INTRODUCTION TO ATTACHMENTS TO PAEDIATRICS & CHILD HEALTH DIVISION, NHS FIFE
Welcome to NHS Fife’s University Department of Paediatrics and Child Health. We hope you enjoy your
stay with us and make the most of it. The attachment in Fife offers you exposure to wide variety of
paediatric problems with lots of opportunities for hands on clinical experience.
Your clinical attachment in Paediatrics and Child Health lasts three or four weeks and is based in:
 Mainly Victoria Hospital, Kirkcaldy (VHK).
 Queen Margaret Hospital, Dunfermline (QMH) to attend OPD some Clinics. (optional only)
During this you will have various teaching opportunities and allocations:
 Paediatric Ward: clinical teaching, working with children, ward rounds, Grand Rounds
 Paediatric Ambulatory Unit: new cases and follow up reviews.
 Day case and special tests unit
 Neonatal Unit & Postnatal Wards
 General & Special Paediatric Clinics.
 On Call Commitment: where you see & clerk fresh cases, once weekly and one day at
weekends
You will meet with our team of Paediatricians & Paediatric Nurses
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Consultants & Senior Paediatricians:
Dr CR Steer
General Paediatrics and Neurology and ADHD
Dr R Humphreys
Paediatric Orthopaedic Physician
Dr M Thanoon
Neonatology & Cardiology
Dr E Menzies
General Paediatrics and Renal Medicine
Dr A Ainine
General Paediatrics and Diabetes, Endocrine & Education
Dr K Aniruddhan
General Paediatrics and Respiratory Medicine
Dr L Pieterse
General Paediatrics and Allergy and ADHD
Dr J Morrice
G. Paediatrics, Gastroenterology and International Child Health
Dr Khalil
Neonatology & cardiology
Dr Dahlinger
Neonatology
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Senior Nurses (shadowing):
Linda Robertson: Paediatric Diabetes Liaison Specialist Nurse
Anne McKean:
Paediatric Outpatient Specialist Nurse (Asthma, Allergy & Endocrine)
Fiona Burt
In Charge of Paediatric Ambulatory Care Unit
Jeana Summers
Charge Nurse Special Care Baby Unit
Angela Toruntay
Endocrine & Growth
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INFORMATION FOR CHILD LIFE & HEALTH (EDINBURGH) /
CHILD HEALTH (DUNDEE) MEDICAL STUDENTS
We hope to offer you the opportunity for direct involvement with patients and parents. You will be
encouraged to participate in the clerking process and we hope you will be able to learn some practical
techniques during your stay in Fife. The accent is therefore more on the “nuts and bolts” or “hands-on”
experiential learning in addition to formal tutorial or lecture-type teaching.
The trend in Paediatrics is towards quick turnover and lower bed occupancy and as a result there are
sometimes relatively few patients in the Ward at any one time. This means that Consultant ward rounds
tend to be less formal and perhaps more discursive and we would encourage you to ask questions and
participate in such discussions. There is a working ward round each morning at 9am, simultaneously
Paediatrics and Neonates. These ward rounds deal with every patient under the care of the unit
irrespective of which Consultant is involved and informal teaching may occur on an ad-hoc basis on such
rounds although this is not at the expense of other pressing nursing and medical commitments. On
Monday’s & Tuesday’s 08:30 to 10:00am there is a grand round in Paediatrics and Neonates.
On the other hand, the number of patients attending the Ward on an ambulatory basis has increased and
the numbers are about equivalent to those referred for actual admission. Between these two sources
there ought to be a good supply of clinical material from which to learn.
Your attachment is busy with tutorials, therefore, try to see as many clinical cases as you can in the
ambulatory unit and after 5pm (when on call).
For Edinburgh Students: Please liaise with the consultants, as early as possible in the first week, to
arrange to take cases to prepare to how to examine the major systems:
 Respiratory,
 Cardiovascular,
 Abdominal,
 Neurology
AND prepare 2 MiniCEx cases every day to be presented to the consultant at 12-1pm. Sometimes it
would be hard to find 2 cases of one system, only then take one case of another system. Try to get one
case with normal examination of the system and another with some abnormality, if feasible.
There will be bedside teaching of the four main body systems for an hour each, at lunchtime. Students
are required to find two suitable cases on the morning and prepare a MiniCEx on each. Frequently, it
might be difficult to find 2 CVS cases, for example; then one case could be another system. It is meant to
have one normal comprehensive system examination and then few cases over the weeks with
abnormalities if possible. Each student is required to present 4 MiniCEx cases, so this will be used as an
opportunity to teach you by senior staff, and to assess students on their last weeks presentations.
All students (Edinburgh & Dundee) will be attached to the ward, the clinics and the neonatal unit; a week
each. Many patients go through the Outpatient Clinics, and the mix of clinical material is somewhat
different, often unusual and complex disorders which do not tend to come in as inpatients. You should
regard attendance at various outpatient clinics as an obligatory part of the attachment. There are many
such Clinics (see attached timetable for a selection).
The department has students from Edinburgh and Dundee Universities which combined can be up to 10
students. It is suggested that you mutually agree amongst yourselves to work in the following way:
All student on the ward or clinics should attend the Monday morning (8.30am) Paediatrics Grand Round.
All consultants attend the Monday Paediatrics Grand Round, after that you can attend either the
ambulatory care or the ward round.
Those allocated for Neonatal Week, should start at the Neonatal Unit. All consultants attend the Tuesday
morning (8.30am) Neonatal Grand Round.
Those allocated clinics should start there, with the Consultant or Registrar, further details on clinics can
be found by contacting Karen Moncrieff, the clinic coordinator.
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INFORMATION FOR EDINBURGH STUDENTS: each student will spend a week at one function area as
follows:
Ward at VHK
Neonates at VHK
Clinics at VHK
Week 1
A, D
B
C
Week 2
B
C, D
A
Week 3
C
A
B, D
The teaching for medical students from Edinburgh University will involve 3 attachments and id meant to
cover the 12 outcomes identified by the university as follows:
Location
Themes
Outcomes
Ward
Examination
Management
1. Biomedical & Clinical Sciences
6. Presentation, Diagnosis & Treatment
7. Clinical Communication
9. clinical pharmacology
Clinics
History
Counselling
2. Psychological Aspects of Medicine
3. Social Science & Public Health
4. Research & Evidence Based Medicine
5. Consultation
Neonatal
Nutrition
Neonatal Problems
(Prematurity, Anomalies)
8. Resuscitation & Emergency
10. Medical Informatics
11. Ethics & Law
12. Personal Professional Development
All students doing Neonates (Edinburgh & Dundee) should also take advantage of any opportunities to
attend high risk deliveries, such as instrumental, and resuscitations, which may take place while they are
in the Unit. Each student should accompany the doctor responsible for baby checks; to observe several
and to perform a few baby checks under supervision. The Baby Hip Clinic at 8.30am on Tuesday
mornings is a good opportunity to become familiar with investigation and treatment of Developmental
Dysplasia of the Infant Hip. Students will get an opportunity to practise their examination skills on our
training dolls. It is also a good opportunity to gain experience in normal child development as you will be
able to interact with and examine well babies who are days old, weeks old and months old along with
their older siblings.
It is obvious that there are a number of options available at any given time and students ought to coordinate matters so that there are not too many at any one of these functions. Bear in mind however that
in many clinics there is more than one member of staff working and it is possible to distribute students
throughout the clinic in this way. It is worthwhile paying attention to the possibility of covering as many of
the available options as possible within the period of your attachment.
We expect a roster to be made up so that there is always a medical student available, including nights
and weekends, to see and assist with inpatient admissions, etc. This is not usually a very onerous
commitment throughout the whole attachment but students should make their own arrangements with the
SHO or Registrar to be called when there are emergencies or interesting events going on out of normal
hours. There is usually an “out of service” bleep, which can be used, provided you let the Switchboard
know which bleep you are carrying. We feel strongly that insight and experience gained in working in this
way is an invaluable part of your learning experience and of great use later for the Undergraduates. This
roster should not be regarded as exclusive and it is quite acceptable for more than one student to be “oncall” at a time.
When clinical commitments allow, the Registrars will be willing (please arrange early in the week and in
your attachment) to undertake bedside teaching or informal tutorials. Because of the unit staffing these
arrangements frequently have to be altered and postponed when pressing commitments interfere and it
has to be understood that this is the basis on which the attachment runs.
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There will be 4-5 class room teaching sessions per week, on Monday morning and Wednesday afternoon
as shown in the table below. Each consultant might contribute either regularly every week or partly once
or twice every four weeks. It might be difficult to determine topics in advance, with a bit of flexibility,
presenting what the students want might help. Additionally, there will be student’s presentations of
various topics, two students will present each week for 10-15 minutes and discussion is around 15
minutes. Presentations might contribute to your assessments.
As well as the Paediatric Unit Meeting on Thursday afternoons there is a Perinatal Meeting once a
month on the third Tuesday when stillbirths, neonatal deaths and interesting cases and matters of
perinatal practice are discussed.
Students interested in Paediatric Orthopaedics are welcome to join Dr Robert Humphreys in his clinics.
In the VHK, these are:
 Talipes Clinic at 1.30pm in Ambulatory Care on Mondays.
 General Paediatric Orthopaedic Clinic (focus on Cerebral Palsy on 1st and 3rd Wed) at 1.30pm
on Wed afternoon in the Paediatric Clinic.
 General Paediatric Orthopaedic Clinic on Friday mornings at 9am in the Paediatric Clinic.
There is a hospital meeting once per month (on the second Wednesday of the month) in the Education
Centre as part of the core programme for training Foundation Doctors and SHOs which students are also
welcome to attend.
Finally, it cannot be stressed too strongly that medical students and attached Postgraduates have access
to patient material and records on the understanding that they strictly observe the code of medical
confidentiality. It is too easily forgotten in a busy hospital setting and especially in the Children’s Unit, and
a deliberate effort is sometimes required. Furthermore, students are tactfully reminded that children and
parents must be accorded personal treatment, which takes into account their fears and expectations and
their right to preservation of personal dignity and privacy.
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PAEDIATRICS AND CHILD HEALTH – DUNDEE & EDINBURGH MEDICAL STUDENTS’ TIMETABLE
(Subject to Change)
Timetable for UGMS teaching
Time
AM
Monday
Tuesday
Wednesday
Thursday
Friday
8:30 – 10 am
Paediatric
Grand Round
8:30 -10 am
NNU
Neonatal
Grand Round
8:30 – 9 am
Paediatric
teaching
Doctors Office
8:30 – 9 am
Paediatric
teaching
Doctors Office
8:30 -9am NNU
Neonatal
Teaching,
10am Dr
Pieterse
10am Dr
Humphreys
11am Dr
Thanoon
11am
Dr Dahlinger or
Dr Khalil
12-13
Ward
Ward teaching
10.30-12 am
Respiratory Ex
2 MiniCEx
Dr Aniruddhan
Neurological
Examination
Abdominal
Examination
Cardiovascular
Examination
2 MiniCEx
Dr Morrice
2 MiniCEx
Dr Khalil
2 - 3 pm
2 Students
presentations
Dr Ainine
PM
3 - 5 pm
Paediatric
teaching
Page 5 of 7
Private study
CLINICS
am
Mondays
Tuesdays
Wednesdays
Thursdays
Fridays
Dr Ainine –
Growth &
Endocrine
Dr Thanoon –
General
Dr Steer –
ADHD
Review
ADHA Clinics
New – Dr
Steer
Review – Dr
Moaman & Dr
Graham (alt.
weeks)
Dr
Humphreys
–
Orthopaedic
General
Clinics
Dr Thanoon
Dr Aniruddhan
(alt. weeks)
Dr Claisse (alt.
weeks)
Anne
McKean –
Asthma
Education
Dr Maddox –
Clinical
Psychology
pm
Dr Morrice –
Gastroenterology
(1st, 3rd and 5th)
Dr
Aniruddhan –
General
Lyndsey Pert
ADHD
Medicine
Review
Dr Pieterse –
Allergy
Dr Maddox –
Clinical
Psychology
Dr Munro –
Surgical (4
weekly).
Laura
Harrison –
Dietetic clinic
Dr Ainine –
Diabetes
(1st,2nd,3rd)
Dr
Aniruddhan –
Respiratory
(monthly)
Dr Thanoon –
General
(Week 3)
Dr Aniruddhan
– Asthma
Dr Steer –
Epilepsy
Dr Pieterse –
General
Dr Menzies –
Constipation (1st,
3rd, 4th and 5th)
Dr Morrice –
Enteral
Feeding
Clinics (week
2)
Dr Morrice –
Weight
managements
(week 4)
Dr Ainine –
Diabetes
(1st,2nd,3rd)
Dr Gibson –
Rheumatology
(2nd)
Dr Humphreys
– Orthopaedic
ENT Pre-op
Assess
Dr burns –
Cardiology (1st
and 5th)
Third
Thursday of
every month
2pm
Paediatric
Outpatient
Specialist
Nurse
Session
(Asthma,
Allergy
&Endocrine)
(Education
Centre – Anne
McKean)
Dr Lam –
Genetics
(week 2 and
4)
Dr Morrice General
Dr Pieterse
– ADHD
Lyndsey
Pert – Sleep
Clinic
PRIVATE
STUDY
Activities run every week unless otherwise indicated
Session starts at 9.15am to give students opportunity to attend Ward handover meeting at
9am.
All ward rounds are consultant-led and therefore represent valuable learning opportunities.
Students assigned to Ward should attend as much of the ward round as possible.
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UNIVERSITY OF DUNDEE MEDICAL STUDENTS
Welcome to paediatrics in Fife. During your time here, we hope to provide you with basic clinical knowledge and
skills required to care for sick children. You will have already attended a number of paediatric lectures and
tutorials at Ninewells in your previous years and will therefore be expected to have some basic understanding of
the principles. We shall aim to build on this knowledge and develop in particular practical clinical skills. Whilst
there are tutorials scheduled on a regular basis, the emphasis will be towards developing your history taking,
physical examination and management planning skills.
Each of these clinical areas provides unique learning opportunities. At any given point of time there maybe up to
3 students from Dundee and 4 from Edinburgh. In addition; less there is frequently a fifth year student on
special placement. Therefore with a view to maintaining harmony we will allocate a rota that will allow you to
rotate through each of these areas. However the nature of acute paediatrics is such that the intensity of clinical
activity can be highly variable. You may find that there are very quiet periods in one area but very busy periods
in adjacent areas. In order to maximise learning opportunities you maybe flexible and utilise areas of higher
activity appropriately. In general, ambulatory care unit, postnatal unit and clinics tend to be more predictably
busy. The in-patient wards on either site are more prone to extreme fluctuation in activity.
During each week in general you will spend the bulk of your time each morning and evening in the clinical area
allocated to you. In addition you will be required to attend tutorials, departmental or bedside teaching sessions
as per the time table below. It is important that you try to attend these sessions as much as possible. I however
appreciate that in some instances there maybe interesting clinical events that may spill over; for instance a
premature baby being delivered at about the same time as a tutorial. You may use your judgment in these
instances and miss the tutorial.
Paediatrics is a very vast speciality and the 4 weeks (less 3 days: 1st and 2nd Mondays; last Friday) is a very
short length of time to achieve your objectives. It is therefore important that from the outset you should focus on
acquiring skills specific to paediatrics. The list below attempts to lay these out but is by no means
comprehensive. These should be taken as the bare minimum to be achieved during your block here:
●
Paediatric history taking
●
Examination of the child
Older child
New born baby examination
●
Assessment of growth and nutrition
●
Developmental assessment
●
Risk assessment of the vulnerable child
In order to achieve your goals I would advise you to be pro-active and function as a member of the team. You
should check with the registrars or consultants on the ward and with their approval speak to parents and
children. You should then present your history to them and discuss the learning points relevant to the case.
Kindly maintain a log of the cases that you have discussed. I would also advise you to maintain a log of tutorials
attended. Taken together these two will serve as a record of your attendance and also help in providing a fairer
way of assessing your progress.
For teaching sessions during your placement please contact me directly. I am also available for informal
discussions and advice on any other issues or difficulties you may experience. I am available anytime on
Monday mornings, all day Friday, and Wednesday and Thursday afternoons.
Finally, while paediatrics can at times be challenging and complex, I hope during this block you will get the
opportunity to enjoy the funnier side of children and be inspired to pursue further training in paediatrics.
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