Paediatric Thrombosis and Bleeding Disorders

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 Thrombosis and Bleeding Disorders

Overview

The Paediatric Thrombosis and Bleeding Disorders Programme in KK Women’s and Children’s Hospital was established in 2011 and provides comprehensive care to paediatric patients with thrombotic and bleeding disorders. It manages patients from the Paediatric Haematology and Oncology Service, as well as patients referred from other specialties in the hospital including Children’s Intensive Care and Neonatology.

The Paediatric Thrombosis and Bleeding Disorders Programme in KKH has an essential laboratory component. Initial coagulation testing is performed in-house at the Haematology Laboratory at KKH, while specialized coagulation testing is performed by the Coagulation Laboratory at the affiliated adult hospital, Singapore General Hospital.

Holistic management of patients with thrombotic and bleeding disorders is supported by specialty nurses, allied health professionals and medical social workers. They provide patients and families essential education, psychosocial support and avenues for financial assistance.

The Paediatric Thrombosis and Bleeding Disorders Programme in KKH engages in clinical trials, basic science and translational research. It houses the Bleeding Disorders Registry which has been collecting prospective data on the demographics, diagnosis, bleeds, treatment details and outcome measures for patients with congenital bleeding disorders since 2017.

Aim of Programme

This comprehensive fellowship programme aims to develop the clinical knowledge, skills and competencies for physicians with a special interest in Paediatric Thrombosis and Bleeding Disorders.

Duration of Programme

6 to 12 months

Learning Outcomes

On successful completion of this programme, the clinical fellow should

• Have developed a comprehensive understanding of paediatric haemostasis, including normal developmental changes in the coagulation system from neonates through adolescence.
• Be able to diagnose and manage inherited bleeding disorders such as haemophilia A and B, von Willebrand disease, and rare factor deficiencies, as well as acquired bleeding disorders including immune thrombocytopenia and disseminated intravascular coagulation.
• Be able to manage thrombotic disorders affecting children, including cerebral sinus venous thrombosis, pulmonary embolism, and catheter-related thrombosis, as well as be able to assess and manage thrombophilia, both inherited conditions such as congenital protein C, S, antithrombin deficiencies and acquired risk factors such as malignancy or immobilisation.
• Learn to manage bleeding risks during procedures and develop comprehensive care plans for children with chronic bleeding or clotting disorders.
• Become proficient in interpreting specialised coagulation studies, including factor assays and factor inhibitor assays.
• Understand the limitations of standard coagulation tests in paediatric patients and know when to order advanced testing such as genetic analysis or specialised factor studies.
• Develop skills in coordinating care with other medical, surgical, anaesthesia, and other specialties.

Content Areas

The programme covers the following areas:

Foundations

• Normal haemostasis in children
• Developmental changes in coagulation
• Interpretation of laboratory assays and limitations
• Basic management of bleeding disorders
• Introduction to thrombosis in paediatrics

Bleeding Disorders

• Haemophilia A and B management
• Von Willebrand disease
• Rare factor deficiencies
• Platelet disorders
• Acquired bleeding conditions

Thrombotic Disorders

• Paediatric thrombophilia assessment
• Venous and arterial thrombosis
• Anticoagulation in children
• Catheter-related complications
• Stroke and cerebral sinus venous thrombosis
• Management of hereditary thrombophilia
• Management of acquired thrombophilia

Advanced Practice

• Complex case management
• Perioperative haemostasis
• Anticoagulation management of circuits (e.g. ECMO, CRRT)
• Emergency bleeding protocolsTransition to adult care

Training Methods

Method of Supervision:

The trainee would be supervised at all times by a SMC approved supervisor from the Paediatric Haematology / Oncology Service, KKH. All Fellows will have a named supervisor / mentor during the entire duration of fellowship. The supervisor will be either the Programme Director or a designated consultant from the Paediatric Haematology / Oncology Service. Supervisors must meet the requirements stated in the SMC’s Supervisory Framework. They are responsible for ensuring regular contact time with the Fellow, and for monitoring and reviewing the training programme. They must be familiar with the Fellow’s abilities and competence and regularly assess the Fellow.

For rotations to the Coagulation Laboratory at Singapore General Hospital, the Fellow will be assigned to another SMC supervisor.

Team of Experts

II Assessment and Evaluation

Aims of Assessment

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

(A) Patient Care

• Fellows must provide compassionate, appropriate and effective patient care for the treatment of paediatric patients with thrombotic and bleeding disorders.

(B) Medical Knowledge

• Fellows must demonstrate up-to-date knowledge about established and evolving biomedical, clinical and epidemiological sciences pertaining to paediatric thrombotic and bleeding disorders, as well as its application to patient care.

(C) Practice-Based Learning and Improvement

• Fellows must demonstrate the ability to investigate and evaluate patient care practices, critically assess scientific evidence to continuously improve patient care based on constant self-evaluation and life-long learning.

(D) Interpersonal and Communication Skills

• Fellows must demonstrate interpersonal and communication skills that result in effective information exchange and collaboration with patients and their families, as well as the healthcare team.

(E) Professionalism

• Fellows must demonstrate a commitment to carrying out professional responsibilities, and adherence to ethical principles.

(F) Systems-Based Practice

• Fellows must demonstrate awareness of, and responsiveness to, the larger context and local system of care including challenges and limitations in order to provide optimal healthcare within current constraints.

Assessment Approaches

Formative assessment:

Regular evaluation between Clinical Fellow and Supervisor

• Case reflections and logbook of competencies achieved
• Regular case presentations at department MDT meetings
• Presentations at department academic meetings

Summative assessment:

• Periodical assessment reports as required by Singapore Medical Council
• 3 monthly review of logbook to assess competencies achieved

Feedback:

• End-of-training feedback form as required by Singapore Medical Council
• End-of-training feedback session with Programme Director

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.

• If a fellow shows unsatisfactory performance (USP) during the first 3 months of a posting, a Performance Improvement Programme (PIP) will be developed in collaboration with the fellow.
• The PIP will outline specific goals, expectations, and support measures to address identified areas of concern.
• The fellow will be given the next 3 months to demonstrate improvement based on the agreed-upon plan.
• Progress will be closely monitored and reviewed at regular intervals throughout the improvement period.

III Target Audience and Eligibility Requirements

Target Audience

• Qualified medical practitioners with a special interest in paediatric thrombotic and bleeding disorders.
• General requirements for Temporary Registration for training (required by SMC):
• A basic medical degree from an accredited medical university or medical school
• Passed the relevant national licensing examination in the country of conferment of basic degree, where applicable
• Evidence of at least 12 months houseman-ship / internship with a certificate of satisfactory completion of houseman-ship or equivalent
• Been registered as a medical practitioner in the country where he/she is currently practicing
• Been certified to be of good standing by the Medical Council or the relevant national authority

Note: The doctor should be in active clinical practice (and been registered as a medical practitioner in the countries of practice) for the 3 years preceding the application for medical registration in Singapore.

In addition to the above criteria, Clinical Fellows must:

• Have a minimum of 3 years working experience as a medical officer (or equivalent)
• Fulfill English Language requirements of SMC if the medium of instruction for the basic medical qualification is not in English
• Preferably have obtained a postgraduate diploma or medical degree in his/her country or overseas
• Provide letter of support from (i) the government, or (ii) regional health authority or (iii) an appropriate institution in the home country. For (d)(iii), the doctor must be on current full-time employment (40 hours or more per week) with the sponsoring institution.

As a Clinical Fellow, the doctor will be allowed to be involved in patient care and make entries in patients’ case note, communicate care plans to patients and fellow healthcare professionals, and perform procedures and write prescriptions under direct supervision or Level 1 supervision under SMC’s Supervisory Framework.

Department’s requirement, if any (only for Fellows in this subspecialty):

• Minimum 36 months experience post-housemanship / internship. Applicants with less experience may be considered on a case-by-case basis.

IV Other Information

Number of Training Places

1 to 2 intakes / July and January

Course Fees

Training Fees: S$3,000.00 per month (excluding GST)

Funding

Applicants must be self-funded or financially supported by their institution, or a third party organization.

They will need a sponsor from:

1. Their government,
2. A regional health authority, or
3. A recognised institution in their home country.

For institutional sponsorship 3, applicants must be employed full-time (≥40 hours/week) by the sponsoring body.

Sponsorship need not be financial but must indicate institutional endorsement and a guarantee of position upon return.

Certification

A certificate may be awarded upon successful completion of the programme, subject to the discretion of the Head of Department or Service.