Final + Special Interests
Final (including special interests) stage Overview
The aim of the final stage is enable the trainee to further develop the skills knowledge and attitude required to complete training and move to practise as a Consultant Paediatric Surgeon in the UK health system.
This final phase of training is when trainees continue to build on the competences achieved in the first phases of the programme, gaining both competences not achieved at earlier stages and further exposure to the more specialised areas of practice. The goals as outlined in previous stages remain pertinent, as it is expected that the trainees will continue to build on their experience and move beyond competent practice to the level of an advanced practitioner, in many of the areas.
The planning of these final attachments is important as it provides an opportunity to remedy areas of training deficiency from earlier in the programme, or the development of a special interest.
The curriculum goals are again presented in a modular fashion for ease of reference and recording of achievement rather than as a suggested teaching package. There will obviously be areas of duplicate coverage and again this curriculum should be viewed as a framework to aid understanding rather than as a proscriptive document. Though the information on the individual conditions is largely unchanged from the intermediate stage, the objectives of these 'modules' have been altered to reflect the expectation that the trainees will be exhibiting a more advanced level of performance.
The different sections will contain a mixture of information on relevant conditions, symptom patterns and associated surgical operations. Overall these goals outlined are simply guides to progress and should be used by trainees, trainers and Programme Directors to help plan rotational placements to ensure a full breadth of training.
The following modules are included:
- Gastrointestinal
- Neonatology
- General Urology
- Thoracic
- Oncology
- Endocrine
- Surgical Disciplines
- Research and Audit
By the end of the final stage of training trainees including those who are following an academic pathway will have:
- Achieved the level of an advanced practitioner in the management of the common surgical problems of childhood
- Acquired the skills to practice with integrity, respect and compassion
- Gained sufficient theoretical knowledge and practical experience to be able to enter for the examination in paediatric surgery as set by the Intercollegiate Board in Paediatric Surgery.
- Developed skills and experience in areas of more specialised practice - with a view to developing a sub-specialty interest if appropriate.
- Achieved the level of advanced practitioner in operations common to Paediatric practice, and be developing competence in procedures appropriate to sub-specialty training.
The list detailed here will not be achieved by all trainees, as many will be looking to specialise in a particular area. Individual circumstance will dictate the experience each trainee will gain. As a guide the trainee will by the end of this phase be expected to both initiate and lead in the operative management. In addition they will be expected to demonstrate the self-awareness of the need for support and advice of senior colleagues.
Elective Procedures
Neonatal
- Repair of Oesophageal atresia (+/- fistula)
- Colonic interposition/ gastric pull up
- Repair of recurrent fistula
- Aortopexy
- Congenital Diaphragmatic hernia repair
- Repair of eventration of diaphragm
- Duodeno-dudenostomy
- Management of congenital atresias of intestine
- Management of duplications
- Management of necrotising enterocolitis
- Neonatal pull-through for Hirschsprungs disease
General Abdominal
- Achalasia management
- Fundoplication
- Gastric disconnection
- Feeding jejunostomy
- ACE procedure
- Bowel lengthening procedure
- Posterior sagittal anorectoplasty
- Pull through for Hirschsprungs disease
- Management of Crohns disease of small and large intestine
- Colonic resection for Ulcerative colitis and ileoanal pouch formation
- Colonoscopy
Thoracic
- Management of empyema
- Resection of lung lesions
- Management of chest wall deformity
- Management of airway anomalies
Endocrine
- Resection of salivary gland lesions
- Thyroid/parathyroid surgery
- Management of hyperinsulinism
Oncology
- Hepatoblastoma
- Wilms tumour
- Adrenal tumours - benign/malignant
- Soft tissue tumours
- Sacrococcygeal tumour
Hepatobiliary
- Biliary atresia
- Choledochal cyst
Urology
- Pyeloplasty
- Partial Nephrectomy
- Management of renal calculi
- Management of posterior urethral valves
- Bladder extrophy closure
- Bladder augmentation / artificial sphincter insertion
- Epispadias repair
- Proximal hypospadias repair
Paediatric Urology Special Interest Overview
Paediatric urology is delivered in a number of different units across United Kingdom, either by surgeons whose entire workload consists of Paediatric Urology, or by those who undertake Paediatric Urology as the major focus of their job plans. The service is often focused in tertiary paediatric units, though a number of specific conditions are treated in supra-regional units
The majority of trainees entering this phase of training will have completed either the essential part of a paediatric surgical programme (ST1-6), or an adult urology programme. Selection criteria will be published as part of the selection process for the specialty
The final part of training to become a full-time paediatric urologist is likely to take place in those designated units that had specified training posts under the Calman system, or are deemed by PMETB to provide sufficient clinical exposure and a rounded educational experience to enable trainees to complete the required training.
Aim
The aim of this aspect of training is to deliver the knowledge skills and experience required by trainees who wish to focus their future practice either solely in the field of paediatric urology, or with paediatric urology as their major special interest.
Outcomes
At completion of this section of the programme the trainee will:
- Be able to manage the index conditions encountered in paediatric urological practice in the United Kingdom
- Be able to formulate appropriate investigation and management strategies for children under his/her care
- Be able to undertake the operative management of the index conditions to the required level
- Be able to communicate these plans effectively to patients, parent, relevant colleagues
- Be able to interact appropriately with other members of the team
- Practise with integrity respect and compassion
Specific Technical Skills
The following list of procedures includes those that it is anticipated that a trainee completing the 2 year module in paediatric urology would be competent to perform to level 4. This list follows from those procedures identified at earlier stages
- Pyeloplasty
- Partial Nephrectomy
- Management of renal calculi
- Operative ablation of valves
- Complex hypospadias repair
- Nephrectomy
- Reimplantation of ureters
- Operative management of impalpable testis
- Operative relief of urinary obstruction (e.g. stent insertion)
The following list is one of which every trainee must have exposure to, though depending on previous exposure and future career path, may not be required to be competent in the performance of individual procedures. (Skill Level 3 or 4)
- Closure of bladder exstrophy (specialist centre)
- Bladder augmentation
- Urethral sphincter insertion
- Epispadias repair (specialist centre)
- Gender re-assignment surgery
Review of Module
The responsibility for the review of the outcomes of this module rests with the SAC in Paediatric Surgery with advice from the British Association of Paediatric Urology (BAPU). Click on Workplace Based Assessments to view the assessment forms including DOPS and PBAs.