INTRODUCTION FOR CLINICAL ATTACHMENT IN CHILD HEALTH NHS FIFE
Welcome to the NHS Fife’s Paediatric & Child Health Department. We hope that you enjoy your time with us.
The Paediatric Department in Victoria Hospital delivers acute secondary care to the children of Fife. We have
recently moved into our new facilities in phase 3 building of Victoria Hospital. The Department is divided into 3
clinical areas:
1.
Children’s ward: The main in-patient bit receiving all Acute Paediatric Medical, Surgical and Orthopaedic
admissions. It admits children from 10 days of age up to 16 years of age. It has 26 beds including a 3
bedded High dependency unit.
2.
Neonatal intensive care unit: This is a level 2 unit which admits infants from 23 weeks gestational age and
has 20 beds including 6 spaces set up for ventilation.
3.
Children’s Ambulatory care unit: This area acts like a day bed area were children maybe admitted for
minor surgeries including ENT procedures and lengthy endocrinological investigations like glucose
tolerance testing. There are 8 beds and also incorporates all outpatient clinics.
In addition out-patient clinics are also delivered from Queen Margaret Hospital in Dunfermline. We also work very
closely with our colleagues in Community Child Health.
The Paediatric Department is staffed by a team of consultants, specialists, specialty trainees, general practice
trainees and nurse specialists. Each member of the team will provide valuable teaching opportunities for you.
We are also exceptionally lucky to have expert dietetic support from Alison McLoed and her team of Paediatric
dieticians as well psychology input from Dr Hillary Maddox and Dr Shona Murphy.
As your site Educational Supervisor I will have overall responsibility in coordinating the delivery of the curriculum
here. I will meet you on the first day of your block here in Kirkcaldy. As you will normally be attending tutorials in
Dundee on the first Monday of your block, this will take place on Tuesday afternoon between 14:00 & 15:30.
Normally this will be in the “Meeting room” (otherwise called the green room) on the children’s ward. This will
also give you the opportunity to meet with Karen Hogg in the morning and complete formalities. As the Medical
Education Services Admin Assistant, Karen (or one of her colleagues in her absence) will be able to sort out your ID
cards, accommodation and provide a brief induction to NHS Fife.
I can be contacted through the internal DECT phone system on extension 29730 or alternatively by e-mailing
kaniruddhan@nhs.net . My secretary Ann Kinnell can be contacted on 28225.
TEACHING PROGRAMME
The teaching sessions are broadly divided into bedside teaching and tutorials. Besides these you will also be
expected to attend scheduled departmental teaching.
In general bedside teaching will be delivered by both consultants and medical specialist registrars. This will
concentrate on basic medical skills of history taking and examination. In the first week of your child health block
you should shadow the Children’s ward and neonatal teams. You will be divided into two groups and allocated to
one of these two areas:
Children’s ward
Neonatal unit
Tuesday, Wednesday
Group 1
Group 2
Thursday, Friday
Group 2
Group 1
You should use these days to observe specialist registrars and consultants taking histories and examining patients.
From the second week onwards you will be allocated to one of the following clinical areas:
1.
2.
3.
Children’s ward
Neonatal unit
Out-patient clinics
You will spend a full week in each of these areas rotating in turn to next area the following week. Whilst on the
children’s ward you will also be expected to undertake long shifts until 21:30 on 2 of the days.
Paediatric Student Teaching Timetable, updated April 2013
Time
Monday
Tuesday
8:30 – 10 am Ward1
8:30 -10 am NNU
Paediatric
Neonatal
AM
Grand Round
Grand Round
Assessment Room 1or2
Wednesday
Thursday
8:30 – 9 am
8:30 – 9 am
Paediatric teaching by Ward
Consultant
Paediatric teaching by Ward
Registrar
Ward Doctors Office
Ward Doctors Office
Friday
8:30 -9am
Neonatal Teaching,
NNU Doctors Office
Dr Morrice
an hour
anytime
between
12-14
Dr Thanoon Cardiovascular Ex
Abdominal Ex
2 MiniCEx
2 MiniCEx
(Arlyne 21253)
Children’s Ward
(Karen 28828)
Dr Aniruddhan
Dr Ainine
Ward teaching
2 Students ppt presentns
2.30-3.30 pm
Education Centre
Respiratory, 2 MiniCEx
2 – 3:30 pm
(Ann 28225)
(Arlyne 21253)
Dr Humphreys
Departmental teaching
Education Centre
Education Centre,
Private study
PM
4-5 pm
Lecture Theatre
(Susan 21733)
3:30 - 5 pm
Please confirm with the Teaching Doctors the day before. Or with the secretaries (numbers in (Name xxxxx)) in the morning of your tutorial to see whether the
teaching is happening or not (annual, study or sick leave…etc.)
Some of these tutorials maybe cancelled or rearranged due to the nominated facilitator being unavailable. Please check with your named tutor or their secretary
on the day before if the scheduled teaching will go ahead as planned.
Departmental Teaching Timetable:
Monday
Tuesday
Wednesday
Thursday
Friday
08:30-10:00
08:30-10:00
08:30-09:00
08:30-09:00
08:30-09:00
Paediatric Grand
Round
Neonatal Grand
Round
Consultant led
teaching
Registrar led
Paediatric teaching
Registrar led
Neonatal teaching
13:00-14:00
15:00-17:00
Journal club
Plenary sessions
Educational Supervisor Meetings:
As your site Educational Supervisor, I will meet with you for one hour each week. These meetings will take place in
the children’s ward between 10:00 and 11:00AM on Fridays. In my absence I shall nominate a replacement to sit in
on these meetings. The aim of these meetings is to identify learning objectives and discuss what help you might
need to achieve them.
At these weekly meetings you will be expected to complete two assessments each of case based discussion (CBD)
and clinical skills (mini CEX). In addition I will also advise you of interesting cases and events in the hospital.
These will serve as a starting point for discussions on broader scientific, clinical and ethical aspects of any problem
and help you to determine what you need to learn.
Assessment:
Final assessment for this block will be undertaken on the last Thursday of your block between 14:30 & 15:30. You
will be required to present a case that you have seen, clerked-in and examined. It should be in the format along the
lines of a typical ward round bedside presentation. 10 minutes will be allocated per presentation and over a further 5
minutes you will be required to answer questions on aspects of the case. Use of PowerPoint or other media is not
permitted for these presentations. Marking scheme will be:



A
B
C
Outstanding/ well above standard expected of a 4 th year Student
Achieving standards expected
Expected standard not achieved
In addition an outcome assessment sheet will also be completed. Whilst completing this I will take into account your
overall attendance and performance during this block. This will also reflect the comments and views of other
members of the Paediatric team who have seen you in action.
Learning objectives:
By the end of this attachment, students should be equipped with knowledge about health and disease in children,
gain competence in clinical skills in assessing children and applying knowledge and skills to suggest provisional
diagnosis and management plans.
1.
Key clinical skills
a. Recognise the seriously ill child and know how to take immediate action.
b. Take a history appropriate to acute and chronic illness
c. Elicit normal and abnormal physical signs to reach a provisional diagnosis
d. ENT examination
e. Have a general knowledge of normal variations in child and adolescent behavior
f. Have a good knowledge of normal child development including psychological, social and sexual
development
g. Formulate a management plan using where appropriate other sources of information, critically
appraising evidence from literature.
h. Give advice to parents
2.
Knowledge base:
a. Health promotion
i. Schedule of immunisation and provide advice on its benefits
ii. Child protection framework
iii. Screening principles and application in paediatrics
iv. Infant nutrition and feeding
1. Breast feeding
2. Weaning
3. Use of growth charts and interpret its results
4. Obesity
b. Neonatal problems:
i. Carry out a routine newborn baby examination
ii. Recognize common newborn problems
1. Jaundice
2. Respiratory distress
3. Irritability
4. Cyanosis
iii. Identifying common congenital abnormalities and discuss the process of informing
family of sensitive diagnosis
c. Respiratory disease
i. Common causes of cough, noisy breathing and breathlessness
ii. Diagnosis and management of asthma in school age child
iii. Instruct children and parents on use of inhaler devices
iv. Recognition of the patterns of presentations of cystic fibrosis
d. Cardiovascular disease
i. Causes of murmurs in children
ii. Recognising congestive heart failure and its causes
iii. Recognising cyanotic heart disease
iv. Modalities of investigating congenital heart disease in infants
e.
f.
g.
h.
i.
j.
k.
GI
i. Common causes, investigation and management of vomiting
ii. Common causes, investigation and management of acute and chronic diarrhea
iii. Common causes, investigation and management of constipation
iv. Common causes, investigation and management of abdominal pain
Renal
i. Collecting and interpreting results of urine samples in children
ii. Common causes of haematuria (including HSP)
iii. Investigating urinary tract infections
iv. Enueresis
Neurology
i. Fits, faints and funny turns: taking history and interpreting information obtained
ii. Advising parents on emergency management of seizures
iii. Advising parents on prevention and management of febrile convulsions
iv. Role of various modalities of investigations: EEG/Imaging
v. Recognise the signs of raised intracranial pressure
vi. Gait disorders
vii. Contribution of different members of a multi-disciplinary team in managing a child with
complex needs
Haematological conditions
i. Anaemia in infancy
ii. Bruising & clotting disorders
iii. Lymphadenopathy
Metabolic disease
i. Presentation and diagnosis of Diabetes management
ii. Principles of treatment: dietary and insulin
iii. Presentations of inborn errors of metabolism
Limping child
i. Common causes of limping child
ii. Initiating and interpreting investigations for child with musculoskeletal pain
Infectious diseases
i. Meningitis
ii. Sepsis
iii. Common exanthematous diseases
iv. Suspecting immunodeficiency
Paediatric team- Medical staff:
Name
Specialty
Sean Ainsworth
Neonatologist and clinical
lead for paediatrics
Ahmad Ainine
Diabetes and endocrine,
Undergraduate supervisor
for University of
Edinburgh
Krishnan Aniruddhan
Respiratory medicine,
Undergraduate Supervisor
for University of Dundee
Aysell Crokett
Clinical lead for child
protection
Norbert Dahlinger
Neonatologist
Robert Humphreys
Orthopaedics
Mohammed Khalil
Neonatology
Evelyn Menzies
Renal, constipation
John Morrice
GI, obesity
Louisa Pietersie
Allergy
Laura Stewart
Neonatology
Chris Steer
Epilepsy, neurology and
behavioral disorders
Manal Thanoon
Neonatology &
Cardiology
Phone
Secretary
29730
28225
28225
Paediatric team- Nursing:
Name
Speciality
Lana Clacher
Coordinator for paediatric division
Joyce McFarlane
Neonatal unit coordinator
Jenna Arnott
Neonatal unit coordinator
Sharon Lappin
Children’s ward coordinator
Fiona Burt
Children’s ward coordinator
Anne Mckean
Asthma nurse specialist
Lyndsey Pert
ADHD nurse specialist
Sarah Smith
CF nurse specialist
Angela Toruntay
Endocrine nurse specialist
Laura Donaldson
Epilepsy nurse specialist
Kenny McCormack
Neonatal nurse practioner
Jackie Lees
Neonatal nurse practioner
Andi Lowe
Neonatal nurse practioner
Lorna Finlay
Neonatal nurse practioner
Pamela Cruickshanks
Paediatric nurse practioner
Liz Melvin
Paediatric nurse practioner
Jacquie Taylor
Paediatric nurse practioner
Linda Robertson
Diabetes nurse specialist
Karen Moir
Diabetes nurse specialist
Karen Davidson
Child protection advisor
Cicillie Rainey
Child protection advisor