DEPARTMENT OF PAEDIATRICS

OVERVIEW

The department has been in existence since the inception of the medical school. Unfortunately, it had been understaffed for the better part of the twenty-six years of its existence. Despite this, the department has experienced modest growth.

The department is involved in teaching medical students, conducting ethical research (in collaboration with institutions local and abroad, training of paediatricians and rendering clinical services to children and adolescents.

Paediatric subspecialties are developing. Currently, Paediatric cardiology, nutrition and neonatology are fairly well established.

OBJECTIVES

The objectives of the postings in paediatrics include:-

1.                   To help the student develop skills of identifying problems in a child by careful history taking, physical examination and rational use of laboratory investigations.

2.                   To teach the student how to differentiate between an ill child and a well child and how to promote healthy growth and development of children and adolescent.

3.                   To give skill in analyzing health problems of children working  out plans of action, including the rational use of drugs and medicaments.

4.                   To provide a solid foundation on which the student may choose to build a career in Paediatrics and child health.

TEACHING & LEARNING METHODS

Students are taught through

a.                   Formal lectures

b.                   Tutorials/seminars

c.                   Bedside teaching

d.                   Clinics

The total duration of the posting in Paediatrics is 16 weeks broken into two parts of 8 weeks each. The junior posting is designed to introduce the students to the spectrum of disease in paediatrics and to develop skills of identifying problems in the child. As a result all the formal lectures are given during this period in addition to other methods of teaching.  It is also designed to develop their clinical skills hence, they are expected to clerk and examine patients as well as join their various consultants during call.

In the senior posting, the student is expected to further develop skills of analyzing clinical problems of the child and developing plans of action. At this stage formal lectures cease and there is emphasis on bedside teaching and small group discussions. Students participate in all formal departmental programmes such as daily post call review meetings, mortality meetings, and seminars.

During the postings in Paediatrics, the students are assigned to consultants in various units and subspecialties. These rotations last two weeks each. The consultant and his team of residents guide the students. The students are expected to be involved in the following:

a.                   Clerking of patients

b.                   Learning and performing procedures like lumbar puncture and venepuncture under supervision of residents/consultants.

c.                   Decision making in management of patients

d.                   Tracing and interpreting laboratory results of patients under the guidance of residents/consultants.

e.                   Out patient clinics

Tutorial sessions are held twice a week at times mutually agreeable to both students and resource persons. Students are expected to read up the subject for discussion ahead of the section. There are also radiology sessions with the consultant radiologist on radiographs relevant to paediatric practice. Sessions are also taken on nutritional rehabilitation and diarrhoea management.

EVALUATION

Logbook – Each student is given a logbook in which satisfactory attendance and performance of procedures are recorded and signed by consultant or resident.

Daily- Students discuss patients they have assessed with consultant and residents on a daily basis.  Their skills of history taking, physical examination and plans of action are evaluated in the process.

End of junior posting test – There is a multiple choice question type examination and a clinical examination given at the end of the junior posting. These cover the whole spectrum of Paediatrics and child health.

End of senior posting test – This consist of :

a.                   Multiple choice questions

b.                   Clinical examination (long and short cases)

c.                   Oral examination

The clinical examinations assess how student reasons through problems in real life situation, using the body of knowledge and skills acquired during the posting.

FINAL EXAMINATION IN PAEDIATRICS - This consists of:

a.                   Continuous assessment- this is based on cumulative scores of all previous tests and the logbook.

b.                   Paper I – Multiple choice questions (50 stems each having 5 arms)

c.                   Paper II – Essays (Four questions; question I is usually broad based and compulsory, while the student is asked to answer two out of questions 2-4).

d.                   Clinical examination – Long case

-          Short case

e.                   Oral examination

Students who fail the final examination are given a repeat posting to review the whole course in 8 weeks. A repeat examination is conducted at the end.  Students who fail the repeat examination are given a chance to repeat the whole year under more careful supervision of a consultant.  These are very special postings. At the end of it, the student is given a chance to sit for the main examination and a repeat examination if he/she fails. After failing at this fourth attempt at the examination, the student is considered ineligible to sit for the examination in Paediatrics and is consequently withdrawn.

400 LEVEL CLASS

PAE 481: JUNIOR POSTING  (4 CREDITS)

Course objectives:

At the end of the course the student should be able to list and describe procedures for clinical examination of the children, including the newborn.

Teaching & Learning Methods:

Lectures, tutorials

Problem based learning.

Evaluation

MCQ (True-False items, Essay, Practical)

Content

Clinical demonstration topics

-Examination of the newborn

-Examination of the CNS

-Examination of the Respiratory System

-Examination of the CNS

-Examination of the UGS/Digestive System/Growth monitoring

Tutorial topics

-Childhood immunization/NPI

-Common Paediatric emergencies

-Childhood poisoning

-Bites and stings in children

-The under-fives clinic

-Vaccine preventable diseases

-Common childhood exanthems

-Otitis media in childhood

-Neonatal resuscitation

-Jaundice in childhood

-Microcephaly and macrocephaly

-Breastfeeding – advantages/disadvantages, BFHI

PAE 482:  BASIC PRINCIPLES IN PAEDIATRICS (4 CREDITS)

Course objectives:

At the end of the course the student should be able to list and describe basic principles in the care and management of diseases of the child.

Teaching & Learning Methods:

Lectures, tutorials

Problem based learning.

Evaluation

MCQ (True-False items, Essay, Practical)

Content

Introduction/Paediatrics in the tropics.

            -Principles of Paediatric history taking/physical examination

Nutrition, Growth and Development

            -Infant nutrition/complementary feeding practices

-Factors affecting growth and development; causes of failure of thrive.

            -Growth monitoring; nutritional assessment/anthropometry.

            -Protein energy malnutrition (1 & 2).

Child Health and Primary care

            -Organisation of integrated child health services/PHC

            -Child survival strategies/NPI

            -Problems of the girl child

            -Rights of the child, child labour and child abuse.

500 LEVEL CLASS

PAE 581: ADVANCED COURSE IN PAEDIATRICS (2 CREDITS)

Course objectives:

At the end of the course the student should be able to list and describe diagnosis and management of systemic diseases of children.

Teaching & Learning Methods:

Lectures, tutorials

Problem based learning.

Evaluation

MCQ (True-False items, Essay, Practical)

Content

Paediatric Respiratory medicine

            -Congenital anomalies of the resp-tract; Respiratory system evaluation

-Upper respiratory infections

            -Low respiratory infections

            -Asthma in childhood

-Pulmonary tuberculosis/ extra-pulmonary tuberculosis

Paediatric Cardiology

            -Evaluation of the CVS in children

            -Congenital heart diseases – acyanotic

            -Congenital heart diseases –cyanotic

            -Acquired heart diseases (1&2)

Paediatric Nephrology

-Developmental and structural anomalies of the UGS

-UTI

-Glomerulonephritis

-Nephrotic syndrome

-Acute renal failure in childhood

-Chronic renal failure

Paediatric Gastroenterology

            -Diarrhoeal diseases in children (1 & 2)

            -Fluid and electrolyte imbalance/therapy

            -Jaundice in childhood/Hepatitis in childhood

            -Abdominal pain in childhood

            -Malabsorption.

Endocrine and Metabolic diseases of Children

            -Hypothyroidism

            -Hyperthyroidism

            -Childhood diabetes mellitus

            -Normal pubertal development

            -Adolescence and its problems

-Precocious and delayed puberty

            -Ambiguous genitalia

            -Vitamin D Metabolism/rickets

            -Inborn errors of metabolism

Paediatric Neurology

            -Acute CNS infections (1&2)

            -Hydrocephalus and microcephaly

            -Convulsions in infancy and childhood (1&2)

            -The unconscious child

            -Cerebral palsy

            -Mental subnormality

            -CNS tumours

Paediatric Haematology & Oncology

            -Anaemia in infancy and childhood

            -Sickle cell anaemia in childhood

            -Childhood leukaemias

            -Childhood lymphomas

            -Bleeding disorders in childhood

            -Abdominal malignancies

            -Other solid tumours in childhood

Paediatric Infectious Diseases and Dermatology

            -Measles and other childhood exanthems

            -Whooping cough

            -Poliomyelitis/Diphtheria

            -Extra-pulmonary tuberculosis

            -Common skin infections/dermatitis

            -Osteomyelitis and septic arthritis

            -Paediatric HIV/AIDS

            -Malaria

-Intestinal parasites

Perinatology, Neonatology & Genetics

1. Introduction to Perinatology/Normal newborn/examination/reflexes

- Birth weight and gestational age assessment

2. Principles of thermoregulation in the newborn (including shivering and non-shivering thermogenesis, the incubator and Kangaroo mother care)

3. LBW/SGA/Prematurity

-definition, classification (by weight and maturity)

-Determinants of LBW, prevalence of LBW

-Common problems of prematurity/SGA

-Feeding issues

-Identification/screening for LBW

4. Perinatal Asphyxia

-Apgar scores

-Definition of Perinatal asphyxia

-Pathophysiology

-Aetiology

-Consequences of birth asphyxia (HIE, PIVH, NEC, Cardiac, renal, skin, lungs, MAS)

-Long-term complications (cerebral palsy, mental retardation, learning disorders)

-Prevention-Delivery  room resuscitation

5. Neonatal Jaundice

-Classification (conjugated and unconjugated hyperbilirubinaemia)

-Aetiology

-Concept of physiologic jaundice

-Kernicterus

-Management-phototherapy,

-Drugs (phenobarbitone, metalloporphyrins) eby

-Hydration

-EBT (indications, procedure, complications, postEBT care)

-Complications, of jaundice

6. Haemorraghic disorders in the Newborn

- (Including role of vitamin K in blood clothing factor synthesis, classification            of HDN-early, classical, late)

7. Common skin conditions in the Newborn

-Aetiopathogenesis

-Clinical features

-Severity score

-Treatment

-Prognosis

-Prevention (immunization of mother, delivery procedure and care of the new born.

Neonatal seizures

8. Respiratory problems in the Newborn

-Apnoea – primary, secondary, Apnoea of prematurity, other causes of Apnoea                   -Resuscitation

-RDS – Pathology/pathopysiology

-Clinical features

-Diagnosis features

-Differential diagnosis

-Management

9. Principles of genetics/chromosomal anomalies

10. Congenital anomalies

11. Prenatal diagnosis and genetic counselling

12. Infants of mothers with vertically transmissible diseases

13. Peculiarities of therapeutics in the newborn.

14. Gastrointestinal bleeding

15. Hypoglycaemia

Ethical Issues in paediatrics

Management of pain in childhood

Computers in paediatrics and child health and Basic research methodologies in -Paediatrics

Miscellaneous

Accidents and poisoning

            -Bites and stings

-Kerosine ingestion

-Household accidents- Burns

-Drug poisoning (salicylate, barbiturate, insecticide poisoning etc)

Psychosocial problems in paediatrics

Emergency paediatrics

Tutorials (see topics)

Clinical demonstrations (see topics)

Beside/ward teaching

Clinics (paediatric outpatients)

PAE 582: SENIOR POSTING IN PAEDIATRICS (4 CREDITS)

Emergency paediatrics

Tutorials (see topics)

Clinical demonstrations

Beside (ward) teaching

Clinical teaching (paediatric outpatients)

Clinical Demonstration Topics

-Examination of the newborn

-Examination of the CNS

-Examination of the Respiratory System

-Examination of the CVS

-Examination of the UGS/Digestive System/ Growth monitoring

-Instrumentation

Tutorial Topics

-Differential diagnosis and management of stridor

-Heart failure in children

-Common childhood exanthems

-Congenital infections

-Neonatal tetanus: prevention and management

-Child survival strategies

-The wheezing child

-Childhood tuberculosis: natural history, management and control

-Psychosocial problems in paediatrics/handicapped child

BFHI

-Neonatal resuscitation

-Diabetic keto-acidosis: presentation and management

PAE 583:  TUTORIALS IN PAEDIATRICS (1 CREDIT)