Paediatric Immunology, Infectious Diseases and Allergy ... · 5/20/2012 · Paediatric Immunology, Infectious Diseases and Allergy Training Guide and Record Version 1.5, Dated 15th

Paediatric Immunology, Infectious Diseases and Allergy Training Guide and Record Version 1.5, Dated 15th May 2012

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Paediatric Immunology, Infectious Diseases and Allergy Subspecialist Training Guide and Portfolio

Version 1.5

Dated 15th May 2012


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Contents Introduction .............................................................................................................................................. 4

CSAC contact details ............................................................................................................................. 4

Requirements for CCT in Paediatric Infectious Diseases, Immunology and Allergy ................................ 5

Subspecialist Training (SST) Portfolio ................................................................................................... 6

Subspecialist training ............................................................................................................................ 7

Paediatric Infectious Diseases and Immunology (PID) ..................................................................... 7

Paediatric Immunology (PIM) ............................................................ Error! Bookmark not defined. Paediatric Allergy and Immunology (PAI) ......................................................................................... 7

Academic training ............................................................................................................................. 9

Clinical laboratory attachments ............................................................................................................ 9

Subspecialist clinical competence ........................................................................................................ 9

Postgraduate taught courses .............................................................................................................. 10

Teaching and appraisal ....................................................................................................................... 11

Clinical governance ............................................................................................................................. 11

Research .............................................................................................................................................. 11

Management ....................................................................................................................................... 11

Additional evidence ............................................................................................................................ 12

Reflective Practice ............................................................................................................................... 12

Assessment framework .......................................................................................................................... 12

Table: Assessment framework for subspecialty training ................................................................ 13

Appendix 1: Laboratory attachments ..................................................................................................... 14

Log of laboratory attendance ............................................................................................................. 14

Microbiology laboratory ..................................................................................................................... 15

Virology laboratory attachment ......................................................................................................... 16

Immunology laboratory attachment .................................................................................................. 17

Appendix 2: Subspecialty competencies ................................................................................................ 18

Subspecialist competencies ................................................................................................................ 18

Good clinical care ............................................................................................................................ 18

Safe-prescribing .............................................................................................................................. 20

Maintaining good medical practice ................................................................................................ 20

Relationships with patients ............................................................................................................ 23

Working with colleagues ................................................................................................................. 23

Probity ............................................................................................................................................. 24

Allergy ................................................................................................................................................. 25

General allergy ................................................................................................................................ 25

Anaphylaxis ..................................................................................................................................... 25

Food Allergy .................................................................................................................................... 26

Eczema ............................................................................................................................................ 27

Urticaria and Angioedema .............................................................................................................. 27

Asthma and recurrent wheeze ....................................................................................................... 28

Rhinoconjunctivitis .......................................................................................................................... 29

Venom Allergy ................................................................................................................................. 29

Drug Allergy..................................................................................................................................... 30

Vaccine reactions ............................................................................................................................ 30

Latex allergy .................................................................................................................................... 30

Idiopathic anaphylaxis .................................................................................................................... 31

Immunology ........................................................................................................................................ 32


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The Immune System ....................................................................................................................... 32

Infections in the immuno‐compromised child ............................................................................... 33

Immune based therapy ................................................................................................................... 34

Infectious Diseases .............................................................................................................................. 35

Micro-organisms ............................................................................................................................. 35

Bacteria ........................................................................................................................................... 35

Viruses ............................................................................................................................................. 36

Atypical infections ........................................................................................................................... 36

Fungi ................................................................................................................................................ 36

Parasitic disease .............................................................................................................................. 37

Antimicrobial Therapeutics ............................................................................................................. 37

Clinical infectious disease ............................................................................................................... 37

Infections of specific organ systems ............................................................................................... 38

Upper respiratory tract infections .................................................................................................. 38

Lower respiratory tract infections .................................................................................................. 39

Central nervous system infections.................................................................................................. 39

Cardiovascular system infections ................................................................................................... 40

Genitourinary tract infections ........................................................................................................ 40

Gastro‐intestinal tract infections .................................................................................................... 41

Musculoskeletal and skin infections ............................................................................................... 41

Systemic infections/inflammations ................................................................................................ 42

Infections of the foetus and newborn ............................................................................................ 43

Infections of the immunocompromised child ................................................................................ 43

Infections in the returning travellers .............................................................................................. 43

Unclassified diseases and inflammatory diseases .......................................................................... 44

Infection Control ............................................................................................................................. 44

Prevention of infection ................................................................................................................... 45

HIV Medicine ................................................................................................................................... 46

Additional Practical Procedures (not specified elsewhere) ................................................................ 47


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This document outlines the training competencies and assessment framework for subspecialist training in Paediatric Immunology, Infectious Diseases and Allergy. It has been designed to assist national grid trainees in completion of their subspecialist training. Most trainees start subspecialist training in ST7 having applied to the National Grid in their ST6 training year. Advice on training and subspecialist careers can be sought from the CSAC Specialty Training Advisors and Academic Representatives. Members of the RCPCH College Specialty Advisory Committee (CSAC) are listed below

CSAC contact details

Chair Dr Mich Lajeunesse [email protected]

Subspecialty Training Advisor Immunology & ID

Dr Scott Hackett [email protected]

Subspecialty Training Advisor Allergy

Dr Gill Vance

[email protected]

BPAIIG convenor (co-opted) Dr Delane Shingadia [email protected]

Academic Representative

Immunology & ID (co-opted)

Prof Adam Finn [email protected]

Academic Representative

Allergy (co-opted)

Prof John Warner [email protected]

Trainee Representative

Immunology & ID

Dr Julia Kenny [email protected]

Trainee Representative

Allergy

Dr Eleanor Minshall [email protected]


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There are three routes for training in Paediatric Immunology, Infectious Diseases, and Allergy:

Training with an emphasis in Paediatric Immunology (PIM)

Training with an emphasis in Paediatric Infectious Diseases and Immunology (PID)

Training with an emphasis in Paediatric Allergy and Immunology (PAI) All lead to the award of GMC subspecialist accreditation in Paediatric Immunology, Infectious Diseases and Allergy. All three areas will be listed on the CCT documentation regardless of the emphasis of training. The competencies acquired during training will reflect the clinical interests of each trainee, and the areas in which they wish to practice as consultants. Although the trainee may have an interest in one area, and should achieve all the competences in that area, their training may also encompass other parts of the curriculum. The CSAC advocates as broad as possible exposure to the diversity of this sub-specialty, with particular attention to a solid foundation in the science of immunology. All trainees will also be expected to meet requirements for CCT in Paediatrics and are expected to be dual accredited in Paediatrics and this sub-specialty. The following associated documents should be used in conjunction with this guide.

1. RCPCH Curriculum for Paediatric Training – Paediatric Allergy, Immunology and Infectious Diseases Sept 2010

2. Standards for Specialty Training in Paediatric ID, Immunology and Allergy - Postgraduate Dean

Checklist

In order to achieve subspecialist CCT trainees must satisfy the CSAC in all of the following areas.

http://www.gmc-uk.org/doctors/subspecialty_page_1.asp

http://www.rcpch.ac.uk/sites/default/files/2010%20Paediatric%20Allergy%20Immunology%20and%20Infectious%20diseases.pdf


http://www.rcpch.ac.uk/sites/default/files/PAIID.doc

http://www.rcpch.ac.uk/sites/default/files/PAIID.doc


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Subspecialist Training (SST) Portfolio

In addition to the e-portfolio, trainees should keep a prospective subspecialist training portfolio (SST) of their developing competence. This will be reviewed annually by the CSAC and at the completion of training. Details of the contents of this portfolio are given throughout this document. This training record provides a format to demonstrate acquisition of subspecialty competences outlined in the RCPCH 2010 Curriculum for Paediatric Training, Paediatric Allergy, Immunology and Infectious Diseases. The e-portfolio is complementary to the training record and items contained within the e-portfolio can be referenced in the training record, and do not need to be duplicated. We recommend that the trainee adapt this framework to display their training and competencies.

a) Curriculum vitae b) Subspecialist Training Experience c) Clinical Competences d) Laboratory Attachments e) Teaching/Training Attended f) Teaching and Appraisal g) Clinical Governance h) Research i) Management j) Additional evidence k) Reflective Notes


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Subspecialist training

Sub-specialty training must take place in accredited training posts during Level 3 training (ST6-8). Admission to subspecialist training is by competition in the RCPCH National Grid interview process and is available to all trainees with a National Training Number in Paediatrics. Subspecialist training normally takes 24 months, the content of which will depend upon the emphasis of training. As with all Grid trainees a minimum of 65% of this time must be spent in subspecialty training. All attachment durations should be adjusted to reflect this proportion: for instance, a 2 month attachment in the clinical laboratories is the equivalent of 26 working days in the lab (65% of 8 weeks adjusted for 5 working days in 7). In the SST portfolio, trainees should include the time in months spent in each training post and the amount of time in each post that has been counted toward training for CCT. Include any training related documents and feedback from ST7A, Educational Supervisor reports, ARCP reports etc.

Paediatric Immunology (PIM)

PIM trainees should spend the majority of their training in an accredited supra-regional paediatric immunology centre with bone marrow transplant facilities for primary immunodeficiency

2 months should be spent attached to adult clinical immunology

2 months should be spent in clinical laboratory attachments

2 months should be spent paediatric ID and paediatric allergy

Paediatric Infectious Diseases and Immunology (PID)

PID trainees should spend the majority of their attachment in an accredited tertiary paediatric ID centre with close working relationships with diagnostic laboratories

2 months should be spent in regional / supra-regional paediatric HIV centres


2 months should be spent in paediatric immunology; and paediatric allergy where available

The requirement to obtain adequate training in HIV management may involve spending time in a London HIV centre, but this can be tailored to the needs of the trainee and the availability of HIV exposure in the training centre.

Paediatric Allergy and Immunology (PAI)

PAI trainees should spend the majority of their training in an accredited tertiary paediatric allergy centre providing extensive experience in food and drug challenges and immunotherapy service (SCIT and SLIT)

2 months should be spent in paediatric immunology and / or adult clinical immunology and / or adult allergy and / or paediatric ID


http://www.rcpch.ac.uk/training-examinations-professional-development/recruitment-paediatrics/sub-specialty-training-ntn-gr


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At least 6 months cumulative clinical experience in Paediatric Respiratory and Gastroenterology, with additional experience in Rheumatology, Dermatology and Otolaryngology


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Academic training

Academic trainees may also be eligible for subspecialty CCT

if they have been prospectively approved by CSAC

and their Level 3 clinical training is in accredited training posts

and their Level 3 training has been reviewed prospectively by CSAC We recommend that the academic supervisor contacts CSAC for advice prior to appointment. A member of CSAC may then be part of the selection process in order to approve the candidate for entry into subspecialist training. In certain circumstances the candidate may also need to attend for a National Grid interview to demonstrate their suitability. Details of the training post should be prospectively submitted for approval by CSAC using the RCPCH subspecialty guidance checklist with supporting evidence.

Clinical laboratory attachments

All trainees must complete 8 weeks in total of laboratory attachments in clinical microbiology, virology, mycology, or immunology laboratories. It is recognised that service commitments can make it difficult to achieve blocks of time for laboratory experience. These can therefore be completed in any combination of days or weeks over the training programme. All trainees should receive a minimum of at least one week’s experience in microbiology, virology and immunology. The balance of further experience should relate to the trainees emphasis, for instance a PID trainee may wish to focus on experience in microbiology and virology whilst a PAI trainee will need more immunology experience. PAI trainees must have experience in a lab accredited in the measurement of specific IgE and flow cytometry for PIM trainees. Trainees should gain an understanding of the principles of bacterial and viral culture, ELISA, quantative PCR, flow cytometry and how a clinical laboratory manages samples, maintains quality standards and ensures the safety of its staff. Experience in a research laboratory may contribute up to 4 weeks of this attachment ONLY if the trainee can demonstrate that techniques learnt are of direct relevance to their future clinical practice. A logbook should be kept during this attachment to record the techniques observed. The logbook template is provided later in this document.

Subspecialist clinical competence

Trainees will be expected to have achieved some competencies in all domains (PID, PIM and PAI) but should have completed ALL of the competencies in one training route (PID or PIM or PAI) depending upon the emphasis of their training

http://www.rcpch.ac.uk/training-examinations-professional-development/quality-training/quality-training

http://www.rcpch.ac.uk/training-examinations-professional-development/quality-training/quality-training


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A list of both general and subspecialist competencies is given in Curriculum for Paediatric Training

Paediatric Allergy, Immunology and Infectious Diseases Level 1, 2 and 3 Training (Sept 2010), which is

available from the RCPCH website. The subspecialist elements of this curriculum are given in

Appendix 2 and should be used as part of the trainee’s subspecialist training portfolio. For each area

evidence needs to be given to demonstrate competency by referencing to completion of an e-

portfolio assessment (CBD, DOPS etc.) or by including evidence of completion in the portfolio.

Examples of evidence would include summary lists of cases seen, case based discussions, case

reports, reflective notes, evidence of further learning – i.e. notes made on postgraduate learning, an

article you have published or conference attended, reference to clinic letters etc. Reference evidence

sequentially and place behind this front sheet in your portfolio.

Trainees may also wish to keep logs of clinics attended, cases seen, procedures performed, examples of clinic letters (anonymous) etc.

Postgraduate taught courses

There are mandatory taught elements for all training routes in this subspecialty.

All trainees should have attended at least 75% of the BPAIIG training modules whilst a grid

trainee

PIM and PAI trainees should attend a basic immunology course e.g the Imperial College Short

Course at the Hammersmith Hospital. Regular in house training may suffice if clear evidence is

provided

PAI trainees may wish to consider the EAACI European Allergy and Clinical Immunology exam

as evidence of meeting the knowledge component of this aspect of training. It is not

mandatory

PID trainees should have attended the PENTA ESPID HIV course and an ID course such as the

Oxford course

PID trainees with an interest in tropical medicine may wish to consider the DTM&H if they

have not already taken this earlier in their training

It is expected that trainees actively participate in local and regional subspecialty training

They are strongly encouraged to join their preferred National OR European professional

organisations, i.e. BPAIIG, BSACI, ESPID, EAACI, ESID, UK-PIN, CHIVA

In your portfolio list all relevant postgraduate training, professional memberships, and conferences

attended including BPAIIG training days. Include evidence of your attendance such a certificates,

programmes, membership certificates etc. Postgraduate taught courses should be listed in this

section e.g. DTM&H, Allergy MSc



http://www1.imperial.ac.uk/medicine/teaching/postgraduate/shortcourses/short_course/

http://www1.imperial.ac.uk/medicine/teaching/postgraduate/shortcourses/short_course/

http://www.eaaci.net/index.php

http://www.chiva.org.uk/health/conferences/events/trainforpedhiv


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Teaching and appraisal

Evidence of formal and informal teaching of students, trainees and other healthcare professionals,

evidence of courses attended on education, appraisal and assessment with evidence. Include

evidence of the evaluation and feedback of your teaching.

Clinical governance

Provide evidence of participation in clinical governance activity. Trainees are expected to have completed at least 2 full audits during their ST7 and ST8 years as Grid trainees. Include evidence of attendance at critical incident meetings, morbidity and mortality reviews, clinical guideline development, and participation in national audits e.g. CHIPs database.

Research

As subspecialists, trainees are expected to develop a practical understanding of clinical research and be able to interpret the evidence base. Trainees are expected

To have completed a higher degree by research (MD, PhD or MSc) OR

Be registered with a University for such a degree but have not yet completed their course of study OR

Have contributed significantly to primary research where, trainees should list their publications, posters and presentations at national or international meetings and describe their involvement in these studies with supporting evidence OR

If the trainee does not have any of the above competencies they should write a 5,000 word dissertation on a relevant topic to be agreed by their educational supervisor and submitted to the CSAC for assessment. The educational supervisor (ES) will be one marker and one member of the CSAC panel the other. Trainees who wish to use this route should discuss this at their ST7 annual review to agree a timetable for submission and marking.

Trainees should submit evidence of training in research ethics and or methodology, and their involvement in clinical or laboratory research.

Management

Evidence of participation in management meetings and projects including attendance at specialty business meetings, participation in Trainees group, chairing of MDT, service development, complex patient care review, planning for BMT, food or drug challenge, immunotherapy etc.


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Additional evidence

Trainees may wish to submit evidence of clinical training not covered elsewhere. This may include overseas experience, training conducted in non accredited centres, relevant training before entering national grid e.g. GUM experience, tropical medicine experience, travel medicine, overseas experience (prospective only) PICU etc. This experience cannot replace training in UK accredited centres but may be used as evidence of breadth of experience within or around the subspecialty.

Reflective Practice

One reflective account should be completed for every 3 months in grid training. A potential template for your reflection is shown below.

Date, trainee

Describe the clinical event in non identifying terms

What did I think and feel?

What were the context / factors which had an influence on the event?

What did I do / say that was effective in the situation?

What happened that exacerbated the problem?

What was the outcome for the patient / parent / myself / others?

Looking back what could I have done differently?

What were the key learning point(s) from this event?

An Educational Supervisor (ES) should be allocated by the training centre and be responsible for the overall training, career advice, progression and assessment of the trainees, preferably throughout their 2 year training period. The ES should be identified to the CSAC. Additionally a clinical supervisor (CS) should be allocated to oversee and supervise clinical work and may change as trainee rotates through different posts. Educational and clinical supervisor should both inform overall yearly review. Local RITA or ARCP should be conducted yearly through the Deanery School of Paediatrics. Personal development Plan and Plan of yearly training at the start of each year should be submitted to CSAC by trainee after discussion with ES.


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Table: Assessment framework for subspecialty training

Year of training

Timing Method Personnel Primary purpose

ST7

(HST 4)

First month Face to face ES/CS

Aims for year and year programme. Submit to CSAC with contact details of ES/CS.

First three months

By letter CSAC - STA Acknowledge receipt of aims for the year to trainee and ES/CS

After 6 months

grid training

ST7A RCPCH

Penultimate year clinical assessment

After 6-8 months Face to face ES/CS Review progress Career advice Plan next year modules

After 10-12 months

Face to face ES/CS Review progress. Supervisors report.

ARCP or RITA Deanery Review progress and assess competency

Structured meeting

CSAC Review subspecialist training record, provide training and career advice

ST8

(HST 5)

First month Face to face ES/CS Aims for year and outcome of CSAC review

After 6-8 months Face to face ES/CS

Review progress Verify no outstanding training needs

After 10 months Face to face exit review

CSAC Review subspecialist training record, provide training and career advice

After 10 -12 months

RITA/ARCP Deanery Review progress and assess competency

After 12 months Written CSAC

Review subspecialist training record and CCT “Yellow” application form. Approve trainee for CCT


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Log of laboratory attendance

Laboratory Location Supervisor Dates


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Microbiology laboratory

Procedure Location Date seen Comments and learning points

Blood culture bench

Gram staining

CSF culture bench

Respiratory bench

ENT bench

Urine bench

Stool bench

Cat III facilities

TB bench

Fungal lab

Serology

Chlamydia

Specimen processing

Media production

Role of quality controls

Other


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Virology laboratory attachment


NPA / throat swab processing

Stool processing

Swab processing

Quantitative PCR e.g. HIV, CMV

Qualitative PCR

Respiratory swab processing; immunofluorescence and PCR

Serology including hepatitis

Viral culture

Electron microscopy if still performed, must know basics

Quality controls

Other


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Immunology laboratory attachment


Understand principles of Flow cytometry

Immunoglobulin measurement

Lymphocyte subsets

Lymphocyte proliferation e.g. PHA, CFSE

NBT / DHR / oxidative burst

Immunoglobulin measurements

ANA / ANCA

Specific IgE measurement

Haemolytic Complement

TRECS assay

V beta studies

Understand principles of quantitative PCR

Quality controls


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These competences are taken directly from RCPCH Curriculum for Paediatric Training – Paediatric Allergy, Immunology and Infectious Diseases Sept 2010 An X denotes an essential competence for training with an emphasis in that area. Subspecialist portfolio (SST).

Subspecialist competencies

Training emphasis

Subspecialist competency Record of achievement

PID PIM PAI E portfolio SST

portfolio reference

Good clinical care

1 X Be able to assess and advise on the future risk of anaphylaxis and allergic reactions and facilitate an appropriate management plan by liaising with community teams

2 X Be able to identify factors which exacerbate acute atopic conditions, to advise parents and families appropriately about allergen reduction and avoidance at homes and in schools

3 X X X Be able to recognise different patterns of clinical representation of primary immunodeficiency disorders and understand the basis for laboratory testing for these disorders

4 X X Know when to use antimicrobial prophylaxis and which treatments to use

5 X X X Know when to use immuno‐modulatory therapy and which treatments to use

6 X X X Have the knowledge and skills to be able to assess and initiate acute and long‐term management of children presenting with immunological, infectious and allergic conditions

7 X X Be able to investigate and manage infections with specific micro‐organisms




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Training emphasis



portfolio reference

8 X X Be able to manage auto‐immune disorders in children and young people

9 X X Be able to investigate and manage infection and/or inflammation of specific organ systems

10 X X Be able to investigate and manage systemic infections and/or inflammation including sepsis and toxic shock

11 X Have experience in the management of HIV in pregnancy to prevent transmission to the foetus

12 X X Be able to investigate and manage infection of the immuno‐compromised host including those undergoing bone marrow transplantation and or sold organ transplantation

13 X X Be able to investigate and manage fever of an unknown origin

14 X Be able to investigate and manage infections of the foetus and newborn

15 X Be able to investigate and manage the protean presentation of tuberculosis in a child and its contacts

16 X Be able to manage, investigate and follow up children presenting with allergic conditions

17 X Recognise the role of allergy in poly-symptomatic illness and behavioural problems, investigate and adjust management plans appropriately

18 X Be able to administer immunotherapy injections safely, including side effect monitoring and dosage adjustment

19 X Be able to treat local and systemic reactions following immunotherapy injections

20 X X Independently administer intradermal injections for example, for Mantoux testing or BCG or allergen immunotherapy


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Training emphasis



portfolio reference

21 X Know and understand the use and limitations of skin‐prick testing and measurement of total and specific IgE

22 X Know the value of diagnostic allergy testing set against the advantages and problems of direct organ challenge

23 X Know about alternative allergy testing and methods of treating allergies

Safe-prescribing

1 X Know and understand the cross‐reactive antigenic determinants and know common cross‐reactivities

2 X Know and understand indications and contra‐indications for specific allergen immunotherapy

3 X Be aware of different allergen preparations and immunotherapy protocols

4 X X Be able to use appropriate treatments for infectious agents including antibacterials, antivirals, antiretrovirals, antifungals and anti‐parasitic agents

Maintaining good medical practice

1 X Know and understand basic allergy mechanisms

2 X Know and understand local tissue responses to allergic inflammation

3 X Know and understand the immuno‐pathogenesis of the immediate and late phase allergic response

4 X X X Know and understand the ontogeny of the immune response in children


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Training emphasis



portfolio reference

5 X X X Know and understand the classification of immuno‐deficiencies

6 X X Know and understand the clinical manifestations of the different types of immuno‐deficiency

7 X X Know and understand the diverse conditions and treatments which result in secondary immuno‐deficiencies

5 X X Know and understand the pathophysiology and the principles of treatment of allergic and auto‐immune disorders

6 X X X Know and understand the basis of the immune system including the innate and specific adaptive systems

7 X X Understand the developmental aspects of immunity and their relevance to infection susceptibility in infants and young children

8 X X X Understand the rationale underlying immunisation strategies in children including active and passive immunisation

9 X X X Understand the development and modes of action for active and passive immunisation

10 X X X Know about routine immunisation of the immuno‐compromised host

11 X X X Understand the mechanisms of auto‐immunity

12 X X Understand the different types of infection, which are more common with different kinds of auto‐immunity

13 X X Know about new and emerging infections as well as, currently “unclassified” diseases with a possible infectious aetiology such as Kawasaki’s Disease or Chronic Fatigue Syndrome

14 X Know the principles of and detail of epidemiology of infectious diseases and be able to apply them


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Training emphasis



portfolio reference

15 X X Know and understand about specific infections in the immuno‐compromised child

16 X X Know and understand the complexities of the relationship between the host and infecting organisms

17 X X Know and understand the management of situations where the host immune response to infection has triggered a pathogenic inflammatory response

18 X X Know and understand the management of situations where the host inflammatory response has been triggered by a non‐infectious condition

19 X Know about the investigation and management of infections in different human situations, such as zoonoses, occupational exposures, nosocomial transmissions, travel acquired infections and bioterrorism

21 X Understand the cellular and molecular pathology of common allergic diseases

22 X Understand the epidemiology, clinical history and natural history of common allergic conditions

23 X Know and understand the ontogeny of the allergic immune responses in early life

24 X Know and understand the way in which allergy allergen exposure and infection interact and manifest as disease

25 X X Know and understand the relationship between immuno‐deficient states and allergic disease

26 X Know about primary and secondary prevention of atopic disease

27 X X X Work closely with the dietetic team to manage nutrition in children with immunological, allergic and infectious conditions

28 X X X Be able to manage the nutritional aspects of immunological and infectious conditions in children


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Training emphasis



portfolio reference

29 X Be able to recommend nutritionally adequate allergen avoidance diets in infants and children

30 X X X Understand the issues for young people growing up with immunological conditions and/or chronic infections that can affect their sexual development, fertility, pubertal development, cognitive development and mental health

31 X Be sensitive to the sexual and emotional development of young people living with a sexually transmissible disease such as HIV or Hepatitis

32 X Understand how manifestations of allergic disease change during adolescence

33 X Understand the effects of stigma on children and families in relation to infections, such as HIV TB and sexually transmitted infections

34 X Understand the controversies in relation to partner notification after exposure to infection such as HIV and sexually transmitted infections

Relationships with patients

1 X Be able to advise on the appropriate use of adrenaline and demonstrate the correct use of adrenaline auto‐injectors

2 X Understand and be able to advise parents and young people on current controversies on allergy prevention, such as allergen avoidance in pregnancy and infancy and the hygiene hypothesis

Working with colleagues

1 X Be able to co‐ordinate local support for children at risk of anaphylaxis at home and in schools and be able to advise about the safety and efficacy of immunotherapy injections

2 X Be able to run an effective immunotherapy service


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Training emphasis



portfolio reference

3 X Be able to run a food challenge service effectively

4 X X X Be able to work collaboratively with the whole range of generalists and organ sub‐specialists in managing complications or associated problems of immunological, infectious, allergic diseases

5 X Be able to work with specialists from other disciplines such as genetics and obstetrics to facilitate prenatal diagnosis of primary immunodeficiency disorders

6 X Be able to compile management plans for children at risk of anaphylaxis and ensure that mechanisms are in place to allow them to be followed in the community

7 X X X Be able to work with research groups to allow translation of new developments into clinical practice in managing children with immunological disorders and infections

8 X X X Know about and have participated in specialist organisations for children with allergy, immunodeficiency and infections (e.g. BPAIIG, BSACI, PIA, ESPID, ESID)

Probity

1 X Develop a non‐judgmental approach to the management of infectious diseases such as HIV and sexually transmitted diseases


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Allergy

Training emphasis



portfolio reference

General allergy

1 X Know the specificity, sensitivities and predictive values of skin‐testing and in vitro IgE antibody measurements for individual allergens

2 X Be aware that these values vary with the allergen involved, the manufacturer the purity of the product and the relative content of the allergen

3 X Identify patients who present symptoms mimicking allergy and know how to refer them to other specialists

4 X Know and be able to recognise the relationship between food allergy, eczema, failure to thrive, asthma and rhinitis

5 X Know and understand the role of exposure to animals in the generation of tolerance

6 X Know and understand pet allergy and be able to advise sympathetically about reducing exposure to animals

Anaphylaxis

1 X Ensure that guidelines for the management of anaphylaxis are implemented

2 X Be able to advise about and interpret investigations performed immediately following acute allergic reactions

3 X Be able to identify precipitating causes using ingestion history, gastric aspirate and serial tryptase levels as appropriate


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Training emphasis



portfolio reference

Food Allergy

1 X Know the common and uncommon foods that trigger IgE mediated and non IgE mediated hypersensitivity reactions

2 X Know the mechanisms of IgE and non‐IgE food hypersensitivity reactions including eosinophilic enteropathy and food intolerances due to pharmacological effects of food and enzyme deficiencies and be able to explain this to parents

3 X Be able to diagnose and manage appropriately food‐induced enteropathy, including interpretation of oesophageal pH monitoring and gut histology

4 X 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

5 X Know the indications for food challenges, challenge protocol procedures and safety precautions

6 X Be able to use measurement of specific IgE and skin test results to optimise the timing of food challenges

7 X Be able to advise about the safe re‐introduction of food following a negative food challenge

8 X Know the relationship and cross‐reactivity between food, pollen and food, and latex and be able to advise children and their families appropriately

9 X Be able to recognise the distinction between food allergy and oral allergy syndrome and advise patients appropriately

10 X Know how to assess future risk of allergic reactions and which children require the prescription of injectable adrenaline


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Training emphasis



portfolio reference

Eczema

1 X 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

2 X Know the role of diet in the pathogenesis of eczema and be able to advise appropriately about dietary modification

3 X Know the role of exposure to airborne allergens in the pathogenesis of eczema and be able to advise appropriately about reducing exposure

4 X Be able to examine and assess the severity of eczema in an affected child

5 X 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

6 X Know how to perform patch testing for contact dermatitis and understand the value and limitations and the potential value and limitations of atopy patch testing

7 X Be able to manage patients with severe eczema including the use of emollients, anti‐inflammatory preparations and wet wraps

Urticaria and Angioedema

1 X X Be able to manage and investigate patients presenting with an acute exacerbation of angioedema

2 X X Be able to identify precipitating causes and advise about future avoidance

3 X X Know the definition causes and exacerbating factors of acute and chronic urticaria and angioedema

4 X X Be able to investigate and manage children with acute and chronic urticaria


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Training emphasis



portfolio reference

5 X X Be able to diagnose accurately and manage children with hereditary angioedema including advise about prophylaxis and peri‐operative management

6 X X Be competent in performing challenge procedures for children with physical urticaria

7 X X Be able to recognise and investigate children with an underlying vasculitis

Asthma and recurrent wheeze

1 X Be able to identify allergen exposure as a cause of acute exacerbations of asthma

2 X Know the role of allergy testing and allergen avoidance in managing children with asthma and be able to advise families about allergen reduction measures

3 X Know the concept of the unified airway and the importance of the treatment of rhinitis in patients with asthma

4 X Be able to advise about the effective methods of reducing exposure to house dust mite

5 X Be able to perform bronchial allergen challenges and to know the indications for using them

6 X Know the value and limitations of environmental sampling for aeroallergens

7 X Be able to perform and interpret spirometry, pulmonary function testing and exercise challenge testing

8 X Be able to recognise, investigate and manage patients with acute and chronic severe asthma including the use of immuno‐modulators and anti – IgE

9 X Understand the changes in asthma which occur during adolescence including remission and deteriorating asthma control


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Training emphasis



portfolio reference

Rhinoconjunctivitis

1 X Know the definitions of seasonal and perennial disease and exacerbating factors

2 X Know about the aerobiology of pollen

3 X Be able to diagnose accurately allergic rhinitis and conjunctivitis, know the differential diagnosis, management guidelines and principles of therapy

4 X 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

5 X Be able to perform nasal and conjunctival allergen provocation tests

6 X Know the pathogenesis and management of obstructive sleep apnoea including indications and interpretation of sleep studies

7 X Be able to identify and manage common co‐morbidities such as sinusitis and sensory abnormalities of smell and taste

8 X Be able to diagnose the common cross‐reacting allergens relevant to the oral allergy syndrome

Venom Allergy

1 X Know the clinical features and grading of local and systemic reactions to insect stings

2 X Be able to perform and interpret skin prick tests, using serial dilutions and measurement of specific IgE

3 X Be able to advise about the avoidance and emergency management of stings and appropriate rescue medications


30

Training emphasis



portfolio reference

4 X Know the indications and contra‐indications to venom immunotherapy

Drug Allergy

1 X Know the management and investigation of suspected drug allergy including allergic reactions to local and general anaesthetics and be able to advise about appropriate alternative drugs

2 X Be able to perform and interpret skin prick test, intradermal test and measurement of specific IgE to antibiotics and local and general anaesthetic agents

3 X Know the indications for limitations of and protocols for drug challenges and desensitisation

4 X Be able to supervise drug challenges and desensitisation procedures

Vaccine reactions

1 X X Know the causes and mechanisms of vaccine reactions and be able to advise about further immunisations in children following vaccine reactions

Latex allergy

1 X Know about routes of exposure risk factors, natural history, aetiology and clinical sequelae of latex allergy

2 X Be able to diagnose latex allergy, including skin prick testing, measurement of specific IgE and provocation tests

3 X 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


31

Training emphasis



portfolio reference

4 X Know about hospital latex policies and be able to advise about their implementation

5 X Be able to identify cross‐reacting latex allergens in common foods and advise patients accordingly

Idiopathic anaphylaxis

1 X Be able to investigate idiopathic anaphylaxis appropriately and exclude common causes

2 X Know the differential diagnosis including exposure to unusual allergens, exercise induced anaphylaxis and systemic mastocytosis

3 X Be able to advise a family with a child at risk of anaphylaxis about prevention, rescue medications and prognosis


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Immunology

Training emphasis


PID PIM PAI E portfolio

SST portfolio reference

The Immune System

1 X X X Know the detailed functioning of the immune system including the complement system, phagocytic system, humoral and cellular immunity and the molecular and genetic basis of such functioning

2 X X X Understand the levels of functioning of the immune system at different ages and the relevance to vaccination strategies

3 X X X Understand the effect of malnutrition and disease on normal immune development

4 X X Know the immunological basis of allergic disorders

5 X X X Know the immunological basis of auto‐immune and inflammatory disorders

6 X X Understand the basis of immunodysregulatory disorders including haemophagocytic lymphohistocytosis

7 X X Understand the basis of hereditary angioedema and its complications

8 X X X Understand immune function testing and be able to interpret the results including antibody assays, complement, phagocytic cell and T cell tests

9 X X X Understand the molecular genetic tests available for the diagnosis basis of primary immunodeficiency disorders

10 X X X Understand the basis of secondary immuno‐deficiencies including those induced by infections, other disease and drug treatments

11 X Understand the epidemiology, manifestations and basis of treatment for HIV infection in children


33

Training emphasis




Infections in the immuno‐compromised child

1 X X Know the nomenclature, epidemiology, incubation periods clinical presentations pathogenesis, diagnostic tests, host response, infection control issues and treatment for the different families of micro‐organisms

2 X X Recognise the atypical manifestations of common infection and the range of atypical organisms causing infection in the immunocompromised child

3 X Be able to recognise the patterns of lymphoproliferative disorders in immunocompromised children

4 X X Know the normal flora found in different sites of the body in infants and children as well as pathogenic flora

5 X X Be able to keep up to date with literature and be aware of the constant evolution and discovery of new pathogenic micro‐organisms

6 X X Have a good understanding of the functioning of a clinical diagnostic microbiology service for different types of infections

7 X Have a good understanding of methodology and limitations of different diagnostic tests for infections including culture, serology, antigen detection and molecular techniques

8 X X Understand the principles of infection control within and without the hospital environment

9 X Have experience of working with the infection control team to limit the spread of infection in hospitals

10 X Be actively involved in the development of hospital antibiotic policies in relation to the management of children in hospital

11 X X Know how to handle bio‐hazardous specimens and be able to advise


34

Training emphasis




Immune based therapy

1 X

X Understand and be able to use appropriate antimicrobial prophylaxis in the immunocompromised child

2 X X Understand and be able to use the full range of antimicrobial therapies for infections in the immunocompromised child

3 X X Have knowledge and experience of the principles and practice of immunoglobulin treatment including the use of intravenous and subcutaneous treatment routes

4 X X Be able to administer immunoglobulin by both intravenous and subcutaneous routes

5 X X Understand the process involved in setting up home therapy with immunoglobulin

6 X X Be able to use immune-modulatory treatments including monoclonal antibodies and growth factors

7 X Understand and be able to manage autoimmune and inflammatory disorders

8 X X Be able to use C1 inhibitor concentrate for Hereditary Angioedema

9 X X X Know how to manage acute anaphylaxis

10 X Understand the principles of donor selection, conditioning treatment and complications including infection and graft versus host disease in bone marrow transplantation


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Infectious Diseases Training

emphasis Subspecialist competency Record of achievement



Micro-organisms

1 X Know the nomenclature, epidemiology, incubation periods, clinical presentations, pathogenesis, diagnostic tests, host response, infection control issues and treatment for the different families of micro‐organisms

2 X Have the knowledge of the likely pattern of infecting organisms in different clinical situations such as human or animal bite

3 X X Know the normal flora found in different sites of the body in infants and children as well as pathogenic flora

4 X Understand the significance of zoonoses in different situations and be able to treat appropriately for the most likely infections

5 X X Be able to keep up to date with literature and be aware of the constant evolution and discovery of new pathogenic micro‐organisms

6 X X Have a good understanding of the functioning of a clinical diagnostic microbiology service for different types of infections

7 X X Have a good understanding of methodology and limitations of different diagnostic tests for infections including culture, serology, antigen detection and molecular techniques

Bacteria

1 X Have an in‐depth knowledge of the nature, consequences and treatment of infections with gram positive organisms including: staphylococci, streptococci, diphtheria, anthrax, listeriosis, tuberculosis and other mycobacteria


36

Training emphasis




2 X Have an in‐depth knowledge of the nature, consequences and treatment of infections with gram negative organisms including: the many enterobacteria such as salmonella; and the many cococcbacilli such as Haemophilus influenzae

3 X Have an in‐depth knowledge of the nature, consequences and treatment of infections with treponematacae such as borrelia and syphilis

4 X Have an in‐depth knowledge of the nature, consequences and treatment of infections with anaerobic bacteria such as clostridium and tetanus

Viruses

1 X X Have an in‐depth knowledge of the nature, consequences and treatment of infections with DNA viruses such as parvoviruses, papilloma viruses, herpes viruses and pox viruses

2 X X Have an in‐depth knowledge of the nature, consequences and treatment of infections with RNA viruses such as picornaviridae, reoviridae, togaviridae, flaviviridae, orthomyxoviridae, paramyxoviridae and retroviridae

Atypical infections

1 X Have an in‐depth knowledge of the nature, consequences and treatment of infections with Chlamydia, mycoplasma and rickettsial diseases

Fungi

1 X X Have an in‐depth knowledge of the nature, consequences and treatment of infections with fungi including Aspergillus, Candida and Cryptococcus


37

Training emphasis




Parasitic disease 1 X Have an in‐depth knowledge of the nature, consequences and treatment of infections with different human

parasites including the protozoa such as malaria, toxoplasmosis and cryptosporidiosis

Antimicrobial Therapeutics

1 X X Have a detailed understanding of the mode of action and pharmacokinetics of antimicrobial drugs in children and infants

2 X X Have a good knowledge of the local flora and its antibiotic resistance patterns

3 X

Know about the resistance patterns of imported organisms

4 X X Have a good understanding of the processes of development of resistance to antimicrobials as well as the assessment and development of drug resistance and strategies to manage drug resistant organisms

5 X X Have a good understanding of the use of immune-modulating agents including cytokines and growth factors

6 X X Know when to use antimicrobial prophylaxis and which treatments to use

Clinical infectious disease

1 X Know and understand the significance of microbial virulence factors in the evolution of disease

2 X Know and understand the nature of potential pathogenic role of indigenous flora in evolution of human disease

3 X Know and understand the variety of host metabolic responses to infection with reference to how these may improve or aggravate clinical disease


38

Training emphasis




4 X Know and understand the interactions of the host inflammatory and coagulation cascades

5 X X Know and understand the pathogenesis of the febrile response to infection

6 X Understand the specific effects of nutrition on infectious disease severity, such as seen with measles infection

Infections of specific organ systems

1 X X Be able to liaise effectively with organ specialist paediatricians, radiologists, microbiologists, intensivists and other therapists in the multi‐disciplinary team to effect the best management of specific organ infections

2 X X Be able to order and interpret appropriate ancillary diagnostic tests such as MRI scan or EEGs

3 X X Be active in the local development of protocols for the best management of infections of specific organ systems to assist junior colleagues as well as organ specialist paediatricians

Upper respiratory tract infections

1 X Have clinical experience of the management of the diverse infection of the mouth and upper respiratory tract

2 X Be able to differentiate trivial infections from severe infectious presentations such as epiglottis, croup and peri‐pharyngeal abscesses

3 X Be able to recognise and treat complications of simple upper respiratory tract infections such as mastoiditis, parotitis or sinusitis

4 X Be able treat otitis media and its potential complications

5 X Be able to investigate and treat cervical lymphadenitis, both the chronic and acute presentations


39

Training emphasis




Lower respiratory tract infections

1 X Have clinical experience of the management of the diverse infections of the lower respiratory tract

2 X Be able to investigate the infectious source of respiratory diseases

3 X Be able to manage bacterial and non‐bacterial pneumonias

4 X Be able to manage complications of pneumonia such as effusions, empyemas and lung abscesses

5 X Be able to manage infants with bronchiolitis and identify those eligible for anti‐viral treatment

6 X Be able to investigate and manage the causes of interstitial pneumonitis

7 X Be able to investigate and manage infectious complications of chronic lung diseases such as cystic fibrosis

Central nervous system infections

1 X Have clinical experience of managing the diverse infections of the CNS

2 X Be able to investigate and manage all forms of infectious meningitis including tuberculosis

3 X Be able to manage the clinical complications of meningitis such as effusions and empyema

4 X Be able to diagnose and manage all forms of meningo‐encephalitits and their complications

5 X Be able to investigate and manage infections of the spinal cord and its coverings


40

Training emphasis




6 X X Be able to manage “post‐infectious” complications in the CNS such as Guillain‐Barre syndrome, acute demyelinating encephalomyelitis and cerebellitis

7 X Be able to diagnose and manage CNS complications of URTI or facial infections such as abscesses, orbital infections, osteomyelitis of skill bones and thrombophlebitis

8 X Be able to liaise with the ophthalmologist for the appropriate management of ocular infections whether acute or chronic such as toxoplasmosis

Cardiovascular system infections

1 X Be able to investigate and manage infections of the different layers of the heart including infective endocarditis, myocarditis and pericarditis

2 X Be able to diagnose and treat acute rheumatic heart disease as well as manage the long term follow up of such patients along with the cardiologist

3 X X Be able to diagnose and treat other vascular infections that may be secondary to intravenous devices

Genitourinary tract infections

1 X Be able to investigate and manage infections of the urinary tract with particular reference to the age of the child and underlying risk factors for infection

2 X Be able to diagnose and manage complications of UTI infections such as renal abscess, prostatitis

3 X Be able to manage UTIs in children with congenital renal tract anomalies and chronic infections with resistant organisms

4 X Be able to diagnose and manage jointly with the gynaecologist, gynaecological infections in girls and be able to refer such children and young people to the child protection team where appropriate

5 X Be able to diagnose and manage jointly with genitourinary specialist sexually transmitted infections in children and adolescents


41

Training emphasis




6 X Be able to refer such children and young people to the child protection team where appropriate

Gastro‐intestinal tract infections

1 X Be able to diagnose and manage all forms of infectious diarrhoea as well as their potential complications and be able to initiate the appropriate contact and control of infection measures for diarrhoeal illnesses

2 X Be able to diagnose and manage viral hepatitis’s and liaise with the hepatology team where appropriate

3 X Be able to diagnose and manage appendicitis, intra‐abdominal abscesses and intra‐abdominal sepsis and liaise appropriately with the abdominal surgeons

4 X Be able to diagnose and manage abdominal tuberculosis and liaise appropriately with the gastroenterologist

Musculoskeletal and skin infections

1 X Be able to investigate and manage infections of the bones and joints, recognising the problems of antibiotic penetration into bone

2 X Be able to liaise with the orthopaedic team for the best management of these infections

3 X Be able to diagnose and manage bacterial myositis as well as necrotising fasciitis and liaise with the surgeons to prevent its complications

4 X X Be able to diagnose and manage bacterial, fungal, parasitic and viral skin infections, recognising aggravating aetiological factors in the host


42

Training emphasis




Systemic infections/inflammations

1 X Be able to recognise, formally diagnose and manage all the viral exanthemas of childhood

2 X Be able to diagnose and manage the complications of the viral exanthemas, such as post Varicella encephalitis

3 X Be able to advise on the incubation periods, exclusion from school/nursery periods and preventive interventions for other family members of the viral exanthemas

4 X Be able to investigate and manage a child with sepsis and shock

5 X Be able to give antibiotic advice for the individual and for prophylaxis, if appropriate, of other family members

6 X X Be able to diagnose and manage toxic shock syndrome with antibiotics and immune modulation

7 X X Be able to liaise with intensivists and surgeons for optimal management of such cases

8 X X Be able to take an in‐depth history, carry out a detailed examination and organise the appropriate diverse range of investigations for the diagnosis of a fever of unknown origin

9 X X Be able to liaise with the microbiologist, radiologist, haematologist and other organ specialists to identify the cause of the fever

10 X X Be able to recognise when the fever is not due to infection but to another inflammatory or malignant condition


43

Training emphasis




Infections of the foetus and newborn

1 X Be able to support the obstetrician and neonatologists in the diagnosis and treatment of congenital infections such as cytomegalovirus, syphilis or toxoplasmosis

2 X Have an in‐depth knowledge of the different pattern of infections in neonates compared to older infants and children

3 X Be able to support the neonatologists in the diagnosis and treatment of severe viral, fungal and bacterial infections of the neonate, such as herpes, encephalitis or bacterial meningitis

Infections of the immunocompromised child

1 X X Be able to recognise infectious or other presentations of specific congenital immune deficiencies and treat and liaise appropriately with the immunologist

2 X X Be able to recognise infectious or other presentations of acquired immune deficiencies whether due to HIV, nosocomial interventions or other problems

3 X X Have an in‐depth knowledge of the presentation and management of opportunistic in the immunocompromised host

4 X X Be able to treat central line infections in immunocompromised hosts

Infections in the returning travellers

1 X Be able to manage fever in a child recently arrived from abroad with knowledge of the possible infections in the country of origin

2 X Be able to diagnose and treat the different presentations of the commoner tropical infections such as malaria, dengue, typhoid, tuberculosis or HIV


44

Training emphasis




3 X Know where to seek advice on management of rarer tropical diseases

4 X Understand the significance of malnutrition, parasitic infections and psychological stress in children from war zones or in families seeking asylum

Unclassified diseases and inflammatory diseases

1 X Be able to diagnose, investigate and treat Kawasaki’s disease

2 X Be able to manage complex cases of Kawasaki’s disease which do not respond to first line treatment

3 X Be able to liaise with the cardiologist for the best management of these cases

4 X X X Be able to recognise and manage rare cases of vasculitis or other inflammatory disorders and liaise with the rheumatologist for their best management

5 X X X Be able to diagnose, investigate and treat within a multi‐disciplinary setting children with chronic fatigue syndrome

Infection Control

1 X X Understand the principles of infection control within and without the hospital environment

2 X Have experience of working with the infection control team to limit the spread of infection in hospitals

3 X X Be actively involved in the development of hospital antibiotic policies in relation to the management of children in hospital

4 X X Know how to handle bio‐hazardous specimens and be able to advise others of the problems associated with such specimens


45

Training emphasis




5 X Be able to advise about incubations periods, periods of infectivity and periods of school/nursery exclusion for childhood exanthems

6 X X Know about infection control in the community and how to liaise with the public health team including the management of outbreaks, statutory notification of diseases, disease surveillance and contact tracing

7 X Know about contact tracing for infectious diseases, in particular for condition such as tuberculosis

8 X Know how to deal with highly contagious infections such as the haemorrhagic fevers

9 X Know where to seek expert advice for the management of these rare infections

Prevention of infection

1 X X Know when to report infections which have implications for public health, whether vaccine preventable tropical or highly infectious

2 X X X Know in depth the UK national vaccination schedule, its continued development and its differences from other nations

3 X X

Know when passive vaccination may be appropriately given, such as for prophylaxis of hepatitis or diphtheria

4 X Understand the global importance of vaccine programmes

5 X Be able to give health information for travel overseas as well as about vaccination for overseas travel

6 X X Know about manipulation of the environment to reduce infection risk, such as the use of impregnated bed nets for prevention of malaria [OR use of positive a negative pressure isolation facilities]

7 X X Know about when to use post‐exposure antimicrobial prophylaxis


46

Training emphasis




HIV Medicine

1 X Have extensive experience in a Paediatric HIV specialist centre including ward‐based experience of inpatient care, outpatient management of children and adolescents with HIV

2 X Understand the classification of HIV disease in children, the modes of presentation of HIV and the management of opportunistic infections

3 X Have an in‐depth knowledge of antiretroviral treatment of HIV in children

4 X Have in‐depth knowledge of the development of resistance to antiretroviral drugs, the short and long term side effects of these drugs and particular problems of administering these drugs to children

5 X Have experience of multi‐disciplinary care meetings for families with HIV

6 X Have experience of recruiting children to HIV treatment trials, usually under the auspices of PENTA (Paediatric European Network for the Treatment of AIDS)

7 X Have experience of working with adolescents with HIV and be able to recognise the complex issue surrounding their care

8 X To report to the UK national study of HIV in Pregnancy and Childhood (NSHPC) and the Collaborative HIV Paediatric Study (CHIPS)

9 X Have experience of attendance and giving presentations at meetings of British HIV Association (BHIVA) and Children’s HIV Association (CHIVA)

10 X Have in‐depth knowledge of the appropriate interventions to reduce mother to child transmission of HIV

11 X Have experience of the multi‐disciplinary perinatal management of mothers and infants to reduce transmission of HIV


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Additional Practical Procedures (not specified elsewhere)

These competencies do not form part of the RCPCH 2010 sub-specialist curriculum but are considered important additional competencies by the CSAC

Training emphasis Procedure Record of Achievement



1 x x x Safe obtaining and handling of clinical specimens

2 x Donning and removal of Personal Protective Equipment (PPE)

3 x Bone marrow harvesting for diagnostic and therapeutic purposes

4 x Oesophageal pH monitoring

5 x Observed GI endoscopy

6 X Observed bronchoscopy and BAL

7 X X Attendance at histopathology MDTs to discuss results of biopsy

8 X Observe exhaled nitric oxide measurement

9 X Observe nasendoscopy

Documents

Paediatric Immunology, Infectious Diseases and Allergy ... · 5/20/2012 · Paediatric Immunology, Infectious Diseases and Allergy Training Guide and Record Version 1.5, Dated 15th