an affected
child.

Know the sensitivity and specificity of measuring total and specific IgE
and skin testing in children with eczema and be able to investigate
them appropriately.

Be able to manage patients with severe eczema including the use of
emollients, anti-inflammatory preparations and wet wraps.
Uritcaria and Angiodema

Be able to manage and investigate patients presenting with an acute
exacerbation of angioedema.

Be able to manage and investigate patients presenting with an acute
exacerbation of angioedema.

Be able to identify precipitating causes and advise about future
avoidance.

Know the definition causes and exacerbating factors of acute and
chronic urticaria and angioedema.

Be able to investigate and manage children with acute and chronic
urticaria.
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Asthma and recurrent Wheeze

Be able to identify allergen exposure as a cause of acute
exacerbations of asthma.

Know the role of allergy testing and allergen avoidance in managing
children with asthma and be able to advise families about allergen
reduction measures.

Know the concept of the unified airway and the importance of the
treatment of rhinitis in patients with asthma.

Be able to advise about the effective methods of reducing exposure to
house dust mite.

Be able to interpret spirometry, pulmonary function testing and
exercise challenge testing.

Understand the changes in asthma which occur during adolescence
including remission and deteriorating asthma control.
Rhinoconjunctivitis

Know the definitions of seasonal and perennial disease and
exacerbating factors.

Know about the aerobiology of pollen.

Be able to diagnose accurately allergic rhinitis and conjunctivitis, know
the differential diagnosis, management guidelines and principles of
therapy.

Be able to advise young people and their families about the effective
application of eye drops and nasal sprays and identify patients who
would benefit from pollen immunotherapy.

Be able to diagnose the common cross‐reacting allergens relevant to
the oral allergy syndrome.
Venom Allergy

Know the clinical features and grading of local and systemic reactions
to insect stings

Know when to refer patients for venom immunotherapy
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Latex Allergy

Be able to diagnose latex allergy, including skin prick testing,
measurement of specific IgE and provocation tests.

Be able to advise about the practical management of patients with
latex allergy, including avoidance and use of latex free alternatives; at
home, in schools and nurseries, in dental clinics and hospitals.

Know about hospital latex policies and be able to advise about their
implementation.

Be able to identify cross‐reacting latex allergens in common foods and
advise patients accordingly
Idiopathic Anaphylaxis

Be able to investigate idiopathic anaphylaxis appropriately and exclude
common causes

Know the differential diagnosis including exposure to unusual
allergens, exercise induced anaphylaxis and systemic mastocytosis.

Be able to advise a family with a child at risk of anaphylaxis about
prevention, rescue medications and prognosis.
Immunology and Infectious Diseases

Know the immunological basis of allergic disorders.

Know how to manage acute anaphylaxis.

Know in depth the UK national vaccination schedule, its continued
development and its differences from other nations.
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Section 4: Practical Procedures in Paediatric Allergy

Safe obtaining and handling of clinical specimens

Skin prick testing

Demonstration of asthma Inhaler technique

Simple spirometry

Eczema cream and dressing application

Demonstration of intranasal steroid technique

Adrenaline autoinjector training

Emergency management of anaphylaxis
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Appendix 2
Paediatric Standards Checklist
These standards were derived to assist in the assessment of the paediatric training
standards in your Deanery
Speciality:
Special Interest Module in Paediatric Allergy
The Programme (which may consist of several posts) should be approved by
the allergy/immunology/ID CSAC) and provide the following:
/
1. Supervision
1.1 An educational supervisor who is a Consultant Paediatrician with an interest in
Allergy trained in assessment and appraisal who works as part of a regional or
national network and is familiar with the SPIN training programme
1.2 An educational supervisor who has time in his/her job plan for delivery of
educational supervision
1.3 Trainer is an approved educational supervisor (has been trained in education
supervision, assessment and appraisal)
2. Other Personnel
2.1 Consultant in Paediatric Allergy within the local region, but not necessarily the
trainees own Deanery, to supervise trainee &/or provide support to general
paediatrician with expertise acting as the trainee’s Educational Supervisor
2.2 More than one ST4 -8 in the children’s department
2.3 MDT consisting of a minimum of a local paediatric dietician and clinical nurse
specialist with allergy expertise. Support from organ-based specialists and clinical
psychology, either locally or within the clinical network depending upon the size of the
local service
3. Service requirements and facilities See Standards for paediatric allergy
services, BSACI
3.1 Specialty specific requirements of subspecialty department:
3.2 Specialty specific requirements of related clinical departments that are
involved in delivery of the curriculum:
Good links with relevant regional clinical services, including adult immunology to
provide transitional care.
3.3 Specialty specific requirements of service departments relevant to delivery
of curriculum (e.g. investigation departments, PAMs departments, surgery or anaesthesia):
Point of care skin prick testing service in outpatients.
Appropriate paediatric day case facilities for food challenges & administration of
sublingual immunotherapy.
Simple spirometry.
Access to accredited immunology diagnostic laboratory
3.4 Specialty specific requirements of clinical networks:
Opportunity to work within established clinical networks for allergy to include shared
care clinical guidelines and protocols
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4. Educational activities and training
4.1 Specialty specific clinical exposure required to provide sufficient learning
opportunities(NB if giving workload data ensure it is explicit whether this is number per
annum or number trainee would be expected to be exposed to over entire programme):
1. Outpatient and inpatient experience of children presenting with the range of
conditions listed in the RCPCH Care Pathways portfolio.
2. Supervised management of patients, as in 1. using skills listed in RCPCH
Care Pathways portfolio
3. Experience of adolescent services and transition to adult services and
independent living
4. Complete 40 new outpatient assessments & review 100 children during 12month training period.
4.2 Specialty specific requirements for structured training opportunities to
include courses:
Attendance at not less than 5 allergy training days during level 3 training &/or
Completion of PG Certificate in Allergy. Appropriate training days would include
attendance at national and international conferences on allergy, national training days
held by BSACI and BPAIIG. Events should be of sufficient academic and educational
quality and should have been granted CPD approval from RCPCH or its equivalent.
4.3 Specialty specific requirements for other experiential learning(excluding
clinics and ward rounds):
Opportunity to attend other specialty clinics, including adult allergy services,
desensitisation and drug testing.
5. Working patterns
5.1 Safe cover arrangements for paediatric department out of hours in line with
RCPCH guidance
5.2 Evidence of compliance with existing employment rules to working time
5.3 Working intensity and pattern that is appropriate for learning
5.4 Access to sub-specialty training time which allows achievement of the
competences throughout the programme
5.5 This post forms part of a complete paediatric training programme which provides
a minimum of 5 years of acute clinical experience, including out of hours
6. Specific Post requirements
6.1 12 months in paediatric allergy within:
Regional training centre &/OR secondary care allergy unit with appropriate training
facilities (see points 1-5 for requirements). The secondary care unit should be
networked to a regional paediatric allergy centre. Day release experience should be
permitted for clinical exposure to tertiary paediatric allergy, dermatology, ENT and
ophthalmology, immunotherapy, drug allergy testing and clinical immunology
laboratory.
Training placements for up to 6 months in related subspecialties such as respiratory
medicine, gastroenterology and or immunology would also be useful.
7. Enabled to learn new skills, necessary skills and curriculum coverage
(speciality specific)
This section can be used to highlight marker conditions to which trainee should be exposed or the numbers of
cases/procedures that trainee will be expected to see/do. Ensure that it is clear whether any numbers are for whole
training programme or per annum
A general paediatrician with an interest in allergy would be expected to be able to
conduct their own skin prick tests and oversee standards of local practice according
to national guidelines. They should be able to interpret skin prick tests and specific
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IgE. They should have broad practical skills in the management of atopic disease.
They should also be able to oversee the management food challenges in a safe and
appropriate manner and setting.
7.1 Specialty specific marker conditions trainee should be exposed to:
Paediatric allergy training emphasises the importance of demonstrating competence
in the management of the range of allergic diseases listed in the RCPCH Care
Pathways portfolio, including acute and chronic conditions of varying severity and
complexity.
8. Access to clinics and ward rounds and long term care of patients
8.1 Specialty specific numbers and types of clinics expected to attend
(including outreach clinics):
Regular access to designated allergy clinics to include new and review patients
8.2 Specialty specific combined clinics expected to attend:
Opportunity to attend combined clinics with appropriate tertiary sub-specialties
8.3 Specialty specific ward rounds consultant led and independent per week:
8.4 Specialty specific involvement in transitional care:
Provision to facilitate transfer to adult allergy services or primary care
9. Meetings
9.1 Specialty specific number and types of MDT meetings expected to be
exposed to:
Regular attendance and participation in allergy multi-disciplinary team meetings
9.2 Specialty specific multi-professional meetings expected to be exposed to:
Attend regional allergy interest groups
Attendance and membership of BSACI &/or BPAIIG &/or EAACI
10. Clinical audit
10.1 Participate in at least 1 clinical audit to demonstrate quality improvement in
allergy care provision.
11. Teaching appraising and assessing
11.1 Opportunities for formal and informal teaching
11.2 For senior trainees: opportunities for involvement of assessment of others
11.3 For senior trainees: opportunity to be involved in the appraisal of others
12. Research
12.1 Knowledge and understanding of GCP principles
12.2 Ability to perform critical literature review
12.3 Opportunity to be involved in collaborative multi-centre research
13. Management
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Demonstration of knowledge and understanding should include:
1. Knowledge of the current national (NICE, BSACI, RCPCH) and
European guidelines (EAACI) on the management of allergic disease
2. Attendance at a minimum of 5 recognised allergy training days during
level 3 training that are of a standard acceptable for level 3 SPIN
training.
3. It is strongly recommended that trainees undertake some formal
postgraduate training such as a Postgraduate Certificate in Paediatric
Allergy.
Imperial College, London
http://www1.imperial.ac.uk/medicine/teaching/postgraduate/allergyprog
ramme/
University of Southampton
http://www.southampton.ac.uk/postgraduate/pgstudy/programmes/med
icine/msc_pg_dip_pg_cert_allergy.html
4. Membership of the British Society for Allergy and Clinical Immunology
(BSACI) and its Paediatric Subgroup +/- the European Academy of
Allergy and Clinical Immunology (EAACI) +/- British Paediatric Allergy
Immunology and Infection Group (BPAIIG).
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