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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. Fellows 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. Fellows 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 Fellows to the sub-specialty discipline of paediatric pathology, incorporating fetal, perinatal, paediatric surgical and placental pathology.

Duration of Programme

Maximum 6 months

Number of Training Places

Only 1 Fellow at any one time

Learning Outcomes

At the end of the programme, Fellows 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; and
  • be acquainted with seminal publications in paediatric pathology.

Content Areas

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

  1. 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

  2. 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:

  1. 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

  2. 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

  3. 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

  4. 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

  5. Endocrine Disorders
    Congenital adrenal hyperplasia
    Hyperinsulinaemia
    Intersex disorders

  6. Skeletal Disorders
    Osteogenesis imperfecta
    Achondroplasia
    Thanatophoric dysplasia

  7. 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

  8. 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)

  9. 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 of 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 Pediatric Pathology is managed by the following experts.

​Name
​Designation
​Qualification
​Adj A/Prof Kenneth ChangSenior Consultant and Head of Department​MBChB, FRCPath
​Dr Derrick Lian
ConsultantMBBS, FRCPath, FAMS, MHPE



II Assessment and Evaluation

Assessment and Evaluation

1. Aims of Assessment

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

(A) Patient Care

  • Fellows must provide effective and efficient reports and consultations.

(B) Medical Knowledge

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

(C) Practice-Based Learning and Improvement

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

(D) Interpersonal and Communication Skills

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

(E) Professionalism

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

(F) Systems-Based Practice

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

2. Assessment Approaches

The Fellow 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.

3. Evaluation Process

The general overall grading system evaluates the Fellow’s performance upon completion of the fellowship programme. All Fellows will be given a general overall grading status at the end of the fellowship programme based on the grading criteria requirements incorporating the six competencies based knowledge, skills and performance that fellows 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.


* Fellows who have attained a USP grade are given options to extend their fellowship programme.
This will depend on the faculty's evaluation on the fellow'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 determined upon application

Funding

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

Certification

A certificate of completion will be presented to each Fellow at the completion of the programme.