Paediatric Surgery (2015)

Entry into ST3 will usually involve a competitive selection process. The current person specifications for entry into ST3 in paediatric surgery are shown on the Modernising Medical Careers website. The essential components here are completion of the common component of the core surgical training programme (as evidenced by successful ARCP, WPBA and completion of the MRCS examination) and completion of the paediatric surgery specific components of the early years training as evidenced by a successful ARCP and completion of the appropriate WPBA.

Intermediate Stage Overview

The aim of the intermediate stage (ST3 and 4) is to allow the trainee to continue to develop the skills knowledge and attitude required to practise Paediatric Surgery in the U.K health system.

Trainee will build on the basic skills and competences achieved in the initial stage of the programme, gaining exposure to the more specialised areas of practice. It is expected that the trainees will continue to build on their clinical experiences and be able to demonstrate competent practice in the operations detailed at the end of the initial stage.

The curriculum goals are presented in a modular fashion for ease of reference and recording of achievement rather than as a suggested teaching package. In some centres the trainees may work for firms in which there is an element of specialisation (paediatric urology is a prime example of this), but in other units there may be a more widespread range of experience to be obtained. 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.

The different sections will contain a mixture of information on relevant conditions, symptom patterns and associated surgical operations. This is in an attempt to represent the variety of clinical practice. 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.

Acquisition of competencies in Paediatric Urology will depend on what year the trainee is in when exposed to this aspect of Paediatric Surgery and in which centre the trainee gets this exposure. If the trainee wishes to acquire the ST7/8 or Paediatric Urology module competencies, it is recommended that the trainee applies for one of the subspecialty posts in the designated Paediatric Urology centres (see final stage and Paediatric Urology Special Interest module later in the syllabus).

The following modules are included:

Gastrointestinal
Neonatology
General Urology
Thoracic
Oncology
Endocrine
Surgical Disciplines
Research and Audit
Teaching and Training.

The expected outcomes for this phase of training are as follows:

Further experience in the management of the common surgical problems of childhood
A practitioner with integrity, respect and compassion
Increasing exposure to the more specialised areas of paediatric surgery to include clinical presentation, operative and non-operative management of cases within the different areas.
Competence in further range of operations common to paediatric practice

The operative skills outlined here are those relevant to this stage of surgical training. Many are related to the conditions outlined in the specialty modules.

Again the curriculum is there to act as a guide to a minimum level of competence to be achieved by the end of ST4. The operations detailed here are those it is reasonable to expect the trainee to be able to perform either independently or with consultant assistance available but not necessarily at the operating table.

Although this list is not exhaustive it gives an indication of those procedures that it is reasonable to expect a trainee by the end of ST4 to have been exposed to and in the case of the marked procedures (*) be deemed competent to perform.

Elective Procedures

Gastrostomy - open / PEG*
Fundoplication
Splenectomy / cholecystectomy
Upper GI Endoscopy (flexible)
Exomphalos minor
Anoplasty for low anorectal malformation
Intestinal resection and anastamosis (non-neonatal)
Rectal Biopsy for Hirschsprungs (suction/open)*
Inguinal herniae - infant and neonatal (not extreme prematurity)
Colostomy closure*
C.V. line insertion*
Open biopsy of tumours
Muscle biopsy*
Cystoscopy*
Repair distal hypospadias
Simple Nephrectomy (dysplastic kidney)
Ureteric reimplant / submucosal injection
Closure of vesicostomy or ureterostomy
Laparoscopic approach for diagnosis*

Emergency Procedures

Gastroschisis closure (primary or silo)
Colostomy formation - anorectal malformations / Hirschsprungs disease*
Correction of malrotation*
Meconium ileus enterotomy / or stoma formation
Operative reduction / resection of intussusception*
Urinary diversion (ureterostomy/vesicostomy formation)
Removal of oesophageal foreign body

Click on Workplace Based Assessments to view the assessment forms including DOPS and PBAs