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Clinical Fellowship in Paediatric Surgery and Paediatric Surgical Oncology

I About The Programme
II Assessment and Evaluation
III Target Audience and Eligibility Requirements
IV Other Information


I About The Programme

Name of Programme

Clinical Fellowship in Paediatric Surgery and Paediatric Surgical Oncology

Overview

A key gap in the advancement of paediatric surgical outcomes is the lack of skilled professionals in geographical areas where the needs are most pronounced. This is especially true in the area of childhood cancer. Around the globe, it is estimated each year there are 180,000 newly diagnosed cases of cancer in children younger than 15. More than 80 percent of these occur in low- and middle-income countries (LMIC). This programme aims to address this gap by training apex subspecialty professionals of the clinical workforce who is required to advance the care of paediatric surgery and surgical oncology in LMICs

The programme builds on the Department’s general paediatric surgery cum paediatric urology fellowship, which has trained clinical fellows and observers from Southeast Asia since 2013. In a similar vein, doctors who complete the training will return to their home countries with the newly gained expertise and experience to contribute towards enhancing their countries’ clinical and research capabilities, particularly in the care of paediatric brain and solid tumours.

The VIVA-KKH Paediatric Brain and Solid Tumour Programme will be providing sponsorship for this fellowship to selected medical doctors from less developed countries in the region, as part of its education and exchange initiatives to enhance inter-institutional collaboration, reach out to the broader population in Southeast Asia and integrate training and education into our healthcare and research activities.

For more information on the services provided by the Department of Paediatric Surgery, click here.

Aim of Programme

The aim of this clinical fellowship is to provide paediatric surgery training to junior paediatric surgeons, particularly those coming from resource-challenged settings, with a special focus on paediatric surgical oncology.

Duration of Programme

The year-long training programme constitutes a 9-month rotation in paediatric surgical oncology and a 3-month rotation in general paediatric surgery.

Number of Training Places

One trainee will be accepted into this programme per year.

Main intake is in July. Entry into the programme at other times is subject to availability.

Learning Outcomes

On completion of the programme, the clinical fellow should:

  • acquire an understanding of the surgical management of general paediatric surgery and paediatric surgical oncology conditions including:
    a) competence in diagnostic workup, surgical resection and support during adjuvant therapy;
    b) competence in performing surgical procedures;
    c) competence in the management of symptoms and the role of surgical care in patients with terminal or incurable disorders.
  • be proficient with the management of elective and emergency paediatric and neonatal surgical conditions.

Content Areas

The programme covers the following areas:

1. Clinical training

  • Patient care
    The fellow will participate in the clinical management of patients with general paediatric surgery and paediatric surgical oncology conditions at KK Hospital. Specifically, for the fellow to gain a good appreciation of preoperative evaluation and pre-surgical optimisation, postoperative assessment and follow-up, and performance of operative procedures under supervision. In addition, the fellow will attend to acute referrals for emergent conditions and diagnostic workups for example for newly diagnosed lesions.

  • Procedural skills
    The fellow will be familiarised with the operative management of the following conditions:

    • Paediatric surgical oncology: Indwelling central lines, including preoperative evaluation, surgical placement, troubleshooting, and removal. Oncologic surgical techniques such as thoracotomy, laparotomy, and minimally invasive surgery for childhood malignancies.
    • General paediatric surgery: Exposure to elective and emergency paediatric and neonatal surgical conditions.

2. Education

Besides participating in the didactic learning, the fellow is responsible for organising cases for discussion and presenting at educational meetings.

  • Core educational activities (compulsory)

    Weekly:
    • Intra-hospital tumor board (Wednesdays)
    • Department academic meetings, consisting of a rotating schedule of X-ray conferences, journal clubs, and educational seminars (Thursdays) 
    • Department morbidity and mortality meetings (Fridays)

    Monthly:
    • Team pathology rounds (last Thursday), inter-hospital tumor board (second Friday)

    Quarterly:
    • Vascular malformations multidisciplinary meeting, clinical pathology meeting, multidisciplinary trauma conference
    • Supplementary educational activities (optional)

    Weekly:
    • Haematology / oncology educational meeting (Mondays)
    • St Jude VIVA Southeast Asia tumor board (Thursdays)

    Monthly:
    • Solid tumor translational research meeting

3. Research

  • Research project
    Completion of research project with aim of (i) submission of abstract and presentation at a scientific meeting, and (ii) completion of manuscript on research project for publication.

Training Methods

The Department of Paediatric Surgery at KKH has had a prior track record of training clinical fellows in general paediatric surgery and paediatric urology. Under this existing programme, the Department has trained 8 clinical fellows and clinical observers from 2013-2015.

Clinical fellows and clinical observers trained at the Department of Paediatric Surgery, KKH from 2013-2015:

Past and Present Fellows

The Department of Paediatric Surgery at KKH has had a prior track record of training clinical fellows and observers in general paediatric surgery and paediatric urology. Under the past programme, the Department has trained 8 clinical fellows and clinical observers from 2013-2015.

Clinical fellows and clinical observers trained at the Department of Paediatric Surgery, KKH from 2013-2015:

​Name
​Country of Origin
Kyaw Hsan​Myanmar
Supratim Howlader​Bangladesh
Alifi Maulidyan​Jakarta, Indonesia
Jiraporn Khorana​Chiang Mai, Thailand
Phyo MarMandalay, ​Myanmar
Londhe Swati Anil​Pune, Maharashtra, India
Jack Mulu​Papua New Guinea
Nazim Uddin Md Arif​Bangladesh


Team of Experts

The Paediatric Surgery and Paediatric Surgical Oncology Fellowship Programme is managed by the following experts:

​Name
​Designation
​Qualification
​Adj A/Prof Low YeeDeputy Chairman, Div of Surgery; Senior Consultant (Paediatric Hepatobiliary Surgery)​MBBS, FRCSEd, FAMS (Paed Surg)
​Adj A/Prof Anette JacobsenSenior Consultant (Paediatric Urology), Associate DeanMB BCh (Ireland), LRCP & SI, FRCSEd, MMed (Surg), FAMS (Paed Surg)
​Asst Prof Amos Loh Hong PhengHConsultant (Paediatric Surgical Oncology); Chairman, VIVA-KKH Paediatric Brain and Solid Tumour Programme​MBBS, MRCSEd, M Med (Surg), FAMS (Paed Surg)
​Dr Ong Lin YinHead & Senior Consultant, Dept of Paediatric Surgery​MBBS, MRCSEd, M Med (Surg), FAMS (Paed Surg)


II Assessment and Evaluation

Aims of Assessment

Key subspecialty areas of competency include:

  • Nonoperative care of paediatric general surgery and oncology patients
  • Performance of relevant general and oncologic operations

Fellows are required to continually demonstrate the following six competencies throughout the programme:

(A) Patient Care

  • Fellows must provide patient care that is compassionate, appropriate and effective, including the treatment of paediatric surgical and oncologic conditions and their associated complications. They need to be familiar with and have a good understanding of management protocols and principles of treatment in paediatric surgical diseases and paediatric cancers. In particular:
    • Inpatient Ward Rounds
      • To actively participate in rounds in surgical wards and other subspecialty wards, in particular paediatric oncology
      • To present and discuss clinical problems effectively during ward rounds, accurately interpret laboratory results and outline subsequent management plans
    • Outpatient Clinics
      • To run weekly general paediatric surgery clinics under supervision of senior staff
      • To assist in weekly paediatric surgical oncology clinics
    • Procedures
      • To assist and perform (under supervision) relevant surgical procedures

(B) Medical Knowledge

  • Fellows must demonstrate knowledge of established and evolving aspects of general and oncologic surgical practice in children, and in particular:
    • diagnosis, staging and management of common paediatric solid tumours;
    • anatomy, physiology, pharmacology, pathology and developmental biology pertinent to the management of paediatric solid tumours;
    • surgical procedures employed in relation to the diagnosis and resection of common paediatric solid tumours, and their complications.

(C) Practice-Based Learning and Improvement

  • Fellows must demonstrate their ability to investigate and evaluate evidence, both in appraisal and assimilation of scientific evidence required for patient care in current and evolving practice settings, including diagnosing and treating health problems and promotion of health.
  • Fellows must demonstrate life-long learning skills and continuous self-assessment based on reflection and feedback required for patient care in current and evolving health care settings.
  • Fellows should demonstrate teaching and learning skills, and perform research to contribute to medical education of health professionals.

(D) Interpersonal and Communication Skills

  • Fellows must demonstrate interpersonal and communication skills necessary for effective exchange of information and demonstrate the ability to collaborate with patients, their families and health professionals to provide quality patient care.

(E) Professionalism

  • Fellows must demonstrate commitment and professional attributes adhering to ethical principles including:
    • compassion and empathy;
    • honour and integrity;
    • accountability and responsibility;
    • duty and service;
    • respect;
    • humility;
    • excellence and scholarship;
    • social responsibility.

(F) Systems-Based Practice

  • Fellows must demonstrate an awareness and responsiveness to the larger context and system of health care, and demonstrate effective use of resources in the system to provide optimal health care for patients.

Assessment Approaches

The clinical fellow will be assessed periodically and will receive an end-of-fellowship report and certificate. Clinical fellows must remain under Level 1 supervision for the entire duration of their training. They will be assessed (using SMC Form T3) during the following time points:

  • 3rd month;
  • 6-monthly intervals;
  • end of term.

Clinical fellows must maintain a logbook of cases.

Evaluation Process

General overall grading system

The overall grading system evaluates the fellow’s performance upon completion of the fellowship programme. All fellows will be given an overall grading status at the end of the fellowship programme based on the grading criteria requirements. These requirements incorporate the six core competencies that fellows must demonstrate throughout the programme.

Grading Status ​Description ​Grading Criteria Requirements
CMP
​Completes the programme
  • More than 80% attendance for all lectures and training skills courses
  • Active participation observed in all lectures and training skills courses
  • Achieves satisfactory multi-source feedback assessment (>70%)
USP
​Unsatisfactory performance
  • Poor attendance rate (less than 50%) for all lectures and training skills courses
  • Poor feedback from different ranks within the department
  • Consistently demonstrates a poor level of meeting the six competencies
  • Consistently demonstrates poor training skills and patient care
  • Consistently demonstrates a poor professional attitude throughout the programme
  • Demonstrates low level of respect towards advisors and other health professionals
  • Demonstrates a lack of responsibility throughout the programme
DCP
​Did not complete the programme
  • Attends less than 50% of lectures and training skills courses
  • Fails to provide supporting documents as a valid reason for not completing the programme (e.g. medical / hospitalisation leave)
  • Did not complete required modes of assessment
WDN
​Withdrawn from the programme
  • Did not complete or attend any part of the programme within two months


The fellow will be terminated from the programme if he/she receives poor interim assessment reviews, or continually unsatisfactory performance assessment reviews during the programme. Such early termination will be recorded in the stipulated SMC assessment form and all relevant parties notified.


III Target Audience and Eligibility Requirements

Target Audience

This fellowship programme aims to provide sub-specialty paediatric surgical oncology training to junior paediatric surgeons, general paediatric surgery and particularly those coming from resource-challenged settings. The candidate who will benefit most from this programme will be a junior surgeon working in a children’s hospital with paediatric oncology service support, and should have completed post-graduate training in paediatric surgery in his/her country of origin, and may have some experience working as a junior paediatric surgeon in his/her hospital.

Pre-requisite/Eligibility Requirement(s)

Candidates must:

  • be recommended by their respective Head of Department OR at least two referees chosen by the applicant;
  • have a good general knowledge of English;
  • provide a letter of good standing from own country’s licensing authority;
  • return to their parent hospital in their country upon completion of the fellowship, with the aim of imparting the new skills and knowledge learnt, for the good of their community.


IV Other Information

Course Fees

No separate course fee.

Funding

Candidates should be self-funded or have funding from external sources/institutions. Sponsorship through the VIVA-KKH Paediatric Brain and Solid Tumour Programme will be considered on a case by case basis.

Certification

Certificate of fellowship will be awarded after completion at the end of the attachment.