PREP 1.1 and 1.2 Programme
To Include:
Practical sessions – incorporate into sub-specialty days, opportunity to observe/practice skills as well
as interpreting results.
Small group sessions – divided into groups, each with a topic to investigate, prepare presentation
and report back to whole group.
Communication sessions – dedicated sessions with actors throughout 3 year programme.
Scenario sessions – emergency management and individual practical skills sessions to be run in
conjunction with clinical skills labs throughout three year programme at start of each day.
Hot topics/red flags – incorporate into subspecialties, either exam hot topics or key
diagnostic/investigation information, short swift session to highlight topics.
Patient talks – especially for chronic disease, patient and parent presentations.
Cheat sheets – concise handouts for common problems and exam topics.
Moodle website – to contain teaching timetable as well as cheat sheets, useful links to external
websites, to develop over next few years.
Aims and Objectives
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To create a comprehensive 3 year programme to run from ST 1 to ST 3.
To ensure the programme is as Inclusive as possible but not repetitive.
To create a solid foundation for all SHOs in the region.
To introduce a symptom/problem based method of learning.
To include generic skills throughout the three year programme.
To include an ICU component throughout the three year programme.
To continue regular teaching of emergency skills and management in scenario format.
To make the teaching programme as a whole more interactive.
To introduce more small group work throughout the programme.
To introduce more regular and formal communication skills sessions.
To develop knowledge for exams, for clinical work and for practical skills.
To help to develop the Paediatric community in Wessex.
Contents
PREP 1.1 - Introduction Session .............................................................................................................. 3
PREP 1.1 - Patient Safety......................................................................................................................... 4
PREP 1.1 - Common Paediatrics 1 (Respiratory) ..................................................................................... 5
PREP 1.1 - Common Paediatrics 2 (Endocrinology) ................................................................................ 6
PREP 1.1 - Common Paediatrics 3 (Neurology) ..................................................................................... 7
PREP 1.1 - Postnates 1 ............................................................................................................................ 8
PREP 1.1 - Postnates 2 ............................................................................................................................ 9
PREP 1.1 - Neonates 1 (Prematurity and Respiratory)......................................................................... 10
PREP 1.1 - Development ....................................................................................................................... 11
PREP 1.1 - Mental Health ...................................................................................................................... 12
PREP 1.1 - Child Protection 1 ................................................................................................................ 13
PREP 1.1 - Genetics and Syndromes ..................................................................................................... 14
PREP 1.2 Year 1 - Neonates 2 (Surgery) ............................................................................................... 15
PREP 1.2 Year 1 - Paediatric Intensive Care .......................................................................................... 16
PREP 1.2 Year 1 - Cardiology 1 .............................................................................................................. 17
PREP 1.2 Year 1 - Oncology ................................................................................................................... 18
PREP 1.2 Year 1 - Neurology 1 .............................................................................................................. 19
PREP 1.2 Year 1 - Gastroenterology ...................................................................................................... 20
PREP 1.2 Year 1 - Nephrology 1 ............................................................................................................ 21
PREP 1.2 Year 1 - Surgery and Urology ................................................................................................. 22
PREP 1.2 Year 1 - Endocrinology ........................................................................................................... 23
PREP 1.2 Year 1 - Rheumatology and Orthopaedics ............................................................................. 24
PREP 1.2 Year 1 - Allergy and Immunodeficiency ................................................................................. 25
PREP 1.2 Year 1 - Respiratory................................................................................................................ 26
PREP 1.2 Year 2 - Neonatology (Neurology and Cardiology) ................................................................ 27
PREP 1.2 Year 2 - Obstetrics and Perinatal Medicine ........................................................................... 28
PREP 1.2 Year 2 - Cardiology 2 .............................................................................................................. 29
PREP 1.2 Year 2 - Haematology............................................................................................................. 30
PREP 1.2 Year 2 - Neurology 2 .............................................................................................................. 31
PREP 1.2 Year 2 - Metabolic, ENT and Ophthalmology......................................................................... 32
PREP 1.2 Year 2 - Nephrology 2 ............................................................................................................ 33
PREP 1.2 Year 2 - Infectious Diseases and Dermatology ...................................................................... 34
PREP 1.2 Year 2 - Community Paediatrics ............................................................................................. 35
PREP 1.2 Year 2 - Mental Health 2 ........................................................................................................ 36
PREP 1.2 Year 2 - Child Protection 2 ..................................................................................................... 37
PREP 1.2 Year 2 - Ethics and Advanced Directives ................................................................................ 38
PREP 1.1 - Introduction Session
Welcome, team building and introductions
Registrar session – fluids
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paeds and neonates
rehydration
Small group session – prescribing (pharmacist)
Nutrition (dietician)
 breast milk vs formula
 NG/NJ
 TPN
Exam preparation session
Cheat sheets
 fluid prescribing
 breast milk vs formula
 surface area chart
PREP 1.1 - Patient Safety
Scenario: Communication skills
Patient safety session (4 hours)
Small group session: Recognising the sick child
 scenarios
 practical session
 case studies
Cheat sheets
 patient safety
 normal parameters of HR, RR, BP
 emergency management flow sheets
PREP 1.1 - Common Paediatrics 1 (Respiratory)
Scenario: BLS and airway adjuncts
Asthma
 pathophysiology
 emergency management
 preventer treatment, stepwise
 peak flow, lung function tests, inhaler technique (asthma nurses)
Cystic Fibrosis
 pathophysiology
 presentation, diagnosis, investigations
 disease manifestations
 treatment, disease progression, follow up
 transplant issues
 patient presentation
Registrar session (wheeze, SOB, stridor, cough, tachypnoea – symptom based)
Small groups presentations covering:
 Asthma
 Bronchiolitis
 Pneumonia/effusions
 Croup
 (as well as relevant differentials)
Radiology (consultant radiologist)
Cheat sheets
 asthma stepwise treatment plan
 lung function interpretation
 inhalers
PREP 1.1 - Common Paediatrics 2 (Endocrinology)
Scenario: defibrillation
Growth
 growth charts
 failure to thrive
 poor feeding (including management options – reflux, overfeeding, CMP intolerance etc)
Puberty
 normal puberty
 delayed puberty
 precocious puberty
Small group sessions
 symptom based (vomiting, abdo pain, abdominal distension, constipation)
 Covering – obstruction, infection, functional, surgical, reflux, atresia, meconium ileus,
hirschprungs
Diabetes
 pathophysiology
 presentation, diagnosis, explanation
 treatment, insulin regimens, needles, BM testing, pumps
 complications (hypos, DKA, injection sites, insulin overdose advice)
 sick day rules, exercise, lifestyle advice
Diabetic nurses/patient presentation
Cheat sheets
 premature correction on growth charts
 causes of delayed and precocious puberty
 insulin regimens
 vomiting management
PREP 1.1 - Common Paediatrics 3 (Neurology)
Scenario: cannulation, venepuncture, blood gases, heal pricks
Symptom based session (headache, nystagmus, photophobia, fever, seizure)
Small group presentations covering:
 space occupying lesions
 epilepsy
 meningitis, encephalitis
 bleeds (NAI, stroke)
 febrile convulsion
 (as well as relevant differentials)
Epilepsy management
Funny turns
Crying baby
Limp
EEG session (Neurophysiologist)
 how to do an EEG
 interpreting common EEG patterns
Neuroradiology session (Neuroradiologist)
 space occupying lesions
 bleeds
 structural abnormalities
 fractures
Neurological examination – cranial and peripheral nerves, gait
Overdose and self harm
Cheat sheets
 red flags for space occupying lesions
 common EEGs
 seizure lifestyle advice
 radiological findings
 epilepsy drugs for different groups
PREP 1.1 - Postnates 1
Scenario: Intubation and airway adjuncts
Baby check (practical session)
Common neonatal abnormalities and how to manage them (photo slide session)
 clefts
 rashes
 extra/missing digits
 head shape
 spinal problems
 genitalia
 birth marks/naevus/haemangioma/portwine/mongolian blue spot
Small group sessions
 BM protocol, at risk groups, management
 Feeding difficulties, inc tongue tie, weight loss
 Irritability (suspected sepsis and withdrawal)
 Jaundice
Risk factors for sepsis
Congenital infections (HIV, Hep B, Varicella)
Breast feeding contraindications
Patient/special presentations - Spires cleft lip and palate
Communication
 vitamin K refusal
 Down’s syndrome
 explanation of admission to NNU for suspected sepsis
 weight loss/top ups discussion with parents
Cheat sheets
 maternal HIV/Hep B management
 congenital infections
 BM protocol
 breast feeding contraindications
PREP 1.1 - Postnates 2
Scenario: Communication skills
 vitamin K refusal
 down’s syndrome breaking bad news/CF positive Guthrie result
 explanation of NNU admission (e.g. with suspected sepsis)
 weight loss/discussing top ups with parents
Immunisations
Guthrie card testing
Birth injuries and deformities (physiotherapists)
 palsies
 talipes
 management and when to refer
Small group sessions (floppy, hypertonic, irritability)
 hypotonic syndromes (downs, Prader Willi, SMA, Myotonic Dystrophy)
 Hypertonia (HIE)
 irritable (withdrawal, suspected sepsis)
Vitamin K
Cheat sheets
 vitamin K information
 immunisation schedule
 BCG information
 birth injury diagrams
PREP 1.1 - Neonates 1 (Prematurity and Respiratory)
Scenario: Neonatal Life Support
Prematurity
 antenatal management, birth and admission to NNU
 common problems in NNU
 fluids and nutrition
 pneumothorax
Patient/parent presentation
Ventilation Workshop (practical session)
 ventilator settings and equipment
 DOPE and increasing oxygen requirement
Small Group Session (Symptom based - Tachypnoea, respiratory distress, grunting)
 Transient Tachypnoea of the Newborn (TTN)
 Persistent Pulmonary Hypertension of the Newborn (PPHN)
 Meconium Aspiration Syndrome (MAS)
 Pneumothorax
Chronic Lung Disease
 definition
 management
 long term implications
Infection/sepsis/congenital infection – including risk factors, presentation, management
Cheat sheets
 prem survival statistics
 ventilation settings and descriptions
 chronic lung disease definition
 causes of respiratory distress in the newborn
 risk factors for sepsis
PREP 1.1 - Development
Scenario: Lumbar puncture, opening pressures, catheters, suprapubic aspirates
Normal Developmental
 milestones
 categories of development
 taking prematurity into account
Developmental Assessment (?practical session/video session)
Causes of Developmental Delay and how to investigate
Hearing (Audiologist – practical session)
 different methods of testing
 age appropriate testing
 hearing aids
 causes of poor hearing and presentation/referral reasons (drugs)
 interpreting tests
Gait (video session)
 common gaits
 causes of different gaits and investigations
 complications
 management/treatment
Cheat sheets
 normal development
 ideas for tools for assessing development
 gaits
 hearing basics
PREP 1.1 - Mental Health
Scenario: Vascular access (long lines, arterial lines, UAC, UVC, CVL, OI)
Small Group Sessions (behavioural disorders)
 Autism
 Aspergers
 ADHD
 Other behavioural disorders (conduct, oppositional defiance)
Mental Health Disorders (CAMHS Team)
 Depression
 Psychosis
 Overdose and deliberate self harm
 Personality disorders
 Eating disorders
 (presentation, management, drugs, support and residential care)
Adolescence (Psychologist)
 Chronic disease
 Compliance
 Overdose/Deliberate Self Harm
 ?patient presentation (chronic disease and adolescence issues)
Child in Mind session?
Cheat sheets
 autism vs aspergers
 depression features
 overdose with classic ECG changes
PREP 1.1 - Child Protection 1
Scenario: Chest drains, emergency tracheostomy, trache resus
Types of abuse (as small group session with photograph slides)
 neglect
 emotional
 physical
 sexual
Referral pathway and relevant paperwork
Multidisciplinary involvement
 safeguarding meetings
 patient advocates
Legal Issues
 Parental responsibility
 Protection orders and other legal issues (ward of court)
 Adoption and fostering
NAI radiology (Radiologist)
 CT scans
 skeletal surveys
Cheat sheets
 parental responsibility
 protection orders
 trache resus
 chest drain markings
PREP 1.1 - Genetics and Syndromes
Scenarios: Communication skills (breaking bad news, counselling for genetic conditions and
inheritance, uniparental disomy)
Inheritance modes and patterns
Small group session on Common syndromes
 Downs, Edwards, Patau, Turners, Noonans, Marfans, Di George, Alagille, CHARGE, VACTERL,
Prader Willi, Angelman, Williams, Wolf Hirschorn, Duchenne, Beckers
 presentation, diagnosis, associations, short and long term management, inheritance
 with photo slide session
Counselling
 prognosis
 inheritance (other children)
Genetic investigations
 different methods
 when to send which test
Floppy infant approach
 presentation
 causes
 investigation
Cheat sheets
 syndrome associations
 duchenne vs beckers
 uniparental disomy
 causes of floppy infant
PREP 1.2 Year 1 - Neonates 2 (Surgery)
Scenario: Neonatal Life Support with gastroschisis, congenital diaphragmatic hernia
Small group session (vomiting, abdo distension, delayed passage meconium)
 NEC
 atresias
 meconium ileus
 hirschprungs
Congenital diaphragmatic hernia
CCAM
PDA
Gastroschisis and Exomphalos
Communication Skills
 meconium ileus (implications)
 NEC explanation
Cheat sheet
 NEC management
 causes of vomiting in neonates
 exomphalos associations
PREP 1.2 Year 1 - Paediatric Intensive Care
Scenario: sepsis
Stabilisation skills (intubation, lines/access, who to call)
Trauma and burns
Inotropes
Prostin
Transport
Ventilation workshop
Head injury, ICP monitoring and management
Pacing and ECMO
Focus on practical skills
Small groups rotating through various stations
PREP 1.2 Year 1 - Cardiology 1
Scenario: SVT, collapse (long QT, aortic stenosis, HOCM)
Fetal to Neonatal transition
Anatomy
Physiology
Acquired Disease (small group session)
 kawasaki
 Rheumatic fever
 cardiomyopathy
 infective endocarditis
Investigations
 CXR
 ECG
 Echos
 Cardiac catheterisation
ECG (practical session)
 how to do an ECG
 common ECG changes
Cheat sheets
 kawasaki and Rh fever criteria
 classic ECG changes
PREP 1.2 Year 1 - Oncology
Scenario: Febrile neutropenia
ALL
AML
Lymphoma
Neuroblastoma
Wilms
Brain tumours
Bone tumours
Retinoblastoma
Investigations
 FBC, film, LFTs. Bone profile, LDH, CXR, scans (CT, MRI, MIBG)
Chemotherapy Regimens
Radiotherapy
Complications
 febrile neutropenia
 line infections
 cardiomyopathy
 peripheral neuropathy
Testicular relapse
Patient experience
Cheat sheets
 wilms vs neuroblastoma
 chemotherapy side effects
PREP 1.2 Year 1 - Neurology 1
Scenario: raised intracranial pressure (SOL, cerebral oedema, bleed)
Encephalopathy approach
Bleeds/stroke
Movement disorders/Chorea
Headache
Infection
Hydrocephalus and shunts
Epilepsy and surgery
EEG (practical session)
Investigations – neuro radiology, LP, EEG, serology
Gait
Small group session
 headache
 seizures
 incontinence
 head shape/size
 movement
Neuro nurse specialist
Cheat sheets
 red flags for SOL inc spinal, gait, bleed types and distribution
PREP 1.2 Year 1 - Gastroenterology
Scenario: Gastrointestinal haemorrhage, abdominal sepsis, intusussception, obstruction
Feeding
 feed types
 feeding methods (enteral, NG, NJ, gastrostomies, fundo, TPN – indications, complications)
 short gut
Reflux
Bleeding, peptic ulcer disease, varices, meckels, oesophageal tear, ingested blood (nose
bleeds/epistaxis) intususseption
Inflammatory bowel disease
Small group (vomiting, loose stool, PR bleeding, abdo pain, constipation)
Investigations – pH studies, endoscopy, colonoscopy, barium swallow/follow through
Hepatology
 jaundice (infection, congenital, metabolic, malaria)
 CF liver disease, Alagille
 kasai procedure and biliary atresia
 transplant
Cheat sheets
 pH studies
 crohns vs UC
 causes of vomiting
 causes of PR bleeding
 jaundice investigations and causes
PREP 1.2 Year 1 - Nephrology 1
Scenario: Communication Skills
 nephrotic discharge explanation, HSP discussion
Physiology
Urinary tract infection
Reflux, categories, complications, management
Small group session
 nephrotic syndrome
 nephritic syndrome
 Henoch Schoenlein Purpura
 Haemolytic Uraemic Syndrome
Acute and Chronic Renal Failure
Dialysis
 patient presentation/nurse specialist
Cheat sheets
 UTI guideline
 nephrotic vs nephritic
 loop of Henle
 reflux
 failure definitions
PREP 1.2 Year 1 - Surgery and Urology
Scenario: Obstruction, volvulus, intusussception, torsion
Appendicitis
Meckels
Obstruction
Atresias
Intususception
Pyloric stenosis
Colostomy/ileostomy
Ambiguous genitalia
Hypospadias/epispadias
Torsion
Posterior urethral valves
Cheat sheets
 meckels scans
 pyloric stenosis gases
PREP 1.2 Year 1 - Endocrinology
Scenario: DKA, cerebral oedema, hypoglycaemia, salt wasting crisis
Diabetes recap (sick day rules, exercise, alcohol, compliance, pregnancy)
Ambiguous genitalia
Thyroid
Adrenals
Panhypopituitarism
Puberty
Cheat sheets
 puberty staging
 somygeni
 honeymoon
 causes of ambiguous genitalia
PREP 1.2 Year 1 - Rheumatology and Orthopaedics
Scenario: Communication Skills
Arthritis
 JIA
 psoriatic
 reactive
Systemic Lupus Eryth
Dermatomyositis
Septic Arthritis
Osteomyelitis
Irritable hip
Perthes
Slipped upper femoral capitis
Congenital hip dysplasia
Spinal
 spina bifida
 scoliosis
PREP 1.2 Year 1 - Allergy and Immunodeficiency
Scenario: Anaphylaxis
Cow’s milk protein intolerance
Food allergy
 coeliac disease
Epipens
 When and how many to dispense
 How to use, how to teach
Skin prick testing (practical session)
Immunodeficiency
 SCID
 Job
 Agammaglobulinaemia
 Wiskott Aldrich
 chronic granulomatous disease
 DiGeorge
HIV
Immunosuppression
Cheat sheets
 immunodeficiency characteristics
 epipen advice
 CMP intolerance management
 Coeliac testing
PREP 1.2 Year 1 - Respiratory
Scenario: Acute asthma, difficult airway, trache resus
Asthma recap
Stridor (small group session)
 laryngomalacia
 croup
 epiglotitis/bacterial tracheitis
 inhaled foreign body/tracheal rings etc
Sleep studies
 how and when to do
 how to interpret
 implications of results
Congenital abnormalities (small group session)
 CCAM
 CDH
 bronchomalacia
 choanal atresia
Difficult airway
Long term ventilation
 NIPPY, BiPAP
 indications, when to initiate
 practical session with NIPPY
 patient/parent experience
PREP 1.2 Year 2 - Neonatology (Neurology and Cardiology)
Scenario: NLS, blue baby, HIE, IVH
Hypoxic Ischaemic Encephalopathy
Interventricular Haemorrhage
Cranial USS
CFAM
ROP
Congenital cardiac disease
Congenital arrhythmias (SVT, complete heart block)
PDA
Cheat sheets
 IVH categories
 HIE categories
 ROP
 common cardiac abnormalities
 SVT management
PREP 1.2 Year 2 - Obstetrics and Perinatal Medicine
Scenario: Basic life support and defibrillation
Embryology
Amnio/CVS
Polyhydramnios
Oligohydramnios
Decreased fetal movements
Diabetes
Scans and dopplers
CTG
APH/abruption/placenta previa
Twin to twin transfusion
Hydrops
Fetal surgery
Infection including GBS
Fetal blood sampling
Single vessel cord
Cheat sheets
 causes oligo and polyhydramnios
 single vessel cord
 GBS implications and management
 embryology
PREP 1.2 Year 2 - Cardiology 2
Scenario: arrhythmias, blue baby
Congenital heart disease (small group session)
 cyanotic
 non-cyanotic
Investigations
 saturations
 CXR
 echos
 cath studies
Management
 emergency
 stabilisation
 surgery
Infective endocarditis
Pacing and internal defibrillators
Transplant
ECMO
Cheat sheets
 infective endocarditis
 congenital heart disease
 classic CXRs
 classic cath sats studies
 scars
 murmurs
PREP 1.2 Year 2 - Haematology
Scenario: difficult airway
Anaemias
 aplastic anaemia
 congenital red cell aplasia
 haemolytic anaemias
Thrombocytopenia
Blood films
Thalassaemias
Sickle cell disease
 pathophysiology
 nurse specialist
 patient/parent experience
Cheat sheets
 anaemia investigations
 HS
 SCD
 thalassaemia
 Inheritance
 management
PREP 1.2 Year 2 - Neurology 2
Scenario: seizures, status, febrile convulsion
Stroke
Movement disorders
Degenerative disorders
Rehab post head injury
 physiotherapists
 patient/parent experience
Neurocutaneous syndromes
 NF1
 NF2
 TS
Cheat sheets
 NF1 vs NF2, TS criteria
 investigating movement disorders
?communication skills
PREP 1.2 Year 2 - Metabolic, ENT and Ophthalmology
Scenario: metabolic – floppy baby, hypoglycaemia (MCADD)
MCADD
Mucopolysaccharidoses
Photo slide ophthalmology session
 ROP
 Retinoblastoma
 lens dislocation
 cherry red spots
 diabetic changes
 blurred discs
 haemangiomas
 coloboma
Eye syndrome associations
Periorbital cellulitis
Orbital cellulitis
Otitis media
Mastoiditis
Grommets
Cochlear implants
Cheat sheets
 eye syndrome associations
 mucopolysaccharidosis classifications
PREP 1.2 Year 2 - Nephrology 2
Scenario: communication skills
Renal investigations:
 blood, urine, USS, eGFR
Small group session
 Polycystic disease
 Dysplastic kidneys
 Potters
 Prune belly
 Posterior urethral valves
Tubulopathies
 barters
 gitelmans
Antenatal dilated renal pelvis
Cheat sheets
 barters vs gitelmans
 cystinosis vs cystinuria
 ADPCKD vs ARPCKD
PREP 1.2 Year 2 - Infectious Diseases and Dermatology
Scenario: sepsis, meningococcal septicaemia
Meningococcal disease
Chicken pox
Mumps
Measles
Parvovirus
Gastrointestinal infections
Notifiable disease
 ?split into resp, skin, gut, head etc
Eczema
Rashes
Sebhorrheic dermatitis
Cheat sheets
 incubation times
 infective periods
 notifiable diseases
 prophylaxis
PREP 1.2 Year 2 - Community Paediatrics
Scenario: seizures, long term ventilation resus
Learning difficulties
Portage
Social services
Respite
Care in community
Physical disabilities
Tantrums
Night terrors
Enuresis
Encopresis
Constipation
Development and delay
Transition to adult care
PREP 1.2 Year 2 - Mental Health 2
Scenario: poisoning, accidental, non accidental, caustic
PREP 1.2 Year 2 - Child Protection 2
Scenario: major incident
Communication skills
 difficult conversations
Sexual abuse session
 multidisciplinary
PREP 1.2 Year 2 - Ethics and Advanced Directives
Scenario: communication
Ethical principles
Medicolegal basics
Parental responsibility
Protection orders
Jehovah’s witnesses
Principles of palliative care
Advanced directives and DNARs
Organ donation