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Pathology and Laboratory Medicine

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 Pathology


Overview

The Clinical Fellowship in Paediatric Pathology in the Department of Pathology and Laboratory Medicine, KK Women’s and Children’s Hospital, is a busy, intense and fast-paced programme. Trainees on the programme are expected to fully participate and immerse themselves in the work and activities of the unit, which spans surgical pathology, placental pathology and perinatal autopsies. Trainees should expect to be fully occupied during office hours attending to the work of the department, which includes, but is not limited to, handling of gross pathological specimens, reporting of microscopy slides, performance of fetal and perinatal post mortems, attendance and presentation at clinical meetings, and participation and presentation at slide teaching sessions.


Aim of Programme

To expose and immerse trainees to the sub-specialty discipline of paediatric pathology, incorporating foetal, perinatal, paediatric surgical and placental pathology.


Duration of Programme

Maximum 6 months


Number of Training Places

Only 1 trainee at any one time


Learning Outcomes

At the end of the programme, trainees will be able to:

  • list the common pathological conditions in the paediatric age group;
  • appreciate the spectrum of pathology in infants and children;
  • handle common paediatric surgical (including oncological) specimens grossly and histologically;
  • diagnose common paediatric surgical (including oncological) specimens;
  • perform a competent gross examination of a placental specimen and diagnose common placental pathological conditions;
  • perform a perinatal autopsy including external examination, evisceration, organ dissection, selection of tissue blocks, utility of ancillary investigations and histological examination, and be able to formulate an autopsy report including clinico-pathologic correlation;
  • be acquainted with seminal publications in paediatric pathology.


Content Areas

The trainee will be exposed to the pathology of the following conditions:

The Placenta
  • Indications for submission to pathology
  • Gross examination of placenta
  • Umbilical cord pathology
  • Acute chorioamnionitis
  • Infectious and non-infectious chronic villitis
  • Chronic histiocytic intervillositis
  • Massive perivillous fibrinoid deposition / Maternal floor infarction
  • Decidual vasculopathy and uteroplacental underperfusion
  • Fetal thrombotic vasculopathy
  • Placenta accreta (increta/percreta)
  • Placental abruption
  • Meconium
  • Chorangiosis/chorangioma/chorangiomatosis
  • Intervillous thrombosis and feto-maternal haemorrhage
  • Multiple gestations including twin-twin transfusion
  • Confined placental mosaicism
Paediatric Tumours
  • Ewing sarcoma / PNET
  • Rhabdomyosarcoma – embryonal, alveolar, anaplasia in RMS
  • Osteosarcoma
  • Neuroblastic tumours
  • Soft tissue tumours including fibromatosis and synovial sarcoma
  • Rhabdoid tumour and INI-1/Baf47
  • Pleuropulmonary blastoma
  • Desmoplastic small round cell tumour
  • Germ cell tumours
  • Histiocytoses – Langerhans cell histiocytosis, Rosai-Dorfmann disease
  • Paediatric vascular tumours including GLUT1-positive juvenile haemangiomas
  • Renal tumours – Wilms tumour, congenital mesoblastic nephroma
  • Liver tumours – Hepatoblastoma
  • Lymphomas – Anaplastic large cell, lymphoblastic and Burkitt lymphomas
  • Molecular techniques (PCR, RT-PCR, FISH) in diagnosis of paediatric tumours

The following conditions may also be encountered in the programme, subject to availability:

Gastrointestinal Disease
  • Reflux, allergic and eosinophilic oesophagitis
  • Neonatal enteropathies – microvillous inclusion disease and tufting enteropathy
  • Coeliac disease
  • Inflammatory bowel disease
  • Hirschsprung disease and other motor disorders
  • Necrotizing enterocolitis
  • Polyps in childhood
Liver Disease
  • Biliary atresia
  • Autoimmune hepatitis
  • Primary sclerosing cholangitis
  • Neonatal giant cell hepatitis
  • Metabolic disorders – α1-antitrypsin deficiency, glycogen storage disease, Wilson disease, Gaucher disease
  • TPN-associated liver disease
  • Alagille syndrome
Cardiovascular Disease
  • Normal anatomy of the heart
  • Atrial and ventricular septal defects
  • Atrioventricular septal defects
  • Tetralogy of Fallot
  • Hypoplastic left heart syndrome
  • Truncus arteriosus
  • Anomalous pulmonary venous return
  • Transposition of great arteries
  • Patent ductus arteriosus
  • Coarctation of aorta
  • Isomerism
  • Cardiomyopathies
  • Myocarditis
Pulmonary Disease
  • Pulmonary hypoplasia
  • Bronchopulmonary dysplasia
  • Congenital pulmonary airway malformation
  • Acinar dysplasia, alveolar capillary dysplasia and congenital alveolar dysplasia
  • Sequestration – intralobar and extralobar
  • Primary pulmonary hypertension
  • Pulmonary haemorrhage
  • Cystic fibrosis
  • Obliterative bronchiolitis
  • Surfactant dysfunction disorders (SFTPB/C and ABCA3 mutations)
  • Pulmonary interstitial glycogenosis
  • Neuroendocrine cell hyperplasia or infancy
  • Diaphragmatic hernia and eventration
Endocrine Disorders
  • Congenital adrenal hyperplasia
  • Hyperinsulinaemia
  • Intersex disorders
Skeletal Disorders
  • Osteogenesis imperfecta
  • Achondroplasia
  • Thanatophoric dysplasia
Chromosomal, Genetic and Congenital Disorders
  • Trisomy 21 (Down syndrome)
  • Trisomy 18 (Edward syndrome)
  • Trisomy 13 (Patau syndrome)
  • Monosomy X (Turner syndrome)
  • Triploidy
  • 22q11 deletion syndrome including DiGeorge/velocardiofacial syndrome
  • Beckwith-Wiedemann syndrome
  • VATER (VACTERL) association
  • CHARGE association
Perinatal / Paediatric Autopsy
  • Stillbirth (causes of and investigation of)
  • Hydrops (causes of)
  • Infections – TORCH organisms and Group B Streptococcus
  • Intrauterine growth restriction
  • Sudden Infant Death Syndrome (SIDS)
Paediatric Neuropathology
  • Hypoxic-ischaemic encephalopathy including periventricular leucomalacia and pontosubicular necrosis
  • Intraventricular haemorrhage
  • Neural tube defects
  • Chiari malformations
  • Dandy Walker malformation
  • Holoprosencephaly
  • Common paediatric brain tumours – medulloblastoma, pilocytic astrocytoma, ependymoma, atypical teratoid/rhabdoid tumour


Training Methods

1. Case Reporting

  • Gross examination of paediatric surgical specimens under appropriate supervision, including handling of unfixed surgical specimens for frozen section assessment, tissue apportioning for molecular testing and research
  • Sign-out cases under consultant supervision

2. Clinico-pathologic Conferences

  • Departmental pathology journal club/Peer review and learning session
  • Paediatric oncology rounds
  • Paediatric neuro-oncology rounds

3. Structured Educational Activities

  • Review of glass slide collection
  • Review of key paediatric pathology articles
  • Presentation of a topic of current interest during the weekly department pathology journal club/peer review and learning session

4. Research

  • Research project: Completion of research project with the aim of submission of abstract and presentation at a scientific meeting, and/or for publication


Team of Experts

The Clinical Fellowship in Paediatric Pathology is managed by the following experts.

​Name
​Designation
​Qualification
​Adj Assoc Prof Kenneth Chang Tou En
Senior Consultant and Head of Department
​MBChB, FRCPath


II Assessment and Evaluation


Aims of Assessment

Trainees will need to demonstrate their proficiency level based on the following competencies:

(A) Patient Care

  • Trainees must provide effective and efficient reports and consultations.

(B) Medical Knowledge

  • Trainees must demonstrate medical knowledge of established and evolving biomedical, clinical, epidemiological, social-behavioral sciences and the application of medical knowledge to diagnosis.
  • Trainees must demonstrate the ability to interpret, synthesise and summarise knowledge.

(C) Practice-Based Learning and Improvement

  • Trainees must be able to recognise errors and discrepancies in practice.
  • Trainees must be able to apply evidence-based medicine in the handling and reporting of specimens.
  • Trainees must demonstrate life-long learning skills and continuous self-assessment based on reflection and feedback.
  • Trainees must demonstrate teaching and learning skills, and perform research to contribute to medical education of health professionals.

(D) Interpersonal and Communication Skills

  • Trainees must demonstrate effective team interactions and leadership within the laboratory.
  • Trainees must demonstrate effective interactions with the interdisciplinary teams.

(E) Professionalism

  • Trainees must demonstrate ethical behavior in carrying out their duties.
  • Trainees must accept responsibility for cases assigned and follow through with them.
  • Trainees must be able to give and receive feedback.
  • Trainees must be responsive to every patient’s individual needs.

(F) Systems-Based Practice

  • Trainees must contribute to patient safety initiatives.
  • Trainees must demonstrate cost effective test utilization.


Assessment Approaches

The trainee will be assessed at the 3rd month, and subsequently at the end of the 6-month programme.
The assessment will be based on his/her performance in routine service work such as:

  • presentation at clinical meetings,
  • journal club presentation,
  • feedback score from supervisor,

as well as, in educational/research activities.


Evaluation Process

The general overall grading system evaluates the trainee’s performance upon completion of the programme. All trainees will be given a general overall grading status at the end of the programme based on the grading criteria requirements incorporating the six competencies that trainees must demonstrate throughout the programme.

​Grading Status
​Description
​Grading Criteria Requirements
CMP​Completes the programme
  • More than 80% attendance for all meetings
  • Active participation observed in all meetings
  • Achieves satisfactory feedback scores from supervisors
USP*​Unsatisfactory performance
  • 80%-50% attendance for all meetings
  • Consistently demonstrates poor participation in meetings
  • Receive unsatisfactory feedback scores from supervisors
DCP​Did not complete the programme
  • <50% attendance for all meetings.
  • Did not complete or attend any part of the programme.
WDN​Withdrawn from the programme
  • Voluntarily withdrawn from programme before completion date, regardless of performance.


* Trainees who have attained a USP grade are given options to extend their training. This will depend on the faculty's evaluation of the trainee's clinical skills and professional attitude.


III Target Audience and Eligibility Requirements


Target Audience

Junior pathologists in regional countries with an interest in paediatric pathology


Pre-requisite/Eligibility Requirement(s)

  • Candidates must be able to converse in English.
  • Candidates must have medical degrees that can be registered by the Singapore Medical Council.
    (Success of the fellowship application is also contingent on approval by the Singapore Medical Council for a temporary medical practising license.)


IV Other Information


Course Fees

Fees will be disclosed upon acceptance.


Funding

Candidates should be self-funded or have funding from external sources/institutions.


Certification

A certificate will be awarded to each trainee at the completion of the programme.