Paediatric Rehabilitation Medicine Advanced Training Curriculum Australasian Faculty of Rehabilitation Medicine Physician Readiness for Expert Practice (PREP) Training Program Paediatric Rehabilitation Medicine Advanced Training Curriculum TO BE USED IN CONJUNCTION WITH: Basic Training Curriculum – Paediatrics & Child Health Professional Qualities Curriculum 1 2 ACKNOWLEDGEMENTS Fellows, trainees and RACP staff have contributed to the development of this curriculum document. The College specifically thanks those Fellows and trainees who have generously contributed to the development of these curriculum documents, through critical comments drawn from their knowledge and experience and the donation of their time and professional expertise. The following Fellows and trainees, in particular, deserve specific mention for their contribution: • Dr Jennifer Ault, FRACP FAFRM • A/Prof Peter Flett, FRACP FAFRM • Dr Remo (Ray) Russo, FRACP FAFRM • Dr Mary-Clare Waugh FRACP FAFRM Development of the Paediatric Rehabilitation Medicine Advanced Training Curriculum content was overseen by the AFRM Education Committee. The process was managed by the Curriculum Development Unit within the College’s Education Deanery, who designed the document, drafted content material, organised and facilitated writing workshops, developed resource materials, and formatted the final document. Paediatric Rehabilitation Medicine Advanced Training Curriculum 3 CONTACT DETAILS THE ROYAL AUSTRALASIAN COLLEGE OF PHYSICIANS AUSTRALIA NEW ZEALAND 145 Macquarie Street 5th Floor Sydney 99 The Terrace NSW 2000 Wellington Australia New Zealand Tel: (+61) (2) 9256 5444 Tel: (+64) (4) 472 6713 Fax: (+61) (2) 9252 3310 Fax: (+64) (4) 472 6718 Email: [email protected] Email: [email protected] Website: www.racp.edu.au Website: www.racp.edu.au COPYRIGHT 1st edition 2010 (revised 2013). Please note: No Domains, Themes or Learning Objectives have been updated for this edition; design changes ONLY. Copyright © 2013. The Royal Australasian College of Physicians (RACP). All rights reserved. Published December 2013. This work is copyright. Apart from any fair use, for the purposes of study or research, it may not be reproduced in whole or in part, by any means electronic or mechanical, without written permission from The Royal Australasian College of Physicians 4 Paediatric Rehabilitation Medicine Advanced Training Curriculum RACP FELLOWSHIP TRAINING PATHWAYS AND THE CONTINUUM OF LEARNING Foundation RACP PREP Training Professional medical practice Basic Training Advanced Training Programs Qualification studies and Programs workplace Division Training Programs experience Cardiology Clinical Genetics Clinical Haematology Clinical Immunology & Allergy Clinical Pharmacology FRACP Community Child Health P Continuing Professional Dermatology (NZ only) Development Endocrinology Initial Medical Basic Training Gastroenterology Qualification in Adult General & Acute Care Medicine A Medicine General Paediatrics P Geriatric Medicine A Infectious Diseases Medical Oncology Neonatal/Perinatal Medicine P Nephrology Neurology Nuclear Medicine Palliative Medicine 1 Respiratory Medicine Rheumatology Sleep Medicine Joint Training Programs 2 RACP & The Australasian Faculty of Rehabilitation Medicine (AFRM) FRACP & • Paediatric Rehabilitation MedicineP FAFRM One or more RACP & The Royal College of Pa- Basic Training initial post- thologists of Australasia (RCPA) in Paediatrics graduate • Endocrinology & Chemical & Child years in the Pathology Health FRACP & workplace • Haematology FRCPA • Immunology & Allergy • Infectious Diseases & Microbiology RACP & The Australasian College FRACP &/OR for Emergency Medicine (ACEM) FACEM • Paediatric Emergency Medicine 3 Chapter Training Programs • Addiction Medicine 3 FAChAM • Palliative Medicine 1,3 FAChPM • Sexual Health Medicine 3 FAChSHM Faculty Training Programs • Rehabilitation Medicine 3 FAFRM • Occupational & Environmental Medicine 3 FAFOEM • Public Health Medicine 3 FAFPHM P Trainees must complete Basic Training in Paediatrics & Child Health to enter this program. A Trainees must complete Basic Training in Adult Medicine to enter this program. 1 Trainees who have entered Advanced Training in Palliative Medicine via a RACP Basic Training Program will be awarded FRACP upon completion and may subsequently be awarded FAChPM. Trainees who have NOT entered Advanced Training in Palliative Medicine via a RACP Basic Training Program will only be awarded FAChPM upon completion. 2 The Child & Adolescent Psychiatry Joint Training Program with the Royal Australian and New Zealand College of Psychiatrists (RANZCP) is currently under review by the RACP and RANZCP and closed to new entrants at present. 3 Alternative entry requirements exist for these training programs; please see the corresponding PREP Program Requirements Handbook for further information. NB1: This diagram only depicts training programs that lead to Fellowship. Please see the RACP website for additional RACP training programs. NB2: For further information on any of the above listed training programs, please see the corresponding PREP Program Requirements Handbook. Paediatric Rehabilitation Medicine Advanced Training Curriculum 5 OVERVIEW OF THE SPECIALTY Paediatric rehabilitation physicians diagnose and assess a young person’s function associated with injury, illness or chronic conditions, to maximise their independence and improve and maintain quality of life. They provide specialist knowledge and expertise in the prevention, assessment, management and medical supervision of children or adolescents with a disability. Paediatric rehabilitation physicians evaluate medical, social, emotional/behavioural, educational and recreational aspects of function. They work with young people and their families using an evidence-based collaborative approach with other disciplines, having a unique overview of the skills and expertise of other health professionals, to develop a patient-centred, individualised treatment plan in a range of settings, including home, public and private hospitals, and community rehabilitation centres and clinics. Paediatric rehabilitation physicians plan, organise, administer and review appropriate and comprehensive rehabilitation management plans, utilising and coordinating the skills of interdisciplinary rehabilitation teams and communicating effectively with patients, their families, rehabilitation teams, medical colleagues and other relevant agencies. In addition, they plan, administer and lead rehabilitation services employing interdisciplinary teams, understand political, legal and ethical issues related to health service administration, and demonstrate effective basic skills in staff and team management. Paediatric rehabilitation physicians play a key role in the transition to adult services for paediatric rehabilitation patients. They help to develop and commence timely and appropriate transition services, working with other physicians, including family practitioners, rehabilitation medicine (adult) physicians and various specialists, in hospital and community service settings. Areas of clinical practice include rehabilitation for: • neurological disorders, including muscle disorders, stroke, cerebral palsy, acquired spinal disorders/injury, acquired brain injury, including traumatic and nontraumatic • developmental disabilities with physical impairment, including cerebral palsy and spina bifida • musculoskeletal and orthopaedic conditions, including arthrogryposis, juvenile rheumatoid arthritis, juvenile osteoporosis, osteogenesis imperfecta, hypermobility disorders, and sporting injuries • persistent pain • congenital and acquired limb deficiencies • complex low incidence conditions, such as genetic short stature disorders, that would benefit from rehabilitation. Note: Also refer to the position statement Paediatric Rehabilitation Medicine: Training and accreditation to become a Consultant Physician in Paediatric Rehabilitation Medicine (Nov 2007) available under AFRM Publications on the AFRM website. www. afrm.racp.edu.au 6 Paediatric Rehabilitation Medicine Advanced Training Curriculum CURRICULUM OVERVIEW Paediatric Rehabilitation Medicine – Advanced Training Curriculum This curriculum outlines the broad concepts, related learning objectives and the associated theoretical knowledge, clinical skills, attitudes and behaviours required and commonly utilised by paediatric rehabilitation physicians within Australia and New Zealand. The purpose of Advanced Training is for trainees to build on the cognitive and practical skills acquired during Basic Training. At the completion of the Paediatric Rehabilitation Medicine Advanced Training Program, trainees should be competent to provide at consultant level, unsupervised comprehensive medical care in paediatric rehabilitation medicine. Attaining competency in all aspects of this curriculum is expected to take three years of training. It is expected that all teaching, learning and assessment associated with the Paediatric Rehabilitation Medicine Advanced Training Curriculum will be undertaken within the context of the physician’s everyday clinical practice and will accommodate discipline- specific contexts and practices as required. As such, it will need to be implemented within the reality of current workplace and workforce issues and the needs of health service provision. There may be learning objectives that overlap with or could easily relate to other domains; however, to avoid repetition, these have been assigned to only one area. In practice, however, it is anticipated that within the teaching/learning environment, the progression of each objective would be explored. Note: The curricula should always be read in conjunction with the relevant College Training Handbook available on the College website. Professional Qualities Curriculum The Professional Qualities Curriculum (PQC) which can be found on the College website outlines the range of concepts and specific learning objectives required by, and utilised by, all physicians, regardless of their specialty or area of expertise. It spans both the Basic and Advanced Training programs and is also utilised as a key component of the Continuing Professional Development (CPD) program. Together with the various Basic and Advanced Training Curricula, the PQC integrates and fully encompasses the diagnostic, clinical, and educative-based aspects of the physician’s/paediatrician’s daily practice. Each of the concepts and objectives within the PQC will be taught, learnt and assessed within the context of everyday clinical practice. It is important, therefore, that they be aligned with, and fully integrated into, the learning objectives within this curriculum. The domains and themes from the Professional Qualities Curriculum are reproduced here for reference: Domain 1 Communication Theme 1.1 Physician-Patient Communication Theme 1.2 Communicating with a Patient’s Family and/or Carers Theme 1.3 Communicating with Colleagues and Broader Health Care Team Theme 1.4 Communicating with the Broader Community Domain 2 Quality and Safety Theme 2.1 Using Evidence and Information Theme 2.2 Safe Practice Theme 2.3 Identifying, Preventing and Managing Potential Harm Paediatric Rehabilitation Medicine Advanced Training Curriculum 7 Domain 3 Teaching and Learning (Scholar) Theme 3.1 Ongoing Learning Theme 3.2 Research Theme 3.3 Educator Domain 4 Cultural Competency Theme 4.1 Ongoing Learning Domain 5 Ethics Theme 5.1 Professional Ethics Theme 5.2 Personal Ethics Theme 5.3 Ethics and Health Law Domain 6 Clinical Decision Making Theme 6.1 Clinical Decision Making Domain 7 Leadership and Management Theme 7.1 Self-Management Theme 7.2 Leadership and Managing Others Domain 8 Health Advocacy Theme 8.1 Advocacy for the Patient Theme 8.2 Individual Advocacy Theme 8.3 Group Advocacy Domain 9 The Broader Context of Health Theme 9.1 Burden of Disease Theme 9.2 Determination of Health Theme 9.3 Prevention and Control Theme 9.4 Priority Population Groups Theme 9.5 Economics of Health EXPECTED OUTCOMES AT THE COMPLETION OF TRAINING Graduates from this training program will be equipped to function effectively within the current and emerging professional, medical and societal contexts. At the completion of the Paediatric Rehabilitation Medicine Advanced Training Program, as defined by this curriculum, it is expected that a new Fellow will have developed the clinical skills and have acquired the theoretical knowledge for competent consultant paediatric rehabilitation medicine practice. It is expected that a new Fellow will have acquired and will continue to develop competencies that ensure the highest standard of patient care. These competencies can be described in terms of identifiable learning objectives employing specific knowledge and skills, as set out in the following pages. Professional competence also demands that paediatric rehabilitation physicians hold attitudes congruent with their responsibilities towards patients, their stage of growth and development, their families, other health professionals and the community, including preschools and schools. These attitudes are in the following areas: 8 Paediatric Rehabilitation Medicine Advanced Training Curriculum Patient Focus A rehabilitation physician: • applies a positive and constructive attitude to the development of strategies to enable the person with disability and activity limitation or participation restriction to realise their full potential • recognises the perspective and beliefs of the patient, and endeavours to incorporate the patient’s needs and expectations into the plan of care • is aware of and sensitive to issues of ethnicity, culture, gender and sexuality • recognises the importance of the family in supporting the patient, as well as the potential difficulties the family may experience in the care of a family member with a disability. Professional Role A rehabilitation physician: • behaves with empathy, courtesy, responsibility and accountability towards patients and their families, and towards other health professionals • understands the extent of their competence and how their role extends the traditional medical role • recognises and respects the contributions and roles of other medical practitioners in the process of care • is prepared and willing to actively promote rehabilitation medicine to the medical profession. Continuing Professional Development A rehabilitation physician: • views competence as a continuing process of education and learning by which he/she ensures that clinical practice is of the highest standard • is willing to openly and regularly review personal competence, and to improve clinical skills as necessary. Interdisciplinary Management While a rehabilitation physician accepts full and ultimate responsibility for the rehabilitation care of the patient, he/she: • recognises the appropriateness of interdisciplinary team management, especially in the care of persons with permanent and complex disability • understands the specific skills of each team member, and develops a close professional relationship with these allied disciplines • appreciates the synergistic effect of cohesive team management, and strives to support the team in achieving holistic and expert care. Patient Advocacy A rehabilitation physician is: • prepared at all times and to the best of his/her ability to represent and support persons with disability in the achievement and defence of their rights to receive optimal medical and rehabilitation care, and to pursue their chosen lifestyle with independence and dignity • aware of the full extent of potential disadvantage arising from disability, and is willing to assist persons with disability in achieving their full rights in society, especially with regard to medical care, accommodation, community support, community access, safety, transport, and appropriate political and legal representation. Paediatric Rehabilitation Medicine Advanced Training Curriculum 9